Hygiene Promotion Research Articles

Water, Sanitation and Hygiene (WASH) in Japanese elementary schools: Current conditions and practices.

BackgroundWater, sanitation, and hygiene (WASH) is the foundation for preventing infectious diseases, as the current COVID‐19 pandemic has shown. WASH is essential for school health, yet there have been very few papers published on WASH in Japanese schools. The objective of this review is to describe the current conditions and practices in Japanese elementary schools using an international framework for WASH in schools and identify implications for handwashing promotion in other areas.MethodsThis research was based primarily on a literature review. Information on common WASH practices was also collected through an international workshop attended by school health experts.ResultsThere is a rigorous legal foundation for ensuring the physical infrastructure and quality control of a safe water supply in Japanese schools. Water quality is monitored regularly by Yogo teachers and school pharmacists. Strategic locations and an abundance of water supply infrastructure facilitate handwashing behavior. Hygiene promotion activities by Yogo teachers and student's health committees play a major role in increasing awareness, while health education classes provide minimal but necessary knowledge on handwashing with soap. Flush toilets are the standard, but there is still a demand for improvement of toilet facilities. Children’s participation in daily cleaning of school toilets contributes to students understanding the importance of cleanliness.ConclusionsDrawing from the Japanese example, WASH in schools' interventions are suggested to include laws and policies, a designated teacher, and children’s participation to sustain both infrastructure and hygiene promotion.

Assessment of Kayakalp yojna in public health-care facilities in Himachal Pradesh

Background: Maintenance of a clean environment in a hospital is challenging and at the same time crucial for patient safety. The importance of the hospital environment in patient care has received worldwide attention, especially in infection prevention and control. The Ministry of Health and Family welfare launched “Kayakalp Yojna,” an initiative to promote cleanliness and enhance the quality of public health facilities. Objective: This study was undertaken to assess the impact of the implementation of the Kayakalp initiative in public health-care facilities of Himachal Pradesh. Material and Methods: This analytical study was conducted to assess the impact of Kayakalp Yojna in six thematic areas; hospital/facility upkeep, sanitation and hygiene, waste management, infection control (IC), supportive services, and hygiene promotion in government hospitals using the Kayakalp assessment tool in the state of Himachal Pradesh in 2017–2018. Results: Post implementation of Kayakalp Yojna, there was an average improvement of 20% in the total scores of the hospitals from internal assessment to external assessment. Four of the 12 district hospitals, three of the 89 community health centers, and 26 of the 475 public health centers scored more than 70% in the external assessment. Conclusion: The Kayakalp assessment results give an insight to the problem areas and present a possibility to improve the public health facilities.

Furuncular myiasis affecting the glans penis of a young boy caused by the larvae of Cordylobia anthropophaga (the Tumbu fly), a case report

Cutaneous myiasis is endemic in West Africa, and it is most commonly caused by the larvae of Cordylobia anthropophaga. In English literature, recorded cases of this cutaneous myiasis affecting the glans penis are rare. This rarity calls for a need to consider this as a differential when looking at furuncular lesions of the glans penis. This awareness is important for practitioners who may come across this case. We report a case of furuncular myiasis of the glans penis due to the larvae of C. anthropophaga of an 11-year-old boy living in Lagos, Nigeria. The patient presented with a lesion on his glans penis, initially thought to be a boil. Upon examination, the lesion contained a single larva of C. anthropophaga. It was extracted, and the area healed well. Although endemic, furuncular myiasis of the glans penis is a very rare condition, likely related to the living circumstance of the patient. An awareness of the clinical features is important to prevent misdiagnoses of foruncular lesions that occur on the glans penis, especially in people with identified risk factors. Health education and promotion of good hygiene are important in reducing the incidence of Cordylobia anthropophaga infestation.

