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Pooseesod K, Umezaki M, Phetrak A, Phuanukoonnon S. Handwashing among caregivers of young children in a protracted and complex refugee and immigration context: a mixed methods study on the Thai-Myanmar border. Front Public Health 2023; 11:1099831. [PMID: 37583886 PMCID: PMC10423810 DOI: 10.3389/fpubh.2023.1099831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Protracted refugee situations create complex contexts that present significant health risks for young children. Effective hand hygiene practices by caregivers can reduce respiratory infections and diarrhoeal disease, the two largest contributors to mortality among children between 1 month and 5 years of age. This study documented handwashing patterns and access to water, sanitation and hygiene (WASH) infrastructure among caregivers of young children living along the Thai-Myanmar border, one of the world's most protracted and complex refugee and immigration contexts. It also examined the association between handwashing and socio-demographic variables and captured participants' explanations for when and how hands are washed. The study broadened the scope of previous research by also including the large number of caregivers living outside formal camps. Methods Caregivers of children attending 11 preschools in Tak province, Thailand participated in a mixed-methods cross-sectional study. Quantitative questionnaire data (n = 384) were supplemented by a thematic analysis of data from in-depth interviews (n = 9). Results Fewer than half the caregivers reported routinely washing their hands before preparing meals or after using the latrine/toilet. Fewer than one-in-five routinely used soap in these situations. Interviewees explained that handwashing was only necessary when a substance could be felt or seen, in which case wiping with a cloth or a rinsing with water were sufficient to clean hands. However, their explanations also suggested some potential avenues for culturally appropriate and feasible interventions to improve hand hygiene. Conclusion The results confirmed previous research on the multi-dimensional barriers to good hand hygiene in protracted refugee situations and other low-resource settings. Additional investment to overcome shortages in the infrastructure necessary to support good hand hygiene and creative means of drawing on and developing human capital will be necessary to realize the potential hand hygiene holds for reducing ill-health and mortality among young children living in these contexts.
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Affiliation(s)
- Kasama Pooseesod
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Thailand
| | - Masahiro Umezaki
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Athit Phetrak
- Department of Human Ecology, Graduate School of Medical Sciences, University of Tokyo, Tokyo, Japan
| | - Suparat Phuanukoonnon
- Department of Human Ecology, Graduate School of Medical Sciences, University of Tokyo, Tokyo, Japan
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Thompson EE. Early COVID-19 Home-Based Care Knowledge and Efficacies: Comparing Ghanaian and US Respondents. JOURNAL OF HEALTH COMMUNICATION 2023:1-9. [PMID: 37154031 DOI: 10.1080/10810730.2023.2208080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Home-based care messages were part of behavioral modification interventions to mitigate COVID-19 spread early in the pandemic. What remains unclear is the types of home-based care knowledge people have and whether different kinds of home-based care knowledge influence a person's self-efficacy and response efficacy in managing mild cases. Using a cross-sectional online survey, this exploratory study investigated differences in biomedical and alternative knowledge about COVID-19 home-based care and their association with self and response efficacy from respondents in Ghana and the US. With a total sample of 736 made up of 50.3% from Ghana and 49.7% from the US, the average age range was of 39-48 years. Sixty two percent were females and 38% males. Using chi-square goodness of fit tests, t-tests, and multiple regression for analysis, we found that US respondents had higher biomedical knowledge while Ghanaian respondents had higher alternative knowledge. Although self-efficacy and response efficacy were high in both countries, both kinds of knowledge did not independently improve respondents' self-efficacy or response efficacy. However, a combination of biomedical and alternative home-based care knowledge items predicted self and response efficacy. Health promoters need to consider ways of utilizing both knowledge types in a complimentary manner during disease outbreaks.
