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Title: Hand hygiene intervention strategies to reduce diarrhoea and respiratory infections among schoolchildren in developing countries : a systematic review
Authors: Mbakaya, BC 
Lee, PH 
Lee, RLT 
Issue Date: 2017
Source: International journal of environmental research and public health, Apr. 2017, v. 14, no. 4, 371
Abstract: Effective and appropriate hand-washing practice for schoolchildren is important in preventing infectious diseases such as diarrhoea, which is the second most common cause of death among school-age children in sub-Saharan Africa. The objective of the review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhoea and respiratory tract infections among schoolchildren aged 6-12 years in developing countries. Published research articles were searched from databases covering a period from as far back as the creation of the databases to November 2015. Eight randomized controlled trials (RCT/CRCT) from developing countries met the inclusion criteria. The Jadad Scale for appraising RCT/CRCT studies revealed methodological challenges in most studies, such that 75% (6/8) were rated as low-quality articles. The review found that hand hygiene can reduce the incidence of diarrhoea and respiratory conditions. Three hand hygiene intervention strategies utilized were training, funding and policy, with training and funding implemented more commonly than policy. These strategies were not only used in isolation but also in combination, and they qualified as multi-level interventions. Factors that influenced hand washing were contextual, psychosocial and technological. Findings can inform school health workers in categorizing and prioritizing activities into viable strategies when implementing multi-level hand-washing interventions. This review also adds to the existing evidence that multi-level hand-washing interventions can reduce the incidence of diarrhoea, respiratory infections, and school absenteeism. Further evidence-based studies are needed with improved methodological rigour in developing countries, to inform policy in this area.
Keywords: Multi-level intervention
Hand washing
Respiratory infections
Developing countries
Publisher: Molecular Diversity Preservation International (MDPI)
Journal: International journal of environmental research and public health 
ISSN: 1660-4601
DOI: 10.3390/ijerph14040371
Rights: © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
The following publication Mbakaya, B.C.; Lee, P.H.; Lee, R.L.T. Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries: A Systematic Review. Int. J. Environ. Res. Public Health 2017, 14, 371, 1-14 is available at
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