Review: Domestic hygiene and diarrhoea - pinpointing the problem

Improving domestic hygiene practices is potentially one of the most effecti ve means of reducing the global burden of diarrhoeal diseases in children. However, encouraging behaviour change is a complex and uncertain business. If hygiene promotion is to succeed, it needs to identify and target only th ose few hygiene practices which are the major source of risk in any setting . Using biological reasoning, we hypothesize that any behaviours which prev ent stools from getting into the domestic arena, the child's main habitat, are likely to have a greater impact on health than those practices which pr event pathogens in the environment from being ingested. Hence safe stool di sposal, a primary barrier to transmission, may be more important than hand- washing before eating, which constitutes a secondary barrier, for example. We review the epidemiological evidence for the effect of primary and second ary barrier behaviours and suggest that it supports this conclusion. In the absence of local evidence to the contrary, hygiene promotion programmes sh ould give priority to the safe disposal of faecal material and the adequate washing of hands after contact with adult and child stools.