Basic Hygiene Research Articles

A systematic review of nudges on hand hygiene against the spread of COVID-19

The COVID-19 pandemic has posed the greatest threat to global health over the last three years. Due to the temporary shortage of appropriate vaccines, a systematic change in human behaviour is necessary to keep the spread of the virus under control, increasing the quality of basic hygiene practices, such as systematic hand hygiene. Nudges are increasingly used in public health interventions to promote critical preventive hygiene behaviours. This review aimed to investigate the effect and the characteristics of nudges on hand hygiene, as a COVID-19 preventive measure. We systematically reviewed the relevant literature from January 2008 to November 2020. A total of 15 articles met the inclusion criteria. The findings of this review showed that most of the nudging interventions had a positive effect on hand hygiene. Nudges should be included in the existing and future public health interventions to prevent the spread of COVID-19 and future pandemics, rather than being an alternative and unconventional tool for public health policies.

The Influence of Clean Water Source, Knowledge, Attitudes and Actions of Mother’s Personal Hygiene on the Incidence of Diarrhea in Toddlers in Medan City 2023

Diarrhea is a health problem that globally contributes to the death rate of two billion children worldwide, WHO reports more than 525,000 cases in toddlers are caused by diarrhea. Riskesdas 2018 found that the prevalence of diarrhea among toddlers in Indonesia was 73,188 cases. Medan City in 2020 had 4,561 cases of diarrhea and in 2021 there were 18,588 cases of diarrhea in toddlers. To analyze the effect of clean water source, knowledge, attitudes and actions of mother’s personal hygiene on diarrhea in toddlers. The type of this research is a quantitative study with a cross sectional design. Data analysis used multiple logistic regression tests with a sample of 120 mothers with toddlers aged 2-5 years. The variables that had an effect on were the mother's knowledge (p=0.042) and actions (p=0.019) of personal hygiene on the incidence of toddler diarrhea. Meanwhile clean water (p=0.362) and attitudes (p=0.115) had not effect on the incidence of toddler diarrhea. The variable that has the most influence on the incidence of diarrhea in toddlers in Medan City is the mother's personal hygiene action which have the highest Exp.B value of 2,792. Knowledge and actions of mother’s personal hygiene had influence on the incidence of toddler diarrhea. Further action for officers to be able to carry out health promotion and education regarding basic sanitation and personal hygiene to mothers whose toddlers experience and do not experience.

Is Benin on track to reach universal household coverage of basic water, sanitation and hygiene services by 2030?

With the end of the Millennium Agenda, the United Nations Member States adopted the Sustainable Development Agenda in 2015. This new agenda identifies 17 Sustainable Development Goals (SDGs) and 169 targets for 2030, including Water, Sanitation and Hygiene (WASH). To study the evolution of household access to WASH services over the last two decades in Benin and make projections for 2030. In this study, secondary analyses were performed using the datasets of the Demographic and Health Surveys in Benin from 2001 to 2017-2018. The statistical unit was the household. The achievement of the WASH SDGs targets was monitored through the proportion of households using individual basic WASH services, the proportion of households using surface water for drinking, and the proportion of households practising open defecation. The study generated Annual Percentage Changes (APCs) for outcome variables. Based on the APCs between 2001 and 2017-2018, projections were made for 2030. From 2001 to 2017-2018, household access to individual basic WASH services increased from 50.54% to 63.98% (APC = +1.44%), 5.39% to 13.29% (APC = +5.62%), and 2.12% to 10.11% (APC = +9.92%), respectively. At the same time, the prevalence of surface water consumption and open defecation among households decreased from 10.54% to 5.84% (APC = -3.52%) and 67.03% to 53.91% (APC = -1.31%), respectively. If the trend observed between 2001 and 2017-2018 remains unchanged, the national coverage of households with basic individual WASH services would be 76.50%, 26.33% and 10.51%, respectively, by 2030. The prevalence of surface water consumption and open defecation among households would be 3.73% and 45.71%, respectively, by 2030. Benin achieved significant progress in household coverage of adequate WASH services over the last two decades. However, progress appears insufficient to achieve universal coverage of households with basic WASH services, and eliminate surface water consumption and open defecation by 2030. There is a need to strengthen research into the drivers of household access to adequate WASH services.

