Clinical trial NCT04753645: BRAC Institute of Governance and Development-Hygiene Behavioural Change and Coalition
Official title: The Effect of Public Handwashing Stations on Health Behaviour and Outcomes During COVID-19
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Hygiene Practices and Knowledge
Keywords: Handwashing station
mask usage
behvaioural change
Lead sponsor: BRAC University
Sponsor class: OTHER
Collaborators: name: The Behavioural Insights Team
name: Brac
First posted: 2021-02-15
Enrollment: 3840
Sex: ALL
Minimum age (years): 10
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Intervention model description: From each of 20 sub-district, out of potential villages for a public handwashing stations (HWS) we randomly selected 10 villages, of which 5 are assigned to control group or non-HBCC intervention villages and 5 are assigned to treatment group receiving the interventions. We have 98 control and 96 treatment villages due to an insufficient number of selected villages in one sub-district. First round survey revealed significant increase in soap use and not-significant decrease in handwashing (HW) frequency and soap expenditure. Our hypothesis is that there might be causality between HW and soap use. To test this, we provide soap to randomly selected 50% of our surveyed households, stratified at the sub-district level. 1,909 and 1,933 hhs from treatment and control villages received soap. Due to nationwide lockdown, we conducted follow-up phone survey. Also, to minimize Ramadan effect, we randomly divided the sample into two groups- to be surveyed before (44%) and during Ramadan (56%).
Primary purpose: PREVENTION

Brief summary: In line with BRAC's overall goals to limit the COVID19 transmission, BRAC has constructed 1,000 handwashing stations coupled with other supports i.e. in-person demonstration, hygiene meetings, and soap distribution in Bangladesh. The purpose of this study is to assess the impact of public handwashing stations (HWSs) on people's hygiene behavior and health outcomes in response to the COVID-19 situation. For this, at the household level, we will collect information on self-reported handwashing practices, income, health status, and HWSs along with other relevant socio-demographic variables in detail. In addition, we will observe people's mobility, mask usage at public places, and the HWSs usage; and will associate the observed HWSs usage with their self-reported health outcomes. This study will conduct surveys on households (7,760) and public (5,820) in 20 sub-districts of Mymensingh, Khulna, and Dhaka divisions.

Overall, this study is expected to directly benefit study participants and their communities by unveiling new evidence to inform BRAC's existing hygiene behavioral change programming in these communities. In addition, this information will yield future societal benefits by generating evidence on how to effectively implement and disseminate infrastructure and information that people can trust, believe, and use to form healthy hygiene habits.

Detailed description: In line with the overall goals of HBCC for reducing the transmission of COVID-19 via rapid response interventions to raise awareness and enacting long-term behaviour change regarding people's personal and environmental hygiene habits, BRAC has taken an adaptive approach under the Hygiene and Behaviour Change Collation (HBCC) platform. The aim of this project is to systematically change the behaviour of people across communities in Bangladesh via interventions such as setting up handwashing stations and broadcasting behaviourally-informed messages to nudge people to adopt healthier prevention and response practices.

To achieve the overall goals of the project and positively impact the lives of over 10 million people in communities across Bangladesh, BRAC primarily chose 20 sub-districts from 3 divisions (out of a total of 8 divisions) for implementing the interventions, namely Dhaka, Mymensingh and Khulna. The prime activity is to install 1,000 handwashing stations across these sub-districts to increase the access of communities to handwashing facilities. The BRAC handwashing stations have been designed to enhance both availability and inclusiveness, fitted with foot-operated pedals for dispensing water and liquid soap, to reduce contact with sink surfaces and thereby reduce probability of transmission from the device surface. They have been fitted with posters, promoting handwashing with proper technique, and have also been designed to allow hand-washers to maintain social distance while using the devices.

In addition to these handwashing stations, there are other supports available in the intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution. After the economy opened up in Bangladesh after a long lockdown, the community engagement activities in the form of in-person communication and forum discussions, to motivate people to uptake safe hygiene behaviours including but not limited to regular handwashing. In these demonstrations and meetings, the participants are motivated to adopt recommended hygiene behaviours such as handwashing with soap, mask usage and disposal, sneezing etiquette, social distancing, etc. Along with the BRAC staff, the WASH entrepreneurs who are members of the local community whom BRAC traditionally supports with free training in entrepreneurship and market development to improve the communities' access and knowledge of hygiene products. The HBCC project empowers them with responsibilities to disseminate the messages of the recommended behaviours and distribute the soap in the communities across the intervention areas, especially the poorest of the poor community and the participants who attend the meetings regularly.

Primary Outcomes (end points)

The main outcome variables of interest in this study are:

i) daily handwashing frequency ii) likelihood of using soap when handwashing iii) prevalence of transmissible diseases in the past 15 days Primary Outcomes (explanation) i) constructed using the self-reported daily frequency of handwashing and typical handwashing times ii) constructed using self-report (times out of 10), rapid observation of the presence of soap near handwashing facilities, and self-reported expenditure on soap iii) constructed using self-report of symptoms and specific diseases Secondary Outcomes i) knowledge of handwashing practices ii) attitudes towards handwashing iii) use of public handwashing stations and alternatives to public handwashing stations iii) frequency of mask-wearing

Eligibility criteria: Inclusion Criteria:

* Must live in the villages where BRAC is implementing the interventions

Exclusion Criteria:

-

Primary outcomes:
measure: Daily handwashing frequency
timeFrame: One day
measure: Likelihood of using soap when handwashing
timeFrame: One day
measure: Prevalence of transmissible diseases in the past 15 days
timeFrame: In last 15 days
Secondary outcomes:
measure: Knowledge of handwashing practices
timeFrame: 3 months
measure: Attitudes
timeFrame: 3 months
measure: Handwashing at the public places
timeFrame: 3 months
measure: Mask usage
timeFrame: 3 months
Other outcomes:
Locations:
city: Dhaka
country: Bangladesh
facility: BRAC, Bangladesh
Study officials:
References: