Effect of washing hands with soap on diarrhoea risk in the community: a systematic review

Identification of Enteric Pathogen Reservoirs and Transmission Pathways Associated with Short Childhood Stature in the Kolkata Indian Site of the Global Enteric Multicenter Study

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12-23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12-59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.

Incidence and Risk Factors for Adrenal Crisis in Pediatric-onset Adrenal Insufficiency: A Prospective Study

CONTEXT

Adrenal crisis (AC) is a life-threatening complication that occurs during follow-up of patients with adrenal insufficiency (AI). No prospective study has thoroughly investigated AC in children with primary and secondary AI.

OBJECTIVE

This work aimed to determine the incidence and risk factors for AC in patients with pediatric-onset AI.

METHODS

This multicenter, prospective cohort study conducted in Japan enrolled patients diagnosed with AI at age ≤15 years. The incidence of AC was calculated as events per person-year (PY), and risk factors for AC were assessed using Poisson regression multivariable analysis.

RESULTS

The study population comprised 349 patients (164 male, 185 female) with a total follow-up of 961 PY. The median age at enrollment was 14.3 years (interquartile range [IQR] 8.5-21.2 years), and the median follow-up was 2.8 years (IQR 2.2-3.3 years). Of these patients, 213 (61%) had primary AI and 136 (39%) had secondary AI. Forty-one AC events occurred in 31 patients during the study period. The calculated incidence of AC was 4.27 per 100 PY (95% CI, 3.15-5.75). Poisson regression analysis identified younger age at enrollment (relative risk [RR] 0.93; 95% CI, 0.89-0.97) and increased number of infections (RR 1.17; 95% CI, 1.07-1.27) as significant risk factors. Female sex (RR 0.99; 95% CI, 0.53-1.86), primary AI (RR 0.65; 95% CI, 0.30-1.41), or equivalent dosage of hydrocortisone per square meter of body area (RR 1.02; 95% CI, 0.96-1.08) was not a significant risk factor.

CONCLUSION

A substantial proportion of patients with pediatric-onset AI experience AC. Younger age and an increased number of infections are independent risk factors for developing AC in these patients.

The lethal effect of soap on Schistosoma mansoni cercariae in water

BACKGROUND

Schistosomiasis is a parasitic disease which is spread through skin contact with water containing Schistosoma cercariae. Drug treatment has been the main control method, but it does not prevent reinfection. The use of soap can be a complementary measure to reduce transmission. Therefore, this study investigates the quantitative effect of different soaps on the mortality of Schistosoma mansoni cercariae.

METHODOLOGY

Four soaps including two powder soaps (Kleesoft and Omo) and two bar soaps (B29 and Rungu) which are used in a schistosomiasis-endemic Tanzanian village were studied. S. mansoni cercariae were exposed to powder soaps of 0 (control), 10, 50, 75, 100 and 1000 mg/L and to bar soaps of 0 (control), 100, 500 and 1000 mg/L. The highest concentration of 1000 mg/L was selected based on the laboratory-estimated average soap concentration during handwashing. Cercariae were observed under a microscope after 0, 5, 15, 30, 45 and 60 minutes of exposure to determine their survival.

CONCLUSIONS

All four soaps can kill S. mansoni cercariae and this lethal effect was related to soap concentration and exposure time. At the highest concentration of 1000 mg/L, all cercariae were dead at 5 minutes post-exposure with two powder soaps and Rungu, while 100% cercarial death was achieved between 5 minutes to 15 minutes for B29. Almost all cercariae survived after being exposed to 10 mg/L powder soaps and 100 mg/L bar soaps for 60 minutes. Powder soaps were more lethal than bar soaps. Considering the widely varying concentrations of soap during real-world hygiene activities and the necessity for a very high soap concentration to eliminate all cercariae in a short 5-minute exposure, providing the efficacy of soap in preventing schistosomiasis becomes challenging. Future studies should investigate whether soap can influence alternative mechanisms such as making cercariae unable to penetrate the skin, thereby providing protection.

Evaluating levels of knowledge and food safety practices among food handlers in the Southern part of Italy

The purpose of the present study is to assess the extent of knowledge and food safety practices among food handlers (FHs) to prevent food risks. This cross-sectional study was conducted between July 2021 and February 2022 in a random sample of FHs working in three regions of the Southern part of Italy. A two-stage cluster random sampling strategy was used to select FHs working at food businesses in the Regions. Data were collected through an anonymous self-administered questionnaire that consisted of 33 questions grouped into five sections to gather sociodemographic and professional characteristics, knowledge about foodborne illnesses (FBIs) and food safety, adherence to proper food handling practices and sources of information. The overall median knowledge score was 8 (interquartile range 6-9), but only 2.2 % of the respondents answered all 12 statements correctly. Among the recruited FHs, 71.2 % and 65.4 % reported always keeping raw and cooked food separate and using different utensils while handling raw and cooked foods, respectively. With respect to the use of personal protective equipments, 79.3 % and 67.6 % stated always wear work clothing and hair restrain (e.g., hats, hairnets), respectively. Just 20.9 % of the FHs properly defrosted food (i.e., in the fridge) and 39.9 % used food warmers for keeping food at least at 65 °C while waiting for service. The findings highlighted poor knowledge concerning the ideal temperatures for cooking, holding and storing foods, exacerbated by poor personal and hand hygiene, certain factors associated with the spread of foodborne pathogens.

Temporal shifts in 24 notifiable infectious diseases in China before and during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic, along with the implementation of public health and social measures (PHSMs), have markedly reshaped infectious disease transmission dynamics. We analysed the impact of PHSMs on 24 notifiable infectious diseases (NIDs) in the Chinese mainland, using time series models to forecast transmission trends without PHSMs or pandemic. Our findings revealed distinct seasonal patterns in NID incidence, with respiratory diseases showing the greatest response to PHSMs, while bloodborne and sexually transmitted diseases responded more moderately. 8 NIDs were identified as susceptible to PHSMs, including hand, foot, and mouth disease, dengue fever, rubella, scarlet fever, pertussis, mumps, malaria, and Japanese encephalitis. The termination of PHSMs did not cause NIDs resurgence immediately, except for pertussis, which experienced its highest peak in December 2023 since January 2008. Our findings highlight the varied impact of PHSMs on different NIDs and the importance of sustainable, long-term strategies, like vaccine development.

Assessment of Hygiene Practices, Awareness, and Water Consumption Regarding Covid-19 Among Children in a Refugee Camp

INTRODUCTION

At the outbreak of infectious diseases, the response of different communities to the disease varies, and children are most affected by the collective anxiety and grief that consequently arises. In this research, the behavior of children and their parents in terms of hygiene and precautions before and during the COVID-19 pandemic was investigated.

METHODOLOGY

The focus of the present research was on sanitation facilities, particularly access to end-use of water for hand washing. The research was conducted in Barika Camp, Kurdistan, Iraq and 311 parents and children were interviewed. A data collection team consisting of two females and one male was responsible for gathering data, primarily from women who served as the main respondents. Questionnaires consisted of three main parts: demography, COVID-19 pandemic effects, and sanitary shelter specifications.

RESULT

The results demonstrated that the behavior of refugees during the COVID-19 pandemic regarding the priority of child protection, type of disinfectants, and water consumption has significantly altered. These changes mainly depended on the women's age and education level.

DISCUSSION

Overall results showed that in 61.09% of the participants, the number of hand washes and in 58.58%, the washing time increased, leading to water shortage in the refugee camp.

