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Pratt C, Kesande M, Tusabe F, Medley A, Prentice-Mott G, Lozier M, Trinies V, Yapswale S, Nabatyanga S, Isabirye H, Lamorde M, Berendes D. Access to and Use of Hand Hygiene Resources during the COVID-19 Pandemic in Two Districts in Uganda, January-April 2021. Am J Trop Med Hyg 2023; 109:881-889. [PMID: 37640292 PMCID: PMC10551090 DOI: 10.4269/ajtmh.23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/12/2023] [Indexed: 08/31/2023] Open
Abstract
To understand access to and use of hand hygiene in healthcare facilities (HCFs) and community locations during the COVID-19 pandemic, we evaluated factors associated with hand hygiene in 60 priority HCFs and community locations in two border districts in Uganda. We assessed water and hand hygiene resource availability and observed hand hygiene practice by staff or patrons. Regression modeling estimated factors associated with the availability or use of hand hygiene. In HCFs, most inpatient (61%), outpatient (71%), and laboratory or staff (90%) rooms contained hand hygiene materials. Only 38% of community locations had hand hygiene materials at all entrances and exits, 35% of congregation areas had hand hygiene materials. Overall, 38% of healthcare staff, 48% of patrons post-latrine use, and 21% of patrons entering or exiting community locations practiced hand hygiene. HCF hand hygiene access was lower in inpatient rooms (odds ratio [OR] = 0.17, 95% CI: 0.06-0.45) and outpatient rooms (OR = 0.23, 95% CI: 0.07-0.70) compared with laboratory/staff rooms. HCF hand hygiene practice was higher for doctors than nurses (OR = 3.58, 95% CI: 1.15-11.14) and with new versus existing patient encounters (OR = 2.27, 95% CI: 1.20-4.27); it was lower before versus after patient contact for both invasive (OR = 0.03, 95% CI: 0.00-0.20) and noninvasive (OR = 0.66, 95% CI: 0.45-0.95) procedures. In community settings, hand hygiene practice after using the latrine was higher than at an entrances/exits (OR = 3.39, 95% CI: 2.08-5.52). Hand hygiene rates were relatively low in healthcare and community settings. Greater emphasis on hand hygiene before patient interactions (at HCFs) and at community entrances/exits for patrons is also needed.
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Affiliation(s)
- Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen Kesande
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Fred Tusabe
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Graeme Prentice-Mott
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victoria Trinies
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sauda Yapswale
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | | | - Herbert Isabirye
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - David Berendes
- U.S. Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Tusabe F, Nanyondo J, Lozier MJ, Kesande M, Tumuhairwe O, Watsisi M, Twinomugisha F, Medley A, Mutoro J, Lamorde M, Berendes D. Improving Access to WHO Formulations of Alcohol-Based Hand Rub in Healthcare Facilities: A District-Wide Approach. Am J Trop Med Hyg 2023:tpmd220554. [PMID: 37188343 DOI: 10.4269/ajtmh.22-0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/14/2023] [Indexed: 05/17/2023] Open
Abstract
Alcohol-based hand rub (ABHR) is an effective hand hygiene measure to mitigate and prevent infectious disease transmission in healthcare facilities (HCFs); however, availability and affordability in low- and middle-income countries are limited. We sought to establish centralized local production of ABHR using a district-wide approach to increase provider access at all public HCFs in Kabarole and Kasese Districts in Western Uganda. Partner organizations worked with district governments to adapt and implement the WHO protocol for local ABHR production at the district scale. These groups identified and upgraded sites for ABHR production and storage to ensure recommended security, ventilation, and air conditioning. District governments selected technicians for training on ABHR production. Raw materials were sourced within Uganda. Alcohol-based hand rub underwent internal quality control by the production officer and external quality control (EQC) by a trained district health inspector before distribution to HCFs. We assessed ABHR production and demand from March 2019 to December 2020. All ABHR batches (N = 316) met protocol standards (alcohol concentration: 75.0-85.0%) with a mean of 79.9% (range: 78.5-80.5%). Internal quality control measurements (mean alcohol concentration: 80.0%, range: 79.5-81.0%) matched EQC measurements (mean: 79.8%, range: 78.0-80.0%). Production units supplied ABHR to 127 HCFs in Kasese District (100%) and 31 HCFs in Kabarole District (56%); 94% of HCFs were small (dispensary or next higher level). This district-wide production met quality standards and supplied ABHR to many HCFs where facility-level production would be unfeasible. Low- and middle-income countries may consider district models to expand ABHR production and supply to smaller HCFs.
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Affiliation(s)
- Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Judith Nanyondo
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Matthew J Lozier
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Olive Tumuhairwe
- Kabarole District Health Office, Kabarole District Local Government, Fort Portal, Uganda
| | - Martin Watsisi
- International Water & Sanitation Centre - WASH, Fort Portal, Uganda
| | | | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David Berendes
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tusabe F, Lamorde M, Medley A, Kesande M, Lozier MJ, Yapswale S, Ociti F, Isabirye H, Nuwamanya E, Nanyondo J, Boore A, Vosburgh W, Kasule JN, Pratt C, Berendes D. Establishment of District-Led Production of WHO-Recommended Alcohol-based Hand Rub (ABHR) during the COVID-19 Pandemic: A Model for Improving Access to ABHR during Health Emergencies. J Water Sanit Hyg Dev 2023; 13:847-856. [PMID: 38410156 PMCID: PMC10896262 DOI: 10.2166/washdev.2023.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
In response to the COVID-19 pandemic, we established and sustained local production of alcohol-based handrub (ABHR) at district scale for healthcare facilities and community, public locations in four districts in Uganda. District officials provided space and staff for production units. The project renovated space for production, trained staff on ABHR production, and transported ABHR to key locations. The production officer conducted internal ABHR quality assessments while trained district health inspectors conducted external quality assessments prior to distribution. Information, education, and communication materials accompanied ABHR distribution. Onsite ABHR consumption was monitored by site staff using stock cards. On average, it took 11 days (range: 8-14) and 5,760 USD (range: 4,400-7,710) to set up a production unit. From March-December 2021, 21,600L of quality-controlled ABHR were produced for 111 healthcare facilities and community locations at an average cost of 4.30 USD/L (range: 3.50-5.76). All ABHR passed both internal and external quality control (average ethanol concentration of 80%, range: 78-81%). This case study demonstrated that establishing centralized, local production of quality-controlled, affordable ABHR at a district-wide scale is feasible and strengthens the ability of healthcare workers and community locations to access and use ABHR during infectious disease outbreaks in low-resource countries.
