Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan - A randomized controlled trial
Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan - A randomized controlled trial
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DOI：
10.1001/jama.291.21.2547
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发表时间：
2004-06-02
影响因子：
120.7
通讯作者：
Hoekstra, RM
中科院分区：
文献类型：
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作者：
Luby, SP;Agboatwalla, M;Hoekstra, RM
用肥皂洗手可以预防腹泻，但死于腹泻的风险最高的儿童年龄小于1岁，太小而不能自己洗手。以前的研究缺乏足够的力量来评估家庭洗手对腹泻infants.Objective的影响，以评估促进家庭洗手的效果，肥皂在儿童死亡的最高风险从diarrheum.Design，设置，和参与者一个集群随机对照试验的36个低收入社区在城市棚户区在卡拉奇，巴基斯坦。从2002年4月15日至2003年4月5日，实地工作人员至少每周访问一次参与家庭。符合条件的家庭位于研究区域至少有2名儿童年龄小于15岁，其中至少有1人年龄小于5 years.Interventions每周访问25个社区，以促进排便后，准备食物，吃饭，喂养孩子之前用肥皂洗手。在干预社区内，300户家庭（1523名儿童）定期获得抗菌肥皂，300户家庭（1640名儿童）获得普通肥皂。十一街坊306个家庭和1528名儿童组成对照组。主要结果测量儿童腹泻发病率密度，定义为每100人-周观察的腹泻发作次数。结果生活在提倡洗手和使用普通肥皂的家庭中的15岁以下儿童腹泻发病率降低53（95%置信区间[CI]，-65%至-41%）与生活在对照社区的儿童相比。与生活在对照社区的婴儿相比，生活在接受洗手宣传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%）。严重营养不良儿童（体重饲料z评分，
Context 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.Objective 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.Interventions 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.Main Outcome Measure Incidence density of diarrhea among children, defined as the number of diarrheal episodes per 100 person-weeks of observation.Results 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 forage z score,