Continued management of sanitation and hygiene services, post-intervention, is a global challenge, particularly in the school-setting. This situation threatens anticipated impacts of school ...sanitation and hygiene investments. To improve programming and policies, and increase the effectiveness of limited development resources, we seek to understand how and why some schools have well-managed sanitation post-intervention, while others do not.
Based on in-depth qualitative data from 16 case schools in Meherpur, Bangladesh, we employ fuzzy-set qualitative comparative analysis to identify the necessary and sufficient conditions, or combinations of conditions (referred to as pathways), that lead to either well-managed or poorly managed school sanitation. We include posited sustainability determinants from the literature and factors that emerged from the cases themselves in the analysis.
We identified three distinct pathways sufficient to support well-managed services, providing multiple options for how well-managed school sanitation could be encouraged. Two of these are applicable to both government and non-government schools: (1) quality construction, financial community support and a champion; and (2) quality construction, financial government support, a maintenance plan and school management committee involvement. On-going financial support for operations and maintenance was identified as a necessary condition for continued service management, which was absent from many schools with poorly managed services. However, financial support was insufficient alone and other conditions are needed in conjunction, including quality construction and incentivizing conditions, such as school management committee involvement in sanitation specifically, a sanitation champion, and/or one teacher clearly responsible for toilet maintenance. Surprisingly, the number of students per toilet (ranging from 18-95 students) and toilet age (ranging from 8-32 months) had no significant effect on sanitation conditions.
Findings corroborate those from a similar study in Belize, and comparison suggests the need for financial community support and the possibly tenuous reliance on local champions in the absence of adequate government support for operations and maintenance. Sub-determinants to the necessary conditions are also discussed which have implications for school sanitation in Bangladesh and may have broader relevance for other low-income countries though further research is needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious ...decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.
Objective
To determine the impact of environmental nudges on handwashing behaviours among primary school children as compared to a high‐intensity hygiene education intervention.
Methods
In a ...cluster‐randomised trial (CRT), we compared the rates of handwashing with soap (HWWS) after a toileting event among primary school students in rural Bangladesh. Eligible schools (government run, on‐site sanitation and water, no hygiene interventions in last year, fewer than 450 students) were identified, and 20 schools were randomly selected and allocated without blinding to one of four interventions, five schools per group: simultaneous handwashing infrastructure and nudge construction, sequential infrastructure then nudge construction, simultaneous infrastructure and high‐intensity hygiene education (HE) and sequential handwashing infrastructure and HE. The primary outcome, incidence of HWWS after a toileting event, was compared between the intervention groups at different data collection points with robust‐Poisson regression analysis with generalised estimating equations, adjusting for school‐level clustering of outcomes.
Results
The nudge intervention and the HE intervention were found to be equally effective at sustained impact over 5 months post‐intervention (adjusted IRR 0.81, 95% CI 0.61–1.09). When comparing intervention delivery timing, the simultaneous delivery of the HE intervention significantly outperformed the sequential HE delivery (adjusted IRR 1.58 CI 1.20–2.08), whereas no significant difference was observed between sequential and simultaneous nudge intervention delivery (adjusted IRR 0.75, 95% CI 0.48–1.17).
Conclusion
Our trial demonstrates sustained improved handwashing behaviour 5 months after the nudge intervention. The nudge intervention's comparable performance to a high‐intensity hygiene education intervention is encouraging.
Objectif
Déterminer l'impact du ‘nudge’ (incitation douce) environnemental sur les comportements de lavage des mains chez les écoliers du primaire par rapport à une intervention d’éducation à l'hygiène de haute intensité.
