Effects of a Water, Sanitation, and Hygiene Mobile Health Program on Diarrhea and Child Growth in Bangladesh: A Cluster-randomized Controlled Trial of the Cholera Hospital-based Intervention for 7 Days (CHoBI7) Mobile Health Program

Abstract

Background The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to three arms: standard recommendation on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus two home visits and mHealth. The primary outcome was reported diarrhea in the past two weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12 month follow-up. Analysis was intention-to-treat. The trial is registered at ClinicalTrials.gov (NCT04008134). Results Between December 4, 2016 and April 26, 2018, 2626 participants in 769 households were randomly allocated to three arms: 849 participants to standard message, 886 to mHealth with no home visits, and 891 to mHealth with two home visits. Children under five years had significantly lower 12-month diarrhea prevalence in both the mHealth with two home visits arm (Prevalence Ratio(PR): 0.73 (95% Confidence Interval(CI): 0.61, 0.87)) and the mHealth with no home visits arm (PR: 0.82 (95% CI: 0.69, 0.97)). Children under 2 years were significantly less likely to be stunted in both the mHealth with two home visits arm (33% vs. 45%, Odds Ratio(OR): 0.55, 95% CI: 0.31, 0.97) and the mHealth with no home visits arm (32% vs. 45%, OR: 0.54, 95% CI: 0.31, 0.96) compared to children in the standard message arm. Conclusion The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households.

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

“…41,42 A recent RCT of the CHoBI7 mHealth program resulted in significantly lower pediatric diarrhea and stunting as well as improved drinking water quality and handwashing with soap. 43 A prospective cohort study nested within this RCT investigated potential risk factors for growth faltering among children under 5 years of age, and found that children with caregiver reports of mouthing soil and children with animals in their sleeping space had a significant reduction in height-for-age Z-scores from baseline to the month 12 followup. 44 A second cohort study in this population assessed the association between soil-and object-to-mouth contacts and diarrhea prevalence for children under 5 years of age, and found that the odds of having a diarrhea episode in the subsequent month were significantly higher for children with caregiver reports of mouthing feces within the past week.…”

Formative Research for the Design of a Baby Water, Sanitation, and Hygiene Mobile Health Program in Bangladesh (CHoBI7 Mobile Health Program)

“…The eligibility criteria for CHoBI7 mHealth RCT participants interviews is reported elsewhere. 35,37 Neighbors were eligible to participate in an interview if they had a child younger than 5 years in the home. Interviews followed a guide that covered the following topics: types of food consumed by young children, food storage and reheating practices, caregivers' experiences with child mouthing of dirt or dirty objects, child toileting practices, child feces disposal practices, male household member involvement in child and household activities, and preferences for mHealth message delivery.…”

“…Thirty-four households were in an intervention arm of the CHoBI7 mHealth RCT and had previously received weekly mobile messages on handwashing with soap and water treatment for 12 months in addition to WASH-enabling technology (a handwashing station and water vessel with lid and tap) and an in-person visit for delivery of a pictorial module; 16 households were in the standard message arm and had received no prior WASH intervention. 35,37 All pilot phase 1 households received at least bi-weekly voice and text messages for up to 3 months from the Baby WASH mHealth program.…”

“…In the third phase of the pilot study, we enrolled 32 new households that had a diarrhea patient admitted to the Dhaka International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospital for treatment in the past 24 hours to mirror the original design of the CHoBI7 mHealth program. 37 The time patients and their household members spend at a health facility for treatment presents an opportunity to deliver WASH behavior change communication when perceived severity of diarrheal diseases and the perceived benefits of the promoted WASH behaviors are likely the highest. 32,51 Twenty-four households received a further modified Baby WASH program including 1) a pictorial module delivered by a promoter in the health facility; 2) two home visits during the first week of program delivery; 3) a handwashing station and a bottle of soapy water 36 and cue cards on the recommended behaviors; and 4) biweekly voice and text messages for up to 1 month.…”

“…Our recent randomized controlled trial (RCT) of the CHoBI7 WASH mHealth program showed significant improvements in handwashing with soap and stored household drinking water quality and lower pediatric diarrhea and stunting over the 12month study period. 37 This was the first RCT of a WASH mHealth program and demonstrates that mHealth is a promising approach to facilitate WASH behavior change. We are currently partnering with the Bangladesh Ministry of Health and Family Welfare to scale this mHealth intervention program across Bangladesh.…”