Benjamin-Chung Jade, Sultana Sonia, Halder Amal K, Ahsan Mohammed Ali, Arnold Benjamin F, Hubbard Alan E, Unicomb Leanne, Luby Stephen P, Colford John M
Jade Benjamin-Chung, Benjamin F. Arnold, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Alan E. Hubbard is with the Division of Biostatistics, School of Public Health, University of California, Berkeley. Sonia Sultana, Amal K. Halder, Mohammed Ali Ahsan, and Leanne Unicomb are with the Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka. Stephen P. Luby is with the Department of Medicine, Stanford University, Stanford, CA.
Am J Public Health. 2017 May;107(5):694-701. doi: 10.2105/AJPH.2017.303686. Epub 2017 Mar 21.
To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access.
We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality.
Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality.
SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes.
评估联合国儿童基金会在孟加拉国农村地区向2000万人推行的名为SHEWA - B的水、环境卫生和个人卫生项目的实施质量是否与健康行为及环境卫生基础设施的可及性相关。
我们在2011年和2012年对SHEWA - B项目覆盖的33027户家庭以及1110名SHEWA - B卫生推广员进行了调查。我们制定了一个实施质量指数，并比较了在不同实施质量情况下健康行为及环境卫生基础设施可及性的概率。
47%的家庭（n = 14622）见过SHEWA - B卫生推广员，47%的卫生推广员（n = 527）能回忆起所有关键项目信息。卫生推广员的走访频率与改善的结果无关。较高的实施质量与更好的健康行为或基础设施可及性无关。在所有群组实施质量低与高的情况下，结果差异仅为1%至3%。
SHEWA - B在任何方面都未达到联合国儿童基金会理想的实施质量。实施质量的提高只会导致健康行为或基础设施可及性的微小变化。这表明SHEWA - B的设计在改善这些结果方面并非最优。
