| BackgroundThe intestinal infectious diseases such as hand,foot and mouth disease(HFMD),diarrhea and respiratory infectious diseases such as influenza are the major cause for children morbidity and mortality.In recent years the incidence of HFMD kept on increasing,there were about 5 million HFMD cases per year in China,in which 80%were children under five.It has become a heavy burden for families and society.Touch containment is an important route transmission for HFMD and other infectious diseases.A large number of studies showed that hand washing was the most simple and effective prevention measure for diseases prevention.But the hand hygiene(HH)compliance of children is not optimistic.This study aims to investigate the HH compliance of kindergarten children in Shenzhen city,conduct a comprehensive HH intervention in kindergarten and evaluate the intervention effect,to develop some intervention strategies which can improve children HH compliance effectively.MethodsStratified random sampling technique was applied and a total of 18 kindergartens were selected from Nanshan and Baoan district of Shenzhen city in April,2015,which were allocated in kindergarten intervention group,kindergarten and family intervention group and control group.After baseline investigation,a comprehensive HH intervention measures were conducted in 12 intervention kindergartens,which included:Providing hand washing products;Kick-off activity for children;Health education materials distribution;Health education session for teachers.The HH compliance data are collected by four rounds direct observation in different intervention phases.The children HH compliance was used for the intervention effect evaluation.Epidata 3.02 is applied for data entry.SPSS 22.0 are used for data analyses.All statistical analysis with P<0.05 for the difference is statistically significant.Results1.Basic informationA total of 18 kindergartens,287 classes and 8275 children were involved in the observation,and 8275 cases of questionnaire investigation were collected.The results showed that children's age was 4-6 years old;50.9%family monthly income was between 10000-30000 Yuan;more household registration in Shenzhen(67.3%);79.1%lived in residential area;more guardian education background was college graduate/undergraduate or above(49.4%).The environment observation results showed that most children reused cotton towel to dry hands after hand washing in both intervention and control group before the intervention;the number of soap dispensers and taps in government sponsored kindergartens was significant more than private and migrant population kindergartens.After the intervention,most children in intervention kindergartens used paper towel to dry hands.For different type kindergartens,we found that the government sponsored and private kindergartens mainly used paper towel to dry hands,and the migrant population kindergartens used both cotton towels and paper towels.2.The status of children HH complianceThe overall HH compliance of children was 28.7%at baseline.Children HH compliance in private kindergartens(48.6%)was higher than that it in government sponsored(30.4%)and migrant population kindergartens(12.9%);no children washed hands correctly in the no level kindergartens;Children in small classes washed hands better(38.7%)than middle classes(31.8%)and big classes(15.5%);Children washed hands more frequently before eating(52.9%).For the influence factors of children HH compliance in a multivariable regression model,we found that increasing of tap number(OR=1.89;95%CI:1.65-2.16),soap dispensers(OR=1.15;95%CI=1.11-1.19)and teachers number(OR =1.09;95%CI=1 02-1.17)could improve children HH compliance.We also found that children washed their hands more frequently if the teachers reminded them(OR=13.11;95%CI=11.56-14.87).In addition,the types of kindergarten,children's age and the intervention measures all influenced children HH compliance.3.The effectiveness of HH interventionAt baseline,HH compliance in the kindergarten intervention group(OR=0.55;95%CI=0.47-0.65)and kindergarten and family intervention group(OR=0.79;95%CI=0.67-0.92)were lower than that control group.The HH compliance in kindergarten and family intervention group at one month follow up had the most obvious effect(OR=7.02;95%CI=5.86-8.39).Comparing the HH compliance in different HH opportunities,HH compliance improved significantly especially before eating.As for different characteristics kindergartens,at baseline,HH compliance of children with all characteristics except government and provincial kindergarten in intervention groups was lower than control group.After the intervention,compliance of kindergarten and family intervention group children in floating population(OR=11.18;95%CI=9.28-13.46)and district kindergartens(OR=11.18;95%CI=9.28-13.46)was significantly higher than control group.At baseline,we found that children HH compliance in two intervention groups were 22.5%and 29.3%,and along with the intervention,the all rate were up,56%and 59%.As for the key moments of HH(before eating,after using the toilet,after playing outside and visibly dirty hand),the compliance rates in kindergarten group before intervention were 32.1%,14.9%,36.2%and 21.7%,after the intervention the rates have improved to 77%,40.1%,57.1%and 51.5%,which improved more significantly than kindergarten and family group.Through the intervention,the big class children HH compliance in two groups also improved:13.3%,22.2%to 47.1%,50.5%.Conclusions1.At present,the HH compliance of kindergarten children in Shenzhen should be improved.2.The comprehensive HH intervention can improve HH compliance of kindergarten children significantly.3.Children HH compliance was influenced by a series of different factors,such as classroom environment,the number of hands washing facilities and teacher's reminding,etc.More targeted intervention measures should be developed for better effects. |
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