Public health system in promotion of water sanitation and hygiene: an analytical study

Public health system in promotion of water sanitation and hygiene: an analytical study

ПРОБЛЕМА МЕДИЦИНСКОЙ АКТИВНОСТИ НАСЕЛЕНИЯ РОССИИ В ЭПОХУ COVID-19

Significance. Medical activity is a person's practice in the field of protecting one's own and public health, expressed in compliance with medical recommendations and hygiene rules, a complex of therapeutic and preventive measures for improving health, identifying and eliminating pathological changes, functional disorders, and preventing diseases. The basis of medical activity is awareness, which is formed through effective hygiene education and promotion of a healthy lifestyle. Therefore, the nature and intensity of the medical activity of an individual is influenced by the level of education and culture, and knowledge of health-related issues. The purpose of the study is to consider the main problems of medical activity, preservation and promotion of health in the context of the COVID-19 pandemic. Material and methods. The information base of the study was publications in periodicals and the Internet, statistical data of the Rosstat, WHO, “Yandex. Coronavirus. Statistics”, polls by the state-run VTsIOM (All-Russia Opinion Research Center). The study used general logical and analytical methods, methods of statistical analysis and empirical research. Results. Medical activity and lifestyle play a leading role in controlling the spread of COVID-19. Non-compliance with anti-epidemic measures and irresponsible hygienic behavior (ignoring the mask regimen, personal hygiene rules, social distancing, “anti-vaccination” attitude), irresponsible medical behavior (undertreatment and ignoring medical rehabilitation), unhealthy diet (unbalanced diet, insufficient intake of vitamins and microelements), inadequate physical activity (its insufficiency) and addictive behaviors (smoking, drinking alcoholic beverages) contribute to both rapid spread of the infection in the social environment, and prolongation of the complicated epidemiological situation over time, minimizing the entire complex mechanism of the anti-COVID actions of the health and administrative services, increasing the risk of severe course of the disease, post-COVID complications and deaths. Reasons of the reduced medical activity of the Russians include lack of confidence in a medical specialist, medical organizations, and the health care system in general; dsregard of one's health; low sanitary culture of the population due to insufficient education in health preservation; reduction in the number of medical institutions and personnel of the state medical institutions, etc. Among the objective reasons, the first and most acute problem is the economic one: low standard of living of the significant part of the population, which dramatically limits the ability to maintain their health. The main vector in improving the current situation is the growth of economic well-being of the citizens; a conscious choice of health improvement strategies, supported by the system of measures to encourage citizens to take care of their health; promotion of a healthy lifestyle and self-preserving behavior; and government measures to support the wellness industry.

Evaluation of Knowledge, Attitude, and Practice Regarding Hand Hygiene Practices among Inpatients of Kalinga Institute of Medical Sciences Bhubaneswar: A Preliminary Study.

Background:Health-care-associated infection or nosocomial infection is defined as patients getting an infection on admission to the hospital if they were not infected or incubating the infection before admission. Hand hygiene is the most important measure that can avoid the transmission of germs and can prevent health-care-associated infections.Materials and Methods:A hospital-based cross-sectional study was conducted between June 2020 to July 2021 with the objective to evaluate knowledge, attitude, and practice of hand hygiene among the inpatients of Kalinga Institute of Medical Sciences, Bhubaneswar. A predesigned structured questionnaire was used for data collection. Knowledge and attitude of the participants were assessed using prevalidated 9 point and 6 point scale. Practice of the health-care providers (HCPs) toward health hygiene observed by the patients was also assessed using 6 point scale.Results:Majority of the participants had average knowledge score (56.7%) and average attitude score (62.0%) on hand hygiene, whereas their observation on the practice of hand hygiene among HCPs has given bad score (50.7%). Males have significantly good knowledge (P = 0.0001) and attitude score (P = 0.00097) compared to female. Similarly higher educational level participants had significantly good knowledge (P = 0.0002) and attitude score (P = 0.0053) on hand hygiene.Conclusions:The findings of this study indicate that there is insufficient hand hygiene awareness among the inpatients in a tertiary care hospital population mainly among the female and less educated participants. Hence, development of community-based hand hygiene promotion programs for the general public are the need of the hour.

Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia.

Background:Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital.Methods:A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval.Results:Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance.Conclusion:The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.

