Impact of an Intensive Hand Hygiene Campaign on Illness-Related Absenteeism Among School Children

Background: Acute respiratory infections and diarrheal diseases are major causes of morbidity and school absenteeism among children in low-resource settings. Hand hygiene is a simple, cost-effective strategy to interrupt transmission of these infections in schools. Aim: To assess the impact of an intensive hand hygiene campaign on illness-related absenteeism and laboratoryconfirmed influenza among primary school children. Methodology: A cluster randomized controlled trial was conducted among 512 children (Grades I–III) in government elementary schools in Bihar, India. Schools were randomized to intervention or control groups. The intervention included supervised handwashing with soap, hygiene education, and behavioral reinforcement over 12 weeks. Illness-related absenteeism, in-class illness, and laboratory-confirmed influenza were compared between groups using school-level rates and relative risks. Results: Overall illness-related absenteeism was significantly lower in the intervention group compared to controls (RR 0.75; 95% CI: 0.64–0.88). Significant reductions were observed for influenza-like illness (RR 0.59), diarrhea (RR 0.64), and conjunctivitis (RR 0.36). Laboratory-confirmed influenza was also significantly reduced in the intervention group (30.0% vs. 48.5%; p = 0.01). Conclusion: Intensive hand hygiene promotion significantly reduced infectious illness and related absenteeism among schoolchildren, supporting its effectiveness as a scalable school-based public health intervention. Keywords: Hand hygiene, school children, absenteeism, influenza-like illness, diarrheal disease, randomized controlled trial.