Abstract:
Background: Neonatal sepsis causes 0.5 million deaths annually, mostly in low resource settings. Babies born in
African rural homes without running water or toilet facilities are especially vulnerable. Alcohol-based hand rub
(ABHR) may be used by mothers and carers as an alternative to hand washing with soap to prevent neonatal
infection. However, no definite study has established the preferred formulation of hand rub for the mothers. This
study aimed to assess the effects of addition of bitterants and perfume towards the acceptability of the alcoholbased
hand rubs by the mothers in their homes after childbirth.
Methods: This was a 3-way blinded cross-over study design. Mothers with children aged ≤3 months were recruited
from immunisation clinics at 3 local health facilities in rural eastern Uganda and received 3-different ABHR formulations
(in the order plain, bitterant and perfumed) packed in 100 ml bottles. Each ABHR was used for 5 consecutive days
followed by a 2-day ‘washout’ period (evaluation period). Overall satisfaction with each hand rub was evaluated at the
end of each week using a 7-point Likert scale.
Results: A total of 43 women were recruited, whose ages ranged from 16 to 45 years (mean 26.2 years old). None of
the participants normally used a hand protective lotion/cream. The three formulations were used for a mean of 5
(range 3–7) days. A significantly greater volume of the “bitterant” and “perfumed” formulations (mean 91 and 83 ml
respectively) were used in comparison to the “plain” formulation (mean 64 ml). Overall satisfaction was high with all
the hand rubs, but the perfumed formulation had a significantly higher overall satisfaction score [mean 6.7, range 4–7]
compared with the plain [6.4, 3–7] and bitterant [6.2, 2–7] formulations.
Conclusions: All the 3 ABHR formulations were well accepted with little to choose between them. The ABHR with
added perfume scored highest on overall satisfaction and was used significantly more often than plain ABHR. ABHR
with bitterant additive did, however, score highly and may be a preferable choice to those with concern over alcohol
misuse.
Trial registration: ISRCTN67852437, prospectively registered on 18/03/2018
