title: Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji.
abstract: The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS). Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change.
  
  
  METHODS
  To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders.
  
  
  RESULTS
  Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies.
  
  
  CONCLUSIONS
  Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.
authors.affiliation: Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand .
authors.forename: James
authors.initials: J
authors.lastname: Greenwell
authors.forename: Judith
authors.initials: J
authors.lastname: McCool
authors.forename: Jacob
authors.initials: J
authors.lastname: Kool
authors.forename: Mosese
authors.initials: M
authors.lastname: Salusalu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005367:Fiji; D017144:Focus Groups; D006235:Hand Disinfection; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008297:Male; D012499:Sanitation; D012915:Soaps; D014171:Transients and Migrants; D014435:Typhoid Fever / Q000453:epidemiology / Q000517:prevention & control*; D014505:Urban Population; D055815:Young Adult
chemical_list: D012915:Soaps
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