• hand washing
• diarrhoea
• hygiene

In my office, I have 12 general textbooks on sport medicine. I am not bragging about this but simply stating an easily verifiable fact. I had recently been reading a newspaper article that noted that the second biggest killer of children in the world is not malaria or tuberculosis, nor AIDS. It is diarrhoea. Over 2000 children die every single day throughout the world from this problem. The simplest solution to reducing this disease burden may be to teach people to wash their hands with soap. Studies suggest that this manouevre alone may reduce diarrhoeal illness by up to 43%. Surprisingly hand washing also reduces the biggest child killer of all, respiratory tract infections. A study by the US military found that respiratory infections dropped by 45% when troops washed their hands five times a day.

Obvious really. Perhaps too obvious because it is surprisingly seldom done. Even in Britain, only one in two mothers wash their hands after changing a baby’s nappy and less than one person in three washes their hands after a trip to the toilet. Research trials are currently being done in various African and Asian countries to improve hand washing rates and interestingly these are sponsored by soap manufacturers.

The connection to sports medicine may seem a little arcane, but I began to wonder about the problem of “traveler’s diarrhoea” that we see in our athletes touring the world and the need to manage this common problem as a team physician in this situation. As I pondered further this question and the prospect of a little “quality assurance” research trial, I did a desktop survey of these tomes to see whether such basic hygiene advice was mentioned in the management of this condition. To cut to the chase, although every book detailed antibiotic cocktails that I could prescribe and rehydration strategies to minimise the problem, none recommended hand washing or any other hygiene advice. In the section about the frequent respiratory infections in the lead up to competition in trained athletes, it is recommended by some that salivary IgA levels are tested or antibiotics prescribed but the athletes hands remain thoroughly unwashed.

Have I missed something here? Perhaps our mothers were right with some of their advice!