Hygiene behaviour and health attitudes in African countries

The prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Vancomycin-resistant Staphylococcus aureus, identified as a "high priority antibiotic-resistant pathogen" by the World Health Organization, poses a significant threat to human health. This systematic review and meta-analysis aimed to estimate the pooled prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia.

METHODS

This systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported VRSA prevalence due to infection or carriage from human clinical specimens were extensively searched in bibliographic databases and grey literatures using entry terms and combination key words. Electronic databases like PubMed, Google Scholar, Wiley Online Library, African Journal Online, Scopus, Science Direct, Embase, and ResearchGate were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata version 14 software was used for statistical analysis. Forest plots using the random-effect model were used to compute the overall pooled prevalence of VRSA and for the subgroup analysis. Heterogeneity was assessed using Cochrane chi-square (I2) statistics. After publication bias was assessed using a funnel plot and Egger's test, trim & fill analysis was carried out. Furthermore, sensitivity analysis was done to assess the impact of a single study on pooled effect size.

RESULTS

Of the 735 studies identified, 31 studies that fulfilled the eligibility criteria were included for meta-analysis consisted of 14,966 study participants and 2,348 S. aureus isolates. The overall pooled prevalence of VRSA was 14.52% (95% CI: 11.59, 17.44). Significantly high level of heterogeneity was observed among studies (I2 = 93.0%, p < 0.001). The region-based subgroup analysis depicted highest pooled prevalence of 47.74% (95% CI: 17.79, 77.69) in Sidama region, followed by 14.82% (95% CI: 8.68, 19.88) in Amhara region, while Oromia region had the least pooled prevalence 8.07% (95% CI: 4.09, 12.06). The subgroup analysis based on AST methods depicted a significant variation in pooled prevalence of VRSA (6.3% (95% CI: 3.14, 9.43) for MIC-based methods, and 18.4% (95% CI: 14.03, 22.79) for disk diffusion AST method) which clearly showed that disk diffusion AST method overestimates the pooled VRSA prevalence. The total number of S. aureus isolates was found to be the responsible variable for the existence of heterogeneity among studies (p = 0.033).

CONCLUSION

This study showed an alarmingly high pooled prevalence of VRSA necessitating routine screening, appropriate antibiotic usage, and robust infection prevention measures to manage MRSA infections and control the emergence of drug resistance. Furthermore, mainly attributable to the overestimation of VRSA burden while using disk diffusion method, there is an urgent need to improve the methods to determine vancomycin resistance in Ethiopia and incorporate MIC-based VRSA detection methods in routine clinical laboratory tests, and efforts should be directed at improving it nationally.

TRIAL REGISTRATION

PROSPERO registration identification number: CRD42023422043.

Mask-Wearing and Handwashing Behaviors of Chinese Rural Residents during the Pandemic of COVID-19: A Cross-Sectional Survey

OBJECTIVE

To understand mask-wearing and handwashing behaviors of Chinese rural residents during the COVID-19 pandemic and to analyze the associated factors.

METHODS

This study used a multi-stage random sampling method to conduct a cross-sectional questionnaire survey during the period of July to December of 2021, in six counties located in Shandong, Shanxi, and Yunnan provinces representing the eastern, central, and western regions of China, respectively. A total of 3864 villagers were surveyed with a questionnaire, and 3832 valid questionnaires were finally analyzed. Descriptive statistics and logistic regression analysis were used for statistical analysis.

RESULTS

Around ninety-four percent (93.6%) of rural residents reported mask-wearing during the COVID-19 pandemic, but only 44.5% of them could replace masks in time. Multivariate logistic regression analysis showed that those who were female, aged 15-59, had an education level of high school and above, were divorced/widowed, worked as farmers (workers), or were rural residents in Shandong Province were more likely to wear masks. Furthermore, those who were female, aged 15-59, had an education level of high school and above, were unmarried and married, were business and service workers, or were rural residents in Shandong and Shanxi Province replaced masks more timely. Around seventy percent (69.7%) of rural residents reported using soap when washing their hands, but only 38.0% of rural residents could wash their hands properly. Multivariate logistic regression analysis showed that rural residents who were aged 35-59, had an education of high school and above, or lived in Shandong Province and Shanxi Province were more likely to wash their hands with soap. Those who were aged 15-59, had an education of high school and above, worked as farmers (workers), were employees of governmental departments and retirees, were business and service workers, or were students had higher proper handwashing rates.

