Limited handwashing facility and associated factors in sub-Saharan Africa: pooled prevalence and multilevel analysis of 29 sub-Saharan Africa countries from demographic health survey data

BMC Public Health, Volume 22, No. 1, Year 2022

Interpretação

Introduction: Handwashing is fundamentally an inexpensive means of reducing the spread of communicable diseases. In developing countries, many people die due to infectious diseases that could be prevented by proper hand hygiene. The recent coronavirus (COVID-19) pandemic is a threat to people who are living in resource-limited countries including sub-Saharan Africa (SSA). Effective hand hygiene requires sufficient water from reliable sources, preferably accessible on premises, and access to handwashing facility (water and or soap) that enable hygiene behaviors. Therefore, this study aims to determine the prevalence of limited handwashing facility and its associated factors in sub-Saharan Africa. Methods: Data from the Demographic and Health Surveys (DHS) were used, which have been conducted in 29 sub-Saharan African countries since January 1, 2010. A two-stage stratified random cluster sampling strategy was used to collect the data. This study comprised a total of 237,983 weighted samples. The mixed effect logistic regression model with a cluster-level random intercept was fitted. Meta-analysis and sub-group analysis were performed to establish the pooled prevalence. Results: The pooled prevalence of limited handwashing facility was found to be 66.16% (95% CI; 59.67%—72.65%). Based on the final model, household head with age group between 35 and 60 [AOR = 0.89, 95% CI; 0.86—0.91], households with mobile type of hand washing facility [AOR = 1.73, 95% CI; 1.70—1.77], unimproved sanitation facility [AOR = 1.58, 95% CI; 1.55—1.62], water access more than 30 min round trip [AOR = 1.16, 95% CI; 1.13—1.19], urban residential area [AOR = 2.08, 95% CI; 2.04—2.13], low media exposure [AOR = 1.47, 95% CI; 1.31—1.66], low educational level [AOR = 1.30, 95% CI; 1.14—1.48], low income level [AOR = 2.41, 95% CI; 2.33—2.49] as well as lower middle-income level [AOR = 2.10, 95% CI; 2.14—2.17] and households who had more than three children [AOR = 1.25, 95% CI; 1.20—1.31] were associated with having limited handwashing facility. Conclusion and recommendation: The pooled coverage of limited handwashing facility was high in sub-Saharan Africa. Raising awareness of the community and promoting access to handwashing materials particularly in poorer and rural areas will reduce its coverage. The Demographic and Health Surveys (DHS) program began in 1984 [20]. It is a nationally representative cross-sectional household survey conducted in low- and middle-income countries. We have used Demographic and Health Surveys (DHS) data which was conducted from 1st January 2010 to 31st December 2016 in 29 sub-Saharan African countries [21]. The survey is designed to collect information about maternal and child health, nutrition, household characteristics and other health issues. For comparison, the DHS survey adheres to the same basic protocols throughout the country. Households in DHS are selected using a two-stage cluster sampling methodology. In the first stage, cluster enumeration areas (EAs) (typically villages in rural areas or blocks in urban areas) were sampled using a probability proportional to the population size technique. In the second stage, all households in the selected area were listed, and then 25–30 households were chosen at random for interviews. This sampling strategy was utilized to get a representative sample of households. A total of 237,983 weighted samples were included in the study. All households located in sub-Saharan African countries were the source of population, while households found in 29 sub-Saharan African countries at the time of the DHS survey were the study population. The outcome of this study was a limited handwashing facility. DHS collected information on handwashing facility, such as the place where handwashing facility found, whether fixed (such as Sink with tap and Tube with outlets) or mobile (such as Tippy tap, Raised bucket with tap/ outlet, Two buckets suspended, Suspended bottle or bag with outlet/hole/ pop-up plug and Foot pump sink). Furthermore, data on the presence of water, soap, and any detergents (ash, mud, or sand) on the premises were gathered through face-to-face interviews and observation. Based on this information, households with both fixed and mobile places and household members washing their hands without water and or soap (confirmed by observation) at the time of the interview, were considered as “having limited handwashing facility” [22]. Individual and household level variables for limited handwashing facility extraction included the following; age of household head, sex of household head, marital status of the household head, household size, household wealth index, educational status of household head, floor material type (standard vs. substandard) [11], place of handwashing facility (fixed vs. mobile), water sources, sanitation facility and the number of under-five children in the household. Community-level factors that affected the availability of limited handwashing facility were place of residence, region, community-level education, income level, and community media exposure. Some of the individual variables were taken directly from DHS such as the sex of the household head. Other variables were computed and categorized further. The operational definition and coding of variables are summarized in the supplementary table (S 1& S 2). We have used STATA version 14.0 software to extract and analyze the data. After the samples were weighted, descriptive statistics were performed. Because of the hierarchical and clustering nature of the DHS data, a mixed effect multilevel logistic model was used. A cluster-level random intercept was utilized to determine the difference in limited handwashing facility between clusters. Meta-analysis was conducted to determine the pooled prevalence of limited handwashing facility in sub-Saharan Africa, as well as sub-group analysis by region, income level, and year of the survey were also employed. Four models were fitted in the multilevel analysis. The first was a null model (Model 1) that was designed to check the variability in limited handwashing facility and which only contains the outcome variable. Model 2 and Model 3 were for individual/household and community-level variables, respectively. In the fourth model (Model 4), both the community and individual/ household variables were fitted simultaneously. Model comparison was done using deviance and the model with the lowest deviance was chosen as the best-fitting model. Permission for data was obtained from the DHS program (https://dhsprogram.com/data/available-datasets.cfm). On the website, a request was made. The researchers had no ethical concerns since the DHS program handled ethical issues both before and throughout the survey.

