Acute respiratory infection (ARI) is a leading cause of morbidity and mortality globally, with 83% of ARI mortality occurring in low-income and middle-income countries (LMICs) before the COVID-19 pandemic. We aimed to estimate the effect of interventions promoting handwashing with soap on ARI in LMICs. In our systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, Global Health, and Global Index Medicus for studies of handwashing with soap interventions in LMICs from inception to May 25, 2021. We included randomised and non-randomised controlled studies of interventions conducted in domestic, school, or childcare settings. Interventions promoting hand hygiene methods other than handwashing with soap were excluded, as were interventions in health-care facilities or the workplace. The primary outcome was ARI morbidity arising from any pathogen for participants of any age. Secondary outcomes were lower respiratory infection, upper respiratory infection, influenza confirmed by diagnostic test, COVID-19 confirmed by diagnostic test, and all-cause mortality. We extracted relative risks (RRs), using random-effects meta-analysis to analyse study results, and metaregression to evaluate heterogeneity. We assessed risk of bias in individual studies using an adapted Newcastle-Ottawa scale, and assessed the overall body of evidence using a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The study is registered with PROSPERO, CRD42021231414. 26 studies with 161 659 participants met inclusion criteria, providing 27 comparisons (21 randomised). Interventions promoting handwashing with soap reduced any ARI compared with no handwashing intervention (RR 0·83 [95% CI 0·76–0·90], I 88%; 27 comparisons). Interventions also reduced lower respiratory infections (0·78 [0·64–0·94], I 64%; 12 comparisons) and upper respiratory infections (0·74 [0·59–0·93], I 91%; seven comparisons), but not test-confirmed influenza (0·94 [0·42–2·11], I 90%; three comparisons), test-confirmed COVID-19 (no comparisons), or all-cause mortality (prevalence ratio 0·95 [95% CI 0·71–1·27]; one comparison). For ARI, no heterogeneity covariates were significant at p<0·1 and the GRADE rating was moderate certainty evidence. Interventions promoting handwashing with soap can reduce ARI in LMICs, and could help to prevent the large burden of respiratory disease. Bill & Melinda Gates Foundation, Reckitt Global Hygiene Institute, and UK FCDO.

中文翻译：

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低收入和中等收入国家用肥皂洗手预防急性呼吸道感染的有效性：系统评价和荟萃分析

急性呼吸道感染 (ARI) 是全球发病和死亡的主要原因，在 COVID-19 大流行之前，83% 的 ARI 死亡率发生在低收入和中等收入国家 (LMIC)。我们的目的是评估促进用肥皂洗手的干预措施对中低收入国家 ARI 的影响。在我们的系统回顾和荟萃分析中，我们检索了 MEDLINE、Embase、Web of Science、Scopus、Cochrane Library、Global Health 和 Global Index Medicus，以查找从成立到 2021 年 5 月 25 日期间中低收入国家用肥皂洗手干预措施的研究。我们纳入了在家庭、学校或儿童保育环境中进行的干预措施的随机和非随机对照研究。除了用肥皂洗手之外，促进手部卫生方法的干预措施被排除在外，卫生保健机构或工作场所的干预措施也被排除在外。主要结果是任何年龄的参与者由任何病原体引起的 ARI 发病率。次要结局是下呼吸道感染、上呼吸道感染、诊断测试证实的流感、诊断测试证实的 COVID-19 以及全因死亡率。我们提取相对风险（RR），使用随机效应荟萃分析来分析研究结果，并使用荟萃回归来评估异质性。我们使用改编后的纽卡斯尔-渥太华量表评估了个别研究的偏倚风险，并使用建议、评估、开发和评价分级（GRADE）方法评估了整体证据。该研究已在 PROSPERO 注册，CRD42021231414。涉及 161 659 名参与者的 26 项研究符合纳入标准，提供了 27 项比较（其中 21 项是随机的）。与不洗手干预相比，促进用肥皂洗手的干预措施减少了 ARI（RR 0·83 [95% CI 0·76–0·90]，I 88%；27 项比较）。干预措施还减少了下呼吸道感染（0·78 [0·64–0·94]，I 64%；12 项比较）和上呼吸道感染（0·74 [0·59–0·93]，I 91%；7比较），但不包括测试确诊的流感（0·94 [0·42–2·11]，I 90%；三项比较）、测试确诊的 COVID-19（无比较）或全因死亡率（患病率0·95 [95% CI 0·71–1·27]；一项比较）。对于 ARI，在 p<0·1 时没有显着的异质性协变量，并且 GRADE 评级是中等确定性证据。提倡用肥皂洗手的干预措施可以减少中低收入国家的急性呼吸道感染，并有助于预防呼吸系统疾病的巨大负担。比尔及梅琳达·盖茨基金会、利洁时全球卫生研究所和英国 FCDO。