Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications.

The impact of a water, sanitation and hygiene education intervention project on diarrhoeal morbidity in children under 5 years old was evaluated in a rural area of Bangladesh. Data were collected throughout 1984-1987, covering both pre- and post-intervention periods, from an intervention and a control area. The 2 areas were similar with respect to most socio-economic characteristics and baseline levels of diarrhoeal morbidity. The project showed a striking impact on the incidence of all cases of diarrhoea, including dysentery and persistent diarrhoea. By the end of the study period, children in the intervention area were experiencing 25% fewer episodes of diarrhoea than those in the control area. This impact was evident throughout the year, but particularly in the monsoon season, and in all age groups except those less than 6 months old. Within the intervention area, children from households living closer to handpumps or where better sanitation habits were practised experienced lower rates of diarrhoea. These results suggest that an integrated approach to environmental interventions can have a significant impact on diarrhoeal morbidity.

Lack of impact of a water and sanitation intervention on the nutritional status of children in rural Bangladesh.

The nutritional impact of a water and sanitation intervention in a rural community of Bangladesh, comprising the provision of handpumps, construction of latrines and hygiene education was assessed. During 3 years, the quarterly anthropometric measures of about 200 children aged 12-35 months from the intervention community were compared with those of a similar number of children from a control area. The interventions reduced the incidence of diarrhoea by 25 per cent among the children less than 5 years of age. There was no significant difference in nutritional status, however, between the two groups of children. Moreover, within the intervention area, indicators of water and latrine use were not significantly related to the children's nutritional status. This suggests that either the obtained reduction of diarrhoea was not large enough to have an impact on nutritional status or that diarrhoea is not an important cause of malnutrition in this community.

Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study.

As part of a health impact evaluation of a water supply and sanitation project in a rural area of Bangladesh, diarrhoeal morbidity was recorded in children 0-4 years of age using weekly recall in household interviews, during the period March 1984 to December 1987. During the baseline year, 1984, the incidence rate of all diarrhoea episodes (3.8 episodes per child per year), and those defined as persistent, duration greater than 14 days (0.6 episodes per child per year), showed a similar age distribution, peaking in the 12-23 month age group. Sixteen per cent of all episodes were classified as persistent, and this proportion was greatest in the 0-5 month age group (25%). Children suffering at least one episode of persistent diarrhoea in 1984 also experienced a higher incidence of acute diarrhoea (less than = 14 days duration) than those suffering acute diarrhoea only (4.2 versus 3.7 episodes per child per year). Persistent diarrhoea showed a similar seasonal pattern to that of all episodes. Rates of abdominal pain, isolation of Shigella spp and a diagnosis of dysentery were significantly higher in persistent episodes than in acute episodes. Closer follow-up of children during 1986 and 1987, through the recording of all periods of absence of the child from the home, showed that overall diarrhoea incidence rates were little affected when absence was taken into account, but that the incidence of persistent diarrhoea and the proportion of episodes classified as persistent were significantly reduced. The implications of this methodological problem are discussed.

Tubewell water consumption and its determinants in a rural area of Bangladesh.

As part of the evaluation of a water supply, sanitation and hygiene education project in rural Bangladesh, the consumption of water from the improved supplies was estimated from an observational study. Women volunteers observed and recorded all water collection activities of each group of households using a handpump over a 2-day period. Data from questionnaire surveys on household characteristics were related to per capita use of water. The mean household water consumption rate was 43 l per capita per day. Univariate analyses showed that several factors were significantly associated with water consumption, including family size and age structure, occupation, distance from the house to the handpump, the number of people served by a handpump, and possession of luxury items. Multiple regression analysis showed that several factors remained associated with per capita consumption, although their predictive value was low. The method of measuring water consumption, and the policy implications of the findings, are discussed.

Effects of floods on the use and condition of pit latrines in rural bangladesh.

The severe floods of 1987 in Bangladesh had devastating effects on many development activities. Here, the use and condition of improved sanitation facilities (double pit water sealed latrines) during the 1987 peak flood period are presented. Two surveys on the use and condition of the latrines were carried out in May (pre-flood) and September (post-flood) 1987 in a rural area 60 km north of Dhaka, with a population of about 4500. General usage of the latrines by the population aged five years or more decreased from 88% to 78% (p < 0.001) after the flood. Only 40% of the 343 latrines which were in use and had no damaged component at the time of the pre-flood survey still had no damaged components after the floods. Fencing was the component which suffered the most damage. It was the only component which was installed and maintained by the users, project staff being responsible for all other components. The estimated post-flood repair cost was approximately US $4.0 per latrine. Development of an affordable and durable fencing is recommended.