Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study.

BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.

Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi.

BACKGROUND: Menstrual hygiene management (MHM) is associated with the menstrual process in women and adolescent girls who face cultural and financial challenges in rural areas of many developing countries. As part of the pilot study, we assessed the sustainability and effectiveness of the approaches and lessons learned from the MHM project intervention in rural areas of Lilongwe, Malawi. METHODS: Rural primary schools (n = 4) were purposively selected where an MHM intervention was implemented in Lilongwe, Malawi. The study employed a mixed-method research design. Assessments and data collection were performed through surveys of learners, literature reviews, key informant interviews (KIIs) (n = 90), and 20 focus group discussions (FGDs). The study participants included boys and adolescent girls (n = 100, 11-19 years; grades 5-8), teachers, mother groups, and community leaders from the selected schools. RESULTS: All the schools had water sanitation and hygiene facilities and latrines (45% improved, 54% ventilated improved pit latrines - VIPs) that promoted menstrual hygiene for adolescent girls. However, two of the schools studied (50%, n = 4) did not have separate washrooms for changing sanitary materials. There was a slight increase in latrine coverage in Kabuthu zone communities (90% at baseline versus 93.4% at midterm). However, the coverage dropped to 85.7% at the final evaluation, which was attributed to too much rain received in the area that damaged most of the latrines. There was a significant reduction (p < 0.05) in the number of girls failing to attend classes due to menstruation (70% at baseline versus 14% at final evaluation). Furthermore, the project resulted in the majority of girls (94.4%) having access to school. There was a strong uptake and adoption of sanitary products (reusable pads and menstrual cups) among adolescent girls of all age groups. The study has demonstrated that the inclusion of key stakeholders such as health workers, parents, mother groups and community leaders promoted the uptake and sustainability of reusable pads and menstrual cups and MHM interventions and programs. CONCLUSION: The MHM project implementation improved adolescent girls' education in the area. The inclusion of boys and other key stakeholders in the health education talks addressed issues of stigma and discrimination. The study, therefore, calls for comprehensive training on MHM and hygiene education to remove discrimination and harmful cultural practices.

Determinants of bather hygiene in public swimming pools: a mixed-methods analysis of online discussion comments.

Swimming in public pools can expose bathers to microbiological (e.g., Cryptosporidium) and chemical (e.g., disinfection by-product) hazards, which can lead to recreational water illness. Adequate hygienic behaviours among bathers are important to reduce these risks. However, prior studies have found low compliance with pre-swim showering and avoidance of urinating in pools. We conducted a mixed-methods analysis of online discussion comments to identify key determinants of these two behaviours. We identified relevant discussion threads on Reddit, Quora, and swimming forums. Identified comments were classified as having a positive or negative sentiment towards the behaviour, and they were thematically analyzed according to the Theoretical Domains Framework (TDF). We analyzed 986 comments from 45 threads; 49.8% of comments were classified as expressing a positive sentiment towards the behaviour. Positive sentiments were more commonly expressed towards pre-swim showering compared to avoidance of urinating in pools (60.1 vs. 47.1%). Eleven themes were identified across the following eight TDF domains: beliefs about consequences (n = 362 comments), social influences (n = 298), beliefs about capabilities (n = 240), social/professional role and identity (n = 144), knowledge (n = 138), emotions (n = 137), reinforcement (n = 78), and environmental context and resources (n = 33). Results can help to inform targeted educational and outreach strategies with bathers to encourage increased adoption of hygienic behaviours.

Assessment of hygiene practices and microbial safety of milk supplied by smallholder farmers to processors in selected counties in Kenya.

