Visibility and transmission: complexities around promoting hand hygiene in young children - a qualitative study

The longitudinal effect of disseminating handwashing public health education to children in India via co-created, culturally relevant resources

Infectious diseases are a leading cause of death for children from low- and middle-income countries (LMICs), often due to inadequate hand-hygiene. This study evaluates culturally relevant educational resources as a vehicle to disseminate the importance of handwashing amongst children in India. Employing a participatory action research (PAR) model and mixed methods, this follow-up longitudinal study evaluates a set of innovate educational handwashing resources and workshops specifically co-created for use in the State of Gujarat, and how they aid teachers in the teaching of hand-hygiene over a 3 year period. Working alongside local NGOs on-the-ground, teacher questionnaires (n=58) and focus groups including a brief questionnaire with teachers (n=35) were conducted to assess the impact of trainer workshops. In addition, pre- and post-workshop worksheets were conducted with children (n=98). Percentage change was calculated between children's pre-and post-worksheet scores and a cumulative frequency of responses to each questionnaire criterion was measured. Data from the focus group found that the resources had been used in over 200 schools by more than 5000 children. In addition, 92.28 % of teachers said they would use the resources within their classrooms in India, with 58.16 % of pupils having an increased understanding of germs/handwashing directly after the workshop. Teachers reported that they are able to teach microbiology and handwashing more effectively. Furthermore, following a focus group, 100 % of teachers noted a reduction in childhood vomiting and diarrhoeal illnesses linked with insufficient hand-hygiene across 46 schools in the State of Gujarat since using the Germ's Journey resources.

Making Germs Visible - Assessing the Impact of a School-Based, Low-Cost Intervention on Hand Hygiene Knowledge, Attitude and Practice of Children in Rural India

Handwashing with soap at critical moments is one of the most important factors in controlling the spread of germs and preventing the spread of infection. The objective of this study was to determine the effectiveness of a low-cost, school-based intervention that simulated germs and their spread on hand hygiene knowledge, attitude and practice of primary school children. Five hundred and sixty-two students from 28 rural schools were enrolled in this pre-posttest study. Endline data was collected 4 weeks after conducting the intervention at baseline. The mean scores for knowledge, attitude and practice improved significantly after the intervention (p < .05). Significant positive gains were also observed in children's understanding of germs, the associated illness threat and washing hands with soap as a prevention mechanism. The present study suggests that entertainment-education-based interventions have the potential to improve hygiene behavior among children while being low-cost.

Hand hygiene knowledge and demonstrated technique among Malawian kindergarten children: A quasi-experimental study

AIM

To evaluate hand hygiene knowledge and demonstrated technique before and after implementation of the hand hygiene programme and its sustainability among Malawian kindergarten students.

DESIGN

Quasi-experimental design, utilizing a repeated measure at three points, namely, before intervention (T₀ ), soon after intervention (T₁ ) and follow-up (T₂ ).

METHODS

The hand hygiene programme consisted of integrating hand hygiene protocol into the school health curriculum, setting up proper handwashing facilities, training school teachers, health talks and developing reminders on hand hygiene. Fifty-three kindergarten children aged 3-6 years were enrolled in the programme. Data were collected at 3 months' intervals (T₀ , T₁ , and T₂ ). Parents, teachers, school authorities and children were involved in the implementation and evaluation of the intervention, utilizing a multilevel approach.

RESULTS

There was a significant difference in knowledge scores across three time points (T₀ , T₁ and T₂ ), Chi-Square (2, n = 53) = 79.02, p < 0.005 and handwashing technique across the three time points, Chi-Square (2, n = 53) = 88.04, p < 0.005. There was a large effect size of 0.62 on the effect of handwashing technique scores from T₀ to T_1.

The knowledge, attitudes and practices of hand, foot, and mouth disease prevention strategies amongst parents and educators of children under 5 years amidst COVID-19 pandemic: A cross-sectional study

Background

Hand, foot, and mouth disease (HFMD) is endemic in Singapore. Prevention efforts have been ramped up since major outbreaks in the early 2000's. This study aims to assess the current knowledge, and attitudes towards and practise (KAP) levels of HFMD prevention strategies (HFMD-PS) amongst parents and teachers of children under 5 years amidst the COVID-19 pandemic.

