Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low‐ and middle‐income countries: a systematic review

• Published in: Tropical medicine & international health 2018-08, Vol.23 (8), p.816-833
• Main Authors: McGuinness, Sarah L., Barker, S. Fiona, O'Toole, Joanne, Cheng, Allen C., Forbes, Andrew B., Sinclair, Martha, Leder, Karin
• Format: Article
• Language: English
• Subjects: Absenteeism; acute respiratory infections; Adult; Adults; behaviour change; changement de comportement; Child; Children; Communicable Disease Control - methods; Data processing; Developing Countries; Evaluation; handwashing; Health Promotion - methods; Heterogeneity; Households; Humans; Hygiene; hygiène; Income; Infections; infections respiratoires aiguës; Influenza; Intervention; lavage des mains; low‐ and middle‐income countries; Morbidity; pays à revenu faible et intermédiaire; Personal hygiene; Quality; Quality assessment; Respiratory tract infection; Respiratory Tract Infections - prevention & control; Schools; Systematic review
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13080

Objectives Acute respiratory infections (ARIs) disproportionately affect those living in low‐ and middle‐income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. Methods We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community‐based settings in LMICs. 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 RCTs evaluating hand‐hygiene interventions in LMICs 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 LMICs. Objectifs Les infections respiratoires aiguës (IRA) affectent de manière disproportionnée les personnes vivant dans les pays à revenu faible et intermédiaire (PRFI). Nous avons voulu déterminer si les interventions d'hygiène appliquées dans les structures d'accueil d'enfants, les écoles ou les milieux domestiques dans les PRFI empêchent ou réduisent efficacement les IRA. Méthodes Nous avons enregistré notre revue systématique sur PROSPERO (CRD42017058239) et avons recherché MEDLINE, EMBASE, CENTRAL et Scopus depuis le début jusqu'au 17 octobre 2017 pour les essais contrôlés randomisés (ECR) examinant l'impa