Water, sanitation, and hygiene (WASH) facilities and infection control/prevention practices in traditional birth homes in Southwest Nigeria

BMC Health Services Research, Volume 21, No. 1, Year 2021

Interpretation

Background: Poor environmental conditions and hygiene practices at the time of childbirth is linked to life-threatening infections and death in mothers and babies. Improvements in water, sanitation, and hygiene (WASH) have been identified as a means through which the lives of mothers and babies could be saved. This study was carried out to explore WASH conditions and infection prevention and control (IPC) practices in traditional birth homes/centers in Abeokuta, Southwest Nigeria. A total of 50 traditional birth centers and attendants (TBAs) were enrolled in the study. Sociodemographic characteristics of the TBAs and features of the birth centers were obtained using a semi-structured questionnaire. Assessment of WASH conditions and IPC practices was based on established protocols. Results: Findings revealed that majority of the centers operated under poor WASH conditions and IPC practices; none met with the WHO minimum standards for environmental health. Conclusions: Adequate WASH facilities and IPC practices remain a critical component of maternal and child health even in non-facility birth. As the transition to facility births continues in many countries, the large number of non-facility births demands their inclusion in WASH-related strategies, if global goals of reducing deaths of newborns and women deaths will be achieved. The study was carried out in Abeokuta, the largest city and capital of Ogun State. Its geographical area covers Abeokuta South and parts of Abeokuta North, Obafemi Owode, and Odeda Local Government Area. In Abeokuta, healthcare is provided by few governmental and private hospitals, primary healthcare centers, as well as a myriad of community, faith-based, herbal, and traditional practitioners. Traditional Birth Attendants (TBAs) commonly provide perinatal care in rural and low-income urban areas of the town. TBAs form traditional birth attendant association and are recognized by the government. The activities and practices of the TBAs are regulated by the Primary Health Care Development Board of the State. A mixed-methods approach was used to assess WASH services and clean delivery practices in the recruited traditional birth homes (TBHs) (Table 1). The tools used for this assessment were adapted from the WHO/UNICEF Joint Monitoring Program for WASH [24], WHO essential environmental health standards [25], and the WASH & CLEAN toolkit developed by the Soapbox Collaborative to assess IPC on maternity units [26]. Data collection methods First, in-depth interviews were conducted with TBAs in their birth homes using a semi-structured questionnaire as a guide. The questionnaire was used to assess the status of WASH facilities and clean delivery practices (six cleans) in the birth homes. For assessing the status of WASH services, the following domains were covered: basic water supply, basic sanitation, waste management, and access to basic hygiene in the TBHs (Table 2). WASH Domains and Definitions according to WHO and WHO/UNICEF Guidelines Assessment of clean delivery practices was based on adherence to WHO’s six cleans including clean hands, clean perineum, clean delivery surface, clean cord cutting, clean cord tying, and clean cord care. Adherence to six cleans was recorded through observation and recording in the walkthrough checklist as well as the use of a questionnaire. Secondly, an in-depth assessment was combined with the walkthrough methodology, which consisted of recording observations in a checklist and collecting water samples for microbiological analysis. This assessment focused on visual and microbiological cleanliness of birth home environments and tools. Data was collected through observation and recording in the walkthrough checklist. Samples were collected from delivery surfaces and cord-cutting instruments as well as from water used for domestic purposes such as hand washing and bathing in the TBHs Water quality testing was conducted in all the TBHs. Samples of water available in birth homes were collected directly from sources (on-site) or storage vessels to assess the microbial quality of water used for domestic purposes and during delivery. Analyses of the TBHs interviews focused on the description of WASH facilities and clean delivery practices. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) software (version 17.0). Descriptive statistics (including frequencies, percentages, charts, and tables) was used to describe WASH conditions and clean practices Visual Inspection and Microbiological Analysis: The analysis of both the checklist and microbiological data focused on describing the cleanliness at different sites of the birth home as well as cleanliness of birth tools/equipment and the cleanliness at the different sites of the birth homes. Isolation of microorganisms from water samples was carried out on general-purpose and selective media using the membrane filtration methods. Microbiological analysis of water samples focused on the presence of Enterococcus and fecal coliforms; standard indicators for assessing water quality. Total bacterial count in the water samples was also determined.

AI Digest

Study Justification:

– Poor environmental conditions and hygiene practices during childbirth can lead to life-threatening infections and death in mothers and babies.
– Improvements in water, sanitation, and hygiene (WASH) have been identified as a way to save the lives of mothers and babies.
– This study aims to explore the WASH conditions and infection prevention and control (IPC) practices in traditional birth homes in Southwest Nigeria.

Study Highlights:

– A total of 50 traditional birth centers and attendants (TBAs) were enrolled in the study.
– Majority of the centers operated under poor WASH conditions and IPC practices, failing to meet the WHO minimum standards for environmental health.
– Adequate WASH facilities and IPC practices are crucial for maternal and child health, even in non-facility births.
– Non-facility births should be included in WASH-related strategies to achieve global goals of reducing newborn and maternal deaths.

