The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study

English version České info

Background:
Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea.

Methods and Findings:
Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.57–1.05), washed both hands with water only (OR = 0.67; 95% CI = 0.51–0.89), or washed at least one hand with soap (OR = 0.30; 95% CI = 0.19–0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR = 0.45; 95% CI = 0.26–0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child's anus who defecated and subsequent child diarrhea.

Conclusions:
These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study. PLoS Med 8(6): e32767. doi:10.1371/journal.pmed.1001052
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001052

Souhrn

Zdroje

1. EjemotREhiriJMeremikwuMCritchleyJ 2008 Hand washing for preventing diarrhoea. Cochrane Database Syst Rev CD004265

2. CurtisVADanquahLOAungerRV 2009 Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 24 655 673

3. ScottBCurtisVRabieTGarbrah-AidooN 2007 Health in our hands, but not in our heads: understanding hygiene motivation in Ghana. Health Policy Plan 22 225 233

4. HoqueBABriendA 1991 A comparison of local handwashing agents in Bangladesh. J Trop Med Hyg 94 61 64

5. IyerPSaraJCurtisVScottBCardosiJ 2005 The handwashing handbook. A guide for developing a hygiene promotion program to increase handwashing with soap Washington (D.C.) World Bank

6. KleinauEPyleDF 2004 Assessing hygiene improvement. Guidelines for household and community levels Washington (D.C.) Environmental Health Project

7. Centers for Disease Control and Prevention 2010 Handwashing: Clean hands save lives Atlanta (Georgia) Centers for Disease Control and Prevention

8. ZeitlynSIslamF 1991 The use of soap and water in two Bangladeshi communities: implications for the transmission of diarrhea. Rev Infect Dis 13 Suppl 4 S259 S264

9. BudlenderBChobokoaneNMpetsheniY 2001 A survey of time use: How South African women and men spend their time Pretoria Statistics South Africa

10. PPPHW 2009 Global Handwashing Day 15 October Planner's Guide Washington (D.C.) PPPHW

11. LoevinsohnBP 1990 Health education interventions in developing countries: a methodological review of published articles. Int J Epidemiol 19 788 794

12. VyasSKumaranayakeL 2006 Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21 459 468

13. BarrosAJDVictoriaCG 2005 A nationwide wealth score based on the 2000 Brazilian demographic census. Rev Saude Publica 39 1 6

14. HouwelingTAKunstAEMackenbachJP 2003 Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter? Int J Equity Health 2 8

15. HanleyJANegassaAEdwardesMDForresterJE 2003 Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol 157 364 375

16. GorterACSandifordPPauwJMoralesPPerezRM 1998 Hygiene behaviour in rural Nicaragua in relation to diarrhoea. Int J Epidemiol 27 1090 1100

17. LynchMFTauxeRVHedbergCW 2009 The growing burden of foodborne outbreaks due to contaminated fresh produce: risks and opportunities. Epidemiol Infect 137 307 315

18. SivapalasingamSFriedmanCRCohenLTauxeRV 2004 Fresh produce: a growing cause of outbreaks of foodborne illness in the United States, 1973 through 1997. J Food Prot 67 2342 2353

19. DavisHTaylorJPPerdueJNStelmaGNJrHumphreysJMJr 1988 A shigellosis outbreak traced to commercially distributed shredded lettuce. Am J Epidemiol 128 1312 1321

20. SrikantiahPBodagerDTothBKass-HoutTHammondR 2005 Web-based investigation of multistate salmonellosis outbreak. Emerg Infect Dis 11 610 612

21. AsplundKNurmiE 1991 The growth of salmonellae in tomatoes. Int J Food Microbiology 13 177 181

22. RangelJMSparlingPHCroweCGriffinPMSwerdlowDL 2005 Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerg Infect Dis 11 603 609

23. GormanRBloomfieldSAdleyCC 2002 A study of cross-contamination of food-borne pathogens in the domestic kitchen in the Republic of Ireland. Int J Food Microbiol 76 143 150

24. IslamMSHasanMKKhanSI 1993 Growth and survival of Shigella flexneri in common Bangladeshi foods under various conditions of time and temperature. Appl Environ Microbiol 59 652 654

25. KolvinJLRobertsD 1982 Studies on the growth of Vibrio cholerae biotype eltor and biotype classical in foods. J Hyg (Lond) 89 243 252

26. DaveyKR 1989 A predictive model for combined temperature and water activity on microbial growth during the growth phase. J Appl Bacteriol 67 483 488

27. McElroyDMJaykusLAFoegedingPM 2000 Validation and analysis of modeled predictions of growth of Bacillus cereus spores in boiled rice. J Food Prot 63 268 272

28. TeunisPFMvan der HeijdenOGvan der GiessenJWBHavelaarAH 1996 The dose-response relation in human volunteers for gastro-intestinal pathogens Bilthoven, The Netherlands National Institute of Public Health and the Environment (RIVM)

29. BollaertsKAertsMFaesCGrijspeerdtKDewulfJ 2008 Human salmonellosis: estimation of dose-illness from outbreak data. Risk Anal 28 427 440

30. RobertsD 1982 Factors contributing to outbreaks of food poisoning in England and Wales 1970–1979. J Hyg (Lond) 89 491 498

31. LubySPKadirMAYushuf SharkerMAYeasminFUnicombL 2010 A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh. Trop Med Int Health 15 1508 1516

32. StantonBFClemensJD 1987 An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea. Am J Epidemiol 125 292 301

33. KaltenthalerEWatermanRCrossP 1991 Faecal indicator bacteria on the hands and the effectiveness of hand-washing in Zimbabwe. J Trop Med Hyg 94 358 363

34. SpruntKRedmanWLeidyG 1973 Antibacterial effectiveness of routine hand washing. Pediatrics 52 264 271

35. LowburyEJLillyHABullJP 1964 Disinfection of hands: removal of transient organisms. Br Med J 2 230 233

36. HoqueBAMahalanabisDPeltoBAlamMJ 1995 Research methodology for developing efficient handwashing options: an example from Bangladesh. J Trop Med Hyg 98 469 475

37. LubySPGuptaSKSheikhMAJohnstonRBRamPK 2008 Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 105 1002 1008

38. IslamMSSiddikaAKhanMNGoldarMMSadiqueMA 2001 Microbiological analysis of tube-well water in a rural area of Bangladesh. Appl Environ Microbiol 67 3328 3330

39. DrankiewiczDDundesL 2003 Handwashing among female college students. Am J Infect Control 31 67 71

40. PedersenDMKeithlySBradyK 1986 Effects of an observer on conformity to handwashing norm. Percept Mot Skills 62 169 170

41. MungerKHarrisSJ 1989 Effects of an observer on handwashing in a public restroom. Perceptual and Motor Skills 69 733 734

42. PittetDSimonAHugonnetSPessoa-SilvaCLSauvanV 2004 Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 141 1 8

43. RamPKHalderAKGrangerSPJonesTHallP 2010 Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation. Am J Trop Med Hyg 83 1070 1076

44. CousensSKankiBToureSDialloICurtisV 1996 Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso. Soc Sci Med 43 1299 1308