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

在今天的低收入国家，仍然有大量婴儿无法活过生命的第一个月，许多妇女继续死于与怀孕和分娩有关的可预防原因。减少这些死亡是联合国会员国在2015年商定的新的可持续发展目标中的一个优先事项，这些目标将在未来15年内实现。70多万婴儿和母亲的死亡与出生时或出生后4-6周内获得的细菌感染有关。在产房助产的卫生工作者以及照顾自己和婴儿的母亲保持良好的卫生习惯，特别是洗手，可大大减少这些感染。由于许多低收入国家的大多数分娩现在发生在卫生设施中，这为教育卫生工作者和母亲了解良好卫生习惯的重要性提供了一个极好的机会。两个多世纪以来，人们已经知道分娩时或临近分娩时的卫生状况与感染风险之间的联系。然而，在高收入和低收入环境中，持续改善洗手和其他卫生习惯仍然具有挑战性，需要采用新的方法来实现行为改变。在我们的研究中，我们将使用小组访谈、问卷调查和行为观察来确定影响坦桑尼亚桑给巴尔低收入地区产科保健工作者和最近分娩的母亲良好手部卫生的关键因素。我们将使用图片和讲故事的方式来帮助参与者解释是什么驱动了他们的行为，然后与当地利益相关者和创意艺术家合作，设计一种实际的干预措施来改善手卫生。在接下来的阶段，我们计划评估这种干预对婴儿行为和感染水平的影响。

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.