Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia

Study Overview
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Brief Summary
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This intervention will experimentally test the hypothesis that sanitation can be improved in a peri-urban setting using state-of-the-art behaviour change communications. Formative research indicated that landlords are the effective decision-makers about investments in sanitation on their plots (which can include a number of tenant households as well). Landlords will therefore be the primary targets of the intervention. The study will take the form of a randomized controlled trial of the intervention evaluated at the plot level. The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s). The desired improvements will be measured via multiple primary outcomes that measure aspects of changes to hardware and software components, including indicators of hygienic quality, psychological desirability, accessibility, and ecological sustainability. This is because the investigators argue that, to have a significant impact on population-level diarrheal disease indicators, any sanitation solution must be: effective at reducing exposure to pathogens (i.e., hygienic), desirable (i.e., seen as valuable or humane), and accessible (i.e., no one excluded), so that it can be used by all for a reasonably long time (i.e., sustainable)

Official Title
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Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia

Conditions
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Diarrhea

Intervention / Treatment
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* Behavioral: Bauleni Secret


Participation Criteria
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Eligibility Criteria
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Plots will be selected for inclusion in the study based on meeting the inclusion criteria. The intervention will be delivered to the landlord on each plot assigned to the intervention arm. Intervention Inclusion Criteria: Plot located in Bauleni compound Adult landlord (age 18 or higher) resides on plot Intervention Exclusion Criteria: * None Data will be collected from the landlord and one randomly selected tenant from all eligible adult tenants on each plot. Data Collection Inclusion Criteria: * Adult landlord or tenant (age 18 or higher) resides on selected plot most of the time Data Collection Exclusion Criteria: * None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A random sample of plots will be selected in Bauleni Compound and invited to participate. Intervention allocation will also be randomized, with approximately equal numbers of plots allocated to the intervention and control arms. Within the chosen plots, resident landlord households will receive the intervention and resident landlord households and one randomly selected tenant household will be chosen for data collection for both intervention and control plots.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Landlords on selected plots will receive the Bauleni Secret intervention. Landlords and selected tenants will be surveyed in baseline/end-line data collection. | Behavioral: Bauleni Secret<br>* The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s).<br>|
| No Intervention: Control<br>Landlords and selected tenants will be surveyed in baseline/end-line data collection only. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Having a hole-cover or water-sealed pan | Reduces spread of pathogens by creating barrier between containment and above-ground environment | 5 months after intervention begins | 
| Having a latrine door that locks from the inside | Provide safety and privacy for toilet users | 5 months after intervention begins | 
| Having a latrine door that locks from the outside | Exclude those not living on the plot from the toilet | 5 months after intervention begins | 
| Having a rotational cleaning system in place | To maintain hygienic condition of the toilet interface | 5 months after intervention begins | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Willingness to pay | Change in landlord stated willingness to pay for toilet improvements | 5 months after intervention begins | 
| Attitudes towards sanitation | Scales measuring landlord attitudes towards the importance of sanitation | 5 months after intervention begins | 
| Financial preparation for toilet improvement | Landlords report saving money, either individually or by participating in a rotating savings scheme, for toilet improvement | 5 months after intervention begins | 
| Partial construction progress towards toilet improvement | Landlords have either amassed raw materials on the plot (concrete blocks, wood, etc.) for toilet improvement or new construction/upgrading of toilet began (hole dug for new toilet, new slab poured for flushing toilet, etc.) | 5 months after intervention begins | 
| Peri-urban Healthy Toilet Index | A theory-based comprehensive index of on-site peri-urban sanitation status including hygienicity, accessibility, desirability, and sustainability of sanitation systems | 5 months after intervention begins | 
| Cleaning rota initiated | Landlord reports taking any action directed at establishing a rotational cleaning system (e.g., holding a plot meeting explicitly for this purpose, posting a written rota, or otherwise tangibly indicating rota responsibilities) | 5 months after intervention begins | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sanitation, Demand, Peri-urban, Behavior Change, Lusaka, Zambia