REACTIVITY AND REPEATABILITY OF HYGIENE BEHAVIOR - STRUCTURED OBSERVATIONS FROM BURKINA-FASO

If interventions promoting improved hygiene behaviour to prevent child hood diarrhoea are to be implemented and evaluated, valid methods for measuring this behaviour will be required. This paper presents finding s from a study to investigate the use of structured observations to me asure hygiene behaviour in Burkina Faso. Two hundred mothers with youn g children (2-36 months) were observed on several occasions, with part icular attention focused on events/behaviour surrounding defaecation. Child defaecation occurred most often in a potty (67% of occasions). S tools were most often disposed of into a latrine (79%). Following defa ecation the child's bottom was usually rinsed using water alone with a bare hand (76%). Subsequent hand washing by the mother/caretaker was much rarer (29%). None of these behaviours appeared ''reactive'' to th e presence of the observer. Less common behaviours showed some evidenc e of reactivity. The frequency of child defaecation in the yard increa sed over the course of three observations (5% to 16%; P = 0.01) and th e proportion of occasions on which the child was observed to be cleane d after defaecation declined (95% to 85%; P = 0.01). Mothers usually t ook with them to the latrine a water recipient (91%). Hand washing aft er leaving the latrine was observed on 30% of occasions. This proporti on declined from 36% to 22% over three observations (P = 0.05). Defaec ation by older siblings (aged 3-5 years) was usually into a potty (48% ) or directly into a latrine (30%), There was no evidence that this be haviour was reactive. The repeatability of behaviours at the individua l level was generally low. The site of index child defaecation (kappa = 0.27), how the child's bottom was cleaned (kappa = -0.01) and whethe r the caretaker washed her hands afterwards (kappa = 0.26) all showed low repeatability. The method of stool disposal was more repeatable (k appa = 0.73). Hand washing by mothers after using the latrine showed m oderate repeatability (kappa = 0.40). Older sibling's defaecation beha viour had excellent repeatability (kappa = 0.90). Our findings suggest that, in studies which aim to measure behaviour at the population lev el, structured observations may provide a useful tool. Studies which i nvestigate links between hygiene behaviour and diarrhoea incidence at the individual level will require repeated observations of mothers and children since measuring behaviour during a single observation will l ead to misclassification of exposure status, resulting in bias which c ould mask any underlying association. This is likely to be very costly . Copyright (C) 1996 Elsevier Science Ltd