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Hand washing for preventing diarrhoea

  1. Regina I Ejemot-Nwadiaro1,*,
  2. John E Ehiri2,
  3. Martin M Meremikwu3,
  4. Julia A Critchley4

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 5 NOV 2007

DOI: 10.1002/14651858.CD004265.pub2

Database Title

Additional Information

How to Cite

Ejemot-Nwadiaro RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004265. DOI: 10.1002/14651858.CD004265.pub2.

Author Information

  1. 1

    University of Calabar, Department of Public Health, College of Medical Sciences, Calabar, Cross River State, Nigeria

  2. 2

    Mel and Enid Zuckerman College of Public Health, University of Arizona, Division of Health Promotion Sciences, Tucson, Arizona, USA

  3. 3

    University of Calabar Teaching Hospital, Department of Paediatrics, Calabar, Cross River State, Nigeria

  4. 4

    Newcastle University, Institute of Health and Society, Newcastle, Tyne and Wear, UK

*Regina I Ejemot-Nwadiaro, Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Cross River State, PMB 11115, Nigeria. idulove@yahoo.com. reginaejemot@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 8 JUL 2009

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Abstract

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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

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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

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科学洗手，预防腹泻

研究背景

腹泻是五岁以下儿童的常见疾病，也是造成其死亡的主要原因，这在中低收入国家尤为突出。腹泻可以通过摄入被污染的食物和饮料，人与人之间的直接接触，或经由受污染的手而发生传染。在阻断致腹泻病原体传播的众多卫生促进干预措施中，洗手是其中之一。

研究目的

评估在儿童及成人中倡导洗手习惯对预防腹泻发生的干预效果。

检索方法

2007年5月，我们检索了来源于Cochrane Infectious Diseases Group Specialized Register, CENTRAL (Cochrane图书馆，2007年第2期), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index 和 Social Science Citation Index, ERIC (1966年∼2007年5月), SPECTR, Bibliomap, RoRe等数据库的文献，并检索了一些灰色文献和文后所列的参考文献。此外，我们还联系了该领域的研究者及相关组织机构。

纳入标准

纳入了随机对照试验，这些试验对两种干预措施进行了比较研究，一种是倡导洗手的卫生干预措施，而另外一种是包含洗手内容但没有进行干预的卫生促进措施；其中随机分配的单位包括机构（例如日间照护中心）、家庭或社区。

数据收集与分析

两位评价者独立评价了试验的合格性以及偏倚风险。我们对分组校正和未分组校正的试验进行了分层分析。发生率比值（IRR）的合成采用逆方差分析（Generic inverse variance method）和随机效应模型，并计算95％可信区间（CI）。

主要结果

14个随机对照试验符合纳入标准，其中8个试验是在高收入国家基于机构的研究，5个是在中低收入国家基于社区的研究，1个则是针对高风险人群（艾滋病患者）的研究。仅从整群随机化调整试验结果而言，倡导洗手的干预措施使得儿童腹泻发生率在高收入国家的机构中减少了39%（IRR 0.61, 95% CI:0.40 ∼ 0.92；2个试验），而在中低收入国家的社区中则减少了32%（IRR 0.68, 95% CI:0.52 ∼ 0.90；4个试验）。

作者结论

倡导洗手的干预措施能使腹泻事件减少约三分之一。在低收入地区，其减少的显著程度甚至可与提供清洁饮水所产生的效果相比拟。然而，仍需要开展长期的随访试验以评价不同干预措施的效果。

 

概要

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科学洗手，预防腹泻

鼓励洗手的策略能够让腹泻的发生率减少三分之一

腹泻是一个严重的全球性公共卫生问题，尤其是在中低收入国家。世界卫生组织估计每年有超过3百万次腹泻事件发生，导致许多人死亡，尤其是中低收入国家中5岁以下儿童。持续性的腹泻也可能导致营养不良，降低对传染病的抵抗力，有时还会影响生长发育。腹泻的病原菌会从带菌的粪便经由食物及饮水、人际接触，或直接接触等方式而发生传播。饭前便后洗手能够减少腹泻发生的风险。本文回顾了在高收入国家的机构以及中低收入国家的社区中倡导洗手的一些干预试验，发现许多干预措施，如教育项目、传单以及讨论等都是行之有效的。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网（China Effective Health Care Network）翻译。

翻译注解"：本摘要由重庆医科大学中国循证卫生保健协作网（China Effective Health Care Network）翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 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。

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