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Changing hygiene behaviours: a cluster-randomized trial, Ethiopia.

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A water, sanitation, and hygiene intervention in Ethiopia improved access to hygiene facilities and promoted better hygiene behaviors, though behavioral changes took several years to become significant. This study highlights the long-term impact of integrated hygiene programs for disease control.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Environmental Health

Background:

  • Trachoma remains a leading cause of preventable blindness globally.
  • Hygiene behaviors, including face washing and sanitation, are critical for preventing trachoma transmission.
  • Previous interventions have shown varying success in changing long-term hygiene practices.

Purpose of the Study:

  • To evaluate the effectiveness of a community- and school-based water, sanitation, and hygiene (WASH) intervention on hygiene behaviors in rural Ethiopia.
  • To assess changes in access to hygiene facilities and reported hygiene practices over a three-year period.

Main Methods:

  • A cluster-randomized trial was conducted in rural Ethiopia involving 40 clusters (20 intervention, 20 control).
  • The intervention included water and sanitation infrastructure, hygiene promotion, a school curriculum, and household support.
  • Intervention fidelity was assessed annually through household surveys.

Main Results:

  • Households in intervention clusters showed significantly higher availability of wash stations, soap, and latrines compared to control clusters.
  • A greater proportion of individuals, particularly children, in intervention clusters reported practicing face washing with soap and using latrines.
  • Statistically significant behavioral changes were observed after at least one year of intervention implementation and were sustained.

Conclusions:

  • The integrated WASH intervention effectively improved hygiene access and promoted key hygiene behaviors relevant to trachoma control.
  • Sustained behavioral changes require a multi-year commitment to community and school-based hygiene promotion and infrastructure development.
  • The findings underscore the importance of long-term, comprehensive WASH programs in public health initiatives targeting infectious diseases.