Alcohol-based hand rub in the prevention of diarrhoea and respiratory-tract infection among children in community settings : a systematic review

[摘要] ENGLISH ABSTRACT: Annually more than 3.5 million children worldwide, less than five years of age die ofdiarrhoea and acute lower respiratory-tract infections. Over the last two decades, thecare of pre-school children outside of their homes has become more common inmost parts of the world and has contributed to an increased risk of respiratory-tractand gastrointestinal infections in children. Children attending day-care centres are atan increased risk for diarrhoea and respiratory-tract infections and hands are theprimary vehicle for transmission of infectious diseases. Thus, hand hygiene isessential for preventing and controlling of infection in the health care and communitysettings. Waterless hand sanitizer as an alternative to hand washing wasinvestigated. Rinse-free hand sanitizer programmes in the community may beeffective, safe and feasible.The aim of the study was to systematically appraise evidence on the effect ofalcohol-based hand rub in the prevention of diarrhoea and acute respiratory-tractinfection among children aged five years and below in community settings.The primary outcome of the study was to assess the incidence of respiratory-tractinfection and diarrhea. Diarrhoea is defined by the World Health Organization as theexcretion of three or more loose or liquid stools per day (or more frequent excretionthan is normal for the individual). The secondary outcome was to assess mortality,admission to hospital and duration of hospital stay.A comprehensive search for relevant studies was conducted on the followingdatabases from 1990 to 2014: EMBASE, MEDLINE, CINAHL, Google Scholar andCochrane Central Register of Controlled Trials (CENTRAL). We searched thereference lists of all relevant articles and textbooks for more studies. Unpublisheddata previously presented at international and scientific meetings have beenincluded in the review. Proceedings of international conferences on diarrhoea andrespiratory-tract infection among children were searched for relevant articles. Subjectexperts were contacted.Two reviewers, Joelynn Steyn (JS) and Oswell Khondowe (OK) selected studiesfollowing a two-step study selection process. This review considered all published randomized controlled trials and quasi-experimental designs published from January1990 to July 2014. The first step was the selection of studies based on titles andabstracts. Both reviewers selected eligible studies which met the set criteria. Duringthe second step, both reviewers retrieved the full-text articles of the studies andassessed the methodological quality of the studies. Four studies were included inthis review. The included studies met most of the quality assessment criteria asstipulated in the Cochrane risk assessment tool. Two studies were clusterrandomizedcontrolled trials, one was a block randomized controlled trial and onewas a randomized controlled trial. Disagreements were resolved by discussion andwhere a lack of consensus existed, consultation with a third reviewer occurred.The use of alcohol hand rub as compared to control interventions significantlyreduced the incidence of diarrhoea in children (RR 0.79, 95% CI 0.63 to 0.99).Statistical heterogeneity was observed among the included studies (I²=69, p=0.04).However this review found no significant difference in respiratory-tract infectionsbetween intervention groups versus control as observed from the confidence interval(RR 0.98, 95% CI 0.90 to 1.07, p=0.63). The results should be interpreted withcaution due to the limited number of studies conducted in communities with alcoholbasedhand rub used by caregivers. Due to limited studies in this review, it makes itdifficult to make strong conclusions on findings and to provide sufficient evidence toguide future research. We therefore recommend that more studies with high qualitymethodologies, using randomized controlled trial designs be conducted especially inpoor resourced communities.

[发布机构] Stellenbosch University