Olivia S Malkowski, Nick P Townsend, Mark J Kelson, Charlie E M Foster, Max J Western
Socio-economic inequalities in the breadth of internet use before and during the COVID-19 pandemic among older adults in England
PloS one
background diarrhoea accounts 18 million deaths children low middleincome countries lmics one identified strategies prevent diarrhoea hand washing objectives assess effects hand washing promotion interventions diarrhoeal episodes children adults search methods searched cochrane infectious diseases group specialized register 27 may 2015 central published cochrane library 2015 issue 5 medline 1966 27 may 2015 embase 1974 27 may 2015 lilacs 1982 27 may 2015 psycinfo 1967 27 may 2015 science citation index social science citation index 1981 27 may 2015 eric 1966 27 may 2015 spectr 2000 27 may 2015 bibliomap 1990 27 may 2015 rore grey literature 2002 27 may 2015 world health organization international clinical trial registry platform ictrp metaregister controlled trials mrct reference lists articles 27 may 2015 also contacted researchers organizations field selection criteria individually randomized controlled trials rcts clusterrcts compared effects hand washing interventions diarrhoea episodes children adults intervention data collection analysis three review authors independently assessed trial eligibility extracted data assessed risk bias stratified analyses child daycare centres schools community hospitalbased settings appropriate incidence rate ratios irr pooled using generic inverse variance method randomeffects model 95 confidence intervals cis used grade approach assess quality evidence main results included 22 rcts 12 trials child daycare centres schools mainly highincome countries 54006 participants nine communitybased trials lmics 15303 participants one hospitalbased trial among people acquired immune deficiency syndrome aids 148 participants hand washing promotion education activities sometimes provision soap child daycare facilities schools prevents around onethird diarrhoea episodes high income countries rate ratio 070 95 ci 058 085 nine trials 4664 participants high quality evidence may prevent similar proportion lmics two trials urban egypt kenya evaluated rate ratio 066 95 ci 043 099 two trials 45380 participants low quality evidence three trials reported measures behaviour change methods data collection susceptible bias one trial usa hand washing behaviour reported improve trial kenya provided free soap hand washing increase soap use data pooled three trials 1845 participants low quality evidence hand washing promotion among communities lmics probably prevents around onequarter diarrhoea episodes rate ratio 072 95 ci 062 083 eight trials 14726 participants moderate quality evidence however six eight trials asian settings single trials south america subsaharan africa six trials soap provided free alongside hand washing education overall average effect size larger two trials provide soap soap provided rate ratio 066 95 ci 056 078 six trials 11422 participants education rate ratio 084 95 ci 067 105 two trials 3304 participants increased hand washing major prompts eatingcooking visiting toilet cleaning babys bottom increased compliance hand hygiene procedure behavioural outcome intervention groups control community trials data pooled three trials 3490 participants high quality evidence hand washing promotion one trial conducted hospital among highrisk population showed significant reduction mean episodes diarrhoea 168 fewer intervention group mean difference 168 95 ci 193 143 one trial 148 participants moderate quality evidence increase hand washing frequency seven times per day intervention group versus three times control hospital trial one trial 148 participants moderate quality evidence found trials evaluating reporting effects hand washing promotions diarrhoearelated deaths allcauseunder five mortality costs authors conclusions hand washing promotion probably reduces diarrhoea episodes child daycare centres highincome countries among communities living lmics 30 however less known help people maintain hand washing habits longer term