Hand hygiene intricacies in maternity departments in Sub-Saharan Africa: A scoping review.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i3.2074Keywords:
Hand hygiene, Healthcare-associated infections, Maternity departments, Sub-Saharan Africa, Scoping reviewAbstract
Introduction
Hand hygiene (HH) is vital in preventing healthcare-associated infections (HAIs), which are a significant concern in maternity departments, particularly in Sub-Saharan Africa (SSA). Despite the critical role of effective HH practices during childbirth, compliance rates remain alarmingly low across the region. This scoping review aims to systematically map the existing research on the intricacies of healthcare workers in maternity departments in Sub-Saharan Africa.
Methods
Literature published in English across three databases: PubMed, Medline, and ScienceDirect, was reviewed. The methodology involved a comprehensive search strategy that encompassed studies published between January 2016 and May 2025. A robust review process was initiated, led by a team of eight reviewers, who collaboratively assessed the identified literature. To ensure the rigour and thoroughness of the review, the review was supported by a lead reviewer, who oversaw the evaluation process and facilitated consensus on key findings.
Results
Out of 481 records identified through database searching, only three studies were ultimately selected for inclusion, conducted across multiple SSA countries, with a focus on assessing knowledge, attitudes, and practices regarding HH. The results highlight significant variability in compliance rates, with many facilities reporting suboptimal HH practices due to inadequate resources, training, and awareness. Barriers to effective HH include a lack of supplies, insufficient infrastructure, and cultural attitudes towards HH.
Conclusion
This scoping review reveals a critical gap in research on hand hygiene practices among healthcare workers in Sub-Saharan African maternity departments, with only three studies meeting the inclusion criteria. These findings underscore an urgent need for expanded research and targeted interventions to improve HH practices and reduce healthcare-associated infections in SSA maternity settings.
References
Afework, A. and Tamene, A., 2025. Uncovering the obstacles: a comprehensive analysis of barriers to hand hygiene adherence among healthcare providers: a systematic review. BMC infectious diseases, 25(1), p.502. https://doi.org/10.1186/s12879-025-10924-4 PMid:40211179 PMCid:PMC11987235
Alex-Hart, B.A. and Opara, P.I., 2011. Handwashing Practices Among Health Workers in a Teaching Hospital. Am J Infect Dis, 7(1), pp.8-15. https://doi.org/10.3844/ajidsp.2011.8.15
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L et al. Burden of endemic health-care-associated infection in developing countries: systematic review. w and meta-analysis. Lancet. 2011;377(9761):228-41.https://doi.org/10.1016/S0140-6736(10)61458-4 PMid:21146207
Arksey, H. and O'Malley, L., 2005. Scoping studies: towards a methodological framework. International journal of social research methodology, 8(1), pp.19-32. https://doi.org/10.1080/1364557032000119616
Buxton, H., Flynn, E., Oluyinka, O., Cumming, O., Esteves Mills, J., Shiras, T., Sara, S., and Dreibelbis, R.,2019. Hygiene during childbirth: an observational study to understand infection risk in healthcare facilities in Kogi and Ebonyi states, Nigeria. International journal of environmental research and public health, 16(7), p.1301. https://doi.org/10.3390/ijerph16071301 PMid:30979005 PMCid:PMC6479678
Centre for Disease Prevention and Control. 2024. Clean Hands: About Hand Hygiene for Patients in Healthcare Settings. Available at: https://www.cdc.gov/clean-hands/about/hand-hygiene-for-healthcare.html (Accessed: 22 February 2025).
Gon, G., de Barra, M., Dansero, L., Nash, S. and Campbell, O.M., 2020. Birth attendants' hand hygiene compliance in healthcare facilities in low and middle-income countries: a systematic review. BMC Health Services Research, 20(1), p.1116. https://doi.org/10.1186/s12913-020-05925-9 PMid:33267879 PMCid:PMC7713338
Levac, D., Colquhoun, H. and O'brien, K.K., 2010. Scoping studies: advancing the methodology. Implementation science, 5(1), p.69. https://doi.org/10.1186/1748-5908-5-69 PMid:20854677 PMCid:PMC2954944
Malonga, K.F., Mbutshu, H.L., Ngandu, J.J.L., Ntambue, M.A. and Makoutode, M., 2017. Hospital Hygiene Maternity Hospital Public Lubumbashi Democratic Republic of Congo. Open Journal of Preventive Medicine, 7(4), pp.74-85Pittet, D. and Boyce, J.M., 2001. Hand hygiene and patient care: pursuing the Semmelweis legacy. The Lancet Infectious Diseases, 1, pp.9-20. https://doi.org/10.4236/ojpm.2017.74007
Ndatimana, D., Habiyakare, C., Niragire, F., Ndibaza, A., Ntakirutimana, O., Manishimwe, O., Mutabazi, J., and Rutayisire, E., 2022. Predictors of compliance with hand hygiene among health care workers in Rwanda. Rwanda Journal of Medicine and Health Sciences, 5(2), pp.170-179.https://doi.org/10.4314/rjmhs.v5i2.6 PMid:40641942 PMCid:PMC12240444
Pittet, D., Allegranzi, B., Sax, H., Dharan, S., Pessoa-Silva, C.L., Donaldson, L. and Boyce, J.M., 2006. Evidence-based model for hand transmission during patient care and the role of improved practices. The Lancet infectious diseases, 6(10), pp.641-652.https://doi.org/10.1016/S1473-3099(06)70600-4 PMid:17008173
Umuhoza, A.G., Kamugisha, J.B., Nashwan, A.J., and Soko, G.T., 2023. Assessment of knowledge and practices of hand hygiene among health workers in Rwanda. International Journal of Africa Nursing Sciences, 19, p.100585. https://doi.org/10.1016/j.ijans.2023.100585
World Health Organisation research agenda for hand hygiene in health care 2023-2030: summary. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
World Bank. 2025. The World Bank in Africa. Available at: https://www.worldbank.org/en/region/afr/overview#1 (Accessed March 12, 2025).
World Health Organisation, 2011. Report on the burden of endemic health care-associated infection worldwide. In Report on the burden of endemic health care-associated infection worldwide. (https://apps.who.int/iris/handle/10665/80135, accessed 3 May 2025).
World Health Organisation. 2025. Infection prevention and control. https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene (Accessed: 25 June 2025).
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Copyright (c) 2026 Siyanda Alex Ngema, Mahlangu Dumisani Wonderboy, Mokonyane Suzen Bokamoso, Makgatho Letlotlo Malebo, Mokoena Sebuti Delta, Magale Lefentse Vannesa, Manganye Ntsakiso Lungile, Shongwe Avuyile Sibonelo

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