Community-Based Trial and Ethnographic Techniques for the Development of Hygiene Intervention in Rural Bangladesh

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Abstract
Community-based three-stage iterative trials were performed to develop interventions for improving hygiene practices to reduce childhood diarrhea in rural Bangladesh. Ethnographic techniques were used to identify practices associated with diarrhea, to understand cultural beliefs and reasoning related to causes of diarrhea, and to tap community resources. Hygiene behaviors and products designed through in-home problem diagnosis went through trials sequentially at three socio-economic levels consisting of ten educated project workers, twenty-five volunteer mothers and twenty-five very low- income mothers. These levels, chosen in order to meet the needs of all including the poorest, permitted new practices which proved feasible in the workers' trial to be then tried by the volunteers. The results were synthesized, with successful behavioral advice translated into simple verbal messages created to resemble locally popular proverbs, poems and folk songs. The messages and products were finalized after pretesting and revision among the very low-income group of mothers. Evaluation of the community-wide campaign showed very high rates of adoption (85%–95%) of the interventions. The involvement of target groups and their opinion leaders in the intervention development process contributed to the sense of ownership reflected in the high rate of adoption. Program organizers' comprehensive understanding of practices associated with diarrhea and its cultural context, and the community's empowerment to find local solutions are both critical to the success of such interventions.