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Abstract
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.
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.
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.
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.