***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: One-quarter of neonatal deaths are attributed to infections . Maternal h and washing with soap may prevent neonatal sepsis . We examined impact of intensive h and washing promotion on h and washing behavior of mothers of neonates . In Matlab , Bangladesh , we r and omly allocated pregnant women at 28–32 weeks ' gestation to intensive h and washing promotion or control . Behavior change communicators used a participatory approach to motivate maternal h and washing with soap and provided soap and h and washing stations . In the neonatal period , we observed soap and water at h and washing places and , at the end of the neonatal period , we estimated impact on maternal h and washing by structured observation . Among 253 women enrolled , intervention households were between 5.7 and 15.2 times as likely as control households to have soap and water present at the h and washing station in the baby 's sleeping area . Intervention mothers  washed h and s with soap  4.1 times as frequently as controls ( 95 % CI 2.55–6.59 )  ; h and washing with soap  at recommended times was infrequent in both intervention ( 9 % ) and control ( 2 % ) groups . Intensively promoting h and washing with soap result ed in increased availability of soap and water at h and washing places , but only a modest increase in maternal h and washing with soap . Novel approaches to motivating h and washing behavior to protect newborns should be developed and evaluated BACKGROUND Effective prevention and control of diarrhoea requires caregivers to comply with a suite of proven measures , including exclusive breastfeeding , h and washing with soap , correct use of oral rehydration salts , and zinc administration . We aim ed to assess the effect of a novel behaviour change intervention using emotional drivers on caregiver practice of these behaviours . METHODS We did a cluster r and omised controlled trial in Lusaka Province , Zambia . A r and om sample of 16 health centres ( clusters ) were selected from a sampling frame of 81 health centres in three of four districts in Lusaka Province using a computerised r and om number generator . Each cluster was r and omly assigned 1:1 to either the intervention-clinic events , community events , and radio messaging-or to a st and ard care control arm , both for 6 months . Primary outcomes were  exclusive breastfeeding ( self-report ) , h and washing with soap ( observation ) , oral rehydration salt solution preparation ( demonstration ) , and zinc use in diarrhoea treatment ( self-report ) . We measured outcome behaviours at baseline before start of intervention and 4 - 6 weeks post-intervention through repeat cross-sectional surveys with mothers of an infant younger than 6 months and primary caregivers of a child younger than 5 years with recent diarrhoea . We compared outcomes on an intention-to-treat population between intervention and control groups adjusted for baseline behaviour . The study was registered with Clinical Trials.gov , number NCT02081521 . FINDINGS Between Jan 20 and Feb 3 , 2014 , we recruited 306 mothers of an infant aged 0 - 5 months ( 156 intervention , 150 st and ard care ) and 343 primary caregiver of a child aged 0 - 59 months with recent diarrhoea ( 176 intervention , 167 st and ard care ) at baseline . Between Oct 20 to Nov 7 , 2014 , we recruited 401 mothers of an infant 0 - 5 months ( 234 intervention , 167 st and ard care ) and 410 primary caregivers of a child 0 - 59 months with recent diarrhoea ( 257 intervention , 163 st and ard care ) at endline . Intervention was associated with increased prevalence of self-reported exclusive breastfeeding of infants aged 0 - 5 months ( adjusted difference 10·5 % , 95 % CI 0·9 - 19·9 ) . Other primary outcomes were not affected by intervention . Cluster intervention exposure ranged from 11 - 81 % , measured by participant self-report with verification questions . Comparison of control and intervention clusters with coverage greater than 35 % provided strong evidence of an intervention effect on oral rehydration salt solution preparation and breastfeeding outcomes . INTERPRETATION The intervention may have improved exclusive breastfeeding ( assessed by self-reporting ) , but intervention effects were diluted in clusters with low exposure . Complex caregiver practice s can improve through interventions built around human motives , but these must be implemented more intensely . FUNDING Absolute Return for Kids ( ARK ) and Comic Relief Background H and washing is a cost-effective way of preventing communicable diseases such as respiratory and food-borne illnesses . However , h and washing rates are low in developing countries . Target 7C of the seventh Millennium Development Goals was to increase by half the proportion of people with sustainable access to safe drinking water and basic sanitation by 2015 . Studies have found that better access to improved water sources and sanitation is associated with higher rates of h and washing . Objective Our goal was to describe  h and washing behaviour and identify the associated factors in Vietnamese households . Design Data from 12,000 households participating in the Vietnam Multiple Indicator Cluster Survey 2011 were used . The survey used a multistage sampling method to r and omly select 100 clusters and 20 households per cluster .  Self-administered question naires were used to collect data from a household representative . Demographic variables , the presence of a specific place for h and washing  , soap and water , access to improved sanitation , and access to improved water sources were tested for association with h and washing behaviour in logistic regression . Results Almost 98 % of households had a specific place for h and washing , and 85 % had cleansing material s and water at such a place . The prevalence of h and washing in the sample was almost 85 % . Educational level , ethnicity of the household head , and household wealth were factors associated with  h and washing practice ( p<0.05 ) . Those having access to an improved sanitation facility were more likely to practise h and washing  [ odds ratio (OR)=1.69 , 95 % confidence interval ( CI ) : 1.37–2.09 , p<0.001 ] , as were those with access to improved water sources ( OR=1.74 , 95 % CI : 1.37–2.21 , p<0.001 ) . Conclusions Households with low education , low wealth , belonging to ethnic minorities , and with low access to improved sanitation facilities and water sources should be targeted for interventions implementing h and washing practice . In addition , the availability of soap and water at h and washing sites should be increased and practical teaching programs should be deployed in order to increase h and washing rates BACKGROUND Diarrhoea and respiratory infections are the two biggest causes of child death globally . H and washing with soap could substantially reduce diarrhoea and respiratory infections , but prevalence of adequate h and washing is low . We tested whether a scalable village-level intervention based on emotional drivers of behaviour , rather than knowledge , could improve h and washing behaviour in rural India . METHODS The study was done in Chittoor district in southern And hra Pradesh , India , between May 24 , 2011 , and Sept 10 , 2012 . Eligible villages had a population of 700 - 2000 people , a state-run primary school for children aged 8 - 13 years , and a preschool for children younger than 5 years . 