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

London School of Hygiene and Tropical Medicine2,800 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

Interventions

Community-Led Total SanitationOTHER

The community-led total sanitation intervention is implemented across an entire Traditional Authority and includes the following village-level activities: 1. Triggering: * Village transect walks and open defecation site mapping * Demonstrations of food contamination and medical expense calculations 2. Development of a Community-Action Plan and identification of "natural leaders" 3. Post-triggering: routine follow-up by selected natural leaders to track and monitor progress against the Community Action Plan In addition to the activities above, the WASH for Everyone team will: * Train a cadre of local masons on sanitation construction * Support the District Health office in the implementation of existing sanitation and hygiene promotion at village markets and other public spaces

Care GroupsOTHER

* Orientation and training of village-level Care Group members on CLTS, latrine construction, and hygiene promotion * Routine house-to-house follow-up of Care Group members to provide peer-to-peer counselling and support on sanitation and hygiene behaviours.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

sanitation coverage

Sanitation coverage is defined as confirmed presence of a functional sanitation facility in the home or compound that meets standard definitions of at least unimproved sanitation facilities according to the Joint Monitoring Programme. This will be determined by reported access to a private, household sanitation facility that respondents self-identify as completed. Self-reported access will be verified through visual inspection of the sanitation facilities.