Thesis (MPH.) -- University of Limpopo, 2019 / Background: School children are mostly affected by diarrhoeal and respiratory infections and these are related to lack of proper hand washing. For children to be able to practice proper hand washing, they must have the knowledge and necessary resources to practice hand washing. The study’s purpose was therefore to establish the knowledge and practice of hand washing among primary school children. Purpose: The study’s aim was to assess the knowledge and practices of hand washing among primary school children in Kweneng Central Sub-District. Methods: A quantitative approach using a self-administered structured questionnaire to collect data regarding knowledge and practices on hand washing among primary school children was used. An observation checklist was also used to assess the practice of hand washing among primary school children. A stratified random sampling method was used to come up with a sample size of 330. SPSS 24.0 version was used to analyse the data. Results: The study revealed that the majority of primary school children had knowledge on hand washing but lacked proper hand washing practices. The results also showed that hand washing knowledge and practice among primary school children had no association with their age and gender. However, there was association between washing hands after going to the toilet and gender as well as the availability of bucket/basin to wash hands and gender. Conclusion: Children spend much of their day time at school; therefore schools are the right institutions to impart hand washing information and emphasise the importance of hand washing to the children. The availability of facilities such as clean water and soap are paramount to the facilitation of hand washing among primary school children and as such should be adequately provided in schools. Keywords: Hand washing, knowledge, practice, children, primary school.

published_or_final_version / Community Medicine / Master / Master of Public Health

Diarrhea caused by rotavirus and Giardia is a major health problem among children attending day-care centers because of inadequate personnel hygiene. Epidemiological evidence suggesting person-to-person transmission of enteric pathogens has long been recognized. This study was initiated to investigate the effectiveness of handwashing for the removal of rotavirus and Giardia from contaminated hands. The palms of participant hands were innoculated with approximately 103 Giardia cysts or 105 plaque forming units of rotavirus and the effect of washing using tap water alone, a liquid soap or a bar soap on their removal was assessed. Handwashing with liquid soap was found to be very effective in the removal of rotavirus and Giardia cysts as compared to washing with bar soap or tap water alone. The overall recovery of viruses in both bar soap and liquid soap was low (0.03-22.5%), probably due to virus inactivation by the detergent.

Hospital-acquired, or nosocomial infections (HAIs) are the major source of mortality and morbidity for hospitalized patients. It is estimated that 7-10% patients developed HAIs during their hospital stays, with most patients got infected from intensive care units (ICU) [1,2]. Hand hygiene (HH) is recognized as the most easy and effective way to prevent HAIs. However, the observed hand hygiene compliance rates among healthcare workers (HCWs) have been regarded as unacceptably low, especially in ICU [3]. This literature review is to discuss the factors influencing the hand hygiene compliance among HCWs in ICU, in both the individual and institutional level, and suggest which factor was important in both levels. Recommendations in comprehensive approach on hand hygiene practices will also be included. / published_or_final_version / Public Health / Master / Master of Public Health

Magister Curationis - MCur / Studies have shown that no great emphasis has been put on hand washing practices in psychiatric health facilities, despite the fact that nosocomial infection outbreaks have been reported for decades. Most studies have focused on hand washing practices among general health personnel; however, little is known about hand washing practices among nurses working at psychiatric hospitals.

No description available.

Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. However, this assumes that the effectiveness of hand hygiene is not constrained by other factors and that improved compliance in excess of a given level, in itself, will result in a commensurate reduction in the incidence of HAI. However, several researchers have found the law of diminishing returns to apply to hand hygiene, with the greatest benefits occurring in the first 20% or so of compliance, and others have demonstrated that poor cohorting of nursing staff profoundly influences the effectiveness of hand hygiene measures. Collectively, these findings raise intriguing questions about the extent to which increasing compliance alone can further reduce rates of HAI. In order to investigate these issues further, we constructed a deterministic Ross-Macdonald model and applied it to a hypothetical general medical ward. In this model the transmission of staphylococcal infection was assumed to occur after contact with the transiently colonized hands of HCWs, who, in turn, acquire contamination only by touching colonized patients. The aim of the study was to evaluate the impact of imperfect hand cleansing on the transmission of staphylococcal infection and to identify, whether there is a limit, above which further hand hygiene compliance is unlikely to be of benefit. The model demonstrated that if transmission is solely via the hands of HCWs, it should, under most circumstances, be possible to prevent outbreaks of staphylococcal infection from occurring at a hand cleansing frequencies <50%, even with imperfect hand hygiene. The analysis also indicated that the relationship between hand cleansing efficacy and frequency is not linear - as efficacy decreases, so the hand cleansing frequency required to ensure R0<1 increases disproportionately. Although our study confirmed hand hygiene to be an effective control measure, it demonstrated that the law of diminishing returns applies, with the greatest benefit derived from the first 20% or so of compliance. Indeed, our analysis suggests that there is little benefit to be accrued from very high levels of hand cleansing and that in most situations compliance >40% should be enough to prevent outbreaks of staphylococcal infection occurring, if transmission is solely via the hands of HCWs. Furthermore we identified a non-linear relationship between hand cleansing efficacy and frequency, suggesting that it is important to maximise the efficacy of the hand cleansing process.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Annually more than 3.5 million children worldwide, less than five years of age die of diarrhoea and acute lower respiratory-tract infections. Over the last two decades, the care of pre-school children outside of their homes has become more common in most parts of the world and has contributed to an increased risk of respiratory-tract and gastrointestinal infections in children. Children attending day-care centres are at an increased risk for diarrhoea and respiratory-tract infections and hands are the primary vehicle for transmission of infectious diseases. Thus, hand hygiene is essential for preventing and controlling of infection in the health care and community settings. Waterless hand sanitizer as an alternative to hand washing was investigated. Rinse-free hand sanitizer programmes in the community may be effective, safe and feasible. The aim of the study was to systematically appraise evidence on the effect of alcohol-based hand rub in the prevention of diarrhoea and acute respiratory-tract infection among children aged five years and below in community settings. The primary outcome of the study was to assess the incidence of respiratory-tract infection and diarrhea. Diarrhoea is defined by the World Health Organization as the excretion of three or more loose or liquid stools per day (or more frequent excretion than is normal for the individual). The secondary outcome was to assess mortality, admission to hospital and duration of hospital stay. A comprehensive search for relevant studies was conducted on the following databases from 1990 to 2014: EMBASE, MEDLINE, CINAHL, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). We searched the reference lists of all relevant articles and textbooks for more studies. Unpublished data previously presented at international and scientific meetings have been included in the review. Proceedings of international conferences on diarrhoea and respiratory-tract infection among children were searched for relevant articles. Subject experts were contacted. Two reviewers, Joelynn Steyn (JS) and Oswell Khondowe (OK) selected studies following a two-step study selection process. This review considered all published randomized controlled trials and quasi-experimental designs published from January 1990 to July 2014. The first step was the selection of studies based on titles and abstracts. Both reviewers selected eligible studies which met the set criteria. During the second step, both reviewers retrieved the full-text articles of the studies and assessed the methodological quality of the studies. Four studies were included in this review. The included studies met most of the quality assessment criteria as stipulated in the Cochrane risk assessment tool. Two studies were clusterrandomized controlled trials, one was a block randomized controlled trial and one was a randomized controlled trial. Disagreements were resolved by discussion and where a lack of consensus existed, consultation with a third reviewer occurred. The use of alcohol hand rub as compared to control interventions significantly reduced the incidence of diarrhoea in