Hand washing with soap and WASH educational intervention reduces under-five childhood diarrhoea incidence in Jigjiga District, Eastern Ethiopia: A community-based cluster randomized controlled trial

Abstract

Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhoea is still a major cause of morbidity and mortality among children in many developing countries, including Ethiopia. Hand washing with soap promotion, water quality improvements and improvements in excreta disposal significantly reduces diarrhoeal diseases. The objective of this study was to evaluate the effect of hand washing with soap and water, sanitation and hygiene (WASH) educational Intervention on the incidence of under-five children diarrhoea. A community-based cluster randomized controlled trial was conducted in 24 clusters (sub-Kebelles) in Jigjiga district, Somali region, Eastern Ethiopia from February 1 to July 30, 2015. The trial compared incidence of diarrhoea among under-five children whose primary caretakers receive hand washing with soap and water, sanitation, hygiene educational messages with control households. Generalized estimating equation with a log link function Poisson distribution family was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval. The results of this study show that the longitudinal adjusted incidence rate ratio (IRR) of diarrhoeal diseases comparing interventional and control households was 0.65 (95% CI 0.57, 0.73) suggesting an overall diarrhoeal diseases reduction of 35%. The results are similar to other trials of WASH educational interventions and hand washing with soap. In conclusion, hand washing with soap practice during critical times and WASH educational messages reduces childhood diarrhoea in the rural pastoralist area.

Keywords: Hand washing with soap, WASH, Education, Childhood diarrhoea, Somali region, Jigjiga, Eastern Ethiopia; Trial Registration: ClinicalTrial.gov: NCT02779010.

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Fig. 1

Map of Jigjiga Woreda; part of the map adopted from (Berisa and Birhanu, 2015). Red-circle indicates Jigjiga city while blue-lines represent Kebelles of Jigjiga district.

Fig. 2

Community randomized trial flow of participants on WASH educational intervention: Jigjiga district, Somali Region, Eastern Ethiopia, 2015. HH = House holds.

Fig. 3

Bi-weekly total episodes of diarrhoea versus weeks of observation of randomized cluster trial: Rural areas of Jigjiga district, Somali Region, Eastern Ethiopia, 2015.

Fig. 4

Bi-weekly total episodes of diarrhoea versus age category of randomized cluster trial: Rural areas of Jigjiga district, Somali Region, Eastern Ethiopia, 2015.