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.

A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho

A health impact evaluation of the Rural Sanitation Pilot Project in Mohale's Hoek district; Lesotho; was conducted from October 1987 to September 1988. A clinic-based case-control design was used to investigate the impact of improved sanitation on diarrhoea morbidity in young children. The results indicate that under-5-year-olds from households with a latrine may experience 24 percent fewer episodes of diarrhoea than such children from households without a latrine (odds ratio = 0.76; 95 percent confidence interval; 0.58-1.01). The impact of latrines on diarrhoea was greater in those households that used more water; practised better personal hygiene; and where the mothers had a higher level of education or worked outside the home. In common with studies conducted in Malawi; Philippines; and Sri Lanka; little evidence was found that the relationship between latrine ownership and diarrhoea was confounded by socioeconomic status or environmental variables. For a sample of cases and controls; data on exposure status (presence or absence of a latrine) that were collected by interview at the clinics agreed closely with those obtained by observation during a home visit

A case-control study of the effect of environmental sanitation on diarrhoea morbidity in Malawi

A case-control design has been applied in the evaluation of improved environmental sanitation on diarrhoeal diseases in rural Malawi. The study demonstrates the feasibility of using such an approach to evaluate two levels of water supply and sanitation service quickly and at moderate cost. Sample sizes would need to be increased substantially to evaluate multiple levels of service or to investigate interactions between water supply and sanitation. The results indicate that children living in families who use good quality water supplies and latrines experience 20 percent less diarrhoea as reported to the health clinics during the warm; rainy season

Ventilated improved pit latrines: recent developments in Zimbabwe

This paper describes recent developments in Zimbabwe in the design of ventilated improved pit latrines (VIP). Two basic designs are presented; one suitable for peri-urban areas and the other; a low-cost version of the first; for rural areas. The peri-urban VIP latrine consists of a circular pit (1.5 m diameter; 3 m deep) fully or partially lined with cement mortar and with; at its top; a brick collar on which is supported a 1.9 m diameter; 75 mm thick concrete slab precast on site. A 1.8 m high spiral shaped superstructure in construct on the cover slab in ferrocement or brick and a flat roof slab placed on top. A 150 mm diameter asbestos cement or polyvinyl chloride vent pipe with a fly screen at its top is then erected immediately adjacent to the outside of the superstructure (alternatively a brick vent pipe may be used in conjuction with a brick superstructure). A commercial kit version of this design is also described. The rural VIP latrine consitsts of a rectangular pit (1.5 m x 0.6 m x 3 m) over which are placed longitudinal and transverse wooden logs of around 100 mm diameter which are then covered with anthill soil and a thin layer of cement mortar. A spiral superstructure is then built in mud and wattle; thatch; soil or local bricks and covered with a conically shaped thatched roof. The vent pipe is made from local reeds; fitted with a fly screen and rendered with cement mortar. Both the peri-urban and rural VIP latrine designs have been found to be socially acceptable in Zimbabwe (where some 20 000 have been built) and very effective in eliminating odors and controlling fly breeding in the latrine

Appropriate sanitation for very low income communities: proceedings and recommendations

It is now well established that the provision of safe water supplies and improved sanitaion form the basic foundation on which all public health must be built. Despite this fact; development programmes in Africa have placed far more emphasis on the provision of improved water supplies; and far too little attention on the provision of improved sanitation not only in the past; but also in the present. Perhaps this is because the provision of water may be more appealing to donors and recipients alike and possibly more prestigious for the Governments concerned. If any group is hardest hit by this imbalance; it is those who live in very low income communities. They often have meagre resources which do not permit them to attempt any self improvement and often have no other support or encouragment. As a result; most low income communities in the developing world have inadequate sanitary facilities

Improved latrine and laundry slab construction

From 14-18 November 1983 a workshop was held in Jali; Zomba district to teach Village Health Committee members how to build Ventilated Improved Pit [VIP] Latrines and laundry slabs. This is a collection of photographs and illustrations depicting the activities and the constuction plans

Appropriate sanitation for very low income communities

It is now well established that the provision of safe water supplies and improved sanitation form the basic foundation on which all public health must be built. Despite this fact; development programmes in Africa have placed far more emphasis on the provision of improved water supplies; and far too little attention on the provision of improved sanitation not only in the past; but also in the present. If any group is hardest hit by this imbalance; it is those who live in very low income communities. They often have meagre resources which do not permit them to attempt any self improvement and often have no other support or encouragment. As a result; most low income communities in the developing world have inadequate sanitary facilities........

Blair latrines builders instruction manual

Many people in Zimbabwe are now proud owners of a Blair latrine. They like these latrines; because: when properly constructed; they do not smell or attract flies; they are easy to maintain; they are safe for children to use; they are private and can also be used for a hygienic bathing place; they are inexpensive to build. It is the wish of the Government of Zimbabwe that each family in the community should have their own latrine

Intergrated water; sanitation and health education programme : builders instruction manual for a double compartment Blair Latrine

Good sanitation is now possible for many families in Zimbabwe because the people are cooperating in latrine building. The Blair ventilated improved pit latrine is very popular. This manual is meant for builders but even a lay builder will find it easy to understand and follow the basic steps for building a Blair latrine

Blair VIP latrine construction programme Masvingo Province

Over the past eighteen months or so of project implementation; despite extreme climatic constraints and their secondary effects; the project has successfully supported the MOH's drive to accelerate the provision of sanitation facilities for residents in rural areas through self help. By the end of the project period the target of 7000 latrines will have been reached and good quality education and training materials have been developed. For the future these achievements should be consolidated and emphasis placed on strenthening planning; management and training aspects of project support