Archives of Public Health

BackgroundEvidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance and neonatal sepsis remains unclear. We assessed the effect of WASH/MNCH integrated interventions on skilled birth attendance and incidence of neonatal Sepsis in a resource-constrained setting in Uganda. MethodsA quasi-experimental study design was conducted in Amuru district. The package of interventions implemented included; training of health workers, facilitation of integrated outreach services, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and skilled birth attendance, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on the incidence of sepsis, ANC and skilled birth attendance, and WASH status was also obtained from 6 healthcare facilities. A total of 12 key informant interviews and 12 Focus group discussions were also conducted. Data were imported into STATA 15 for analysis. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative was analyzed using thematic content analysis. ResultsThere was a significant increase in the number of women delivering at the health facilities that were supported by the project from 41.4% at baseline to 63.0% at endline (p= <0.0001). There was a reduction in the incidence of neonatal sepsis from 0.6% to 0.2% (p = 0.0687), although the difference was not significant. There was an increase in the percentage of households with sanitation facilities and improved hygiene practices. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% at baseline to 0.6% at endline, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline. ConclusionThis study revealed that integrated WASH/MNCH interventions can significantly increase ANC and skilled birth attendance, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC in the maternity wards and the capacity of healthcare workers to deliver clean and safe MNCH services can also be realized. We recommend the integration of WASH/MNCH interventions for projects aimed at improving skilled birth attendance and WASH practices and reduction of childhood infections.

ObjectiveThis scoping review protocol outlines the steps to conduct a scoping review to assess the health experiences of female head porters and their unique health challenges and needs. The review aims to broaden our understanding of the occupational health challenges facing head porters in sub-Saharan Africa and identify any gaps in the health literature related to this population. IntroductionHead portering is an informal occupation predominantly undertaken by women and girls in sub-Saharan Africa. Female head porters often lack education and skills, which makes head portering an appealing yet laborious occupation to improve income and associated social conditions and support families left behind. Inclusion criteriaStudies were included in the review if they included females of all ages engaging in head-portering activities as a livelihood in sub-Saharan Africa. Methods and AnalysisThe six stages of the Arksey and OMalley (2005) framework guided the design and reporting of this scoping review. The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for scoping reviews. Relevant articles and grey literature were identified through searches of health-related databases. The extracted data will be presented using a narrative summary to complement a data table. Ethics and disseminationThe ethical approval submission for this scoping review protocol was not completed as it is not required. Formal knowledge translation and dissemination activities will include publishing findings in African-based high-impact journals and conference presentations to reach relevant audiences. The final recommendations for practice, policy, and research will be shared and distributed through toolkits for healthcare professionals and stakeholder information leaflets. RegistrationThe review has been registered with Open Science Framework Registries: https://osf.io/c3q7as Strengths and LimitationsThis scoping review explores the literature on the health implications of head portering among female head porters, encompassing a broad range of studies and evidence. It aims to identify research gaps, highlight key health concerns requiring further investigation, and serve as a foundation for future reviews and primary studies. However, this review does not include a formal quality assessment of the included studies, which may impact the reliability of the findings. Due to its broad scope, detailed analyses of specific health issues may be limited. Additionally, the risk of selection and interpretation bias may constrain the depth of analytic synthesis, reducing its applicability for precise policy and practice recommendations.

ObjectiveHealthcare workers (HCWs) are at increased risk of COVID-19 infection and play a critical role in influencing public vaccine acceptance. This study aimed to assess vaccination coverage and identify the determinants of vaccine uptake among healthcare workers in Cameroon, in order to inform targeted strategies to strengthen immunization programs and improve epidemic preparedness. ResultsAmong 406 participants (75.6% female, 65.5% aged 30-44 years, 61.3% nurses), 42.4% were fully vaccinated against COVID-19, while only 4.7% had completed the cholera vaccine series. Coverage varied across districts, with Biyem-Assi (53.0%) and Odza (46.0%) recording the highest COVID-19 uptake, and Nkolndongo (11.5%) leading for cholera vaccination. Independent predictors of COVID-19 uptake included being a nurse (aOR = 3.96; 95% CI: 2.07-7.81; p = 0.001) and laboratory technician professions (aOR = 8.00; 95% CI: 1.38-69.8; p =0.032). For cholera vaccination, working in internal medicine wards (aOR=11.2; 95% CI: 1.04-120; p = 0.046) and being a nurse (aOR = 1.54; p = 0.001) emerged as significant predictors. Although 62.8% of HCWs perceived their work environment as high-risk, knowledge of recommended vaccines was limited, with only 18.7% aware of cholera vaccination recommendations. Strengthening vaccine education, improving accessibility, and reducing financial barriers could enhance vaccine acceptance among HCWs. These findings provide important insights for designing targeted immunization strategies in Cameroon and similar contexts.

