Hygiene Promotion Research Articles

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.

Soil-transmitted helminths and associated factors among pregnant women in Doreni district, Oromia region, Ethiopia: a cross-sectional study

BackgroundSoil-transmitted helminthiasis (STH) refers to a set of parasitic illnesses caused by nematode worms and spread to people through faeces-contaminated soil. It is highly prevalent in low- and middle-income countries due to a lack of environmental sanitation and personal hygiene. Pregnant women are among the risk groups for infection by soil-transmitted helminths. Former studies of the disease burden among pregnant women in Ethiopia didn’t indicate the intensity of parasitic infection. The aim of this study was to assess the prevalence and associated factors of soil-transmitted helminths among pregnant women.MethodsAn institution-based cross-sectional study was conducted among 416 randomly selected pregnant women. The data were collected using a structured interview-administered questionnaire and a laboratory test. The Kato-Katz technique was used to diagnose soil-transmitted helminthiasis and determine the intensity of the infection. The collected data were entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis. Multivariate logistic regression analysis was used to identify independent predictors of soil-transmitted helminths at a p-value < 0.05.ResultsThe overall prevalence of soil-transmitted helminths among pregnant women was 30%. (95%, CI: 26-34%). Living in a rural area (AOR = 3.35; 95% CI = 1.83–6.13), drinking from an unprotected water source (AOR = 2.52; 95% CI = 1.45–4.37), not washing one’s hand after the toilet (AOR = 2.75; 95% CI = 1.55–4.88), lacking health information (AOR = 1.70; 95% CI = 1.01–2.85), working as a daily labourer (AOR = 2.88; 95% CI = 1.01–8.20), and walking barefoot (AOR = 4.00; 95% CI = 2.29–7.00) were significantly associated with the presence of soil-transmitted helminths among pregnant women.ConclusionThe prevalence of STH was significantly moderate in the study area, where pregnant women were mostly affected by ascariasis and hookworms. Living in a rural area, being a daily labourer, walking barefoot, not washing hands after the toilet, drinking from an unprotected water source, and lacking health information were the determining factors. Interventions including health education, the expansion of pure drinking water sources, the promotion of personal hygiene, and the wearing of shoes are recommended to reduce the burden of soil-transmitted helminths in the study area.

Exploring the Interplay of Socio-demographic Enablers in Sustaining Open Defecation-Free Status among Households in Kakamega County, Kenya

This study aimed to explore the interplay between socio-demographic enablers and the sustainability of post-open-defecation-free status among households in Butere Sub-County, Kakamega County, Kenya. The research adopted a cross-sectional survey to assess the sustainability of the open defecation-free status at the household level, surveying 6286 certified Open Defecation Free (ODF) households through stratified random sampling. A sample size of 376 households across three wards was selected for the study. Both quantitative and qualitative data were employed; quantitative data was analysed using SPSS Version 28.1, summarized using descriptive statistics, and presented in tables, pie charts, and frequency tables, whereas qualitative data was analysed thematically. Data analysis involved three stages; univariate, bivariate and multivariate analyses. Chi-square tests analysed the statistically significant association between dependent and independent variables. Binary logistic regression predicted the probability of post-ODF status (whether the ODF status was sustainable or not), and 2x2 contingency tables were used to compute the odd ratio. Results revealed that only 9% of households sustained post-ODF status. The chi-square tests revealed a significant association between respondents' gender (χ² = 0.124, p = 0.009*), age distribution (χ² = 6.471, p &lt; 0.05), presence of children under 5 years old in the household (χ² = 1.884, p = 0.004*), level of education (χ² = 5.726, p = 0.006*), employment status (χ² = 9.602, p = 0.006*), and monthly earning brackets (χ² = 11.783, p&lt;0.001*). However, there was no statistically significant association between marital status (χ² = 10.409, p = 0.94&gt;0.05), household size (χ² = 1.782, p = 0.56&gt;0.05), and the sustainability of ODF. On the other hand, the odds ratio for employment status suggests that significant association (OR=1.333; p = 0.007*&lt;0.05; 95% CI: 1.082-1.642), where employed individuals were 1.333 times more likely to sustain ODF status. Further analysis revealed that employment status was a statistically significant predictor of post-ODF sustainability (aOR=1.837 P=0.011; 95% CI: 1.132-2.980). The study concluded that most households (91%) did not sustain post-ODF status after the ODF declaration. It was recommended that health practitioners improve door-to-door monitoring and develop post-ODF tracking tools at the household level, focusing on important parameters from Ministry of Health guidelines. The government and other Water sanitation and hygiene (WASH) stakeholders should support communities in establishing and enhancing economic empowerment programs to increase household income and encourage investments in sanitation infrastructure and hygiene promotion activities.

