Factors affecting hand hygiene practice during the COVID-19 pandemic in the Zimbabwean population: a qualitative study.

BACKGROUND: Practicing hand hygiene is recommended as one of the key preventive measures for reducing the transmission of COVID-19 and other infectious agents. However, it is often not practiced frequently enough or correctly by the public. We aimed to identify barriers to and facilitators of hand hygiene in the Zimbabwean population during the COVID-19 pandemic. METHODS: A qualitative study was conducted with a purposive sample of health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected from ten districts across the country from September to October 2022. Semistructured interviews were conducted with 3 key informant interviews per site. In addition, one homogenous focus group discussion was also conducted per site using a focus group discussion guide. The data were recorded on audiotapes, transcribed verbatim, and translated into English. All the analyses were performed manually using thematic analysis. RESULTS: Two themes were identified as facilitators of hand hygiene. These include individual factors (knowledge of hand hygiene practices and how they are performed) and access-related factors (access to hand washing infrastructure, soap, and sanitizers). Among the barriers to hand hygiene, four themes were identified: individual factors (knowledge gaps in proper hand washing, lack of conviction about hand hygiene, and habitual behaviour), access-related factors (lack of access to hand washing infrastructure, soap, and sanitizers), safety concerns (concern about the side effects of sanitizers), and sociocultural and religious factors (social customs, cultural beliefs, values, and religious practices). CONCLUSION: During public health emergencies, there is a need for people to access uninterrupted, on-premises water supplies to promote compliance with hand hygiene. The provision of clean water and hand washing facilities is critical for vulnerable communities to afford them the opportunity to improve quality of life and facilitate resilience in the event of future pandemics. Community engagement is important for identifying vulnerability factors to provide appropriate mitigatory measures.

Early use of oral cholera vaccines as a prime control measure during outbreaks: Necessary but not sufficient.

INTRODUCTION: Despite being a preventable and treatable disease, cholera remains a public health problem in Sudan. The objective of the outbreak investigation was to identify associated risk factors that would help institute appropriate control measures. MATERIAL AND METHODS: A case control study design was chosen to identify the risk factors for cholera in Gadarif State. RESULTS: Multi-variate analysis of identified two risk factors and three preventive factors for cholera in Gadarif City. RISK FACTORS: Buying foods or drinks from street vendors (OR = 71.36), 95 % CI: 16.58-307.14), living in an urban setting (Gadarif City) (OR = 5.38), 95 % CI: 2.10-13.81); and the preventive factors were: Washing hands with water after defecation but without soap (OR = 0.16), 95 % CI: 0.04-0.63) or with soap (OR = 0.01), 95 % CI: 0.00-0.03), washing hands before eating (OR = 0.15), 95 % CI: 0.05-0.51) and taking Oral Cholera Vaccine (OCV) (OR = 0.19, 95 % CI: 0.08-0.44). The effectiveness of OCV (VE) was (Unadjusted VE: 80 %, 95 % CI: 69 %-87 %) or (Adjusted VE = 81.0 %, 95 % CI: 56.0 %-92.0 %). DISCUSSION: Cholera outbreaks, especially in the setting of a complex humanitarian crises, can spread rapidly, resulting in many deaths, and quickly become a public health crisis. Implementation of a community-wide vaccination campaign using OCV as early as possible during the outbreak while implementing other control measures to target hotspots and at-risk populations would expedite halting outbreaks of cholera and save lives.

Knowledge, awareness, and risk practices related to bacterial contamination of antiseptics, disinfectants, and hand hygiene products among healthcare workers in sub-saharan Africa: a cross-sectional survey in three tertiary care hospitals (Benin, Burkina Faso, and DR Congo).

