Association of environmental factors and high HFMD occurrence in northern Thailand
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RESEARCH ARTICLE
Open Access
Association of environmental factors and high HFMD occurrence in northern Thailand Pussadee Laor1* , Tawatchai Apidechkul1,2*, Siriyaporn Khunthason1,2, Vivat Keawdounglek1, Suntorn Sudsandee1, Krailak Fakkaew1 and Weerayuth Siriratruengsuk1
Abstract Background: The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand. Methods: A case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews. Results: Two variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention. Conclusions: The number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs. Keywords: Children, Day care center, Environment and sanitation, HFMD, Hygiene
* Correspondence: [email protected]; [email protected] 1 School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The imag
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