Effectiveness Of Hand Washing Research Articles

Effect of Hand Washing with Soap Education Using Puzzle Media on Hand Washing with Soap Behavior in Elementary School Age Children

Clean and healthy living behavior by washing hands is an important effort to minimize the emergence of disease. However, many people, including children, do not know how to properly maintain hand hygiene. The aim of the research was to determine the effect of hand washing with soap education using puzzle media on the hand washing behavior with soap of elementary school aged children. The research used a pre-experimental design with a One Group Pretest-Posttest Design approach. The sample consisted of 56 students as the intervention group. Data analysis used the Wilcoxon Signed Ranks Test. The use of puzzle media has been proven to have an influence with a significance value of 0.000 < 0.005 on behavior in the domain of knowledge, attitudes and actions in elementary school age children. Teachers, health workers and the general public can provide education through puzzle media to children because it is interesting, easy to understand and affordable. INDEX TERMS : Education, Elementary School Age Children, Hand Washing with Soap, Puzzle

Using a Fluorescent Concretization Intervention Improves Hand Hygiene Training in Primary School Students: A Randomized Controlled Study

Introduction: Inadequate hand hygiene increases the rates of childhood infectious diseases and deaths, leading to the death of one child per minute. Aim: To examine the effects of an educational strategy, “using a fluorescent concretization intervention,” on the hand-washing skills of primary school students. Method: This single-center randomized controlled trial using a pretest and posttest design was conducted with 35 intervention and 35 control participants. Data were collected with Dermalux Test Lotion containing fluorescently detectable under ultraviolet light, Hand Washing Skill Checklist, Hand Washing Skill Efficacy, and Hand Hygiene Assessment Question Form in School Children. Results: After the training for both hands, the intervention group participants created a difference in the effectiveness of hand washing from dirty to clean in all areas (p < 0.001). The scores regarding psychomotor skills and duration of hand washing increased in all participants. Total score percentage changes increased more in the intervention group participants when the first and final follow-ups were compared (p < 0.001). Hand washing skills and durations increased after hand washing training using the fluorescent concretization method. Conclusion: Visual concretization and explanation to the students increase handwashing effectiveness. For this reason, it is highly recommended that technological devices that provide such visual feedback be used in schoolchildren's education.

Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study.

Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.

Self- and non-self-DNA on hands and sleeve cuffs.

Studying DNA transfer and persistence has become increasingly important over the last decade, due to the impressive sensitivity of modern DNA detection methods in forensic genetics. To improve our understanding of background DNA that could also potentially be transferred, we analyzed the DNA composition on the outside of sleeve cuffs and sampled DNA directly from the hands of four different collaborators upon their arrival at work during 25 working days. Sampling of their hands was repeated after several hours working in our department. The shedder status of the participants, as assumed from previous internal studies, was well re-produced in the study. However, we noticed that the DNA shedding capacity could also change drastically during the day, with one participant showing a more than sixfold increase between hands sampled in the morning and hands sampled in the afternoon. As expected, poor DNA shedders carry more relative amounts of non-self-DNA on their hands than good shedders. Non-self-alleles were detected in 95% of the samples. We also observed potential effects of hand washing and the mode of transport to get to work on the DNA amount. People living with family members occasionally carried their DNA on their hands and more frequently on their sleeve cuffs. Sleeve cuffs, as being close to our hands, have a large potential to transfer DNA from one place to another, yet they have sparsely been studied as DNA transfer intermediates so far. In general, we collected consistently more DNA from the sleeve cuffs than from the hands of the participants, demonstrating their importance as potential transfer vectors. More DNA was recovered from sleeve cuffs made of synthetic fabric than from cuffs made of cotton or leather. In the afternoon, DNA from co-habitant family members could not be detected on the hands anymore and the detection of profiles from colleagues became more frequent. From two out of 100 analyzed sleeve cuffs and two out of 200 sampled hands, we established unknown major DNA profiles that would have been suitable for an entry in the national DNA database. This finding demonstrates the possibility to transfer DNA that has most likely been picked up somewhere in the public space.

