Abstract：
Acute respiratory infection (ARI) is a leading cause of morbidity and mortality globally, with 83% of ARI mortality occurring in low-income and middle-income countries (LMICs) before the COVID-19 pandemic. We aimed to estimate the effect of interventions promoting handwashing with soap on ARI in LMICs.
In our systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, Global Health, and Global Index Medicus for studies of handwashing with soap interventions in LMICs from inception to May 25, 2021. We included randomised and non-randomised controlled studies of interventions conducted in domestic, school, or childcare settings. Interventions promoting hand hygiene methods other than handwashing with soap were excluded, as were interventions in health-care facilities or the workplace. The primary outcome was ARI morbidity arising from any pathogen for participants of any age. Secondary outcomes were lower respiratory infection, upper respiratory infection, influenza confirmed by diagnostic test, COVID-19 confirmed by diagnostic test, and all-cause mortality. We extracted relative risks (RRs), using random-effects meta-analysis to analyse study results, and metaregression to evaluate heterogeneity. We assessed risk of bias in individual studies using an adapted Newcastle-Ottawa scale, and assessed the overall body of evidence using a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The study is registered with PROSPERO, CRD42021231414.
26 studies with 161 659 participants met inclusion criteria, providing 27 comparisons (21 randomised). Interventions promoting handwashing with soap reduced any ARI compared with no handwashing intervention (RR 0·83 [95% CI 0·76-0·90], I2 88%; 27 comparisons). Interventions also reduced lower respiratory infections (0·78 [0·64-0·94], I2 64%; 12 comparisons) and upper respiratory infections (0·74 [0·59-0·93], I2 91%; seven comparisons), but not test-confirmed influenza (0·94 [0·42-2·11], I2 90%; three comparisons), test-confirmed COVID-19 (no comparisons), or all-cause mortality (prevalence ratio 0·95 [95% CI 0·71-1·27]; one comparison). For ARI, no heterogeneity covariates were significant at p<0·1 and the GRADE rating was moderate certainty evidence.
Interventions promoting handwashing with soap can reduce ARI in LMICs, and could help to prevent the large burden of respiratory disease.
Bill & Melinda Gates Foundation, Reckitt Global Hygiene Institute, and UK FCDO.
In our systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, Global Health, and Global Index Medicus for studies of handwashing with soap interventions in LMICs from inception to May 25, 2021. We included randomised and non-randomised controlled studies of interventions conducted in domestic, school, or childcare settings. Interventions promoting hand hygiene methods other than handwashing with soap were excluded, as were interventions in health-care facilities or the workplace. The primary outcome was ARI morbidity arising from any pathogen for participants of any age. Secondary outcomes were lower respiratory infection, upper respiratory infection, influenza confirmed by diagnostic test, COVID-19 confirmed by diagnostic test, and all-cause mortality. We extracted relative risks (RRs), using random-effects meta-analysis to analyse study results, and metaregression to evaluate heterogeneity. We assessed risk of bias in individual studies using an adapted Newcastle-Ottawa scale, and assessed the overall body of evidence using a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The study is registered with PROSPERO, CRD42021231414.
26 studies with 161 659 participants met inclusion criteria, providing 27 comparisons (21 randomised). Interventions promoting handwashing with soap reduced any ARI compared with no handwashing intervention (RR 0·83 [95% CI 0·76-0·90], I2 88%; 27 comparisons). Interventions also reduced lower respiratory infections (0·78 [0·64-0·94], I2 64%; 12 comparisons) and upper respiratory infections (0·74 [0·59-0·93], I2 91%; seven comparisons), but not test-confirmed influenza (0·94 [0·42-2·11], I2 90%; three comparisons), test-confirmed COVID-19 (no comparisons), or all-cause mortality (prevalence ratio 0·95 [95% CI 0·71-1·27]; one comparison). For ARI, no heterogeneity covariates were significant at p<0·1 and the GRADE rating was moderate certainty evidence.
Interventions promoting handwashing with soap can reduce ARI in LMICs, and could help to prevent the large burden of respiratory disease.
Bill & Melinda Gates Foundation, Reckitt Global Hygiene Institute, and UK FCDO.
