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Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low‐ and middle‐income countries: a systematic review
Author(s) -
McGuinness Sarah L.,
Barker S. Fiona,
O'Toole Joanne,
Cheng Allen C.,
Forbes Andrew B.,
Sinclair Martha,
Leder Karin
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13080
Subject(s) - medicine , hygiene , psychological intervention , absenteeism , randomized controlled trial , environmental health , pediatrics , nursing , management , pathology , economics , surgery
Objectives Acute respiratory infections ( ARI s) disproportionately affect those living in low‐ and middle‐income countries ( LMIC s). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMIC s effectively prevent or reduce ARI s. Methods We registered our systematic review with PROSPERO ( CRD 42017058239) and searched MEDLINE , EMBASE , CENTRAL , and Scopus from inception to 17 October 2017 for randomised controlled trials ( RCT s) examining the impact of hygiene interventions on ARI morbidity in adults and children in community‐based settings in LMIC s. 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 RCT s evaluating hand‐hygiene interventions in LMIC s 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 LMIC s.