Using Data to Advocate for Children: How Save the Children’s Open-Access Assessment Tool Helped Expand Pre-School in Rwanda

Written by Caroline Dusabe, Lauren Pisani and Frannie Noble

Access to quality preschool, also known as early childhood education (ECE), provides children with strong foundations for future academic achievement and learning. There is evidence of the vital importance of the early childhood years from countries all over the world, but the vast majority comes from high-income countries like the United States. The lack of local research and evidence often leaves governments in low- and middle-income countries, like Rwanda, wondering whether these ECE programs will have the same effects in their countries, and how to invest in ECE appropriately.

The number of national policies supporting ECE across low and middle income countries has been increasing, due in large part to Sustainable Development Goal 4.2, which calls for all boys and girls to have access to quality early childhood development, care and preprimary education. However, investment and changes in practice have been slower to follow. This is particularly true in Sub-Saharan Africa. There, though ECE enrollment rates are starting to rise, less than half of children have access to these services and the quality of existing programs is generally poor.

Source: World Development Indicators, https://data.worldbank.org/indicator/se.pre.enrr

What We Did

Faced with this challenge in Rwanda, Save the Children used a data-driven approach to strategically advocate for greater investment in ECE. Our work highlighted local evidence about the positive impact of ECE on children’s learning and development. First, we identified key education advocates and decision makers at different levels of the Rwandan government, and determined opportunities for affecting change at those levels. Then, we designed evaluations of different ECE approaches to test the effectiveness of these initiatives for improving children’s development. Most importantly, we worked with local experts and staff to zero in on specific strengths and weaknesses existing in the Rwandan system and identify potential solutions for improving ECE quality for all children in the country.

What We Used

A critical tool in this research process was the International Development and Early Learning Assessment (IDELA). IDELA is an open-access, holistic assessment tool that measures literacy, numeracy, social-emotional and motor development for 3 – 6 year old children. IDELA was developed by Save the Children and is now used by 100+ partners around the world, free of cost. Using IDELA as the key outcome across multiple studies allowed us to easily compare the results of different trials to one another.


Lessons learned were shared with other NGO partners in the country through the Rwanda Education NGOs Coordination Platform (RENCP), and were used to develop targeted advocacy messages. The RENCP group created policy briefs, position papers, and made presentations for the key ECD actors identified at the beginning of the project.

As a result of the research and targeted advocacy of Save the Children and other NGOs, the Ministry of Education in Rwanda committed to building preschool classrooms in all communities, including purchasing storybooks and other age-appropriate toys for all classrooms. The Ministry of Education of Rwanda also agreed to create a national preprimary teacher training system, and budgeted for preprimary teacher salaries for the first time. Previously, parents were responsible for paying volunteer teachers’ incentives, which meant that often teachers were not paid consistently and that many of the poorest families did not send their children to school. Providing teacher salaries was a critical step toward ensuring preschool teacher motivation and retention, and enabled even the poorest children to access preschool for the first time.

What IDELA Helped Us Learn about ECE in Rwanda

Without IDELA we would not have been able to demonstrate the strong connections between the quality of children’s classroom and home environments and their learning outcomes. IDELA allowed us to share rigorous, relevant information with the Ministry of Education, local NGO partners, and communities. A few of the most important lessons learned were:

  • High quality learning environments, at home or in a school setting, are strongly correlated with improvements in school readiness
  • Quality learning environments for Rwandan children require a play-based curriculum that leverages age-appropriate learning and teaching materials
  • Professionalization of ECE teachers and ongoing teacher training is critical for maintaining quality
  • Parenting education on simple strategies and activities for promoting learning at home is effective in improving children’s school readiness beyond the school walls, especially for those who don’t have access to pre-schools yet.

Now What?

Many low- and middle-income countries are also in the early stages of adopting preprimary education into their basic education systems. The stage and scope of ECE policies in different countries varies, but the access and quality challenges seen in Rwanda are common. By leveraging free tools like IDELA, Save the Children and our partners can determine how to address these challenges in a very resource-efficient way. As we saw in Rwanda, using this data to create focused advocacy and harmonized messages while working with a network of like-minded organizations can be highly effective. Deliberately using locally generated evidence is also critical when sharing our work with policy makers. These examples and experiences help them connect the dots on the benefits children and families stand to gain from their policies. Using data-driven approaches, as we did in with IDELA in Rwanda, ensures that we understand and can advocate for the most effective approaches for children.

