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Effectiveness of a community-based water, sanitation, and hygiene (WASH) intervention in reduction of diarrhoea among under-five children: Evidence from a repeated cross-sectional study (2007-2015) in rural Bangladesh
- Source :
- International journal of hygiene and environmental health. 222(8)
- Publication Year :
- 2019
-
Abstract
- Diarrhoea, the most common disease directly related to water, sanitation, and hygiene (WASH), still remains one of the most significant health problems among children under-five worldwide. In this reality, BRAC, the largest NGO in the world initiated a comprehensive WASH intervention in 50 upazilas (sub-districts) of Bangladesh in 2007 which was later scaled up to cover 150 upazilas in two subsequent phases. The intervention period of the programme was 2007-2011. The present study encompassed 30 upazilas of the first phase of intervention. The aim of the study was to investigate the effectiveness of this intervention on reduction of diarrhoea among under-five children, and to identify the factors associated with childhood diarrhoea. A repeated cross-sectional study design was followed, and a population-based survey was carried out on four occasions: baseline (2007), midline (2009), endline (2011), and post-endline (2015) among 4,775 households. This analysis considers only households having at least one under-five children. Absence of handwashing practice with soap after defecation and before eating food, unclean latrine condition, and unsafe disposal of child faeces were identified as significant risk factors associated with under-five diarrhoea from Log-binomial regression. The prevalence of under-five diarrhoea within the past 2 weeks of the survey declined from 13.7% at baseline to 3.6% at end-line (p 0.001) in the WASH intervention area. However, the progress seemingly stalled after 2011, which may have occurred due to the lack of improvement in unsafe disposal of child faeces and unclean latrine condition after the intervention period. Study findings suggest that, to reduce the prevalence of childhood diarrhoea it is important to promote safe disposal of child faeces, maintaining cleanliness of latrines, and washing hand with soap at critical times, beyond merely increasing the sanitation coverage. Findings also underline the necessity of maintaining a small-scale monitoring component involving local community, such as a WatSan committee (a local committee comprising the user communities for supervising WASH related activities) for periodic monitoring at household level for a certain period after the program intervention works to make the behavioural change more sustainable and to keep the reduction rate of under-five diarrhoeal prevalence steady.
- Subjects :
- Diarrhea
Male
Rural Population
Sanitation
Cross-sectional study
media_common.quotation_subject
Population
Health Promotion
010501 environmental sciences
01 natural sciences
03 medical and health sciences
0302 clinical medicine
Hygiene
Water Supply
Intervention (counseling)
Environmental health
Medicine
Humans
030212 general & internal medicine
Community Health Services
education
0105 earth and related environmental sciences
media_common
education.field_of_study
Bangladesh
business.industry
Public Health, Environmental and Occupational Health
Infant, Newborn
Infant
Water
Local community
Cross-Sectional Studies
Child, Preschool
Defecation
Latrine
Female
business
Program Evaluation
Subjects
Details
- ISSN :
- 1618131X
- Volume :
- 222
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- International journal of hygiene and environmental health
- Accession number :
- edsair.doi.dedup.....0de1b54e2c4f525be6d5da0222cb0832