scholarly journals What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries

2018 ◽  
Vol 3 (3) ◽  
pp. e000648 ◽  
Author(s):  
Maha Bouzid ◽  
Oliver Cumming ◽  
Paul R Hunter
Keyword(s):  
Patient Satisfaction ◽  
Low Income ◽  
Maternal Health Services ◽  
Care Seeking ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Patient Dissatisfaction ◽  
Middle Income Countries ◽  
Sanitation And Hygiene ◽  
Care Seeking Behaviour

Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. Pubmed and Medline Ovid were searched using a combination of search terms. 984 papers were retrieved and only 21 had a WASH component warranting inclusion. WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers’ attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients’ socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed.

scholarly journals Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

2018 ◽  
Vol 3 (3) ◽  
pp. e000466 ◽  
Author(s):  
Iryna Postolovska ◽  
Stéphane Helleringer ◽  
Margaret E Kruk ◽  
Stéphane Verguet
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Low Income ◽  
Child Health Services ◽  
Demographic And Health Surveys ◽  
Care Seeking ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health

BackgroundMeasles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services.MethodsWe analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000–2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough).ResultsSIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country.ConclusionThe paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

scholarly journals Water, sanitation, and hygiene (WASH) in healthcare facilities of 14 low- and middle-income countries: to what extent is WASH implemented and what are the ‘drivers’ of improvement in their service levels?

2021 ◽  
Author(s):  
Laura Kmentt ◽  
Ryan Cronk ◽  
James Benjamin Tidwell ◽  
Elliott Rogers
Keyword(s):  
Prevention And Control ◽  
Infection Prevention And Control ◽  
Middle Income ◽  
Service Levels ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Sanitation And Hygiene ◽  
Increased Risk ◽  
And Control ◽  
Low And Middle Income

Abstract Prevention and control of healthcare-associated infections through the provision of water, sanitation, and hygiene (WASH) in healthcare facilities (HCF) is inadequate in low- and middle-income countries (LMICs), resulting in high patient morbidity and mortality, additional costs, and increased risk of antibiotic resistance. There is little evidence describing factors leading to improved WASH conditions in LMICs. We aim to identify the extent to which WASH is implemented in HCFs in LMICs and understand the ‘drivers’ of improvement in their service levels. WASH service levels in 14 LMICs were descriptively analysed, and potential drivers of service-level differences were explored using univariable and multivariable mixed-model logistic regression analyses. Descriptive analysis showed a lack of adequate water quality, sanitation, hand, and environmental hygiene, and waste disposal. We found that the presence of infection prevention and control protocols (IPCPs), having an IPC/WASH focal person at the facility, and conducting WASH training for staff were associated with higher levels of WASH services. This study demonstrates a lack of basic WASH services in HCF in LMICs. We show that there are potential interventions, such as implementing IPCPs, identifying WASH leaders in HCF, and conducting training that may lead to service improvements.

scholarly journals Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review

2019 ◽  
Vol 4 (4) ◽  
pp. e001632 ◽  
Author(s):  
Julie Watson ◽  
Lauren D'Mello-Guyett ◽  
Erin Flynn ◽  
Jane Falconer ◽  
Joanna Esteves-Mills ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scoping Review ◽  
Low Income ◽  
Grey Literature ◽  
Healthcare Associated Infections ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Healthcare Associated ◽  
The Impact

IntroductionHealthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date.MethodsAs per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps.ResultsOnly three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps.ConclusionsAlthough there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs.PROSPERO registration numberCRD42017080943.

scholarly journals Review on the Recent Advances on Typhoid Vaccine Development and Challenges Ahead

2020 ◽  
Vol 71 (Supplement_2) ◽  
pp. S141-S150
Author(s):  
Khalid Ali Syed ◽  
Tarun Saluja ◽  
Heeyoun Cho ◽  
Amber Hsiao ◽  
Hanif Shaikh ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Vaccine Development ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sanitation And Hygiene ◽  
Contaminated Food ◽  
Improved Sanitation ◽  
Typhoid Vaccines ◽  
And Control

Abstract Control of Salmonella enterica serovar typhi (S. typhi), the agent of typhoid fever, continues to be a challenge in many low- and middle-income countries. The major transmission route of S. typhi is fecal-oral, through contaminated food and water; thus, the ultimate measures for typhoid fever prevention and control include the provision of safe water, improved sanitation, and hygiene. Considering the increasing evidence of the global burden of typhoid, particularly among young children, and the long-term horizon for sustained, effective water and sanitation improvements in low-income settings, a growing consensus is to emphasize preventive vaccination. This review provides an overview of the licensed typhoid vaccines and vaccine candidates under development, and the challenges ahead for introduction.

