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Article

Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

1
Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
2
Division of Psychiatry, University College London, London W1T 7BN, UK
3
Policy and Programs Division, WaterAid Australia, Melbourne 3002, Australia
4
National Institute of Public Health, Phnom Penh, Cambodia
5
WASH and Health Division, WaterAid Cambodia, Phnom Penh, Cambodia
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(9), 4416; https://doi.org/10.3390/ijerph18094416
Received: 19 March 2021 / Revised: 16 April 2021 / Accepted: 17 April 2021 / Published: 21 April 2021
(This article belongs to the Section Global Health)
Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusions: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers. View Full-Text
Keywords: neonatal infection; hand hygiene; behaviour change; Cambodia; post-natal care; newborn care; formative research; intervention design; health facility; household neonatal infection; hand hygiene; behaviour change; Cambodia; post-natal care; newborn care; formative research; intervention design; health facility; household
MDPI and ACS Style

Nalule, Y.; Buxton, H.; Macintyre, A.; Ir, P.; Pors, P.; Samol, C.; Leang, S.; Dreibelbis, R. Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia. Int. J. Environ. Res. Public Health 2021, 18, 4416. https://doi.org/10.3390/ijerph18094416

AMA Style

Nalule Y, Buxton H, Macintyre A, Ir P, Pors P, Samol C, Leang S, Dreibelbis R. Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia. International Journal of Environmental Research and Public Health. 2021; 18(9):4416. https://doi.org/10.3390/ijerph18094416

Chicago/Turabian Style

Nalule, Yolisa, Helen Buxton, Alison Macintyre, Por Ir, Ponnary Pors, Channa Samol, Supheap Leang, and Robert Dreibelbis. 2021. "Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia" International Journal of Environmental Research and Public Health 18, no. 9: 4416. https://doi.org/10.3390/ijerph18094416

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