

@article {7093,
	title = {Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial},
	journal = {Tropical medicine \& international health: TM \& IH},
	volume = {11},
	number = {4},
	year = {2006},
	month = {apr},
	pages = {479{\textendash}489},
	abstract = {OBJECTIVES: To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap. METHODS: The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea. RESULTS: Study participants in control neighbourhoods had diarrhoea on 5.2\% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55\% (95\% CI 17\%, 80\%) lower in bleach and water vessel neighbourhoods, 51\% (95\% CI 12\%, 76\%) lower in hand washing promotion with soap neighbourhoods, 64\% lower (95\% CI 29\%, 90\%) in disinfectant-disinfectant neighbourhoods, and 55\% (95\% CI 18\%, 80\%) lower in disinfectant-disinfectant plus hand washing with soap neighbourhoods. CONCLUSIONS: With an intense community-based intervention and supplies provided free of cost, each of the home-based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.},
	keywords = {Adolescent, Breast Feeding, Child, Diarrhea, Disinfectants, Female, Hand Disinfection, Humans, Infant, Male, Pakistan, Patient Acceptance of Health Care, Preschool, prevalence, Soaps, Socioeconomic Factors, Sodium Hypochlorite, Treatment Outcome, Water Purification, Water Supply},
	issn = {1360-2276},
	doi = {10.1111/j.1365-3156.2006.01592.x},
	author = {Luby, Stephen P. and Agboatwalla, Mubina and Painter, John and Altaf, Arshad and Billhimer, Ward and Keswick, Bruce and Hoekstra, Robert M.}
}
