Public-health experts now say the increase in hand-washing across the country may have had some collateral benefits, not only in helping to reduce H1N1 infections, but also the spread of other common diseases in Bolivia. "We see a steady 10% to 15% drop in the rate of incidence of acute diarrheal diseases in all age groups, compared with last year's numbers at this time," says Dr. René Lenis, Bolivia's director of epidemiology, referring to data collected on the number of weekly cases of diarrheal disease reported in medical centers nationwide in 2008 and 2009.
Often, though, the problem is not just about good habits or bad ones but about access to clean water or the ability to afford soap. In Bolivia, 25% of the country still doesn't have access to water in the home. Health officials recognize that every citizen must have a sink to wash their hands in before they can expect significant reduction in disease. But when more than half the population is already living with some sort of bacterial or parasitic stomach infection, it's crucial to encourage those who can wash their hands to do so.Some are still wary of the short-term data on Bolivia's descending rates of diarrheal disease; it remains to be seen whether the trend will hold up. But the findings "make a lot of sense, because behavior change like increased hand-washing happens quicker when there is a perceived threat," says Therese Dooley, a senior advisor for UNICEF's Water, Sanitation and Hygiene (WASH) project.
Bolivia's challenge now is to maintain the good numbers. The last time Bolivia witnessed a plummet in diarrheal-disease rates was during the cholera outbreak of 1992 and 1993, when better personal-hygiene habits led to a reduction in the spread of infection. But as the threat of the disease died down, so too did people's standards of cleanliness.
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