| Methods |
Controlled before and after study carried out in a 16 classrooms of special needs school for Down Syndrome children in New York State. The study took place between November 1991 and November 1993. The 'before' period between November 1991 and October 1992, followed by a 1‐month washout period during which the intervention was introduced, followed by 12 months of 'after' period (December 1992 to November 1993) |
| Participants |
33 children aged 6 weeks to 5 years took part in the 'before' and 38 in year 2 ('after' period). During the study period there were about 110 children in the school but the parents of the majority did not agree to replying to 2‐weekly questionnaires, so their children were not entered in the study. In addition 5 sets of questionnaires in the 'before' and 2 in the 'after' periods did not contain sufficient data (6 months' worth) and were excluded. Despite this there were no significant differences between 'before' and 'after' children. The authors also describe viral circulation during the study periods from isolates in the local hospital. All community isolates were constant with the exception of adenovirus which doubled in the 'after' period of the study |
| Interventions |
Training and sanitary programme with handwashing, disinfection of school buses, appliances and toys. In addition a person designated a study monitor carried out intensive monitoring of classroom behaviour and reinforced messages. Disinfection took place with Reckitt & Colman products (sponsors of the study) |
| Outcomes |
Laboratory: viral isolates from surrounding community (non‐random samples)
Effectiveness: ARI (cough, runny nose, sore throat, wheezing or rattling in the chest, ear ache). Vomiting and diarrhoea (data not extracted). Follow up was carried out on the basis of parents' questionnaire
Safety: N/A |
| Notes |
Risk of bias: high (disinfectants provided and study sponsored by manufacturer)
Notes: the authors concluded that respiratory illnesses decreased from a median of 0.67 to 0.42 per child per month (P < 0.07), physician visits, 0.50 versus 0.33 (P < 0.05), mean course of antibiotics prescribed 0.33 versus 0.28 (P < 0.05) and days of school missed because of respiratory infections 0.75 versus 0.40 (P < 0.05). Respiratory illnesses decreased from a median of 0.67 to 0.42 per child per month. Small study with a serious selection bias and generalisability problems |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
N/A |
| Allocation concealment (selection bias) |
Unclear risk |
N/A |
| Blinding (performance bias and detection bias)
All outcomes |
Unclear risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
N/A |
| Selective reporting (reporting bias) |
Unclear risk |
N/A |
