Hygiene Promotion Research Articles

Theory-driven approach to hand hygiene promotion intervention in hospitals: a case of theory of planned behaviour.

Nosocomial infections are among the major challenges faced by health systems worldwide, with hand hygiene being one of the simplest and most important preventive measures. This study aimed to assess the effectiveness of an educational intervention based on the Theory of Planned Behaviour (TPB) in improving hand hygiene behaviour among hospital nursing staff. A total of 194 nursing staff members were selected using a random sampling method and randomly assigned to intervention and control groups. Data were collected through researcher-made questionnaire based on the TPB and the World Health Organization's five moments of hand hygiene. The intervention programme was developed and implemented following a pretest, response analysis, and educational needs assessment. The results showed a significant change in the mean scores of subjective norms, perceived behavioural control, behavioural intention, and behaviour at baseline, immediately after, and 2 months after the intervention in the intervention group. Hand hygiene adherence at the moments of 'before touching a patient', 'after body fluid exposure', and 'after touching a patient' showed significant differences in the intervention group. Given the effectiveness of TPB-based intervention and the influence of factors like the environment and reinforcement, combining TPB with constructs from other behaviour change theories, particularly Social Cognitive Theory is recommended to improve hand hygiene compliance.

An Explorative Study on the Role of Family Members in Caring for Mental Health Care Users in South Africa.

The ultimate custodians of Mental Health Care Users (MHCUs) when they get discharged from mental health institutions are their family members. Thus, the family members have a significant role in rendering comprehensive and multifaceted care to MHCUs. The study investigated the family members' role in the care of mental health care users in South Africa. An explorative, descriptive design was utilised. Family members who cared for their loved ones suffering from mental illness were selected using purposive sampling. Individual, in-depth, unstructured interviews were conducted. Data analysis was done using Colaizzi's method. The COREQ checklist was used to prepare this publication. (1) Mental health care users' family support to ensure treatment adherence. (2) Promotion of hygiene for MHCUs. (3) Knowledge deficit regarding mental illness and (4) Challenges encountered regarding care and support are the themes that emerged from the analysis. Family members play a significant role in the treatment of their loved ones suffering from mental disorders. Female next of kin are primarily involved in the treatment of MHCUs. Support from psychiatric mental health nurses and other health professionals is needed. The involvement of more males would be more beneficial in the care of MHCUs in dealing with non-compliant users who may undermine females. Empowerment of family members by psychiatric mental health nurses requires priority. Further research on guidelines development to address the role issues among family members could enhance the care of MHCUs.

Environmental factors influencing hygiene practices among pupils in selected public primary schools in Kiambu County, Kenya

Background: Hygiene practices, including hand washing with soap and water, are essential for preventing diseases like diarrhoea, especially in developing countries. Poor hygiene, inadequate water, and sanitation contribute to over 60% of the disease burden among students. This study investigates how hygiene promotion approaches, such as school-led sanitation programs, affect cleanliness practices among public primary school students in Kiambu County, Kenya. Methods: Analytical cross-sectional study design was used and 121 participants in public primary schools from Gatundu South, Juja, Ruiru, and Kiambu sub-counties. Data was collected using administered structured questionnaire, and Key Informant Interview. Quantitative data analysis was conducted using SPSS version 29.0 and involved univariate and bivariate analysis. Qualitative data was analyzed by thematic content analysis. Results: The study involved 121 respondents, aged 22-59 years (mean age 38.29±8.1), with 52.9% being female and 49.6% had undergraduate degrees, and 39.7% were senior teachers. The pupil-to-toilet ratio in the schools was 1:29, which did not meet the recommended standards for boys (1:36) but met the standard for girls (1:24). Hygiene promotion activities included parades (66.1%), classroom sessions (61.2%), and health clubs (60.3%). Factors like observing, demonstrating, and inspecting hygiene practices were strongly linked to improved handwashing, with ORs of 5.4, 8.8, and 5.8, respectively. Conclusions: The study found strong associations between hygiene practices and implementors' expertise, with significant environmental factors influencing student hygiene. The public health and community health volunteers should take more active role in dissemination timely and accurate information on hygiene and health promotion.

