Characteristics of included studies
| Study author (study name) | Year of study | Population | Intervention (product details provided where reported) | Control (not all authors defined standard practice) | Study design (cluster RCTs) | ||||
|---|---|---|---|---|---|---|---|---|---|
| Participants | Age in years (school grade) | Setting | Location | Cluster | Number of clusters | ||||
| School-based studies | |||||||||
| Azor Martínez et al27 28 | 2009–2010 | School children (n=1640) | 4–12 years | Primary school (n=5) | Spain (Almeria) | Handwashing with soap followed by hand sanitiser (ALCO ALOE GEL) | Standard practice | School and classroom | 4 schools, 29 classes from another school |
| Bowen et al33 (Safeguard Promotion Program) | 2003–2004 | School children (n=3962) | Median 7.53 years (1st grade) | Primary school (n=90) | China (3 counties in Fujian Province) | (1) Standard programme (teacher training to encourage handwashing with soap, student take home pack) (2) Enhanced programme (standard programme plus supply of safeguard soap, student peer mentors) | Standard practice (Annual statement about Handwashing before eating and after toilet) | School | 90 30 intervention (1), 30 intervention (2), 30 controls |
| Freeman et al (WASH programme)34 35 | 2007 | School children (n=5989 supplied absence data) | 6–16 years; median 13 years (4th–8th grade) | Public primary school (n=135) | Kenya (4 districts in Nyanza Province) | (1) Hygiene promotion (HP) and water treatment (WT) (3 days teacher training, follow-up sessions) (2) HP and WT plus up to 7 new latrines per school | Standard practice | School | 135 45 intervention (1) 45 intervention (2) 45 controls |
| Graves et al36 (substudy of NICHE: Nyando Integrated Child Health and Education) | 2008–2009 | School children (precise number not reported) | Age not reported (Students in NICHE study were in 4th–8th grade) | Primary school (n=21) | Kenya (rural western area) | NICHE intervention (multiple components including health promotion by teachers, installation of drinking water, handwashing stations) plus a visual aid poster designed by students in intervention schools | NICHE intervention only | School | 21 schools 10 intervention 11 control (14 included in analysis) |
| Morton and Schultz (Healthy hands)22 | 2000–2001 | School children (n=253) | Age not reported (Kindergarten–3rd grade) | Elementary school (n=1) | USA (New England) | Handwashing with soap and AlcoSCRUB alcohol gel use (45 min session for students) | Standard practice (handwashing with soap) | Classroom | 17 (cross-over design) |
| Pandejpong et al24 | 2009–2010 | School children (n=1437) | 2–3, 3–4, 4–5, 5–6 years | Private school (n=1) | Thailand (suburban Bangkok) | Application of alcohol hand gel: Two intervention groups (1) every 60 min; (2) every 120 min | Standard practice (alcohol gel application once, before lunch) | Classroom | 68 (not clear how many classes in each arm) |
| Pickering et al37 | Unclear | School children (n=1364) | 5–10 years (preunit to P5). 1 included a nursery (2–4 years), 4 included 10–13-year-olds (P6-8 grades) | Primary school (n=6) | Kenya (Kibera urban community in Nairobi) | (1) Handwashing with soap. Two soap dispensers installed by toilets, eating area (plus water tank with a spigot). (2) Alcohol-based hand sanitiser use (Purell). Two dispensers installed by toilets, eating area | No intervention (standard practice) | School | 6 2 intervention (1) 2 intervention (2) 2 controls |
| Priest et al38–40 | 2009 | School children (n=16 245) | 5–11 years (school years 1–6) | Primary school (n=68) | New Zealand (Dunedin, Christchurch, Invercargill) | 30 min inclass hand hygiene education session, instruction on hand sanitiser use, ‘no touch’ dispensers installed in classrooms | 30 min inclass hand hygiene education session only (no instruction on hand sanitiser use) | School | 68 schools 34 intervention 34 controls |