Impact investing in action: A framework for sustainability

The Sustainable Development Goals (SDGs) are a set of goals designed to be a “blueprint to achieve a better and more sustainable future for all.” Despite being meticulous about achieving the SDGs, India’s overall SDG score is 61.9 out of 100. While multiple models and frameworks have been developed, a new concept that has gained currency is impact investing. Content analysis of academic journal articles was employed to analyze the terminology, definition, and similarities and differences in the use of the term impact investing. Impact investing helps to benefit society and the environment without the need to sacrifice financial returns. It attempts to address the global challenges of access to energy, potable water, basic hygiene, nutrition, health, and education by exploring innovative commercial solutions. The degree of sustainability achieved through impact investing depends upon the efficiency of the multidisciplinary team formed to conduct the due diligence to achieve the social and financial goals by paying equal attention to risk, value addition, impact, and investor expectations. This study builds a case for India, suggesting the execution strategy of impact investing as an answer to India’s sustainability conundrum.

ASSOCIATIONS OF WATER, SANITATION, AND HYGIENE WITH TYPHOID FEVER IN CASE-CONTROL STUDIES: A SYSTEMATIC REVIEW AND META- ANALYSIS

Typhoid fever is a major public health issue in low- and middle-income countries. It is transmitted through fecally contaminated food or water and thus improving water, sanitation, and hygiene (WASH) is considered key to its control. We sought to quantify the association between WASH and typhoid fever. We updated a previous review by including new findings from the literature indexed in Web of Science, Embase, and PubMed. We kept the search terms, typhoid and case-control, consistent with the previous review. We assessed the risk of bias using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I). We categorized WASH exposures according to the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) classification. We conducted a Bayesian random-effects meta- analysis of odds ratios (ORs) extracted from the studies without a critical risk of bias. We identified 25 eligible articles including 19 articles from the previous review. Pooled ORs indicated limited hygiene (OR = 2.26, 95% CrI: 1.38 to 3.64), untreated water (OR = 2.21, 95% CrI: 1.53 to 3.48) and using surface water (OR = 2.16, 95% CrI: 1.24 to 3.60) increased odds of culture-confirmed typhoid fever. On the other hand, basic hygiene (OR = 0.6, 95% CrI: 0.38 to 0.97) and treated water (OR = 0.62, 95% CrI: 0.41 to 0.89) reduced odds of culture-confirmed typhoid fever. Our analyses updated quantitative evidence of association between WASH and typhoid fever. Our study findings will be useful to infer actionable insights on the most effective ways to control typhoid fever in low- and middle-income countries. Our analyses also offer a possibility to leverage JMP WASH data to explore potential burden of typhoid fever.

Sleep Disturbances in At-Risk Mental States and First Episode of Psychosis: A Narrative Review on Interventions.

Sleep disturbances are a common yet often overlooked symptom of psychosis that can drastically affect the quality of life and well-being of those living with the condition. Sleep disorders are common in people diagnosed with schizophrenia and have significant negative effects on the clinical course of the illness and the functional outcomes and quality of life of patients. There is a limited number of studies addressing this question in first-episode psychosis (FEP). In this narrative review, we aimed to provide an overview of sleep disorders in populations with FEP and at-risk mental states (ARMS). The review was focused on the various treatments currently used for sleep disorders, including both non-pharmacological and pharmacological treatments. A total of 48 studies were included. We found that sleep disturbances are associated with attenuated psychotic symptoms and other psychopathological symptoms in ARMSs. The association of sleep disturbances with the transition to psychosis has been poorly investigated. Sleep disturbances have an impact on the quality of life and the psychopathological symptoms of people suffering from FEP. The non-pharmacological treatments include cognitive behavioral therapy for insomnia, bright light therapy, cognitive restructuring techniques, sleep restriction therapy, basic sleep hygiene education, and the provision of portable sleep trackers. Other treatments include antipsychotics in acute phases and melatonin. The early intervention in sleep disturbances may improve overall prognosis in emerging psychosis populations.

Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa.

Sub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa. We carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child's status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression. The analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24-6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51-58.78), 28.18% (95% CI = 27.74-28.63), and 17.06% (95% CI = 16.71-17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04-1.16) or surface water (aOR = 1.11; 95% CI = 1.03-1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04-1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality. Interventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.

