WASH Interventions Research Articles

Intervención Multicomponente de Enfermería para Promover el Hábito del Lavado de Manos en Escolares.

Diarrheal diseases and respiratory infections represent the main reasons for school absenteeism, which if complicated, will be part of the mortality statistics in children under five years of age. In this sense, it is important to focus on hand washing and multicomponent interventions with theoretical references for behavioral changes to promote sustained and long-term behavior, washing hands with soap and water has been shown to be a life-saving hygiene habit. The Nursing professional, through the Nursing Care Process (PAE), has the necessary skills to design, implement and evaluate multicomponent interventions. Objective: implement a PAE aimed at schoolchildren to promote the habit of handwashing, through a multicomponent intervention and the theory of disruptive behavior. Methodology: community case study with PAE, implemented in a public and rural primary school in Yucatán, Mexico. For the assessment, brainstorming techniques, non-participant observation and social cartography were used. For the diagnostic process, results and interventions, the NANDA 2021-2023 taxonomy, NOC Results Classification and NIC Intervention Classification was used. Results: we worked with a diagnosis, a result and three interventions on health education, community environmental management and behavior modification. Conclusions: through the PAE and the multicomponent intervention, it was possible for the school population to generate a more active and committed practice with handwashing.

Impact of integrated WASH and maternal and child health interventions on diarrhea disease prevalence in a resource-constrained setting in Kenya

BackgroundWater, sanitation and hygiene (WASH) and child health interventions are proven simple and cost-effective strategies for preventing diarrhea and minimizing excess mortality. Individually, they are able to prevent diarrhea though sub-optimally, and their effectiveness when combined may be higher. This study examined the effect of integrated WASH and maternal and child health (MCH) interventions on prevalence of diarrhea, in a resource-limited setting in Kenya.MethodsA controlled intervention was implemented in Narok County. The interventions included WASH interventions integrated with promotion of MCH. A structured questionnaire was used to collect data on targeted indicators before and after the interventions. Data were analyzed using descriptive statistics and Chi-square to establish the impact of the interventions.ResultsA total of 431and 424 households and 491 and 487 households in intervention and control sites, respectively, participated in the baseline and endline surveys. Following implementation of the interventions, prevalence of diarrhea decreased by 69.1% (95% CI: 49.6–87.1%) and 58.6% (95% CI: 26.6–82.4%) in the intervention and control site, respectively. Treatment of drinking water and animal husbandry practices were significantly associated with diarrhea post-interventions.ConclusionsIntegrating WASH interventions with other diarrhea control strategies and contextualizing them to meet site-specific needs may effectively prevent diarrhea.

Comparison of metrics for assessing face washing behaviour for trachoma control.

There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.

Factors affecting Bangladeshi high school students' practices of sanitation and hygiene

Background: Better sanitation and hygiene standards are beneficial for preventing infections, limiting the spread of pathogens, and fostering overall health in educational environments. On the other hand, not much is known about school-student's hygiene and sanitation habits. The purpose of this study is to identify and comprehend the variables that affect students' behavior related to sanitation and hygiene in classrooms. Method: This study was carried out at the Katiadi Government High School, a high school in a Bangladeshi upazilla town. An exploratory qualitative study design, based on the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH) was used. Before utilizing them, the effectiveness and clarity of the semi-structured interview guides were tested, which included questions about behavior, access, and practices related to sanitation and hygiene. Result: The students had quite low sanitation and hygiene practices despite having a reasonable level of awareness and knowledge. Sanitation and hygiene practices were influenced by a wide range of interrelated factors, which also affected one another. Contextual factors (lack of upkeep and cleanliness, availability of sanitary products), socio-behavioral factors (norms, peer influence), and individual factors (gender awareness, perception, and sense of health benefits). Conclusion: To advance improved sanitation and hygiene practices among school students, multi-level interventions such as regular delivery of WASH-related materials and agents, promotion of low-cost WASH interventions, quality cleaning services improvement, close observation of cleaning activities, individual hygiene behavior promotion, and introduction of gender-sensitive WASH infrastructure and construction may be helpful.

The role of the Field Epidemiology Training Program in the public health emergency response: Sudan armed conflict 2023.

