Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings: A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion :The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.

Objectif Déterminer si une intervention au niveau de l'eau, de l'assainissement et de l'hygiène pourrait avoir une influence sur les comportements en la matière, considérés comme importants dans la lutte contre le trachome. Méthodes Nous avons mené un essai randomisé par grappes dans les régions rurales d'Éthiopie entre le 9 novembre 2015 et le 5 mars 2019. Nous avons réparti aléatoirement 20 échantillons où l'intervention consistait à développer les infrastructures d'assainissement et d'approvisionnement en eau et à promouvoir l'hygiène, et 20 échantillons n'ayant fait l'objet d'aucune intervention. Tous les échantillons du groupe d'intervention ont suivi une formation sur l'hygiène à l'école primaire, disposaient d'un point d'eau communautaire, d'un poste de lavage par ménage, de savon à domicile, et recevaient des visites de la part de travailleurs chargés d'enseigner les bonnes pratiques en matière d'hygiène. Nous avons évalué le niveau d'observance des mesures en effectuant des enquêtes annuelles au sein des foyers. Résultats En l'espace de 3 ans, le nombre de postes de lavage, de savons et de latrines dans les ménages a davantage augmenté dans le groupe d'intervention que dans le groupe de contrôle: la différence de risque s'élevait à 47 points de pourcentage (intervalle de confiance de 95%, IC: 41­53) pour les postes de lavage, à 18 points de pourcentage (IC de 95%: 12­24) pour le savon et à 12 points de pourcentage (IC de 95%: 5­19) pour les latrines. La proportion de gens déclarant se laver le visage au savon était plus grande dans le groupe d'intervention (différence de risque de 21 points de pourcentage; IC de 95%: 15­27 pour les enfants de 0 à 5 ans), tout comme celle mentionnant l'usage de latrines (différence de risque de 9 points de pourcentage; IC de 95%: 2­15 pour les enfants de 6 à 9 ans). Pour de multiples indicateurs, il a fallu attendre minimum un an après l'instauration du programme pour que les variations observées entre les groupes d'intervention et de contrôle deviennent statistiquement significatives; ces variations se sont ensuite maintenues lors des visites ultérieures. Conclusion Intervenir à l'école et au sein de la communauté a permis d'améliorer l'accès à l'hygiène et les comportements en la matière. Néanmoins, cette évolution prend du temps et plusieurs années d'intervention sont nécessaires.

Application of kingdon and hall models to review environmental sanitation and health promotion policy in Ethiopia: a professional perspective as a review

BACKGROUND: In the world, many countries, including Ethiopia, are framing policies to roll back the problem of the sanitation. For this, the Kingdon and Hall models are the two distinct models formed to articulate the policy agenda to the health problem. The Kingdon model includes problem, policy and politics streams whereas the Hall model includes legitimacy, feasibility and support of the health policies. Therefore, this review aims to integrate the two models with diseases prevention and health promotion policies of Ethiopia. METHODS: We used the existing frameworks of the models as a guiding principle. Then, we applied the frameworks of the two models as an important consideration to interlink policy agenda to a given health problem. We also described the existing scientific literature about the sanitation and health promotion. After thoroughly reviewing, possible policy inputs and country setups were included with a brief discussion by comparing different kinds of literatures. RESULTS: The two models are recognized as an opportunity to get an essential sanitation policy. The government settled and has closed links to the new innovation as an emerged discourse. Therefore, the two model streams came together for setting sanitation problem on the policy agenda. The technical feasibility, public acceptability and congruence with existing values were all judged to be favorable. CONCLUSION: The integration of policies within the policy frameworks has very important outputs in various countries. Therefore, the field specialists should figure out the problem of policy integration through policy evaluation researches

The effects of water quality and sanitation on immunocompromised: A case study of people living with HIV/AIDS in Kibera slum, Kenya

Background: Closer inspection of the spread of HIV/AIDS and its implications on individuals; communities and societies reveals several significant linkages with water and sanitation. In the context of poverty; malnutrition; high prevalence of co-infections with other opportunistic diseases; and overburdened health systems; individuals may be more susceptible to acquiring HIV and less able to cope with HIV-related illnesses; both physically and economically.Objectives: To determine the effect of sanitation and water quality on people living with HIV/AIDS in Kibera slum.Design: A cross sectional study.Settings: The study was carried out in Kibera informal settlement in Nairobi; Kenya.Subject: Randomly recruited 369 adults living with HIV/AIDS in Kibera slum.Results: Logistic regression analysis employed to predict the probability that a respondent living with HIV/AIDS in Kibera slum would be infected with diseases related to taking contaminated water and living in poor environmental sanitary conditions using the predictor variables and showed a significant partial effect; x2 (5; N = 369) = 73.912; p 0.001.Conclusions: Safe drinking water was inaccessible to a majority of participants indicating a high risk of opportunistic diseases and high economic burden

Epidemic Cholera in Kakuma Refugee Camp; Kenya; 2009: the Importance of Sanitation and Soap