More information about this project is available here.

Kindness in the Classroom

By: Nimma Adhikari, Sponsorship Communication Coordinator

My first visit to Kapilvastu, Nepal, was back in 2013 when I had accompanied my then supervisor to meet sponsored children in schools supported by Save the Children’s Sponsorship Program. Of those schools, some had very small classrooms for a large volume of students, while others did not have enough students. Some were undergoing construction building new classrooms, early learning centers and age-appropriate water taps. This was the fourth year of Save the Children programs in Kapilvastu. 

Fast forward to 2019, and I meet 14-year-old Goma, a grade eight student in one of the schools we work at in Kapilvastu. She remembers how she and her friends studied in cramped classrooms when she was in her primary school. They did not have enough classrooms to house all the students comfortably, and on top of that, most teachers walked around with sticks in their hands reminding them to behave. Learning was not much fun for Goma and her siblings. It was a task that she did to please her parents — especially her father who had a brief career as a teacher but had settled as a farmer.  

“Many years ago, a bunch of people had come to take our photos. Soon after, I received a letter from someone who I was told was my friend from Italy. Her name is Paola,” shares Goma who first started participating in Save the Children’s sponsorship program in 2014. “My school is much better now and so are my teachers,” she continues, “especially Lila ma’am and Sushil sir. They teach us Nepali and math.”

Goma playing her favorite game, football, with a school friend

Trained by Save the Children, the teachers in Goma’s school gain the trust of students by being polite, attentive, and responsive to their questions and individual needs in class. Discarding all forms of corporal punishment are some important lessons given to teachers during teacher trainings. “Lila ma’am asks us several questions before starting her lessons. Once she starts the lesson, we realize the questions are related to the current chapter. This helps us remember and understand important points made in the chapter,” explains Goma. In addition to that, Lila and other teachers in Goma’s school make sure they connect with their students by sharing interesting general knowledge they have learned.

Goma sitting outside her school

Goma adds that Save the Children programs, as well as her sponsor Paola’s kind advice to study well and take care of her health, motivated her to become a doctor in the future. “Knowing about her concern for me, it feels like she is my sister even though I have never met her.”

This was probably one of my last visits to Kapilvastu, as Save the Children will hand over the programs for continuation to the community and local government agencies by early 2020. Save the Children has now moved to other impoverished areas in the Mahottari and Sarlahi districts where lack of quality education and basic health facilities, as well as child marriage are just a few of the greater challenges for children.


Basics’ Partners Mobilize Global Responses to Combat Pandemic’s Impacts

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

With frightening speed, COVID-19 has turned the world on end. Over 1.9 million cases had been confirmed in 213 countries or territories as of April 15, according to the World Health Organization. Borders have been sealed, travel bans and lockdowns have been implemented, and health systems are under immense pressure.

All four BASICS partners have pivoted quickly to help. We have mobilized responses that put us on the front line – producing research, guidance and recommendations for governments and task forces; strengthening the ability of health systems in low- and middle-income countries to respond through training, supplies and water, sanitation and hygiene (WASH) infrastructure; and helping to directly alleviate the pandemic’s impact on vulnerable populations.

Here are highlights of the ways that Save the Children, the London School of Hygiene and Tropical Medicine, WaterAid and Kinnos are leveraging our expertise in global health – the same expertise that BASICS draws on – to react to this unprecedented crisis. 

Save the Children
Save the Children has mobilized a response unlike any other humanitarian mission in its more than 100 years of alleviating the needs of vulnerable and marginalized children. It was among the very first international aid organizations to deliver critical supplies to health workers and provide families with trusted information to reduce transmission and keep children safe.

It is supporting 500,000 community health workers and plans to support another 100,000 over the next six months by providing them with resources, tools and skills to deliver essential services to treat common childhood illnesses and malnutrition, and to recognize symptoms and prevent COVID-19. Many of its country offices are working with Ministries of Health to equip local health workers with protective equipment and medical supplies, training and emotional and professional support.

