{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:42:04Z","timestamp":1793104924922,"version":"4.5.0"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,6]]},"abstract":"<jats:p>We assessed the impact of handwashing promotion on reported respiratory illness as a secondary outcome from among &gt; 60,000 low-income households enrolled in a cluster-randomized trial conducted in Bangladesh. Ninety geographic clusters were randomly allocated into three groups: cholera-vaccine-only; vaccine-plus-behavior-change (handwashing promotion and drinking water chlorination); and control. Data on respiratory illness (fever plus either cough or nasal congestion or breathing difficulty within previous 2 days) and intervention uptake (presence of soap and water at handwashing station) were collected through monthly surveys conducted among a different subset of randomly selected households during the intervention period. We determined respiratory illness prevalence across groups and used log-binomial regression to examine the association between respiratory illness and presence of soap and water in the handwashing station. Results were adjusted for age, gender, wealth, and cluster-randomized design. The vaccine-plus-behavior-change group had more handwashing stations with soap and water present than controls (45% versus 25%; <jats:italic>P<\/jats:italic> &lt; 0.001). Reported respiratory illness prevalence was similar across groups (vaccine-plus-behavior-change versus control: 2.8% versus 2.9%; 95% confidence interval [CI]: \u22120.008, 0.006; <jats:italic>P<\/jats:italic> = 0.6; cholera-vaccine-only versus control: 3.0% versus 2.9%; 95% CI: \u22120.006, 0.009; <jats:italic>P<\/jats:italic> = 0.4). Irrespective of intervention assignment, respiratory illness was lower among people who had soap and water present in the handwashing station than among those who did not (risk ratio<jats:sub>adjusted<\/jats:sub>: 0.82; 95% CI: 0.69\u20130.98). With modest uptake of the handwashing intervention, we found no impact of this large-scale intervention on respiratory illness. However, those who actually had a handwashing station with soap and water had less illness. This suggests improving the effectiveness of handwashing promotion in achieving sustained behavior change could result in health benefits.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0644","type":"journal-article","created":{"date-parts":[[2019,1,3]],"date-time":"2019-01-03T07:00:30Z","timestamp":1546498830000},"page":"742-749","source":"Crossref","is-referenced-by-count":16,"title":["Impact of a Large-Scale Handwashing Intervention on Reported Respiratory Illness: Findings from a Cluster-Randomized Controlled Trial"],"prefix":"10.4269","volume":"100","author":[{"given":"Nusrat","family":"Najnin","sequence":"first","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Leder","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Forbes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Unicomb","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Winch","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavani K.","family":"Ram","sequence":"additional","affiliation":[{"name":"University at Buffalo, Buffalo, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fosiul A.","family":"Nizame","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaila","family":"Arman","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Begum","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shwapon","family":"Biswas","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Cravioto","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Facultad de Medicina, Universidad Nacional Aut\u00f3noma de Mexico, Ciudad de Mexico, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Luby","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;"},{"name":"Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"2151","article-title":"Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000","volume":"379","author":"Liu","year":"2012"},{"key":"b2","series-title":"Lancet","first-page":"1725","article-title":"Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Wang","year":"2016"},{"key":"b3","series-title":"Ann Intern Med","first-page":"463","article-title":"Hand-to-hand transmission of rhinovirus colds","volume":"88","author":"Gwaltney","year":"1978"},{"key":"b4","series-title":"J Infect Dis","first-page":"98","article-title":"Possible transmission by fomites of respiratory syncytial 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