Methods and results

A convenience sample of 240 teachers and 404 parents responded to a self-administered standardised questionnaire between mid-October and December 2020. A scoring framework was used to assess responses in the 'knowledge', 'attitude', and 'practice' domains. A multivariable analysis was adjusted for ethnicity and attitudes towards getting children to follow proper handwashing steps and regularly disinfecting children's toys amongst parents, knowledge about HFMD's infectious period, and the responses to a child turning symptomatic in the childcare centre amongst teachers. Existing levels of knowledge and attitudes of parents and teachers were not high, and only a small proportion practised high levels of prevention measures (99 parents and 28 teachers). Key facilitators for a higher practise level in parents include the following: (1) awareness of regular liquid soap's efficacy as a disinfectant, (2) toy cleaning before and after playtime, and (3) the cleaning agent used for this practise. Teachers had no significant factors associated with higher practise levels.

Conclusion

This study suggested potential gaps between positive knowledge and attitudes towards prevention strategies and their actual adoption levels in homes and childcare centres during COVID-19 pandemic. These evidences suggest the importance of continuous promotion of HFMD prevention practise in homes and childcare centres, even amidst pandemics.

The Rapid Adaptation and Optimisation of a Digital Behaviour-Change Intervention to Reduce the Spread of COVID-19 in Schools

The rapid transmission of COVID-19 in school communities has been a major concern. To ensure that mitigation systems were in place and support was available, a digital intervention to encourage and facilitate infection-control behaviours was rapidly adapted and optimised for implementation as a whole-school intervention. Using the person-based approach, 'Germ Defence' was iteratively adapted, guided by relevant literature, co-production with Patient and Public Involvement representatives, and think-aloud interviews with forty-five school students, staff, and parents. Suggested infection-control behaviours deemed feasible and acceptable by the majority of participants included handwashing/hand-sanitising and wearing a face covering in certain contexts, such as crowded public spaces. Promoting a sense of collective responsibility was reported to increase motivation for the adoption of these behaviours. However, acceptability and willingness to implement recommended behaviours seemed to be influenced by participants' perceptions of risk. Barriers to the implementation of recommended behaviours in school and at home primarily related to childcare needs and physical space. We conclude that it was possible to rapidly adapt Germ Defence to provide an acceptable resource to help mitigate against infection transmission within and from school settings. Adapted content was considered acceptable, persuasive, and accessible.

Hygiene-related knowledge, attitude and practice: An imperative study among primary caregivers of the under three aboriginal children in Malaysia

BACKGROUND

Parental and caregivers' hygiene-related knowledge, attitude and practice are compelling factors in the prevention of stunting and malnutrition among the aboriginal children in Malaysia, which are highly modifiable. This study was conducted to explore the knowledge, attitude and practice related to hygiene among primary caregivers of the under three aboriginal (known as Orang Asli) children community in Malaysia.

METHODS

A total of 166 primary caregivers of the under three children of the aboriginal community in Kuala Langat district, Selangor were recruited. Data related to caregivers', child's and environmental factors were collected using a validated and reliable questionnaire, with knowledge, attitude and practice being the dependent variables. IBM Statistical Package for Social Science (SPSS) version 25.0 was used to analyse the data. Pearson's correlation was conducted to identify the relationship between continuous data. Multiple linear regression analysis was performed to determine the relationship between knowledge, attitude and practice related to hygiene, as well as the predictors.

RESULTS

The mean scores for knowledge, attitude and practice related to hygiene were 6.91 (2.12), 23.67 (3.16), 29.97 (3.55) and 43.05 (4.41), respectively. Significant moderate positive correlations were found between attitude and hygiene practice (r = 0.445, P < 0.001). Self-efficacy was significantly correlated with attitude (r = 0.442, P < 0.001) and practice (r = 0.557, P < 0.001), with every unit increase in self-efficacy will predict 0.281 and 0.536 increase in attitude (B = 0.281, 95% CI: 0.126-0.435) and practice (B = 0.536, 95% CI: 0.348-0.725) scores respectively.

CONCLUSION

Moderate mean scores for hygiene related knowledge, attitude and practice were observed in this study, with self-efficacy being a significant predictor for both hygiene-related attitude and practice but not knowledge. The self-efficacy of the caregivers should be sustained through continuous health education and counselling, to ensure improved hygiene practice. Future related research should consider the mediating role of self-efficacy on attitude and practice.

