WASH for Everyone: Testing Alternative Approaches to Sanitation and Hygiene Behaviour Change in Chiradzulu, Malawi (W4E)

London School of Hygiene and Tropical Medicine

Status: Completed

Conditions: Behavior

Treatments: Other: Care Groups; Other: Community-Led Total Sanitation

Study type: Interventional

Funder types: Other

Identifiers

NCT05808218

28249

Details and patient eligibility

About

This study aims to assess the impact of multiple community-based behaviour change approaches on sanitation and hygiene behaviours in rural Malawi. Three different sub-districts (Traditional Authorities) in Chiradzulu District will be selected, each receiving a different combination of community-based interventions or will serve as controls. Eligible communities, households, and individuals will be randomly selected in each Traditional Authority and sanitation and hygiene behaviours assessed through self-report and direct observation after 1 year of intervention.

Full description

This is a controlled before-and-after study that will evaluate the impact on sanitation and hygiene behaviours of different community-based interventions implemented as part of the WASH For Everyone programme. WASH for Everyone, implemented by World Vision and Water For People. WASH for Everyone is a 3-year project (2022 - 2024) that aims to achieve universal access to water, sanitation, and hygiene (WASH) in Chiradzulu district, and promote improved sanitation and hygiene behaviours. There are two primary community-based sanitation and hygiene behaviour change approaches included in the WASH for Everyone interventions: 1) community-led total sanitation (CLTS), a widely implemented participatory approach to ending open defecation at the community-level and 2) Care Groups, a model using locally-based volunteer groups to implement peer-to-peer counselling and support with a long history in nutrition programming.

For the purposes of this study, one Traditional Authority will receive the CLTS intervention. A second Traditional Authority will receive the CLTS intervention with the additional of village-level Care Groups (CLTS +). A third traditional authority will serve as the comparison group.

Within study Traditional Authorities, communities will be selected at random for inclusion in the study. Twenty communities will be enrolled in both the CLTS and the CLTS+ Traditional Authorities. Thirty communities will be enrolled from the comparison Traditional Authority. In each selected community, an average of 20 households will be enrolled at baseline and again at endline. Difference-in-difference analysis will be used to measure the changes in primary and secondary outcomes between either intervention and control and between the two intervention groups.

Enrollment: 2,800 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Households are primary sampling unit. Household eligibility requirements are:

Inclusion Criteria:

• Presence of an adult head of household age 18 or over who gives consent for the household to participate in the study; household is permanent resident of selected village

Exclusion Criteria:

• No permanent resident aged 18 or over; temporary resident of community/households

In selected households, 1 individual will be selected at random to complete study survey. Individual eligibility requirements are:

Inclusion criteria:

• Permanent resident of selected household; able to provide informed consent

Exclusion criteria:

• Not a permanent resident of selected household, not able to provide informed consent

Trial design

Primary purpose: Prevention

Allocation: N/A

Interventional model: Parallel Assignment

Masking: None (Open label)

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2,800 participants in 3 patient groups

CLTS

Experimental group

Description:

This arm will receive a standard community-led total sanitation) intervention).

Treatment:

Other: Community-Led Total Sanitation

CLTS Plus

Experimental group

Description:

Includes all activities in the CLTS arm with the addition of village-level Care Groups for sanitation and hygiene promotion.

Treatment:

Other: Community-Led Total Sanitation

Other: Care Groups

Control

No Intervention group