On April 15, 2023, the armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in Khartoum state, Sudan. This conflict was complicated by the preexisting complicated epidemiological situation and fragile health system in Sudan. This study endeavors to illuminate the pivotal role essayed by the Sudan FETP (SFETP) in enhancing the nation's public health response, particularly amidst the tumultuous backdrop of armed conflicts that have left their indelible mark on the region. Employing a blend of quantitative and qualitative methodologies, we investigated the SFETP's contributions to the public health response during the initial 4 months of the conflict (April-July 2023). Sixty-four SFETP residents and graduates were invited to participate, and data were gathered through semi-structured questionnaires. A total of 44 (69%) SFETP residents and graduates were included in this study. Out of 38 SFETPs present in the states, 32 have considerably contributed to the crisis response at state and locality levels. Three-quarters of them have played key leadership, planning, and management roles. In essence, 38% (n = 12) of them have contributed to public health surveillance, particularly in data management, reports, Early Warning Alert and Response System (EWAR) establishment, and epidemic investigation. SFETPs have made special contributions to crisis response at the community level. The involved SFETPs supported WASH interventions (n = 4), and almost one-third of them strengthened risk communication and community engagement (n = 9). Despite their physical presence at the subnational level, 27% of graduates were not deployed to the crisis emergency response. Notably, throughout this time, half of the total SFETPs were formally retained during this response. The study highlighted the importance of FETP engagement and support during public health crises. SFETP residents and graduates played diverse roles in the various levels of public health emergency response to the crisis. However. Strategies to improve the deployment and retention of FETP residents are necessary to ensure their availability during crises. Overall, FETP has proven to be an asset in public health crisis management in Sudan.

Priority setting for global WASH challenges in the age of wastewater-based epidemiological surveillance.

HIGHLIGHTS Mortality due to inadequate WASH facilities exceeded that of COVID-19 in the regions of South-East Asia and Africa. The costs and benefits of wastewater-based surveillance are not known; however, the benefits of WASH interventions greatly exceed the costs. The dedication of effort and resources to wastewater-based surveillance and WASH in low- and middle-income countries should reflect disease burdens and cost/benefit assessments.

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

BackgroundWater, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.MethodsFrom 2020–2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.ResultsParticipants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02–1.58), sanitation (Adj RR:1.28; 95% CI: 1.07–1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15–1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12–1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27–1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01–1.89).ConclusionThe lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Gut microbiota shifts favorably with delivery of handwashing with soap and water treatment intervention in a prospective cohort (CHoBI7 trial)

BackgroundCholera can result in the expulsion of important microbiota from the gut and result in death if left untreated. The disease transmits mainly via drinking water carrying Vibrio cholerae; and household contacts (HHC) of cholera patients are at elevated risk during the first week of infection. The gut microbiota profiles of HHC-children of cholera patients at Dhaka city slums were investigated before (day 0) and after (day 8) delivery of chlorinated water as part of the major study ‘CHoBI7 trial (cholera-hospital-based intervention for 7 days)’.ResultResults of sequencing and analysis of bacterial community DNA revealed the predominance of two bacterial phyla: Bacteroidetes and Firmicutes at day 0 with a relative abundance of 62 ± 6 (mean ± SEM%) and 32 ± 7, respectively. The pattern reversed at day 8 with a decreased relative abundance of Bacteroidetes (39 ± 12; p = 0.034) and an increased abundance of Firmicutes (49 ± 12; p = 0.057). Of 65 bacterial families confirmed at day 0, six belonging to Proteobacteria including Vibrionaceae disappeared at day 8. Interestingly, the relative abundance of four Firmicutes families—Lachnospiraceae, Bifidobacteriaceae, Clostridiaceae, and Ruminococcaceae was increased in all five study children at day 8.ConclusionThe observed exclusion of pathogenic Proteobacteria and enhancement of beneficial Firmicutes in the gut of children delivered with chlorinated water as part of WASH intervention reflect a great promise of the CHoBI7 program in preventing cholera and improving child health.

Validation of a Bacteriophage Hide Application to Reduce STEC in the Lairage Area of Commercial Beef Cattle Operations.

