Hygiene education

Meaza Kifly [L], a hygiene education teacher in Ethiopia.

Credit: WaterAid / Caroline Irby

Hygiene education is about helping people to understand, firstly, what causes some of their health problems and, secondly, what preventative measures might be possible. It needs to be approached in a very sensitive way, with a great deal of respect being shown to local beliefs and practices.

It is estimated that diarrhoea kills about two million children each year in the developing world.

Diarrhoea is frequently caused by pathogens from human faeces entering a person's mouth. Much, but not all, of hygiene education is concerned with explaining this route, which is called the faecal-oral route, and suggesting ways in which it can be blocked.

This section does not attempt to tackle the whole range of topics in hygiene education. It concentrates on providing information about the faecal-oral transmission route and how it might be blocked.

The faecal-oral transmission route, which causes diarrhoea

If pathogens from human faeces enter a person's mouth and are swallowed, they will cause diarrhoea.  If proper treatment is not given, this can prove fatal, particularly to children.

The pathogens can enter the mouth in a number of ways; these include:

Directly from a person's hands or fingers

If hands are not washed after a person has defecated.

• If hands come into contact with someone else's faeces on the ground (such as when small children are crawling, or playing, on the ground or when adults clear up a child's faeces)
• Indirectly from a person's hands, if not washed after defecation from food which has been prepared by them, from food which is eaten with dirty hands and from cups or other utensils, handled by dirty hands

Food
Pathogens can be present in food that has been contaminated by flies which settle first on excreta, in a latrine or on the ground, then transfer faeces to food by settling on it.

Water
Pathogens can enter the body in water that has been contaminated by faeces.

Soil
If soil contains faeces, pathogens can be transferred:

• By hands which are not washed before eating
• By crops which are not cleaned properly before cooking, or not cooked properly.

These routes are shown in the following diagram:

Blocking the faecal-oral transmission route

School children learning safe hygiene practices in Bangladesh.

Credit: WaterAid / Abir Abdullah

The likelihood of diarrhoea can be greatly reduced by blocking the various faecal-oral transmission routes.

This can be achieved by a combination of building latrines which incorporate blocking mechanisms and hygiene education which is designed to result in changes to people's personal behaviour.

The process can be illustrated by using the same diagram as before, but adding vertical bars to represent the different blocking actions, as follows:

Measures required in addition to building latrines

Girls queueing to use the toilets at breaktime in India.

Credit: WaterAid / Libby Clarke

Building latrines in a community is desirable, but will not be sufficient to prevent the occurrence of diarrhoea.

It must be combined with hygiene education which is designed to encourage the changes in people's patterns of personal behaviour which are necessary in order to block the faecal-oral transmission route and reduce the spread of disease.

Therefore a sanitation project without accompanying hygiene education will have little impact on community health unless:

• Most (preferably all) of the people use the new latrines
• Children's faeces are properly disposed of
• Latrines are properly maintained and cleaned
• Hands are washed by everyone after defecation, after clearing a child's stools, before eating and before preparing food
• Water sources are protected, or water is purified before consumption
• Food is prepared properly with thorough cooking and thorough re-heating
• Food is stored in a way that does not allow it to be contaminated by insects or small animals
• Food is cleaned thoroughly before being eaten raw

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