ASPPH logo


Member Research & Reports

Member Research & Reports

Arizona Researchers and Their Colleagues Found Hand Washing Promotion Reduces Diarrhea Episodes By 30 Percent

Diarrhea is a serious global health challenge that accounts for 1.5 million deaths annually, especially among children under five years of age. The yearly global diarrheal disease burden is estimated at 72.8 million disability adjusted life years (DALYs) lost through incapacitation and premature deaths, mainly in low- and middle-income countries. Diarrhea contributes significantly to malnutrition in children through a combination of forced low-nutrient intake, reduced absorption, and increased nutrient excretion. The malnutrition-infection complex is clearly reinforced during diarrhea episodes, as poor nutritional status predisposes children to more severe and persistent diarrhea, impaired growth and development, and higher case fatality rates.

Diarrheal disease pathogens are usually transmitted through the fecal-oral route, and the pathways include ingestion of food and water contaminated by fecal matter, person-to-person contact, or direct contact with infected feces. Thus, hand washing is a viable intervention for control of diarrhea because it decontaminates hands and prevents cross transmission of diarrheal-causing pathogens. Hand washing is listed in the UNICEF/WHO 2009 seven-point plan for comprehensive control of diarrhea. Given that resources spent on interventions to promote hand washing could be invested on other equally important public health programs, it is crucial to ascertain that hand washing promotion is an efficient use of scarce health resources. To provide evidence regarding the effects of hand washing on prevention of diarrhea, Professor John Ehiri, head of the Department of Health Promotion Sciences at the University of Arizona’s Mel and Enid Zuckerman College of Public Health and his colleagues at the University Calabar, Nigeria, and the University of London, England conducted a Cochrane Systematic Review and Meta-analysis of available data.

The review included twenty-two randomized controlled trials (RCTs involving 69,457 participants globally. Results revealed that hand washing promotion at child day-care facilities or schools in high income countries can be effective in preventing up to 30 percent of diarrhea episodes. Among communities in low- and middle-income countries, hand washing promotion was found to prevent up to 28 percent of diarrhea episodes. “Hand washing promotion for preventing diarrhoea” was published in September issue of the Cochrane Database of Systematic Reviews with the following citation: Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004265. DOI: 10.1002/14651858.CD004265.pub3.

Journal article:;jsessionid=A8C259122D747965F731C1049D24DCD1.f03t02