Smallholder farmers dominate the Kenyan dairy sector producing 95% of the total milk. However, several concerns have been raised on the quality and safety of the milk they produce. This study assessed the hygienic practices and microbial safety of milk supplied by smallholder farmers to processors in Bomet, Nyeri, and Nakuru counties in Kenya. Interviews and direct observations were carried out to assess hygiene and handling practices by farmers and a total of 92 milk samples were collected along four collection channels: direct suppliers, traders, cooperatives with coolers, and cooperatives without coolers. Microbial analysis was done following standard procedures and data analysed using GenStat and SPSS. This study revealed that farmers did not employ good hygienic practices in their routine dairy management. They used plastic containers for milking and milk storage (34.2%); they did not clean sheds (47.9%) and did not set aside cows that suffered from mastitis factors (83.6%), resulting in poor microbial quality of raw milk along the collection channels. The highest mean total viable counts (8.72 log10 cfu/ml) were recorded in Nakuru while Nyeri had the highest mean E. coli counts (4.97 log10 cfu/ml) and Bomet recorded the highest mean counts of 5.13 and 5.78 log10 cfu/ml for Staphylococcus aureus and Listeria monocytogenes respectively. Based on all above-mentioned parameters, the microbial load in most samples from all three counties exceeded the set Kenyan standards. Farmer training, improving road infrastructure, use of instant coolers at cooperatives, and quality-based payment systems are recommended as measures to curb microbial growth.

Effects on childhood infections of promoting safe and hygienic complementary-food handling practices through a community-based programme: A cluster randomised controlled trial in a rural area of The Gambia.

BACKGROUND: The Gambia has high rates of under-5 mortality from diarrhoea and pneumonia, peaking during complementary-feeding age. Community-based interventions may reduce complementary-food contamination and disease rates. METHODS AND FINDINGS: A public health intervention using critical control points and motivational drivers, delivered February-April 2015 in The Gambia, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up in September-October 2015 and October-December 2017, respectively. After consent for trial participation and baseline data were collected, 30 villages (clusters) were randomly assigned to intervention or control, stratified by population size and geography. The intervention included a community-wide campaign on days 1, 2, 17, and 25, a reminder visit at 5 months, plus informal community-volunteer home visits. It promoted 5 key complementary-food and 1 key drinking-water safety and hygiene behaviours through performing arts, public meetings, and certifications delivered by a team from local health and village structures to all villagers who attended the activities, to which mothers of 6- to 24-month-old children were specifically invited. Control villages received a 1-day campaign on domestic-garden water use. The background characteristics of mother and clusters (villages) were balanced between the trial arms. Outcomes were measured at 6 and 32 months in a random sample of 21-26 mothers per cluster. There were no intervention or research team visits to villages between 6 and 32 months. The primary outcome was a composite outcome of the number of times key complementary-food behaviours were observed as a proportion of the number of opportunities to perform the behaviours during the observation period at 6 months. Secondary outcomes included the rate of each recommended behaviour; microbiological growth from complementary food and drinking water (6 months only); and reported acute respiratory infections, diarrhoea, and diarrhoea hospitalisation. Analysis was by intention-to-treat analysis adjusted by clustering. (Registration: PACTR201410000859336). We found that 394/571 (69%) of mothers with complementary-feeding children in the intervention villages were actively involved in the campaign. No villages withdrew, and there were no changes in the implementation of the intervention. The intervention improved behaviour adoption significantly. For the primary outcome, the rate was 662/4,351(incidence rate [IR] = 0.15) in control villages versus 2,861/4,378 (IR = 0.65) in intervention villages (adjusted incidence rate ratio [aIRR] = 4.44, 95% CI 3.62-5.44, p < 0.001), and at 32 months the aIRR was 1.17 (95% CI 1.07-1.29, p = 0.001). Secondary health outcomes also improved with the intervention: (1) mother-reported diarrhoea at 6 months, with adjusted relative risk (aRR) = 0.39 (95% CI 0.32-0.48, p < 0.001), and at 32 months, with aRR = 0.68 (95% CI 0.48-0.96, p = 0.027); (2) mother-reported diarrhoea hospitalisation at 6 months, with aRR = 0.35 (95% CI 0.19-0.66, p = 0.001), and at 32 months, with aRR = 0.38 (95% CI 0.18-0.80, p = 0.011); and (3) mother-reported acute respiratory tract infections at 6 months, with aRR = 0.67 (95% CI 0.53-0.86, p = 0.001), though at 32 months improvement was not significant (p = 0.200). No adverse events were reported. The main limitations were that only medium to small rural villages were involved. Obtaining laboratory cultures from food at 32 months was not possible, and no stool microorganisms were investigated. CONCLUSIONS: We found that low-cost and culturally embedded behaviour change interventions were acceptable to communities and led to short- and long-term improvements in complementary-food safety and hygiene practices, and reported diarrhoea and acute respiratory tract infections. TRIAL REGISTRATION: The trial was registered on the 17th October 2014 with the Pan African Clinical Trial Registry in South Africa with number (PACTR201410000859336) and 32-month follow-up as an amendment to the trial.

Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms.

BACKGROUND: The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs' behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. METHODS: The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. RESULTS: HPs' information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. CONCLUSIONS: Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.

Cleaning and disinfection programmes in food establishments: a literature review on verification procedures.

In food establishments, cleaning and disinfection programmes contribute to provide the environmental conditions that are necessary for the production of safe and healthy food. Compliance with validated programmes is evaluated through verification activities, in order to establish, through objective evidence, if they are implemented as they were written and if they are effective, achieving continuous improvement of the sanitation programmes. In accordance with the specific guidelines of each country, food companies set up their technical specifications and develop their own cleaning and disinfection programmes. Depending on the analytical method used, one of the main challenges was to establish a reasonable limit of acceptability according to the impact that each surface has on the safety and hygiene of the food that is prepared. This review was focused on the procedures implemented to verify the cleaning and disinfection programmes in food establishments. In particular, this study examines the methodologies used (audits and analytical methods), sites for the collection of samples, acceptance criteria and main findings. The results of the analysed studies constitute a scientific basis for designing or improving sanitation procedures and their verification in food companies, and also provide relevant information for food safety authorities.

A place-based analysis of COVID-19 risk factors in Bangladesh urban slums: a secondary analysis of World Bank microdata.

BACKGROUND: There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities. METHODS: In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities. RESULTS: The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m2 per person up to 67.7 m2 per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities. CONCLUSION: The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.

Microbiological Evaluation of Opened Saline Bottles for Scleral Lens Use and Hygiene Habits of Scleral Lens Patients.

SIGNIFICANCE: Scleral lenses have become a widely used treatment option for patients with irregular corneas and ocular surface disease. Successful wear entails use of a nonpreserved saline solution to fill the lens before application on the eye. PURPOSE: The purposes of this study were to evaluate solution from opened bottles of multidose preservative-free saline for microbiological growth and to better understand study participant hygiene habits while handling these bottles for scleral lens wear. METHODS: Eligible study participants in this single-center prospective study were patients who routinely used multidose preservative-free saline solution for scleral lens rinsing and filling. Study participants completed a 12-question survey regarding their scleral lens hygiene habits and donated their opened multidose preservative-free saline bottle (PuriLens Plus; The Lifestyle Company, Inc., Freehold, NJ), which was processed for bacterial and fungal cultures. RESULTS: Thirty-five participants (19 males, 16 females) with ages ranging from 6 to 81 years (mean, 47.9 years) were included. Indications for scleral lens wear included those with irregular corneas and ocular surface disease. The overall rate of microbial contamination among saline samples was 62.9% (n = 22). Twenty-one different microorganisms were identified. The survey responses did not differ significantly (P > .05) for any of the questions with regard to likelihood of positive culture. There were no significant age or sex differences between participants with positive or negative culture results. No significant differences were found between isolation of specific microorganisms and any of the survey responses. CONCLUSIONS: This study suggests that off-label multidose preservative-free saline commonly used to rinse and fill scleral lenses before application on the eye may become contaminated with microorganisms once the bottle has been opened. Eye care practitioners and scleral lens patients should be aware of these potential contaminations and prioritize lens, hand, and environmental hygiene to minimize the risk of ocular complications.

Antecedents of Individuals' Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study.

