Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh.
Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh.
Int J Hyg Environ Health. 2023 May;250:114149. doi: 10.1016/j.ijheh.2023.114149. Epub 2023 Mar 11.
Sanitation interventions typically result in modest increases in latrine access, and any gains in latrine access and use are often not sustained over time. Sanitation programs also rarely include child-focused interventions such as potties. We aimed to assess the sustained effect of a multi-component sanitation intervention on access to and use of latrines and child feces management tools in rural Bangladesh.
We conducted a longitudinal substudy nested within the WASH Benefits randomized controlled trial. The trial provided latrine upgrades, child potties and sani-scoops for feces removal, along with behavior change promotion to encourage use of the delivered hardware. Promotion visits to intervention recipients were frequent during the first 2 years after intervention initiation, decreased in frequency between years 2-3, and ceased after 3 years. We enrolled a random subset of 720 households from the sanitation and control arms of the trial in a substudy and visited them quarterly between 1 and 3.5 years after intervention initiation. At each visit, field staff recorded sanitation-related behaviors through spot-check observations and structured questionnaires. We assessed intervention effects on observed indicators of hygienic latrine access, potty use and sani-scoop use and investigated whether these effects were modified by duration of follow-up, ongoing behavior change promotion and household characteristics.
The intervention increased hygienic latrine access from 37% among controls to 94% in the sanitation arm (p < 0.001). Access among intervention recipients remained high 3.5 years after intervention initiation, including periods with no active promotion. Gains in access were higher among households with less education, less wealth and larger number of residents. The intervention increased availability of child potties from 29% among controls to 98% in the sanitation arm (p < 0.001). However, fewer than 25% of intervention households reported exclusive child defecation in a potty or had observed indicators of potty and sani-scoop use, and gains in potty use declined over the follow-up period, even with ongoing promotion.
Our findings from an intervention that provided free products and intensive initial behavior change promotion suggest a sustained increase in hygienic latrine access up to 3.5 years after intervention initiation but infrequent use of child feces management tools. Studies should investigate strategies to ensure sustained adoption of safe child feces management practices.
卫生设施干预措施通常会使厕所的使用量适度增加，但厕所得益于这些措施的任何增加往往都不能长期持续。卫生设施计划通常也很少包括以儿童为重点的干预措施，例如便盆。我们旨在评估一项多组成分卫生干预措施对孟加拉国农村地区厕所使用和儿童粪便管理工具的获取和使用的持续效果。
我们在 WASH Benefits 随机对照试验中进行了一项纵向子研究。该试验提供了厕所升级、儿童便盆和粪便清除用的卫生铲，同时还开展了行为改变促进活动，以鼓励使用提供的硬件。在干预启动后的头 2 年内，对干预接受者的推广访问很频繁，在 2-3 年之间的频率降低，在 3 年后停止。我们从试验的卫生和对照组中随机抽取了 720 户家庭作为子研究的一部分，并在干预启动后 1 至 3.5 年内每季度进行一次访问。在每次访问中，实地工作人员通过抽查观察和结构化问卷记录与卫生相关的行为。我们评估了干预对卫生厕所获取、便盆使用和卫生铲使用等观察指标的影响，并研究了这些影响是否因随访时间、持续的行为改变促进和家庭特征而有所改变。
该干预措施将对照组中卫生厕所的获取率从 37%提高到了卫生组的 94%（p<0.001）。在干预启动后 3.5 年内，干预接受者的获取率仍然很高，包括在没有积极推广的时期。受教育程度较低、财富较少和居民人数较多的家庭的获取率增加幅度更大。该干预措施将对照组中儿童便盆的可获得率从 29%提高到了卫生组的 98%（p<0.001）。然而，不到 25%的干预家庭报告说儿童只在便盆中排便，或者观察到了便盆和卫生铲的使用迹象，而且随着随访时间的延长，便盆的使用率下降了，即使有持续的推广。
我们从一项提供免费产品和强化初始行为改变促进措施的干预措施中发现，在干预启动后 3.5 年内，卫生厕所的获取率持续增加，但儿童粪便管理工具的使用频率较低。研究应探讨确保安全儿童粪便管理措施持续采用的策略。