Introduction: Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies; poor sanitation and hygiene; overcrowding; and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009. Methodology: We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls.Results: From 18 September to 15 December 2009; a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital. Three refugees and one Kenyan national died of cholera. V. cholerae O1; serotype Inaba was isolated in 44 (42) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model; washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p 0.01); while presence of dirty water storage containers was a risk factor (AORConclusion: Provision of soap; along with education on hand hygiene and cleaning water storage containers; may be an affordable intervention to prevent cholera

Prevalence and Predisposing Factors Regarding Intestinal Parasitic Infections among Rural Primary School Pupils at Minia Governorate; Egypt

About 400 million school-age children are infected with roundworm; whipworm and hookworm worldwide. This study aims to assess prevalence of parasitic infections among rural primary school pupils at Minia Governorate; Egypt; and to identify relevant predisposing factors of the school and pupils to intestinal parasitic infections. A total of 264 pupils out of 1053; aged 6-12 years; were randomly selected for parasitological investigation and the school was inspected on site for sanitary facilities and conditions of hygiene; as well as the conditions of hygiene of the pupils. The pupils were examined for ova; cysts and/or larvae of intestinal parasites using direct wet mount and formal-ether concentration techniques. Inspection of sanitary facilities and the conditions of hygiene of the school; as well pupil's conditions of hygiene; were carried out through observation checklists. Findings revealed the following intestinal parasites: Entamoeba coli (in 19.3of pupils); Ascaris lumbricoides (3.8); Hymenolepiasis nana (12.5); Enterobious vermicularis (5.7) and Giardia lamblia (12.5); with varying percentages between male and female pupils; and a highly statistical association between pupil sex and type of parasites (P0.001). Unapproved sanitary facilities and conditions of hygiene of the school and pupils were observed. Many intestinal parasitic infections among the primary school pupils were found. Unapproved and low inventory school sanitary facilities were observed; in addition to poor conditions of hygiene of pupils which may play a crucial role in these infections. The school facilities and sanitary conditions; especially the quality of water in the toilets; should be improved. Pupils and school personnel have a real need for health education about modes of transmission and preventive methods of intestinal parasitic infections

Health-Related Baseline Millennium Development Goals Indicators for Local Authorities in Malawi

The Malawi Social Action Fund (MASAF) is implementing a 12 year programme to close service gaps in rural communities. These service gaps are primarily those in health; education; household food security; water and sanitation; transport and communications. The impact indicators of the Project are selected Millennium Development Goal indicators. MASAF conducted a baseline study of the MDG indicators for all districts in Malawi. This paper presents available health related MDG baseline indicators for all districts in Malawi. Other stakeholders implementing health interventions could use these baseline indicators for planning purposes

An Investigation into the Perceived Sanitation Challenges in the Eastern Rural Communities

There is a dearth of information on studies that have sought to examine qualitatively the sanitation challenges that rural communities experience. In this regard; an exploratory qualitative study was conducted to determine the perceived structural; economic; educational; social and technological sanitation challenges in the rural communities of the Eastern Cape (EC). A purposive sample of 122 officials was drawn from the identified EC sanitation stakeholder organisations; of these 74 were male and 48 were female. The 122 participants were divided into 15 focus groups (M = 8 participants) by organisation and randomly assigned to five trained moderators for interviews - four groups with the Provincial Sanitation Task Team (PSTT); six with the District Municipalities and three with the Department of Water Affairs and Forestry (DWAF); one with the Mvula Trust and one with the Rural Support Services (RSS). The findings show that rural sanitation is a complex issue that is affected by a wide range of challenges. Structural challenges include lack of physical; natural; human and organisational resources. Lack of funding was identified as the main economic challenge. Educational challenges include lack of advocacy; training; access to information and information exchange with local people. Inadequate community participation was identified as a social challenge. Lack of cultural flexibility; awareness and sensitivity in the development of technologies that recognise; respect and value culture constitute the technological challenge. The results of the study provide a knowledge base on which strategies for promoting good sanitation practices at community level can be built

Sanitation in schools in Yaounde : cause for concern

The objective of the study was to survey school sanitation facilities in two health districts in Yaounde. Questionnaires were administered to head teachers by medical students during the sanitary inspection of school premises. 15 out of 30 schools surveyed (50 percent) did not have the minimum number of toilets ; 25 schools (83 percent) did not have enough wash basins while 27 (90 percent) did not have enough urinals. All nursery schools had soap; toilet paper and hand towels in wash rooms as opposed to very few primary and secondary schools. School health nurses were not involved in health education and sanitation activities. Both head teachers and surveyors rated sanitation in the schools to be fair or poor in well over 59 percent of cases. Recommendations have been made for present Cameroonian sanitary norms to be updated and their strict application ensured

Environment and health in Africa

The World Health Organization has identified four priority areas related to the environment and of vital importance to people's well-being in Africa. These include adequate and safe supply of water; hygienic disposal of human excreta; disposal of solid and household wastes; hygiene and appropriate housing. Contaminated water constitutes the most important vehicle for disease transmission. Therefore; provision of safe drinking water is essential in provision of public health services. Hygienic disposal of excreta reduces contamination of water. Safe disposal of solid and household wastes is also of extreme importance to families and communities wishing to maintain a reasonable standard of public hygiene and to keep their village and homes clean and attractive. Habitat; which encompasses the house and its immediate surroundings is where all people spend at least two-thirds of their life. It has a crucial influence on the physical; mental; and social well-being of all individuals; families and communities. The principles outlined in this article aim to make this influence favourable to people

