Effectiveness of a large‐scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh

Evaluation of occupational health and safety intervention for the waste and sanitation workers in Bangladesh during COVID-19

Waste and sanitation workers in South-Asian countries are vulnerable to injuries and diseases, including COVID-19. In Bangladesh, an intervention was implemented during COVID-19 to lower these workers' occupational health risks through training and PPE distribution. We assessed how the intervention affected their occupational health behaviors using a randomized cluster trial in 10 Bangladeshi cities, including seven intervention and three control areas. We conducted 499 surveys (Control-152, Intervention-347) and 47 structured observations (Control:15, Intervention:32) at baseline and 499 surveys (Control:150, Intervention:349) and 50 structured observations (Control:15, Intervention:35) at endline. To evaluate the impact of intervention at the endline, we used the difference in difference (DID) method. Compared to control, workers from intervention areas were more likely to have increased knowledge of using/maintaining PPEs (adjusted DID: 21%, CI: 8, 33), major COVID-19 transmission causes (adjusted DID: 27%, CI: 14, 40), and preventive measures (adjusted DID: 12%, CI: -0.6, 25), and improved attitude about using PPEs (adjusted DID: 36%, CI: 22, 49), washing PPEs (adjusted DID: 20%, CI: 8, 32). The intervention was more likely to improve workers' self-reported practice of taking adequate precautions after getting back from work (adjusted DID: 37%, CI: 27, 47) and changing/cleaning masks every day (adjusted DID: 47%, CI: 0.03, 94), and observed practices of maintaining coughing etiquette (DID: 20%, CI: 0.2, 40) at workplace and handwashing before wearing PPEs (DID: 27%, CI: 2, 52), after finishing work (DID: 31%, CI: -7, 69) & during work intervals (DID: 30%, CI: -33, 93). There was not much improvement in observed practices of mask use (DID: 1%, CI: -40, 42), handwashing before meals (DID: 2%, CI: -61, 65), and after toilet (DID: 7%, CI: -41, 55). This intervention has improved the knowledge, attitude and practice of the workers about critical occupational risk mitigation, which may be replicated in similar settings. Future interventions need to address occupational health-related injuries and health complications, introduce regular health checkups/insurance for the workers, create a balance between the quality and comfort of the PPEs and ensure a mechanism to ensure a regular supply of PPEs.

Evaluating knowledge, awareness and associated water usage towards hand hygiene practices influenced by the current COVID-19 pandemic in Bangladesh

Hand hygiene is considered as one of the most effective ways for preventing transmissible diseases, especially for preventing virus-borne diseases. The study has been conducted to evaluate changes in knowledge, awareness and practices of hand hygiene due to the outbreak of the coronavirus disease (COVID-19) in Bangladesh. The potential factors influencing human behaviours for maintaining hand hygiene have also been explored. Moreover, a probable increase in daily water demand associated with the changed situation has been assessed. An online survey was performed among a total of 367 Bangladeshi residents about their practices of hand hygiene during pre-corona, corona, and of their perceived future practices at post-corona period. It has been observed that a significant percentage (62.1%) of the respondents have received basic hygiene education at any level of their academic education. Nevertheless, their hygiene practices were very poor before the COVID-19 pandemic. The outbreak of the COVID-19 has reinforced their previous knowledge and greatly influenced their behavioural changes towards practicing hand hygiene as per World Health Organization guidelines for preventing the virus outbreak. The changes, however, have created increased water demand. The estimated water usage is found to be 2.68 times (9.15 L/c/d) and 2.52 times (8.59 L/c/d) higher in the corona and post-corona period respectively than that of the pre-corona situation (3.41 L/c/d). The principal component analysis (PCA) elucidated that an individual's practice of hand hygiene was associated with income, level of academic and hygiene education, and the COVID-19 outbreak itself. Moreover, the influence of hygiene education and COVID-19 outbreak affecting the duration of handwashing are found highly significant (p-value < 0.001) from the regression analysis. Raising awareness towards behavioural change of an individual about water usage, improvement of academic curriculum regarding hand hygiene and provision of water pricing are recommended to attain sustainable development goals of the country.

Preparedness for and impact of COVID-19 on primary health care delivery in urban and rural Malawi: a mixed methods study

OBJECTIVE

Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers.

