Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature

Elizabeth McDonald, Ross Stewart Bailie, David Brewster, Peter Morris

Research output: Contribution to journalArticleResearchpeer-review


Background. Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions. The objective of this systematic literature review was to examine the epidemiological evidence for a relationship between various hygiene and public health intervention strategies, separately or in combination, and the occurrence of common preventable childhood infectious diseases. The purpose was to determine what intervention/s might most effectively reduce the incidence of skin, diarrhoeal and infectious diseases experienced by children living in remote Indigenous communities. Methods. Studies were identified through systematically searching electronic databases and hand searching. Study types were restricted to those included in Cochrane Collaboration Effective Practice and Organisation of Care Review Group (EPOC) guidelines and reviewers assessed the quality of studies and extracted data using the same guidelines. The types of participants eligible were Indigenous populations and populations of developing countries. The types of intervention eligible for inclusion were restricted to those likely to prevent conditions caused by poor personal hygiene and poor living environments. Results. The evidence showed that there is clear and strong evidence of effect of education and handwashing with soap in preventing diarrhoeal disease among children (consistent effect in four studies). In the largest well-designed study, children living in households that received plain soap and encouragement to wash their hands had a 53% lower incidence of diarrhoea (95% CI, 0.35, 0.59). There is some evidence of an effect of education and other hygiene behaviour change interventions (six studies), as well as the provision of water supply, sanitation and hygiene education (two studies) on reducing rates of diarrhoeal disease. The size of these effects is small and the quality of the studies generally poor. Conclusion. Research which measures the effectiveness of hygiene interventions is complex and difficult to implement. Multifaceted interventions (which target handwashing with soap and include water, sanitation and hygiene promotion) are likely to provide the greatest opportunity to improve child health outcomes in remote Indigenous communities. � 2008 McDonald et al; licensee BioMed Central Ltd.
Original languageEnglish
Pages (from-to)153-166
Number of pages14
JournalBMC Public Health
Publication statusPublished - 2008


  • Aborigine
  • article
  • Australia
  • child health
  • community living
  • diarrhea
  • educational status
  • hand washing
  • health education
  • human
  • hygiene
  • incidence
  • infection
  • intervention study
  • major clinical study
  • outcome assessment
  • preschool child
  • prevention and control
  • public health
  • sanitation
  • water supply
  • female
  • male
  • public health service
  • review
  • rural population
  • Female
  • Health Education
  • Humans
  • Hygiene
  • Male
  • Oceanic Ancestry Group
  • Public Health Practice
  • Rural Population

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