Impact of the Integration of Water Treatment and Handwashing Incentives with Antenatal Services on Hygiene Practices of Pregnant Women in Malawi

Anandi N. Sheth Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Elizabeth T. Russo Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Manoj Menon Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Kathleen Wannemuehler Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Merri Weinger Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Amose C. Kudzala Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Blessius Tauzie Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Humphreys D. Masuku Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Tapona E. Msowoya Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Robert Quick Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea. We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers, sodium hypochlorite water treatment solution, soap, and educational messages. Program participants were more likely to know correct water treatment procedures (62% versus 27%, P < 0.0001), chlorinate drinking water (61% versus 1%, P < 0.0001), demonstrate correct handwashing practices (68% versus 22%, P < 0.0001), and purchase water treatment solution after free distribution (32% versus 1%, P < 0.0001). Among participants, 72% had at least three antenatal visits, 76% delivered in a health facility, and 54% had a postnatal check. This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women. Participants had high use of antenatal, delivery, and postnatal services, which could improve maternal and child health.

Author Notes

*Address correspondence to Anandi N. Sheth, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-38, Atlanta, GA 30333. E-mail: asheth@cdc.gov

Authors' addresses: Anandi N. Sheth, Elizabeth T. Russo, Manoj Menon, Kathleen Wannemuehler, and Robert Quick, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: asheth@cdc.gov, erusso@cdc.gov, mmenon@cdc.gov, kpw9@cdc.gov, and rquick@cdc.gov. Merri Weinger, United States Agency for International Development, Washington, DC, E-mail: mweinger@usaid.gov. Amose C. Kudzala, Blessius Tauzie, and Tapona E. Msowoya, United Nationals Children's Fund, Lilongwe, Malawi, E-mails: akudzala@unicef.org, btauzie@unicef.org, and tmsowoya@unicef.org. Humphreys D. Masuku, Government of Malawi Ministry of Health, Lilongwe, Malawi, E-mail: dzanjom@yahoo.co.uk.

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