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| ID | Type | Description | Link |
|---|---|---|---|
| ESRC P176/2015 | Other Identifier | Amref |
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Donor altered priorities for available funding and eliminated the project
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| Name | Class |
|---|---|
| Save the Children | OTHER |
| United States Agency for International Development (USAID) | FED |
| Unilever R&D | INDUSTRY |
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The purpose of the handwashing intervention trial is to determine whether an interactive, storytelling approach to promoting handwashing with soap by health care workers can improve mothers' handwashing behavior during the first month of her child's life.
Infectious diseases, such as umbilical cord infection, pneumonia, and sepsis, are responsible for about a quarter of neonatal deaths. Contaminated hands likely play a role in transmitting pathogens to a neonate, therefore handwashing with soap has the potential to interrupt transmission and improve neonatal health. The primary objective of this study is to develop and evaluate a scalable, cost-effective handwashing promotion program to improve handwashing behavior among mothers and caregivers of neonates. The investigators will first conduct a qualitative study to assess the feasibility and acceptability of a set of interventions. The investigators propose to evaluate the impact of the intervention components, designed as three progressively intense interventions, using a randomized controlled trial with elements of a stepped wedge design. The study will be conducted in Meru County, Kenya, enrolling a total of 800 pregnant women who seek non-emergency antenatal care at a government health facility during a 1 year period. Clinic based health care workers and community health volunteers will disseminate the intervention using an interactive storytelling approach. The focus of the interactions between the health care workers and volunteers and the participant will be on addressing barriers to handwashing through interactive question and answer sessions, rather than a didactic, educational session. The investigators will assess the impact of interventions on observed maternal and caregiver handwashing behavior and estimate the cost effectiveness for each intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | Women will receive standard antenatal care but will not receive any additional handwashing promotion, soap, or handwashing device during their enrollment. At the end of data collection, handwashing with soap will be recommended to participants in the control arm and their families. | |
| Clinic | Experimental | Handwashing promotion from healthcare workers at antenatal care clinic. |
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| Clinic + home | Experimental | Handwashing promotion from healthcare workers at antenatal care clinic and from community health volunteers at home visits. |
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| Clinic + home + handwashing device | Experimental | Handwashing promotion from healthcare workers at antenatal care clinic and from community health volunteers at home visits with provision of one handwashing device. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinic | Behavioral | Pregnant women will receive handwashing promotion from a trained facility-based health care worker during her regular antenatal visit at a healthcare clinic. To the extent feasible, everyone accompanying the pregnant woman will be invited to take part in the behavior change communication session. The participant will be provided with several bars of soap to take home and she will be encouraged to maintain a designated place for washing hands (with soap and water) at the home. A poster indicating the key events for handwashing with soap will be posted at the clinic and smaller posters will be given to the participant to post in her home. A system will be established to send regular SMS messages to the participant promote handwashing with soap during the neonatal period. |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of washing hands with soap at potential pathogen transmission events by mothers of neonate | Direct observation of handwashing behavior of mothers at times when pathogens may be transmitted from the mother to the neonate | 1 week post-natal |
| Frequency of washing hands with soap at potential pathogen transmission events by mothers of neonate | Direct observation of handwashing behavior of mothers at times when pathogens may be transmitted from the mother to the neonate | 2 weeks post-natal |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of washing hands with soap at potential pathogen transmission events by caregivers of neonate (other than mother) | Direct observation of handwashing behavior of caregivers (other than mother) at times when pathogens may be transmitted from the caregiver to the neonate | 1 week post-natal |
| Number of participants with soap and water present at a handwashing station |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Pavani K. Ram, M.D. | State University of New York at Buffalo | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Government funded antenatal care clinics | Igembe North and Igembe South Subcounties | Meru County | Kenya |
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| ID | Term |
|---|---|
| D007239 | Infections |
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| ID | Term |
|---|---|
| D000554 | Ambulatory Care Facilities |
| D006699 | Home Care Services |
| ID | Term |
|---|---|
| D006268 | Health Facilities |
| D005159 | Health Care Facilities Workforce and Services |
| D003153 | Community Health Services |
| D006296 | Health Services |
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| Clinic + home | Behavioral | Women will receive all components of the clinic-based handwashing promotion in addition to handwashing promotion during 3-4 home visits before their expected delivery date and during the neonatal period from a community health volunteer. All household members present will be invited to join in the session, with emphasis on including all caregivers of the neonate. |
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| Clinic + home + handwashing device | Behavioral | Women will receive all components of the clinic + home-based handwashing promotion intervention in addition to one handwashing device (i.e. tap and basin to use as a handwashing station) during the first home visit by the community health volunteer. The community health volunteer will work with the woman and her family to identify the location where the neonate will be most of the time in order to position the handwashing station as close to the neonate as possible. |
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Observed presence of soap and/or water at a handwashing station |
| 1 week post-natal |
| Cost-effectiveness | Approximate cost of the intervention per participant | 1 month post-partum |
| Frequency of washing hands with soap at potential pathogen transmission events by caregivers of neonate (other than mother) | Direct observation of handwashing behavior of caregivers (other than mother) at times when pathogens may be transmitted from the caregiver to the neonate | 2 weeks post-natal |
| Number of participants with soap and water present at a handwashing station | Observed presence of soap and/or water at a handwashing station | 2 weeks post-natal |
| D009739 | Nursing Services |