It is supporting 500,000 community health workers and plans to support another 100,000 over the next six months by providing them with resources, tools and skills to deliver essential services to treat common childhood illnesses and malnutrition, and to recognize symptoms and prevent COVID-19. Many of its country offices are working with Ministries of Health to equip local health workers with protective equipment and medical supplies, training and emotional and professional support.

  • In-country and international health staff in Kenya, Mozambique, South Sudan and Tanzania are participating in and advising national COVID-19 task forces or technical working groups.
  • In Malawi, Save the Children teams have collaborated with the Ministry of Health to develop and disseminate simple messages on handwashing and have set up sample handwashing stations at the Ministry building.
  • In Sierra Leone, Save the Children has reprised its role in the 2015-16 Ebola outbreak response by engaging in COVID-19 coordination mechanisms at the national level and in its districts of operation. National staff attend daily COVID-19 coordination meetings and have an active part in the development and dissemination of national COVID prevention messages. They are collaborating with the government on training community health workers on COVID prevention, so that they can pass accurate information to their communities.
  • In select refugee contexts where populations are extremely vulnerable and social distancing is impossible in overcrowded camps and settlements, such as camps of Rohingya refugees in Bangladesh, the agency will work with local health authorities to support isolation and treatment of those with COVID-19.

The London School of Hygiene and Tropical Medicine

LSHTM experts are involved in a diverse range of COVID-19 research initiatives and are providing technical support and guidance to governments and organizations. LSHTM has a strong track record of responding to emergencies and major outbreaks, whether through research or by providing immediate information, advice, courses and action on the ground.

There are a number of specific LSHTM COVID-19 responses directly related to the goals of BASICS. The School is hosting a massive open online course summarizing the latest evidence on COVID-19. Members of the LSHTM community are actively involved in providing expert commentary on COVID-19 response relevant to low- and middle-income countries, including the role of cleaning and the risks from hand-touch sites by Professor Wendy Graham from the BASICS team.

LSHTM experts are providing technical support to the UK government and Unilever’s Hygiene Behaviour Change Coalition. Its researchers have also developed and are coordinating the COVID-19 Hygiene Hub – a broad partnership that will provide technical resources and dedicated support to government and organizations implementing hygiene programs to combat COVID-19 transmission and provide a platform for communication and learning among partners.

Water Aid

The first phase of WaterAid’s COVID-19 response is focused on delivering key hygiene behavior change campaigns in coordination with national governments, distributing materials such as soap, water, personal protection equipment and, where possible, handwashing stations. WaterAid’s experts are providing technical support to national governments and key coordinating mechanisms.

  • In Bangladesh, WaterAid’s ‘Fight Corona’ campaign, which uses social media and radio, has reached over 3 million people. It has installed free handwashing facilities in public areas such as bus stops, railway stations, markets and shopping malls.
  • In Pakistan, 22 million people across the country have been reached through a similar WaterAid awareness campaign on the importance of handwashing with soap and social distancing. The campaign uses regional and local languages and has been broadcast over radio, local cable networks and through SMS service. WaterAid has also installed handwashing facilities in hospitals, quarantine centers and public places in Islamabad, Lahore, Multran, Muzzaffargarh, Mardan and Quetta districts in close coordination with the district administrations.
  • In Zambia, WaterAid is working with celebrities and artists to record hygiene promotion videos that are being posted on social media. For example, Pompi, a popular musician, produced a music video on handwashing and promoted a #handwashingchallenge #Kutuba2020
  • In Malawi, WaterAid has developed a pedal handwashing device to reduce contact with soap and taps.
  • In Cambodia, through the Building and Wood Workers Trade Union of Cambodia, WaterAid is providing guidance and online training for members to create simple hand hygiene facilities using local recycled materials. It is providing hand hygiene facilities and materials to hospitals and medical students for training. WaterAid and the National Institute of Public Health are also undertaking a rapid assessment of the role of cleaners during the COVID-19 response and identifying knowledge gaps.

Kinnos

Kinnos provided its Highlight® color additive technology to hospitals in China during the onset of the COVID-19 outbreak. It is now supplying various EMS/fire departments with Highlight® to help decontaminate ambulances and PPE equipment, and to hospitals for disinfecting screening rooms. Kinnos has also started manufacturing hand sanitizers to aid in the shortage and has provided them to multiple medical organizations.

