An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Intl Health, Mar 2014.
Authors: Julie A. Nicholson, et al.
Objectives – To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children’s school absenteeism.
Methods – We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).
Results – Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (−25%, 95% confidence intervals [CI] = −37%, −2%), ARIs (−15%, 95% CI = −30%, −8%), school absences due to illnesses (−27%, 95% CI = −41%, −18%) and eye infections (−46%, 95% CI = −58%, −31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for ‘whole families’ (−31%, 95% CI = −37%, −5%; and −14%, 95% CI = −23%, −6%, respectively), 6- to 15-year-olds (−30%, 95% CI = −39%, −7%; and −15%, 95% CI = −24%, −6%) and under 5 s (−32%, 95% CI = −41%, −4%; and −20%, 95% CI = −29%, −8%).
Conclusions – Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public–private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.
