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

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dc.contributor.authorBriceno, Bertha
dc.contributor.authorCoville, Aidan
dc.contributor.authorMartinez, Sebastian
dc.date.accessioned2015-02-03T15:16:30Z
dc.date.available2015-02-03T15:16:30Z
dc.date.issued2015-01
dc.description.abstractThe 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.en
dc.identifierhttp://documents.worldbank.org/curated/en/2015/01/23804984/promoting-handwashing-sanitation-evidence-large-scale-randomized-trial-rural-tanzania
dc.identifier.doi10.1596/1813-9450-7164
dc.identifier.urihttps://hdl.handle.net/10986/21383
dc.languageEnglish
dc.language.isoen_US
dc.publisherWorld Bank Group, Washington, DC
dc.relation.ispartofseriesPolicy Research working paper;no. WPS 7164
dc.relation.ispartofseriesPolicy Research Working Paper;No. 7164
dc.rightsCC BY 3.0 IGO
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/igo/
dc.subjectADEQUATE WATER
dc.subjectAGE DISTRIBUTION
dc.subjectANEMIA
dc.subjectASCARIASIS
dc.subjectBABY
dc.subjectBEHAVIOR CHANGE
dc.subjectBLIND
dc.subjectBREASTFEEDING
dc.subjectBURDEN OF DISEASE
dc.subjectCAREGIVERS
dc.subjectCHILD HEALTH
dc.subjectCHILD MORBIDITY
dc.subjectCHILD MORTALITY
dc.subjectCHOLERA
dc.subjectCLEANLINESS
dc.subjectCOMMUNITIES
dc.subjectCOMMUNITY HEALTH
dc.subjectDANCING
dc.subjectDEFECATION
dc.subjectDESCRIPTION
dc.subjectDEVELOPING COUNTRIES
dc.subjectDEVELOPMENT INTERVENTIONS
dc.subjectDEVELOPMENT POLICY
dc.subjectDIARRHEA
dc.subjectDIARRHEAL DISEASES
dc.subjectDIARRHOEA
dc.subjectDIARRHOEAL DISEASES
dc.subjectDIRTY HANDS
dc.subjectDISSEMINATION
dc.subjectDISTRICTS
dc.subjectDRINKING WATER
dc.subjectDWELLING
dc.subjectE. COLI
dc.subjectEARLY CHILDHOOD
dc.subjectEPIDEMIOLOGY
dc.subjectFAMILIES
dc.subjectFERTILITY
dc.subjectFOOD HANDLING
dc.subjectFOOD PREPARATION
dc.subjectGENDER
dc.subjectGLOBAL HEALTH
dc.subjectGROUNDWATER
dc.subjectHAND WASHING
dc.subjectHANDS WITH SOAP
dc.subjectHANDWASHING
dc.subjectHEALTH EFFECTS
dc.subjectHEALTH INDICATORS
dc.subjectHEALTH OUTCOMES
dc.subjectHEALTH WORKERS
dc.subjectHELMINTHES
dc.subjectHOLISTIC APPROACH
dc.subjectHOOKWORM
dc.subjectHOUSEHOLD ASSETS
dc.subjectHOUSEHOLD SURVEYS
dc.subjectHOUSEHOLDS
dc.subjectHUMAN CAPITAL
dc.subjectHUMAN EXCRETA
dc.subjectHYGIENE
dc.subjectHYGIENE BEHAVIOR
dc.subjectHYGIENE PRACTICES
dc.subjectHYGIENE PROMOTION
dc.subjectIMPORTANT POLICY
dc.subjectINADEQUATE SANITATION
dc.subjectINFECTION
dc.subjectINFECTIONS
dc.subjectINFECTIOUS DISEASES
dc.subjectINTERNATIONAL COMMUNITY
dc.subjectINTERVENTION
dc.subjectINTERVENTIONS
dc.subjectIRON
dc.subjectJA
dc.subjectLATRINE CONSTRUCTION
dc.subjectLATRINE PROMOTION
dc.subjectLIVING STANDARDS
dc.subjectLOCAL GOVERNMENTS
dc.subjectMALARIA
dc.subjectMALNUTRITION
dc.subjectMASS MEDIA
dc.subjectMIGRATION
dc.subjectMINISTRIES OF HEALTH
dc.subjectMINISTRY OF HEALTH
dc.subjectMOBILITY
dc.subjectMORBIDITY
dc.subjectMORBIDITY AND MORTALITY
dc.subjectMORTALITY
dc.subjectMORTALITY RATE
dc.subjectMOTHER
dc.subjectNATIONAL GOVERNMENTS
dc.subjectNATIONAL LEVEL
dc.subjectNATIONAL POLICY
dc.subjectNATIONAL POPULATION
dc.subjectNUMBER OF CHILDREN
dc.subjectNUMBER OF HOUSEHOLDS
dc.subjectNURSING
