Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: a hospital-based quasi-experimental study

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the post-intervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general

HIV Testing and HIV Positivity Among People Who Inject Drugs (PWIDs) With and Without History of High-Risk Behaviors: Findings From a Respondent-Driven Sampling (RDS) Survey in Southern Thailand

People who inject drugs (PWIDs) may engage in other behaviors with high risk of HIV transmission to various extents. However, data are scarce regarding differences in HIV testing and HIV positivity among PWIDs with and without high-risk behaviors. Such data can help inform stakeholders with regard to program prioritization. The objective of this study was to assess the extent that lifetime and past-year histories of HIV tests and HIV positivity varied by history of high-risk behaviors among PWIDs. We conducted a cross-sectional study with respondent-driven sampling (RDS) in the deep south provinces of Thailand during late 2019 thru early 2020. Data collection was done using structured questionnaire with face-to-face interviews. We analyzed data using descriptive statistics and multivariate logistic regression analyses. A total of 283 PWIDs gave verbal informed consent, and 282 PWIDs participated in the interview ( n  = 282 PWIDs). Approximately 44.6% of the participants never had an HIV test. Participants with history of high-risk behaviors had significantly higher odds of lifetime HIV testing than participants with no history of high-risk behaviors (Adjusted OR = 2.94; 95% CI [1.11, 7.78]). Among participants with lifetime history of HIV tests, those with history of high-risk behaviors had significantly higher odds of being HIV-positive than those with no history of high-risk behaviors (Adjusted OR = 2.44; 95% CI [0.73, 8.17]). Stakeholders should consider encouraging those without history of high-risk behaviors not to be complacent about HIV testing, and ensure that those with high-risk behaviors have full access to HIV care when they test positive

Variations by sex and age in the association between alcohol use and depressed mood among Thai adolescents.

BackgroundAlcohol is associated with depression among adolescents, but variations in the association by age and sex are relatively unexplored. This study aims to assess variations in the association between alcohol consumption and depressed mood among adolescents by age and sex.MethodsWe analyzed data from a school-based survey of 38,186 students in junior high school (Year 7 and 9) and senior high school (Year 11). The mean age of the participants was 15.2 (SD = 1.9) years. We used multivariate logistic regression to measure the association between self-reported alcohol drinking (past-year, past-month, and binge-drinking) and history of depressed mood for two weeks or more during the past year. We stratified the analyses by school level (as proxy for age group) and sex of the respondent.ResultsApproximately 1% of students in surveyed schools refused to answer the questionnaires and fewer than 5% of all questionnaires were invalid. Prevalence of depressed mood was 13.2%. Prevalence of past-year alcohol drinking was 41.0% among those with depressed mood vs. 24.6% among those with no depressed mood (Adj OR = 1.78, 95% CI = 1.60, 1.98). The association was strongest among girls in junior high school (Adj OR = 2.38, 95% CI = 2.03, 2.79) and weakest among boys in senior high school (Adj OR = 1.19, 95% CI = 0.99, 1.42).ConclusionAssociations between alcohol drinking and depressed mood were particularly strong among junior high school girls. Youth mental health and alcohol programs should consider prioritizing this sub-group accordingly

Growth and development of children aged 1–5 years in low-intensity armed conflict areas in Southern Thailand: a community-based survey

BACKGROUND: A low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. However, its impact on child health has not yet been investigated. This study aimed to estimate the prevalence of delayed child growth and development in the affected areas and to determine the association between the violence and health among children aged 1–5 years. METHODS: A total of 498 children aged 1–5 years were recruited. Intensity of conflict for each sub-district was calculated as the 6-year average number of incidents per 100,000 population per year and classified into quartiles. Growth indices were weight-for-age, height-for-age, and weight-for-height, while development was measured by the Denver Development Screening Test II (Thai version). Food insecurity, child-rearing practice, health service accessibility, household sanitation, and depression among the caregivers were assessed using screening scales and questionnaires. Contextual information such as average income and numbers of violent events in each sub-district was obtained from external sources. RESULTS: Growth retardation was highly prevalent in the area as reported by rates of underweight, stunting, and wasting at 19.3%, 27.6% and 7.4%, respectively. The prevalence of developmental delay was also substantially high (37.1%). Multi-level analysis found no evidence of association between insurgency and health outcomes. However, children in areas with higher intensity of violence had a lower risk of delay in personal-social development (OR = 0.4; 95% CI = 0.2 - 0.9; p-value = 0.05). CONCLUSION: Unlike war refugees and internally-displaced persons in camp-like settings, the relationship between level of armed conflict and growth and developmental delay among children aged 1–5 years could not be demonstrated in the community setting of this study where food supply had been minimally perturbed

Behavioral health and experience of violence among cisgender heterosexual and lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) adolescents in Thailand.

