title: Do alcohol-based hand rubs reduce the incidence of acute diarrhea during military deployments? A prospective randomized trial.
abstract: BACKGROUND
  Acute diarrhea remains a public health concern in armed forces deployed in tropical areas where access to water and soap is limited. This study aims to assess the effectiveness of alcohol-based hand rubs (ABHR) on incidence of diarrhea in poor hygiene conditions.
  
  
  METHODS
  A prospective randomized trial was conducted between November 2014 and January 2015 among French military troops deployed in Africa to compare a group of soldiers receiving usual hand hygiene recommendations (control group), to a group of soldiers who received ABHR in addition to usual hand hygiene recommendations (intervention group). Data on diarrhea and hygiene behaviors were collected using self-questionnaires. The incidence rate of diarrhea episodes in groups was compared.
  
  
  RESULTS
  Participation rate was 59% (236/400). The proportion of individuals who used ABHR was 97% in the intervention group and 62% in the control group. The overall incidence rate of diarrheal episodes was observed to be in the region of 60 per 100 persons-month without any significant difference between groups after adjustment on confounding factors (p = 0.93). Handwashing with soap was used on average 4 times a day in the control group and twice a day in the intervention group (p = 0.93). It was the only significant protective factor for diarrhea (p < 10-3).
  
  
  CONCLUSIONS
  Our results support that supplying soap and good quality water should be a priority on the field.
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France. Electronic address: succo.tiphanie@gmail.com.
authors.forename: Tiphanie
authors.initials: T
authors.lastname: Succo
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: De Laval
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Sicard
authors.affiliation: Joint French Military Health Service Department in French Guyana, Cayenne, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Belleoud
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France; SESSTIM-UMR 912, Aix-Marseille University, Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Marimoutou
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France; SESSTIM-UMR 912, Aix-Marseille University, Marseille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Mayet
authors.affiliation: SESSTIM-UMR 912, Aix-Marseille University, Marseille, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Sagaon-Teyssier
authors.affiliation: French Military Center for Epidemiology and Public Health, Marseille, France; SESSTIM-UMR 912, Aix-Marseille University, Marseille, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Michel
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000438:Alcohols; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D004202:Disinfectants; D005260:Female; D006235:Hand Disinfection; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards; D064548:Hand Sanitizers; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D012915:Soaps; D011795:Surveys and Questionnaires; D014195:Travel; D055815:Young Adult
chemical_list: D000438:Alcohols; D004202:Disinfectants; D064548:Hand Sanitizers; D012915:Soaps
keywords: Alcohol-based hand rubs; Diarrhea; Military deployment; Traveller