BACKGROUND: More than 3.5 million
children aged less than 5 years die from diarrhea and acute lower
respiratory-tract infection every year. We undertook a randomized controlled trial to assess the effect of handwashing promotion with soap
on the incidence of acute respiratory infection, impetigo, and diarrhea.
METHODS: In adjoining squatter
settlements in Karachi, Pakistan, we randomly assigned 25 neighborhoods to handwashing promotion; 11
neighborhoods (306 households) were randomized as controls. In neighborhoods
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 diarrhea, 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.
FINDINGS: 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 diarrhea
(-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.
INTERPRETATION: Handwashing with
soap prevents the two clinical syndromes that cause the largest number
of childhood deaths globally — namely,
diarrhea and acute lower respiratory infections. Handwashing with daily
bathing also prevents impetigo.