BACKGROUND: Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. METHODS: Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). RESULTS: 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained < 1 year ago. Near two-thirds (64.2%) preferred liquid soap for hand hygiene, versus 33.1% for alcohol-based hand rub (ABHR). Most (58.3%) expressed confidence in the locally available products. Knowledge of product categories, storage conditions and shelf-life was inadequate: eosin was considered as an antiseptic (47.5% of (para)medical staff), the shelf life and storage conditions (non-transparent container) of freshly prepared chlorine 0.5% were known by only 42.6% and 34.8% of participants, respectively. Approximately one-third of participants approved using tap water for preparation of chlorine 0.5% and liquid soap. Most participants (> 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p < 0.0001). CONCLUSIONS: The present findings can guide tailored training and IPC implementation at the healthcare facility and national levels, and sensitize stakeholders' and funders' interest.

VOC source apportionment, reactivity, secondary transformations, and their prioritization using fuzzy-AHP method in a coal-mining city in India.

This study assessed the air quality status in different functional zones of Dhanbad-a coal-mining and industrial hub, based on the measurement of aromatic and halogenated volatile organic compounds (VOCs) using gas chromatography. The study encompasses source apportionment of VOCs and their chemical reactivity in terms of OH radical loss rate (LOH), ozone-forming potential (OFP), and their secondary organic aerosol forming potential (SOAp). Furthermore, prioritization of VOCs based on a fuzzy-analytical hierarchical process (F-AHP) has also been done. The results found xylene species to have the highest concentration in all three seasons across traffic-intersection and industrial zones and toluene at the institutional zone. The study identified four sources using positive matrix factorization (PMF) model, viz., mixed traffic exhaust (35%), coal combustion sources (30%), industrial (26%), and solvent usage (9%). LOH and SOAp were ~ 16 times more at the industrial and traffic-intersection zone than the institutional zone. The aromatic species contributed 97% to the OFP, and many species exhibited less contribution to the mixing ratio of VOCs but displayed a high contribution to LOH, OFP, and SOAp, suggesting the need to prefer reactivity-based strategies in addition to concentration-based strategies in the future for their regulation. The F-AHP-based priority component analysis identified 16 species out of 29 in the priority watch list (nine in tier-1, four in tier-2, and three in tier-3). The paucity of data and lack of ambient air quality standards on VOCs (except benzene) make it difficult to determine which aspect should be dealt with first and which species require more attention. Therefore, the F-AHP method used in this study could help identify the influencing parameters to be considered while devising efficient VOC management policies.

Improving hand hygiene of young children with a digital intervention: a cluster-randomised controlled field trial.

Contagious diseases that affect young children place a great burden on them and their families. Proper hand hygiene is an important measure to reduce the disease burden, however, its implementation in day care centres is challenging. This paper introduces a digital intervention to support independent and good handwashing among young children. The intervention leverages animated instructions triggered by water and soap use, together with a symbolic reward shown to children on a screen during and immediately after handwashing. We tested the intervention in a pre-registered, cluster-randomised controlled field trial in 4 day care centres in Finland and Germany with 162 children over 42 days. The intervention increased soaping time, used as a proxy for handwashing quality, by 5.30 s (+ 62%, p < 0.001). The effect occurs immediately at the onset of the intervention and is maintained throughout the intervention phase.

Water, sanitation and hygiene at sex work venues to support menstrual needs.

Introduction: Adequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods: Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor's consent. WASH scores ranging 0-3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results: Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine; and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion: WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed. Trial registration: Clinicaltrial.gov NCT0566678.

Eye infection risks from Pseudomonas aeruginosa via hand soap and eye drops.

