People will listen to me because I m medically trained Hygiene education often assumes that health personnel are automatically believed and respected. This is often untrue in both developed and developing countries. There is no reason why an outsider with foreign ideas should be given higher credence than tried and tested local explanations of diseases. Even in the best of circumstances, replacing old ideas about disease with new ones is a long, slow process. New ideas replace old ones Most people hold a variety of ideas about the origins of disease in their heads at the same time.
Few people blame child diarrhoea on lapses stool hygiene.
Hygiene education often just adds one more idea about disease without erasing the old ones. Fear of disease is not a constant pre-occupation and is often not a good motivator of behaviour change. Women and girl-children in many cultures do not have equal access to the 'right to defecate' as men. Very often even when a latrine exists women are not allowed access to it, particularly when pregnant or menstruating. In many cultures, the only time when women and girls can defecate, if they have no latrine, is after dark.