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Affiliation(s)
- Esi E Thompson
- The Media School, Indiana University, Bloomington, Indiana, USA
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Zambrana W, Tong J, E. Anderson C, B. Boehm A, Wolfe MK. Quantifying the Viral Reduction Achieved Using Ash and Sand as Handwashing Agents. Am J Trop Med Hyg 2023; 108:441-448. [PMID: 36535259 PMCID: PMC9896316 DOI: 10.4269/ajtmh.22-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
The WHO recommends handwashing with soap and water for 20-40 seconds. In settings where soap is not available, ash or sand is used for handwashing, yet their efficacy as handwashing materials is underresearched. The purpose of this study was to quantify the removal of viruses using ash and sand as handwashing agents, and compare their efficacy to commonly recommended handwashing methods. We performed a volunteer study to estimate the log reduction value (LRV) of model viruses Phi6 and MS2 on hands after six handwashing conditions: two handwashing agents (ash and water, and sand and water) with two time points (5 and 20 seconds), and two handwashing agents (soap and water, and water only) with one time point (20 seconds). Plaque assays were used to measure infectious virus reduction. Handwashing with any of the handwashing agents for 20 seconds resulted in a greater LRV than the 2-log reduction U.S. Food and Drug Administration criteria for both viruses. Soap and water resulted in a significantly greater LRV (2.7-4.8) than washing with ash and water (2.0-2.8) or sand and water (1.8-2.7) for 5 seconds for both viruses, and water only resulted in a significantly higher LRV (2.8) than all ash (2.0-2.6) and sand (1.8-2.4) conditions for MS2 only. These results suggest that using ash or sand as handwashing agents can be efficacious in reducing viruses but may be less efficacious than soap, especially when used for shorter durations. Further research should investigate the use of ash and sand as handwashing agents in real-world settings.
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Affiliation(s)
- Winnie Zambrana
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California
| | - Jingyan Tong
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California
| | - Claire E. Anderson
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California
| | - Alexandria B. Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California
| | - Marlene K. Wolfe
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Sarker AR, Zabeen I, Ali N, Ashraf A, Hossain Z. Inequality of handwashing practice using antimicrobial agents in Bangladesh: a household level analyses. Public Health 2023; 214:106-115. [PMID: 36549019 DOI: 10.1016/j.puhe.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES About 2.3 billion individuals worldwide are still deprived of the amenity of handwashing with antimicrobial agents. The progress of handwashing with antimicrobial agents in Bangladesh is relatively slower than in many developing countries. The objective of this study was to capture the inequality of the prevalence of handwashing with antimicrobial agents and to identify the factors that are potentially contributing to socio-economic inequalities of handwashing practice in Bangladesh. STUDY DESIGN Cross-sectional study. METHODS The present study used the nationally representative cross-sectional data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18. A total of 19,457 households were included in the analysis of this study. A regression-based decomposition method was applied to assess the socio-economic contributors of inequality. RESULTS This study showed that only 38% of Bangladeshi households wash their hands with antimicrobial agents while a pro-rich socio-economic inequality was observed. Household's wealth index was responsible for about 46% of the overall inequality of handwashing with antimicrobial agents while the type of place for handwashing variable contributed 38% of total inequalities. Hygienic toilet facilities (12%) and exposure to mass media (7.4%) are other determinants of total inequalities of handwashing with antimicrobial agents. CONCLUSIONS Despite recent declines in attributable mortality, handwashing with antimicrobial agents remains an important determinant of public health problems in many developing countries like Bangladesh. The regular programs aimed at promoting best hand hygiene practices and ensuring the availability of the necessary infrastructure at the community level will be important measures to eliminate this inequality at the population level.
