Re: handwashing, child neglect - The Lancet

["Virginio Oddone" <oddovir@xxxxxxxxx>]

The latest issue of the british medical journal has another very interesting
paper, which may be not-so-indirectly related to child neglect: children and
handwashing. It has been done with Third & Fourth World countries children;
however, neglecting families are - in many aspects - reproducing a pattern
close to that of 3rd & 4th World countries, although amid affluence. Just
think of the relevance that malnourishment has among them; and, of course,
of very poor hygiene, diarrhoea etc.. See below for the Summary. The links
are:

http://www.thelancet.com/journals/lancet/full?volume=366&issue=9481
http://www.thelancet.com/journals/lancet/article/PIIS0140673605669127/abstract

Virginio

*******************

Dr. Virginio ODDONE, M.D.
V. Avogadro 6
10121 - Torino (Italy)
e-mail: oddovir@ipsnet.it
 medico.legale@cto.to.it

******************
J'ai enfin le droit de saluer des êtres que je ne connais pas
Ils passent devant moi et s'accumulent au loin
Tandis que tout ce que j'en vois m'est inconnu
Et leur espoir n'est pas moins fort que le mien.
(Apollinaire, Le musicien de Saint-Merry.)

******************

The Lancet 2005; 366:225-233

DOI:10.1016/S0140-6736(05)66912-7

Effect of handwashing on child health: a randomised controlled trial
Stephen P Luby  a ,   Mubina Agboatwalla b,   Daniel R Feikin a,   John
Painter a,   Ward Billhimer d,   Arshad Altaf c   and   Robert M Hoekstra a

Summary
Background
More than 3·5 million children aged less than 5 years die from diarrhoea and
acute lower respiratory-tract infection every year. We undertook a
randomised controlled trial to assess the effect of handwashing promotion
with soap on the incidence of acute respiratory infection, impetigo, and
diarrhoea.

Methods
In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned
25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306
households) were randomised as controls. In neighbourhoods 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 diarrhoea, 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
diarrhoea (−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, diarrhoea and acute

lower respiratory infections. Handwashing with daily bathing also prevents
impetigo.

Affiliations

a Division of Bacterial and Mycotic Diseases, National Centers for
Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
30333, USA
b Health Oriented Preventive Education, Karachi, Pakistan
c Community Health Sciences, Aga Khan University, Karachi, Pakistan
d The Procter and Gamble Company, Cincinnati, OH, USA