title: Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan: a cross-sectional study.
abstract: Sustained civil and military conflict, resulting in large numbers of internally displaced persons (IDP), in combination with rapid urbanization has strained public health and sanitation within cities in Afghanistan. In order to examine the association between preventive sanitary behaviors and diarrhea within two high risk settings located within Kabul, Afghanistan, this study aimed to evaluate the prevalence of hygienic practices and diarrheal illness in an IDP camp and an urban slum.
  
  
  
  In this cross sectional study, a convenience sample of residents of an IDP camp and an urban slum in Kabul, Afghanistan, was used. Participants were asked to describe their hygienic practices and interviewers independently documented household sanitation. The knowledge and attitudes about and practice of hygienic activities to prevent diarrhea were compared between the two settings.
  
  
  
  Two hundred participants, 100 from each setting, were enrolled. Knowledge, attitudes, and practices regarding hygienic activities to prevent diarrhea were greater among the slum dwellers than the IDP. Fewer than half of participants washed their hands with soap before eating or after eating: 31 % of slum dwellers washed before eating compared to 11 % of IDPs (P = 0.0050), and 25 % of slum dwellers washed after defecating compared to 4 % of IDPs (P = 0.0020). The IDPs were more likely to share a latrine (P = 0.0144) and less likely to disinfect their latrine than slum dwellers. Diarrhea in the household within the past 3 months was more common in the IDP camp (54 %) than the slum (20 %) (P = 0.0020).
  
  
  
  Even though certain sanitary and hygienic practices were more common among slum dwellers than IDPs, the lack of hygienic activities in both setting indicates that interventions to change behavior, like increasing the availability of soap and encouraging hand washing, are needed. Any initiative will have to be developed in the context of pervasive illiteracy among persons in both of these settings.
authors: Department of Microbiology, Kabul Medical University, Jamal Mina, 3rd District, University Road, Kabul, Afghanistan.
authors: Mohammad Yousuf
authors: MY
authors: Mubarak
authors: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA. awag@umich.edu.
authors: Abram L
authors: AL
authors: Wagner
authors: Area on Water Management, Department of Environmental Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
authors: Mari
authors: M
authors: Asami
authors: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
authors: Bradley F
authors: BF
authors: Carlson
authors: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
authors: Matthew L
authors: ML
authors: Boulton
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D002947:Cities; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control; D005191:Family Characteristics; D005260:Female; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D015995:Prevalence; D012307:Risk Factors; D012499:Sanitation; D055815:Young Adult
keywords: Diarrheal diseases; Drinking water; Hand washing; Hygiene; Sanitation