Reducing Childhood Diarrhoea by Integrated Home-Based Interventions

A combination of better indoor air, clean drinking water and improved hygiene in Peruvian households reduces the prevalence of childhood diarrhoea by 29% according to a community randomised trial conducted by the Swiss Tropical and Public Health Institute (Swiss TPH) and the Instituto de Investigación Nutricional (IIN). Therefore, major causes of childhood morbidity and mortality can be prevented by simple low-cost interventions conclude the authors in the International Journal of Epidemiology.

Diarrhoea and lower respiratory infections are among the major causes of childhood morbidity and mortality in rural Peru. Researchers from Swiss TPH and IIN showed that the prevalence of childhood diarrhoea and diarrhoea episodes can be reduced by 29% and 22% respectively by introducing low-cost intervention at household level, consisting of clean-energy cook stoves, kitchen sinks, solar-purified water and hygiene education. «The lives of many children can be prevented by integrated low-cost-interventions», says Stella Hartinger-Peña, first author of the study. The study supports recent trends by the World Health Organization to address child morbidity and mortality in underprivileged families through improved household air quality, water and home-, personal- and food hygiene conditions.

Training of Mothers is Key for Improved Child Health

Mothers were assigned a crucial role in the trial. They acquired skills in solar drinking-water disinfection and in washing their own and children’s hands with soap after defecation, after changing diapers or before preparing food and eating. While the results showed a positive health impact on childhood diarrhoea, no effects on respiratory infections and on child growth were measured. “Sensitising mothers to child health issues and child growth by improving their relationship with their child may have lessened the possibilities to measure effects of the home-environmental improvements in the kitchens and hygiene”, explains Daniel Mäusezahl, study leader from Swiss TPH. 

Improved Living Conditions

In empowering women, the scientists also adapted for the first time the urban-based Peruvian National Early Child Development Programme (Wawa Wasi) and brought it to the doorstep of mothers living in the rural Cajamarca region. Over one year mothers of children below the age of three were guided to enhance psychomotor skills of their toddlers through daily playing with age-based toys. The mother-child psychomotor stimulation based on the Wawa Wasi programme was applied in households of 25 communities in a control group only. Overall, 51 communities participated in the trial and at the end of the trial had established clean kitchen environments and hygiene conditions with ventilated improved cook stoves, running water, household drinking water treatment  and a new kitchen sink in their homes. The convenience gains from the new kitchen made the intervention highly popular and acceptable among the rural population.

Publication

Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health, SM Hartinger; CF Lanata; J Hattendorf; H Verastegui; AI Gil; J Wolf; D Mäusezahl, International Journal of Epidemiology 2016; doi: 10.1093/ije/dyw242