Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

• Type of Material: Article
• Authors: Solomon Aragie, The Carter Center Ethiopia; Wondyifraw Tadesse, Catholic Relief Services; Adane Dagnew, The Carter Center Ethiopia; Dagnachew Hailu, The Carter Center Ethiopia; Melese Dubie, The Carter Center Ethiopia; Dionna M Wittberg, University of California San Francisco; Jason S Melo, University of California San Francisco; Mahteme Haile, Amhara Public Health Institute; Taye Zeru, Amhara Public Health Institute; Matthew Freeman, Emory University; Scott Nash, Emory University; Kelly E Callahan, The Carter Center, Atlanta; Zerihun Tadesse, The Carter Center Ethiopia; Benjamin F Arnold, University of California San Francisco; Travis C Porco, University of California San Francisco; Thomas M Lietman, University of California San Francisco; Jeremy D Keenan, University of California San Francisco
• Language: English
• Date: 2021-11-01
• Publisher: WORLD HEALTH ORGANIZATION
• Publication Version: Final Published Version
• Copyright Statement: (c) 2021 The authors; licensee World Health Organization.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2471/BLT.21.285915
• Title of Journal or Parent Work: BULLETIN OF THE WORLD HEALTH ORGANIZATION
• Volume: 99
• Issue: 11
• Start Page: 762
• End Page: +
• Keywords: Science & Technology; WATER-QUALITY; LATRINE; CHILD GROWTH; NUTRITIONAL INTERVENTIONS; HEALTH; SANITATION; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; DIARRHEA; IMPACT; TRACHOMA CONTROL; INFECTION
• Research Categories: Health Sciences, Public Health

Abstract

Objective To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control. Methods We conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys. Findings Over the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41–53) for wash stations, 18 percentage points (95% CI: 12–24) for soap and 12 percentage points (95% CI: 5–19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15–27 for 0–5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2–15 for 6–9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits. Conclusion The community-and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.