Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan

Details

• Alternative Title:
  Arch Pediatr Adolesc Med
• Personal Author:
  Bowen, Anna ; Agboatwalla, Mubina ; Luby, Stephen ; Tobery, Timothy ; Ayers, Tracy ; Hoekstra, R. M.
• Description:
  Objective
  
  To evaluate associations between handwashing promotion and child growth and development.
  
  Design
  
  Cluster randomized controlled trial.
  
  Setting
  
  Informal settlements in Karachi, Pakistan.
  
  Participants
  
  A total of 461 children who were enrolled in a trial of household-level handwashing promotion in 2003 and were younger than 8 years at reassessment in 2009.
  
  Interventions
  
  In 2003, neighborhoods were randomized to control (n=9), handwashing promotion (n=9), or handwashing promotion and drinking water treatment (n=10); intervention households received free soap and weekly handwashing promotion for 9 months.
  
  Main Outcome Measures
  
  Anthropometrics and developmental quotients measured with the Battelle Developmental Inventory II at 5 to 7 years of age.
  
  Results
  
  Overall, 24.9% (95% CI, 20.0%–30.6%) and 22.1% (95% CI, 18.0%–26.8%) of children had z scores that were more than 2 SDs below the expected z scores for height and body mass index for age, respectively; anthropometrics did not differ significantly across study groups. Global developmental quotients averaged 104.4 (95% CI, 101.9–107.0) among intervention children and 98.3 (95% CI, 93.1–103.4) among control children (P=.04). Differences of similar magnitude were measured across adaptive, personal-social, communication, cognitive, and motor domains.
  
  Conclusions
  
  Although growth was similar across groups, children randomized to the handwashing promotion during their first 30 months of age attained global developmental quotients 0.4 SDs greater than those of control children at 5 to 7 years of age. These gains are comparable to those of at-risk children enrolled in publicly funded preschools in the United States and suggest that handwashing promotion could improve child wellbeing and societal productivity.
  
  Trial Registration
  
  clinicaltrials.gov Identifier: NCT01538953
  
  
• Subjects:
  Article Body Height Body Weight Child Child, Preschool Child Development Drinking Water Female Follow-Up Studies Hand Disinfection Health Promotion Humans Infant Infant, Newborn Male Psychological Tests Water Purification

  More +
• Source:
  Arch Pediatr Adolesc Med. 166(11):1037-1044.
• Pubmed ID:
  22986783
• Pubmed Central ID:
  PMC4648282
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Place as Subject:
  Pakistan
• Volume:
  166
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4b05199daa1e5404b09cbfd7c7d048317b765a4689627f3a017222fa23bf8957
• Download URL:
  https://stacks.cdc.gov/view/cdc/36660/cdc_36660_DS1.pdf
• File Type:
  [PDF - 1.49 MB ]