Association between wash-related behaviors and knowledge with childhood diarrhea in Tanzania

International Journal of Environmental Research and Public Health, Volume 18, No. 9, Year 2021

Interpretação

Background: Diarrhea remains a major cause of morbidity and mortality among children in Tanzania. The purpose of this study was to explore associations between diarrheal disease and water, sanitation, and hygiene (WASH) related behaviors and determine care-seeking predictors for diarrheal disease. Methods: Data from 9996 female primary caregivers were collected as part of a larger integrated nutrition program. Logistic regression was used to measure associations between predictor and dependent variables and diarrheal and care-seeking outcomes. Results: Knowledge of the importance of handwashing after assisting a child who has defecated (OR 0.79, CI 0.72–0.87), before preparing food (OR 0.88, CI 0.80–0.97), and before feeding a child (OR 0.89, CI 0.81–0.99) were each associated with not having a child with diarrhea in the past two weeks. Fathers or male caregivers (OR 0.65, CI 0.48–0.89) were less likely to seek medical care for a child with diarrhea. No associations were found between WASH-related knowledge or behavior and seeking medical care for a child with diarrhea. Conclusions: Findings indicate that knowledge of handwashing importance was significant in washing hands after assisting a child who has defecated, before preparing food, and prior to feeding a child. These findings demonstrate the value of parental involvement to lower morbidity and mortality among children. An evidence-based communication campaign was implemented between 2015 to 2020 in five regions of the Lake Zone in Tanzania. The purpose of the campaign was to prevent childhood stunting through the promotion of optimal health behaviors and knowledge regarding WASH and community nutritional practices. The communication campaign included support groups, mobile outreach clinics, home visits, WASH intervention training, and a media campaign that was broadcasted via radio and television between June 2017 and March 2020. This study does not report directly on the effects of the campaign or any of its related components, but instead opportunistically uses the cross-sectional data gathered for the campaign and examines associations between WASH-related knowledge and behaviors, as well as diarrheal outcomes. A survey was developed by the Addressing Stunting in Tanzania Early (ASTUTE) program to examine trends in key maternal and child health related behaviors. Eligibility for participation included households with children aged 0–23 months. Questions were directed to female caregivers. The survey contained 169 questions and took an average of 50–60 min to complete. The survey was written in English and translated to Kiswahili by Ipsos, a data collection firm. Pilot testing occurred prior to survey administration. Data were collected by a field team consisting of 10 supervisors and 50 enumerators. Data collection occurred digitally via smartphones and personal digital assistants (PDAs). The National Institute for Medical Research in Tanzania and relevant local government authorities authorized the research (NIMR/HQ/R.8a/Vol.IX/2344). Institutional Review Board (IRB) approval was obtained through an internal IRB at Developmental Medial International (DMI), a research and communications not-for-profit organization that implemented mass media activities. Quality checks were verified by 11 quality controllers and new interviews were conducted when the quality of a completed interview could not be validated. Prior to the intervention, villages were randomly selected (n = 243) from five regions (Geita, Kagera, Kigoma, Mwanza, and Shinyanga) of the Lake Zone. A stratified, multi-staged random sample design was used to select survey participants. Participants within each village were randomly sampled anew during each survey period. All participation was voluntary and required informed consent. Data was collected from 9996 households from 2017 through 2020. This study examined household and demographic information. All major variables used were dichotomous. Dependent variables included whether the child experienced diarrhea within the past 2 weeks and if the child received medical treatment for the diarrhea. Behavioral variables used were optimal stool disposal, access to a water source, how frequently the household washes hands with soup, if a handwashing station exists in the home, if there is soap or ash at the handwashing station, if there is water at the handwashing station, and if the household owns their own soap. Knowledge variables used were based upon knowledge of when it is important to wash one’s hands including after latrine use, after assisting child who has defecated, before preparing food, before eating food, and before feeding a child as well as knowledge on whether or not handwashing with water alone makes one’s hands clean. Sociodemographic-related predictor variables used included number of children, sex of the child, relationship to the child, mother’s education, household wealth, child’s age, and mother’s age. Optimal stool disposal was determined by whether the child used latrine, put stool into a latrine, or threw stool into the garbage. Poor stool disposal included putting it in a ditch, buried, left in the open, or unknown. The wealth index was constructed using a similar approach to wealth measurement used by Briceño [18]. In brief, the wealth index included access to safe drinking water sources, access to safe sanitation, as well as ownership of a radio, television, bicycle, motorcycle, automobile, mobile phone, boat, and/or animal-drawn cart. Relationship of the caregiver was re-coded into three variables denoting mother, father, and other (i.e., grandmother, grandfather, sibling, aunt/uncle). This decision-maker variable was composed of one’s self, partner, or both as equal decision makers. Logistic regression was used to examine the association between WASH practices and diarrhea and also the association between predictor variables and whether an individual sought out medical care for diarrheal disease. Adjusted models controlled for maternal age, maternal education level, and household wealth. Dependent variables included whether or not the child had diarrhea within the past 2 weeks and if the child received medical care for the diarrhea. Risk factors included WASH behaviors exhibited by the primary caregiver including handwashing techniques and method of stool disposal. Predictor variables (key indicators) included maternal age, child age, number of children, child gender, maternal education, maternal literacy, which parent stays home when the child is sick, and who makes decisions on healthcare. Odds ratios, p-values (a = 0.05) and 95% confidence intervals were used to assess the strength of the associations. Significant findings were determined by <0.05 p-value. Data were examined using SAS 9.4 software (SAS Institute, Cary, NC, USA). Hosmer and Lemeshow goodness of fit tests were computed for all models and only those models that met assumptions for fit were retained.

