Mbakaya Balwani Chingatichifwe, Lee Paul H, Lee Regina L T
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
World Health Organization Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China.
Int J Environ Res Public Health. 2017 Apr 1;14(4):371. doi: 10.3390/ijerph14040371.
Effective and appropriate hand-washing practice for schoolchildren is important in preventing infectious diseases such as diarrhoea, which is the second most common cause of death among school-age children in sub-Saharan Africa. The objective of the review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhoea and respiratory tract infections among schoolchildren aged 6-12 years in developing countries. Published research articles were searched from databases covering a period from as far back as the creation of the databases to November 2015. Eight randomized controlled trials (RCT/CRCT) from developing countries met the inclusion criteria. The Jadad Scale for appraising RCT/CRCT studies revealed methodological challenges in most studies, such that 75% (6/8) were rated as low-quality articles. The review found that hand hygiene can reduce the incidence of diarrhoea and respiratory conditions. Three hand hygiene intervention strategies utilized were training, funding and policy, with training and funding implemented more commonly than policy. These strategies were not only used in isolation but also in combination, and they qualified as multi-level interventions. Factors that influenced hand washing were contextual, psychosocial and technological. Findings can inform school health workers in categorizing and prioritizing activities into viable strategies when implementing multi-level hand-washing interventions. This review also adds to the existing evidence that multi-level hand-washing interventions can reduce the incidence of diarrhoea, respiratory infections, and school absenteeism. Further evidence-based studies are needed with improved methodological rigour in developing countries, to inform policy in this area.
对学童而言，有效且恰当的洗手习惯对于预防诸如腹泻等传染病至关重要，腹泻是撒哈拉以南非洲学龄儿童中第二大常见死因。本综述的目的是确定手部卫生干预策略，以减少发展中国家6至12岁学童中腹泻和呼吸道感染等传染病的发生。从数据库中检索已发表的研究文章，涵盖从数据库创建到2015年11月的时间段。来自发展中国家的八项随机对照试验（RCT/CRCT）符合纳入标准。用于评估RCT/CRCT研究的雅达量表显示，大多数研究存在方法学挑战，75%（6/8）的文章被评为低质量文章。该综述发现，手部卫生可降低腹泻和呼吸道疾病的发病率。所采用的三种手部卫生干预策略是培训、资金和政策，培训和资金的实施比政策更为普遍。这些策略不仅单独使用，也相互结合使用，属于多层次干预措施。影响洗手的因素包括环境、心理社会和技术因素。研究结果可为学校卫生工作者在实施多层次洗手干预措施时将活动分类并按优先级纳入可行策略提供参考。本综述还补充了现有证据，即多层次洗手干预措施可降低腹泻、呼吸道感染和学校缺勤率的发生率。发展中国家需要开展方法学严谨性更高的进一步循证研究，为该领域的政策提供依据。