children (RR 0.79, 95% CI 0.63 to 0.99). Statistical heterogeneity was observed among the included studies (I²=69, p=0.04). However this review found no significant difference in respiratory-tract infections between intervention groups versus control as observed from the confidence interval (RR 0.98, 95% CI 0.90 to 1.07, p=0.63). The results should be interpreted with caution due to the limited number of studies conducted in communities with alcoholbased hand rub used by caregivers. Due to limited studies in this review, it makes it difficult to make strong conclusions on findings and to provide sufficient evidence to guide future research. We therefore recommend that more studies with high quality methodologies, using randomized controlled trial designs be conducted especially in poor resourced communities. / AFRIKAANSE OPSOMMING: Meer as 3.5 miljoen kinders jonger as vyf jaar oud sterf jaarliks wêreldwyd as gevolg van diarree en akute laer respiratoriese lugweginfeksies. Oor die laaste dekades het die versorging van voorskoolse kinders buite hul tuiste meer algemeen geword in die meeste dele van die wêreld wat bygedra het tot ’n risiko in die toename van respiratoriese en spysverteringskanaalinfeksies by kinders. Kinders by dagsorgsentrums het ’n groter risiko vir diarree en respiratoriese lugweë infeksies want die oordra van siekte-infeksies word veral deur die hande wat as die primêre bron daarvan beskou word, gesien. Dus is hand-higiëne noodsaaklik om infeksies in gesondheidsorg en gemeenskapsentrums te voorkom en te beheer. ’n Waterlose hande-ontsmettingsmiddel as ’n alternatief om hande te was, is ondersoek. Spoelvrye hande-ontsmettingsmiddel programme in die gemeenskap mag effektief, veilig en uitvoerbaar wees. Die doel van die studie was om sistematies die geslaagdheid van bewyse op die effek van alkoholgebaseerde hande-smeermiddel in die voorkoming van diarree en akute lugweginfeksies by kinders 5 jaar en jonger in gemeenskapsentrums te ondersoek. Die primêre uitkoms van die studie was om die voorkoms van respiratoriese lugweginfeksie en diarree te asseseer. Diarree soos gedefinieer deur die WGO is die uitskeiding van drie of meer los- of waterige stoelgange per dag (of meer gereelde uitskeiding wat normaal vir die individu is). Die sekondêre uitkoms was om mortaliteit, toelating tot die hospitaal en duur van hospitaalverblyf te assesseer. ’n Omvattende soektog vir relevante studies was op die volgende databasisse van 2004-2014 uitgevoer: EMBASE, MEDLINE, CINAHL, Google Scholar en Cochrane Sentrale Register van Beheerde Toetse. Ons het die verwysingslyste van alle relevante artikels en handboeke vir meer navorsingstudies nagegaan. Ongepubliseerde data wat voorheen aangebied is by internasionale en wetenskaplike vergaderings, is ingesluit in die oorsig. Bevindings by internasionale konferensies oor diarree en lugweginfeksies by kinders was nagegaan in die soektog na relevante artikels. Onderwerpdeskundiges was gekontak. Die twee navorsers, Joelynn Steyn (JS) en Oswell Khondowe (OK) het studies geselekteer deur ’n twee-stap studieselekteringsproses te volg. Die oorsig het alle gepubliseerde, ewekansige gekontroleerde proewe en kwasi-eksperimenteerde studies oorweeg tussen Januarie 1990 en Julie 2014. Die eerste stap was die selektering van studies gebaseer op hul titels en opsommings. Beide navorsers het geskikte studies slegs geselekteer as die studie aan die bepaalde kriteria voldoen het. Tydens die tweede stap het beide navorsers die volledige artikels geneem van die studies geselekteer en die gehalte van die metodologie geassesseer. Vierstudies is in die oorsig ingesluit. Die ingeslote studies het aan die meeste vereistes soos deur die Cochrane risiko assesseringsinstrument gestipuleer voldoen. Twee studies was groep-ewekansige gekontroleerde proewe, een was ’n blok ewekansige gekontroleerde proef en een was ’n ewekansige gekontroleerde proef. Verskille is opgelos deur bespreking en waar daar onderbreking in konsensus was, het ’n konsultasie met ’n derde beoordelaar plaasgevind. Die gebruik van ’n alkohol handreiniger, soos vergelyk met kontrole-intervensies, het die voorkoms van diarree in kinders beduidend verminder (RR 0.79, 95% CI 0.63 to 0.99). Statistiese heterogeniteit is egter tussen die ingeslote studies waargeneem (I²=69, p=0.04). Hierdie studie het geen beduidende verskille in lugweg infeksies tussen die intervensiegroepe teenoor die kontrolegroep gevind nie soos waargeneem uit die vertroue interval (RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die resultate moet met omsigtigheid geïnterpreteer word as gevolg van die beperkte aantal studies wat in gemeenskappe uitgevoer was met alkohol-gebasseerde handreiniger wat deur versorgers gebruik word. As gevolg van die beperkende aantal studies in hierdie studie, is dit moeilik om sterk gevolgtrekkings te maak op bevindinge en om voldoende bewyse te gee om toekomstige navorsing te rig. Ons beveel dus aan dat meer studies met hoë kwaliteit metodologie en wat ewekansige gekontroleerde proef-ontwerpe gebruik, uitgevoer word, veral in swak-toegeruste gemeenskappe. (RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die resultate moet met omsigtigheid geïnterpreteer word as gevolg van die beperkte aantal studies wat gedoen is in gemeenskappe met alkohol-

published_or_final_version / Public Health / Master / Master of Public Health

clanata@iin.sld.pe / Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence. / This study received financial support of the UBS Optimus Foundation, through a grant given to the IIN and Swiss TPH. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. / Revisión por pares