1. INTRODUCTION Diarrheal and respiratory diseases cause 3.5 million deaths annually among children in the developing world. 1 Reduced rates of these diseases have been measured during intensive, home-based handwashing interventions. 2 Effecting behavior change is often expensive, time-consuming, and may be only temporary or not retained. We evaluated a school-based handwashing program for elementary students to determine whether a more scalable intervention could reduce illness rates and absenteeism. The program has been in use since 1995 and has reached more than 80 million Chinese first-grade students. A. Bowen MD MPH 1,2 ; H. Ma BS 3 ; J. Ou MD 4 ; W. Billhimer MS 5 ; T. Long PhD 5 ; M. Zeng MS 6 ; E. Wang MS 7 ; J. Painter DVM MS 1 ; E. Mintz MD MPH 1 ; R.M. Hoekstra PhD 1 ; S. Luby MD 1,8 1 National Center for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, GA; 2 Office of Workforce & Career Development, Centers for Disease Control & Prevention, Atlanta, GA; 3 China Centers for Disease Control & Prevention, Beijing, China; 4 Fujian Provincial Center for Disease Control & Prevention, Fuzhou, China; 5 Procter & Gamble Company, Cincinnati, OH; 6 Procter & Gamble Company, Guangzhou, China; 7 Procter & Gamble Company, Beijing, China; 8 ICDDRB:Center for Health & Population Research, Dhaka, Bangladesh Effect of a Hand Washing Promotion Program in Chinese Primary Schools Provision of a hand washing promotion program and soap significantly reduces the rates of illness and absence, as well as duration of absence among 1 st grade students. While the program alone without additional soap did yield less illness and school absence, the benefit was not statistically significant. These benefits continued in both intervention groups for 4 months after introducing the simple hand washing program. If soap is concomitantly available, a simple, scalable school-based hand washing program could improve the health and lives of children worldwide. References 1.World Health Organization. World Health Report 2005 – make every mother and child count. Geneva: World Health Organization, 2005:190-91. 2.Luby SP, Agboatwalla M, Freikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial. Lancet 2005; 366:225-233. CONCLUSIONS RESULTS OBJECTIVE Setting 30 schools from each of 3 counties in Fujian Province, China. This largely rural region consists of nearly 35 million people and is approximately 64% agrarian and light industry. Groups The schools were randomly assigned to the following groups: Control group – No hygiene intervention beyond normal routine hygiene training, Standard intervention – a corporate sponsored hygiene promotion program, Expanded intervention – a corporate sponsored hygiene promotion program + antibacterial soap for school sinks + a peer hygiene monitor for each class. Intervention The corporate sponsored hygiene promotion program consists of 1 hour of instruction conducted by hygiene trained teachers during the first month of the 1 st grade and 1 antibacterial soap take-home kit per pupil. It combines classroom education, posters, games and take-home activities directed to proper handwashing with soap, tooth-brushing, and cleaning the children’s workspace and home. Measurements Teachers collected illness symptom information from students weekly and recorded student absences daily between January and April, 2005. Mean illness and absence rates were calculated for each school. METHODS Participation There were 52,369 student-weeks of observation. Results Wilcoxon ranked sums tests were performed on school-based means. Both interventions reduced illness rates compared to the control group (Fig. 1). Fig. 1 Illness rates observed. Both interventions reduced the incidence of absence from school relative to the control group (Fig. 2). Fig. 2 Incidence of absence from school The duration of absence due to illness was reduced by both interventions (Fig. 3). Fig. 3 School absence prevalence rates Only the Expanded Intervention yielded significant benefit relative to the control group in all parameters measured. This study evaluated the impact of a school-based hand washing intervention program on the knowledge and attitudes of first-grade students toward hand washing. The impact of soap and this program on the reduction of acute respiratory illness and diarrheal disease symptoms as well as infectious disease- related school absence among these children and their teachers was also assessed along with changes in hand washing frequency. Study Group ControlStandardExpanded # Schools302729 # Students126512751270 Participation Rate (%) 999290 ControlStandardExpanded Median 1.9 P=0.03 Median 2.3 P=0.20 Median 4.0 ControlStandardExpanded Median 2.1 Median 1.2 P=0.10 Median 1.4 P=0.03 ControlStandardExpanded Median 2.74 Median 1.87 P=0.14 Median 1.19 P=0.01 Fujian Province This work was funded by P&G Beauty