The Impact of Enhanced, Demand-side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

Not Applicable

Completed

Interventions: Behavioral: Enhanced demand-side sanitation, hygiene
Behavioral: Standard of care

Brief Summary: This study is a two-year evaluation investigating the impacts of an enhanced, demand-side sanitation and hygiene intervention on sustainable adoption of improved water, sanitation, and hygiene (WASH) practices and mental well-being.

Detailed Description: This study utilizes a cluster randomized, controlled trial design to examine the impacts of an enhanced, demand-side sanitation and hygiene intervention on behavior change and health in Amhara, Ethiopia. The study will test hypotheses set out in the investigation team's theory of change through the measurement and evaluation of process indicators, intermediate and shorter-term behavioral outcomes, and longer-term behavioral and health impacts, including mental well-being.

The study aims to: (1) identify ways in which WASH-related behavior change components preventive for neglected tropical diseases (NTDs) can be mainstreamed into the government-led Health Extension Program; (2) document the effectiveness of an enhanced demand-side sanitation and hygiene intervention; (3) investigate whether changes in personal hygiene, sanitation, and water behaviors are sustained; (4) document the cost-effectiveness of integrated WASH-related NTD-preventive behavior change promotion; and (5) assess whether collective efficacy and water security modify intervention effectiveness.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Enhanced demand-side sanitation, hygiene	Enhanced demand-side sanitation, hygiene	The intervention group will receive a package of enhanced, demand-side sanitation and hygiene interventions that are informed by formative research and facilitated by local government and Emory Ethiopia partners.
Standard of care	Standard of care	The comparison group will receive the current standard of care, including potential implementation of government-led policies and programs.

Primary Outcome Measures

Name	Time	Method
Sustainability of WASH-related behaviours, including NTD-preventive WASH behavior measures	Endline (Up to two years)	Sustainability of WASH-related behaviors, as measured through changes in the proportion of individuals and households practicing targeted improved NTD-preventive WASH behaviors.
Mental well-being measures	Up to two years	Mental well-being, as measured through the changes in mental well-being scale scores

Secondary Outcome Measures

Name	Time	Method
Shorter-term behavioral outcome measures	Up to two years	Proportion of households with improved or shared, but otherwise improved household latrine and washing facilities that are functional and available for use; proportion of households using functional latrines and washing facilities; proportion of households with all members exclusively using a latrine for defecation purposes; proportion of households disposing of child feces in an improved latrine; proportion of households with all children in the household with a clean face and hands.
Collective efficacy measures	Up to two years	Collective efficacy, as measured through changes in collective efficacy scale scores
Intermediate behaviour change antecedent measures	Up to two years	Proportion of households with improved knowledge regarding the implications of improved WASH practices; proportion of households that indicate positive attitudes, perceptions toward improved sanitation and good hygiene practices; change in normative beliefs and behaviors related to open defecation, exclusive latrine use for defecation, and personal hygiene practices.
Sanitation insecurity measures	Up to two years	Sanitation insecurity, as measured through changes in sanitation insecurity scale scores
Water insecurity measures	Up to two years	Water insecurity, as measured through changes in water insecurity scale scores