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Water Treatment and Handwashing Behaviors among Non-Pregnant Friends and Relatives of Participants in an Antenatal Hygiene Promotion Program in Malawi

Elizabeth T. RussoDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Anandi ShethDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Manoj MenonDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Kathleen WannemuehlerDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Merri WeingerDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Amose C. KudzalaDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Blessius TauzieDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Humphreys D. MasukuDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Tapona E. MsowoyaDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Robert QuickDivision of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Arlington, Virginia; United Nations Children’s Fund, New York, New York; Government of Malawi Ministry of Health, Blantyre, Malawi

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Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases. To integrate hygiene improvement with antenatal care, free hygiene kits (water storage containers, water treatment solution, soap) and educational messages were distributed to pregnant women at antenatal clinics in Malawi. We assessed water treatment and hygiene practices of 275 non-pregnant friends and relatives of the hygiene kit recipients at baseline and follow-up nine months later to measure program impact on non-participants in the same communities. At follow-up, friends and relatives who did not receive kits or education were more likely than at baseline to purchase and use water treatment solution (25% versus 1%; P < 0.0001) and demonstrate correct handwashing practices (60% versus 18%; P < 0.0001). This antenatal clinic–based program resulted in improved water treatment and hygiene behaviors among non-pregnant friends and relatives living in the same communities as hygiene kit recipients, suggesting that program benefits extended beyond direct beneficiaries.

Author Notes

*Address correspondence to Elizabeth T. Russo, c/o Robert Quick, Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop C09, Atlanta, GA 30333. E-mail:elizabeth.russo@gmail.com

Financial support: This study was supported by the United States Agency for International Development.

Authors’ addresses: Elizabeth T. Russo, Anandi Sheth, and Manoj Menon, Division of Foodborne, Waterborne, and Environmental Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: elizabeth.russo@gmail.com, asheth@cdc.gov, and mmenon@gmail.com. Kathleen Wannemuehler, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: kpw9@cdc.gov. Merri Weinger, United States Agency for International Development, Arlington, VA, E-mail: mweinger@usaid.gov. Amose C. Kudzala, Blessius Tauzie, and Tapona E. Msowoya, United Nations Children’s Fund, New York, NY, E-mails: akudzala@unicef.org, btauzie@unicef.org, and tmsowoya@unicef.org. Humphreys D. Masuku, Government of Malawi Ministry of Health, Blantyre, Malawi, E-mail: dzanjom@yahoo.co.uk. Robert Quick, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: rquick@cdc.gov.

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