Bowen Anna, Agboatwalla Mubina, Luby Stephen, Tobery Timothy, Ayers Tracy, Hoekstra R M
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Arch Pediatr Adolesc Med. 2012 Nov;166(11):1037-44. doi: 10.1001/archpediatrics.2012.1181.
To evaluate associations between handwashing promotion and child growth and development.
Cluster randomized controlled trial.
Informal settlements in Karachi, Pakistan.
A total of 461 children who were enrolled in a trial of household-level handwashing promotion in 2003 and were younger than 8 years at reassessment in 2009.
In 2003, neighborhoods were randomized to control (n = 9), handwashing promotion (n = 9), or handwashing promotion and drinking water treatment (n = 10); intervention households received free soap and weekly handwashing promotion for 9 months.
Anthropometrics and developmental quotients measured with the Battelle Developmental Inventory II at 5 to 7 years of age.
Overall, 24.9% (95% CI, 20.0%-30.6%) and 22.1% (95% CI, 18.0%-26.8%) of children had z scores that were more than 2 SDs below the expected z scores for height and body mass index for age, respectively; anthropometrics did not differ significantly across study groups. Global developmental quotients averaged 104.4 (95% CI, 101.9-107.0) among intervention children and 98.3 (95% CI, 93.1-103.4) among control children (P = .04). Differences of similar magnitude were measured across adaptive, personal-social, communication, cognitive, and motor domains.
Although growth was similar across groups, children randomized to the handwashing promotion during their first 30 months of age attained global developmental quotients 0.4 SDs greater than those of control children at 5 to 7 years of age. These gains are comparable to those of at-risk children enrolled in publicly funded preschools in the United States and suggest that handwashing promotion could improve child well-being and societal productivity.
clinicaltrials.gov Identifier: NCT01538953.
评估洗手推广与儿童生长发育之间的关联。
整群随机对照试验。
巴基斯坦卡拉奇的非正式定居点。
共有461名儿童，他们于2003年参加了一项家庭层面洗手推广试验，并在2009年重新评估时年龄小于8岁。
2003年，社区被随机分为对照组（n = 9）、洗手推广组（n = 9）或洗手推广及饮用水处理组（n = 10）；干预家庭获得免费肥皂，并接受为期9个月的每周一次洗手推广。
在5至7岁时用贝利婴幼儿发展量表第二版测量人体测量学指标和发育商数。
总体而言，分别有24.9%（95%CI，20.0%-30.6%）和22.1%（95%CI，18.0%-26.8%）的儿童身高和年龄别体重指数的z评分低于预期z评分超过2个标准差；各研究组间人体测量学指标无显著差异。干预组儿童的总体发育商数平均为104.4（95%CI，101.9-107.0），对照组儿童为98.3（95%CI，93.1-103.4）（P = 0.04）。在适应性、个人社交、沟通、认知和运动领域也测量到了类似幅度的差异。
尽管各组间生长情况相似，但在出生后头30个月被随机分配到洗手推广组的儿童，在5至7岁时的总体发育商数比对照组儿童高0.4个标准差。这些收益与美国参加公共资助学前班的高危儿童相当，表明洗手推广可改善儿童健康和社会生产力。
clinicaltrials.gov标识符：NCT01538953。
