Abstract
BackgroundThe major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand.MethodsA case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews.ResultsTwo variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention.ConclusionsThe number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs.
Highlights
The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, those who are cared for at day care centers (DCCs)
A total of 109 DCCs were recruited into the study, 62 from areas with high HFMD case numbers and 47 from areas with low HFMD case numbers
Among the DCCs from areas with high HFMD case numbers, 56.5% were small in size (≤ 50 children), 56.5% had at least one hill tribe child, and 54.8% were located in urban fringe areas
Summary
The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, those who are cared for at day care centers (DCCs). HFMD has become a major public health threat, especially among people living in tropical zones [2]. People living in crowded places in rural areas with poor sanitation and hygiene conditions, including limited access to a sufficient water supply, are at a high risk for HFMD infection [3, 4]. In the nervous system, have been reported for HFMD patients [5]. All HFMD patients including those who present with mild and moderate symptoms, they must be properly observed and treated by a medical doctor to prevent death [6]. HFMD is caused by viruses, such as enterovirus A71 [7, 8] and coxsackievirus [9,10,11], a specific treatment is not available
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