Background Handwashing prevalence in schools in Kenya is low due to lack of access to water and soap and lack of drive for handwashing. Soapy water made from detergent powder is an inexpensive alternative to bar soap and disgust and social norms change can be powerful drivers of handwashing, but their effectiveness has not been assessed in school setting. In Kenyan public schools, we evaluated an equipment-behavior change intervention’s effect on handwashing outcomes. We also monitored functionality of the Povu Poa prototypes to identify design improvements necessary for continued high usage in institutional settings. Methods The intervention included the “Povu Poa”, a new type of handwashing station that dispensed foaming soap and rinse water, combined with school-wide behavior change promotion based on disgust and social norms. In this stepped-wedge cluster-randomized trial, we randomly selected 30 schools and divided them into 3 groups of 10. Following baseline data collection, we delivered the intervention sequentially (Group 1: 3–5 weeks after baseline; Group 2: 6–8 weeks; Group 3: 19–24 weeks). We observed outcomes [1] availability of handwashing materials at handwashing places, and; 2) observed handwashing behavior after toilet use among schoolchildren) at baseline and in three follow-up rounds. We compared the outcomes between schools that had received the intervention and schools that had not yet received the intervention. Results Water and soap/soapy water were available at 2% of school visits before intervention, and at 42% of school visits after intervention.. Before intervention, we observed handwashing with water after 11% of 461 toilet use events; no one was observed to wash hands with soap/soapy water. After intervention, we observed handwashing after 62% of 383 toilet use events (PR = 5.96, 95% CI = 3.02, 11.76) and handwashing with soap/soapy water after 26% of events (PR incalculable). Foaming soap dispenser caps were cracked in 31% of all observations, but were typically still functional. Conclusions Our combined equipment-behavior intervention increased availability of handwashing materials and improved the compliance with handwashing after using the toilet, but handwashing with soap was still rare. Equipment durability must be improved for deployment in schools at scale. American Economic Association’s Registry for Randomized Controlled Trials; Trial Registry Number (TRN): AEARCTR-0000662; Date of Registry: April 14, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-019-6902-2) contains supplementary material, which is available to authorized users.

BackgroundA low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. However, its impact on child health has not yet been investigated. This study aimed to estimate the prevalence of delayed child growth and development in the affected areas and to determine the association between the violence and health among children aged 1–5 years.MethodsA total of 498 children aged 1–5 years were recruited. Intensity of conflict for each sub-district was calculated as the 6-year average number of incidents per 100,000 population per year and classified into quartiles. Growth indices were weight-for-age, height-for-age, and weight-for-height, while development was measured by the Denver Development Screening Test II (Thai version). Food insecurity, child-rearing practice, health service accessibility, household sanitation, and depression among the caregivers were assessed using screening scales and questionnaires. Contextual information such as average income and numbers of violent events in each sub-district was obtained from external sources.ResultsGrowth retardation was highly prevalent in the area as reported by rates of underweight, stunting, and wasting at 19.3%, 27.6% and 7.4%, respectively. The prevalence of developmental delay was also substantially high (37.1%). Multi-level analysis found no evidence of association between insurgency and health outcomes. However, children in areas with higher intensity of violence had a lower risk of delay in personal-social development (OR = 0.4; 95% CI = 0.2 - 0.9; p-value = 0.05).ConclusionUnlike war refugees and internally-displaced persons in camp-like settings, the relationship between level of armed conflict and growth and developmental delay among children aged 1–5 years could not be demonstrated in the community setting of this study where food supply had been minimally perturbed.

Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

In Thailand, the prevalence of smoking has steadily declined over the past 20 years, suggesting an effective tobacco control policy. However, the prevalence has recently stabilised and youth smoking now appears to be on the rise. Tobacco use is the third highest risk factor contributing to the burden of disease in the country. This is an issue of concern and led to the present review of tobacco control measures in Thailand. The present evidence-based review shows that Thailand's tobacco control measures are relatively strong and comply well with the WHO Framework Convention on Tobacco Control in terms of taxation, advertisement through popular media, and warning labels on cigarettes and other tobacco product packages. However, challenges remain in dealing with highly prevalent roll-your-own cigarettes, strict prohibition of tobacco sale to underage youths, household smoking, illicit trade of tobacco products, viable tobacco crop diversification for domestic tobacco growers and liability. If these challenges are met, the prevalence of tobacco consumption could possibly be further reduced.