Hygiene publique en derive au Zaire : plaidoyer pour la relance de la sante publique! [editorial]

L'heritage colonial en matiere de l'hygiene est en derive au Zaire. La deterioration des conditions du milieu surtout dans les grandes villes du Zaire se manifeste sous plusieurs facettes; dont celles d'insalubrite generalisee dans divers secteurs. Les consequences de cette insalubrite sur la sante publique sont faciles a identifier. En effet; les excreta et les eaux usees domestiques contiennent une gamme tres variee des micro-organismes saprophytes et pathogenes impliques dans l'eclosion des maladies diarrheiques

Etude de la productivite en moustiques d'un tas d'ordures menageres

La presente etude ecologique consiste en l'observation des larves de moustiques dans un tas d'ordures menageres afin de determiner leurs durees de developpement. Ceci pourrait etre exploitable dans l'execution de la lutte antivectorielle basee sur l'amelioration de l'environnement urbain par exemple dont le but est de prevenir la reproduction des moustiques vecteurs ou non

An investigation of diarrhoeal disease outbreak at Bilate Military Training Centre

This study was conducted to investigate a reported disease outbreak among higher education student recruits in Bilate Military Centre; Sidamo Administrative Region. Out of the total patients of 5;245 who visited at the out-patient department 1;616 (30.1 per cent) were patients with diarrhoea. There were 99 patients admitted to the hospital out of which 27 (27.2 per cent) were diarrhoeal patients. There were no deaths reported. A total of 965 (75.6 per cent) were treated with antimicrobial; mainly Tetracyclines; Chloramphenicol; Metronidazole and Chloroquine. Only 114 (8.9 per cent) were treated with Oral Rehydration Salts (ORS) while 86 (7.11 per cent) with Anti-diarrhoeal (Charcoal) and ORS. There was no proper excreta disposal and the water source was found to be bacteriologically non-potable. Among the 34 stool specimens collected for culture and sensitivity tests; the genus Shigella was isolated in 6 patients; where 4 were Shigella flexneri (Group B) and 2 were Shigella dysenteriae (Group A) one type 1 (Shiga's Bacillus) and the other type 2 (Schmitz's Bacillus). Shigella dysenteriae serogroups 1 and 2 showed resistance to eight and seven drugs including Trimethoprim Sulpha-Methoxazole (TSM) respectively. This study highlights the importance of safe water and improvement of general hygiene and environmental sanitation for prevention and control of epidemics and indicates the importance of continuous surveillance of drug resistant Shigella for the control of outbreaks of Shigellosis

Water handling procedures and their association with childhood diarrhoea

Acute childhood diarrhoea is the leading cause of death in children under five in Ethiopia. This is largely the result of lack of access to safe water; poor environmental sanitation; and crowding. In view of this; the aim of the present study was to document water handling practices and their association with childhood diarrhoea in the Garamuleta District of East Hararghe Region; Ethiopia. Water handling practices of families were monitored and the occurrence of diarrhoea was documented every two weeks over a 16 week period in 254 children under 6 years of age. The mean walking distance from the primary water source was 4.5 minutes and the mean per capita daily water consumption was 7.6 litres. The two week period prevalence for diarrhoea during these follow-up visits ranged from 2.4 per cent to 14.8 per cent with a mean of 9 per cent; which corresponds to 2.3 episodes per child per year. There was no statistical difference between safe and unsafe water handling exposure groups in the occurrence of diarrhoea. Religion; site of water collection; time to fetch water; mother's education; type of container; per capita water consumption; and age of the child were found to be significantly associated with the occurrence of diarrhoea. It is concluded that relative to generally inadequate environmental sanitation; water handling practices are not an important contributor to acute childhood diarrhoea

La salubrite de l'environnement : gage de bonne sante

L'importance de la salubrite et de la sante dans le processus de developpement tout court et plus particulierement de developpement social des populations releve du domaine des evidences et tout responsable devrait en etre conscient. La reussite de la sante pour tous en l'an 2000 et au-dela depend aussi de la salubrite de l'environnement. car sans environnement sain tous les efforts de developpement socio-sanitaires risquent detre vains

Gestion de l'espace et maladies liees a l'environnement : cas de l'Afrique de l'Ouest

L'environnement peut etre incrimine de bien des facons dans l'existence de pathologies tropicales. Les interactions peuvent expliquer les phenomenes sanitaires a l'echelle de la transmission dans le cadre de l'environnement compris comme un systeme. Il ne s'agit pas de nier le role des facteurs qui conditionnent l'existence du vecteur dynamique. Par contre au sein d'une zone d'endemicite ce sont les comportements et donc la gestion de l'espace qui vont provoquer des disparites face au risque sanitaire