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Affiliation(s)
- A R Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - I Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - N Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - A Ashraf
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - Z Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
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Rifat M, Talukdar IH, Lamichhane N, Atarodi V, Alam SS. Food safety knowledge and practices among food handlers in Bangladesh: A systematic review. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ahamad MG, Burbach M, Tanin F. Relationships Among Toilet Sharing, Water Source Locations, and Handwashing Places Without Observed Soap: A Cross-Sectional Study of the Richest Households in Bangladesh. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211060163. [PMID: 35173443 PMCID: PMC8842486 DOI: 10.1177/11786302211060163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND A high percentage of the richest households in Bangladesh lack soap at their handwashing places, a problem that is typically considered to be one of the poor. OBJECTIVE We investigated toilet sharing practices, locations of water sources, and relevant sociodemographic factors associated with the observed handwashing places that lack soap in the richest (ninth wealth decile) households in Bangladesh. METHODS We used data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS). Logistic regression technique was used to investigate how toilet sharing practices, water source locations, and different sociodemographic factors were associated with observed handwashing places without soap. RESULTS We found that 25.8% of the richest households were observed to have no soap at their handwashing places. Of these households, those that shared their toilets with another household were 4.6 times (95% CI 3.15-6.60) more likely to observe handwashing places without soap as compared with those that did not share their toilets. Further, the richest households were 4.2 times (95% CI 2.38-7.33) more likely to observe handwashing places without soap if they collected water from their own yard or plot, and 7.1 times (95% CI 3.61-13.97) more likely to observe handwashing places without soap if they collected water from elsewhere in comparison to the reference group that collected water from their own dwelling. CONCLUSION Sharing toilet with other households and location of main water source are associated with handwashing places without observed soap in the richest households in Bangladesh. These results can inform discussions of water availability and soap-handwashing-related policy and program development.
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Affiliation(s)
| | - Mark Burbach
- University of Nebraska–Lincoln, Lincoln, NE, USA
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PALO SUBRATAKUMAR, KANUNGO SRIKANTA, SAMAL MOUSUMI, PRIYADARSHINI SUBHADRA, SAHOO DEBADUTTA, PATI SANGHAMITRA. Water, Sanitation, and Hygiene (WaSH) practices and morbidity status in a rural community: findings from a cross-sectional study in Odisha, India. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E392-E398. [PMID: 34604579 PMCID: PMC8451357 DOI: 10.15167/2421-4248/jpmh2021.62.2.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/26/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Global evidence indicates an association between poor WaSH practice and inferior health outcomes. In rural areas, this practice is predominantly compromised with limited access to safe drinking water, knowledge gaps, and unhealthy socio-behavioural practices. Suboptimal WaSH practice leads to increased vulnerability of various infections, thereby posing a challenge to the primary health care system. METHODS A community based cross-sectional study was conducted among 879 participants of two villages in Tigiria block, Cuttack district, Odisha, India. Information pertaining to socio-demography, WaSH practices and self-reported morbidities were captured and analysed. Bi-variate analysis was done to assess the association between WaSH practices and any acute illnesses. Differences were considered statistically significant if p-value was less than 0.05. RESULTS Tube well was the main source of drinking water (49.3%) followed by dug well (46.6%). Only 7.1% of participants reported to purify drinking water and around 40% were still practicing open defecation. The prevalence of acute and chronic illnesses was 9.2% and 19.1% respectively. Major acute illnesses were respiratory diseases, diarrhoeal disorders, and musculoskeletal problems, while major chronic illnesses were gastrointestinal problems, musculoskeletal problems, and hypertension. After adjusting for age, gender, and education, a significant odds ratio of 3.79 [CI = (1.23-11.70)] was observed between drinking water source (surface water Vs tube well water) for acute illnesses. CONCLUSIONS Poor WaSH practices among rural people make them vulnerable to acute and chronic morbidities. Health awareness and socio behavioural changes pertaining to WaSH practices need utmost priority to ensure better health for rural people of Odisha.
