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What is the F Diagram?

Gary Swanepoel | ITB - Friday, May 10, 2013

The f-diagram is used by many NGOs to help promote behaviour change surrounding hygiene.

The famous f-diagram, demonstrates the major transmission routes of faecal-oral diseases. It illustrates the different routes that the microbes of diarrhoea take from faeces, through the environment, to a new person. For example; microbes in faeces on the ground by a well can get into the water system and be drunk by a child, hands that have not been washed after going to the toilet can carry microbes onto foods, which are then eaten, infecting another child, who gets diarrhoea and spreads more microbes...[1]


Photo courtesy of

 What is the faecal-oral route?

The faecal–oral route is a route of transmission of a disease, when pathogens in faecal particles pass from one host and are introduced into the oral cavity of another host.

The most common steps are:

  • water that has come into contact with faeces and is then inadequately treated before   drinking;
  • food that has been handled with faeces present;
  • poor sewage treatment along with disease vectors like houseflies;
  • poor or absent cleaning after handling faeces or anything that has been in contact with it[2]


Why do we need to worry about Faeces?

In simple terms, the average faeces can contain 10,000,000 viruses and 1,000,000 bacteria.[3]

What diseases can you get via the fecal-oral route?

  • Cholera
  • Poliomyelitis
  • Typhoid Fever
  • Hepatitis A and E
  • Shigellosis

Key practices designed to prevent diarrhoeal infection and break the transmission route:

Safe disposal of Faeces

Faeces in the public and domestic environment are the primary source of diarrhoeal pathogens. Safe disposal of stools is the best way to prevent infection. Ideally adult and child stools should be disposed of in toilets or latrines. In places where this is not possible, stools should be buried.[4]

Hand washing

Hands readily become contaminated with faecal material after going to the toilet or cleaning children’s bottoms. Rinsing fingers with water alone is not enough. Hands need to be well washed after contact with faeces; either rubbed with an abrasive such as ash or mud, or with a detergent such as soap.[5]

Photo courtesy of

Keeping water clean

A plentiful and accessible water supply makes hand washing and cleaning easier, which helps to keep the environment free of pathogens. Ensuring that faecal material does not get into water supplies at the source is probably far more effective than boiling, filtering, and covering water jars. [6]

Fly control

Though flies can carry microbes from faeces to food, fly control is difficult to achieve. If stools are disposed of in toilets or latrines and these latrines have covers, then fly-based disease transmission will be minimised.[7]

Food hygiene

Poor food handling practices contribute to diarrhoeal infection largely because they offer bacterial pathogens the opportunity to multiply. This way people can consume much greater doses of microbes. Diarrhoeas often peak in warm, humid seasons in the tropics, when conditions are favourable to the multiplication of bacteria on food.

Feeding bottles are especially dangerous because they are hard to sterilise and bacteria grow quickly in warm milk.[8]

Key facts on Diarrhoea

(Courtesy of WHO)

  1. Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.
  2. Each year diarrhoea kills around 760 000 children under five.
  3. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.
  4. Globally, there are nearly 1.7 billion cases of diarrhoeal disease every year.
  5. Diarrhoea is a leading cause of malnutrition in children under five years old.


Photo courtesy of

Diarrhoea can last several days, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhoea.

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene.[9]

A 2009 UNICEF study found hand washing with soap to be among the most effective and inexpensive ways to prevent diarrhoeal diseases and pneumonia, which together account for 3.5 million child deaths annually.[10]

In addition, improved sanitation will contribute to reducing malnutrition in children, improve[ing] the quality of life and dignity of girls and women, protect[ing] the environment, and generat[ing] economic benefits for communities and nations.[11]

LIFESAVER and the f-diagram

LIFESAVER technology can support the introduction of hygiene promotion programmes by providing clean safe drinking water at the hand washing and food preparation stage as well as reducing numbers of children being diagnosed with diarrhoea. LIFESAVER technology can dramatically weaken several of the transmission routes shown in the f-diagram above, and can be used in partnership with pit latrines/toilets and health awareness programmes to reduce the transmission of diseases via the faecal-oral route.


  • UNICEF, 1999. A Manual on hygiene promotion [pdf] Available at: 
  • UNICEF, 2009. Soap, Toilets and Taps [pdf] Available at: 
  • WHO, 2013. Diarrhoeal Disease Fact sheet [online] Available at:

  • [1] UNICEF, 1999. A Manual on hygiene promotion [pdf] Available at: [Accessed 7 May 2013], p. 34.
  • [2] <–oral_route> [Accessed 7 May 2013]
  • [3] UNICEF, 1999, p.33.
  • [4] UNICEF, 1999, p.36.
  • [5] UNICEF, 1999, p. 36.
  • [6] UNICEF, 1999, p. 36.
  • [7] UNICEF, 1999, p. 37.
  • [8] UNICEF, 1999, p. 37.
  • [9] WHO, 2013. Diarrhoeal Disease Fact sheet [online] Available at: <> [accessed 7 May 2013]
  • [10] UNICEF, 2009. Soap, Toilets and Taps, p.17.
  • [11] UNICEF, 2009. Soap, Toilets and Taps, p.21.

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