CONCLUSION

During the COVID-19 pandemic, the proportion of Chinese rural residents wearing masks reached 93.6%, but only 44.5% were able to replace masks in time, gender, age, education level, marital status, occupation, and living place had an impact on mask-wearing. The proportion of Chinese rural residents who could wash hands with soap reached 69.7%, but only 38.0% could wash their hands properly. Age and education level were influencing factors for both washing-hand with soap and proper handwashing.

Subjective selection and the evolution of complex culture

Why is culture the way it is? Here I argue that a major force shaping culture is subjective (cultural) selection, or the selective retention of cultural variants that people subjectively perceive as satisfying their goals. I show that people evaluate behaviors and beliefs according to how useful they are, especially for achieving goals. As they adopt and pass on those variants that seem best, they iteratively craft culture into increasingly effective-seeming forms. I argue that this process drives the development of many cumulatively complex cultural products, including effective technology, magic and ritual, aesthetic traditions, and institutions. I show that it can explain cultural dependencies, such as how certain beliefs create corresponding new practices, and I outline how it interacts with other cultural evolutionary processes. Cultural practices everywhere, from spears to shamanism, develop because people subjectively evaluate them to be effective means of satisfying regular goals.

Is the continued existence of diseases of poverty an indictment of our current humanitarian ethos?

The continued existence of diseases of poverty is one of the great medical moral dilemmas of the 21st century. That this group of largely either preventable or treatable diseases still plagues a great many of the world's poorest citizens is a challenging problem to address. This paper examines diseases of poverty not by looking at the pathogenic diseases themselves but by looking at the 'diseases' of society that lead to the prevalence of such morbidity. 'Diseases' such as lack of infrastructure, lack of nutrition, lack of education, lack of funding and lack of socioeconomic stability. By addressing each of these, in turn, this paper looks to stimulate thought on how society can approach and prevent diseases of poverty in the future.

COVID-19 and handwashing: Implications for water use in Sub-Saharan Africa

Because the main modes of transmission of the COVID-19 virus are respiration and contact, WHO recommends frequent washing of hands with soap under running water for at least 20 s. This article investigates how the level of concern about COVID-19 affects the likelihood of washing hands frequently in sub-Saharan Africa. We discuss the implication of the findings for water-scarce environment. The study makes use of a unique survey dataset from 12 sub-Saharan African countries collected in April 2020 (first round) and May 2020 (second round) and employs an extended ordered probit model with endogenous covariate. The results show that the level of concern about the spread of the virus increases the likelihood of washing hands with soap under running water for a minimum of 20 s at least five times a day. The increase in the probability of handwashing due to concern about COVID-19, ranges from 3% for Benin to 6.3% for South Africa. The results also show heterogeneous effects across gender- and age-groups, locality and various water sources. However, in Africa, the sustainability of the handwashing protocol could be threatened by the severe water scarcity that exists in the region. To sustain frequent handwashing, sub-Saharan Africa needs an effective strategy for water management and supply.

The Era of Coronavirus: Knowledge, Attitude, Practices, and Barriers to Hand Hygiene Among Makerere University Students and Katanga Community Residents

BACKGROUND

The Novel Coronavirus was declared as a pandemic by the WHO at the end of 2019. Proper hand hygiene was identified as one of the simplest most cost-effective Covid-19 control and prevention measures. It is therefore very important to identify gaps in the knowledge, attitude, and practices, and barriers regarding hand hygiene in the community.

METHODS

A descriptive cross-sectional study was conducted using a simple random sampling technique. An interviewer-guided questionnaire with questions on knowledge, attitude, practice, and barriers to hand hygiene was used in data collection. Collected data were analyzed using Microsoft office excel 2016 and STATA 15 software. A 95% confidence interval was used and statistical significance was P<0.05.