BackgroundForeign caregivers are assuming increasing importance in Japan due to a significant shortage of caregivers. To secure and train stable human resources, it is important to understand the needs and challenges of foreign caregivers. ObjectiveTo identify the needs and challenges of Vietnamese technical interns, the largest group of foreign caregivers in Japan, to facilitate system reforms for foreign caregivers and a more efficient recruitment process. MethodsA semi-structured interview survey was conducted with 27 Vietnamese technical interns (caregivers). Interview items included reasons for choosing technical internship in Japan, desired length of stay, and expectations in Japan, as well as career advancement after returning home. Descriptive statistics and k-means clustering were used to analyze the data. ResultsSurvey results showed that all respondents had made their own decision to come to Japan and wanted to pursue caregiver certification; 44% had also considered other countries apart from Japan; most wanted to stay in Japan for as long as possible; 37% wanted to live in Japan permanently. The k-means method revealed three clusters: Japanophile cluster or those who preferred Japan for its landscape, culture, and national character; Word-of-mouth cluster or those influenced by personal referrals; and Intellectual cluster or those influenced by Japans economic development and care levels. ConclusionsVietnamese technical interns hoped to study advanced Japanese, become certified care workers, and work in the nursing field after returning to their home country. They also tended to want to stay in Japan for a longer period than that assumed for technical internship programs. Our findings indicate that support for obtaining qualifications, Japanese language skills, and caregiving skills are important to secure stable foreign caregivers. Since each cluster had different backgrounds and reasons, motives, and assumptions for coming to Japan, it is necessary to tailor recruitment, training, and support for each cluster.

BackgroundThe SARS-Cov-2 pandemic (COVID-19) sudden onset disrupted the direct access to face-to-face nutrition consultation fostering the rapid adoption of Telehealth by dietitians. ObjectiveThis study investigates Telehealth use among Lebanese Licensed Dietitians (LDs) amid COVID-19, in the absence of national Telehealth practical guidelines (TPG), and offers insights on Telehealth application under uncertainties of pandemic event, economic crisis, and destructed infrastructure occurring simultaneously in Lebanon. DesignA cross-sectional study during March 2023, using an anonymous online survey (44 questions), diffused through the Lebanese Order of Dietitians and social media platforms. ParticipantsThe sample (n=94) consisted mostly of females (98.9%) and young dietitians (mean(SD) age: 30.54(6.41) years) having a mean(SD) of 7.89(5.7) years of experience. Most respondents identified clinical nutrition as their primary practice area (87.2%), mostly in weight management (84%). Main outcome measuresTelehealth experience amid COVID-19 including tools utilized in remote consultations, barriers, facilitators, and perspectives of Telehealth use. Statistical analysesDescriptive analysis (counts, frequencies) using SPSS version 28. ResultsAlthough 48.4% of LDs reported using Telehealth prior COVID-19, this proportion increased to 97.8% during the pandemic. The most common tools used were WhatsApp (90.3%), Zoom (72.0%), and E-mails (41.9%). Reported barriers included bad internet connection (74.2%), patients preferring face-to-face consultation (61.3%), and patients lacking technical literacy (33.3%); benefits included scheduling and time flexibility (83.9%), decrease in practice-related costs (77.4%), and compliance with social distancing measures (53.8%). The majority agreed that Telehealth is needed (78.5%) and applicable in the Lebanese context (64.6%) and expressed the need for Telehealth trainings (78.5%) and TPG for nutrition care (74.2%). ConclusionsThis study recognizes increasing use of Telehealth in Lebanon, warranting the development of Telehealth nutrition care infrastructure comprising national regulations and evidence-based practical guidelines to respond to the innovation in the healthcare industry, and to assure Telehealth sustainability in LDs routine practice.

