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      Hygiene: new hopes, new horizons

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      Author(s): , Dr, PhD a , * , , PhD a ,   , MD b , c , , PhD d , , PhD a
      Publication date (Electronic):
      Journal: The Lancet. Infectious Diseases
      Publisher: Elsevier Ltd.

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          Summary

          Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

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          Most cited references59

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          Effect of handwashing on child health: a randomised controlled trial.

          Stephen P Luby, Mubina Agboatwalla, Daniel Feikin … (2005)
          More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year. We undertook a randomised controlled trial to assess the effect of handwashing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea. In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned 25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306 households) were randomised as controls. In neighbourhoods with handwashing promotion, 300 households each were assigned to antibacterial soap containing 1.2% triclocarban and to plain soap. Fieldworkers visited households weekly for 1 year to encourage handwashing by residents in soap households and to record symptoms in all households. Primary study outcomes were diarrhoea, impetigo, and acute respiratory-tract infections (ie, the number of new episodes of illness per person-weeks at risk). Pneumonia was defined according to the WHO clinical case definition. Analysis was by intention to treat. Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI (-65% to -34%). Also compared with controls, children younger than 15 years in households with plain soap had a 53% lower incidence of diarrhoea (-65% to -41%) and a 34% lower incidence of impetigo (-52% to -16%). Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap. Handwashing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely, diarrhoea and acute lower respiratory infections. Handwashing with daily bathing also prevents impetigo.
          Article 0 comments Cited 201 times – based on 0 reviews     Review now
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            Handwashing and risk of respiratory infections: a quantitative systematic review

            Tamer Rabie, Valerie A Curtis (2006)
            Summary Objective  To determine the effect of handwashing on the risk of respiratory infection. Methods  We searched PubMed, CAB Abstracts, Embase, Web of Science, and the Cochrane library for articles published before June 2004 in all languages. We had searched reference lists of all primary and review articles. Studies were included in the review if they reported the impact of an intervention to promote hand cleansing on respiratory infections. Studies relating to hospital‐acquired infections, long‐term care facilities, immuno‐compromised and elderly people were excluded. We independently evaluated all studies, and inclusion decisions were reached by consensus. From a primary list of 410 articles, eight interventional studies met the eligibility criteria. Results  All eight eligible studies reported that handwashing lowered risks of respiratory infection, with risk reductions ranging from 6% to 44% [pooled value 24% (95% CI 6–40%)]. Pooling the results of only the seven homogenous studies gave a relative risk of 1.19 (95% CI 1.12%–1.26%), implying that hand cleansing can cut the risk of respiratory infection by 16% (95% CI 11–21%). Conclusions  Handwashing is associated with lowered respiratory infection. However, studies were of poor quality, none related to developing countries, and only one to severe disease. Rigorous trials of the impact of handwashing on acute respiratory tract infection morbidity and mortality are urgently needed, especially in developing countries.
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              Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race.

              Randal Kaufman, Matthew McGee, Amber Cooper (1997)
              A large number of epidemiologic studies have focused on racial/ethnic differences, particularly between blacks and whites. Because health endpoints and racial categorizations are associated with socioeconomic status, investigators generally adjust for socioeconomic indicators. The intention is usually to control for confounding, thereby making groups comparable and excluding socioeconomic status as an alternative explanation to hypotheses of innate physiologic differences. A threat to the validity of these analyses is therefore the presence of residual confounding. We identify four potential sources of residual confounding in this analytical design: categorization of socioeconomic status variables, measurement error in socioeconomic indicators, use of aggregated socioeconomic status measures, and incommensurate socioeconomic indicators. Using simulations and examples from the literature, we demonstrate that the effect of residual confounding is to bias interpretation of data toward the conclusion of independent racial/ethnic group effects. Investigators often refer to possible "genetic" differences on the basis of models that control for socioeconomic status. We propose that such conclusions on the basis of this analytical strategy are generally unwarranted. Racial/ethnic differences in disease are a pressing public health concern, but the current approach does not often provide a basis for inference about putative biological factors in the etiology of this disparity.
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                Author and article information

                Contributors
                Val Curtis
                Journal
                Journal ID (nlm-ta): Lancet Infect Dis
                Journal ID (iso-abbrev): Lancet Infect Dis
                Title: The Lancet. Infectious Diseases
                Publisher: Elsevier Ltd.
                ISSN (Print): 1473-3099
                ISSN (Electronic): 1474-4457
                Publication date PMC-release: 28 March 2011
                Publication date (Print): April 2011
                Publication date (Electronic): 28 March 2011
                Volume: 11
                Issue: 4
                Pages: 312-321
                Affiliations
                [a ]The Hygiene Centre, London School of Hygiene and Tropical Medicine, London, UK
                [b ]International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
                [c ]Water and Sanitation Programme, Lima, Peru
                [d ]Ministry of Health, Bamako, Mali
                Author notes
                [* ]Correspondence to: Dr Val Curtis, The Hygiene Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK val.curtis@ 123456lshtm.ac.uk
                Article
                Publisher ID: S1473-3099(10)70224-3
                DOI: 10.1016/S1473-3099(10)70224-3
                PMC ID: 7106354
                PubMed ID: 21453872
                SO-VID: d1fd6e20-8fb0-421a-b546-7bce7f326b2e
                Copyright © Copyright © 2011 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                ScienceOpen disciplines: Infectious disease & Microbiology
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                ScienceOpen disciplines: Infectious disease & Microbiology

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