Hand hygiene infrastructure and behaviours in resource-limited healthcare facilities

Hand hygiene infrastructure and behaviours in resource-limited healthcare facilitie

Reducing health inequalities among girls and adolescent women living in poverty: the success of Bangladesh

Background: Bangladesh has made dramatic improvements in the health of girls and women in the last 20 years. This paper examines whether gender inequalities in health are evident among older children and adolescents among extremely poor households, and identifies future health challenges for improving the health of girls and women. Method: Gender inequalities in health were examined using data from a school health survey of school children and adolescents (n=900, 6.5-13.5 years). Anthropometric status; household possessions and number of siblings were measured. Undernutrition was assessed as stunting (height-for-age z-score) and thinness (BMI-for-age z-score). Results: The prevalence of undernutrition was high (35.3% stunting; 42.4% thinness), but there were no significant differences according to gender or socio-economic indicators (via possession score). Girls had more younger siblings (p<0.05), while boys had more older siblings (p<0.05). Conclusions: These findings accord with the national picture of successful reductions in gender inequalities in health through low cost, community-based health programmes and education policies targeting the poorest sectors. The prevalence of undernutrition, however, remains high. Reproductive behaviours may still be influenced by poverty and the gender of existing offspring. Future challenges lie in reducing the adverse health consequences to women and their infants associated with early age at marriage and childbirth

Gaps in communication between different staff groups and older adult patients foster unnecessary antibiotic prescribing for urinary tract infections in hospitals: a qualitative translation approach

BackgroundStudies have reported large scale overprescribing of antibiotics for urinary tract infection (UTI) in hospitalised older adults. Older adults often have asymptomatic bacteriuria, and clinicians have been found to diagnose UTIs inappropriately based on vague symptoms and positive urinalysis and microbiology. However, the joined perspectives of different staff groups and older adult patients on UTI diagnosis have not been investigated.MethodsThematic analysis of qualitative interviews with healthcare staff (n = 27) and older adult patients (n = 14) in two UK hospitals.ResultsInterviews featured a recurrent theme of discrepant understandings and gaps in communication or translation between different social groups in three key forms: First, between clinicians and older adult patients about symptom recognition. Second, between nurses and doctors about the use and reliability of point-of-care urinary dipsticks. Third, between nurses, patients, microbiologists and doctors about collection of urine specimens, contamination of the specimens and interpretation of mixed growth laboratory results. The three gaps in communication could all foster inappropriate diagnosis and antibiotic prescribing.ConclusionInterventions to improve diagnosis and prescribing for UTIs in older adults typically focus on educating clinicians. Drawing on the sociological concept of translation and interviews with staff and patients our findings suggest that inappropriate diagnosis and antibiotic prescribing in hospitals can be fuelled by gaps in communication or translation between different staff groups and older adult patients, using different languages and technologies or interpreting them differently. We suggest that interventions in this area may be improved by also addressing discrepant understandings and communication about symptoms, urinary dipsticks and the process of urinalysis.</div

Urban South African adolescents' perceptions of their neighborhood socio-economic environments: the Birth to Twenty plus cohort study

The Apartheid era led to major differences in the living conditions between population groups in South Africa. Subsequently, reforms have been implemented to reduce poverty and inequalities. This study aims to assess neighborhood and school socio-economic (SE) environments reported by adolescents to determine whether geographic and population group differences in the SE environment exist. Neighborhood SE status was assessed using a novel questionnaire adapted to the urban South African context. Black African and Mixed Ancestry participants lived in more deprived SE environments and reported studying in less favorable school environments compared to Whites. Among Black Africans, those living in Soweto versus metropolitan Johannesburg reported more deprived economic and school environments

Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

Background: Overdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. In older adults, diagnosis of UTI using near-patient urine tests (reagent strip tests, dipsticks) is advised against because the age-related increase in asymptomatic bacteriuria can cause false-positive results. Instead, UTI diagnosis should be based on a full clinical assessment. Previous research lacks systematic information on urine dipstick use in hospitals. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. A further aim was to assess factors associated with the use of dipsticks. Methods: A case series review of patients aged ≥70 years admitted to two NHS Trust hospitals in England. Records from 312 patients admitted in 2015 meeting inclusion criteria were selected at random. Results: Of 298 complete patient records, 54% had at least one urine dipstick test recorded. 13% (21/161) of patients who received a urine dipstick test were diagnosed as having a UTI, only 2 out of these 21 cases had two or more clinical signs and symptoms. 60 patients received a second dipstick test, leading to 13 additional cases of UTI diagnosis. Dipstick tests were more likely to be performed on patients with a history of falls (OR 1.93, 95% CI:1.21, 3.07, p < 0.01), and less likely on those with dementia (OR 0.44, 95% CI: 0.22, 0.87, p < 0.05). The most common reason for testing was routine admissions policy (49.1% of cases), but these cases were predominantly in one hospital. Conclusions: Use of urine dipstick tests was high among older adults admitted to hospitals. Most cases were asymptomatic and therefore received inappropriate antibiotic therapy. This paper highlights the need to implement new Public Health England diagnostic guidelines to hospital admission and emergency departments

Household environment and behavioral determinants of respiratory tract infection in infants and young children in northern Bangladesh

Objectives: Respiratory tract infections (RTI) are one of the leading causes of under-five mortality in Bangladesh. Solid biomass fuels are the main source of domestic fuel used for cooking across Bangladesh, leading to smoke and pollution exposure in the home. This paper aims to identify risk-factors for RTI among children aged under five years in Bangladesh with a particular focus on the household environment, fuel use and cooking practices. Method: A cross-sectional household-health survey was carried out in 321 households in northern Bangladesh. The survey included care-giver interviews on cooking practices, child health and household behaviors during cooking. Health status of the youngest child (under 5 years) from each household was recorded through maternal interviews, medical diagnosis, and assessment of biomarkers (c-reactive protein (CRP), hemoglobin) from finger-prick blood samples. Anthropometric status (weight, height) was recorded. Results: Children who spent ≥30 minutes/day within five feet of the stove during cooking had a significantly increased risk of moderate/severe RTI compared with children spending <30 minutes/day close to the stove (OR=2.15, 95%CI: 1.20-3.86, p=0.01), independent of socio-economic status (SES), biomass fuel type (wood, dung, plant-derived, compressed risk husks), child age, anthropometric status, CRP and hemoglobin. Conclusions: In environments with a heavy reliance on solid biomass fuels, the amount of time a child spends near the stove during cooking may be an important risk for RTI. These novel findings from Bangladesh warrant further investigation of mother-infant behaviors during cooking in relation to child health, to ascertain whether the association is likely to be causal

Socio-economic status and body composition outcomes in urban South African children

Objective: To determine which aspects of socio-economic status (SES) measured at birth and 9/10 years are associated with body composition at ages 9/10 years. Design: Mixed longitudinal cohort Setting: Johannesburg-Soweto South Africa Participants: A sub-sample of the Birth to Twenty (Bt20) cohort (n=281) with data on birthweight, height, weight, fat and lean tissue (whole body DXA), and birth and 9/10 years SES measures. Main Outcome Measures: Linear regression was used to estimate the influence of birth and ages 9/10 years SES measures on three outcomes; fat mass index (FMI) (Fat Mass (Kg)/height(m)4), lean mass index (LMI) (lean mass (Kg)/height(m)2), and BMI at ages 9/10 years controlling for sex, age, birthweight and pubertal status. Results: Compared to the lowest SES tertile, being in the highest birth SES tertile was associated with increased LMI at 9/10 years (β = 0.43, SE = 0.21 for White and Black children and β = 0.50, SE = 0.23 for Black children only), whereas children in the high SES tertile at 9/10 years had increased FMI (β = 0.46, SE = 0.22 for White and Black children and β = 0.65, SE = 0.23 for Black children only). SES at birth and 9/10 years accounted for 8 and 6% of the variance in FMI and BMI respectively (Black children). Conclusions: These findings underline the importance of examining SES across childhood ages when assessing nutrition inequalities. Results emphasise the need to consider lean and fat mass as well as BMI when studying SES andbody composition in children

