A critique of approaches to measuring effective hand washing in Mpumalanga, South Africa

Diarrhoeal disease was ranked fifth on the list of causes of premature mortality in South Africa in 2000. High standards of hygiene and access to safe water and sanitation services can be related to a reduced risk of diarrhea. Based on the understanding and interpretation of good sanitation, hygiene and related practices in South Africa, all sanitation programmes and interventions in the country focus to some degree on hand washing practices and behaviours. Health and hygiene interventions are implemented from the knowledge that hand washing can act as a barrier to several of the transmission routes of diarrhoeal pathogens. As a result, many sanitation interventions in South Africa begin with a baseline assessment which includes a review of present sanitation, hygiene and related practices. This paper focuses specifically on the measurement of one aspect of health and hygiene awareness in South Africa, namely hand washing behaviours. The paper is a critique of methods used in assessing these household behaviours in two villages in the Mpumalanga Province of South Africa.