Effect of handwashing on child health: a randomised controlled trial.

Abstract

BACKGROUND:

More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year. We undertook a randomised controlled trial to assess the effect of handwashing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea.

METHODS:

In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned 25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306 households) were randomised as controls. In neighbourhoods with handwashing promotion, 300 households each were assigned to antibacterial soap containing 1.2% triclocarban and to plain soap. Fieldworkers visited households weekly for 1 year to encourage handwashing by residents in soap households and to record symptoms in all households. Primary study outcomes were diarrhoea, impetigo, and acute respiratory-tract infections (ie, the number of new episodes of illness per person-weeks at risk). Pneumonia was defined according to the WHO clinical case definition. Analysis was by intention to treat.

FINDINGS:

Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI (-65% to -34%). Also compared with controls, children younger than 15 years in households with plain soap had a 53% lower incidence of diarrhoea (-65% to -41%) and a 34% lower incidence of impetigo (-52% to -16%). Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap.

INTERPRETATION:

Handwashing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely, diarrhoea and acute lower respiratory infections. Handwashing with daily bathing also prevents impetigo.

• Authors: Stephen P Luby, Mubina Agboatwalla, Daniel R Feikin, John Painter, Ward Billhimer, Arshad Altaf, Robert M Hoekstra
• Journal: Lancet (London, England) (Lancet) 2005 Jul 16-22 Vol. 366 Issue 9481 Pg. 225-33 ISSN: 1474-547X [Electronic] England
• PMID: 16023513 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Carbanilides
• Soaps
• triclocarban

Topics

• Acute Disease
• Carbanilides (administration & dosage)
• Child
• Child, Preschool
• Developing Countries
• Diarrhea (epidemiology, prevention & control)
• Hand Disinfection
• Health Education
• Humans
• Impetigo (epidemiology, prevention & control)
• Incidence
• Infant
• Pakistan
• Poverty
• Respiratory Tract Infections (epidemiology, prevention & control)
• Soaps