Hand-washing, subclinical infections, and growth: a longitudinal evaluation of an intervention in Nepali slums
Abstract
OBJECTIVE: We conducted a longitudinal study to assess the impact of a hand-washing intervention on growth and biomarkers of child health in Nepali slums. This is the first study to evaluate the impact of hand-washing on markers of subclinical, asymptomatic infections associated with childhood growth faltering. METHODS: We recruited a total sample of infants in the target age-range (3-12 months) living in the eight largest Kathmandu slums, allocating them to intervention (n = 45) and control (n = 43) groups. In intervention areas, a small-scale community-based hand-washing program was implemented for six months; in control areas, mothers continued their normal practices. Time series linear regression was used to assess the impact of the intervention on levels of morbidity, mucosal damage, immune stimulation and growth. RESULTS: As expected, children with higher levels of mucosal damage exhibited worse growth over the period of the intervention (P = 0.01, <0.001 and 0.03 for height-for-age, weight-for-age, and weight-for-height z-scores, respectively). We observed a 41% reduction in diarrheal morbidity (P = 0.023) for the intervention group relative to control. However, the hand-washing intervention did not lower levels of mucosal damage or immune stimulation, nor slow growth faltering. CONCLUSIONS: Reducing exposure to pathogens is an important global health priority. This study confirms the importance of hand-washing campaigns for reducing childhood morbidity. Yet our data suggest that promoting hand-washing is necessary but not sufficient to address chronic, subclinical infections. From a human biology standpoint, tackling the root causes of childhood infections is needed to address growth faltering in the context of highly contaminated slum environments.
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- Authors
- Langford, R., Lunn, P., & Brick, C. P.
- Affiliations
- University of Bristol (GB)
- University of Cambridge (GB)
- Corresponding author
- Langford, Rebecca
- ORCID
- Langford, Rebecca
- Venue
- American Journal of Human Biology
- Publisher
- Wiley
- Published
- 2011-05-31
- Volume
- 23
- Issue
- 5
- Pages
- 621-629
- ISSN
- 1042-0533 (ISSN-L)
- 1520-6300
- OpenAlex
- W1969831932
- Cited by
- 86
- References
- 30
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 3 · 2022: 11 · 2021: 6 · 2020: 9 · 2019: 14 · 2018: 7 · 2017: 7 · 2016: 5 · 2015: 7 · 2014: 3 · 2013: 7 · 2012: 1
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Human Biology (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- Economic and Social Research Council (ES/G007543/1)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Health Professions › Emergency Medical Services › Pediatric health and respiratory diseases
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- asymptomatic infection, mucosal injury, immunostimulation, infant health, height-for-age z-score, weight-for-age z-score
- MeSH terms
- Developing Countries, Diarrhea, Growth Disorders, Hand Disinfection, Humans, Infant, Intestinal Mucosa, Longitudinal Studies, Nepal, Poverty Areas, Prospective Studies, Random Allocation, Urban Population, Biomarkers, Asymptomatic Infections
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.
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