***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Rationale There is little evidence for the efficacy of h and washing for prevention of influenza transmission in re source -poor setting s. We tested the impact of intensive h and washing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh . Methods In 2009–10 , we identified index case- patients with influenza-like illness ( fever with cough or sore throat ) who were the only symptomatic person in their household . Household compounds of index case- patients were r and omized to control or intervention ( soap and daily h and washing promotion ) . We conducted daily surveillance and collected oropharyngeal specimens . Secondary attack ratios ( SAR ) were calculated for influenza and ILI in each arm . Among controls , we investigated individual risk factors for ILI among household contacts of index case- patients . Results Among 377 index case- patients , the mean number of days between fever onset and study enrollment was 2.1 ( SD 1.7 ) among the 184 controls and 2.6 ( SD 2.9 ) among 193 intervention case- patients . Influenza infection was confirmed in 20 % of controls and 12 % of intervention index case- patients . The SAR for influenza-like illness among household contacts was 9.5 % among intervention ( 158/1661 ) and 7.7 % among control households ( 115/1498 ) ( SAR ratio 1.24 , 95 % CI 0.92–1.65 ) . The SAR ratio for influenza was 2.40 ( 95 % CI 0.68–8.47 ) . In the control arm , susceptible contacts < 2 years old ( RRadj 5.51 , 95 % CI 3.43–8.85 ) , those living with an index case-patient enrolled ≤24 hours after symptom onset ( RRadj 1.91 , 95 % CI 1.18–3.10 ) , and those who reported multiple daily interactions with the index case-patient ( RRadj 1.94 , 95 % CI 1.71–3.26 ) were at increased risk of influenza-like illness . Discussion H and washing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza . Behavior may not have changed rapidly enough to curb transmission between household members . A reactive approach to reduce household influenza transmission through h and washing promotion may be ineffective in the context of rural Bangladesh . Trial Registration Clinical Trials.gov This paper analyzes a r and omized experiment that uses novel strategies to promote h and washing with soap at critical points in time in Peru . It evaluates a large-scale comprehensive initiative that involved both community and school activities in addition to communication campaigns . The analysis indicates that the initiative was successful in reaching the target audience and in increasing the treated population 's knowledge about appropriate h and washing behavior . These improvements translated into higher self-reported and observed h and washing with soap at critical junctures . However , no significant improvements in the health of children under the age of 5 years  were observed . Copyright © 2015 John Wiley & Sons , Please cite this paper as : Simmerman et al. ( 2011 ) Findings from a household r and omized controlled trial of h and washing and face masks to reduce influenza transmission in Bangkok , Thail and . Influenza and Other Respiratory Viruses 5(4 ) , 256–267 Background Evidence is needed on the effectiveness of non‐pharmaceutical interventions ( NPIs ) to reduce influenza transmission . Methodology We studied NPIs in households with a febrile , influenza‐positive child . Households were r and omized to control , h and washing ( HW ) , or h and washing plus paper surgical face masks ( HW + FM ) arms . Study nurses conducted home visits within 24 hours of enrollment and on days 3 , 7 , and 21 . Respiratory swabs and serum were collected from all household members and tested for influenza by RT‐PCR or serology . Principal Findings Between April 2008 and August 2009 , 991 ( 16·5 % ) of 5995 pediatric influenza‐like illness patients tested influenza positive . Four hundred and forty‐two index children with 1147 household members were enrolled , and 221 ( 50·0 % ) were aged < 6 years . Three hundred and ninety‐seven ( 89·8 % ) households reported that the index patient slept in the parents ’ bedroom . The secondary attack rate was 21·5 % , and 56/345 ( 16·3 % ; 95 % CI 12·4–20·2 % ) secondary cases were asymptomatic . H and ‐washing subjects reported 4·7 washing episodes/day , compared to 4·9 times/day in the HW + FM arm and 3·9 times/day in controls ( P = 0·001 ) . The odds ratios ( ORs ) for secondary influenza infection were not significantly different in the HW arm ( OR = 1·20 ; 95 % CI 0·76–1·88 ; P‐0.442 ) , or the HW + FM arm ( OR = 1·16 ; 95 % CI .0·74–1·82 ; P = 0.525 ) . Conclusions Influenza transmission was not reduced by interventions to promote h and washing and face mask use . This may be attributable to transmission that occurred before the intervention , poor facemask compliance , little difference in h and ‐washing frequency between study groups , and shared sleeping arrangements . A prospect i ve study design and a careful analysis of sociocultural factors could improve future NPI studies Intensive h and washing promotion can reduce  diarrheal and respiratory disease incidence . To determine whether less intensive , more scalable interventions can improve health , we evaluated a school-based h and washing program . We r and omized 87 Chinese schools to usual practice s : st and ard intervention ( h and washing program ) or exp and ed intervention ( h and washing 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 st and ard 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 exp and ed 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 h and washing promotion program and soap was associated with significantly reduced absenteeism . Similar programs could improve the health of children worldwide The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement was developed to improve the reporting of r and omised controlled trials . It was initially published in 1996 and focused on the reporting of parallel group r and omised controlled trials . The statement was revised in 2001 , with a further up date in 2010 . A separate CONSORT statement for the reporting of abstract s was published in 2008 . In earlier papers we considered the