Cited by 310Child Nutrition and Water AccessFood Safety and HygieneViral gastroenteritis research and epidemiology

The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.

Effect of Intensive Handwashing Promotion on Childhood Diarrhea in High-Risk Communities in Pakistan: A Randomized Controlled Trial

Luby, Stephen P., Agboatwalla, Mubina, Painter, John, Altaf, Arshad, Billhimer, Ward L., Hoekstra, Robert M.·2004·JAMA

Open this paper in CoChat — free account

Abstract

CONTEXT: Washing hands with soap prevents diarrhea, but children at the highest risk of death from diarrhea are younger than 1 year, too young to wash their own hands. Previous studies lacked sufficient power to assess the impact of household handwashing on diarrhea in infants. OBJECTIVE: To evaluate the effect of promoting household handwashing with soap among children at the highest risk of death from diarrhea. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized controlled trial of 36 low-income neighborhoods in urban squatter settlements in Karachi, Pakistan. Field workers visited participating households at least weekly from April 15, 2002, to April 5, 2003. Eligible households located in the study area had at least 2 children younger than 15 years, at least 1 of whom was younger than 5 years. INTERVENTIONS: Weekly visits in 25 neighborhoods to promote handwashing with soap after defecation and before preparing food, eating, and feeding a child. Within intervention neighborhoods, 300 households (1523 children) received a regular supply of antibacterial soap and 300 households (1640 children) received plain soap. Eleven neighborhoods (306 households and 1528 children) comprised the control group. MAIN OUTCOME MEASURE: Incidence density of diarrhea among children, defined as the number of diarrheal episodes per 100 person-weeks of observation. RESULTS: Children younger than 15 years living in households that received handwashing promotion and plain soap had a 53% lower incidence of diarrhea (95% confidence interval [CI], -65% to -41%) compared with children living in control neighborhoods. Infants living in households that received handwashing promotion and plain soap had 39% fewer days with diarrhea (95% CI, -61% to -16%) vs infants living in control neighborhoods. Severely malnourished children (weight for age z score, <-3.0) younger than 5 years living in households that received handwashing promotion and plain soap had 42% fewer days with diarrhea (95% CI, -69% to -16%) vs severely malnourished children in the control group. Similar reductions in diarrhea were observed among children living in households receiving antibacterial soap. CONCLUSION: In a setting in which diarrhea is a leading cause of child death, improvement in handwashing in the household reduced the incidence of diarrhea among children at high risk of death from diarrhea.

Integrity signals

Registry

Crossref · 10.1001/jama.291.21.2547

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

The World Health Report 2002 - Reducing Risks, Promoting Healthy Life
Available, N. A. N. (2003) · Education for Health · doi:10.1080/1357628031000116808 · Cited by 6,078
Approximation Theorems of Mathematical Statistics
Serfling, R. J. (1980) · Wiley series in probability and statistics · doi:10.1002/9780470316481 · Cited by 5,908
Design and Analysis of Cluster Randomization Trials in Health Research
DONNER, A. P., & Klar, N. S. (2000) · Cited by 1,236
Effect of washing hands with soap on diarrhoea risk in the community: a systematic review
Curtis, V., & Cairncross, S. (2003) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(03)00606-6 · Cited by 1,208
Activity and mechanisms of action of selected biocidal agents on Gram-positive and-negative bacteria
Walsh, S. E., Maillard, J.-Y., Russell, A. D., Catrenich, C. E., Charbonneau, D. L., & Bartolo, R. G. (2003) · Journal of Applied Microbiology · doi:10.1046/j.1365-2672.2003.01825.x · Cited by 527
Measuring the impact of water supply and sanitation investments on diarrhoeal diseases: problems of methodology
BLUM, D., & FEACHEM, R. G. (1983) · International Journal of Epidemiology · doi:10.1093/ije/12.3.357 · Cited by 236
AN EDUCATIONAL INTERVENTION FOR ALTERING WATER-SANITATION BEHAVIORS TO REDUCE CHILDHOOD DIARRHEA IN URBAN BANGLADESH
STANTON, B. F., & CLEMENS, J. D. (1987) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114529 · Cited by 163
Disinfection of Hands: Removal of Transient Organisms
Lowbury, E. J. L., Lilly, H. A., & Bull, J. P. (1964) · BMJ · doi:10.1136/bmj.2.5403.230 · Cited by 161
Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village.
Shahid, N. S., Greenough, W. B., Samadi, A. R., Huq, M. I., & Rahman, N. (1996) · PubMed · Cited by 141
Persistent diarrhea in Northeast Brazil: etiologies and interactions with malnutrition
Lima, A. Â. M., Fang, G., Schorling, J. B., de Albuquerque, L., McAuliffe, J. F., Mota, S., Leite, R. D., & Guerrant, R. L. (1992) · Acta Paediatrica · doi:10.1111/j.1651-2227.1992.tb12370.x · Cited by 121

