A household handwashing program in Pakistan substantially reduced the occurrence of diarrhea among children living in a high-risk situation, according to a report in this week’s Journal of the American Medical Association.

The results come from a study of more than 4500 children living in 36 low-income neighborhoods in Karachi. In 25 of the neighborhoods, handwashing was promoted to encourage the use of plain or antibacterial soap after defecation, food preparation, eating, and child feeding. The other 11 neighborhoods served as the control group.

In their report, Dr. Stephen P. Luby, from the Centers for Disease Control and Prevention in Atlanta, and colleagues write: “In these communities in which diarrhea is the leading cause of childhood death, wash water was heavily contaminated with human fecal organisms, and no provisions were made for clean drying of hands, handwashing promotion with soap halved the burden of diarrheal disease.”

Compared with children from control neighborhoods, those from a neighborhood encouraging plain soap use had a 53 percent lower rate of diarrhea. In addition, the plain soap intervention was tied to a 39 percent reduction in the number of days with diarrhea.

No apparent advantage was seen for using antibacterial soap rather than plain soap, since the antibacterial agent has no effect on many organisms that cause diarrhea.

“Although visiting households weekly to provide free soap and encourage handwashing was effective in reducing diarrhea, this approach is prohibitively expensive for widespread implementation,” the authors point out. Therefore, less costly approaches are needed to reach the millions of children living in at-risk households.

SOURCE: Journal of the American Medical Association, June 2, 2004.