SETTING

Primary and maternal healthcare in Blantyre District, Malawi.

PARTICIPANTS

We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021.

RESULTS

Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19.

CONCLUSION

Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.

Frequency and patterns of exposure to live poultry and the potential risk of avian influenza transmission to humans in urban Bangladesh

Avian influenza is endemic in Bangladesh, where greater than 90% of poultry are marketed through live poultry markets (LPMs). We conducted a population-based cross-sectional mobile telephone survey in urban Dhaka, Bangladesh to investigate the frequency and patterns of human exposure to live poultry in LPMs and at home. Among 1047 urban residents surveyed, 74.2% (95% CI 70.9-77.2) reported exposure to live poultry in the past year, with the majority of exposure occurring on a weekly basis. While visiting LPMs was less common amongst females (40.3%, 95% CI 35.0-45.8) than males (58.9%, 95% CI 54.0-63.5), females reported greater poultry exposure through food preparation, including defeathering (13.2%, 95% CI 9.5-17.9) and eviscerating (14.8%, 95% CI 11.2-19.4) (p < 0.001). A large proportion of the urban population is frequently exposed to live poultry in a setting where avian influenza viruses are endemic in LPMs. There is thus not only ample opportunity for spillover of avian influenza infections into humans in Dhaka, Bangladesh, but also greater potential for viral reassortment which could generate novel strains with pandemic potential.

Measuring household hygiene access and handwashing behaviors: Findings from 14 low- and middle-income countries

Handwashing with soap (HWWS) is critical for preventing diarrheal and respiratory infections and is an important policy priority to achieve the Sustainable Development Goals (SDGs). We analyzed hygiene data from 36,860 household surveys from rural areas in India, Honduras, and twelve countries in sub-Saharan Africa (SSA). We report descriptive statistics and compare and critique three indicators: (1) access to basic hygiene services, defined as a reported designated handwashing area with observed water and soap at the time of the survey; (2) use of both soap and water during demonstrated handwashing; and (3) reported handwashing both after defecation and before preparing food. Overall, 10% of surveyed households (4% in SSA) had access to basic hygiene services and 48% of respondents (45% in SSA) used both soap and water during demonstrated handwashing. Inconsistencies between these indicators suggest no single indicator can provide a holistic picture of household hygiene; reporting on handwashing infrastructure alone may underestimate household access to soap and water and HWWS behaviors. Across the 14 countries, there was an average 22 percentage point (p.p.) gap (median 20 p.p.) in use of both water and soap during demonstrated handwashing between respondents in the wealthiest and poorest quintiles surveyed. This finding highlights the continued need to emphasize inclusivity aspects of the SDGs. Data around respondents' reported exposure to hygiene promotion showed that respondents rarely heard messaging about cleanliness from faith leaders, revealing an overlooked opportunity to empower faith leaders to promote handwashing in low- and middle-income countries.

Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: A hospital-based quasi-experimental study

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the postintervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.

Reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors: a 2020 online survey

COVID-19 pandemic currently affects nearly all countries and regions in the world. Washing hands, together with other preventive measures, to be considered one of the most important measures to prevent the disease. This study aimed to characterize reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors. Kobo Toolbox platform was used to design the online survey. There were 837 people participating in this survey. All independent variables were described by calculating frequencies and percentages. Univariate linear regression was used with a significant level of 0.05. Multiple linear regression was conducted to provide a theoretical model with collected predictors. Seventy-nine percent of the respondents used soap as the primary choice when washing their hands. Sixty percent of the participants washed their hands at all essential times, however, only 26.3% practiced washing their hands correctly, and only 28.4% washed their hands for at least 20 seconds. Although 92.1% washed hands after contacting with surfaces at public places (e.g., lifts, knob doors), only 66.3% practiced handwashing after removing masks. Females had better reported handwashing practices than male participants (OR = 1.88; 95% CI: 1.15–3.09). Better knowledge of handwashing contributed to improving reported handwashing practice (OR = 1.30; 95% CI: 1.20–1.41). Poorer handwashing practices were likely due, at least in part, to the COVID-19 pandemic information on the internet, social media, newspapers, and television. Although the number of people reported practicing their handwashing was rather high, only a quarter of them had corrected reported handwashing practices. Communication strategy on handwashing should emphasize on the minimum time required for handwashing as well as the six handwashing steps.