Hand washing promotion for preventing diarrhoea


Regina I Ejemot-Nwadiaro1, John E Ehiri2, Dachi Arikpo3, Martin M Meremikwu4, Julia A Critchley5

1. University of Calabar, Department of Public Health, College of Medical Sciences, Calabar, Cross River State, Nigeria
2. University of Arizona, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, Tucson, Arizona, USA
3. Institute of Tropical Diseases Research and Prevention, Nigerian Branch of the South African Cochrane Centre, Calabar, Cross River State, Nigeria
4. University of Calabar Teaching Hospital, Department of Paediatrics, Calabar, Cross River State, Nigeria
5. St George's, University of London, Population Health Sciences Institute, London, UK

To read  the full article please follow this link: DOI: 10.1002/14651858.CD004265.pub3/full

Review question

This Cochrane Review summarises trials evaluating the effects of promoting hand washing on the incidence of diarrhoea among children and adults in day-care centres, schools, communities, or hospitals. After searching for relevant trials up to 27 May 2015, we included 22 randomized controlled trials conducted in both high-income countries (HICs) and low- and middle-income countries (LMICs). These trials enrolled 69,309 children and 148 adults.

How does hand washing prevent diarrhoea and how might hand washing be promoted

Diarrhoea causes many deaths in children below five years of age, mostly in LMICs. The organisms causing diarrhoea are transmitted from person to person through food and water contaminated with faeces, or through person-to-person contact. Hand washing after defecation, or after cleaning a baby's bottom, and before preparing and eating food, can therefore reduce the risk of diarrhoea. Hand washing can be promoted through group or individual training on hygiene education, germ-health awareness, use of posters, leaflets, comic books, songs, and drama.

What this review says

Hand washing promotion at child day-care facilities or schools in HICs probably prevents around 30% of diarrhoea episodes (high quality evidence), and may prevent a similar proportion in schools in LMICs (low quality evidence). Among communities in LMICs hand washing promotion prevents around 28% of diarrhoea episodes (moderate quality evidence). In the only hospital-based trial included in this review, hand washing promotion also had important reduction in the mean episodes of diarrhoea (moderate quality evidence). This is based on only a single trial with few participants and thus there is need for more trials to confirm this. Effects of hand washing promotion on related hand hygiene behaviour changes improved more in the intervention groups than in the control in all the settings (low to high quality evidence). None of the included trials assessed the effect of handwashing promotion on diarrhoeal-related deaths, all-cause under-five mortality, or the cost-effectiveness of hand washing promotions.


Hand washing promotion in HICs and LMICs settings may reduce incidence of diarrhoea by about 30%. However, less is known about how to help people maintain hand washing habits in the longer term.