Clinical trial NCT03174015: Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia
Official title: Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diarrhea
Keywords: Sanitation
Demand
Peri-urban
Behavior Change
Lusaka
Zambia
Lead sponsor: London School of Hygiene and Tropical Medicine
Sponsor class: OTHER
Collaborators: name: Centre for Infectious Disease Research in Zambia
First posted: 2017-06-02
Enrollment: 1085
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention 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.
Primary purpose: PREVENTION

Brief summary: 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)


Eligibility criteria: 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

Primary outcomes:
measure: Having a hole-cover or water-sealed pan
timeFrame: 5 months after intervention begins
measure: Having a latrine door that locks from the inside
timeFrame: 5 months after intervention begins
measure: Having a latrine door that locks from the outside
timeFrame: 5 months after intervention begins
measure: Having a rotational cleaning system in place
timeFrame: 5 months after intervention begins
Secondary outcomes:
measure: Willingness to pay
timeFrame: 5 months after intervention begins
measure: Attitudes towards sanitation
timeFrame: 5 months after intervention begins
measure: Financial preparation for toilet improvement
timeFrame: 5 months after intervention begins
measure: Partial construction progress towards toilet improvement
timeFrame: 5 months after intervention begins
measure: Peri-urban Healthy Toilet Index
timeFrame: 5 months after intervention begins
measure: Cleaning rota initiated
timeFrame: 5 months after intervention begins
Other outcomes:
Locations:
city: Lusaka
country: Zambia
facility: Bauleni Compound
Study officials:
affiliation: London School of Hygiene and Tropical Medicine
name: Robert Aunger, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Center for Infectious Disease Research in Zambia
name: Roma Chilengi, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: London School of Hygiene and Tropical Medicine
name: Valerie Curtis, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Tidwell JB, Chipungu J, Bosomprah S, Aunger R, Curtis V, Chilengi R. Effect of a behaviour change intervention on the quality of peri-urban sanitation in Lusaka, Zambia: a randomised controlled trial. Lancet Planet Health. 2019 Apr;3(4):e187-e196. doi: 10.1016/S2542-5196(19)30036-1.