14 villages ( clusters ) were selected , stratified by population size ( < 1200 vs > 1200 ) , and r and omly assigned in a 1:1 ratio to intervention or control ( no intervention ) . Clusters were enrolled by the study manager . R and om allocation was done by the study statistician using a r and om number generator . The intervention included community and school-based events incorporating an animated film , skits , and public pledging ceremonies . Outcomes were measured by direct observation in 20 - 25 households per village at baseline and at three follow-up visits ( 6 weeks , 6 months , and 12 months after the intervention ) . Observers had no connection with the intervention and observers and participant households were told that the study was about domestic water use to reduce the risk of bias . No other masking was possible . The primary outcome was the proportion of h and washing with soap at key events ( after defecation , after cleaning a child 's bottom , before food preparation , and before eating ) at all follow-up visits . The control villages received a shortened version of the intervention before the final follow-up round . Outcome data are presented as village-level means . FINDINGS H and washing with soap at key events was rare at baseline in both the intervention and control groups ( 1 % [ SD 1 ] vs 2 % [ 1 ] ) . At 6 weeks ' follow-up , h and washing with soap at key events was more common in the intervention group than in the control group ( 19 % [ SD 21 ] vs 4 % [ 2 ] ; difference 15 % , p=0·005 ) . At the 6-month follow-up visit , the proportion h and washing with soap was 37 % ( SD 7 ) in the intervention group versus 6 % ( 3 ) in the control group ( difference 31 % ; p=0·02 ) . At the 12-month follow-up visit , after the control villages had received the shortened intervention , the proportion h and washing with soap was 29 % ( SD 9 ) in the intervention group and 29 % ( 13 ) in the control group . INTERPRETATION This study shows that substantial increases in h and washing with soap can be achieved using a scalable intervention based on emotional drivers . FUNDING Wellcome Trust , SHARE Background We analyzed data from the baseline assessment of a large intervention project to describe typical h and washing practice s in rural Bangladesh , and compare measures of h and cleanliness with household characteristics . Methods We r and omly selected 100 villages from 36 districts in rural Bangladesh . Field workers identified 17 eligible households per village using systematic sampling . Field workers conducted 5-hour structured observations in 1000 households , and a cross-sectional assessment in 1692 households that included spot checks , an evaluation of h and cleanliness and a request that residents demonstrate their usual  h and washing practice s after defecation . Results Although 47 % of caregivers reported and 51 % demonstrated washing both h and s with soap  after defecation , in structured observation , only 33 % of caregivers and 14 % of all persons observed washed both h and s with soap after defecation . Less than 1 % used  soap and water  for h and washing  before eating and /or feeding a child . More commonly people washed their h and s only with water , 23 % after defecation and 5 % before eating . Spot checks during the cross sectional survey classified 930 caregivers ( 55 % ) and 453 children ( 28 % ) as having clean appearing h and s. In multivariate analysis economic status and water available at h and washing locations were significantly associated with h and cleanliness among both caregivers and children . Conclusions A minority of rural Bangladeshi residents  washed both h and s with soap  at key h and washing times , though rinsing h and s with only water was more common . To realize the health benefits of h and washing , efforts to improve h and washing in these communities should target adding soap to current h and rinsing practice Background In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality . H and washing with soap reduces the risk of infection ; however , h and washing rates in infrastructure-restricted setting s remain low . H and washing stations – a dedicated , convenient location where both soap and water are available for h and washing – are associated with improved h and washing practice s. Our aim was to identify a locally feasible and acceptable h and washing station that enabled frequent h and washing for two subsequent r and omized trials testing the health effects of this behaviour . Methods We conducted formative research in the form of household trials of improved practice s in urban and rural Bangladesh . Seven c and i date h and washing technologies were tested by nine to ten households each during two iterative phases . We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks , depending on the phase . We used the Integrated Behavioural Model for Water , Sanitation and Hygiene ( IBM-WASH ) to guide selection of c and i date h and washing stations and data analysis . Factors presented in the IBM-WASH informed thematic coding of interview transcripts and context ualized feasibility and acceptability of specific h and washing station design s. Results Factors that influenced selection of c and i date design s were market availability of low cost , durable material s that were easy to replace or replenish in an infrastructure-restricted and shared environment . Water storage capacity , ease of use and maintenance , and quality of material s determined the acceptability and feasibility of specific h and washing station design s. After examining technology , psychosocial and context ual factors , we selected a h and washing system with two different water storage capacities , each with a tap , st and , basin , soapy water bottle and detergent powder for pilot testing in preparation for the subsequent r and omized trials . Conclusions A number of context ual , psychosocial and technological factors influence use of h and washing stations at five aggregate levels , from habitual to societal . In interventions that require a h and washing station to facilitate frequent h and washing with soap , elements of the technology , such as capacity , durability and location(s ) within the household are key to high feasibility and acceptability . More than one h and washing station per household may be required . IBM-WASH helped guide the research and research in-turn helped vali date the framework In this study , we report on the results of a trial of an intervention to improve five food hygiene behaviors  among mothers 
    Output:
    
Hygiene promotion programmes are likely to be most successful if they use multi-modal approaches , combining infrastructural improvement with ' soft ' hygiene promotion which addresses a range of determinants rather than just education about disease transmission