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Affiliation(s)
- SUBRATA KUMAR PALO
- ICMR-RMRCBhubaneswar
- Correspondence: Subrata Kumar Palo, Scientist-D, ICMR-RMRC Bhubaneswar - E-mail:
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Pradhan MR, Mondal S. Pattern, predictors and clustering of handwashing practices in India. J Infect Prev 2020; 22:102-109. [PMID: 34239608 DOI: 10.1177/1757177420973754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Research on handwashing continues to draw researchers' interest owing to its public health importance and significance in the reduction of infectious diseases. The aims of this study are to: (1) understand the pattern and predictors of handwashing using soap/detergent and water; and (2) assess the spatial clustering of handwashing through soap/detergent and water at the district level in India. Methods Data of households where the place for handwashing was observed by the research investigators (n = 582,064), gathered through the National Family Health Survey-4 (2015-2016), were used for this analysis. The availability of soap/detergent and water at the usual place of handwashing was assumed to be used for handwashing. Binary logistic regression was carried out to examine the adjusted effect of socioeconomic characteristics on the use of soap/detergent and water for handwashing. The univariate local indicator of spatial association (LISA) cluster map and Moran's I statistics were applied for assessing spatial autocorrelations at the district level. Analyses were carried out with IBM-SPSS Software. Results Two-fifths of Indian households do not use both soap/detergent and water for handwashing. Households using both the cleansing elements vary considerably by socioeconomic characteristics- worse for the socioeconomically disadvantaged groups. There is spatial clustering in the use of soap/detergent and water for handwashing: lower in a cluster of districts in eastern India. Conclusion Results suggest the need to generate awareness, particularly among the socioeconomically weaker populations, about advantages of hand hygiene, which will reduce the prevalence of infectious diseases like COVID-19 and be helpful to achieve many Sustainable Development Goals.
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Affiliation(s)
- Manas Ranjan Pradhan
- Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
| | - Sourav Mondal
- International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
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Paludan-Müller AS, Boesen K, Klerings I, Jørgensen KJ, Munkholm K. Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd013571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Kim Boesen
- Nordic Cochrane Centre; Rigshospitalet; Copenhagen Denmark
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation; Danube University Krems; Krems Austria
| | | | - Klaus Munkholm
- Nordic Cochrane Centre; Rigshospitalet; Copenhagen Denmark
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Paludan-Müller AS, Boesen K, Klerings I, Jørgensen KJ, Munkholm K. Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review. Cochrane Database Syst Rev 2020; 4:CD013597. [PMID: 32343408 PMCID: PMC7192094 DOI: 10.1002/14651858.cd013597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Handwashing is important to reduce the spread and transmission of infectious disease. Ash, the residue from stoves and fires, is a material used for cleaning hands in settings where soap is not widely available. OBJECTIVES To assess the benefits and harms of hand cleaning with ash compared with hand cleaning using soap or other materials for reducing the spread of viral and bacterial infections. SEARCH METHODS On 26 March 2020 we searched CENTRAL, MEDLINE, Embase, WHO Global Index Medicus, and the WHO International Clinical Trials Registry Platform. SELECTION CRITERIA We included all types of studies, in any population, that examined hand cleaning with ash compared to hand cleaning with any other material. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and full texts, and one review author extracted outcome data and assessed risk of bias, which another review author double-checked. We used the ROBINS-I tool for observational studies, we used RoB 2.0 for three interventional studies, and we used GRADE to assess the certainty of the evidence. We planned to synthesise data with random-effects meta-analyses. Our prespecified outcome measures were overall mortality, number of cases of infections (as defined in the individual studies), severity of infectious disease, harms (as reported in the individual studies), and adherence. MAIN RESULTS We included 14 studies described in 19 records using eight different study designs, but only one randomised trial. The studies were primarily conducted in rural settings in low- and lower-middle-income countries. Six studies reported outcome data relevant to our review. A retrospective case-control study and a cohort study assessed diarrhoea in children under the age of five years and self-reported reproductive tract symptoms in women, respectively. It was very uncertain whether the rate of hospital contacts for moderate-to-severe diarrhoea in children differed between households that cleaned hands using ash compared with households cleaning hands using soap (RR 0.97, 95% CI 0.84 to 1.11; very low-certainty evidence). Similarly, it was very uncertain whether the rate of women experiencing symptoms of reproductive tract infection differed between women cleaning hands with ash compared with cleaning hands using soap (RR 0.48, 95% CI 0.12 to 1.86; very low-certainty evidence) or when compared with handwashing with water only or not washing hands (RR 0.50, 95% CI 0.13 to 1.96; very low-certainty evidence). Four studies reported on bacteriological counts after hand wash. We rated all four studies at high risk of bias, and we did not synthesise data due to methodological heterogeneity and unclear outcome reporting. AUTHORS' CONCLUSIONS Based on the available evidence, the benefits and harms of hand cleaning with ash compared with soap or other materials for reducing the spread of viral or bacterial infections are uncertain.
