Assessment of the effects of teaching germ theory on changes in hygiene behaviors, cleanliness, and diarrheal incidence in rural bangladesh.

Germ theory was taught as part of a hygiene intervention in five villages in Bangladesh in which 87 percent of mothers were illiterate. Volunteer mothers taught other community mothers interactively in small groups using demonstration and teaching aids developed by a community working group. At final measurement 91 percent of mothers could explain five simple messages defining germ theory. Using germ theory in groups they identified forty high risk day-to-day practices and modified them to reduce diarrheal transmission. They adopted these new hygiene practices at rates ranging from 65 percent to 100 percent. Regression analysis suggests that understanding of germ theory was an important determinant of hygiene practices, cleanliness, and reduction in diarrheal incidence. Understanding of germ theory appeared to reduce diarrheal incidence not only through the interventions designed by the project but also changing perceptions of risk in the environment which led to spontaneous improvement in hygiene behaviors. We believe that accurate understanding of causes, transmission, and prevention of disease can 1) empower community and individual actions; and 2) contribute significantly to the impact of hygiene interventions. Therefore, it may be imperative to integrate teaching germ theory into community health education.