Handwashing with soap reduces the likelihood of acute respiratory infections in lower- and middle-income countries

1. Studies that encouraged handwashing reduced acute respiratory infections, including the upper and lower respiratory airways.

2. There was minimal effect of handwashing on influenza, COVID-19, and all-cause mortality.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Acute respiratory infections (ARIs) account for a large proportion of fatalities among children living in low-income and middle-income countries (LMICs). Although hand hygiene is well-known to reduce the spread of respiratory pathogens, the extent to which handwashing with soap impacts the chance of developing ARIs is unclear. This systematic review and meta-analysis aimed to evaluate the effect of hand hygiene on ARIs in LMICs. The primary outcome was the prevalence of ARIs while key secondary outcomes included upper and lower respiratory infections. According to study results, handwashing with soap significantly reduced the incidence of ARIs including both upper respiratory tract and lower respiratory tract infections. Although this study was well done, it was unable to assess the impact of handwashing frequency on ARIs. The association between the frequency of handwashes and the incidence of ARIs remains unclear.

Click to read the study in The Lancet

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In-depth [systematic review and meta-analysis]: This meta-analysis consisted of 26 studies with 161 659 patients that met the inclusion criteria. Eligible patients were those from LMICs residing in households, schools, and childcare, while appropriate interventions were ones that promoted handwashing with soap. Studies that encouraged handwashing reduced any ARI compared to no handwashing (relative risk [RR] 0.83, 95% confidence interval [CI] 0.76-0.90, I2 = 88%). Furthermore, there was a decreased likelihood of upper (RR 0.74, 95% CI 0.59-0.93, I2 = 91%) and lower (RR 0.78, 95% CI 0.64-0.94, I2 = 64%) respiratory infections among the hand-hygiene group. The impact of hand hygiene on influenza (RR 0.94, 95% CI 0.42-2.11, I2 90%), COVID-19, and all-cause mortality (prevalence ratio 0.95) was minimal. Findings from this meta-analysis suggest that handwashing with soap may reduce ARIs in LMICs.

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