dc.subjectNUTRITION
dc.subjectPARASITES
dc.subjectPARASITIC INFECTIONS
dc.subjectPATHOGENS
dc.subjectPIT LATRINES
dc.subjectPOLICY DISCUSSIONS
dc.subjectPOLICY MAKERS
dc.subjectPOLICY RESEARCH
dc.subjectPOLICY RESEARCH WORKING PAPER
dc.subjectPOOR HYGIENE
dc.subjectPOOR NUTRITION
dc.subjectPOPULATION SIZE
dc.subjectPOSTERS
dc.subjectPRACTITIONERS
dc.subjectPREGNANT WOMEN
dc.subjectPREVALENCE
dc.subjectPROGRESS
dc.subjectPROMOTIONAL MATERIALS
dc.subjectPROVISION OF LATRINES
dc.subjectRADIO
dc.subjectRANDOMIZED CONTROLLED TRIALS
dc.subjectRESPIRATORY INFECTIONS
dc.subjectRISK OF CONTAMINATION
dc.subjectRISK OF EXPOSURE
dc.subjectRISK OF INFECTION
dc.subjectRURAL AREAS
dc.subjectRURAL COMMUNITIES
dc.subjectRURAL POPULATION
dc.subjectRURAL POPULATIONS
dc.subjectSAFE HYGIENE
dc.subjectSAFE HYGIENE PRACTICES
dc.subjectSANITATION
dc.subjectSANITATION FACILITIES
dc.subjectSANITATION PRACTICES
dc.subjectSANITATION PROMOTION
dc.subjectSCHISTOSOMIASIS
dc.subjectSEPTIC TANKS
dc.subjectSOAP
dc.subjectSOCIAL MARKETING
dc.subjectSOCIAL WELFARE
dc.subjectSYMPTOM
dc.subjectSYMPTOMS
dc.subjectTECHNICAL ASSISTANCE
dc.subjectTOILETS
dc.subjectTRACHOMA
dc.subjectTREATMENT
dc.subjectTRICHURIASIS
dc.subjectTROPICAL DISEASES
dc.subjectTROPICAL MEDICINE
dc.subjectVILLAGE LEVEL
dc.subjectVILLAGES
dc.subjectWASHING HANDS
dc.subjectWATER CONTAMINATION
dc.subjectWATER QUALITY
dc.subjectWATER SOURCE
dc.subjectWATER SUPPLY
dc.subjectWORKERS
dc.subjectYOUNG CHILDREN
dc.titlePromoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzaniaen
dspace.entity.typePublication
okr.crossref.titlePromoting Handwashing and Sanitation: Evidence from a Large-Scale Randomized Trial in Rural Tanzania
okr.date.disclosure2015-01-15
okr.date.doiregistration2025-04-10T10:37:28.979728Z
okr.doctypePublications & Research
okr.doctypePublications & Research::Policy Research Working Paper
okr.docurlhttp://documents.worldbank.org/curated/en/2015/01/23804984/promoting-handwashing-sanitation-evidence-large-scale-randomized-trial-rural-tanzania
okr.globalpracticeWater
okr.guid545961468165561161
okr.identifier.doi10.1596/1813-9450-7164
okr.identifier.externaldocumentum000158349_20150115160116
okr.identifier.internaldocumentum23804984
okr.identifier.reportWPS7164
okr.language.supporteden
okr.pdfurlhttp://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2015/01/15/000158349_20150115160116/Rendered/PDF/WPS7164.pdfen
okr.region.administrativeAfrica
okr.region.countryTanzania
okr.topicHealth Monitoring and Evaluation
okr.topicWater Supply and Sanitation::Hygiene Promotion and Social Marketing
okr.topicHousing and Human Habitats
okr.topicHealth, Nutrition and Population::Population Policies
okr.topicDisease Control and Prevention
okr.topicCommunities and Human Settlements
okr.unitWater Global Practice Group and the Impact Evaluation Team, Development Research Group
relation.isAuthorOfPublicationb4555361-7e37-58c4-a8b7-fa1807da46a2
relation.isAuthorOfPublication.latestForDiscoveryb4555361-7e37-58c4-a8b7-fa1807da46a2
relation.isSeriesOfPublication26e071dc-b0bf-409c-b982-df2970295c87
relation.isSeriesOfPublication.latestForDiscovery26e071dc-b0bf-409c-b982-df2970295c87
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