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Using soap prevents diarrhoea, pneumonia, and impetigo

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Diarrhoea and acute lower respiratory tract infections kill more than 3.5 million children under 5 years old each year. Most of the children are in poor communities in developing countries. Regular handwashing with soap reduces the incidence of diarrhoea but little is known about its effect on respiratory infections in these communities. Now a study in Karachi, Pakistan (

) has confirmed that regular handwashing and bathing with soap is effective in preventing both diarrhoea and pneumonia.

In two side-by-side multiethnic squatter settlements in central Karachi 25 neighbourhoods were randomised to handwashing promotion and 11 to a control group. Three hundred households were assigned to promotion of handwashing with antibacterial soap containing 1.2% triclocarban and 300 to handwashing with plain soap. Three hundred and six households acted as controls. Each household contained at least two children under 15 years, at least one of them under 5 years. Fieldworkers visited intervention and control households weekly for a year to record symptoms, and to encourage regular handwashing and daily bathing, and to supply soap, in the intervention households. (In these communities thorough handwashing with soap is not universal practice although soap is sold in neighbourhood shops.)

In the intervention households the incidences of respiratory symptoms in children under 15 years, pneumonia in children under 5 years, and diarrhoea in children under 15 years were all halved. The results were similar in antibacterial and plain soap households. The incidence of pneumonia in under-5s was 4.4 episodes per 100 person-weeks in control households, 2.4 per 100 person-weeks in antibacterial soap households, and 2.2 per 100 person-weeks in plain soap households. The incidences of diarrhoea in children under 15 years were 4.1, 2.0, and 1.9 episodes per 100 person-weeks respectively. The incidence of impetigo in children under 15 years was reduced by one third in intervention households (0.94, 0.61, and 0.62 episodes per 100 person-weeks).

Promotion of handwashing and bathing with soap halved the incidence of both diarrhoea and pneumonia in children and reduced the incidence of impetigo by one third.

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