JMIR Publications

ABSTRACT

Background:

Community-based behaviour change interventions are a common approach to Water, Sanitation, and Hygiene (WASH). Yet, published evaluations of how these interventions work in district-wide approaches are rare.

Objective:

This study reports the baseline characteristics and study design for a trial assessing the effectiveness of a district-level Community-led Total Sanitation (CLTS) intervention compared to the additional integration of local Care Groups (CG) on sanitation coverage and use and hygiene behaviours in Chiradzulu District, Malawi.

Methods:

This study is a controlled before-and-after trial with two treatment arms and a control group. Clusters are rural villages in three Traditional Authorities (TAs). One arm will receive CLTS and the CG model (CLTS+CG group), one arm CLTS only (CLTS group), and one group will serve as the control. The trial is part of the wider WASH for Everyone (W4E) project, led by World Vision Malawi which aims to expand access to WASH services across the entire district by 2025. Study participants were selected from the three TAs. Systematic sampling procedures were used to select 20 households per cluster with a total of 1,400 households at both baseline and endline. The primary outcome is sanitation coverage. Secondary outcome measures include sanitation use, safe disposal of child faeces, observed handwashing facility, and Sanitation-related Quality of Life index (SanQoL-5).

Results:

The baseline observations indicate a balanced distribution of potential demographic confounders in the trial arms with a slight variation on some WASH proxy measures. We noted low coverage of handwashing facilities with soap and water in all the three arms: 8% in the CLTS group, 4% in the CLTS+CG group, and 4% in the control group. There was a marginal variation in handwashing practices among the study arms with 3% of individuals handwashing with soap and water in the CLTS group, 5% in the CLTS+CG group, and 2% in the control group. Sanitation coverage also varied among the study arms at baseline as 83% of households had access to unimproved sanitation in the CLTS group, 70% in the CLTS+CG group, and 81% in the control group.

Conclusions:

Results from this trial will provide evidence on whether the CLTS+CG approach is effective at improving sanitation and hygiene practices in the W4E programme area compared to CLTS alone and no intervention, as well as inform implementing partners on future interventions in Chiradzulu District, Malawi. The results are expected to be published in2025. Clinical Trial: The trial was registered at clinicaltrials.gov NCT05808218 (https://clinicaltrials.gov/study/NCT05808218).