Mary Ann Wright Title: Water treatment and hand washing behaviors among non-pregnant friends and relatives

of participants in an antenatal hygiene promotion program in Malawi. Diarrhea is a leading cause of death in children less than five years of age in the world. In Malawi 24% of children less than five had an episode of diarrhea in the preceding two weeks. In 68 countries where 97% of maternal and child deaths occur, 88% of women reported at least one antenatal visit which could be a very productive intervention to improve overall health. The attempt to teach these people about safe drinking practices and proper hand washing techniques decreased the diarrheal illness in the developing world. Research will show that when you tell one person a whole household will learn. Reason for the research: Was to teach the people of Blantyre District and the Salima District in Malawi how to properly treat their water and to properly wash their hands to prevent diarrheal illness that results in death. It is interesting to note how many people actually did what they were taught and it literally teaches generations proper hygiene techniques. The Centers for Disease control and Prevention Institutional Review Board collaborated fully in the implementation and evaluation of this program as public health practice. Oral consent was obtained from all survey participants and personal identifiers were permanently removed from the database. Methods & Materials: 275 women that participated in the Antenatal Clinic Program were asked at enrollment to identify friends or relatives who were not currently pregnant and were mothers of children less than five years of age. A cross-sectional survey and preformed a follow-up survey of the same women nine months later. They collected data in May 2007 to collect data on demographic and socioeconomic characteristics, water sources, water storage, treatment, and hygiene practices. During

the home visit they observed water storage, treatment, hygiene practices, presence of soap, and demonstration of hand washing procedure. During the Antenatal care, free hygiene kits, water storage containers, water treatment solution, and soap were available to all participants. Data from baseline and follow-up surveys were entered into an Access 2003 database and analyzed by using SAS software version 9.2 and SUDAAN version 10.0.l. Results: 230 friends and relatives from the Blantyre District and Salilma District were enrolled in the program. 45 were disqualified because of poor data quality (12%) which included moved away (65%) refused to participate (3%), died (1%). The average age of the participants were 16-42 years of age and children were from 1-4 years of age. Other demographic and socioeconomic characteristics were urban residence, completion of primary school, and the ability to read. At baseline, 89% of all participants reported using an improved drinking water source. 98% reported storing their drinking water, and by observation, 89% used a lid on their container. From the baseline to follow-up, the proportion of participants who reported having treated their drinking water increased from 62% to 92%. The most commonly reported treatment methods were boiling the water. 68% had soap in their homes at baseline and at follow-up 76% had soap in their homes. When friends and relatives were asked to demonstrate proper hand washing technique 18% lathered their hands completely with soap at baseline compared with 60% at follow-up. The factors associated with improved water treatment and hand hygiene practices were upper wealth, whether or not they completed primary school, and if they were literate. The baseline was 1.66 and the follow-up was 2.85 for safe water use. For correct hand washing demonstration at baseline it was 0.70 and at follow-up it was 2.08.

Discussion The results of the evaluation would suggest that the water treatment and hand washing behaviors reached friends and relatives who were not part of the program. Word of mouth really helped others as well. Social networks are known to have an influence on ones behavior. So if they saw family or friends using proper water techniques and proper hand washing techniques they also wanted to part of it. Therefore, intervention techniques has had a dramatic impact of their cities. Conclusion The Antenatal Hygiene Promotion Program in Malawi is really spreading the word about safe and proper techniques in water and hand washing. I think it is a wonderful program so that people will realize that that germs and bacteria are causing their diarrheal illnesses.