Improving WASH facilities and practices in Bangladeshi schools: progress and challenges from 2014 to 2018

ABSTRACT Background In low- and middle-income countries like Bangladesh, inadequate water, sanitation, and hygiene (WASH) practices lead to a higher disease burden among children and hinder their academic performance. However, there have been efforts to improve WASH between 2014 and 2018. Objectives The study aimed to investigate changes in WASH facilities and practices in Bangladeshi schools from 2014 to 2018. Methods We analyzed pooled data from Bangladesh National Hygiene Survey 2014 and 2018. We performed descriptive analysis, bivariate analysis, and multivariate Generalized Estimating Equation (GEE) to analyze the changes over the four years time period. Results Results showed that basic drinking water services increased from 78% in 2014 to 90% in 2018. Schools showed a significant increase in basic sanitation services from 19% in 2014 to 52% in 2018. We discovered that students’ access to water and soap increased from 2014 to 2018, from 21% to 35%. In the GEE model, we found that change in time, non govt urban schools were associated factors with improved basic drinking water services. For basic sanitation services, changes in time, school type and area type were significantly associated higher services. And for basic hygiene services, the associated factors were: schools having hygiene promotion visits, and availability of hygiene brigades at schools managed by students. Conclusion WASH services in Bangladeshi schools have improved significantly, yet disparities exist, particularly in government and rural schools. Although students’ knowledge improved, their practices still need improvements through training on proper WASH practices.

P-257. Effectiveness of Pulsed-Xenon Ultraviolet Disinfection during Terminal Cleaning of Patient Rooms in the Intensive Care Unit on the Sustained Containment of Drug-resistant Acinetobacter baumannii

Abstract Background Environmental disinfection by ultraviolet (UV) has been shown to be effective in controlling transmission of multidrug-resistant organisms, and introduced into daily practices in addition to manual terminal cleaning in some hospitals in the US. However, its effectiveness outside the US healthcare setting is not well investigated. Moreover, its effectiveness to control gram-negative bacteria has not been well described. Methods This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic transmission of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite intensified hand hygiene promotion and manual terminal cleaning, transmission of 2DRA continued. In January 2018, we added pulsed-xenon ultraviolet (PX-UV) disinfection for the terminal cleaning after every patient discharge. The study periods were defined as follows: the baseline period (August 2016 to January 2018, manual cleaning only) and the intervention period (February 2018 to December 2023, addition of PX-UV). All patients admitted in the ICU were regularly screened for 2DRA for the detection of possible acquisition of 2DRA throughout the study periods. Results The incidence of acquisition of 2DRA in the ICU significantly declined (4.45 per 1,000 patient days in the baseline period to 1.09 in the intervention period, relative risk (RR): 0.26, 95% confidence interval: 0.12-0.51). Cases in the intervention period were sporadic, and no cluster was found. In contrast, in non-ICU wards, where PX-UV disinfection was performed only after the discharge of patients known to be colonized or infected with 2DRA or other multidrug-resistant pathogens, possible transmission of 2DRA was observed several times. Conclusion Adding PX-UV after manual terminal cleaning was effective in controlling acquisition of 2DRA in the ICU patients. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested. In contrast, there was room for improvement in controlling of 2DRA in non-intervention wards. Disclosures All Authors: No reported disclosures

Case-area targeted interventions and free chlorine residual in household drinking water: An observational cohort study during a cholera outbreak in Northeast Nigeria.