Personal hygiene:Knowledge, attitude, and practice among higher primary school children in Urban Bengaluru, India

Good hygiene practices is crucial to avoid the spread of communicable diseases, which can be taught to children from an early age. Children, especially school-going ones, tend to neglect basic personal hygiene and thus require specific attention to develop good habits. The aim of this study is to assess the personal hygiene knowledge, attitude, and practice of school children, as well as to examine the correlation between these three factors. Methods: A cross-sectional study was conducted with students in grades six to eight attending higher primary schools. Convenience sampling was used to select the schools, while purposive sampling was employed to select the potential participants. To assess the students' knowledge, attitudes, and practices regarding personal hygiene, a validated KAP questionnaire was used. The data collected were analysed using statistical tests such as Mann-Whitney U, Kruskal-Wallis, Spearman's correlation, as well as descriptive statistics such as mean, standard deviation, frequency, and percentage. Results: The study found that, almost half of the students (49.07%) displayed good knowledge regarding personal hygiene, while approximately (58.33%) held a positive attitude and (59.26%) had moderate practice regarding personal hygiene. The female students showed the highest median scores in terms of knowledge, attitude, and practice of personal hygiene. Furthermore, the study found that students' knowledge, attitude, and practice of personal hygiene increased as they progressed from sixth to eighth grade. Conclusion: The children displayed a moderate level of knowledge, attitude, and practice regarding personal hygiene and females demonstrating better personal hygiene than males.

Research on the Service Quality Improvement of Guilin Homestay Based on Online Bad Reviews

In the era of digital economy, customer online reviews are an important basis for measuring the service quality of homestays and a keyfactor influencingfuture consumer decisions. Taking Guilin homestay as an example, we collected online bad review texts on Ctrip.com, coded the content of online bad reviews in layers by applying the grounded theory method, and sorted out and summarized the model offactors influencing the service quality of Guilin homestay. The results show that among the main factors causing customer dissatisfaction, operation service is the core factor, facilities and equipment is the key factor, transportation location is the basic factor, and safety and hygiene is the guarantee factor. Based on this, countermeasure suggestions such as improving infrastructure, implementing standardized management, and attaching importance to tourism experience are proposed at both government and homestay levels in order to improve the service quality of Guilin homestay and help Guilin build into a world-class tourism city.

Hygiene of Dog keeping

The article provides data on the study of the norms and rules of keeping and feeding dogs in kennels and at home. Cynology as a science has developed in such a way that long before various scientific theories and justifications, there was practice and experience in breeding and keeping dogs. Over the centuries, hundreds of breeds adapted to his needs have been bred by man, and assessment methods and control standards for these breeds have been formed and developed in dog breeding communities. Breeding dogs is always inextricably linked with their full feeding, maintenance and care. So, a room intended for keeping dogs must meet basic hygiene requirements, not disrupt the normal course of life processes and not reduce its resistance to various diseases. Because with the wrong methods of growing, even from the most outstanding producers, it is impossible to get high-quality viable livestock.

Basic Hazard Control Plan for Small Wild Ungulates Slaughtered for Meat Production.

Animal slaughter plans and related activities must not increase the number of hazards in meat. In their nature, these processes must reduce possible hazards to minimum or acceptable levels. This is a generally accepted concept worldwide; hence, authorities continue to develop regulations that seek to mitigate the scourge of meat hazards for consumer protection. The situation is similar with small wild ungulate meat, in which a hazard analysis plan needs developing to improve meat safety. This investigation follows a narrative review of articles published for a PhD program and other scholarly articles supporting the concept of a basic slaughter plan for small wild ungulate animals in South Africa. The findings of this investigation highlight the need to control hazards within one health concept plan, which should be implemented and propagated by establishing forums that will drive meat safety solutions in these communities. There should be a basic hygiene slaughter plan developed and endorsed by all members of the forum. The outcome must be the control of microbiological, chemical and physical hazards from farm-to-fork, and as part of a system imbedded in game meat policies and regulations.

Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh

BackgroundThe School Nutrition for Adolescents Project (SNAP) provided weekly iron and folic acid (WIFA) supplementation and menstrual hygiene management (MHM) support for girls; actions to improve water, sanitation, and hygiene (WASH) practices; and behavior change interventions to adolescents aged 10–19 y in 65 intervention schools in 2 districts of Bangladesh. ObjectivesWe aimed to describe the project design and select baseline results of students and school project implementers. MethodsGirls (n = 2244) and boys (n = 773) in 74 schools (clusters) and project implementers [headteachers (n = 74), teachers (n = 96), and student leaders (n = 91)] participated in a survey assessing nutrition, MHM, and WASH knowledge and experience. Hemoglobin, inflammation-adjusted ferritin, retinol-binding protein, and serum and RBC folate (RBCF) levels in girls were measured. School WASH infrastructure was observed and drinking water was tested for E. coli. ResultsIFA and deworming tablet intake in the last 1 and 6 mo were 4% and 81% for girls and 1% and 86%, respectively. Applying the Minimum Dietary Diversity for Women (MDD-W) tool, most (63%–68%) girls and boys achieved minimum dietary diversity. Fewer adolescents (14%–52%) had ever heard of anemia, IFA tablets, or worm infestation than project implementers (47%–100%). Girls (35%) missed school during menstruation; 39% reported of ever leaving school due to unexpected menstruation. The micronutrient status and deficiency severity varied: anemia (25%), RBCF insufficiency (76%), risk of serum folate deficiency (10%), deficiencies of iron (9%), and vitamin A (3%). WASH in school sustainable development goal (SDG) indicators achievement varied: basic drinking water service (70%), basic sanitation service (42%), and basic hygiene service (3%); 59% of sampled drinking water access points complied with WHO E. coli standards. ConclusionsThere is room for improvement of nutrition and health awareness, practices, micronutrient status, SDG basic WASH in-school services, and E coli contamination in school drinking water.This trial was registered in clinicaltrials.gov as NCT05455073.

Characteristics and Components of the Cyber Hygiene as a Subclass of Cyber Security in Military Environment and Educational Issues

In the present study based on the main characteristics and components of the cyber hygiene as a subclass of the cyber security, educational challenges on the cyber hygiene in military area are considered. Based on institutional experience in the scope of the cyber security in the digital environment, a sequence of activities to keep resilient and reliable cyber hygiene in army organizations are analyzed and recommended. Definitions of basic cyber hygiene characteristics are suggested. Cyber hygiene software issues and institutional information security controls are discussed. A malware infection as main cyber hygiene concern is analyzed. Fundamental cyber hygiene instructions to ensure military Internet users and institutions stay protected are defined. Exemplary curriculum for education of military staff with basic themes is presented.

Quality of sleep among healthcare workers treating patients with coronavirus disease-19

IntroductionSince the declaration of the first Covid-19 case on December 08th ,2019, and to curb the spread of this pandemic, each country and notably Tunisia, has implemented a preventive strategy dominated by general lockdowns in accordance with social distancing and basic hygiene measures. These measures were not applicable in the health care sector as health care workers are at the forefront in the fight against COVID-19. This condition affects not only their physical health caused by elevated workload, but also their mental health causing anxiety, fear, and depression. Previous studies have reported that health care professionals feel stigmatized, experience high levels of anxiety and symptoms of depression, and have sleep problems. Impaired Quality of Sleep (QoS) can affect their efficiency in providing medical services and adequate psychological support for patients suffering from COVID-19.ObjectivesTo evaluate the QoS among health care professionals treating patients with COVID-19 and quantifying the symptoms of depression and levels of anxiety.MethodsA cross-sectional study was conducted in 75 health care professionals matched by age and sex working in public hospital Taher Sfar Mahdia. The study was based in a self administred, French language questionnaire containing three validated questionnaires: 7-item Generalized Anxiety Disorder (GAD-7) Scale, 9-items Patient Health Questionnaire (PHQ-9) Scale, Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study.ResultsHealthcare professional treating COVID-19 patients (Group I) group was predominately females mean aged of 32.67±7.04. The health professionals treating COVID-19 patients had poorer Quality of Sleep; Pittsburgh score 10.6 ± 742 vs 7.89 ± 6.14 in the group not treating COVID-19 patients ( p=0.001). Levels of anxiety and depression were significantly higher in the group I (respectively p=0.005 and 0.03). Multiple linear regression analysis revealed that higher scores on GAD (beta = .809, p < .01) and the lower one was the number of persons in charge (beta = –0.632; p < .01) were independent predictors of a poorer quality of sleepConclusionsThis study has revealed the heavy mental health burden health care professionals treating infected patients in Tunisia during the COVID-19 pandemic are exposed to. Providing early psychological support and a psychologically safe environment for these healthcare workers may alleviate their stress and, consequently, ameliorate their QoS. More attention should be devoted to their quality of sleep and work schedules. In many countries, online training, telehealth supports, behavioral group therapy, cognitive behavioral therapy, and mindfulness-based therapy have been deployed for frontier Healthcare workers and have proven effective in such circumstances.Disclosure of InterestNone Declared

