Evaluation of the Provision of Hand-washing and Drinking Water Stations on Provider and Patient Knowledge and Practices in Zambia Open Access

Naz, Anila (2011)

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Abstract

Abstract
Evaluation of the Provision of Hand-washing and Drinking Water Stations on Provider and Patient Knowledge and Practices in Zambia
By Anila Naz

Background: Many health facilities in developing countries, particularly in rural regions, lack access to safe water supplies and hand-washing at facilities, placing patients and health workers at risk for health facility-acquired infections. In Zambia, only 46% of populations have access to improved drinking water sources and 43% using improved sanitation facilities in rural areas and high prevalence of diarrhoea in children under the age of 5 years. To address these problems hand-washing and drinking water stations were installed in 8 rural health facilities and evaluated their use by health workers for patient care and education.

Methods: An intervention trial with cross sectional sampling design was used. Primary baseline surveys were conducted which included a sanitary assessment of each health facility, surveys of knowledge and practices of health workers, exit interviews with clinic clients, and household surveys of clients for their knowledge and practices. We had tested stored water in clinics and households for residual chlorine as an objective measure of water treatment, and observed hand-washing technique in clients. It was followed by distribution and installation of the hand-washing and drinking water stations (consisting of 40-liter plastic buckets with spigots and lids, metal stands, chlorine solution, and soap) to the rural (CHAZ) health facilities as well as training of health staff in safe water and hygiene. After four months of the intervention a follow-up survey was conducted using the baseline survey instruments.

Results:
At follow-up visit, of the 8 health facilities, 7 (87.5%) facilities were using installed water stations, chlorination of water was reported by 4 (50%) facilities and chlorine residuals were present in stored drinking water of 2 (25%) facilities. Compared to baseline a higher percentage of clinic clients were using improved water storage containers (19% vs. 61%), had detectable residual chlorine in their stored water (3% to 15%) and could demonstrate correct hand-washing procedure (42% vs. 65%).

Conclusion: This simple intervention had resulted in improvements in water treatment and storage practices in health facilities and households of health facility clients, and in the ability of clients to demonstrate proper hand-washing techniques.

Table of Contents

Table of Contents
Abstract...iv
Acknowledgements...vi
Table of contents...vii
List of Tables...ix
List of Figures...xi
Definition of Terms...xii
Chapter 1: Introduction...1

1.1 Background...1
1.2 Millennium Development Goal (MDG) 7...3
1.3 Significance...3
1.4 Objectives...5

Chapter 2: Literature review...6

2.1 Burden of diarrheal diseases and role of water, sanitation, and hygiene in diarrheal diseases...6
2.2 Intervention trials of point of use (POU) water treatment methods...7

2.2.1 Community based interventions...7
2.2.2 Health facility based interventions...10

Chapter 3: Methods and Results...12

3.1 Methods...12

3.1.1Study design...12
3.1.2 Evaluation sites...12
3.1.3 Baseline survey...13
3.1.4 Study population...13
3.1.5 Sample size...13
3.1.6 Evaluation instrument...14
3.1.7 Evaluation assistant training...17
3.1.8 Interview procedure...17
3.1.9 Project implementation...17
3.1.10 Follow-up survey...20
3.1.11 Informed consent...20
3.1.12 Data management and analysis...21

3.2 Results...22

3.2.1 Health facilities assessment...22
3.2.2 Health worker survey...31
3.2.3 Clinic client survey...35

Chapter 4...41

4.1. Discussion...41
4.2 Conclusion...47
4.3 Limitations...48
4.4 Recommendations...51

References...53
Appendix 1: Health facility assessment form...56
Appendix 2: Health staff survey...60
Appendix 3: Patient exit interviews...64

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