Prevalence and determinants of hand hygiene behavior among Indian population: a systematic review and meta-analysis

Despite a global call to action, many deaths occur yearly in developing nations from contagious diseases due to poor sanitation and hygiene. Although hand hygiene (HH) behavior was critical in preventing the COVID-19 pandemic, the sustainability of such practices is still questionable. Therefore, the current systematic review and meta-analysis investigated the prevalence and determinants of HH behavior among the Indian population (PROSPERO registration ID: CRD42022344961). Systematic searches on electronic databases, including ScienceDirect, Scopus, Web of Science, JSTOR, PubMed, and Google Scholar, targeted qualitative and quantitative studies that report HH behaviors in India. Pooled effect sizes were calculated with the inverse-variance method using random-effects models, acknowledging the study heterogeneity. Out of 1053 studies, 15 studies that met eligibility criteria were included in the qualitative synthesis. Among them, five studies were included in the meta-analyses. The overall prevalence of HH before food was 55% (95% CI = 31-78), and after the toilet was 84% (95% CI = 65-96). Subgroup analysis showed that before-food HH prevalence pre- and post-COVID-19 was 61% and 36%, respectively, whereas after-toilet HH prevalence was 91% and 74%, respectively. Meta-regression revealed statistically non-significant results for COVID-19 status. While it could not adequately explain the heterogeneity of the 'before-food prevalence' studies (Adj. R2 = - 34.80%), it did account for more than 19% in 'after-toilet prevalence' (Adj. R2 = 19.72%). This systematic review highlights various demographic, psychosocial, and environmental determinants of HH behavior. The results offer the potential for a deeper comprehension of the key factors influencing HH in India and could find implications for developing viable interventions. This aids in planning efficient promotional campaigns to enhance personal hygiene and control infectious diseases in the nation.

No Child's Play: Under-five Child Feces Management in a Rural Area of Bengaluru Urban District, India

Background

Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors.

Materials and Methods

A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria - defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing.

Results

Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20-25 years (adjusted odds ratio, aOR: 9.02), 26-30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years.

Conclusion

The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Prevalence and risk factors of childhood diarrhea among wastewater irrigating urban farming households in Addis Ababa

INTRODUCTION

Childhood diarrhea is one of the major contributors to the morbidity of under-five children in Ethiopia. Although researchers determine the risk factors varyingly, the exposure route to the pathogens is usually complicated. This study aims to investigate the prevalence and risk factors of diarrhea among children under the age of five among wastewater irrigation farming households in Addis Ababa, Ethiopia.

METHODS

Cross-sectional study was conducted among 402 farming households from November 2021 to February 2022. Data was collected using a face-to-face interviewer-administered questionnaire. Stata version 14 software was used to analyze data. Factors associated with the prevalence of diarrhea was identified using binary logistic regression. Multivariable analysis was carried out to determine an adjusted odds ratio at a confidence level of 95% and level of significance at 0.05.

RESULTS

The overall prevalence of under-five children diarrheal cases was 22.3%. The odds of diarrhea are associated with a multitude of variables. Major wastewater-related determinants associated with diarrhea are body washing with irrigation water [AOR: 37.7, 95%CI (3.1, 358)], contaminated cloth with irrigation water [AOR:10.8,95%CI(0.6, 205)], use of protective clothing during farm work [28.9,95%CI (3.9, 215)], use of farm work cloths at home [AOR: 31.7, 95%CI (4.4, 226)], and bringing unwashed farm tools to home [94 (5.7, 1575)].

CONCLUSION

The high prevalence of under-five children diarrheal disease among wastewater irrigation households was strongly associated with factors related to occupational exposure. Thus, to decrease childhood diarrheal among urban agriculture farmers, appropriate precautions need to be taken.

The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia

BACKGROUND

To make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia.

METHODS

Using a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance.

RESULTS

We found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01-2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15-1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11-6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10-2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73- 6.62).

CONCLUSION

Our results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.

Tools for measuring individual self-care capability: a scoping review

BACKGROUND

Our ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking.

OBJECTIVE

The aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties.

DESIGN

Scoping review with content assessment.

METHODS

The search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool.

RESULTS

We screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care.

CONCLUSIONS

Various tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of self-care. There is a need to develop a comprehensive, validated tool and easily accessible tool to measure individual self-care capability including the assessment of a wide range of self-care practices. Such a tool could be used to inform targeted health and social care interventions.

The Impact of On-Ground Activation Events on Improved Toilet Coverage: A Case Study From the Tanzania National Sanitation Campaign "Nyumba ni Choo"

In 2017, Tanzania was one of the countries in the world with the lowest proportion of households having access to improved toilets. Between 2017 and 2021, the government launched a national sanitation campaign under the brand Nyumba ni Choo. The objective of this paper is to assess the impact of one component of this campaign, "direct consumer contact" events, on the coverage of improved household latrines in Tanzania. Secondary data from both the National Sanitation Management Information System (NSMIS; https://nsmis.moh.go.tz/) and internal project reports were used to extract data on coverage and dates of events, respectively. Regression estimation models were used to estimate impact at ward and regional levels. The study used quarterly panel data from all 26 regions between 2017 (baseline) and 2020 (endline) for estimation purposes. The study shows that direct consumer contact events had a significant positive effect on the rate at which households subsequently improved their toilets at both small and large scale in Tanzania. On average, the rate of household latrine improvement increased by 12.91% at ward level and 14.17% at regional level. These results testify to the importance of designing an effective behavioral change campaign to achieve significant improvements in sanitation coverage.

Development of a novel hand cleansing product for low-income contexts: The case of tab soap

Handwashing with soap is a widely advocated public health measure, but seldom practiced, partly because it is often difficult (especially outside of rich Western country contexts) to make both soap and water readily available in relevant situations. This study used both Behaviour Centred Design and Human Centred Design to guide development of a novel hand cleansing technology appropriate for the context of post-toilet hand cleansing in resource-poor societies. Extensive prototyping and field testing resulted in the pilot production of 'tab' soap, a small but durable single-use, decomposable substrate embedded with soap. It can be produced in dispenser roll or tear-off formats. With this affordable solution, one may use soap without worrying about contamination pretty much anytime and anywhere. A small-scale field test showed that all poor households in rural and peri-urban areas in Tanzania included in the proof-of-concept study (N = 12 households) would use the product reliably over the medium term. Tab soap awaits full-scale production and marketing but could make hand cleansing a more popular practice around the world.

Effect of a novel hygiene intervention on older children's handwashing in a humanitarian setting in Kahda district, Somalia: A cluster-randomised controlled equivalence trial

INTRODUCTION

Improving handwashing with soap (HWWS) among children in humanitarian emergencies has the potential to reduce the transmission of several important infectious diseases. However, there is limited evidence on which approaches are effective in increasing HWWS among children in humanitarian settings. One recent innovation - the "Surprise Soap" intervention - was shown to be successful in a small-scale efficacy trial in a humanitarian setting in Iraq. This intervention includes soap with embedded toys delivered through a short household session comprising a glitter game, instruction of how and when to wash hands, and HWWS practice. Whilst promising, this approach has not been evaluated at programmatic scale in a complex humanitarian setting.

METHODS

We conducted a cluster-randomised controlled equivalence trial of the Surprise Soap intervention in IDP camps in Kahda district, Somalia. Proportionate stratified random sampling was employed to recruit 200 households, with at least one child aged 5-12, across the camps. Eligible households were randomly allocated to receive the Surprise Soap intervention (n = 100) or an active comparator handwashing intervention in which plain soap was delivered in a short household session comprising standard health-based messaging and instruction of how and when to wash hands (n = 100). The primary outcome was the proportion of pre-specified occasions when HWWS was practiced by children aged 5-12 years, measured at baseline, 4-weeks, 12 weeks, and 16 weeks post invention delivery.