Cholera outbreaks are surging worldwide. Growing research supports case-area targeted interventions (CATIs), whereby teams provide a package of interventions to case and neighboring households, as an effective strategy in cholera outbreak control, particularly in humanitarian settings. While research exists on individual CATI interventions, research gaps exist on outcomes of integrated interventions during CATI responses. We conducted a prospective observational cohort study on CATIs during the 2021 cholera outbreak in Northeast Nigeria. During CATI response in Borno, Adamawa, and Yobe, research enumerators accompanied CATI teams to households and observed interventions (including provision of soap, Aquatabs, educational materials, and jerrycans; latrine and bedding disinfection; and hygiene promotion) and collected data on demographics, existing household water, sanitation, and hygiene, and household water free chlorine residual (FCR). Enumerators returned to households 10-14 days later to conduct follow-up surveys. We tested differences in reported delivery and receipt of interventions, and household drinking water FCR concentrations before and after CATIs. We also analyzed the associated relationship between CATI and environmental factors and odds of FCR <0.2 mg/L using quasi-Poisson multivariate logistic regression models with generalized estimating equations (GEE). We found household drinking water FCR significantly increased (p<0.001) post-CATI in Adamawa state. Self-reported receipt of Aquatabs and handwashing station availability were significantly associated with reduced odds of FCR <0.2 mg/L at follow-up. Self-reported receipt of hygiene promotion lacked significant associations with FCR in both Adamawa and Borno. These associations varied by type of water source. These findings suggest that CATIs improved household drinking water FCR, a key protective measure against cholera, in Northeast Nigeria. Our research highlights factors associated with FCR concentrations <0.2 mg/L post-CATI in Adamawa and Borno, offering valuable insights for response planning, and overall supports the continued use of CATIs in humanitarian settings.

Contribution of stakeholders from the Dakoussa pre-school and primary education inspectorate school to the promotion of hygiene and sanitation in Niger

The aim of this research is to evaluate the contribution of local actors to the promotion of hygiene and sanitation within the IEPP of Dakoussa, Takiéta department - Niger. The objective is to identify the roles that different stakeholders in preschool and primary schools play in promoting hygiene and sanitation. The approach used for data collection is both qualitative and quantitative. The sample consists of 19 teachers from the Middle Course classes, 11 school directors, 11 Decentralized Management Committees of secondary institutions, 111 school governments from 11 schools, and students from the Middle Course, along with 2 pedagogical advisors, 1 infrastructure and school health officer, and 1 departmental hygiene and sanitation technician. The results show that teachers, the CGDS, and students play an important role in promoting hygiene and sanitation in the schools of the IEPP of Dakoussa. However, these results also highlight challenges. The lack of adequate sanitation infrastructure, the persistence of open defecation, insufficient follow-up on actions, a lack of training, and the continuation of certain traditional practices are obstacles that need to be overcome. To strengthen the commitment of local actors, it is necessary to implement targeted actions such as ongoing teacher training, community mobilization, and the

The impact of oral health promotion on the quality of life of children with bleeding disorders: fighting misconceptions

ABSTRACT Background: Understanding the disease-specific risks and patient-related barriers of children with bleeding disorders is necessary for primary oral health promotion. Our goal was to assess the oral health status and the impact of oral health promotion among patients with bleeding disorders. Research design and methods: At baseline, 70 patients with inherited and acquired bleeding disorders had a complete intraoral examination, completed the oral health-related quality of life (OHRQoL) questionnaires, and an oral health education was given. After 6 months, the effectiveness of the oral hygiene promotion was evaluated clinically and through the OHRQoL questionnaires. Results: Our cohort included 33 patients with chronic immune thrombocytopenia (cITP), 27 hemophilia A patients, and 10 with inherited thrombasthenia. Forty patients (57.1%) had dental caries, 90.0% showed fair oral hygiene status with variable degrees of gingivitis. The baseline self-image score was significantly inferior among patients with inherited bleeding disorders, while the psychological domain for family was greatly affected among cITP patients. After 6 months, there was a significant reduction in the oral debris, the modified gingival indexes, the percentages of cases with oral bleeding, and a significantly improved mean OHRQoL total score. Conclusions: After the oral health education, the OHRQoL scores had significantly improved, and oral hygiene status were acceptable among patients with bleeding disorders.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Hand hygiene intervention in the prevention of healthcare associated infections

