The State of Handwashing in 2016

2016 was a big year in hand hygiene! This summary outlines key themes and findings from 59 peer-reviewed handwashing-related research papers published in 2016, relevant to low and middle-income countries, around 1) the benefits of handwashing with soap, 2) handwashing compliance, 3) approaches to handwashing behavior, 4) determinants of handwashing with soap, and 5) handwashing hardware efficacy

An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals

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Food safety requirements in African green bean exports and their impact on small farmers:

"Many African countries have moved into the production of non-traditional agricultural products, in an effort to diversify their exports and increase foreign currency earnings. However, in order to access developed country markets and urban domestic markets, these products must meet food safety requirements, including protocols relating to pesticide residues, field and pack house operations, and traceability. Faced with stringent food safety requirements, companies that establish production centers in low-income countries might exclude poor farmers, thus negatively impacting the poor. We herein study this issue in the case of the green bean export sectors in three African countries: Ethiopia, Kenya and Zambia. In the short-term, stringent food safety standards have screened out smallholders in all these countries, excluding them from the green bean export chain. However, some institutional arrangements have helped support the smallholders who continue to function in the export-oriented green bean supply chains. In particular, public-private partnerships have played a key role in creating farm-to-fork linkages that can satisfy market demands for food safety while retaining smallholders in the supply chain. Furthermore, organized producer groups capable of monitoring their own food safety requirements through collective action have become attractive to buyers who are looking for ways to ensure traceability and reduce transaction costs." from Authors' AbstractInternational food safety standards, Small farmers, Supply chains, Agricultural trade, Public-private partnerships,

In pursuit of best practice : Benchmarking tools and processes for the management of hazardous substances in the workplace

Many organisations now strive to achieve excellence in various aspects of occupational health and safety. Benchmarking of the techniques and approaches of other organisations is becoming a popular way of bridging gaps and seeking to achieve high levels of performance. There exist many sources of guidance in the form of external and internal standards, regulations, codes of practice, publications by professional institutions and similar. However, there are clear shortfalls in terms of tools and processes needed to identify areas of opportunity and to overcome barriers to the efficient transfer of ideas and techniques from one enterprise to another. This is true for all organisations, but particularly so for small/medium sized facilities with limited resources and expertise. This study has sought to develop and test new tools and processes to make benchmarking activity and the transfer of technology, ideas and approaches more efficient and meaningful. It has drawn heavily from state-of-the-art management theory and has sought to establish the linkage between the people factor, the workplace environment factor and the organisation of work factor as they contribute to workplace health and safety performance. It has used qualitative inquiry methodologies and an approach based on personal contact and insight, as expressed by Patton (1990, p. 46), to generate data. The fieldwork component of the study was conducted at eight mining, mineral processing and related industry sites within Western Australia. The subject of the study was the facility\u27s processes and practices in regard to the management of hazardous materials. This was chosen partly because chemical-induced injury and disease remain a significant problem for workers in industry (Winder, 1999b, p. 168) and partly because of its complexity and degree of difficulty. Data collection was based on the three qualitative inquiry methods, namely in-depth, open-ended interviews with the Site Manager and the Site Occupational Health and Safety (OHS) Professional, direct observation and review of written documents. Also tested was the assumption that if the materials developed during the study can be applied successfully in the area of hazardous materials, then other less complex areas under the OHS umbrella could be approached with confidence. There is potential for the tools and processes developed and evaluated in this work to be used widely in the transfer of best practice, that is, to be deployed beyond the hazardous substances focus of this study and beyond the Mining Industry of Western Australia. Study outcomes and the new materials that have been generated will assist with the selection of benchmarking partners and will help to identify pockets of excellence for focused attention. This will encourage and assist organisations to take steps towards identifying and implementing Industry best practice in the element of interest. There is potential for study outcomes to impact positively on OHS practices within many organisations - and thereby to reduce the personal and societal cost of injury and illness outcomes associated with the use of hazardous materials at work

