A case-control study was conducted to evaluate whether, after selected confounders were controlled for, children aged less than 6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed.

Children in the study came from 111 villages: 90 villages in Ghizer district and 21 in Gilgit district. Forty-three (39%) villages had WASEP interventions. Cases were more likely to come from non-WASEP villages than controls (55% vs 47%). All 111 villages received ongoing hygiene education from their field teams. In addition, 19 (17%) villages had an onsite Aga Khan Health Services, Pakistan (AKHS,P) health facility: 205 (45%) case children lived in a village with an AKHS,P health facility compared with 144 (41%) control children.

Changes in knowledge, attitude, and practices:

Data collected on knowledge, attitude, and practices about health and hygiene showed virtually no differences between cases and controls. Evaluators speculate that response bias from participants giving socially acceptable answers to questions may have accounted for the small differences observed. They hypothesise that this lack of demonstrated impact may also reflect the presence of organisations other than WASEP that delivered similar health-related interventions in the project area. Approximately one-third of cases and controls resided in villages where other groups were working on water, sanitation, and hygiene-related issues.

Health-related programme impact:

Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages. Boys had 25% lower odds of having diarrhoea than girls. A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age and a 1.4% decrease for every monthly increase in the child's age.

"Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan" [PDF], Bulletin of the World Health Organization 2003 Vol. 81: 160-165.