Effective and appropriate hand-washing practice for schoolchildren is important in preventing infectious diseases such as diarrhoea, which is the second most common cause of death among school-age children in sub-Saharan Africa. The objective of the review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhoea and respiratory tract infections among schoolchildren aged 6–12 years in developing countries. Published research articles were searched from databases covering a period from as far back as the creation of the databases to November 2015. Eight randomized controlled trials (RCT/CRCT) from developing countries met the inclusion criteria. The Jadad Scale for appraising RCT/CRCT studies revealed methodological challenges in most studies, such that 75% (6/8) were rated as low-quality articles. The review found that hand hygiene can reduce the incidence of diarrhoea and respiratory conditions. Three hand hygiene intervention strategies utilized were training, funding and policy, with training and funding implemented more commonly than policy. These strategies were not only used in isolation but also in combination, and they qualified as multi-level interventions. Factors that influenced hand washing were contextual, psychosocial and technological. Findings can inform school health workers in categorizing and prioritizing activities into viable strategies when implementing multi-level hand-washing interventions. This review also adds to the existing evidence that multi-level hand-washing interventions can reduce the incidence of diarrhoea, respiratory infections, and school absenteeism. Further evidence-based studies are needed with improved methodological rigour in developing countries, to inform policy in this area.

Background: The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives’ experiences and perception of the clinical learning environment in Malawi. Methods: A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed. Results: A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment. Conclusion: Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

We estimated the seroprevalence of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre‐prints that reported anti‐SARS‐CoV‐2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty‐three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti‐SARS‐CoV‐2 antibodies in Africa was 22% (95%CI: 14–31) with very high heterogeneity (I² = 100%, p < 0.001). Seroprevalence was highest in studies conducted in Central Africa compared to Southern Africa, West Africa, North Africa and East Africa respectively. The number of days between the first reported coronavirus disease 2019 case in each country and when a seroprevalence study was conducted was a significant moderator of seroprevalence. Seropositivity was numerically influenced by gender and age of the participants with males and those aged below 50 years being most affected with SARS‐CoV‐2 infection. The highest pooled seroprevalence in Africa reported in this review should be interpreted cautiously due to high heterogeneity between studies. Continued seroprevalence surveillance is warranted to establish Africa's transition towards herd immunity.

Adolescents living with HIV (ALWHIV) in sub-Saharan Africa encounter multiple health problems that are often unrecognised by the public and the healthcare workforce. The aim of this systematic review was to identify risky health behaviours and their associated factors among ALWHIV in sub-Saharan Africa. We systematically searched for articles in Medline, SCOPUS, Directory of Open Access Journals, Science Direct, ProQuest, Psych-info, Web of science, WHO Global Index Medicus library, Cochrane, and Google Scholar. Studies were included in this review if: they were original studies; participants were aged from 10 to 19 years; participants were ALWHIV or they had data from different key informants focusing on ALWHIV within the age group; they had health behaviours as an outcome; they were conducted in sub-Saharan Africa and were published before December 2016. Data were extracted and the quality of the studies was appraised using the Mixed Method Appraisal Tool (MMAT). Thirty-six studies met the eligibility criteria. Nineteen studies scored 100% (indicating high quality), sixteen studies scored 75% (indicating moderate quality) and one study scored 50% (indicating low quality) on the MMAT scale. Adherence to antiretroviral therapy among ALWHIV was suboptimal and was negatively affected by forgetfulness, opportunistic infection, long distance to clinics, and fear of unplanned disclosure. Many adolescents were sexually active, but the majority did not disclose their HIV status to sexual partners, despite knowing their diagnosis (range 76–100% across available studies) and some did not use protection (condoms) to prevent transmission of HIV and other sexually transmitted diseases (range 35–55%). Disclosure to and from adolescents was low across the studies and was associated with fear of disclosure aftermaths including stigma and discrimination (range 40–57%). A considerable proportion of ALWHIV in sub-Saharan Africa engage in multiple risky health behaviours, which have a substantial negative impact on their wellbeing and cause significant risk and burden to their families, sexual partners and societies.

Malaria is the main cause of morbidity and mortality among children under the age of five years in Malawi. The aim of this study was to compare the prevalence and factors associated with malaria parasitaemia among children under the age of five years in Malawi between the 2014 and 2012 Malaria Indicator Surveys (MISs). Data on demographic factors, vector control interventions, and blood for malaria test were collected from a representative sample of children under the age of five years in Malawi through multistage cluster sampling method. Data were analysed by chi-square test and logistic regression using complex samples analysis of the Statistical Package for the Social Sciences (SPSS) version 22. The prevalence of malaria parasitaemia among children under the age of five years increased from 28% in 2012 to 33% in 2014 (p > 0.05). Likewise, the proportion of children using long-lasting insecticide-treated net (LLIN) increased significantly from 54% in 2012 to 65% in 2014 MIS (p < 0.05). The proportion of households that had used indoor residual spraying (IRS) was 9% for both surveys. In multivariate analysis, use of LLIN significantly predicted for malaria parasitaemia in the 2012 MIS but not in the 2014 MIS. Older children and those coming from the poorest families were significantly associated with having malaria parasites in both surveys. The increase in the use of LLIN among children in 2014, did not result in the reduction of malaria parasitaemia in children. The use of LLIN significantly predicted for malaria parasitaemia among children in the 2012 MIS but not in the 2014 MIS. The results of this study underscore the need to increase the coverage of IRS, mosquito repellents and larvicide alongside LLINs in order to reduce the burden of malaria among children in Malawi.

Background: Tippy-taps are locally made devices for washing hands with running water. They are simple and low-cost, enabling technology that provides adequate water sources, handwashing stations and motivation for people to prioritise handwashing. This systematic review aimed to establish the use, benefits, adoption and effectiveness of enabling technology; tippy-tap handwashing station, in resource-limited settings.Methods: We systematically searched for articles in the PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptable best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles. Search terms such as tippy-taps, enabling technology, hand-washing station, hand-washing behaviour, diarrhoea, respiratory infection, increase handwashing behaviour were used. In addition, a PRISMA flow diagram was used to elaborate on the number of articles retrieved, retained, excluded and reasons for every action. Studies that used tippy-tap hand washing station as a handwashing facility regardless of the design were included in this review. A mixed method appraisal tool was used to appraise studies.Results: Twenty articles met the eligibility criteria. The use of tippy-taps for handwashing by household members or school children was reported by authors of 16 studies, and it ranged from 2.7 to 80%. The availability of tippy-taps increased handwashing and use of soap among participants. Furthermore, the majority of people who were oriented to tippy-taps or recruited to tippy-tap studies built their tippy-tap stations even after the promotional activities or programs had ended. In one study, tippy-taps were reported by participant to be effective in preventing episodes of stomach pain among participants.Conclusion: Tippy-tap handwashing station could help in promoting handwashing practice in resource constraint settings. Future studies are needed to evaluate the effectiveness of tippy-tap hand washing station on preventing water and hygiene-related infections.