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Randomized Controlled Trial
. 2021 May;6(5):e005030.
doi: 10.1136/bmjgh-2021-005030.

Effects of a community-driven water, sanitation and hygiene intervention on water and sanitation infrastructure, access, behaviour, and governance: a cluster-randomised controlled trial in rural Democratic Republic of Congo

John Paul Quattrochi  1 , Aidan Coville  2 , Eric Mvukiyehe  2 , Caleb Jeremie Dohou  3 , Federica Esu  4 , Byron Cohen  5 , Yannick Lokaya Bokasola  3 , Kevin Croke  5
Affiliations
Randomized Controlled Trial

Effects of a community-driven water, sanitation and hygiene intervention on water and sanitation infrastructure, access, behaviour, and governance: a cluster-randomised controlled trial in rural Democratic Republic of Congo

John Paul Quattrochi et al. BMJ Glob Health. 2021 May.

Abstract

Introduction: Inadequate water and sanitation is a central challenge in global health. Since 2008, the Democratic Republic of Congo government has implemented a national programme, Healthy Villages and Schools (Villages et Ecoles Assainis (VEA), with support from UNICEF, financed by UK's Foreign, Commonwealth and Development Office.

Methods: A cluster-level randomised controlled trial of VEA was implemented throughout 2019 across 332 rural villages, grouped into 50 treatment and 71 control clusters. Primary outcomes included time spent collecting water; quantity of water collected; prevalence of improved primary source of drinking water; and prevalence of improved primary defecation site. Secondary outcomes included child health, water governance, water satisfaction, handwashing practices, sanitation practices, financial cost of water, school attendance and water storage practices. All outcomes were self-reported. The primary analysis was on an intention-to-treat basis, using linear models. Outcomes were measured October-December 2019, median 5 months post-intervention.

Results: The programme increased access to improved water sources by 33 percentage points (pp) (95% CI 22 to 45), to improved sanitation facilities by 26 pp (95% CI 14 to 37), and improved water governance by 1.3 SDs (95% CI 1.1 to 1.5), water satisfaction by 0.6 SD (95% CI 0.4 to 0.9), handwashing practices by 0.5 SD (95% CI 0.3 to 0.7) and sanitation practices by 0.3 SD (95% CI 0.1 to 0.4). There was no significant difference in financial cost of water, school attendance, child health or water storage practices.

Conclusion: VEA produced large increases in access to and satisfaction with water and sanitation services, in self-reported hygiene and sanitation behaviour, and in measures of water governance.

Trial registration number: AEARCTR-0004648; American Economic Association RCT registry.

Keywords: environmental health; health policy; health systems; public health; randomised control trial.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trial profile.
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References

    1. UNICEF/WHO JMP . Progress on drinking water, sanitation, and hygeine: 2017 update and SDG baselines. Geneva: World Health Organization; 2017: 1–116. https://washdata.org. 978-92-4-151289-3.
    1. Prüss-Ustün A, Bartram J, Clasen T, et al. . Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 2014;19:894–905. 10.1111/tmi.12329 - DOI - PMC - PubMed
    1. Adair LS, Fall CHD, Osmond C, et al. . Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet 2013;382:525–34. 10.1016/S0140-6736(13)60103-8 - DOI - PMC - PubMed
    1. Cumming O, Cairncross S. Can water, sanitation and hygiene help eliminate stunting? current evidence and policy implications. Matern Child Nutr 2016;12 Suppl 1:91–105. 10.1111/mcn.12258 - DOI - PMC - PubMed
    1. Grantham-McGregor S, Cheung YB, Cueto S, et al. . Developmental potential in the first 5 years for children in developing countries. Lancet 2007;369:60–70. 10.1016/S0140-6736(07)60032-4 - DOI - PMC - PubMed

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