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Topics

Systematic review : hygiene and health : systematic review of handwashing practices worldwide and update of health effects

Objective

To estimate the global prevalence of handwashing with soap and derive a pooled estimate of the effect of hygiene on diarrhoeal diseases, based on a systematic search of the literature.

Methods

Studies with data on observed rates of handwashing with soap published between 1990 and August 2013 were identified from a systematic search of PubMed, Embase and ISI Web of Knowledge. A separate search was conducted for studies on the effect of hygiene on diarrhoeal disease that included randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined. The search used Cochrane Library, Global Health, BIOSIS, PubMed, and Embase databases supplemented with reference lists from previously published systematic reviews to identify studies published between 1970 and August 2013. Results were combined using multilevel modelling for handwashing prevalence and meta-regression for risk estimates.

Results

From the 42 studies reporting handwashing prevalence we estimate that approximately 19% of the world population washes hands with soap after contact with excreta (i.e. use of a sanitation facility or contact with children's excreta). Meta-regression of risk estimates suggests that handwashing reduces the risk of diarrhoeal disease by 40% (risk ratio 0.60, 95% CI 0.53–0.68); however, when we included an adjustment for unblinded studies, the effect estimate was reduced to 23% (risk ratio 0.77, 95% CI 0.32–1.86).

Conclusions

Our results show that handwashing after contact with excreta is poorly practised globally, despite the likely positive health benefits.

TitleSystematic review : hygiene and health : systematic review of handwashing practices worldwide and update of health effects
Publication TypeJournal Article
Year of Publication2014
AuthorsFreeman, M.C., Stocks, M.E., Cumming, O., Jeandron, A., Higgins, J.P.T., Wolf, J., Pruss-Ustun, A., Bonjour, S., Hunter, P.R., Fewtrell, L., Curtis, V.
Secondary TitleTropical medicine & international health
Volume19
Pagination906–916
Date Published05/2014
Publication LanguageEnglish
Keywordshealth impact, meta-analysis, soap
Abstract

Objective

To estimate the global prevalence of handwashing with soap and derive a pooled estimate of the effect of hygiene on diarrhoeal diseases, based on a systematic search of the literature.

Methods

Studies with data on observed rates of handwashing with soap published between 1990 and August 2013 were identified from a systematic search of PubMed, Embase and ISI Web of Knowledge. A separate search was conducted for studies on the effect of hygiene on diarrhoeal disease that included randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined. The search used Cochrane Library, Global Health, BIOSIS, PubMed, and Embase databases supplemented with reference lists from previously published systematic reviews to identify studies published between 1970 and August 2013. Results were combined using multilevel modelling for handwashing prevalence and meta-regression for risk estimates.

Results

From the 42 studies reporting handwashing prevalence we estimate that approximately 19% of the world population washes hands with soap after contact with excreta (i.e. use of a sanitation facility or contact with children's excreta). Meta-regression of risk estimates suggests that handwashing reduces the risk of diarrhoeal disease by 40% (risk ratio 0.60, 95% CI 0.53–0.68); however, when we included an adjustment for unblinded studies, the effect estimate was reduced to 23% (risk ratio 0.77, 95% CI 0.32–1.86).

Conclusions

Our results show that handwashing after contact with excreta is poorly practised globally, despite the likely positive health benefits.

Notes

Includes 55 ref.

DOI10.1111/tmi.12339

Disclaimer

The copyright of the documents on this site remains with the original publishers. The documents may therefore not be redistributed commercially without the permission of the original publishers.