WASH Benefits Bangladesh

NCT01590095 | Unknown DMC

• 2 other identifiers: PR-110632011-09-3652 (UC Berkeley)
• Study Type: interventional
• Target: 5,040
• Locations: 1 country
• Sites: 1

Brief Summary

Brief Summary: The purpose of this study is to measure the independent and combined effects of interventions that improve water quality, sanitation, hand washing, and nutrition on child growth and development in the first years of life.

Conditions

Malnutrition; Diarrhea; Child Development

Keywords

Chlorine water treatment; Point-of-use water treatment; Household water treatment with safe storage; Hand washing with soap; Hand hygiene; Latrines; Child potties; Point-of-use fortification; Lipid-based nutrient supplement; Environmental enteropathy; Tropical enteropathy; Gut function; Intestinal parasitic infection; Soil transmitted helminths; Intestinal protozoans; Antibody response; Water; Sanitation; Hand washing; Breast Feeding; Complementary Feeding; Micronutrients; Malnutrition; Nutrition Disorders; Diarrhea; Child Development

Outcome Measures

Primary Outcomes (2)

• Length-for-Age Z-scores

  Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 24monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol.

  Measured 24 months after intervention

• Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence

  Diarrhea is defined as 3+ loose or watery stools in 24 hours or 1+ stools with blood in 24 hours. Diarrhea will be measured in interviews using caregiver-reported symptoms with 2-day and 7-day recall, measured 12- and 24-monthsafter intervention.

  Measured 12- and 24-months after intervention

Secondary Outcomes (4)

• Length-for-Age Z-scores

  Measured 12 months after intervention

• Stunting Prevalence

  Measured 24 months after intervention

• Enteropathy Biomarkers

  Measured 12- and 24 months after intervention

• ASQ Child Development Scores

  Measured 24 months after intervention

Other Outcomes (3)

• Infection with ascaris, trichuris, hookworm, and giardia

  Measured 24 months after interventions began

• Hemoglobin concentration and anemia

  Measured 24 months after interventions began

• Micronutrient status, including iron, vitamin A, folate, and B12

  Measured 24 months after interventions began

Study Arms (7)

Water quality

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Water quality

Sanitation

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Sanitation

Hand washing

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Hand washing

Combined WASH

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Water quality, Sanitation, Hand washing (Combined WASH)

Nutrition

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Nutrition

Nutrition + Combined WASH

ACTIVE COMPARATOR

90 clusters, approx. 720 newborns

Behavioral: Nutrition, Water quality, Sanitation, Hand washing

Non-intervention

NO INTERVENTION

180 clusters, approx. 1,440 newborns

Interventions

Water quality BEHAVIORAL

Hardware: Free supplies chlorine tablets (Aquatabs; NaDCC) and a safe storage vessel to treat and store drinking water. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the treatment of all drinking water for children \< 36 months of age.

Water quality

Sanitation BEHAVIORAL

Hardware: Free child potties, sani-scoop hoes to remove feces from household environments, latrine upgrades to a dual pit latrine Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the use of latrines for defecation and the removal of human and animal feces from the compound.

Sanitation

Hand washing BEHAVIORAL

Hardware: Hand washing stations, soapy water bottles located at hand washing locations, detergent soap to supply soapy water bottles. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on hand washing with soap at critical times around food preparation, defecation, and contact with feces.

Hand washing

Water quality, Sanitation, Hand washing (Combined WASH) BEHAVIORAL

Hardware: Free supplies Aquatabs; (NaDCC) and a safe storage vessel to treat and store drinking water. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the treatment of all drinking water for children \< 36 months of age. Hardware: Free child potties, sani-scoop hoes to remove feces from household environments, latrine upgrades to a dual pit latrine. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the use of latrines for defecation and the removal of human and animal feces from the compound. Hardware: Hand washing stations, soapy water bottles located at hand washing locations, detergent soap to supply soapy water bottles. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on hand washing with soap at critical times around food preparation, defecation, and contact with feces.