BACKGROUND: The COVID-19 pandemic poses a major challenge to people's everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service-related affective reactions and anticipated behaviors during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to identify key factors that are associated with individuals' concerns about hygiene in hospitals and the postponement of surgeries. METHODS: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. RESULTS: We found that anxiety had a direct effect on people's concerns about safety (ß=-.12, 95% CI -.20 to -.05) and hygiene in hospitals (ß=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. CONCLUSIONS: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients.

The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries.

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.

Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance.

PURPOSE: The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS: A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS: Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION: RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.

Prevalence and predictors of adolescent linear growth and stunting across the urban-rural gradient in eastern Ethiopia.

OBJECTIVE: To assess the magnitude and factors associated with adolescent linear growth and stunting in two eastern Ethiopian communities. METHODS: This cross-sectional study was conducted in the urban Harar Health Demographic Surveillance Site (HDSS) and rural Kersa Demographic Surveillance and Health Research Center (KDS-HRC). Univariate analysis was used to describe the data. Multiple regression models examined predictors of linear growth. Logistic regression was used to examine factors associated with stunting. RESULTS: The study included 2010 adolescents. The prevalence of stunting was 26.9% (95% CI 24.9, 28.9), with 8.1% among urban adolescents (95% CI 6.5, 9.9) vs. 47.9% among rural ones (95% CI 44.6, 51.1). There was a significant interaction between residence and sex on the risk of stunting [AOR = 4.17 (95% CI 2.66, 9.9), P < 0.001], and height-for-age z score (HAZ) (ß = -0.51, P < 0.001). For urban adolescents, older age (18 to 19 years) was negatively associated with linear growth (ß= -0.29; P < 0.001). In the rural setting, handwashing practice after toileting was positively associated with HAZ (0.62; P < 0.001) and with lower risk of stunting [AOR = 0.51 (95% CI 0.34, 0.76)]. Urban females had significantly higher HAZ than urban males [ß = 0.52; P < 0.01)], and a significantly lower risk of stunting [AOR = 0.29 (95% CI 0.18, 0.48)]. CONCLUSIONS: There are significant disparities in the magnitude of stunting between urban and rural adolescents. The gender gap in stunting and linear growth, along with a high prevalence of stunting in early adolescence, calls for age-appropriate and gender-sensitive interventions. Particular attention and context-specific interventions are warranted for adolescents in these and similar rural eastern Ethiopian communities.

OBJECTIF: Evaluer l'ampleur et les facteurs associés à la croissance linéaire et au retard de croissance chez les adolescents dans deux communautés de l'est de l'Ethiopie. MÉTHODES: Cette étude transversale a été menée dans le site de Surveillance Démographique de Santé (SSDS) de Harar, en milieu urbain et dans le Centre de Surveillance Démographique et de Recherche sur la Santé (KDS-HRC) de Kersa, en milieu rural. L'analyse univariée a été utilisée pour décrire les données. Les modèles de régression multiple ont examiné les prédicteurs de la croissance linéaire. La régression logistique a été utilisée pour examiner les facteurs associés au retard de croissance. RÉSULTATS: L'étude a porté sur 2.010 adolescents. La prévalence du retard de croissance était de 26,9% (IC95%: 24,9-28,9), avec 8,1% (IC95%: 6,5, 9,9) chez les adolescents en milieu urbain et 47,9% (IC95%: 44,6, 51,1) chez les adolescents en milieu rural. Il existait une association significative entre la résidence et le sexe avec le risque de retard de croissance [AOR = 4,17 (IC95%: 2,66, 9,9), P < 0,001] et le score Z de la taille pour l'âge (ZAT) (ß = -0,51 ; P < 0,001).). Pour les adolescents en milieu urbain, l'âge plus élevé (18 à 19 ans) était associé négativement à la croissance linéaire (ß = -0,29 ; P < 0,001). En milieu rural, la pratique du lavage des mains après la toilette était positivement associée au score ZAT (0,62; P < 0,001) et à un risque plus faible de retard de croissance [AOR = 0,51 (IC95%: 0,34-0,76)]. En milieu urbain les femmes avaient un score ZAT beaucoup plus élevé que les hommes [ß = 0,52; P < 0,01)] et un risque significativement plus faible de retard de croissance [AOR = 0,29 ; IC95% 0,18-0,48]. CONCLUSIONS: Il existe des disparités significatives dans l'ampleur du retard de croissance entre les adolescents en milieu urbain et rural. L'écart entre les sexes en matière de retard de croissance et de croissance linéaire, ainsi que la prévalence élevée du retard de croissance au début de l'adolescence appellent à des interventions adaptées à l'âge et tenant compte du genre. Une attention particulière et des interventions spécifiques au contexte sont nécessaires pour les adolescents dans ces communautés rurales de l'est de l'Ethiopie et dans des communautés similaires.