Making Health Care Clean: Steve Sara, Save the Children, On How an Approach to Clean Clinics Can Be Cheap and Sustainable

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%. Tanzania is one of the four countries where BASICS’ rollout is planned

Implementing clean care and quality infection prevention and control in healthcare facilities in low-income countries can be simple, cheap and show quick progress. How can we save money for governments, the health systems and families but ensure a lower rate of infection, saved lives and saved time? WASH expert Steve Sara takes you through the power of the Clean Clinics approach.

Teaching the Science of Cleaning: Professor Wendy Graham of LSHTM on the Crucial Importance of “Basics” in Fighting Infections

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%. Tanzania is one of the four countries where BASICS’ rollout is planned

Cleaning is a science, but cleaning staff in low resourced healthcare facilities are often not equipped with the right training, supplies or the power to ask for what they need to carry out effective cleaning and effective change in behavior.

How can we make teaching the science of clean easy, practical and unforgettable for those who hold the power of ensuring hygiene in healthcare is safe, of high quality and successful? Professor Wendy Graham takes you through the power of TEACH CLEAN.

 

STRONG HEALTH SYSTEMS DON’T EXIST WITHOUT WATER, SANITATION AND HYGIENE: LESSONS FROM COVID-19

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%. Tanzania is one of the four countries where BASICS’ rollout is planned

This post originally appeared on WaterAid’s website on April 1, and is reposted with permission.

As of March 31, the World Health Organization (WHO) had reported some 719,000 confirmed cases of coronavirus (COVID19) and 33,000 deaths in 203 countries. Declared a pandemic by the WHO on March 11, infections have spread at a rapid pace, creating an unprecedented global crisis. Many countries continue with full lockdown measures to help slow transmission. Healthcare systems are overwhelmed.

The pandemic has hit Europe and North America hard, and there are fears that African countries could see a similar outbreak, which could have devastating impacts on people’s health, education and livelihoods.

The ability to protect ourselves literally falls into our own hands, as COVID-19 can spread between people through contact with droplets of an infected person. Good hygiene practices are among the key measures for preventing the spread of COVID-19 – and hand hygiene is at the forefront. Effective hand hygiene entails washing hands with soap for at least 20 seconds – this is one of the main ways to protect yourself from contracting the infection.

Handwashing with soap is simple but effective. This is because it inactivates and removes virus particles that may be on our hands. When used properly, soap effectively dissolves the fatty membrane that surrounds the virus particles, causing them to fall apart and be inactivated.

Research shows that handwashing with soap is linked to a 16-23% reduction in acute respiratory infection, substantial reductions in neonatal infections, and a 50% reduction in pneumonia (source: The Lancet).

While the WHO has called on people and governments to emphasize hand hygiene and environmental cleanliness as the most effective way to prevent the infection and spread of COVID-19, this advice is difficult in countries lacking access to clean water, decent toilets and good hygiene. Statistics from the WHO/Joint Monitoring Programme (JMP) show that one in 10 people worldwide have no access to clean water close to home, and around 1.4 billion people have no handwashing facility at all.

Water, soap, and supplies to prevent and control the spread of infections are quintessential for frontline health workers to be able to perform their jobs effectively – yet one in six healthcare facilities globally has no soap and water available for patients, doctors and nurses to wash their hands. Research has shown that over 30% of healthcare facilities in Tanzania lack access to clean water, making hand hygiene a challenge (source: Tanzania Service Provision Assessment).

Additionally, while European countries are implementing lockdown measures and social distancing, many people in low-income countries rely on day-to-day incomes and simply don’t have the option of remaining home. In these places, investing in water, sanitation and hygiene (WASH) is an effective strategy for helping people to practice good hygiene and reduce their risk of COVID-19 and other diseases.

The pandemic and other contagions underscore the practical need for Tanzania to invest in WASH in our communities, schools, public utilities (markets, bus stations) and healthcare facilities. Ensuring that communities can practice good hygiene will dramatically reduce the risk of people contracting infections and reduce the strain on the already stretched healthcare system.

In 2017, the Ministry of Health, Community Development, Gender, Elderly and Children launched the National Guidelines for Water, Sanitation and Hygiene in Healthcare Facilities. The Ministry of Education, Science and Technology also launched guidelines for WASH in schools. We must support the government to ensure these guidelines are resourced and rolled out. This will create resilience within the health and education systems and put us in a better position to deal with future disease outbreaks.