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Affiliation(s)
| | - Kim Boesen
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Klaus Munkholm
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
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Kivuti-Bitok LW, Chepchirchir A, Waithaka P, Ngune I. Dry Taps? A Synthesis of Alternative "Wash" Methods in the Absence of Water and Sanitizers in the Prevention of Coronavirus in Low-Resource Settings. J Prim Care Community Health 2020; 11:2150132720936858. [PMID: 32578477 PMCID: PMC7315655 DOI: 10.1177/2150132720936858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Social distancing and hand washing with soap and water have been advocated as the main proactive measures against the spread of coronavirus. We sought to find out what other alternative materials and methods would be used among populations without running water and who may not afford alcohol-based sanitizers. Results: We reviewed studies that reported use of sand, soil, ash, soda ash, seawater, alkaline materials, and sunlight as possible alternatives to handwashing with soap and water. We identified the documented mechanism of actions of these alternative wash methods on both inanimate surfaces and at cellular levels. The consideration of use of these alternative locally available in situations of unavailability of soap and water and alcohol-based sanitizers is timely in the face of coronavirus pandemic. Further randomized studies need to be carried out to evaluate the effectiveness of these alternatives in management of SARS-Cov-2.
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Affiliation(s)
| | | | | | - Irene Ngune
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western, Australia
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Nizame FA, Alam MU, Masud AA, Shoab AK, Opel A, Islam MK, Luby SP, Unicomb L. Hygiene in Restaurants and among Street Food Vendors in Bangladesh. Am J Trop Med Hyg 2019; 101:566-575. [PMID: 31333161 DOI: 10.4269/ajtmh.18-0896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Poor hand hygiene and food handling put consumers of restaurant and street food at risk of enteric disease, especially in low-income countries. This study aimed to collect hygiene indicators from a nationally representative sample of restaurants and street food vendors. The field team collected data from 50 rural villages and 50 urban administrative units (mahallas). We explored restaurant service staff, cook, and food vendor hygiene practices (N = 300 restaurants and 600 street food vendors), by observing hygiene facilities, food handling, and utensil cleaning. A qualitative assessment explored perceptions of hygiene related to food handling. During restaurant spot checks, 91% (273/300) had soap and water at handwashing location for customers but in only 33% (100) at locations convenient for restaurant staff. Among street food-vending stalls, 11% (68/600) had soap and water when observed. During 90-minute structured observations, cooks used soap to wash hands on 14/514 (3%) of occasions before food preparation, 6/82 (8%) occasions after cutting fish/meat/vegetables, 3/71 (4%) occasions before serving food, and 0/49 (0%) occasions) before hand-mashing food/salad preparation; no street food vendors washed hands with soap during these food-handling events. Most of the qualitative study participants perceived that customers select a vendor based on tastiness of the food, whereas no one mentioned the importance of food hygiene. The study demonstrates widespread poor hygiene and food-handling practices in restaurants and among food vendors. Based on our study findings, we proposed a food premises Hygiene Investigation Model to create action plans to improve food safety.