| Sandora et al25 | 2006 | School children (n=285) | Age not reported (3rd–5th grade) | Elementary school (n=1) | USA (Avon, Ohio) | Handwashing with soap, Aerofirst hand sanitiser use, plus Clorox disinfectant wipes (Student instruction, teachers wiped students’ desks once a day, after lunch) | Standard practice (handwashing with soap) | Team | 6 teams in 15 classrooms |
| Stebbins et al (Pittsburgh Influenza Prevention Project)41–44 | 2007–2008 | School children (n=3360) | Age not reported (Kindergarten—5th grade) | Elementary school (n=10) | USA (Pittsburgh, Pennsylvania) | Handwashing and Purell hand sanitiser use (45 min presentation for students, educational materials for parents) | Standard practice | School | 10 5 intervention 5 controls |
| Talaat et al45 | 2008 | School children (n=44 451) | Median 8 years (1st–3rd grade) | Elementary school (n=60) | Egypt (Cairo) | Handwashing with soap (school-specific activities, coordinated by teachers, school nurse; pupils provided soap, drying materials) | Standard practice | School | 60 30 intervention 30 controls |
| Vessey et al23 | Not known | School children (n=383) | Age not reported (2nd and 3rd grades) | Elementary school (n=4) | USA (Butte, Montana) | Hand sanitiser use (one educational session for students) | Handwashing with soap | Classroom | 18 (cross-over design) |
| White et al26 | 1999 | School children (n=769) | 5–12 years (Kindergarten—6th grade) | Elementary school (n=3) | USA (California) | Handwashing and alcohol-free hand sanitiser use (all students attended 22-min assembly) | Handwashing and placebo sanitiser use (all students had 22-min assembly) | Classroom | 72 32 retained for analysis: 16 intervention, 16 controls |
| Non-school based studies | |||||||||
| Correa et al46 | 2008 | Children (n=1727) | 1–5-years | Child care centre (n=42) | Colombia (6 urban settings) | Purell alcohol-based hand sanitiser use (training workshop for staff and children, monthly refresher workshops) | Standard practice (handwashing with soap) | Child care centre | 42 (32 community, 10 preschool) |
| Ladegaard and Stage19 | Not known | Children (n=399 aged 3–6 years) | 0–2 years and 3–6 years | Nursery (n=8) | Denmark (Borough of Odense) | Handwashing with soap (staff training, take home book, 1 h education session for children) | Standard practice | Nursery | 8 4 intervention, 4 controls |
| Lennell et al47 | 2004–2005 | Children (n=1477) | 0–5 years. Mean: 3.2 years (intervention), 3.1 years (control). Circa 30% <3 years | Day care centre (n=60) | Sweden (10 counties, south and mid-Sweden) | Handwashing with soap and alcohol-based oily disinfectant gel use (instruction, demonstration to staff and children) | Standard practice (handwashing with soap) | Day care centre | 60 30 intervention, 30 controls (matched pairs) |
| Rosen et al (Jerusalem handwashing study)48–52 | 2001 | Children (n=1029) | 3 years and 4 years | Preschool (n=40) | Israel (Jerusalem) | Handwashing with soap (2 3-h staff training sessions, child education programme, take home pack) | Standard practice and alternative take-home pack (about oral hygiene) | Preschool | 40 20 intervention 20 controls |
| Uhari and Möttönen53 | 1991–1992 | Children (n=1522) | 861 >3 years 661 <3 years Mean: 3.6 years (intervention), 3.5 years (control) | Child day care centre (n=20) | Finland (Oulu city) | Handwashing with soap and alcohol-based oily disinfectant use, plus cleaning environment (staff lecture on infection prevention; cleaning toys; staff encouraged to take sick leave at first sign of symptoms) | Standard practice | Day care centre | 20 10 intervention 10 controls (matched pairs) |
RCT, randomised controlled trial; WASH, Water, Sanitation and Hygiene.