Handwashing Promotion Research Articles

Viral Hepatitis in Pregnant Mexican Women: Its Impact in Mother-Child Binomial Health and the Strategies for Its Eradication.

Viral hepatitis is the main cause of infectious liver disease. During pregnancy, a risk of vertical transmission exists both during gestation and at birth. HAV, HBV, and HCV might progress similarly in pregnant and non-pregnant women. In this study, we found a prevalence of 0.22% of viral hepatitis in pregnant women, with a light preponderance of HCV over HAV and HBV. Here, it was observed that acute HAV infection is more symptomatic and has higher risks for the mother and fetus, in a similar manner to what has been reported for HEV. Histopathological alterations were observed in all except one placenta, indicating that it is an important tissue barrier. Regarding the Mexican strategies for viral hepatitis eradication, success may be related to vaccination at birth, whereas for HCV, the national program for eradication is aimed at treating the infection via direct-acting antiviral agents. The HBV strategy has positively impacted pregnant women and their children, diminishing the risk of vertical transmission. The HCV strategy is still in its early years, and it is expected to be just as successful. For acute hepatitis, HAV and HEV, programs promoting hand washing and those aimed at providing clean food and water are applicable as preventive strategies, alongside other programs such as vaccination.

Assessment of Hospital Infection Prevention and Control Practices: Insights from Kampala International University Teaching Hospital, Ishaka, Uganda

The study aimed to identify factors affecting hospital infection prevention and control practices among medical personnel at Kampala International University Teaching Hospital in Ishaka, Uganda. The research was conducted using a quantitative descriptive research design. The result revealed that 76% of respondents felt they had sufficient knowledge about infection control and prevention practices. However, 34% of respondents found precautionary measures interfered with their work, and 70% recap needles after use. Only 32% reported a 0.3% chance of acquiring HIV after a needle stick injury. The study also showed 44% of respondents had received training on hand washing within 6 months. Most respondents 78% were able to wash hands before and after procedures. Only 44% of respondents had received training on waste segregation within a 6-month period. Policies and guidelines also influenced infection prevention and control practices. 52% of respondents considered the hospital infection prevention and control committee active, and 78% of them believed that waste segregation and post-exposure prophylaxis policies were available in their departments. The study found that hand washing is being carried out as recommended due to adequate on-the-job training. However, 54% of staff perceive hand washing as a challenge, and 78% were able to wash hands before and after every procedure as recommended. Only 30% of workers have access to a regular supply of soap and detergents for washing hands. Waste segregation is being practiced as recommended, but challenges persist for medical personnel. The management team should integrate infection prevention and control into the regular supervision of healthcare providers. The study suggests that promoting hand washing in a hospital requires adequate training, facilities, supplies, staffing, and a positive attitude. It recommends frequent hand washing training, accessible running water infrastructure, disposable towels, and soap and detergents. Staff should be trained on attitude change and proper waste segregation. Keywords: Hospital, Infection, Waste, Hand washing, supplies, training.

THE CORRELATION BETWEEN MATERNAL AWARENESS, HYGIENE PRACTICES, AND THE INCIDENCE OF DIARRHOEAL CASES: A CROSS-SECTIONAL STUDY IN LAHORE

Diarrhea is the second leading cause of death among children under five years of age and causes 53,000 child deaths in Pakistan annually. Lahore, being densely populated, is the most affected area compared to the other cities of Punjab. This cross-sectional survey was conducted in the urban areas of Lahore, in the surroundings of the Punjab University. A questionnaire was filled out by 100 participant mothers whose child was affected at least once. Several variables were evaluated, and significance was checked using Chi-square. Of the total of the participants, 85% of the mothers were aware and mainly educated. About two-thirds (63%) of children were vaccinated for Rotavirus. Hand washing habits and safe drinking were significantly reducing the incidence. Spreading more awareness through media, stopping the unnecessary use of medications, promoting hand washing practice and increasing awareness about the Rotavirus vaccine will help reduce the incidence and prevalence of diarrhea.

The Glasgow declaration on sustainability in Anaesthesiology and Intensive Care.

The Glasgow declaration on sustainability in Anaesthesiology and Intensive Care.

Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges

Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.Disclosures: None

Hand-washing promotion during Covid-19 outbreak in Riverbank of Kahayan River, Central Kalimantan, Indonesia

In mid-2020, COVID-19 cases in Central Kalimantan showed relatively high, approximately 10.5% of children suffered from COVID -19. Many institutions have been implementing health education on the positive healthy behaviour standard for COVID-19 prevention, including regular hand washing, mask-wearing, and social distancing. The purpose of this article is to give clear and actionable guidance for children living in river-basin residences. Central Kalimantan geographically has a number of rivers known as a watershed area (DAS). This photo essay records health promotion given during Covid-19 outbreak in Riverbank of Kahayan River, Central Kalimantan, Indonesia. In this study area, children use small boat made by wood to mobile or visit their friends to play. Before the Covid-19 Outbreak, using face mask in not compulsory and parents will just freely give permission to their children to play outside. It is shown that it is challenging to encourage children to protect themselves from the COVID-19 infection in the area of DAS. Moreover, the existence of this abundant water source is a potential natural asset for positive hygiene behaviour. Thus, it is worth noting that hand washing with soap and water is recommended. A cultural approach can also be an alternative for health campaigns. This paper shows how we use one of traditional musical instruments of Central Kalimantan, called Japen, and the lute is used as an instrument for making audio-visuals. This instrument is made from a sack. It includes education and has a key message of moral wisdom with the social value of the Dayak people in Borneo. Maintaining children's health during the Covid 19 pandemic with creative educational campaigns, using various modes such as posters, multimedia, and storytelling is beneficial for positive health behaviours.

Outbreak of Acute Gastroenteritis Among Rafters and Backpackers in the Backcountry of Grand Canyon National Park, April-June 2022.

On May 11, 2022, the National Park Service (NPS) Office of Public Health (OPH) and Coconino County Health and Human Services (CCHHS) in Flagstaff, Arizona contacted CDC about a rising number of acute gastroenteritis cases among backcountry visitors to Grand Canyon National Park (Grand Canyon). The agencies reviewed illness report forms, assessed infection prevention and control (IPC) practices, and distributed a detailed survey to river rafters and hikers with backcountry permits (backpackers) who visited the Grand Canyon backcountry. During April 1-June 17, a total of 191 rafters and 31 backpackers reported symptoms consistent with acute gastroenteritis. Specimens from portable toilets used by nine river rafting trip groups were tested using real-time reverse transcription-polymerase chain reaction and test results were positive for norovirus. Norovirus-associated acute gastroenteritis is highly transmissible in settings with close person-to-person contact and decreased access to hand hygiene, such as backpacking or rafting. IPC assessments led to recommendations for regular disinfection of potable water spigots throughout the backcountry, promotion of proper handwashing with soap and water when possible, and separation of ill persons from those who are not ill. Prevention and control of acute gastroenteritis outbreaks in the backcountry requires rapid reporting of illnesses, implementing IPC guidelines for commercial outfitters and river rafting launch points, and minimizing interactions among rafting groups.

Behavioural Determinants for Hand Hygiene Practices among Primary School Children during COVID-19 Pandemic

Background: Children acquire SARS CoV-2 infection from their family members but they experience mild symptoms. Hand washing promotion programs are being executed in many countries to enhance child healthcare development. Objective: This study was designed to identify behavioural determinants to increase hand washing practices among primary school children during COVID-19 pandemic. Methods: This was a cross-sectional study conducted by the Department of Pediatrics, King Edward Medical University/ Mayo Hospital, Lahore from June to November 2020. Total of 195 mothers of primary school children were enrolled by non-probability consecutive sampling. A 23-item, 5 points likert scale questionnaire assessed 5 domains related to handhygiene. Data was entered in SPSS 24. Domains were presented as frequency tables. Independent sample t-test was applied to 8 mean score of sub-category of each domain, and to cumulative mean score of each domain. A cut off mean score of ≥3 was taken as satisfactory. Results: We found satisfactory mean scores amongst mothers for knowledge regarding the importance of hand-washing (3.59±0.62), and commitment regarding maintenance of hand-hygiene (3.44±0.773). Better mean score for liking hand washing with alcohol rub/sanitizer than with soap and water (3.14±1.063 versus 1.10±1.229) was seen. Children reported not feeling dirty if they did not practice hand-hygiene (2.99±1.195). Elders in the households promoted hand-washing, but lacked practicing it themselves (3.48±0.881 versus 2.85±1.242). There was below satisfactory mean score for hand-hygiene amongst children after sneezing, coughing, blowing their nose, or playing (2.50±1.253, 2.23±1.265, 2.27±1.301, 2.83±1.280 respectively). Norm and self-efficacy factors had adequate overall scores (3.17±0.84, 3.17±0.65). The total score for this study was 2.8759±0.419. Conclusion: We found satisfactory mean scores for risk, attitudes, norms, ability, and self-regulation factors of handhygiene among primary school children.

