Summary of findings 2. Summary of findings table 2.
| Hand washing among communities compared to no intervention for preventing diarrhoea | |||||
| Patient or population: Children Settings: Communities Intervention: Hand washing promotion through community structures (± provision of hand washing materials) Comparison: No intervention | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (trials) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| No intervention | Hand washing promotion | ||||
| Episodes of diarrhoea | Low‐ or middle‐income countries | Rate ratio 0.72 (0.62 to 0.83) | 14,726 (8 trials) | ⊕⊕⊕⊖ moderate2,3,4,5 | |
| 3 episodes per 100 children per year1 |
2 episodes per 100 children per year1 (2 to 2) |
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| Hand washing behavioural changes/changes in knowledge, attitude and practice Follow‐up: mean 7 months | — | — | Not pooled | 3490 (3 trials) | ⊕⊕⊕⊕ high6,7,8,9 |
| *The basis for the assumed risk (for example, the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1The median incidence of diarrhoea in the control groups was 3 episodes per 100 children per year. 2No serious risk of bias: Most trials are at high or unclear risk of detection or reporting bias due to no description of blinding of outcome assessors. Restriction of the analysis to just the blinded trials finds a slightly smaller effect size but the result remains statistically significant. Not downgraded. 3No serious inconsistency: Although statistical heterogeneity was high, this heterogeneity was related to the size of the effect not the direction of effect. The individual effect sizes in trials ranged from an 6% relative reduction in diarrhoea to a 30% reduction. 4Downgraded by 1 for serious indirectness: These eight trials were conducted in LMICs (the Democratic Republic of Congo, Pakistan, Bangladesh, Myanmar, Peru, India and Nepal). 5No serious imprecision: The result is statistically significant and the meta‐analysis adequately powered to detect this result. 6No serious risk of bias: Most trials are at high or unclear risk of detection or reporting bias due to no description of blinding of outcome assessors. Restriction of the analysis to just the blinded trials finds a slightly smaller effect size but the result remains statistically significant. Not downgraded. However this is limited to three trials in low‐income countries. Further trials from other income settings are needed to confirm if this result can be generalized. 7No serious inconsistency: All the included trials found reductions in diarrhoea incidence. 8No serious indirectness: The three trials were conducted in low‐income communities/countries (Nepal, low‐income urban communities in Mumbai, India and Bangladesh). The trials found statistically significant benefit on diarrhoea incidence. 9No serious imprecision: The result is statistically significant and adequately powered to detect this result.