Factors associated with hand washing effectiveness: an institution-based observational study

BackgroundFew studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness.MethodsA total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant’s hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing.ResultsStep 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4–5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs.ConclusionsPerformance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.

Association between handwashing and gargling education for children and prevention of respiratory tract infections: a longitudinal Japanese children population-based study.

A longitudinal study was conducted to examine the effects of handwashing and gargling education for children on the prevention of respiratory tract infections (RTIs) in children in Japan. The study included 38,554 children born in 2010 who were enrolled in a longitudinal study. Information on children's hygiene education regarding handwashing and gargling was collected in a survey at the age of 3.5years. Based on parents' reports of doctors' diagnoses, airway infections and influenza events in the 12-month duration before the survey were evaluated for RTIs at the ages of 4.5 and 9years. Poisson regression with robust variance was performed to examine the effects of hygiene education on RTIs prevention. The supplementary analysis was stratified by household income. Children were categorized into different groups: 38% in the handwashing and gargling group, 29% in the handwashing group, 0.1% in the gargling group, and 9.7% in the no-education group. Exclusions were made for non-respondent children (23%) and those in the gargling group. Hygiene education was associated with decreased influenza at the age of 4.5years in the handwashing (adjusted RR [aRR] = 0.8; 95% CI, 0.8-0.9) and handwashing and gargling groups (aRR = 0.8; 95% CI, 0.8-0.9) compared with no education. However, no preventive effects on airway infections at the age of 4.5 and 9, influenza at the age of 9, or hospitalization between the ages of 3.5 and 9years were detected. Handwashing and gargling could significantly prevent influenza in low-income households (aRR = 0.7; 95% CI, 0.6-0.8). Conclusions: Gargling education was widespread and mostly combined with handwashing education in Japan. Hygiene education significantly affected prevention of influenza infections at the age of 4.5years, especially in low-income households. •Previous intervention studies showed handwashing and gargling are effective in preventing respiratory tract infections. •We conducted a longitudinal study on handwashing and gargling education in Japanese children and found that handwashing and gargling were widely practiced together. •Handwashing and gargling education were related to a reduction in influenza, particularly in low-income households.

Effects of Handwashing and Antimicrobials on Bacterial Counts

It is everyday practice to utilize aseptic techniques, which are simply actions taken to prevent the accumulation of bacteria and other microbes to prevent diseases and their spread. Handwashing is an important aspect of hand hygiene because hands pick up the microbes from surfaces and are easily transported from person to person through direct contact or indirect contact. According to the CDC and WHO, many diseases are spread by not washing hands effectively, therefore hand hygiene is important everywhere in society, especially in healthcare where the spread of disease can mean life or death. In this study, we analyzed data collected from the student population of microbiology classesfrom the University of Charleston in West Virginia over the span of nine years (2014 to present). We measured the number of colony forming units (CFU) from students’ hands prior to manipulation (control), using just water, using soap and water, and using hand sanitizer. We hypothesized that handwashing and use of antimicrobial aids such as hand sanitizer will reduce the number of bacteria on hands compared to controls. An analysis was also performed comparing pre-pandemic and post-pandemic data to determine if handwashing behaviors have changed behavior which would alter the normal microfauna on the hands. This analysis revealed that there was a significant difference between handwashing techniques (p<0.001). There was a difference in formation of colony forming units between pre and post pandemic times (p<0.001).

Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study

Background: This study aimed to evaluate the impact of self-preventive measures (handwashing, mask-wearing, and social distancing) on preventing the Coronavirus Disease-2019 (COVID-19) infection in Saudi Arabia (KSA). Methods: An unmatched case-control study (1 to 1 ratio) was conducted with a sample size of 1102. The researchers used descriptive, bivariate, and multivariate analyses to determine the effect of handwashing, mask-wearing behavior, and social gatherings on COVID-19 infection. Results: The results evinced that participants who believed that the facemask was important for preventing COVID-19 infection were more likely protected against the disease (OR=0.450; 0.320—0.631). Using a facemask during social visits and shopping indicated a lower protective effect than using it at work (OR=1.299; 1.011—1.668). The type of mask (disposable versus cloth; OR=0.929; 0.590—0.1.462) and its wearing period (1< dayversus ≤1 day; OR=0.907; 0.662—1.243) showed an almost neutral statistical association with acquiring the infection. Contrarily, handwashing time for ≥20 seconds, compared to a shorter time, had a statistically significant protective association with the infection even after adjusting the odds ratio (OR=0.616; 0.4763—0.796). It was also noted that gathering with relatives and friends ≥4 times per month exhibited a higher and statistically significant association with the infection compared to the lower times (OR=1.347; 1.046—1.734). Furthermore, people who prayed five times a day at the mosque showed a higher risk of infection than those who prayed less than five times (adjusted OR=1.740; 1.152—2.626). Conclusions: This study suggested that handwashing for more than 20 seconds is the most important preventive factor among all considerations investigated. Moreover, it was noticed that disposable and cloth facemasks may have the same effect regardless of the wearing period or sterilization status. Furthermore, gathering with relatives and friends, as well as praying five times a day at the mosque, were ascertained as significant social factors in acquiring the COVID-19 infection.

Kronik Hastalığı Olan Kadınlarda Eğitimin El Yıkama ve Beslenmeye Etkisi

Objective: This study was conducted to evaluate the effectiveness of handwashing and nutrition education given to women with chronic diseases living in rural areas during the Covid-19 pandemic. Methods: The research is a randomized controlled study and its population consists of women over the age of 18 with at least one chronic disease registered in a Family Health Center of a District in Turkey. A total of 90 women were included in the study, 45 of which were drawn among the volunteers for each group. Hand washing and nutrition training were given to the intervention group, and the questionnaires were filled out again after 3 months. Only routine follow-ups were performed in the control group. For collecting the research data, the Descriptive Information Form, the Social Hand-Washing Knowledge Form, and the Nutritional Knowledge Level Scale for Adults prepared by the researchers by scanning the literature were used. Results: By the groups, the educational status, having children, smoking, alcohol use, monthly income, and working status of the cases do not show a statistically significant difference (p> 0.05) and it is seen that both groups are homogeneous. The mean age of women in the intervention group was 54.67±8.17 years, and the mean age of women in the control group was 57.18±9.88 years. The post-training scores of the intervention group in the Social Hand-Washing Knowledge Form and Food Choice were found to be significantly high compared to the cases of the control group (p=0.001; p<0.01). Conclusion: The training given to the women in rural areas created a significant benefit for them to have the appropriate food choices and hand-washing behaviours. More studies are needed to examine the effects of these interventions (ClinicalTrials.gov-Identifier Number: NCT04957017).

PENGARUH PERILAKU CUCI TANGAN PAKAI SABUN DALAM PENCEGAHAN DIARE PADA ANAK USIA SEKOLAH

Abstract: The high rate of diarrheal disease in children is caused by many factors, namely, poor hand washing habits, children consuming food that is not guaranteed to be clean, and an unhealthy school environment. One way to prevent the transmission of diarrheal disease is by washing hands with soap. The purpose of this study was to determine the effect of handwashing with soap in preventing diarrhea in school-age children. This study was conducted by searching for national and international journals that match the inclusion criteria through 2 databases, namely Google Scholar and Science Direct. The Study Design used is a Cross Sectional Study. Search articles using keywords that have been adjusted by MeSH. The selection was taken by paying attention to the PICOS framework, then the articles were analyzed one by one. Found 8 national journals and 1 international journal, then the journals were analyzed one by one. The results of the study, namely the majority of articles (8 of 9 articles) stated that there was a significant relationship between the effect of washing hands with soap in preventing diarrhea in school-age children. The conclusion of the study is that there is an effect of hand washing with soap and prevention of diarrhea in school-age children. Suggestions for future researchers are expected not to lean on only one search source and develop a more analytical PICOS design study.

Draft Genome Sequence for Klebsiella michiganensis B199A, Originally Identified as Enterobacter aerogenes.

ABSTRACTHere, we report the draft genome sequence of a strain of Klebsiella michiganensis originally identified as Enterobacter aerogenes B199A. This strain has been used as a Salmonella surrogate to study the effectiveness of handwashing and measure cross-contamination to and from a wide variety of surfaces and foods.