Eye infections from bacterial contamination of bulk-refillable liquid soap dispensers and artificial tear eye drops continue to occur, resulting in adverse health outcomes that include impaired vision or eye enucleation. Pseudomonas aeruginosa (P. aeruginosa), a common cause of eye infections, can grow in eye drop containers and refillable soap dispensers to high numbers. To assess the risk of eye infection, a quantitative microbial risk assessment for P. aeruginosa was conducted to predict the probability of an eye infection for two potential exposure scenarios: (i) individuals using bacteria-contaminated eye drops and (ii) contact lens wearers washing their hands with bacteria-contaminated liquid soap prior to placing the lens. The median risk of an eye infection using contaminated eye drops and hand soap for both single and multiple exposure events (per day) ranged from 10-1 to 10-4, with contaminated eye drops having the greater risk. The concentration of P. aeruginosa was identified as the parameter contributing the greatest variance on eye infection risk; therefore, the prevalence and level of bacterial contamination of the product would have the greatest influence on health risk. Using eye drops in a single-use container or with preservatives can mitigate bacterial growth, and using non-refillable soap dispensers is recommended to reduce contamination of hand soap. Given the opportunistic nature of P. aeruginosa and its ability to thrive in unique environments, additional safeguards to mitigate bacterial growth and exposure are warranted.IMPORTANCEPseudomonas aeruginosa (P. aeruginosa) is a pathogen that can persist in a variety of unusual environments and continues to pose a significant risk for public health. This quantitative microbial risk assessment (QMRA) estimates the potential human health risks, specifically for eye infections, associated with exposure to P. aeruginosa in bacteria-contaminated artificial tear eye drops and hand soap. This study applies the risk assessment framework of QMRA to evaluate eye infection risks through both consumer products. The study examines the prevalence of this pathogen in eye drops and soap, as well as the critical need to implement measures that will mitigate bacterial exposure (e.g., single-use soap dispensers and eye drops with preservatives). Additionally, limitations and challenges are discussed, including the need to incorporate data regarding consumer practices, which may improve exposure assessments and health risk estimates.

Evaluation of physical parameters and spectral characterization of the quality of soaps containing by-products from the food industry.

The present study investigated several properties such as friction, hardness, penetration work, and cutting forces in soaps formulated with apple and carrot pomace at varying concentrations of 5%, 10%, and 15%. To gain insights into the molecular-level alterations within the formulated soap samples, they were spectroscopically analyzed using Fourier-transform infrared spectroscopy. The sliding friction analyses revealed that the investigated extrudate additives had no significant impact on the frictional forces of the soaps. However, notable differences were observed in the cutting force, hardness, and penetration work between the control and pomace-added samples. Excluding the control samples, no statistically significant distinctions were found between the cutting force, hardness, and work of penetration of soaps containing apple pomace and carrot pomace. Moreover, the quantity of pomace incorporated did not induce any significant variations in the results. The obtained samples were characterised at the molecular level using FTIR Fourier transform infrared spectroscopy. On the other hand, alterations in band intensities suggested improved molecular packing of the compounds within the samples due to the presence of the additives.

Prevalence of trachomatous inflammation-follicular and associated factors among children aged 1-9 years in northeastern Ethiopia.

BACKGROUND: Trachoma is the most prevalent eye disease in Ethiopia, especially among children aged 1-9 years and continues to be a public health concern. Nevertheless, in Ethiopia's rural Jamma district in South Wollo Zone of Amhara Regional State, factors associated with trachomatous inflammation-follicular (TF) among children aged 1-9 years have not yet been studied. METHODS: A community-based cross-sectional study was conducted among 616 children aged 1-9 years in rural Jamma district in Ethiopia from January-March, 2019. Data were collected using a pre-tested structured questionnaire, an observation checklist and clinical examination of study participants for active trachoma. The presence of TF and trachomatous inflammation-intense (TI) was clinically assessed by integrated eye care workers using the World Health Organization simplified grading system. Data were analysed using SPSS (Statistical Package for Social Sciences) Version 25.0. A logistic regression model with 95% CI was used. From the multivariable analysis, variables with p-value < 0.05 were declared as associated factors of TF. RESULT: The prevalence of TF was 10.9% (95% CI [8.6 - 13.6%]) among the rural children aged 1-9 years. The mean family size was 5.5 ± 1.9 persons. About one-fifth (20.6%) of households kept domestic animals overnight in the same room as family. Almost one-sixth (17.5%) of the children involved in this study had an ocular discharge. Two-thirds of the children (68.8%) washed their hands once per day and just over half (55.8%) washed their faces once per day. From multivariable analysis, we found that the presence of domestic animals kept overnight in the same room as the family (adjusted odds ratio [AOR] = 4.32; 95%CI [2.49-9.52]), mother's/caregiver's illiteracy (AOR = 2.01; 95%CI [1.11-4.67]), household size (> 7 persons) (AOR = 3.50; 95%CI [1.66-8.50]), washing of children's hands and face without soap (AOR = 2.41; 95%CI [1.29-5.18]), feces observed in the compound (AOR = 5.10; 95%CI [2.01-10.14]), presence of ocular discharge (AOR = 7.23, 95%CI [4.10-12.51]) and nasal discharge (AOR = 4.54, 95%CI [1.95-9.26]) were significantly associated with TF. CONCLUSION: The prevalence of TF among rural children aged 1-9 years in this study was almost two times higher than the WHO-recommended threshold (TF < 5%) for trachoma elimination and beyond the trachoma control target (TF < 10%). Presence of domestic animals kept overnight in the same room as the family, mother's/caregiver's illiteracy, household size (> 7 persons), washing of children's hands and face without soap, feces observed in the compound, presence of ocular and nasal discharge were significantly associated with TF. We recommended interventions that will help household income to be improved to enable families to be able to construct separate rooms in which to keep animals overnight. Furthermore, we also recommend to policy makers to design mechanisms for enhancement of behavioural change among householders to keep household compounds clean and creating awareness among mothers/caregivers about prevention of trachoma.