Show all 23 references

Sorted by citations

Items 101–200 of 310

Promoting Handwashing Behavior in Peru: The Effect of Large-Scale Mass-Media and Community Level Interventions
Galiani, S., Gertler, P., & Vidal, A. O. (2012) · World Bank, Washington, DC eBooks · doi:10.1596/1813-9450-6257 · Cited by 40
“Hence, adequate handwashing is a primary barrier to the transmission of enteric pathogens, as hands can be cleansed of viruses and bacteria by washing with soap (Curtis and Cairncross 2003), (Faix 1987; Ansari et al. 1989; Luby et al. 2001; Gibson et al. 2002; Montville et al. 2002; Larson et al. 2003).”
Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review
Shafique, S., Bhattacharyya, D. S., Nowrin, I., Sultana, F., Islam, M. R., Dutta, G. K., del Barrio, M. O., & Reidpath, D. D. (2024) · Systematic Reviews · doi:10.1186/s13643-024-02651-9 · Cited by 54
“Similar to the WASH interventions highlighted in the summary of the present review, one study in the LMIC setting underscores the effectiveness of BCC and hygiene practices in lowering diarrhea prevalence, demonstrating the impact of hygiene promotion on public health outcomes [57].”
Result
Family factors associated with children's handwashing hygiene behavior
Song, I. H., Kim, S., & Park, W.-S. (2012) · Journal of Child Health Care · doi:10.1177/1367493512456106 · Cited by 39
“…prevents over 70 percent of diseases (KCDC, 2005) and that handwashing with soap has reduced 40–50 percent of the incidence of pneumonia, diarrheal diseases, and bacterial dysentery (Curtis and Cairncross, 2003; Han and Hlaing, 1989; Luby et al., 2004) underline the importance of hand hygiene.”
Background
The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China
Luo, R., Shi, Y., Zhang, L., Zhang, H., Miller, G., Alexis Medina, D., & Rozelle, S. (2012) · CESifo Economic Studies · doi:10.1093/cesifo/ifs023 · Cited by 39
Safe Water as the Key to Global Health
Schuster‐Wallace, C. J., Grover, V. I., Adeel, Z., Confalonieri, U., & Elliott, S. J. (2008) · HARVEST (University of Saskatchewan) · Cited by 39
Essential health care package for children - the ‘Fit for School’ program in the Philippines
Monse, B., Naliponguit, E. C., Belizario, V., Benzian, H., & Helderman, W. H. V. P. (2010) · International Dental Journal · doi:10.1016/s0020-6539(20)34067-3 · Cited by 38
Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya
Kamm, K. B., Feikin, D. R., Bigogo, G., Aol, G., Audi, A. O., Cohen, A. L., Shah, M. M., Yu, J., Breiman, R. F., & Ram, P. K. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12263 · Cited by 37
“Interventions promoting handwashing with soap can reduce diarrhoea and pneumonia in resource-poor settings (Curtis et al. 2001; Stanton & Clemens 1987; Luby et al. 2004, 2005; Peterson et al. 1998).”
Cochrane review: Hand washing for preventing diarrhoea
Ejemot-Nwadiaro, R. I., Ehiri, J. E., Meremikwu, M. M., & Critchley, J. (2009) · Evidence-Based Child Health A Cochrane Review Journal · doi:10.1002/ebch.373 · Cited by 37
Knowledge and practice of handwashing among mothers of under five children in rural coastal South India
Datta, S. S. (2011) · International Journal of Medicine and Public Health · doi:10.5530/ijmedph.1.2011.6 · Cited by 37
Developing an evidence‐based, preventive care package for persons with HIV in Africa
Mermin, J., Bunnell, R. E., Lule, J., Opio, A., Gibbons, A., Dybul, M. R., & Kaplan, J. (2005) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2005.01488.x · Cited by 37
“A randomized controlled study in Pakistan showed that supplying households with soap and education on hand washing reduced diarrhoea among children by 50% (Luby et al. 2004), and a study of hand washing education alone in Zaire reduced diarrhoea among children by 11% (Haggerty et al.”
Background
Hand Hygiene Regimens for the Reduction of Risk in Food Service Environments
Edmonds, S. L., McCormack, R. R., Zhou, S. S., Macinga, D. R., & Fricker, C. M. (2012) · Journal of Food Protection · doi:10.4315/0362-028x.jfp-11-449 · Cited by 36
“Proper hand hygiene has been associated with reductions of gastrointestinal illness ranging from 42 to 57% (5, 11, 25).”
Background
Economic Gains of a Home Fortification Program
Sharieff, W., Horton, S., & Zlotkin, S. H. (2006) · Canadian Journal of Public Health · doi:10.1007/bf03405206 · Cited by 36
Back to the Future: Rising to the Semmelweis Challenge in Hand Hygiene
Stewardson, A. J., Allegranzi, B., Sax, H., Kilpatrick, C., & Pittet, D. (2011) · Future Microbiology · doi:10.2217/fmb.11.66 · Cited by 36
“There is also convincing evidence that hand hygiene, both hand washing [149,150] and hand rubbing [151–157], is effective against infectious respiratory viral syndromes and diarrheal diseases when introduced in a lay populations outside the healthcare setting.”
Background
Evaluation of Students' Social Hand Washing Knowledge, Practices, and Skills in a University Setting
Ergin, A., Bostancı, M. S., Önal, Ö., Bozkurt, A. İ., & Ergin, N. (2011) · Central European Journal of Public Health · doi:10.21101/cejph.a3664 · Cited by 36
“An interventional study showed that children younger than 15 years living in households that received handwashing promotion and plain soap had a 53% lower incidence of diarrhea than the controls (8).”
Background
