Tuesday, 17th of May 2011 |
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CSU 37/2009: COCHRANE REVIEW/ EFFECT OF A HANDWASHING-PROMOTION PROGRAM
IN CHINESE PRIMARY SCHOOLS
NOTE TO READERS
Thanks to reader James Cheyne for this notice.
New online tool for group A meningococcal meningitis and rotavirus decision
making
The Advanced Immunization Management (AIM) e-Learning website recently
launched two new modules to help decision making on the introduction of two
vaccines – rotavirus and a new group A meningococcal meningitis conjugate
vaccine. The meningitis vaccine module is available in English and French.
The modules provide comprehensive information from basic disease
characteristics through immunization session planning; these interactive
online tools are primarily aimed at immunization program managers but will
also be useful for country program officers, medical providers, public
health educators, and public health managers.
Developed by PATH and partners, the AIM e-Learning site also features
modules on:
Hepatitis B vaccine (also in French and Russian)
Immunization financing (also in French, Russian and Bahasa Indonesia), and
an Excel tutorial (also in French).
An updated module on Japanese encephalitis vaccine and a new module on
strategic planning for measles control are forthcoming.
The group A meningococcal meningitis conjugate vaccine AIM module is online
at http://aim.path.org/en/vaccines/mening/index.html
The rotavirus AIM module is available at
http://aim.path.org/en/vaccines/rota/index.html.
Both modules are also available on CD upon request to info@aim.path.org.
The AIM homepage address is www.aim.path.org
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|------|1: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004265.
Comment in:
Int J Epidemiol. 2008 Jun;37(3):470-3.
J Adv Nurs. 2008 Oct;64(1):14-5.
Hand washing for preventing diarrhoea.
Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA.
University of Calabar, Dept. of Public Health, College of Medical
Sciences, Calabar, Nigeria. reginaejemot@yahoo.com
BACKGROUND: Diarrhoea is a common cause of morbidity and a leading
cause of death among children aged less than five years,
particularly in low- and middle-income countries. It is transmitted
by ingesting contaminated food or drink, by direct person-to-person
contact, or from contaminated hands. Hand washing is one of a range
of hygiene promotion interventions that can interrupt the
transmission of diarrhoea-causing pathogens. OBJECTIVES: To
evaluate the effects of interventions to promote hand washing on
diarrhoeal episodes in children and adults. SEARCH STRATEGY: In May
2007, we searched the Cochrane Infectious Diseases Group
Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2),
MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and
Social Science Citation Index, ERIC (1966 to May 2007), SPECTR,
Bibliomap, RoRe, The Grey Literature, and reference lists of
articles. We also contacted researchers and organizations in the
field.
SELECTION CRITERIA: Randomized controlled trials, where the unit of
randomization is an institution (eg day-care centre), household, or
community, that compared interventions to promote hand washing or a
hygiene promotion that included hand washing with no intervention
to promote hand washing.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed
trial eligibility and methodological quality. Where appropriate,
incidence rate ratios (IRR) were pooled using the generic inverse
variance method and random-effects model with 95% confidence
intervals (CI).
MAIN RESULTS: Fourteen randomized controlled trials met the
inclusion criteria. Eight trials were institution-based, five were
community-based, and one was in a high-risk group (AIDS patients).
Interventions promoting hand washing resulted in a 29% reduction in
diarrhoea episodes in institutions in high-income countries (IRR
0.71, 95% CI 0.60 to 0.84; 7 trials) and a 31% reduction in such
episodes in communities in low- or middle-income countries (IRR
0.69, 95% CI 0.55 to 0.87; 5 trials).
AUTHORS' CONCLUSIONS: Hand washing can reduce diarrhoea episodes by
about 30%. This significant reduction is comparable to the effect
of providing clean water in low-income areas. However, trials with
longer follow up and that test different methods of promoting hand
washing are needed.