RESULTS

HWWS increased in both groups (by 48 percentage points in the intervention group and 51 percentage points in the control group, at the 4-week follow up), however, there was no evidence of a difference in HWWS between the groups at the 4-week (adjusted RR (aRR) = 1.0, 95% CI 0.9-1.1), 12-week (aRR = 1.1, 95% CI 0.9-1.3), or 16-week (aRR = 1.0, 95% CI 0.9-1.2) follow-up.

CONCLUSIONS

In this complex humanitarian setting, where soap availability and past exposure to handwashing promotion was low, it appears that well-designed, household-level targeted handwashing interventions that include soap provision can increase child HWWS and potentially reduce disease risk, but the Surprise Soap intervention offers no marginal benefit over a standard intervention that would justify the additional costs.

Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis

BACKGROUND

In low- and middle-income countries (L&MICs), the biggest contributing factors to the global burden of disease in childhood are deaths due to respiratory illness and diarrhoea, both of which are closely related to use of water, sanitation, and hygiene (WASH) services by households. However, current estimates of the health impacts of WASH interventions use self-reported morbidity, which may fail to capture longer-term or more severe impacts. Reported mortality is thought to be less prone to bias than other reported measures. This study aimed to answer the question: What are the impacts of WASH interventions on reported childhood mortality in L&MICs?

METHODS AND FINDINGS

We conducted a systematic review and meta-analysis, using a published protocol. Systematic searches of 11 academic databases and trial registries, plus organisational repositories, were undertaken to locate studies of WASH interventions, which were published in peer review journals or other sources (e.g., organisational reports and working papers). Intervention studies of WASH improvements implemented under endemic disease circumstances in L&MICs were eligible, which reported findings at any time until March 2020. We used the participant flow data supplied in response to journal editors' calls for greater transparency. Data were collected by two authors working independently. We included evidence from 24 randomized and 11 nonrandomized studies of WASH interventions from all global regions, incorporating 2,600 deaths. Effects of 48 WASH treatment arms were included in analysis. We critically appraised and synthesised evidence using meta-analysis to improve statistical power. We found WASH interventions are associated with a significant reduction of 17% in the odds of all-cause mortality in childhood (OR = 0.83, 95% CI = 0.74, 0.92, evidence from 38 interventions), and a significant reduction in diarrhoea mortality of 45% (OR = 0.55, 95% CI = 0.35, 0.84; 10 interventions). Further analysis by WASH technology indicated interventions providing improved water in quantity to households were most consistently associated with reductions in all-cause mortality. Community-wide sanitation was most consistently associated with reductions in diarrhoea mortality. Around one-half of the included studies were assessed as being at "moderate risk of bias" in attributing mortality in childhood to the WASH intervention, and no studies were found to be at "low risk of bias." The review should be updated to incorporate additional published and unpublished participant flow data.

CONCLUSIONS

The findings are congruent with theories of infectious disease transmission. Washing with water presents a barrier to respiratory illness and diarrhoea, which are the two biggest contributors to all-cause mortality in childhood in L&MICs. Community-wide sanitation halts the spread of diarrhoea. We observed that evidence synthesis can provide new findings, going beyond the underlying data from trials to generate crucial insights for policy. Transparent reporting in trials creates opportunities for research synthesis to answer questions about mortality, which individual studies of interventions cannot be reliably designed to address.

Evaluating food safety knowledge and practices among Saudi women in Al-Ahsa Region, Saudi Arabia

Foodborne illnesses are responsible for about half a million deaths annually, of which 30% occur among kids. This study aimed to assess the current food safety knowledge and practice level of Saudi women in Al-Ahsa region, Saudi Arabia. A cross-sectional study was conducted through personal interviews among 239 Saudi women. The questionnaire consisted of close-ended questions covering different aspects of food safety knowledge and practices at home and during shopping. Descriptive analyses were used to identify the level of participant's awareness, and the scores were shown in three categories (good - fair - poor) based on their food safety knowledge and practice awareness. The effect of socio-demographic characteristics and their correlation to food safety knowledge and practices was conducted using Chisquare analysis. The results about food safety knowledge showed that around 50% of participants achieved a good score, and 37.5% achieved a fair score, while 12.5% achieved a poor score. In comparison, the participants achieved 75% good score, whereas 12.5% achieved both fair and poor in food safety practices. The results also highlighted a significant correlation (P<0.05) between level of food safety knowledge, practices of participants and their age, marital status, work status, and educational level, while there's no correlation with their family size and total income. Although, the overall result showed good level in food safety knowledge and slightly less in food safety practices among Saudi women living in Al-Ahsa region, continuous education, training, awareness, and motivation are highly recommended to improve women's knowledge and practices to higher levels.

Hand-Washing at Critical Times and Associated Factors Among Mothers/Caregivers of Under-Five Year Children in Nefas Silk Lafto Sub-City, Addis Ababa, Ethiopia

Background

Hand washing is the simplest, most affordable, and most effective means of limiting the spread of infections. Despite increasing efforts to improve hand washing at critical times (after defecation, after handling child/adult feces or cleaning child's bottom, after cleaning the environment, before preparing food, and before eating food), mothers/caregivers of under-five children fail to conduct it; but the reason appears unclear. Thus, this study sought to identify hand washing at critical times and associated factors among mothers/caregivers of under-five children in Nefas Silk Lafto Sub-City, Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted on April 1-15, 2019, and 312 mothers/caregivers participated. A pretested questionnaire was used to collect data from participants by interviewer-administered technique and the data were analyzed with the Statistical Package for Social Science version 20. The factors were determined by conducting logistic regression and the crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals. All statistical tests were conducted at a 5% level of significance.

Results

The study revealed that 232 (74.4%; 95% CI [69.6%-79.2%]) mothers/caregivers washed their hands at critical times. The illiterate mothers/caregivers and mothers/caregivers who lacked tap water inside the home or the backyard had 66% (AOR = 0.34; 95%CI [0.17-0.69]) and 62% (AOR = 0.38; 95%CI [0.18-0.80]) reduced odds of washing hands at critical times, respectively. Mothers/caregivers from middle had (AOR = 4.56; 95%CI [1.84-11.33]), richer had (AOR = 5.61; 95%CI [2.11-15.30]), and the richest had (AOR = 6.14; 95%CI [2.24-16.72]) times increased likelihood of washing hands at critical times than the poorest.

Conclusion

The majority of mothers/caregivers practiced hand washing at critical times, and improving maternal literacy, household economy, and availability of water sources in the backyard are needed to maintain and enhance the practice.