Background and aims Vietnam implemented numerous measures to reduce the transmission of COVID-19 among school students, including study-at-home/self-quarantine. During the study-at-home period, adolescents may engage in more video gaming than usual, potentially contributing to gaming disorder. However, the regionally-representative prevalence of gaming disorder and its association with parenting practice and discipline practice have not been described. We assessed the prevalence of gaming disorder among Vietnamese adolescents during the initial 6 months of the COVID-19 pandemic and the associations between gaming disorder and parenting practice and discipline practice. Methods We conducted a school-based, self-administered cross-sectional survey of 2,084 students in Hanoi, Vietnam (response rate = 97.1%). The survey included standardized instruments translated from English to Vietnamese. We performed multilevel logistic regressions to assess the associations between parenting practice, discipline practice, and gaming disorder. Results The prevalence of gaming disorder among the respondents was 11.6%. Healthy parent-child relationship was protective against gaming disorder (Adj OR = 0.36; 95% CI = 0.21, 0.62). Non-supervision, non-discipline, violent discipline were positively associated with gaming disorder. Discussion and Conclusions We found associations between gaming disorder and parent-child relationship, parental supervision, and parental discipline. Future interventional studies should consider assessing the effect of fostering healthy parent-child relationships and appropriate discipline on the occurrence or prognosis of gaming disorders.

Background The term "transgender" refers to an individual whose gender identity is different from their sex assigned at birth, whereas the term "cisgender" refers to an individual whose gender identity is the same as their sex assigned at birth. In Thailand, studies on health outcomes and quality of life of Thai transgender youths have not included assessments from nationally-representative samples. The objective of this study is to assess the extent that behavioral health outcomes and exposure to violence varied by gender among respondents of the National School Survey on Alcohol Consumption, Substance Use and Other Health-Risk Behaviors. Methods We used data from a nationally-representative self-administered survey of secondary school students in years 7, 9 and 11 and classified participants as cisgender boys, cisgender girls, transgender boys, and transgender girls. Participants also answered questions on depressive experience, suicidality, sexual behaviors, alcohol and tobacco use, drug use, and past-year experience of violence. We analyzed data using descriptive statistics and modified multivariate Poisson regression with adjustment for sampling weights to calculate adjusted prevalence ratios (APR) with 95% confidence intervals. Results A total of 31,898 respondents (82.8% of those who returned complete and valid questionnaires) answered questions on sex and gender identity and were included in the analyses (n = 31,898 respondents), approximately 2.5% of whom identified as transgender. Transgender boys had a higher prevalence suicidal ideation than cisgender boys (APR = 2.97; 95% CI = 1.89, 4.67) and cisgender girls (APR = 2.29; 95% CI = 1.55, 3.40). Transgender girls were less likely than cisgender boys and girls to be ever drinkers, while transgender boys were more likely than cisgender boys and girls to be ever drinkers. Transgender girls had higher past-year exposure to sexual violence than cisgender boys (APR = 2.74; 95% CI = 1.52, 4.95) and cisgender girls (APR = 4.93; 95% CI = 2.52, 9.67). Conclusion We found disparities in behavioral health and experience of violence between transgender and cisgender adolescents in Thailand. The findings highlighted the need for program managers and policy makers to consider expanding local efforts to address health gaps in the LGBTQ community to also include school-going youth population.

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the post-intervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.

objective The behavioural effect of large-scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large-scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh.methods We analysed data from a cluster-randomised trial that included three arms: vaccine-andbehaviour-change intervention (VBC), vaccine-only (V) and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: (i) temporal variation in availability of soap and water at handwashing place; (ii) the use of water and soap by participants when asked to demonstrate handwashing, and; (iii) handwashing behaviour according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PRs) and 95% confidence intervals and compare outcomes by study arms.results Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (P-for-trends <0.001), and no significant trend during months 10-28 (P-fortrend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43%) than in V (23%) (PR = 1.92; CI = 1.72, 2.15) and Control (28%) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17%) than in V (8%) (PR = 1.47, CI = 0.58, 3.75) and Control (2%) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen transmission events, the prevalence of handwashing with soap was ≤3%.conclusion VBC households maintained soap and water for handwashing, but the prevalence of observed handwashing was low in all study arms. The results underscore the need to strengthen scalable behaviour change approaches.