Recent Advances on Chemically Functionalized Cellulose-Based Materials for Arsenic Removal in Wastewater: A Review

Clean water is very important for the good health of society. In South Africa, it is estimated that people need 20 to 50 litres of safe water daily for basic hygiene, drinking, and cooking. In recent times, water bodies have harboured harmful pollutants, including oil, heavy metal ions, and dyes. As a result, this has become a major global concern. Societies with limited clean water are often forced to utilise contaminated water or buy filtered water, which might be a problem for poor residents. The health consequences that are related to contaminated water include Guinea worm disease, dysentery, cholera, etc. The side effects associated with the utilisation of unclean water are gastrointestinal diseases such as cramps, vomiting, and diarrhoea. The wastewater disposed of by chemical industries contains toxic elements such as arsenic. Wastewater that is released directly without treatment causes serious damage to the environment. Chronic arsenic poisoning can lead to keratinisation of the skin and even cancer. Cellulose biomass materials have the potential to become the greatest bio-based materials used in wastewater treatment applications. There are two major reasons that validate this statement: firstly, cellulose is a low-cost material that is abundant in nature, and, secondly, cellulose is an environmentally friendly material. However, these are not the only reasons that validate cellulose as a good candidate for wastewater treatment applications. Cellulose has a unique structure a large surface area, good mechanical properties and is degradable, renewable, and biocompatible. Cellulose also has an abundance of hydroxyl groups on its surface. These hydroxyl functional groups allow cellulose to be chemically modified in various ways, which results in the fabrication of nanocomposites with tunable characteristics. Since arsenic pollution has become a serious global concern, this review uniquely provides a broad discussion of the work that has been accomplished recently on the fabrication of functionalised cellulose-based materials designed specifically for the removal of arsenic heavy metal species from wastewater treatment facilities. Furthermore, the functionalised cellulose materials’ arsenic adsorption capacities are also discussed. These adsorption capacities can reach up to a maximum of 350 mg/g, depending on the system used. Factors such as pH and temperature are discussed in relation to the adsorption of arsenic in wastewater. The removal of As(V) was found to be effective in the pH range of 3.0–8.8, with a removal efficiency of 95%. Moreover, the removal efficiency of As(III) was reported to be effective in the pH range of 6–9. However, the effective pH range also depends on the system used. The selective extraction of cellulose from various sources is also discussed in order to verify the percentage of cellulose in each source. Future work should be focused on how the chemical modification of cellulose affects the toxicity, efficiency, selectivity, and mechanical stability of cellulose materials. The use of cheaper and environmentally friendly chemicals during cellulose functionalisation should be considered.

Factors influencing access to basic water, sanitation, and hygiene (WASH) services in schools of Bishoftu Town, Ethiopia: a cross-sectional study

