title: An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities.
abstract: OBJECTIVE
  To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism.
  
  
  METHODS
  We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).
  
  
  RESULTS
  Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (-25%, 95% confidence intervals [CI] = -37%, -2%), ARIs (-15%, 95% CI = -30%, -8%), school absences due to illnesses (-27%, 95% CI = -41%, -18%) and eye infections (-46%, 95% CI = -58%, -31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (-31%, 95% CI = -37%, -5%; and -14%, 95% CI = -23%, -6%, respectively), 6- to 15-year-olds (-30%, 95% CI = -39%, -7%; and -15%, 95% CI = -24%, -6%) and under 5 s (-32%, 95% CI = -41%, -4%; and -20%, 95% CI = -29%, -8%).
  
  
  CONCLUSIONS
  Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Nicholson
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Naeeni
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoptroff
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Matheson
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Roberts
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Lifebuoy Marketing, Nairobi, Kenya.
authors.forename: Myriam
authors.initials: M
authors.lastname: Sidibe
authors.affiliation: Weir Partners Limited, Wirral, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Weir
authors.affiliation: Maharishi Markandeshwar University, Ambala, India.
authors.forename: Satyawan G
authors.initials: SG
authors.lastname: Damle
authors.affiliation: Unilever Research & Development, Bebington, UK.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wright
mesh_terms: D000041:Absenteeism; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D005192:Family Health; D006235:Hand Disinfection / Q000379:methods*; D006266:Health Education / Q000379:methods; D006801:Humans; D006920:Hygiene; D007194:India / Q000453:epidemiology; D009035:Mothers; D011203:Poverty; D015397:Program Evaluation; D055818:Public-Private Sector Partnerships; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D012574:Schools; D012915:Soaps / Q000627:therapeutic use*; D012925:Social Conformity; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D012915:Soaps
keywords: acute respiratory infection; diarrhoea; hand washing with soap; hygiene; school absence