Role of Triphala Kwatha Gandusha in the management of Aphthous ulcer: A review study

Mukhapaka (Stomatitis) is a common ailment seen in general practice. The Pittaja Mukhapaka (Aphthous ulcer) is fully described in Ayurveda under the term Mukha rogas. Oral ulcers are estimated to impact 4% of the global population, with aphthous ulcers being the most frequent, affecting up to 25% of the global population. Psychological stress, hormonal impacts, dietary sensitivity, and nutritional insufficiency are the primary causes of Pittaja Mukhapaka (Aphthous ulcer). It is a painful and frequently recurring inflammatory disorder of the oral mucosa that can develop as a result of several well-defined disease processes. As a result, Gandusha is described as one of the key therapies in the Ayurvedic system of medicine for both preventing and treating oral cavity illnesses. Triphala (tri means three and phala means fruits) is an Ayurvedic preparation made up of three equal parts of Indian subcontinent herbal fruits: Terminalia belerica, Phyllanthus emblica, and Terminalia chebula. Triphala includes powerful antioxidants as well as other bioactive substances such as flavonoids, saponins, anthraquinones, amino acids, fatty acids, and different carbohydrates. As a result, it promotes the maintenance and promotion of oral hygiene by exerting a cleansing activity and strengthening the defence mechanism in the oral cavity. An attempt is made in this regard to discuss the role of Triphala Kwatha Gandusha in Pittaja Mukhapaka.

A Qualitative Inquiry into Rural Primary Schooler's Hygiene during the Covid-19 Pandemic in Kupang regency, East Nusa Tenggara Province, Indonesia

Introduction: The importance of personal hygiene in preventing the spread of infection cannot be underestimated. Handwashing is an essential aspect of personal hygiene, especially among children. This study aimed to explore primary school students' hygiene in rural and remote areas in the Kupang regency. Methods: This study was conducted as a part of the end line evaluation of the MEMBACA II project. Teachers from four primary schools in three villages were purposively selected to participate in this study. The teachers were recruited from the participant schools of the MEMBACA II Project. Data was collected using phone interviews. Data were analyzed using inductive thematic analysis. Results: In total, there were 31 participants across four primary schools interviewed. The participants consisted of teachers, village leaders, village reading camp facilitators, and school supervisors. Participants were recruited as a proxy for providing information about students' hygiene. There were three themes identified as a result of the data analysis. The first theme is an improvement in children’s hygiene behavior. The second theme is the benefit of the little doctor program in children’s hygiene practices. The third theme challenges in children’s hygiene promotion and education. Overall, children were used to handwashing practices. They understood the importance of handwashing, especially during the Covid-19 pandemic. They were also aware of four essential times of handwashing. However, the adults perceived the need for handwashing equipment and access to clean water were the main challenges to maintaining students' hygiene. Conclusion: The study demonstrated the significance of regularly teaching children about handwashing in making handwashing habits among these youngsters. A continuing provision of health literacy and access to clean water is required to maintain hygiene behavior

Hand Hygiene Compliance and Associated Factors among Healthcare Workers in Ethiopia: A Systematic Review and Meta-Analysis

Background Promoting hand hygiene compliance should be a priority for health authorities and all healthcare facilities at all levels. Therefore, this systematic review and meta-analysis aimed to provide a pooled estimate of hand hygiene compliance and associated factors among healthcare professionals in Ethiopia. Methods PubMed, Science Direct, EMBASE, the Google search engine, and Google Scholar were used to retrieve studies that were eligible for the study. The searches included all studies published in English prior to July 2021. Using a structured data extraction format, two authors independently extracted the required data. STATA Version 16 software has been used for statistical analysis. To measure the heterogeneity of the studies, the Cochrane Q-test statistics and I2 test were used. Because of the significant heterogeneity, a random-effects model was used. Results The pooled hand hygiene compliance among healthcare workers in Ethiopia was 38% (95% CI: 0.16–0.59). According to the study's subgroup analysis, Addis Ababa City administration health workers had the highest hand hygiene compliance, at 73% (95% CI: 0.50–0.96), while SNNP regional state had the lowest, at 9% (95% CI: 0.05–0.13). Presence of hand hygiene promotion (OR: 2.14, 95% CI: 1.04–3.24), towel/tissue paper availability (OR: 3.97, 95% CI: 2.09–5.86), having a positive attitude toward hand hygiene (OR: 1.79, 95% CI: 1.28–2.30), having good knowledge about hand hygiene (OR: 3.45, 95% CI: 1.26–5.64), and being trained for hand hygiene (OR:4.97, 95% CI:1.81–8.14) were significantly associated with hand hygiene compliance. Conclusion In this analysis, hand hygiene compliance among healthcare workers in Ethiopia was less than half. Providing hand hygiene promotion, towel/tissue paper presence, having a positive attitude toward hand hygiene, having good knowledge about hand hygiene, and being trained for hand hygiene were important variables for the increment of hand hygiene compliance.

Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial

SummaryBackgroundWHO promotes the SAFE strategy for the elimination of trachoma as a public health programme, which promotes surgery for trichiasis (ie, the S component), antibiotics to clear the ocular strains of chlamydia that cause trachoma (the A component), facial cleanliness to prevent transmission of secretions (the F component), and environmental improvements to provide water for washing and sanitation facilities (the E component). However, little evidence is available from randomised trials to support the efficacy of interventions targeting the F and E components of the strategy. We aimed to determine whether an integrated water, sanitation, and hygiene (WASH) intervention prevents the transmission of trachoma.MethodsThe WASH Upgrades for Health in Amhara (WUHA) was a two-arm, parallel-group, cluster-randomised trial in 40 rural communities in Wag Hemra Zone (Amhara Region, Ethiopia) that had been treated with 7 years of annual mass azithromycin distributions. The randomisation unit was the school catchment area. All households within a 1·5 km radius of a potential water point within the catchment area (as determined by the investigators) were eligible for inclusion. Clusters were randomly assigned (at a 1:1 ratio) to receive a WASH intervention either immediately (intervention) or delayed until the conclusion of the trial (control), in the absence of concurrent antibiotic distributions. Given the nature of the intervention, participants and field workers could not be masked, but laboratory personnel were masked to treatment allocation. The WASH intervention consisted of both hygiene infrastructure improvements (namely, construction of a community water point) and hygiene promotion by government, school, and community leaders, which were implemented at the household, school, and community levels. Hygiene promotion focused on two simple messages: to use soap and water to wash your or your child’s face, and to always use a latrine for defecation. The primary outcome was the cluster-level prevalence of ocular chlamydia, measured annually using conjunctival swabs in a random sample of children aged 0–5 years from each cluster at 12, 24, and 36 month timepoints. Analyses were done in an intention-to-treat manner. This trial is ongoing and is registered at ClinicalTrials.gov, NCT02754583.FindingsBetween Nov 9, 2015, and March 5, 2019, 40 of 44 clusters assessed for eligibility were enrolled and randomly allocated to the trial groups (20 clusters each, with 7636 people from 1751 households in the intervention group and 9821 people from 2211 households in the control group at baseline). At baseline, ocular chlamydia prevalence among children aged 0–5 years was 11% (95% CI 6 to 16) in the WASH group and 11% (5 to 18) in the control group. At month 36, ocular chlamydia prevalence had increased in both groups, to 32% (24 to 41) in the WASH group and 31% (21 to 41) in the control group (risk difference across three annual monitoring visits, after adjustment for prevalence at baseline: 3·7 percentage points; 95% CI −4·9 to 12·4; p=0·40). No adverse events were reported in either group.InterpretationAn integrated WASH intervention addressing the F and E components of the SAFE strategy did not prevent an increase in prevalence of ocular chlamydia following cessation of antibiotics in an area with hyperendemic trachoma. The impact of WASH in the presence of annual mass azithromycin distributions is currently being studied in a follow-up trial of the 40 study clusters. Continued antibiotic distributions will probably be important in areas with persistent trachoma.FundingNational Institutes of Health—National Eye Institute.

Costs of hand hygiene for all in household settings: estimating the price tag for the 46 least developed countries

IntroductionDomestic hand hygiene could prevent over 500 000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility (HWF) with...

Evaluation of facial cleanliness and environmental improvement activities: Lessons learned from Malawi, Tanzania, and Uganda.

The World Health Organization promotes the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control and prevention. The F&E components of the strategy focus on promotion of healthy hygiene and sanitation behaviors. In order to monitor F&E activities implemented across villages and schools in Malawi, Tanzania, and Uganda, an F&E Monitoring and Evaluation (FEME) framework was developed to track quarterly program outputs and to provide the basis for a pre and post evaluation of the activities. Results showed an increase in knowledge at the school and household levels, and in some cases, an increase in presence of hand/face washing stations. However, this did not always result in a change in trachoma prevention behaviors such as facial cleanliness or keeping compounds free of human feces. The results highlight that the F&E programs were effective in increasing awareness of trachoma prevention but not able to translate that knowledge into changes in behavior during the time between pre and post-surveys. This study also indicates the potential to improve the data collection and survey design and notes that the period of intervention was not long enough to measure significant changes.

Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study.

Diarrheal diseases and respiratory infections (RI) are two leading causes of childhood mortality in low and middle-income countries. Effective handwashing at critical time-points may mitigate these diseases. However, there is a lack of published data investigating this association in school-aged children in India. This study is part of a larger prospective handwashing intervention study in a low-income community in New Delhi, India examining the associations between handwashing behavior and diarrhea and RI in schoolchildren. This current study reports the findings of the baseline survey administered to 272 mother–child dyads. Children aged 8–12 years, and their mothers, were recruited from six schools. A baseline questionnaire was used to collect sociodemographic data, handwash behavior, and mother-reported recent diarrhea and RI incidence among the children. Handwashing before and after preparing food, after defecation, and after cleaning dishes significantly reduced the odds of diarrhea by over 70%, and of RI by over 56%. Using a clean cloth after handwashing lowered odds of diarrhea and RI by 72% and 63% respectively. Around 60% of the participants believed that handwashing could prevent diarrhea and RI in their children. There was a low prevalence of handwashing at critical time-points and a poor perception regarding handwashing benefits. To improve handwashing behavior, hygiene promotion programs need to understand what motivates and hinders handwashing in vulnerable populations.

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia.

ObjectiveTo determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control.MethodsWe conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys.FindingsOver the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41–53) for wash stations, 18 percentage points (95% CI: 12–24) for soap and 12 percentage points (95% CI: 5–19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15–27 for 0–5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2–15 for 6–9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits.ConclusionThe community- and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.

Prevalence and associated factors of Tunga penetrans infestation among 5-14-year-olds in rural Ethiopia.

BackgroundTunga penetrans, also known as sand flea, causes Tungiasis in humans and animals. Despite its notoriety as an entomological problem, however, the ectoparasite receives little consideration from public health professionals. It is against this background that this article aims to assess the prevalence of and factors associated with Tunga penetrans infestation among 5-14-year-olds in rural Western Ethiopia.MethodsFrom November to December 2020, 487 children aged 5 to 14 were selected from four primary schools in a cross-sectional study using systematic random sampling. Clinical exams, Interviews with parents/guardians and observations of the housing and classroom environments were used to collect data. Descriptive statistics and multivariable regression were used to characterize the data and identify factors associated with Tunga penetrans infestation.ResultTunga penetrans infestation (Tungiasis) was diagnosed in 138 of the 487 children examined, placing the prevalence at 28.3% (95% CI: 24.2%, 32.2%). Mud plastered walls [AOR: 5.83, % CI (3.44–9.88)], having cats in the house [AOR: 5.91, 95% CI (3.51–10.11)], not having separated sleeping quarters for animals [AOR: 4.60, 95% CI (2.69–7.86)], using self-supplied water [AOR: 6.30, 95% CI (3.33–11.93)], walking>30 minutes to school [AOR: 2.37, 95% CI (1.48–3.80)] were associated with Tungiasis.ConclusionIn one way or another, several of the identified factors were linked to poverty. Improved house wall materials, fumigation of mud-plastered houses, dusting or spraying insecticides on domestic animals (such as cats), improved access to water, community education about keeping animals separated from living spaces, and hygiene promotion are all needed, with a focus on locally available, low-cost technologies that the poorest families can afford.

Microbial load of edible termites (macroterme spp.) from collection to marketing in Serenje District, Central Zambia

Edible insects including termites form a suitable alternative for sustainable provision of animal protein to fight protein-energy malnutrition. It is as cardinal to study the food safety of edible termites as it is for any other food stuff. Twenty seven (27) samples were collected and analysed for total viable counts and Enterobacteriaceae. The microbial load was assessed using culture, microscopic and biochemical methods. The isolates identified in this study includeStaphylococcus aureus, Escherichia coli, yeasts other thanCandida albicans andZygomycetes. Investigation of the total viable counts and Enterobacteriaceae of open air traded edible termites revealed loads higher than those recommended for minced meat 5.7 to 6.7 log10 cfu/g. The mean ranges were between 6.87 and 9.29 log10 cfu/g for total viable counts and 6.64 and 8.537 log10 cfu/g for Enterobacteriaceae. The presence ofE. coli suggests faecal contamination of the sample along the value chain whereasS. aureus, yeasts other thanC. albicans, andZygomycetes indicate unhygienic handling of the food samples. Heat treatments can reduce the loads but may not be effective for enterotoxins and recontamination of the sample is possible. Poor hygiene and sanitation by handlers may contribute to contamination and recontamination of Edible termites. Food safety and hygiene education on processing and handling practices that reduce microbial loads at collection sites, transportation and display points are important especially since termites are sold as ready to eat foods in African open air Markets. Legislation on open defecation, use of toilets and promotion of hand washing hygiene can effectively reduce the risk of contamination with gastrointestinal microflora from faecal matter.

