Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.3
, Sep
t
em
b
e
r
20
14, pp
. 206
~212
I
S
SN
: 225
2-8
8
0
6
2
06
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Maternal Knowledge and Practi
ces Towards Sanitation and
Their Relationships with Occurren
ce of Diarrhoea in Children
Shriya A. Sek
s
aria, Mini
K.
Sheth
Department o
f
F
oods and Nutrition, Facu
lty
of F
a
mily
and
Community
Scien
ces
, Th
e Mah
a
ra
ja
Say
a
jir
ao Univ
er
sity
of
Baroda, Vadodara, Gujarat, INDIA
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
May 08, 2014
Rev
i
sed
Ju
ly 20
, 20
14
Accepted Aug 27, 2014
Diarrhoea, a major contribu
tor
of
childhood morbidity
and
mortality
is
mostly
caused b
y
poor h
y
gien
e
and sanita
tion.
Liter
a
ture r
e
veal that h
y
gien
e
practices
at hou
sehold levels g
r
eatly
af
fects th
e occurren
c
e of
diarrho
e
a
among children
.
A cross
sectional
stud
y
was conducted to
determine
association between h
y
giene
knowledge
and
practices of mothers with
occurren
ce of
diarrhoea in
y
oung
childr
e
n below 3
y
ears in
the
tribal villag
e
s
of Gujarat
.
Str
u
ctured qu
estio
nnaire w
a
s used to el
ic
it info
rm
ation o
n
personal h
y
g
i
ene (PH), food H
y
giene (FH),
and
en
vironmental H
y
g
i
ene (EH)
practices of 536 mothers with children be
tween 6-36 months of ag
e. Past one
month diarrhoeal episodes were
record
ed us
ing t
h
e rec
a
ll m
e
thod
. The m
ean
percen
t s
c
or
es
f
o
r F
H
, P
H
and
EH
practices
were 77%
, 88
% and 80%
res
p
ect
ivel
y.
Al
m
o
s
t
35% child
ren s
u
ffe
r
e
d fro
m diarrhoea in
the past on
e
m
onth of which
10 were adm
itte
d to the hospital
.
Diarrhoeal in
cid
e
nces were
associated with
FH and
EH practices (p<0
.001)
a
nd not with P
H
practices.
Improvement in the environmental and
p
e
rs
on
al h
y
gien
e pra
c
tic
es
of the
mothers can co
ntribute larg
ely in reducing th
e prevalen
ce of
diarrho
ea
among childr
e
n
in Chikhli taluka
of Gujarat.
Keyword:
Ch
ild
hoo
d d
i
arr
h
ea
Trib
al m
o
th
ers
Hyg
i
en
e and
san
itatio
n
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Shriya A.
Se
ks
aria,
Depa
rt
m
e
nt
of
Fo
ods
an
d
N
u
t
r
i
t
i
on,
Fac
u
l
t
y
of
Fam
i
ly
and
C
o
m
m
uni
t
y
Sci
e
nces,
The M
a
hara
ja
Say
a
ji
ra
o
Uni
v
ersi
t
y
of
B
a
r
o
d
a
,
Vad
o
d
ara
,
Gu
jarat,
I
N
DI
A
Em
a
il: sh
riya.sek
saria@g
m
ail
.
co
m
1.
INTRODUCTION
An
est
i
m
at
ed 80
1,
0
0
0
chi
l
d
r
e
n y
o
u
nge
r t
h
a
n
5 y
ears
o
f
a
g
e peri
s
h
fr
om
di
ar
rhea
eac
h
year, m
o
stly
in de
veloping
countries. This
am
ount
s to
11% of the
7.6 m
illion deaths of
childre
n
unde
r the age of
five and
means that about 2,200 c
h
ildren are
dy
ing e
v
ery day as a result of
diarrheal
di
seases [
1
]
.
R
e
duci
n
g
di
arr
h
ea
l
deat
hs
by
m
o
re
t
h
an
1
.
4
m
i
ll
i
on
per
y
ear
wo
u
l
d be
a m
a
jor
c
ont
ri
b
u
t
i
o
n
t
o
war
d
s M
D
G
4
[
2
]
.
Diarrho
ea targets
m
o
stly
th
e p
o
o
r
co
mm
u
n
ity d
u
e
to
po
or env
i
ro
n
m
en
tal san
itatio
n
,
in
ad
equ
a
te
wat
e
r su
p
p
l
y
, po
ve
rt
y
and p
o
o
r
ed
ucat
i
o
n [3]
.
As
per
WHO
20
0
8
[4]
est
i
m
a
t
e
s 81%
cases of di
ar
r
hoe
a
worldwid
e are
attrib
u
t
ab
le t
o
u
n
s
afe
water, in
ad
equ
a
te sa
n
itatio
n
or insufficien
t
h
y
g
i
en
e.
Th
ese cases resu
lt i
n
1.5 m
i
llion dea
t
hs each year,
m
o
st bei
ng the
deaths
of c
h
ildre
n.
In a
d
diti
on t
h
e total num
ber of deat
hs caused
di
rect
l
y
and i
ndi
rect
l
y
by
m
a
l
nut
ri
t
i
on i
n
d
u
ce
d by
u
n
s
afe wat
e
r
,
i
n
adeq
uat
e
sa
ni
t
a
t
i
on an
d i
n
s
u
f
f
i
c
i
e
nt
h
y
g
i
en
e is 860 0
0
0
d
eaths p
e
r
year
in
ch
ildr
e
n
u
n
d
e
r
f
i
v
e
year
s o
f
ag
e.
G
l
ob
ally, ar
oun
d
2
.
4
mill
io
n
d
eath
s
(
4
.2
% of
all
death
s
)
cou
l
d be pr
ev
en
ted ann
u
a
lly if
e
v
e
r
yone
practised
appropriate hy
giene a
n
d
ha
d good,
rel
i
a
bl
e
sani
t
a
t
i
on
a
n
d dri
nki
n
g
wat
e
r [5]
.
Ac
cor
d
i
n
g
t
o
est
i
m
at
i
ons,
88%
of al
l
di
ar
rh
oea
l
di
seases a
r
e c
a
use
d
d
u
e
to
co
n
t
am
i
n
ated
water and
in
ad
equ
a
te hyg
ien
e
and
sanitatio
n
[6
]. Other research
ers also
po
in
ted
ou
t th
at
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mat
e
rn
al
K
n
o
w
l
e
dge
a
n
d
Pr
act
i
ces T
o
w
a
r
d
s S
ani
t
a
t
i
o
n
a
n
d
T
h
ei
r Rel
a
t
i
o
nshi
ps
...
. (
S
hri
y
a A
.
Seksa
r
i
a
)
20
7
t
h
at
am
ong t
h
e
m
a
i
n
chi
l
d
h
o
o
d
di
seases t
h
at
are di
rect
l
y
l
i
nked t
o
p
o
o
r
hy
gi
ene a
nd sa
ni
t
a
t
i
on i
s
di
ar
rhe
a
[7]
-
[1
0]
.
World
Health
Org
a
n
i
satio
n
[1
1
]
h
a
s ou
tlin
ed
th
e b
a
sic p
r
i
n
cip
l
es fo
r th
e
p
r
ep
aration
of safe food
for
i
n
fa
nt
s an
d y
o
u
n
g
c
h
i
l
d
re
n
b
u
t
t
h
e ef
fect
o
f
fo
o
d
-
h
y
g
i
e
ne
pract
i
ces
of m
o
t
h
e
r
s o
n
di
ar
r
hoea am
on
g c
h
i
l
d
re
n
i
n
com
m
uni
t
y
set
t
i
ngs ha
s be
en spa
r
i
n
gl
y
re
po
rt
ed
[1
2]
,[
1
3
]
. M
o
reo
v
e
r
t
h
e t
r
i
b
al
areas o
f
I
ndi
a
n
su
bc
o
n
t
i
n
ent
are
une
xplore
d in this
area.