RESULTS

Only 88 (24.5%) of the participants had adequate knowledge of hand hygiene. 32.8% of the university students had adequate knowledge compared to 6.3% of the Katanga residents. The majority of 336 (93.6%) participants had a good attitude towards hand hygiene. University students had a significantly better knowledge of hand hygiene while Katanga slum residents had a slightly better attitude towards hand hygiene. Only 19.6% accomplished all the seven steps of handwashing. 38.4% of the participants were still greeting by handshaking. Of the participants, 60.1% noted lack of soap as a barrier to hand hygiene and 62.9% reported having more than three barriers to hand hygiene. Participants who had been taught handwashing were more likely to have better hand hygiene knowledge and practice.

CONCLUSION

There was an overall high proportion of participants with a low level of hand hygiene knowledge. There is a need for optimizing hand-hygiene practices through addressing the barriers and promoting public health education.

Clinical Dry Eye and Meibomian Gland Features Among Dry Eye Patients in Rural and Urban Ghana

Aim

To compare differences in clinical dry eye features and meibomian gland health status between dry eye patients from rural and urban populations in Ghana.

Methods

We examined 211 (rural=109, urban=102) participants with subjective dry eye symptoms. Tear film break -up time (TBUT), Schirmer’s test and ocular surface staining (OSS) were assessed. Symptoms were evaluated using the SPEED II questionnaire. Meibomian glands (MG) in the right eye upper (UL) and lower lids (LL) were imaged using a custom meibographer. MG area was determined by intensity threshold segmentation using Image J software. MG loss (MGL) was also graded based on Pult’s grading scheme. Mann–Whitney, Spearman correlation, chi-square and odds analyses were performed; p<0.05 was considered significant.

Results

Rural participants showed greater SPEED scores, reduced TBUT, and lower Schirmer scores, p <0.05. The proportion of rural participants with MGL were significantly more (82.3%) than urban participants (63.3%), p <0.05. They also showed greater MGL than urban participants, p <0.05. Chi-square test revealed significantly different meiboscale distributions (UL: χ²=13.58, LL: χ²=15.29) between the groups, p <0.05. Overall significant relationships were observed between MGL and age [r_s= 0.61], OSS [r_s= 0.35], TBUT [r_s= −0.52], and Schirmer scores [r_s= −0.40], p <0.05.

Conclusion

The data suggest that the participants from the rural population have worse dry eye and meibomian gland health status than those from the urban population. The significant relationships between the various clinical variables suggest important links between MGD and DED. Subtle differences in the everyday working and living environment could likely account for the differences in the severity of DED and MGD between the two groups. And considering the increased pattern of urbanization, industrialization and modernization and the related environmental effects in Africa, future longitudinal studies on specific environmental risk factors or mediators of DED and MGD are necessary to ascertain the MGD and DED situation in Ghana and Africa at large.

Efficacy of the SuperTowel®: An Alternative Hand-washing Product for Humanitarian Emergencies

Handwashing with soap reduces the transmission of diarrheal pathogens, but access to hand-washing facilities, water, and soap in humanitarian emergencies is limited. The SuperTowel^® (ST) is a fabric treated with permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The aim of this study was to test the efficacy of the ST as a hand-cleaning product. Two sets of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of different prototypes of the ST. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the ST and handwashing with the reference soap, using a crossover design. Participants also completed a questionnaire about product perceptions. Three of the prototypes of the ST were more efficacious at removing E. coli from pre-contaminated hands than handwashing with soap (mean log₁₀ reduction of 4.11 ± 0.47 for ST1, 3.84 ± 0.61 for ST2, and 3.71 ± 0.67 for ST3 versus 3.01 ± 0.63 for soap [P < 0.001, P = 0.002, and P = 0.005, respectively]). The ST prototypes used less water than handwashing with soap, were well accepted, and were considered preferable in communal settings. The ST has the potential to be a suitable complementary hand-cleaning product for humanitarian emergencies.

Knowledge, Attitudes, and Practices Related to Schistosomiasis Among Children in Northern Senegal

BACKGROUND

Schistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection.

