Adam Biran

Dirt, Disgust, and Disease: Is Hygiene in Our Genes?

Anthropologists have long puzzled over why certain objects and activities are avoided, reviled, or proscribed in many cultures. Numerous theories have been proposed, but as Reinhart (1990) suggests above, a full explanation remains elusive. Psychologists recently have begun to explore the nature of the revulsion that is occasioned by the sight of excreta, rotten food, slime, and bugs. They have described and categorized the emotion of disgust and have even proposed a location in the brain where disgust may be seated. However, the total body of research into disgust is so scant that it has been described as the “forgotten emotion of psychiatry” (Phillips et al. 1998). Our interest in disgust has its roots in a decade of work exploring hygiene behavior in Africa, India and Europe. The failures of the health education

Hygiene: new hopes, new horizons

Summary Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

Comparing the performance of indicators of hand-washing practices in rural Indian households

Objective  To compare the results obtained from 26 proxy indicators of domestic hand‐washing practices with those obtained from direct, ‘structured’ observation of hand‐washing in a sample of 387 households and to assess the potential of these indicators for use in the evaluation of hygiene promotion campaigns.

Hygiene in the home: relating bugs and behaviour

Much infectious intestinal disease (IID) arises in the home environment. If programmes to prevent infection are to be effective it is essential to both identify the particular practices that risk disease transmission, and to understand the reasons for these practices. An in-depth, multidisciplinary study of carer and child hygiene in the domestic environment in the Wirral, UK, employed structured observation, surface swabbing for polio vaccine virus and enteric marker organisms, semi-structured interviews, projective interviews and focus group discussions. Observations revealed that child carers washed hands with soap after changing a dirty nappy on 42% of occasions, and that one in five toilet users did not wash hands with soap afterwards. Microbiological samples were taken from household surfaces at sites thought likely to be involved in the transfer of faecal material. 15% of bathroom samples showed contamination with polio vaccine virus. Nappy changing took place mainly in living rooms. Contact with living room surfaces and objects during nappy changing was frequent and evidence of faecal contamination was found in 12% of living room samples. Evidence of faecal contamination was also found in kitchens, again on surfaces thought likely to be involved in the transmission of faeces (taps and soap dispensers). Key factors motivating hygiene were the desire to give a good impression to others, protection of the child and aesthetics. In this setting, the particular risk practices to be addressed included washing hands with soap after stool and nappy contact and preventing the transfer of pathogenic organisms to the kitchen. The occasion of the birth of a child may be a privileged moment for the promotion of safer home hygiene practices. Using polio vaccine virus as an indicator of faecal contamination produces results that could be used in large-scale studies of household disease transmission. A better understanding of the household transmission of the agents of IID using multidisciplinary methods is needed if effective hygiene promotion programmes are to be designed.

The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial

Objective  To investigate the effectiveness of a hygiene promotion intervention based on germ awareness in increasing handwashing with soap on key occasions (after faecal contact and before eating) in rural Indian households.

Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure

Background  To explore how structural constraints such as lack of reliable water supply, sanitation, educational and other socio‐economic factors limit the adoption of better hygiene.

Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India

Objectives  To explore and explain patterns of use of communal latrine facilities in urban poverty pockets.

Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya

Objective  To further the understanding of sanitation and hygiene in long‐term camp populations.

Implementing effective hygiene promotion: lessons from the process evaluation of an intervention to promote handwashing with soap in rural India

BackgroundAn intervention trial of the ‘SuperAmma’ village-level intervention to promote handwashing with soap (HWWS) in rural India demonstrated substantial increases in HWWS amongst the target population. We carried out a process evaluation to assess the implementation of the intervention and the evidence that it had changed the perceived benefits and social norms associated with HWWS. The evaluation also aimed to inform the design of a streamlined shorter intervention and estimate scale up costs.MethodsIntervention implementation was observed in 7 villages. Semi-structured interviews were conducted with the implementation team, village leaders and representatives of the target population. A questionnaire survey was administered in 174 households in intervention villages and 171 households in control villages to assess exposure to intervention activities, recall of intervention components and evidence that the intervention had produced changes in perceptions that were consistent with the intervention core messages. Costs were estimated for the intervention as delivered, as well as for a hypothetical scale-up to 1,000 villages.ResultsWe found that the intervention was largely acceptable to the target population, maintained high fidelity (after some starting problems), and resulted in a high level of exposure to most components. There was a high recall of most intervention activities. Subjects in the intervention villages were more likely than those in control villages to cite reasons for HWWS that were in line with intervention messaging and to believe that HWWS was a social norm. There were no major differences between socio-economic and caste groups in exposure to intervention activities. Reducing the intervention from 4 to 2 contact days, in a scale up scenario, cut the estimated implementation cost from

Use of Behavior Change Techniques in Clean Cooking Interventions: A Review of the Evidence and Scorecard of Effectiveness

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