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Intervention Review

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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: 23 JAN 2008

Assessed as up-to-date: 5 NOV 2007

DOI: 10.1002/14651858.CD004265.pub2

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.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 23 JAN 2008


This is not the most recent version of the article. View current version (03 SEP 2015)


References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Bartlett 1988 {published data only}
  • Bartlett AV, Jarvis BA, Ross V, Katz TM, Dalia MA, Englender SJ, et al. Diarrheal illness among infants and toddlers in day care centers: effects of active surveillance and staff training without subsequent monitoring. American Journal of Epidemiology 1988;127(4):808-17.
Black 1981 {published data only}
  • Black RE, Dykes AC, Anderson KE, Wells JG, Sinclair SP, Gary GW, et al. Handwashing to prevent diarrhea in day-care centers. American Journal of Epidemiology 1981;113(4):445-51.
Bowen 2007 {published data only}
  • Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, et al. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. American Journal of Tropical Medicine and Hygiene 2007;76(6):1166-73.
Butz 1990 {published data only}
Carabin 1999 {published data only}
  • Carabin H, Gyorkos TW, Soto JC, Joseph L, Payment P, Collect JP. Effectiveness of a training program in reducing infections in toddlers attending day care centers. Epidemiology 1999;10(3):219-27.
Haggerty 1994 {published data only}
  • Haggerty PA, Muladi K, Kirkwood BR, Ashworth A, Manunebo M. Community-based hygiene education to reduce diarrhoeal disease in rural Zaire: impact of the intervention on diarrhoeal morbidity. International Journal of Epidemiology 1994;23(5):1050-9.
Han 1989 {published data only}
Huang 2007 {published data only}
  • Huang DB, Zhou J. Effect of intensive handwashing in the prevention of diarrhoeal illness among patients with AIDS: a randomized controlled study. Journal of Medical Microbiology 2007;56(5):659-63.
Kotch 1994 {published data only}
  • Kotch JB, Weigle KA, Weber DJ, Clifford RM, Harms TO, Loda FA, et al. Evaluation of an hygienic intervention in child day-care centers. Pediatrics 1994;94(6 Suppl 2):991-4.
Ladegaard 1999 {published data only}
  • Ladegaard MB, Stage V. Hand-hygiene and sickness among small children attending day care centres. An intervention study [Handhygiejne og smabornssygelighed i daginstitutioner: En interventionsundersogelse (Danish)]. Ugeskr Laeger 1999;161(31):4396-400.
Luby 2004a {published data only}
  • Luby SP, Agboattwalla M, Feikin DR, Painter J, Billheimer W, Hoekstra R. Effect of handwashing in child health: a randomized controlled trial. Lancet 2005;366:225-33.
  • Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA 2004;291(21):2547-54.
Luby 2006 {published and unpublished data}
Roberts 2000 {published data only}
  • Roberts L, Jorm L, Patel M, Smith W, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized controlled trial. Pediatrics 2000;105(4):743-6.
Stanton 1987 {published data only}
  • Stanton BF, Clemens JD. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. American Journal of Epidemiology 1987;125(2):292-301.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Ahmed 1993 {published data only}
  • Ahmed NU, Zeitlin MF, Beiser AS, Super CM, Gershoff SN. A longitudinal study of the impact of behavioural change intervention on cleanliness, diarrhoeal morbidity and growth of children in rural Bangladesh. Social Science & Medicine 1993;37(2):159-71.
Alam 1989 {published data only}
  • Alam N, Wojtyniak B, Henry FJ, Rahaman MM. Mothers' personal and domestic hygiene and diarrhoea incidence in young children in rural Bangladesh. International Journal of Epidemiology 1989;18(1):242-7.
Barros 1999 {published data only}
Clemens 1987 {published data only}
  • Clemens JD, Stanton BF. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. 1. Application of the case-control method for development of an intervention. American Journal of Epidemiology 1987;125(2):284-91.