Access to basic water, sanitation and hygiene services is the most effective mechanism to reduce many infectious diseases. WASH in schools related to better educational outcomes although adequate water, sanitation, and hygiene services were unavailable to millions of school-age children in Ethiopia. Therefore, it is crucial to assess the level of WASH coverage and identify factors affecting access to basic water, sanitation, and hygiene services. A cross-sectional study was carried out among 82 school facilities. A structured questionnaire and an observational checklist were used to gather the data. Water samples were taken from the schools' water storage. Descriptive and multivariable logistic regression analyses were used to analyze the data. In this study, 74.7%, 61. 3% and 37.3% of the schools had access to basic drinking water, sanitation, and hygiene services, respectively. Additionally, 21.3%, 29.4%, and 30.7% of the schools had access to limited drinking water, sanitation, and hygiene services, respectively. However, 4%, 9.3%, and 32% of the schools lacked water, sanitation, and hygiene services, respectively. We discovered that schools with male heads were 7% less likely to have access to basic hygiene services (AOR = 0.07 with 95% CI 0.01–0.5) than those with female directors. In addition, schools with hygiene and environmental health clubs had an 11.8-fold higher access rate to basic hygiene services (AOR = 11.8 with 95% CI 1.35–104) than schools without such clubs. Besides, schools that conduct WASH lessons at least once a week were 8.63 times more likely to use basic hygiene services (AOR = 8.63; 95% CI 1.18–63.22) than schools that did not. This study offers scientific evidence that could be used for sound decisions to fill the school WASH gaps. This is a unique study in determining the level of WASH coverage and identifying factors affecting access to basic hygiene services. The investigation provides some insights into how access to WASH services can be improved at the grassroots level. Federal and regional governments should implement effective interventions that assist schools to attain Sustainable Development Goal 6 by 2030. School administrators and other partner organizations should take proactive measures to enhance and maintain the WASH services.

Knowledge, Attitude and Practices of Menstrual Hygiene Management among Orphan and Vulnerable Adolescents in Lagos State

Purpose: During adolescence, young people develop their adult identity, and move toward physical and psychological maturity. Puberty, marked by the onset of menarche, is recognized as an important stage, marking the transition from girlhood to womanhood. From this stage until menopause, reproductive health and basic menstrual hygiene practices are important aspects in their lives. The study examined the knowledge, attitude, and practices of menstrual hygiene management among orphan and vulnerable adolescents in Lagos State.
 Methodology: the study was cross sectional and used quantitative research methods. Semi-structured questionnaires were used to collect data from the female adolescent students aged 8-17 years. A total of 434 orphan and vulnerable female adolescents enrolled in the Integrated Child Health and Social Services Award (ICHSSA 2) project funded by USAID in Lagos State, Nigeria. The study was conducted across the 11 local government areas where the ICHSSA 2 project is being implemented. Adolescents were scored for their level of knowledge, attitude, and practices of menstrual hygiene management.
 Findings: the study found that the mean age at menarche is 12 years. Knowledge and menstruation about menstruation is appreciable. About 92% of the participants had knowledge about menstruation before experiencing it, Majority of the adolescent receive information on MHM first from their mother (62.7%) and 88.5% of the participants use sanitary pads using 3-4 pads per day. 94.5% of the participants have good Practices (WASH) of Menstrual Hygiene Management. Access to sanitary pads is challenging.
 Unique Contribution to Theory, Practice and Policy: Most of the orphans and vulnerable adolescent girls had good knowledge and practices of menstrual hygiene management. This demonstrates a need to design acceptable awareness creation and advocacy programs to improve the knowledge and promote safe hygiene practices of adolescent girls, in line with the SCT and KAP theory. Provision of MHM materials in schools and the inclusion of menstrual hygiene management into the school curriculum to achieve a near total coverage of safe hygiene practices among adolescent girls should also be prioritized as a matter of policy.

Living with a C2-Sacrum Spinal Fusion: Surgical Outcomes and Quality of Life in Patients Fused from C2 to the Sacrum.

