***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: Elementary school-age children are particularly vulnerable to infections . While h and washing is the best method of preventing infections , many elementary schools are housed in buildings that have barriers to effective h and hygiene . The purpose of this study was to determine the effectiveness of an alcohol gel as an adjunct to h and washing in reducing absenteeism secondary to infectious illness .  Two-hundred and fifty-three elementary school children were r and omized by classroom into an experimental or control group . With a crossover design , all children participated in both groups , with a one-week washout period between phases . A 45-minute “ Germ Unit ” was taught to all children as they started the experimental phase and a st and ard unit on h and hygiene was taught as they started the control phase . Sixty-nine children were absent due to illness while in the control group . Thirty-nine children became ill while in the experimental group . Alcohol gel as an adjunct to h and washing was shown to be effective in reducing absenteeism due to infectious illness by 43 % From October 1981 to September 1984 , the authors conducted a three-year longitudinal study of diarrhea among infants and toddlers attending day care centers in Maricopa County , Arizona . In the third year of study , they evaluated the effects on diarrhea rates of staff training without external monitoring and of active surveillance conducted throughout the study . From 21 study day care centers , they r and omly selected 10 ( " intervention day care centers " ) to receive staff training in procedures  to reduce transmission of infectious diarrhea . Continuing active surveillance in the 10 intervention and 11 control day care centers found no difference between diarrhea rates in intervention day care centers in the pre- and posttraining years and no difference between diarrhea rates in the two groups of centers either before or after the training intervention . Biweekly family-based surveys during the two months after training also demonstrated no difference between infant-toddler diarrhea rates in intervention and control day care centers . These surveys found the 21 study day care centers to have significantly higher diarrhea rates than did day care homes or households not using day care , but significantly lower rates than day care centers not included in the active surveillance . Continuous surveillance without training was associated with a significant decrease in diarrheal illness during the course of longitudinal study . One-time staff training without subsequent monitoring did not result in additional decreases and did not lower day care center diarrhea rates to the levels observed in day care homes and households not using day care The objective of this study was to assess the effectiveness of a hygiene program in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centers . A r and omized field trial was conducted in 52 day care centers in Quebec , Canada , between September 1 , 1996 and November 30 , 1997 . Absences for any reasons and the daily occurrence of colds and /or diarrhea in toddlers were recorded on calendars by the educators . The number of fecal coliforms on children 's h and s and on educators ' h and s was measured during three unannounced visits . Overall , 1,729 children were followed in 47 day care centers for a total of 153,643 child-days . The incidence rate of diarrhea was considerably reduced by the effect of monitoring ( IRR = 0.73 , 95 % CI = 0.54,0.97 ) , and the intervention reduced the incidence rate of upper respiratory tract infections ( IRR = 0.80 , 95 % CI = 0.68,0.93 ) . Monitoring alone also had an important effect in reducing the level of bacterial contamination on children 's and educators ' h and s. The results indicate that both an intervention program and monitoring alone play a role in reducing infections in children attending day care centers Diarrhea has been recognized as a frequent health problem among children enrolled in day-care centers . Thus , we evaluated the effect of a h and washing program in two day-care centers ( HWC ) on the incidence of diarrhea among children when compared to children in two control centers ( CC ) . After the program was begun , the incidence of diarrhea at the HWC began to fall and after the second month of the study was consistently lower than that at the CC . The incidence of diarrhea in the HWC was approximately half that of the CC for the entire 35-week study period . Adenoviruses , rotavirus , Giardia lamblia , and enteropathogenic Escherichia coli were found in the stools of a small number of ill children , but not pathogen was identified in the stools of most children with diarrhea . These results suggest that a h and washing program will probably prevent at least some of the diarrhea in day-care centers Transmission of enteric pathogens is facilitated in child day care centers , including family day care homes , by frequent and intimate exposure among susceptible hosts , with diaper changing as the highest-risk procedure for such transmission . The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period . Each of 24 family day care homes was r and omly assigned to an intervention or control group . The intervention included four components : ( 1 ) a h and washing educational program and ( 2 ) use of vinyl gloves , ( 3 ) use of disposable diaper changing pads , and ( 4 ) use of an alcohol-based h and rinse by the day care provider .  Symptoms of enteric disease ( diarrhea and vomiting ) were significantly reduced in intervention family day care homes ( p less than or equal to 0.05 ) , whereas respiratory symptoms were not significantly different between intervention and control family day care homes ( p = 0.35 ) . Diarrhea was reported in 1 of every 100 child care days , representing one diarrhea episode per month in a typical family day care home OBJECTIVES To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing  diarrhoea  and the additional benefit of promoting h and washing with soap . METHODS The study was conducted in squatter settlements of Karachi , Pakistan , where diarrhoea is a leading cause of childhood death . Interventions were r and omly assigned to 47 neighbourhoods . Households in 10 neighbourhoods received diluted bleach and a water vessel ; nine neighbourhoods received soap and were encouraged to wash h and s ; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel ; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash h and s ; and nine neighbourhoods were followed as controls . Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea . RESULTS Study participants in control neighbourhoods had diarrhoea on 5.2 % of days . Compared to controls , participants living in intervention neighbourhoods had a lower prevalence of diarrhoea : 55 % ( 95 % CI 17 % , 80 % ) lower in bleach and water vessel neighbourhoods , 51 % ( 95 % CI 12 % , 76 % ) lower in h and washing promotion with soap neighbourhoods , 64 % lower ( 95 % CI 29 % , 90 % ) in disinfectant-disinfectant neighbourhoods , and 55 % ( 95 % CI 18 % , 80 % ) lower in disinfectant-disinfectant plus h and washing with soap neighbourhoods . CONCLUSIONS With an intense community-based intervention and supplies provided free of cost , each of the home-based interventions significantly reduced diarrhoea . There was no benefit by combining h and washing promotion with water treatment 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 BACKGROUND Diarrhoeal disease is a leading cause of morbidity in young children in rural Zaire . Few diarrhoea prevention programmes have been implemented in B and undu Province , where available data suggest an annual prevalence rate of 10 % . The urgent need to reduce diarrhoeal morbidity in Zaire , together with the potential effectiveness and feasibility of hygiene education as a diarrhoea prevention strategy , led to the development of the present research project . METHODS A r and omized , controlled trial of an education intervention to reduce diarrhoea through improved personal and domestic hygiene behaviours was conducted in 18 geographically separate village clusters ( sites ) in rural Zaire . For 12 weeks baseline information on the diarrhoeal morbidity of 2082 children aged 3 - 35 months was collected at weekly home visits , and structured observations of hygiene practice s related to diarrhoea were made on a subset of 300 families . Intervention messages addressed disposal of animal faeces from the yard , h and washing after defecation and before meal preparation and eating , and disposal of children 's faeces . Three months after the start of the intervention and exactly 1 year after the baseline studies , a second diarrhoeal morbidity study and a second observational study were conducted in order to evaluate the intervention . RESULTS Children in intervention communities experienced an 11 % reduction in the risk of reporting diarrhoea during the peak diarrhoeal season , compared to controls ( P < 0.025 ) . The largest differences were seen among children aged 24 - 35 months , with those from intervention communities reporting significantly fewer episodes , shorter mean duration s and hence fewer days of diarrhoea . There was some evidence that greater reductions in diarrhoea occurred in sites where the quality of the intervention , a scored measure of volunteer efficacy and community participation , was highest . CONCLUSIONS The results of this study suggest that hygiene education may be an effective approach to reduce the incidence and duration of diarrhoeal episodes in rural Zaire . Children aged 2 years appear to benefit the most . A Hawthorne effect of the education may contribute to diarrhoeal reductions A case-control study was performed to develop an empirically based intervention for improving water-sanitation practice s and rates of  childhood diarrhea among families residing in urban Bangladesh . For three months fortnightly , histories of diarrhea were taken for all children under six years of age among 1,350 families to estimate age-specific rates of diarrhea in the population . A total of 247 r and omly sample d families , termed sentinel families , were visited once during the study for prolonged observations of water-sanitation practice s. Behaviors potentially affecting incidence of diarrhea were compared in a case group ( n = 45 ) , defined as sentinel families whose children had rates at least 1.7 times the rates expected for similarly aged children , and in a control group ( n = 53 ) , defined as sentinel families without any episodes of childhood diarrhea during the period of observation . Three practice s differentiated the two groups : more control ( 82 % ) than case ( 53 % ) mothers who were observed to prepare food washed their h and s before beginning the preparation ( p less than 0.01 ) ; fewer control families ( 33 % ) than case families ( 80 % ) had ambulatory children who , when observed to defecate , did so in the family 's living area ( p less than 0.01 ) ; and fewer control ( 30 % ) than case ( 47 % ) families had children who were observed to place garbage or waste products in their mouth ( p less than 0.10 ) . Focus on these three empiric associations enabled the design of a community-specific educational intervention which is simple in construction and based upon naturally occurring , financially feasible , salutory practice Context Household cleaning products containing antibacterial ingredients are widely available and popular . Although manufacturers use cl aims of health benefits to market these products , evidence linking the use of antibacterial products to health outcomes has been lacking . Contribution This innovative trial found no difference in episodes of infectious disease symptoms over one year in 228 inner-city households r and omly assigned to use antibacterial household cleaning products or identically packaged products without antibacterial ingredients . Implication s These findings highlight the need to better educate consumers about the use and limitations of household antibacterial cleaning products . The Editors Changing demographic and social patterns , such as more working parents , increased numbers of meals eaten in restaurants , and more child-care outside of the home , are causing concomitant changes in patterns of infectious diseases ( 1 ) . For example , recent foodborne outbreaks have result ed from widespread distribution of contaminated foods , such as meat or ice cream . Media attention to such outbreaks and the result ant public concern about disease transmission may be one reason for the burgeoning of various products that are labeled antibacterial and that are readily available for personal hygiene and general cleaning . These demographic and social shifts raise the question of the relative importance of home hygienic practice s in the prevention 
    Output:
    
H and washing can reduce diarrhoea episodes by about 30 % .
This significant reduction is comparable to the effect of providing clean water in low-income areas .