Sustaining a gain: difficult in any setting

A new study in the American Journal of Tropical Medicine and Hygiene confirms, yet again, how difficult it is to sustain improvements in hand hygiene performance. The interesting thing about this study is the setting (squatter settlements in Karachi, Pakistan). In 2003, the investigators demonstrated that a hand hygiene intervention (free soap and weekly visits to promote handwashing) successfully reduced rates of childhood diarrhea and pneumonia by over 50% in this population. They returned to the same households in 2005 for a follow up evaluation. Although the intervention homes were more likely to have a designated place for handwashing, there were no longer differences in either soap use or diarrheal disease between the intervention and control households.