A pilot project: handwashing educational intervention decreases incidence of respiratory and diarrheal illnesses in a rural Malawi orphanage

Abstract

Children who live in orphanages represent a population particularly vulnerable to transmissible diseases. Handwashing interventions have proven efficacy for reducing the rate of transmission of common infectious diseases. Few studies have analyzed the delivery of health interventions for children in orphanages in sub-Saharan Africa. To address this gap, we conducted an ecological assessment and piloted a handwashing intervention in an orphanage in rural Malawi, focusing on caregiver knowledge and behaviors, child handwashing behaviors, and disease incidence. A secondary study aim was to demonstrate program feasibility for a future randomized controlled trial. Orphanage caregivers participated in a three-module educational intervention on handwashing based on WHO recommendations and workshops on how to teach the curriculum to children. Seventeen orphanage caregivers and 65 children were monitored for handwashing behavior and child disease incidence. Friedman’s tests were conducted to compare changes in caregiver knowledge and behaviors. Child handwashing behaviors and surveillance of child disease incidence were measured pre- and post-intervention. There were significant increases in caregiver hand hygiene knowledge. At six months post-intervention, handwashing with soap increased significantly among caregivers ( p < 0.001) and was observed in children. The incidence of acute respiratory infections decreased from 30% to 6% post-intervention, resulting in an 80% decrease. The incidence of diarrhea decreased from 9.2% to 6.2% post-intervention, resulting in a 33% decrease. A brief educational intervention may improve handwashing knowledge and behaviors and help to decrease the incidence of common infectious diseases in an orphanage in rural Malawi. In addition, the caregiver uptake of the intervention demonstrated feasibility for future studies.

Effect of handwashing with soap at crtitical times and home based water treatment in combating hot spot areas of childhood diarrhea in Ethiopia

“…This study revealed that there was a 45% (IRR: 0.55, 0.48, 0.61, P < 0.001) reduction of CHDincidence among households intervened with handwashing with soap at critical times, which is constituent with previous ndings reported a 42-47% reduction [31]. Another nding from Pakistan indicated a 53 %, diarrhea reduction [32] and a 33% in Malawi [33] despite the level of reduction varied. The variation in reduction might be due to caregivers' handwashing practices and knowledge on diarrhea prevention.…”

The Short-term Effects of Temperature on Infectious Diarrhea among Children under 5 Years Old in Jiangsu, China: A Time-series Study (2015–2019)

“…Moreover, the age and the education of the mother, the type of toilet facilities, non-exclusive breastfeeding and bottle feeding were also risk factors for diarrhea in children [24] . A clinical trial showed a significant reduction in parasite detection rates following water, sanitation, and hygiene interventions [25,26] . Fang et al had reported three high endemic regions of infectious diarrhea in Jiangsu Province from 2013 to 2017, which were Xuzhou, Yancheng and the border area between Wuxi and Suzhou [27] .…”

Hand hygiene knowledge and demonstrated technique among Malawian kindergarten children: A quasi‐experimental study

“…While the 5‐step strategy is a promising strategy to improve in school‐going children, there is limited information regarding school‐going children and the use of a five‐step handwashing technique among kindergarten children globally. In Malawi, assessments regarding hand hygiene have focused on different populations (adults) (Rissman et al, 2020 ; Sheth et al, 2010 ; Slekiene & Mosler, 2020 ). Therefore, it is essential to evaluate hand hygiene knowledge and demonstrated technique before and after the implementation of a hand hygiene programme and its sustainability among kindergarten students in Malawi.…”