Finalyse, a T4 bacteriophage, is a pre-harvest intervention that utilizes a combination of bacteriophages to reduce incoming Escherichia coli O157:H7 prevalence by destroying the bacteria on the hides of harvest-ready cattle entering commercial abattoirs. The objective of this study was to evaluate the efficacy of Finalyse, as a pre-harvest intervention, on the reduction in pathogens, specifically E. coli O157:H7, on the cattle hides and lairage environment to overall reduce incoming pathogen loads. Over 5 sampling events, a total of 300 composite hide samples were taken using 25 mL pre-hydrated Buffered Peptone Water (BPW) swabs, collected before and after the hide wash intervention, throughout the beginning, middle, and end of the production day (n = 10 swabs/sampling point/timepoint). A total of 171 boot swab samples were also simultaneously taken at the end of the production day by walking from the front to the back of the pen in a pre-determined 'Z' pattern to monitor the pen floor environment from 3 different locations in the lairage area. The prevalence of pathogens was analyzed using the BAX® System Real-Time PCR Assay. There were no significant reductions observed for Salmonella and/or any Shiga toxin-producing E. coli (STEC) on the hides after the bacteriophage application (p > 0.05). Escherichia coli O157:H7 and O111 hide prevalence was very low throughout the study; therefore, no further analysis was conducted. However, boot swab monitoring showed a significant reduction in E. coli O157:H7, O26, and O45 in the pen floor environment (p < 0.05). While using Finalyse as a pre-harvest intervention in the lairage areas of commercial beef processing facilities, this bacteriophage failed to reduce E. coli O157:H7 on the hides of beef cattle, as prevalence was low; however, some STECs were reduced in the lairage environment, where the bacteriophage was applied. Overall, an absolute conclusion was not formed on the effectiveness of Finalyse and its ability to reduce E. coli O157:H7 on the hides of beef cattle, as prevalence on the hides was low.

BabyWASH and diarrhea prevention practices following multimedia educational intervention in hard-to-reach areas of the Afar and Somali regions of Ethiopia: a mixed-method endline evaluation

BackgroundWater, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children—known as “BabyWASH”—reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia.MethodsA mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings.ResultsThe multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p < 0.001), handwashing with soap or ash (t-test = 8.85; p < 0.001), maintaining separate playgrounds for young children (t-test = 2.83; p < 0.001), washing of child’s body, hands, and faces (t-test = 15.78; p < 0.001), and food hygiene practices (t-test = 2.74; p < 0.05). The findings of the qualitative assessment also revealed that the multimedia intervention packages and the approaches used were successful in influencing key BabyWASH and diarrhea prevention behaviors in the intervention implementation woredas. In addition, providing capacity building training to local actors and community leaders and recording radio talk shows and sharing them with community members were recognized as effective intervention implementation strategies.ConclusionThe endline evaluation found that the multimedia educational intervention improved awareness, perception, and practice of BabyWASH and diarrhea prevention behaviors in intervention woredas compared to control woredas. Sanitation and hygiene promotion interventions in pastoralist settings can be effective when using locally and contextually appropriate intervention strategies. However, considerations for integrating both behavioral and structural components in WASH interventions is essential.

Violence Related to Daily Water and Sanitation Needs in South Africa.

There is a critical lack of research on violence experienced by women when meeting their daily water and sanitation needs. This short report describes the cumulative lifetime incidence of exposure to violence when using the toilet or collecting water (water, sanitation, and hygiene [WASH]-related violence) and identifies associated health and behavioral risks. Data from 1,870 participants collected in 2013-2015 from a longitudinal cohort of young women in rural South Africa were included in this analysis. We found that exposure to WASH-related violence was high: 25.9% experienced violence when collecting water or when using the toilet. Those who experienced violence were more likely to report pregnancy, an older partner, unprotected sex, experience of intimate partner violence, engaging in transactional sex, depressive symptoms, and anxiety. Future research should investigate the location and type of violence experienced and examine how WASH-related violence is related to health outcomes to identify gender-centered WASH interventions that reduce violence exposure.

