Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster-randomised controlled trial

Mahbub Ul Alam, Peter J. Winch, Ronald E. Saxton, Fosiul A. Nizame, Farzana Yeasmin, Guy Norman, Abdullah Al Masud, Farzana Begum, Mahbubur Rahman, Kamal Hossain, Anita Layden, Leanne Unicomb, Stephen P. Luby

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness. Methods: We conducted a cluster-randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six-month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (DID) to assess outcomes and accounted for clustering effects using generalised estimating equations. Results: Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (DID: +4.7%, 95% CI: 0.2, 9.2), access to brush/broom for cleaning (DID: +8.4%, 95% CI: 2, 15) and waste bins (DID: +63%, 95% CI: 59, 66), while less likely to have visible faeces inside the pan (DID: −13%, 95% CI: −19, −5), the smell of faeces (DID: −7.6%, 95% CI: −14, −1.3) and household waste inside the cubicle (DID: −4%, 95% CI: −7, −1). Conclusions: In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self-finance toilet maintenance, or employ mass media to reduce per-capita costs of behaviour change.

Original languageEnglish (US)
Pages (from-to)1000-1011
Number of pages12
JournalTropical Medicine and International Health
Volume22
Issue number8
DOIs
StatePublished - Aug 2017

Keywords

  • Bangladesh
  • behaviour change
  • cleanliness
  • sanitation
  • shared toilet
  • urban slum

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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