Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster‐randomised controlled trial of the CHoBI7 mobile health program

Abstract

Objective The Cholera‐Hospital‐Based‐Intervention‐for‐7‐days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members. Methods A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The ‘Standard Message’ Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The ‘Health Facility Visit + Soapy Water’ Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The ‘Health Facility Visit + Handwashing Station’ Arm received this same intervention plus a small plastic handwashing station. Within 24 h of intervention delivery, three‐hour structured observation of handwashing practices at stool/vomit‐ and food‐related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members. Results Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit + Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14). Conclusion These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.

Mobile Health Technologies Are Essential for Reimagining the Future of Water, Sanitation, and Hygiene

“…29,37,38 However, evidence is limited about successful integration of mHealth applications and their effectiveness for environmental health interventions-especially in urban communities where this work is critical. [39][40][41][42] Potential examples of mHealth deployment [43][44][45] to meet urban sanitation challenges are highlighted in Figure 1 and include interactive messages, uploading and geotagging of pictures to report and record the location of environmental issues, and user-provider feedback loops. 26 In many settings, evidence shows that mHealth approaches can be highly cost-effective and scalable.…”

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

“…44 A second cohort study in this population assessed the association between soil-and object-to-mouth contacts and diarrhea prevalence for children under 5 years of age, and found that the odds of having a diarrhea episode in the subsequent month were significantly higher for children with caregiver reports of mouthing feces within the past week. 16 Additional publications document the CHoBI7 mHealth program effect on handwashing with soap while in the hospital, 45 diarrheal disease knowledge, 46 process evaluation for CHoBI7 mobile health program delivery, 47 and recent formative research to develop a CHoBI7 Baby WASH mHealth program targeting safe child feces disposal, improved food hygiene, and safe child mouthing practices. 48 This prospective cohort study, also nested within the recent CHoBI7 mHealth program RCT, adds to this body of literature by investigating the environmental and individual-level risk factors for diarrheal disease among children under 5 years of age residing in slum areas of Dhaka, Bangladesh.…”

Role of seasonality variation in prevalence and trend of childhood wasting in India: An empirical analysis using National Family Health Surveys, 2005–2021

“…There is a concomitant occurrence between wasting, stunting, and diarrhea. Dehydrating diarrhea is reported more frequently (69%) among children with severe wasting and severe stunting than among children with severe wasting (55%) or severe stunting (43%) 28 . A recent study in Odisha, India found that around 24% of children suffered from wasting during the monsoon season as compared to only 16% in the winter season 24 .…”