Reduced Diarrhea Prevalence and Improvements in Handwashing with Soap and Stored Drinking Water Quality Associated with Diarrheal Disease Awareness Measured by Interactive Voice Response Messages in the CHoBI7 Mobile Health Program

Md Sazzadul Islam Bhuyian International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Md Sazzadul Islam Bhuyian in
Current site
Google Scholar
PubMed
Close
,
Jamie Perin Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Search for other papers by Jamie Perin in
Current site
Google Scholar
PubMed
Close
,
Kelly Endres Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Search for other papers by Kelly Endres in
Current site
Google Scholar
PubMed
Close
,
Fatema Zohura International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Fatema Zohura in
Current site
Google Scholar
PubMed
Close
,
Jahed Masud International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Jahed Masud in
Current site
Google Scholar
PubMed
Close
,
Tahmina Parvin International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Tahmina Parvin in
Current site
Google Scholar
PubMed
Close
,
Ismat Minhaj Uddin International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Ismat Minhaj Uddin in
Current site
Google Scholar
PubMed
Close
,
Tasdik Hasan International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Tasdik Hasan in
Current site
Google Scholar
PubMed
Close
,
Shirajum Monira International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Shirajum Monira in
Current site
Google Scholar
PubMed
Close
,
David A. Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Search for other papers by David A. Sack in
Current site
Google Scholar
PubMed
Close
,
Abu S. G. Faruque International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Abu S. G. Faruque in
Current site
Google Scholar
PubMed
Close
,
Munirul Alam International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

Search for other papers by Munirul Alam in
Current site
Google Scholar
PubMed
Close
, and
Christine Marie George Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Search for other papers by Christine Marie George in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) mobile health program promotes water, sanitation, and hygiene (WASH) behaviors through interactive voice response (IVR), voice, and text messages to reduce diarrheal diseases in Bangladesh. The objective of this study was to investigate the relationship between responses to CHoBI7 WASH IVR quiz messages and subsequent diarrhea and WASH behaviors. Fourteen CHoBI7 IVR quiz messages on handwashing with soap and treatment of stored water were sent to 517 households with 1,777 participants during the 12-month program period. IVR message responses were classified as correct answer, incorrect answer, no response (did not press 1 or 2), and failed (did not answer the phone). Diarrhea prevalence was assessed through self-reported monthly clinical surveillance visits. Handwashing with soap was assessed by a 5-hour structured observation, and stored water quality was defined by Escherichia coli concentration. Households that responded correctly to a CHoBI7 IVR quiz message had significantly lower odds of diarrhea for all age groups (adults and children) at the subsequent visit 1 month later (odds ratio [OR], 0.73; 95% CI, 0.54–0.98), and significantly greater odds of handwashing with soap after stool-related events (OR, 2.48; 95% CI, 1.12–5.49) and E. coli levels < 100 colony forming units (CFU)/100 mL (World Health Organization high-risk cutoff) in the stored household water (OR, 2.04; 95% CI, 1.25–3.33) compared with households that did not answer CHoBI7 IVR quiz calls. Correct responses to CHoBI7 IVR quizzes were associated with decreased diarrhea prevalence and improved stored drinking water quality and handwashing with soap behaviors at the subsequent visits. These findings suggest engagement in the CHoBI7 mobile health (mHealth) program and awareness of diarrheal disease prevention can reduce diarrhea and facilitate changes in WASH behaviors.

    • Supplemental Materials (PDF 436 KB)

Author Notes

Address correspondence to Christine Marie George, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Rm. E5535, Baltimore, MD 21205-2103. E-mail: cmgeorge@jhu.edu

Financial support: This research was funded by a USAID grant to Johns Hopkins School of Public Health.

Authors’ addresses: Md Sazzadul Islam Bhuyian, Fatema Zohura, Jahed Masud, Tahmina Parvin, Ismat Minhaj Uddin, Tasdik Hasan, Shirajum Monira, Abu S. G. Faruque, and Munirul Alam, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: sazzadul.islam@icddrb.org, fzohura@icddrb.org, jahed@icddrb.org, tparvin@icddrb.org, ismat.minhaj@icddrb.org, tasdikhdip@yahoo.com, smoniralab@gmail.com, gfaruque@icddrb.org, and munirul@icddrb.org. Jamie Perin, Kelly Endres, David A. Sack, and Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: kendres4@jhu.edu, jperin@jhu.edu, dsack1@jhu.edu, and cgeorg19@jhu.edu.

  • 1.

    Troeger CE et al., 2020. Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: An analysis of the Global Burden of Disease Study 2017. Lancet Infect Dis 20: 3759.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    GBD Diarrhoeal Diseases Collaborators , 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 897.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ejemot RI , Ehiri JE , Meremikwu MM , Critchley JA , 2009. Cochrane review: Hand washing for preventing diarrhoea. Evid Based Child Health 4: 893939.

  • 4.

    Wolf J et al., 2014. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: Systematic review and meta-regression. Trop Med Int Health. 19: 928942.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Wolf J et al., 2018. Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: Updated meta-analysis and meta-regression. Trop Med Int Health. 23: 508525.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Luby SP , Agboatwalla M , Bowen A , Kenah E , Sharker Y , Hoekstra RM , 2009. Difficulties in maintaining improved handwashing behavior, Karachi, Pakistan. Am J Trop Med Hyg 81: 140145.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    De Buck E et al., 2017. Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: A mixed method systematic review. Campbell Syst Rev 13: 1447.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Arnold B , Arana B , Mäusezahl D , Hubbard A , Colford JM Jr , 2009. Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala. Int J Epidemiol 38: 16511661.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Huda TM , Unicomb L , Johnston RB , Halder AK , Yushuf Sharker MA , Luby SP , 2012. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med 75: 604611.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Yang QH , Van Stee SK , 2019. The comparative effectiveness of mobile phone interventions in improving health outcomes: Meta-analytic review. JMIR Mhealth Uhealth 7: e11244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Shin JC , Kim J , Grigsby-Toussaint D , 2017. Mobile phone interventions for sleep disorders and sleep quality: Systematic review. JMIR Mhealth Uhealth 5: e131.

