Is Hygiene Promotion a Drop in the Bucket to Reduce Diarrheal Disease Among Poor Households in Sahelian Africa?

Diarrheal disease is the second cause for child morbidity and mortality among children under five. 88% of diarrheal disease prevalence is related to water, sanitation and hygiene (WASH). Resolving WASH problems, especially in families with children under five, is a matter of equity: those affected by diarrheal disease are mainly the lower socio-economic quintiles in developing countries with lower DGP per capita. Water and sanitation MDGs exist for a reason. The USAID Hygiene Improvement Project (HIP) works in Central Madagascar and Western Ethiopia to influence the adoption of practices that may reduce diarrheal disease by almost half: handwashing with soap at critical junctures, household drinking water treatment and storage, and hygienic disposal of human excreta. In Madagascar, between 2007 and 2009, HIP activities resulted in a significant drop in the practice of open defecation by household members from 39% to 19%. Also, the use of simple latrines without slabs jumped from 58% to 72%, and the access to improved sanitation increased from 3% to 9%, with latrine sharing mainly among extended family members remaining constant. Indications that the latrine was being used jumped slightly from 95% to 98%. The installation of hand washing devices within or 10 paces from latrines increased from 3% to 24%. Findings comparing baseline and endline in three intervention intensity levels in Ethiopia will be presented. The role of outreach workers and school-based hygiene promotion in centralized and decentralized government structures and programs will be addressed.