Effect of a Low-Cost Behaviour Change Intervention on Latrine Use and Safe Child Faeces Disposal in Rural Odisha, India: A Cluster-Randomized Controlled Trial

Abstract

Background: Uptake of government-promoted sanitation remains a challenge. We evaluated a low-cost, theory-driven behavioural intervention designed to increase latrine use and safe child faeces disposal in India. Methods: We conducted a cluster-randomized controlled trial in 66 rural villages in Puri, Odisha. Villages were eligible if not adjacent to another included village and not designated by the government to be open defecation free. All latrine-owning households in selected villages were eligible. We assigned 33 villages to the intervention via stratified randomization. The intervention was required to meet a US$20/household threshold and included a folk performance, transect walk, community meeting, positive-deviant banners, community wall painting, mother’s meeting, household visits, and latrine repairs. Control villages received no intervention. Neither participants nor field assessors were blinded to study arm assignment. We estimated intervention effects on reported latrine use and safe child faeces disposal ~4 months following completion of the intervention delivery using a difference-in-difference analysis and stratified results by sex. Clinicaltrials.gov registration: NCT03274245. Findings: We enrolled 3,723 households (1,807 intervention; 1916 control). Analysis included 14,181 individuals (6,921 intervention; 7,260 control). We found a 6·4% (CI: 2·0%-10·7%) increase in latrine use and a 15.2% (CI: 7·9-22.5) increase in safe child faeces disposal. Interpretation: A low-cost behavioural intervention achieved modest increases in latrine use and marked increases safe child faeces disposal, at least in the near term, but was unlikely to reduce exposure to a level necessary to achieve health gains. Trial Registration: NCT03274245 Funding: The Bill & Melinda Gates Foundation and International Initiative for Impact Evaluation. Declaration of Interest: We declare no competing interests. Ethical Approval: The Emory University Institutional Review Board (Atlanta, GA, USA; REF: 00098293), and the London School of Hygiene & Tropical Medicine (London, UK; REF: 14415) and the Xavier Institute of Management (Bhubaneswar, Odisha, India; REF: 131216) Ethics Review Committees approved study protocols. Participants provided oral consent prior to data collection.