Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries: a systematic review
Open accessAbstract
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.
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The existing systematic review evidence is misaligned with the geography of the endemic disease burden.
“Second, the evidence base is misaligned with the geography of the endemic disease burden.”
Reviews have been restrictive in terms of included study designs.
“Third, reviews have been restrictive in terms of included study designs.”
The review by McGuinness and colleagues included only randomised controlled trials.
“The review by McGuinness and colleagues included only randomised controlled trials”
An LMIC-focused systematic review by McGuinness and colleagues with similar inclusion criteria to ours did not conduct a meta-analysis, but identified 14 randomised studies up to 2017.
“An LMIC-focused systematic review by McGuinness and colleagues with similar inclusion criteria to ours did not conduct a meta-analysis, but identified 14 randomised studies up to 2017.16”
McGuinness and colleagues did not conduct a meta-analysis.
“the authors did not conduct a meta-analysis”
McGuinness and colleagues' 2017 systematic review focused on ARI in LMICs and included 14 studies.
“another systematic review conducted in 2017 by McGuinness and colleagues did focus on ARI in LMICs and included 14 studies”
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- Authors
- McGuinness, S. L., Barker, S. F., O'Toole, J., Cheng, A. C., Forbes, A. B., Sinclair, M., & Leder, K.
- Affiliations
- The Alfred Hospital (AU)
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
- Monash University (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- McGuinness, Sarah L.
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2018-07-10
- Volume
- 23
- Issue
- 8
- Pages
- 816-833
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2804925188
- Cited by
- 36
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 2
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council of Australia (APP1068732, APP1084351, APP1115196)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Pediatric health and respiratory diseases
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- acute respiratory infections, hygiene interventions, hand hygiene, childcare settings, school environment, domestic settings, influenza, absenteeism, pneumonia, household transmission, low- and middle-income countries
- MeSH terms
- Adult, Child, Communicable Disease Control, Developing Countries, Health Promotion, Humans, Hygiene, Respiratory Tract Infections, Schools
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