We aimed to measure the impact of a structured health education programme on the incidence of infectious disease in young children of a rural Gambian village. In a prospective intervention study, mothers of children under 3 years living in a rural West African village without running water (population 1600) were divided into two groups by site of residence. Group 1 (n = 70) received a fortnightly education talk on hand-washing and skin hygiene, and group 2 (n = 84) on family planning. The incidence of infectious skin and diarrhoeal, eye, and respiratory diseases were recorded at the clinics attended by all children. The mean incidence of skin infections in the children of mothers of group 1 (1.07) was significantly lower (p < 0.05) than that of group 2 (1.59) during the rainy season. Between 1981 and 1994 the incidence of skin, diarrhoeal, and eye disease showed a statistically significant (p < 0.0001) decline following the implementation of the health education programme. There was no statistical significance in the trend for respiratory disease, the incidence of which would not be expected to be affected by hygiene education. Focused health education had a sustained beneficial effect on the health of young children living in conditions where infectious diseases and poor hygiene are common.