WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial

Unicomb, Leanne; Begum, Farzana; Leontsini, Elli; Rahman, Mahbubur; Ashraf, Sania; Naser, Abu Mohd; Nizame, Fosiul Alam; Jannat, Kaniz; Hussain, Faruqe; Parvez, Sarker Masud; Arman, Shaila; Mobashara, Moshammot; Luby, Stephen P.; Winch, Peter J.

doi:10.1186/s13063-018-2709-1

Cited by 23 publications

(32 citation statements)

References 33 publications

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“…Four studies evaluated sanitation hardware and behaviour change interventions, which included the provision of child sanitation hardware (potties and sani‐scoops) and behaviour messaging (Caruso 2019 IND; Christensen 2015a KEN; Luby 2018 BGD; Null 2018 KEN). Three of these trials were from WASH Benefits (WASH B) study, one from the pilot in Kenya (Christensen 2015a KEN), and on the main outcomes from Kenya (Null 2018 KEN) and Bangladesh (Luby 2018 BGD). The WASH B studies included several study arms, for this review we included only the sanitation versus control results as they were most relevant.…”

Section: Resultsmentioning

confidence: 99%

“…Stanton 1987 BGD was conducted in urban Bangladesh; Barrios 2008 PHI in rural Philippines; Cameron 2013 INA in rural Indonesia; Caruso 2019 IND, Dickinson 2015 IND, Nair 2017 IND, and Patil 2014 IND in rural India; and Luby 2018 BGD in rural Bangladesh. Altmann 2018 TCD was conducted in Chad, Briceño 2015 TAN in rural Tanzania, Christensen 2015a KEN and Null 2018 KEN in rural Kenya, Haggerty 1994 DRC in rural Democratic Republic of Congo (DRC), Hashi 2017 ETH in rural Ethiopia, Jinadu 2007 NGR in rural Nigeria, Pickering 2015 MLI in rural Mali, Sarrassat 2018 BUR in rural Burkina Faso, Sinharoy 2017 RWA in rural Rwanda, and Humphrey 2019 ZIM in rural Zimbabwe.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Majorin

Torondel

Chan

et al. 2019

Cochrane Database of Systematic Reviews

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BackgroundDiarrhoea and soil‐transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low‐income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation.ObjectivesTo assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018.Selection criteriaWe included randomized controlled trials (RCTs) and non‐randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults.Data collection and analysisTwo review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta‐analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach.Main resultsSixty‐three studies covering more than 222,800 participants met the inclusion criteria. Twenty‐two studies were cluster RCTs, four were controlled before‐and‐after studies (CBA), and 37 were NRS (27 case‐control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross‐sectional studies). Most study sites (56/69) were in low‐ or lower middle‐income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low‐certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low‐certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low‐certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoe...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Majorin

Torondel

Chan

et al. 2019

Cochrane Database of Systematic Reviews

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“…This was followed by regular monthly meeting between supervisors and CHPs. Refresher training was also arranged about a year after initiation of intervention (Unicomb et al, 2018). Each cluster of 6–8 months was monitored by one CHP.…”

Section: Methodsmentioning

confidence: 99%

Snack food consumption among Bangladeshi children, supplementary data from a large RCT

Jannat

Luby

Unicomb

et al. 2020

Maternal & Child Nutrition

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Childhood obesity has been associated with consumption of energy‐dense foods such as caloric beverages and fast foods. Many low‐ and middle‐income countries like Bangladesh are now experiencing a rising problem of noncommunicable diseases along with the long‐standing problem of stunting and undernutrition. WASH Benefits Bangladesh was a large community‐based cluster randomized controlled trial conducted in rural Bangladesh. Study clusters were randomized into seven arms: single nutrition (N); water (W); sanitation (S); hygiene (H); combined water, sanitation, and hygiene (WSH); WSH and nutrition (N + WSH); and a double sized control (C). Nutrition intervention messages included four promotional components: maternal nutrition, breastfeeding, complementary feeding, and lipid‐based nutrient supplements. The World Health Organization infant food frequency questionnaire (24‐hr recall and 7‐day recall) was administered at Year 1 and Year 2 of intervention. The likelihood of any snack food consumption was significantly lower (odds ratio 0.37: 95% confidence interval [0.28, 0.49]) in the nutrition intervention arms compared to the control arm in Year 2 follow‐up. In addition, in the water intervention arm, fewer children (about 50% less) consumed soft drinks, but not the other sugar‐sweetened beverages, compared with control in Year 2. There were no other differences between groups. Simple messages about balanced diet and feeding family foods were effective in lowering commercially produced snack food consumption of the young children in low‐income rural communities of Bangladesh. Provision of safe water apparently encouraged mothers to reduce offering unhealthy beverages to the young children.