An ecological approach to health promotion in remote Australian Aboriginal communities
McDonald, E., Bailie, R. S., Grace, J., & Brewster, D. (2010) · Health Promotion International · doi:10.1093/heapro/daq004 · Cited by 39
Community-based interventions
Polk, D. E., King, C. M., & Heller, K. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511543579.075 · Cited by 34
What prevents child diarrhoea? The impacts of water supply, toilets, and hand-washing in rural India
Fan, V. Y., & Mahal, A. S. (2011) · Journal of Development Effectiveness · doi:10.1080/19439342.2011.596941 · Cited by 36
“2004 , which promoted hand-washing with soap for children as young as 30 months old).”
Background
Quantifying Contact with the Environment: Behaviors of Young Children in Accra, Ghana
Teunis, P. F. M., Reese, H. E., Null, C., Yakubu, H., & Moe, C. L. (2016) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.15-0417 · Cited by 32
“Recent studies have examined the impact of water, sanitation, and hygiene interventions in low-income countries and documented decreased incidence of diarrheal illness after interventions in sanitation and/or hygiene behavior.(7,8) Interventions in sanitation and/or hygiene usually lead to a reduction of 30–50% in inc…”
Background
Choice and quantity demand for improved and unimproved public water sources in rural areas: Evidence from Benin
Groß, E., & Elshiewy, O. (2019) · Journal of Rural Studies · doi:10.1016/j.jrurstud.2019.02.021 · Cited by 32
Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: a cluster randomized controlled trial
Solomon, E. T., Gari, S. R., Kloos, H., & Alemu, B. M. (2021) · Tropical Medicine and Health · doi:10.1186/s41182-021-00315-1 · Cited by 39
“Therefore, improved handwashing methods play key role on reducing diarrheal incidence [11].”
BackgroundResult
Effect of recent diarrhoeal episodes on risk of pneumonia in children under the age of 5 years in Karachi, Pakistan
Ashraf, S., Huque, M. H., Kenah, E., Agboatwalla, M., & Luby, S. P. (2013) · International Journal of Epidemiology · doi:10.1093/ije/dys233 · Cited by 32
Under five diarrhea among model household and non model households in Hawassa, South Ethiopia: a comparative cross-sectional community based survey
Berhe, F., & Berhane, Y. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-187 · Cited by 30
Systematic re-review of WASH trials to assess women’s engagement in intervention delivery and research activities
Caruso, B. A., Ballard, A. M., Sobolik, J. S., Patrick, M., Dsouza, J., Sinharoy, S. S., Cumming, O., Wolf, J., & Ray, I. (2024) · Nature Water · doi:10.1038/s44221-024-00299-2 · Cited by 28
“For the two studies that reported different outcomes related to the same intervention 27,28 , the study reporting on diarrhoea as the focal outcome 27 did not specify who was targeted for engagement in intervention activities, leading to a GRAS assessment of ‘gender una-ware’.”
Result
The effect of compliance to Hand hygiene during COVID-19 on intestinal parasitic infection and intensity of soil transmitted helminthes, among patients attending general hospital, southern Ethiopia: Observational study
Seid, M., Yohanes, T., Goshu, Y., Jemal, K., & Siraj, M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270378 · Cited by 31
“Moreover the protective effect of hand hygiene attained in the present study is consistent with results of similar studies in Kenya and trials in Karachi, Pakistan [68].”
Result
Polio immunization in Pakistan: ethical issues and challenges
Basharat, S., & Shaikh, B. T. (2017) · Public health reviews · doi:10.1186/s40985-017-0049-4 · Cited by 28
Dermal and pulmonary absorption of ethanol from alcohol-based hand rub
Ahmed-Lecheheb, D., Cunat, L., Hartemann, P., & Hautemanière, A. (2012) · Journal of Hospital Infection · doi:10.1016/j.jhin.2012.02.006 · Cited by 28
Multisectoral approaches to improving nutrition : water, sanitation, and hygiene
Chase, C., & Ngure, F. M. (2016) · Cited by 28
Housing Quality in a Rural and an Urban Settlement in South Africa
Mathee, A., Moyes, J., Mkhencele, T., Kleynhans, J., Language, B., Piketh, S., Moroe, E., Wafawanaka, F., Martinson, N. A., McMorrow, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052240 · Cited by 28
“Furthermore, the unwieldy procedure of having to access water for handwashing from a container, may reduce levels of handwashing, which has been shown to significantly increase the risk of influenza infection [12,13,22].”
Background
Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program
Huo, S., Wang, K., Liu, Z., Yang, Y., Hee, J. Y., He, Q., Takesue, R., & Tang, K. (2021) · JMIR Public Health and Surveillance · doi:10.2196/33394 · Cited by 27
“Several experimental studies [8-13] have demonstrated that increased access to water, sanitation, and hygiene is significantly associated with lower risks of stunting.”
Background
Burden and Transmission of Zoonotic Foodborne Disease in a Rural Community in Mexico
Zaidi, M. B., Campos, F. D., Estrada‐García, T., Gutierrez, F., Leon, M. S., Chim, R., & Calva, J. J. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis300 · Cited by 26
“Several studies have shown that even modest reductions in hand contamination can reduce the risk of pathogen transmission [33, 34].”
Background
