Effectiveness of a large-scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh

Wit Wichaidit, Shwapon Biswas, Farzana Begum, Farzana Yeasmin, Fosiul Alam Nizame, Nusrat Najnin, Elli Leontsini, Peter John Winch, Leanne Unicomb, Stephen P. Luby, Pavani K. Ram

Research output: Contribution to journalArticle

Abstract

Objective: The behavioural effect of large-scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large-scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods: We analysed data from a cluster-randomised trial that included three arms: vaccine-and-behaviour-change intervention (VBC), vaccine-only (V) and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: (i) temporal variation in availability of soap and water at handwashing place; (ii) the use of water and soap by participants when asked to demonstrate handwashing, and; (iii) handwashing behaviour according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PRs) and 95% confidence intervals and compare outcomes by study arms. Results: Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (P-for-trends <0.001), and no significant trend during months 10–28 (P-for-trend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43%) than in V (23%) (PR = 1.92; CI = 1.72, 2.15) and Control (28%) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17%) than in V (8%) (PR = 1.47, CI = 0.58, 3.75) and Control (2%) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen transmission events, the prevalence of handwashing with soap was ≤3%. Conclusion: VBC households maintained soap and water for handwashing, but the prevalence of observed handwashing was low in all study arms. The results underscore the need to strengthen scalable behaviour change approaches.

Original languageEnglish (US)
JournalTropical Medicine and International Health
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hand Disinfection
Bangladesh
Soaps
Vaccines
Water
Infectious Disease Transmission
Regression Analysis
Observation
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Bangladesh
  • behaviour
  • handwashing
  • ICVB
  • intervention

ASJC Scopus subject areas

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

Cite this

Effectiveness of a large-scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh. / Wichaidit, Wit; Biswas, Shwapon; Begum, Farzana; Yeasmin, Farzana; Nizame, Fosiul Alam; Najnin, Nusrat; Leontsini, Elli; Winch, Peter John; Unicomb, Leanne; Luby, Stephen P.; Ram, Pavani K.

In: Tropical Medicine and International Health, 01.01.2019.

Research output: Contribution to journalArticle

Wichaidit, Wit ; Biswas, Shwapon ; Begum, Farzana ; Yeasmin, Farzana ; Nizame, Fosiul Alam ; Najnin, Nusrat ; Leontsini, Elli ; Winch, Peter John ; Unicomb, Leanne ; Luby, Stephen P. ; Ram, Pavani K. / Effectiveness of a large-scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh. In: Tropical Medicine and International Health. 2019.
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title = "Effectiveness of a large-scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh",
abstract = "Objective: The behavioural effect of large-scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large-scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods: We analysed data from a cluster-randomised trial that included three arms: vaccine-and-behaviour-change intervention (VBC), vaccine-only (V) and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: (i) temporal variation in availability of soap and water at handwashing place; (ii) the use of water and soap by participants when asked to demonstrate handwashing, and; (iii) handwashing behaviour according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PRs) and 95{\%} confidence intervals and compare outcomes by study arms. Results: Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (P-for-trends <0.001), and no significant trend during months 10–28 (P-for-trend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43{\%}) than in V (23{\%}) (PR = 1.92; CI = 1.72, 2.15) and Control (28{\%}) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17{\%}) than in V (8{\%}) (PR = 1.47, CI = 0.58, 3.75) and Control (2{\%}) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen transmission events, the prevalence of handwashing with soap was ≤3{\%}. Conclusion: VBC households maintained soap and water for handwashing, but the prevalence of observed handwashing was low in all study arms. The results underscore the need to strengthen scalable behaviour change approaches.",
keywords = "Bangladesh, behaviour, handwashing, ICVB, intervention",
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AU - Wichaidit, Wit

AU - Biswas, Shwapon

AU - Begum, Farzana

AU - Yeasmin, Farzana

AU - Nizame, Fosiul Alam

AU - Najnin, Nusrat

AU - Leontsini, Elli

AU - Winch, Peter John

AU - Unicomb, Leanne

AU - Luby, Stephen P.

AU - Ram, Pavani K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The behavioural effect of large-scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large-scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods: We analysed data from a cluster-randomised trial that included three arms: vaccine-and-behaviour-change intervention (VBC), vaccine-only (V) and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: (i) temporal variation in availability of soap and water at handwashing place; (ii) the use of water and soap by participants when asked to demonstrate handwashing, and; (iii) handwashing behaviour according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PRs) and 95% confidence intervals and compare outcomes by study arms. Results: Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (P-for-trends <0.001), and no significant trend during months 10–28 (P-for-trend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43%) than in V (23%) (PR = 1.92; CI = 1.72, 2.15) and Control (28%) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17%) than in V (8%) (PR = 1.47, CI = 0.58, 3.75) and Control (2%) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen transmission events, the prevalence of handwashing with soap was ≤3%. Conclusion: VBC households maintained soap and water for handwashing, but the prevalence of observed handwashing was low in all study arms. The results underscore the need to strengthen scalable behaviour change approaches.

AB - Objective: The behavioural effect of large-scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large-scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods: We analysed data from a cluster-randomised trial that included three arms: vaccine-and-behaviour-change intervention (VBC), vaccine-only (V) and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: (i) temporal variation in availability of soap and water at handwashing place; (ii) the use of water and soap by participants when asked to demonstrate handwashing, and; (iii) handwashing behaviour according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PRs) and 95% confidence intervals and compare outcomes by study arms. Results: Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (P-for-trends <0.001), and no significant trend during months 10–28 (P-for-trend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43%) than in V (23%) (PR = 1.92; CI = 1.72, 2.15) and Control (28%) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17%) than in V (8%) (PR = 1.47, CI = 0.58, 3.75) and Control (2%) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen transmission events, the prevalence of handwashing with soap was ≤3%. Conclusion: VBC households maintained soap and water for handwashing, but the prevalence of observed handwashing was low in all study arms. The results underscore the need to strengthen scalable behaviour change approaches.

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KW - behaviour

KW - handwashing

KW - ICVB

KW - intervention

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