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 Int Health. 2014 Mar;19(3):284-292. doi: 10.1111/tmi.12254. Epub 2014 Jan 2.

Abstract

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.

Keywords: acute respiratory infection; diarrhoea; hand washing with soap; hygiene; school absence.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism*
  • Acute Disease
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Diarrhea / epidemiology
  • Diarrhea / prevention & control*
  • Family Health*
  • Hand Disinfection / methods*
  • Health Education / methods
  • Humans
  • Hygiene
  • India / epidemiology
  • Mothers
  • Poverty
  • Program Evaluation
  • Public-Private Sector Partnerships
  • Regression Analysis
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / prevention & control*
  • Schools
  • Soaps / therapeutic use*
  • Social Conformity
  • Treatment Outcome
  • Urban Population

Substances

  • Soaps