BackgroundAssessment of health disparities between population groups is essential to provide basic information for resource prioritization in public health. The objective of this study is to assess the extent that behavioral health outcomes and experience of violence varied between cisgender heterosexual adolescents and those who identified as lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) in the 5th National School Survey on Alcohol Consumption, Substance Use and Other Health-Risk Behaviors.MethodsWe surveyed secondary school students in years 7, 9 and 11 in 113 schools in Thailand. We used self-administered questionnaires to ask participants about their gender identity and sexual orientation and classified participants as cisgender heterosexual, lesbian, gay, bisexual, transgender, queer and questioning, or asexual, stratified by sex assigned at birth. We also measured depressive symptoms, suicidality, sexual behaviors, alcohol and tobacco use, drug use, and past-year experience of violence. We analyzed the survey data using descriptive statistics with adjustment for sampling weights.ResultsOur analyses included data from 23,659 participants who returned adequately-completed questionnaires. Among participants included in our analyses, 23 percent identified as LGBTQA+ with the most common identity being bisexual/polysexual girls. Participants who identified as LGBTQA+ were more likely to be in older year levels and attending general education schools rather than vocational schools. LGBTQA+ participants generally had higher prevalence of depressive symptoms, suicidality, and alcohol use than cisgender heterosexual participants, whereas the prevalence of sexual behaviors, lifetime history of illicit drug use, and past-year history of violence varied widely between groups.ConclusionWe found disparities in behavioral health between cisgender heterosexual participants and LGBTQA+ participants. However, issues regarding potential misclassification of participants, limitation of past-year history of behaviors to the context of the COVID-19 pandemic, and the lack of data from youths outside the formal education system should be considered as caveats in the interpretation of the study findings

Effect of an equipment-behavior change intervention on handwashing behavior among primary school children in Kenya: the Povu Poa school pilot study.

BackgroundHandwashing prevalence in schools in Kenya is low due to lack of access to water and soap and lack of drive for handwashing. Soapy water made from detergent powder is an inexpensive alternative to bar soap and disgust and social norms change can be powerful drivers of handwashing, but their effectiveness has not been assessed in school setting. In Kenyan public schools, we evaluated an equipment-behavior change intervention's effect on handwashing outcomes. We also monitored functionality of the Povu Poa prototypes to identify design improvements necessary for continued high usage in institutional settings.MethodsThe intervention included the "Povu Poa", a new type of handwashing station that dispensed foaming soap and rinse water, combined with school-wide behavior change promotion based on disgust and social norms. In this stepped-wedge cluster-randomized trial, we randomly selected 30 schools and divided them into 3 groups of 10. Following baseline data collection, we delivered the intervention sequentially (Group 1: 3-5 weeks after baseline; Group 2: 6-8 weeks; Group 3: 19-24 weeks). We observed outcomes [1] availability of handwashing materials at handwashing places, and; 2) observed handwashing behavior after toilet use among schoolchildren) at baseline and in three follow-up rounds. We compared the outcomes between schools that had received the intervention and schools that had not yet received the intervention.ResultsWater and soap/soapy water were available at 2% of school visits before intervention, and at 42% of school visits after intervention.. Before intervention, we observed handwashing with water after 11% of 461 toilet use events; no one was observed to wash hands with soap/soapy water. After intervention, we observed handwashing after 62% of 383 toilet use events (PR = 5.96, 95% CI = 3.02, 11.76) and handwashing with soap/soapy water after 26% of events (PR incalculable). Foaming soap dispenser caps were cracked in 31% of all observations, but were typically still functional.ConclusionsOur combined equipment-behavior intervention increased availability of handwashing materials and improved the compliance with handwashing after using the toilet, but handwashing with soap was still rare. Equipment durability must be improved for deployment in schools at scale. American Economic Association's Registry for Randomized Controlled Trials; Trial Registry Number (TRN): AEARCTR-0000662; Date of Registry: April 14, 2015