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Randomized Controlled Trial
. 2022 Jan 14;375(6577):eabi9069.
doi: 10.1126/science.abi9069. Epub 2022 Jan 14.

Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh

Jason Abaluck #  1 , Laura H Kwong #  2   3 , Ashley Styczynski #  4 , Ashraful Haque  5 , Md Alamgir Kabir  5 , Ellen Bates-Jefferys  6 , Emily Crawford  1 , Jade Benjamin-Chung  7 , Shabib Raihan  5 , Shadman Rahman  5 , Salim Benhachmi  8 , Neeti Zaman Bintee  5 , Peter J Winch  9 , Maqsud Hossain  10 , Hasan Mahmud Reza  11 , Abdullah All Jaber  10 , Shawkee Gulshan Momen  10 , Aura Rahman  10 , Faika Laz Banti  10 , Tahrima Saiha Huq  10 , Stephen P Luby #  2   4 , Ahmed Mushfiq Mobarak #  1   12
Affiliations
Randomized Controlled Trial

Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh

Jason Abaluck et al. Science. .

Abstract

We conducted a cluster-randomized trial to measure the effect of community-level mask distribution and promotion on symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask type (cloth versus surgical) and promotion strategies at the village and household level. Proper mask-wearing increased from 13.3% in the control group to 42.3% in the intervention arm (adjusted percentage point difference = 0.29; 95% confidence interval = [0.26, 0.31]). The intervention reduced symptomatic seroprevalence (adjusted prevalence ratio = 0.91 [0.82, 1.00]), especially among adults ≥60 years old in villages where surgical masks were distributed (adjusted prevalence ratio = 0.65 [0.45, 0.85]). Mask distribution with promotion was a scalable and effective method to reduce symptomatic SARS-CoV-2 infections.

Trial registration: ClinicalTrials.gov NCT04630054.

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Figures

None
Impact of intervention on mask use and biological outcomes.
The figure shows the raw means of mask-wearing (left), COVID-19 symptoms (middle), and symptomatic seropositivity (right) in the control and treatment arms. The estimated change in each outcome, confidence intervals, and p values adjust for preregistered covariates (and thus are not computable from the raw values). Individuals who were symptomatic but did not consent to blood collection were dropped from the sample; measured symptomatic seropositivity thus understates the true fraction of the population that was symptomatic seropositive.
Fig. 1.
Fig. 1.. Map of 600 treatment and control unions.
The figure shows the location of the 600 treatment and control unions in the study. RCT, randomized controlled trial; 1 mile = 1.6 km.
See this image and copyright information in PMC

Comment in

  • doi: 10.1126/science.abn7802

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