Abstract
objectives Acute respiratory infections (ARIs) disproportionately affect those living in low-and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. methods We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. results We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low-to moderate-quality evidence). In school settings, 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 settings, 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). conclusions Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.
| Original language | English |
|---|---|
| Pages (from-to) | 816-833 |
| Number of pages | 18 |
| Journal | Tropical Medicine and International Health |
| Volume | 23 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2018 |
Keywords
- Acute respiratory infections
- Behaviour change
- Handwashing
- Hygiene
- Low-and middle-income countries
Cite this
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Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries : A systematic review. / McGuinness, Sarah L.; Barker, S. Fiona; O’Toole, Joanne; Cheng, Allen C.; Forbes, Andrew B.; Sinclair, Martha; Leder, Karin.
In: Tropical Medicine and International Health, Vol. 23, No. 8, 08.2018, p. 816-833.Research output: Contribution to journal › Review Article › Research › peer-review
TY - JOUR
T1 - Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries
T2 - A systematic review
AU - McGuinness, Sarah L.
AU - Barker, S. Fiona
AU - O’Toole, Joanne
AU - Cheng, Allen C.
AU - Forbes, Andrew B.
AU - Sinclair, Martha
AU - Leder, Karin
PY - 2018/8
Y1 - 2018/8
N2 - objectives Acute respiratory infections (ARIs) disproportionately affect those living in low-and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. methods We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. results We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low-to moderate-quality evidence). In school settings, 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 settings, 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). conclusions Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.
AB - objectives Acute respiratory infections (ARIs) disproportionately affect those living in low-and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. methods We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. results We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low-to moderate-quality evidence). In school settings, 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 settings, 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). conclusions Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.
KW - Acute respiratory infections
KW - Behaviour change
KW - Handwashing
KW - Hygiene
KW - Low-and middle-income countries
UR - http://www.scopus.com/inward/record.url?scp=85054579952&partnerID=8YFLogxK
U2 - 10.1111/tmi.13080
DO - 10.1111/tmi.13080
M3 - Review Article
VL - 23
SP - 816
EP - 833
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
SN - 1360-2276
IS - 8
ER -