Growing attention on water, sanitation, and hygiene (WASH) and its links to infection prevention and control (IPC) is coming to the forefront of positive change in maternal and newborn health services in low- and middle-income countries. Joanna MacQueen, Junior Communications Officer at The Soapbox Collaborative, examines the importance of simple solutions.
It should be no secret that approximately 830 women die every day of pregnancy- or delivery-related complications. A significant proportion of these deaths, and the deaths of 7000 newborns every day, is due to infection. Without clean water and basic sanitation, a safe delivery, without risk of infection, is severely compromised. Instead of viewing WASH as a separate issue from maternal and newborn health, we must include WASH when recognising and tackling the factors that cause infection and threaten safe, clean birth.
At The Soapbox Collaborative, we are committed to ensuring mothers and babies avoid preventable infections at the time of delivery. Working in low- and middle-income countries (LMICs) with overseas and UK partners, we aim to improve hygiene practices with low-cost simple interventions through both research and action.
Since our previous HEART blog, our work has developed a strong focus on the importance of cleaners and domestic staff in health facilities, a group which is often marginalised and forgotten in the bigger WASH picture. This key group is often neglected when it comes to proper training in cleaning practice and IPC measures. A barrier to this is low-literacy, meaning a traditional lecture-style approach based on reading and writing is not sufficient for training. Soapbox has developed a participatory training package for cleaners that we have piloted in The Gambia and can be adapted for local contexts. This package includes practical teaching modules and visual, accessible guidelines for IPC and cleaning. Training in this area makes health facilities cleaner, safer places for mothers and newborns, and indeed all patients, who may be at risk of life-threatening infections.
WASH is linked in many ways to maternal and newborn health. Imagine giving birth in a facility where there was no clean water to prevent infections during delivery and aid the healing process. In LMICs however, 35% of health facilities lack access to water and soap for handwashing. These basic resources are critical to hand hygiene, which has been hailed as the single most important intervention to prevent infection. Our work on the HANDS Project with partners from the Ministry of Health, Jhpiego, WaterAid Tanzania and others, looked at resource availability and other barriers to hand hygiene in maternity units in Zanzibar, Tanzania. The resulting interventions included the restructuring of the maternity units to improve workflow and make practising effective hand hygiene easier. Simple solutions such as this can make all the difference to improving IPC and hygiene.
Finding and implementing solutions to WASH and IPC within maternity units requires commitment from partners at every level; from national and global, right down to local health facility staff. The solutions to improving WASH and IPC, and reducing deaths and illness from maternal and newborn infections can often be the simplest ones. With maternal and newborn health, WASH, and IPC undeniably linked, they must be addressed together to ensure no more lives are lost to preventable infection.
By Joanna MacQueen (Junior Communications Officer, The Soapbox Collaborative), June 2018.