scholarly journals Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho

2019 ◽  
Vol 4 (2) ◽  
pp. e001217 ◽  
Author(s):  
Mark Hellowell
Keyword(s):  
Low Income ◽  
Healthcare Delivery ◽  
Sub Saharan Africa ◽  
Public Private Partnerships ◽  
Empirical Literature ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
High Profile ◽  
Sub Saharan

Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs—even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.

scholarly journals The safe handling of chemotherapy drugs in low- and middle-income countries: An overview of practices

2021 ◽  
pp. 107815522199553
Author(s):  
Sandrine von Grünigen ◽  
Antoine Geissbühler ◽  
Pascal Bonnabry
Keyword(s):  
Low Income ◽  
Incident Management ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Safe Handling ◽  
Chemotherapy Drugs ◽  
Middle Income Countries ◽  
Improve Access ◽  
Low And Middle Income ◽  
Safe Practices

Introduction The rising burden of cancer in low- and middle-income countries (LMICs) has led to substantial efforts to improve access to chemotherapy. The present study’s objectives were to obtain an overview of the safe handling practices implemented in LMICs’ healthcare facilities when dealing with chemotherapy drugs and to prioritize opportunities for improving them. Methods We conducted an online survey, from June 2018 to April 2019, among LMIC healthcare facilities dealing with chemotherapy drugs. Facilities were asked to self-assess their chemotherapy handling processes using Cyto-SAT, a self-assessment tool incorporating 134 items organized into 10 domains (management, personnel, logistics, prescription, preparation, administration, incident management, waste management, cleaning, and patient counselling). Data were recorded on an online platform ( www.datapharma.ch/cyto-SAT ). Results The survey enrolled 53 healthcare facilities (15 from low-income, 26 from lower-middle-income, and 12 from upper-middle-income countries). The median level of implementation of safe practices was 63% (Q1:39%–Q3:77%). Facilities in low-income countries (LICs) reported lower median levels of safe practices than middle-income countries (MICs) [LICs: 32% (Q1:24%–Q3:62%), Lower-MICs: 63% (Q1:49%–Q3:70%), Upper-MICs: 85% (Q1:77%–Q3:93%)]. The biggest differences between country categories were observed in the domains related to personnel, preparation processes, and incident management. Conclusion This overview of practices highlighted a large variability and major gaps in the safe handling of chemotherapy drugs in LMICs. Improvement strategies are needed to increase patient and staff safety and limit environmental contamination, especially in LICs. Safe handling programs should be part of continuing efforts to improve access to quality cancer drugs and should be integrated into national cancer control programs.

scholarly journals Situation of menstrual management facilities in schools of peri-urban areas of Nepal: WASH, privacy, and healthcare

2021 ◽  
Author(s):  
Sadhana Shrestha ◽  
Salina Shrestha ◽  
Yuri Ito ◽  
Yuka Kobayashi ◽  
Kei Nishida ◽  
...  
Keyword(s):  
Urban Schools ◽  
Urban Areas ◽  
Middle Income ◽  
Running Water ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
The Past ◽  
Sanitation And Hygiene ◽  
Sanitary Pads ◽  
Water Provision

Abstract Menstrual management (MM) facilities in schools are neglected in low- and middle-income countries. We examined the existing MM facilities, identified the deficient, and collected students' ideas in peri-urban schools of Nepal. The schools had basic MM facilities including water sanitation and hygiene (WASH) infrastructures, gender-segregated toilet facilities with taps, dustbins and running water, provision of emergency sanitary pads, etc. Out of 71 students who reported soiling of dresses with menstrual blood as a common problem, 27% went home and did not return in such situation instead of washing off at school. Forty-six per cent of students used washable absorbents, but washing and drying facilities were lacking, and students adapted by using disposable pads at school and washable at home. Out of 126 students, 106 took days off during menstruation in the past three months with an average of 2.6 days by one student. Sixty-one per cent gave the reason as pain and 39% tiredness for taking days off. Healthcare facilities were lacking in schools, hence, lack of these facilities in schools might be contributing to absenteeism. The traditionally advocated list of MM facilities for schools, largely involving WASH facilities, should be updated, including newly identified factors which were also suggested by students.

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