Hand Washing with Soap and Nail Clipping: Effect on Anaemia and Thinness in School-aged Children in Ethiopia: A Factorial Randomised Controlled Trial

Abstract

Objectives: To assess the impact of hand-washing with soap and nail clipping on the prevalence of anaemia and thinness among school-aged children. Methods: We randomly assigned 369 parasite negative school-aged children to receive both, one or the other, or neither of the interventions. Soap and nail clippers were provided and field workers visited households weekly for six months to encourage hand-washing and do nail clipping. Haemoglobin was determined using a HemoCue spectrometer at the end of the trial. Weight and height were measured following intervention, and children below -2Z scores for BMI-for-age were classified as thin. Analysis was by intention-to-treat. Results: Children that received hand-washing with soap intervention had a 51% lower prevalence of anaemia (OR 0.49, 95% CI: 0.28 to 0.88) and a 46% lower prevalence of thinness (OR 0.54, 95% CI: 0.35 to 0.86) than controls. Compared with controls, finger nail clipping did not result into significant reduction of anaemia (p=0.063) and thinness (p=0.218) prevalence. When looking at the four groups individually, children that received both interventions had a 69% lower anaemia (OR 0.31, 95% CI 0.14 to 0.70) and a 59% lower thinness prevalence (OR 0.41, 95% CI 0.21 to 0.79) than controls. Children in the hand-washing with soap only group had a 60% lower prevalence of anaemia than controls (OR 0.40, 95% CI: 0.18 to 0.87). Prevalence of anaemia and thinness did not differ significantly between children in the nail clipping only group and those in the control group. Conclusions: Hand-washing with soap was effective in reducing anaemia and thinness.