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59ml/PD. Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

A global survey of national oral health policies and its coverage for young children.

There is no accessible information on countries with oral health policies. The purpose of this study was to identify World Dental Federation (FDI) member countries with oral health policies and their scope and extent of coverage of oral health care for young children. This international survey recruited chief dental officers, oral health advisors to national ministries of health, and other key informants of the 158 FDI member countries between December 2020 and December 2021. The survey tool was administered online to the study participants. Key questions explored the following outcome measures: countries with oral health policies; the thrusts of the oral health policies; policy thrusts targeting young children; and dental care plans as a component of a universal health care plan. Descriptive statistics were conducted to determine the number of countries with any of the study outcome measures and coverage per country. Sixty (38%) of the 158 FDI member-countries responded to the survey. Forty-eight (55.2%) of the 60 countries had a national oral health policy document or position statement on oral health; 54 (62.1%) countries had plans on universal health care, and 42 (48.3%) included dental care within their universal health care plan. The most common policy thrusts addressing the oral health needs of children were the promotion of oral hygiene (71.7%), provision of fluoride products for children (53.3%), collaboration with primary care providers (35%), and prenatal oral health education (50%). There were differences in the scope of oral health care coverage and the coverage for young children between continents as well as between countries. Europe had many countries with children-friendly oral health policy coverage. About half of the surveyed countries had a national oral health policy. There were variations in the scope of oral health care coverage, particularly for young children, both between continents and among individual countries. These findings underscore the importance of understanding the landscape of oral health policies globally. Such insights can help inform targeted interventions to enhance oral health policies, thereby contributing to improved oral health outcomes on a global level.

Assessing the Effectiveness of a Multicomponent Intervention on Hand Hygiene and Well-Being in Primary Health Care Centers and Schools Lacking Functional Water Supply in Protracted Conflict Settings: Protocol for a Cluster Randomized Controlled Trial.

Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings. This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently. This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ≥5 employees, and schools if they had ≤7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating. The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024. This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion. ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478. DERR1-10.2196/52959.

Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018–2019

BackgroundHepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR).MethodsBlood samples were collected from 352 patients aged 0–85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis.ResultsOf the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0–10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water.ConclusionThis epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.

Common Childhood Sleep Problems and Disorders.

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

The need of the hour: Providing water in shared toilet facilities for menstrual hygiene management in urban India

Abstract Shared sanitation services continue to expand in India's growing cities, yet, these facilities are blighted by issues including lack of privacy, overflow of raw sewage, and notably, a lack of water supply. Access to water in shared toilets for menstruating women and girls to wash themselves, their reusable menstrual products, their stained clothes, and sanitation infrastructure is a critical but all too-often neglected aspect of menstrual hygiene management (MHM). Drawing on the existing literature and data from Maharashtra, this commentary article uses the example of urban India to highlight the ‘need of the hour’, the provision of water in shared sanitation facilities in the global South for MHM as and when required. Evidence-based water supply norms in shared sanitation for MHM, from menarche to the perimenopause, are key, to highlight the need for water as an ‘MHM plus’ requirement for women and girls reliant on shared facilities. Connecting shared toilets to piped water is a long-term process, but the provision of water in buckets is a start. Hygiene promotion can create awareness of the importance of water for sustainable MHM. Monitoring and evaluation can determine the impact of supplying water in shared toilets on MHM.