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. 2021 Mar 23;49(1):26.
doi: 10.1186/s41182-021-00315-1.

Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: a cluster randomized controlled trial

Ephrem Tefera Solomon  1   2 , Sirak Robele Gari  3 , Helmut Kloos  4 , Bezatu Mengistie Alemu  5
Affiliations

Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: a cluster randomized controlled trial

Ephrem Tefera Solomon et al. Trop Med Health. .

Abstract

Background: Handwashing with soap reduces diarrheal diseases burden considerably. However, the importance of handwashing in homes has received little attention in rural eastern Ethiopia. The effectiveness of handwashing may be reduced by lack of information on when and in what event hands must be washed, the frequency of handwashing, the individual who should wash his/her hands, and the procedure of handwashing. In these areas, indicators of adherence to handwashing are yet to be established. This study aimed at assessing the efficiency of handwashing on reducing diarrheal disease in children under 5 years old in rural kebeles of Dire Dawa, east Ethiopia.

Methods: Community-based cluster randomized controlled trial was conducted in rural kebeles of Dire Dawa for 4 months starting from October 2018 to January 2019. Selected clusters were randomized in intervention and control arms using draw method and data collectors conducted the baseline survey. Households assigned to the intervention group were given two bars of plain soap on a bi-monthly basis together with information promoting hand hygiene. Control households were allowed to continue their habitual handwashing practices. We compared the diarrheal incidences of the intervention and non-intervention households. Generalized estimation equations using Poisson family and log choice of the link was employed to calculate adjusted incidence rate ratio with its 95% confidence interval.

Results: We recorded a significant lesser diarrheal incidence in the handwashing arm than in the non-intervention arm (6.9 versus 13.8 episodes per 100 person weeks of observation). In all, there was a 41% reduction in diarrheal incidence in the intervention arm in relation to the non-intervention arm.

Conclusion: Handwashing with soap complemented with hand hygiene promotion significantly decreased diarrheal episodes in children under 5 years old in rural kebeles of Dire Dawa. We recommend the promotion and adaptation of washing hands using soap at recommended times to be an effective means of reducing childhood diarrhea morbidity in rural populations of Ethiopia towards achieving the Sustainable Development Goal 6.

Trial registration: PACTR, PACTR201807815961394 . Registered 16 July 2018.

Keywords: Childhood diarrhea; Ethiopia; Handwashing compliance; Under-five children.

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Conflict of interest statement

No conflict of interests is declared by the authors.

Figures

Fig. 1
Fig. 1
Selection and follow-up flow of study participants for the community randomized controlled trial, rural Dire Dawa, eastern Ethiopia, 2019
Fig. 2
Fig. 2
Total number of episodes of diarrhea recorded at 2-week observations for intervention and control groups in rural Dire Dawa, eastern Ethiopia, 2019
See this image and copyright information in PMC

References

    1. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Cochrane review: hand washing for preventing diarrhoea. Evid Based Child Health. 2009;4(2):893–939. doi: 10.1002/ebch.373. - DOI - PubMed
    1. UNICEF . Diarrhoeal disease. 2019.
    1. World Health Organization . World health statistics 2016: monitoring health for the SDGs sustainable development goals. Geneva: World Health Organization; 2016.
    1. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins J, et al. Systematic review: hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Tropical Med Int Health. 2014;19(8):906–916. doi: 10.1111/tmi.12339. - DOI - PubMed
    1. George CM, Biswas S, Jung D, Perin J, Parvin T, Monira S, Saif-Ur-Rahman KM, Rashid MU, Bhuyian SI, Thomas ED, Dreibelbis R, Begum F, Zohura F, Zhang X, Sack DA, Alam M, Sack RB, Leontsini E, Winch PJ. Psychosocial factors mediating the effect of the CHoBI7 intervention on handwashing with soap: A randomized controlled trial. Health Educ Behav. 2017;44(4):613–625. doi: 10.1177/1090198116683141. - DOI - PubMed

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