Hen
ce t
h
e stud
y was und
ert
a
k
e
n
with
an
o
b
j
ectiv
e to
determin
e if th
e h
y
g
i
en
e an
d san
itatio
n
k
nowledg
e
and
p
r
actices of m
o
th
ers
ar
e
asso
ciated
with o
ccurren
c
e
of d
i
arrho
ea i
n
child
ren. Th
e
stud
y will
h
e
lp
h
i
gh
ligh
t
th
e und
esirab
le p
r
actices
fo
l
l
o
w
ed
b
y
th
e m
o
th
ers
with
resp
ect
to
do
mestic
h
y
g
i
en
e wh
ich
m
i
ght
co
nt
ri
b
u
t
e t
o
occ
u
rre
nc
e o
f
di
arr
h
oea i
n
c
h
i
l
d
re
n.
2.
R
E
SEARC
H M
ETHOD
Lo
ca
le o
f
study
Th
e
st
u
d
y
was
carried
o
u
t
in
th
e
trib
al v
illag
e
s o
f
Ch
ikh
li ta
lu
ka
, Nav
s
ar
i
District
o
f
G
u
ja
rat, In
dia
.
Gu
ja
rat
ha
s
33
di
st
ri
ct
s a
n
d
Navs
ari
di
st
ri
c
t
com
p
ri
ses
of
6 t
a
l
u
kas
w
h
i
c
h i
n
cl
u
d
es
3
8
9
u
r
ba
n,
r
u
ral
a
n
d
t
r
i
b
al
v
illag
e
s. Ch
i
k
hli a trib
al talu
k
a
o
f
Nav
a
sri d
i
strict h
a
s 88
v
i
llag
e
s [14
]
. As repo
rted
Ch
i
k
h
li h
a
s a pop
u
l
atio
n
o
f
293
014
,
w
ith
1
4
8
,
72
9 m
a
l
e
s and
14
4,285 f
e
m
a
les [
1
5
]
,[1
6
]
.
Un
de
r t
h
e
I
n
t
e
grat
e
d
C
h
i
l
d
Devel
opm
ent
Schem
e
(IC
D
S
)
of
G
o
ver
n
m
e
nt
of
I
n
di
a,
C
h
i
k
hl
i
t
a
l
u
k
a
has ab
o
u
t
40
0
fu
nct
i
o
nal
ang
a
nwa
d
i
s
(c
om
m
uni
t
y
cent
r
e)
. Taki
n
g
an a
v
erage
of 1
0
chi
l
dre
n
bet
w
ee
n
t
h
e age
group 6- 36 mont
hs enrolled
in each
anganwadi, it was assum
e
d that th
e
r
e are approxi
mately 4000 childre
n
bet
w
ee
n 6
-
3
6
m
ont
hs i
n
C
h
i
khl
i
.
W
i
t
h
a co
nfi
d
ence i
n
t
e
rv
al
of 4 an
d co
n
f
i
d
e
n
ce l
e
vel
o
f
95
% t
h
e m
i
ni
m
u
m
sam
p
le size calculates to
be
522.
T
h
ere
f
ore a
sam
p
l
e
of
53
6
was
selected
for the st
udy.
Sa
mpling
A m
a
p
o
f
Ch
ikh
li tu
lu
k
a
was tak
e
n
an
d
with Ch
ik
h
li v
illage as th
e cen
ter p
o
i
n
t
a circle o
f
15
cm was
drawn. The area was di
vided int
o
4 zones. Four villages were
random
ly selected from
each zone and
i
n
cl
udi
ng
Ch
ikh
l
i
, a t
o
tal of
1
7
v
illag
e
s
were id
en
tified.
Ab
ou
t 31
ho
useho
l
d
s
with
ch
ild
ren
b
e
tween
6
-
36
m
onths we
re s
e
lected ra
ndomly from
each
vi
llage.
Collecti
o
n of data
Data were co
llected
b
y
a train
e
d
i
n
v
e
stigato
r
u
s
ing
a pretested
proforma. Th
e in
stitu
ti
o
n
a
l eth
i
cal
co
mmittee
g
a
ve ap
prov
al to
th
e d
a
ta sch
e
dule. In
form
ed
c
o
n
s
en
t was taken
fro
m
th
e
mo
th
ers and
th
ey were
expl
ai
ne
d t
h
e
p
u
r
p
ose
of
t
h
e st
udy
.
Th
e qu
estio
nnaire
con
s
isted o
f
d
i
fferen
t
sectio
n
s
t
o
elicit in
fo
rm
atio
n
un
d
e
r t
h
e fo
llowing
h
eads
i
)
.bac
k
g
r
o
u
n
d
i
n
f
o
rm
at
i
on t
o
assess
t
h
e
soc
i
o ec
on
om
i
c
stat
us
of
t
h
e
fa
m
i
ly
;
i
i
)
ho
use
hol
d i
n
f
o
rm
at
ion
i
i
i
)
di
sease
pr
ofi
l
e
of
t
h
e c
h
i
l
d
fo
r t
h
e
past
o
n
e m
ont
h
wi
t
h
re
fer
e
nce t
o
R
T
I a
n
d
di
a
r
rh
oeal
e
p
i
s
o
d
e
s
i
v
)
k
now
ledg
e an
d pr
actices of
mo
th
er
s
o
n
h
y
g
i
en
e an
d san
itatio
n
.
Back
groun
d
i
n
form
at
io
n
was co
llected
wh
ich
in
clud
ed
qu
estion
s
related
to
in
co
m
e
o
f
th
e fam
ily,
ed
u
cation
a
l
q
u
alificatio
n
of
m
o
th
er an
d fath
er,
own
e
rs
hip of
property, etc. This i
n
form
ation wa
s used t
o
assess the
s
o
cio ec
onom
ic sta
t
us
of t
h
e
fam
ily accord
ing t
o
criteria de
veloped by
Agra
wa
l et al [17].
Th
e
h
y
g
i
en
e
an
d san
itatio
n qu
estion
n
a
ire in
clud
ed several clo
s
e end
e
d qu
estion
s
related
t
o
envi
ro
nm
ent
a
l
,
fo
od a
nd
pers
onal
hy
gi
ene
whi
c
h hel
p
e
d
assess t
h
e p
r
es
ent
kn
o
w
l
e
d
g
e
and p
r
act
i
ces of t
h
e
m
o
thers in rel
a
tion to the t
h
ree
hygie
n
e
aspects.
Th
e
qu
estion
n
a
ire was co
m
p
iled
as p
e
r th
e ch
eck
lists
devel
ope
d a
n
d
use
d
by
m
a
ny
i
n
vest
i
g
at
o
r
s a
n
d
g
o
v
er
n
m
ent
sur
v
ey
s
[1
8]
-
[
2
6
]
.
T
h
e q
u
est
i
o
nnai
r
e was
pret
est
e
d
wi
t
h
15
m
o
t
h
ers an
d m
odi
fi
ed ac
cor
d
i
n
gl
y
.
Eac
h
desi
ra
bl
e res
p
o
n
se
was
gi
v
e
n a sc
ore
o
f
2
or
3
(de
p
e
ndi
ng
o
n
t
h
e
q
u
est
i
o
n
)
and
an
un
desi
r
a
bl
e res
p
on
se
was
gi
ve
n a
s
c
ore
o
f
1.