The effects of Jawoongo soap on skin improvement.

BACKGROUND: Jawoongo is used to treat and prevent skin issues such as dry and keratinization disorders, burns, trauma, pigmentation, scarring, and inflammatory skin conditions. In this study, the efficacy and safety of 0.47% Jawoongo extract-containing soap (JAUN-CS) were assessed in terms of skin improvement effects such as cleansing, moisturizing, sebum secretion management, and skin elasticity enhancement. METHODS: Twenty healthy adult men and women aged 20-60 years old took part in the study. Before and after using JAUN-CS, the participants were divided into groups, and various skin improvement effects were measured utilizing machines such as the Corneometer, Tewameter TM 300, and Visioscan. A dermatologist analyzed the product's safety in accordance with Frosch & Kligman and the Cosmetic, Toiletry, and Fragrance Association (CTFA) rules. RESULTS: Using JAUN reduced the amount of base and point makeup by 25.7% and 76.7%, respectively. Also, JAUN showed a great facial exfoliation effect by removing the old and lifted skin keratins by 84.7% and 20.3%, respectively. Impurities in facial pores decreased by 58%, too. Furthermore, JAUN increased the moisture content of deep skin and skin surface by 3.5% and 74.0%, and skin elasticity by 2.8%. Skin tone, skin texture, skin radiance, and skin barrier all showed improvements of 3.3%, 20.0%, 15.0%, and 115.2%, respectively. Lastly, cleansing with JAUN successfully enhanced the condition of the youth triangle by 7.6%, while TEWL significantly decreased by 52.7%. Neither the JAUN nor the control group soap showed any adverse reactions, such as erythema or allergies, during the testing period. CONCLUSIONS: The results of this study demonstrated that JAUN is safe for human use and has various skin-improving properties, making Jawoongo a promising natural material for the development of functional cosmetics in the future.

A Rare Presentation of Pica Disorder in Soap Ingestion Variant: Case Report and Review.

ABSTRACT: Pica indicates the persistent ingestion of inedible substances over a period of at least 1 month, being discordant to the individual's cognitive development level and not directly attributable to cultural or social normative practices. The literature suggests that the prevalence of pica varies significantly according to the social and clinical context. It can co-occur with psychiatric disorders, with its etiology being poorly understood and most likely multifactorial. In this article, we report the case of a patient in her 50s with a clinical setting compatible with soap ingestion variant of pica disorder. In addition to the variety of ingested substances, pica can be associated with heterogeneous behavior, mainly of the obsessive-compulsive spectrum. Despite recent research, this condition is still a target of much speculation. This is a very rare and challenging presentation of a soap ingestion variant of pica with very few similar cases described to date.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial.