AI Digest

Study Justification:

– Diarrhea is a major cause of illness and death among children in Tanzania.
– Understanding the associations between water, sanitation, and hygiene (WASH) behaviors and diarrheal disease can inform interventions to prevent and manage diarrhea.
– This study aims to explore these associations and identify predictors of care-seeking for diarrheal disease.

Highlights:

– Knowledge of the importance of handwashing after assisting a child who has defecated, before preparing food, and before feeding a child was associated with lower likelihood of having a child with diarrhea.
– Fathers or male caregivers were less likely to seek medical care for a child with diarrhea.
– WASH-related knowledge and behavior did not show significant associations with seeking medical care for a child with diarrhea.
– Parental involvement in promoting handwashing can help reduce morbidity and mortality among children.

Recommendations:

– Promote and educate caregivers about the importance of handwashing after assisting a child who has defecated, before preparing food, and before feeding a child.
– Encourage fathers and male caregivers to actively seek medical care for children with diarrhea.
– Develop targeted interventions to improve WASH-related knowledge and behavior among caregivers.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation of interventions.
– Non-governmental organizations (NGOs): Implementers of communication campaigns and WASH interventions.
– Community health workers: Provide education and support to caregivers.
– Media organizations: Disseminate information through radio and television campaigns.

Cost Items for Planning Recommendations:

– Training and capacity building for community health workers.
– Development and production of educational materials.
– Media campaign costs (radio and television broadcasting).
– Monitoring and evaluation of interventions.
– Coordination and management of interventions.
– Research and data collection for ongoing monitoring and assessment.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides detailed information about the study design, data collection methods, and statistical analysis. However, it does not mention the sample size or the representativeness of the study population. To improve the evidence, the abstract could include information about the sample size and how the study population was selected to ensure its generalizability. Additionally, it would be helpful to include the effect sizes and statistical significance of the associations found in the study.

