Direct observation of hygiene in a Peruvian shantytown: Not enough handwashing and too little water

William E. Oswald, Gabrielle C. Hunter, Andres G. Lescano, Lilia Cabrera, Elli Leontsini, William K. Pan, Valerie Paz Soldan, Robert H. Gilman

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective: To document frequency of hygiene practices of mothers and children in a shantytown in Lima, Peru. Methods: Continuous monitoring over three 12-h sessions in households without in-house water connections to measure: (i) water and soap use of 32 mothers; (ii) frequency of interrupting faecal-hand contamination by washing; and (iii) the time until faecal-hand contamination became a possible transmission event. Results: During 1008 h of observation, 55% (65/119) of mothers' and 69% (37/54) of children's faecal-hand contamination events were not followed within 15 min by handwashing or bathing. Nearly 40% (67/173) of faecal-hand contamination events became possible faecal-oral transmission events. There was no difference in the time-until-transmission between mothers and children (P = 0.43). Potential transmission of faecal material to food or mouth occurred in 64% of cases within 1 h of hand contamination. Mean water usage (6.5 l) was low compared to international disaster relief standards. Conclusions: We observed low volumes of water usage, inadequate handwashing, and frequent opportunities for faecal contamination and possible transmission in this water-scarce community.

Original languageEnglish (US)
Pages (from-to)1421-1428
Number of pages8
JournalTropical Medicine and International Health
Issue number11
StatePublished - Nov 2008


  • Handwashing
  • Hygiene
  • Peru
  • Water supply

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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