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

NCT ID: NCT05808218

Last Updated: 2025-03-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 2800 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-04-13
• Study Completion Date: 2024-05-01

Brief Summary

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.

Detailed Description

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.

Conditions

Behavior

Study Design

• Allocation Method: NA
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

CLTS

This arm will receive a standard community-led total sanitation) intervention).

Group Type: EXPERIMENTAL

Community-Led Total Sanitation

Intervention Type: OTHER

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

CLTS Plus

Includes all activities in the CLTS arm with the addition of village-level Care Groups for sanitation and hygiene promotion.

Group Type: EXPERIMENTAL

Community-Led Total Sanitation

Intervention Type: OTHER

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 Groups

Intervention Type: OTHER

• 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.

Control

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Community-Led Total Sanitation

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

Intervention Type: OTHER

Care Groups

• 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.

Intervention Type: OTHER

Other Intervention Names

CLTS

Eligibility Criteria

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

• Permanent resident of selected household; able to provide informed consent

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:

• Not a permanent resident of selected household, not able to provide informed consent

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Malawi University of Business and Applied Sciences (MUBAS) WASHTED Centre

UNKNOWN

Sponsor Role: collaborator

University of Strathclyde

OTHER

Sponsor Role: collaborator

London School of Hygiene and Tropical Medicine

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Robert Dreibelbis, PhD

Role: PRINCIPAL_INVESTIGATOR

London School of Hygiene and Tropical Medicine

Locations

Malawi University of Business and Applied Sciences, WASHTED Centre

Blantyre, , Malawi

Countries

Malawi

References

Chidziwisano K, Panulo M, MacLeod C, Vigneri M, White B, Wells J, Ross I, Morse T, Dreibelbis R. Water, Sanitation, and Hygiene for Everyone Intervention Study: Protocol for a Controlled Before-and-After Trial. JMIR Res Protoc. 2025 May 15;14:e68280. doi: 10.2196/68280.

Reference Type: DERIVED

PMID: 40373302 (View on PubMed)

Other Identifiers

28249

Identifier Type: -

Identifier Source: org_study_id