Factors associated with compliance among users of solar water disinfection in rural Bolivia
Christen, A., Pacheco, G. D., Hattendorf, J., Arnold, B. F., Cevallos, M., Indergand, S., Colford, J. M., & Mäusezahl, D. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-210 · Cited by 29
“Such courtesy bias and over-reporting of compliance with the intervention is well known from water, sanitation and hygiene intervention studies [7,26,36-42].”
The effects of food safety education on adolescents' hand hygiene behavior: an analysis of stages of change
Kim, E. J., Pai, A. J., Kang, N.-E., Kim, W. K., Kim, Y. S., Moon, H., & Ha, A. W. (2012) · Nutrition Research and Practice · doi:10.4162/nrp.2012.6.2.169 · Cited by 26
“[6] showed that incidences of disease were not significantly different between households that were given plain soap and those given antibacterial soap.”
Background
Hygiene improvement: Essential to improving child health in remote Aboriginal communities
McDonald, E., & Bailie, R. S. (2010) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2010.01846.x · Cited by 24
Diarrheal Diseases
Keusch, G. T., Walker, C. L. F., Das, J. K., Horton, S., & Habte, D. (2016) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0348-2_ch9 · Cited by 25
Rational Habit Formation: Experimental Evidence from Handwashing in IndiaPreprint
Hussam, R., Rabbani, A., Reggiani, G., & Rigol, N. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.3040729 · Cited by 24
Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya
Kawakatsu, Y., Tanaka, J., Ogawa, K., Ogendo, K., & Honda, S. (2017) · BMC Public Health · doi:10.1186/s12889-017-4107-0 · Cited by 25
Vomiting, Diarrhea, Constipation, and Gastroenteritis
Getto, L. P., Zeserson, E., & Breyer, M. J. (2011) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2011.01.005 · Cited by 23
“One, in urban squatter settlements in Pakistan, found campaigns promoting handwashing reduced the incidence of diarrhea by 53% among children younger than 15 years.(86) A recent review, which examined 33 trials with more than 53,000 participants,”
Impact of Infectious Diseases on Cognitive Development in Childhood and Beyond: Potential Mitigational Role of Hygiene
Ijaz, M. K., & Rubino, J. R. (2012) · The Open Infectious Diseases Journal · doi:10.2174/1874279301206010065 · Cited by 21
“In a follow-up study in the same setting, improvement in hand washing with soap and water in the household reduced the incidence of diarrhea among children at high risk of death from diarrhea [41].”
Background
The Variability of Childhood Diarrhea in Karachi, Pakistan, 2002–2006
Luby, S. P., Agboatwalla, M., & Hoekstra, R. M. (2011) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2011.10-0364 · Cited by 21
SaniTwice: A Novel Approach to Hand Hygiene for Reducing Bacterial Contamination on Hands When Soap and Water Are Unavailable
Edmonds, S. L., Mann, J., McCormack, R. R., Macinga, D. R., Fricker, C. M., Arbogast, J. W., & Dolan, M. J. (2010) · Journal of Food Protection · doi:10.4315/0362-028x-73.12.2296 · Cited by 21
“Proper hand hygiene reduces the risk of transmission of pathogens from hands to food (7, 20, 21) and is associated with a reduction in gastrointestinal illness (2, 8, 18).”
Background
Prevalence and Correlates of Water, Sanitation, and Hygiene (WASH) and Spatial Distribution of Unimproved WASH in Nepal
Dhital, S. R., Chojenta, C., Evans, T., Acharya, T. D., & Loxton, D. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063507 · Cited by 25
Effects of Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children: A Group Randomized Trial in China
Ban, H., Li, T., Jin, S., Jin, L. I., Peng, P. Z., Ye, H., & ZHANG, L. B. (2015) · Biomedical and Environmental Sciences · doi:10.1016/s0895-3988(15)30108-2 · Cited by 20
A machine learning logistic classifier approach for identifying the determinants of Under-5 child morbidity in Bangladesh
Methun, M. I. H., Kabir, A., Islam, S., Hossain, M. I., & Darda, M. A. (2021) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2021.100812 · Cited by 21
Combining interventions: improved chimney stoves, kitchen sinks and solar disinfection of drinking water and kitchen clothes to improve home hygiene in rural Peru.
Hartinger, S. M., Lanata, C. F., Gil, A. M., Hattendorf, J., Verástegui, H., & Mäusezahl, D. (2014) · Americanae (AECID Library) · Cited by 19
Lowering child mortality in poor countries: the power of knowledgeable parentsPreprint
Boone, P., & Zhan, Z. (2006) · RePEc: Research Papers in Economics · Cited by 19
Evaluation of cluster‐randomized trials on maternal and child health research in developing countries
Handlos, L. N., Chakraborty, H., & Sen, P. K. (2009) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2009.02313.x · Cited by 18
Projected Behavioural Change in Swachh Bharat Mission: A Public Policy Perspective
Mohapatra, G. (2019) · Indian Journal of Public Administration · doi:10.1177/0019556119863856 · Cited by 18
“Another study conducted by Luby et al. (2004) reveals that children belonging to the age group under 15 years residing in households that received hand-washing promotion and soap had half the diarrhoeal rates of children living in control neighbourhoods (Luby et al., 2004).”
Background
Infectious Diseases and Vaccine Sciences: Strategic Directions
