Identifying the most important hygiene behaviours
There are many transmission routes for cholera, all of which are influenced by different hygiene behaviours. A hygiene education programme, however, cannot concentrate on all behaviours immediately. It is important to rank behaviours in terms of their potential impact, and to target those hygiene behaviours which, if altered, will have the greatest effect in reducing the transmission of infectious diarrhoeal disease. In order to identify these behaviours, the community's current practices, the disease pattern and environment must first be studied.
In order to identify priorities, the following questions will need to be asked, among others:
• What is the evidence that the behaviour represents a problem in the community?
• Which behaviour changes will have the greatest impact on improving health?
• What are the specific behavioural requirements of the water supply or sanitation facilities that are being promoted in the community?
• Which hygiene behaviours will be the easiest to change?
• What do the community consider to be their needs and priorities?
Based on an understanding of the community, it should be possible to identify the hygiene behaviours to be tackled. The community should have a say in deciding which behaviours should take priority. Hygiene practices which the community already sees a need for and which do not conflict with any traditions should be the focus for initial efforts. Hygiene practices which the community do not see as important or which conflict with their culture and traditions will require more effort to change.
Behaviours which together prevent the transmission of cholera
• All children, women and men in the community should use safe water sources for drinking, washing of clothes and bathing.
• Water should be efficiently used and not wasted. Wastewater should be properly disposed of.
• Improved water sources should be used with care and maintained in a good condition. There should be no risk of contamination of water sources from nearby latrines, wastewater drainage, animals or chemicals.
• If necessary, simple treatment procedures should be carried out. This will often mean the chlorination of drinking water supplies.
• If necessary, water should be filtered to remove any solid material before chlorination.
• Drinking water should be collected in clean vessels, without coming into contact with hands. Water should be transported in a covered container.
• Water should be stored in vessels which are covered and regularly cleaned.
• Drinking water should be stored in a separate container from other domestic water, wherever possible.
• Drinking water should be taken from the storage vessel with a dipper or ladle so that hands, cups or other objects cannot contaminate the water.
• Adequate amounts of water should be available and employed for personal and domestic hygiene. It is estimated that 30-40 litres per person per day are needed for personal and domestic hygiene.
• Hands should be washed with soap or ash before preparing or eating food.
• Vegetables and fruits should be washed with safe water, and food should be properly covered.
• Kitchen utensils should be washed with clean water as soon as possible after use and stored in a clean place.
• All members of the community should use sanitary excreta disposal facilities at home, work and school.
• All faeces, especially those of babies, young children and sick people, should be safely disposed of.
• Latrines should be regularly cleaned and maintained.
• Latrines, seepage pits or drainfields from aquaprivies and septic tanks, should all be sited so that the pit contents cannot wash into water sources or enter the groundwater.
• Handwashing facilities, including soap or ash, should be available, and hands should always be washed after defecation, after handling the faeces of babies, before feeding and eating, and before preparing food.
• Household wastewater should be disposed of or reused properly. Measures should be taken to ensure that wastewater is not left to create breeding places for mosquitoes and other disease transmission vectors or to contaminate water sources.