Make it a habit: how habit strength, goal importance and self-control predict hand washing behaviour over time during the COVID-19 pandemic

Objective Hand washing has been at the core of recommendations and guidelines that aim to curb infectious diseases in general, and COVID-19 in particular. As hand washing comes down to an individual’s behaviour, we aimed to study how individual psychological variables influence hand washing over time during the COVID-19 pandemic. Design Over the course of 20 weeks, participants answered questions about their hand washing behaviour, goal importance, habit strength and self-control. Participants from an experimental and a control condition completed a baseline and final measurement, and the experimental condition was invited to bi-weekly measurements through reminders. Main outcome measure Hand washing behaviour over the past 14 days was assessed by self-report at baseline and final measurement, and additionally repeatedly over the course of 20 weeks in the experimental condition. Results Hand washing behaviour decreased over time, but this decrease was buffered by habit strength and goal importance. The decrease was smaller in the experimental condition that received reminders every 2 weeks. Conclusion Sending personal reminders on hand washing behaviour contributes to hand washing behaviour. Moreover, taking habit strength and goal importance, and to a lesser extent self-control into account is important when designing interventions to promote hand washing behaviour.

The multi-level factors influencing the development and impact of COVID-19 response in a university community: A review of the experiences of Kabale University in southwestern Uganda.

The index case of COVID-19 in Uganda was reported on 20th March 2020. The first confirmed imported case of COVID-19 in Kigezi sub- region South Western Uganda, where Kabale University is located, was reported on April 24th 2020. On August 2nd 2020 the first COVID-19 community case was recorded in the Kigezi Sub-region. Right from the early days of the threat of COVID-19 spread in Uganda, Kabale University put in place multiple mechanisms and interventions to contain the pandemic including: A COVID-19 Study Group: set up in February 2020 to study the disease, carry out risk assessment and advise the University on how to be prepared to handle cases if the disease were to reach the environment of the University. A multidisciplinary Kabale University COVID-19 Task Force: set up on 30th March 2020 to advise the University on preparations to ensure safe continuity of business at the university during a possible outbreak of COVID-2019 by designing and implementing appropriate infection prevention and control (IPC) measures, the Standard Operating Procedures (SOPs), for the University community. COVID-19 Knowledge Attitudes & Practice (KAP) Study –to inform planning for safe maintenance of business continuity at the university in the face of the COVID-19 outbreak. Following a national lockdown, the purpose of the study was to guide development of necessary measures to be undertaken to minimize the spread of COVID-19 among students, staff and visitors when re-opening of the University became imminent. The study revealed high levels of knowledge (84% correct rate of response); an overall positive attitude (77% positive rate of response); but only moderate COVID-19 preventive practices (68.8% correct rate of preventive practice). Knowledge was higher among male students (p=0.033); students older than 20 years (p=0.000); and students taking health related courses such as Medicine or Nursing (p=0.019). Attitudes about COVID-19 were better among female students (p=0.034); and in students older than 20 years (p=0.000). Age and sex are significant predictors of COVID-19 prevention practices (p=0.001, p=0.000 respectively). These findings informed the need for: Effective behavioral change communication: to alert the university and the neighboring communities about COVID-19. The strategies to be used to achieve this were; Internal memos to the university community through e-mail, social media and written notices placed in strategic areas, Radio talk shows through several FM radio stations in Kabale town and, Branded health literacy print-outs in form of posters, leaflets and brochures. Promotion of good respiratory and oral and hand hygiene – to discourage; haphazard spitting, ejecting or smearing nasal mucus on public places, sneezing or coughing in public without protection, and promotion of frequent handwashing. Random COVID-19 testing – One such test in June 2021 revealed positivity rate of 17.8% Development of the Kabale University COVID-19 Standard Operating Procedures. The order of personal prevention priorities emphasized in the SOPs were; face masking, hand washing with running water and soap or disinfectant, hand sanitizing with 70% alcohol and, keeping a physical distance of at least 2 meters from one another etc. With vaccination, this order has now been revised to give top priority to vaccination, although we still equally emphasize maintenance of the previous strategies.

