Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Thailand.
Faculty of Public Health, Thammasat University, Bangkok, Thailand.
Front Public Health. 2023 Jul 31;11:1099831. doi: 10.3389/fpubh.2023.1099831. eCollection 2023.
Protracted refugee situations create complex contexts that present significant health risks for young children. Effective hand hygiene practices by caregivers can reduce respiratory infections and diarrhoeal disease, the two largest contributors to mortality among children between 1 month and 5 years of age. This study documented handwashing patterns and access to water, sanitation and hygiene (WASH) infrastructure among caregivers of young children living along the Thai-Myanmar border, one of the world's most protracted and complex refugee and immigration contexts. It also examined the association between handwashing and socio-demographic variables and captured participants' explanations for when and how hands are washed. The study broadened the scope of previous research by also including the large number of caregivers living outside formal camps.
Caregivers of children attending 11 preschools in Tak province, Thailand participated in a mixed-methods cross-sectional study. Quantitative questionnaire data ( = 384) were supplemented by a thematic analysis of data from in-depth interviews ( = 9).
Fewer than half the caregivers reported routinely washing their hands before preparing meals or after using the latrine/toilet. Fewer than one-in-five routinely used soap in these situations. Interviewees explained that handwashing was only necessary when a substance could be felt or seen, in which case wiping with a cloth or a rinsing with water were sufficient to clean hands. However, their explanations also suggested some potential avenues for culturally appropriate and feasible interventions to improve hand hygiene.
The results confirmed previous research on the multi-dimensional barriers to good hand hygiene in protracted refugee situations and other low-resource settings. Additional investment to overcome shortages in the infrastructure necessary to support good hand hygiene and creative means of drawing on and developing human capital will be necessary to realize the potential hand hygiene holds for reducing ill-health and mortality among young children living in these contexts.
旷日持久的难民局势造成了复杂的环境，给幼儿带来了巨大的健康风险。照顾者的有效手部卫生习惯可以减少呼吸道感染和腹泻病，这两种疾病是 1 个月至 5 岁儿童死亡的主要原因。本研究记录了生活在泰国-缅甸边境的幼儿照顾者的洗手模式和获得水、环境卫生和个人卫生（WASH）基础设施的情况，该地区是世界上时间最长、最复杂的难民和移民环境之一。它还研究了洗手习惯与社会人口统计学变量之间的关系，并记录了参与者对何时以及如何洗手的解释。本研究通过包括居住在非正规难民营之外的大量照顾者，扩大了以往研究的范围。
泰国达府 11 所幼儿园的儿童照顾者参加了一项混合方法的横断面研究。定量问卷数据（ = 384）补充了深入访谈（ = 9）的主题分析数据。
不到一半的照顾者表示在准备饭菜或使用厕所/洗手间后经常洗手。不到五分之一的人在这些情况下经常使用肥皂。受访者解释说，只有在感觉到或看到有物质时才需要洗手，在这种情况下，用布擦拭或用水冲洗就足以清洁双手。然而，他们的解释也表明了一些可能的途径，可以进行文化上适当和可行的干预，以改善手部卫生。
研究结果证实了先前关于旷日持久的难民局势和其他资源匮乏环境中良好手部卫生的多维度障碍的研究。为了克服支持良好手部卫生所必需的基础设施短缺，并创造性地利用和发展人力资本，需要额外投资，以实现手部卫生在减少这些环境中幼儿健康不良和死亡方面的潜力。
