Assessment of water, sanitation, and hygiene services in district health care facilities in rural area of Mekong Delta, Vietnam.

Access to sufficient water, sanitation, and hygiene (WASH) services is a crucial requirement for patients during therapy and general well-being in the hospital. However, in low- and middle-income countries, these services are often inadequate, resulting in increased morbidity and mortality of patients. This study aimed at assessing the current situation of WASH services in six District Health Care Facilities (DHCFs) in rural areas of the Mekong Delta provinces, Vietnam. The results showed that these services were available with inappropriate quality, which did not compromise the stakeholders' needs. The revealed WASH infrastructures have raised concerns about the prolonged hospital stays for patients and push nosocomial infections to a high level. The safety of the water supply was doubted as the high E. coli (> 60%) and total coliform incidence (86%) was observed with very low residual chlorine concentration (< 0.1 mg/L) in water quality assessment. Moreover, water supply contained a high concentration of iron (up to 15.55 mg/L) in groundwater in one DHCF. Technical assessment tool analysis proved that the improper management and lack of knowledge by human resources were the primary roots of the observed status WASH services. Improvement of the perceptions of WASH should be done for the hospital staff with collaboration and support from the government to prevent incidents in the future.

Towards Climate Resilient and Environmentally Sustainable Health Care Facilities.

The aim of building climate resilient and environmentally sustainable health care facilities is: (a) to enhance their capacity to protect and improve the health of their target communities in an unstable and changing climate; and (b) to empower them to optimize the use of resources and minimize the release of pollutants and waste into the environment. Such health care facilities contribute to high quality of care and accessibility of services and, by helping reduce facility costs, also ensure better affordability. They are an important component of universal health coverage. Action is needed in at least four areas which are fundamental requirements for providing safe and quality care: having adequate numbers of skilled human resources, with decent working conditions, empowered and informed to respond to these environmental challenges; sustainable and safe management of water, sanitation and health care waste; sustainable energy services; and appropriate infrastructure and technologies, including all the operations that allow for the efficient functioning of a health care facility. Importantly, this work contributes to promoting actions to ensure that health care facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their local settings. To this end, we propose a framework to respond to these challenges.

Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST.

BACKGROUND: Poor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations' Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system. METHODS: We adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability. RESULTS: We present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals' overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees. CONCLUSION: We propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.

Strengthening Healthcare Facilities Through Water, Sanitation, and Hygiene (WASH) Improvements: A Pilot Evaluation of "WASH FIT" in Togo.

Water, sanitation, and hygiene (WASH) services in healthcare facilities are essential to ensure quality health care and to facilitate infection, prevention, and control practices. They are critical to responding to outbreaks and preventing healthcare-associated infections and, therefore, critical to global health security. Many healthcare facilities in low- and middle-income settings have limited WASH services. One tool to address this issue is the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) Water and Sanitation for Health Facility Improvement Tool, or "WASH FIT." WASH FIT is a continuous improvement tool based on key WHO environmental health and infection, prevention, and control standards. While using WASH FIT, internal teams regularly perform self-assessments at their facilities, using up to 65 WASH indicators to develop and implement an improvement plan. The Ministry of Health and Social Protection (MSPS) in Togo, with support from WHO and the US Centers for Disease Control and Prevention (CDC), piloted this tool in 3 healthcare facilities. The pilot included facility assessments at 3 time points and in-depth interviews and document review 7 months after initiating WASH FIT. Facilities made improvements without significant external financial or material support. On average, pilot facilities improved from 18% of total indicators meeting standards at baseline to 44% after 7 months. Examples included improved drinking water supply, medical waste segregation, and increased soap at handwashing stations. Participants reported improvements in staff and patient satisfaction, hand hygiene, and occupational safety. Findings suggest that WASH FIT, coupled with training and supervision, may help facilities improve WASH services and practices, thus contributing to global health security. Based on these findings, the Togolese MSPS plans to scale up nationwide. Les services d'eau, d'assainissement, et d'hygiène (WASH) dans les établissements de santé sont essentiels pour assurer des soins de qualité et faciliter les pratiques de prévention et contrôle des infections. Ils sont essentiels pour répondre aux épidémies et prévenir les infections associées aux soins de santé, et donc à la sécurité sanitaire mondiale. De nombreux pays à revenu faible ou intermédiaire ont des services WASH limités dans les établissements de soins. Un outil récemment publié pour remédier cette situation est l'outil WASH FIT [Water and Sanitation for Health Facility Improvement Tool] de l'Organisation mondiale de la Santé (OMS) et le Fonds des Nations Unies (UNICEF) pour l'amélioration de l'eau et l'assainissement dans les formations sanitaires. WASH FIT est un outil d'amélioration continue basé sur les normes de l'OMS en matière de santé environnementale et de prévention et contrôle des infections. Lors de l'utilisation de WASH FIT, les équipes internes effectuent régulièrement des auto-évaluations dans leurs installations en utilisant jusqu'à 65 indicateurs pour élaborer et mettre en œuvre leur plan d'amélioration. Le ministère de la Santé et de la Protection Sociale (MSPS) du Togo, avec le soutien de l'OMS et les Centres pour le contrôle et la prévention des maladies (CDC), a fait un pilotage de cet outil dans 3 centres de santé. Ce pilotage comprenait 3 évaluations dans chaque formation sanitaire, des interviews approfondies, et une revue documentaire, 7 mois après l'initiation du WASH FIT. Les formations sanitaires ont réalisé des progrès, sans aide financière ou matérielle extérieure. En moyenne, les formations sanitaires sont passées de 18% des indicateurs atteignant les standards au départ, à 44% après 7 mois. Les exemples incluent l'approvisionnement en eau potable, le tri des déchets médicaux, et le savon aux points de lavage des mains. Les participants ont signalé des améliorations dans la satisfaction du personnel et des patients, l'hygiène des mains, et la sécurité au travail. Les résultats indiquent que WASH FIT, associé à la formation et à la supervision, pourrait être un outil pour aider les formations sanitaires à améliorer les services et pratiques WASH, contribuant ainsi à la sécurité sanitaire mondiale. Sur la base de ces résultats, le MSPS prévoit une extension à l'échelle nationale.