A method to evaluate factors influencing the microbial reduction in domestic dishwashers.

AIMS: To develop a method that is able to determine the microbial reduction in different dishwasher cleaning cycles and differentiate between different program parameters used. METHODS AND RESULTS: Stainless steel biomonitors were contaminated with Micrococcus luteus or Entereococcus faecium and cleaned in a specially programmed household dishwasher with different cleaning temperatures and durations. No detergent, bleach-free detergent or detergent containing activated oxygen bleach was used. The logarithmic reduction (LR) was determined. The microbial reduction depended on the cleaning temperature, the duration of the cleaning cycles and the detergent type used. LR increased with higher temperatures, longer cleaning cycles and use of detergent. CONCLUSIONS: The factors cleaning cycle temperature, cleaning cycle duration, final rinsing temperature and the use of detergent all contributed to the reduction of test-strains in dishwasher cycles. A combination of longer dishwashing cycles and increased temperatures resulted in LRmax of the microbial load. SIGNIFICANCE AND IMPACT OF THE STUDY: Cycles in domestic appliances are very diverse; therefore a standardized method to determine their ability to reduce the microbial load is of great use. The method described here is able to demonstrate the reductions achieved by dishwashing cycles with different parameters and might help to find the necessary balance between energy saving and an acceptable level of hygiene.

'. . . and then no more kisses!' Exploring patients' experiences on multidrug-resistant bacterial microorganisms and hygiene measures in end-of-life care A mixed-methods study.

BACKGROUND: In end-of-life care hygiene, measures concerning multidrug-resistant bacterial microorganisms may contradict the palliative care approach of social inclusion and be burdensome for patients. OBJECTIVES: To integrate patients' perspectives on handling multidrug-resistant bacterial microorganisms at their end of life, their quality of life, the impact of positive multidrug-resistant bacterial microorganisms' diagnosis, protection and isolation measures on their well-being and patients' wishes and needs regarding their care. DESIGN: A mixed-methods convergent parallel design embedded quantitative data on the patients' multidrug-resistant bacterial microorganisms' trajectory and quality of life assessed by the Schedule for the Evaluation of Individual Quality of Life in qualitative data collection via interviews and focus groups. Data analysis was performed according to Grounded Theory and qualitative and quantitative results were interrelated. SETTING/PARTICIPANTS: Between March 2014 and September 2015 at two hospitals adult patients diagnosed with multidrug-resistant bacterial microorganisms and treated in a palliative care department or a geriatric ward were included in the sample group. RESULTS: Patients in end-of-life and geriatric care reported emotional and social impact through multidrug-resistant bacterial microorganisms' diagnosis itself, hygiene measures and lack of information. This impact affects aspects relevant to the patients' quality of life. Patients' wishes for comprehensive communication/information and reduction of social strain were identified from the focus group discussion. CONCLUSION: Patients would benefit from comprehensible information on multidrug-resistant bacterial microorganisms. Strategies minimizing social exclusion and emotional impact of multidrug-resistant bacterial microorganisms' diagnosis in end-of-life care are needed as well as adaption or supplementation of standard multidrug-resistant bacterial microorganisms' policies of hospitals.

Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan.