A
c
o
m
posi
t
e
sco
r
e was
calculated for
each as
pect a
n
d the
m
o
thers
were
ra
nke
d i
n
to four cate
g
ories i.e exce
llent (with a
sc
ore
of
91-
1
0
0
%
)
,
v
e
r
y
go
od
(7
6-
90
%)
, f
a
ir
(
6
1
-
75
%) an
d
poo
r
(
≤
6
0
%)
.
The
que
st
i
o
n
n
a
i
r
e was
de
vel
ope
d i
n
E
ngl
i
s
h
but
was t
r
a
n
sl
at
ed t
o
t
h
e
l
o
cal
l
a
ng
ua
g
e
(G
u
j
arat
i
)
du
ri
n
g
a
d
m
i
ni
st
rat
i
on.
Th
e i
n
vest
i
g
at
o
r
t
o
o
k
ab
out
2
0
-
3
0 m
i
nut
es t
o
a
d
m
i
ni
st
er
one
q
u
es
t
i
onnai
r
e.
St
at
ist
i
ca
l analy
s
is
M
eans an
d st
a
nda
r
d
de
vi
at
i
o
ns f
o
r va
ri
o
u
s
resp
o
n
ses
wer
e
cal
cul
a
t
e
d us
i
ng M
i
cr
os
oft
Excel
2
0
0
7
.
Ep
i Inf
o
sof
t
w
a
r
e
(V
er
si
o
n
20
00)
w
a
s
used
t
o
o
b
t
ain
association of
diarrhoeal
d
i
sease in
ch
ildren
with
v
a
ri
o
u
s
factors lik
e ch
ild
’s ag
e, SES,
m
o
th
ers’ ed
u
cation
,
h
o
u
s
eh
o
l
d
fac
ilit
ies etc. p
- Valu
es sm
aller
th
an
0
.
0
5
were con
s
id
ered
to b
e
statistical
ly sig
n
i
fican
t.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
2
06
–
21
2
20
8
3.
R
E
SU
LTS AN
D ANA
LY
SIS
Socio-dem
o
gr
aphic c
h
ar
ac
teristics of res
pondents
Out
t
h
e
53
6 ch
i
l
d
ren e
n
r
o
l
l
e
d
m
o
st
(25
5
;
4
7
.
6%
) we
re i
n
t
h
e age
gr
ou
p o
f
1
3
-
24 m
ont
h
s
, 1
53
wer
e
aged
bet
w
een
6-
1
2
m
ont
hs a
n
d
rest
were
b
e
t
w
een
2
5
-
3
6
m
ont
hs. T
h
e e
n
r
o
l
l
e
d s
u
bject
s ha
d al
m
o
st
equal
perce
n
t
a
ge
of
m
a
l
e
s and fem
a
l
e
s. M
a
jo
ri
t
y
of t
h
e
fam
i
l
i
es
(
473
; 8
8
.2%)
w
e
r
e
H
i
nd
us an
d
50
% of
th
e
ch
ild
ren
were
the
first
o
ffs
pri
n
g
o
f
t
h
eir
pare
nts (
T
abl
e
1
)
.
Onl
y
1
1
out
of
53
6
fam
i
l
i
e
s
bel
o
nge
d t
o
t
h
e up
pe
r hi
gh
S
E
S g
r
o
u
p
wi
t
h
m
a
jori
t
y
o
f
fa
m
i
li
es (2
34
;
4
3
.7%)
b
e
longin
g
t
o
l
o
w
e
r
mid
d
l
e
g
r
ou
p.
Up
p
e
r
m
i
d
d
l
e inco
m
e
g
r
oup
h
a
d
2
0
0
f
a
m
i
l
i
es an
d 37
f
a
m
i
l
i
e
s
w
e
r
e
categorized i
n
poor inc
o
m
e
group.
Alm
o
st an
eq
u
a
l d
i
stribu
tion
was ob
serv
ed
in
th
e fam
i
l
y
co
m
p
o
s
itio
n with
1
7
0
(31
.
7
%
)
n
u
c
lear
fam
i
lies, 193
(36.0%
) joi
n
t and
173 (32.3%) extende
d
fam
i
lies. Alm
o
st 75% (400) fam
ilies
were non
veget
a
ri
ans.
Table 1. Bac
k
ground infor
m
ation
of the
child/
fa
m
i
l
y
Total
No.
%
Chi Square
Value
Age
3.
16
NS
6 -
12
m
onths
153
59
11.
0
13 -
24
m
onths
255
93
17.
4
25 -
36
m
onths
128
37
6.
9
Sex
0.
991
NS
M
a
le 285
95
17.
7
Fem
a
le 251
94
17.
5
Religion
10.
2
**
Hindu
473
155
28.
9
M
u
slim
61
33
6.
2
Chr
i
stian
2
1
0.
2
Birth Order
4.
96
NS
Fir
s
t 268
89
16.
6
Second
194
66
12.
3
T
h
ir
d 54
24
4.
5
Four
th 15
7
1.
3
Fifth
2
1
0.
2
Sixth and above
3
2
0.
4
Socio econo
m
i
c s
t
atus (SES)
22.
8
*
**
Upper
High
11
1
0.
2
High 53
15
2.
8
Upper
M
i
ddle
200
57
10.
6
L
o
wer
M
i
ddle
234
93
17.
4
Poor
37
23
4.
3
Very
Poor
1
1
0.
2
Type of Fa
m
ily
1.
01
NS
Nuclear 170
61
11.
4
Joint
193
63
11.
8
E
x
tended
173
65
12.
1
Age of Mother
5.
13
NS
18 – 20
17
10
1.
9
21 – 25
283
109
20.
3
26 – 30
145
29
5.
4
31 and above
37
12
2.
2
Don’
t Know
54
29
5.
4
Age of Fat
h
er
19.
0
**
18 – 20
3
1
0.
2
21 – 25
72
34
6.
3
26 – 30
191
69
12.
9
31 and above
214
56
10.
4
Don’
t Know (
3
father
s who wer
e
dead ar
e included
in this category)
56
29
5.
4
Educational qualification of
m
o
ther
4.
2
NS
Illiterat
e
84
35
6.5
Pr
im
ary
to Higher
secondar
y
(
G
r
a
de
1 to 10)
126
50
9.
3
Higher
senior
seco
ndar
y
(Gr
a
de 11 and above)
326
104
19.
4
Educat
ional qualif
icat
ion of
f
a
t
h
er
(
O
UT
OF
533)
1.
97
NS
Illiterat
e
37
17
3.2
Pr
im
ary
to Higher
secondar
y
(
G
r
a
de
1 to 10)
135
48
9.
0
Higher
senior
seco
ndar
y
(Gr
a
de 11 and above)
361
124
23.
1
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mat
e
rn
al
K
n
o
w
l
e
dge
a
n
d
Pr
act
i
ces T
o
w
a
r
d
s S
ani
t
a
t
i
o
n
a
n
d
T
h
ei
r Rel
a
t
i
o
nshi
ps
...
. (
S
hri
y
a A
.
Seksa
r
i
a
)
20
9
The a
v
era
g
e a
g
e of the m
o
thers was
25 yrs a
n
d that
o
f
f
a
th
ers w
a
s
30
yr
s.
A
bou
t 10
% m
o
th
er
s
d
i
dn
’
t
k
now th
ei
r ag
e o
r
th
eir hu
sb
an
d’s ag
e. Majority o
f
t
h
e
p
a
ren
t
s were literat
e
with
on
ly 15
.7
%
(84
)
m
o
th
ers an
d
6
.