Socio-economic influences on anthropometric status in urban South African adolescents: sex differences in the Birth to Twenty Plus cohort

Objective: To investigate the associations between household and neighbourhood socio-economic position (SEP) with indicators of both under- and over-nutrition in adolescents and to explore sex differences. Design: Analysis of anthropometric, household and neighbourhood SEP data from the “Birth to Twenty Plus” cohort born in 1990. Anthropometric outcomes were BMI (thinness, overweight and obesity) and percent fat (¿; low, high). Associations between these and the household wealth index, caregiver education and neighbourhood SEP tertile measures were examined using binary logistic regression. Setting: Johannesburg-Soweto, South Africa. Subjects: Adolescents aged 17-19 years (n=2019; 48.2% men). Results: Women had a significantly higher combined prevalence of overweight/obesity (26.2%) than men (8.2%) whereas men had a significantly higher prevalence of thinness than women (22.2% vs 10.6% respectively). Having a low neighbourhood social support index was associated with higher odds of high percent fat in women (OR=1.59 [1.03-2.44]. A low household wealth index was associated with lower odds of both overweight (OR=0.31 [0.12-0.76]) and high percent fat in men (OR=0.28 [0.10-0.78]) A low or middle household wealth index was associated with higher odds of being thin in men (OR=1.90 [1.09-3.31] and OR=1.80 [1.03-3.15] respectively). For women, a low household wealth index was associated with lower odds of being thin (OR=0.49 [0.25-0.96]). Conclusions: This study highlights that even within a relatively small urban area, the nutrition transition manifests itself differently in men and women and across SEP indicators. Understanding the challenges for different sexes at different ages is vital in helping to plan public health services

Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol

Introduction: Increasing antibiotic resistance (ABR) in low and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic resistant bacteria and concentrations of antibiotic resistant genes from a ‘One Health’ perspective. The holistic assessment of antibiotic resistance in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis: The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: i) rural poultry-owning households, ii) commercial poultry farms and iii) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and foodproducing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract. Ethics and dissemination: The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b) and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. STRENGTHS AND LIMITATIONS OF THIS STUDY • We present a study protocol focused on integrated surveillance of ABR in urban and rural Bangladesh using a One Health approach • Assessment of the human, poultry and environmental prevalence of antibiotic resistant E. coli will identify potential hotspots for transmission in Bangladesh • Seasonal and spatial variation on the occurrence of antibiotic resistant bacteria in humans, poultry and the wider environment will be assessed • The two regions included in the study may not be typical of all regions within Banglades

Determinants of relative skeletal maturity in South African children

The variation of skeletal maturity about chronological age is a sensitive indicator of population health. Age appropriate or advanced skeletal maturity is a reflection of adequate environmental and social conditions, whereas delayed maturation suggests inadequate conditions for optimal development. There remains a paucity of data, however, to indicate which specific biological and environmental factors are associated with advancement or delay in skeletal maturity. The present study utilises longitudinal data from the South African Birth to Twenty (Bt20) study to indentify predictors of relative skeletal maturity (RSM) in early adolescence. A total of 244 black South African children (n=131 male) were included in this analysis. Skeletal maturity at age 9/10 years was assessed using the Tanner and Whitehouse III RUS technique. Longitudinal data on growth, socio-economic position and pubertal development were entered into sex-specific multivariable general linear regression models with relative skeletal maturity (skeletal age-chronological age) as the outcome. At 9/10 years of age males showed an average of 0.66 years delay in skeletal maturation relative to chronological age. Females showed an average of 1.00 year delay relative to chronological age. In males, being taller at 2 years (p<0.01) and heavier at 2 years (p<0.01) predicted less delay in RSM at age 9/10 years, independent of current size and body composition. In females, both height at 2 years and conditional weight at 2 years predicted less delay in RSM at 9/10 years (p<0.05) but this effect was mediated by current body composition. Having greater lean mass at 9/10 years was associated with less delayed RSM in females (p<0.01) as was pubertal status at the time of skeletal maturity assessment (p<0.01). This study identifies several predictors of skeletal maturation at 9/10 years, indicating a role for early life exposures in determining the rate of skeletal maturation during childhood independently of current stature