BackgroundChild wasting, or acute malnutrition, is a life-threatening condition that increases the risk of death and serious illness. Despite efforts such as the Global Action Plan on Child Wasting, which aims to reduce wasting prevalence to less than 3% by 2030, challenges persist, with Ethiopia recording a 7.2% rate. A major shortcoming of the global strategy is the focus on contact coverage, which often overlooks service quality. Effective coverage that incorporates the quality of health services offers a solution. ObjectiveTo assess the effective coverage of management of child wasting in six regions of Ethiopia. Data and MethodsWe conducted a secondary analysis of cross-sectional data obtained from household and institutional surveys. Participants included caregivers and children aged 6-59 months. By combining household data with expanded measures of health facility readiness and process quality from health posts, we calculated the quality-adjusted coverage. ResultsContact coverage for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) was 40% and 37%, respectively. Readiness scores for providing SAM and MAM services at health posts were 57.9% and 76.4%, respectively. The input-adjusted coverage for SAM and MAM, considering facility readiness, was 23% and 28%, respectively. The coverage adjusted for complete intervention receipt was 7% for SAM and 12% for MAM. Quality-adjusted coverage for both SAM and MAM was 4%. ConclusionEfforts to address acute malnutrition in the Ethiopian health system show commendable progress but also highlight critical gaps and inconsistencies. A holistic, quality-driven approach is needed to effectively combat child-wasting in Ethiopia. Strengths and limitations of this studyO_LIHousehold surveys and facility data were concurrently collected within the same year. This allowed for an effective comparison between the readiness of facilities and services provided for acute malnutrition at that time. C_LIO_LIThe selection of items for readiness and process quality was guided by WHO Service Availability and Readiness Assessment and the National Guideline for the Management of Acute Malnutrition. C_LIO_LIThe study included only health posts in selected IMAM districts. This restricts the generalizability of the findings, as the care characteristics and quality at these excluded facilities might differ significantly. C_LIO_LIAlthough the health facility survey was extensive, it did not capture all the necessary data for a holistic calculation of the care cascade, particularly missing information needed for user adherence-adjusted coverage and outcome-adjusted coverage. C_LI

BackgroundIn Uganda, the informal sector, particularly public markets, presents a concerning array of unregulated workplace hazards, predominantly affecting female traders. These hazards pose significant threats to the health of female market traders, who make up the majority of the workforce. However, there has been limited attention given to identifying and addressing the occupational risks faced by these women. This study aimed to assess the occupational hazards and the contributing factors to health effects among female market traders in Nakasero market, central Kampala. MethodsA descriptive cross-sectional study was conducted among female market traders in Nakasero market, central Kampala. The study employed a mixed-methods approach, utilizing both quantitative and qualitative methods. Data collection involved face-to-face, interviewer-administered, semi-structured questionnaires and key informant interviews. Quantitative data were analyzed using EPIDATA 3.02, STATA 14, and Microsoft Excel, while qualitative data were subjected to deductive thematic analysis. ResultsThe hazards encompassed biological risks, where a significant proportion reported suffering from mosquito bites within the market (87.36%), and urinary tract infections (UTIs) attributed to microorganisms stemming from unclean toilet facilities (80.46%). Furthermore, the investigation revealed the presence of physical, ergonomic, and psychological hazards, all of which posed a threat to the health of female market traders. Various factors contributed to the health effects experienced by these traders. Notably, many of them endured prolonged working hours without adequate rest or sleep, with 47% of female market traders spending over 12 hours in the market. The study also found that a majority of respondents failed to use personal protective equipment (PPE), totaling 70.49%. Additionally, a substantial portion (42%) admitted to not practicing proper hand hygiene while in the market. Issues related to sanitary facilities were prevalent, including a shortage of toilet stalls, unclean conditions, and occasional water shortages. Poor market infrastructure, inadequate working space, and overcrowding further compounded the challenges faced by female market traders. The health effects and problems reported by these traders encompassed a spectrum of issues, including musculoskeletal pain, malaria, UTIs, respiratory problems, COVID-19, skin conditions, headaches, and obesity. ConclusionThis study underscores the ongoing occupational hazards and health effects faced by female market traders in public markets throughout Uganda, arising from a combination of various contributing factors. Addressing these issues is crucial to safeguard the well-being of these women and improve their working conditions.

