Hand washing promotion for preventing diarrhoea

Background Diarrhoea accounts for 1.8 million deaths in children in low‐ and middle‐income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. Objectives To assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field. Selection criteria Individually randomized controlled trials (RCTs) and cluster‐RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention. Data collection and analysis Three review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day‐care centres or schools, community, and hospital‐based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random‐effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence. Main results We included 22 RCTs: 12 trials from child day‐care centres or schools in mainly high‐income countries (54,006 participants), nine community‐based trials in LMICs (15,303 participants), and one hospital‐based trial among people with acquired immune deficiency syndrome (AIDS) (148 participants). Hand washing promotion (education activities, sometimes with provision of soap) at child day‐care facilities or schools prevents around one‐third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participant