Promoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzania

Briceno, Bertha ; Coville, Aidan ; Martinez, Sebastian

World Bank Group, Washington, DC

关键词: ADEQUATE WATER;    AGE DISTRIBUTION;    ANEMIA;    ASCARIASIS;    BABY;   

DOI  :  10.1596/1813-9450-7164
RP-ID  :  WPS7164

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The association between hygiene,sanitation, and health is well documented, yet thousands ofchildren die each year from exposure to contaminated fecalmatter. At the same time, evidence on the effectiveness ofat-scale behavior change interventions to improve sanitationand hygiene practices is limited.This paper presents theresults of two large-scale, government-led handwashing andsanitation promotion campaigns in rural Tanzania. For thecampaign, 181 wards were randomly assigned to receivesanitation promotion, handwashing promotion, bothinterventions together, or neither. One year after the endof the program, sanitation wards increased latrineconstruction rates from 38.6 to 51 percent and reducedregular open defecation from 23.1 to 11.1 percent.Households in handwashing wards show marginal improvementsin handwashing behavior related to food preparation, but notat other critical junctures. Limited interaction is observedbetween handwashing and sanitation on intermediate outcomes:wards that received both handwashing and sanitationpromotion are less likely to have feces visible around theirlatrine and more likely to have a handwashing station closeto their latrine facility relative to individual treatmentgroups. Final health effects on child health measuredthrough diarrhea, anemia, stunting, and wasting are absentin the single-intervention groups. The combined-treatmentgroup produces statistically detectable, but biologicallyinsignificant and inconsistent, health impacts. The resultshighlight the importance of focusing on intermediateoutcomes of take-up and behavior change as a critical firststep in large-scale programs before realizing the changes inhealth that sanitation and hygiene interventions aim to deliver.