WaterAid Tanzania and our partners will continue to support the government to invest in national hygiene promotion to help equip citizens with the hand-hygiene knowledge and tools they need to protect themselves and their communities. WaterAid will also increase our investment to scale up the provision of WASH services, improve access to handwashing facilities at key locations, use mass media to share important handwashing and hygiene messages, and support healthcare and frontline workers on Infection Prevention and Control training.

In the long term, more investments in WASH are needed to accelerate access and achieve the goals of Tanzania’s Development Vision 2025 and Sustainable Development Goal 6 – universal access to water and sanitation. This means embedding WASH interventions into key national development sectors – putting it firmly at the center of national development. We must take the lessons from COVID-19 to create stronger and more effective health systems.

This is a time where we can all take action. Individuals can  practice good hygiene behaviours to protect themselves and others from the coronavirus; donors can invest in WASH as a core priority of global health security; NGOs and development partners can support the government in its efforts to strengthen hygiene behaviour change programmes and WASH interventions; and media can support getting correct information to the public.

Lastly, we are all indebted to our healthcare workers across Tanzania and across the globe, who are putting themselves at risk to save the lives of others. The best way we can support them is to ensure that they are working in a safe environment, and for that let us push to ensure all healthcare facilities have clean water, decent toilets and good hygiene.

Inclusiveness and a Happier Classroom

By: Nan Kay Thi Win, Community Development Facilitator

Edited By: Su Yadanar Kyaw, Senior Coordinator, Sponsorship Operations

Ei Chaw is eight years old and was born with a physical disability that affects her mobility and makes daily tasks challenging. The oldest of three siblings, she lives with her family in a small village in Myanmar. Because her parents both work long hours in a rubber plantation near their home, Ei Chaw and her siblings are cared for by their grandmother.

Her parents did not understand how to deal with her disability, and she was treated poorly at home. Instead of teaching her to take care of herself, they did everything for her, making her very dependent on others. At school, her teachers did not recognize the needs of children with physical disabilities, and Ei Chaw was often left out of group activities.

Ei Chaw with her mother and younger sister Hnin

Fortunately, in 2018, Sponsorship programs came to the village and conducted teacher trainings and community awareness on “Inclusive Education,” a program to enable all children to learn together and receive support for their individual needs. The program objectives are to increase and improve access to education for the most vulnerable children, particularly children with disabilities and children from ethnic minorities in early grades.

“Before our training, children with disabilities were accepted in the regular classroom but were not provided with proper accommodations,” explains Ei Chaw’s homeroom teacher Daw Aye. “Our school did not have the facilities to accommodate this group of children, for example appropriately sized passageways and safety handrails, and we didn’t really know how to address the different needs of disabled children.”

The training provided teachers with various strategies and tools to strengthen their capacity to include all children in their lessons. “I learned that there is lot of value in promoting peer learning because children are such a super resource,” shares Daw Aye. “I am now confident enough to handle the challenges posed by children with disabilities in the classroom. I realise the power of positive feedback, how it can help children feel included, and motivated to learn.”

Inclusive education ensures that all children participate in a range of activities – academically and socially. Children work together, share their ideas and learn to accept one another. They learn that the right to a quality inclusive education is for ALL children, not just those who are easiest to reach and teach.

Ei Chaw with her mother and ready for school

Ei Chaw used to be quiet and shy, but now school is one of her favorite daily activities. Her favorite subject at school is English, and she wants to be a doctor when she grows up. Ei Chaw tells excitedly how she participated in a sport competition at school. “I signed up in picking up potatoes competition. My teacher encouraged me to do that. The competition included running, it was really difficult for me, but my friends cheered me during the competition. I was so happy.”

COVID-19 AND SURFACE DISINFECTION: THE IMPORTANCE OF THE “FOUR C’S” OF DISINFECTANTS

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

This post originally appeared on Kinnos’ website on March 26th, and is reposted with permission.