Analysis of risk-factors associated with diarrhea prevalence among underfive children in Galkayo District Puntland State, Somalia

Background: The study analysed risk factors associated with diarrhea prevalence among underfive children in Galkayo District Puntland State, Somalia.Methods: The study used analytical cross-sectional survey conducted in Galkayo, from February to March 2020. The inclusion criteria were caregivers with underfive children, and exclusion criteria were children over five years, caregivers who have no underfive children and children with chronic diarrhea. Sample of 385 was calculated using Yamane formula. Caregivers were randomly selected using simple random sampling after cluster sampling. The researcher administered structured questionnaires, collected data from eligible caregivers using interview guide and elicited on diarrhea perceptions. Quantitative data was analysed using SPSS, qualitative data was identified common and sub-themes.Results: The study found diarrhea was affecting 30% of underfive children. The presence of two under-fives in the household was associated with high diarrhea prevalence [OR=1.93, 95% CI= (1.21, 3.08)]. Low educational level of underfive caregivers were associated with high diarrhea occurrence [OR=1.36, 95% CI= (0.68, 2.66)]. Households headed by non-biological mothers, diarrhea prevalence was high [OR=0.06, 95% CI= (0.00, 0.50) and OR=0.17, 95% CI= (0.03, 0.79)] respectively. Those children under the care of employed caregivers, diarrhea occurrence was high [OR=2.41 (0.99, 5.80)]. Poor personal hygiene (32%), sanitation (28%), and water quality (28%) were attributed to the cause of diarrhea among children.Conclusions: The study recommends, practice of child spacing, improve caregivers’ basic education to better understand risk factors and seek treatment, establish routine water quality surveillance at source and at household level, conduct awareness behaviour change by promotion of handwashing.

Efektivitas promosi kesehatan pencegahan Covid-19 dengan CTPS

COVID-19, the infectious disease caused by SARS-CoV-2, has emerged as a global health crisis and pandemic. Children are very susceptible to disease transmission because their immune system is not yet perfect. To achieve the spread and transmission of this virus, interventions are needed across the population. The promotion of hand washing in children is needed to increase children's knowledge about preventing covid-19 by washing hands with soap. The purpose of this study is to give Indonesian children additional education about handwashing with soap and to make them be able to demonstrate good and correct hand washing. The health education is conducted by giving lecture to the children and showing them videos in the end of the sessions. After that, an evaluation of the health education is carried out by giving the children pre-test and post-test designs. The result of the study showed that 96% children (49 of 51) who attended the health education experienced an increase in their post-test results. This indicated that the content of the health education can be easily understood by most of the children. A good learning process requires several supporting factors such as careful preparation, interactive way of delivering instruction, and good team coordination. In order to monitor the application of the knowledge obtained in the health education, it is necessary to carry out continuous educative activities so that hopefully there will be an increase in the health quality of Indonesian children.
 Keywords : Covid-19, Education, Hand Washing Steps

SARS-CoV-2 (COVID-19) and the Teaching of Ignaz Semmelweis and Florence Nightingale: a Lesson of Public Health from History, after the "Introduction of Handwashing" (1847).

SummaryIgnác Fülöp Semmelweis (1818-1865) and Florence Nightingale (1820-1910) were two important personalities in the history of medicine and public health. They dealt with the problem of handwashing. Semmelweis is also known as the “father of hand hygiene”; just in 1847 he discovered the etiology and prophylaxis of puerperal sepsis and imposed a new rule mandating handwashing with chlorine for doctors. He also tried to persuade European scientific community of the advantages of handwashing. During the Crimean War, in Scutary (Turkey), Florence Nightingale strengthened handwashing and other hygiene practices in the war hospital where she worked and her handwashing practices reached a reductions in infections. Unfortunately the hygiene practices promoted by Semmelweis and Nightingale were not widely adopted. In general handwashing promotion stood still for over a century. During current pandemic SARS-CoV-2 (COVID-19) one of the most important way to prevent the spread of the virus is still to wash the hands frequently.

Diarrhoea among Children Aged under Five Years and Risk Factors in Informal Settlements: A Cross-Sectional Study in Cape Town, South Africa.

