Introduction: Water and sanitation interventions were delivered in the northern areas of Pakistan as a joint venture of the Aga Khan University and the Aga Khan Health Systems Oshikhandass Diarrhea and Dysentery Project (1989-96) followed by the Aga Khan Water, Sanitation, Health and Hygiene Studies Program (WSHHSP). Through these interventions water treatment plants, new pit latrines along with a component of health education were introduced. Objectives: To explore perceptions, knowledge and practices of inhabitants of Oshikhandass village in Gilgit related to water quality, latrine use and hand washing following the intervention. Methods: Through a cross-sectional study during June-July 2012, six focus group discussions (FGDs) were conducted in various sectors of Oshikhandass supplied by filtered water (intervention area), piped water and mixed water (piped and channel water). The latter two were designated as the non- intervention areas. Participants included mothers (3 FGDs, 26 participants), LHWs (1 FGD, 5 participants) and youth (2 FGDs, 9 participants each). Results: Irrespective of health education by LHWs, residents of both intervention and non- intervention communities had learnt about proper hygienic practices from daily life experiences, parents, teachers and media. LHWs role at best had been that of a positive reinforcement. Despite uniformly good awareness, intervention communities still had relatively better health and hygiene knowledge and practices as compared to non-intervention areas. Conventional practices of water purification such as using gulk as domestic filter cum refrigerator was prevalent. Non-intervention communities, however, knew that accessibility to safe water makes a difference and they would have practiced better hygiene if they had resources. Inhabitants of intervention area commented that the functionality and coverage of the filtration plant was not enough to cater to the needs of the village. Conclusion: Knowledge alone is ineffective in modifying hygiene related behaviors. Sound context-specific integrated interventions for water and sanitation infrastructure development are much needed.
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