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Affiliation(s)
- Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Matthew J. Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - Sauda Yapswale
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Francis Ociti
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Herbert Isabirye
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Elly Nuwamanya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Judith Nanyondo
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Amy Boore
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Waverly Vosburgh
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Juliet N. Kasule
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Country Office Kampala, Uganda
| | - Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. Mailstop H24-11, Atlanta, GA, USA, 30329
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Tusabe F, Tahir IM, Akpa CI, Mtaki V, Baryamujura J, Kamau B, Lidoroh S, Kobugabe PL, Maaga NO, Bongomin F. Lessons Learned from the Ebola Virus Disease and COVID-19 Preparedness to Respond to the Human Monkeypox Virus Outbreak in Low- and Middle-Income Countries. Infect Drug Resist 2022; 15:6279-6286. [PMID: 36329989 PMCID: PMC9624151 DOI: 10.2147/idr.s384348] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Recently, the World Health Organization (WHO) declared the human monkeypox virus disease an international health emergency. In the past decades, infectious disease epidemics have significantly impacted low- and middle-income countries (LMICs), with coronavirus disease-2019 (COVID-19) being the most recent. LMICs, particularly in Africa and Asia, responded reasonably well by strengthening health systems, including infection prevention and control strategies, laboratory systems, risk communication, and training of essential healthcare workers for surge capacity in preparation for and response to COVID-19. With the possibility of other epidemics, such as the current epidemic of human Monkeypox, a consolidated global response is required. This article discusses lessons learned from previous Ebola and COVID-19 outbreaks and also provides recommendations on how these lessons can be useful to strengthen monkeypox disease outbreak preparedness and response in LMIC.
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Affiliation(s)
- Fred Tusabe
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda,Correspondence: Fred Tusabe, Tel +256 777317065, Email
| | - Imtiaz Mahmood Tahir
- College of Allied Health Professionals, Faculty of Medical Sciences, Government College University, Faisalabad, Pakistan
| | - Chijioke Igwe Akpa
- Surveillance and Epidemiology Department, Nigeria Centre for Disease Control (NCDC), Abuja, Nigeria
| | - Victor Mtaki
- Medical Laboratory Department, Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Jovan Baryamujura
- Global Health Security Department, Baylor College of Medicine Children’s Foundation, Kampala, Uganda
| | - Beatrice Kamau
- Health Services Department, Nairobi County, Nairobi, Kenya
| | - Sharon Lidoroh
- Public Health Department, Africa Centers for Disease Control and Prevention (Africa CDC), Addis Ababa, Kenya
| | - Penlope Lillian Kobugabe
- Counselling Department, Makerere University-John Hopkins Research Collaboration, Kampala, Uganda
| | - Nathan Okemwa Maaga
- Department of Diagnostics, Ministry of Health, Kisii County Government, Nairobi, Kenya
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Gulu University, Gulu, Uganda
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Berendes D, Martinsen A, Lozier M, Rajasingham A, Medley A, Osborne T, Trinies V, Schweitzer R, Prentice-Mott G, Pratt C, Murphy J, Craig C, Lamorde M, Kesande M, Tusabe F, Mwaki A, Eleveld A, Odhiambo A, Ngere I, Kariuki Njenga M, Cordon-Rosales C, Contreras APG, Call D, Ramay BM, Ramm RES, Paulino CJT, Schnorr CD, Aubin MD, Dumas D, Murray KO, Bivens N, Ly A, Hawes E, Maliga A, Morazan GH, Manzanero R, Morey F, Maes P, Diallo Y, Ilboudo M, Richemond D, Hattab OE, Oger PY, Matsuhashi A, Nsambi G, Antoine J, Ayebare R, Nakubulwa T, Vosburgh W, Boore A, Herman-Roloff A, Zielinski-Gutierrez E, Handzel T. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 2022; 1:e0000027. [PMID: 38410139 PMCID: PMC10896259 DOI: 10.1371/journal.pwat.0000027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices-for example, hand hygiene-are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.
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Affiliation(s)
- David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea Martinsen
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matt Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anu Rajasingham
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor Osborne
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victoria Trinies
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Ryan Schweitzer
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Graeme Prentice-Mott
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina Craig
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | | | | | | | | | | | - Douglas Call
- Washington State University, Pullman, Washington, USA
| | | | | | | | | | - Michael De Aubin
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Devan Dumas
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nicholas Bivens
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anh Ly
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ella Hawes
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adrianna Maliga
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Gerhaldine H Morazan
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | | | - Francis Morey
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Peter Maes
- UNICEF, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | - Gertrude Nsambi
- Department of Hygiene and Public Health, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Waverly Vosburgh
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Boore
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Herman-Roloff
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global Health Protection, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Tom Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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