Combined WASH

Nutrition BEHAVIORAL

Supplement: Lipid-based Nutrient Supplement (LNS) delivered daily from ages 6 to 24 months. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages modeled on those recommended in the Guiding Principles for Complementary Feeding of the Breastfed Child and the recent UNICEF Program Guide for Infant and Young Child Feeding Practices.General messages will include (1) practice exclusive breastfeeding from birth to 6 months of age and introduce complementary foods at 6 months of age while continuing to breastfeed; (2) continue breast feeding as you did before receiving LNS; (3) provide your child micronutrient-rich foods such as meat, fish, eggs, and vitamin A rich fruits and vegetables; and (4) feed your child at least 2-3 times per day when 6-8 months old and 3-4 times per day when 9-24 months old.

Nutrition

Nutrition, Water quality, Sanitation, Hand washing BEHAVIORAL

Each of the interventions described above for Water Quality, Sanitation \& Hand washing (Combined WASH) Plus the intervention described above for nutrition.

Nutrition + Combined WASH

Eligibility Criteria

• Age: 1 Day - 63 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• (1) Infants (target child) will be eligible to participate in the study if they are:
• They are in utero at the baseline survey
• Their parents/guardians are planning to stay in the study village for the next 12 months (if a mother is planning to give birth at her natal home and then return, she will still be a candidate for enrollment)
• (2) Children \< 36 months old at baseline that are living in the compound of a target child will be eligible to participate in diarrhea measurement if:
• They are \< 36 months old at the baseline survey
• Their parents/guardians are planning to stay in the study village for the next 12 months
• (3) Children 18 - 27 months old at baseline that are living in the compound of a target child will be eligible to participate in intestinal parasite specimen collection if:
• They are 18 - 27 months old at the baseline survey
• Their parents/guardians are planning to stay in the study village for the next 12 months

Sponsors & Collaborators

• International Centre for Diarrhoeal Disease Research, Bangladesh: lead
• University of California, Berkeley: collaborator
• University of California, Davis: collaborator
• Stanford University: collaborator
• Emory University: collaborator
• Innovations for Poverty Action: collaborator

Study Sites (1)

Dr. Mahbubur Rahman

Dhaka, 1212, Bangladesh

Location

Related Publications (17)

• Chen B, Mertens AN, Lin CH, Tan ST, Jamshed F, Figueroa D, Hemlock C, Butzin-Dozier Z, Fernald LC, Stewart CP, Hubbard AE, Rahman MZ, Ali S, Arnold BF, Dhabhar FS, Granger DA, Rahman M, Luby SP, Colford JM Jr, Lin A. Associations Between Micronutrient Status, Hormones, and Immune Status During Pregnancy and Child Growth in Rural Bangladesh: A Prospective Cohort Study. Curr Dev Nutr. 2025 Nov 8;9(12):107596. doi: 10.1016/j.cdnut.2025.107596. eCollection 2025 Dec.

  PMID: 41467215 DERIVED

• Tofail F, Pitchik HO, Islam M, Khan R, Shoab AK, Akter F, Aktar S, Huda TMN, Rahman M, Winch PJ, Luby SP, Fernald LCH. Effects of early water, sanitation, handwashing, and nutrition interventions on child development at school age: a follow-on study of a cluster-randomized trial in rural Bangladesh. PLoS Med. 2025 Dec 16;22(12):e1004793. doi: 10.1371/journal.pmed.1004793. eCollection 2025 Dec.

  PMID: 41401135 DERIVED

• Lin A, Mertens AN, Rahman MZ, Tan ST, Il'yasova D, Spasojevic I, Ali S, Stewart CP, Fernald LCH, Kim L, Yan L, Meyer A, Karim MR, Shahriar S, Shuman G, Arnold BF, Hubbard AE, Famida SL, Akther S, Hossen MS, Mutsuddi P, Shoab AK, Shalev I, Rahman M, Unicomb L, Heaney CD, Kariger P, Colford JM Jr, Luby SP, Granger DA. A cluster-randomized trial of water, sanitation, handwashing and nutritional interventions on stress and epigenetic programming. Nat Commun. 2024 Apr 26;15(1):3572. doi: 10.1038/s41467-024-47896-z.