We want to make it clear from the start that all aspects of infection prevention are crucial in the response against COVID-19: compliance with social distancing, availability of personal protective equipment (PPE), effective hand hygiene, and thorough surface disinfection, and that one isn’t necessarily more important than the other. While the media has widely reported on social distancing and (unfortunately severe deficiencies of) PPE and hand sanitizer, we feel that the nuances of surface disinfection are not frequently discussed. And having been in the disinfection space for over 5 years now, we feel pretty competent in talking about it. Kinnos has previously written about the “Four C’s of Disinfectants” in a prior blog post and we wanted to revisit some of those aspects here, which will also help people better understand how to use the EPA’s list for “Disinfectants for Use Against SARS-CoV-2”.

Before we jump into disinfection, let’s talk about COVID-19 itself. We know that COVID-19 can be transmitted through aerosolized droplets and that these droplets can land on surfaces and remain viable for hours or days depending on the surface material. We also know that COVID-19 is an enveloped virus, meaning that it’s protected by a fatty lipid bilayer. Fatty layers are easily exploited: when you wash your hands with soap, what you’re really doing is creating a fat-soluble layer for the virus’s fatty layer to bind to so that it’ll wash away with the soap. Unlike more robust pathogens like non-enveloped viruses and bacterial spores that contain layers of tough protein, fatty layers are susceptible to bonding with alcohol which causes the fat to un-bond with each other, opening up the envelope and allowing the alcohol to go in and denature proteins. Stronger oxidizing disinfectants, like bleach and hydrogen peroxide, literally rip electrons off molecules to destroy the structure of the pathogen. All of this to say that using a disinfectant to inactivate droplets on surfaces seems like a good way to prevent COVID-19 transmission.

With this context, we can look at the Four C’s of Disinfectants (Chemistry, Concentration, Contact Time, and Coverage) and why they’re important. When we talk about the first three, Chemistry, Concentration, and Contact Time, we really mean 1) what, 2) how much, and 3) how long it takes kill a specific pathogen. For example, the active ingredient in Clorox Healthcare Germicidal Bleach Wipes is 0.55% sodium hypochlorite and it claims a 3-minute contact time against C. difficile spores. In order to go to market, all disinfectants have to submit data to the EPA proving these claims. To be classified as a sanitizer, for instance, the requirement is usually conducting an AOAC- or ASTM-standard test demonstrating a minimum 3-log reduction (e.g. 99.9% reduction, 4-log would be 99.99%, and so on) within 10 minutes on a couple of pathogens. Specifically in the context of COVID-19, we can look at a recent paper that compiled data on the efficacy of disinfectants against enveloped viruses. Sodium hypochlorite at a concentration of 0.5% was able to achieve a >3.0-log reduction in human coronavirus after 1 minute, whereas a 0.06% sodium hypochlorite solution was only able to achieve a 0.4-log reduction in transmissible gastroenteritis virus after the same time period, suggesting that a longer Contact Time than 1 minute is needed for a more diluted bleach solution to effectively kill enveloped viruses or that stronger concentrations should be used in practice.

And this is the key point – all the disinfectants you see on the EPA’s disinfectant list against COVID-19 have varying concentrations of active ingredients that require a different amount of time to be effective [FN1]. So if we go into the database, we’ll see that Micro-kill Bleach Wipes have a 30 second contact time, Sani-Cloth Bleach Wipes have a 1 minute contact time, and Cavicide Bleach has a 3 minute contact time, even though they’re all sodium hypochlorite. You’ll also notice that many of the quaternary ammonium (“quat”) disinfectants (which is the active ingredient in household disinfectants like Lysol and what the media means when they say “alcohol” because quats are dissolved in alcohol) tend to have longer contact times at the 10 minute mark. As discussed above, it’s generally because alcohol breaks down the membrane by bonding and then the quats go in and denature proteins whereas bleach is ripping the virus apart more rapidly via oxidation. One of our gripes with all of the news articles saying that bleach is overkill and that alcohol is sufficient is that they completely neglect the Contact Time. Yes, alcohol can be effective, but often only if you’re letting it sit on the surface undisturbed for 10 minutes, in which time the alcohol could evaporate and you may need to reapply. But who’s actually sitting there with a timer for 10 minutes and making sure the surface stays wet for that time? For the record, this post is NOT meant to incite fear or to say that your standard quat/alcohol disinfectants can’t be effective (you’ll notice some bleach products have 10 minute contact times and some quat disinfectants are 3 minutes [FN2]) but the main message here is to help you understand that effectively disinfecting surfaces requires following a process and not just buying a product. It’s like that saying: it’s how you use it that matters.

