Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries

A systematic review

Research output: Contribution to journalReview ArticleResearchpeer-review

2 Citations (Scopus)

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 languageEnglish
Pages (from-to)816-833
Number of pages18
JournalTropical Medicine and International Health
Volume23
Issue number8
DOIs
Publication statusPublished - Aug 2018

Keywords

  • Acute respiratory infections
  • Behaviour change
  • Handwashing
  • Hygiene
  • Low-and middle-income countries

Cite this

@article{64e5c29edcc340d1a2a6ab022e4402ba,
title = "Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries: A systematic review",
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.",
keywords = "Acute respiratory infections, Behaviour change, Handwashing, Hygiene, Low-and middle-income countries",
author = "McGuinness, {Sarah L.} and Barker, {S. Fiona} and Joanne O’Toole and Cheng, {Allen C.} and Forbes, {Andrew B.} and Martha Sinclair and Karin Leder",
year = "2018",
month = "8",
doi = "10.1111/tmi.13080",
language = "English",
volume = "23",
pages = "816--833",
journal = "Tropical Medicine and International Health",
issn = "1360-2276",
publisher = "Wiley-Blackwell",
number = "8",

}

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 -