Background Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts. Methods We conducted a qualitative assessment of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised a ‘hardware’ infrastructural component (provision of the Oxfam Handwashing Station) and a ‘software’ hygiene promotion package (Mum’s Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention. Results Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The implementation of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component. Conclusions The combination of a ‘hardware’ and ‘software’ intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.

Background Birth weight remains as one of the facing factors and one of the leading causes of child suffering worldwide. This is a major problem especially in low and middle income countries and most importantly in vulnerable populations like refugee. However, there is a limited evident as yet in the study area. Objective The aim of this study was to assess the birth weight and associated factors among host and refugee neonates at health facilities in Gambella Region. Methods A facility based comparative cross-sectional study was applied in host and refugee settings. A total of five hundred ninety six neonates were included in this study from February 1st, 2020 to March 31st, 2020 through multi-stages sampling technique. The data were collected using structured interview and documents review methods with structured questionnaires as instruments. Pretesting of the tool and training of data collectors and field supervision were made. Using statistical package for social science version 25, variables with p ≤ 0.05 from multiple linear regression analysis were declared as factors significantly associated with the birth weight. Furthermore, independent samples t-test was computed to compare the mean birth weights. Results The study resulted in 100% response rate. The mean birth weights were found to be significantly difference between host and refugee neonates with means of 3282.55 ± 415.97 grams and 3109.40 ± 635.10 grams respectively (m1-m2 = 173.15, 95% CI: (86.75, 259.56)). Several factors such as number of fetuses (β = -148.35, 95% CI: (-234.86, -61.83)), gestational age at delivery (β = 90.83, 95% CI: (66.72, 114.93)), household food security status (β = 166.33, 95% CI: (100.68, 231.97)), individual dietary diversity score (β = 88.75, 95% CI: (68.69, 108.81)) and pregnancy induced hypertension (β = -148.35, 95% CI: (-234.86, -61.83)) were found to be the most influential factors significantly associated with the birth weight. Conclusions In the study area, host neonates have larger mean birth weight than the refugee neonates. Number of fetuses, gestational age at delivery, household food security, individual dietary diversity score and pregnancy induced hypertension were factors influencing the birth weight.

Background: Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts. Methods: We conducted a process evaluation of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised an infrastructural component (provision of the Oxfam Handwashing Station) and a hygiene promotion package (Mum’s Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention. Results: Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The fidelity and dose of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component. Conclusions: The combination of a ‘hardware’ and ‘software’ intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.

Background: Birth weight remains as one of the facing factors and one of the leading causes of child suffering worldwide. This is a major problem especially in low and middle income countries and most importantly in vulnerable populations like refugee. However, there is a limited evident as yet in the study area. Objective: The aim of this study was to assess the birth weight and associated factors among host and refugee neonates at health facilities in Gambella Region. Methods: A facility based comparative cross-sectional study was applied in host and refugee settings. A total of five hundred ninety six neonates were included in this study from February 1 st , 2020 to March 31 st , 2020 through multi-stages sampling technique. The data were collected using structured interview and documents review methods with structured questionnaires as instruments. Pretesting of the tool and training of data collectors and field supervision were made. Using statistical package for social science version 25, variables with p<=0.05 from multiple linear regression analysis were declared as factors significantly associated with the birth weight. Furthermore, independent samples t-test was computed to compare the mean birth weights. Results : The study resulted in 100% response rate. The mean birth weights were found to be significantly difference between host and refugee neonates with means of 3282.55±415.97 grams and 3109.40±635.10 grams respectively (m 1 -m 2 = 173.15, 95% CI: (86.75, 259.56)). Several factors such as number of fetuses (β = -148.35, 95% CI: (-234.86, -61.83)), gestational age at delivery (β = 90.83, 95% CI: (66.72, 114.93)), household food security status (β = 166.33, 95% CI: (100.68, 231.97)), individual dietary diversity score (β = 88.75, 95% CI: (68.69, 108.81)) and pregnancy induced hypertension (β = -148.35, 95% CI: (-234.86, -61.83)) were found to be the most influential factors significantly associated with the birth weight. Conclusions: In the study area, host neonates have larger mean birth weight than the refugee neonates. Number of fetuses, gestational age at delivery, household food security, individual dietary diversity score and pregnancy induced hypertension were factors influencing the birth weight.