Curtis 2001 {published data only}
  • Curtis V, Kanki B, Cousen S, Diallo I, Kpozehouen A, Sangare M, et al. Evidence of behaviour change following a hygiene promotion programme in Burkina Faso. Bulletin of the World Health Organization 2001;79(6):518-27.
Doebbeling 1992 {published data only}
  • Doebbling BN, Stanley GL, Sheetz CT, Pfalier MA, Houston AK, Annis L, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. New England Journal of Medicine 1992;327(2):88-93.
Dyer 2000 {published data only}
Guinan 2002 {published data only}
Hammond 2000 {published data only}
Khan 1982 {published data only}
Larson 2003 {published data only}
  • Larson E, Aiello A, Lee LV, Della-Latta P, Gomez-Duarte C, Lin S. Short- and long-term effects of handwashing with antimicrobial or plain soap in the community. Journal of Community Health 2003;28(2):139-50.
Larson 2004 {published data only}
  • Larson EL, Lin SX, Gomez-Pichardo C, Delta-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Annals of Internal Medicine 2004;140(5):321-9.
Lee 1991 {published data only}
  • Lee W, Stoeckel J, Jintaganont P, Romanarak T, Kullavanijaya S. The impact of a community based health education program on the incidence of diarrheal disease in Southern Thailand. Southeast Asian Journal of Tropical Medicine and Public Health 1991;22(4):548-56.
Luby 2001 {published data only}
  • Luby SP, Agboatwalla M, Raza A, Sobel J, Mintz ED, Baier K, et al. Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan. Epidemiology of Infections 2001;127(2):237-44.
Luby 2004b {published data only}
  • Luby SP, Agboatwalla M, Hoekstra RM, Rahbar MH, Billhimer W, Keswick BH. Delayed effectiveness of home-based intervention in reducing childhood diarrhea, Karachi, Pakistan. American Journal of Medicine and Hygiene 2004;71(4):420-7.
Master 1997 {published data only}
  • Master D, Hess Longe SH, Dickson H. Scheduled hand washing in an elementary school population. Family Medicine 1997;29(5):336-9.
Morton 2004 {published data only}
  • Morton JL, Schultz AA. Healthy Hands: Use of alcohol gel as an adjunct to handwashing in elementary school children. Journal of School Nursing 2004;20(3):161-7.
Peterson 1998 {published data only}
Pinfold 1996 {published data only}
  • Pinfold JV, Horan NJ. Measuring the effect of a hygiene behaviour intervention by indicators of behaviour and diarrhoeal disease. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1996;90(4):366-71.
Shahid 1996 {published data only}
  • Shahid NS, Greenough WB, Samadi AR, Huq MI, Rahaman N. Handwashing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. Journal of Diarrhoeal Disease Research 1996;14(2):85-9.
Sircar 1987 {published data only}
  • Sircar BK, Sengupta PG, Mondal SK, Gupta DN, Saha NC, Ghosh S, et al. Effect of handwashing on the incidence of diarrhoea in a Calcutta slum. Journal of Diarrhoeal Disease Research 1987;5(2):112-4.
White 2003 {published data only}
  • White C, Kolble R, Carison R, Lipson N, Dolan M, Ali Y, et al. The effect of hand hygiene on illness rate among students in university residence halls. American Journal of Infection Control 2003;31(6):364-70.
Wilson 1991 {published data only}
  • Wilson JM, Chandler GM. Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia. Transactions of the Royal Society of Tropical Medicine and Hygiene 1993;87(6):615-6.
  • Wilson JM, Chandler GN, Muslihatun, Jamiluddin. Hand-washing reduces diarrhoea episodes: a study in Lombok, Indonesia. Transactions of the Royal Society of Tropical Medicine and Hygiene 1991;85(6):819-21.

Additional references

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Bern 1992
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Borghi 2002
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Curtis 2000
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Ehiri 2001
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Esrey 1989
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Fewtrell 2005
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