Category Archives: Hygiene Promotion

WASHplus Weekly: Focus on Hygiene

WASHplus Weekly – Issue 190| May 8, 2015 | Focus on Hygiene

This issue focuses on hygiene advocacy, hygiene promotion, and hygiene in emergency settings. Included are webinars; a toolkit; a literature review from the Global Public-Private Partnership for Handwashing; a blog post by Orlando Hernandez, USAID/WASHplus project; IRC and BRAC reports on handwashing promotion; World Health Organization (WHO) hygiene guidelines for Ebola and other emergencies; and other studies and resources. WASHPlus_HTMLbanner_weekly_600x159

WEBINARS

Healing Hands: The Role of Hand Hygiene in Healthcare Globally. May 2015. Global Public-Private Partnership for Handwashing (PPPHW). Link
PPPHW hosted this webinar to discuss the importance of hand hygiene in health care, the challenges of achieving good hand hygiene, and lessons for improving hand hygiene in health care settings. The speakers included Benedetta Allegranzi, the WHO’s Lead for the Clean Care is Safer Care program, Cyrus Engineer, director of the Healthcare Management Program at Towson University, and Robert Aunger from the London School of Hygiene and Tropical Medicine.

Handwashing and Global Food Hygiene: A World Health Day Webinar. April 2015. PPPHW. Link
This webinar explores why food hygiene matters for child health in the global context. It includes a case study from the London School of Hygiene and Tropical Medicine about a creative food and handwashing behavior change intervention in Nepal; WASHplus’s Julia Rosenbaum talks about small doable actions; and UNICEF discusses the successes and challenges associated with its group handwashing and mid-day meal program in India.

TOOLKITS

Hygiene Advocacy Toolkit, 2015. PPPHW. Link
Developed by PPPHW, in cooperation with the UNICEF/WHO Joint Monitoring Programme’s Advocacy and Communications Group, this hygiene advocacy toolkit is an evidence-based resource that outlines why hygiene must be a priority in the post-2015 development agenda and beyond. The role of hygiene in the global development agenda is misunderstood. This toolkit seeks to address any confusion and provide the necessary facts and talking points to successfully advocate for the inclusion of hygiene in the Post-2015 Sustainable Development Goals.

Community Handwashing Guide: Utilizing Available Resources to Initiate a Handwashing InterventionWorld Med Health Policy, Mar 2014. MP Sandhu. Link (The full text of this article can be downloaded free of charge through May 2015.)
In this article, the current handwashing recommendations and their applicability to hygiene interventions in developing nations were examined. The results of this review suggested that a new handwashing paradigm is needed to address the varying resources available for hand hygiene. Thus, a novel community handwashing guide was developed. This guide emphasizes the importance of increasing access to physical handwashing resources in developing communities, and can be applied to communities regardless of their socioeconomic status. The community handwashing guide promotes sustainable, incremental improvements in hygiene within a community, and is a more feasible approach than previous recommendations.

LITERATURE REVIEWS

Handwashing Research Summary: What We Learned about Handwashing in the First Quarter of 2015.  L McCay, PPPHW. Link
Between January and March 2015, 16 relevant peer-reviewed handwashing studies were published. This review discusses studies on the benefits of handwashing, measurement of handwashing behavior, handwashing “hardware,” and other topics.

Improving Household Food Hygiene in a Development Context, 2015. M Woldt, FANTA. Link
This literature review presents information on foodborne disease and key areas and considerations at the household level to reduce foodborne contaminants in developing countries. Recommendations on potential programmatic and research activities related to foodborne disease are also included.

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Culture and the health transition: Understanding sanitation behaviour in rural north India

Culture and the health transition: Understanding sanitation behaviour in rural north India, April 2015. International Growth Centre (ICG) Working Paper.

Authors: Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears, Nikhil Srivastav, and Sangita Vyas.

Key Facts

  • Poor sanitation spreads bacterial, viral, and parasitic infections including diarrhoea, polio, cholera, and hookworm. Despite this, 70% of rural Indian households defecate in the open, without a toilet
    or latrine. Over 60% of the people worldwide who defecate in the open live in India. Bangladesh, which shares a border with India, has a rural open defecation rate of only 5%.
  • Based on a survey of around 3,200 households, and 100 in-depth interviews, this research finds that having a household latrine is widely seen to damage the purity of the home. Open defecation, on
    the other hand, is widely seen to promote purity and strength, and is also associated with health and longevity.
  • A further reason for particularly poor hygiene in Indian public spaces is due to the ongoing renegotiation of caste-based social rules. Most Hindus remain inflexibly opposed to emptying their own latrine pits. As part of a push for greater equality, people from the lowest “untouchable” castes resist emptying latrine pits because this work is widely seen as degrading and reinforcing of their low social status.

Health workers must have #safeHANDS – WHO annual call to action

WHO #safeHANDS poster

This year’s annual day to recognize hand hygiene among health workers commemorates ten years of the Clean Care is Safer Care programme (2005-2015) of the World Health Organization (WHO).

Hand hygiene is an important element of infection prevention and control. A recent WHO/UNICEF survey of  66,000 health facilities in developing countries revealed that over a third of them lacked soap for hand washing.

