Planned, motivated and habitual hygiene behaviour: an eleven country review.

Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash 'habits' were generally not inculcated at an early age. Key 'motivations' for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. 'Plans' involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study

The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines.

BACKGROUND: Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. METHODS AND FINDINGS: This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract ('cases') and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. CONCLUSION: Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term

A descriptive survey of cancer helplines in the United Kingdom: Who they are, the services offered, and the accessibility of those services

Abstract Background There are more than 1500 UK health helplines in operation, yet we have scant knowledge about the resources in place to support the seeking and delivering of cancer‐related telephone help and support. This research aimed to identify and describe cancer and cancerrelated helpline service provision: the number of helplines available, the variety of services provided, and the accessibility of those services. Method This study used online national questionnaire survey sent to 95 cancer and cancerrelated helplines in the United Kingdom. Results A total of 69 (73%) of 95 surveyed cancer and cancer‐related helplines completed the survey. Most helplines/organizations were registered charities, supported by donations; 73.5% of helplines had national coverage. Most helplines served all age‐groups, ethnic groups, and men and women. Only 13.4% had a number that was free from landlines and most mobile networks, and 56.6% could only be contacted during working hours. More than 50% of helplines reported no provisions for callers with additional needs, and 55% had no clinical staff available to callers. Ongoing support and training for helpline staff was available but variable. Conclusion Although cancer helplines in the United Kingdom offer reasonably broad coverage across the country, there are still potential barriers to accessibility. There are also opportunities to optimize the training of staff/volunteers across the sector. There are further prospects for helplines to enhance services and sustain appropriate and realistic quality standards

A Cluster-Randomized Trial to Evaluate the Impact of an Inclusive, Community-Led Total Sanitation Intervention on Sanitation Access for People with Disabilities in Malawi.

Community-led total sanitation (CLTS) is a common method for promoting sanitation in low-income settings. This cluster-randomized trial evaluated an intervention to improve inclusion of people with disability in CLTS through training facilitators. A qualitative study examined intervention acceptability. The trial included 171 people with disabilities (78 control and 93 intervention) living in 15 intervention and 15 control communities. In the intervention arm, respondents were more likely to participate in a community meeting about sanitation (+18.7%, 95% confidence interval [CI]: 3.2, 34.2) and to have been visited to discuss sanitation (+19.7, 95% CI: 0.6, 37.8). More intervention households improved latrine access for the disabled member (+9%, CI: -3.1, 21.0). Inclusive CLTS could improve sanitation access for people with disability but requires support to households beyond that provided in this trial

Use of a mobile application for Ebola contact tracing and monitoring in northern Sierra Leone: a proof-of-concept study.

BACKGROUND: The 2014-2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors. The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts. METHODS: The intervention was a customised three-tier smartphone application developed using Dimagi's CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April-August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used. RESULTS: For 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h. CONCLUSION: There were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial

Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers

BackgroundThere are few studies documenting the persistence of self-injury in individuals with autism spectrum disorder (ASD) and consequently limited data on behavioural and demographic characteristics associated with persistence. In this longitudinal study, we investigated self-injury in a cohort of individuals with ASD over 3 years to identify behavioural and demographic characteristics associated with persistence.MethodsCarers of 67 individuals with ASD (Median age of individuals with ASD in years = 13.5, Interquartile Range = 10.00–17.00), completed questionnaires relating to the presence and topography of self-injury at T1 and three years later at T2. Analyses were conducted to evaluate the persistence of self-injury and to evaluate the behavioural and demographic characteristics associated with persistence of self-injury.ResultsAt T2 self-injurious behaviour had persisted in 77.8 % of individuals. Behavioural correlates of being non-verbal, having lower ability and higher levels of overactivity, impulsivity and repetitive behaviour, were associated with self-injury at both time points. Risk markers of impulsivity (p = 0.021) and deficits in social interaction (p = 0.026) at T1 were associated with the persistence of self-injury over 3 years.ConclusionsImpulsivity and deficits in social interaction are associated with persistent self-injury in ASD and thus may act as behavioural risk markers. The identification of these risk markers evidences a role for behaviour dysregulation in the development and maintenance of self-injury. The findings have clinical implications for proactive intervention; these behavioural characteristics may be utilised to identify ‘at risk’ individuals for whom self-injury is likely to be persistent and therefore those individuals for whom early intervention may be most warranted.<br/