9
%
(37) illite
rate fathers. M
o
st
o
f
t
h
e m
o
th
ers, (5
05
; 9
4
.25
%
)
were ho
u
s
es
wi
v
e
s.
Ho
useho
l
d info
rma
t
ion
o
f
the fa
milies
Mo
re t
h
an
h
a
lf th
e
fam
i
lies, 6
0
.6% (32
5
)
resid
e
d in
sem
i
pakka
ho
uses
an
d
o
p
en
d
r
ai
nage
sy
st
em
was f
o
u
n
d
i
n
64
.4
% (3
4
5
)
h
ous
eh
ol
ds
(Ta
b
l
e
2)
. Ha
nd
p
u
m
p
or b
o
re
ho
l
e
was t
h
e
m
a
in so
urce
of
dri
nki
ng
water fo
r m
a
j
o
rity (257
; 4
7
.9
%)
o
f
th
e
famil
i
es. On
ly 11
ho
useho
l
d
s
u
s
ed
op
en
well water for drin
k
i
ng
pu
r
poses
(
T
abl
e
2
)
.
€: house with tem
p
or
ar
y r
oof and walls,
m
a
de of
m
a
ter
i
als like wood,
tin sheets,
hay,
asbestos
etc.
£: House with concr
e
te
walls but te
m
por
ar
y
r
oof.
¥: house with conc
r
e
te
r
oof and walls.
Mo
rbidity
profile o
f
the chil
dren
A
s
r
e
po
r
t
ed
b
y
m
o
th
er
s, 69
% (
370
)
ch
ildr
e
n su
ff
er
ed
f
r
o
m
cou
g
h
an
d co
l
d
, and
35
.3
%
(1
89)
fr
o
m
di
arr
h
oea i
n
t
h
e past
o
n
e m
ont
h. M
a
j
o
rity of the
diarrhoea
l
cases (171; 90
.5%)
we
re wa
tery diarrhoea, 9.5%
(1
8)
bl
oo
dy
di
arr
hoea
an
d
1
0
chi
l
d
ren
we
re
adm
i
t
t
e
d t
o
ho
spi
t
a
l
d
u
ri
n
g
t
h
e di
ar
rh
oeal
e
p
i
s
odes
.
Knowledge and
pr
actices of moth
ers on
hy
gi
ene and
s
a
ni
ta
ti
on
.
Table 3 s
u
mmarizes the ranki
ng
of m
o
thers accordi
ng
to scores obta
ined
for different hygie
n
e
aspects.
Table 3. Ran
k
ing
of the
m
o
thers
for dif
f
eren
t hygien
e aspects
K
E
H
P
E
H
K
F
H P
F
H
K
P
H
P
P
H
No.
% No.
%
No. %
No. % No. % No.
%
91-
100%
(Excellent)
382
71.
3
75
14.
0
45
8.
4
49
9.
1
410
76.
5
159
29.
7
76 -
90 % (
V
er
y
Good)
36
6.
7
99
18.
5
198
36.
9
423
78.
9
88
16.
4
264
49.
3
61 -
75% (
F
air
)
47
8.
8
95
17.
7
256
47.
8
63
11.
8
24
4.
5
100
18.
7
≤
60
%
(
P
oor
) 71
13.
2
267
49.
8
37
6.
9
1
0.
2 14
2.
6 13
2.
4
Chi squar
e
value
1.
92
N
S
14.
0
**
5.
77
N
S
0.
595
N
S
5.
89
N
S
5.
89
*
KE
H:
Knowledge on envir
o
n
m
ental
hy
giene
PE
H: Pr
actices on envir
o
n
m
ental hygiene
KFH: Knowledge
on fo
od hy
giene
PFH: P
r
actices
on f
o
od hygiene
KPH: Knowledge
on per
s
onal hy
giene
PPH: Pr
actices
on per
s
onal hy
giene
NS
: Non significant
*
: p< 0.
05
**
: p<0.
001
***
: p<0.
0001
Table 2. Househo
l
d infor
m
ation of
the fa
m
ily
Total
No.
%
Chi Square
Value
Drainage facility
3.
82
*
Open
345
132
24.
6
Close 191
57
10.
6
Type of House
10.
5
**
Kaccha
€
62
27
5.
0
Semi Pakka
£
325
125
23.
3
Pakka
149
37
6.
9
Source of d
r
in
k
i
n
g
w
a
ter
6.
61
NS
piped water
/
m
unicipal supply
83
37
6.
9
Open well
6
3
0.
6
Han
d
p
u
m
p
/ Bo
reh
o
le
2
5
7
9
3
1
7
.
4
Bottled water
190
56
10.4
Source of coo
k
ing
w
a
ter
8.
92
*
piped water
/
m
unicipal supply
118
54
10.
1
Open well
11
3
0.
6
Handpu
m
p
/ Bor
e
h
o
le
348
117
21.
8
Bottled water
59
15
2.8
Source of w
a
ter f
o
r other househol
d activities
4.
80
*
Piped water
/
m
unicipal supply
164
69
12.
9
Handpu
m
p
/ Bor
e
h
o
le
372
120
22.
4
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
2
06
–
21
2
21
0
Environment
a
l hy
giene (E
H)
M
a
jo
ri
t
y
of m
o
t
h
e
r
s (
3
8
2
;
7
1
.
3
%)
had e
x
c
e
l
l
e
nt
scores f
o
r k
n
o
wl
e
d
ge on E
H
. M
o
t
h
e
r
s k
n
ew t
h
at
accum
u
lated water, flies,
feca
l
m
a
tter outside the house
and m
opping,
sweeping; anim
als and flies insi
de the
house
can affe
ct their c
h
ild’s
health
.
D
i
sposin
g hou
seho
l
d
so
lid w
a
ste in op
en
w
a
s consid
er
ed
d
e
sir
a
ble b
y
alm
o
st
43%
(
2
29
) m
o
t
h
ers
.
The environm
ental hygiene
practices of the
m
o
th
ers we
re com
p
aratively poor,
with alm
o
st 50%
m
o
thers scoring
≤
60%.
The
m
o
st undesira
ble practices inc
l
ude
d
ope
n defecation by
239 (44.
6%
)
fam
ilies
and
ope
n c
o
l
l
ect
i
on an
d
di
sp
osal
of s
o
l
i
d
wast
e
by
7
9
.
3
%
(4
2
5
) a
n
d 6
1
.
4
%
(3
2
9
)
fam
i
l
i
e
s
respect
i
v
el
y
a
n
d n
o
t
usi
n
g a
n
y
di
si
n
f
ect
ant
f
o
r m
oppi
ng
by
6
1
.
8
% (
3
3
1
)
fam
i
l
i
es.
Fo
od
Hy
gi
ene
(
F
H)
Maj
o
rity o
f
th
e
m
o
th
ers (256
; 4
7
.8
%) scored
fair
ly on
fo
od
h
y
g
i
en
e.
Mo
st o
f
th
e mo
th
er
s (
317
;
59%)
were
unaware a
b
out the safe tem
p
eratures for h
eat
i
ng l
e
ft
ov
er m
o
i
s
t
foo
d
f
o
r co
nsum
pt
i
on a
n
d
alm
o
st
h
a
lf th
e m
o
th
ers d
i
d
n
’t kn
ow abou
t th
e safe du
ration
of
sto
r
ag
e
o
f
co
ok
ed
m
o
ist f
o
od
stor
ed
at r
o
o
m
t
e
m
p
erat
ure
be
fo
re co
ns
um
pt
ion
.
A l
a
r
g
e pe
rcent
a
ge o
f
m
o
t
h
e
r
s (
4
7
6
;
8
8
.
8
%)
rega
rd
e
d
“b
ul
k
washi
ng
onl
y
once”
as t
h
e i
d
eal
way
o
f
wa
s
h
i
n
g f
r
u
i
t
s
an
d
ve
get
a
bl
es. M
a
ny
(
3
5
9
;
67%
) m
o
t
h
ers
bel
i
e
ved
t
h
at
“wa
r
m
i
ng”
t
h
e st
ore
d
m
o
i
s
t
weani
n
g f
o
o
d
s i
s
su
ffi
ci
ent
bef
o
re
feedi
n
g t
h
e b
a
by
. B
o
i
l
i
ng wat
e
r a
n
d
addi
ng c
h
l
o
ri
ne was
rep
o
rte
d
as
a m
e
tho
d
to
m
a
ke water sa
fe
fo
r
dri
nki
ng
by
2
8
9
m
o
thers.
H
i
gh
p
e
r
c
en
tag
e
of
m
o
th
er
s
(
423
; 78
.9
%)
w
e
r
e
r
a
nk
ed
as “v
er
y
g
ood
” fo
r
p
r
actices
o
n
f
ood
h
y
g
i
ene
(PFH). Desira
ble food hy
giene practices followe
d by
m
o
th
ers in
clud
ed
u
s
ing
so
ap
fo
r
wash
ing u
t
en
sils,
washi
n
g fruits
and ve
getables
before use and air
drying
of utensils a
f
ter
washi
n
g. T
h
e
m
o
st undesira
ble food
hy
gi
ene
pract
i
ces i
n
cl
ude
d
d
i
ppi
n
g
a co
nt
a
i
ner i
n
st
o
r
e
d
wat
e
r ve
ssel
(
w
he
re ha
n
d
co
m
e
s i
n
cont
act
wi
t
h
water) fo
r drawing
water and
co
nsu
m
in
g
m
o
ist le
fto
v
e
r
food
wit
h
ou
t su
fficien
t
heating
.
Personal Hy
gi
ene (PH)
Ex
cellen
t
scores were ob
tained
b
y
m
o
st o
f
th
e
m
o
th
ers (4
10
; 76
.5
%). Alm
o
st al
l
m
o
th
ers (52
4
;
97.8%)
knew t
h
at washi
n
g their ha
nds a
n
d
child’s
hand
s
(506;
94.4%) before
feedi
n
g t
h
e c
h
ild is
nec
e
ssary.
Man
y
k
n
e
w that wash
ing
h
a
nd
s with
so
ap
is
m
u
ch
b
e
tter than
water alon
e
as it facili
tates
efficien
t rem
o
v
a
l o
f
di
rt
and
germ
s
and
hel
p
s p
r
e
v
ent
di
seases. P
e
rso
n
al
hy
gie
n
e practices of the m
o
thers we
re assessed
pri
m
arily
with
resp
ect to th
eir h
a
nd
wash
ing
practices with so
ap
.
M
o
t
h
e
r
s were
qu
est
i
one
d rega
r
d
i
n
g use
o
f
s
o
ap fo
r
wash
i
n
g
h
a
nd
s b
e
fore an
d aft
e
r a
nu
m
b
er of
activ
ities.
All the m
o
thers use
d
soa
p
aft
e
r visiting t
o
ilet a
nd also a
f
ter attendi
ng the child who
ha
s defecate
d
.
Every
m
o
t
h
er
bat
h
e
d
dai
l
y
and
w
o
re cl
ea
n
cl
ot
hes.
O
n
l
y
h
a
l
f
use
d
so
ap
f
o
r
was
h
i
n
g ha
nds
be
fo
re fee
d
i
n
g t
h
e
chi
l
d
a
n
d
an
al
m
o
st
sim
i
l
a
r
num
ber
be
fo
re eat
i
ng
f
o
o
d
. In
suf
f
i
c
i
e
nt
use of soa
p
was fo
un
d bef
o
re
c
o
oki
ng
,
b
e
fo
r
e
br
eastf
eed
i
ng
th
e ch
ild an
d af
ter
t
o
u
c
h
i
ng
r
a
w
f
ood
s. Th
e
ov
er
all sco
r
es
show
ed
t
h
at on
ly 29
.7
% (
159
)
m
o
t
h
er ha
d e
x
cel
l
e
nt
sco
r
es
f
o
r
pe
rs
onal
hy
gi
ene
p
r
act
i
ces.
Ass
o
ci
ati
o
n
o
f
di
arrh
oe
a w
i
th various par
a
meter
s:
Diarrho
eal d
i
seases were
h
i
gh
ly sign
ifican
t
with
t
h
e SES, and
typ
e
of
ho
u
s
e in wh
ich
th
e fam
ilies
resi
de
d (Ta
b
l
e
1-
3)
. Ot
her fac
t
ors ass
o
ci
at
ed
wi
t
h
di
ar
rh
oea
l
diseases included
religion of the fam
i
ly , a
g
e of
fath
er, drain
a
ge facility, typ
e
o
f
ho
u
s
e, so
urce o
f
co
o
k
i
n
g
water
and
water u
s
ed
fo
r o
t
h
e
r h
o
u
s
eho
l
d
activ
ities,
pract
i
ces o
n
envi
ro
nm
ent
a
l
and
pers
o
n
al
h
y
g
i
e
ne pr
act
i
ces of t
h
e m
o
t
h
ers. A
g
e an
d s
e
x of t
h
e c
h
i
l
d
, bi
rt
h
or
der
o
f
t
h
e c
h
i
l
d
an
d t
y
pe
of
fam
i
l
y
were not
st
at
i
s
tically asso
ciated
with
th
e occurrence of diarrhoeal
d
i
seases along w
ith
th
e m
o
th
er
’
s
ag
e, p
a
r
e
nts ed
u
cation
a
l
q
u
a
lif
ication
,
m
o
th
er
’
s
wor
k
in
g
status, sour
ce of
dri
nki
ng
wat
e
r
,
m
o
t
h
er’s
k
n
o
w
l
e
d
g
e
on
E
H
,
FH
an
d
PH
an
d
pract
i
ces
on
FH.
4.
DIS
C
USSI
ON
The
p
r
esent
st
udy
i
s
o
n
e
o
f
i
t
s
ki
n
d
s as
no
dat
a
is av
ailab
l
e fro
m
th
e trib
al reg
i
on
s
of In
d
i
an
sub
contine
n
t eliciting
household
hygiene
practices as a ca
us
ative factor
of dia
r
rhoea
am
on
g y
o
u
n
g
c
h
i
l
d
re
n.
Ho
use
hol
d i
n
f
o
rm
at
i
on o
f
t
h
e fam
i
l
i
e
s sho
w
s t
h
at
64
.4
%
ho
use
h
ol
ds
h
a
d o
p
e
n
drai
n
a
ge sy
st
em
in
d
i
cating
poor env
i
ron
m
en
t
a
l co
nd
itio
ns.
Ch
ild
ren
resi
d
i
ng
in
semi
pakk
a
h
ouse
s
were f
o
u
n
d
t
o
ha
ve
m
a
xim
u
m
num
ber
o
f
di
arr
h
oe
al
epi
s
o
d
es i
n
t
h
e
prese
n
t
st
ud
y
.
Tho
ugh
m
a
j
o
r
ity o
f
m
o
th
er
s (
7
1
.
