Hand-washing education and use of soap to prevent acute respiratory infections and diarrhea in the rural municipality of Quezalguaque, Nicaragua

Background: Our 2006 household survey of 20 communities in the municipality of Quezalguaque, Nicaragua confirmed local Ministry of Health data that diarrhea and acute respiratory infections (ARI) are major causes of morbidity, and that there is poor access to health services in rural communities. In collaboration with Brookline Sister City Project of Brookline, MA and the Ministry of Health health center in Quezalguaque, we designed, implemented and evaluated a program targeting children under 6 years and their caregivers in rural communities. The program goal was to reduce morbidity due to diarrhea and ARI, and the timeline was from June 2007 to January 2008. The grant was funded by APHA in collaboration with Colgate-Palmolive Company.

Objectives: (1) improve knowledge of disease prevention; and (2) increase hand washing with soap and water.

Design: Phase I included a qualitative assessment of hand washing practices and barriers, including key informant interviews and focus groups. Phase II included a baseline survey of two intervention and two control communities, and program implementation. The program consisted of distribution of hand soap (donated by Colgate-Palmolive, Central America) and monthly educational events on hygiene and disease prevention. Both intervention and control communities received twice-monthly home visits by two community health workers (CHWs) for collection of data on symptom occurrence. Phase III included a follow-up survey of health outcomes and hygiene behaviors in all four communities.

Findings: The Phase I qualitative assessment revealed that community members had difficulty distinguishing between prevention and treatment of diarrhea and ARIs, and were unaware of the causes of diarrhea. Cost, access, and storage were also identified as barriers to using soap. The educational content of the Phase II intervention incorporated these findings. Further analysis will reveal the program impact on knowledge of disease prevention and hand washing practices.

Conclusion: Qualitative assessment of hand washing practices and barriers was instrumental in the design and implementation of the intervention, providing a model for future health interventions in similar communities. The Brookline Sister City Project and the Quezalguaque Ministry of Health are interested in replicating the project's methodology in Quezalguaque.