The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study
The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study
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DOI：
10.1371/journal.pmed.1001052
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发表时间：
2011-06-01
期刊：
影响因子：
15.8
通讯作者：
Johnston, Richard B.
中科院分区：
文献类型：
--
作者：
Luby, Stephen P.;Halder, Amal K.;Johnston, Richard B.
背景：在儿童死亡率较高的社区，改善手卫生的标准公共卫生干预措施鼓励社区居民在五个不同的关键时间用肥皂洗手，这一建议将要求生活在贫困家庭的母亲通常每天用肥皂洗手十次以上。我们分析了在一项大型前瞻性项目评估中没有接受干预的家庭的数据，以评估观察到的洗手行为与随后的腹泻之间的关系。方法和结果：2007年，现场工作人员对孟加拉国农村50个村庄的347户家庭进行了5小时的结构化观察和横断面调查。在接下来的两年里，一名训练有素的社区居民每月走访每个登记的家庭，并收集关于5岁以下家庭居民在过去48小时内发生腹泻的信息。与不洗手准备食物的家庭中的儿童相比，食品制作者至少用水洗手(优势比[OR]=0.78；95%可信区间[CI]=0.57~1.05)、只用水洗手(OR=0.67；95%CI=0.51~0.89)、或用肥皂至少洗手(OR=0.30；95%CI=0.19~0.47)的儿童腹泻较少。在居民大便后至少用肥皂洗手的家庭，儿童腹泻较少(OR=0.45；95%CI=0.26-0.77)。儿童喂奶前、进食前或清洁肛门后使用或不使用肥皂洗手与随后的儿童腹泻之间没有显著关联。结论：这些观察结果表明，准备食物之前洗手是预防儿童腹泻的一个特别重要的机会，仅用水洗手可以显著减少儿童腹泻。
Background: Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea.Methods and Findings: Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.57-1.05), washed both hands with water only (OR = 0.67; 95% CI = 0.51-0.89), or washed at least one hand with soap (OR = 0.30; 95% CI = 0.19-0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR = 0.45; 95% CI = 0.26-0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child's anus who defecated and subsequent child diarrhea.Conclusions: These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea.