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October 13, 2004

Handwashing Promotion and Childhood Diarrhea in Pakistan—Reply

Author Affiliations

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

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

In Reply: Dr Mujeeb argues there was no equipoise for the Karachi Soap Health Study because public health scientists already know that handwashing reduces diarrhea. However, the degree of diarrhea reduction that can be achieved with intensive handwashing in highly contaminated settings, especially among children at highest risk of death, is not well established. Indeed, as noted in our article, there has been substantial methodological criticism of the prior studies on handwashing. If handwashing is going to be advocated for prevention of diarrhea, it is important to understand the degree of its effectiveness.