INTRODUCTION: Reducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children. METHOD: The study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6-12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children's Fear Scale. RESULTS: The pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001). CONCLUSION: The active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

From soap bubbles to multicellular organisms: Unraveling the role of cell adhesion and physical constraints in tile pattern formation and tissue morphogenesis.

Tile patterns, in which numerous cells are arranged in a regular pattern, are found in a variety of multicellular organisms and play important functional roles. Such regular arrangements of cells are regulated by various cell adhesion molecules. On the other hand, cell shape is also known to be regulated by physical constraints similar to those of soap bubbles. In particular, circumference minimization plays an important role, and cell adhesion negatively affects this process, thereby regulating tissue morphogenesis based on physical properties. Here, we focus on the Drosophila compound eye and the mouse auditory epithelium, and summarize the mechanisms of tile pattern formation by cell adhesion molecules such as cadherins, Irre Cell Recognition Modules (IRMs), and nectins. Phenomena that cannot be explained by physical stability based on cortical tension alone have been reported in the tile pattern formation in the compound eye, suggesting that previously unexplored forces such as cellular concentric expansion force may play an important role. We would like to summarize perspectives for future research on the mechanisms of tissue morphogenesis.

Observational assessment of hand hygiene compliance among healthcare workers in public hospitals of Northeastern Ethiopia.

This study examined the magnitude and predictors of hand hygiene compliance among 325 healthcare workers in three public hospitals of Northeastern Ethiopia using standardized observational tool. A multivariable logistic regression analysis was computed to identify factors associated with non-compliance. The overall proportion of observed hand hygiene non-compliance was 41.8% (95%CI: 36.6-48.1). Having <5 years of work experience (AOR = 1.5; 95%CI: 1.2-2.5), absence of hand washing soap (AOR = 3.1; 95%CI: 2.3-5.4), work overload (AOR = 2.5; 95%CI: 1.9-4.1), pipe water supply interruption (AOR = 2.8; 95%CI: 2.1-4.9), lack of hand hygiene training (AOR = 3.1; 95%CI: 2.2-4.4), and absence of infection prevention committee (AOR = 2.1; 95%CI: 1.5-4.9) were determinant factors for hand hygiene non-compliance. Therefore, regional health bureau and hospitals' managers should work towards the provision of regular hand hygiene trainings, uninterrupted piped water supply, hand washing soap, and establishment of functional infection prevention committee. Moreover, healthcare workers should be also committed to comply with hand hygiene.

Isolation, identification and pathogenicity of local entomopathogenic bacteria as biological control agents against the wild cochineal Dactylopius opuntiae (Cockerell) on cactus pear in Morocco.

The Opuntia ficus-indica (L.) cactus, a crucial crop in Morocco, is threatened by the wild cochineal, Dactylopius opuntiae (Cockerell). The aim of this research was to investigate the efficacy of nine bacterial strains against both D. opuntiae nymphs and adults females applied individually or after black soap in the laboratory, greenhouse, and field conditions. Using the partial 16S ribosomal DNA, the bacterial isolates were identified as Pseudomonas koreensis, Pseudomonas sp., Burkholderia sp. and Bacillus sp. Under laboratory conditions, the insecticidal activity of P. koreensis strain 66Ms.04 showed the level mortality (88%) of adult females' at 108 CFU/mL, 7 days after application. At a concentration of 108 CFU/mL, P. koreensis strain 66Ms.04 and Pseudomonas sp. (strains 37 and 5) caused 100% nymphs mortality rate three days after application. Under greenhouse conditions, the use of P. koreensis strain 66Ms.04 at 108 CFU/mL following the application of black soap (60 g/L) demonstrated the maximum levels of females and nymphs' mortalities with 80 and 91.25%, respectively, after 8 days of treatment. In field conditions, the combined application of the P. koreensis strain 66Ms.04 at 108 CFU/mL with black soap at 60 g/L, for an interval of 7 days, significantly increased the mortality of adult females to 93.33% at 7 days after the second application. These findings showed that the combined treatment of P. koreensis strain 66Ms.04 with black soap can be a potent and eco-friendly pesticide against D. opuntiae.

