'iati«©«n of indicators of hygiene behavior with persistent diarrhea of young children

We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration > 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty-four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti-hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicalors were also strongly correlated with each other. In individual logistic regression models, which included overall rale of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicalors maintained signilicanl associalion with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, ihc hands of the mother being dirty, presence of a locally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicalors, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose-response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea. D Child diarrhea, persistent diarrhea, hygiene