Water cost and availability: Key determinants of family hygiene in a Peruvian shantytown

Objectives. This study was conducted to determine whether poor hygiene practices are owing to difficulty in getting enough water and/or to ignorance of sanitary principles. Methods. In a water-scarce shantytown in Lima, Peru, we observed in 12-hour periods over 3 consecutive days the amount of water and soap used for personal and domestic activities in 53 families and the frequency with which direct fecal contamination of hands was interrupted by washing. We also surveyed women in a similar shantytown concerning their knowledge of hygiene to ascertain whether noncompliance was owing to ignorance. Results. Three hundred fecal contamination events were registered, of which only 38 (13%) were interrupted by hand washing within 15 minutes. The mean 12-hour per capita amount of water and soap used by the families was low. More than 80% of the water stored by these families had fecal coliforms. Yet the level of knowledge concerning the importance of hand washing and other hygienic practices was high. Conclusions. In water-scarce areas, sanitary education programs probably will not change hygiene practices. In these areas, an adequate supply of water is essential for good hygiene.