Applying a biopsychosocial perspective to address hand washing behaviors among young learners in Limpopo, South Africa

Despite its perceived simplicity, the promotion of hand washing for disease prevention remains a challenge particularly in resource-limited settings. We report on a quasi-experimental study to measure the independent effect of contextual (resource modifications) and individual-level (education) factors on hand washing behaviors of learners attending two primary schools in Limpopo, South Africa. Resource modifications were made at School A and included improvements in hygiene and sanitation facilities that increased access to soap and water. Subsequently, education programs, developed in collaboration with local educators and focused on hand washing for disease prevention, were delivered at both schools. Observations included total counts of hand washing and hand washing paired with toilet facility use. At School A, significant increases in hand washing occurred following resource modifications (total counts: T0=359, T1=712; t=3.61, p=0.018). Additional increases in total hand washing behaviors occurred following education (T2=1095, t=3.88; p=0.015). In contrast, at School B, with education alone smaller increases in total hand washing were observed (T0=249; T1=324; t=2.08, p=0.065). Resource improvements are necessary in order to promote disease prevention behaviors such as hand washing. However, education aids to both promote and sustain these behaviors at the individual level. Results confirm that coordinated interventions that address health promoting behaviors at multiple levels are likely to achieve more substantial change

A pilot study of Aboriginal health promotion from an ecological perspective

<p>Abstract</p> <p>Background</p> <p>For health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour?</p> <p>Methods</p> <p>Rather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies).</p> <p>Results</p> <p>There were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion.</p> <p>Conclusions</p> <p>The evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities.</p

Determination of critical concentrations of second-line anti-tuberculosis drugs with clinical and microbiological relevance

BACKGROUND: Reliable DST against second-line anti-tuberculosis drugs (SLDs) is crucial for the management of the increasing burden of patients affected by multidrug- and extensively drug-resistant TB. METHODS: This study utilizes 252 clinical isolates of Mycobacterium tuberculosis from five countries (Hong Kong Special Administrative Region, Korea, Latvia, Peru, Philippines) with documented treatment histories to establish clinically and microbiologically relevant critical concentrations (CCs) of six SLDs for three routine testing methods: the absolute concentration method using Lowenstein-Jensen (LJ) medium, the 1% proportion method using Middlebrook 7H10 agar medium, and the radiometric BACTEC 460 system. FINDINGS: In LJ medium, CCs of capreomycin, ethionamide, kanamycin, ofloxacin, rho-aminosalicylic acid and cycloserine (CS) were respectively 40.0, 40.0, 30.0, 3.0, 1.0 and 30.0 mg/l. In 7H10 agar medium, the respective CCs for the first five antibiotics (except CS) were 8.0, 2.0-3.0, 3.0-5.0, 1.0-1.5 and 0.5-1.0 mg/l. In BACTEC 460 broth, the respective CCs were 1.5-2.0, 1.0-1.5, 2.0-3.0, 0.5-1.0 and 0.5-1.0 mg/l. Precautions in DST interpretation was also discussed. INTERPRETATION: By adopting this set of CCs as a global standard to define second-line drug susceptibility and resistance, as well as precautions in result interpretation, the screening, diagnosis and management of patients with drug-resistant TB can be greatly improved