Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia
Methods: Fifty-seven mothers in Indonesia were involved in a face-to-face health education programme which encouraged hand-washing with soap. The intervention spanned 4 months and comprised fortnightly visits by 2 community organizers, who supplied free soap. Two years after the intervention, 79% of mothers were still using hand soap, despite the fact that they now had to buy it themselves. The community seemed to be benefiting from a sustained reduction in diarrhoea episodes due to improved hygiene practices. In early-mid 1990, in Balai Lua in Central Lombok, Indonesia, two community organizers distributed free hand soap and a plastic soap box to 65 mothers of children aged less than 11 years and encouraged them to wash their hands and those of their children after defecation and before contact with food. They also encouraged mothers to clear away immediately the feces of their children left near houses. They visited the same mothers every two weeks for 2-3 days to replenish soap, reinforce hygiene messages, and record morbidity information. Diarrheal prevalence decreased by 89%. Almost two years later, members of an Australian International Development Assistance Bureau mission to the village had the impression that the villagers had maintained the improved hygiene practices and the health benefits had been sustained.
Results: In August 1992, one of the community organizers returned to Balai Lua to determine if the hand-washing health education program was indeed able to sustain improved health benefits and hygiene practices. She was able to interview 57 mothers and collect data on 102 children aged less than 11 years. Before the intervention, no mother used soap to wash their hands or those of their children after defecation or before eating; 26% did before cooking. After the intervention, almost all (92-100) used soap after defecation or before eating; 60% did before cooking. At follow-up, 56% and 43% of mothers, respectively, reported always or sometimes using soap to wash their own or their children's hands after defecation. 94% claimed to always wash their hands with soap before eating, yet only 79% could show soap to the interviewer. 73% always had their children use soap when they washed their hands before a meal. The disease prevalence rate was lower than that before the intervention (1 vs. 3 episodes/100 children/week) but higher than that immediately after the intervention (0.33). Diarrhea rates appeared to be inversely related to reported soap use. 19% of the women understood the health reasons for hand-washing and why they should buy soap.