This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies. Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components. Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap. None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health. Plain language summary Community‐based approaches are most effective in promoting changes in hygiene practices, but sustainability is a challengeCommunity‐based approaches to promote handwashing and sanitation efforts seem to work better than social marketing, messaging and interventions based on psychosocial theory. Programs combining hygiene and sanitation measures appears to have a larger impact than either one alone. What is this review about?Diarrhoeal diseases are very common causes of death in low and middle‐income countries. Improved sanitation and hygiene reduce diarrhoea, but adoption remains a challenge.This review assesses the evidence for two questions: (1) how effective are different approaches to promote handwashing and sanitation behaviour change; and (2) what factors influence the implementation of these approaches? What studies are included?Studies of effectiveness had to be impact evaluations using an experimental or quasi‐experimental design and analytical observational studies. Implementation studies used qualitative designs.Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa. What are the main findings of this review?Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.Sanitation and hygiene messaging with a focus on hand...

This study focused on an 80% ethanol:water extract of Galenia africana and Dicerothamnus rhinocerotis in which a phytochemical study revealed the presence of flavonoids as the major secondary plant metabolites. Eleven pure flavonoids viz., (E)-2',4'-dihydroxychalcone 1, (S)-7-hydroxyflavanone 2, (E)-2',4'-dihydroxy-2,3-dihydrochalcone 3, (S)-5,7-dihydroxyflavanone 4, (S)-2',5,7,-trihydroxyflavanone 5, (S)-5,7-dihydroxy-2'-methoxyflavanone 6, 5,7-dihydroxy-4H-chromen-4-one 7, (S)-5-hydroxy-7-methoxyflavanone 8 and (E)-2-hydroxy-3',6'-dimethoxychalcone 9 were isolated from G. africana, while [sakuranetin] (S)-4',5-dihydroxy-7-methoxyflavanone 10 and [eriodictyol-3',7-dimethyl ether] (S)-4',5-dihydroxy-3',7-dimethoxyflavanone 11 were isolated from D. rhinocerotis. Compounds 6 and 9 are new while this is the first reported isolation of 1, 2, 3, 4, 5, 7, 8, 10 and 11 from these plants. All isolated compounds were tested for their antimycobacterial activity against the reference strain Mtb H37Rv. The most active compound, 9, demonstrated a MIC 99 of 5 µM against Mtb H37Rv American Type Culture (ATCC) and (ATCC27294), which were also sensitive to Isoniazid (INH) and Rifampicin. The antibacterial activity of 9 might be ascribed to the presence of features such as the α,β-unsaturated ketone and the substitution patterns on the A and B rings.

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The study provides evidence that use of wood likely to contain CCA as a fuel for informal food outlets and household purposes may increase the absorption of inorganic As, Cu and Cr.

ObjectivesDespite significant advances in the science of quality of care measurement over the last decade, approaches to developing quality of care indicators for global health priorities are not clearly defined. We conducted a scoping review of concepts and methods used to develop quality of healthcare indicators to better inform ongoing efforts towards a more harmonised approach to quality of care indicator development in global health.MethodsWe conducted a systematic search of electronic databases, grey literature and references for articles on developing quality of care indicators for routine monitoring in all healthcare settings and populations, published in English between 2010 and 2020. We used well-established methods for article screening and selection, data extraction and management. Results were summarised using a descriptive analysis and a narrative synthesis.ResultsThe 221 selected articles were largely from high-income settings (89%), particularly the USA (46%), Canada (9%), UK (9%) and Europe (17%). Quality of care indicators were developed mainly for healthcare providers (56%), for benchmarking or quality assurance (37%) and quality improvement (29%), in hospitals (32%) and primary care (26%), across many diseases. The terms ‘quality indicator’ and ‘quality measure’ were the most frequently encountered terms (50% and 21%, respectively). Systematic approaches for quality of care indicator development emerged within national quality of care systems or through cross-country collaborations in high-income settings. Maternal, neonatal and child health (33%), mental health (26%) and primary care (57%) studies applied most components of systematic approaches, but not consistently or rigorously.DiscussionThe current evidence shows variations in concepts and approaches to developing quality of care indicators, with development and application mainly in high-income countries.ConclusionAdditional efforts are needed to propose ‘best-practice’ conceptual frameworks and methods for developing quality of care indicators to improve their utility in global health measurement.