AI Digest

Study Justification:

– Handwashing is an inexpensive and effective way to prevent the spread of communicable diseases.
– Many people in developing countries, including sub-Saharan Africa, die from infectious diseases that could be prevented by proper hand hygiene.
– The recent COVID-19 pandemic has highlighted the importance of hand hygiene, especially in resource-limited countries.
– This study aims to determine the prevalence of limited handwashing facilities and identify associated factors in sub-Saharan Africa.

Study Highlights:

– The study used data from the Demographic and Health Surveys conducted in 29 sub-Saharan African countries.
– A total of 237,983 weighted samples were included in the study.
– The pooled prevalence of limited handwashing facilities in sub-Saharan Africa was found to be 66.16%.
– Factors associated with limited handwashing facilities included age of household head, type of handwashing facility, sanitation facility, water access, residential area, media exposure, educational level, income level, and number of children in the household.

Recommendations:

– Raise awareness in the community about the importance of handwashing and promote access to handwashing materials.
– Focus on improving handwashing facilities in poorer and rural areas.
– Ensure reliable access to water sources and sanitation facilities.
– Increase media exposure and educational opportunities to promote hand hygiene.
– Implement policies and programs to address the factors associated with limited handwashing facilities.

Key Role Players:

– Government agencies responsible for public health and sanitation.
– Non-governmental organizations (NGOs) working in the field of hygiene and sanitation.
– Community leaders and influencers.
– Health professionals and educators.
– Researchers and academics specializing in public health and hygiene.

Cost Items for Planning Recommendations:

– Awareness campaigns and educational materials.
– Infrastructure development for handwashing facilities, including sinks, taps, and soap dispensers.
– Water supply and sanitation system improvements.
– Training programs for health professionals and educators.
– Research and monitoring activities to assess the effectiveness of interventions.
– Administrative and logistical support for implementing policies and programs.

