RESUMEN
BACKGROUND: Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings. OBJECTIVE: This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently. METHODS: This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ≥5 employees, and schools if they had ≤7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating. RESULTS: The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024. CONCLUSIONS: This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion. TRIAL REGISTRATION: ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52959.
RESUMEN
In rural settings of Côte d'Ivoire, access to water, sanitation, and hygiene (WASH) at schools is often lacking. The purpose of this study was to assess the availability, quality, and use of WASH infrastructure in schools in the south-central part of Côte d'Ivoire, and to determine the hygiene practices of schoolchildren. A cross-sectional study was conducted in 20 primary schools with (n = 10) or without (n = 10) direct access to drinking water. The survey was comprised of a questionnaire directed at schoolchildren aged 8-17 years, an assessment of the WASH infrastructure, and the testing of drinking water samples for Escherichia coli and total coliforms. Overall, 771 schoolchildren were enrolled in the study. One out of four children (24.9%) reported that they used available toilets. Among those children not using toilets, more than half (57.5%) reported that they practised open defecation. Drinking water infrastructure was limited in most schools because of poor storage tanks, the low flow of water, or broken wells. All drinking water samples (n = 18) tested positive for total coliforms and 15 (83.3%) tested positive for E. coli. The lack of WASH infrastructures in primary schools in the south-central part of Côte d'Ivoire, in combination with poor hygiene practices, might govern disease transmission and absenteeism at school, especially among females.