Motivating school communities towards behavior change and local ownership: a gamification intervention to prevent trachoma at primary schools in southern Ethiopia.

BACKGROUND: Ethiopia alone carries 49% of the global burden of trachoma, associated with a lack of safe water, sanitation and hygiene (WASH) and poor health practices. The aim of this study was to examine whether gamification among schoolchildren and promotion of local ownership of school WASH is associated with healthy behaviors and WASH infrastructure improvements. METHODS: Application of the Accelerate gamification intervention for elimination of trachoma, with an emphasis on gamification among schoolchildren and community involvement in motivating face-washing, handwashing and functional use of latrines, was undertaken. RESULTS: The study was conducted over 9 mo in 223 rural schools from six districts within the intervention area, reaching 93 518 schoolchildren. At baseline, students were observed washing their hands after using latrines in 23 (10.3%) schools. This increased to 132 (59%) schools (p≤0.001) at follow-up. The number of latrines increased from 585 at baseline to 594 at follow-up (p=0.031). The availability of handwashing stations in schools increased from 31 (13.9%) with water access (8%) and soap (5%) to 155 (69.5%) schools with handwashing stations with water access in 153 (98.7%) (p<0.001) and soap in 121 (78%) (p<0.001). CONCLUSIONS: Motivational strategies such as gamification among schoolchildren and promotion of local ownership of school WASH may be associated with healthy behaviors and WASH infrastructure improvements.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review.

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Making Germs Visible - Assessing the Impact of a School-Based, Low-Cost Intervention on Hand Hygiene Knowledge, Attitude and Practice of Children in Rural India.

Handwashing with soap at critical moments is one of the most important factors in controlling the spread of germs and preventing the spread of infection. The objective of this study was to determine the effectiveness of a low-cost, school-based intervention that simulated germs and their spread on hand hygiene knowledge, attitude and practice of primary school children. Five hundred and sixty-two students from 28 rural schools were enrolled in this pre-posttest study. Endline data was collected 4 weeks after conducting the intervention at baseline. The mean scores for knowledge, attitude and practice improved significantly after the intervention (p < .05). Significant positive gains were also observed in children's understanding of germs, the associated illness threat and washing hands with soap as a prevention mechanism. The present study suggests that entertainment-education-based interventions have the potential to improve hygiene behavior among children while being low-cost.

Gut microbiota shifts favorably with delivery of handwashing with soap and water treatment intervention in a prospective cohort (CHoBI7 trial).

BACKGROUND: Cholera can result in the expulsion of important microbiota from the gut and result in death if left untreated. The disease transmits mainly via drinking water carrying Vibrio cholerae; and household contacts (HHC) of cholera patients are at elevated risk during the first week of infection. The gut microbiota profiles of HHC-children of cholera patients at Dhaka city slums were investigated before (day 0) and after (day 8) delivery of chlorinated water as part of the major study 'CHoBI7 trial (cholera-hospital-based intervention for 7 days)'. RESULT: Results of sequencing and analysis of bacterial community DNA revealed the predominance of two bacterial phyla: Bacteroidetes and Firmicutes at day 0 with a relative abundance of 62 ± 6 (mean ± SEM%) and 32 ± 7, respectively. The pattern reversed at day 8 with a decreased relative abundance of Bacteroidetes (39 ± 12; p = 0.034) and an increased abundance of Firmicutes (49 ± 12; p = 0.057). Of 65 bacterial families confirmed at day 0, six belonging to Proteobacteria including Vibrionaceae disappeared at day 8. Interestingly, the relative abundance of four Firmicutes families-Lachnospiraceae, Bifidobacteriaceae, Clostridiaceae, and Ruminococcaceae was increased in all five study children at day 8. CONCLUSION: The observed exclusion of pathogenic Proteobacteria and enhancement of beneficial Firmicutes in the gut of children delivered with chlorinated water as part of WASH intervention reflect a great promise of the CHoBI7 program in preventing cholera and improving child health.