Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia

NCT03174015 | Completed DMC

• 1 other identifier: QA_840
• Study Type: interventional
• Target: 1,085
• Locations: 1 country
• Sites: 1

Brief Summary

This intervention will experimentally test the hypothesis that sanitation can be improved in a peri-urban setting using state-of-the-art behaviour change communications. Formative research indicated that landlords are the effective decision-makers about investments in sanitation on their plots (which can include a number of tenant households as well). Landlords will therefore be the primary targets of the intervention. The study will take the form of a randomized controlled trial of the intervention evaluated at the plot level. The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s). The desired improvements will be measured via multiple primary outcomes that measure aspects of changes to hardware and software components, including indicators of hygienic quality, psychological desirability, accessibility, and ecological sustainability. This is because the investigators argue that, to have a significant impact on population-level diarrheal disease indicators, any sanitation solution must be:

• effective at reducing exposure to pathogens (i.e., hygienic),
• desirable (i.e., seen as valuable or humane), and
• accessible (i.e., no one excluded), so that it can be used by all
• for a reasonably long time (i.e., sustainable)

Conditions

Diarrhea

Keywords

Sanitation; Demand; Peri-urban; Behavior Change; Lusaka; Zambia

Outcome Measures

Primary Outcomes (4)

• Having a hole-cover or water-sealed pan

  Reduces spread of pathogens by creating barrier between containment and above-ground environment

  5 months after intervention begins

• Having a latrine door that locks from the inside

  Provide safety and privacy for toilet users

  5 months after intervention begins

• Having a latrine door that locks from the outside

  Exclude those not living on the plot from the toilet

  5 months after intervention begins

• Having a rotational cleaning system in place

  To maintain hygienic condition of the toilet interface

  5 months after intervention begins

Secondary Outcomes (6)

• Willingness to pay

  5 months after intervention begins

• Attitudes towards sanitation

  5 months after intervention begins

• Financial preparation for toilet improvement

  5 months after intervention begins

• Partial construction progress towards toilet improvement

  5 months after intervention begins

• Peri-urban Healthy Toilet Index

  5 months after intervention begins

Study Arms (2)

Intervention

EXPERIMENTAL

Landlords on selected plots will receive the "Bauleni Secret" intervention. Landlords and selected tenants will be surveyed in baseline/end-line data collection.

Behavioral: Bauleni Secret

Control

NO INTERVENTION

Landlords and selected tenants will be surveyed in baseline/end-line data collection only.

Interventions

Bauleni Secret BEHAVIORAL

The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s).

Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Plot located in Bauleni compound
• Adult landlord (age 18 or higher) resides on plot

You may not qualify if:

• \* None
• Data will be collected from the landlord and one randomly selected tenant from all eligible adult tenants on each plot.
• \* Adult landlord or tenant (age 18 or higher) resides on selected plot most of the time
• \* None

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine: lead
• Centre for Infectious Disease Research in Zambia: collaborator

Study Sites (1)

Bauleni Compound

Lusaka, Zambia

Location

Related Publications (1)

• Tidwell JB, Chipungu J, Bosomprah S, Aunger R, Curtis V, Chilengi R. Effect of a behaviour change intervention on the quality of peri-urban sanitation in Lusaka, Zambia: a randomised controlled trial. Lancet Planet Health. 2019 Apr;3(4):e187-e196. doi: 10.1016/S2542-5196(19)30036-1.

  PMID: 31029230 DERIVED

Related Links

• Study website

MeSH Terms

Conditions

Diarrhea

Condition Hierarchy (Ancestors)

Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Robert Aunger, PhD

  London School of Hygiene and Tropical Medicine

  PRINCIPAL INVESTIGATOR

• Roma Chilengi, MD

  Center for Infectious Disease Research in Zambia

  PRINCIPAL INVESTIGATOR

• Valerie Curtis, PhD

  London School of Hygiene and Tropical Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The study will be partially single blinded. Participants and investigators cannot be masked to the intervention but outcome assessors will not know where the intervention has taken place and will be given only minimal information to enable assessment of intervention exposure at the end of the survey.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: A random sample of plots will be selected in Bauleni Compound and invited to participate. Intervention allocation will also be randomized, with approximately equal numbers of plots allocated to the intervention and control arms. Within the chosen plots, resident landlord households will receive the intervention and resident landlord households and one randomly selected tenant household will be chosen for data collection for both intervention and control plots.

Study Record Dates

• First Submitted: February 22, 2017
• First Posted: June 2, 2017
• Study Start: August 7, 2017
• Primary Completion: March 5, 2018
• Study Completion: March 5, 2018
• Last Updated: April 25, 2019

Record last verified: 2019-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: Data will be available from approximately June 2018 for at least 5 year on study website.
• Access Criteria: Data will be accessible with consent from study PIs per submitted proposals and protocols.

Locations

ZA (1)