Measuring hand washing behaviour in low income settings: methodological and validity issues

Significant global health attention and promotion has been focused on hand washing with soap due to theclear benefits observed in promoting and ensuring child health. However, the measurement and evaluationof hand washing behaviours remains complex. The Sanitation, Hygiene Education and Water Supply inBangladesh Programme (SHEWA-B) is a large project being implemented by the Government ofBangladesh and UNICEF.This research assessed methodological issues of measuring hand washing behaviours through comparisonof structured observation and responses to cross-sectional survey measures (spot-check observation, selfreportedhand washing and a hand washing demonstration) and discusses the suitability of indicators. Focusgroup discussions with fieldworkers were also conducted.The results of this study indicate that hand washing behaviours were over-reported compared withstructured observation findings. This implies that current estimates of hand washing from large scalesurveys, for example, Demographic and Health Surveys (DHS) are also likely to be overestimates.In about 1000 households, approximately 1% or less of female caregivers were observed to wash theirhands with soap or ash before preparing food, before eating, and 3% before feeding a child. Hand washingwith soap was higher for defecation related events with approximately 29% of female caregivers using soaptwo thirds or more of the time after cleaning a child’s anus/disposing of a child’s stools and 38% used soaptwo-thirds or more of the time after defecation. Soap was observed at the hand washing location in about50% of the households but actual practice was much lower. Reported knowledge was high; approximately90% identified the important times for hand washing as being before eating and after defecation andapproximately 50% identified before preparing food and after cleaning/changing a baby.The measurement of hand washing is complex and there has been limited research into the validity ofdifferent measurement methods. This research used an epidemiological style approach using the concepts ofscreening/diagnostic testing and calculation of kappa statistics to assess validity.In conclusion, this research demonstrates that self report hand washing measures are subject to overreporting. Structured observation provides useful information on directly observed hand washing behavioursand the frequency of behaviours. Spot check methods of soap and hand washing locations also provide moreoptimistic data than observations and can be used as an alternative to structured observation. In addition, theuse of questions on the 24 hour recall of soap and other self report questions on knowledge and theavailability of spare soap demonstrate potential for use as potential indicators as an alternative to structuredobservation. Further validation of measurement methods is required in different country settings

Intra-household access to WASH in Uganda and Zambia: do variations exist?

This paper explores intra-household variations in access to WASH through analysis of baseline data from the Undoing Inequity project in Zambia and Uganda. The purpose of which is to explore whether differences exist between head of household and ‘vulnerable’ individual (disabled, older or chronically ill persons) reports on access and use of WASH at the household level. The results indicate that water indicators reported by the household head e.g. use of the same water, showed high levels of agreement between head of household and ‘vulnerable’ individual. On the contrary, indicators on access to sanitation facilities and consumption of drinking water showed divergence. Indicators on hygiene were shown to have poor levels of agreement. These results indicate that there is a specific need to ask particular questions to individuals who may be vulnerable to exclusion themselves in national WASH surveys, in order to obtain accurate information to monitor intra-household inequalities

Toward eliminating blindness due to uncorrected refractive errors: assessment of refractive services in the northern and central regions of Ghana.

PURPOSE: This study sought to document current refractive services in the northern and central regions of Ghana as a first step toward evidence-based planning of refractive services. METHODS: A descriptive cross-sectional survey was carried out in health facilities in the northern and central regions of Ghana, which provided eye-care services. A semi-structured questionnaire was administered to gather information on each facility type, human resources providing refractive services, assessment of refraction and spectacle dispensing output and provider barriers to the services. RESULTS: Current outputs of refraction in the northern and central regions were 0.5 and 1.2 per cent of the estimated refractive needs, respectively. Spectacle dispensing services were below the outputs of refraction. Lack of equipment (36.8 per cent) and cost of providing spectacles frames (31.6 per cent), were identified as the main barriers to providing refractive services. CONCLUSION: The provision of refractive services in the study regions was inadequate. Lack of infrastructure and inadequate human resource were the major reasons for the limited service provision. This should be considered for planning refractive services in the study regions and Ghana as a whole