Luby, S. P., Brooks, W. A., Zaman, K., Hossain, S., & Ahmed, T. (2009) · Journal of Health Population and Nutrition · doi:10.3329/jhpn.v26i3.1897 · Cited by 18
“Malnutrition increases the risk of diarrhoea and the risk of mortality from diarrhoeal disease (19-21).”
Background
Comprehensive family hygiene promotion in peri-urban Cape Town: Gastrointestinal and respiratory illness and skin infection reduction in children aged under 5
Cole, E. C., Hawkley, M., Rubino, J. R., Crookston, B. T., McCue, K. A., Dixon, J., Maqelana, T., Cwayi, J., Adams, C., & Kim, J. (2012) · South African Journal of Child Health · doi:10.7196/sajch.459 · Cited by 17
Interventions for High-Burden Infectious Diseases in Children and Adolescents: A Meta-analysis
Khan, D. S. A., Naseem, R., Salam, R. A., Lassi, Z. S., Das, J. K., & Bhutta, Z. A. (2022) · PEDIATRICS · doi:10.1542/peds.2021-053852c · Cited by 20
Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review
Huberts, J. C. D. W., Greenland, K., Schmidt, W., & Curtis, V. (2016) · American Journal of Infection Control · doi:10.1016/j.ajic.2016.01.045 · Cited by 17
Meteorological and social conditions contribute to infectious diarrhea in China
Xiang, Y., Xiong, W., Huang, T., & He, J. (2021) · Scientific Reports · doi:10.1038/s41598-021-00932-0 · Cited by 20
Evaluation of Slum Upgrading Programs: A Literature ReviewPreprint
Jaitman, L. (2013) · SSRN Electronic Journal · doi:10.2139/ssrn.2305396 · Cited by 17
Determinants of handwashing practice and its associated factors among mothers of under-5 children in Kolladiba town, Northwest Ethiopia: cross-sectional study
Wolde, M., Abate, M., Mandefro, G., Beru, E., Belew, A. K., & Tesema, G. A. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058960 · Cited by 16
“13 16 Furthermore, a study done in southern Ethiopia showed that the frequency of diarrhoea among participants with poor and good handwashing practices was 54.4% and 28.8%, respectively.”
BackgroundInfluential
Comparison of the Activity of Alcohol-Based Handrubs Against Human Noroviruses Using the Fingerpad Method and Quantitative Real-Time PCR
Liu, P., Macinga, D. R., Fernandez, M. L., Zapka, C. A., Hsiao, H., Berger, B. E., Arbogast, J. W., & Moe, C. L. (2011) · Food and Environmental Virology · doi:10.1007/s12560-011-9053-x · Cited by 16
Hand decontamination: influence of common variables on hand-washing efficiency
Miller, T. E., Patrick, D., & Ormrod, D. J. (2011) · Healthcare Infection · doi:10.1071/hi10027 · Cited by 16
Ordeal Mechanisms, Information, and the Cost-effectiveness of Strategies to Provide Subsidized Eyeglasses
Sylvia, S. Y., Ma, X., Shi, Y.-J., & Rozelle, S. (2022) · Journal of Health Economics · doi:10.1016/j.jhealeco.2022.102594 · Cited by 14
Assessing the Health Impact of the following Measures in Schools in Maradi (Niger): Construction of Latrines, Clean Water Supply, Establishment of Hand Washing Stations, and Health Education
Boubacar Maïnassara, H., & Tohon, Z. (2014) · Journal of Parasitology Research · doi:10.1155/2014/190451 · Cited by 15
“Furthermore, interventions that focus on hygiene have been associatedwith a reduction in the number of visits to health centres [24].”
Background
Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households
Hamzah, L., Boehm, A. B. B., Davis, J., Pickering, A. J., Wolfe, M. K., Mureithi, M., & Harris, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17020608 · Cited by 16
“Handwashing with soap is especially critical in preventing food and water contamination [7] by ruminants [60], can reduce diarrheal disease risk by between 40% and 65% [61,62], and can protect against exposure to enteric zoonoses found in animal waste [63].”
Background
Risk Factors Associated with Diarrhea Morbidity Among Children Younger than Five Years in the Atwima Nwabiagya District, Ghana: A Cross-Sectional Study
Danquah, L. (2015) · Science Journal of Public Health · doi:10.11648/j.sjph.20150303.17 · Cited by 15
BabyGel pilot: a pilot cluster randomised trial of the provision of alcohol handgel to postpartum mothers to prevent neonatal and young infant infection-related morbidity in the community
Ditai, J., Abeso, J., Odeke, N., Mobbs, N. A., Dusabe-Richards, J., Mudoola, M., Carrol, E. D., Olupot‐Olupot, P., Storr, J., Medina‐Lara, A., et al. (2019) · Pilot and Feasibility Studies · doi:10.1186/s40814-019-0432-7 · Cited by 14
An Integrated Approach to Hygiene, Sanitation, and Storage Practices for Improving Microbial Quality of Drinking Water Treated at Point of Use: A Case Study in Makwane Village, South Africa
Moropeng, R. C., Budeli, P., & Momba, M. N. B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126313 · Cited by 17
The reality of pediatric emergency mass critical care in the developing world
Burkle, F. M., Argent, A. C., & Kissoon, N. “. (2011) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e318234a906 · Cited by 14
Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study
Khan, K. M., Chakraborty, R., Brown, S. C., Sultana, R., Colón, A., Toor, D., Upreti, P., & Sen, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312535 · Cited by 22
“Our results are consistent with several other studies conducted elsewhere, which have identified regular hand hygiene practice as an effective barrier against these two diseases [15,16,23,36].”
