Hand hygiene practice and associated factors among rural communities in northwest Ethiopia

What's happening in the kitchen? The influence of nutritional knowledge, attitudes and, practices (KAP), and kitchen characteristics on women's dietary quality in Ethiopia

BACKGROUND

Low dietary quality significantly contributes to public health risks in low-income countries. This situation is particularly concerning for vulnerable groups, such as women and children, who are at increased risk of malnutrition due to inadequate access to proper nutrition. This study aimed to assess the influence of nutrition-related knowledge, attitudes, and practices, and kitchen characteristics on women's dietary quality in Ethiopia.

METHOD

A population-based cross-sectional survey was conducted from August to September 2022 in five regions and two city administrations in Ethiopia. A multistage stratified cluster sampling method was employed. From ninety-nine enumeration areas, twenty eligible households were selected. A total of 1,980 women aged 15-49 years were included in this survey. The data were collected using a structured questionnaire about socio-demographic characteristics, food frequency, 24-hour dietary recall, and nutrition-related knowledge, attitudes, and practices. The determinants of dietary quality were identified using Poisson, logistic, and ordinary least square regression analyses. Variables with a p-value less than 0.05 were considered to indicate statistical significance.

RESULTS

The results showed that the average dietary diversity score for women was 3.4 ± 0.85. Only 21.5% of the participants achieved the minimum dietary diversity for women (MDD-W), and the mean adequacy ratio for nutrients was 61.6%. The participants' average nutrition-related knowledge, attitudes, and practices scores were 63%, 39%, and 23%, respectively. The regression analysis showed knowledge and attitude positively associated with dietary diversity and the mean nutrient adequacy ratio (P < 0.01). Cooking time and propensity to prepare new food were also positively associated with dietary diversity and with minimum dietary diversity (P < 0.01).

CONCLUSION

Our study showed that good nutrition-related knowledge and a positive attitude toward nutrition positively and significantly influence dietary quality, along with cooking time and the propensity to prepare new foods.

Water, sanitation, and hygiene service inequalities and their associated factors among urban slums and rural communities in Eastern Ethiopia

Background

Understanding the level of inadequate water, sanitation, and hygiene (WaSH) services in urban and rural settlements is crucial for prioritizing community interventions and resource allocation. However, there is a lack of evidence regarding discrepancies in WaSH services across rural and urban slum communities in Ethiopia.

Objective

This study aims to assess inequalities in households' WaSH services and their associated factors among urban slums and rural communities in Eastern Ethiopia from February to April 2024.

Methods

A comparative community-based cross-sectional study design was conducted, with study participants selected through stratified random sampling using proportional-to-size allocation. Data were entered into Epi Data version 3.1 and then exported to STATA version 17 for analysis. Bi-variable and multivariable logistic regression was conducted, and associations were reported as odds ratios (ORs) with 95% confidence intervals (CI), using a p-value less than 0.05 as the significance threshold.

Result

A total of 278 urban and 301 rural households participated in the study, with a response rate of 94%. Key indicators showed that WaSH services were significantly better in urban areas compared to rural households. For example, 98% (95% CI: 96, 99) of urban households had access to an improved water source compared to 76% (95% CI: 71, 80) of rural households. The proportion of households with improved latrines was 44% (95% CI: 38, 50) in urban areas and only 14% (95% CI: 11, 19) in rural areas. Handwashing practices at all five critical times were reported by 52% (95% CI: 46, 58) of urban household heads, compared to 22% (95% CI: 18, 27) of rural households. Additionally, occupation (such as being a farmer, p = 0.000) and water service satisfaction (p = 0.000) were significantly associated with these key WaSH outcomes.

Conclusion

The study revealed that the WaSH services in urban slums are considerably better than in rural households. Socioeconomic factors significantly influence the existing disparities in WaSH services. Stakeholders should focus on providing targeted, strategic support to communities to address the challenges in WaSH service provision.

Exposure behaviour to Escherichia coli among households in Imvepi refugee settlement, Terego district Uganda

INTRODUCTION

Exposure to Escherichia coli (E. coli) is a risk factor for diarrhoeal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to faecal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, and soil among others. While these pathways are well-documented, specific exposure behaviours remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related disease in refugee settlements.

METHODS

Guided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (minors living on their own, having borne a child, married, or pregnant). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome.

RESULTS

Over 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58-0.90), being aged 35-49 years (APR = 0.76, 95% CI: 0.60-0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38-0.77), high knowledge (APR = 0.69, 95% CI: 0.59-0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64-0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08-1.48) was associated with a higher prevalence of high-risk exposure behaviours.

CONCLUSION

The study indicates a substantial prevalence of high-risk E. coli exposure behaviours in the refugee settlement.. There's a need to implement behaviour change interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli.

Effectiveness of hand hygiene campaigns and interventions across the League of Arab States: a region-wide scoping review

Hand hygiene is a standard public health practice for limiting the spread of infectious diseases, yet they are still not routine global health behaviours. This review aimed to examine the effectiveness of various hand hygiene interventions conducted across the League of Arab States, identify gaps in the existing literature, and propose areas for future research and intervention development. A scoping review was conducted across 16 databases for relevant publications published up to and including October 2023. Forty studies met the inclusion criteria; of these, 34 were hospital-based and six community-based. Of the reviewed studies, 24 provided adequate details that would enable replication of their intervention. Eighteen of the studies used some variation of the World Health Organization's Five Moments for intervention content or assessment. More than half (N = 25) reported healthcare worker or student hand hygiene behaviours as an outcome and 15 studies also included some form of patient-centred outcomes. Six studies specified the use of theory or framework for their evaluation design or intervention content, and four studies mentioned use of local government guidelines or recommendations. Future research should focus on bridging the literature gaps by emphasizing community-based studies and integrating cultural nuances into intervention designs. Additionally, applying theoretical frameworks to hand hygiene studies could enhance understanding and effectiveness, ensuring sustainable improvements in hygiene practices across diverse settings in the League of Arab States.