Dental health problems and treatment-seeking behavior among special need school students in Amhara region, Ethiopia

BackgroundOral diseases are a public health concern with a significant impact on the quality of life of individuals. Children with special needs face significant challenges in carrying out oral hygiene due to their disability, and they are more prone to poor oral health and illnesses. This study assessed dental health problems and treatment-seeking behaviors of special needs school students in Amhara region, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from November 2020 to April 2021, in eight special needs schools located in the Amhara Regional State, Ethiopia. A total of 443 randomly selected special needs students were included. Data were collected using a structured interview-administered questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with oral health problems and treatment-seeking behavior. A p-value of less than 0.05 was used to declare statistical significance.ResultsThe prevalence of self-reported dental health problems and treatment-seeking behaviors among special needs school students was 46.1% (95% CI: 41.4%, 50.7%) and 60.3% (95% CI: 53.4%, 66.8%), respectively. Place of residence, grade level, religious affiliation, years lived with disability, and knowledge of dental health-related risk behaviors were associated with dental health problems. Whereas, place of residence, being hearing impaired, and having prior information about dental health problems were associated with dental treatment-seeking behavior.ConclusionsA significant number of special needs students reported dental problems and about 40% of them did not seek dental treatment. Oral hygiene practice and access to dental care services are important in the prevention of dental problems. Hence, oral hygiene promotion programs focusing on oral hygiene practice and dental treatment services are needed in special needs schools. It is also strongly suggested to incorporate oral health related information in health-related academic lessons to enhance optimum oral health among special needs students.

The effect of hand hygiene promotion programs during epidemics and pandemics of respiratory droplet-transmissible infections on health outcomes: a rapid systematic review

BackgroundPublic health strategies in the context of respiratory droplet-transmissible diseases (such as influenza or COVID-19) include intensified hand hygiene promotion, but a review on the effectiveness of different ways of promoting hand hygiene in the community, specifically for this type of infections, has not been performed. This rapid systematic review aims to summarize the effectiveness of community-based hand hygiene promotion programs on infection transmission, health outcomes and behavioral outcomes during epidemic periods in the context of respiratory droplet-transmissible diseases. We also included laboratory-confirmed health outcomes for epidemic-prone disease during interepidemic periods.MethodsWe searched for controlled experimental studies. A rapid systematic review was performed in three databases and a COVID-19 resource. Following study selection (in which studies performed in the (pre-)hospital/health care setting were excluded), study characteristics and effect measures were synthesized, using meta-analyses of cluster-RCTs where possible. Risk of bias of each study was assessed and the certainty of evidence was appraised according to the GRADE methodology.ResultsOut of 2050 unique references, 12 cluster-RCTs, all in the context of influenza, were selected. There were no controlled experimental studies evaluating the effectiveness of hand hygiene promotion programs in the context of COVID-19 that met the in−/exclusion criteria. There was evidence that preventive hand hygiene promotion interventions in interepidemic periods significantly decreased influenza positive cases in the school setting. However, no improvement could be demonstrated for programs implemented in households to prevent secondary influenza transmission from previously identified cases (epidemic and interepidemic periods).ConclusionsThe data suggest that proactive hand hygiene promotion interventions, i.e. regardless of the identification of infected cases, can improve health outcomes upon implementation of such a program, in contrast to reactive interventions in which the program is implemented after (household) index cases are identified.

Barriers to the Delivery and Uptake of Water Sanitation and Hygiene (WASH) Promotion and Infant Diarrhea Prevention Services: A Case Study in Rural Tribal Banswara, Rajasthan

We aimed to identify key barriers to Water Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India. A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers. ASHAs' prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers' lack of trust in ASHA's health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA's health promotion services. Strengthening ASHAs' health activism roles and building trust on frontline health workers' knowledge among tribal communities will be the key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.