Software Interventions for Improving Hand Washing and Sanitation in Rural Tanzania: an Impact Evaluation

Not Applicable

Completed

• Conditions: Diarrhea
• Interventions: Other: Hardware; Behavioral: CLTS; Behavioral: PHAST; Other: Placebo poster; Behavioral: RANAS; Behavioral: mini-RANAS

• Registration Number: NCT03709368
• Lead Sponsor: Centre for Evidence-Based Practice, Belgium

Brief Summary

BACKGROUND. Diarrhea is ubiquitous, particularly among people in low- and middle-income countries. Unsafe drinking water, poor sanitation, and insufficient hygiene are responsible for nearly 90% of diarrhea-related mortalities. Despite extensive knowledge that has been obtained in recent years, there is no consensus as to the most efficacious approach to improve Water, Sanitation, and Hygiene behavior and health. With this study, we want to determine whether multi-faceted contextualized and non-contextualized WASH interventions have a differential impact.

OBJECTIVES. The primary objective is to determine the effectiveness of a contextualized and non-contextualized add-on intervention for improving hand washing (HW) behavior. Secondary objectives include the impact on latrine use, health, coverage of HW and latrine infrastructure, quality of life, and cost-effectiveness.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-04-23
• Study First Submitted: 2018-10-02
• Study First Submitted QC: 2018-10-12
• Study First Posted: 2018-10-17
• Primary Completion: 2021-05-31
• Study Completion: 2021-05-31
• Status Verified: 2022-03
• Last Update Submitted: 2022-03-08
• Last Update Posted: 2022-03-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1500

Inclusion Criteria

• All people above 18 years of age.

Exclusion Criteria

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control	Placebo poster	Hardware CLTS+PHAST Placebo
Mini-RANAS	PHAST	Hardware CLTS+PHAST mini-RANAS (norms)
RANAS	PHAST	Hardware CLTS+PHAST RANAS (contextualized)
RANAS	RANAS	Hardware CLTS+PHAST RANAS (contextualized)
Mini-RANAS	CLTS	Hardware CLTS+PHAST mini-RANAS (norms)
Mini-RANAS	mini-RANAS	Hardware CLTS+PHAST mini-RANAS (norms)
Control	PHAST	Hardware CLTS+PHAST Placebo
RANAS	Hardware	Hardware CLTS+PHAST RANAS (contextualized)
Control	Hardware	Hardware CLTS+PHAST Placebo
RANAS	CLTS	Hardware CLTS+PHAST RANAS (contextualized)
Mini-RANAS	Hardware	Hardware CLTS+PHAST mini-RANAS (norms)
Control	CLTS	Hardware CLTS+PHAST Placebo

Primary Outcome Measures

Name	Time	Method
Change in hand washing behavior	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	The primary outcome is the percentage of households washing hands. The outcome measure will be obtained by means of a self-developed WASH questionnaire, which involves both multiple choice questions and spot checks.; A household was defined to have correct HW behavior when they: 1) have a HW station available (spot check), 2) have water and soap available at the HW station (spot check), and 3) indicate to wash their hands with water and soap (questionnaire). The analysis will be repeated for each of the critical times. Critical times of interest include: after defecation or using the latrine, before cooking or handling food, before eating, and before feeding a child.

Secondary Outcome Measures

Name	Time	Method
Change in EQ-5D-3L	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	The EQ-5D-3L is a validated questionnaire, examining 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. All items are scored on a 3-point Likert scale. Results of the EQ-5D-3L can be used to calculate the quality-adjusted life-year (QALY), a generic measure of disease burden. The QALY will be used to determine the cost-effectiveness of each intervention arm.
Quality of the latrine infrastructure	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	Latrine infrastructure is assessed using a self-developed questionnaire and spot checks. The quality of the latrine infrastructure is scored based on the type of facility (i.e. does it have a roof, a door, etc.) (spot check), the cleanliness (spot check), and the number of people who use the latrine (questionnaire). Information about whether or not the pit has ever been emptied, and how will also be gathered (questionnaire) as this will allow for the measurement of Sustainable Development Goal (SDG) 6 according to the WHO/UNICEF JMP (https://washdata.org/) tools.
Change in latrine use behavior	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	Latrine use is assessed by means of a self-developed WASH questionnaire, involving both multiple choice questions and spot checks.; A household is defined to have correct latrine use behavior when: 1) they have a latrine available (spot check), 2) the latrine minimally includes walls, a roof, a door or curtain, and a slab or concrete floor (spot check), 3) the latrine is clean (spot check), 3) they indicate to normally use the latrine when defecating at home (questionnaire), and 4) they indicate to not defecate in the open when they are at home (questionnaire). A similar analysis will be performed for latrine use behavior when people are elsewhere.
Quality of the hand washing infrastructure	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	Hand washing infrastructure is assessed using a self-developed questionnaire and spot checks. The quality of the HW infrastructure is scored based on the type of HW facility (i.e. running water vs. bucket) (spot check), the presence of water and/or soap (spot check), and whether or not the station is always operational (questionnaire).
Change in health	The outcome is measured at baseline, and after 1 and 2 years of intervention. In addition, a measurement will occur 1 year after the intervention has finished to see whether improvements have been maintained.	Health is assessed using a self-developed health questionnaire. The questionnaire is used to probe the prevalence rates of diarrhea, vomiting, limitations of daily activities, and need for medical care due to diarrheal illness in the past two weeks. The questionnaire also probes about the prevalence rates of hospitalization due to diarrheal illness in the past twelve months. Prevalence is subdivided into people below 5 years of age and people above 5 years of age. In some questions, a distinction was also made between men and women.

Trial Locations

Locations (1)

Tanzania Red Cross Society; 🇹🇿 Kigoma, Tanzania