Birth attendants’ hand hygiene compliance in healthcare facilities in low and middle-income countries: a systematic review

© 2020, The Author(s). Background: With an increasing number of women delivering in healthcare facilities in Low and Middle Income Countries (LMICs), healthcare workers’ hand hygiene compliance on labour wards is pivotal to preventing infections. Currently there are no estimates of how often birth attendants comply with hand hygiene, or of the factors influencing compliance in healthcare facilities in LMICs. Methods: We conducted a systematic review to investigate the a) level of compliance, b) determinants of compliance and c) interventions to improve hand hygiene during labour and delivery among birth attendants in healthcare facilities of LMICs. We also aimed to assess the quality of the included studies and to report the intra-cluster correlation for studies conducted in multiple facilities. Results: We obtained 797 results across four databases and reviewed 71 full texts. Of these, fifteen met our inclusion criteria. Overall, the quality of the included studies was particularly compromised by poorly described sampling methods and definitions. Hand hygiene compliance varied substantially across studies from 0 to 100%; however, the heterogeneity in definitions of hand hygiene did not allow us to combine or compare these meaningfully. The five studies with larger sample sizes and clearer definitions estimated compliance before aseptic procedures opportunities, to be low (range: 1–38%). Three studies described two multi-component interventions, both were shown to be feasible. Conclusions: Hand hygiene compliance was low for studies with larger sample sizes and clear definitions. This poses a substantial challenge to infection prevention during birth in LMICs facilities. We also found that the quality of many studies was suboptimal. Future studies of hand hygiene compliance on the labour ward should be designed with better sampling frames, assess inter-observer agreement, use measures to improve the quality of data collection, and report their hand hygiene definitions clearly.The Soapbox Collaborative contributed by funding the corresponding author, GG. The writing of this paper provided part of the background needed for the HANDS study funded by the Medical Research Council−PHIND scheme, award number MR/N015975/1, and the CLEAN Study, funded by the United Kingdom Joint Global Health Trials (Wellcome, MRC, DFID, and DOH), award number MR/R019274/1. SN is supported by an award jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union. Grant Reference MR/K012126/1

Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing

Background: Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) “Ultra-processed” foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements. Methods: After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25–p75: 58–66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF). Results: Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were –0.07 and –0.37 for elaidic acid and 4-methyl syringol sulfate, respectively). Conclusion: These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods

Ouagadougou : horticulture in Ouagadougou: an Emerging Urban Food System

The population of Ouagadougou has been growing at a very high pace for several decades. The demographic and spatial growth of the city is accompanied by a consumption of agricultural space, which causes difficulties for the inhabitants in the supplying of food products, whose demand is growing. Faced with this scenario, public policies struggle to find the ideal option between different, sometimes opposite needs. At the same time the local population \u2013 first informally, then in an increasingly institutionalized way, with the support of international cooperation \u2013 has developed urban and peri-urban horticultural activities, in particular around the artificial basins close to the capital. The paper analyzes more specifically the case of the local food system that emerged around the Loumbila dam

Alcune riflessioni attorno al concetto di City Region Food System nelle politiche locali del cibo

Nel presente contributo affrontiamo la questione di un approccio nello studio e progettazione delle rela- zioni cibo-territorio, nella prospettiva di politiche locali del cibo come nuovo ambito di policy. Dopo aver sinteticamente deli- neato l’affermazione di tali politiche nel dibattito internazionale e italiano, ci interroghiamo su quale sia il loro territorio di riferi- mento. Il dibattito internazionale, stimolato da studi collegati alla FAO, fa riferimento al concetto di City Region Food System (CRFS), che metteremo in relazione sia con il più ampio dibattito sulla city-region, sia con altri modi di vedere il rapporto cibo-territorio, suggerendo alcune interessanti prospettive di approfondimento e un ulteriore bisogno di ricerca geografica

Cooperazione e reti locali del cibo nelle città africane: il caso di Ouagadougou

I temi dell\u2019agricoltura e dell\u2019alimentazione sono sempre stati centrali all\u2019interno delle pratiche di cooperazione allo sviluppo. Solo negli ultimi anni tuttavia, i progetti di cooperazione hanno iniziato a porre un accento specifico sul tema dell\u2019accesso al cibo nelle citt\ue0. Lo spostamento di attenzione verso l\u2019alimentazione delle citt\ue0 si colloca in una generale rivalutazione del tema delle politiche urbane del cibo avviata nelle aree ad alto sviluppo economico, ma sempre pi\uf9 importante anche nelle citt\ue0 del Sud globale. Tale nuovo approccio si propone di superare visioni settoriali per costruire strategie complessive che integrino le diverse dimensioni della problematica alimentare (agricola, socio-economica, territoriale). Per questo ha assunto un ruolo di primo piano la riflessione sull\u2019agricoltura urbana e periurbana, sulla ridefinizione dei rapporti citt\ue0-campagna, e pi\uf9 in generale sulla costruzione di reti locali del cibo. In Africa, i temi delle politiche urbane del cibo e delle reti locali del cibo presentano diversi elementi di interesse, in particolare all\u2019interno del dibattito su sicurezza e sovranit\ue0 alimentare, ma anche alcune criticit\ue0 connesse con le dinamiche passate, presenti e future del processo di urbanizzazione nel continente. All\u2019interno di questo quadro, la citt\ue0 di Ouagadougou rappresenta un caso studio interessante non solo perch\ue9 il Burkina Faso ha sviluppato nel corso dei decenni importanti reti di cooperazione internazionale, ma anche perch\ue9 l\u2019agricoltura peri-urbana ha trovato in queste aree uno sviluppo significativo, in particolare intorno ai bacini artificiali prossimi alla capitale. A partire dal caso studio di Ouagadougou e da riflessioni pi\uf9 generali sulle politiche urbane del cibo in Africa sub-sahariana, il contributo discute il ruolo dei centri urbani all\u2019interno delle geografie della cooperazione internazionale contemporanea. La rinnovata attenzione intorno alle aree periurbane e alle reti locali del cibo, infatti, non solo ridefinisce i rapporti tra centri urbani e aree rurali, ma trasforma l\u2019esperienza urbana, producendo nuovi modelli di citt\ue0