Community perceptions of health and chronic disease in South Indian rural transitional communities: a qualitative study.

BACKGROUND: Chronic diseases are now the leading cause of death and disability worldwide; this epidemic has been linked to rapid economic growth and urbanisation in developing countries. Understanding how characteristics of the physical, social, and economic environment affect behaviour in the light of these changes is key to identifying successful interventions to mitigate chronic disease risk. DESIGN: We undertook a qualitative study consisting of nine focus group discussions (FGDs) (n=57) in five villages in rural Andhra Pradesh, South India, to understand people's perceptions of community development and urbanisation in relation to chronic disease in rural transitional communities. Specifically, we sought to understand perceptions of change linked to diet, physical activity, and pollution (because these exposures are most relevant to chronic diseases), with the aim of defining future interventions. The transcripts were analysed thematically. RESULTS: Participants believed their communities were currently less healthy, more polluted, less physically active, and had poorer access to nutritious food and shorter life expectancies than previously. There were contradictory perceptions of the effects of urbanisation on health within and between individuals; several of the participants felt their quality of life had been reduced. CONCLUSIONS: In the present study, residents viewed change and development within their villages as an inevitable and largely positive process but with some negative health consequences. Understanding how these changes are affecting populations in transitional rural areas and how people relate to their environment may be useful to guide community planning for health. Measures to educate and empower people to make healthy choices within their community may help reduce the spread of chronic disease risk factors in future years.

A qualitative study exploring parental accounts of feeding pre-school children in two low-income populations in the UK.

Good nutrition in the early years of life is essential, yet the diets of many pre-school children in the UK are known to be poor. Understanding the decisions parents make when feeding young children is very important in determining what type and nature of interventional support may be developed to promote good nutrition. The aim of this study was to explore using qualitative methods, parental perceptions of feeding their children in order to inform the development of a nutrition intervention. Focus groups (n = 33) and individual interviews (n = 6) were undertaken with parents, most of whom were attending children's centres in two deprived populations from one urban (Islington, north London) and one rural (Cornwall) location in England. Accounts of feeding pre-school children were primarily concerned with dealing with the practicalities of modern life, in particular the cost of food and the need to manage on a restricted household budget. Time pressures, a lack of perceived knowledge and confidence in preparing food and managing conflict over food choices between family members were also strong themes. Parents commonly reported differences between how they would like to feed their children and the reality of what they were able to do in their circumstances. These findings suggest that the poor eating habits of many pre-school children may be less a case of parental ignorance but rather the product of a range of coping strategies. Designing an intervention, which helps parents to build their confidence and self-efficacy, may enable them to make positive changes to their children's diets.

Methodological development of an exploratory randomised controlled trial of an early years' nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young).

Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings.

Parental food involvement predicts parent and child intakes of fruits and vegetables.