Result
Improving the Health and Education of Elementary Schoolchildren in Rural China: Iron Supplementation Versus Nutritional Training for Parents
Wong, H. L., Shi, Y., Luo, R., Zhang, L., & Rozelle, S. (2014) · The Journal of Development Studies · doi:10.1080/00220388.2013.866223 · Cited by 13
“…control group for comparison (Badruddin et al., 2008; Onyango-Ouma, Aagaard-Hansen, & Jensen, 2005) and some other works instead bundle health education programmes with the provision of free or subsidised health inputs (Huttly et al., 1990; Luby et al., 2004; Quick et al., 2002; Rhee et al., 2005).”
Background
Hand hygiene practices among community Health Officers in Rivers State, Nigeria
Braimoh, O., & Udeabor, S. E. (2013) · African Health Sciences · doi:10.4314/ahs.v13i2.43 · Cited by 13
Changes in Diarrheal Disease and Treatment Among Brazilian Children from 1986 to 1996
Sastry, N., & Burgard, S. A. (2010) · Population Research and Policy Review · doi:10.1007/s11113-010-9179-9 · Cited by 13
“Simple actions, such as hand washing, are very effective in preventing diarrhea (Curtis and Cairncross 2003; Luby et al. 2004).”
Background
Non‐clinical interventions for acute respiratory infections and diarrhoeal diseases among young children in developing countries
Seguin, M., & Niño‐Zarazúa, M. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12423 · Cited by 13
“…al. 1999; Quick et al. 1999; Roberts et al. 2001; Jensen et al. 2003; Nanan et al. 2003; Reller et al. 2003; Sobsey et al. 2003; Clasen et al. 2004; Luby et al. 2004, 2006; Oberhelman et al. 2006; Garrett et al. 2008; Kolahi et al. 2009; Rana 2009; Langford et al. 2011), health facility admissions…”
Background
Mobility up the sanitation ladder following community-led total sanitation in rural Zambia
Russpatrick, S., Tiwari, A., Markle, L., Musonda, E., Mutunda, A., Osbert, N., Pinfold, J., Winters, A., Winters, B., & Larsen, D. A. (2017) · Journal of Water, Sanitation and Hygiene for Development · doi:10.2166/washdev.2017.111 · Cited by 12
Higiene de manos: una prioridad para la seguridad de los pacientes hospitalizados
Ferrer, C., & Almirante, B. (2007) · Enfermedades Infecciosas y Microbiología Clínica · doi:10.1157/13106960 · Cited by 12
A guide to water and sanitation sector impact evaluations
Poulos, C. M., Pattanayak, S. K., & Jones, K. (2006) · Cited by 12
Cost-Effective Prevention of Diarrheal Diseases: A Critical ReviewPreprint
Kremer, M. R., & Zwane, A. P. (2007) · SSRN Electronic Journal · doi:10.2139/ssrn.1003255 · Cited by 12
“Weekly or daily reminders, which Luby et al. (2004b) identify as critical for adoption by the poorest households as compared to richer households (and upon which all of these studies rely), are prohibitively expensive to provide on a large-scale basis.”
BackgroundInfluential
Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 2 - Hand hygiene and other hygiene measures: systematic review and meta-analysisPreprint
Al‐Ansary, L. A., Bawazeer, G. A., Beller, E., Clark, J. M., Conly, J. M., Mar, C. D., Dooley, E., Ferroni, E., Glasziou, P., Hoffmann, T., et al. (2020) · medRxiv · doi:10.1101/2020.04.14.20065250 · Cited by 12
Progress on the Global Research Agenda for Antimicrobial Resistance in Human Health in Pakistan: Findings and Implications
Maryam, S., Saleem, Z., Haseeb, A., Qamar, M. U., Amir, A., Abuhussain, S. S. A., Imam, M. T., Afzal, S., Meyer, J. C., Mudenda, S., et al. (2025) · Infection and Drug Resistance · doi:10.2147/idr.s531874 · Cited by 15
Relationship between the rate of giardiasis and knowledge and practice of prevention in primary school children in south of Tehran
Hedayati, A., Sadraei, J., & Ghofranipour, F. F. (2008) · Parasitology Research · doi:10.1007/s00436-008-1176-0 · Cited by 11
Water, sanitation, and diarrhea incidence among children: evidence from Guatemala
Vásquez, W. F., & Aksan, A. (2015) · Water Policy · doi:10.2166/wp.2015.211 · Cited by 11
Triclosan and triclocarban exposure, infectious disease symptoms and antibiotic prescription in infants—A community-based randomized intervention
Ley, C., H, V. S. M. P., Sanchez, M. D. L. L., Desai, M., & Parsonnet, J. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199298 · Cited by 11
Wilderness Medical Society Clinical Practice Guidelines for Water Disinfection for Wilderness, International Travel, and Austere Situations
Backer, H., Derlet, R. W., & Hill, V. R. (2019) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2019.06.006 · Cited by 11
How We Didn’t Clean Up Until We Washed Our Hands: Shigellosis in an Elementary and Middle School in North Texas
Schulte, J., Williams, L., Asghar, J., Dang, T., Bedwell, S., Guerrero, K., Hamaker, D., Stonecipher, S., Zoretic, J., & Chow, C. C. (2012) · Southern medical journal (Birmingham, Ala. Print) · doi:10.1097/smj.0b013e31823c411e · Cited by 9
Income, Income Shocks, and Transactional Sex
LoPiccalo, K., Robinson, J., & Yeh, E. (2016) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199915248.013.21 · Cited by 18
Persistent Diarrhea in Developing Countries
Bhutta, Z. A. (2005) · Annales Nestlé (English ed ) · doi:10.1159/000086498 · Cited by 11
“In the absence of the latter, interventions to promote hand-washing strategies and domestic measures to purify water are key to reducing the burden of diarrhea [ ,”
