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Association between handwashing and gargling education for children and prevention of respiratory tract infections: a longitudinal Japanese children population-based study

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Abstract

Purpose

A longitudinal study was conducted to examine the effects of handwashing and gargling education for children on the prevention of respiratory tract infections (RTIs) in children in Japan.

Methods

The study included 38,554 children born in 2010 who were enrolled in a longitudinal study. Information on children’s hygiene education regarding handwashing and gargling was collected in a survey at the age of 3.5 years. Based on parents' reports of doctors’ diagnoses, airway infections and influenza events in the 12-month duration before the survey were evaluated for RTIs at the ages of 4.5 and 9 years. Poisson regression with robust variance was performed to examine the effects of hygiene education on RTIs prevention. The supplementary analysis was stratified by household income.

Results

Children were categorized into different groups: 38% in the handwashing and gargling group, 29% in the handwashing group, 0.1% in the gargling group, and 9.7% in the no-education group. Exclusions were made for non-respondent children (23%) and those in the gargling group. Hygiene education was associated with decreased influenza at the age of 4.5 years in the handwashing (adjusted RR [aRR] = 0.8; 95% CI, 0.8–0.9) and handwashing and gargling groups (aRR = 0.8; 95% CI, 0.8–0.9) compared with no education. However, no preventive effects on airway infections at the age of 4.5 and 9, influenza at the age of 9, or hospitalization between the ages of 3.5 and 9 years were detected. Handwashing and gargling could significantly prevent influenza in low-income households (aRR = 0.7; 95% CI, 0.6–0.8).

    Conclusions: Gargling education was widespread and mostly combined with handwashing education in Japan. Hygiene education significantly affected prevention of influenza infections at the age of 4.5 years, especially in low-income households.

What is Known:

• Previous intervention studies showed handwashing and gargling are effective in preventing respiratory tract infections.

What is New:

• We conducted a longitudinal study on handwashing and gargling education in Japanese children and found that handwashing and gargling were widely practiced together.

• Handwashing and gargling education were related to a reduction in influenza, particularly in low-income households.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

95% CI:

95% Confidence intervals

IQR:

Interquartile range

NPI:

Non-pharmaceutical interventions

RCT:

Randomized control trial

RR:

Risk ratio

RTIs:

Respiratory tract infections

SES:

Socioeconomic status

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

This work was supported by JSPS KAKENHI (Grants-in-Aid for Scientific Research) Grant Number 20K1049802 and The Okayama Medical Research Association.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Kensuke Uraguchi, Naomi Matsumoto, Soshi Takao & Takashi Yorifuji

  2. Department of Otolaryngology-Head and Neck Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Kensuke Uraguchi, Seiichiro Makihara & Mizuo Ando

  3. Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan

    Toshiharu Mitsuhashi

Authors
  1. Kensuke Uraguchi
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  7. Takashi Yorifuji
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Contributions

This study was conceived and designed by KU, TM and SM. Data acquisition was performed by KU and NM, while data analysis and interpretation were carried out by KU, TM, and NM. The initial draft of the manuscript was prepared by KU and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kensuke Uraguchi.

Ethics declarations

Ethical approval

This study was approved by the Okayama University Certified Review Board (IRB approval number: No.1506–073) and conducted in accordance with the Declaration of Helsinki 2013.

Consent to participate and publish

This study is based on the utilization of measures implemented by the Ministry of Health, Labor and Welfare in Japan and is anonymized, so consent is not required.

Competing interests

The authors declare they have no conflict of interest with respect to this research study and paper.

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Communicated by H. Babaie

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Uraguchi, K., Mitsuhashi, T., Matsumoto, N. et al. Association between handwashing and gargling education for children and prevention of respiratory tract infections: a longitudinal Japanese children population-based study. Eur J Pediatr 182, 4037–4047 (2023). https://doi.org/10.1007/s00431-023-05062-5

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  • DOI: https://doi.org/10.1007/s00431-023-05062-5

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