Força da prova

N/A

Resumo

The Demographic and Health Surveys (DHS) program began in 1984 [20]. It is a nationally representative cross-sectional household survey conducted in low- and middle-income countries. We have used Demographic and Health Surveys (DHS) data which was conducted from 1st January 2010 to 31st December 2016 in 29 sub-Saharan African countries [21]. The survey is designed to collect information about maternal and child health, nutrition, household characteristics and other health issues. For comparison, the DHS survey adheres to the same basic protocols throughout the country. Households in DHS are selected using a two-stage cluster sampling methodology. In the first stage, cluster enumeration areas (EAs) (typically villages in rural areas or blocks in urban areas) were sampled using a probability proportional to the population size technique. In the second stage, all households in the selected area were listed, and then 25–30 households were chosen at random for interviews. This sampling strategy was utilized to get a representative sample of households. A total of 237,983 weighted samples were included in the study. All households located in sub-Saharan African countries were the source of population, while households found in 29 sub-Saharan African countries at the time of the DHS survey were the study population. The outcome of this study was a limited handwashing facility. DHS collected information on handwashing facility, such as the place where handwashing facility found, whether fixed (such as Sink with tap and Tube with outlets) or mobile (such as Tippy tap, Raised bucket with tap/ outlet, Two buckets suspended, Suspended bottle or bag with outlet/hole/ pop-up plug and Foot pump sink). Furthermore, data on the presence of water, soap, and any detergents (ash, mud, or sand) on the premises were gathered through face-to-face interviews and observation. Based on this information, households with both fixed and mobile places and household members washing their hands without water and or soap (confirmed by observation) at the time of the interview, were considered as “having limited handwashing facility” [22]. Individual and household level variables for limited handwashing facility extraction included the following; age of household head, sex of household head, marital status of the household head, household size, household wealth index, educational status of household head, floor material type (standard vs. substandard) [11], place of handwashing facility (fixed vs. mobile), water sources, sanitation facility and the number of under-five children in the household. Community-level factors that affected the availability of limited handwashing facility were place of residence, region, community-level education, income level, and community media exposure. Some of the individual variables were taken directly from DHS such as the sex of the household head. Other variables were computed and categorized further. The operational definition and coding of variables are summarized in the supplementary table (S 1& S 2). We have used STATA version 14.0 software to extract and analyze the data. After the samples were weighted, descriptive statistics were performed. Because of the hierarchical and clustering nature of the DHS data, a mixed effect multilevel logistic model was used. A cluster-level random intercept was utilized to determine the difference in limited handwashing facility between clusters. Meta-analysis was conducted to determine the pooled prevalence of limited handwashing facility in sub-Saharan Africa, as well as sub-group analysis by region, income level, and year of the survey were also employed. Four models were fitted in the multilevel analysis. The first was a null model (Model 1) that was designed to check the variability in limited handwashing facility and which only contains the outcome variable. Model 2 and Model 3 were for individual/household and community-level variables, respectively. In the fourth model (Model 4), both the community and individual/ household variables were fitted simultaneously. Model comparison was done using deviance and the model with the lowest deviance was chosen as the best-fitting model. Permission for data was obtained from the DHS program (https://dhsprogram.com/data/available-datasets.cfm). On the website, a request was made. The researchers had no ethical concerns since the DHS program handled ethical issues both before and throughout the survey.

Materiais

https://efashare.b-cdn.net/materials/0f3606175dea27799a3fee2e03259cbfc94dc4b401278e4cdce1f8735d772b8a/12889_2022_14390_MOESM1_ESM.docx

Inovações

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

1. Mobile Handwashing Facilities: Develop and promote portable handwashing facilities that are easy to transport and set up, particularly in resource-limited areas. These facilities should provide access to water and soap, enabling proper hand hygiene for healthcare providers and pregnant women.

2. Community Awareness Campaigns: Implement targeted awareness campaigns to educate communities about the importance of handwashing in preventing the spread of infectious diseases, including maternal health complications. These campaigns should emphasize the benefits of proper hand hygiene during pregnancy and childbirth.

3. Improved Sanitation Facilities: Focus on improving sanitation facilities in households and healthcare facilities to ensure access to clean water and proper waste management. This includes the availability of functional toilets and handwashing stations with soap and water.

4. Infrastructure Development: Invest in infrastructure development to improve access to reliable water sources in rural and low-income areas. This could involve building water supply systems, wells, or rainwater harvesting systems to ensure a sustainable and accessible water supply for handwashing.

5. Behavior Change Interventions: Implement behavior change interventions that promote regular handwashing practices among pregnant women, healthcare providers, and community members. This could include educational programs, reminders, and incentives to encourage consistent hand hygiene.

6. Partnerships and Collaboration: Foster partnerships between government agencies, non-profit organizations, and private sectors to pool resources and expertise in addressing the challenges of limited handwashing facilities. Collaborative efforts can lead to innovative solutions and sustainable improvements in maternal health access.

It is important to note that these recommendations are based on the information provided and may need to be further evaluated and tailored to specific contexts and resources available in sub-Saharan Africa.