The influence of COVID-19 barrier measures on the positivity rate of typhoidal salmonellosis and amoebiasis in the Buea Health District, South West Region of Cameroon

Typhoidal salmonellosis and amoebiasis are prevalent in the Buea Health District (BHD) and it is evident that hand hygiene can reduce the transmissibility of these diseases. The barrier measures enforced by the government, in the wake of the corona virus disease 2019 (COVID-19) pandemic has led to behavioural changes which may have had an influence on the positivity rate of these diseases. This study seeks to determine the influence of COVID-19 barrier measures and the implementation of COVID-19 vaccination on the positivity rate of typhoidal salmonellosis and amoebiasis in the BHD. A retrospective study, with purposive and random sampling methods were used to select health facilities in BHD, whose laboratory records were reviewed using a data extraction form to obtain health information of patients who tested for typhoidal salmonella and/or Entamoeba histolytica from June 1, 2018 to December 31, 2021. Chi-square test was used to compare the positivity rate in the pre-and-COVID-19 and in the pre-and-vaccination era. The positivity rate of typhoidal salmonellosis and amoebiasis dropped from 57.8% and 2.7% in the pre-COVID-19 era to 34% and 1.8% in the COVID-19 era respectively, which were significant (χ2 = 945.8; P<0.001 and χ2 = 11.8; P = 0.001 respectively). Within the COVID-19 era, the positivity rate of salmonellosis and amoebiasis decreased from 39% and 2.6% before the implementation of COVID-19 vaccination to 27.7% and 0.8% respectively in the COVID-19 vaccination era and these differences were significant (χ2 = 149.1; P<0.001 and χ2 = 33.8; P<0.001 respectively). However, the positivity rate of salmonellosis between the rainy (43.5%) and the dry (42.8%) seasons and amoebiasis between the rainy (2.2%) and the dry (2%) seasons were not significantly different (χ2 = 0.6; P = 0.429 and χ2 = 0.54; P = 0.463 respectively). A significant decline in the positivity rate of typhoidal salmonellosis and amoebiasis was observed after the implementation of COVID-19 barrier measures and vaccination.

Co-designing the Embodiment of a Minimalist Social Robot to Encourage Hand Hygiene Practises Among Children in India

We conducted an empirical study to co-design a social robot with children to bring about long-term behavioural changes. As a case study, we focused our efforts to create a social robot to promote handwashing in community settings while adhering to minimalistic design principles. Since cultural views influence design preferences and technology acceptance, we selected forty children from different socio-economic backgrounds across India as informants for our design study. We asked the children to design paper mock-ups using pre-cut geometrical shapes to understand their mental models of such a robot. The children also shared their feedback on the eight resulting different conceptual designs of minimalistic caricatured social robots. Our findings show that children had varied expectations of the robot's emotional intelligence, interactions, and social roles even though it was being designed for a specific context of use. The children unequivocally liked and trusted anthropomorphized caricatured designs of everyday objects for the robot's morphology. Based on these findings, we present our recommendations for the physical and interaction features of a minimalist social robot assimilating the children's inputs and social robot design principles grounded in prior research. Future studies will examine the children's interactions with a built prototype.

The overlapping burden of the three leading causes of disability and death in sub-Saharan African children

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.

Enterobius Vermicularis Infections in Iraq

Enterobiasis continues to be among the highest parasitic infections affecting the human population worldwide. A study was conducted between 2011 - 2015 in Iraq to evaluate the enterobiasis reported by the Communicable Diseases Control Center (n=220,607 cases) in relation to demographic (age, sex, rural population and family size) and spatial variables (local and regional sources). Females were more parasitized than males, as well as children and youth ages 4 to 15. Approximately 40 % of cases are from the South region provinces (Thiqar, Miasan, Basrah and Wassit). However, most cases occurred in regions with high rural populations and a high family size average. The results may provide insights for researchers assessing management approaches to control enterobiasis in Iraq.

Hand washing practice among public primary school children and associated factors in Harar town, eastern Ethiopia: An institution-based cross-sectional study

Background

Hand washing with soap and water reduces the risk of diarrheal episode by 28-48% and acute respiratory infection by 20-50%. However, there is limited evidence on hand washing practices among students in Eastern Ethiopia, particularly in Harari town. Therefore, this study aimed to determine hand washing practice among primary school students and associated factors in Harar town, Eastern Ethiopia.

Methods

An institution-based cross-sectional study was applied among 670 students in Harar town from June 1 to 30, 2021. A multi-stage sampling was employed; 6 out of 20 schools were selected through simple random sampling, while eligible children from each school was selected by probability proportional to size sampling method. Data were collected using a pre-tested questionnaire with a face-to-face interview technique and via observation. The data were analyzed using SPSS software version 23. Binary and mult-variable analysis were used to determine the association between factors and outcome variable. Finally, a p-value of < 0.05 was considered to declare a statistically significant association.

Results

A total of 670 participants were included in the study, of which 248 (37.0%) had washed their hands [95% CI: 33.3-40.06]. Being in grade 8 Adjusted Odd Ratio[AOR = 4.9; 95% Confidence Interval (CI): 2.28-10.52], living in an urban area [AOR = 3.49; 95% CI: 1.29-9.40], having role models (parents [AOR = 4.41; 95% CI: 1.79-10.86], teachers [AOR = 3.69; 95% CI: 1.39-8.81], and health professionals [AOR = 3.17, 95% CI: 1.17-8.63]), availability of hand washing facility [AOR = 3.62; 95% CI: 1.57-8.34], access to soap and water [AOR = 2.89; 95% CI: 1.39-5.98] and being membership of water sanitation and hygiene (WASH) club [AOR = 2.39; 95% CI: 1.41-4.03] were found to be significantly associated with hand washing practice.

Conclusions

The current study found that nearly a third of students practiced proper hand washing. Hand washing practice was influenced by students' grade level, residence, referents (role models for hand washing), presence of a hand washing facility, access to water and soap, and membership of WASH club. Therefore, the finding revealed that there is a need to improve hand-washing practices in schools by concerned agencies.

Limited handwashing facility and associated factors in sub-Saharan Africa: pooled prevalence and multilevel analysis of 29 sub-Saharan Africa countries from demographic health survey data

Introduction

Handwashing is fundamentally an inexpensive means of reducing the spread of communicable diseases. In developing countries, many people die due to infectious diseases that could be prevented by proper hand hygiene. The recent coronavirus (COVID-19) pandemic is a threat to people who are living in resource-limited countries including sub-Saharan Africa (SSA). Effective hand hygiene requires sufficient water from reliable sources, preferably accessible on premises, and access to handwashing facility (water and or soap) that enable hygiene behaviors. Therefore, this study aims to determine the prevalence of limited handwashing facility and its associated factors in sub-Saharan Africa.

Methods

Data from the Demographic and Health Surveys (DHS) were used, which have been conducted in 29 sub-Saharan African countries since January 1, 2010. A two-stage stratified random cluster sampling strategy was used to collect the data. This study comprised a total of 237,983 weighted samples. The mixed effect logistic regression model with a cluster-level random intercept was fitted. Meta-analysis and sub-group analysis were performed to establish the pooled prevalence.

Results

The pooled prevalence of limited handwashing facility was found to be 66.16% (95% CI; 59.67%—72.65%). Based on the final model, household head with age group between 35 and 60 [AOR = 0.89, 95% CI; 0.86—0.91], households with mobile type of hand washing facility [AOR = 1.73, 95% CI; 1.70—1.77], unimproved sanitation facility [AOR = 1.58, 95% CI; 1.55—1.62], water access more than 30 min round trip [AOR = 1.16, 95% CI; 1.13—1.19], urban residential area [AOR = 2.08, 95% CI; 2.04—2.13], low media exposure [AOR = 1.47, 95% CI; 1.31—1.66], low educational level [AOR = 1.30, 95% CI; 1.14—1.48], low income level [AOR = 2.41, 95% CI; 2.33—2.49] as well as lower middle-income level [AOR = 2.10, 95% CI; 2.14—2.17] and households who had more than three children [AOR = 1.25, 95% CI; 1.20—1.31] were associated with having limited handwashing facility.

Conclusion and recommendation

The pooled coverage of limited handwashing facility was high in sub-Saharan Africa. Raising awareness of the community and promoting access to handwashing materials particularly in poorer and rural areas will reduce its coverage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14390-4.