Establishing Healthy Personal Hygiene Habits with Young Children in Australia: A Cross-Sectional Mixed Methods Study

Effective and consistent engagement in personal hygiene practices is important for preventing the acquisition and transmission of communicable diseases in childhood. This study aimed to investigate trends in adherence to recommended hygiene practices and identify factors contributing to difficulties in establishing good hygiene habits with young children (0–4 years) in Australia. A self-selected community sample of parents (N = 426) completed an online survey assessing children's adherence to recommended hygiene practices and barriers and enablers of establishing good personal hygiene habits. Parents reported interest in receiving information/tips on children's personal hygiene (yes/no) and nominated topics of interest. Less than half of children in any age group consistently (always/almost always) covered coughs and sneezes, washed hands after toileting, or washed hands before meals or when dirty. Children's non-compliance (i.e. resistance, refusal) was the most commonly reported barrier to establishing good personal hygiene habits, while children's compliance (i.e. cooperative behaviour, following or complying with caregivers’ instructions) was the most commonly cited enabler. Despite low levels of adherence, less than half (41.2%) of parents wanted information/tips on children's hygiene. Results suggest a disconnect between parents’ knowledge about recommended hygiene practices and actual behaviour. Development and testing of approaches to behaviour change that incorporate evidence-based strategies to manage children's resistance and support parents to encourage the development of healthy hygiene habits is warranted.

Patient, family, and visitor hand hygiene knowledge, attitudes, and practices at pediatric and maternity hospitals: A descriptive study

BACKGROUND

Patient, family, and visitor hand hygiene can prevent health care-associated infections, but little is known about their hand hygiene knowledge, attitudes, and practices. We aimed to assess patient, family, and visitor hand hygiene knowledge, attitudes, and practices at a pediatric and maternity hospital in Vancouver, British Columbia, Canada.

METHODS

Surveys based on the Theoretical Domains Framework were distributed to patients, families, and visitors to provide cross-sectional qualitative and quantitative data. This was supplemented with covert observations by trained medical students to determine patient, family, and visitor hand hygiene rates.

RESULTS

Of 348 survey respondents, there was a clear preference for hand washing with soap and water over use of alcohol-based hand rub. Beliefs about consequences were the main driver for hand hygiene. Self-reported hand hygiene rates were higher than observed rates. The overall hand hygiene rate was observed to be 10.3% (72/701), with soap and water used for 75% of hand hygiene events.

CONCLUSION

There are misconceptions regarding hand hygiene practices and low hand hygiene rates among patients, families, and visitors. Development of interventions to improve hand hygiene should focus on correcting misconceptions and emphasizing consequences of failing to perform hand hygiene in the health care setting.

Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries

BACKGROUND

Public health measures to prevent, detect, and respond to events are essential to control public health risks, including infectious disease outbreaks, as highlighted in the International Health Regulations (IHR). In light of the outbreak of 2019 novel coronavirus disease (COVID-19), we aimed to review existing health security capacities against public health risks and events.

METHODS

We used 18 indicators from the IHR State Party Annual Reporting (SPAR) tool and associated data from national SPAR reports to develop five indices: (1) prevent, (2) detect, (3) respond, (4) enabling function, and (5) operational readiness. We used SPAR 2018 data for all of the indicators and categorised countries into five levels across the indices, in which level 1 indicated the lowest level of national capacity and level 5 the highest. We also analysed data at the regional level (using the six geographical WHO regions).

FINDINGS

Of 182 countries, 52 (28%) had prevent capacities at levels 1 or 2, and 60 (33%) had response capacities at levels 1 or 2. 81 (45%) countries had prevent capacities and 78 (43%) had response capacities at levels 4 or 5, indicating that these countries were operationally ready. 138 (76%) countries scored more highly in the detect index than in the other indices. 44 (24%) countries did not have an effective enabling function for public health risks and events, including infectious disease outbreaks (7 [4%] at level 1 and 37 [20%] at level 2). 102 (56%) countries had level 4 or level 5 enabling function capacities in place. 32 (18%) countries had low readiness (2 [1%] at level 1 and 30 [17%] at level 2), and 104 (57%) countries were operationally ready to prevent, detect, and control an outbreak of a novel infectious disease (66 [36%] at level 4 and 38 [21%] at level 5).

INTERPRETATION

Countries vary widely in terms of their capacity to prevent, detect, and respond to outbreaks. Half of all countries analysed have strong operational readiness capacities in place, which suggests that an effective response to potential health emergencies could be enabled, including to COVID-19. Findings from local risk assessments are needed to fully understand national readiness capacities in relation to COVID-19. Capacity building and collaboration between countries are needed to strengthen global readiness for outbreak control.

FUNDING

None.