Background: There is limited data on the association between diarrhoea among children aged under five years (U5D) and water use, sanitation, hygiene, and socio-economics factors in low-income communities. The study investigated U5D and the associated risk factors in the Zeekoe catchment in Cape Town, South Africa. Methods: A cross-sectional study was conducted in 707 households in six informal settlements (IS) two formal settlements (FS) (March–June 2017). Results: Most IS households used public taps (74.4%) and shared toilets (93.0%), while FS households used piped water on premises (89.6%) and private toilets (98.3%). IS respondents had higher average hand-washing scores than those of FS (0.04 vs. −0.14, p = 0.02). The overall U5D prevalence was 15.3% (range: 8.6%–24.2%) and was higher in FS than in IS (21.2% vs. 13.4%, respectively, p = 0.01). Water storage >12 h was associated with increasing U5D (OR = 1.88, 95% CI 1.00–3.55, p = 0.05). Water treatment (OR = 0.57, 95%CI 0.34–0.97, p = 0.04), good hand-washing practices (OR = 0.59, 95%CI 0.42–0.82, p = 0.002) and Hepatitis A vaccination (OR = 0.51, 95%CI 0.28–0.9, p = 0.02) had significant preventing effects on U5D. Conclusions: The study highlights that good hygiene practice is a key intervention against U5D in informal settlements. The promotion of hand-washing, proper water storage, and hygienic breastfeeding is highly recommended.

The Impact of Hand Washing Initiative on Young People in the Eastern Region of Ghana

Hand washing has been a lifelong practice because of its many health benefits, social and moral obligations. It is perceived to be one of the most important and cost-effective methods of preventing infectious and diarrhoeal diseases like the Coronavirus disease 2019, (COVID-19). (Ghana Health Survey, 2020). Promoting hand washing as an intervention for hand hygiene and behaviour change activity for continuous practice have been rolled out among young people so that they learn proper hand washing and maintain personal hygiene. This study assesses the impact of hand washing initiative among young people in the Eastern Region of Ghana.This is an exploratory and qualitative study that combines a Focus Group Discussions (FGD) of young people and In-Depth Interviews of key stakeholders such as parents, teachers, community leaders, health workers and NGO’s in the Eastern Region of Ghana. The data derived from the study was analyse using a qualitative technique such as thematic analysis to extract the key findings. During the study, ethical considerations were observed to protect respondents.Key findings from the study indicates that there is a general awareness of hand washing and its importance among young people. However, they find it difficult to adhere to the practice because of non-availability of basic items such as soap, water and knowledge of proper hand washing techniques. The study also revealed that key stakeholders contribute to promote hand washing initiative in diverse ways at home, in schools, health facilities and in the community. However, some stakeholders are predisposed to resources that enable them to achieve hand washing initiative. The least of those not predisposed to basic resources to support the practice are teachers, schools and community leaders because of shortage basic resources such as soap and water to support the practice of hand washing. This study concludes that despite all the efforts by young people to adhere to practice and key stakeholders’ effort to promote hand washing, they are confronted with basic challenges. Hence, the need to have basic resources such as water and soap in schools and communal areas, to advocate for young people to engage in global hand washing day and using young people as ambassadors to advocate for proper hand washing practices especially among their peers. Keywords: Infectious Diseases, Hand Washing Initiative, Non-Governmental organizations, Focus Group Discussion, Thematic Analysis, Behavioural Changes DOI: 10.7176/PPAR/11-4-01 Publication date: May 31 st 2021

An Outbreak of Gastroenteritis among students of a religious boarding school, district Islamabad: A Retrospective Cohort Study.

