Combining hygiene behavior change with water and sanitation: monitoring progress in Hato Mayor, Dominican Republic

In December 2001 and May 2002, two surveys were conducted as part of a hygiene behaviour change programme participatory monitoring process in nine poor rural communities of the municipality of Hato Mayor, Dominican Republic. The purpose of these surveys was to provide NGO programme managers and communities with timely information about changes in diarrhoea prevalence and hygiene behaviors before and after water and hygiene interventions were introduced and to quantify the changes that were plausibly associated with their efforts.

Of the 165 children under five years of age included in the baseline sample, 27% were reported to have had diarrhea within the previous two weeks. Five months later, this fell to 11% for the 209 children included in the mid-term survey. The overall reduction was found to be highly statistically significant (P-value=.0001). While this decrease may be attributable to the programme interventions, it may also reflect seasonal variations.

Most of the hygiene behaviors promoted as part of the intervention showed statistically significant improvements from the time of baseline to mid-term. Increases in handwashing after going to the bathroom were reported by the primary caregiver (a 12% improvement) for herself and the youngest child (a 16% improvement). An increase from 15% to 31% was recorded for reported handwashing of the youngest child before eating. Use of soap improved from 59% to 79%. Also, there appears to be a trend for improved handwashing technique. Handwashing demonstrations showed an increase in the proportion of respondents who rubbed their hands together three or more times from 47% (at baseline) to 77% (at mid-term).

No significant changes were detected over the study period for
caregivers reporting handwashing before food preparation, before eating, after cleaning a child who had defecated or before breastfeeding. This may be demonstrative of the emphasis given to handwashing after going to the bathroom by the Community Hygiene Promoters (CHPs).