Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil‐transmitted helminth infections and behaviour change, in low‐ and middle‐income countries

Abstract

Abstractobjectives To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low-and middle-income country settings.methods A systematic review of the literature was performed by searching eight databases, and reference lists were hand-searched for additional articles. Studies were reviewed for inclusion according to pre-defined inclusion criteria and the quality of all studies was assessed.results Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective.conclusion Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children's handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area, however, does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC.

The Challenge of Behaviour Change and Health Promotion

“…The evidence about the effectiveness of behaviour change approaches is unclear, for example, about handwashing among children [3] and cooking and food skills among adults [4]. However, this has not prevented health promoters from continuing to extensively invest in this approach.…”

“…The simple logic is that some behaviour leads to ill-health, and so persuading people directly to change their behaviour must be the most efficient and effective way to reduce illness. This reasoning is attractive to decision-makers because it promises quantifiable results within a short time frame, can deal with high prevalence health problems, is relatively simple and offers savings in health care services, especially for people suffering from chronic diseases [2].The evidence about the effectiveness of behaviour change approaches is unclear, for example, about handwashing among children [3] and cooking and food skills among adults [4]. However, this has not prevented health promoters from continuing to extensively invest in this approach.…”

Knowledge of Clean and Healthy Behavior and Quality of Life among School-Children

“…Providing the facilities for washing hands and encouraging the health counseling by the school will make students and also the teachers aware of the importance of washing hands with running water and using soap. Hand washing with running water and using soap to train the value of discipline character (Watson et al, 2017). Children who are accustomed to good behavior since childhood will bring the behavior into adulthood, and vice versa if children get an education that is not appropriate, will complicate the education of the next stages.…”

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

“…For example, of the 13 studies that focus on determinants of hand hygiene, the most investigated determinants are knowledge (n=8, 62%), materials/supplies (n=6, 46%) and infrastructure (n=3, 23%). This is surprising given the body of evidence suggesting that while knowledge and access to materials are necessary precursors for improved hygiene practices these determinants alone are not sufficient to ensure adoption of behaviours ( [74][75][76][77][78][79]). Studies of handwashing behaviour outside of the perinatal period place a much greater emphasis on factors such as social opportunity and automatic motivation.…”