  PMID: 38670986 DERIVED

• Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM Jr, Ercumen A. Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh. PLoS Med. 2022 Aug 8;19(8):e1004041. doi: 10.1371/journal.pmed.1004041. eCollection 2022 Aug.

  PMID: 35939520 DERIVED

• Lin A, Mertens AN, Arnold BF, Tan S, Lin J, Stewart CP, Hubbard AE, Ali S, Benjamin-Chung J, Shoab AK, Rahman MZ, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Naved RT, Mamun MMA, Parvin K, Dhabhar FS, Kariger P, Fernald LC, Luby SP, Colford JM Jr. Telomere length is associated with growth in children in rural Bangladesh. Elife. 2021 Sep 8;10:e60389. doi: 10.7554/eLife.60389.

  PMID: 34494545 DERIVED

• Kwong LH, Sen D, Islam S, Shahriar S, Benjamin-Chung J, Arnold BF, Hubbard A, Parvez SM, Islam M, Unicomb L, Rahman MM, Nelson K, Colford JM Jr, Luby SP, Ercumen A. Effect of sanitation improvements on soil-transmitted helminth eggs in courtyard soil from rural Bangladesh: Evidence from a cluster-randomized controlled trial. PLoS Negl Trop Dis. 2021 Jul 28;15(7):e0008815. doi: 10.1371/journal.pntd.0008815. eCollection 2021 Jul.

  PMID: 34319986 DERIVED

• Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Longitudinal Effects of a Sanitation Intervention on Environmental Fecal Contamination in a Cluster-Randomized Controlled Trial in Rural Bangladesh. Environ Sci Technol. 2021 Jun 15;55(12):8169-8179. doi: 10.1021/acs.est.1c01114. Epub 2021 Jun 4.

  PMID: 34086447 DERIVED

• Parvez SM, Rahman MJ, Azad R, Rahman M, Unicomb L, Ashraf S, Mondol MH, Jahan F, Winch PJ, Luby SP. Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh. Int J Equity Health. 2021 Jan 6;20(1):16. doi: 10.1186/s12939-020-01353-7.

  PMID: 33407549 DERIVED

• Ercumen A, Benjamin-Chung J, Arnold BF, Lin A, Hubbard AE, Stewart C, Rahman Z, Parvez SM, Unicomb L, Rahman M, Haque R, Colford JM Jr, Luby SP. Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: A cluster-randomized controlled trial in rural Bangladesh. PLoS Negl Trop Dis. 2019 May 3;13(5):e0007323. doi: 10.1371/journal.pntd.0007323. eCollection 2019 May.

  PMID: 31050672 DERIVED

• Lin A, Ali S, Arnold BF, Rahman MZ, Alauddin M, Grembi J, Mertens AN, Famida SL, Akther S, Hossen MS, Mutsuddi P, Shoab AK, Hussain Z, Rahman M, Unicomb L, Ashraf S, Naser AM, Parvez SM, Ercumen A, Benjamin-Chung J, Haque R, Ahmed T, Hossain MI, Choudhury N, Jannat K, Alauddin ST, Minchala SG, Cekovic R, Hubbard AE, Stewart CP, Dewey KG, Colford JM, Luby SP. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh. Clin Infect Dis. 2020 Feb 14;70(5):738-747. doi: 10.1093/cid/ciz291.

  PMID: 30963177 DERIVED

• Stewart CP, Dewey KG, Lin A, Pickering AJ, Byrd KA, Jannat K, Ali S, Rao G, Dentz HN, Kiprotich M, Arnold CD, Arnold BF, Allen LH, Shahab-Ferdows S, Ercumen A, Grembi JA, Naser AM, Rahman M, Unicomb L, Colford JM Jr, Luby SP, Null C. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. Am J Clin Nutr. 2019 Jan 1;109(1):148-164. doi: 10.1093/ajcn/nqy239.