  • 12.

    Bassi A , John O , Praveen D , Maulik PK , Panda R , Jha V , 2018. Current status and future directions of mHealth interventions for health system strengthening in India: Systematic review. JMIR Mhealth Uhealth 6: e11440.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Free C et al., 2013. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med 10: e1001362.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Demena BA , Artavia-Mora L , Ouedraogo D , Thiombiano BA , Wagner N , 2020. A systematic review of mobile phone interventions (SMS/IVR/calls) to improve adherence and retention to antiretroviral treatment in low-and middle-income countries. AIDS Patient Care STDS 34: 5971.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Kabukye JK , Ilozumba O , 2021. Implementation of an interactive voice response system for cancer awareness in Uganda. Mixed Methods Study 9: e22061.

  • 16.

    Byonanebye DM et al., 2021. Impact of a mobile phone-based interactive voice response software on tuberculosis treatment outcomes in Uganda (CFL-TB): A protocol for a randomized controlled trial. Trials 22: 391.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Tidwell JB et al., 2019. Effect of two complementary mass-scale media interventions on handwashing with soap among mothers. J Health Commun 24: 203215.

  • 18.

    Henry CA , 2017. Using mHealth to promote hand washing with soap: how do Tanzanian youth perceive text message interventions for hand hygiene? Am J Trop Med Hyg 97: 280.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Imaja IM , Ndayizigamiye P , Maharaj M , 2017. A Design of a Mobile Health Intervention for the Prevention and Treatment of Cholera in South Kivu in the Democratic Republic of Congo. 2017 IEEE Global Humanitarian Technology Conference, October 19–22, San Jose, CA.

    • PubMed
    • Export Citation
  • 20.

    ITU, n.d Statistics. Available at: https://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx. Accessed October 22, 2022.

    • PubMed
    • Export Citation
  • 21.

    Gibson DG et al., 2017. Evaluation of mechanisms to improve performance of mobile phone surveys in low- and middle-income countries: Research protocol. JMIR Res Protoc 6: e7534.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Mobile phone subscribers web-based repot, 2021. Avaliable at: http://www.btrc.gov.bd/content/mobile-phone-subscribers-bangladesh-july-2021. Accessed December 22, 2022.

    • PubMed
    • Export Citation
  • 23.

    George CM et al., 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 22: 233241.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Weil AA et al., 2009. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis 49: 14731479.

  • 25.

    George CM et al., 2015. Shigella infections in household contacts of pediatric shigellosis patients in rural Bangladesh. Emerg Infect Dis 21: 20062013.

  • 26.

    Black RE et al., 1981. Enterotoxigenic Escherichia coli diarrhoea: acquired immunity and transmission in an endemic area. Bull World Health Organ 59: 263268.

  • 27.

    George CM et al., 2021. Effects of a water, sanitation, and hygiene mobile health program on diarrhea and child growth in Bangladesh: A cluster-randomized controlled trial of the Cholera Hospital-Based Intervention for 7 Days (CHoBI7) Mobile Health Program. Nephrol Dial Transplant 73: e2560e2568.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Islam Bhuyian MS et al., 2020. Process evaluation for the delivery of a water, sanitation and hygiene mobile health program: findings from the randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 25: 985995.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    George CM et al., 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1028.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Islam M et al., 2001. Microbiological analysis of tube-well water in a rural area of Bangladesh. Appl Environ Microbiol 67: 33283330.

  • 31.

    World Health Organization , 2011. Guidelines for Drinking-Water Quality. Geneva, Switzerland: WHO. Available at: https://apps.who.int/iris/bitstream/handle/10665/44584/9789241548151_eng.pdf. Accessed January 13, 2023.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Higgs ES et al., 2014. Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: An evidence review. J Health Commun 19(Suppl 1): 164189.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    George CM et al., 2021. Psychosocial factors mediating the effect of the CHoBI7 Mobile Health Program on handwashing with soap and household stored water quality: A randomized controlled trial. Health Educ Behav 49: 326–339.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    George CM et al., 2017. Psychosocial factors mediating the effect of the CHoBI7 intervention on handwashing with soap. Health Educ Behav 44: 613–625.

  • 35.

    Mashoto KO , Malebo HM , Msisiri E , Peter E , 2014. Prevalence, one week incidence and knowledge on causes of diarrhea: Household survey of under-fives and adults in Mkuranga district, Tanzania. BMC Public Health 14: 985.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Andualem Z , Dagne H , Taddese AA , Dagnew B , 2019. Mothers’ handwashing knowledge as a predictor of diarrheal disease among under-five children visiting pediatric ward in University of Gondar Comprehensive Specialized Hospital. Northwest Ethiopia 2019: 189194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Karinja M et al., 2020. Risk reduction of diarrhea and respiratory infections following a community health education program: A facility-based case-control study in rural parts of Kenya. BMC Public Health 20: 586.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Wald DS , Butt S , Bestwick JP , 2015. One-way versus two-way text messaging on improving medication adherence: Meta-analysis of randomized trials. Am J Med 128: 1139.e11139.e5.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 1522 538 51
Full Text Views 239 157 2
PDF Downloads 113 35 3
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save