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October 13, 2004

Handwashing Promotion and Childhood Diarrhea in Pakistan

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(14):1682-1683. doi:10.1001/jama.292.14.1682-b

To the Editor: The major cause of diarrhea in poor settlements in Pakistan is strongly believed to be the contamination of drinking water,1 and water treatment, food hygiene, and handwashing are the standard intervention practices.2,3 I believe that there is no equipoise in this regard, and because of this no need to have a “placebo” control with standard habits and practices as was done in the study on handwashing and childhood diarrhea by Dr Luby and colleagues.2 In their study, field workers neither encouraged nor discouraged handwashing in the control group, allowing habits and practices that were promoting diarrhea in the community to continue. I believe that it would have been more ethical to have a control group that received handwashing promotional messages, and 2 intervention groups that received handwashing promotional messages and either plain or antibacterial soap.

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