Resumo

An evidence-based communication campaign was implemented between 2015 to 2020 in five regions of the Lake Zone in Tanzania. The purpose of the campaign was to prevent childhood stunting through the promotion of optimal health behaviors and knowledge regarding WASH and community nutritional practices. The communication campaign included support groups, mobile outreach clinics, home visits, WASH intervention training, and a media campaign that was broadcasted via radio and television between June 2017 and March 2020. This study does not report directly on the effects of the campaign or any of its related components, but instead opportunistically uses the cross-sectional data gathered for the campaign and examines associations between WASH-related knowledge and behaviors, as well as diarrheal outcomes. A survey was developed by the Addressing Stunting in Tanzania Early (ASTUTE) program to examine trends in key maternal and child health related behaviors. Eligibility for participation included households with children aged 0–23 months. Questions were directed to female caregivers. The survey contained 169 questions and took an average of 50–60 min to complete. The survey was written in English and translated to Kiswahili by Ipsos, a data collection firm. Pilot testing occurred prior to survey administration. Data were collected by a field team consisting of 10 supervisors and 50 enumerators. Data collection occurred digitally via smartphones and personal digital assistants (PDAs). The National Institute for Medical Research in Tanzania and relevant local government authorities authorized the research (NIMR/HQ/R.8a/Vol.IX/2344). Institutional Review Board (IRB) approval was obtained through an internal IRB at Developmental Medial International (DMI), a research and communications not-for-profit organization that implemented mass media activities. Quality checks were verified by 11 quality controllers and new interviews were conducted when the quality of a completed interview could not be validated. Prior to the intervention, villages were randomly selected (n = 243) from five regions (Geita, Kagera, Kigoma, Mwanza, and Shinyanga) of the Lake Zone. A stratified, multi-staged random sample design was used to select survey participants. Participants within each village were randomly sampled anew during each survey period. All participation was voluntary and required informed consent. Data was collected from 9996 households from 2017 through 2020. This study examined household and demographic information. All major variables used were dichotomous. Dependent variables included whether the child experienced diarrhea within the past 2 weeks and if the child received medical treatment for the diarrhea. Behavioral variables used were optimal stool disposal, access to a water source, how frequently the household washes hands with soup, if a handwashing station exists in the home, if there is soap or ash at the handwashing station, if there is water at the handwashing station, and if the household owns their own soap. Knowledge variables used were based upon knowledge of when it is important to wash one’s hands including after latrine use, after assisting child who has defecated, before preparing food, before eating food, and before feeding a child as well as knowledge on whether or not handwashing with water alone makes one’s hands clean. Sociodemographic-related predictor variables used included number of children, sex of the child, relationship to the child, mother’s education, household wealth, child’s age, and mother’s age. Optimal stool disposal was determined by whether the child used latrine, put stool into a latrine, or threw stool into the garbage. Poor stool disposal included putting it in a ditch, buried, left in the open, or unknown. The wealth index was constructed using a similar approach to wealth measurement used by Briceño [18]. In brief, the wealth index included access to safe drinking water sources, access to safe sanitation, as well as ownership of a radio, television, bicycle, motorcycle, automobile, mobile phone, boat, and/or animal-drawn cart. Relationship of the caregiver was re-coded into three variables denoting mother, father, and other (i.e., grandmother, grandfather, sibling, aunt/uncle). This decision-maker variable was composed of one’s self, partner, or both as equal decision makers. Logistic regression was used to examine the association between WASH practices and diarrhea and also the association between predictor variables and whether an individual sought out medical care for diarrheal disease. Adjusted models controlled for maternal age, maternal education level, and household wealth. Dependent variables included whether or not the child had diarrhea within the past 2 weeks and if the child received medical care for the diarrhea. Risk factors included WASH behaviors exhibited by the primary caregiver including handwashing techniques and method of stool disposal. Predictor variables (key indicators) included maternal age, child age, number of children, child gender, maternal education, maternal literacy, which parent stays home when the child is sick, and who makes decisions on healthcare. Odds ratios, p-values (a = 0.05) and 95% confidence intervals were used to assess the strength of the associations. Significant findings were determined by <0.05 p-value. Data were examined using SAS 9.4 software (SAS Institute, Cary, NC, USA). Hosmer and Lemeshow goodness of fit tests were computed for all models and only those models that met assumptions for fit were retained.

Materiais

N/A

Inovações

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile Outreach Clinics: Implementing mobile clinics that travel to remote areas to provide maternal health services, including prenatal care, postnatal care, and family planning. This would help overcome geographical barriers and ensure that women in underserved areas have access to essential healthcare services.

2. Community Health Workers: Training and deploying community health workers who can provide education, support, and basic healthcare services to pregnant women and new mothers in their own communities. Community health workers can help bridge the gap between healthcare facilities and the community, improving access to maternal health services.

3. Telemedicine: Utilizing telemedicine technology to provide remote consultations and follow-up care for pregnant women. This would be particularly beneficial for women in rural or remote areas who may have limited access to healthcare facilities.

4. Maternal Health Education Campaigns: Implementing evidence-based communication campaigns, similar to the one described in the provided information, to raise awareness about maternal health, including the importance of proper hygiene practices, prenatal care, and seeking medical help for maternal and child health issues.

5. Improving Water, Sanitation, and Hygiene (WASH) Infrastructure: Investing in the development and improvement of WASH infrastructure, such as clean water sources, sanitation facilities, and handwashing stations, in healthcare facilities and communities. This would help prevent the spread of diseases and improve overall maternal and child health outcomes.