Abstract Background Healthcare associated infections are a major cause of morbidity and mortality in intensive care units. Observance hand hygiene is singled out as a key element in interruption of these infections. The present study aimed to assess whether hand hygiene intervention program in intensive care unit at the Sahloul University Hospital of Sousse is able to decrease healthcare associated infections. Methods We carried out a pre-experimental study among patients hospitalized in seven intensive care units at the Sahloul University Hospital of Sousse during two distinct periods of 3 months, the first in 2019 and the second in 2021. During these two periods, we monitored only patients hospitalized in the ICU for more than 48 hours and incidence of healthcare associated infections was compared. Healthcare associted infections were defined as infections occurred at least 48 hours after admission to the intensive care units. The hand hygiene promotion intervention, done during the year 2020, was based on 3 axes (training sessions, procedures writing and professional practicesevaluation). Results Incidence of healthcare associated infections decreased significantly in post-intervention (p = 0.000). The decrease of Ventilator-associated pneumonia was significantly higher than other types of infections(p = 0.042). Extended Spectrum B-Lactamase Producing Enterobacteriaceae infections and Ceftazidim resistant Pseudomonas Aeruginosa infections decreased significantly in after intervention (p = 0.000). Conclusions The results of our study showed that improved hand hygiene resulted in a reduction in healthcare associated infections. Key messages • Observance hand hygiene is singled out as a key element in interruption of healthcare associated infections. • Improved hand hygiene resulted in a reduction in healthcare associated infections.

ROLE OF PERFORMANCE IMPROVEMENT MEASURES TO IMPROVE THE QUALITY OF INFECTION PREVENTION PROGRAMS IN TERTIARY CARE HOSPITAL

Healthcare-associated infections (HAIs) pose a significant risk in hospital settings. Performance improvement measures can enhance the quality of infection prevention programs, leading to better outcomes for patients. Objective: To assess the impact of performance improvement measures on enhancing the quality of infection prevention programs in a tertiary care hospital. Methods: This quasi-experimental study was conducted with healthcare workers (HCWs), including doctors, nurses, infection prevention officers, and support staff, at a tertiary care hospital. The intervention included comprehensive performance improvement measures: rigorous training, educational initiatives, regular audits with feedback, adherence to standard operating procedures (SOPs), checklists, monitoring tools, and hand hygiene promotion. Quantitative data on infection rates, infection control compliance, hand hygiene adherence, and antibiotic usage were collected at baseline and 3, 6, and 12 months post-intervention. Qualitative data were gathered from semi-structured interviews and focus groups to explore barriers and facilitators to infection prevention. Results: The intervention group showed a significant reduction in HAIs per 1,000 patient days compared to the control group (3.06 ± 1.09 vs. 8.23 ± 5.18; p = 0.00). Compliance with infection control practices (71.0% vs. 61.0%; p = 0.13) and hand hygiene adherence (64.0% vs. 48.0%; p = 0.02) were also higher in the intervention group. However, no statistically significant difference in antibiotic usage was observed between the two groups (59.0% vs. 49.0%; p = 0.1). Conclusion: The study demonstrates that performance improvement measures significantly reduce HAIs and improve compliance with infection control protocols. These targeted strategies are essential for enhancing infection prevention in healthcare settings and improving overall patient safety.

Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: a comprehensive health economic assessment analysis

BackgroundMonitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting.MethodsA before and after study in 40 clinical departments with 4,524 healthcare providers was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared.ResultsThe total cost spent on ESM for the 40 departments (17,702.92 CNY) was 4,123.76 CNY lower than that of MPM (21,826.68 CNY). The HHC of MPM (80.16%) was higher than that of ESM (69.82%) (p < 0.01). In high- and medium-risk departments, the cost-effectiveness ratio of ESM (7,977.90 CNY and 13,794.60 CNY, respectively) was lower than that of MPM (9,039.61 CNY and 14,549.05 CNY, respectively). In low-risk departments, the cost-effectiveness ratio of ESM (3,910.77 CNY) was higher than that of MPM (3,899.06 CNY). Compared with ESM, the incremental cost of MPM in all departments was 4,123.76 CNY, the incremental effectiveness was 10.34%, and the incremental cost-effectiveness ratio was 39,881.62 CNY. Between the two monitoring methods, the efficiency of ESM (48.11%) in all departments was higher than that of MPM (14.20%) (p < 0.01). The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The extent of Hawthorne effect of MPM of HHC in all departments (43.99%) was higher than that of ESM (35.69%) (p < 0.01). When ESM was used as the HHC monitoring approach, the HAI rates (1.39%) in all departments were higher than that when MPM was used (1.34%) (p = 0.562). When the payment willingness was less than 40,000 CNY, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness.ConclusionsESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect.

Implementing a pragmatic randomised controlled trial in a humanitarian setting: lessons learned from the TISA trial

IntroductionHigh-quality evidence is crucial for guiding effective humanitarian responses, yet conducting rigorous research, particularly randomised controlled trials, in humanitarian crises remains challenging. The TISA (“traitement intégré de la sous-nutrition aiguë”) trial aimed to evaluate the impact of a Water, Sanitation and Hygiene (WASH) intervention on the standard national treatment of uncomplicated Severe Acute Malnutrition (SAM) in children aged 6–59 months. Implemented in two northern Senegalese regions from December 22, 2021, to February 20, 2023, the trial faced numerous challenges, which this paper explores along with the lessons learned.MethodsThe study utilised trial documentation, including field reports, meeting minutes, training plans, operational monitoring data and funding proposals, to retrace the trial timeline, identify challenges and outline implemented solutions. Contributions from all TISA key staff—current and former, field-based and headquarters—were essential for collecting and interpreting information. Challenges were categorised as internal (within the TISA consortium) or external (broader contextual issues).ResultsThe TISA trial, executed by a consortium of academic, operational, and community stakeholders, enrolled over 2000 children with uncomplicated SAM across 86 treatment posts in a 28,000 km2 area. The control group received standard outpatient SAM care, while the intervention group also received a WASH kit and hygiene promotion. Initially planned to start in April 2019 for 12 months, the trial faced a 30-month delay and was extended to 27 months due to challenges like the COVID-19 pandemic, national strikes, health system integration issues and weather-related disruptions. Internal challenges included logistics, staffing, data management, funding and aligning diverse stakeholder priorities.Discussion and conclusionDespite these obstacles, the trial concluded successfully, underscoring the importance of tailored monitoring, open communication, transparency and community involvement. Producing high-quality evidence in humanitarian contexts demands extensive preparation and strong coordination among local and international researchers, practitioners, communities, decision-makers and funders from the study’s inception.Trial registrationClinicaltrials.gov NCT04667767.

Comparative Efficacy of Medium and Soft Toothbrushes in Plaque Removal and Gingivitis Control.

BACKGROUND Regularly removing dental plaque is key to good oral hygiene and gingival health promotion. This study aimed to compare the effects of using soft and medium toothbrushes using the plaque index (PI), gingival index (GI), and bleeding on probing (BOP) index. MATERIAL AND METHODS A randomized parallel-group study design was used. Sixty-four participants were randomly assigned to 2 similar intervention groups (medium and soft toothbrush groups). The PI, GI, and BOP indexes were used. The median and median difference of PI, GI, and BOP were calculated. SPSS was used for data entry and analysis. Wilcoxon and Mann-Whitney U tests were used for data analysis. RESULTS The median scores of GI, PI, and BOP significantly decreased from 1.8, 1.7, and 2.0, respectively, before using medium toothbrushes to 0.0, 0.1, and 0.0, respectively, after using medium toothbrushes (all P<0.0001). Similarly, the median scores of GI, PI, and BOP significantly decreased from 2.0, 1.7, and 2.0, respectively, before using soft toothbrushes to 1.1, 0.9, and 1.0, respectively, after using soft toothbrushes (P<0.0001). The median differences in GI, PI, and BOP scores among those using medium toothbrushes were higher than the median differences among those using soft toothbrushes [(1.8 vs 0.9), (1.6 vs 0.8), and (2.0 vs 1.0), respectively]. These differences were statistically significant (P<0.0001). CONCLUSIONS This study concludes that medium and soft toothbrushes were effective in removing plaque and controlling gingivitis. Medium toothbrushes were more effective than soft toothbrushes in achieving these outcomes.

