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CSU 37/2009: COCHRANE REVIEW/ EFFECT OF A HANDWASHING PROMOTION PROGRAM IN CHINESE PRIMARY SCHOOLS

Tuesday, 17th of May 2011

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.