6. Strengthening Health Systems: Investing in the overall strengthening of health systems, including training healthcare providers, improving supply chains for essential maternal health commodities, and ensuring the availability of quality maternal health services in healthcare facilities.

It’s important to note that the specific recommendations for improving access to maternal health would depend on the local context, resources available, and the specific challenges faced in the target population.

AI Innovations Description

Based on the provided description, the recommendation to improve access to maternal health and reduce childhood diarrhea in Tanzania is to implement an evidence-based communication campaign focused on promoting optimal water, sanitation, and hygiene (WASH) behaviors and knowledge.

The campaign should include the following components:

1. Support groups: Establish support groups where caregivers can learn and share knowledge about WASH practices and maternal health. These groups can provide a platform for discussing challenges, exchanging ideas, and receiving support.

2. Mobile outreach clinics: Set up mobile clinics that visit communities to provide healthcare services, including education on WASH practices and maternal health. These clinics can offer medical check-ups, vaccinations, and counseling to caregivers.

3. Home visits: Conduct home visits by trained healthcare workers to educate caregivers on proper WASH practices and provide personalized guidance. These visits can also help identify and address specific challenges faced by households.

4. WASH intervention training: Provide training sessions on WASH practices to caregivers, emphasizing the importance of handwashing after assisting a child who has defecated, before preparing food, and before feeding a child. This training should also cover optimal stool disposal methods and access to clean water sources.

5. Media campaign: Launch a media campaign using radio and television to reach a wider audience. The campaign should focus on raising awareness about the importance of WASH practices and maternal health, and provide practical tips and guidance.

By implementing these recommendations, it is expected that caregivers will have improved knowledge and awareness of WASH practices, leading to better hygiene behaviors and reduced incidence of childhood diarrhea. This, in turn, can contribute to improved maternal and child health outcomes in Tanzania.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Implement targeted educational campaigns: Develop evidence-based communication campaigns that specifically focus on educating mothers and caregivers about the importance of handwashing after assisting a child who has defecated, before preparing food, and before feeding a child. These campaigns can be delivered through various channels such as support groups, mobile outreach clinics, home visits, and media campaigns.

2. Strengthen community-based interventions: Enhance community-based interventions that promote optimal health behaviors and knowledge regarding water, sanitation, and hygiene (WASH) practices. This can include training programs on WASH interventions, establishing handwashing stations in homes, and ensuring access to clean water sources.

3. Improve care-seeking behaviors: Address barriers to seeking medical care for children with diarrhea by raising awareness among fathers and male caregivers about the importance of seeking medical care promptly. This can be done through targeted messaging and educational programs that emphasize the benefits of seeking medical treatment for diarrheal diseases.

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

1. Define the indicators: Identify key indicators that reflect improved access to maternal health, such as reduced incidence of childhood diarrhea, increased knowledge and adoption of proper handwashing practices, and increased utilization of medical care for diarrheal diseases.

2. Data collection: Collect baseline data on the selected indicators before implementing the recommendations. This can be done through surveys or other data collection methods, similar to the approach described in the provided study.

3. Intervention implementation: Implement the recommended interventions, such as educational campaigns and community-based interventions, in the target population.

4. Post-intervention data collection: After a sufficient period of time, collect data on the indicators again to assess the impact of the interventions. This can be done using the same data collection methods as in the baseline data collection.

5. Data analysis: Analyze the data using appropriate statistical methods, such as logistic regression, to measure the associations between the interventions and the selected indicators. Adjust the models for relevant confounding factors, such as maternal age, education level, and household wealth, as described in the provided study.

6. Interpretation of results: Interpret the findings to determine the effectiveness of the interventions in improving access to maternal health. Assess the significance of the associations and calculate odds ratios, p-values, and confidence intervals to quantify the strength of the impact.

7. Recommendations and further actions: Based on the results, make recommendations for scaling up successful interventions and identify areas for further improvement. This can inform future policies and programs aimed at improving access to maternal health.

It is important to note that this methodology is a general framework and may need to be adapted based on the specific context and resources available for the evaluation.

Autor

Dima Health

Statistics:

Citations: 3

Identifiers:

DOI: 10.3390/ijerph18094681

ISSN: 16617827

Research Areas:

Community Interventions, Environmental, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Tanzania

Study Design:

Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Male & Female

Partilhar isto: