Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Trop Med Int Health. 2022 Oct;27(10):913-924. doi: 10.1111/tmi.13813. Epub 2022 Sep 12.
The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) was a 5-year intervention aiming to improve water, sanitation and hygiene (WASH) practices among 20 million rural residents through community hygiene promoters. This analysis evaluates the impact of SHEWA-B on knowledge, behaviour and childhood diarrhoea outcomes.
The evaluation included repeated cross-sectional surveys and health surveillance in matched cohorts in intervention and control clusters. Cross-sectional surveys and structured observations at baseline, midline, and endline assessed the availability of WASH technology, caregiver knowledge and behaviour. Fieldworkers collected monthly health data in a subset of control and intervention households to determine the prevalence of diarrhoea.
Of 5091 households surveyed, participants residing in intervention clusters showed minimal improvements in knowledge, reported behaviour, or use of WASH technology compared to the control clusters. During structured observations, intervention households increased more than control households at handwashing before preparing food and after cleaning a baby's anus when comparing endline to baseline, but these changes were not seen when comparing endline to the midline. The prevalence of childhood diarrhoea remained similar in both groups before (10.2% in intervention, 10.0% in control) and after (8.8% in intervention, 11.7% in control) midline changes were made to improve the intervention. Intervention clusters showed no improvement in diarrhoea over time compared to control clusters.
SHEWA-B's community-based WASH promotion did not yield the intended impact on knowledge, behaviour or health. Greater priority should be given to approaches that have demonstrated effectiveness. Including rigorous evaluations would broaden the evidence base to support and improve large-scale programmes.
孟加拉国环境卫生、个人卫生和供水促进项目（SHEWA-B）是一个为期五年的干预项目，旨在通过社区卫生促进者改善 2000 万农村居民的水、环境卫生和个人卫生（WASH）习惯。本分析评估了 SHEWA-B 对知识、行为和儿童腹泻结局的影响。
评估包括在干预和对照群组中进行重复的横断面调查和健康监测。在基线、中程和终线进行横断面调查和结构观察，评估 WASH 技术、照顾者知识和行为的可得性。野外工作人员在对照和干预家庭的子集中每月收集健康数据，以确定腹泻的患病率。
在接受调查的 5091 户家庭中，与对照群组相比，居住在干预群组的参与者在知识、报告的行为或 WASH 技术的使用方面仅略有改善。在结构观察中，与基线相比，干预家庭在手接触食物前和清洁婴儿肛门后洗手的次数增加多于对照家庭，但在与中程线相比时，这些变化并未出现。在进行中程线改变以改善干预措施之前（干预组为 10.2%，对照组为 10.0%）和之后（干预组为 8.8%，对照组为 11.7%），两组儿童腹泻的患病率相似。与对照组相比，干预组在整个研究期间的腹泻率没有改善。
SHEWA-B 的基于社区的 WASH 促进措施并未对知识、行为或健康产生预期影响。应更加重视已证明有效的方法。包括严格的评估将扩大证据基础，以支持和改进大规模计划。
