Handwashing Station Research Articles

"Kuteteza": A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi.

The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. In response to early concerns about vulnerable older people in rural areas, we developed 'Kuteteza': a COVID-19 mitigation response project. Clinicians, public health professionals, and researchers collaborated with government and district-level staff in two Southern Malawi districts. Interventions included supported 'shielding' of older people - minimising social mixing whilst having their daily needs supported. Additional mitigation strategies included provision of masks, handwashing stations, and soap. Government partnerships allowed additional support for vulnerable groups. We present the findings of a realist project evaluation, assessing the feasibility of this approach. We collated anonymised descriptive data on Kuteteza procedures and conducted qualitative structured observations in villages involved in the initiative. We carried out three focus groups involving community members, frontline health staff, and volunteers in each setting. These provided deeper insights into experiences of the pandemic and impacts of the intervention, including suggested opportunities during future outbreaks. The project involved 25 villages across two districts, with 1,087 people over the age of 60 voluntarily participating in 'shielding'. Supplies of food, water, and cooking fuel were mostly arranged within the family. In Kuteteza villages, the handwashing stations and soap were widely used, and there was awareness and some observance of COVID-19 prevention measures. The project, including the provision of supplies, was greatly appreciated by communities, but wider contextual constraints - namely widespread economic insecurity - presented persisting challenges. Suggestions for improvement largely concerned project enhancements and extensions. Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project helped raise COVID-19 awareness and supported populations at a critical time in the pandemic. Kuteteza approaches were welcomed locally and may be incorporated in future epidemic responses. Supported 'shielding' should be paired with government-led measures to mitigate economic hardship.

Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic.

During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.

Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area

BackgroundHand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda.MethodsWe conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings.ResultsAbout 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies.ConclusionsThe study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees.Trial registrationISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.

An explanation of the stagnant under-5 mortality rate in Bangladesh using multilevel, multivariable analysis of three Demographic and Health Surveys

Despite remarkable success in the Millennium Development Goal era, Bangladesh experienced a sluggish reduction in the under-5 mortality rate (U5MR) between 2014 and 2017–18. Our study aimed to explain this stagnancy by examining the variation in the key predictor-specific mortality risks over time, using the Bangladesh Demographic and Health Survey 2011, 2014 and 2017–18 data. We applied multilevel mixed effects logistic regression to examine the extent to which the under-5 mortality (U5M) risks were associated with the key sociodemographic and health service-specific predictors. We found that the rise in mortality risks attributable to maternal age 18 years or below, low maternal education, mother’s overweight or obesity and the absence of a handwashing station within the household were the key contributors to the stagnant U5MR between 2014 and 2017–18. Poverty and low education aggravated the mortality risks. Besides, antenatal care (ANC) and postnatal care (PNC) did not impact U5M risks as significantly as expected. Compulsory use of ANC and PNC cards and strict monitoring of their use may improve the quality of these health services. Leveraging committees like the Upazila Hospital Management Committee can bring harmony to implementing policies and programmes in the sectors related to U5M.

Presence of SARS-CoV-2 in wastewater from handwash stations in selected facilities in Ghana

Presence of SARS-CoV-2 in wastewater from handwash stations in selected facilities in Ghana

Memelihara Kebersihan Tangan Mendukung Kesehatan Anak di SD Watdek Maluku Tenggara

Hands are exposed to many microorganisms because human activities are dominated by hands. Therefore, hands are the most common place to transmit disease. Maintaining hand hygiene means maintaining health. School age children are known to be very active, therefore they are susceptible to various infectious diseases. At the same time, school age is the right time to provide health education about maintaining health. Maintaining hand hygiene is a simple and easy way to do it but has a big impact, namely maintaining overall body health. The implementation of community service activities is based on health promotion. The activity stage is preparation with the school, while the implementation stage is providing health education followed by a demonstration and re-demonstration of the correct way to wash hands to students in grades 1 and 2 of Watdek Elementary School, Southeast Maluku. At the end of the activity, the service team handed over a poster of steps for washing hands to the teacher to be placed in each class near the hand washing station. Hopefully this activity can build the habit of maintaining hand hygiene which will be implemented at all times by students at Watdek Elementary School, Southeast Maluku, to support their health

Impact of In-Home Handwashing Stations on Hand Hygiene During the COVID-19 Pandemic in Unpiped Rural Alaska Native Homes.

