Division of Pediatric Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, USA.
Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, USA.
Glob Health Promot. 2021 Sep;28(3):14-22. doi: 10.1177/1757975920963889. Epub 2020 Oct 25.
Children who live in orphanages represent a population particularly vulnerable to transmissible diseases. Handwashing interventions have proven efficacy for reducing the rate of transmission of common infectious diseases. Few studies have analyzed the delivery of health interventions for children in orphanages in sub-Saharan Africa. To address this gap, we conducted an ecological assessment and piloted a handwashing intervention in an orphanage in rural Malawi, focusing on caregiver knowledge and behaviors, child handwashing behaviors, and disease incidence. A secondary study aim was to demonstrate program feasibility for a future randomized controlled trial. Orphanage caregivers participated in a three-module educational intervention on handwashing based on WHO recommendations and workshops on how to teach the curriculum to children. Seventeen orphanage caregivers and 65 children were monitored for handwashing behavior and child disease incidence. Friedman's tests were conducted to compare changes in caregiver knowledge and behaviors. Child handwashing behaviors and surveillance of child disease incidence were measured pre- and post-intervention. There were significant increases in caregiver hand hygiene knowledge. At six months post-intervention, handwashing with soap increased significantly among caregivers ( < 0.001) and was observed in children. The incidence of acute respiratory infections decreased from 30% to 6% post-intervention, resulting in an 80% decrease. The incidence of diarrhea decreased from 9.2% to 6.2% post-intervention, resulting in a 33% decrease. A brief educational intervention may improve handwashing knowledge and behaviors and help to decrease the incidence of common infectious diseases in an orphanage in rural Malawi. In addition, the caregiver uptake of the intervention demonstrated feasibility for future studies.
生活在孤儿院的儿童是特别容易感染传染病的人群。洗手干预措施已被证明能有效降低常见传染病的传播率。很少有研究分析过在撒哈拉以南非洲的孤儿院提供卫生干预措施的情况。为了解决这一差距，我们在马拉维农村的一家孤儿院进行了生态评估，并试点了一项洗手干预措施，重点关注照顾者的知识和行为、儿童洗手行为以及疾病发病率。次要研究目的是展示该方案在未来进行随机对照试验的可行性。孤儿院的照顾者参加了基于世卫组织建议的关于洗手的三个模块的教育干预以及关于如何向儿童教授课程的讲习班。17 名孤儿院照顾者和 65 名儿童接受了监测，以了解他们的洗手行为和儿童疾病发病率。采用 Friedman 检验比较照顾者知识和行为的变化。在干预前后测量儿童的洗手行为和儿童疾病发病率的监测情况。照顾者的手部卫生知识显著增加。在干预后 6 个月，照顾者用肥皂洗手的频率显著增加（<0.001），且观察到儿童也在用肥皂洗手。急性呼吸道感染的发病率从干预前的 30%降至 6%，降幅为 80%。腹泻的发病率从 9.2%降至 6.2%，降幅为 33%。简短的教育干预可能会提高孤儿院照顾者的洗手知识和行为，并有助于降低马拉维农村孤儿院常见传染病的发病率。此外，照顾者对干预措施的接受情况表明未来研究具有可行性。