To join the campaign and learn more visit: http://www.who.int/gpsc/5may/en/

Webinar: Healing Hands, 5 May 2015, 3:00 PM – 4:00 PM CEST

Hear from experts from WHO, the London School of Hygiene and Tropical Medicine, and Johns Hopkins University on the importance of hand hygiene, the current state of practices and lessons learned from the recent West Africa Ebola Outbreak.

To join the discussion register at the site of the Global Public-Private Partnership for Handwashing.

Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia

Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia, 2015. WaterSHED; London School of Tropical Medicine and Hygiene.

Authors: Molly Miller-Petrie, Lindsay Voigt, Lyn McLennan, Sandy Cairncross, Marion Jenkins

Background – Despite evidence that children’s faeces play a major role in diarrheal disease transmission through the contamination of the household environment, relatively little priority has been given to research and interventions in this area. In Cambodia, only 20% of children’s faeces were disposed of in an improved sanitation facility according to the 2010 Demographic and Health Survey. This study explores current practices and the role that enabling products may play in increasing hygienic management practices.

Methods – A household survey was conducted in 130 houses in 21 villages and two provinces in Cambodia. Four focus group discussions were conducted, two in each province. Households were restricted to those with an improved sanitation facility and at least one child under five. Results were analysed using STATA13 and explanatory variables were tested individually and using logistic regression to control for child age. Focus group results were analysed qualitatively.

Results – Main place of defecation, method of moving faeces, and main place of disposal differed depending on child age, with children under two least likely to have their faeces disposed of hygienically. Overall, 62.7% of households reported using a hygienic main disposal site while 35.7% reported doing so consistently. Factors associated with hygienic disposal included the number of years a household had owned a latrine, the age of the caregiver, the consistency of adult latrine use, and the presence of tools for child faeces management in the latrine.

Discussion – The results demonstrate a need for interventions targeting the hygienic management of faeces of children under five in Cambodia, and particularly for children under two. The technologies most likely to facilitate hygienic disposal for these age ranges include reusable diapers, potties, and potentially latrine seats. Design features should ensure child safety, time-savings, cost-savings, ease of disposal, and ease of cleaning. Product marketing will also need to address hygiene behaviours related to child cleaning and caretaker hand washing to ensure reduction of disease transmission.

Orlando Hernandez – Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage

Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage by Orlando Hernandez, USAID/WASHplus Project and Senior Monitoring and Evaluation Advisor, Global Health, Population and Nutrition (GHPN), FHI 360.

The comments below are from Dr. Hernandez’s participation at the World Water Forum 2015 and then posted to the Sanitation and Water for All website.

Behavior change specialists rely on frameworks to dissect a problem and define a strategy to address it. The Water Improvement Framework (WIF), previously named the Hygiene Improvement Framework (HIF) developed in connection to USAID WASH projects some 15 years ago, is one such framework. Given its openness and comprehensiveness, the WIF has stood the test of time. Other donors and implementation agencies are thinking along the same lines as there are other similar frameworks developed by WSP, SVN, the London School of Hygiene and Tropical Medicine, among others.

The WIF is a three-legged stool which brings together: 1) supply, 2) demand, and 3) the enabling environment. It suggests that behavior change (BC) strategies are more than mere promotion, channels and messages. They bring a human dimension to the WASH sector, and when based on the WIF’s the three elements, it guides us to design, implement and evaluate WASH activities.  orlando2

Behavior change frameworks require us to segment our audiences as social groups involved in development are not monolithic. One obvious breakdown in sanitation is a split between urban, peri-urban and rural dwellers. The needs, preferences, sanitation practices and certainly resources of urban, peri-urban and rural populations may be different. With growing urbanization throughout the developing world, coverage in peri-urban areas represent a challenge, especially when we think of tenants living in crowded quarters with no services.

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Water, sanitation and hygiene in health care facilities

A new report by the World Health Organization (WHO and Unicef provides an “alarming picture of the state of WASH in health care facilities”.

Drawing on limited data from 54 low- and middle-income countries the report concludes that 38% of the facilities lack access to even rudimentary levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.

In addition, “training and capacity building to ensure there are sufficient resources and personnel to operate and maintain WASH facilities and enable health care staff to deliver hygiene behaviour change messages is urgently needed”, the report says.

“While the situation appears bleak, there are a number of global initiatives for which WASH in health care facilities is a foundational element and examples of national governments taking the initiative to improve standards, implementation and monitoring”, the report concludes. Through coordinated, global action, with leadership from the health sector, WHO and Unicef believe that all health care facilities can have adequate WASH services.

Besides the full report, you can also download:

Cronk, R. & Bartram, J., 2015. Water, sanitation and hygiene in health care facilities : status in low and middle income countries and way forward, Geneva, Switzerland: World Health Organization (WHO) and Unicef. x, 38 p. : 8 boxes, 2 fig, 8 tab. Avaialable at:
www.who.int/water_sanitation_health/publications/wash-health-care-facilities/en/

Feb/March 2015 selected studies on sanitation, hygiene & handwashing

TROPICAL MEDICINE & INTERNATIONAL HEALTH – FEB/MAR 2015

Household-Level Risk Factors for Influenza among Young Children in Dhaka, Bangladesh: A Case-Control Study(Abstract/order)

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.

LANCET INFECTIOUS DISEASES – FEB 2015

Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.

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