Breastfeeding has many benefits for the newborn and mother therefore, the World Health Organization guidelines recommend exclusive breastfeeding for the first 6 months, with continued breastfeeding for up to two years. However, exclusive breastfeeding rates in the first 6 months in Thailand were reported to be approximately, 14% in 2019. Research has highlighted that many mothers have a lack of belief in their ability to breastfeed, and some physical conditions, such as tiredness and difficulty continually holding their baby in a comfortable position. Additionally, first-time breastfeeding can contribute to mothers having difficulties breastfeeding during the early postnatal period. Therefore, the Arm sling innovation (device) has been designed to provide support and comfort whilst holding the newborn. This study compared the effectiveness of the breastfeeding arm sling innovation to support breastfeeding in cross-cradle hold position and normal cross-cradle hold position breastfeeding in first-time mothers. A quasi-experimental pretest-posttest research design was used to evaluate the effectiveness of breastfeeding before and after the intervention among first-time mothers in the postnatal unit, at Ramathibodi hospital, Thailand. A total of 46 postpartum mothers participated in the study. The results showed that the effectiveness of breastfeeding reported by mothers between using a normal cross-cradle hold position and using breastfeeding arm sling innovation was statistically significantly different (t = 4.32, P < 0.001) with helping to hold the baby securely without slipping (t=5.68, p<0.001) and mothers can continue to breastfeed (t=2.09, p <0.001). Majority of mothers were satisfied with the support of using the breastfeeding arm sling innovation design. The breastfeeding arm sling innovation contributes to the effectiveness of breastfeeding by assisting and supporting the mother and babys position to breastfeed more comfortably, thus assisting first-time mothers to feel comfortable, confident, and able to continue breastfeeding.

Using the Herzbergs Two-Factor Theory, this study explored factors influencing job satisfaction among nurses in a private hospital in Nigeria. Ten nurses were recruited through purposive sampling to participate in interviews. Data was analyzed in MAXQDA using a thematic analysis approach. Extrinsic (hygiene) factors (i.e., high workload, low salary, limited opportunities for career advancement) were noted by respondents as significant sources of dissatisfaction, while intrinsic (motivational) factors (i.e., autonomy, peer support, and recognition) enhanced job satisfaction. Findings offer insights into how systemic and interpersonal factors influence nurse satisfaction and provide evidence-based strategies for enhancing retention in low-resource, profit-driven healthcare environments.

ObjectiveTo assess the knowledge, attitude and Practices among healthcare workers towards covid-19 preventive measures at Women and New-born Hospital of the University Teaching Hospitals in Lusaka. MethodsCross-sectional study conducted at WNH-UTH, Lusaka. Convenient sample of 264 frontline healthcare workers responded to self-administered questionnaire to determine their knowledge, attitudes and practices on COVID-19 preventive measures. ResultsMajority (31.9%) of the respondents were aged 25 - 29 years. The study revealed that 63.4% had a good knowledge, 60.3% had positive attitudes and 59.9% had a good practice. Attitude was positively related with practice (r = 0.524, p < 0.001) and knowledge (r = 0.469; p < 0.001). Further, knowledge was positively correlated with practice (r = 0.51; p < 0.001). Bivariate analysis results showed that only high knowledge score (75.6%; p < 0.001) and high attitude score (77.6%; p < 0.001) was associated with an increase in good practice among healthcare workers towards Covid-19 preventive measures. ConclusionThe study showed the need for continued assessment of Knowledge Attitude and Practice among healthcare workers towards Covid-19 preventive measures. It further showed the need of designing interventions aimed at encouraging sustained compliance to preventive measures among healthcare workers to prevent COVID-19 transmission. ARTICLE SUMMARYO_ST_ABSStrengths and LimitationsC_ST_ABSThis study was conducted at Women and Newborn Hospital of the University of Zambia and described the Knowledge, Attitude and Practice among Healthcare workers towards Covid-109 preventive measures. The study showed the need for continued assessment of Knowledge Attitude and Practice among healthcare workers towards Covid-19 preventive measures. This study has the potential to yield significant benefits for the participants and the community at large. The study is reproducible and feasible with results which can be used in designing interventions aimed at encouraging use of preventive measures available to healthcare workers to prevent COVID-19 transmission. The study was a cross-sectional study which limits our ability to make causal inferences. Further the study was conducted at only one hospital which is located in the capital city and so the findings cannot be generalized to HCW in other parts of Zambia.