The efficacy of soap against schistosome cercariae: A systematic review

BACKGROUND

Schistosomiasis is a parasitic disease that is endemic in 78 countries and affects almost 240 million people worldwide. It has been acknowledged that an integrated approach that goes beyond drug treatment is needed to achieve control and eventual elimination of the disease. Improving hygiene has been encouraged by World Health Organisation, and one aspect of good hygiene is using soap during water-contact activities, such as bathing and doing laundry. This hygiene practice might directly reduce the skin exposure to cercariae at transmission sites. A systematic review was carried out to investigate the efficacy of soap against schistosome cercariae and to identify the knowledge gaps surrounding this topic.

METHODOLOGY

Six online databases were searched between 5th and 8th July of 2021. Records returned from these databases were screened to remove duplicates, and the remaining records were classified by reading titles, abstracts, and full texts to identify the included studies. The results were categorised into two groups based on two different protective mechanisms of soap (namely, damage to cercariae and protection of skin).

CONCLUSIONS

Limited research has been conducted on the efficacy of soap against schistosome cercariae and only 11 studies met the criteria to be included in this review. The review demonstrates that soap has the potential of protecting people against schistosome cercariae and there are two protective aspects: (1) soap affects cercariae adversely; (2) soap on the skin prevents cercariae from penetrating the skin, developing into adult worms and producing eggs. Both aspects of protection were influenced by many factors, but the differences in the reported experimental conditions, such as the cercarial endpoint measurement used and the cercaria numbers used per water sample, lead to low comparability between the previous studies. This review indicates that more evidence is needed to inform hygiene advice for people living in schistosomiasis endemic areas.

Handwashing Practice among Elementary Schoolchildren in Urban Setting, Mongolia: A School-Based Cross-Sectional Survey

Objectives

Handwashing with soap is the simplest, most affordable, and cost-effective preventative intervention for reducing the burden of communicable diseases, including the COVID-19. This study was aimed at investigating elementary schoolchildren's handwashing practice at two critical moments, namely, before eating and after using the toilet and its associated factors.

Methods

The cross-sectional study was conducted at ten public secondary schools in Ulaanbaatar, Mongolia, between February and March 2019. Data were collected from all fifth-grade children's parents at the selected schools by using a self-reported questionnaire. Descriptive and multiple regression analyses were conducted using STATA/MP version 13.0.

Results

A total of 1507 parents/guardians of 5^th-grade school children participated. Reported schoolchildren's handwashing practice for both critical moments was 50.1%. It was significantly associated with female gender (adjusted odds ratio [AOR] = 0.56 (95%CI = 0.45, 0.70)), number of siblings (AOR = 0.72 (95%CI = 0.61, 0.80)), and availability of handwashing amenity at school (AOR = 1.1595%CI = 0.86, 1.42)). Only 34% of children wash their hands with soap at school, and the most common reasons for skipping handwashing were an absence of soap (23.9%), lack of sink (14.5%), and the use of hand sanitizer (19.7%).

Conclusions

The school children's handwashing practice at two critical moments is considerably low. The main disabling factors of regular handwashing at school included insufficient handwashing facility and soap. Therefore, promoting HW facilities and innovative and participatory education for elementary schoolchildren should be prioritized.

Diarrhoea, malnutrition, and dehydration associated with school water, sanitation, and hygiene in Metro Manila, Philippines: A cross-sectional study

INTRODUCTION

Diarrhoea, malnutrition, and dehydration threaten the lives of millions of children globally due to inadequate water, sanitation, and hygiene (WaSH). Our study aimed to identify environmental and behavioural risk factors of these health outcomes among schoolchildren in Metro Manila, Philippines.

MATERIALS AND METHODS

We analysed data from a multistage cluster sample of schoolchildren in grades 5, 6, 7, 9, and 10 (ages ~10-15 years old) to investigate WaSH facilities and hygiene practices. Outcomes were: self-reported diarrhoea, measured via questionnaire; observed malnutrition (stunting, undernutrition [underweight/thin and wasted/severely thin], over-nutrition [overweight and obese]), measured via anthropometry; dehydration, measured via urine specific gravity/urine test strips. We used multiple logistic regression to explore correlates.

RESULTS

We included 1558 students from 15 schools in three cities. Over 28% (421) of students had diarrhoea and 68% (956) were dehydrated. Over 15% (227) of students were stunted, ~9% (127) were undernourished, and >21% (321) were over-nourished. Diarrhoea was associated with poor handwashing, while dehydration was associated with the lack of water in school restrooms. Stunting was linked with not using the school restroom, the lack of water in school restrooms, and the lack of hygiene lessons in school. Undernutrition was associated with the lack of a school restroom cleaning policy. Risks of diarrhoea, stunting, and undernutrition decreased as the number of school restrooms increased. Risks of stunting and overnutrition decreased as the numbers of school toilets increased. Having more than seven handwashing basins was associated with decreased risk of dehydration.

DISCUSSION

Findings from our cross-sectional study cannot describe causation. We have found associations that suggest that school restroom cleaning policies, adequate water supply, improved handwashing, and hygiene education are needed to prevent disease. School-based WaSH interventions are recommended to provide water in school WaSH facilities, promote handwashing, and improve hygiene-related knowledge.

Adherence to Hand Hygiene among Nurses and Clinicians at Chiradzulu District Hospital, Southern Malawi

Healthcare associated infections (HAIs) are a burden in many countries especially low-income countries due to poor hand hygiene practices in the healthcare settings. Proper hand hygiene in the healthcare setting is an effective way of preventing and reducing HAIs, and is an integral component of infection prevention and control. The objective of this study was to determine adherence to hand hygiene guidelines and associated factors among nurses and clinicians. A quantitative cross-sectional study was conducted at Chiradzulu District Hospital (Malawi) where stratified random sampling was used to obtain the sample of 75 nurses and clinicians. Data were collected using self-administered questionnaires (n = 75), observation checklists (n = 7) and structured observations (n = 566). The study findings confirmed low adherence to hand hygiene practice among healthcare workers (HCWs) in Malawi. Overall, higher hand hygiene practices were reported than observed among nurses and clinicians in all the World Health Organization's (WHO) five critical moments of hand hygiene. This calls on the need for a combination of infrastructure, consumables (e.g., soap) and theory driven behavior change interventions to influence adoption of the recommended hand hygiene behaviors. However, such interventions should not include demographic factors (i.e., age, profession and ward) as they have been proven not to influence hand hygiene performance.

Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey

PURPOSE

To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey.

DESIGN AND METHODS

Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed.

RESULTS

A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors.

CONCLUSION

The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches.

PRACTICE IMPLICATION

The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants.

U can't touch this! Face touching behaviour whilst driving: implications for health, hygiene and human factors

Analysis of thirty-one hours of video-data documenting 36 experienced drivers highlighted the prevalence of face-touching, with 819 contacts identified (mean frequency: 26.4 face touches/hour (FT/h); mean duration: 3.9-seconds). Fewer face-touches occurred in high primary workload conditions (where additional physical/cognitive demands were placed on drivers), compared to low workload (4.4 and 26.1 FT/h, respectively). In 42.5% of touches (or 11.2 FT/h), mucous membrane contact was made, with fingertips (33.1%) and thumbs (35.6%) most commonly employed. Individual behaviours differed (ranging from 5.1 to 90.7 FT/h), but there were no significant differences identified between genders, age-groups or hand used. Results are of relevance from an epidemiological/hygiene perspective within the context of the COVID-19 pandemic (and can therefore inform the design of practical solutions and encourage behavioural change to reduce the risk of self-inoculation while driving), but they also help to elucidate how habitual human behaviours are imbricated with the routine accomplishment of tasks.