Méthodes
Dans un essai randomisé en grappes, nous avons comparé les taux de lavage des mains au savon (LMS) après un événement de toilettage chez des écoliers du primaire dans les zones rurales du Bangladesh. Les écoles éligibles (gérées par le gouvernement, avec des sanitaires et de l'eau sur place, sans intervention sur l'hygiène l'année précédente, avec moins de 450 élèves) ont été identifiées et 20 écoles ont été sélectionnées aléatoirement et attribuées ouvertement à raison de cinq écoles par groupe à l'une des quatre interventions suivantes: infrastructure de lavage des mains simultanée à une construction de nudge, infrastructure séquentielle de lavage des mains puis construction de nudge, infrastructure de lavage ses mains simultanée à l’éducation à l'hygiène (EH) de haute intensité et infrastructure séquentielle de lavage des mains et HE. Le résultat principal, l'incidence de LMS après un événement de toilettage, a été comparé entre les groupes d'intervention à différents points de collecte des données avec une analyse de régression de Poisson robuste avec des équations d'estimation généralisées, en ajustant pour regroupement des résultats au niveau de l’école.
Résultats
L'intervention ‘nudge’ et l'intervention EH se sont révélées tout aussi efficaces avec un impact soutenu sur 5 mois après l'intervention (IRR ajusté: 0,81; IC95%: 0,61 ‐ 1,09). En comparant le délai de délivrance des interventions, la délivrance simultanée de l'intervention EH surpassait significativement la délivrance EH séquentielle (IRR ajusté: 1,58; IC: 1,20 ‐ 2,08), alors qu'aucune différence significative n’était observée entre les interventions ‘nudge’ séquentielles et simultanées (IRR ajusté: 0,75; IC95%: 0,48 ‐ 1,17).
Conclusion
Notre étude démontre une amélioration du comportement du lavage des mains soutenu 5 mois après l'intervention ‘nudge’. La performance de l'intervention ‘nudge’ comparable à une intervention d’éducation à l'hygiène de haute intensité est encourageante.
We analyzed data from a cluster-randomized controlled trial conducted among 20 schools in Rajshahi, Bangladesh, to explore the role of social influence on handwashing with soap (HWWS) in a primary ...school setting. Using data collected through covert video cameras outside of school latrines, we used robust Poisson regression analysis to assess the impact of social influence-defined as the presence of another person near the handwashing location-on HWWS after a toileting event. In adjusted analyses, we found a 30% increase in HWWS when someone was present, as compared with when a child was alone (Prevalence ratio 1.30; 95% confidence interval: 1.14-1.47,
< 0.001). The highest prevalence of HWWS was found when both child(ren) and adult(s) were present or when just children were present (64%). Our study supports the conclusion that the presence of another individual after a toileting event can positively impact HWWS in a primary school setting.
This paper examines water, sanitation, and hygiene (WASH) conditions that enable and hinder Philippine schoolgirls to hygienically manage their menstruation. We collected qualitative data from 13 ...schools in three regions of the Philippines. Schools in both urban (Metro Manila) and rural areas (Masbate and South Central Mindanao) were included to allow for comparison across settings. Unreliable access to water, lack of disposal mechanisms for menstrual materials, unclean facilities, and insufficient number of latrines were identified as the key barriers to effective menstrual management in Masbate and Metro Manila. In South Central Mindanao, there was greater oversight of WASH hardware at schools and hardware was in better condition, which created a more enabling environment for girls to manage menstruation. Creating an enabling WASH environment for girls to manage menstruation requires sustained support and system oversight, combined with knowledge and information.
This study examined access to mental health providers in health maintenance organization (HMO) networks.
A telephone survey was conducted with a stratified random sample of mental health providers ...listed as being in a network for at lease one of six HMOs operating in Connecticut (response rate=72%; N=366). Data were collected between December 2006 and March 2007. Measures included the accuracy of network listings, acceptance rates of new patients, and reasons for not accepting new patients. Acceptance of new patients was defined as scheduling an appointment within two weeks from the time of the initial contact. Logistic regression was used to examine acceptance rates of new patients while controlling for type of provider (social worker, nurse, psychologist, or psychiatrist) and practice characteristics.
Findings indicate that 17% of sampled HMO network listings were inaccurate. Among the providers with an accurate listing, 73% were accepting new HMO patients and 76% were accepting new self-pay patients. These aggregate acceptance rates of new patients mask differences among providers, with psychiatrists significantly less likely than other providers to accept new patients (55% of psychiatrists were accepting new patients). The most common reason for not accepting new patients was the lack of available appointments.