BACKGROUND: The current study is aimed to assess menstruation-related knowledge and practices of adolescent females visiting a public health care institute of Quetta city, Pakistan. METHODS: A questionnaire-based cross-sectional survey was conducted. Nine hundred and twenty three female adolescents attending general out-patient departments of Mohtarma Shaheed Benazir Bhutto Hospital Quetta, Balochistan, was approached for data collection. Based on the objectives of the study, descriptive analysis was conducted and SPSS v. 21.0 was used for the data analysis. RESULTS: Demographic characteristics revealed that the mean age of the respondents was 15 years. Mothers' (67%) were the main source of menstruation-related information. Majority (77.7%) of our respondents never had a class or session regarding menstruation-related education in their schools. About (44%) knew that menstruation is a physiological phenomenon while 60.2% knew that menstrual blood comes from the vagina. Nearly 40% of our study respondents missed their schools because of menarche. The use of absorbent material was frequent (90%) among the adolescent females and (68.7%) used commercially available sanitary napkins/pads. Although majority of the respondents (58.2%) were not taking baths during menstruation, 80.5% do cleaned their genitalia with water during menstruation. CONCLUSION: Female adolescents of our study had certain misconception regarding menstruation because of poor access to health-related education. Education can be provided at healthcare facilities, residential area as well as religious centers. Adolescent reproductive health should be included in the school curriculum; this will influence general reproductive health of females.

Determinants of clean birthing practices in low- and middle-income countries: a scoping review.

BACKGROUND: Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. METHODS: We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants - capability, opportunity and motivation. RESULTS: Seventy-eight studies were included in the review: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours - commonly referred to as "the six cleans" - featured in 31 studies. Determinants of hand hygiene (n = 13) and clean cord care (n = 11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. CONCLUSIONS: Efforts to combine clean birthing practices into a single suite of behaviours - such as the "six cleans"- may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.

Technical Report: Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting.

SIGNIFICANCE: Standardized guidelines that are clinically practical are needed to assist the prescriber in minimizing the risk of conveying infection through multiuse diagnostic contact lens use and reuse.Contact lens prescribers face the specter of transferring potential pathogens from one patient to another when reusing diagnostic (trial) contact lenses on multiple patients because infectious organisms have been recovered from worn contact lenses, although there is no evidence of transmission through this mechanism. These pathogens can be introduced into the system from one patient to another, or they may be introduced by clinician lens handling, storage, or both. These pathogens can cause acute or chronic systemic or ocular infection that can lead to significant morbidity (temporary or permanent) that includes vision loss.

Short communication: Design and validation of a hygiene score for calves.

The objective of this study was the establishment and validation of a scoring system for calf dirtiness. Defined areas of the belly, side, and rear of the calves were scored according to the percentage of dirtiness: score 1 ranges from 0 to 10% of the area (no or little soiling), score 2 from over 10 to 30% (medium soiling), and score 3 applies to soiling of more than 30% of the area (heavy soiling). The scores of the individual regions were summed up to yield the calf hygiene score (CHS) ranging from 3 to 9. The validation of the CHS was performed by 5 veterinarians on 42 calves. It was validated for its inter- and intra-observer-reliability and against a standard method created by image processing of photographs of calves. The agreement between the observers and the standard method was weak to moderate with kappa values from 0.58 to 0.67. Inter- and intra-observer reliability resulted in a moderate to strong agreement with 29 of 36 kappa values between 0.60 and 0.89. The CHS was thus successfully validated as reliable and could be a useful tool for herd health management.

Oral Health and COVID-19: Increasing the Need for Prevention and Access.

Populations disproportionately affected by coronavirus disease 2019 (COVID-19) are also at higher risk for oral diseases and experience oral health and oral health care disparities at higher rates. COVID-19 has led to closure and reduced hours of dental practices except for emergency and urgent services, limiting routine care and prevention. Dental care includes aerosol-generating procedures that can increase viral transmission. The pandemic offers an opportunity for the dental profession to shift more toward nonaerosolizing, prevention-centric approaches to care and away from surgical interventions. Regulatory barrier changes to oral health care access during the pandemic could have a favorable impact if sustained into the future.