Comprehensive family hygiene promotion in peri-urban Cape Town: Gastrointestinal and respiratory illness and skin infection reduction in children aged under 5

Abstract

Background. Hygiene promotion has become increasingly important to public health policy makers as an illness reduction strategy. The primary aim of this study was to assess the differential effects of hygiene education alone compared with hygiene education plus hygiene products on the reduction of target illnesses/infections.

Aims and methods. We hypothesised that a participatory learning and action (PLA) family hygiene education approach plus the regular use of hygiene products could result in marked reduction of morbidity in children aged under 5 years. Population groups in two separate geographical areas were utilised (685 households). Each group consisted of a government (Reconstruction and Development Programme, RDP) housing community (indoor tap/flush toilet) and an informal (INF) housing community (communal tap/latrines). Illness data were gathered in both groups before hygiene education was introduced in June - November 2006 (study baseline) and for the same period in 2007 (study follow-up) after one group had received hygiene education only (control) and the other group hygiene education plus hygiene products (intervention). Facilitators from the communities monitored symptoms weekly and reinforced disease prevention behaviours, focusing on handwashing and bathing with soap, cleaning toilet/food surfaces, and treating skin problems with antiseptic.

Results. Children aged under 5 years in all communities had significant reductions in gastrointestinal and respiratory illnesses and skin infections over time. At study follow-up the control RDP community with hygiene education only was 2.46 times more likely to experience gastrointestinal illnesses (hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.17 - 4.91) and 4.56 times more likely to experience respiratory illnesses (HR 4.56, CI 1.97 - 10.54) at study follow-up than the intervention group. There was no statistical difference in the incidence of skin infections for children living in RDP housing. The INF community with hygiene education only was 1.64 times more likely to experience gastrointestinal illnesses (HR 1.64, CI 1.32 - 2.03), 4.62 times more likely to experience respiratory illnesses (HR 4.62, CI 4.19 - 5.09) and 1.29 times more likely to experience skin infections (HR 1.29, CI 1.26 - 1.32) than the intervention group.

Conclusion. While hygiene education alone resulted in meaningful reductions in gastrointestinal and respiratory illness and skin infections in children aged under 5 years across all communities, families with hygiene education plus consistent use of provided hygiene products had greater reductions.