*6.2.1 Mberengwa District, Zimbabwe*

The household observation included 7477 households in the end line survey (**Figure 2**) in Mberengwa District, with a clear pattern of community effort being evident in all indicators (p > 0.001).

Of the 21 indicators, 12 were found in over 90% of CHC households, and three indicators were found in over 80% of households after 8 months. To measure the effect of the CHC it is important to note which indicators have made the most change. The most impressive change from baseline to the post intervention 8 months later, was in the use of hand washing facilities in the home which increased by 85.4% (from 6.4 to 91.8%), the use of ladles to draw water from a bucket increased by 65% (18–83%), bathing rooms increased by 51% (16–67%), the use of pot racks to dry plates increased by 51% (46–97%), the use of refuse pits to ensure fly control increased by 39% (58–97%), decorated kitchens increased by 30% (66–95%), Blair Ventilated Improved Latrine (BVIP) for a household increased by 27% (from

14–41% households), the use of protected water sources for drinking water increased by 23% (61–84%), ventilation of housing increased by 21% (65–86%). Use of mosquito nets whilst still low (8.9–19.8%) increased by 11% and fuel-efficient stoves increased by 14% (4.2–18.2%) (**Figure 4**) [46]. The effect of the improved hygiene could be quantified by the condition of the children. Over 90% of CHC households could demonstrate children with no skin diseases, no worms, and a complete immunization card for all children. Mothers in over 90% of CHC homes could demonstration how to treat dehydration with a Sugar salt rehydration solution.

It is noteworthy that changes which required purchasing were on the lower end of the scale with BVIP latrine construction, buying mosquito nets and fuel efficient stoves being the least amount of change. As this was during a time when Zimbabwe was completely dysfunctional economically and while there was over 75% unemployment in the country, with over 3 million Zimbabweans living abroad as economic migrants, it is not surprising there was little affordability. Indeed given this context it is impressive that 2108 high quality BVIP latrines which cost at least US\$100 at the time (when cement was in short supply nationally) were built by self-supply by households in some of the most challenging areas in the country.

After only 8 months, the post intervention survey showed that compliance level was over 80% of the registered CHC members in 15 indicators (**Figure 4**), of which 12 were over 90%, which leaves little doubt as to the effectiveness of the CHC training to stimulate exceptional levels of community response in Mberengwa District.

**Figure 4.**

*Percentage hygiene behaviour change of 7477 CHC members in Mberengwa District, Zimbabwe. 2012 [46].*

**47**

**Figure 5.**

*Comparative Assessment of Hygiene Behaviour Change and Cost-Effectiveness of Community…*

In one ward of Mberengwa a qualitative study was conducted in three villages [10] which established that CHC members were considerably more knowledgeable than non CHC members. Understanding the cause of diseases was claimed by CHC members to be the reason for their increased use of safe borehole water and the construction of latrines raising coverage in a village from 36.6–53%, and hand

*'As community members reflected on the impact of CHCs on their lives, the increases in their health knowledge was evident and participatory practices were prevalent across the CHCs. CHCs are currently bringing about a multitude of positive change, as the activities initiated by their members are practiced at the community level. Not only have health indicators changed, but more importantly, village member's perceptions of their capacity have increased; they feel more able to control disease and improve their lives. More importantly, they are taking action to prevent disease and sharing what they have learned with other communities' [10]*

Safe hygiene correlated positively in all but three of the 24 indicators with the

To demonstrate an impact on sanitation in Rwanda was complicated by the fact that four of the indicators did not change significantly simply because, even *before* the start of the intervention, compliance was already exceptionally high - meaning little

number of sessions attended by members (p-value <0.001) (**Figure 5**).

*Percentage hygiene behaviour change of all CHC in Rusizi District, Rwanda. 2017 [45].*

*DOI: http://dx.doi.org/10.5772/intechopen.89995*

washing facilities by 22.1% (from 5 to 27.1%). The study states in the conclusion,

*6.2.2 Qualitative study*

*6.2.3 Rusizi District, Rwanda*

*Comparative Assessment of Hygiene Behaviour Change and Cost-Effectiveness of Community… DOI: http://dx.doi.org/10.5772/intechopen.89995*
