***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: The impact of improved water , sanitation , and hygiene ( WASH ) access on mitigating illness is well documented , although impact of school-based WASH on school-aged children has not been rigorously explored . We conducted a cluster-r and omized trial in Nyanza Province , Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary -school pupils . Two study population s were used : schools with a nearby dry season water source and those without . Pupils attending ' water-available ' schools that received hygiene promotion and water treatment ( HP&WT ) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools . Those pupils in schools that received only the HP&WT showed similar results . Pupils in ' water-scarce ' schools that received a water-supply improvement , HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness . Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea Background To control soil-transmitted helminth ( STH ) infections , the World Health Organization recommends school-based deworming programs with a health hygiene education component . The effect of such health hygiene interventions , however , has not been adequately studied . The objective of the present study was to determine the effectiveness of a health hygiene education intervention on the occurrence of STH re-infection four months post-de-worming . Methodology /Principal Findings An open-label pair-matched cluster-r and omized trial was conducted in Grade 5 schoolchildren of 18 primary schools ( 9 intervention and 9 control ) in the Peruvian Amazon . Baseline assessment included interview with a pre-tested question naire and collection of single stool specimens that were examined using the single Kato-Katz thick smear . All schoolchildren were then treated with single-dose albendazole ( 400 mg ) . Schoolchildren in intervention schools then received 1 ) an initial one hour in-class activity on health hygiene and sanitation and 30-minute refresher activities every two weeks over four months ; and 2 ) a half-day workshop for teachers and principals , while children in control schools did not . Four months later , STH infection was re-assessed in all schools by laboratory technologists blinded to intervention status . From April 21–October 20 , 2010 , a total of 1,089 schoolchildren ( 518 and 571 from intervention and control schools , respectively ) participated in this study . Intervention children scored significantly higher on all aspects of a test of STH-related knowledge compared with control children ( aOR = 18·4 ; 95 % CI : 12·7 to 26·6 ) . The intensity of Ascaris lumbricoides infection at follow-up was statistically significantly lower ( by 58 % ) in children in intervention schools compared with children in control schools ( aIRR = 0·42 ; 95 % CI = 0·21 to 0·85 ) . No significant changes in hookworm or Trichuris trichiura intensity were observed . Conclusions / Significance A school-based health hygiene education intervention was effective in increasing STH knowledge and in reducing Ascaris lumbricoides infection . The benefits of school-based periodic deworming programs are likely to be enhanced when a sustained health hygiene education intervention is integrated into school curricula The Ny and o  Integrated Child Health Education ( NICHE ) project was a collaborative effort by the U.S. Centers for Disease Control and local partners to assess the effectiveness of multiple interventions for improving child survival in western Kenya . To increase h and washing in schools ,  NICHE trained teachers  and installed h and washing stations with treated water and soap in 51 primary schools . This cluster-r and omized trial evaluated an additional educational strategy ( a poster contest themed , “ H and washing with Soap ” ) to improve h and washing behavior in 23 NICHE primary schools . Pupils were engaged in the poster development . Pupil h and washing behavior was observed unobtrusively at baseline and after four months . Intervention schools displayed a significant increase in the number of h and washing stations and proportion of teacher-supervised stations over the study period . No significant between-group differences of intervention in h and washing frequency , soap availability , or visibility of h and washing stations was observed . Despite finding a limited effect beyond the NICHE intervention , the trial appeared to promote sustainability across some measures 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year . We undertook a r and omised controlled trial to assess the effect of h and washing promotion with soap on the incidence of  acute respiratory infection , impetigo , and diarrhoea .  METHODS In adjoining squatter settlements in Karachi , Pakistan , we r and omly assigned 25 neighbourhoods to h and washing promotion ; 11 neighbourhoods ( 306 households ) were r and omised as controls . In neighbourhoods with h and washing promotion , 300 households each were assigned to antibacterial soap containing 1.2 % triclocarban and to plain soap . Fieldworkers visited households weekly for 1 year to encourage h and washing by residents in soap households and to record symptoms in all households . Primary study outcomes were diarrhoea , impetigo , and acute respiratory-tract infections ( ie , the number of new episodes of illness per person-weeks at risk ) . Pneumonia was defined according to the WHO clinical case definition . Analysis was by intention to treat . FINDINGS Children younger than 5 years in households that received plain soap and h and washing promotion had a 50 % lower incidence of pneumonia than controls ( 95 % CI ( -65 % to -34 % ) . Also compared with controls , children younger than 15 years in households with plain soap had a 53 % lower incidence of diarrhoea ( -65 % to -41 % ) and a 34 % lower incidence of impetigo ( -52 % to -16 % ) . Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap . INTERPRETATION H and washing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely , diarrhoea and acute lower respiratory infections .  H and washing with daily bathing also prevents impetigo We conducted a cluster-r and omized trial to assess the impact of a school-based water treatment , hygiene , and sanitation program on reducing infection with soil-transmitted helminths ( STHs ) after school-based deworming . We assessed infection with STHs at baseline and then at two follow-up rounds 8 and 10 months after deworming . Forty government primary schools in Nyanza Province , Kenya were r and omly selected and assigned to intervention or control arms . The intervention reduced reinfection prevalence ( odds ratio [ OR ] 0.56 , 95 % confidence interval [ CI ] 0.31 - 1.00 ) and egg count ( rate ratio [ RR ] 0.34 , CI 0.15 - 0.75 ) of Ascaris lumbricoides . We found no evidence of significant intervention effects on the overall prevalence and intensity of Trichuris trichiura , hookworm , or Schistosoma mansoni reinfection . Provision of school-based sanitation , water quality , and hygiene improvements may reduce reinfection of STHs after school-based deworming , but the magnitude of the effects may be sex- and helminth species-specific BACKGROUND Soil-transmitted helminths are among the most prevalent sources of human infections globally . We determined the effect of an educational package at rural schools in Linxiang City District , Hunan province , China , where these worms are prevalent . The intervention aim ed to increase knowledge about soil-transmitted helminths , induce behavioral change , and reduce the rate of infection . METHODS We conducted a single-blind , unmatched , cluster-r and omized intervention trial involving 1718 children , 9 to 10 years of age , in 38 schools over the course of 1 school year . Schools were r and omly assigned to the health-education package , which included a cartoon video , or to a control package , which involved only the display of a health-education poster . Infection rates , knowledge about soil-transmitted helminths ( as assessed with the use of a question naire ) , and h and -washing behavior were assessed before and after the intervention . Albendazole was administered in all the participants at baseline and in all the children who were found to be positive for infection with soil-transmitted helminths at the follow-up assessment at the end of the school year . RESULTS At the follow-up assessment , the mean score for the knowledge of helminths , calculated as a percentage of a total of 43 points on a question naire , was 90 % higher in the intervention group than in the control group ( 63.3 vs. 33.4 , P<0.001 ) , the percentage of children who washed their h and s after using the toilet was nearly twice as high in the intervention group ( 98.9 % , vs. 54.2 % in the control group ; P<0.001 ) , and the incidence of infection with soil-transmitted helminths was 50 % lower in the intervention group than in the control group ( 4.1 % vs. 8.4 % , P<0.001 ) . No adverse events were observed immediately ( within 15 
    Output:
    
The reported effect of child-targeted h and washing interventions on our outcomes of interest varied between studies .
Of the different interventions reported , no one approach to promoting h and washing among children appeared most effective .
It is plausible that interventions which succeed in changing children 's h and washing practice s will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group .