Epidemiology of cryptosporidiosis in rural Malawi

A hospital and community based study was conducted in Malawi, within a rural population over a 23 month period, to identify the incidence, causative species and possible determinants for cryptosporidiosis in under fives. 5.9% (25/423) of samples collected were positive for Cryptosporidium oocysts of which 18 amplified by PCR-RFLP indicating the following species: C. hominis, C. parvum, C. meleagridis and C. andersoni. Consenting positive cases were included in a case control study. 96 home interviews were conducted in 24 communities (cases n=24; unmatched controls n=72). A total of 61 risk factors were investigated with a questionnaire, and combined with quantitative data from samples of domesticated animal stools and drinking water. Oocysts were not isolated from domesticated animals or water samples. Multivariate logistic regression of questionnaire data revealed an increased risk of cryptosporidiosis associated with ownership of pigs (OR 7.2, 95%CI 1.9–27.5, p=0.004), presence of diarrhoea in the household (OR 8.8, 95%CI 1.8–53.4, p=0.008), bathing in the river (OR 76.7, 95%CI 1.1–23.8, p=0.037) and no education within the household (OR 3.6, 95%CI 1.1–11.8, p=0.038). Bacteriological results indicating faecal contamination of both drinking water stored within the home (76%), and the surface of guardians’ hands (75%) were indicative of poor hygienic practices and potential sources of infection

Scotland Chikwawa Health Initiative - improving health from community to hospital

The Scotland Chikwawa Health Initiative is a three year programme funded by the Scottish Executive International Development Fund which aims to achieve measurable reductions in major causes of disease and death in four villages within the Chikwawa District of Malawi alongside improving the hospital environment for the good of both staff and patients. The initiative has developed a holistic approach to health improvements through the provision of infrastructure at both health facilities and within communities, and training of government personnel and community volunteers. Specific areas targeted have included water and sanitation, maternal health, and communicable disease control with provision of training and materials to facilitate interventions and health education. At the end of the second year the programme has already seen reductions in diarrhoeal disease (30% overall in target communities), improved access to safe water, an increase in the uptake of growth monitoring and immunisations in children under the age of five years (15% increase since training volunteers), improved safe delivery of babies within the community (245 babies delivered safely in target communities with 25 referred due to complications) and increased community health activity (training and integration of village health committees, water point committees, traditional birthing attendants and health surveillance assistants). The programme hopes to act as a model for the District to follow in other communities to achieve it’s obligations under the Malawi Ministry of Health Essential Health Package

Ecological sanitation - Implementation, opportunities and challenges in Chikwawa

Ecological sanitation (EcoSan) in not a new technology but rather a recognition that human excreta is a valuable natural resource (not a waste to be disposed of), containing plant nutrients which after containment and sanitization can be recycled in agriculture to enhance food production, with minimal risk of pollution of the environment and with minimal threat to human health. Various organizations are implementing EcoSan technologies in Malawi. Chikwawa is a rural district that is currently implementing EcoSan initiatives with resources from the Scotland Chikwawa Health Initiative and the US Ambassador’s Self Help Fund. The benefits from EcoSan are clear. For example, EcoSan systems help reduce the risk of spreading diseases by containing and treating human excreta before collecting it; minimising surface and groundwater contamination and recylcing the nutrients found in excreta and returning them to soil to enhance food production. However, EcoSan poses some challenges in its implementation such as a correct utilization, acceptability and sustainability of the concept

Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis

Background: access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator “use of an improved source,” which does not account for water quality measurements. Our objectives were to determine whether water from “improved” sources is less likely to contain fecal contamination than “unimproved” sources and to assess the extent to which contamination varies by source type and setting.Methods and findings: studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio [OR] = 0.15 [0.10–0.21], I2 = 80.3% [72.9–85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52–3.71]; p<0.001) and rural areas (OR = 2.37 [1.47–3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption.Conclusion: access to an “improved source” provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water qualit