In order to develop successful interventions to improve children's diets, the factors influencing food choice need to be understood. Parental food involvement - the level of importance of food in a person's life - may be one of many important factors. The aim of this study was to determine whether parental food involvement is associated with parents' and children's diet quality. As part of an intervention study, 394 parents with children aged between 18 months and 5 years were recruited from children's centres in Cornwall and Islington, UK. Questionnaires were used to collect data on socio-demographic characteristics, parents' diets, and attitudes towards food including food involvement. Children's diets were assessed using the multiple pass 24 h recall method. Parents reported low intakes of fruits and vegetables and high intakes of sugary items for themselves and their young children. Parental food involvement was strongly correlated with consumption of fruits and vegetables (amount and diversity) for both parents and children. Correlations with consumption of sugary drinks and snacks/foods were not significant. These findings indicate that parental food involvement may influence consumption of fruits and vegetables, more so than sugary items. Further research is needed to investigate how parental food involvement could mediate dietary changes.

Developing a nutrition intervention in children's centres: exploring views of parents in rural/urban settings in the UK.

OBJECTIVE: The present study explored parents' requirements for healthy eating support prior to the development of a tailored intervention. DESIGN: A cross-sectional study of parents attending children's centres. SETTING: Children's centres in Cornwall (rural south-west England) and Islington (urban London borough). SUBJECTS: A total of 261 parents (94.2% female) of pre-school children (aged 2­5 years) completed a questionnaire on factors influencing food choice, and preferences for and views on healthy eating support. RESULTS: Parents reported that health, taste, freshness and quality were the most important factors influencing their food choices for their pre-school children. The importance of individual factors varied according to level of educational attainment. Over a third (38 %) of parents said they wanted more advice on healthy eating for children. Less educated parents showed the greatest interest in learning more about several aspects: what a 'healthy diet' means, how to prepare and cook healthy food, how to understand food labels, budgeting for food, examples of healthy food and snacks for children, appropriate portion sizes for children and ways to encourage children to eat well. CONCLUSIONS: There was demand for healthy eating support among parents of pre-school children, especially those who are less educated, in one rural and one urban area of England

Nutrition-related health effects of organic foods: a systematic review.

BACKGROUND: There is uncertainty over the nutrition-related benefits to health of consuming organic foods. OBJECTIVE: We sought to assess the strength of evidence that nutrition-related health benefits could be attributed to the consumption of foods produced under organic farming methods. DESIGN: We systematically searched PubMed, ISI Web of Science, CAB Abstracts, and Embase between 1 January 1958 and 15 September 2008 (and updated until 10 March 2010); contacted subject experts; and hand-searched bibliographies. We included peer-reviewed articles with English abstracts if they reported a comparison of health outcomes that resulted from consumption of or exposure to organic compared with conventionally produced foodstuffs. RESULTS: From a total of 98,727 articles, we identified 12 relevant studies. A variety of different study designs were used; there were 8 reports (67%) of human studies, including 6 clinical trials, 1 cohort study, and 1 cross-sectional study, and 4 reports (33%) of studies in animals or human cell lines or serum. The results of the largest study suggested an association of reported consumption of strictly organic dairy products with a reduced risk of eczema in infants, but the majority of the remaining studies showed no evidence of differences in nutrition-related health outcomes that result from exposure to organic or conventionally produced foodstuffs. Given the paucity of available data, the heterogeneity of study designs used, exposures tested, and health outcomes investigated, no quantitative meta-analysis was justified. CONCLUSION: From a systematic review of the currently available published literature, evidence is lacking for nutrition-related health effects that result from the consumption of organically produced foodstuffs.

Nutritional quality of organic foods: a systematic review.

BACKGROUND: Despite growing consumer demand for organically produced foods, information based on a systematic review of their nutritional quality is lacking. OBJECTIVE: We sought to quantitatively assess the differences in reported nutrient content between organically and conventionally produced foodstuffs. DESIGN: We systematically searched PubMed, Web of Science, and CAB Abstracts for a period of 50 y from 1 January 1958 to 29 February 2008, contacted subject experts, and hand-searched bibliographies. We included peer-reviewed articles with English abstracts in the analysis if they reported nutrient content comparisons between organic and conventional foodstuffs. Two reviewers extracted study characteristics, quality, and data. The analyses were restricted to the most commonly reported nutrients. RESULTS: From a total of 52,471 articles, we identified 162 studies (137 crops and 25 livestock products); 55 were of satisfactory quality. In an analysis that included only satisfactory-quality studies, conventionally produced crops had a significantly higher content of nitrogen, and organically produced crops had a significantly higher content of phosphorus and higher titratable acidity. No evidence of a difference was detected for the remaining 8 of 11 crop nutrient categories analyzed. Analysis of the more limited database on livestock products found no evidence of a difference in nutrient content between organically and conventionally produced livestock products. CONCLUSIONS: On the basis of a systematic review of studies of satisfactory quality, there is no evidence of a difference in nutrient quality between organically and conventionally produced foodstuffs. The small differences in nutrient content detected are biologically plausible and mostly relate to differences in production methods.