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Affiliation(s)
- Fosiul A Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbub U Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abdullah A Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abul K Shoab
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Wichaidit W, Biswas S, Begum F, Yeasmin F, Nizame FA, Najnin N, Leontsini E, Winch PJ, Unicomb L, Luby SP, Ram PK. Effectiveness of a large‐scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh. Trop Med Int Health 2019; 24:972-986. [DOI: 10.1111/tmi.13277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Wit Wichaidit
- Department of Epidemiology and Environmental Health State University of New York Buffalo NY USA
| | - Shwapon Biswas
- Johns Hopkins University Baltimore MD USA
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | - Farzana Begum
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | - Farzana Yeasmin
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | | | - Nusrat Najnin
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Elli Leontsini
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | | | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | | | - Pavani K. Ram
- Department of Epidemiology and Environmental Health State University of New York Buffalo NY USA
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Hossain S, Ahmed F, Hossain S, Sikder T. Nutritional Status and Basic Hygiene Practices of Rural School Age Children of Savar Region, Dhaka, Bangladesh. Cent Asian J Glob Health 2019; 7:282. [PMID: 30863662 PMCID: PMC6393051 DOI: 10.5195/cajgh.2018.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction School children in the developing countries are susceptible to nutrition related health problems due to demographic and socio-economic factors, as well as limited access to food. Since BMI is a common proxy measure used to evaluate nutritional status, the aim of this study was to investigate the BMI categories in school-aged children in Dhaka, Bangladesh. Methods A cross sectional study of 155 children, aged 6–12 years was conducted at Jahangirnagar University School in Dhaka, Bangladesh. The data collection was performed by in-person interviews and semi-structured questionnaires. Descriptive statistics, χ2 test, Fisher’s exact test, and One-Way ANOVA test were performed to compare the variables based on BMI percentiles. Data were analyzed using the Microsoft Excel program (version 2010). Results Mean BMI of the students was 17.27 (SD=3.16). The prevalence of underweight and overweight/obesity was 11.0% and 25.8%, respectively. Categories of BMI percentiles were associated with birth order (p=0.026), personal hygiene practices (washing hands after coming home from outside (p<0.001) and before meal (p=0.045)), brushing teeth (p<0.001), the number of food items consumed daily (p<0.001), and mothers’ occupation (p=0.006). In context of basic hygiene practice, 61.3 % of respondents washed hands after coming home from outside, and 93.5 % reported washing hands before the meals. Conclusions This study revealed that more than one third of the students had abnormal BMI. BMI screening in rural schools needs to be recommended in early grades for all children.
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Affiliation(s)
- Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Fahad Ahmed
- Department of Environmental Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Shakhaoat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
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Gadgil MA, Sharker Y, Unicomb L, Ram PK, Luby SP. Serial Measurements of Soap Weights and Soap Availability to Describe Handwashing Behavior. Am J Trop Med Hyg 2018; 99:899-904. [PMID: 30141393 DOI: 10.4269/ajtmh.17-0583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Available measures of handwashing are prone to bias. We tested the feasibility and reliability of weighing soap at repeated visits and subtracting the measured weight from the prior weight to assess daily per capita soap consumption in a low-income community in Dhaka, Bangladesh. Fieldworkers approached 220 households twice weekly over 2 months. They interviewed participants, weighed soap, and assessed hand cleanliness and the presence of a handwashing station. Respondents used bar soap (91% [201]) and laundry detergent cakes (39% [85]) for handwashing as well as for bathing and laundry. Ninety-eight percent of households had bar soap present on at least one visit, although only 50% had bar soap at every visit during the 2-month period. Fieldworkers observed a soap fragment on the wall near the latrine in 27% (470) of visits. Households consumed a mean 1.5 g of bar soap and 3.2 g detergent cake per person per day. Daily per capita soap consumption was similar in households visited by fieldworkers after different intervals (2, 3, 4, or 5 days). Soap consumption was not associated with household wealth, education of the household head, the presence of a handwashing station, the presence of water or soap at a handwashing station, or palm inspections of the mother or child. Soap weight measurements were an objective, reliable measure of soap consumption that provided different information from other handwashing indicators. The frequent use of a soap product for purposes other than handwashing complicates using soap consumption as a handwashing measure.
