Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster‐randomised controlled trial of the CHoBI7 mobile health program

Abstract

Objective The Cholera‐Hospital‐Based‐Intervention‐for‐7‐days (CHoBI7) is a water treatment and handwashing with soap intervention for patients and household members which is initially delivered in a health facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a health facility setting. Methods A randomized controlled trial of the CHoBI7 program was conducted among 404 diarrhea patients and their accompanying household members in health facilities in Dhaka, Bangladesh. The “Standard Message” arm received the standard message given in Bangladesh to diarrhea patients on the use of oral rehydration solution. The “Health Facility Visit + Soapy Water” arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the health facility. The “Health Facility Visit + Handwashing Station” arm received this same intervention plus a small plastic handwashing station. Within 24 hours of intervention delivery, three‐hour structured observation of handwashing practices at stool/vomit and food related events (key events) was conducted in health facilities. Results Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Handwashing Station Arm (58% vs. 25%) (Odds Ratio (OR): 4.12; (95% Confidence Interval (CI): 1.86, 9.14), and the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (OR: 3.02; (95% CI: 1.41, 6.45). Conclusion These findings demonstrate that delivery of the CHoBI7 module presents a promising approach to increase handwashing with soap in a health facility setting in Bangladesh.