Finally, there’s Coverage, which is pretty intuitive and ties everything back to the importance of process – cover every part of the surface and make sure the surface is covered for the correct Contact Time. Of course, this can be difficult when you’re dealing with large surface areas and using a transparent disinfectant, so just try your best to be thorough. It’s worth noting that many of the surfaces you tend to disinfect are waterproof, and when you put a liquid on a waterproof surface, it beads up. If beading occurs, you’re physically unable to achieve the contact time on every part of that surface. The good news is that more disinfectant manufacturers have been addressing this problem by adding surfactants which lower the surface tension of the liquid to allow it to spread out and cover waterproof surfaces. If you spray or wipe down a dark-colored surface, you should be able to see if your disinfectant is forming beads or not.

Normally, this is the part where we pitch you on how Kinnos has developed our Highlight® color additive to solve the Coverage and Contact Time problem, but the intent of this post is to be informational rather than promotional, so just take a look at our website if you’re interested. We hope that this post will help people use disinfectants more effectively, and that we can all work more well-informed to protect ourselves and our loved ones.


Footnote 1: You might be asking how the EPA has approved all of these disinfectants given that no one has actually been able to run tests specifically against COVID-19, and the answer is that the EPA allows disinfectants to use efficacy against the “most resistant representative virus” to claim efficacy on weaker ones. So if you have approval for a more robust non-enveloped virus, then the assumption is that you can easily kill an enveloped one. That’s why the database tells you to follow the instructions for killing things like canine parvovirus, which is a non-enveloped virus.

Footnote 2: One of the secrets of the disinfection world is that specific products are marketed for specific use cases. For example, most hospitals use bleach to kill C. difficile spores, which generally has a contact time of 3-4 minutes, and they’ll slap that number onto their marketing materials. So even if that bleach product can kill a virus in 1 minute, sometimes the manufacturer will just use a 3 minute contact time (or longer) because they know they can easily pass the required AOAC- or ASTM-standard test at that time point and they’re marketing 3 minutes already anyway. To an extent, this is why some of the bleach products may have 10 minute contact times on their EPA labels even though it’s generally known that bleach easily destroys enveloped viruses. Even so, always better to follow the instructions for Contact Time on the label of the disinfectant.

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Breaking Taboos

Afou is a smart, yet shy 15-year-old girl who lives with her parents and siblings in a rural Mali village. Her favorite subjects at school are biology, physics, chemistry and English. She enjoys spending time with her friends and she is determined to complete her studies to become a doctor.

Yet adolescent girls like Afou encounter many obstacles as they approach young adulthood. Historically, cultural customs have prevented adequate education in the areas of female hygiene, sexuality and reproductive health during these crucial years. Such basic knowledge is often not passed from mothers to daughters because such subjects are considered taboo. The consequences of this lack of communication are unwanted pregnancies, and sexually transmitted diseases.

Afou in her school yard

In addition, many young girls face the hardship of early or forced marriage — a dire situation that robs them of their childhood. In fact, teenage girls under the age of 16 are often forced by their parents to get married, which means they must leave school and any hopes of achieving a meaningful education are thwarted.

At age 13, Afou’s father wanted her to marry a man that she did not know. She disliked the idea of leaving school and not being able to play with her friends. Afou’s dreams of becoming a doctor were dashed and her future looked bleak.

However, in 2016, Save the Children implemented an Adolescent Development program in Afou’s village to combat these problems, raise awareness and enable adolescents to develop and grow to their full potential. The program provided courses in sexual and reproductive health while at the same time informs the community on the effects of early child marriage.

In addition, the program’s Peer Educators guide teens on how best to manage relationships with peers and parents through various activities and presentations. By 2018, the program reached 13,283 adolescents including 6,875 girls. As a result, the rates of teen pregnancy went down substantially. “Now the program is on track, and the awareness has paid off,” explains a peer educator.

Afou and her Peer Educators

Afou’s outlook brightened, too. She invited her parents to participate with her in various sketches and awareness skits held in the public square of the village and at school. This training gave her confidence to continue the discussions at home, and she soon persuaded her father to give up on the idea of an early marriage.

“No girl from our family will leave school. The mistakes we did in the past, will no longer be repeated; I am proud of the strong girl she has become today,” proclaims Afou’s Uncle Issa.