Single center, retrospective cohort study. Little is known about the surgical outcomes and quality of life in patients with C2-sacrum posterior spinal fusion (PSF). Though it is thought to be a "final" construct, it remains unknown how patients fare postoperatively. We sought to evaluate the surgical outcomes and quality of life of patients after C2-sacrum PSF. Consecutive patients undergoing C2-Sacrum PSF from 2015-2020 by 4 surgeons at a single institution were included. The study time period for each patient began after their index operation that led to the C2-sacrum fusion. Dates of surgery, complications, reoperations, patient reported outcomes (PROs) including EuroQol 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) questionnaires, and activities of daily living (ADL) questions were collected and analyzed. Descriptive statistics, paired t-tests, student t-tests, and linear regression were used. Of the 23 patients who underwent C2-sacrum PSF, 6 patients (26%) required a total of 10 reoperations after a mean of 1.5years (range 0-4years) after C2-sacrum PSF. Five reoperations were for mechanical failure; 3 for wound complications/infection; and 2 for instrumentation and spinous process prominence. PROs were collected on 18 patients with mean follow-up of 2.4 years (range .5-4.5) after their C2-sacrum PSF. At 6-months, both SRS-22 and ODI scores improved significantly after C2-sacrum PSF (SRS: 57.5 to 76.3, P = .0014; ODI: 47.0 to 31.7, P = .013). Similarly, at a mean 2.4years postoperatively, mean ODI improved significantly (47.0 to 30.4, P = .0032). Six patients (33%) had minimal symptoms (ODI <20). The median postoperative EQ-5D score was .74 (range .19 to 1.0), which compares favorably to patients with hip/knee osteoarthritis (EQ-5D .63) and diabetes mellitus (DM) (EQ-5D .69) and hypertension (HTN). In terms of activities of daily living (ADL), 10 patients (56%) exercised regularly-a mean 4.5 days/week. 11 (61%) could do light aerobic activity (e.g. stationary bike). 10 (55%) were able to play with children/grandchildren as desired. Eight patients (44%) hiked, and 2 (11%) drove independently. 11 (61%) could tolerate short air-travel comfortably. Of the 17 patients who could toilet and perform basic hygiene preoperatively, 16 (94%) were able to do so postoperatively. Though C2-sacrum PSF is thought to be a "final" construct, approximately 1 in 4 patients require subsequent operations. However, C2-sacrum PSF patients had a significant improvement in SRS and ODI scores by 6 months postop. Over 60% of patients were regularly performing light aerobic activity 2years after their C2-sacrum PSF. EQ-5D suggests that this population fares better than those with degenerative hip/knee arthritis and similarly to those with common chronic conditions like DM and HTN.

The Status of School Water, Sanitation, and Hygiene Services in Addis Ababa, Ethiopia: Progress Towards Achieving the SDG 6.

The provision of safe water, sanitation, and hygiene (WASH) facilities and services for schools is vital to students' health, development, and educational performance. However, school WASH coverage in developing countries remains low. This study aimed to assess the adequacy of WASH services in Addis Ababa, Ethiopia. A school-based quantitative cross-sectional study was conducted from January to March 2020 in 98 schools. A multistage sampling technique was used to select schools included in the study. Data were collected using observational checklists and pretested interviewer-administered questionnaires. We entered the data into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. Logistic regression was used to examine the associated factors with school WASH services. The basic school water, sanitation, and hygiene services were found to be 65.3%, 31.6%, and 36.7%, respectively. The facility-to-student ratio was 1:48 for drinking water point, 1:59 for toilet stance, and 1:147 for handwashing point. The analysis of facilities access by sex revealed that the toilet to student ratio was 1:68 for females and 1:49 for males, whereas the handwashing point-to-student ratio was 1:179 for females and 1:114 for males, indicating disparities in facilities access by sex. The non-functionality rates for drinking water, toilets, and handwashing facilities were 22.5%, 8%, and 19.5%, respectively. School ownership was significantly associated with the availability of basic water services [COR = 4.6, 95% CI: 1.466-14.426] and basic sanitation services [COR = 15, 95% CI: 3.27-68.28]. Moreover, the results demonstrate training on WASH [COR = 5, 95% CI: 1.087-23.018] and teaching programs on WASH [COR = 0.21, 95% CI: 0.056-0.810] were significantly associated with basic hygiene services. The provision of WASH facilities and services in schools was inadequate and not on track to meet the targets of SDG 6. Training, WASH education program, and stakeholder commitment and cooperation at all levels are required to achieve the goal.

Progress toward alleviating preventable waterborne diseases over the past 30 years

Abstract Over the past several decades, there have been a number of national and international meetings on waterborne diseases. Conclusions from these meetings often seem remarkably similar and suggest little progress in the field of water and health. This is both a true and a false premise, as our ability to use molecular tools to describe microbial communities has advanced to the level at which whole genome sequencing is now a routine practice and can even be deployed in the field. This article seeks to illustrate both these advances and their limitations, especially for use in low-resourced settings. What remains clear is that for most of the world, basic hygiene and sanitation measures can do more for human health than any of our current advances in molecular biology. That is not to say that these advances are not remarkable and that they can undoubtedly revolutionize risk-based testing and surveillance. Although there are many factors that contribute to increased risks from waterborne diseases, climate change above all else is creating challenges that we are ill-prepared to meet. The biggest barrier to control of these diseases is not limitations in technology but has been and continues to be the lack of political will and economic incentives.