Study Recommendations:

– Improve WASH conditions and IPC practices in traditional birth homes.
– Include non-facility births in WASH-related strategies to reduce newborn and maternal deaths.

Key Role Players:

– Traditional Birth Attendants (TBAs)
– Primary Health Care Development Board of the State
– Governmental and private hospitals
– Primary healthcare centers
– Community, faith-based, herbal, and traditional practitioners

Cost Items for Planning Recommendations:

– Training and capacity building for TBAs and healthcare providers
– Infrastructure improvements for WASH facilities
– Equipment and supplies for clean delivery practices
– Monitoring and evaluation of WASH conditions and IPC practices
– Advocacy and awareness campaigns for the importance of WASH in traditional birth homes

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong as it presents findings from a study conducted in Southwest Nigeria, specifically in Abeokuta. The study used a mixed-methods approach and adapted tools from established protocols to assess WASH conditions and infection prevention and control practices in traditional birth homes. The results indicate that the majority of the centers operated under poor WASH conditions and IPC practices, and none met the WHO minimum standards for environmental health. The conclusions emphasize the importance of adequate WASH facilities and IPC practices in non-facility births. To improve the evidence, the abstract could provide more specific details about the sample size, data collection methods, and statistical analysis used in the study.

Abstract

The study was carried out in Abeokuta, the largest city and capital of Ogun State. Its geographical area covers Abeokuta South and parts of Abeokuta North, Obafemi Owode, and Odeda Local Government Area. In Abeokuta, healthcare is provided by few governmental and private hospitals, primary healthcare centers, as well as a myriad of community, faith-based, herbal, and traditional practitioners. Traditional Birth Attendants (TBAs) commonly provide perinatal care in rural and low-income urban areas of the town. TBAs form traditional birth attendant association and are recognized by the government. The activities and practices of the TBAs are regulated by the Primary Health Care Development Board of the State. A mixed-methods approach was used to assess WASH services and clean delivery practices in the recruited traditional birth homes (TBHs) (Table 1). The tools used for this assessment were adapted from the WHO/UNICEF Joint Monitoring Program for WASH [24], WHO essential environmental health standards [25], and the WASH & CLEAN toolkit developed by the Soapbox Collaborative to assess IPC on maternity units [26]. Data collection methods First, in-depth interviews were conducted with TBAs in their birth homes using a semi-structured questionnaire as a guide. The questionnaire was used to assess the status of WASH facilities and clean delivery practices (six cleans) in the birth homes. For assessing the status of WASH services, the following domains were covered: basic water supply, basic sanitation, waste management, and access to basic hygiene in the TBHs (Table 2). WASH Domains and Definitions according to WHO and WHO/UNICEF Guidelines Assessment of clean delivery practices was based on adherence to WHO’s six cleans including clean hands, clean perineum, clean delivery surface, clean cord cutting, clean cord tying, and clean cord care. Adherence to six cleans was recorded through observation and recording in the walkthrough checklist as well as the use of a questionnaire. Secondly, an in-depth assessment was combined with the walkthrough methodology, which consisted of recording observations in a checklist and collecting water samples for microbiological analysis. This assessment focused on visual and microbiological cleanliness of birth home environments and tools. Data was collected through observation and recording in the walkthrough checklist. Samples were collected from delivery surfaces and cord-cutting instruments as well as from water used for domestic purposes such as hand washing and bathing in the TBHs Water quality testing was conducted in all the TBHs. Samples of water available in birth homes were collected directly from sources (on-site) or storage vessels to assess the microbial quality of water used for domestic purposes and during delivery. Analyses of the TBHs interviews focused on the description of WASH facilities and clean delivery practices. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) software (version 17.0). Descriptive statistics (including frequencies, percentages, charts, and tables) was used to describe WASH conditions and clean practices Visual Inspection and Microbiological Analysis: The analysis of both the checklist and microbiological data focused on describing the cleanliness at different sites of the birth home as well as cleanliness of birth tools/equipment and the cleanliness at the different sites of the birth homes. Isolation of microorganisms from water samples was carried out on general-purpose and selective media using the membrane filtration methods. Microbiological analysis of water samples focused on the presence of Enterococcus and fecal coliforms; standard indicators for assessing water quality. Total bacterial count in the water samples was also determined.

Materials

N/A

Innovations

The study titled “Water, sanitation, and hygiene (WASH) facilities and infection control/prevention practices in traditional birth homes in Southwest Nigeria” focuses on the poor WASH conditions and infection prevention and control (IPC) practices in traditional birth homes/centers in Abeokuta, Southwest Nigeria. The study found that none of the centers met the minimum standards for environmental health set by the World Health Organization (WHO).

Based on the findings of the study, the following recommendations can be made to improve access to maternal health:

1. Infrastructure improvement: Enhance the infrastructure of traditional birth homes/centers by providing access to clean water supply, proper sanitation facilities, and waste management systems.