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Affiliation(s)
- Meghana A Gadgil
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.,Center for Innovation in Global Health, Stanford University, Stanford, California
| | - Yushuf Sharker
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pavani K Ram
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Stephen P Luby
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Center for Innovation in Global Health, Stanford University, Stanford, California
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Rahman MJ, Nizame FA, Unicomb L, Luby SP, Winch PJ. Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study. BMC Public Health 2017; 17:392. [PMID: 28476100 PMCID: PMC5420163 DOI: 10.1186/s12889-017-4307-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health programs commonly promote handwashing by drawing attention to potential fecal contamination in the environment. The underlying assumption is that the thought of fecal contamination will result in disgust, and motivate people to wash their hands with soap. However, this has not proven sufficient to achieve high rates of handwashing with soap at key times. We argue that handwashing with soap is influenced by broader range of antecedents, many unrelated to fecal contamination, that indicate to people when and where to wash their hands. This exploratory study aimed to identify and characterize this broader range of handwashing antecedents for use in future handwashing promotion efforts. METHODS First, an initial list of behavioral antecedents was elicited through unstructured interviews, focus group discussions and observation with residents, from a low-income community in Dhaka, Bangladesh, who were also recipients of a handwashing intervention. Then, photographs representing three categories of behavioral antecedents were taken: activities of daily living, visual or tactile sensations, and handwashing-related hardware and activities. Finally, the research team conducted ranking exercises with a new set of participants, from the same area, to assess the perceived importance of each antecedent illustrated by the photographs. The research team probed about perceptions regarding how and why that particular antecedent, represented by the photograph, influences handwashing behavior. RESULTS After coming out of the bathroom and dirt (moyla) on hands were the two antecedents that ranked highest. In all the categories, intervention-related antecedents (three key times for handwashing which included handwashing after coming out of the bathroom, after cleaning a child's anus and before food preparation; intervention provided items that included handwashing station, soapy water bottle, handwashing reminders from posters and community health provider visits) that were being promoted actively in this community were perceived favorably in the qualitative responses, but did not consistently rank higher than non-intervention items. However, many other antecedents were reported to influence when and where people wash their hands: cutting greasy fish, starting a meal, contact with oil and fat stuck to dishes, oil and lice from hair, sweat, unwashed vegetables, reminders from son and daughter or observing others wash hands, and observing the sunset. CONCLUSIONS Beyond well-recognized antecedents related to fecal contact and dirt on hands, we identified a broader set of antecedents not reported in the literature. Adopting a handwashing promotional strategy to highlight existing antecedents that people themselves have identified as important can help inform the content of an intervention that is more relatable and effective in increasing handwashing practices.
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Affiliation(s)
- Musarrat J Rahman
- International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Fosiul A Nizame
- International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Leanne Unicomb
- International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Peter J Winch
- Social and Behavioral Interventions (SBI) Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Ashraf S, Nizame FA, Islam M, Dutta NC, Yeasmin D, Akhter S, Abedin J, Winch PJ, Ram PK, Unicomb L, Leontsini E, Luby SP. Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. Am J Trop Med Hyg 2017; 96:421-429. [PMID: 28025233 PMCID: PMC5303048 DOI: 10.4269/ajtmh.16-0304] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/08/2016] [Indexed: 11/07/2022] Open
Abstract
We conducted a nonrandomized trial of strategies to promote soapy water for handwashing in rural Bangladesh and measured uptake. We enrolled households with children < 3 years for three progressively intensive study arms: promotion of soapy water (N = 120), soapy water promotion plus handwashing stations (N = 103), and soapy water promotion, stations plus detergent refills (N = 90); we also enrolled control households (N = 72). Our handwashing stations included tap-fitted buckets and soapy water bottles. Community promoters visited households and held community meetings to demonstrate soapy water preparation and promote handwashing at key times. Field workers measured uptake 4 months later. In-depth interviews and focus group discussions assessed factors associated with uptake. More households had soapy water at the handwashing place in progressively intensive arms: 18% (promotion), 60% (promotion plus station), and 71% (promotion, station with refills). Compared with the promotion-only arm, more households that received stations had soapy water at the primary handwashing station (44%, P ≤ 0.001; 71%, P < 0.001 with station plus detergent refill). Qualitative findings highlighted several dimensions that affected use: contextual (shared courtyard), psychosocial (perceived value), and technology dimensions (ease of use, convenience). Soapy water may increase habitual handwashing by addressing barriers of cost and availability of handwashing agents near water sources. Further research should inform optimal strategies to scale-up soapy water as a handwashing agent to study health impact.
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Affiliation(s)
- Sania Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fosiul A. Nizame
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahfuza Islam
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Notan C. Dutta
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dalia Yeasmin
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sadika Akhter
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jaynal Abedin
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pavani K. Ram
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Leanne Unicomb
- Enteric and Respiratory Disease Program, Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
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Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey. J Hosp Infect 2016; 94:286-294. [PMID: 27665311 PMCID: PMC5495692 DOI: 10.1016/j.jhin.2016.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. AIM To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. METHODS The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. FINDINGS More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). CONCLUSION Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities.