청소년의 코로나19로 인한 주관적 건강상태가 불안에 미치는 영향

This study aims to analyze the effect of subjective health conditions caused by COVID-19 in adolescents on anxiety and to verify the mediating effects of stress and hand washing. To this end, data from the 17th Youth Health Behavior Survey in 2021 were used, and data from a total of 54,848 teenagers attending the first grade of middle school to the third grade of high school were analyzed. Data analysis was correlated with descriptive statistical analysis with SPSS 26.0, and mediated effect analysis was conducted using Process Macro 4.0. As a result of verifying the mediating effect of stress and hand washing in the relationship between adolescents' subjective health status and anxiety, subjective health status had a significant effect on anxiety, and stress and hand washing also had a significant mediating effect on anxiety. Based on this, it should contribute to the development of programs on hand washing, stress management, and anxiety intervention according to subjective health conditions.

Wash Deployment and Geo-helminth Ova Dispersion in Primary Schools in Akure North and Owo Local Government Areas, Ondo State, Nigeria

Soil-Transmitted Helminths (geo-helminths) are intestinal parasites causing human infections that are soil-borne. The study assessed the level of soil contamination with geo-helminths ova and also evaluated the level of compliance to WASH policies in some selected public and private schools in Akure North and Owo Local Government Areas of Ondo state, respectively. The study was conducted in the major districts of the two towns.&#x0D; Methods&#x0D; Soil samples were collected from three (3) different locations within each school premise: Toilet areas, classroom and playground. Assessment sheets were used to evaluate data on indicators of compliance to WASH interventions. Modified Baemann’s culture technique was used in the extraction of geo-helminths larvae and sedimentation techniques were used in the concentration and isolation of geo-helminths eggs. The significant difference in soil contamination between public and private schools was obtained using statistical analysis.&#x0D; Result&#x0D; Of the 162 soil samples examined from each local government area, Akure North had the highest number of contaminated samples, n=116 (71.61%), while Owo local government had the least, n =88 (54.32%). Four (4) different geo-helminth species were identified; Hookworm, Ascaris lumbricoides, Strongyloides stercoralis, and Trichuris trichiura. The most occurring parasites seen in Akure North were hookworm larvae (67.83%), Strongyloides stercoralis (67.83%), hookworm ova (11.25%) and ova of Ascaris lumbricoides (7.56%). Likewise, Hookworm larvae had the highest level of occurrence (51.67%), while Trichuris trichiura was the least occurring (0.77%) in Owo local government area. Public schools had the higher parasite count 668/780 (85.64%), while private schools had the lesser parasite count, 112 /780 (14.36%).&#x0D; Conclusion&#x0D; The study revealed poor deployment of WASH in the schools, and children were predisposed to geo-helminths infections due to the high level of contamination, particularly in the public schools.

Interventions to improve sanitation for preventing diarrhoea.

Interventions to improve sanitation for preventing diarrhoea.

Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Cholera Rapid Response Program to Reduce Diarrheal Diseases in Bangladesh.

(a) Objective: To build an evidence base on effective water, sanitation, and hygiene interventions to reduce diarrheal diseases in cholera hotspots, we developed the CHoBI7 Cholera Rapid Response Program. (b) Methods: Once a cholera patient (confirmed by bacterial culture) is identified at a health facility, a health promoter delivers a targeted WASH intervention to the cholera hotspot (households within 20 m of a cholera patient) through both in-person visits during the first week and bi-weekly WASH mobile messages for the 3-month program period. A randomized controlled trial of the CHoBI7 Cholera Rapid Response Program was conducted with 284 participants in 15 cholera hotspots around cholera patients in urban Dhaka, Bangladesh. This program was compared to the standard message in Bangladesh on the use of oral rehydration solution for dehydration. Five-hour structured observation of handwashing with soap and diarrhea surveillance was conducted monthly. (c) Findings: Handwashing with soap at food- and stool-related events was significantly higher in the CHoBI7 Cholera Rapid Response Program arm compared to the standard message arm at all timepoints (overall 54% in the CHoBI7 arm vs. 23% in the standard arm, p < 0.05). Furthermore, there was a significant reduction in diarrheal prevalence for all participants (adults and children) (Prevalence Ratio (PR) 0.35, 95% CI: 0.14–0.85) and for children under 5 years of age (PR: 0.27, 95% CI: 0.085–0.87) during the 3-month program. (d) Conclusions: These findings demonstrate that the CHoBI7 Cholera Rapid Response Program is effective in lowering diarrhea prevalence and increasing handwashing with soap for a population at high risk of cholera.

