Handwashing with soap prevents
diarrhoea, pneumonia, and impetigo in squatter communities in Pakistan
Families in Pakistan can dramatically reduce their children's risk of diarrhoea
or pneumonia simply by washing their hands more often with soap. In a randomised
trial in Karachi, weekly encouragement of handwashing and bathing and a free
supply of soap reduced the incidence of pneumonia in children aged < 5 years by
50% (2.2 v 4.4 cases/100 person weeks) and the incidence of diarrhoea in
children aged < 15 by 53% (1.9 v 4.06). Bathing with soap also reduced the
incidence of impetigo by a third compared with the incidence in control
neighbourhoods, where researchers visited households but did not discuss hygiene.
Researchers randomised 36 poor neighbourhoods in Karachi, including 906
households with a mean of nearly 10 residents each. The intervention was fairly
intensive, with field workers holding community meetings, showing videos, and
visiting households once a week for a year. The hard work and free soap (from
the sponsors Procter and Gamble) paid off, but the authors think their
intervention may be too expensive to roll out to all poor communities in the
developing world. They have shown once again that handwashing protects against
common and lethal infectious diseases. The challenge now is to find a cheap way
to promote it.
Lancet 2005;366: 225-33