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Promoting handwashing and sanitation : evidence from a large-scale randomized trial in rural Tanzania

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Listed:
  • Briceno, Bertha
  • Coville, Aidan
  • Martinez , Sebastian

Abstract

The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited. This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent. Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups. Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.

Suggested Citation

  • Briceno, Bertha & Coville, Aidan & Martinez , Sebastian, 2015. "Promoting handwashing and sanitation : evidence from a large-scale randomized trial in rural Tanzania," Policy Research Working Paper Series 7164, The World Bank.
  • Handle: RePEc:wbk:wbrwps:7164
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    Cited by:

    1. Youngmee Tiffany Jung & Ryan James Hum & Wendy Lou & Yu-Ling Cheng, 2017. "Effects of neighbourhood and household sanitation conditions on diarrhea morbidity: Systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-17, March.
    2. Emmy De Buck & Hans Van Remoortel & Karin Hannes & Thashlin Govender & Selvan Naidoo & Bert Avau & Axel Vande Veegaete & Alfred Musekiwa & Vittoria Lutje & Margaret Cargo & Hans‐Joachim Mosler & Phili, 2017. "Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: a mixed method systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 13(1), pages 1-447.

    More about this item

    Keywords

    Health Monitoring&Evaluation; Hygiene Promotion and Social Marketing; Housing&Human Habitats; Disease Control&Prevention; Population Policies;
    All these keywords.

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