Luby Stephen P, Agboatwalla Mubina, Painter John, Altaf Arshad, Billhimer Ward L, Hoekstra Robert M
Foodborne and Diarrheal Diseases, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
JAMA. 2004 Jun 2;291(21):2547-54. doi: 10.1001/jama.291.21.2547.
Washing hands with soap prevents diarrhea, but children at the highest risk of death from diarrhea are younger than 1 year, too young to wash their own hands. Previous studies lacked sufficient power to assess the impact of household handwashing on diarrhea in infants.
To evaluate the effect of promoting household handwashing with soap among children at the highest risk of death from diarrhea.
DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized controlled trial of 36 low-income neighborhoods in urban squatter settlements in Karachi, Pakistan. Field workers visited participating households at least weekly from April 15, 2002, to April 5, 2003. Eligible households located in the study area had at least 2 children younger than 15 years, at least 1 of whom was younger than 5 years.
Weekly visits in 25 neighborhoods to promote handwashing with soap after defecation and before preparing food, eating, and feeding a child. Within intervention neighborhoods, 300 households (1523 children) received a regular supply of antibacterial soap and 300 households (1640 children) received plain soap. Eleven neighborhoods (306 households and 1528 children) comprised the control group.
Incidence density of diarrhea among children, defined as the number of diarrheal episodes per 100 person-weeks of observation.
Children younger than 15 years living in households that received handwashing promotion and plain soap had a 53% lower incidence of diarrhea (95% confidence interval [CI], -65% to -41%) compared with children living in control neighborhoods. Infants living in households that received handwashing promotion and plain soap had 39% fewer days with diarrhea (95% CI, -61% to -16%) vs infants living in control neighborhoods. Severely malnourished children (weight for age z score, <-3.0) younger than 5 years living in households that received handwashing promotion and plain soap had 42% fewer days with diarrhea (95% CI, -69% to -16%) vs severely malnourished children in the control group. Similar reductions in diarrhea were observed among children living in households receiving antibacterial soap.
In a setting in which diarrhea is a leading cause of child death, improvement in handwashing in the household reduced the incidence of diarrhea among children at high risk of death from diarrhea.
用肥皂洗手可预防腹泻,但腹泻致死风险最高的儿童年龄小于1岁,太小而无法自己洗手。以往研究缺乏足够的效力来评估家庭洗手对婴儿腹泻的影响。
评估在腹泻致死风险最高的儿童中推广家庭用肥皂洗手的效果。
设计、地点和参与者:在巴基斯坦卡拉奇城市棚户区的36个低收入社区进行的一项整群随机对照试验。从2002年4月15日至2003年4月5日,现场工作人员至少每周访问参与家庭一次。位于研究区域内的符合条件的家庭有至少2名15岁以下儿童,其中至少1名年龄小于5岁。
每周访问25个社区,以促进排便后以及准备食物、进食和喂孩子前用肥皂洗手。在干预社区内,300户家庭(1523名儿童)获得定期供应的抗菌肥皂,300户家庭(1640名儿童)获得普通肥皂。11个社区(306户家庭和1528名儿童)组成对照组。
儿童腹泻的发病密度,定义为每100人周观察期内的腹泻发作次数。
与生活在对照社区的儿童相比,生活在接受洗手推广和普通肥皂的家庭中的15岁以下儿童腹泻发病率降低了53%(95%置信区间[CI],-65%至-41%)。与生活在对照社区的婴儿相比,生活在接受洗手推广和普通肥皂的家庭中的婴儿腹泻天数减少了39%(95%CI,-61%至-16%)。生活在接受洗手推广和普通肥皂的家庭中的5岁以下重度营养不良儿童(年龄别体重Z评分,<-3.0)腹泻天数比对照组的重度营养不良儿童减少了42%(95%CI,-69%至-16%)。在接受抗菌肥皂的家庭中的儿童中也观察到腹泻有类似程度的减少。
在腹泻是儿童死亡主要原因的环境中,家庭洗手情况的改善降低了腹泻致死高风险儿童的腹泻发病率。