Educational intervention to reduce disease related to sub-optimal basic hygiene in Rwanda: initial evaluation and feasibility study

Margaret A. Stone, Hormisdas Ndagijimana

Despite a global reduction in morbidity related to sub-optimal water, sanitation and hygiene, the incidence of such diseases remains a significant problem in sub-Saharan Africa. This study aimed to initially assess the potential effectiveness (primarily in terms of impact on morbidity) of a simple educational intervention delivered in Rwanda. Additionally, we sought to explore feasibility relating to the practicality of evaluating and implementing this type of intervention in a low- and middle-income country. Two districts in Northern Province were purposively selected; one was randomly allocated to receive the intervention, with the other acting as control. The intervention was based on an interactive DVD about basic hygiene. Baseline and follow-up data for incident cases of relevant morbidities were collected from health centre records. Changes were compared between the two districts using descriptive statistics and chi-squared tests. Qualitative data were obtained through observations, discussions and feedback and were analysed thematically. Cases of infection with intestinal worms and parasites were frequently recorded in both districts. For these morbidities, there was a 39% decrease in cases between baseline and follow-up in the intervention district (4995 reduced to 3069), compared to 13% (5002 reduced to 4356) in the control district (p < 0.001). Numbers of cases recorded as diarrhoea or dysentery, and changes between baseline and follow-up, were much lower (intervention district 1274 cases reduced to 1171; control district 1949 reduced to 1944). Qualitative data indicated a high level of acceptability for the intervention and also feasibility relating to the practicality of evaluation and implementation, whilst also highlighting problems encountered and possible solutions, in particular, the potential advantages of training local personnel to deliver this type of intervention. This small-scale study has a number of acknowledged limitations which would need to be addressed in a larger study in order to confidently confirm the effectiveness of the intervention. It nevertheless provides evidence suggesting that the educational intervention is promising in terms of a potential impact on health and feasible to deliver and evaluate. These findings indicate that further evaluation and possibly early implementation are warranted. Research Registry, researchregistry2180.