Development of a hand hygiene intervention to reduce bacterial infections among newborns & mothers delivered in maternity units in Tanzania

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In low-income countries today, an unacceptably high number of babies still fail to survive the first month of life and many women continue to die from preventable causes related to pregnancy and childbirth. Reducing these deaths is a priority within the new sustainable development goals, which were agreed by the UN member states in 2015 and are to be achieved over the next 15 years. Over 700,000 of the deaths to babies and mothers are linked with bacterial infections acquired at the time of birth or during the 4-6 weeks afterwards. Good hygiene, and in particular hand washing, by both those health workers attending births in maternity units as well as mothers caring for themselves and their babies, can lead to significant reductions in these infections. As the majority of births in many low-income countries now occur in health facilities, this provides an excellent opportunity to educate health workers and mothers on the importance of good hygiene practices.The link between hygiene at or close to birth and the risks of infection has been known about for over two centuries. Nevertheless, sustaining improvements in hand washing and other hygiene practices remains challenging in both high and low-income settings, and novel new approaches to achieving behaviour change are needed. In our study, we will use group interviews, questionnaires and observations of behaviour to identify the key factors influencing good hand hygiene among health workers on maternity units and recently-delivered mothers in the low-income context of Zanzibar, Tanzania. We will use pictures and story-telling to help participants explain what drives their behaviour, and then work with local stakeholders and creative artists to design a practical intervention to improve hand hygiene. In a subsequent phase, we plan to evaluate the impact of this intervention on both behaviour and levels of infections in babies.