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

ADEQUATE WATER AGE DISTRIBUTION ANEMIA ASCARIASIS BABY BEHAVIOR CHANGE BLIND BREASTFEEDING BURDEN OF DISEASE CAREGIVERS CHILD HEALTH CHILD MORBIDITY CHILD MORTALITY CHOLERA CLEANLINESS COMMUNITIES COMMUNITY HEALTH DANCING DEFECATION DESCRIPTION DEVELOPING COUNTRIES DEVELOPMENT INTERVENTIONS DEVELOPMENT POLICY DIARRHEA DIARRHEAL DISEASES DIARRHOEA DIARRHOEAL DISEASES DIRTY HANDS DISSEMINATION DISTRICTS DRINKING WATER DWELLING E. COLI EARLY CHILDHOOD EPIDEMIOLOGY FAMILIES FERTILITY FOOD HANDLING FOOD PREPARATION GENDER GLOBAL HEALTH GROUNDWATER HAND WASHING HANDS WITH SOAP HANDWASHING HEALTH EFFECTS HEALTH INDICATORS HEALTH OUTCOMES HEALTH WORKERS HELMINTHES HOLISTIC APPROACH HOOKWORM HOUSEHOLD ASSETS HOUSEHOLD SURVEYS HOUSEHOLDS HUMAN CAPITAL HUMAN EXCRETA HYGIENE HYGIENE BEHAVIOR HYGIENE PRACTICES HYGIENE PROMOTION IMPORTANT POLICY INADEQUATE SANITATION INFECTION INFECTIONS INFECTIOUS DISEASES INTERNATIONAL COMMUNITY INTERVENTION INTERVENTIONS IRON JA LATRINE CONSTRUCTION LATRINE PROMOTION LIVING STANDARDS LOCAL GOVERNMENTS MALARIA MALNUTRITION MASS MEDIA MIGRATION MINISTRIES OF HEALTH MINISTRY OF HEALTH MOBILITY MORBIDITY MORBIDITY AND MORTALITY MORTALITY MORTALITY RATE MOTHER NATIONAL GOVERNMENTS NATIONAL LEVEL NATIONAL POLICY NATIONAL POPULATION NUMBER OF CHILDREN NUMBER OF HOUSEHOLDS NURSING NUTRITION PARASITES PARASITIC INFECTIONS PATHOGENS PIT LATRINES POLICY DISCUSSIONS POLICY MAKERS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POOR HYGIENE POOR NUTRITION POPULATION SIZE POSTERS PRACTITIONERS PREGNANT WOMEN PREVALENCE PROGRESS PROMOTIONAL MATERIALS PROVISION OF LATRINES RADIO RANDOMIZED CONTROLLED TRIALS RESPIRATORY INFECTIONS RISK OF CONTAMINATION RISK OF EXPOSURE RISK OF INFECTION RURAL AREAS RURAL COMMUNITIES RURAL POPULATION RURAL POPULATIONS SAFE HYGIENE SAFE HYGIENE PRACTICES SANITATION SANITATION FACILITIES SANITATION PRACTICES SANITATION PROMOTION SCHISTOSOMIASIS SEPTIC TANKS SOAP SOCIAL MARKETING SOCIAL WELFARE SYMPTOM SYMPTOMS TECHNICAL ASSISTANCE TOILETS TRACHOMA TREATMENT TRICHURIASIS TROPICAL DISEASES TROPICAL MEDICINE VILLAGE LEVEL VILLAGES WASHING HANDS WATER CONTAMINATION WATER QUALITY WATER SOURCE WATER SUPPLY WORKERS YOUNG CHILDREN
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World Bank Group, Washington, DC
Africa | Tanzania
2015-02-03T15:16:30Z | 2015-02-03T15:16:30Z | 2015-01

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.

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