Prevalence of Intestinal Parasites among Immunocompromised Patients, Children, and Adults in Sana'a, Yemen

Intestinal parasite infection (IPI) is still a very important public health issue. The severity of the parasitic disease has been reported as a high infection in immunocompromised patients and children. Hence, this study aimed to investigate the prevalence of intestinal parasites among immunocompromised patients and children with various gastrointestinal system complications in Sana'a city, Yemen, with different variables, including genus and age, and explore the risk factors associated with parasitic intestinal infections. The study socioeconomic data and certain behavioral and environmental risk factors and stool samples were collected from immunocompromised adult and children's patients, including children (one to eight years old), pregnant women, diabetes mellitus patients, cancer patients, HIV patients, and older adults. Out of 436 fecal samples, the overall prevalence rate of IPIs among immunocompromised patients and children in Sana'a was 51.8%. In contrast, the rate of infection in children (26.1%) was higher than that in old patients (25.7%) and in females (38.5%) and higher than that in males (13.3%). The protozoa (44.5%) have been shown more than intestinal helminths (7.3%) in samples, and the most common intestinal protozoan was Giardia lamblia and Entamoeba histolytica (13.8% and 12.8%), respectively. The most common intestinal helminthiasis was Hymenolepis nana with 1.8%. Concluding that the rate of infection was high for several reasons, including lack of commitment to hygiene as not handwashing after using the toilet (88.9%), eating uncovered food (56.3%), poor sanitation as lack of water sources (59.5%), reduced health education, and presence of other family members infected by parasites (61.3%). Interventions are required to reduce intestinal parasites, including health education on personal hygiene for patients, increasing awareness, and improving the environment and healthcare system.

An index of access to essential infrastructure to identify where physical distancing is impossible

To identify areas at highest risk of infectious disease transmission in Africa, we develop a physical distancing index (PDI) based on the share of households without access to private toilets, water, space, transportation, and communication technology and weight it with population density. Our results highlight that in addition to improving health systems, countries across Africa, especially in the western part of Africa, need to address the lack of essential domestic infrastructure. Missing infrastructure prevents societies from limiting the spread of communicable diseases by undermining the effectiveness of governmental regulations on physical distancing. We also provide high-resolution risk maps that show which regions are most limited in protecting themselves. We find considerable spatial heterogeneity of the PDI within countries and show that it is highly correlated with detected COVID-19 cases. Governments could pay specific attention to these areas to target limited resources more precisely to prevent disease transmission.

Lack of private infrastructure remains a major challenge potentially hampering a societies’ ability to contain the transmission of communicable diseases. Areas at high risk in Africa are identified based on access to essential basic infrastructure.

Sense and Manner of WASH and Their Coalition With Disease and Nutritional Status of Under-five Children in Rural Bangladesh: A Cross-Sectional Study

This study aimed to assess the knowledge and practice of caregivers and their relationship to the disease and nutritional status of children under 5 years of age in rural areas of Sylhet, Bangladesh. A total of 110 households with at least a child aged 6 to 59 months were selected by simple random method from 10 rural communities of three Upazila of Sylhet from September 2019 to February 2020. Descriptive statistics were used to assess the "Water Access, Sanitation, and Hygiene" (WASH) knowledge and practice, and multivariate chi-square analyses were performed to assess associations among diseases and nutritional status with WASH following a structured questionnaire. The study found a significant association between WASH with childhood disease and nutritional status, and 65% of children were found to be in a diseased state and 35% of children were found in a no exposure of disease state within the last 6 months. The findings sketched that mother with poor WASH knowledge and practice was at greater risk for disease outbreaks, disease frequency, and duration. The highest incidence of diarrhea was 17% in children aged 12 to 23 months. A significant effect of WASH was also found in children's nutritional status, which was reflected in the ratio of stunted, underweight, and wasted children. Integrated convergent work focusing on providing clean water within the household, stopping open defecation, promoting handwashing, behavior change, and poverty alleviation is needed to improve the situation. Health, nutrition, and livelihood programs should be uninterrupted, and mothers or caregivers should be encouraged to participate in these programs.

Knowledge Level on Infection Control among Romanian Undergraduate and Postgraduate Dental Students

Background and Objectives: Infection control practices in dentistry should be continuously evaluated. The aim of the present study was to assess the knowledge of dental students from Iași, Romania about infection control in the dental office. Materials and Methods: Dental students and resident dentists attending the “Grigore T. Popa” University of Medicine and Pharmacy in Iași were randomly selected in accordance with ethical guidelines, and a cross-sectional, questionnaire-based online study was conducted. The questionnaire included 21 items about infection control in dentistry. A descriptive statistical analysis was performed, and the chi-square test was used for data comparison, with a cutoff point of 0.05 for statistical significance. Results: The study sample included 150 subjects (75.3% female and 24.7% male) with a mean age of 25.71 ± 4.54 years. Mode of infection transmission was known by 74% of the subjects, and 76% were aware of standard precautions, with significant differences by the year of study (p = 0.012, r = 0.002). A percentage of 20% of subjects knew the means of transmission of the hepatitis B virus (HBV) (p = 0.032, r = 0.166). Most of the subjects were not vaccinated against HBV (p = 0.002, r = −0.274). Notions of high-level disinfection and sterilization were confused by 19.5% of the subjects. Only 22% of the subjects knew the correct processing of handpieces (p = 0.048, r = −0.071). The sources of information were diverse for 64.66% of the respondents, while 31.33% of them used courses and seminars only. Conclusions: There is a need for improvement in the level of knowledge on infection control for both dental students and residents.

The potential impact of intensified community hand hygiene interventions on respiratory tract infections: a modelling study

Hand hygiene is among the most fundamental and widely used behavioural measures to reduce the person-to-person spread of human pathogens and its effectiveness as a community intervention is supported by evidence from randomized trials. However, a theoretical understanding of the relationship between hand hygiene frequency and change in risk of infection is lacking. Using a simple model-based framework for understanding the determinants of hand hygiene effectiveness in preventing viral respiratory tract infections, we show that a crucial, but overlooked, determinant of the relationship between hand hygiene frequency and risk of infection via indirect transmission is persistence of viable virus on hands. If persistence is short, as has been reported for influenza, hand-washing needs to be performed very frequently or immediately after hand contamination to substantially reduce the probability of infection. When viable virus survival is longer (e.g. in the presence of mucus or for some enveloped viruses) less frequent hand washing can substantially reduce the infection probability. Immediate hand washing after contamination is consistently more effective than at fixed-time intervals. Our study highlights that recommendations on hand hygiene should be tailored to persistence of viable virus on hands and that more detailed empirical investigations are needed to help optimize this key intervention.

Identifying gaps in hand hygiene practice to support tailored target audience messaging in Soweto: A cross-sectional community survey

Effective risk communication is essential for outbreak mitigation, as recently highlighted during the coronavirus disease 2019 (COVID-19) pandemic. Hand hygiene is one of the proposed public health interventions to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) acquisition and transmission along with social distancing, improved ventilation, environmental cleaning, and wearing of masks. Improving hand hygiene practices in the community requires an understanding of the socio-behavioural context. This cross-sectional community survey in Soweto identified gaps in hand hygiene, which can inform appropriate messaging at the community level. Only 42% of survey respondents practiced adequate hand hygiene. Tailored educational messaging should be targeted at young adults in particular, and the importance of soap for hand hygiene must be emphasised for all age groups. Risk communication should expand to focus on preventing multiple infectious diseases during and beyond the COVID-19 pandemic.

