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Soil-transmitted helminth infections are highly prevalent infections affecting over 1.5 billion people worldwide. These infections have negative effects child development. Current control strategy is the WHO recommended annual deworming among all at-risk people living in endemic areas including school children. In 2009, the Tanzanian government began school-based annual deworming for STH control in areas with high prevalence including Kagera, a region situated in north-western Tanzania west of Lake Victoria. School children of this area have received annual treatment with albendazole for the past eight years. However, recent survey data on the distribution of STH in Tanzania shows that the prevalence of these infections has remained high, showing rapid re-infection following MDA programmes that are implemented alone. The Mikono Safi (Swahili for “clean hands”) intervention was designed to increase handwashing with soap (HWWS) among school-aged children in an attempt to sustain the effects of routine deworming. The intervention has several components, which includes: combining health education, games and stories targeting key motivational drivers, improvements in school handwashing infrastructure, and training and support to school staff. The aim of this qualitative study was to explored the mechanisms by which and the extent to which the Mikono Safi intervention influenced the determinants of handwashing behaviour from the perspectives of students and teachers. Findings from this research will be used to further understand the extent to which school-based interventions influence individual drivers of behaviour, and to provide contextual information for interpreting forthcoming trial results.
The findings show that the Mikono Safi intervention increased students’ reported knowledge and skills as well as motivation to wash their hands with soap at key times, particularly after visiting the toilet. Improvements in students’ handwashing knowledge and skills were reported by both teachers and students. Newly established handwashing stations improved the physical opportunity to wash hands, although the availability of water and the provision of soap was not always consistent (e.g. due to internal organisational shortcomings or during the dry season). The intervention created social environment that support and valued handwashing. Handwashing opportunity was also greatly improved through the improvement of hand washing facilities, but the supply with water and soap was sometimes interrupted, calling for much stronger multi-sectoral collaboration to improve access to water at schools.


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This page is a summary of: Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania, BMJ Open, November 2019, BMJ,
DOI: 10.1136/bmjopen-2019-030947.
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