Effect of Water, Sanitation and Hygiene Educational Intervention on Incidence of Diarrhea and Childhood Stunting Among Under Five Children in Bule Hora Wereda, Southern Ethiopia

NCT07867860 | Completed

• 1 other identifier: Bule Hora University
• Study Type: interventional
• Target: 287
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Childhood malnutrition and diarrhea remains life-threatening, yet these conditions are preventable. Water, Sanitation, and Hygiene (WASH) interventions are among the most effective measures against diarrhea and stunting. Objective: To evaluate the effect of WASH education intervention on incidence of diarrhea and childhood stunting among under-five children in Southern Ethiopia. Methods: A Community based cluster randomized controlled trial was conducted in Bule Hora Woreda, West Guji Zone, Southern Ethiopia from November 1, 2024 - April 30, 2025. A total sample of 26 clusters (13 intervention groups and 13 control groups) were randomly selected and assigned to the intervention and control groups. Diarrhea incidence was measured through caregiver reporting of diarrheal episodes over 2 weeks for 6 month. Stunting was assessed using standardized anthropometry and calculated height-for-age Z-scores based on WHO growth standards. Generalized estimating equation with log link Poisson distribution family was used to assess the effect of intervention after adjusting for potential confounders.

Conditions

Diarrhea; Stunting; Children Under 5 Years

Keywords

WASH Intervention; incidence of diarrhea; Stunting; Cluster randomized trial; Ethiopia

Outcome Measures

Primary Outcomes (1)

• The effect of WASH education intervention on incidence of diarrhea among under-five children in Bule hora wereda, Southern Ethiopia

  The primary outcome was incidence of diarrhea at every 2 weeks period. Primary care takers were instructed to follow the child and report incidence of diarrhea in the previous two weeks. One health extension workers from each cluster was recruited and trained to collect information on the longitudinal incidence of diarrhea. These health extension workers visited each enrolled household every 2 weeks for 6 months after baseline. The bi-monthly report included information on any episodes of diarrhea for each under five child of the household.

  6 months

Secondary Outcomes (1)

• The effect of WASH education intervention on childhood stunting among under-five children in Bule hora wereda, Southern Ethiopia

  6 months

Study Arms (2)

13 clusters in Berdaye district

EXPERIMENTAL

From 6 districts that originally organized by the Bule Hora woreda health office for the ease of health service program implementation, 2 districts were randomly selected. Accordingly, Garba district containing 10 kebeles ((54 sub-kebeles)), which is found at the north direction from the Bule Hora town, and the Berdaye district containing 9 kebeles (47 sub-kebeles) that found at the southern direction from the Bule Hora town was selected to include in the study. Besides, from each of the north and south districts 3 kebeles (that accounts 30% of the total kebeles in each cluster) was randomly selected. The selected kebele was further divided in to sub-kebelles (neighbourhood villages). Finally, 26 Sub-kebeles (Clusters), 13 from Gerba district in the north direction and 13 from Berdaye district in the south direction were selected randomly and assigned to the intervention and control group respectively.

Other: WASH Education Intervention

Control Arm: 13 clusters in Gerba district

NO INTERVENTION

From 6 districts that originally organized by the Bule Hora woreda health office for the ease of health service program implementation, 2 districts were randomly selected. Accordingly, Garba district containing 10 kebeles ((54 sub-kebeles)), which is found at the north direction from the Bule Hora town, and the Berdaye district containing 9 kebeles (47 sub-kebeles) that found at the southern direction from the Bule Hora town was selected to include in the study. Besides, from each of the north and south districts 3 kebeles (that accounts 30% of the total kebeles in each cluster) was randomly selected. The selected kebele was further divided in to sub-kebelles (neighbourhood villages). Finally, 26 Sub-kebeles (Clusters), 13 from Gerba district in the north direction and 13 from Berdaye district in the south direction were selected randomly and assigned to the intervention and control group respectively.

Interventions

WASH Education Intervention OTHER

Health education on key hygiene and environmental sanitation components of the Ethiopian Health Extension Program, plus handwashing-with-soap for demonstration.

13 clusters in Berdaye district

Eligibility Criteria

• Age: 6 Months - 59 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

* A household that have at least one child aged 6-59 months living in the home * Not a model household

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• Bule Hora University: lead

Study Sites (1)

Bule Hora University

Addis Ababa, Oromiya, 144, Ethiopia

Location

Related Publications (1)

• 1. Merid MW, Alem AZ, Chilot D, Belay DG. Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: a propensity score matched analysis. Trop Med Health [Internet]. 2023;51:36. Available from: https://doi.org/10.1186/s41182-023-00525-92. Dhital SR, Chojenta C, Loxton D, Asia E. Effects of mothers' water, sanitation and hygiene habits on diarrhoea and malnutrition among children under 5 years in Nepal. BMJ Public Heal. 2025;3(e001815). 3. Auma B, Id MM, Ojuka E, Kigongo E, Tumwesigye R, Id WA, et al. Prevalence of diarrhea and water sanitation and hygiene (WASH) associated factors among children under five years in Lira City Northern Uganda: Community based study. PLoS One [Internet]. 2024;425:1-14. Available from: http://dx.doi.org/10.1371/journal.pone.03050544. World Health Organization (WHO). Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. 2014. 5. Zhu H, Xu F, Zhao W, Wang H, Wang H. The global burden of childhood diarrhea and its epidemiological characteristics from 1990 to 2021. Front Pediatr [Internet]. 2025;13(1656234):1-13. Available from: doi: 10.3389/fped.2025.16562346. Ri E, Je E, Arikpo D, Mm M, Ja C. Hand washing promotion for preventing diarrhoea (Review). Cochrane Database Syst Rev. 2015;(9). 7. UNICEF. Integrating water, sanitation and hygiene interventions across sectors to impact child health outcomes. In: Baby WASH Programming. 2020. 8. Ademas A, Adane M, Keleb A, Berihun G, Tesfaw G. Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study. Ital J Pediatr. 2021;47(174):1-11. 9. GBD 2019 Ethiopia Subnational-Level Disease Burden Initiative Collaborators. Progress in health among regions of Ethiopia, 1990-2019: a subnational country analysis for the Global Burden of Disease Study 2019

  BACKGROUND

MeSH Terms

Conditions

Diarrhea; Growth Disorders

Condition Hierarchy (Ancestors)

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

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: From 6 districts that originally organized by the Bule Hora woreda health office for the ease of health service program implementation, 2 districts were randomly selected. Accordingly, Garba district containing 10 kebeles ((54 sub-kebeles)), which is found at the north direction from the Bule Hora town, and the Berdaye district containing 9 kebeles (47 sub-kebeles) that found at the southern direction from the Bule Hora town was selected to include in the study. Besides, from each of the north and south districts 3 kebeles (that accounts 30% of the total kebeles in each cluster) was randomly selected. The selected kebele was further divided in to sub-kebelles (neighbourhood villages). Finally, 26 Sub-kebeles (Clusters), 13 from Gerba district in the north direction and 13 from Berdaye district in the south direction were selected randomly and assigned to the intervention and control group respectively (Figure 1). Data collectors and outcome assessors were blinded to group allocation. P
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Mr.

Study Record Dates

• First Submitted: September 12, 2026
• First Posted: October 9, 2026
• Study Start: November 1, 2024
• Primary Completion: April 30, 2025
• Study Completion: April 30, 2025
• Last Updated: October 9, 2026

Record last verified: 2026-10

Data Sharing

• IPD Sharing: Will not share

Locations

ET (1)