Association among the exposure to giving knowledge, attitude and practice for handwashing in people residing in Seoul, South Korea: a retrospective cross-sectional study

ObjectivesHandwashing is known as the most preventive method for various infectious diseases. Health authorities have conducted various campaigns and public relations targeting the general population but few evaluations of these...

Use of ultraviolet light in graduate medical education to assess confidence among residents and fellows in handwashing instruction.

Coronavirus disease 2019 (COVID-19) has made it imperative to focus on strategies to improve hand hygiene to minimize threats of viral transmission in hospitals. We investigated the potential of using ultraviolet (UV) light as a visual tool in hand-hygiene education to bring awareness of individual handwashing effectiveness to healthcare workers. In 2020, 117 individuals participated in the simulation and completed surveys on proper handwashing technique. Of these, 114 were first-year residents and fellows. Surveys of confidence in hand hygiene were obtained before and after formal hand-hygiene education utilizing UV light with Glo Germ lotion. The UV light and Glo Germ lotion were used to identify deficiencies in individual handwashing technique. With a total response rate of 97.4%, first-year residents and fellows demonstrated a significant decrease in handwashing confidence in pre- and posteducation surveys. Study participants who had had formal hand-hygiene training in the previous 3 years also indicated confidence in hand hygiene similar to those who had not had previous hand-hygiene training. Conclusions: Overall, resident interns and fellows may have falsely elevated their hand-hygiene confidence levels. However, conclusions regarding the confidence of residents and fellows individually could not be made due to sample size. Many healthcare personnel practice improper handwashing techniques, which may be improved with education and training that includes UV light.

Trends in handwashing behaviours for COVID-19 prevention: Longitudinal evidence from online surveys in 10 sub-Saharan African countries.

Handwashing is essential for respiratory virus prevention, but uptake of handwashing in the context of the SARS-CoV-2 pandemic remains under-explored. This study examines trends in and determinants of handwashing practices for COVID-19 prevention in 10 countries in West, East, and Southern Africa. Data are derived from an online global Facebook survey assessing COVID-19 knowledge, attitudes, and practices, fielded in July (Round 1) and November 2020 (Round 2). Adults ≥18 years (N = 29,964) were asked if they practiced handwashing with soap and water in the past week to prevent COVID-19. Design-corrected F-statistics compared knowledge and practice of handwashing, at country and regional levels, between survey rounds. A country-level fixed-effects logistic regression model then identified socio-demographic and ideational correlates of handwashing at Round 2. Most participants were >30 years-old, men, post-secondary educated, and urban residents. Between survey rounds, handwashing prevalence declined significantly across regions and in each country, from a 14% decline (Δ84%-70%) in Tanzania to a 3% decline (Δ92%-89%) in South Africa. Handwashing was higher among participants aged >30 years (Adjusted Odds Ratio [aOR] = 1.25, 95% confidence interval [95%CI]: 1.15-1.35) and with post-secondary education (aOR = 1.62, 95%CI: 1.49-1.77) but lower among men (aOR = 0.71, 95%CI: 0.64-0.78). Ideational factors associated with handwashing included perceived effectiveness of handwashing (aOR = 2.17, 95%CI: 2.00-2.36), knowing someone diagnosed with COVID-19 (aOR = 1.28, 95%CI: 1.18-1.40), and perceived importance of personal action for COVID-19 prevention (aOR = 2.93; 95%CI: 2.60-3.31). Adjusting for socio-demographic and ideational factors, country-level marginal probabilities of handwashing ranged from 67% in Tanzania to 91% in South Africa in Round 2. COVID-19 prevention messages should stress the importance of handwashing, coupled with mask use and physical distancing, for mitigating respiratory disease transmission. Behaviour change communications should be sensitive to resource heterogeneities in African countries, which shape opportunities for sustainable handwashing behaviours.

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort.

