Does targeting children with hygiene promotion messages work? the effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries
Open accessAbstract
Objectives: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil‐transmitted helminth infection and handwashing behaviour, in low‐ and middle‐income country settings. Methods: A systematic review of the literature was performed by searching eight databases, and reference lists were hand‐searched for additional articles. Studies were reviewed for inclusion according to pre‐defined inclusion criteria and the quality of all studies was assessed. Results: Eight studies were included in this review: seven cluster‐randomised controlled trials and one cluster non‐randomised controlled trial. All eight studies targeted children aged 5–12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child‐targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective. Conclusion: Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children's handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area, however, does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Most handwashing interventions focus on infant caregivers, not on <5 year siblings and playmates.
“Most handwashing interventions focus on infant caregivers, not on <5 year siblings and playmates.8”
From Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study (2022) · cites this paper as [8]
The Discussion (page unavailable) says all interventions identified by this review targeted primary-school children aged five to twelve, and identifies children outside school as an overlooked group. That supports the concern about younger children being missed, but the paper does not establish that most handwashing interventions focus on infant caregivers. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Transforming our world: the 2030 Agenda for Sustainable Development
(2022) · doi:10.5040/9781509934058.0025 · Cited by 6,562 · see citing works
Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61698-6 · Cited by 3,167 · see citing works
(2017) · The SHAFR Guide Online · doi:10.1163/2468-1733_shafr_sim010030025 · Cited by 2,357 · see citing works
Fewtrell, L., Kaufmann, R. B., Kay, D., Enanoria, W. T. A., Haller, L., & Colford, J. M. (2004) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(04)01253-8 · Cited by 1,688 · see citing works
Disease control priorities in developing countries
Frenk, J. M. (2006) · Salud Pública de México · doi:10.1590/s0036-36342006000600011 · Cited by 1,615 · see citing works
Global numbers of infection and disease burden of soil transmitted helminth infections in 2010
Pullan, R. L., Smith, J. L., Jasrasaria, R., & BROOKER, S. J. (2014) · Parasites & Vectors · doi:10.1186/1756-3305-7-37 · Cited by 1,428 · see citing works
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 · see citing works
Prüss‐Ustün, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A. D., De France, J., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12329 · Cited by 1,198 · see citing works
Self-citationChild undernutrition, tropical enteropathy, toilets, and handwashing
Humphrey, J. H. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60950-8 · Cited by 862 · see citing works
Strunz, E. C., Addiss, D. G., Stocks, M. E., Ogden, S., Utzinger, J., & Freeman, M. C. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001620 · Cited by 807 · see citing works
Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis
Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008) · American Journal of Public Health · doi:10.2105/ajph.2007.124610 · Cited by 796 · see citing works
An Agenda for Research on the Sustainability of Public Health Programs
Scheirer, M. A., & Dearing, J. W. (2011) · American Journal of Public Health · doi:10.2105/ajph.2011.300193 · Cited by 775 · see citing works
Water, sanitation and hygiene for the prevention of diarrhoea
Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W.-P. (2010) · International Journal of Epidemiology · doi:10.1093/ije/dyq035 · Cited by 667 · see citing works
Handwashing and risk of respiratory infections: a quantitative systematic review
Rabie, T., & Curtis, V. (2006) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2006.01568.x · Cited by 556 · see citing works
Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P. T., Wolf, J., Prüss‐Ustün, A., Bonjour, S., Hunter, P. R., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12339 · Cited by 524 · see citing works
Self-citationInterventions to improve water quality for preventing diarrhoea
Clasen, T., Alexander, K., Sinclair, D., Boisson, S., Peletz, R., Chang, H. H., Majorin, F., & Cairncross, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004794.pub3 · Cited by 498 · see citing works
Planned, motivated and habitual hygiene behaviour: an eleven country review
Curtis, V. A., Danquah, L. O., & Aunger, R. V. (2009) · Health Education Research · doi:10.1093/her/cyp002 · Cited by 482 · see citing works
Hand washing promotion for preventing diarrhoea
Ejemot-Nwadiaro, R. I., Ehiri, J. E., Arikpo, D., Meremikwu, M. M., & Critchley, J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004265.pub3 · Cited by 351 · see citing works
Nikolay, B., BROOKER, S. J., & Pullan, R. L. (2014) · International Journal for Parasitology · doi:10.1016/j.ijpara.2014.05.009 · Cited by 285 · see citing works
Biran, A., Schmidt, W., Varadharajan, K. S., Rajaraman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R. V., & Curtis, V. (2014) · The Lancet Global Health · doi:10.1016/s2214-109x(13)70160-8 · Cited by 277 · see citing works
Publication bias: what is it? How do we measure it? How do we avoid it?
