Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Aragie, Solomon; Tadesse, Wondyifraw; Dagnew, Adane; Hailu, Dagnachew; Dubie, Melese; Wittberg, Dionna M; Melo, Jason S; Mahteme, Haile; Zeru, Tàye; Freeman, Matthew C.; Nash, Scott D.; Callahan, E. Kelly; Tadesse, Zerihun; Arnold, Benjamin F.; Porco, Travis C.; Lietman, Thomas M.; Keenan, Jeremy D.

doi:10.2471/blt.21.285915

Cited by 6 publications

(6 citation statements)

References 25 publications

(20 reference statements)

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“…The WUHA trial found statistically significant improvements in various observed and self-reported hygiene indicators among intervention communitiesincluding face-washing with soapsuggesting that the intervention did indeed have a positive effect on the hygiene status of community members in the intervention clusters. 3 Despite the observed improvements in hygiene we were unable to detect a difference in ocular chlamydia between the intervention and control groups after 3 years. 2 Facial cleanliness, typically defined as ocular discharge, nasal discharge, or face flies, is a plausible mediator of a potential association between WASH and trachoma because ocular and nasal secretions harbour chlamydia organisms.…”

Section: Authors' Replymentioning

confidence: 70%

Trachoma control using water, sanitation, and hygiene – Authors' reply

Aragie

Lietman

Keenan

2022

The Lancet Global Health

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Section: Authors' Replymentioning

confidence: 70%

Trachoma control using water, sanitation, and hygiene – Authors' reply

Aragie

Lietman

Keenan

2022

The Lancet Global Health

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“…Analysis of fidelity outcomes in this trial showed significant improvements in water and sanitation infrastructure and positive changes in self-reported hygiene behaviours in the WASH intervention group. 23 And yet, the final prevalence of ocular chlamydia was not significantly different in the two treatment groups. Several reasons could explain the null result.…”

Section: Discussionmentioning

confidence: 87%

“…Intervention fidelity is reported separately. 23 All communities had: a water point constructed; delivery of wash stations and WASH education picture books to at least 90% of the households; soap deliveries at least nine times per year; and a visit by the hygiene promotion worker at least six times per year to at least 90% of households. All 20 intervention schools implemented the hygiene curriculum.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, hygiene behaviour changes, although markedly greater in the WASH group, were not universal, and much of the evidence for adherence did not become apparent until the 24-month household survey. 23 The trial was designed as an efficacy trial, to provide proof of concept that WASH could reduce transmission of trachoma. Some components of the intervention (eg, monthly soap distributions or hygiene promotion workers) might not be feasible or sustainable for some trachoma programmes.…”

Section: Discussionmentioning

confidence: 99%

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Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial

Aragie

Wittberg

Tadesse³

et al. 2022

The Lancet Global Health

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Background WHO promotes the SAFE strategy for the elimination of trachoma as a public health programme, which promotes surgery for trichiasis (ie, the S component), antibiotics to clear the ocular strains of chlamydia that cause trachoma (the A component), facial cleanliness to prevent transmission of secretions (the F component), and environmental improvements to provide water for washing and sanitation facilities (the E component). However, little evidence is available from randomised trials to support the efficacy of interventions targeting the F and E components of the strategy. We aimed to determine whether an integrated water, sanitation, and hygiene (WASH) intervention prevents the transmission of trachoma. MethodsThe WASH Upgrades for Health in Amhara (WUHA) was a two-arm, parallel-group, cluster-randomised trial in 40 rural communities in Wag Hemra Zone (Amhara Region, Ethiopia) that had been treated with 7 years of annual mass azithromycin distributions. The randomisation unit was the school catchment area. All households within a 1•5 km radius of a potential water point within the catchment area (as determined by the investigators) were eligible for inclusion. Clusters were randomly assigned (at a 1:1 ratio) to receive a WASH intervention either immediately (intervention) or delayed until the conclusion of the trial (control), in the absence of concurrent antibiotic distributions. Given the nature of the intervention, participants and field workers could not be masked, but laboratory personnel were masked to treatment allocation. The WASH intervention consisted of both hygiene infrastructure improvements (namely, construction of a community water point) and hygiene promotion by government, school, and community leaders, which were implemented at the household, school, and community levels. Hygiene promotion focused on two simple messages: to use soap and water to wash your or your child's face, and to always use a latrine for defecation. The primary outcome was the cluster-level prevalence of ocular chlamydia, measured annually using conjunctival swabs in a random sample of children aged 0-5 years from each cluster at 12, 24, and 36 month timepoints. Analyses were done in an intention-to-treat manner. This trial is ongoing and is registered at ClinicalTrials.gov, NCT02754583.

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“…Trachoma is a highly focal disease, found to cluster in communities and within households [ 12 ]. Previous reviews and more recent studies demonstrate that trachoma is associated with individual- and household-level factors including inadequate access to water which can affect hygiene practices (lack of cleaning face with soap) [ 16 ], poor sanitation (the specific fly vector species preferentially breeds in human faeces left exposed on the soil) [ 17 ], and household crowding [ 4 , 12 , 18 ]. However, trachoma is a community disease usually managed at district level.…”

Section: Introductionmentioning

confidence: 99%

Community-level trachoma ecological associations and the use of geospatial analysis methods: A systematic review

et al. 2022

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Background Trachoma is targeted for global elimination as a public health problem by 2030. Understanding individual, household, or community-associated factors that may lead to continued transmission or risk of recrudescence in areas where elimination has previously been achieved, is essential in reaching and maintaining trachoma elimination. We aimed to identify climatic, demographic, environmental, infrastructural, and socioeconomic factors associated in the literature with trachoma at community-level and assess the strength of their association with trachoma. Because of the potential power of geospatial analysis to delineate the variables most strongly associated with differences in trachoma prevalence, we then looked in detail at geospatial analysis methods used in previous trachoma studies. Methods We conducted a systematic literature review using five databases: Medline, Embase, Global Health, Dissertations & Theses Global, and Web of Science, including publications from January 1950 to January 2021. The review protocol was prospectively registered with PROSPERO (CRD42020191718). Results Of 35 eligible studies, 29 included 59 different trachoma-associated factors, with eight studies also including spatial analysis methods. Six studies included spatial analysis methods only. Higher trachomatous inflammation—follicular (TF) prevalence was associated with areas that: had lower mean annual precipitation, lower mean annual temperatures, and lower altitudes; were rural, were less accessible, had fewer medical services, had fewer schools; and had lower access to water and sanitation. Higher trachomatous trichiasis (TT) prevalence was associated with higher aridity index and increased distance to stable nightlights. Of the 14 studies that included spatial methods, 11 used exploratory spatial data analysis methods, three used interpolation methods, and seven used spatial modelling methods. Conclusion Researchers and decision-makers should consider the inclusion and potential influence of trachoma-associated factors as part of both research activities and programmatic priorities. The use of geospatial methods in trachoma studies remains limited but offers the potential to define disease hotspots and areas of potential recrudescence to inform local, national, and global programmatic needs.

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Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Cited by 6 publications

References 25 publications

Trachoma control using water, sanitation, and hygiene – Authors' reply

Trachoma control using water, sanitation, and hygiene – Authors' reply

Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial

Community-level trachoma ecological associations and the use of geospatial analysis methods: A systematic review

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