Direct observation of hygiene in a Peruvian shantytown: not enough handwashing and too little water.
OBJECTIVE
To document frequency of hygiene practices of mothers and children in a shantytown in Lima, Peru.


METHODS
Continuous monitoring over three 12-h sessions in households without in-house water connections to measure: (i) water and soap use of 32 mothers; (ii) frequency of interrupting faecal-hand contamination by washing; and (iii) the time until faecal-hand contamination became a possible transmission event.


RESULTS
During 1008 h of observation, 55% (65/119) of mothers' and 69% (37/54) of children's faecal-hand contamination events were not followed within 15 min by handwashing or bathing. Nearly 40% (67/173) of faecal-hand contamination events became possible faecal-oral transmission events. There was no difference in the time-until-transmission between mothers and children (P = 0.43). Potential transmission of faecal material to food or mouth occurred in 64% of cases within 1 h of hand contamination. Mean water usage (6.5 l) was low compared to international disaster relief standards.


CONCLUSIONS
We observed low volumes of water usage, inadequate handwashing, and frequent opportunities for faecal contamination and possible transmission in this water-scarce community.
Oswald
William E
WE
Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. william.oswald@emory.edu
Hunter
Gabrielle C
GC
Lescano
Andres G
AG
Cabrera
Lilia
L
Leontsini
Elli
E
Pan
William K
WK
Soldan
Valerie Paz
VP
Gilman
Robert H
RH
D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000382:microbiology / Q000517:prevention & control*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006235:Hand Disinfection / Q000592:standards*; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D019370:Observation; D010568:Peru; D011204:Poverty Areas; D012915:Soaps; D014871:Water Microbiology; D014881:Water Supply / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*
D012915:Soaps