OBJECTIVES

The aim of this study was to investigate the knowledge attitudes, and practices related to schistosomiasis among schoolchildren in 2 rural villages in Northern Senegal and to evaluate their impact on the disease.

METHODS

A cross-sectional study was conducted. Data about children's knowledge of schistosomiasis, behavior, and preventive measures were collected through a questionnaire.

FINDINGS

Questionnaire responses from 575 schoolchildren were analyzed. Correct answers about risky behavior for schistosomiasis were associated with early symptoms (P = 0.010). Wearing shoes and washing hands with soap were associated with not having hematuria and dysuria (P = 0.007 and 0.049, respectively). Playing in rivers was associated with the aforementioned symptoms (P < 0.001). Children who had good knowledge of schistosomiasis reportedly did not have symptoms (P = 0.002). A logistic regression model showed that female sex (odds ratio = 0.35; P = 0.01) and attending a primary school (odds ratio = 0.13; P < 0.001) were significant predictors of a lower risk of the early symptoms of urinary schistosomiasis.

CONCLUSIONS

This study revealed that the level of knowledge among children in North Senegal about the causes, transmission, prevention, and treatment of schistosomiasis warrants implementing educational intervention.

Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana

In low-income countries, rapid urbanization adds pressure to already stressed water and sanitation systems that are critical to the health of communities. Drainage networks, designed for stormwater but commonly used for disposing of waste, are rarely covered completely, allowing residents to easily come into contact with their contents. This study used spatial mapping, documentation of physical drain characteristics, microbiological analysis of drain samples, and behavioral observation to comprehensively examine drains as a route of exposure to fecal contamination in four low-income neighborhoods in Accra, Ghana. A stochastic model of six likely exposure scenarios was constructed to estimate children's exposure to drain water. Regardless of the age of the child, any exposure scenario considered resulted in exposure to a high level of fecal contamination. Fecal contamination levels in drains were high (Escherichia coli: geometric mean (GM), 8.60 cfu log(10)/100 mL; coliphage: GM, 5.56 pfu log(10)/100 mL), and did not differ by neighborhood or physical drain characteristics, indicating that frequency of contact with drains, and not drain type or location, drives exposure risk. To mitigate health risks associated with this exposure, drains should be covered, with priority given to large concrete and small to medium dirt-lined drains that children were most commonly observed entering.

Health education in primary school textbooks in iran in school year 2010-2011

OBJECTIVES

Health education in schools is one of the most effective ways of promoting health in a society. Studies have shown the effectiveness of health interventions aimed at improving students' knowledge, attitude, and behaviors about health issues. The aim of this study was to evaluate health issues in primary school textbooks in Iran.

MATERIALS AND METHODS

In school year 2010-2011, the contents of all primary school textbooks in Iran were assessed in accordance to their health-related teachings. Health lessons of these 27 textbooks in the form of picture and text were retrieved and analyzed using content analysis method.

RESULTS

In total, 502 health-related lessons were found. The textbooks of the third grade contained the highest (144) and those of the fourth grade had the lowest (26) number of health lessons. Among health-related issues, the largest number (87) of lessons were about personal hygiene, while prevention of high risk behaviors comprised the least number (8). Some important health issues such as nutrition, oral health, and prevention of high-risk behaviors were not adequately discussed in the textbooks.

CONCLUSION

The potential of primary school textbooks in delivering health messages has been neglected in Iran. Taking the critical importance of school ages into account, incorporating health issues in textbooks should be more strongly emphasized.

New curriculum in dentistry for Tanzania: competency-based education for patient and population health (2008-2011)

From 2008 to 2011, the School of Dentistry at Muhimbili University of Health and Allied Sciences in Tanzania revised and then initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. As an increasing body of research demonstrates the detrimental effects of oral diseases on health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dentistry education grows. We describe the population oral health problems in Tanzania, the need to enhance the dental workforce, and the process of curricular reform to meet these needs. This reform included transition to a competency-based curriculum featuring teaching methods that will enhance the effectiveness of the education and performance of graduates in traditional and new roles. We conclude with lessons for Tanzania and for health professions educational institutions elsewhere, as well as for public health-care planners concerned about linking health professions education to improving population health in resource-poor countries.