- Aragie, Solomon;
- Tadesse, Wondyifraw;
- Dagnew, Adane;
- Hailu, Dagnachew;
- Dubie, Melese;
- Wittberg, Dionna M;
- Melo, Jason S;
- Haile, Mahteme;
- Zeru, Taye;
- Freeman, Matthew C;
- Nash, Scott D;
- Callahan, E Kelly;
- Tadesse, Zerihun;
- Arnold, Benjamin F;
- Porco, Travis C;
- Lietman, Thomas M;
- Keenan, Jeremy D
Objective
To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control.Methods
We conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys.Findings
Over the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41-53) for wash stations, 18 percentage points (95% CI: 12-24) for soap and 12 percentage points (95% CI: 5-19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15-27 for 0-5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2-15 for 6-9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits.Conclusion
The community- and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.