Ward Billhimer

Effect of handwashing on child health: a randomised controlled trial.

BACKGROUND More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year. We undertook a randomised controlled trial to assess the effect of handwashing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea. METHODS In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned 25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306 households) were randomised as controls. In neighbourhoods with handwashing promotion, 300 households each were assigned to antibacterial soap containing 1.2% triclocarban and to plain soap. Fieldworkers visited households weekly for 1 year to encourage handwashing by residents in soap households and to record symptoms in all households. Primary study outcomes were diarrhoea, impetigo, and acute respiratory-tract infections (ie, the number of new episodes of illness per person-weeks at risk). Pneumonia was defined according to the WHO clinical case definition. Analysis was by intention to treat. FINDINGS Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI (-65% to -34%). Also compared with controls, children younger than 15 years in households with plain soap had a 53% lower incidence of diarrhoea (-65% to -41%) and a 34% lower incidence of impetigo (-52% to -16%). Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap. INTERPRETATION Handwashing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely, diarrhoea and acute lower respiratory infections. Handwashing with daily bathing also prevents impetigo.

Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial

Objectives  To evaluate the effectiveness of point of use water treatment with flocculent‐disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.

Field trial of a low cost method to evaluate hand cleanliness.

Objective  To evaluate a simple low cost method for measuring hand contamination as an objective assessment of handwashing practices.

USE OF CLINICAL AND CONSUMER EYE IRRITATION DATA TO EVALUATE THE LOW-VOLUME EYE TEST

AbstractThis paper evaluates further a previous finding that the low-volume eye test (LVET) is predictive of eye irritation potential in humans caused by exposure to specific consumer products. We reviewed consumer eye irritation comments from 1985 through 1992 on over 70 marketed beauty/personal care, laundry, and household cleaning products. Twenty-four products evaluated during this time were also tested in the LVET. A comparison was made of the time needed for consumer and rabbit eye irritation to clear after exposure to one of the 24 products. In addition, the results of clinical eye studies on two prototype shampoo formulations were evaluated against parallel LVET data. The clinical data and consumer experience showed less eye irritation in humans from exposure to these products than in the rabbit tests. The consistency of the data over a 13 year period presents strong evidence that human eye irritation is less severe than predicted by the LVET and that the LVET provides an adequate margin of safety...

Evaluation of antibacterial soap in the management of lymphoedema in Leogane, Haiti

In areas endemic for lymphatic filariasis, progression of lymphoedema is associated with recurrent bacterial acute dermatolymphangioadenitis (ADLA). The role of antibacterial soap in preventing ADLA is unknown. In a randomized double-blinded clinical trial in Leogane, Haiti, lymphoedema patients washed affected legs with antibacterial (n = 97) or plain soap (n = 100). Reported ADLA incidence (by recall) before the study was 1.1 episodes per person-year, compared to 0.40 assessed during the 12-month study. ADLA incidence was significantly associated with age, illiteracy and lymphoedema stage, but not with soap type. Washing with soap, regardless of its antibacterial content, can help decrease ADLA incidence. (ClinicalTrials.gov identifier number NCT00139100.).