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“…Hence, human feces were observed in 21% of sanitation-arm compounds and 30% of control-arm compounds at the time of our STH assessment (33). Further details of the trial design, intervention delivery and uptake assessments have been described elsewhere (33,(35)(36)(37).…”

Section: Intervention Uptakementioning

confidence: 99%

Effect of sanitation improvements on soil-transmitted helminth eggs in courtyard soil from rural Bangladesh: Evidence from a cluster-randomized controlled trial

Kwong

Sen

Islam

et al. 2020

Preprint

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Improved sanitation has been hypothesized to reduce soil-transmitted helminth (STH) infections by reducing the prevalence and abundance of STH eggs/larvae in soil. We evaluated the effect of a randomized sanitation program (providing households with an improved dual-pit latrine, tools for child/animal feces management, and behavioral messaging) on reducing STH eggs in soil from household courtyards. We collected soil samples from 1405 households enrolled in the sanitation intervention (n=419) and control (n=914) groups of a cluster-randomized controlled trial (WASH Benefits) in rural Bangladesh approximately 2 years after the initiation of the interventions. We analyzed samples for Ascaris lumbricoides, Trichuris trichiura, and hookworm eggs by microscopy. We estimated prevalence ratios (PR) and relative egg count reductions (ECR) to compare the prevalence of any STH eggs and arithmetic and geometric mean egg counts for any STH per gram of soil between the sanitation and control arms.Among intervention households, latrines achieved high and sustained user uptake by adults while child open defecation remained common and most households did not dispose of child feces hygienically. In courtyard soil from control households, the prevalence of any STH eggs was 75.7% and the prevalence of any larvated STH eggs was 67.3%. A. lumbricoides was detected in 63.0% of control samples and T. trichiura in 55.7% of control samples; hookworm was not detected in any sample. The arithmetic mean egg count for any STH was 3.96 eggs/dry gram, while the geometric mean was 1.58 eggs/dry gram. There was no difference between the intervention and control groups in the prevalence of any STH eggs (PR=0.98 (95% CI: 0.91–1.05)) or mean egg counts (ECR=0.08 (95% CI: −0.10, 0.26) for geometric mean and 0.07 (95% CI: −0.22, 0.37) for arithmetic mean). Adjusted models gave similar results.A compound-level sanitation intervention that provided improved latrines and tools for disposal of child and animal feces did not have an impact on environmental reservoirs of STH eggs. In order to effectively reduce the prevalence and abundance of STH eggs in the environment, sustained, widespread use of sanitation strategies to isolate and hygienically dispose of child and animal feces may need to complement traditional strategies for containment of adult human feces.Author summaryImproved sanitation has been hypothesized to reduce soil-transmitted helminth (STH) infections by reducing the prevalence and abundance of STH eggs/larvae in soil. We evaluated the effect of a randomized sanitation program (providing households with an improved dual-pit latrine, tools for child/animal feces management, and behavioral messaging) on reducing STH eggs in soil from household courtyards. We collected soil samples from 1405 households enrolled in the control and sanitation groups of a cluster-randomized controlled trial (WASH Benefits) in rural Bangladesh approximately 2 years after the initiation of the interventions. We analyzed samples for Ascaris lumbricoides, Trichuris trichiura and hookworm eggs by microscopy. We found no effect of the sanitation intervention on STH eggs in soil. In order to effectively reduce the prevalence and abundance of STH eggs in the environment, sustained, widespread use of sanitation strategies to isolate and hygienically dispose of child and animal feces may need to complement traditional strategies for containment of adult human feces.

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WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial

Cited by 23 publications

References 33 publications

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Snack food consumption among Bangladeshi children, supplementary data from a large RCT

Effect of sanitation improvements on soil-transmitted helminth eggs in courtyard soil from rural Bangladesh: Evidence from a cluster-randomized controlled trial

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