Ram 2015.

Study characteristics
Methods	RCT
Participants	377 household compounds (index cases) completed the study. Control arm has 184 compounds with 1607 contacts, and intervention group has 193 compounds with 1814 contacts. Final analysis was performed on 193 index cases and 1661 contacts in the intervention group and 184 index cases and 1498 contacts in the control group. In 2009, index case‐patients with symptom onset within 7 days preceding enrolment were eligible. Eligibility criteria changed in 2010 to include index case‐patient with symptom onset within 48 hours preceding enrolment. Inclusion criteria: Individuals ≥ 5 years old: ILI, defined as history of fever and either cough or sore throat with fever onset within the previous 24 hours. Individuals < 5 years old: any child with acute fever with onset within the previous 24 hours. Return to home within 24 hours of presentation to Upazilla Health Complex, Jahurul Islam Medical College Hospital or the local pharmacies, i.e. the index case cannot be admitted for treatment. If admitted, the patient would not be eligible. No fever in any bari resident during the 7 days preceding the patient's presentation to hospital (see definition below). At least 2 individuals (in addition to the index case‐patient) who intend to reside in the bari during the subsequent 20 days. Residence within 30 minutes travel time (1‐way) from the Upazilla Health Complex or Jahurul Islam Medical College Hospital or the local pharmacy. Exclusion criteria: compounds were excluded if any compound member(s) was reported to have fever within 3 days before index case‐patient enrolment. At another time point, compounds were excluded if any primary household member was reported to have fever (fever occurring within 48 hours prior to enrolment recorded).
Interventions	Promoting intensive hand‐washing in households to prevent transmission of ILI. See Table 4 for details.
Outcomes	Laboratory: PCR for influenza A and B, with further subtyping of influenza A isolates for all ILI amongst contacts Effectiveness: incidence of ILI. An age‐based definition of ILI was used as follows. For individuals > 5 years old, ILI was defined as history of fever with cough or sore throat. For children < 5 years old, ILI was defined as fever (the authors used this relatively liberal case definition in order to include influenza cases with atypical presentations in children). Safety: no safety data planned or reported by investigators
Notes	Inclusion/exclusion criteria changed 3 times during the study conduct. The period study conducted: June 2009 to December 2010 Funding: government
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Block randomisation, with a block size of 4, in order to promote random and even allocation of household compounds to the 2 treatment arms. The list of random assignments was generated by an investigator with no contact with the participants.
Allocation concealment (selection bias)	Low risk	Once baseline data collection was complete, the data collector notified the field research officer, who consulted the block randomisation list to make the assignment of the household compound to intervention or control.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Relied on symptom reporting from the head of family. Inclusion/exclusion criteria changed 3 times during the study conduct. Given the provision of a hand‐washing station as part of the intervention, it was not possible to ensure blinding of participants, intervention staff, or data collectors.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Relied on symptom reporting from the head of family. Inclusion/exclusion criteria changed 3 times during the conduct of the study. Given the provision of a hand‐washing station as part of the intervention, it was not possible to ensure blinding of participants, intervention staff, or data collectors.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Flow chart followed all households an individuals from recruitment to analysis.
Selective reporting (reporting bias)	Low risk	The specified outcomes are clearly accounted for. Investigators report all outcomes for each modified enrolment.