implication s of the 2001 version of the CONSORT statement for the reporting of cluster r and omised trial . In this paper we provide up date d and extended guidance , based on the 2010 version of the CONSORT statement and the 2008 CONSORT statement for the reporting of abstract s. OBJECTIVE To evaluate the effectiveness of alcohol-based h and rubs ( ABH ) in reducing  acute diarrheal diseases ( ADD ) and acute respiratory infections ( ARI ) among children 1 - 5 years of age in childcare centers with limited tap water . METHODS This was the first cluster-r and omized controlled trial in a developing country . The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia . Participants were r and omly assigned to use ABH as a complement to h and washing ( intervention arm : 21 centers/794 children ) ; or to continue existing h and washing practice s ( control arm : 21 centers/933 children ) . ADD and ARI cases were identified through teacher-reported signs and symptoms of illness . Adverse events were monitored . Hazard ratios ( HR ) were obtained using Cox proportional hazards multivariate regression shared frailty models . RESULTS  Child-days of surveillance totaled 336 038 . Loss to follow up was 14.5 % . For both ADD and ARI , there were no differences in hazard ratios during the first trimester of the study . In the second and third trimesters , significant reductions in the risk of ADD were found in the intervention compared to control arm ( HR = 0.55 , P < 0.001 and HR = 0.44 , P < 0.001 , respectively ) . There were also significant risk reductions for ARI in the second trimester ( HR = 0.80 , P < 0.05 ) and in the third trimester ( HR = 0.69 , P < 0.001 ) . No adverse events occurred . CONCLUSIONS ABH effectively prevent ADD and ARI , and are safe . Colombia 's national public health policies for prevention of these diseases should include use of ABH , especially in setting s where h and washing with soap and water is limited by water availability Background We studied the efficacy of different time-interval applications of alcohol h and gel as a strategy for the prevention of  influenza-like illness ( ILI ) in preschool-age children . Methods We performed a classroom-based cluster r and omization at a kindergarten school in Bangkok , Thail and . A total of 1437 children were placed into 3 test groups , based on the frequency of alcohol h and gel use for h and hygiene : only before lunch ( q lunch ) , every 120 minutes ( q 120 ) , and every 60 minutes ( q 60 ) . The primary outcome was a change in the school absenteeism rate caused by ILI . Results The rates of absenteeism from confirmed ILI ( sick days/present days ) were 0.026 in the q lunch group , 0.025 in the q 120 group , and 0.017 in the q 60 group . Significant reductions in absenteeism rates were seen when comparing the q 60 group with the q 120 group ( rate difference , 0.009 ; 95 % confidence interval [ CI ] , −0.002 to 0.015 ; P = .008 ) and comparing the q 60 group with the q lunch group ( rate difference , 0.0096 ; 95 % CI , 0.004 - 0.016 ; P = .002 ) . No such differences were detected between the q 120 and q lunch groups ( rate difference , 0.001 ; 95 % CI , 0.005 - 0.007 ; P = .743 ) . Conclusions The compulsory hourly use of alcohol gel as classroom h and disinfection could significantly reduce the rate of absenteeism from ILI in preschool-age children BACKGROUND The causes of stunting are complex but likely include prenatal effects , inadequate postnatal nutrient intake , and recurrent infections . Low-birth-weight ( LBW ) infants are at high risk of stunting . More than 25 % of live births in low- and middle-income countries are at full term with low birth weight ( FT-LBW ) . Evidence on the efficacy of specific interventions to enhance growth in this vulnerable group remains scant . OBJECTIVE We investigated the independent and combined effects of a directed use of a water-based h and sanitizer ( HS ) and a mineral- and vitamin-enhanced micronutrient powder ( MNP ) ( 22 minerals and vitamins ) to prevent infections and improve nutrient intake to reduce stunting in FT-LBW infants . DESIGN The study was a prospect i ve 2 × 2 factorial , cluster-r and omized trial in 467 FT-LBW infants during 2 periods : from 0 to 5 mo postpartum ( 0 - 180 d postpartum ) and from 6 to 12 mo postpartum ( 181 - 360 d postpartum ) with the use of 48 clusters . All groups received the same general nutrition , health , and hygiene education ( NHHE ) at enrollment and throughout the 12 mo . Group assignments initially included the following 2 groups : no HS ( control ) group or HS from 0 to 5 mo postpartum . These assignments were followed by further divisions into the following 4 groups from 6 to 12 mo postpartum : 1 ) no HS and no MNP ( control ) , 2 ) HS only , 3 ) MNP only , and 4 ) HS and MNP . RESULTS When delivered in combination with NHHE , the use of an HS showed no additional benefit in reducing indicators of infection in the first or second half of infancy or the likelihood of stunting at 12 mo postpartum . FT-LBW infants who received the MNP ( with or without the HS ) were significantly less likely to be stunted at 12 mo than were controls ( OR : 0.35 ; 95 % CI : 0.15 , 0.84 ; P = 0.017 ) . CONCLUSIONS The use of a mineral- and vitamin-enhanced MNP  significantly reduced stunting in FT-LBW infants in this high-risk setting . The use of a water-based HS did not have an additive effect . This trial was registered at clin 
    Output:
    
In school setting s , we found reduced ARI-related absenteeism and laboratory-confirmed influenza ( moderate- to high- quality evidence ) , but no reduction in ARI illness ( low- quality evidence ) .
In domestic setting s , we found reduced ARI illness and pneumonia amongst children in urban settlements ( high- quality evidence ) but not in rural settlements ( low- quality evidence ) , and no effect on secondary transmission of influenza in households ( moderate- quality evidence ) .
Evidence suggests that h and -hygiene interventions delivered in childcare , school and domestic setting s can reduce ARI morbidity , but effectiveness varies according to setting , intervention target and intervention compliance .