More than 3300 rural Alaska Native homes lack piped water, impeding hand hygiene. During the COVID-19 pandemic, the Alaska Native Tribal Health Consortium and the Centers for Disease Control and Prevention partnered with 10 Tribal communities and regional Tribal health organizations to install a low-cost, intermediate-technology water and sanitation system, the Miniature Portable Alternative Sanitation System (Mini-PASS). We assessed the impact of the Mini-PASS handwashing station on handwashing, other water-related uses, and problems encountered over time. In this pre-postintervention study, we conducted semi-structured interviews by telephone seasonally with representatives of 71 households with the Mini-PASS from February 2021 through November 2022 to assess the impact of the units on water use and health. Before Mini-PASS installation, all participating households primarily used washbasins for handwashing. Postintervention, more than 70% of households reported using the Mini-PASS as their primary handwashing method in all 3 follow-up intervals (3, 6-9, and 12 months postintervention). The proportion of households using the handwashing station for other household tasks increased during 12 months, from 51.4% (19 of 37) at 3 months postintervention to 77.8% (21 of 27) at 12 months postintervention. Although approximately 20% to 40% of households reported problems with their handwashing station during the 12 months postintervention, a large proportion of interviewees (47% to 60%) said they were able to conduct repairs themselves. Households in rural Alaska quickly adopted the Mini-PASS for hand hygiene and other needs and were largely able to troubleshoot problems themselves. Further research evaluating the impact of improved handwashing behaviors facilitated by the Mini-PASS should be conducted.

Adherence to Infection Prevention Practice Standard Protocol and Associated Factors Among Healthcare Workers.

Healthcare-associated infection affects more than 100 million patients annually. Healthcare workers' poor adherence to standard infection prevention and control procedures can result in many negative consequences, ranging from disability to death. A facility-based, cross-sectional study was conducted in June 2021 among 379 healthcare workers selected using a stratified random sampling technique. All types of healthcare providers except pharmacy professionals were included in the study. Standardization and validation of the study tool were performed ahead of data collection. Multivariable regression was used to assess the variables associated with adherence. The study found that 60.2% of healthcare workers (95% CI, 55.1-65.2) had good adherence to infection prevention practices, and 68.7% and good knowledge of infection prevention practices. Training on infection prevention methods (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.04-2.72), availability of water supply at hand washing station (AOR = 2.90; 95% CI, 1.62-5.31), and attitude toward infection prevention (AOR = 2.64; 95% CI, 1.65-4.24) were identified as predictors of adherence to infection prevention and control procedures. More than half of the participants had good adherence to infection prevention guideline practices. In-service infection prevention training, a consistent water supply at the hand washing station, and a positive attitude of participants were associated with good adherence to infection prevention practices.

Utilization of Environmental Sanitation Policy Guidelines on the Use of Sanitation Facilities in Public Primary Schools

There is a need for a healthy and conducive learning environment, safe drinking water, and child-friendly sanitation facilities in the school where children spend a lot of time. The objectives of the study were to establish the use of existing types of sanitation facilities and find out the status of the existing types of sanitation facilities within primary schools concerning Kenya School Health Policy and the Safety Standards Manual for schools. To achieve its objective, the study adopted a descriptive survey design. A sample of 169 schools was selected from the 773 primary schools in Meru County using simple random sampling. Data was collected using a structured direct observation schedule. Data was analyzed using SPSS software. Descriptive statistics including mean and cross-tabulations were used. The study purposively sampled 167 primary school heads with boys and girls populations of 132,180 and 131,712 respectively. Pearson’s Chi-Square test was used to determine relationships between the variables. The study revealed that 75% of the schools visited kept hygiene and had pit latrines with hand washing stations. Through observation, it was evident that 93% of the schools visited had clean environments that were free from litter. The study concluded that ratios for the sample population fell within the WHO guidelines which recommend a ratio of 25:1 for girls and 50:1 for boys’ toilets. It was concluded that in 46.1 % of the sampled primary schools, pupils living with disabilities experienced challenges in accessing sanitation facilities. The study recommended schools come up with clear budget provisions on sanitation that includes employing a staff specifically for cleaning toilets

Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Hand Washing Practice among Secondary School Students in a Rural Area of Bangladesh

Background: Human hands play a significant role in the spread of diseases, especially respiratory and diarrheal diseases, which continue to be the leading cause of morbidity and mortality among children worldwide. Hand washing is the most widely used preventive measure to lessen the spread of infectious diseases. It involves washing hands with ordinary or antimicrobial soap and water. This is especially important for school-age children, since they may be more susceptible to diseases associated with poor hygiene than adults’ age. There is evidence linking the promotion of hand washing habits through health education to a lower incidence of communicable diseases in school-age children. Objectives: To determine the socio-demographic characteristics of the respondents and to find out the practice of hand washing among the secondary school children. Materials & Methods: A cross sectional study was conducted on 340 school students from 1st June 2022 to 30th November 2022 in Alekjan Memorial High School and College, Durgapur, Adarsha Sadar, Cumilla. Purposive sampling was used to gather all pertinent data using a structured questionnaire. Results: In schools, 69.7% of the respondents washed their hands properly. 96.7% of them used soap to wash their hands. About 98.2%, 95%, 86.8%, 82.9% and 80.3% of school children reported that they wash their hands before eating, after using the restroom, after eating, after playing and after working. Conclusion: According to the study, having access to soap and water is necessary for good hand washing technique as the majority of the students used soap during hand washing. By installing hand washing stations in schools, the regional government, that is, the education and health bureaus-should enhance the hand washing practices in schools. It is important for parents and other family members to focus more on behavior guidance related to hand washing. Eastern Med Coll J. July 2023; 8 (2): 40-44

PHBS Tk Aisyiyah Bustanul Athfal 2 Grogol Jakarta Barat

Many diseases that occur are caused by poor living behavior of the community itself. This includes illnesses experienced by kindergarten students. At Asisyiyah Kindergarten Bustanul Athfal 2 Grogol Jakarta Barat, on average every week there are students who do not go to school because they are sick, Among others: diarrhea, cold cough, typhoid, etc. Observation results show that: students cannot wash yet hands properly, students are not used to washing their hands, there are no washing facilities in the classroom hands, students are accustomed to snacking carelessly in front of school, students do not throw rubbish in the trash, Many students have difficulty eating and more often snack on instant food at food stalls. Implementation method:promotive by providing education on clean and healthy living behavior to kindergarten students involving students and their parents, facilitate clean hand washing stations in each class, forming an alert group cleanliness in schools consisting of teachers, students and food sellers. Results of implementing activities among others students' knowledge and awareness about clean and healthy living behavior has increased, students have practicing clean hand washing before and after eating, the school's hygiene monitoring group is in place formed and functioning. Kindergarten students' clean and healthy living behavior includes: washing hands, throwing away rubbish in place, brushing your teeth, avoiding cigarette smoke, eating nutritious food, defecating and in the bathroom, cutting nails, brushing shoes, cleaning clothes. Conclusion: with implementation of community service by Universitas Muhammadiyah Jakarta lecturers at ABA 2 Grogol Jakarta Barat Kindergarten, then there is a change in the healthy clean behavior of ABA 2 Kindergarten students who were previously unhealthy to become healthy behavior

Mixed-Methods Assessment of Farmworkers’ Perceptions of Workplace Compliance with Worker Protection Standards and Implications for Risk Perceptions and Protective Behaviors

