School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, South Africa.
Southern Africa Labour and Development Research Unit, University of Cape Town, Private Bag X3, Rondebosch, 7701, South Africa.
BMC Public Health. 2018 Jun 7;18(1):709. doi: 10.1186/s12889-018-5573-8.
While regular handwashing effectively reduces communicable disease incidence and related child mortality, instilling a habit of regular handwashing in young children continues to be a challenging task, especially in developing country contexts. This randomised controlled pilot study assessed the effect of a novel handwashing intervention - a bi-monthly delivery of a colourful, translucent bar of soap with a toy embedded in its centre (HOPE SOAP©) - on children's handwashing behaviour and health outcomes.
Between September and December 2014, 203 households in an impoverished community in Cape Town, South Africa, were randomised (1:1) to the control group or to receive HOPE SOAP©. Of all children (N = 287) aged 3-9 years and not enrolled in early childhood development programmes, 153 residing in intervention households received a bar of HOPE SOAP© every two weeks (total of 4 bars). Children in control households received a colourful, translucent bar of soap of equal size to HOPE SOAP©, with a toy alongside it. Two 'snack tests' (children were offered crackers and jam) were used to provide objective observational measures of handwashing. Through baseline and endline surveys, data were collected from caregivers on the frequency (scale of 1-10) of handwashing by children after using the toilet and before meals, and on soap-use during handwashing. Data on 14 illnesses/symptoms of illness experienced by children in the two weeks preceding the surveys were collected. Multivariable Ordinary Least Squares regression analyses were used to assess the intervention effect on handwashing behaviours and health outcomes.
At endline, HOPE SOAP© children were directly observed as being more likely to wash their hands unprompted at both snack tests (49% vs 39%, β: 0.10, p = 0.27). They were more likely to score ≥8/10 for using soap when washing their hands (β: 0.14, p = 0.011). HOPE SOAP© children, in general, had better health outcomes, and those who used the soap as intended, and did not cheat to remove the toy from the soap, were less likely to have been ill (β: - 0.15, p = 0.049).
Results point towards HOPE SOAP© being an effective intervention to improve handwashing among children. Further research on this novel handwashing intervention is warranted.
NCT03280771 ( www.clinicaltrials.gov ) retrospectively registered on 8 September 2017.
尽管经常洗手可以有效地降低传染病的发病率和相关儿童死亡率，但在发展中国家，培养幼儿经常洗手的习惯仍然是一项具有挑战性的任务。本随机对照试验评估了一种新型洗手干预措施（每两个月提供一次带有玩具的彩色半透明肥皂）对儿童洗手行为和健康结果的影响。
2014 年 9 月至 12 月，南非开普敦一个贫困社区的 203 户家庭被随机分为对照组或接受 HOPE SOAP©（1:1）。在所有年龄在 3-9 岁且未参加幼儿发展计划的儿童中，153 名居住在干预家庭的儿童每两周（共 4 块）收到一块 HOPE SOAP©。对照组家庭的儿童收到一块与 HOPE SOAP©大小相同的彩色半透明肥皂，旁边有一个玩具。进行了两次“零食测试”（提供饼干和果酱给孩子们），以提供儿童使用厕所和饭前洗手的客观观察指标。通过基线和终线调查，从照顾者那里收集了儿童在使用厕所和饭前洗手的频率（1-10 分制）以及在洗手时使用肥皂的数据。在调查前两周内，收集了儿童经历的 14 种疾病/疾病症状的数据。多变量最小二乘回归分析用于评估干预措施对洗手行为和健康结果的影响。
在终线时，直接观察到 HOPE SOAP©的儿童在两次零食测试中更有可能在没有提示的情况下洗手（49%对 39%，β：0.10，p=0.27）。他们在洗手时更有可能获得≥8/10 的肥皂使用评分（β：0.14，p=0.011）。一般来说，HOPE SOAP©儿童的健康结果更好，那些按预期使用肥皂且不欺骗以将玩具从肥皂中取出的儿童生病的可能性较低（β：-0.15，p=0.049）。
结果表明 HOPE SOAP©是一种有效的改善儿童洗手习惯的干预措施。需要进一步研究这种新型洗手干预措施。
NCT03280771（www.clinicaltrials.gov）于 2017 年 9 月 8 日进行了回顾性注册。
