Table 1 Intervention studies’ characteristics
Study ID | Country | Aim of the study | Study design | Population | Sample size | Intervention | Comparator | Type of respiratory infection | Relevant outcomes | Findings | Protection effect of HH (effect estimates) |
|---|---|---|---|---|---|---|---|---|---|---|---|
Biswas et al. [24] | Bangladesh | To evaluate the effectiveness of a behaviour change intervention with ABHR and respiratory hygiene messages in school settings to reduce the incidence of influenza virus infections among schoolchildren | cRCT | School children | N = 10,855 school children | Provision of ABHR, HH education & respiratory hygiene education | No ABHR provided and no HH & respiratory education provided | Influenza | Influenza acquisition | The incidence of laboratory-confirmed influenza per 1000 student-weeks among children in the intervention schools was 53% lower than in the control schools (IRR: 0.5; 95% CI: 0.3, 0.8; p = 0.01). | Significant protective effect (OR: 0.40; 95% CI: 0.22, 0.71) |
Cowling et al. [19] | China | To investigate whether HH and use of face masks prevents household transmission of influenza | cRCT | General public | N = 259 households | (1) Provision of soap, ABHR & HH education vs. (2) face masks education, provision of surgical masks, soap, ABHR & HH education | Healthy diet and lifestyle education | Influenza | Influenza transmission (secondary attack rates) | Secondary attack ratios (percentage of household members that became infected) did not significantly differ at the household level (24% in the education group, 14% in the HH group, and 18% in the face mask & HH group; p = 0.37). However, when intervention was implemented within 36 hours of symptom onset in the index patient, there was a significant difference in the secondary attack ratios between groups (4% in face masks & HH group, 5% in HH group and 12% in education group; p = 0.04). | No significant effect (OR: 0.52; 95% CI: 0.27, 1.00) |
Larson et al. [20] | USA | To test the effectiveness of three household interventions on incidence & transmission of URI & influenza, knowledge of transmission of URIs, & vaccination rates | cRCT | General public | N = 509 primarily Hispanic households | (1) educational materials & ABHR vs. (2) educational materials & ABHR & masks | Educational materials only | Influenza | Influenza acquisition & secondary transmission | No significant difference in influenza cases between the education group and ABHR group (p = 0.2) or ABHR & face masks group (p = 0.9). | No significant effect (OR: 1.16; 95% CI: 0.67, 2.01) |
Ram et al. [21] | Bangladesh | To test the impact of intensive hand washing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh | RCT | General public | N = 384 household compounds | Provision of education and skills training, set up of hand washing station and provision of soap & water, provision of reminders (cue cards) | No education or training, no soap or water provided, no hand washing stations, no cue cards | Influenza | Influenza transmission (secondary attack rate ratio) | No significant difference in secondary attack ratio between the intervention arm households (9.6%) and the control arm households (4.0%) of patients with laboratory-confirmed influenza (secondary attack ratio: 2.40; 95% CI: 0.68, 8.47; p = 0.17). | No significant effect (OR: 2.52; 95% CI: 1.12, 5.64) |
Stebbins et al. [22] | USA | To assess the impact of non-pharmacological interventions on the incidence of laboratory-confirmed influenza infections among elementary school children | cRCT | School children | N = 3360 pupils | HH & respiratory hygiene training & ABHR | No ABHR provided and no HH & respiratory training provided | Influenza | Influenza acquisition | No significant effect of the intervention on the number of laboratory-confirmed influenza cases (IRR: 0.81; 95% CI: 0.54, 1.23; p = 0.33), but children in intervention schools had significantly fewer influenza A infections in comparison with control schools (IRR: 0.48; 95% CI: 0.26, 0.87; p < 0.02). | No significant effect (OR: 0.94; 95% CI: 0.64, 1.39) |
Talaat et al. [23] | Egypt | To evaluate the effectiveness of an intensive HH campaign on reducing the incidence of laboratory-confirmed influenza | cRCT | School children | N = 44,451 pupils | HH education messages & activities and hand washing twice a day | No HH education provided & no instruction to hand wash twice a day | Influenza | Influenza acquisition | The rate of laboratory-confirmed influenza was higher among pupils who reported their illness in the control schools (35%) than in the intervention schools (18%) (p < 0.01). | Significant protective effect (OR: 0.64; 95% CI: 0.51, 0.80) |