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Nizame FA, Leontsini E, Luby SP, Nuruzzaman M, Parveen S, Winch PJ, Ram PK, Unicomb L. Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions. Am J Trop Med Hyg 2016; 95:288-97. [PMID: 27296388 DOI: 10.4269/ajtmh.15-0377] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 04/14/2016] [Indexed: 11/07/2022] Open
Abstract
This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process. Food preparation was interrupted by tasks that could contaminate the preparers' hands, after which they continued food preparation without washing hands. Community members typically ate hand-mixed, uncooked mashed food and salad as accompaniments to curry and rice at meals. Hand-mixed dried foods were mostly consumed as a snack. Observers recorded handwashing during preparation of these foods. Among 24 observed caregivers, of 85 opportunities to wash hands with soap during food preparation, washing hands with soap occurred twice, both times after cutting fish, whereas washing hands with water alone was common. A simple and feasible approach is promotion of handwashing with soap upon entering and re-entering the food preparation area, and ensuring that everything needed for handwashing should be within easy reach.
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Affiliation(s)
- Fosiul A Nizame
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Elli Leontsini
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Md Nuruzzaman
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahana Parveen
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pavani K Ram
- University at Buffalo, State University of New York, Buffalo, New York
| | - Leanne Unicomb
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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20
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Shafique S, Sellen DW, Lou W, Jalal CS, Jolly SP, Zlotkin SH. Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh. Am J Clin Nutr 2016; 103:1357-69. [PMID: 27053383 DOI: 10.3945/ajcn.115.117770] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 03/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The causes of stunting are complex but likely include prenatal effects, inadequate postnatal nutrient intake, and recurrent infections. Low-birth-weight (LBW) infants are at high risk of stunting. More than 25% of live births in low- and middle-income countries are at full term with low birth weight (FT-LBW). Evidence on the efficacy of specific interventions to enhance growth in this vulnerable group remains scant. OBJECTIVE We investigated the independent and combined effects of a directed use of a water-based hand sanitizer (HS) and a mineral- and vitamin-enhanced micronutrient powder (MNP) (22 minerals and vitamins) to prevent infections and improve nutrient intake to reduce stunting in FT-LBW infants. DESIGN The study was a prospective 2 × 2 factorial, cluster-randomized trial in 467 FT-LBW infants during 2 periods: from 0 to 5 mo postpartum (0-180 d postpartum) and from 6 to 12 mo postpartum (181-360 d postpartum) with the use of 48 clusters. All groups received the same general nutrition, health, and hygiene education (NHHE) at enrollment and throughout the 12 mo. Group assignments initially included the following 2 groups: no HS (control) group or HS from 0 to 5 mo postpartum. These assignments were followed by further divisions into the following 4 groups from 6 to 12 mo postpartum: 1) no HS and no MNP (control), 2) HS only, 3) MNP only, and 4) HS and MNP. RESULTS When delivered in combination with NHHE, the use of an HS showed no additional benefit in reducing indicators of infection in the first or second half of infancy or the likelihood of stunting at 12 mo postpartum. FT-LBW infants who received the MNP (with or without the HS) were significantly less likely to be stunted at 12 mo than were controls (OR: 0.35; 95% CI: 0.15, 0.84; P = 0.017). CONCLUSIONS The use of a mineral- and vitamin-enhanced MNP significantly reduced stunting in FT-LBW infants in this high-risk setting. The use of a water-based HS did not have an additive effect. This trial was registered at clinicaltrials.gov as NCT01455636.
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Affiliation(s)
- Sohana Shafique
- Departments of Nutritional Sciences and Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and
| | - Daniel W Sellen
- Departments of Nutritional Sciences and Department of Anthropology, and Dalla Lana School of Public Health, University of Toronto, Toronto Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto Canada
| | | | - Saira P Jolly
- Research and Evaluation Division, BRAC, Dhaka, Bangladesh
| | - Stanley H Zlotkin
- Departments of Nutritional Sciences and Pediatrics, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and
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