Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru.
OBJECTIVE
To estimate the association between improved water and sanitation access and handwashing of mothers living in a peri-urban community of Lima, Peru.


METHODS
We observed 27 mothers directly, before and after installation of private, piped water and sewerage connections in the street just outside their housing plots, and measured changes in the proportion of faecal-hand contamination and hand-to-mouth transmission events with handwashing.


RESULTS
After provision of water and sewerage connections, mothers were approximately two times more likely to be observed washing their hands within a minute of defecation, compared with when they relied on shared, external water sources and non-piped excreta disposal (RR = 2.14, 95% CI = 0.99-4.62). With piped water and sewerage available at housing plots, handwashing with or without soap occurred within a minute after 48% (10/21) of defecation events and within 15 min prior to 8% (11/136) of handling food events.


CONCLUSIONS
Handwashing increased following installation of private, piped water and sewerage connections, but its practice remained infrequent, particularly before food-related events. Infrastructural interventions should be coupled with efforts to promote hygiene and ensure access to water and soap at multiple on-plot locations convenient to mothers.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
William E
WE
Oswald
Gabrielle C
GC
Hunter
Michael R
MR
Kramer
Elli
E
Leontsini
Lilia
L
Cabrera
Andres G
AG
Lescano
Robert H
RH
Gilman
D000328:Adult; D005260:Female; D005506:Food Contamination / Q000517:prevention & control*; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D019370:Observation; D010568:Peru; D011204:Poverty Areas; D012044:Regression Analysis; D012499:Sanitation / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D014504:Urban Health; D014881:Water Supply / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
Peru; handwashing; hygiene; sanitation; water supply