2. Training and education: Provide comprehensive training and education to traditional birth attendants (TBAs) on proper hygiene practices, including hand hygiene, clean delivery techniques, and infection prevention measures.

3. Monitoring and evaluation: Establish a system for regular monitoring and evaluation of WASH facilities and IPC practices in traditional birth homes/centers to identify areas that need improvement and ensure compliance with established standards.

4. Collaboration and partnerships: Foster collaboration between government agencies, healthcare providers, NGOs, and community organizations to collectively address the challenges related to WASH facilities and IPC practices in traditional birth homes/centers.

5. Advocacy and policy support: Advocate for the inclusion of WASH facilities and IPC practices in maternal health policies and guidelines at the national and local levels to prioritize resource allocation and ensure sustainability.

Implementing these recommendations can create safer and more hygienic environments for childbirth in traditional birth homes/centers, ultimately improving access to maternal health and reducing the risk of infections and complications for mothers and babies.

AI Innovations Description

The study titled “Water, sanitation, and hygiene (WASH) facilities and infection control/prevention practices in traditional birth homes in Southwest Nigeria” highlights the poor WASH conditions and infection prevention and control (IPC) practices in traditional birth homes/centers in Abeokuta, Southwest Nigeria. The study found that none of the centers met the minimum standards for environmental health set by the World Health Organization (WHO).

Based on the findings of the study, a recommendation can be developed into an innovation to improve access to maternal health. The recommendation is to prioritize and invest in improving WASH facilities and IPC practices in traditional birth homes/centers. This can be achieved through the following strategies:

1. Infrastructure improvement: Enhance the infrastructure of traditional birth homes/centers by providing access to clean water supply, proper sanitation facilities, and waste management systems. This may involve installing water sources, toilets, and handwashing stations, as well as implementing proper waste disposal mechanisms.

2. Training and education: Provide comprehensive training and education to traditional birth attendants (TBAs) on proper hygiene practices, including hand hygiene, clean delivery techniques, and infection prevention measures. This can be done through workshops, seminars, and ongoing mentorship programs.

3. Monitoring and evaluation: Establish a system for regular monitoring and evaluation of WASH facilities and IPC practices in traditional birth homes/centers. This can help identify areas that need improvement and ensure compliance with established standards.

4. Collaboration and partnerships: Foster collaboration between government agencies, healthcare providers, NGOs, and community organizations to collectively address the challenges related to WASH facilities and IPC practices in traditional birth homes/centers. This can involve sharing resources, expertise, and best practices to achieve sustainable improvements.

5. Advocacy and policy support: Advocate for the inclusion of WASH facilities and IPC practices in maternal health policies and guidelines at the national and local levels. This can help prioritize the allocation of resources and ensure the sustainability of the implemented interventions.

By implementing these recommendations, access to maternal health can be improved by creating safer and more hygienic environments for childbirth in traditional birth homes/centers. This can contribute to reducing the risk of infections and complications, ultimately saving the lives of mothers and babies.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Selection of traditional birth homes/centers: Identify a representative sample of traditional birth homes/centers in Abeokuta, Southwest Nigeria, that will be included in the simulation. This sample should reflect the diversity of traditional birth homes/centers in terms of location, size, and infrastructure.

2. Baseline assessment: Conduct a comprehensive assessment of the WASH facilities and IPC practices in the selected traditional birth homes/centers using the same protocols and tools as described in the study. This will provide a baseline measurement of the current conditions.

3. Intervention implementation: Implement the recommended strategies in the selected traditional birth homes/centers. This may involve infrastructure improvement, training and education programs for traditional birth attendants, establishment of monitoring and evaluation systems, fostering collaboration and partnerships, and advocating for policy support.

4. Monitoring and evaluation: Establish a system for monitoring and evaluating the implementation of the interventions. This can include regular site visits, interviews with traditional birth attendants, and data collection on the status of WASH facilities and IPC practices. This will allow for tracking progress and identifying areas that need further improvement.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. This can involve comparing the baseline assessment results with the post-intervention results to identify changes in WASH conditions and IPC practices.

6. Evaluation of outcomes: Evaluate the outcomes of the interventions in terms of their impact on maternal health. This can include measuring the reduction in infections and complications during childbirth, as well as assessing the satisfaction and experiences of mothers who gave birth in the traditional birth homes/centers.

7. Recommendations and scaling up: Based on the findings of the simulation, develop recommendations for scaling up the interventions to a larger number of traditional birth homes/centers in Abeokuta and potentially other regions in Southwest Nigeria. These recommendations can inform policy and programmatic decisions to improve access to maternal health on a broader scale.

By following this methodology, the impact of the main recommendations on improving access to maternal health can be simulated and evaluated, providing valuable insights for future interventions and policy development.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1186/s12913-021-06911-5

Research Areas:

Community Interventions, Disparities, Environmental, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Nigeria

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female