3
%
)
go
t ex
cellen
t
scor
es f
o
r
K
E
H
,
almo
st 50
% sco
r
ed
poo
r
l
y
for
PEH.
High pe
rcentage (44.6
and
61.4) of fa
milies practiced open
def
ecati
on a
nd
ope
n di
sposal of s
o
lid waste,
whi
c
h we
re t
h
e
m
o
st
co
m
m
o
n
u
nde
si
rabl
e
envi
ro
nm
ent
a
l
hy
gi
ene
pract
i
ces fol
l
o
wed
.
Sim
i
l
a
r obser
v
a
t
i
ons
were m
a
de by
sur
v
ey
o
r
s i
n
a
st
udy
c
o
n
d
u
ct
ed at
Dem
o
crat
i
c
R
e
pu
bl
i
c
of
t
h
e C
o
n
go
[2
7]
.The
pre
s
ent
s
t
udy
reveal
e
d
t
h
at
t
h
e m
o
t
h
ers w
h
o ha
d p
o
o
r PE
H sco
r
es ha
d t
h
e m
a
xim
u
m
num
ber o
f
chi
l
dre
n
su
ffe
ri
n
g
fr
om
diarrhoea.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mat
e
rn
al
K
n
o
w
l
e
dge
a
n
d
Pr
act
i
ces T
o
w
a
r
d
s S
ani
t
a
t
i
o
n
a
n
d
T
h
ei
r Rel
a
t
i
o
nshi
ps
...
. (
S
hri
y
a A
.
Seksa
r
i
a
)
21
1
En
vi
ro
nm
ent
a
l
hy
gi
ene as a
d
e
t
e
rm
i
n
at
e of d
i
arrh
oeal
di
sea
s
es has bee
n
p
o
i
n
t
e
d
o
u
t
i
n
m
a
ny
st
udi
es
[2
8]
-[
3
2
]
.
M
a
un
g
[3
3]
a
nd
Fre
j
i
[
34]
i
n
t
h
ei
r st
udi
es
po
in
ted ou
t th
at b
e
tter fam
ily
in
co
m
e
s is lik
ely to
tran
slate in
to
i
m
p
r
o
v
e
m
e
n
t
s in
hou
sing
with
m
o
re h
y
g
i
en
ic to
ilets, fewer
flies in
th
e
h
o
u
s
e an
d
i
n
g
e
sti
o
n
of
b
e
tter
wean
i
n
g fo
od
s. Accord
ing
to
WHO
[35
]
m
a
j
o
rity o
f
diarrhoeal c
a
ses are
attributed t
o
unsafe
wate
r,
i
n
ade
quat
e
sa
n
i
t
a
t
i
on and
hy
g
i
ene. I
n
the
present study also environm
enta
l hygiene
pra
c
tices of the mothe
r
s
were
found to
be ass
o
ciated
with the
occ
u
rrence
of diarrhoea in the
c
h
ildren.
In t
h
e
pre
s
ent
st
udy
ha
n
d
wa
s
h
i
n
g p
r
act
i
ces of t
h
e
m
o
th
ers was fo
und
to
b
e
con
s
id
erab
ly g
o
o
d
.
All
m
o
thers were
washi
ng
hands with s
o
ap
after self
and child defecat
ion which is
a desirable
practice.
Ins
u
f
f
i
c
i
e
nt
ha
nd
was
h
i
n
g wa
s obse
r
ve
d be
fo
re co
oki
ng
and fe
edi
ng t
h
e chi
l
d
whi
c
h
can be a sou
r
ce o
f
cont
am
i
n
at
i
on.
In a sim
i
l
a
r study
i
n
I
ndi
a,
R
a
y
et al
[36]
poi
nt
ed o
u
t
t
h
a
t
m
o
t
h
ers were
washi
n
g ha
n
d
s
wi
t
h
so
ap
after
d
e
fecatio
n
bu
t no
t after activ
ities lik
e ch
ang
i
ng
b
a
b
i
es n
a
pp
ies,
b
e
fo
re p
r
ep
arin
g
food
,
imme
d
i
ately
aft
e
r
han
d
l
i
n
g
raw
ve
get
a
bl
es
an
d aft
e
r ha
n
d
l
i
n
g
pet
s
a
n
d
d
o
m
e
sti
c
ani
m
al
s. W
i
l
s
on
et
al
[3
7]
re
po
rt
ed a
red
u
ct
i
o
n i
n
di
arr
h
oea i
n
ci
dence
o
f
8
9
%
t
h
r
o
ug
h
t
h
e p
r
om
ot
i
on
of
ha
n
d
was
h
i
ng i
n
fo
u
r
d
i
ffere
nt
circum
stances, includi
ng a
f
ter defaecation,
in an Indonesia
n
village. St
udies in Nicaragua and Sal
v
ador have
shown that dia
r
rhoeal epis
odes increas
e
d
w
i
t
h
po
or h
a
n
d
washi
n
g pract
i
ces [3
8]
,[
39]
.
The st
u
d
y
al
so
sho
w
ed
statistical association of pers
onal hy
giene practices (attr
ibu
t
ed
to
h
a
nd
wash
ing
practices) o
f
th
e m
o
th
ers wit
h
occurre
nce
of diarrhoeal diseases
in childre
n. He
nce
a
n
i
n
crease i
n
the
use of s
o
a
p
for
hanwas
hing ca
n
hel
p
b
r
i
n
g dow
n th
e d
i
arr
h
o
eal ep
i
s
o
d
es in ch
ildren
.
Diarrhoeal
dis
eases
we
re not associated with
a
g
e
an
d s
e
x
o
f
th
e
ch
ild
,
mo
th
er
s
an
d f
a
the
r
s
ed
u
c
a
t
ion
q
u
a
lification
,
weigh
t
fo
r ag
e o
f
th
e ch
ild,
kn
owledg
e
on
E
H
,
FH, PH a
n
d pra
c
tices on FH. T
h
ese
are
s
i
m
i
lar
to
th
e find
ing
o
f
p
r
ev
iou
s
stud
ies wh
ich
showed
m
a
te
rnal characte
r
istics suc
h
as educat
ion,
occupation and
age
had no e
ffe
ct on dia
r
r
h
o
eal in
cid
e
nce [40],[
41
].
Th
is stud
y
h
a
s certain
lim
i
t
a
tio
n
s
.
Firstly th
e
h
y
g
i
en
e practices were
grad
ed
o
n
th
e
b
a
sis
o
f
sel
f
rep
o
rt
e
d
beh
a
v
i
ou
rs
of
t
h
e m
o
t
h
e
r
s a
n
d
he
n
ce are s
u
bj
ect to
inacc
uracy. There
f
ore
fu
rt
h
e
r inv
e
stig
atio
n is
req
u
i
r
e
d
w
h
i
c
h s
h
o
u
l
d
use
ho
use
h
ol
d
obs
ervat
i
o
ns.
Ot
h
e
r resea
r
c
h
ers
have
p
o
i
n
t
e
d
out
t
h
at
va
ri
et
y
of
m
e
thods are currently utilized to
capt
u
re s
a
nitation and
hygiene
be
ha
viours. Intervie
w and questionnai
r
e
app
r
oaches
, w
h
i
l
e
easi
l
y
m
odi
fi
ed t
o
rep
r
ese
n
t
t
h
e c
o
m
m
uni
t
y
unde
r st
u
d
y
,
m
a
y
not
be
as
easi
l
y
st
andar
d
i
zed
as ot
he
r a
v
ai
l
a
bl
e m
e
t
hods a
nd t
y
pi
cal
l
y
re
sul
t
i
n
o
v
e
r
-
r
e
p
o
r
t
i
n
g o
f
‘
g
o
o
d
’
beha
vi
o
u
r
s
, t
h
u
s
, re
d
u
ci
n
g
t
h
ei
r
v
a
lid
ity [42
]
-[4
5
]
.
