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Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial
Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.
Author Notes
Financial support: This research was supported by the Center for Global Health at Johns Hopkins University and NIAID.
Authors' addresses: Christine Marie George, Danielle S. Jung, David A. Sack, Peter J. Winch, Elli Leontsini, Jamie Perin, and R. Bradley Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mails: cmgeorge@jhsph.edu, daniellesjung@gmail.com, dsack1@jhu.edu, pwinch@jhu.edu, eleontsi@jhu.edu, jperin@jhu.edu, and rsack1@jhu.edu. K. M. Saif-Ur-Rahman, Shirajum Monira, Mahamud-ur Rashid, Md. Toslim Mahmud, Munshi Mustafiz, Zillur Rahman, Sazzadul Islam Bhuyian, Farzana Begum, Fatema Zohura, Shwapon Biswas, Tahmina Parvin, and Munirul Alam, icddr,b, Center for Communicable Diseases, Dhaka, Bangladesh, E-mails: s.rahman2312@yahoo.com, shirajum_monira@yahoo.com, palash1898@gmail.com, palashmahmud@ymail.com, rimonstate@gmail.com, zillur_rahman05@yahoo.com, sazewu@yahoo.com, docfrzn@gmail.com, fatema_zohura@yahoo.co, drskbiswas2004@yahoo.com, tahminaph14@yahoo.com, and munir563@yahoo.com.