1Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh.
2Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California.
Am J Trop Med Hyg. 2021 Jan 18;104(4):1546-1553. doi: 10.4269/ajtmh.20-1154.
Water, sanitation, and handwashing interventions that use intensive interpersonal communication improve targeted behaviors, but are expensive at scale. Mass media is an alternative that could reach more people at lower cost but has rarely been rigorously evaluated. We assessed the effectiveness of a mass media campaign in improving handwashing knowledge and practices in rural Bangladesh. We conducted a cross-sectional assessment before the campaign among 8,947 households and again after 4 months of the campaign among 8,400 different households in the same areas. Trained enumerators conducted spot checks of water, sanitation, and hygiene facilities, and recorded reported knowledge and practices. We compared these outcomes after versus before the campaign using generalized linear models with robust standard errors. After the media campaign, caregivers were more likely to recall ≥ 3 messages regarding handwashing (prevalence ratio [PR] = 1.44, 1.34-1.55), sanitation (PR = 1.45, 1.35-1.55), and safe water (PR = 1.17, 1.08-1.26). After the campaign, the prevalence of using soap and water during handwashing demonstrations was higher among caregivers (PR = 1.15, 1.12-1.19) and children (PR = 1.31, 1.22-1.41). Hands were more commonly observed to be visibly clean among caregivers (PR = 1.14, 1.07-1.20) and children (PR = 1.13, 1.05-1.21). Soap and water was more commonly observed in handwashing stations near latrines (PR = 1.12, 1.06-1.19) and in cooking/eating places (PR = 1.09, 1.01-1.18). Our findings indicate improved handwashing knowledge and behaviors following a mass media campaign. This promising approach can be deployed to improve water, sanitation, and hygiene practices at scale and should be evaluated in other contexts.
水、环境卫生和手卫生干预措施，通过强化人际交流来改善目标行为，但在规模上费用高昂。大众媒体是一种替代方案，可以以更低的成本覆盖更多的人，但很少经过严格评估。我们评估了大众媒体运动在改善孟加拉国农村地区手卫生知识和实践方面的效果。在运动前，我们对 8947 户家庭进行了横断面评估，在运动后 4 个月，对同一地区的 8400 户不同家庭进行了再次评估。经过培训的普查员对水、环境卫生和个人卫生设施进行了抽查，并记录了报告的知识和做法。我们使用广义线性模型和稳健标准误差比较了运动前后的这些结果。在媒体运动之后，照顾者更有可能回忆起至少 3 条关于手卫生（流行比率[PR] = 1.44，1.34-1.55）、环境卫生（PR = 1.45，1.35-1.55）和安全用水（PR = 1.17，1.08-1.26）的信息。运动后，在进行手卫生演示时使用肥皂和水的照顾者（PR = 1.15，1.12-1.19）和儿童（PR = 1.31，1.22-1.41）的比例更高。在照顾者（PR = 1.14，1.07-1.20）和儿童（PR = 1.13，1.05-1.21）中，手更常被观察到明显清洁。在厕所附近（PR = 1.12，1.06-1.19）和烹饪/就餐场所（PR = 1.09，1.01-1.18）的洗手站中，更常观察到肥皂和水。我们的研究结果表明，在大众媒体运动后，手卫生知识和行为有所改善。这种很有前景的方法可以大规模用于改善水、环境卫生和个人卫生习惯，应该在其他环境中进行评估。
