Reducing infection risks in maternity and neonatal wards through improved environmental hygiene: an exploratory study in The Gambia.

Context of the research

Infection is a leading cause of maternal and newborn deaths, particularly in sub-Saharan Africa where there is also a high burden of hospital-acquired infections (HAIs), and where exposure to unhygienic practices and environment further poses a substantial risk to mothers and newborns. The HAIs occurring in these settings are often caused by antibiotic-resistant bacteria, whose transmission is the result of several factors including inadequate water, sanitation and hygiene (WASH), poor infection control, inadequate cleaning, and overcrowding wards.

Aims and objectives

Our research aims to explore the role of an environmental cleaning package and its effect on some of the most vulnerable patients in African hospitals - women and newborns. The specific objectives are:

1. To establish baseline measurements of environmental contamination in the maternity and neonatal units in two hospitals in The Gambia, including two-weekly variability in such measures;

2. To develop a contextually appropriate cleaning training package specifically for newborn units in LMICs, with a focus on sub-Saharan Africa

3. To pilot this training package intervention in two large hospitals in The Gambia and measure potential impact on environmental cleanliness.

4. To establish a network of researchers and relevant WASH/IPC stakeholders, including the regional Maternal-Newborn Infection network and Infection Control Africa Network (ICAN), and build collaborations to support a future West African trial of the same cleaning intervention across multiple regional neonatal units, bringing together academic partners in West Africa and the UK.

Potential applications and benefits

Clean and hygienic health care facilities can help establish trust in health services and encourage mothers to seek prenatal care and deliver in facilities rather than at home - two important elements of the strategy to reduce maternal and newborn mortality.

The findings from our study will also contribute new evidence for the new global action plan arising from the World Health Resolution on WASH, IPC and AMR

We will use the learning derived from this preliminary work to convene a network of researchers to build the case for a future African trial of this cleaning training package intervention against an infectious outcome across multiple neonatal units.