COMMUNITY-BASED HYGIENE EDUCATION TO REDUCE DIARRHEAL DISEASE IN RURAL ZAIRE - IMPACT OF THE INTERVENTION ON DIARRHEAL MORBIDITY

Background. Diarrhoeal disease is a leading cause of morbidity in youn g children in rural Zaire, Few diarrhoea prevention programmes have be en implemented in Bandundu Province, where available data suggest an a nnual prevalence rate of 10%. The urgent need to reduce diarrhoeal mor bidity in Zaire, together with the potential effectiveness and feasibi lity of hygiene education as a diarrhoea prevention strategy, led to t he development of the present research project. Methods. A randomized, controlled trial of an education intervention to reduce diarrhoea thr ough improved personal and domestic hygiene behaviours was conducted i n 18 geographically separate village clusters (sites) in rural Zaire. For 12 weeks baseline information on the diarrhoeal morbidity of 2082 children aged 3-35 months was collected at weekly home visits, and str uctured observations of hygiene practices related to diarrhoea were ma de on a subset of 300 families. Intervention messages addressed dispos al of animal faeces from the yard, handwashing after defecation and be fore meal preparation and eating, and disposal of children's faeces. T hree months after the start of the intervention and exactly 1 year aft er the baseline studies, a second diarrhoeal morbidity study and a sec ond observational study were conducted in order to evaluate the interv ention. Results. Children in intervention communities experienced an 1 1% reduction in the risk of reporting diarrhoea during the peak diarrh oeal seaon, compared to controls (P < 0.025). The largest differences were seen among children aged 24-35 months, with those from interventi on communities reporting significantly fewer episodes, shorter mean du rations and hence fewer days of diarrhoea. There was some evidence tha t greater reductions in diarrhoea occurred in sires where the quality of the intervention, a scored measure of volunteer efficacy and commun ity participation, was highest. Conclusions. The results of this study suggest that hygiene education may be an effective approach to reduce the incidence and duration of diarrhoeal episodes in rural Zaire. Chi ldren aged 2 years appear to benefit the most. A Hawthorne effect of t he education may contribute to diarrhoeal reductions.