Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya

Determinants of Handwashing at Critical Times Among Mothers/Caregivers of Children Under-Five Years Old: Panel Data Evidence From Rural Afghanistan

Background

Very few studies have used panel data regression models to estimate the determinants of handwashing with water and soap at critical times in a developing country.

Objective

To analyse the predictors of handwashing with water and soap at critical times among mother/caregivers of children under-5 years in rural Afghanistan.

Method

This study used data from 1208 mothers/caregivers of children under-5 years who were selected and interviewed at baseline and endline in 7 provinces using systematic probability proportional-to-size sampling method.

Results

Mother/caregivers with access to handwashing facility with water and soap had 1.20 higher odds of washing hands at 5 critical times. Treatment at public facility, an indirect proxy of health education and having children under 2 years was associated with 1.07 and 1.05 higher odds of washing hands at 5 critical times. Access to handwashing with water and soap, treatment at public facility and children under 2 years were significant and robust to alternative specification of handwashing at least 3 times. Mothers/caregivers who reported contracting infectious diseases in the past 6 months had 1.04- and 1.52-times higher odds of handwashing at 5 critical times and at least 3 times respectively.

Conclusion

Access to handwashing facility with water and soap, health education, children under 2 years and occurrence of infectious diseases were the predictors of appropriate handwashing behaviour. Therefore, there is need to improve the availability of handwashing facilities with clean water and soap to promote appropriate handwashing behaviour at critical times. In addition, there is need to promote activities that increase disposable income for households to purchase soap and handwashing facilities. There is need to promote healthcare seeking behaviour for mothers to access medical treatment and health hygiene education at public facilities vital for prevention of infectious diseases.

Knowledge and Behavioral Practice of Mothers About Childhood Diarrhea in Arar City, Saudi Arabia

BACKGROUND

Diarrhea is the second most significant cause of child morbidity and mortality, especially in developing countries. The World Health Organization (WHO) advises that mothers and other caregivers be able to recognize the symptoms of dehydration. Therefore, this study aimed to assess the knowledge and behavioral practices regarding diarrhea among mothers in Arar City, Saudi Arabia.

METHODS

This cross-sectional survey used an anonymous online questionnaire distributed among mothers of children aged one to five years in Arar City. The snowball convenient sampling method was used to recruit the participants. Information on knowledge and behavioral practices regarding diarrhea was obtained from the mothers of children through an electronic questionnaire. The Chi-square test and Fisher's exact test were used to evaluate the relationship between studied variables, as appropriate with statistical significance at P<0.05.

RESULTS

A total of 479 mothers participated in this survey. Of these, 421 were included in the analysis. Most mothers fall within the age range of 20-40 years (71.1%). A large sector of the studied mothers had high education (72.4%) and was a housewife (40.4%). Most children were above one year old (77.7%). Most participants (69.6%) fell into the moderate knowledge category and 56.3% had moderate behavioral practice scores. Maternal education was significantly associated with knowledge. Furthermore, maternal education and behavioral practice levels were significantly correlated (P < 0.01).

CONCLUSION

The findings highlight the importance of targeted education programs and community-based interventions to improve mothers' knowledge and promote appropriate behavioral practices related to childhood diarrhea that ultimately will lead to improved health outcomes for children globally.

Copula based trivariate spatial modeling of childhood illnesses in Western African countries

Acute respiratory infections (ARI), diarrhea, and fever are three common childhood illnesses, especially in sub-Saharan Africa. This study investigates the marginal and pairwise correlated effects of these diseases across Western African countries in a single analytical framework. Using data from nationally representative cross-sectional Demographic and Health Surveys, the study analyzed specific and correlated effects of each pair of childhood morbidity from ARI, diarrhea, and fever using copula regression models in fourteen contiguous Western African countries. Data concerning childhood demographic and socio-economic conditions were used as covariates. In this cross-sectional analysis of 152,125 children aged 0-59 months, the prevalence of ARI was 6.9%, diarrhea, 13.8%, and fever 19.6%. The results showed a positive correlation and geographical variation in the prevalence of the three illnesses across the study region. The estimated correlation and 95% confidence interval between diarrhea and fever is 0.431(0.300,0.539); diarrhea and ARI is 0.270(0.096,0.422); and fever and ARI is 0.502(0.350,0.614). The marginal and correlated spatial random effects reveal within-country spatial dependence. Source of water and access to electricity was significantly associated with any of the three illnesses, while television, birth order, and gender were associated with diarrhea or fever. The place of residence and access to newspapers were associated with fever or ARI. There was an increased likelihood of childhood ARI, diarrhea, and fever, which peaked at about ten months but decreased substantially thereafter. Mother's age was associated with a reduced likelihood of the three illnesses. The maps generated could be resourceful for area-specific policy-making to speed up mitigation processes.