Background
Clean Hands: Prevention of Typhoid Fever in Rural Communities in Egypt
Lohiniva, A., Saeed, M., El-Sayeed, N., & Talaat, M. (2008) · International Quarterly of Community Health Education · doi:10.2190/iq.28.3.d · Cited by 10
The split-plot design was useful for evaluating complex, multilevel interventions, but there is need for improvement in its design and report
Goulão, B., MacLennan, G., & Ramsay, C. R. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.10.019 · Cited by 10
Effect of deploying community health assistants on appropriate treatment for diarrhoea, malaria and pneumonia: quasi‐experimental study in two districts of Zambia
Biemba, G., Yeboah‐Antwi, K., Vosburg, K. B., Prust, M. L., Keller, B., Worku, Y., Zulu, H., White, E. E., & Hamer, D. H. (2016) · Tropical Medicine & International Health · doi:10.1111/tmi.12730 · Cited by 10
Impact on childhood mortality of interventions to improve drinking water, sanitation and hygiene (WASH) to households: systematic review and meta-analysisPreprint
Waddington, H., Masset, E., Bick, S., & Cairncross, S. (2023) · medRxiv · doi:10.1101/2023.03.13.23287185 · Cited by 2
Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update
Backer, H., Derlet, R. W., & Hill, V. R. (2023) · Wilderness and Environmental Medicine · doi:10.1177/10806032231218722 · Cited by 11
Moving from efficacy to effectiveness: using behavioural economics to improve the impact of WASH interventions
Coville, A., & Orozco-Olvera, V. (2014) · Waterlines · doi:10.3362/1756-3488.2014.004 · Cited by 10
A Review of the Evidence Base for WASH interventions in Emergency Responses
Parkinson, J. (2009) · Cited by 9
Hand washing behavior change effect of community-based hygiene and sanitation intervention in low resource setting
Qazi, U., & Anwar, S. (2019) · Journal of Public Health · doi:10.1093/pubmed/fdz130 · Cited by 9
La importancia del lavado de manos por parte del personal a cargo del cuidado de los pacientes hospitalizados
Alba‐Leonel, A., Fajardo-Ortíz, G., & Papaqui-Hernández, J. (2014) · Revista de Enfermería Neurológica · doi:10.37976/enfermeria.v13i1.178 · Cited by 9
“5 millones de niños no llegan a celebrar su quinto cumpleaños debido a enfermedades como la diarrea y a la neumonía.(8-11) Al respecto, se puede afi rmar que podrían evitarse la mitad de estas muertes si los niños se lavaran las manos con jabón antes de comer y después de ir del baño.”
Background
Health policy analysis: the case of Pakistan
Khan, M. M. (2006) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 9
A pilot study describing infant formula preparation and feeding practices
Herbold, N. H., & Scott, E. A. (2008) · International Journal of Environmental Health Research · doi:10.1080/09603120802272185 · Cited by 8
Developing a Scorecard to Assess Global Progress in Scaling Up Diarrhea Control Tools: A Qualitative Study of Academic Leaders and Implementers
Rosinski, A. A., Narine, S., & Yamey, G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0067320 · Cited by 8
“For example, despite good evidence on efficacy [44– 45], the Global Scaling Up Handwashing Project notes that ‘‘large-scale promotion of handwashing behavior change is a challenge’’ [46].”
Background
Preventing Waterborne Diseases: Analysis of a Community Health Worker Program in Rural Tamil Nadu, India
Gupta, N., Mutukkanu, T., Nadimuthu, A., Thiyagaran, I., & Sullivan‐Marx, E. M. (2011) · Journal of Community Health · doi:10.1007/s10900-011-9472-5 · Cited by 8
Effects of biocides and metals on antibiotic resistance: a genomic and metagenomic perspective
Pal, C. (2017) · Gothenburg University Publications Electronic Archive (Gothenburg University) · doi:10.13140/rg.2.2.27592.72967 · Cited by 7
Promoting Handwashing Behavior in Peru: The Effect of Large-Scale Mass-Media and Community Level Interventions
Galiani, S., & Welch, K. (2014) · AEA Randomized Controlled Trials · doi:10.1257/rct.318-1.0 · Cited by 8
Evaluation of the impact of antimicrobial hand towels on hand contamination with Escherichia coli among mothers in Kisumu County, Kenya, 2011–2012
Kim, S. K., Brown, A. C., Murphy, J. L., Oremo, J., Owuor, M., Ouda, R., Person, B., & Quick, R. E. (2019) · Water Research · doi:10.1016/j.watres.2019.03.085 · Cited by 7
Updating the assumptions on the impact of household water, sanitation and hygiene interventions on diarrhea morbidity in young children
Walker, C. L. F., Walker, N., & Black, R. E. (2022) · Journal of Global Health · doi:10.7189/jogh.12.08003 · Cited by 8
Comparison of Hygiene Behavior between College Students and Adults
Choi, H. (2015) · Asia-pacific Journal of Multimedia services convergent with Art Humanities and Sociology · doi:10.14257/ajmahs.2015.08.67 · Cited by 7
“특별히 위생행위 중 손 씻기에 대한 선행연구를 체계적으로 분석한 결과에 따르면 올바른 손 씻기만으로도 폐렴과 같 은 호흡기계 감염 위험을 감소시키고[2], 설사병, 농가진과 같은 전염성 질환도 예방한다고 보고하 였다[3-4].”
An evaluation of water, sanitation, and hygiene status and household assets and their associations with soil-transmitted helminthiasis and reported diarrhea in Nueva Santa Rosa, Guatemala
Rao, G., Blackstock, A. J., Derado, G., Cuéllar, V. M., Juliao, P., Alvarez, M., López, B., Muñoz, F., Thornton, A., Patel, J. C., et al. (2021) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2021.160 · Cited by 7