Afou and her Uncle Issa

Afou now collaborates with peer educators to help and advise other adolescents in her village. She is also preparing for her high school entrance exam. “The Adolescent Development [Program] has positively impacted my life and changed my parents mind. I love this program that helped me to reach grade 9. May God bless the work of Save the Children.”

COVID-19 Pandemic Reinforces the Need for Healthcare Facilities’ Preparedness

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by the BASICS Team

In declaring the COVID-19 coronavirus a pandemic, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus urged nations to “ready your hospitals” and “protect and train your health workers.”

Those two actions are at the core of what BASICS (Bold Action to Stop Infections in Clinical Settings) proposes: helping health systems to adopt simple, inexpensive measures to reduce infections at the point where care is delivered; measures supported by training platforms, upgraded water, sanitation and hygiene infrastructure, reliable supply chains and monitoring and accountability processes.

As the COVID-19 crisis has deepened worldwide, BASICS can play another role beyond reducing healthcare-associated infections and combatting antimicrobial resistance. Establishing a healthcare workforce equipped with the knowledge, training, resources and incentives needed to maintain a clean healthcare environment and the supplies is critical. Without adequate infrastructure, functional supply chains, modern training, monitoring progress and rewarding high performance, staff cannot protect themselves and their patients during routine care, let alone during high-risk events like a global pandemic.

Largely overlooked is the toll that COVID-19 is exacting on frontline healthcare workers, who are themselves becoming infected or spreading the disease because of a shortage of personal protective equipment like facemasks and gloves. A stable supply chain would help ensure that staff and facilities have vital materials. 

“Without secure supply chains, the risk to healthcare workers around the world is real … We can’t stop COVID-19 without protecting health workers first,” Ghebreyesus warned on March 3.

While frequent handwashing is one of the most effective ways of reducing tranmission of infections and a pillar of the BASICS solution, handwashing is more effective when coupled with the cleaning of high-touch surfaces. BASICS addresses handwashing alongside cleaning practices that create “safe to touch” surfaces like bedside tables, doorknobs and faucets.

BASICS Partners Responding to the Pandemic

Save the Children, the London School of Hygiene and Tropical Medicine, WaterAid and Kinnos have all mobilized responses to the pandemic.

Save the Children was among the very first international aid organizations to deliver critical supplies to health workers on the front lines of the crisis, as well as provide families with supplies and trusted information to reduce transmission and keep children safe. Its regional and country offices will be responding directly to vulnerable children and families to support their needs, with an emphasis on those in places with weakened health systems, fragile contexts or a limited capacity to respond due to other ongoing crises. 

Its global and national health teams are participating in daily conversations with the World Health Organization, the UN and other COVID-19 coordination bodies and advising the global READY consortium, which seeks to strengthen preparations among nongovernmental organizations for major disease outbreaks or pandemics.

The London School of Hygiene and Tropical Medicine’s experts are involved in many aspects of research and are providing guidance to those responding around the globe to the pandemic. Since January, teams from the School have mobilized to help slow the spread and mitigate COVID-19’s impact. Its global public health experts are working around the clock to provide accurate, measured and objective information and advice to governments, industry and the public.

The School’s mathematical modellers have been mapping the virus since the earliest days of the outbreak. Their insights into patterns of transmission, behavioural response and control measures are also informing the global response, including helping assess how many hospital beds will be needed, the stress on healthcare systems and how communities can prepare.

WaterAid is supporting the sharing of hygiene messaging and activities through social media and other media channels based on global and national recommendations, including developing materials in local language and with visuals to showcase good hygiene practices. In some countries, building off existing hygiene programs, it is working with government on promoting hygiene, predominantly handwashing, through government-supported behaviour change campaigns in response to COVID-19. This may expand beyond government to others, such as private-sector employers, and expand to include improving infrastructure where needed in line with government action.

WaterAid is committed to tackling inequalities in all aspects of WASH. This extends to COVID-19, as we know the most marginalized and discriminated against will be impacted the most. WaterAid is committed to supporting responses that are gender and socially-inclusive.

Kinnos, the social venture whose colorized decontamination technology Highlight®  will be used in BASICS to help cleaners and other healthcare workers achieve full disinfection of surfaces, has sent shipments of Highlight® to China to help with that country’s outbreak.