COVID-19 pandemic in Africa: Is it time for water, sanitation and hygiene to climb up the ladder of global priorities?

The authors would like to thank the authors of the freely-usable images from Unsplash and Pixnio included in the Graphical Abstract: photos by Janice-Haney Carr and Dr. Ray Butler (USCDCP), USCDCP and Crystal Thompsom (USAID) on Pixnio; photos by CDC, UN COVID- 19 response and Raymond Hui on Unsplash.Wewould also like to thank the reviewers for their comments and keen interest in this article.In the current pandemic context, it is necessary to remember the lessons learned from previous outbreaks in Africa, where the incidence of other diseases could rise if most resources are directed to tackle the emergency. Improving the access to water, sanitation and hygiene (WASH) could be a win-win strategy, because the lack of these services not only hampers the implementation of preventive measures against SARS-CoV-2 (e.g. proper handwashing), but it is also connected to high mortality diseases (for example, diarrhoea and lower respiratory infections (LRI)). This study aims to build on the evidence-based link between other LRI andWASH as a proxy for exploring the potential vulnerability of African countries to COVID-19, as well as the role of other socioeconomic variables such as financial sources or demographic factors. The selected methodology combines several machine learning techniques to single out the most representative variables for the analysis, classify the countries according to their capacity to tackle public health emergencies and identify behavioural patterns for each group. Besides, conditional dependences between variables are inferred through a Bayesian network. Results show a strong relationship between low access toWASH services and high LRI mortality rates, and that migrant remittances could significantly improve the access to healthcare and WASH services. However, the role of Official Development Assistance (ODA) in enhancing WASH facilities in the most vulnerable countries cannot be disregarded, but it is unevenly distributed: for each 50–100 US$of ODA per capita, the probability of directing more than 3 US$ toWASH ranges between 48% (Western Africa) and 8% (Central Africa)

Einhaltung der Händehygiene: Überbrückung der Kluft zwischen Bewusstsein und Praxis in Afrika südlich der Sahara

This review provides an exploratory overview of hand hygiene compliance in sub-Saharan Africa and examines strategies to bridge the compliance gap.While there is increasing awareness on hand hygiene, empirical evidence suggests that there is no concurrent increase in correct hand hygiene practice among key populations in sub-Saharan Africa. Children, adolescents and even healthcare providers (HCPs) in sub-Saharan Africa consistently assume poor hand hygiene compliance levels resulting in negative health consequences. Faecal-oral diseases remain common among schoolchildren, leading to school absenteeism and disease-specific morbidity. Additionally, the incidence of nosocomial infections in health facilities in sub-Saharan Africa remains high, as many HCPs do not adopt good hand hygiene practice. Increased disease burden, high healthcare costs and eroding public confidence in the healthcare system are a few implications of HCPs' poor compliance with hand hygiene. These trends underscore the inadequacies of educational approaches (cognition model) to hand hygiene promotion commonly adopted in sub-Saharan Africa.It was therefore recommended that the governments of sub-Saharan Africa should focus on promoting skill-based hygiene education which will help schoolchildren develop good hand hygiene practice as a lifelong skill. In addition, efforts should be made to implement a multimodal hand hygiene strategy in healthcare facilities in order to increase compliance by healthcare providers.Die Übersicht gibt einen explorativen Überblick über die Einhaltung der Händehygiene in Afrika südlich der Sahara und untersucht Strategien zur Überbrückung der Compliance-Lücke.Während das Bewusstsein für die Händehygiene zunimmt, weisen empirische Daten darauf hin, dass es in den Hauptbevölkerungsgruppen in Afrika südlich der Sahara keine übereinstimmende Zunahme der korrekten Händehygiene gibt. Bei Kindern und Jugendlichen, aber auch bei Mitarbeitern in Gesundheitseinrichtungen (GE) in Afrika südlich der Sahara ist durchweg von einer schlechten Händehygiene auszugehen, was sich negativ auf die Gesundheit auswirkt. Fäkal-orale Erkrankungen treten bei Schulkindern weiterhin häufig auf, was zu Fehlzeiten und krankheitsspezifischer Morbidität führt. Darüber hinaus ist die Inzidenz nosokomialer Infektionen in Gesundheitseinrichtungen in Afrika südlich der Sahara nach wie vor hoch, da viele GE keine gute Handhygienepraxis anwenden. Erhöhte Krankheitslast, hohe Gesundheitskosten und schwindendes Vertrauen der Öffentlichkeit in das Gesundheitssystem sind nur einige Folgen der schlechten Einhaltung der Händehygiene durch die GE. Diese Trends unterstreichen die Unzulänglichkeiten der pädagogischen Ansätze (Kognitionsmodell) zur Förderung der Händehygiene in Afrika südlich der Sahara. Als Schlussfolgerung wird die Notwendigkeit einer kompetenzbasierten Hygieneausbildung abgeleitet, die Schülern helfen soll, eine gute Handhygienepraxis als lebenslange Fertigkeit zu entwickeln. Für GE steht die Umsetzung einer multimodalen Strategie im Krankenhausumfeld im Mittelpunkt, um die Compliance zu verbessern