E-drug: Handwashing and diarrhoeal diseases
-------------------------------------------------------------------------
BMJ 2003;326:1004 (10 May 2003)
Handwashing programmes could be intervention of choice for
diarrhoeal diseases
Roger Dobson
Handwashing could prevent more than one million deaths a year from
diarrhoeal diseases. A new systematic review that set out to
determine the impact of washing hands with soap in the community
worldwide concludes that handwashing could reduce the risk of
diarrhoea by up to 47%.
"On current evidence, washing hands with soap can reduce the risk
of diarrhoeal diseases by 42 47% and interventions to promote hand
washing might save a million lives. In the absence of adequate
mortality studies, we extrapolate the potential number of diarrhoea
deaths that could be averted by hand washing at about a million,"
wrote the authors (Lancet Infectious Diseases 2003;3:275-81).
The authors, from the London School of Hygiene and Tropical
Medicine, add, "Although more and more rigorous intervention trials
of the health impact of hand washing are badly needed, current
evidence shows a clear and consistent pattern. If hand washing with
soap could save over a million lives, if rates of hand washing are
currently very low, and if carefully designed hand washing promotion
programmes can be effective and cost-effective, then hand washing
promotion may become an intervention of choice."
Diarrhoeal diseases are among the top three killers of children, and
the authors say that the most recent published estimate of the total
annual death rate from diarrhoeal diseases is 2.2 million.
The authors of the review set out to identify all studies published in
English up to the end of 2002 that related handwashing to the risk of
infectious intestinal or diarrhoeal diseases in the community. They
selected 17 (of the 38 papers with relevant content) for inclusion in
the meta-analysis and estimated the effect of handwashing on
mortality on the basis of published figures.
The authors say that, although there is much discussion about how to
improve handwashing habits in healthcare settings, the importance of
handwashing in homes, particularly in developing countries, gets
scant attention.
"Interest in the diarrhoeal diseases peaked in the 1980s with efforts to
promote oral rehydration and improved water supply. Today, they are
ranked third as cause of death and second as cause of healthy life
years lost due to premature mortality and disability. However,
whereas major new initiatives to combat malaria, HIV, and
tuberculosis have been announced, interest in research and
intervention in the diarrhoeal diseases has waned," they say in their
article.
Although their evidence suggests that the promotion of handwashing
with soap in homes in developing countries should become a public
health intervention of choice, the authors say much work remains to
be done.
"Rigorous intervention trials are needed to explore the impact of hand
washing on diarrhoea and other infections, in a variety of settings.
Basic work is still needed to clarify when hands should be washed,
how often, by whom, and in what manner. Simple indicators of hand
washing compliance need to be developed and validated," they say.
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug