Department of Epidemiology and Environmental Health, State University of New York, Buffalo, NY, USA.
Johns Hopkins University, Baltimore, MD, USA.
Trop Med Int Health. 2019 Aug;24(8):972-986. doi: 10.1111/tmi.13277. Epub 2019 Jul 3.
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.
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.
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%.
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.
大规模洗手推广计划的行为效果很少得到评估，而且随着时间的推移，其效果也没有得到描述。我们评估了在孟加拉国达卡的一个社区环境中，大规模洗手推广计划对洗手结果的影响。
我们分析了一项包括三个组的整群随机试验的数据：疫苗和行为改变干预组（VBC）、仅疫苗组（V）和无干预组（对照组）。数据收集员在研究期间每月随机选择不同的家庭子集，并评估：（i）洗手处肥皂和水的可用性随时间的变化；（ii）当要求参与者演示洗手时，他们使用水和肥皂的情况；以及；（iii）根据结构化观察的洗手行为。我们使用对数二项式回归分析计算患病率比（PR）和 95%置信区间，并按研究组比较结果。
数据收集员在 28 个月内调查了 9325 户家庭。在 VBC 组中，从干预开始到 9 个月后，肥皂和水的可用性呈显著正趋势（趋势 P<0.001），而在 10-28 个月期间没有明显趋势（趋势 P=0.297）。在整个研究期间，VBC 组（43%）的水和肥皂供应情况高于 V 组（23%）（PR=1.92；CI=1.72，2.15）和对照组（28%）（PR=1.53；CI=1.38，1.69）。在演示洗手时使用肥皂方面，各组之间没有差异。在 VBC 组（17%）观察到的便后用肥皂洗手的比例高于 V 组（8%）（PR=1.47，CI=0.58，3.75）和对照组（2%）（PR=3.47，CI=0.48，23.33）。在其他可能的病原体传播事件中，用肥皂洗手的患病率≤3%。
VBC 家庭保持了肥皂和水供洗手用，但所有研究组的观察到的洗手率都很低。结果强调需要加强可扩展的行为改变方法。