The Effectiveness of Nutritional Interventions Implemented through Lady Health Workers on the Reduction of Stunting in Children under 5 in Pakistan: The Difference-in-Difference Analysis.

In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.

The Roles of NGOs in Skill Development of The Street Food Vendors for Hygienic Food Preparation and Serving in Bangladesh

This paper tried to explore the roles of non-government organizations in developing the skills of street food microentrepreneurs in health and safe food preparation and servicing in the western part of Bangladesh. The study utilized a qualitative approach, using a purposive sampling method to select respondents for in-depth interviews, key informant interviews, and focus group discussions. The street food vendors and stakeholders were selected from the project team, and the research tools included in-depth interviews with 20 vendors, interviews with 8 key stakeholders, and two focus group discussions with customers and entrepreneurs. The researcher discovered that NGO plays a critical role in skill development for street food vendors in Bangladesh. Prior to the project, vendors were unfamiliar with safety, hygiene, cleanliness, and sustainable promotion. The project improved their skills in safety and security, market promotion, hygiene maintenance, cleanliness, and sustainable development by implementing various activities like training, meetings, workshops, food festivals and fairs, market linkage, stakeholder involvement, online and offline market promotion, and so on. The project also increased restaurant customers and market creation. However, the study found that food safety NGO workers and street food programs have collaborated to raise awareness about food safety, health, hygiene, and environmental issues. These initiatives have improved health and lifestyles, improved food quality, increased client numbers, and increased business profits. The stakeholders gathering in Bogura and Rajshahi focused on promoting product certification, with some microenterprises pursuing it. Microenterprises received work-based training on food safety and hygiene, leading to advancements in food packaging, safe raw materials, cleanliness, and hygiene practices. Product certification training increased stakeholders’ understanding of the importance of certification, and some MEs are now following it. The NGO organized a fair to highlight reputable food businesses and raise awareness of environmental sustainability, hygiene, and food safety. The entrepreneurs know how to prepare healthy dishes, increasing sales and revenue. This awareness have been raised due to the NGO’s interventions implemented for street food vendors in the study area.

Parental perception of neonatal care in urban slums of Jammu city

Background: India is undergoing rapid urbanization and many rural residents relocate to urban regions in search of employment, better living conditions and access to education and health care facilities. Neonatal morbidity and mortality are attributed to misperceptions in the community about newborn care. In many parts of urban slums in India, care seeking from multiple providers and use of traditional/home remedies hampered appropriate and timely medical care seeking. Aim was to study awareness, knowledge and practice of newborn care among postnatal mothers in Urban slums of Jammu city. Methods: This observational study was conducted in Urban slums of Jammu city. A total of 100 mothers of newborns residing in urban slums participated in the study after taking Informed Consent from them. A self-structured proforma was used to collect data. Results: Most of the deliveries were conducted in hospital (82%) and 18% were home deliveries. Regarding newborn care practices 88 % had wrapped the newborn with clean cloth immediately after birth. 58% of newborns were given first bath within 2-7 days. 39% of mothers-initiated breast feeding within 6-24 hours. Majority (68%) newborns were fed with colostrum. Regarding cord cutting procedures among home deliveries, it was observed that clean blade was used in 15 newborns while in 3 cases aseptic practice for cord cutting was not followed. Conclusions: Good newborn practices like promotion of warmth, cord care, hygiene and early breastfeeding should be the main focus of community-based health workers. The present study concluded that some unhealthy neonatal care practices were still found to be prevalent which can be mitigated by increasing awareness among parents through IEC activities.