摘要：
背景：急性呼吸道感染（ARI）是全球发病率和死亡率的主要原因，在COVID-19大流行之前，83%的ARI死亡率发生在低收入和中等收入国家(LMICs)。我们旨在评估促进用肥皂洗手的干预措施对LMIC中ARI的影响。
方法：在我们的系统评价和荟萃分析中，我们搜索了MEDLINE,Embase,WebofScience,Scopus,科克伦图书馆,全球卫生,和全球指数药物，从开始到2021年5月25日，研究中低收入国家用肥皂干预洗手。我们纳入了国内干预措施的随机对照和非随机对照研究，学校,或儿童保育设置。除了用肥皂洗手之外，促进手部卫生方法的干预措施被排除在外，医疗设施或工作场所的干预措施也是如此。主要结果是任何年龄参与者的任何病原体引起的ARI发病率。次要结果是下呼吸道感染，上呼吸道感染,通过诊断测试确认的流感，COVID-19通过诊断测试证实，和全因死亡率。我们提取了相对风险(RR)，使用随机效应荟萃分析来分析研究结果，和回归来评估异质性。我们使用适应的纽卡斯尔-渥太华量表评估个体研究中的偏倚风险，并使用建议分级评估整体证据，评估,发展,和评估(等级)方法。这项研究在PROSPERO注册，CRD42021231414。
结果：26项研究有161659名参与者符合纳入标准，提供27个比较（21个随机）。与没有洗手干预相比，促进用肥皂洗手的干预措施降低了任何ARI(RR0·83[95%CI0·76-0·90]，I288%；27个比较）。干预还可以减少下呼吸道感染（0·78[0·64-0·94]，I264%；12个比较）和上呼吸道感染（0·74[0·59-0·93]，I291%；七个比较)，但不是测试确认的流感（0·94[0·42-2·11]，I290%；三次比较)，测试确认的COVID-19（无比较），或全因死亡率（患病率0·95[95%CI0·71-1·27]；一次比较）。对于ARI，在p<0·1时无异质性协变量显著,GRADE评分为中度确定性证据.
结论：促进肥皂洗手的干预措施可以降低LMIC的ARI，并有助于预防呼吸道疾病的巨大负担。
背景：比尔和梅琳达·盖茨基金会，Reckitt全球卫生研究所，和英国FCDO。
方法：在我们的系统评价和荟萃分析中，我们搜索了MEDLINE,Embase,WebofScience,Scopus,科克伦图书馆,全球卫生,和全球指数药物，从开始到2021年5月25日，研究中低收入国家用肥皂干预洗手。我们纳入了国内干预措施的随机对照和非随机对照研究，学校,或儿童保育设置。除了用肥皂洗手之外，促进手部卫生方法的干预措施被排除在外，医疗设施或工作场所的干预措施也是如此。主要结果是任何年龄参与者的任何病原体引起的ARI发病率。次要结果是下呼吸道感染，上呼吸道感染,通过诊断测试确认的流感，COVID-19通过诊断测试证实，和全因死亡率。我们提取了相对风险(RR)，使用随机效应荟萃分析来分析研究结果，和回归来评估异质性。我们使用适应的纽卡斯尔-渥太华量表评估个体研究中的偏倚风险，并使用建议分级评估整体证据，评估,发展,和评估(等级)方法。这项研究在PROSPERO注册，CRD42021231414。
结果：26项研究有161659名参与者符合纳入标准，提供27个比较（21个随机）。与没有洗手干预相比，促进用肥皂洗手的干预措施降低了任何ARI(RR0·83[95%CI0·76-0·90]，I288%；27个比较）。干预还可以减少下呼吸道感染（0·78[0·64-0·94]，I264%；12个比较）和上呼吸道感染（0·74[0·59-0·93]，I291%；七个比较)，但不是测试确认的流感（0·94[0·42-2·11]，I290%；三次比较)，测试确认的COVID-19（无比较），或全因死亡率（患病率0·95[95%CI0·71-1·27]；一次比较）。对于ARI，在p<0·1时无异质性协变量显著,GRADE评分为中度确定性证据.
结论：促进肥皂洗手的干预措施可以降低LMIC的ARI，并有助于预防呼吸道疾病的巨大负担。
背景：比尔和梅琳达·盖茨基金会，Reckitt全球卫生研究所，和英国FCDO。
