Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

• Published in: Bulletin of the World Health Organization Vol. 99; no. 11; pp. 762 - 772
• Main Authors: Aragie, Solomon, Tadesse, Wondyifraw, Dagnew, Adane, Hailu, Dagnachew, Dubie, Melese, Wittberg, Dionna M, Melo, Jason S, Haile, Mahteme, Zeru, Taye, Freeman, Matthew C, Nash, Scott D, Callahan, E Kelly, Tadesse, Zerihun, Arnold, Benjamin F, Porco, Travis C, Lietman, Thomas M, Keenan, Jeremy D
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.11.2021
• Subjects: Child; Child, Preschool; Ethiopia; Humans; Hygiene; Infant; Infant, Newborn; Sanitation; Toilet Facilities; Trachoma - prevention & control; Ethiopia
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.21.285915

To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control. 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. 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. 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.