AI Innovations Description

Based on the research findings, the recommendation to improve access to maternal health in sub-Saharan Africa is to focus on raising awareness and promoting access to handwashing materials, particularly in poorer and rural areas. This can help reduce the prevalence of limited handwashing facilities, which is a significant factor in the spread of communicable diseases and maternal health risks.

Specific actions that can be taken include:

1. Community awareness campaigns: Implement educational programs and campaigns to raise awareness about the importance of hand hygiene in preventing the spread of diseases. This can be done through community meetings, radio broadcasts, and other local communication channels.

2. Infrastructure development: Improve access to handwashing facilities by providing reliable water sources and promoting the installation of fixed handwashing facilities in households, healthcare facilities, and public spaces. This may involve working with local authorities and organizations to ensure the availability of water and soap in these locations.

3. Targeted interventions: Focus on reaching vulnerable populations, such as households with low income levels, low educational levels, and larger numbers of children. Provide targeted support and resources to these households to improve their access to handwashing facilities and promote proper hand hygiene practices.

4. Collaboration and partnerships: Engage with local communities, healthcare providers, NGOs, and other stakeholders to develop and implement sustainable solutions. Collaboration can help leverage resources, expertise, and knowledge to address the challenges of limited handwashing facilities and improve access to maternal health services.

5. Monitoring and evaluation: Establish mechanisms to monitor the progress and impact of interventions aimed at improving access to handwashing facilities. Regularly evaluate the effectiveness of these interventions and make necessary adjustments to ensure their success.

By implementing these recommendations, it is possible to enhance access to maternal health services and reduce the prevalence of limited handwashing facilities, ultimately improving the overall health and well-being of mothers and their children in sub-Saharan Africa.

AI Innovations Methodology

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

1. Increase awareness: Raise awareness among communities about the importance of hand hygiene in preventing the spread of infectious diseases, including maternal health-related issues. This can be done through educational campaigns, community outreach programs, and media platforms.

2. Improve infrastructure: Enhance access to handwashing facilities by improving infrastructure, such as installing more fixed handwashing stations in public places, healthcare facilities, and households. Additionally, promote the use of mobile handwashing facilities, like tippy taps, in areas where fixed facilities are not feasible.

3. Ensure water availability: Address water scarcity issues by improving access to reliable water sources, especially in rural and resource-limited areas. This can involve implementing water supply projects, drilling wells, or providing water storage solutions.

4. Provide soap and hygiene materials: Ensure the availability of soap and other hygiene materials, such as sanitizers or detergents, in healthcare facilities and households. This can be achieved through partnerships with local organizations, government initiatives, or donation programs.

5. Target vulnerable populations: Focus on reaching vulnerable populations, such as those living in poverty, rural areas, or with limited education. Tailor interventions to their specific needs and provide support in terms of education, resources, and access to healthcare services.

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

1. Define indicators: Identify key indicators that reflect access to maternal health, such as the percentage of households with adequate handwashing facilities, the availability of water and soap in healthcare facilities, or the level of awareness about hand hygiene among pregnant women.

2. Data collection: Collect baseline data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources, such as the Demographic and Health Surveys (DHS) program.

3. Implement interventions: Implement the recommended interventions, such as awareness campaigns, infrastructure improvements, and provision of hygiene materials. Ensure that interventions are targeted and tailored to specific populations and areas.

4. Monitor and evaluate: Continuously monitor and evaluate the impact of the interventions on the identified indicators. This can involve collecting data at regular intervals, conducting surveys or interviews, and analyzing the results.

5. Analyze and compare: Analyze the collected data to assess the changes in the identified indicators over time. Compare the post-intervention data with the baseline data to determine the impact of the recommendations on improving access to maternal health.

6. Adjust and refine: Based on the analysis, make adjustments and refinements to the interventions as needed. This can involve scaling up successful interventions, addressing any challenges or barriers identified, and continuously improving the strategies.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for further interventions and improvements.

Autor

Dima Health

Identifiers:

DOI: 10.1186/s12889-022-14390-4

Research Areas:

Community Interventions, COVID, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Social Determinants

Study Design:

Cross Sectional Study

Study Approach:

Mixed-methods, Quantitative, Systematic Review

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