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Evidence summaries

Hand Washing for Preventing Diarrhoea

Interventions to promote hand washing reduce diarrhoea episodes by about 30% both in child day-care centres in high-income countries and among communities in low- and middle-income countries. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 29 studies: 13 studies from child day-care centres or schools in mainly high-income countries (n=54 471), 15 community-based studies in low- and middle-income countries (LMICs) (n=29 347), and one hospital-based study among people with acquired immune deficiency syndrome (AIDS) (n=148).

Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevented around one-third of diarrhoea episodes in high income countries (incidence rate ratio, IRR 0.70, 95% CI 0.58 to 0.85; 9 studies, n=4 664), and may prevent a similar proportion in LMICs but only 2 studies from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 studies, n=45 380). Only 4 studies reported measures of behaviour change and the methods of data collection were susceptible to bias. In one study from the USA hand washing behaviour was reported to improve; and in the study from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 studies, n=1 845).

Hand washing promotion among communities in LMICs prevented diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 studies, n=15 950). In 7 studies, soap was provided free alongside hand washing education, and the overall average effect size was larger than in the 2 studies which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 studies, n=12 646; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 studies, n=3 304). There was increased hand washing at major prompts (before eating/cooking, after visiting the toilet or cleaning the baby's bottom), and increased compliance to hand hygiene procedure (behavioural outcome) in the intervention groups than the control in community trials (data not pooled: 4 studies, n=3 591).Hand washing promotion for the one study conducted in a hospital among high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (MD 1.68, 95% CI 1.93 to 1.43; 1 study, n=148). There was increase in hand washing frequency, 7 times per day in the intervention group versus 3 times in the control in this hospital trial.No studies evaluating the effects of hand washing promotions on diarrhoea-related deaths or cost effectiveness were found.

    References

    • Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D et al. Hand-washing promotion for preventing diarrhoea. Cochrane Database Syst Rev 2021;(12):CD004265. [PubMed]

Primary/Secondary Keywords