<em>Background:</em> On 1 March, 2018, 15 students of a religious boarding school presented to a tertiary care hospital in Islamabad with complaints of nausea, vomiting, abdominal pain and diarrhea. A team of FELTP fellows were tasked to investigate the suspected outbreak to confirm diagnosis, determine magnitude, evaluate possible risk factors, identify the source and implement control measures. <em>Methods:</em><strong> </strong>A retrospective cohort study was conducted from 25 February to 5 March, 2018. Medical records were reviewed at the hospital. All the students and staff of the boarding school were interviewed using a structured questionnaire. A case was defined as any student of the religious school reported with nausea, abdominal discomfort and one of the following symptoms of vomiting, diarrhea, and chills on 1 March, 2018. Information on demographics, history of food intake and clinical features was collected. Suspected food items and drinking water samples were sent to the National Institute of Health for microbiological analysis. Frequencies and attack rates were calculated and risk ratios computed at 95% confidence interval at the margin of error P&lt;0.05. <em>Results:</em> Out of a total of 120 students, 39.1% (n=47) developed symptoms with an overall attack rate (AR) of 39%. All the students were male with a mean age of 11 years (range 8-14 years). The most affected age group was 10 -11 years (AR 62%). The highest food specific attack rate (82%) was calculated for rice. Among all food items served at breakfast, rice was found statistically significant. Out of 57 students who ate rice, 47 developed illness (RR=17.31, 95% CI 5.70-52.58). During interviews with staff it was found that the food was cooked a day before and stored before being donated to the school by a local restaurant. Staphylococcus <em>aureus</em> was isolated from rice samples. <em>Conclusion:</em><strong> </strong>Consumption of contaminated rice was the most probable cause of the outbreak. Unhygienic storage and handling lead to contamination of the rice. Proper training of food handlers can prevent the transmission of food borne disease. It is strongly recommended that extreme care should be taken while accepting food items from the locals as donation and it should be ascertained that food is not old or smelly. Food must also be accepted with the identity of the person who donates food and this was adopted as a policy later on. In addition to the internal food safety checks, implementation of frequent hand washing and hygiene promotion operating procedures were recommended for the restaurant. Further, an awareness session was conducted on spot among the students and staff.

Hand-washing promotion for preventing diarrhoea.

BackgroundDiarrhoea accounts for 1.8 million deaths in children in low‐ and middle‐income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.ObjectivesTo assess the effects of hand‐washing promotion interventions on diarrhoeal episodes in children and adults.Search methodsWe searched CENTRAL, MEDLINE, Embase, nine other databases, the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and metaRegister of Controlled Trials (mRCT) on 8 January 2020, together with reference checking, citation searching and contact with study authors to identify additional studies.Selection criteriaIndividually‐randomized controlled trials (RCTs) and cluster‐RCTs that compared the effects of hand‐washing interventions on diarrhoea episodes in children and adults with no intervention.Data collection and analysisThree review authors independently assessed trial eligibility, extracted data, and assessed risks of bias. We stratified the analyses for child day‐care centres or schools, community, and hospital‐based settings. Where appropriate, we pooled incidence rate ratios (IRRs) using the generic inverse variance method and a random‐effects model with a 95% confidence interval (CI). We used the GRADE approach to assess the certainty of the evidence.Main resultsWe included 29 RCTs: 13 trials from child day‐care centres or schools in mainly high‐income countries (54,471 participants), 15 community‐based trials in LMICs (29,347 participants), and one hospital‐based trial among people with AIDS in a high‐income country (148 participants). All the trials and follow‐up assessments were of short‐term duration.Hand‐washing promotion (education activities, sometimes with provision of soap) at child day‐care facilities or schools prevent around one‐third of diarrhoea episodes in high‐income countries (incidence rate ratio (IRR) 0.70, 95% CI 0.58 to 0.85; 9 trials, 4664 participants, high‐certainty evidence) and may prevent a similar proportion in LMICs, but only two trials from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 trials, 45,380 participants; low‐certainty evidence). Only four trials reported measures of behaviour change, and the methods of data collection were susceptible to bias. In one trial from the USA hand‐washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 trials, 1845 participants; low‐certainty evidence).Hand‐washing promotion among communities in LMICs probably prevents around one‐quarter of diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 trials, 15,950 participants; moderate‐certainty evidence). However, six of these nine trials were from Asian settings, with only one trial from South America and two trials from sub‐Saharan Africa. In seven trials, soap was provided free alongside hand‐washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 trials, 12,646 participants; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 trials, 3304 participants). There was increased hand washing at major prompts (before eating or cooking, after visiting the toilet, or cleaning the baby's bottom) and increased compliance with hand‐hygiene procedure (behavioural outcome) in the intervention groups compared with the control in community trials (data not pooled: 4 trials, 3591 participants; high‐certainty evidence).Hand‐washing promotion for the one trial conducted in a hospital among a high‐risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (mean difference −1.68, 95% CI −1.93 to −1.43; 1 trial, 148 participants; moderate‐certainty evidence). Hand‐washing frequency increased to seven times a day in the intervention group versus three times a day in the control arm in this hospital trial (1 trial, 148 participants; moderate‐certainty evidence).We found no trials evaluating the effects of hand‐washing promotions on diarrhoea‐related deaths or cost effectiveness.Authors' conclusionsHand‐washing promotion probably reduces diarrhoea episodes in both child day‐care centres in high‐income countries and among communities living in LMICs by about 30%. The included trials do not provide evidence about the long‐term impact of the interventions.

