Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units

Abstract

Recent national surveys in The United Republic of Tanzania have revealed poor standards of hygiene at birth in facilities. As more women opt for institutional delivery, improving basic hygiene becomes an essential part of preventative strategies for reducing puerperal and newborn sepsis. Our collaborative research in Zanzibar provides an in-depth picture of the state of hygiene on maternity wards to inform action. Hygiene was assessed in 2014 across all 37 facilities with a maternity unit in Zanzibar. We used a mixed methods approach, including structured and semi-structured interviews, and environmental microbiology. Data were analysed according to the WHO ‘cleans’ framework, focusing on the fundamental practices for prevention of newborn and maternal sepsis. For each ‘clean’ we explored the following enabling factors: knowledge, infrastructure (including equipment), staffing levels and policies. Composite indices were constructed for the enabling factors of the ‘cleans’ from the quantitative data: clean hands, cord cutting, and birth surface. Results from the qualitative tools were used to complement this information.Only 49% of facilities had the ‘infrastructural’ requirements to enable ‘clean hands’, with the availability of constant running water particularly lacking. Less than half (46%) of facilities met the ‘knowledge’ requirements for ensuring a ‘clean delivery surface’; six out of seven facilities had birthing surfaces that tested positive for multiple potential pathogens. Almost two thirds of facilities met the ‘infrastructure (equipment) requirement’ for ‘clean cord’; however, disposable cord clamps being frequently out of stock, often resulted in the use of non-sterile thread made of fabric. This mixed methods approach, and the analytical framework based on the WHO ‘cleans’ and the enabling factors, yielded practical information of direct relevance to action at local and ministerial levels. The same approach could be applied to collect and analyse data on infection prevention from maternity units in other contexts.

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

“…The project was a partnership between the University of Aberdeen, the London School of Hygiene and Tropical Medicine, and the Public Health Laboratory-Ivo De Carneri. Previous work in eight of these maternity wards found the majority had policies and basic material and infrastructure to perform HH but only 50% had received HH training in the previous year [25].…”

Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection

“…Subjects with mild inflammatory response mostly suffer from the local infection in the reproductive system, while those with severe inflammatory response may have sepsis and even septicopyemia, threatening the life 9. Therefore, effective measures should be actively taken in clinic to ensure the clinical therapeutic effect once puerperal infection occurs, thereby improving the prognosis of pregnant women, and minimizing the impact of puerperal infection on puerperae and neonates 10. In this study, in order to better investigate the occurrence, development, and prevention of puerperal infection, levels of inflammatory factors were compared between subjects with and without puerperal infection.…”

Water, Sanitation, and Hygiene Services in Public Health-Care Facilities in Indonesia: Adoption of World Health Organization/United Nations Children’s Fund Service Ladders to National Data Sets for a Sustainable Development Goal Baseline Assessment

“… 11 Importantly, both studies highlighted the need for further data collection, especially in Southeast Asia. 10 , 11 There are limited journal-published studies on WASH in HCFs mostly in Africa, 12 – 14 and rural Cambodia. 15 Efforts to establish a SDG baseline for WASH in HCFs have been underway in several countries, 1 but to our best knowledge, few studies have examined the condition of WASH in HCFs in the Southeast Asia region including Indonesia, except three WASH services in HCFs overview reports.…”