ABSTRACT Introduction The Environmental Protection Agency (EPA)’s Worker Protection Standards is the primary set of legislation aimed at protecting farmworkers from occupational pesticide exposure in the United States. Previous studies suggest that worker adoption of Pesticide Protective Behaviors (PPBs) promoted by WPS is associated with lower urinary pesticide concentrations. However, adoption of PPBs is often outside of the control of individual farmworkers and dependent on workplace factors such as employer provisioning of Personal Protective Equipment (PPE) and access to trainings/resources. Methods We conducted a mixed-method study including urinary pesticide biomonitoring, surveys, and interviews with 62 Latinx farmworkers in southwestern Idaho from April to July 2022. We integrated findings across the various data sources to identify emergent themes relating to farmworkers’ perceptions of workplace compliance with WPS and potential implications for their pesticide risk perceptions, protective behaviors, and urinary pesticide concentrations. Results Participants reported some indications of poor workplace compliance with WPS regulations, notably inconsistent access to clean handwashing stations and notification of pesticide applications. Some farmworkers, particularly pesticide applicators, viewed herbicides to be categorically safer than other classes of pesticides such as insecticides; these perceptions appeared to influence protective behaviors, such as the relatively low use of PPE while applying herbicides. These findings are underscored by the higher concentrations of biomarkers of herbicides, but not insecticides, among pesticide applicators compared with non-applicators (e.g. median 2,4-D concentrations = 1.40 µg/L among applicators and 0.69 µg/L among non-applicators). Participants further reported concerns regarding the inadequacy of pesticide safety training, pesticide drift, and the lack of communication regarding pesticide applications on and near fields where they are working. Discussion Participants’ perceptions that herbicides are categorically safer than other pesticide classes is in direct conflict with WPS training, raising concerns about discrepancies between WPS instruction and other on-the-job training, as well as the inadequate provisioning of PPE during the application of certain pesticides. Our findings also suggest that current WPS regulations may not sufficiently address farmworkers’ concerns, particularly in regard to pesticide drift.

Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross-sectional, observational study.

During the COVID-19 pandemic in Kenya, 5,311 handwashing stations were distributed by the National Business Compact Coalition (NBCC) to help combat the virus. This study evaluated 316 of these stations across five counties, assessing functionality, usability, and accessibility. Quantitative data, including spot checks and surveys, revealed that 83.9% of the evaluated stations were functional, with paid caretakers, which is associated with higher functionality rates. Qualitative insights underscored challenges such as inadequate signage and limited soap and water availability, particularly affecting individuals with disabilities. Despite initial success, only 61% of stations remained functional 6-8 months post-distribution, often due to relocation by caretakers. Future distributions should prioritize long-term support for caretakers to sustain station functionality. This study highlights the importance of ongoing monitoring and support for public handwashing facilities in pandemic response efforts.

Repositioning for the future: African hand-washing innovation Shesha Geza streamlines its strategic direction

Learning outcomes After completion of this case study, students should be able to reflect on the concept of creating shared value and then determine whether Shesha Geza can be referred to as a shared value company and, if so, what level of shared value it demonstrates. They will be able to subjectively and objectively understand the possible meaning of when a social enterprise embarks on a strategy to scale the organisation; clarity of construct will enable managers to better plan and successfully implement scalability goals. They will also be able to recognise, once scalability goals are better understood and planned, that there are a multitude of intra-organisational levers and drivers that may contribute to the organisation’s ability to scale its operations, which are related to specific internal organisational capabilities of social enterprise companies. In addition, there are situational factors that may affect the business either positively or negatively in relation to the scalability success of which a social entrepreneur should be aware. Case overview/synopsis In April 2021, Dean Boniface and his brother, Roger, had just signed off a new informational video for their Shesha Geza innovation, a low-cost hand-washing station designed for use at commuter hubs and high-traffic areas across the African continent. The unit used diluted chlorine instead of alcohol-based sanitisers to ensure a more expedient and sustainable solution, one better suited to Africa’s logistical challenges. Boniface, the co-founder of Vue Architects, had conceptualised the idea of the hand-washing hub during South African Government’s enforced COVID-19 lockdown from 27 March 2020 to 1 May 2020. Shesha Geza’s speed to market was a key contributor to its successful response in solving a critical social need. Throughout 2020, Boniface and his team built successful partnerships and secured an impressive order pipeline within a short span. Export opportunities across Africa, installations and maintenance of a sizable number of units across South Africa and the development of a behavioural change programme aimed at hygiene in schools kept the momentum going in the business. However, a year into the business and the future sustainability of a crisis–response enterprise and the ability of a shared value enterprise to scale were playing on Boniface’s mind. He was worried about the future of the small resource-constrained business. Holding onto the mental map of everything the team had learned over the past year, Boniface was confident about one thing: “All the programmes we build around Shesha Geza are value-adds to our current business. Hand hygiene will not diminish after COVID-19; it will continue to be an important social issue across the African continent.” Complexity academic level This case is intended for discussion in post-graduate-level courses such as an MBA and in postgraduate courses focused on business model innovation or on creating shared value. This case is suitable for use in the environment of business courses in relation to environmental situational factors that may affect the ability to scale social enterprises or strategic implementation courses, considering the still pervasive challenge of scaling increasingly important social impact enterprises. Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2023

