Hand hygiene compliance during labour and delivery in maternity units in Zanzibar

  • G. Gon
  • S. Ali
  • O. Campbell
  • M. de Barra
  • W. J. Graham
  • L. Penn-Kekana
  • S. Virgo
  • S. Woodd
  • M. de Bruin


Background: Hand hygiene is necessary during birth to prevent newborn and maternal infection. This study aimed to assess hand hygiene compliance and its determinants among birth attendants in the 10 high-volume maternity units in Zanzibar. Methods: Data were collected on hand hygiene and its determinants between March and December 2016. In four facilities, we conducted unstructured observation and 54 qualitative interviews with health professionals. The quantitative phase included longitudinal observation of all birth attendants in situ in each of the 10 facilities and a questionnaire with each of them (N=107). We calculated the mean hand hygiene compliance using different definitions. We used thematic analysis to analyse the qualitative data, and multi-level logistic regression models to analyse the quantitative data. Findings: Using the World Health Organisation definition of hand hygiene which includes avoiding unclean touches between handwashing/rubbing and a clinical procedure, the mean compliance before delivery was 11.6%; when allowing for unclean touches this rose to 30.1%. The relative importance of psychological and context variables in explaining compliance are different for the two hand hygiene definitions. Descriptive norms seem associated with the second definition (OR=1.12,CI:0.99-1.28,p-value=0.069), whilst not with the first (p-value=0.305). From the qualitative results, an efficient physical layout of the ward seems to explain poor compliance to the first but not the second definition. Discussion: Compliance to hand hygiene during birth was low in this context. This study suggests that handwashing/rubbing and avoiding unclean touches are two distinct behaviours, and that both individual and environmental factors influence these behaviours.