This Cochrane Review summarises trials evaluating the effects of
promoting hand washing on the incidence of diarrhoea among children and
adults in day-care centres, schools, communities, or hospitals. After
searching for relevant trials up to 27 May 2015, we included 22
randomized controlled trials conducted in both high-income countries
(HICs) and low- and middle-income countries (LMICs). These trials
enrolled 69,309 children and 148 adults.
Diarrhoea causes many deaths in children below five years of age, mostly
in LMICs. The organisms causing diarrhoea are transmitted from person to
person through food and water contaminated with faeces, or through
person-to-person contact. Hand washing after defecation, or after
cleaning a baby's bottom, and before preparing and eating food, can
therefore reduce the risk of diarrhoea. Hand washing can be promoted
through group or individual training on hygiene education, germ-health
awareness, use of posters, leaflets, comic books, songs, and drama.
What this review says
Hand washing promotion at child day-care facilities or schools in HICs
probably prevents around 30% of diarrhoea episodes (high quality
evidence), and may prevent a similar proportion in schools in LMICs (low
quality evidence). Among communities in LMICs hand washing promotion
prevents around 28% of diarrhoea episodes (moderate quality evidence).
In the only hospital-based trial included in this review, hand washing
promotion also had important reduction in the mean episodes of diarrhoea
(moderate quality evidence). This is based on only a single trial with
few participants and thus there is need for more trials to confirm this.
Effects of hand washing promotion on related hand hygiene behaviour
changes improved more in the intervention groups than in the control in
all the settings (low to high quality evidence). None of the included
trials assessed the effect of handwashing promotion on
diarrhoeal-related deaths, all-cause under-five mortality, or the
cost-effectiveness of hand washing promotions.
Hand washing promotion in HICs and LMICs settings may reduce incidence
of diarrhoea by about 30%. However, less is known about how to help
people maintain hand washing habits in the longer term.
This research is supported by the Department for International Development’s Evidence Building and Synthesis Research Programme which is led by Liverpool School of Tropical Medicine
Ejemot-Nwadiaro, R.I.; Ehiri, J.E.; Arikpo, D.; Meremikwu, M.M.; Critchley, J.A. Hand washing promotion for preventing diarrhoea. Cochrane Database of Systematic Reviews (2016) : [DOI: 10.1002/14651858.CD004265.pub3]
Hand washing promotion for preventing diarrhoea