Hand washing for preventing diarrhoea

 

Abstract

Background

Diarrhoea is a common cause of morbidity and a leading cause of death among children aged less than five years, particularly in low- and middle-income countries. It is transmitted by ingesting contaminated food or drink, by direct person-to-person contact, or from contaminated hands. Hand washing is one of a range of hygiene promotion interventions that can interrupt the transmission of diarrhoea-causing pathogens.

Objectives

To evaluate the effects of interventions to promote hand washing on diarrhoeal episodes in children and adults.

Search methods

In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and Social Science Citation Index, ERIC, SPECTR, Bibliomap, RoRe, The Grey Literature, and reference lists of articles. We also contacted researchers and organizations in the field.

Selection criteria

Randomized controlled trials, where the unit of randomization is an institution (eg day-care centre), household, or community, that compared interventions to promote hand washing or a hygiene promotion that included hand washing with no intervention to promote hand washing.

Data collection and analysis

Two authors independently assessed trial eligibility and risk of bias. We stratified the analyses for cluster adjusted and non-adjusted trials. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CI).

Main results

Fourteen randomized controlled trials met the inclusion criteria. Eight trials were institution-based in high-income countries, five were community-based in low or middle-income countries, and one was in a high-risk group (people with acquired immune deficiency syndrome (AIDS)). Considering only trial results that adjusted for cluster randomization, interventions promoting hand washing resulted in a 39% reduction in diarrhoea episodes in children in institutions in high-income countries (IRR 0.61, 95% CI 0.40 to 0.92; 2 trials) and a 32% reduction in such episodes in children living in communities in low- or middle-income countries (IRR 0.68, 95% CI 0.52 to 0.90; 4 trials).

Authors' conclusions

Interventions that promote hand washing can reduce diarrhoea episodes by about one-third. This significant reduction is comparable to the effect of providing clean water in low-income areas. However, trials with longer follow up and that test different methods of promoting hand washing are needed.

 

Plain language summary

Strategies to encourage hand washing can reduce the incidence of diarrhoea by about one third

Diarrhoea is a serious global public health problem, particularly in low-income and middle-income countries. The World Health Organization estimates that over three million episodes occur each year, with many people dying, especially children aged less than five years in low- and middle-income countries. Persistent diarrhoea can also contribute to malnutrition, reduced resistance to infections, and sometimes impaired growth and development. The organisms causing diarrhoea can be transmitted from infected faeces to people through food and water, person-to-person contact, or direct contact. Hand washing after defecation and handling faeces, and before preparing and eating food can reduce the risk of diarrhoea. This review looked at trials of interventions to increase the use of hand washing in institutions in high-income countries and in communities in low- or middle-income countries, and found many of the interventions like educational programmes, leaflets, and discussions to be effective.

 

摘要

背景

洗手預防腹瀉的效果

腹瀉是五歲以下兒童生病常見，且是造成死亡的主要原因，尤其是在中低收入的國家中。腹瀉是藉由吃進受到污染的食物或飲料，或藉由人對人直接接觸，或經由受到污染的手來傳染。洗手是眾多衛生提升的宣導中可以阻斷腹瀉致病體散佈的其中一個方式，能夠中斷腹瀉病原體的傳播。

目標

評估在兒童及成人中宣導洗手的介入後對於腹瀉事件發生的影響。

搜尋策略

在2007年5月，我們搜尋了Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and Social Science Citation Index, ERIC (1966 to May 2007), SPECTR, Bibliomap, RoRe, 灰色文獻(The Grey Literature),以及文章後面所列之參考文獻。我們也接觸了該領域的研究者及組織。

選擇標準

隨機對照試驗。隨機分配的單位包括機構(例如日間照護中心)、家庭或社區，以介入洗手宣導或衛生宣導(包含洗手)和未提供洗手宣導時進行比較。

資料收集與分析

兩位作者獨立評估試驗的合格性以及方法學上的品質。發生率比值(IRR)是採用Generic inverse variance method，以隨機效應模型(randomeffects model) 及95％信賴區間所計算的。

主要結論

14個隨機對照試驗符合了納入標準。8個試驗在機構中進行，5個在社區中，1個則是針對高危險群(愛滋病患者)。在高收入國家的機構中洗手的宣導讓腹瀉事件減少了29%(IRR 0.71, 95% CI 0.60 至 0.84;7 個試驗)，在中低收入國家的社區中則使得腹瀉事件減少了31%(IRR 0.69, 95% CI 0.55 至 0.87;5 個試驗)。

作者結論

洗手能使腹瀉事件減少約30%。在低收入地區中，此顯著的減少可與提供乾淨的水產生的效果相比擬。然而，還是需要較長時間追蹤以及測試不同方法宣導洗手的試驗。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

鼓勵洗手的策略能夠讓腹瀉的發生率減少三分之一。腹瀉是一個嚴重的全球性公共衛生問題，尤其是在低收入及中收入國家。世界衛生組織估計每年超過3百萬個腹瀉事件發生，導致許多人死亡，尤其是中低收入國家中小於5歲的兒童。持續性的腹瀉也可能導致營養不良及對傳染病抵抗力降低，往往也會使得生長及發展受損。導致腹瀉的致病菌會從受感染的糞便，經過食物及飲水、人與人接觸，或直接接觸等方式來傳播給其他人。在排便後或處理糞便，以及準備食物及進食前洗手能夠減少造成腹瀉的風險。本文回顧了在高收入國家的機構以及中低國家的社區中，加強洗手的介入性試驗。結果發現許多介入措施，例如教育專案、傳單以及討論會都有效果。