Assessing Water, Sanitation and Hygiene Infrastructures and Practices among Healthcare Workers in Maternal and Neonatal Wards of Six Rural Health Centers, Cambodia Public

Abstract

 

Background: Cambodia continues to be among the highest maternal and neonatal mortality rates in the region with 161 maternal deaths per 100,000 live births, and 15 neonatal deaths per 1,000 live births. These reported deaths of mothers and newborns are largely preventable. Maternal and newborn health outcomes may adversely be impacted by poor access to water, sanitation and hygiene (WASH). Inadequate access to WASH combined with limited health care services are likely to increase the risks of maternal and neonatal mortality. Therefore, this research study will explore the current state of WASH infrastructures and practices in Cambodian rural health centers, and provide recommendations accordingly.

 

Objectives: The objective of this qualitative study was to provide useful information and evidence to help improve WASH in Cambodian rural health centers. This research study aimed to assess the WASH conditions, such as infrastructures and practices, in maternal and neonatal wards as well as to identify gaps, related barriers, constraints, and potential solutions to the problems.

 

Methods: A number of qualitative methods including structured observations and semi-structured interviews were used to understand WASH infrastructures and WASH practices of healthcare workers in maternal and neonatal wards in six rural health centers in Tbong Khmum province, Cambodia.

 

Results: Severe lack of WASH resources, such as sanitation and hand hygiene facilities, as well as poor WASH practices in rural health centers were observed in the study, which are the main concerns regarding the improvement of maternal and neonatal health and survival. In addition to that, semi-structured interviews with healthcare workers show a lack of proper WASH, and infection prevention and control trainings in all studied health centers. 

 

Conclusions: The study revealed major gaps in WASH infrastructures and practices in rural health centers in resource-limited settings towards maintaining safe care during ante-natal and post-natal periods. These issues need to be considered in global and national strategies, which will result in the improvement of quality of care for mothers and newborns. This research study highlights opportunities for future research, and offers insights that could influence policy and improve programming in WASH sectors, in order to reduce maternal and neonatal mortality.

 

Table of Contents

TABLE OF CONTENTS

Chapter 1: Background and Literature Review........................................... 1

     Background ............................................................................................. 1

     Literature Review..................................................................................... 3

     Research Study Overview........................................................................ 10

Chapter 2: Manuscript................................................................................  14

     Introduction.............................................................................................  14

     Methodology ........................................................................................... 16

     Results...................................................................................................... 23

     Findings and Discussion ......................................................................... 35

     Strengths and Limitations of the Study.................................................... 37

Chapter 3: Public Health Implications and Recommendations................... 39

References..................................................................................................... 43

Graphs........................................................................................................... 47

Appendices.................................................................................................... 47

     Appendix A. WASH Infrastructure Assessment Tools ............................ 47

     Appendix B. WASH Practices Assessment Tools..................................... 56

     Appendix C. Semi-structured interview guide – Midwives...................... 59

     Appendix D. Patient Inform Consent Form (English Version) ................ 62

     Appendix D. Patient Inform Consent Form (Khmer Version) ................. 63

     Appendix E. 5 Key Moments of Hand Hygiene ...................................... 64

     Appendix F. 6 Steps of Hand Washing...................................................... 65

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology
Mot-clé	Maternal Neonatal Cambodia
Committee Chair / Thesis Advisor	Ryan P. Barry, Emory University
Committee Members	Tolbert Paige, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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