BackgroundMusculoskeletal disorders are growing public health problems both in developed and developing countries including Ethiopia. However, its prevention and control has not yet received due attention. This study aimed to determine. the prevalence and associated factors of musculoskeletal disorders musculoskeletal disorders among cleaners of health institutions in Gondar town, Northwest Ethiopia MethodAn institutional based cross-sectional study was conducted, from April to May 2016 in all health institutions of Gondar town. All the available cleaners of health institutions were taken as study participants. Data were collected by face-to-face interview technique after verbal informed consent. Additionally, weight and height of participants were measured following standard procedures. Data were collected by trained physiotherapists and then entered into a computer using Epi Info version 3.5.3 and exported to SPSS version 20 for analysis. Descriptive statistics was performed to describe the data in percentage and mean. Multiple logistic regressions were fitted and Odds ratios with 95% confidence intervals were calculated to identify associated factors. ResultsA total of 242 participants were included in this study. The majority of the study participants were females (79.3%) and between 25-44 age group (65.3%). Two hundred 0ne (83.1%) of the respondents reported that they had pain in at least one of the body parts in the previous 12 months. Of the nine body parts examined, neck (76%), upper back (40.5%) and lower back (45%) were the most frequently body parts reported to exhibit pain. Job status (AOR = 2.71, 95%CI; 1.37-5.36), and static work habit (AOR = 2.71, 95%CI; 1.37-5.36), were factors associated with musculoskeletal disorders. ConclusionThere is a high prevalence of musculoskeletal disorders among cleaners in the health institutions of Gondar Town. Job status and static work habit were the significant associated factors. Hence, we recommend the design and implementation of institution based screening programs for musculoskeletal disorders

BackgroundProviding patients with falls prevention education can improve their overall safety and reduce their risk of falling in hospital. Partnering with patients and staff in developing and evaluating such programs could better enable patient learning and translation of safety messages. AimTo create a revised version of the Safe Recovery falls prevention education program (SRP) in partnership with patients and hospital allied health staff, to improve patient engagement in undertaking strategies to reduce their risk of falling in hospital. MethodsTwo-phase sequential mixed methods participatory design. In phase 1 patient (n=10) and staff (n=10) consumer engagement surveys and discussions were undertaken to inform program revision. New resources (video and workbook) were co-produced and staff were trained to deliver the revised program to patients. In phase 2 patients (n=10) were surveyed pre and post revised program delivery and staff were surveyed regarding their reaction to the revised program. Deductive content analysis and Wilcoxon Signed Rank Tests were used respectively to analyse qualitative and quantitative findings. ResultsPatients and staff were very satisfied with the revised program, with patients demonstrating significant improvements in knowledge, awareness, motivation and intention to reduce their risk of falling. Staff perceived that the revised resources showed significant improvements in aesthetic appeal and ability to engage patients in learning. ConclusionPatients and staff contributed to successfully revising the Safe Recovery program with positive reactions to the co-produced resources. Participating in the revised program significantly improved patients knowledge and attitudes to reduce their risk of falling. Investigating the impact of the revised program on patients behaviour change and on reducing hospital falls is warranted.

BackgroundWater access and sanitation are two of the most fundamental critical urban services upon which people in cities depend. Lack of these services may pose a major threat of disease especially in low- and middle-income countries. Mwanza City in Tanzania faces serious challenges regarding to sanitation services to the public and occupational on mobile bases such as Boda-boda. Boda-boda drivers are mobile and often come up into contact with people which might lead to the spread of diseases through the fecal-oral route. Thus, the aim of this study was to determine the level of accessibility and the barriers to sanitation and hygiene among the boda-boda drivers in Mwanza city. MethodsThis was a community based cross sectional study carried out in Nyamagana District that involved a randomly selected 196 participants. Data were collected using a pretested questionnaire. Data was be analyzed for frequency distribution, proportion and percentages for quantitative variables, mean {+/-} SD. ResultsAlmost a quarter (27.05%) had difficulties towards accessing latrines when they needed to use one. This was almost in parallel with 27.04% of the participants claiming latrines are not convenient in the community. Almost thirty percent (32.14%) were not satisfied with the availability of clean latrines, 67.35% claimed there are community laws or rules in place that make it more likely them to use a latrine every time they need to defecate or urinate. 84.69% showed great awareness towards realizing the importance of using latrines instead of the opposite. ConclusionOur results indicate that some of the Boda-boda drivers claims that latrines are not accessible and convenient but also habit has been a limiting factor which makes them to practice open defecation. Thus, there is inevitable need for the authority to build more clean latrines and run them as a business oriented low-cost facility i.e., pay per use. Together with making strict laws that enforces the use of latrine among the boda-boda drivers should be a priority.

