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Am. J. Trop. Med. Hyg., 76(6), 2007, pp. 1166-1173
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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Right arrow Diarrheal diseases

A CLUSTER-RANDOMIZED CONTROLLED TRIAL EVALUATING THE EFFECT OF A HANDWASHING-PROMOTION PROGRAM IN CHINESE PRIMARY SCHOOLS

ANNA BOWEN*, HUILAI MA, JIANMING OU, WARD BILLHIMER, TIMOTHY LONG, ERIC MINTZ, ROBERT M. HOEKSTRA, AND STEPHEN LUBY
National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; China Centers for Disease Control and Prevention, Beijing, China; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China; Procter & Gamble Company, Cincinnati, Ohio; ICDDR,B Center for Health and Population Research, Dhaka, Bangladesh

Intensive handwashing promotion can reduce diarrheal and respiratory disease incidence. To determine whether less intensive, more scalable interventions can improve health, we evaluated a school-based handwashing program. We randomized 87 Chinese schools to usual practices: standard intervention (handwashing program) or expanded intervention (handwashing program, soap for school sinks, and peer hygiene monitors). We compared student absence rates, adjusting for cluster design. In control schools, children experienced a median 2.0 episodes (median 2.6 days) of absence per 100 student-weeks. In standard intervention schools, there were a median 1.2 episodes (P = 0.08) and 1.9 days (P = 0.14) of absence per 100 student-weeks. Children in expanded intervention schools experienced a median 1.2 episodes (P = 0.03) and 1.2 days (P = 0.03) of absence per 100 student-weeks. Provision of a large-scale handwashing promotion program and soap was associated with significantly reduced absenteeism. Similar programs could improve the health of children worldwide.

Received December 19, 2006. Accepted for publication February 27, 2007.

Acknowledgments: Many thanks to the teachers and students who participated in this study, and to John Painter, Robert Fontaine, James Mendlein, Lu Mei, May Zeng, Eileen Wang, Susan Lee, Yan Yansheng, and Cai Shaojian for their suggestions and support.

Disclosure: Stephen Luby and Anna Bowen were supported by the grant used to fund this study. Ward Billhimer and Timothy Long were employees of Procter & Gamble. The other authors have no conflicts of interest to declare. Inclusion of soap trade names is for identification purposes only and does not imply endorsement by CDC or the U.S. Department of Health and Human Services.

* Address correspondence to Anna Bowen, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-38, Atlanta, GA 30333. E-mail: abowen{at}cdc.gov

Authors’ addresses: Anna Bowen and Eric Mintz, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-38, Atlanta, GA 30333, Telephone: +1 (404) 639-4636, Fax: +1 (404) 639-2205, E-mail: abowen{at}cdc.gov. Huilai Ma, Field Epidemiology Training Program, China Centers for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China, Telephone +86-10-83171510, Fax: +86-10-83171509. Jianming Ou, Fujian Province Centers for Disease Control and Prevention, 76 Jintai Road, Fuzhou, 350001, China, Telephone: +86 591-7528254, Fax: +86 591-7670235. Ward Billhimer, Hilltop Research, 11511 Reed Hartman Highway—SWTC, Cincinnati, OH 45241, Telephone: +1 (513) 239-2344, Fax: +1 (513) 602-2452. Timothy Long, Procter & Gamble Company, 11511 Reed Hartman Highway—SWTC, Cincinnati, OH, Telephone: +1 (513) 626-0704, Fax: +1 (513) 626-0912. Robert Michael Hoekstra, Division of Foodborne, Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-09, Atlanta, GA 30333, Telephone: +1 (404) 639-4712, Fax: +1 (404) 639-2205. Stephen Luby, ICCDR,B, Center for Health and Population Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali (GPO Box 128, Dhaka 1000), Dhaka 1212, Bangladesh, Telephone: +880-2-8860523-32, Fax: +880-2-8823116.






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Copyright © 2007 by the American Society of Tropical Medicine and Hygiene.