Song, F., Hooper, L., & Loke, Y. (2013) · Open Access Journal of Clinical Trials · doi:10.2147/oajct.s34419 · Cited by 261 · see citing works
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E., & El-Sayed, N. (2011) · Emerging Infectious Diseases · doi:10.3201/eid1704.101353 · Cited by 238 · see citing works
Behaviour Centred Design: towards an applied science of behaviour change
Aunger, R. V., & Curtis, V. A. (2016) · Health Psychology Review · doi:10.1080/17437199.2016.1219673 · Cited by 223 · see citing works
BOWEN, A., MA, H., OU, J., BILLHIMER, W., LONG, T., MINTZ, E., HOEKSTRA, R. M., & LUBY, S. (2007) · The American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2007.76.1166 · Cited by 208 · see citing works
Health-Education Package to Prevent Worm Infections in Chinese Schoolchildren
Bieri, F. A., Gray, D. J., Williams, G. M., Raso, G., Li, Y.-S., Yuan, L., He, Y., Li, R. S., Guo, F.-Y., Li, S.-M., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1204885 · Cited by 198 · see citing works
Ram, P. K., Halder, A. K., Granger, S. P., Jones, T., Hall, P., Hitchcock, D., Wright, R. L., Nygren, B., Islam, M. S., Molyneaux, J. W., et al. (2010) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2010.09-0763 · Cited by 164 · see citing works
Gyorkos, T. W., Maheu‐Giroux, M., Blouin, B., & Casapía, M. (2013) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0002397 · Cited by 151 · see citing works
Dreibelbis, R., Kroeger, A., Hossain, K., Venkatesh, M., & Ram, P. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13010129 · Cited by 151 · see citing works
Self-citationComparing the performance of indicators of hand-washing practices in rural Indian households
Biran, A., Rabie, T., Schmidt, W., Juvekar, S., Hirve, S., & Curtis, V. (2008) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2007.02001.x · Cited by 145 · see citing works
Contzen, N., Pasquale, S. D., & Mosler, H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0136445 · Cited by 134 · see citing works
Nicholson, J. A., Naeeni, M., Hoptroff, M., Matheson, J. R., Roberts, A. J., Taylor, D., Sidibe, M., Weir, A. J., Damle, S. G., & Wright, R. L. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12254 · Cited by 88 · see citing works
Racey, M., O'Brien, C., Douglas, S., Marquez, O., Hendrie, G. A., & Newton, G. S. (2016) · Journal of School Health · doi:10.1111/josh.12396 · Cited by 83 · see citing works
Pickering, A. J., Davis, J., Blum, A. G., Scalmanini, J., Oyier, B., Okoth, G., Breiman, R. F., & Ram, P. K. (2013) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.13-0008 · Cited by 73 · see citing works
Al-Delaimy, A. K., Al‐Mekhlafi, H. M., Lim, Y. A. L., Nasr, N. A., Sady, H., Atroosh, W. M. M., & Mahmud, R. (2014) · Parasites & Vectors · doi:10.1186/1756-3305-7-416 · Cited by 71 · see citing works
Bresee, S., Caruso, B. A., Sales, J., Lupele, J., & Freeman, M. C. (2016) · Health Education Research · doi:10.1093/her/cyw022 · Cited by 61 · see citing works
Effects of an Observer on Conformity to Handwashing Norm
Pedersen, D. M., Keithly, S., & Brady, K. (1986) · Perceptual and Motor Skills · doi:10.2466/pms.1986.62.1.169 · Cited by 44 · see citing works
Pickering, A. J., Blum, A. G., Breiman, R. F., Ram, P. K., & Davis, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092571 · Cited by 36 · see citing works
Graves, J. M., Daniell, W., Harris, J. R., Obure, A., & Quick, R. E. (2012) · International Quarterly of Community Health Education · doi:10.2190/iq.32.4.d · Cited by 26 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [13]13. World Health Organisation, The United Nations Children's Fund. End Preventable Deaths: Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea. WHO Press: Geneva, Switzerland, 2013.
- [31]31. Talaat M, Afifi S, Dueger E et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza © 2017 John Wiley & Sons Ltd 537 Tropical Medicine and International Health volume 22 no 5 pp 526-538 may 2017
- [32]32. J. A. Watson et al. Does targeting children with hygiene promotion messages work? 13653156, 2017, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/tmi.12861 by Mount Vernon Nazarene University, Wiley Online Library on [11/08/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License and absenteeism in schoolchildren, Cairo Egypt. Emerg Infect Dis 2011: 17: 619-625.
Cited by
Sorted by citations
Sanitation and hygiene practices among primary school learners in Ngamiland district, Botswana
Thakadu, O. T., Ngwenya, B. N., Phaladze, N. A., & Bolaane, B. (2018) · Physics and Chemistry of the Earth, Parts A/B/C · doi:10.1016/j.pce.2018.02.006 · Cited by 27 · see citing works
Baker, K. K., Mumma, J. A. O., Simiyu, S., Sewell, D., Tsai, K., Anderson, J. D., MacDougall, A., Dreibelbis, R., & Cumming, O. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059878 · Cited by 19 · see citing works
Self-citation
- Authors
- Watson, J. A., Ensink, J. H. J., Ramos, M., Benelli, P., Holdsworth, E., Dreibelbis, R., & Cumming, O.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Save the Children (GB)
- Corresponding author
- Watson, Julie A.
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2017-03-31
- Volume
- 22
- Issue
- 5
- Pages
- 526-538
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2594826899
- Cited by
- 58
- References
- 41
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 8 · 2019: 2 · 2018: 8 · 2017: 3
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Tropical Medicine & International Health (publishedVersion, other-oa)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Keywords
- handwashing promotion, diarrhea, soil-transmitted helminthiasis, handwashing behavior, hygiene promotion, elementary school students, low- and middle-income countries, behavior change, soap use
- MeSH terms
- Child, Child Behavior, Developing Countries, Diarrhea, Hand Disinfection, Health Promotion, Helminthiasis, Humans, Hygiene, Soil
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
