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

ANNA BOWENNational 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

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HUILAI MANational 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

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JIANMING OUNational 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

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WARD BILLHIMERNational 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

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TIMOTHY LONGNational 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

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ERIC MINTZNational 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

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ROBERT M. HOEKSTRANational 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

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STEPHEN LUBYNational 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

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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.

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