Abstract Opportunities for the public to interact with animals in public settings such as petting zoos, fairs, and farm visits can be valuable learning and entertainment experiences. However, zoonotic disease transmission from healthy animals on exhibit and their environments, as well as injuries and other health problems, may result from these interactions if steps are not taken to minimize risks. The 2023 Compendium of Measures to Prevent Disease Associated with Animals in Public Settings provides background about these potential risks and updates recommendations for reducing those risks. Enteric zoonotic disease risks from animal contact in public settings include Shiga toxin–producing Escherichia coli infections, cryptosporidiosis, and campylobacteriosis. These infections occur when pathogens are accidentally ingested by individuals following direct contact with animals or contaminated objects. Zoonotic influenza infections can occur in a similar manner or through aerosols generated from infected animals. Other infectious diseases, parasitic infections, bites, and other injuries are also possible hazards in these settings. Inadequate handwashing and facility design flaws are frequent contributors to these risks, especially on farms or temporary exhibits not specifically designed for public use. Venues should provide sufficient handwashing stations and establish clearly defined animal contact areas. Operators should educate visitors about potential disease and injury risks, steps necessary to minimize exposure, and the importance of handwashing after the visit. Additionally, operators and visitors alike should realize that certain individuals are at heightened risk for zoonotic infections. Signs, handouts, and other educational materials are publicly available in a toolkit that accompanies the compendium.

Protecting healthcare workers and patients during the COVID-19 pandemic: a comparison of baseline and follow-up infection prevention and control needs in Nigerian military healthcare facilities delivering HIV services

BackgroundProtecting the HIV health workforce is critical for continuity of services for people living with HIV, particularly during a pandemic. Early in the COVID-19 pandemic, the Nigerian Ministry of Defence, in partnership with the US Military HIV Research Program, took steps to improve infection prevention and control (IPC) practices among staff working in select PEPFAR-supported Nigerian military health facilities.MethodsWe identified a set of IPC activities a priori for implementation at four Nigerian military hospitals in HIV and related departments in early 2021, including continuous medical masking, physical distancing, placement of additional hand washing stations and hand sanitizers throughout facilities, and training. We fine-tuned planned intervention activities through a baseline needs assessment conducted in December 2020 that covered eight IPC components: ‘IPC program structure, funding and leadership engagement’; ‘IPC policies, guidelines and standard operating procedures (SOPs)’; ‘infrastructure’; ‘triage and screening’; ‘training, knowledge and practice’; ‘personal protective equipment (PPE) materials, availability and adequacy’; ‘biosafety and waste management’; and ‘monitoring and remediation’ prior to implementation. Baseline results were compared with those of a follow up assessment administered in August 2021, following intervention implementation.ResultsIPC readiness remained high at both baseline and follow-up assessments for ‘IPC guidelines, policies, and SOPs’ (96.7%). The components ‘infrastructure’ and ‘monitoring and remediation’, which needed improvement at baseline, saw modest improvements at follow-up, by 2% and 7.5%, respectively. At follow-up, declines from high scoring at baseline were seen in ‘IPC program structure, funding and leadership engagement’, ‘training, knowledge and practice’, and ‘biosafety and waste management’. ‘PPE materials availability and adequacy’ improved to 88.9% at follow-up. Although unidirectional client flow was newly implemented, the score for ‘triage and screening’ did not change from baseline to follow-up (73%).ConclusionVariability in IPC component readiness and across facilities highlights the importance of building resilience and employing a quality improvement approach to IPC that includes regular monitoring, re-assessment and re-training at set intervals. Results can be used to encourage solutions-oriented dialogue between staff and leadership, determine needs and implement action plans to protect staff and people with HIV.