IntroductionIn Ireland, there has been a substantial recent investment in the Community Specialist Team for Older People (CST OP) service model. This approach provides timely integrated assessment and intervention for older adults in the community by a specialist multidisciplinary team. To inform the ongoing development and refinement of the CST OP service model, and ensure it is responsive to the needs and preferences of older adults, it is important to understand how older adults experience this new model of care. This qualitative descriptive study aims to resolve a research gap by exploring older adults experiences of the CST OP service model. MethodsA qualitative descriptive study design was employed to explore older adults experiences of the CST OP service model. Purposive non-probability sampling was used to recruit 13 older adults who had completed intervention with a CST OP intervention. All interviews were completed in participants own homes, audio recorded and transcribed verbatim. A reflexive approach to thematic analysis guided data analysis. FindingsThree themes were identified; older adults were uncertain about what to expect from the CST OP service and encountered accessibility barriers (theme1); the CST OP team provided coordinated, comprehensive care and built strong relationships with older adults (theme 2); CST OP intervention enabled older adults to better manage everyday activities and long-term conditions, thereby improving their wellbeing (theme 3). Discussion/ conclusionOur findings highlight the importance of CGA in community-based care for older adults. Further research is needed to address access barriers and evaluate older adults experiences with case management and care coordination in the CST OP service model.

BackgroundBackyard poultry-raising is common in rural Bangladeshi households. Raising poultry contributes to fecal contamination of the domestic environment, increasing childrens exposure to enteric pathogens, including Campylobacter, which has been associated with child stunting. ObjectiveTo investigate the effectiveness of a behavior change communication and counseling intervention to encourage households to confine poultry outside of the household dwelling in a shed at night and improve poultry feces management. MethodsWe conducted a two-arm pre-post pilot study. Households in both arms received the behavior change communication and counseling intervention. Households in the subsidy arm also received ~23 USD for the construction of a poultry shed for nighttime housing. We administered a household survey and spot-check before and after intervention implementation among 37 subsidy and 42 non-subsidy households. ResultsAt endline, 58% of all households had a poultry shed (87% of subsidy and 33% of non-subsidy households) and the percentage of households confining all poultry outside the house the previous night was significantly higher at endline (33%) compared to baseline (2.5%) (prevalence difference [PD]: 30 percentage points [pp]; 95% CI: [19, 41]). Additionally, more households had no visible poultry feces piles inside the house compared to baseline (PD: 26pp 95% CI: [12, 41]), but there were no significant differences in the number of poultry feces piles in the courtyard or veranda. DiscussionOur intervention effectively encouraged households to confine poultry outside of household dwellings at night and to maintain an indoor living space free of poultry feces. Households were willing and able to construct a shed even without a subsidy. Households that received a subsidy were more likely to construct a shed. Future studies should assess if housing all poultry outside the household dwelling reduces childrens exposure to poultry feces enough to mitigate health risks associated with poultry ownership.

IntroductionAccidental exposure to body fluids (AEBs) increases the risk of blood-borne infections among susceptible HCWs. While 90% of the AEB reported occur in developed nations, developing countries bear 90% of the burden of healthcare associated infections, especially those of sub-Saharan Africa. Social insecurity may contribute further to the vulnerability of HCWs. Our study sought to determine the prevalence, reporting and management of AEBs among HCWs in the security-challenged Region of South-West Cameroon. MethodsA cross-sectional study was carried out from February 2023 to April 2023, at the Buea Regional Hospital. Following informed consent, a 28-item interviewer-administered questionnaire to HCW was used. Data was entered and analyzed using R Statistics version 4.3.1. ResultsOut of the 230 HCWs that were approached, 200 were responded for a participation rate of >85%. The prevalence of AEB was high (93%). Exposures occurred while administering injections (37%), during blood sample collection (16%), delivery (11%), surgery (10.2%) and washing. The main risk factors for AEB included female gender (aOR=2.86) and those exercising in the medical (aOR=5.95), pediatrics (aOR=10.5), obstetrical (aOR=22.6), dental (aOR=26.3) units. Only 46.8% of AEBs were reported. Post-exposure management was carried out for 67.2% of the reported cases. Most HCW were unaware of the existence of an Infection Control Committee within the study setting, corroborating gaps in the observance of Standard Precautions. ConclusionsMost HCWs experienced AEBs over the last year. There is a need to sensitize and enforce the observance of universal precautions among HCW of the Buea Regional Hospital. Such measures should be extended to other health facilities in related settings.

