Effect of handwashing on the reduction of Escherichia coli on children's hands in an urban slum Indonesia.

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect.

Comprehensive assessment of handwashing and faecal contamination among elementary school children in an urban slum of Indonesia.

OBJECTIVE: Globally, the challenge of handwashing with soap (HWWS) still exists despite the importance of HWWS being shown previously. This study aimed to evaluate faecal contamination on the hands of children and to find factors related to faecal contamination from handwashing techniques, HWWS, knowledge and awareness of water, sanitation, and hygiene (WASH), and a comprehensive WASH index. METHODS: The study was conducted at two elementary schools with 169 children in a densely populated area of Bandung, Indonesia. The survey involved handwashing observation using a checklist, hand bacteria sampling and questionnaires. RESULTS: Most children (98.7%) had faecal contamination. Girls had significantly fewer Escherichia coli than boys (P < 0.05). Ability in handwashing techniques, HWWS, and knowledge and awareness of WASH were poor in the lower grades. Escherichia coli counts were negatively correlated with handwashing technique (r = -0.171, P < 0.05), HWWS (r = -0.225, P < 0.01) and the WASH index (r = -0.205, P < 0.05). CONCLUSIONS: Proper handwashing technique and HWWS at appropriate times can reduce faecal contamination. Moreover, it is important that both grade-based and gender-based handwashing education be considered in elementary school education.

OBJECTIF: A l'échelle mondiale, le défi du lavage des mains au savon (HWWS) existe toujours, en dépit de l'importance révélée de ce procédé. Cette étude visait à évaluer la contamination fécale sur les mains des enfants et à trouver des facteurs liés à la contamination fécale résultant des procédés de lavage des mains, du lavage des mains au savon, de la connaissance et de la sensibilisation à l'eau, aux sanitaires et à l'hygiène (WASH), ainsi qu'un indice WASH détaillé. MÉTHODES: L'étude a été menée dans deux écoles élémentaires avec 169 enfants dans une zone densément peuplée de Bandung, en Indonésie. L'enquête comprenait l'observation du lavage des mains à l'aide d'une liste de contrôle, un échantillonnage bactérien sur les mains et des questionnaires. RÉSULTATS: La plupart des enfants (98,7%) avaient une contamination fécale. Escherichia coli était nettement moins présent chez les filles que chez les garçons (p <0,05). L'aptitude dans les techniques de lavage des mains, le lavage des mains au savon, ainsi que la connaissance et la sensibilisation au WASH étaient faibles dans les classes inférieures. Les comptages d'E. Coli corrélaient négativement avec la technique de lavage des mains (r = -0,171 ; p <0,05), le lavage des mains au savon (r = 0,225 ; p <0,01) et l'indice WASH (r= - 0,205 ; p <0,05). CONCLUSIONS: Une technique de lavage des mains appropriée et un lavage des mains au savon à des moments opportuns peuvent réduire la contamination fécale. De plus, il est important de prendre en compte l'éducation au lavage des mains basée sur le niveau et le sexe dans l'enseignement primaire.

Domestic wastewater in Indonesia: generation, characteristics and treatment.

With a 270 million Indonesian population, domestic wastewater is one of the major contributors to wastewater generated from human activities. This review aimed to give an overview of the current state of domestic wastewater generation, characteristics and treatment systems in Indonesia. Overall, grey water quantity in Indonesia was 1 to 4 times higher than black water quantity, while the quantity of untreated grey water was 3 to 6 times higher than untreated black water. Parameters of concern include suspended solids, biochemical oxygen demand, chemical oxygen demand, oil and grease, nitrogen and coliforms. Our analysis shows that grey water can be a significant source of water pollution due to the large quantity and lack of treatment. In addition, black water treatment that relies mainly on on-site treatment is often inadequate due to the lack of quality control for the infrastructure, operation and maintenance. An incentive or penalty scheme to build and ensure the quality of domestic wastewater treatment is required and can be applied at the household, community or central (city) level.

Risk Factors for Undernutrition and Diarrhea Prevalence in an Urban Slum in Indonesia: Focus on Water, Sanitation, and Hygiene.

Unsafe drinking water and poor sanitation and hygiene lead to deterioration of the child health condition in low- and middle-income countries. This study aimed to evaluate the nutritional and health status of children living in an urban slum and to clarify the factors contributing to undernutrition and diarrhea prevalence by focusing on water, sanitation, and hygiene from three viewpoints: household environments, child personal hygiene practices, and knowledge and awareness. The study was conducted at a preschool and two elementary schools in the densely populated area of Bandung, Indonesia. Participants were 228 pairs of children and their caretakers. The survey involved 1) anthropometric measurements (height and weight), 2) handwashing observation using a checklist, and 3) questionnaires. On multivariate logistic regression analysis, not using a towel for handwashing practices (adjusted odds ratio [AOR] = 2.37; 95% confidence interval [CI] = 1.13-4.96) was significantly associated with an increased risk of stunting. Regarding household environments, children from households using tap water as drinking water were significantly associated with an increased risk of stunting and thinness compared with households using tank water (AOR = 2.26; 95% CI = 1.03-4.93; and AOR = 2.88; 95% CI = 1.13-7.35, respectively). Moreover, children from households using open containers for water storage were significantly associated with an increased risk of diarrhea (AOR = 5.01; 95% CI = 1.08-23.15). Therefore, drinking water management at home and proper personal hygiene practices of children are important for maintaining and promoting child health in urban Indonesian slums.