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Water will do where soap is scarce

Hand washing with soap helps prevent childhood diarrhoea in rural areas of developing countries. But soap is expensive, hard to come by, and often kept some way from the communal water source. Hand washing with water alone is much more common in these communities, and may also protect children from diarrhoea, according to a study from rural Bangladesh. Young children in families where adults regularly washed both hands with water before preparing food had significantly less diarrhoea than children in families where adults did not regularly wash their hands before preparing food (odds ratio 0.67 (95% CI 0.51 - 0.89)).

Hand washing before preparing food or after a trip to the toilet looked more important than hand washing before feeding a child, before eating, or after cleaning a soiled child in these analyses. All were adjusted for characteristics that might confound the association between more washing and less diarrhoea, such as income and education. As expected, hand washing with soap, though unusual, was associated with the lowest risk of diarrhoea among children under 5 years old in these 347 households in 50 villages.

Local hygiene programmes continue to promote soap here and elsewhere, say the authors. They also promote an unrealistic schedule of hand washing that would leave low income parents with time for little else. A sharper focus on washing before preparing food and after going to the toilet might be a reasonable compromise, they write.

Luby SP et al. PLoS Med 2011, doi:10.1371/journal.pmed.1001052

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BRIDGET FARHAM

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