title: Direct observation of hygiene in a Peruvian shantytown: not enough handwashing and too little water.
abstract: 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.
authors.affiliation: Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. william.oswald@emory.edu
authors.forename: William E
authors.initials: WE
authors.lastname: Oswald
authors.forename: Gabrielle C
authors.initials: GC
authors.lastname: Hunter
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: Elli
authors.initials: E
authors.lastname: Leontsini
authors.forename: William K
authors.initials: WK
authors.lastname: Pan
authors.forename: Valerie Paz
authors.initials: VP
authors.lastname: Soldan
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
mesh_terms: 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*
chemical_list: D012915:Soaps