Second
ly maj
o
rity of th
e sub
j
ects in
t
h
e study
reside
d in areas
whe
r
e the
r
e
was
neither
a
pr
o
v
i
s
i
on
of
p
ubl
i
c
t
o
i
l
e
t
s
no
r pr
o
p
er
di
sp
os
al
of sol
i
d
wa
st
e. Hence
ope
n
defecat
i
o
n an
d
sol
i
d
wast
e di
s
pos
al
was
hi
g
h
l
y
p
r
a
c
t
i
ced w
h
i
c
h
c
ont
ri
b
u
t
e
d t
o
l
o
w
en
vi
r
o
nm
ent
a
l
hy
gi
e
n
e
pr
act
i
ce scores
.
5.
CO
NCL
USI
O
N
To
co
n
c
l
u
d
e
t
h
e r
e
su
lts of
th
e stud
y suggest th
at i
m
p
r
ov
em
en
t in
th
e en
v
i
r
o
n
m
en
tal
an
d
p
e
r
s
on
al
hygiene
practi
ces of the m
o
thers ca
n contribute larg
ely in
r
e
du
cing
the p
r
ev
alence of diarrhoea
a
m
ong
ch
ild
ren
.
Ap
art fro
m
th
at i
m
p
r
o
v
e
m
e
n
t
in
th
e civ
i
c
facilities l
i
k
e
pro
v
i
si
o
n
fo
r t
o
ilets an
d
d
i
spo
s
al
o
f
h
o
u
s
eho
l
d
waste will au
to
m
a
tically
co
n
t
ribu
te to
i
m
p
r
ov
emen
t in
en
v
i
ron
m
en
tal h
y
g
i
en
e practices. Hen
c
e
at
t
e
nt
i
on of
t
h
e
co
ncer
ne
d nee
d
s
t
o
be dra
w
n
i
n
t
h
i
s
part
i
c
ul
ar
area
.
REFERE
NC
ES
[1]
.
Liu L, Johnson HL, Cousens S,
Perin J,
Scott S, Lawn JE, Rud
a
n
I, Campbell H, Cibulskis
R,
Li M, Mathers C,
Black RE, “Child Health
Epidemiolo
g
y
Ref
e
rence Group of
WHO and UNI
CE
F.
Global, r
e
gional, and national
causes of child
mortality
:
an up
dated s
y
s
t
emat
ic analy
s
is for 2010 with
time tren
ds since 2000”,
L
ancet
, vol/issue:
379(9832), pp
. 2
151-61, 2012
.
[2]
.
Wa
lke
r
CLF,
P
e
rin J,
Ary
e
e
MJ,
Pinto CB and Black RE,
“Diarrhea in
cid
e
nce
in low- and middle-inco
me
countries in
199
0 and 2010
:
a s
y
stematic rev
i
ew”,
BMC
Pub
lic
H
e
alth
, vol. 12
, pp
. 220
, 2012
.
[3]
.
P
A
TH, “
A
catal
ys
t for g
l
obal
h
eal
th”,
Diarrho
e
al dis
e
as
e: S
o
lu
t
i
ons
to def
eat
th
e globa
l kil
l
er
,
W
a
s
h
ington DC,
2009.
[4]
.
WHO 2008, “Safe Water, bett
er
health”, Genev
a
, 2008.
[5]
.
Bartram J, Cairncross S., “Hy
g
iene, Sanitation,
and Water”,
Forgotten Foundations of Health
, vol/issue: 7(11),
2010. e1000367
. PLoS Medicine.
[6]
.
Karambu S; Ma
tiru V; Kiptoo M; Oundo J
., “Characterization
and factors asso
ciated with dia
rrhoeal diseases
caused b
y
enter
i
c bacterial
pathogens among childr
e
n ag
ed
five
y
e
ars and b
e
low at
tending
Igembe
District
Hospital”
,
K
e
nya.Pan
African
M
e
dica
l Journal,
v
o
l. 16
, pp
. 37
, 20
13. doi:10.11604
/pamj.2013.16
.3
7.2947.
[7]
.
Curtis V; Cairnc
ross S;
Yonil R.,
“
R
eview: Dom
e
stic
h
y
g
i
en
e and
diarrhoea – pinp
ointing th
e problem”,
Trop Me
d
Internat Hea
lth
,
vol/issue:
5(1), p
p
22–32, 2000.
[8]
.
Elain
e
L and
Al
lis
on E
., “
H
ygie
ne an
d
Heal
th:
An epidem
iolog
i
c link
?
”
,
Am J I
n
fect Control
, v
o
l. 29
, pp
. 232-8
,
2001.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
2
06
–
21
2
21
2
[9]
.
Em
ina JBO, Kandala N-B., “
A
ccount
ing for r
ecen
t trends
in
the prev
alen
ce
of diarrhoe
a in
the Dem
o
crat
i
c
Republic of Con
go (DRC): results from consecutive cross-section
a
l survey
s”,
BM
J Open
, vo
l. 2
,
2012. e001930
.
doi:10.1136
/bmjopen-2012- 001
930.
[10]
.
Agustina R, Sari TP, Satroamid
j
oj
o S, Oudenhoven IMJb., Feskens EJM
and
Kok FJ., “Association of food-
h
y
giene practices and diarrhea
pr
evalence amo
ng Indonesian
y
oung
child
ren
from low socio
economic urb
a
n
areas
”
,
BMC Pu
blic
Health
, vo
l.
13, pp
. 977
, 201
3.
[11]
.
http://www.who.int/water_sanitat
ion_health/monitoring/om
s_brochure_core_qu
estionsfinal24608
.p
df
[12]
.
http://pdf.usaid.gov/pdf_docs/PNADF300.pdf
[13]
.
http://www.
unicef.
org/oPt/
FINAL_WASH_REP
O
RT.
pdf.
[14]
.
http://navsar
i
dp.gujarat.gov
.in/n
a
vs
ari/eng
lish/ch
i
k
li-ta
luka
.htm
.
[15]
.
http://navsar
i
dp.gujarat.gov
.in/n
a
vsari/taluka/chik
h
ali/index
.
htm.
[16]
.
http://www.
onefiveni
ne.
c
om/india/villag
/N
avsari/Chikhali.
[17]
.
Aggarwal OP,
Bhasin SK, Sharma AK, Chhab
r
a P, Agga
rw
a
K, Rajour
a OP., “A New Instrument (Scale) for
Measuring th
e S
o
cioeconom
ic Status of
a Family
:
Preliminar
y
S
t
u
d
y
”,
Ind
J Com
m
Med
, vol/issue: 30(4), 2005.
[18]
.
www.zpjalgaon
.
gov.in/pdf
/VillagePanch
ay
at/TSC/baselin
esurvey.pdf
.
[19]
.
http://www.measuredhs.com/pubs
/pdf/FRIND3/FRIND3-VOL2.pdf
[20]
.
http://www.argh
y
a
m.org
/
sites/
d
e
fault/files/Ashwas%20Proce
ss%20Handbook%20-%20pdf%20version.pdf
[21]
.
http://sangamind
ia.org
/uploads/MGRSurvey
.pdf
[22]
.
http://www.who.int/water_sanitat
ion_health/monitoring/om
s_brochure_core_qu
estionsfinal24608
.p
df
[23]
.
http://pdf.usaid.gov/pdf_docs/PNADF300.pdf
[24]
.
http://www.
unicef.
org/oPt/
FINAL_WASH_REP
O
RT.
pdf.
