Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India
Abstract Background Poor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latri...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-021-12405-0 |
| _version_ | 1819006740981612544 |
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| author | Gloria D. Sclar Valerie Bauza Hans-Joachim Mosler Alokananda Bisoyi Howard H. Chang Thomas F. Clasen |
| author_facet | Gloria D. Sclar Valerie Bauza Hans-Joachim Mosler Alokananda Bisoyi Howard H. Chang Thomas F. Clasen |
| author_sort | Gloria D. Sclar |
| collection | DOAJ |
| description | Abstract Background Poor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latrines often do not safely dispose of their child’s feces. Working with caregivers in rural Odisha, India, we co-developed an intervention aimed at improving safe disposal of child feces and encouraging child latrine use at an earlier age. We describe the rationale for the intervention and summarize the protocol for a cluster randomized trial (CRT) to evaluate its effectiveness at changing CFM practices. Methods The intervention consists of six behavior change strategies together with hardware provision: wash basin and bucket with lid to aid safe management of soiled nappies and a novel latrine training mat to aid safe disposal and latrine training. The intervention will be offered at the village level to interested caregivers of children < 5 years of age by a community-based organization. Following a baseline survey, 74 villages were randomly allocated to either intervention or control arm. The primary outcome is caregiver reported safe disposal of child feces after last defecation, either by the caregiver disposing of the child’s feces into the latrine or the child using the latrine, measured approximately four to six months following intervention delivery. Secondary outcomes include fecal contamination of household drinking water and the childs’ hands. A process evaluation will also be conducted to assess intervention fidelity and reach, and explore implementer and participant feedback. Discussion This study addresses a crucial knowledge gap in sanitation by developing a scalable intervention to improve safe management of child feces. The behavior change strategies were designed following the Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) approach, which has shown to be effective for other environmental behavior change interventions in low-income settings. The latrine training mat hardware is a novel design developed cooperatively and manufactured locally. The evaluation follows a rigorous CRT study design assessing the impact of the intervention on CFM behavior change, as well as fecal contamination of two sources of potential exposure. Trial registration This trial is registered at ISRCTN: ISRCTN15831099. |
| first_indexed | 2024-12-21T00:13:30Z |
| format | Article |
| id | doaj.art-53bd81599314494a836622d242551f6a |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-21T00:13:30Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-53bd81599314494a836622d242551f6a2022-12-21T19:22:18ZengBMCBMC Public Health1471-24582022-01-0122111210.1186/s12889-021-12405-0Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, IndiaGloria D. Sclar0Valerie Bauza1Hans-Joachim Mosler2Alokananda Bisoyi3Howard H. Chang4Thomas F. Clasen5Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory UniversityGangarosa Department of Environmental Health, Rollins School of Public Health, Emory UniversityRanasMoslerIndependent ConsultantGangarosa Department of Environmental Health, Rollins School of Public Health, Emory UniversityGangarosa Department of Environmental Health, Rollins School of Public Health, Emory UniversityAbstract Background Poor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latrines often do not safely dispose of their child’s feces. Working with caregivers in rural Odisha, India, we co-developed an intervention aimed at improving safe disposal of child feces and encouraging child latrine use at an earlier age. We describe the rationale for the intervention and summarize the protocol for a cluster randomized trial (CRT) to evaluate its effectiveness at changing CFM practices. Methods The intervention consists of six behavior change strategies together with hardware provision: wash basin and bucket with lid to aid safe management of soiled nappies and a novel latrine training mat to aid safe disposal and latrine training. The intervention will be offered at the village level to interested caregivers of children < 5 years of age by a community-based organization. Following a baseline survey, 74 villages were randomly allocated to either intervention or control arm. The primary outcome is caregiver reported safe disposal of child feces after last defecation, either by the caregiver disposing of the child’s feces into the latrine or the child using the latrine, measured approximately four to six months following intervention delivery. Secondary outcomes include fecal contamination of household drinking water and the childs’ hands. A process evaluation will also be conducted to assess intervention fidelity and reach, and explore implementer and participant feedback. Discussion This study addresses a crucial knowledge gap in sanitation by developing a scalable intervention to improve safe management of child feces. The behavior change strategies were designed following the Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) approach, which has shown to be effective for other environmental behavior change interventions in low-income settings. The latrine training mat hardware is a novel design developed cooperatively and manufactured locally. The evaluation follows a rigorous CRT study design assessing the impact of the intervention on CFM behavior change, as well as fecal contamination of two sources of potential exposure. Trial registration This trial is registered at ISRCTN: ISRCTN15831099.https://doi.org/10.1186/s12889-021-12405-0Child fecesSafe disposalLatrine trainingBehavior changeSanitationTheory-based intervention |
| spellingShingle | Gloria D. Sclar Valerie Bauza Hans-Joachim Mosler Alokananda Bisoyi Howard H. Chang Thomas F. Clasen Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India BMC Public Health Child feces Safe disposal Latrine training Behavior change Sanitation Theory-based intervention |
| title | Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India |
| title_full | Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India |
| title_fullStr | Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India |
| title_full_unstemmed | Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India |
| title_short | Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India |
| title_sort | study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural odisha india |
| topic | Child feces Safe disposal Latrine training Behavior change Sanitation Theory-based intervention |
| url | https://doi.org/10.1186/s12889-021-12405-0 |
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