Frontline Extension Workers’ Information Use, Protective Behaviors and Counseling Practices During Covid -19 Pandemic in Imo State, Nigeria

The only people close to the farmers are the extension workers, and to function well, they need the right information, good health and sound mind all the time. However, the sources of information on covid 19 available to them is unknown, hence this study. The study seeks to identify covid 19 information sources of extension workers, examine their protective behaviors, and describe counseling practices they adopt to reach farmers. A total of 120 extension staff purposively chosen from Imo ADP was used to elicit information for the study using questionnaire. Data were analyzed descriptively. The results revealed that the extension staff get information from a variety of ways, such as health organizations (72.5%), healthcare professionals (74.2%), ministries of Health and Agriculture (79.2%). They practice social distancing (83.3%), wearing of face masks (70.5%), avoid contact with eyes, nose and mouth (68.3%), promote hand washing (70.5%), avoid public gathering and many more. In counseling the farmers, the educate them regularly (85%), training of farmers (78.3%) and many more. It is worthy of commendation that since life has no duplicate, the extension staff are doing great job by adhering to covid 19 protocols and should be praised for service to humanity.

A Methodological Crisis in the WASH Sector: Crunching Numbers and Throwing Them over the Wall

Some pre-digital ‘Common Sense’ is urgently needed to salvage the WASH sector. A spate of recent Randomized Control Trials (RCTs) have shown negligible effect of improved water, safe sanitation and non-risk hygiene behaviour on health outcomes, prompting a methodological crisis amongst practitioners. Three different behaviour change methodologies, Community Led Total Sanitation (CLTS) routinely used to trigger improved sanitation, Social Marketing to promote hand washing, and the Community Health Club (CHC) approach to improve hygiene behaviour, have all shown through RCTs to have little impact on health, with much debate as to the reasons for such failure. When RCTs question the validity of such interventions, lives may be affected as funding is hard to justify. In one case at least, common sense prevailed, when Rwandan Ministry of Health, instead of aborting the Community Based Environmental Health Promotion Programme (CBEHPP) on the recommendation of the cRCT, chose instead to enhance it by including a substantial nutrition component with the rationale this would be essential if stunting as well as diarrhoea was to be controlled. There is increasing recognition that to achieve sustained health impact much more time is needed in WASH programmers than is normally available to inventions evaluated through most RCTs.

Compliance with COVID-19 Preventive and Control Measures among Food and Drink Establishments in Bench-Sheko and West-Omo Zones, Ethiopia, 2020.

IntroductionDespite the implementation of many preventive and control systems developed by governments, the spread of COVID-19 and its resulting infection rate are alarmingly increasing from time to time all over the world. In Ethiopia, public places visited by large numbers of people where preventive and control measures are poorly practiced are considered to be potentially contributing to the spread of the disease. Food and drink establishments are among the highly susceptible public establishments visited by large numbers of people who interact among themselves and with employees. Hence, this study aimed to measure the compliance with COVID-19 preventive and control measures among food and drink establishments in the selected towns of Bench-Sheko and West-Omo Zones in Ethiopia.MethodsA cross-sectional study was conducted among food and drink establishments in selected towns of Bench-Sheko and West-Omo zones from May 15, 2020 to June 15, 2020. A census of all 324 food and drink establishments found in the study area was conducted, and data were obtained from managers of the establishments through face-to-face interviews. Data were entered in to Epidata manager and exported to SPSS version 24.0 for analysis. Percentage compliance score was computed to describe the level of compliance. Ethical approval was obtained from Mizan-Tepi University Institutional Review Board, and written informed consent was obtained from every participant.ResultsThe overall compliance level with COVID-19 preventive and control measures was 55.5%. The majority (89%) of the food and drink establishments had functional hand washing facilities at the main entrance gate. Less than half of the food and drink establishments had posted written materials promoting hand washing, arranged tables and chairs in a manner that they accommodate not more than four people at once and at least 2 meters apart, carry out daily cleaning and disinfection of frequented touched surfaces, and provided education or training for their workers about COVID-19.ConclusionThe overall compliance level with COVID-19 preventive and control measures among food and drink establishments was very poor. Thus, it is highly recommended that the federal government of Ethiopia, the federal ministry of health, and local health authorities consider a move towards more solid, strict, and comprehensive compulsory measures, including fines that can lead up to the closure of non-compliant establishments.