Epidemiology and Infection



Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan


S. P.  LUBY  a1 c1, M.  AGBOATWALLA  a2, A.  RAZA  a1, J.  SOBEL  a3, E. D.  MINTZ  a3, K.  BAIER  a4, R. M.  HOEKSTRA  a5, M. H.  RAHBAR  a1, R.  HASSAN  a6, S. M.  QURESHI  a6 and E. J.  GANGAROSA  a7
a1 Community Health Sciences, Aga Khan University, Karachi, Pakistan
a2 Health Oriented Preventive Education (HOPE), Karachi Pakistan
a3 Foodborne and Diarrheal Diseases Branch, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
a4 Procter and Gamble Company, Cincinnati, OH 45241, USA
a5 Biostatistics and Information Management Branch, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
a6 Department of Microbiology, Aga Khan University Hospital Laboratory, Karachi, Pakistan
a7 Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA

Abstract

We conducted a study in a squatter settlement in Karachi, Pakistan where residents report commonly washing their hands to determine if providing soap, encouraging hand washing, and improving wash-water quality would improve hand cleanliness. We allocated interventions to 75 mothers and collected hand-rinse samples on unannounced visits. In the final model compared with mothers who received no hand-washing intervention, mothers who received soap would be expected to have 65% fewer thermotolerant coliform bacteria on their hands (95% CI 40%, 79%) and mothers who received soap, a safe water storage vessel, hypochlorite for water treatment, and instructions to wash their hands with soap and chlorinated water would be expected to have 74% fewer (95% CI 57%, 84%). The difference between those who received soap alone, and those who received soap plus the safe water vessel was not significant (P = 0·26). Providing soap and promoting hand washing measurably improved mothers' hand cleanliness even when used with contaminated water.

(Accepted June 6 2001)


Correspondence:
c1 Author for correspondence: Mailstop A-38, Foodborne and Diarrheal Diseases, Centers for Disease Control, Atlanta, GA 30333, USA.


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