title: Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.
abstract: Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh cmgeorge@jhsph.edu.
authors.forename: Christine Marie
authors.initials: CM
authors.lastname: George
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Jung
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: K M
authors.initials: KM
authors.lastname: Saif-Ur-Rahman
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shirajum
authors.initials: S
authors.lastname: Monira
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: David A
authors.initials: DA
authors.lastname: Sack
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.lastname: Mahamud-ur Rashid
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Md Toslim
authors.initials: MT
authors.lastname: Mahmud
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Munshi
authors.initials: M
authors.lastname: Mustafiz
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Zillur
authors.initials: Z
authors.lastname: Rahman
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sazzadul Islam
authors.initials: SI
authors.lastname: Bhuyian
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Elli
authors.initials: E
authors.lastname: Leontsini
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Farzana
authors.initials: F
authors.lastname: Begum
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Fatema
authors.initials: F
authors.lastname: Zohura
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shwapon
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Tahmina
authors.initials: T
authors.lastname: Parvin
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: R Bradley
authors.initials: RB
authors.lastname: Sack
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Munirul
authors.initials: M
authors.lastname: Alam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D060766:Drinking Water; D005191:Family Characteristics; D005260:Female; D006235:Hand Disinfection; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012915:Soaps; D060753:Water Quality
chemical_list: D060766:Drinking Water; D012915:Soaps