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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.

The study used a standard habits and practices population as a control because this was the comparison that would answer the relevant question, ie, what is the maximum benefit that can be achieved with an intensive handwashing promotion campaign in a highly contaminated setting? This control group already did purchase and use soap routinely. Having a control . . . [Full Text of this Article]

Stephen P. Luby, MD
sluby@icddrb.org
Centers for Disease Control and Prevention
Atlanta, Ga

Mubina Agboatwalla, MBBS
Health Oriented Preventive Education
Aga Khan University
Karachi, Pakistan

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