Ensemble Machine Learning Model to Predict the Waterborne Syndrome

The COVID-19 epidemic has highlighted the significance of sanitization and maintaining hygienic access to clean water to reduce mortality and morbidity cases worldwide. Diarrhea is one of the prevalent waterborne diseases caused due to contaminated water in many low-income countries with similar living conditions. According to the latest statistics from the World Health Organization (WHO), diarrhea is among the top five primary causes of death worldwide in low-income nations. The condition affects people in every age group due to a lack of proper water used for daily living. In this study, a stacking ensemble machine learning model was employed against traditional models to extract clinical knowledge for better understanding patients’ characteristics; disease prevalence; hygienic conditions; quality of water used for cooking, bathing, and toiletries; chemicals used; therapist’s medications; and symptoms that are reflected in the field study data. Results revealed that the ensemble model provides higher accuracy with 98.90% as part of training and testing phases when experimented against frequently used J48, Naïve Bayes, SVM, NN, PART, Random Forest, and Logistic Regression models. Managing outcomes of this research in the early stages could assist people in low-income countries to have a better lifestyle, fewer infections, and minimize expensive hospital visits.

The risk of water, sanitation and hygiene on diarrhea-related infant mortality in eastern Ethiopia: a population-based nested case-control

BACKGROUND

Diarrhea is still appeared to be as one of the leading global killers and disability-adjusted life-years lost, particularly in the infant and children. As per WHO, about 88% of diarrhea-related deaths are attributable to unsafe water, inadequate sanitation and insufficient hygiene, mainly in developing world. Thus, the main objective of this study was to find out the risk of such factors that contribute for diarrhea-related infant mortality in Eastern Ethiopia.

METHODS

This study employed community based unmatched nested case-control study design in Eastern Ethiopia. The cases were infants who died from diarrheal disease while controls were those who survived their first year of life from September, 2016 to August, 2018. A total of 305 study subjects (61 cases and 244 controls) were included in the study. Infants dying from diarrhea were compared to four neighborhood controls in terms of several risk components of Water, Sanitation and Hygiene. Data were collected from mothers/care takers of infants using pre-tested structured questionnaires, and entered onto CSpro version 5.1 and transform to SPSS version 23 to analyzed potential risk factors.

FINDINGS

Finding of this study revealed that the risk factors that found to be significantly associated with infant death from diarrhoea after adjustment for confounding variables included the age of mother with < 20 years old (P = 0.009, AOR: 0.01, 95% CI: 0.01, 0.47), unsafe drinking water storage (P = 0.013, AOR: 0.4, 95% CI: 0.18, 0.81), infants in households without point-of-use water treatment practices (P = 0.004, AOR: 0.21, 95% CI: 0.08, 0.61), households with unimproved sanitation (P = 0.050, AOR: 0.36, 95% CI: 0.13, 1.00), unsafe disposing of child feces (P = 0.014, AOR: 0.34, 95% CI: 0.15, 0.81), and improper management of solid waste (P = 0.003, AOR: 0.29, 95% CI: 0.13, 0.66). These exposure factors had lower risk for the contribution of infants dying from diarrhoea than those with their reference group in the study area. However, infants in households with improper management of liquid waste management showed strongly significant association which had three times more likely to occur diarrhea-related infant death (P = 0.010, AOR: 3.43, 95% CI: 1.34, 8.76). Similarly, infants whose mother/caretaker practiced hand washing with less critical time (one-two occasions) had three times greater risk to infant death from diarrhea than those who had practice more than three critical times of hand washing (P = 0.027, AOR: 3.04, 95% CI: 1.13, 8.17).

CONCLUSION

This study suggests that infants in households with improper management of liquid waste and hand washing practices with fewer occasions (one-two critical time) are a greater risk of getting a diarrhea-related infant death. Therefore, efforts should be made to ensure intervention taking such risk factors into consideration, typically in the infantile period.

Cross-Sectional Study to Evaluate Knowledge on Hand Hygiene in a Pandemic Context with SARS-CoV-2

Background and Objectives: The basis of any infection control program is hand hygiene (HH). The aim of this study was to investigate knowledge of HH among medical students. Materials and Methods: Students were randomly selected from two Romanian universities and a cross-sectional, questionnaire-based study was conducted between January and May 2021. The answers regarding demographic data and knowledge concerning the methods, the time and the antiseptics used for HH were collected. The selection of the study group was made according to selection criteria in accordance with ethical issues. A descriptive statistical analysis was performed, and a chi-square test was used for data comparison, with a cut-off point of 0.05 for statistical significance. Results: The results indicated that the attitude of the students towards the practice of HH improved significantly. Most students believe that simple HH can control infections. Significant differences were found by the year of study in terms of the hand surfaces included and recommended duration (p < 0.05). Conclusions: In conclusion, the study shows that most respondents have sufficient knowledge on HH, meaning that a higher compliance is required to control infections. The indicated reasons of non-compliance with HH are emergencies and other priorities.

Determinants of hand-hygiene practices in India: reflections from the 76th round National Sample Survey, 2018

This paper studies the differences and determinants of handwashing practices in India and identifies sections of the population with poor handwashing practices who are relatively more vulnerable during the COVID-19 pandemic. We have used the data from the recent National Sample Survey (NSS, 76th round) for India (2018). Bivariate and logistic regression analyses have been performed to predict the determinants of handwashing practices across states and socio-economic groups. Levels of education of the household head, Usual Monthly Per Capita Expenditure (UMPCE) of the household, access to water (other than drinking water) resources and sanitation facilities, and the availability of water with soap in and around latrines are major socio-economic and demographic factors that impact handwashing practices. Higher access to principal sources of water for drinking and other purposes, access to bathrooms and latrines with soap, and the availability of water in or around latrines increase the likelihood of handwashing among the people. Universal handwashing across different sections of the population will be effective to prevent further infection. The available data help us to identify the vulnerable sections of the population which are towards the lower end of the handwashing compliance spectrum. The policymakers can outline specific planning and strategy implementation for them.

A new measure of hygiene inequality applied to urban-rural comparison

Access to hygiene services remains one of the most urgent challenges facing countries, especially low-income ones. This has become much more critical in the current context of the COVID-19 pandemic. The WHO/UNICEF Joint Monitoring Program globally monitors access to hygiene service levels. As data are in three parts with a constant sum and a positive value, they are compositional data. Inequality is monitored in disaggregated data; in the urban-rural case, this is done through a simple difference between the urban and rural service levels. However, this simple form of calculation does not take into account the characteristics of the data, which can lead to erroneous interpretations of the results. Therefore, we propose an alternative measure of inequality that uses a ternary diagram and does not infringe on the data properties. The results of the new urban-rural inequality measure show spatial heterogeneity. The highest inequality occurs in Colombia, with a value of 37.1 percentage points, and the lowest in Turkmenistan, with a value of zero. Our results also show that 73 of the 76 countries evaluated have higher basic hygiene services in urban areas than in rural areas. This means that urban households have more availability of a handwashing facility on-premises with soap and water than rural households. Likewise, by subdividing the ternary diagram into ternary parcels, we could group and rank the countries based on hygiene service conditions in a hierarchical order using tripartite information. Finally, our study finds that a multivariate measure of inequality can be important for the public policies of the sector with a general vision, which underscores the value of making evidence-based decisions.

Water, Sanitation and Hygiene (WASH) in Japanese elementary schools: Current conditions and practices

BACKGROUND

Water, sanitation, and hygiene (WASH) is the foundation for preventing infectious diseases, as the current COVID-19 pandemic has shown. WASH is essential for school health, yet there have been very few papers published on WASH in Japanese schools. The objective of this review is to describe the current conditions and practices in Japanese elementary schools using an international framework for WASH in schools and identify implications for handwashing promotion in other areas.

