International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Trop Med Hyg. 2021 Nov 29;106(1):239-249. doi: 10.4269/ajtmh.20-1335.
Schoolchildren frequently transmit respiratory and gastrointestinal infections because of dense person-to-person contact in schools. We piloted a low-cost handwashing intervention among elementary schoolchildren in Bangladesh. We trained teachers to lead behavior change communication sessions using flipcharts to encourage students' handwashing before eating, after defecating, and after cleaning school toilets; provided handwashing stations (reservoirs with taps and stool + basin + soapy water solution [mix of 30 gm detergent with 1.5 L water] + pump top bottle with steel holder); and formed hygiene committees for maintenance and covering the recurrent cost of detergent. We evaluated intervention acceptability, feasibility, and potential for sustainability at 1 and 14 months after the intervention. At baseline, of 300 before eating events, no one washed hands with soap, and 99.7% (299) did not wash hands at all as soap was unavailable. Out of 269 after toileting events, 0.7% (2) washed hands with soap, and 88% (237) did not wash hands. After 4 weeks of the intervention, 45% (87/195 before eating events), 83% (155/186 after toileting events), and 100% (15/15 after cleaning toilet events) washed both hands with soapy water as children found it accessible, low cost, and child friendly. After 14 months, 9.4% (55/586 before eating events) and 37% (172/465 after toileting events) washed both hands with soapy water for health benefits. The intervention was acceptable and feasible; it overcame limited access to soap and water and was affordable as schools covered the recurrent costs of detergent. Further research should explore long-term habit adoption and impact on health and attendance.
在校学生之间存在密切的人际接触，因此经常传播呼吸道和胃肠道感染。我们在孟加拉国的小学开展了一项低成本的洗手干预措施试点。我们培训教师使用翻页挂图进行行为改变沟通课程，鼓励学生在进食前、便后和清洁学校厕所后洗手；提供洗手站（带水龙头和马桶的蓄水池+盆+肥皂水溶液[每 1.5 升水混合 30 克清洁剂] +带钢支架的顶部泵瓶）；并成立卫生委员会负责维护和承担清洁剂的经常性费用。我们在干预后 1 个月和 14 个月评估了干预措施的可接受性、可行性和可持续性潜力。在基线时，在 300 次进食前事件中，没有人用肥皂洗手，由于没有肥皂，99.7%（299 次）根本没有洗手。在 269 次便后事件中，只有 0.7%（2 次）用肥皂洗手，88%（237 次）没有洗手。在干预的第 4 周，45%（195 次进食前事件中的 87 次）、83%（186 次便后事件中的 155 次）和 100%（15 次清洁厕所事件中的 15 次）都用肥皂水洗了双手，因为孩子们发现这种方法容易获得、成本低且适合儿童。在 14 个月后，9.4%（55 次进食前事件中的 55 次）和 37%（172 次便后事件中的 172 次）为了健康益处而用肥皂水洗了双手。该干预措施是可以接受且可行的；它克服了肥皂和水供应有限的问题，并且由于学校承担了清洁剂的经常性费用，因此负担得起。还需要进一步研究以探索长期习惯的养成以及对健康和出勤率的影响。
