Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster-randomised controlled trial of the CHoBI7 mobile health program

Fatema Zohura, Md Sazzadul Islam Bhuyian, Ronald E Saxton, Tahmina Parvin, Shirajum Monira, Shwapon K Biswas, Jahed Masud, Sharika Nuzhat, Nowshin Papri, M Tasdik Hasan, Elizabeth D Thomas, David Sack, Jamie Perin, Munirul Alam, Christine Marie George, Fatema Zohura, Md Sazzadul Islam Bhuyian, Ronald E Saxton, Tahmina Parvin, Shirajum Monira, Shwapon K Biswas, Jahed Masud, Sharika Nuzhat, Nowshin Papri, M Tasdik Hasan, Elizabeth D Thomas, David Sack, Jamie Perin, Munirul Alam, Christine Marie George

Abstract

Objective: The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members.

Methods: A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The 'Standard Message' Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The 'Health Facility Visit + Soapy Water' Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The 'Health Facility Visit + Handwashing Station' Arm received this same intervention plus a small plastic handwashing station. Within 24 h of intervention delivery, three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members.

Results: Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit + Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14).

Conclusion: These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.

Keywords: Bangladesh; diarrhoeal disease; handwashing; healthcare facilities; structured observation.

© 2020 John Wiley & Sons Ltd.

References

    1. George CM, Jung DS, Saif-Ur-Rahman K et al. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 Days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 2016: 94: 428-436.
    1. George CM, Monira S, Sack DA et al. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 2016: 22: 233-241.
    1. World Health Organization. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. World Health Organization; 2015.
    1. Troeger C, Forouzanfar M, Rao PC et al. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 2017: 17: 909-948.
    1. Bern C, Martines J, De Zoysa I, Glass R. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ 1992: 70: 705.
    1. Holmgren J, Clemens J, Sack DA, Svennerholm A-M. New cholera vaccines. Vaccine 1989: 7: 94-96.
    1. George CM, Burrowes V, Perin J et al. Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 2018: 23: 26-33.
    1. D'Souza RM. Housing and environmental factors and their effects on the health of children in the slums of Karachi, Pakistan. J Biosoc Sci 1997: 29: 271-281.
    1. George CM, Jung DS, Saif-Ur-Rahman K et al. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (Cholera-Hospital-Based Intervention for 7 days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 2016: 94: 428-436.
    1. Wolf J, Hunter PR, Freeman MC et al. Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression. Trop Med Int Health 2018: 23: 508-525.
    1. Islam MS, Luby SP, Sultana R et al. Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control. Am J Infect Control 2014: 42: 305-310.
    1. Rimi NA, Sultana R, Luby SP et al. Infrastructure and contamination of the physical environment in three Bangladeshi hospitals: putting infection control into context. PLoS One 2014: 9: e89085.
    1. World Health Organization (WHO). Prevention of Hospital-acquired Infections: A Practical Guide. World Health Organization: Geneva, Switzerland, 2002.
    1. Zohura F, Bhuyian SI, Monira S et al. Observed handwashing with soap practices among cholera patients and accompanying household members in a hospital setting (CHoBI7 trial). Am J Trop Med Hyg 2016: 95: 1314-1318.
    1. Hadley MB, Blum LS, Mujaddid S et al. Why Bangladeshi nurses avoid ‘nursing’: social and structural factors on hospital wards in Bangladesh. Soc Sci Med 2007: 64: 1166-1177.
    1. Horng LM, Unicomb L, Alam MU et al. Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey. J Hosp Infect 2016: 94: 286-294.
    1. George CM, Hasan K, Monira S et al. A prospective cohort study comparing household contact and water Vibrio cholerae isolates in households of cholera patients in rural Bangladesh. PLoS Negl Trop Dis 2018: 12: e0006641.
    1. George CM, Ahmed S, Talukder KA et al. Shigella infections in household contacts of pediatric shigellosis patients in rural Bangladesh. Emerg Infect Dis 2015: 21: 2006.
    1. Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Coch Database Syst Rev 2015(9).
    1. Bouzid M, Cumming O, Hunter PR. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries. BMJ Global Health 2018: 3: e000648.
    1. George CM, Jung DS, Saif-Ur-Rahman KM et al. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 2016: 94: 428-436.
    1. George CM, Zohura F, Teman A et al. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 2019: 19: 1028.
    1. George CM, Monira S, Zohura F, et al. Effects of a water, sanitation and hygiene mobile health program on diarrhea and child growth in Bangladesh: A cluster-randomized controlled trial of the CHoBI7 mobile halth program. Clin Infect Dis 2020.
    1. Keleher H, MacDougall C. Understanding health. Oxford University Press, 2015.
    1. Baum F. The New Public Health. Oxford University Press: Oxford, 2016.
    1. Thomas ED, Zohura F, Hasan MT, et al. Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program). BMC Public Health 2020: 20(1): 831.
    1. Wichaidit W, Biswas S, Begum F et al. Effectiveness of a Large-Scale Handwashing Promotion Intervention on Handwashing Behavior in Dhaka. Tropical Medicine International Health: Bangladesh, 2019.
    1. Hulland KR, Leontsini E, Dreibelbis R et al. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health 2013: 13: 877.
    1. Luby SP, Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston RB. Household characteristics associated with handwashing with soap in rural Bangladesh. Am J Trop Med Hyg 2009: 81: 882-887.
    1. Luby SP, Halder AK. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Trop Med Int Health 2008: 13: 835-844.
    1. Ruel MT, Arimond M. Spot-check observational method for assessing hygiene practices: review of experience and implications for programmes. J Health Popul Nutr 2002: 65-76.
    1. Luby SP, Kadir MA, Yushuf Sharker MA, Yeasmin F, Unicomb L, Sirajul Islam M. A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh. Trop Med Int Health 2010: 15: 1508-1516.

Source: PubMed

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