1. Pan American Health Organization 2002

2. Partnership USAID-EHP/PAHO-IMCI PAHO/Peru MOH/Peru local NGO/Peru PAHO/Nicaragua MOH/Nicaragua local NGO/Nicaragua

3. Pan American Health Organization 2002 Focus èprevent diarrhea in children under five by changing family behaviors nhands wash nsafe excreta disposal

4. Pan American Health Organization 2002 Diarrheal Disease and Childrens Health Diarrheal Disease in Child Control Programs EHPs Approach to Hygiene Improvement Field Examples

5. Pan American Health Organization 2002 FieldsFluidsFingersFliesFecesFood New Host Primary Prevention The F-Diagram Hand Washing Sanitation Source: Wagner and Lanois, 1958 Water Quality Water Quantity

6. Pan American Health Organization 2002 010203040 Excreta Disposal Facilities Water Quantity Water Quality Handwashing Effectiveness of Hardware and Hygiene Interventions in Reducing Diarrhea Morbidity Intervention Median reduction (%) Source: Esrey et al. 1991; Hutley et al. 1997.

7. Pan American Health Organization 2002 Methodology èidentify the problem with and within the community èidentify and negotiate the solutions with the community èdoor to door visits to assist and encourage the community for the changing èDuration of two years

8. Pan American Health Organization 2002 Main activities èhealth personnel training èlocal and participatory diagnosis èlocal promoters training èbase line of diarrhea occurrence èdevelop diarrhea prevention materials integrated into IMCI materials

9. Pan American Health Organization 2002 Outcomes èhealth professionals and promoters from MOH and NGOs able to apply an effective behavioral changing methodology èguide to reapply the methodology èdiarrhea prevention materials integrated into IMCI materials

10. Pan American Health Organization 2002 Expected Results ènew pattern of behavior incorporated in the values and practices of the community èreduction of the diarrhea cases in children under five

11. Pan American Health Organization 2002 Percentage of children <5 years of age with diarrhea in the last two weeks Impact Indicators Percentage of population using hygienic sanitation facilities Percentage of child caregivers and food preparers with appropriate handwashing behavior Quantity of water used per capita per day