Results indicate that access to mental health providers in HMO networks varied by type of provider. For HMO enrollees seeking treatment for mental health problems from a provider with a master's degree in social work (M.S.W. degree), network access was not a major problem. Scheduling an appointment with a psychiatrist, particularly a psychiatrist treating children only, was more difficult.
OBJECTIVEThis study examined access to mental health providers in health maintenance organization (HMO) networks.METHODSA telephone survey was conducted with a stratified random sample of mental ...health providers listed as being in a network for at lease one of six HMOs operating in Connecticut (response rate=72%; N=366). Data were collected between December 2006 and March 2007. Measures included the accuracy of network listings, acceptance rates of new patients, and reasons for not accepting new patients. Acceptance of new patients was defined as scheduling an appointment within two weeks from the time of the initial contact. Logistic regression was used to examine acceptance rates of new patients while controlling for type of provider (social worker, nurse, psychologist, or psychiatrist) and practice characteristics.RESULTSFindings indicate that 17% of sampled HMO network listings were inaccurate. Among the providers with an accurate listing, 73% were accepting new HMO patients and 76% were accepting new self-pay patients. These aggregate acceptance rates of new patients mask differences among providers, with psychiatrists significantly less likely than other providers to accept new patients (55% of psychiatrists were accepting new patients). The most common reason for not accepting new patients was the lack of available appointments.CONCLUSIONResults indicate that access to mental health providers in HMO networks varied by type of provider. For HMO enrollees seeking treatment for mental health problems from a provider with a master's degree in social work (M.S.W. degree), network access was not a major problem. Scheduling an appointment with a psychiatrist, particularly a psychiatrist treating children only, was more difficult.
The neglected tropical disease (NTD) leishmaniasis is the collective name given to a diverse group of illnesses caused by ~20 species belonging to the genus Leishmania, a majority of which are vector ...borne and associated with complex life cycles that cause immense health, social, and economic burdens locally, but individually are not a major global health priority. Therapeutic approaches against leishmaniasis have various inadequacies including drug resistance and a lack of effective control and eradication of the disease spread. Therefore, the development of a rationale-driven, target based approaches towards novel therapeutics against leishmaniasis is an emergent need. The utilization of Artificial Intelligence/Machine Learning methods, which have made significant advances in drug discovery applications, would benefit the discovery process. In this review, following a summary of the disease epidemiology and available therapies, we consider three important leishmanial metabolic pathways that can be attractive targets for a structure-based drug discovery approach towards the development of novel anti-leishmanials. The folate biosynthesis pathway is critical, as Leishmania is auxotrophic for folates that are essential in many metabolic pathways. Leishmania can not synthesize purines de novo, and salvage them from the host, making the purine salvage pathway an attractive target for novel therapeutics. Leishmania also possesses an organelle glycosome, evolutionarily related to peroxisomes of higher eukaryotes, which is essential for the survival of the parasite. Research towards therapeutics is underway against enzymes from the first two pathways, while the third is as yet unexplored.
Leishmaniasis is caused by ∼20 species of Leishmania that affects millions in endemic areas. Available therapies are not sufficient to effectively control the disease, cause severe side effects and ...eventually lead to drug resistance, making the discovery of novel therapeutic molecules an immediate need. Molecular target-based drug discovery, where the target is a defined molecular gene, protein or a mechanism, is a rationale driven approach for novel therapeutics. Humans obtain the essential amino acid such as threonine from dietary sources, while Leishmania synthesize it de-novo. Enzymes of the threonine biosynthesis pathway, including the rate limiting Homoserine kinase (HSK) which converts L-homoserine into ortho-phospho homoserine are thus attractive targets for rationale driven therapy. The absence of HSK in humans and its presence in Leishmania donovani enhances the opportunity to exploit HSK as a molecular target for anti-leishmanials therapeutic development. In this study, we utilize structure-based high throughput drug discovery (SBDD), followed by biochemical validation and identified two potential inhibitors (RH00038 and S02587) from Maybridge chemical library that targets L. donovani HSK. These two inhibitors effectively induced the mortality of Leishmania donovani in both amastigote and promastigote stages, with one of them being specific to parasite and twice as effective as the standard therapeutic molecule.
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