Reduced Diarrhea Prevalence and Improvements in Handwashing with Soap and Stored Drinking Water Quality Associated with Diarrheal Disease Awareness Measured by Interactive Voice Response Messages in the CHoBI7 Mobile Health Program

The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) mobile health program promotes water, sanitation, and hygiene (WASH) behaviors through interactive voice response (IVR), voice, and text messages to reduce diarrheal diseases in Bangladesh. The objective of this study was to investigate the relationship between responses to CHoBI7 WASH IVR quiz messages and subsequent diarrhea and WASH behaviors. Fourteen CHoBI7 IVR quiz messages on handwashing with soap and treatment of stored water were sent to 517 households with 1,777 participants during the 12-month program period. IVR message responses were classified as correct answer, incorrect answer, no response (did not press 1 or 2), and failed (did not answer the phone). Diarrhea prevalence was assessed through self-reported monthly clinical surveillance visits. Handwashing with soap was assessed by a 5-hour structured observation, and stored water quality was defined by Escherichia coli concentration. Households that responded correctly to a CHoBI7 IVR quiz message had significantly lower odds of diarrhea for all age groups (adults and children) at the subsequent visit 1 month later (odds ratio [OR], 0.73; 95% CI, 0.54-0.98), and significantly greater odds of handwashing with soap after stool-related events (OR, 2.48; 95% CI, 1.12-5.49) and E. coli levels < 100 colony forming units (CFU)/100 mL (World Health Organization high-risk cutoff) in the stored household water (OR, 2.04; 95% CI, 1.25-3.33) compared with households that did not answer CHoBI7 IVR quiz calls. Correct responses to CHoBI7 IVR quizzes were associated with decreased diarrhea prevalence and improved stored drinking water quality and handwashing with soap behaviors at the subsequent visits. These findings suggest engagement in the CHoBI7 mobile health (mHealth) program and awareness of diarrheal disease prevention can reduce diarrhea and facilitate changes in WASH behaviors.

Toward mandatory health insurance in low-income countries? An analysis of claims data in Tanzania

Many low-income countries are in the process of scaling up health insurance with the goal of achieving universal coverage. However, little is known about the usage and financial sustainability of mandatory health insurance. This study analyzes 26 million claims submitted to the Tanzanian National Health Insurance Fund (NHIF), which covers two million public servants for whom public insurance is mandatory, to understand insurance usage patterns, cost drivers, and financial sustainability. We find that in 2016, half of policyholders used a health service within a single year, with an average annual cost of 33 US$ per policyholder. About 10% of the population was responsible for 80% of the health costs, and women, middle-age and middle-income groups had the highest costs. Out of 7390 health centers, only five health centers are responsible for 30% of total costs. Estimating the expected health expenditures for the entire population based on the NHIF cost structure, we find that for a sustainable national scale-up, policy makers will have to decide between reducing the health benefit package or increasing revenues. We also show that the cost structure of a mandatory insurance scheme in a low-income country differs substantially from high-income settings. Replication studies for other countries are warranted.

Microbiology and Epidemiology of Escherichia albertii—An Emerging Elusive Foodborne Pathogen

Escherichia albertii, a close relative of E. coli, is an emerging zoonotic foodborne pathogen associated with watery diarrhea mainly in children and immunocompromised individuals. E. albertii was initially classified as eae-positive Hafnia alvei, however, as more genetic and biochemical information became available it was reassigned to its current novel taxonomy. Its infections are common under conditions of poor hygiene with confirmed transmission via contaminated water and food, mainly poultry-based products. This pathogen has been isolated from various domestic and wild animals, with most isolates being derived from birds, implying that birds among other wild animals might act as its reservoir. Due to the absence of standardized isolation and identification protocols, E. albertii can be misidentified as other Enterobacteriaceae. Exploiting phenotypes such as its inability to ferment rhamnose and xylose and PCR assays targeting E. albertii-specific genes such as the cytolethal distending toxin and the DNA-binding transcriptional activator of cysteine biosynthesis encoding genes can be used to accurately identify this pathogen. Several gaps exist in our knowledge of E. albertii and need to be bridged. A deeper understanding of E. albertii epidemiology and physiology is required to allow the development of effective measures to control its transmission and infections. Overall, current data suggest that E. albertii might play a more significant role in global infectious diarrhea cases than previously assumed and is often overlooked or misidentified. Therefore, simple, and efficient diagnostic tools that cover E. albertii biodiversity are required for effective isolation and identification of this elusive agent of diarrhea.

How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

OBJECTIVE

To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.

DESIGN

Realist review.

DATA SOURCES

PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).

ANALYSIS

Inductive and deductive coding was used to generate context-mechanism-outcome configurations.

RESULTS

73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.

CONCLUSIONS

The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

A scoping review of current practices on community engagement in rural East Africa: Recommendations for snakebite envenoming

Community empowerment and engagement is one of the four strategic aims highlighted in the WHO strategy to prevent and control snakebite envenoming. Inappropriate health-seeking behaviours contribute to adverse outcomes, and community engagement is key in driving behavioural change. WHO has highlighted East Africa as a geographical area of concern for snakebite envenoming. The overall aim of the project is to develop a community engagement toolkit for snakebite envenoming and other NTDs. The objective of this scoping review was to identify current practices in recent community engagement in rural East Africa; the applicability of these results to snakebite envenoming are discussed. PubMed, Web of Science, PsycINFO and Google Scholar were searched from 1 January 2017 to 3 September 2020. Search terms were used to identify publications which related to rural communities and health or disease, for both humans and animals. After reviewing the full papers for all geographical areas, 112 publications were included, 30 of which were conducted in East Africa. Papers included nine different countries and covered a broad range of health topics; notably, water, sanitation and hygiene, nutrition, and maternal and child health. Only one publication considered animal health. The most common form of engagement was in the context of a group meeting, lecture, presentation, discussion or question and answer session (63.3%). A variety of locations within the community were used to engage with people, the most common being an individual's household (23.3%). Communication factors was the key influencer for engagement, both positively and negatively. Key barriers to engagement include local languages and health beliefs, literacy levels, mobile phone ownership and the level of mobile Internet coverage, burden of agricultural work and weather conditions. This study provides an extensive overview of recent public health community engagement in East Africa, which will serve as a useful resource for any group seeking to plan an intervention in remote and rural areas in East Africa. Furthermore, it serves as a guide to help tailor community engagement to snakebite envenoming.