title: Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries.
abstract: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low- and middle-income country settings.
  
  
  
  A systematic review of the literature was performed by searching eight databases, and reference lists were hand-searched for additional articles. Studies were reviewed for inclusion according to pre-defined inclusion criteria and the quality of all studies was assessed.
  
  
  
  Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective.
  
  
  
  Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children's handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area, however, does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC.
authors.affiliation: Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Watson
authors.affiliation: Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jeroen H J
authors.initials: JHJ
authors.lastname: Ensink
authors.affiliation: Save the Children, London, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Ramos
authors.affiliation: Save the Children, London, UK.
authors.forename: Prisca
authors.initials: P
authors.lastname: Benelli
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holdsworth
authors.affiliation: Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
authors.affiliation: Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Cumming
mesh_terms: D002648:Child; D002652:Child Behavior; D003906:Developing Countries; D003967:Diarrhea / Q000517:prevention & control*; D006235:Hand Disinfection; D006293:Health Promotion / Q000379:methods*; D006373:Helminthiasis / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene; D012987:Soil
chemical_list: D012987:Soil
keywords: behaviour change; cambio de comportamiento; changement de comportement; children; diarrea; diarrhoea; diarrhée; enfants; hand washing; helminth; helminthes; helmintos; lavado de manos; lavage des mains; niños; revisión sistemática; revue systématique; systematic review