An intervention for the promotion of hygienic feces disposal behaviors in a shanty town of Lima, Peru

Abstract

This paper describes the design, implementation and evaluation of an intervention to promote improved hygiene practices in a shanty town area of Lima, Peru. Following formative research, the intervention focused on behaviors associated with the hygienic use of potties by children aged 15-47 months and keeping the home environment free from feces. A health communications strategy was developed involving delivery through routine health services, and using video presentations, leaflets and counseling by health staff during consultations. Intervention activities occurred during a 6-month period in health centers and posts of four intervention communities; four other communities acted as a comparison group. Process and impact indicators were measured through questionnaires and 4-h structured observations conducted in over 600 households both pre- and post-intervention implementation, and through intervention monitoring activities. The intervention materials and approach were well received by the study community; however, in the time-frame of the project only limited coverage of the target audience was achieved, which was insufficient to result in an impact on behaviors. Nevertheless sufficient positive features existed to suggest that with higher coverage, an impact on target behaviors might have been achieved. Reasons for the intervention's shortcomings are discussed and suggestions made for more effective implementation.

Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: a mixed method systematic review

“…Since there was too much heterogeneity it was not possible to pool the outcomes across and within the promotional approaches. For sanitation and hygiene messaging, only one study was included, showing statistically significant increased safe faeces disposal practices(RR 1.68, 95% CI [1.21, 2.32]), however a significant effect on safe child faeces disposal practices could not be demonstrated (RR 1.07, 95% CI [0.70, 1.65]) (Yeager et al, 2002). • Behaviour change: open defecation (Analysis 9).…”

“…On the other hand, the intention (e.g. intention to read a leaflet at home, Yeager et al, 2002) and motivation of people targeted by the promotional approach (e.g. motivation to adopt sanitation technology, Malebo et al 2012) may act as facilitators in reaching a substantial amount of people when implementing sanitation and handwashing promotion programmes.…”

Systematic review of evidence on the effectiveness of safe child faeces disposal interventions

“…was in urban Dhaka, Bangladesh ; another study by Yeager et al . was conducted in a shanty town in urban Lima, Peru ; and all other studies were conducted in rural settings . Three were randomised controlled trials, and five were pre‐ and post‐evaluation studies.…”

“…Three were randomised controlled trials, and five were pre‐ and post‐evaluation studies. Hygiene education was a major component of all the interventions: four were studies of hygiene education alone ; two combined hygiene education with installation of water and sanitation infrastructure (hand pumps and/or latrines) ; one study provided hygiene education along with a faeces disposal sani‐scooper tool (a dust pan with a paddle), child potties and latrine improvements (including a plastic latrine slab with a drop‐hole cover) ; and one study implemented a potty training intervention . All eight studies included assessments of child faeces disposal practices.…”

“…There was wide variability in the definition used for ‘safe disposal’ of child faeces across the studies. Three studies did not give a specific definition for safe child faeces disposal , and four studies did not specify the location(s) considered safe for child faeces disposal . In one study, no formal definition was given for diarrhoea .…”