Sunday July 6, 2008
Keeping it clean
New landmark study confirms the importance of home and personal hygiene in reducing infectious diseases and infections.
ACCORDING to results from the Hygiene Promotion and Illness Reduction study, children aged five years or under experienced significantly fewer respiratory, gastrointestinal, and skin diseases when their families participated in intensive hygiene education plus the use of hygiene products.
The results of the three year study, which was conducted in impoverished urban communities in South Africa and presented during the 13th International Congress on Infectious Diseases (ICID) held in Kuala Lumpur recently, also show that hygiene education alone offers meaningful improvements in illness reduction compared to no education at the start of the study.
However when effective hygiene products (antibacterial soap, surface cleanser/disinfectant, and skin antiseptic) were used in addition to education, an even greater reduction in the risk of illness was noted.
“These are highly significant results that have far-reaching consequences. The illnesses studied here are largely preventable with appropriate use of hygiene education and hygiene products, offering the potential to reduce major risks associated with morbidity and mortality rates amongst children in impoverished communities,” says lead investigator, Dr Eugene Cole, Brigham Young University, Utah, US.
A total 1,292 families of lower socio-economic communities outside of Cape Town, South Africa, participated in the study.
Community learning and empowerment
A unique aspect of this study was the participatory learning and action approach. This involved identifying and training study facilitators from the local communities on aspects of good hygiene, including correct hand washing/bathing with soap, cleaning toilet and food surfaces, and treating skin conditions with an antiseptic.
The educational materials used were developed with the community leaders in a format that the participants identified with and could understand.
While comprehensive and reinforced hygiene education alone showed meaningful reduction of gastrointestinal, respiratory and skin infections in children less than five across all communities, families with education plus the use of key hygiene products saw significant reduction of those infections.
The outcome of this study demonstrates an association between hygiene education and good hygiene practice and a reduction in the incidence of communicable disease.
In this unique study, community-based participatory learning and action proved to be a powerful approach through supporting families in the adoption of new hygiene practices and in mobilising the community for health and social change. As such, this educational model could have many applications for both developed and developing nations.
Dr Christopher KC Lee, consultant infectious diseases physician and chairman of the local organising committee of the 13th ICID, adds, “This study confirms the importance of personal and home hygiene in helping to reduce levels of illness in impoverished communities. The learnings from this study can be used to improve health and hygiene around the world”.
About the study
The study was developed and conducted under the guidance of the Health and Hygiene Promotion Partnership (HPP), a community-based project founded in 2005 by cooperation between Reckitt Benckiser Inc and Brigham Young University with members of the participating housing communities, under the approval of the Cape Town City Health Department.
Most deaths among under-fives are still attributable to just a handful of conditions and are avoidable through existing interventions.
These conditions are: acute lower respiratory infections, mostly pneumonia (19% of all deaths), diarrhoea (18%), malaria (8%), measles (4%), HIV/AIDS (3%), and neonatal conditions, mainly preterm birth, birth asphyxia, and infections (37%).
Morbidity due to diarrhoea disproportionately affects children younger than five years. According to the United States Center for Disease Control, approximately 2.2 million young children die every year from diarrhoeal disease (another 1.5 million die from hospital-acquired infections).
40% of the world’s population (2.5 billion) has no access to clean water and proper sanitation (every 5 seconds someone dies from contaminated water). WHO estimates that it would cost US$10bil (RM33bil) to bring clean water and sanitary sewage to the developing world, half the amount that the US spends on pet food and same amount spent by Europeans on ice-cream.
A lack of running clean water or sanitation does not exclude good hygiene practice. Communities can learn to improvise, for example the use of squeezy bottles fastened close to toilet areas and cooking areas offers running water to wash hands, the most common source of disease transmission.
1. Cole E, Hawkley M, Rubino J, McCue K, Crookston B, and Dixon J. Comprehensive family hygiene promotion in peri-urban Cape Town: Gastrointestinal and skin disease reduction in children under five. 13th ICID; abstract no 68.012.
2. Cole E, Crookston B, Rubino J, McCue K, Hawkley M, and Dixon J. Comprehensive family hygiene promotion in peri-urban Cape Town: Reduction of respiratory illness in children under five. 13th ICID; abstract no 68.030.
3. The world health report 2005 - make every mother and child count. www.who.int/whr/2005/en