  PMID: 30624600 DERIVED

• Parvez SM, Azad R, Rahman M, Unicomb L, Ram PK, Naser AM, Stewart CP, Jannat K, Rahman MJ, Leontsini E, Winch PJ, Luby SP. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials. 2018 Jul 6;19(1):358. doi: 10.1186/s13063-018-2710-8.

  PMID: 29976251 DERIVED

• Rahman M, Ashraf S, Unicomb L, Mainuddin AKM, Parvez SM, Begum F, Das KK, Naser AM, Hussain F, Clasen T, Luby SP, Leontsini E, Winch PJ. WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. Trials. 2018 Jul 6;19(1):360. doi: 10.1186/s13063-018-2708-2.

  PMID: 29976234 DERIVED

• Lin A, Ercumen A, Benjamin-Chung J, Arnold BF, Das S, Haque R, Ashraf S, Parvez SM, Unicomb L, Rahman M, Hubbard AE, Stewart CP, Colford JM Jr, Luby SP. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial. Clin Infect Dis. 2018 Oct 30;67(10):1515-1522. doi: 10.1093/cid/ciy320.

  PMID: 29669039 DERIVED

• Tofail F, Fernald LC, Das KK, Rahman M, Ahmed T, Jannat KK, Unicomb L, Arnold BF, Ashraf S, Winch PJ, Kariger P, Stewart CP, Colford JM Jr, Luby SP. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018 Apr;2(4):255-268. doi: 10.1016/S2352-4642(18)30031-2.

  PMID: 29616235 DERIVED

• Lin A, Arnold BF, Mertens AN, Lin J, Benjamin-Chung J, Ali S, Hubbard AE, Stewart CP, Shoab AK, Rahman MZ, Hossen MS, Mutsuddi P, Famida SL, Akther S, Rahman M, Unicomb L, Dhabhar FS, Fernald LCH, Colford JM Jnr, Luby SP. Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh. Elife. 2017 Oct 5;6:e29365. doi: 10.7554/eLife.29365.

  PMID: 28980942 DERIVED

• Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, Ahmed T, Ashraf S, Christensen G, Clasen T, Dentz HN, Fernald LC, Haque R, Hubbard AE, Kariger P, Leontsini E, Lin A, Njenga SM, Pickering AJ, Ram PK, Tofail F, Winch PJ, Colford JM Jr. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open. 2013 Aug 30;3(8):e003476. doi: 10.1136/bmjopen-2013-003476.

  PMID: 23996605 DERIVED

Related Links

• Related protocol
• Click here for more informaiton about the study

MeSH Terms

Conditions

Malnutrition; Diarrhea; Sprue, Tropical; Intestinal Diseases, Parasitic; Breast Feeding; Nutrition Disorders

Interventions

Water Quality; Sanitation; Hand Disinfection; Nutritional Status

Condition Hierarchy (Ancestors)

Nutritional and Metabolic Diseases; Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Malabsorption Syndromes; Intestinal Diseases; Gastrointestinal Diseases; Digestive System Diseases; Metabolic Diseases; Parasitic Diseases; Infections; Feeding Behavior; Behavior

Intervention Hierarchy (Ancestors)

Environmental Monitoring; Environmental Exposure; Environmental Pollution; Public Health; Environment and Public Health; Water Pollution; Communicable Disease Control; Public Health Practice; Hand Hygiene; Hygiene; Nutritional Physiological Phenomena; Diet, Food, and Nutrition; Physiological Phenomena; Health Status; Demography; Population Characteristics

Study Officials

• Stephen P Luby, MD

  Stanford University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 30, 2012
• First Posted: May 2, 2012
• Study Start: May 1, 2012
• Primary Completion: December 1, 2022
• Study Completion: December 1, 2022
• Last Updated: April 13, 2022

Record last verified: 2022-01

Locations

BA (1)