Formative Research on Hygiene Promotion through Routine Immunization
Diarrheal diseases remain one of the leading causes of child mortality and morbidity in Nepal. A
significant contributing factor is the widespread lack of fundamental determinants of good
health, such as access to safe drinking water, proper hygiene practices, and adequate sanitation
services. Addressing diarrheal diseases requires a comprehensive approach that combines
protective, preventive, and curative measures.
This formative research aimed to understand existing hygiene practices, identify their key
determinants, and prioritize essential hygiene behaviors for integration into the routine
immunization program.
Study Design and Methodology
The research adopted a descriptive, cross-sectional, and exploratory design, incorporating both
qualitative and quantitative methods. A total of 303 mothers from diverse ethnic and educational
backgrounds participated in the study, which was conducted across four districts Bardiya,
Jajarkot, Myagdi, and Nawalparasi. To ensure representation, at least two Village Development
Committees (VDCs) and one municipality were randomly selected from each district.
Additionally, health institutions, immunization (EPI) clinics/sessions, Female Community Health
Volunteers (FCHVs), and health personnel within these areas were also included as participants.
Key Findings and Implications
The study provides critical insights into water and sanitation conditions, key hygiene behaviors
among mothers, and the feasibility of incorporating hygiene promotion into routine
immunization efforts. Despite recurrent diarrheal disease outbreaks across Nepal, efforts to
improve water, sanitation, and hygiene (WASH) remain insufficient, and maternal hygiene
practices are still suboptimal.
Several barriers hinder the adoption of better hygiene practices. Physical constraints, such as
shortages of cooking fuel, and attitudinal factors, including children's preference for cold milk,
pose challenges to maintaining optimal food hygiene. However, the study also revealed
encouraging signs—many community members are increasingly aware of diarrhoeal diseases,
their causes, and treatment options. Yet, cases of diarrhea persist among children under five,
underscoring the urgent need for more effective interventions.
By shedding light on prevailing maternal hygiene behaviors and their impact on child health, this
research reinforces the importance of integrating hygiene promotion activities into Nepal’s
routine immunization programs. Strengthening these efforts can play a vital role in reducing
diarrheal diseases and improving overall child health outcomes.