[25]
.
Nielsen M, Hoogvorst A, Konradsen F,
Mudasser M, van
der Ho
ek W., “Cause
s
of childhood
diarrhea
as perceiv
e
d
b
y
m
o
thers
in
t
h
e P
unjab,
P
a
ki
s
t
an”,
Sou
theast Asian J Trop
Med Public Health
,
vol/issue: 3
4
(2), pp. 343
-51
,
2003.
[26]
.
Takan
a
shi K, Ch
onan Y, Qu
y
e
n
D T, Khan
NC ,
Poudel KC
,
and
Jimba M., “Survey
of
Food-h
y
giene Practices
at
Home and Child
hood
Diarrhoea
in Hanoi, Viet N
a
m
”,
J Health
Popul Nutr
, vol/issue: 27(5), pp
. 6
02-611, 2009
.
[27]
.
MDF
Afrique Centrale, “Baseline Su
rvey
Water, Sanitation
and Hy
g
i
en
e”, N
y
ir
agongo Terr
itor
y
,
North Kivu
Province Democratic Repub
lic of
the Congo (DR
C
), Octob
e
r 200
8.
[28]
.
Strina A, C
a
irn
c
ross S, Barreto
ML
, Larrea C, Prado MS., “Childhood Diarrh
ea
and Observed H
y
giene B
e
hav
i
or
in Salv
ador”
,
Br
azil
Am J Epide
m
iol
, vo
l. 157, p
p
. 1032–1038
, 2
003.
[29]
.
Shamebo, D., Sandstrom, A. M
uhe, L., “The Bu
tajir
a project in
Ethiopia:
A nested case-ref
e
ren
t
stud
y
of und
erfiv
e
m
o
rtalit
y
and
its
public
hea
lth
det
e
rm
inants”,
Bu
ll.
WHO
, vol. 71
, p
p
. 389-396
, 199
3.
[30]
.
Kolsk
y
PJ., “Water, san
i
tation
an
d
diarrhoea:
limits of understanding”,
Trans. Roy. Soc. Trop. Med
.
Hyg.
, vo
l. 87
,
pp 43-46, 1993.
[31]
.
D.L. Dani
els
D.
L., Cous
ens
S
N
, M
a
koae
LN, F
each
em
RG., “
A
cas
e-contro
l s
t
ud
y
of
the im
p
act of im
proved
sanitation on
diarrhoea morbid
ity in
Lesotho
”
,
Bu
ll WHO
, vol/issue: 66(4)
, pp
. 455
-463, 1990
.
[32]
.
UNICEF, “Palestinian
H
y
drolog
y
Group
. Water,
Sanita
tion
and H
y
giene Household Survey
Gaza”, April 2010
.
[33]
.
Maung KU,
Kh
in M, Wai NN,
Hman NW, My
int TT, Butler
T., “Risk factors for the de
velopm
ent of persistent
diarrhoea and
malnutritio
n
in Bu
rm
es
e childr
e
n”
,
Int J
Ep
id
, vol/issue: 21(5), pp.
1021-1021, 199
2.
[34]
.
Freij, L
., and W
a
lls, S., “
E
xplor
i
ng Child Health
a
nd its ecolog
y
”, The Kirkos stud
y
in Addis Abatia.
Ac
ta Paed
.
Scand.
, vol/issue: 267(1), pp. 1-1
20, 1997
.
[35]
.
WHO,
“Combating waterborne
disease at
th
e h
ousehold level,
The Intern
at
ional Network to Promote Household
Water
Treatment and Saf
e
Stor
ag
e”, WHO Document
Production
Services, Gen
e
v
a
, Switzer
land
2
007.
[36]
.
Ra
y SK; Zam
a
n
FA and Laskar
NB., “
H
andwashing prac
ti
ces
in
two com
m
unities in two sta
t
es
of Eastern
India
”
,
An Interven
tion
Stud
y
,
Ind J Pub
.
Health
, vol/issue: 54(3)
, 2010
.
[37]
.
Wilson JM, Chandler GN, Mu
slihatun
, Jamilu
ddin, “Ha
nd washing reduces diarrhoea ep
isodes: a stud
y
in
Lombok, Indonesia”,
Ro
y. Soc. T
r
op. Med
.
Hyg
,
vol. 85
, pp
. 819–
821, 1991
.
[38]
.
Gorte
r
AC,
Sa
ndiford P,
Pa
uw J,
Mora
le
s P,
Pe
re
z
RM,
Alb
e
r
t
s H., “H
y
g
iene behavior
in rur
a
l Nic
a
ra
cgua i
n
rela
tion to
d
i
arrh
ea”
,
In
t J
Ep
i
, vo
l. 27
, pp
. 1090-1
100, 1998
.
[39]
.
Strina A, Cairn
c
ross S, Barr
eto
ML,
Larr
ea C
,
and
Prado
MS., “Childhood
d
i
arrhoea
and ob
served h
y
giene
behaviour
in
Salvador, Br
azil”,
A J
E
p
i,
vol/issue: 157(11), 2003.
[40]
.
Marouz YY,
Aziz KMS,
Khalil M.
,
“A
ssociatio
n of paren
t
s edu
cation and f
a
thers occupation with prevalen
ce of
diarrhoea among children less than five
y
ears of age in Saudi Arabia”,
J. diarrhoeal Dis. Res,
vol.
9, pp. 301-304,
1991.
[41]
.
Mo
y
JP, Booth IW, Choto R, McNeish AS., “Risk factor
s for high diarrh
oeal fr
equency
:
a stud
y
in rur
a
l
Zim
b
abwe”,
Trans. Roy. So
c. Trop. Med
.
H
y
g.
, v
o
l. 85
, pp
. 814-8
18, 1991
.
[42]
.
Curtis V, Cousens S, Mertens
T et
al., “Structur
e
d obser
vations
of h
y
g
i
en
e beh
a
viours in Burkin
a Faso: v
a
lid
ity
,
va
ri
a
b
i
l
ity
, a
nd ut
i
l
ity
”,
Bu
ll
WHO
, vol. 71
, pp
. 2
3–32, 1993
.
[43]
.
Manun’ebo MN, Cousens S, Haggerty
PA
et
al., “Measuring h
ygiene pr
actic
es:
a comparison of
questionnaires
with dir
ect
obser
vations
in rur
a
l
Zair
e”
,
Trop Med Int Hea
lth
, vol. 2
,
pp
. 1015–21
, 1997.
[44]
.
Odujinrin OM,
Akito
y
e
CO, Od
ugbemi T, O
y
erinde JP,
Esumeh
FI., “Ethnogr
aph
i
c stud
y
on
child
hood diarrho
eal
dis
eas
es
in
a
rur
a
l Nig
e
rian
com
m
unit
y
”
,
We
st
Afr J
Me
d
, vol. 12
, pp
. 185–88
, 19
93.
[45]
.
Stanton BF, Clemens JD, Aziz KMA,
Rahman M., “Twen
t
y
-four hour
re
call, knowledg
e-
attitude-pr
actice
questionnaires, and direct observ
a
tions of h
y
gien
e behav
i
or
s in B
u
rkina Faso: validity
,
v
a
riab
ility
,
and utility
”
,
Bu
ll
WHO
, vol. 65, p
p
. 217–22
, 1987
.
Evaluation Warning : The document was created with Spire.PDF for Python.