Case-area targeted interventions during a large-scale cholera epidemic: A prospective cohort study in Northeast Nigeria.

Cholera outbreaks are on the rise globally, with conflict-affected settings particularly at risk. Case-area targeted interventions (CATIs), a strategy whereby teams provide a package of interventions to case and neighboring households within a predefined "ring," are increasingly employed in cholera responses. However, evidence on their ability to attenuate incidence is limited. We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints. We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks. Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8-10 total clusters, relative risk of 2.2-5.5, 16.6-19.9 day duration, including 11.1-56.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group. CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.

Sleep initiation patterns and sleep quality among toddlers in the southeast of China: initial study results

BackgroundA large number of psychological consequences including sleep health emerged during the 2019 Coronavirus disease (COVID-19) pandemic. Sleep patterns in toddlers are vulnerable to negative environmental exposures, however, very few studies on this topic have been published so far.ObjectivesIn this paper, we aimed to investigate the sleep patterns and associated factors in toddlers from China confined at home in the context of COVID-19 pandemic.MethodsFrom April to November 2021, a convenience sample of 493 parents of young children aged (12–35 months) were surveyed from Fuzhou, Sanming, Quanzhou, Nanping, and Longyan cities in the Fujian Province, China. A cross-sectional survey was conducted via Electronic questionnaires to collect parent and child social-demographic characteristics. The Brief Infant Sleep Questionnaire (BISQ) was used to collect data on sleep practices, sleep duration and patterns, as well as the number of nocturnal awaking .ResultsThe mean age of toddlers was 2.11 years old, and 52.54% (259/493) were males. Among the 493 toddlers’ sleep patterns, 331(67.1%) initiated sleep accompanied by parents, 67(13.6%) slept independently, 59 (12.0%) were breast fed/bottle fed to initiate sleep, 27 (5.5%) were held and 9 (1.8%) rocked. The clear longitudinal association between the duration of night-time sleep, the frequency of nighttime awakenings, and various sleep patterns remains clear (p < 0.05). Multiple linear regression analysis indicated that sleep initiation with bottle-feeding/breast-feeding and rocked significantly increased the frequency of nighttime awakenings and reduced the duration of nighttime sleep (p < 0.05), as held was dramatically only for increasing the number of nighttime awakenings (p < 0.05). Multi-variate logistic regression analysis demonstrated that toddlers with severe sleep difficulties had a higher probability of being rocked to initiate sleep (p < 0.05). Conversely, young children with minor sleep problems were more apt to be in bed alone to initiate sleep (p < 0.05).ConclusionsDuring the COVID-19 pandemic, most infants and toddlers initiated sleep accompanied by parents and tend to have electronic media exposure before bedtime. Increased waking at night may be associated with sleep initiation with breast-feeding/bottle-feeding. Therefore, pediatric practitioners in primary community hospitals should pay attention to the education and promotion of sleep hygiene and parenting knowledge of young children to avoid the formation of poor sleep hygiene habits.

Increase in dental hygienists’ competency and self-directed capacity after capstone-designed class on community dental hygiene

Objectives: This study aimed to verify the effect on students’ competency and self-directed capacity after a capstone-designed teaching method with community dental hygiene class. Methods: The study participants were 34 dental hygiene students taking a 4-year community dental hygiene course at a university located in City C. The research tool consisted of 52 questions on major competency and 20 questions on self-directed capacity. Results: After the capstone design class, overall dental hygienists’ competency increased (p&lt;0.05), and competencies of clinical dental hygiene and community health promotion showed a high increase (p&lt;0.001). As a result of analyzing the increase in dental hygienists’ competency according to self-directed learning ability, the group with low self-directed capacity showed high improvement in clinical dental hygiene competency and community oral health promotion competency. Conclusions: This study confirmed that the capstone-designed community dental hygiene class improved students’ competency and self-directed capacity, and suggests that it is an excellent teaching method for training competencies required for future society.