Child-centred methods for school-based WASH interventions: co-creating sanitation research and interventions for and with children

Child-centred methods for school-based WASH interventions: co-creating sanitation research and interventions for and with children

WASH to control COVID-19: A rapid review.

BackgroundPreventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19.MethodsWe conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations.Main resultsWe included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures.ConclusionsCurrent evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.

Systematic Literature Review of Complementary Food Hygiene Interventions on Child Health Outcomes

ObjectivesDespite known associations of contaminated food with enteric infections and diarrheal diseases, we have limited understanding about effective strategies to improve complementary food (CF) hygiene. We aim to conduct a systematic review to assess the effectiveness of CF hygiene interventions on caregiver and child health outcomes.MethodsSystematic review included experimental and quasi-experimental studies that assessed caregivers’ food hygiene knowledge and practices, microbiological contamination in CF, and incidences of enteric disease in children. Review includes studies carried out in home/community settings with a control comparison and among caregivers of children 6 mo-5y. The search strategy was conducted in Cochrane, PUBMED, and Web of Science. Title, abstract, and full-text screening were conducted by two independent coders using Covidence.Results1,773 studies were imported and after removal of duplicates and title/abstract screening, 40 studies were assessed for full-text eligibility. 24 studies, conducted in African and Asian countries, met the inclusion criteria; 6 studies had interventions that focused exclusively on CF hygiene while the rest integrated CF hygiene into broader nutrition or WASH interventions. Studies used behavioral change communication (BCC) strategies through home visits, group meetings, community campaigns, or media. Among the 6 studies, 3 examined microbial outcomes, 4 assessed caregivers’ knowledge or behavior, no studies assessed children's diarrhea or enteric disease. Microbial contamination (C. perfringens, E. coli, fecal coliform and KF-streptococcus) levels were significantly reduced (p-value < 0.05) in all studies. Targeted complementary food hygiene behaviors outcomes significantly increased in 3 out of the 4 studies (ranging from 20–50% improvement).ConclusionsMost studies evaluating CF hygiene interventions used BCC strategies but it was difficult to identify their independent effects since they were often packaged within a broader interventions. Further attention is needed particularly in urban settings given the rise in individuals residing in urban settings with limited sanitation infrastructure.Funding SourcesSupported by contributors to the CGIAR Trust Fund and conducted by the Agriculture for Nutrition and Health Program.

Seasonal variation in water use for hygiene in Oromia, Ethiopia, and its implications for trachoma control: An intensive observational study.

If facial hygiene practices vary seasonally this could have important implications for the design of interventions for trachoma control. This observational study was conducted to explore seasonal variation in hygiene behaviours in 9 households with at least one child aged 1-9 years-of-age in the West Arsi zone in rural Oromia, Ethiopia. Sixty-one household members were observed intensively over two days in the dry season (January), the rainy season (July) and during the harvest period (October) in 2018. Structured record forms were used to document household water availability and use. Daily water use per capita was very low in all seasons (3.1-4.2 litres). Around one third of water consumed in households in all seasons was associated with body washing. Soap was used during 44 of 677 (6%) of these observed occasions and half of all body washes (n = 340; 50%) included face washing. Overall, 95% of 58 individuals washed their faces at least once between 06:30h and 21:30h in the dry season (21% with soap), compared with 79% in the rainy season (2% with soap) (p = 0.013). Sixty-five percent of householders washed their faces during the harvest observation period (06:30h to 17:30h), none of whom used soap. Twenty-eight percent of 204 children aged 11 and under still had ocular or nasal discharge on their faces after washing. Seventy-three percent of those who washed their faces did so more than once in the dry season, compared with 33% in the rainy season (p<0.001). Face washing occurred throughout the day during the dry season, with a clear peak in the early morning and extra washes in the early evening. Face washing mainly took place in the early morning in the other two seasons. Genuine water scarcity in this area is likely to limit the impact of face washing interventions for trachoma control in the absence of water supply interventions. However, face washing was most common at the time of year when water is the hardest to come by, and seasonal differences in behaviour should be considered in any resulting intervention design.

Stories of change in nutrition in Burkina Faso 1992–2018: a micro-level perspective

Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.