CoChat
Sign Up
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
DOI 10.1001/jama.291.21.2547
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.

Overview

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.

Verification

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.

Citations

Cites

Show all 23 references

Cited by

Sorted by citations

Items 201–300 of 310

Related

See all

Metadata

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
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