BackgroundAchieving adequate nutrition for vulnerable populations is an objective of the Sustainable Development Goals. Nutrition-sensitive social protection programs, including those that promote nutrition through Social and Behaviour Change Communication (SBCC), have the potential to reduce malnutrition and provide social supports to those most in need. Country-level needs assessments can clarify key issues. When supported by co-design approaches, program formative research may provide more culturally contextualised SBCC for the improved delivery of nutrition social protection to vulnerable groups. This formative study from Pakistan and Bangladesh, integrated co-design to more fully explore program beneficiary knowledge, attitudes and perceptions toward nutrition social protection to inform the design of SBCC key messages and an entry-point platform to ensure effective message dissemination. MethodsQualitative formative research was conducted to support findings from a systematic review. Thirty semi-structured interviews with program stakeholders and 12 focus group discussions (134 participants) were conducted with program beneficiaries in Bangladesh and Pakistan. Co-design sessions supplemented the needs assessment protocol. A COREQ checklist ensured best practice approaches in research design, analysis and reporting. NVIVO 2023 qualitative software supported the thematic analysis. ResultsFour organising themes were identified: 1. Barriers to Program Engagement, 2. Opportunities for Program Improvement, 3. Knowledge Attitudes and Practices, and 4. Target Groups, Messaging and SBCC Entry-Points, with 21 sub-themes emerging under the four organising themes. Main barriers related to resource constraints and maladministration of SPPs while opportunities identified greater integration of cash transfers with nutritious food provision, increased engagement with key influencers in vulnerable communities, and identification of culturally nuanced messages with dissemination through preferred channels. Integrating co-design sessions provided greater ownership, participation and engagement by program beneficiaries and more pragmatic SBCC solutions to challenges identified. ConclusionThe needs assessments and integrated co-design sessions highlighted the benefits of close consultation with program beneficiaries in the design of culturally appropriate SBCC interventions to support nutrition-sensitive social protection programs. A SBCC entry-point platform was developed from participant recommendations to provide options for programmers on message designs, advocacy approaches and dissemination channels with the approaches applicable for a number of low -and middle-income countries where malnutrition is a major challenge.

Breastfeeding is recognized as the optimal form of infant nutrition. The World Health Organization recommends initiation of breastfeeding within the first hour after birth and exclusive breastfeeding (EBF) for the first six months. However, facility-based breastfeeding practices, especially for small and sick newborns (SSN), face numerous challenges. The Saving Little Lives (SLL) program in Ethiopia seeks to improve SSN survival by promoting comprehensive neonatal healthcare practices, including appropriate feeding. Despite these efforts, limited data exist on clinicians experiences and perspectives regarding SSN feeding support in healthcare facilities. This qualitative study explored the neonatal feeding experiences of clinicians in selected SLL facilities in the Amhara region, Ethiopia. Semi-structured interviews revealed multilevel barriers influencing facility-based SSN feeding practices. These barriers were categorized as: (1) facility factors--including insufficient clinician training, staff shortages, and inadequate feeding tools; (2) neonatal/maternal factors--such as health complications in newborns and mothers and maternal concerns about insufficient milk production; and (3) sociocultural factors-- including traditional practices like uvulectomy and prelacteal feeding. A key facilitator identified was the role of predominantly female clinicians with personal breastfeeding experience, which positively influenced feeding support efforts. The findings suggest that many barriers are modifiable through targeted interventions, including enhanced clinician training, integration of infant feeding counseling into prenatal and postnatal care, and improved access to feeding tools in healthcare facilities. These insights offer critical guidance for developing evidence-based strategies to strengthen facility-based SSN feeding support, contributing to improved neonatal health outcomes in low-resource settings. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSBreastfeeding is crucial for infant nutrition, with early initiation and exclusive breastfeeding (EBF) for six months recommended by the World Health Organization. However, challenges persist in supporting small and sick newborns (SSN), particularly in low-resource healthcare settings. What this study addsThis study highlights multilevel barriers to facility-based SSN feeding in Ethiopia. The barriers include clinician training gaps, inadequate feeding tools, insufficient facility-based neonatal feeding support to struggling mothers and neonates, and sociocultural practices like uvulectomy and prelacteal feeding. A key facilitator was having predominantly female clinicians with personal breastfeeding experience. How this study might affect research, practice and policyThe findings inform targeted interventions, such as clinician training, integration of newborn feeding counseling into maternal care, and improved access to feeding tools, shaping research, policy, and practice to enhance neonatal feeding outcomes in low-resource settings.

