Spillover Effects of Water, Sanitation, and Hygiene Interventions on Child Health

NCT02396407 | Completed DMC

• 1 other identifier: 1R21HD076216-01A1
• Study Type: interventional
• Target: 1,789
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to measure whether a combined water, sanitation, and hygiene intervention leads to improved health of children who did not receive the intervention themselves and who live within a close vicinity of intervention recipients.

Conditions

Helminthiasis; Diarrhea; Respiratory Infection

Keywords

Chlorine water treatment; Point-of-use water treatment; Household water treatment with safe storage; Handwashing with soap; Hand hygiene; Latrines; Child potties; Intestinal parasitic infection; Soil-transmitted helminths; Water; Sanitation; Handwashing; Diarrhea; Herd immunity; Helminths

Outcome Measures

Primary Outcomes (2)

• Prevalence of soil-transmitted helminths (Ascaris, hookworm, Trichuris)

  Children's stool will be collected. Kato-Katz will be used to detect Ascaris, hookworm, Trichuris ova in stool. Stool samples with any ova will be considered positive.

  Measured approximately 24 months after intervention

• Intensity of soil-transmitted helminth infections (Ascaris, hookworm, Trichuris)

  Children's stool will be collected. Kato-Katz will be used to detect Ascaris, hookworm, Trichuris ova in stool. Intensity will be measured using WHO cutoffs based on the number of eggs per gram of stool (\>=5,000 eggs/gram for Ascaris, \>=1,000 eggs/gram for hookworm, and \>=2,000 eggs/gram for Trichuris).

  Measured approximately 24 months after intervention

Secondary Outcomes (2)

• Diarrhea prevalence

  Measured approximately 24 months after intervention

• Respiratory illness prevalence

  Measured approximately 24 months after intervention

Study Arms (2)

Combined water, sanitation, and hygiene

ACTIVE COMPARATOR

Water quality, Sanitation, Handwashing

Behavioral: Combined water, sanitation, and hygiene

Non-intervention arm

NO INTERVENTION

None. Households will continue their usual practices.

Interventions

Combined water, sanitation, and hygiene BEHAVIORAL

Water: Free chlorine tablets (Aquatabs; NaDCC) and safe storage vessel to treat and store drinking water. Sanitation: Free child potties, sani-scoop hoes to remove feces from household, and latrine upgrades to a dual pit latrine for all households in study compounds. Handwashing: Handwashing stations including soapy water bottles and detergent soap. Local promoters visit study compounds at least monthly to deliver behavior change messages that focus on (1) treating drinking water for children \< 36 months of age, (2) use of latrines for defecation and the removal of human and animal feces from the compound, and (3) handwashing with soap at critical times around food preparation, defecation, and contact with feces.

Combined water, sanitation, and hygiene

Eligibility Criteria

• Age: Up to 60 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Children not enrolled in WASH Benefits who live in a compound within 120 steps (2 minutes walking time) of a compound enrolled in WASH Benefits (combined WSH or control arms) and are 0-60 months 24 months after intervention

You may not qualify if:

• Children enrolled in WASH Benefits
• Children who live in compounds (baris) that share a courtyard with a compound enrolled in the WASH Benefits study
• Children who live in compounds (baris) that share a latrine or handwashing station with a compound enrolled in the WASH Benefits study

Sponsors & Collaborators

• University of California, Berkeley: lead
• International Centre for Diarrhoeal Disease Research, Bangladesh: collaborator
• Stanford University: collaborator
• Bill and Melinda Gates Foundation: collaborator
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

International Centre for Diarrhoeal Disease Research, Bangladesh

Dhaka, Bangladesh

Location

Related Publications (7)

• 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 BACKGROUND

• Lin A, Arnold BF, Afreen S, Goto R, Huda TMN, Haque R, Raqib R, Unicomb L, Ahmed T, Colford JM, Luby SP. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg. 2013 Jul;89(1):130-137. doi: 10.4269/ajtmh.12-0629. Epub 2013 Apr 29.

  PMID: 23629931 BACKGROUND

• Sultana R, Mondal UK, Rimi NA, Unicomb L, Winch PJ, Nahar N, Luby SP. An improved tool for household faeces management in rural Bangladeshi communities. Trop Med Int Health. 2013 Jul;18(7):854-60. doi: 10.1111/tmi.12103. Epub 2013 Apr 5.

  PMID: 23557125 BACKGROUND

• Hulland KR, Leontsini E, Dreibelbis R, Unicomb L, Afroz A, Dutta NC, Nizame FA, Luby SP, Ram PK, Winch PJ. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health. 2013 Sep 23;13:877. doi: 10.1186/1471-2458-13-877.

  PMID: 24060247 BACKGROUND

• Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP. The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013 Oct 26;13:1015. doi: 10.1186/1471-2458-13-1015.

  PMID: 24160869 BACKGROUND

• Vujcic J, Ram PK, Hussain F, Unicomb L, Gope PS, Abedin J, Mahmud ZH, Islam MS, Luby SP. Toys and toilets: cross-sectional study using children's toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices. Trop Med Int Health. 2014 May;19(5):528-36. doi: 10.1111/tmi.12292. Epub 2014 Mar 19.

  PMID: 24645919 BACKGROUND

• Ercumen A, Naser AM, Unicomb L, Arnold BF, Colford JM Jr, Luby SP. Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial. PLoS One. 2015 Mar 27;10(3):e0121907. doi: 10.1371/journal.pone.0121907. eCollection 2015.

  PMID: 25816342 BACKGROUND

Related Links

• WASH Benefits Bangladesh ClinicalTrials.gov Registration
• Description of the design and rationale for WASH Benefits (open access article)

MeSH Terms

Conditions

Helminthiasis; Diarrhea; Respiratory Tract Infections; Intestinal Diseases, Parasitic

Interventions

Sanitation; Hygiene

Condition Hierarchy (Ancestors)

Parasitic Diseases; Infections; Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Respiratory Tract Diseases; Intestinal Diseases; Gastrointestinal Diseases; Digestive System Diseases

Intervention Hierarchy (Ancestors)

Communicable Disease Control; Public Health Practice; Public Health; Environment and Public Health; Therapeutics

Study Officials

• John M Colford, Jr., MD PhD

  University of California, Berkeley

  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: March 18, 2015
• First Posted: March 24, 2015
• Study Start: January 1, 2015
• Primary Completion: May 1, 2016
• Study Completion: May 1, 2016
• Last Updated: October 26, 2016

Record last verified: 2016-10

Locations

BA (1)