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

KNOWLEDGE ATTITUDE AND PRACTICE TOWARD COVID-19 DISEASE AMONG VARIOUS PROFESSIONALS: A CROSS-SECTIONAL ONLINE SURVEY

Objectives: This study aims to assess the knowledge, attitude, and practice associated with COVID-19 disease by undertaking a web-based online survey.
 Methods: A cross-sectional survey was conducted all over India during the initial phase of COVID-19 hit between March 19, 2020, and March 29, 2020. Anyone aged 18 years and above using social media were included in the study. The questionnaire had a section on sociodemography which had questions regarding age, gender, marital status, and occupation. This was followed by questions on knowledge, attitude, and practice regarding the COVID-19 pandemic. The knowledge scores were summarized as median with interquartile range as the data followed a non-normal distribution. Attitude and practice questions were summarized individually as proportions and its association with socio-demographic variables was established using Chi-square test. The statistical significance was set at p<0.05.
 Results: Occupational groups, marital status, and age group had significant difference between the groups with at least one of the practices with p<0.05.
 Conclusion: Since the study provides enhancing effect of knowledge toward protective behaviors, the awareness raising activities and health education through mass media and campaigns, this should urgently be conducted focusing on effectiveness of hand washing, cough etiquette, social distancing, and responsibility to inform suspected cases to local health authority to prevent COVID-19.

Duration or technique to improve the effectiveness of children' hand hygiene: A randomized controlled trial

How to wash hands is as important as when and how often to wash hands for acquiring proper hand hygiene habits. The study aimed to compare the effect of education based on technique or duration for developing children's handwashing skills. The double-blind randomized controlled study was conducted in a primary school between the 10th and 28th of December, 2018 with 155 children who were divided into Group-I, Group-II, and Control groups. One group was taught by a multi-stage technique, the other was by duration-based teaching, and the control group was provided with usual training. Handwashing efficacy was assessed by variance analysis on fluorescent residue after using glo-germ. The students' mean age was 9.74 ± 0.69 years, 53.6% of them were girls. Effective handwashing was highest in the Group-I. There was a difference between Group-I and Group-II, and Group-I and Control group in terms of hand cleanness. The frequently missed areas when cleaning hands were palmar surface, dorsal metacarpal area, and fingertips. Teaching hand hygiene to children by multi-step technique may increase the handwashing effectiveness. Conducting comparative studies with new techniques including fewer stages is recommended.

Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: a cluster randomized controlled trial

BackgroundHandwashing with soap reduces diarrheal diseases burden considerably. However, the importance of handwashing in homes has received little attention in rural eastern Ethiopia. The effectiveness of handwashing may be reduced by lack of information on when and in what event hands must be washed, the frequency of handwashing, the individual who should wash his/her hands, and the procedure of handwashing. In these areas, indicators of adherence to handwashing are yet to be established. This study aimed at assessing the efficiency of handwashing on reducing diarrheal disease in children under 5 years old in rural kebeles of Dire Dawa, east Ethiopia.MethodsCommunity-based cluster randomized controlled trial was conducted in rural kebeles of Dire Dawa for 4 months starting from October 2018 to January 2019. Selected clusters were randomized in intervention and control arms using draw method and data collectors conducted the baseline survey. Households assigned to the intervention group were given two bars of plain soap on a bi-monthly basis together with information promoting hand hygiene. Control households were allowed to continue their habitual handwashing practices. We compared the diarrheal incidences of the intervention and non-intervention households. Generalized estimation equations using Poisson family and log choice of the link was employed to calculate adjusted incidence rate ratio with its 95% confidence interval.ResultsWe recorded a significant lesser diarrheal incidence in the handwashing arm than in the non-intervention arm (6.9 versus 13.8 episodes per 100 person weeks of observation). In all, there was a 41% reduction in diarrheal incidence in the intervention arm in relation to the non-intervention arm.ConclusionHandwashing with soap complemented with hand hygiene promotion significantly decreased diarrheal episodes in children under 5 years old in rural kebeles of Dire Dawa. We recommend the promotion and adaptation of washing hands using soap at recommended times to be an effective means of reducing childhood diarrhea morbidity in rural populations of Ethiopia towards achieving the Sustainable Development Goal 6.Trial registrationPACTR, PACTR201807815961394. Registered 16 July 2018,

Clean and Healthy Lifestyle Behavior (PHBS Program) for Children with Intellectual Disability

Clean and Healthy Lifestyle Behavior (PHBS Program) for Children with Intellectual Disability