Merri Weinger | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Access to safe drinking water and improved hygiene are important for reducing diarrhea morbidity and mortality. A clinic-based intervention to integrate the distribution of hygiene kits (including safe water storage containers, sodium hypochlorite water treatment solution, soap, ORS, and educational materials) at first antenatal visit, and refills of water treatment solution and soap at follow-up antenatal visits, delivery, and postnatal visits, was implemented in Malawi in 2007.  A program evaluation completed 9 months after implementation demonstrated significantly increased use of water treatment solution, improved handwashing technique, and increased use of antenatal, delivery and postnatal services.   An assessment of program sustainability was conducted 3 years after implementation.

Methodology: The sustainability study surveyed the same group of program participants in 2010, 3 years after program implementation was initiated, about hygiene habits and tested stored drinking water for residual chlorine as an objective confirmation of water treatment.  Survey results at follow-up were compared to baseline.

Results:  Of 389 participants enrolled at baseline, 198 participants were located and surveyed at 3-year follow up to assess current water treatment practices, test drinking water for residual chlorine, and observe handwashing technique. Compared to baseline, a significantly higher percentage of program participants at 3-year follow-up demonstrated knowledge of correct water treatment procedure (67% vs. 36%, p<0.0001), confirmed treatment of drinking water (24% vs. 2%, p<0.0001), reported purchase and confirmed use of water treatment product (21% vs. 1%, p<0.001), and correct handwashing technique (50% vs. 21%, p<0.001).

Conclusion:  This antenatal clinic-based program appeared to be an effective strategy for promoting sustained water treatment behavior and proper handwashing technique among pregnant women with the potential for impact on household hygiene behavior.