Vaccine hesitancy has emerged as a significant global challenge impacting healthcare institutions, workplaces and governments alike. Despite concerted efforts by the government and numerous other institutions in South Africa, low vaccination rates persist (33% as of November 13, 2023), reflecting the persistence of this global challenge. This challenge is particularly pronounced in educational institutions such as institutions of higher learning in South Africa, where many people converge, increasing the risk of viral exposure. This study aims to assess the knowledge, attitudes, and perceptions of healthcare workers (HCWs) at a Nursing College regarding voluntary and mandatory COVID-19 vaccination. Employing a quantitative approach, a survey with closed-ended Likert-type questions was administered to 504 individuals at the College. The sample size of 218 respondents was calculated based on a margin of error of 5%, a confidence level of 95%, and an additional 25% contingency for potential incomplete data, resulting in a final representative sample of 270 respondents. The Statistical Package for Social Sciences (SPSS) was used for the analysis. Findings indicate a high uptake of voluntary COVID-19 vaccinations among HCWs, with some being mandated. Most HCWs demonstrated a strong commitment to safeguarding themselves and others. Despite concerns, HCWs thought the COVID-19 vaccines were effective, and their views were supported by a low level of infection among the participants, underscoring its efficacy in preventing transmission. Effective communication emerged as a critical factor in addressing post-vaccination behaviours and enhancing vaccine acceptance. However, the findings also highlighted the need for tailored outreach strategies to specific audiences, such as pregnant women, and the importance of addressing concerns about adverse effects through clear and open communication. Several factors influencing the choice between mandatory and voluntary vaccination were identified, including eligibility concerns, religious convictions, and financial considerations. Notably, concerns about safety and knowledge gaps outweighed these factors, suggesting the need for targeted educational initiatives to bolster vaccine acceptance. In conclusion, this study provides valuable insights into the dynamics of vaccination acceptance among an influential occupational group, with implications for the acceptance of other vaccines. Vaccination efforts can be strengthened by addressing concerns, enhancing communication strategies, and tailoring outreach efforts to promote public health in light of future outbreaks. Author summaryConception and design of the study: LM, TS Data acquisition: LM Data analysis: LM Interpretation of the data: LM, TS Drafting of the paper: LM Critical revision of the paper: TS Both authors approved the final manuscript

Purpose of the StudyIn India, the rate of population aging, the greater burden of chronic disease-related care, and smaller families question the sustainability of traditional family based, home long term support and services (LTSS). However, little is still known about Indians perception of formal LTSS. Design and MethodsA mixed-methods design of family caregivers for older adults from Jodhpur, Rajasthan (n=30 in-depth interviews; n=100 quantitative survey). Inductive qualitative data analysis identified emergent themes about perceptions of either informal or formal LTSS. Caregivers self-reported which common LTSS they needed in a quantitative survey. Multivariable Poisson and logistic regression models were used to estimate the average total number of LTSS and probabilities of self reporting wanting individual LTSS, respectively. ResultsThe central theme was a negative perception of formal LTSS, especially the idea of paid helpers. A second theme served as the rationale for the first theme: caregivers reported a "duty" to provide care to ones family that "others" and those "doing it for money" could not meet. Caregivers reported on average 2.8 LTSS needs of 10 options. Formal LTSS, like home-health care assistance with instrumental activities of daily living, were least frequently reported; caregiver education and self-care activities were the most reported. ImplicationsDespite providing intensive amounts of informal LTSS and care for their family members, Indian caregivers consistently reported disinterest in using formal LTSS alternatives in qualitative and quantitative data. Caregivers reported a stronger desire for services that support their ability to carry out their caregiving roles.