Etnomathematics: exploration sanitary industry center of Malang

This study aims to explore the mathematical elements contained in the center of the sanitation industry in Malang City. The Sanitary Industry Setra is in the form of flower pots, gravestones, tombstones, fountains, hand washing stations, chairs, and so on. The object is an object of exploration based on an ethnomathematical point of view. This study uses a qualitative approach to the type of ethnographic research. The subjects in the study were sanitary ware craftsmen in the Karangbesuki area of Malang City. The subject is experienced and has a fairly large turnover. Data collection techniques in the study were carried out by observation or direct observation in the field, interviews, and also by studying literature. This research will provide evidence that without realizing it, people have applied the concepts of comparison, calculation and mathematical measurement in creating an object of crafts that have been carried out since ancient times. The mathematical implementation carried out by craftsmen produces crafts in the form of spatial geometric shapes such as: blocks, tubes, half balls, and others. In creating craft objects, researchers also found the concept result from geometric transformations such as: of translation, rotation, and also reflection on some of the crafts produced.

Low-cost domestic rainwater harvesting in rural southeast Madagascar: A process and outcome evaluation

In settings where communities rely on unimproved water sources, household rainwater harvesting (HRWH) may improve the quality and quantity of water available. This research presents results from a two-year controlled before-and-after study that evaluated the impact of low-cost HRWH on household water collection habits, hygiene practices and prevalence of childhood diarrhoea in rural Madagascar. The study assessed system functionality, water quality and the acceptability of requesting household financial investment (16–20 USD). Surveys were administered to enrolled intervention households (n = 138) and control households (n = 276) at baseline and endline. Water quality tests at endline compared microbial contamination in a sub-sample of HRWH systems (n = 22) and public water sources (n = 8). Difference-in-difference analyses were used to compare changes in outcomes between study arms at baseline and endline. At endline 111 (75%) of systems were functional with an average age of 1.25 years. Microbial contamination was 39.3 TTC/100ml in community water sources compared with 23.3 TTC/100ml in the HRWH systems (coef: -16.0, 95CI: -37.3 to 5.2, p = 0.133). 85 (57%) of households completed their repayment plans while remaining households owed on average 3.7 USD. There was weak evidence to suggest that intervention households collected more water per capita day than controls (adj coefficient: 3.45; 95CI: -2.51 to 9.41, p = 0.257). Intervention households had 11% higher absolute risk of owning a handwashing station compared against controls (95CI: 0.00 to 0.23; p = 0.06). There was no evidence of differences in ownership of soap or prevalence of childhood diarrhoea between study arms. Overall, operation and maintenance of the systems remained high, users demonstrated willingness to pay, and there was weak evidence that water provision at the household increased domestic consumption. However, the systems did not provide contaminant-free water. We conclude that HRWH using low-cost, locally available materials can increase household access to water in areas reliant on limited communal water sources.

Health and Sanitation Condition of Pregnant Women: A Case of Arghakhanchi District

This paper aims to explore the situation of sanitation and changing the behaviour of married Nepalese women of reproductive age (15-49). A concurrent mixed-method (qual-quan) research design was employed in this research under the pragmatism worldview. The data are collected through a questionnaire survey, in-depth interviews, and a transect walk. Arghakhanchi district was selected purposively in this study. Diffusion of innovation theory was applied to understand the factors influencing sanitation and hygiene behavior change. The key research participants were the pregnant women of reproductive age (15-45) in the study. A thematic framework was used to analyze qualitative data, while bivariate analysis was performed to show the association between the background variables of sanitation and the health condition of pregnant women. It was found that most of the women used soap and water for hand washing before each meal and after the toilet. There is the provision of soap at hand washing stations and toilets among the study population. However, sufficient hand washing and toilet facilities were not available and 23% of the women reported being scratchy with the use of soap and water regularly.