METHODS

This research was based primarily on a literature review. Information on common WASH practices was also collected through an international workshop attended by school health experts.

RESULTS

There is a rigorous legal foundation for ensuring the physical infrastructure and quality control of a safe water supply in Japanese schools. Water quality is monitored regularly by Yogo teachers and school pharmacists. Strategic locations and an abundance of water supply infrastructure facilitate handwashing behavior. Hygiene promotion activities by Yogo teachers and student's health committees play a major role in increasing awareness, while health education classes provide minimal but necessary knowledge on handwashing with soap. Flush toilets are the standard, but there is still a demand for improvement of toilet facilities. Children's participation in daily cleaning of school toilets contributes to students understanding the importance of cleanliness.

CONCLUSIONS

Drawing from the Japanese example, WASH in schools' interventions are suggested to include laws and policies, a designated teacher, and children's participation to sustain both infrastructure and hygiene promotion.

OUP accepted manuscript

BACKGROUND

Diarrhoea is a leading cause of preventable childhood morbidity and mortality worldwide. Unfortunately, Pakistan has the third-highest burden of diarrhoea-related deaths in children <5 y of age. Therefore we aimed to evaluate factors associated with diarrhoea among Pakistani children.

METHODS

A retrospective 1:2 matched case-control study nested in a baseline cross-sectional survey was conducted from October to December 2018 in Taluka Kotri, a two-thirds urban locality in the Jamshoro district. Children between the ages of 0 and 23 months with a history of diarrhoea in the 2 weeks preceding the survey were labelled as cases. Age-matched controls were children without symptoms of diarrhoea. Univariate and multivariable conditional logistic regression was performed to identify diarrhoea-related factors.

RESULTS

A total of 1558 cases were matched with 3116 controls. Factors significantly associated with lower odds of diarrhoea in the multivariate analysis included increasing maternal age (odds ratio [OR] 0.78 [95% confidence interval {CI} 0.67 to 0.90]), breastfeeding (OR 0.77 [95% CI 0.66 to 0.90]), higher paternal education (OR 0.79 [95% CI 0.65 to 0.97]) and belonging to the rich (OR 0.66 [95% CI 0.54 to 0.80]) and richest quintiles (OR 0.54 [95% CI 0.44 to 0.66]).

CONCLUSIONS

This study identifies risk factors associated with diarrhoea in children <23 months of age, including younger maternal age, higher paternal education, not breastfeeding and poverty, which has implications for developing preventive programs and strategies that target populations with a higher risk of diarrhoea.

Poor Provision of Sanitary Facilities in Markets of Lusaka District Zambia

Background:

Although provision of sanitary facilities in workplaces is an important issue, very few studies have been undertaken in this regard.

Objective:

This study assessed the provision of sanitary facilities for market traders and their perceptions of the provided facilities in Lusaka district Zambia.

Methods:

A cross-sectional study of workplace observations in 12 randomly selected markets and interviews with 386 traders, conducted in Lusaka district.

Findings:

The study revealed that eleven of the twelve markets provided toilets, hand-washing and drying facilities, water, urinals, soap, and toilet paper. However, most of the markets did not comply with the Zambian laws in terms of the adequacy and privacy of facilities. One market did not have any of the listed facilities. Most traders perceived facilities to be unsatisfactory and used them only because of the lack of alternatives. Poor provision of sanitary facilities was observed at markets thus predisposing its workforce and trading population to multiple public health hazards.

Conclusions:

The findings of this study call for urgent investments in sanitary structures and surveillance systems to guarantee the safety of the population and to promote the health of market traders as well as the community at large.

The Role of Household Flooring on Childhood Diarrhea Among Children 0 to 23 Months of Age in Ethiopia: A Nationally Representative Cross-Sectional Study Using a Multi-Level Mixed Effect Analysis

INTRODUCTION

Household flooring has been associated with diarrhea, but few studies have examined the association between childhood diarrhea and type of household flooring considering the individual and community level characteristics. We aimed to determine if household flooring was associated with childhood diarrhea among children 0 to 23 months of age in Ethiopia.

METHODS

Data from the fourth round of the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 is used to carry out the analysis. The EDHS was large, cross-sectional by design and nationally representative. In the current analysis, we included children 0 to 23 months of age (n = 4552) with their mother and 636 community clusters. To get information about the occurrence of diarrhea, mothers/caregivers were asked, "Has (NAME) had diarrhea in the last 2 weeks?" The response to this question was recorded as, "yes" or "no." A multilevel binary logistic regression model was fitted to identify factors associated with childhood diarrhea.

RESULTS

The overall prevalence of diarrhea among children 0 to 23 months of age in Ethiopia was 15.5% (95% CI [confidence interval] 14.4-16.5). No association was found between childhood diarrhea and type of household flooring (adjusted odds ratio [AOR] 1.05, 95% CI 0.59-1.88). The adjusted odds also showed that the age of the child, having an acute respiratory infection (ARI), and size of the child at birth were associated with diarrhea.

CONCLUSION

We found no association between childhood diarrhea and the type of household flooring. Further research with strong research design is needed to determine the effect of household flooring on childhood diarrhea.

COVID-19 Lesson for Respiratory Syncytial Virus (RSV): Hygiene Works

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTIs) in infants worldwide. The global direct medical cost associated with RSV LRTIs reaches billions of dollars, with the highest burden in low–middle-income countries. Many efforts have been devoted to improving its prevention and management, including both non-pharmaceutical and pharmaceutical strategies, often with limited routine use in high-income countries due to high costs. During the ongoing COVID-19 pandemic, a dramatic decrease in RSV infections (up to 70–90%) has been reported around the globe, directly related to the implementation of containment measures (face masks, hand hygiene, and social distancing). Primary prevention has demonstrated the highest cost effectiveness ratio in reducing the burden of a respiratory infection such as RSV, never reached before. Thus, we emphasize the importance of non-pharmaceutical preventive hygiene measures that should be implemented and maintained even after the COVID-19 outbreak.

Cost-effectiveness of a weaning food safety and hygiene programme in rural Gambia

OBJECTIVE

The main objective of the economic evaluation was to determine the cost-effectiveness of a weaning food safety and hygiene programme in reducing rates of diarrhoea compared with the control in rural Gambia.

METHODS

The public health intervention, using critical control points and motivational drivers, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up. An economic evaluation was undertaken alongside the RCT with data collected prospectively from a societal perspective. Decision-analytic modelling was used to explore cost-effectiveness over a longer time period (4 years).

RESULTS

Direct out-of-pocket healthcare expenditure for households due to diarrhoea was large. The intervention significantly reduced reported childhood diarrhoeal episodes after 6 months (incident risk ratio = 0.40, 95% CI 0.33, 0.49) and 2 years after the intervention (incident risk ratio = 0.68, 95% CI 0.46, 1.02). The within-trial analysis found that the intervention led to total savings of 8064 dalasi 6 months after the intervention and 4224 dalasi 2 years after the intervention. Based on the model results, if the intervention is successful in maintaining the reduction in the risk of diarrhoea, the ICER is US$ 814 per DALY avoided over 4 years. This is cost-effective.

CONCLUSIONS

This study suggests that there are substantial household costs associated with diarrhoeal episodes in children. The within-trial analysis and model results suggest that the community-based approach to improving weaning food hygiene and safety is likely to be cost-effective compared with control.