Promoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzania
The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change intervention...
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| Language: | English en_US |
| Published: |
World Bank Group, Washington, DC
2015
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| Online Access: | http://documents.worldbank.org/curated/en/2015/01/23804984/promoting-handwashing-sanitation-evidence-large-scale-randomized-trial-rural-tanzania http://hdl.handle.net/10986/21383 |
| Summary: | The association between hygiene,
sanitation, and health is well documented, yet thousands of
children die each year from exposure to contaminated fecal
matter. At the same time, evidence on the effectiveness of
at-scale behavior change interventions to improve sanitation
and hygiene practices is limited. This paper presents the
results of two large-scale, government-led handwashing and
sanitation promotion campaigns in rural Tanzania. For the
campaign, 181 wards were randomly assigned to receive
sanitation promotion, handwashing promotion, both
interventions together, or neither. One year after the end
of the program, sanitation wards increased latrine
construction rates from 38.6 to 51 percent and reduced
regular open defecation from 23.1 to 11.1 percent.
Households in handwashing wards show marginal improvements
in handwashing behavior related to food preparation, but not
at other critical junctures. Limited interaction is observed
between handwashing and sanitation on intermediate outcomes:
wards that received both handwashing and sanitation
promotion are less likely to have feces visible around their
latrine and more likely to have a handwashing station close
to their latrine facility relative to individual treatment
groups. Final health effects on child health measured
through diarrhea, anemia, stunting, and wasting are absent
in the single-intervention groups. The combined-treatment
group produces statistically detectable, but biologically
insignificant and inconsistent, health impacts. The results
highlight the importance of focusing on intermediate
outcomes of take-up and behavior change as a critical first
step in large-scale programs before realizing the changes in
health that sanitation and hygiene interventions aim to deliver. |
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