Food Hygiene

Domestic hygiene and diarrhoea – pinpointing the problem

Domestic hygiene and diarrhoea – pinpointing theproblemValerie Curtis1, Sandy Cairncross1and Raymond Yonli21 London School of Hygiene and Tropical Medicine, London, UK2 Regional Centre for Health Education and Sanitation, Ministry of Health, Bobo-Dioulasso, Burkina FasoSummary Improving domestic hygiene practices is potentially one of the most effective means of reducing the globalburden 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 those few hygienepractices which are the major source of risk in any setting. Using biological reasoning, we hypothesize thatany behaviours which prevent stools from getting into the domestic arena, the child’s main habitat, are likelyto have a greater impact on health than those practices which prevent pathogens in the environment frombeing ingested. Hence safe stool disposal, a primary barrier to transmission, may be more important thanhand-washing before eating, which constitutes a secondary barrier, for example. We review the epidemiological evidence for the effect of primary and secondary barrier behaviours and suggest that it supports thisconclusion. In the absence of local evidence to the contrary, hygiene promotion programmes should givepriority to the safe disposal of faecal material and the adequate washing of hands after contact with adultand child stools.keywords hygiene, diarrhoea, excreta, hand washing, developing countriescorrespondence Valerie Curtis, Roghorst 123, Wageningen 6708, The Netherlands.