2) EFFECT OF A HANDWASHING PROGRAM
This CDC study, published in The American Journal of Tropical Medicine and
Hygiene, is the largest trial to date of the impact on absenteeism and
reported illness of hand washing in schools. Abstract is below; Full text
is at http://www.ajtmh.org/cgi/content/full/76/6/1166
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Am. J. Trop. Med. Hyg., 76(6), 2007, pp. 1166-1173
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene
A CLUSTER-RANDOMIZED CONTROLLED TRIAL EVALUATING THE EFFECT OF A
HANDWASHING-PROMOTION PROGRAM IN CHINESE PRIMARY SCHOOLS
ANNA BOWEN*, HUILAI MA, JIANMING OU, WARD BILLHIMER, TIMOTHY LONG, ERIC
MINTZ, ROBERT M. HOEKSTRA, AND STEPHEN LUBY
National Center for Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia; China Centers for Disease Control and
Prevention, Beijing, China; Fujian Provincial Center for Disease Control
and Prevention, Fuzhou, China; Procter & Gamble Company, Cincinnati, Ohio;
ICDDR,B Center for Health and Population Research, Dhaka, Bangladesh
Intensive handwashing promotion can reduce diarrheal and respiratory
disease incidence. To determine whether less intensive, more scalable
interventions can improve health, we evaluated a school-based handwashing
program. We randomized 87 Chinese schools to usual practices: standard
intervention (handwashing program) or expanded intervention (handwashing
program, soap for school sinks, and peer hygiene monitors). We compared
student absence rates, adjusting for cluster design. In control schools,
children experienced a median 2.0 episodes (median 2.6 days) of absence per
100 student-weeks. In standard intervention schools, there were a median
1.2 episodes (P = 0.08) and 1.9 days (P = 0.14) of absence per 100
student-weeks. Children in expanded intervention schools experienced a
median 1.2 episodes (P = 0.03) and 1.2 days (P = 0.03) of absence per 100
student-weeks. Provision of a large-scale handwashing promotion program and
soap was associated with significantly reduced absenteeism. Similar
programs could improve the health of children worldwide.
Received December 19, 2006. Accepted for publication February 27, 2007.
Acknowledgments: Many thanks to the teachers and students who participated
in this study, and to John Painter, Robert Fontaine, James Mendlein, Lu
Mei, May Zeng, Eileen Wang, Susan Lee, Yan Yansheng, and Cai Shaojian for
their suggestions and support.
Disclosure: Stephen Luby and Anna Bowen were supported by the grant used to
fund this study. Ward Billhimer and Timothy Long were employees of Procter
& Gamble. The other authors have no conflicts of interest to declare.
Inclusion of soap trade names is for identification purposes only and does
not imply endorsement by CDC or the U.S. Department of Health and Human
Services.
* Address correspondence to Anna Bowen, Enteric Diseases Epidemiology
Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE,
MS A-38, Atlanta, GA 30333. E-mail: abowen@cdc.gov
Authors’ addresses: Anna Bowen and Eric Mintz, Enteric Diseases
Epidemiology Branch, Centers for Disease Control and Prevention, 1600
Clifton Road NE, MS A-38, Atlanta, GA 30333, Telephone: +1 (404) 639-4636,
Fax: +1 (404) 639-2205, E-mail: abowen@cdc.gov. Huilai Ma, Field
Epidemiology Training Program, China Centers for Disease Control and
Prevention, 27 Nanwei Road, Beijing, 100050, China, Telephone
+86-10-83171510, Fax: +86-10-83171509. Jianming Ou, Fujian Province Centers
for Disease Control and Prevention, 76 Jintai Road, Fuzhou, 350001, China,
Telephone: +86 591-7528254, Fax: +86 591-7670235. Ward Billhimer, Hilltop
Research, 11511 Reed Hartman Highway—SWTC, Cincinnati, OH 45241, Telephone:
+1 (513) 239-2344, Fax: +1 (513) 602-2452. Timothy Long, Procter & Gamble
Company, 11511 Reed Hartman Highway—SWTC, Cincinnati, OH, Telephone: +1
(513) 626-0704, Fax: +1 (513) 626-0912. Robert Michael Hoekstra, Division
of Foodborne, Bacterial and Mycotic Diseases, Centers for Disease Control
and Prevention, 1600 Clifton Road NE, MS C-09, Atlanta, GA 30333,
Telephone: +1 (404) 639-4712, Fax: +1 (404) 639-2205. Stephen Luby,
ICCDR,B, Center for Health and Population Research, 68 Shahid Tajuddin
Ahmed Sharani, Mohakhali (GPO Box 128, Dhaka 1000), Dhaka 1212, Bangladesh,
Telephone: +880-2-8860523-32, Fax: +880-2-8823116.
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