Authors: Luby, S. P., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W. L., & Hoekstra, R. M.
Affiliations: Centers for Disease Control and Prevention (US)
ORCID: Luby, Stephen P.
Altaf, Arshad
Hoekstra, Robert M.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2004-06-02
Volume: 291
Issue: 21
Pages: 2547
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.291.21.2547
OpenAlex: W2165965969
Cited by: 309
References: 23
Citations by year: 2026: 5 · 2025: 8 · 2024: 13 · 2023: 10 · 2022: 13 · 2021: 16 · 2020: 6 · 2019: 12 · 2018: 9 · 2017: 13 · 2016: 16 · 2015: 21 · 2014: 28 · 2013: 11 · 2012: 17
FWCI: 13.77
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
Keywords: handwashing with soap, childhood diarrhea, infants, severe malnutrition, antibacterial soap, urban slums, low-income communities, diarrhea prevention, child mortality
MeSH terms: Adolescent, Adult, Child, Child, Preschool, Diarrhea, Infantile, Family, Female, Hand Disinfection, Humans, Hygiene, Infant, Male, Pakistan, Poverty, Risk Factors, Soaps

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Effect of Intensive Handwashing Promotion on Childhood Diarrhea in High-Risk Communities in Pakistan: A Randomized Controlled Trial

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Citations

Cites

Cited by

Related

Metadata

Record

About these checks