背景:手部卫生在卫生保健中心和学校中对于避免疾病传播至关重要。目前,在旷日持久的冲突环境中,对此类设施的手部卫生知之甚少。
目的:本方案旨在评估多组分手部卫生干预对洗手行为的有效性,潜在的行为因素,以及医护人员和学生的福祉。此外,我们透明地报告我们的方法和统计分析计划。
方法:这是一项集群随机对照试验,在4个国家进行2个平行组,为期1年。在布基纳法索和马里,我们在每个国家的24个初级卫生保健中心工作,而在尼日利亚和巴勒斯坦,我们专注于每个国家的26所小学。如果设施没有连接到正常运行的水源,但被视为执行伙伴可以使用,则这些设施符合资格。此外,医疗保健中心如果有产科病房和≥5名员工,就有资格,和学校,如果他们有≤7000名学生在5至7年级学习。我们使用协变量约束随机化来分配接受硬件的干预设施,管理和监测支持,和行为改变。控制设施将在端线数据收集后接受相同或改进的干预。为了评估干预措施,在基线和终点,我们用了一个自我报告的调查,结构化洗手观察,和手冲洗样品。在后续行动中,手动冲洗样品被丢弃。从干预实施入手,我们收集了与卫生相关的健康状况和旷工的纵向数据.我们还通过焦点小组讨论和访谈收集了定性数据。对数据进行描述性分析,并使用随机效应回归模型在聚类水平进行随机效应分析。保健中心的主要结果是洗手率,定义为在世界卫生组织的5个手部卫生时刻之一,医护人员使用肥皂或酒精为基础的手擦进行良好洗手的次数,除以观察后一小时内患者互动过程中出现的手部卫生时刻的数量。对于学校来说,主要结果是吃饭前洗手的学生人数。
结果:所有国家的基线数据收集从2023年2月持续到6月。我们从布基纳法索和马里的135和174名医护人员那里收集了数据,分别。在尼日利亚,我们收集了1300名学生和1127名巴勒斯坦学生的数据。终点线数据收集始于2024年2月。
结论:这是调查长期冲突环境中初级卫生保健中心和学校手卫生的首批研究之一。凭借我们强大的学习设计,我们期望支持当地决策者和人道主义组织制定可持续的卫生促进议程。
背景:ClinicalTrials.govNCT05946980(布基纳法索和马里);https://www.clinicaltrials.gov/study/NCT0594680和NCT05964478(尼日利亚和巴勒斯坦);https://www.clinicaltrials.gov/研究/NCT05964478。
■DERR1-10.2196/52959。
BACKGROUND: Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings.
OBJECTIVE: This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently.
METHODS: This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ≥5 employees, and schools if they had ≤7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating.
RESULTS: The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024.
CONCLUSIONS: This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion.
BACKGROUND: ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478.
UNASSIGNED: DERR1-10.2196/52959.