Purpose The purpose of this paper is to identify how the introduction and dissemination of the 5S-KAIZEN-TQM approach positively influence the Egyptian health sector and its sustainability. It also seeks to encourage effective and efficient introduction of the 5S-KAIZEN-TQM approach into the health sectors of low- and middle-income countries. Design/methodology/approach The pilot program introducing the 5S-KAIZEN-TQM approach into five Egyptian public hospitals spanned over 13 months from January 2016 to February 2017. During the pilot program, a series of interventions occurred to introduce the approach, such as seminars on the 5S and KAIZEN approach, consultation visits and progress report meetings. Data and information were collected through conducting interviews, observing directly and evaluating the implementation progress of 5S-KAIZEN-TQM activities. Findings The study identified the following factors in effective and efficient dissemination of 5S-KAIZEN-TQM activities in the Egyptian health sector: restructuring the quality management structure to establish Quality Improvement Teams and Work Improvement Teams in hospitals, generating strong leadership and commitment among leaders, conducting effective in-house trainings on the 5S-KAIZEN-TQM approach, monitoring and following up on 5S-KAIZEN-TQM activities and introducing the 5S-KAIZEN-TQM approach using non-clinical sections, which could also influence the sustainability of the activities. Originality/value This study holds value in its clarification of meaningful ways to disseminate and encourage the sustainability of the 5S-KAIZEN-TQM approach in Egyptian public health facilities. Moreover, officials from the Ministry of Health and Population and hospital managers in Egypt can use the findings to plan and disseminate this approach nationwide.

Background: Giardia intestinalis (G. intestinalis) is one of the most common human enteric protozoa that infect Egyptian children, causing most of the diarrhoeic outbreaks worldwide. Identification of G. intestinalis assemblage is important because of its role in determining sources of infection, in understanding the ecological and clinical impact of giardiasis, and hence its management and control. Objective: Study of this cross-sectional sample aimed to determine the genotypes of G. intestinalis isolated from the feces of diarrhoeic children attending outpatient clinic of Zagazig University hospital. Subjects and Methods: A single fecal sample was collected from each child (n=126). All samples were subjected to microscopic examination by direct wet mount before and after formal-ethyl acetate concentration. Positive samples were amplified by nested PCR (nPCR) and sequenced for intra and inter assemblage identification targeting tpi gene. Results: Microscopic examination revealed detection of G. intestinalis in 38 samples (30.2%). In 36 (28.6%) samples there was assemblage B predominance in 34 (94.4%) isolates, among which 24 (70.6%) were subgenotype BIV and 10 (29.4%) were sub-genotype BIII. Only 2 (5.6%) samples had assemblage A; all of them were AII subgenotype. All studied patient`s demographic and clinical data showed no significant association with Giardia infection or prevailing Giardia assemblages. Conclusion: G. intestinalis is the prevailing intestinal pathogen in diarrhoeic Egyptian children, with Giardia assemblage B predominance. These findings necessitate physicians' attention and further genetic studies in Egypt and other endemic areas targeting different genetic loci, with the inclusion of larger population samples. This will lead to a better understanding of the ecological and clinical impact of giardiasis, its management and control. MATERIALS AND METHODS Study type and populations: This cross-sectional study sample included 126 children (5 to 12 years old),

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