Background: In January 1993, Nyamithuthu Camp in Malawi housed 64000 Mozambican refugees. Communicable diseases, primarily diarrhoea, pneumonia, malaria and measles, contribute to substantially higher mortality rates in refugee populations compared to similar non-displaced populations.
Method: A systematic sample of 402 households in one portion of the camp were surveyed for diarrhoeal risk factors, and then interviewed twice weekly for 4 months regarding new diarrhoea episodes and the presence of soap in the household. Two-hundred grams of soap per person was distributed monthly.
Results: Households had soap on average only 38% of the interview days. Soap was used primarily for bathing and washing clothes (86%). Although 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. The presence of soap in a household showed a significant protective effect: there were 27% less episodes of diarrhoea in households when soap was present compared to when no soap was present (RR = 0.73, 95% CI: 0.54 < RR < 0.98). Potential confounding factors were assessed and did not appear to be responsible for the association between the presence of soap and reductions in diarrhoea incidence.
Conclusion: In summary, our findings suggest that the provision of regular and adequate soap rations, even in the absence of a behaviour modification or education programme, can play an important role in reducing diarrhoea in refugee populations. If subsequent study confirms the soap as a cheap and effective measure to reduce diarrhoea, its provision in adequate amounts should be a high priority in refugee settings.
PIP: In January 1993, Nyamithuthu Camp in Malawi housed 64,000 Mozambican refugees. Communicable diseases such as diarrhea, pneumonia, malaria, and measles cause substantially higher mortality rates in refugee populations compared to similar nondisplaced populations. A sample of 402 households in one part of the camp was surveyed for diarrheal risk factors, then interviewed twice weekly for 4 months about new diarrhea episodes and the presence of soap in the household. Each refugee was routinely rationed 240 g of soap in bar form per month. Surveyed households had soap on an average of only 38% of interview days, with soap used mainly for bathing and washing clothes. While 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. There were 27% fewer episodes of diarrhea in households where soap was present compared to when soap was not present. No potential confounding factors were found to be responsible for the association between the presence of soap and reductions in the incidence of diarrhea. These findings highlight the importance of regularly providing adequate soap rations in reducing diarrhea in refugee populations.