Waterless hand sanitizer for diarrhea prevention in a humanitarian emergency

描述（由申请人提供）：腹泻和急性呼吸道感染占因人道主义紧急情况而流离失所的儿童死亡人数的近30%，腹泻导致急性紧急情况下儿童死亡人数的40%。极度拥挤以及急性和慢性营养不良造成了腹泻和急性呼吸道感染的沉重负担。随着流离失所者的涌入，卫生基础设施可能很快不堪重负，水质可能很差，导致腹泻风险很高。反复地，洗手已被证明是不经常在有关的病原体传播的时候。但是，有大量的证据支持洗手宣传对预防腹泻和急性呼吸道感染的影响。向难民人口提供肥皂已被证明可使家中保持肥皂，并减少家中有肥皂的家庭的腹泻发作。缺水是用肥皂和水洗手的一个严重障碍，特别是在流离失所者营地环境中。将洗手用水保存在小容器中是一个持续的挑战，特别是当洗手设施由无关的家庭共用时。流离失所者定居点的繁忙生活可能会进一步挑战在各种关键时刻坚持用水和肥皂洗手的做法。无水洗手液因其高效、方便和无需用水而在高收入环境中得到广泛采用。许多无水消毒剂含有酒精，但其他选择，如氯己定凝胶，具有类似的抗菌功效，可能更容易被一些宗教或文化反对酒精的人群接受。在人道主义紧急情况下，改善手部卫生的无水方法可以克服供水问题，需要比水更少的补充，并且是关键时刻洗手的有效方法。此外，无水洗手液可以作为卫生套件的一部分有效地分发。在持续的人道主义紧急情况下，我们建议评估两种无水洗手液配方的可接受性，并衡量提供和推广无水洗手液对洗手行为和预防腹泻发病率和死亡率的有效性的影响。我们将使用定性研究方法来调查酒精基和非酒精基无水洗手液的可接受性和使用障碍。我们将在一个流离失所者安置点分发最可接受的配方，并评估消毒剂的摄入量和摄入量对腹泻发病率的影响。采用病例对照研究方法，我们将评估消毒剂摄入量和腹泻死亡率之间的关系。这项创新的研究将为公共卫生方法提供信息，以防止受人道主义紧急情况影响的幼儿中不合理的高腹泻死亡率。 公共卫生相关性：在人道主义紧急情况下，幼儿特别容易发生腹泻和死亡。我们建议了解在难民营环境中使用洗手液是否会导致与厄立特里亚有关的病例和死亡减少。这一创新项目将为预防腹泻死亡率的国际努力提供信息 在人道主义紧急情况下的儿童中。

DESCRIPTION (provided by applicant): Diarrhea and acute respiratory infections account for nearly 30% of deaths among children displaced due to humanitarian emergencies, with diarrhea causing up to 40% of child deaths in acute emergency settings. Intense crowding and acute and chronic malnutrition contribute to the high burden of diarrhea and acute respiratory infection. Sanitation infrastructure can be overwhelmed quickly with the influx of displaced persons and water quality can be poor, contributing to the high diarrhea risk. Repeatedly, handwashing has been shown to be infrequent at times relevant to pathogen transmission. But, there is a wealth of evidence supporting the impact of handwashing promotion for prevention of both diarrhea and acute respiratory infections. Provision of soap to a refugee population has been shown to lead to maintenance of soap in the home, and fewer episodes of diarrhea in households with soap in the home. Water scarcity represents a critical barrier to handwashing with soap and water, particularly in the displaced persons' camp setting. Maintaining water for handwashing in small containers is a constant challenge, particularly when handwashing facilities are shared amongst unrelated households. The hectic nature of life in a displaced persons' settlement may further challenge adherence to handwashing with water and soap at various critical times. Waterless hand sanitizer has been adopted widely in high-income settings because of its efficiency, convenience, and elimination of the need for water. Many waterless sanitizers contain alcohol but alternative options, such as chlorhexidine gel, have similar antimicrobial efficacy and may be more acceptable to some populations with religious or cultural proscriptions against alcohol. In the humanitarian emergency context, a waterless method of improving hand hygiene could overcome water supply concerns, require less frequent replenishment than water, and represent an efficient method of hand cleansing at critical times. Moreover, waterless hand sanitizer can be efficiently distributed as part of hygiene kits. In the context of an ongoing humanitarian emergency, we propose to evaluate the acceptability of two formulations of waterless hand sanitizers, and to measure the impact of provision and promotion of waterless hand sanitizer on hand cleansing behavior and effectiveness for prevention of diarrhea morbidity and mortality. We will use qualitative research methods to investigate the acceptability and barriers to use of alcohol-based and non-alcohol based waterless hand sanitizers. We will distribute the most acceptable formulation in a displaced persons' settlement and evaluate uptake and impact of sanitizer uptake on diarrhea morbidity. Using a case-control study approach, we will evaluate the association between sanitizer uptake and diarrhea mortality. This innovative study will inform public health approaches to prevent unconscionably high rates of diarrhea mortality among young children affected by humanitarian emergencies. PUBLIC HEALTH RELEVANCE: During humanitarian emergencies, young children are particularly vulnerable to diarrhea episodes and death. We propose to understand whether use of hand sanitizer in the refugee camp setting will result in a decrease in diarrhea-related cases and deaths. This innovative project will inform international efforts to prevent diarrhea mortality among young children in humanitarian emergencies.