Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 2 - Hand hygiene and other hygiene measures: systematic review and meta-analysis.

Lubna A Al-Ansary; Ghada A Bawazeer; Elaine Beller; Justin Clark; John Conly; Chris Del Mar; Elizabeth Dooley; Eliana Ferroni; Paul Glasziou; Tammy Hoffman; Tom Jefferson; Sarah Thorning; Mieke van Driel; Mark Jones

Four c-RCTs implemented complex, multi-modal sanitation, education, cooking and hygiene interventions (see Tables 1, 2 and S1). All four trials were conducted in low-income countries in settings with minimal to no access to basic sanitation. In one trial in 100 primary schools in Laos [59] clean water supply, sanitation facilities, handwashing equipment and drinking water filters were provided to the intervention schools as part of a Water, Sanitation and Hygiene (WASH) programme with hygiene education. The control schools received the intervention after the trial period. They did not find an effect on infections or absenteeism amongst the students and conclude that such interventions alone are insufficient. The study by Huda et al [60] in villages in Bangladesh used local 'promotors' to visit households with young children regularly to deliver hygiene education including handwashing, latrine use, faeces and waste disposal, and water storage. Although the intervention households showed more 'desired behaviour' this did not result in a measurable reduction of respiratory illness. In another study in urban Bangladesh [61] , handwashing equipment (bucket, tap, soap) and point-of-use water treatment were provided to intervention households and community health promotors delivered a behavioural intervention in addition to an oral cholera vaccine. There was no impact of this large-scale intervention on respiratory illness.