In line with BRAC's overall goals to limit the COVID19 transmission, BRAC has constructed 1,000 handwashing stations coupled with other supports i.e. in-person demonstration, hygiene meetings, and soap distribution in Bangladesh. The purpose of this study is to assess the impact of public handwashing stations (HWSs) on people's hygiene behavior and health outcomes in response to the COVID-19 situation. For this, at the household level, we will collect information on self-reported handwashing practices, income, health status, and HWSs along with other relevant socio-demographic variables in detail. In addition, we will observe people's mobility, mask usage at public places, and the HWSs usage; and will associate the observed HWSs usage with their self-reported health outcomes. This study will conduct surveys on households (7,760) and public (5,820) in 20 sub-districts of Mymensingh, Khulna, and Dhaka divisions. Overall, this study is expected to directly benefit study participants and their communities by unveiling new evidence to inform BRAC's existing hygiene behavioral change programming in these communities. In addition, this information will yield future societal benefits by generating evidence on how to effectively implement and disseminate infrastructure and information that people can trust, believe, and use to form healthy hygiene habits.
In line with the overall goals of HBCC for reducing the transmission of COVID-19 via rapid
response interventions to raise awareness and enacting long-term behaviour change regarding
people's personal and environmental hygiene habits, BRAC has taken an adaptive approach under
the Hygiene and Behaviour Change Collation (HBCC) platform. The aim of this project is to
systematically change the behaviour of people across communities in Bangladesh via
interventions such as setting up handwashing stations and broadcasting behaviourally-informed
messages to nudge people to adopt healthier prevention and response practices.
To achieve the overall goals of the project and positively impact the lives of over 10
million people in communities across Bangladesh, BRAC primarily chose 20 sub-districts from 3
divisions (out of a total of 8 divisions) for implementing the interventions, namely Dhaka,
Mymensingh and Khulna. The prime activity is to install 1,000 handwashing stations across
these sub-districts to increase the access of communities to handwashing facilities. The BRAC
handwashing stations have been designed to enhance both availability and inclusiveness,
fitted with foot-operated pedals for dispensing water and liquid soap, to reduce contact with
sink surfaces and thereby reduce probability of transmission from the device surface. They
have been fitted with posters, promoting handwashing with proper technique, and have also
been designed to allow hand-washers to maintain social distance while using the devices.
In addition to these handwashing stations, there are other supports available in the
intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution.
After the economy opened up in Bangladesh after a long lockdown, the community engagement
activities in the form of in-person communication and forum discussions, to motivate people
to uptake safe hygiene behaviours including but not limited to regular handwashing. In these
demonstrations and meetings, the participants are motivated to adopt recommended hygiene
behaviours such as handwashing with soap, mask usage and disposal, sneezing etiquette, social
distancing, etc. Along with the BRAC staff, the WASH entrepreneurs who are members of the
local community whom BRAC traditionally supports with free training in entrepreneurship and
market development to improve the communities' access and knowledge of hygiene products. The
HBCC project empowers them with responsibilities to disseminate the messages of the
recommended behaviours and distribute the soap in the communities across the intervention
areas, especially the poorest of the poor community and the participants who attend the
meetings regularly.
Primary Outcomes (end points)
The main outcome variables of interest in this study are:
i) daily handwashing frequency ii) likelihood of using soap when handwashing iii) prevalence
of transmissible diseases in the past 15 days Primary Outcomes (explanation) i) constructed
using the self-reported daily frequency of handwashing and typical handwashing times ii)
constructed using self-report (times out of 10), rapid observation of the presence of soap
near handwashing facilities, and self-reported expenditure on soap iii) constructed using
self-report of symptoms and specific diseases Secondary Outcomes i) knowledge of handwashing
practices ii) attitudes towards handwashing iii) use of public handwashing stations and
alternatives to public handwashing stations iii) frequency of mask-wearing
Behavioral: Handwashing stations at the public places and no soap
BRAC has built 1000 handwashing stations in 20 sub-districts from 3 divisions (out of a total of 8 divisions), namely Dhaka, Mymensingh and Khulna, to increase the access of communities to handwashing facilities. In addition to these handwashing stations, there are other supports available in the intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution from BRAC. However, this group did not receive any soap from the research team.
Other Name: In-person demonstration
Behavioral: No activities of the HBCC project and also no soap (Pure Control)
In these randomly selected villages, BRAC did not implement any activity of its HBCC project. Also, the research team did not distribute soap to these households
Behavioral: Soap distributed but no activities of the HBCC project
In these randomly selected villages, BRAC did not implement any activity of its HBCC project but the research team randomly selected this group for soap distribution.
Behavioral: HBCC project and Soap
These households belong to those villages where the HBCC project has been implemented and also received the soap from the research team.
Inclusion Criteria:
- Must live in the villages where BRAC is implementing the interventions
Exclusion Criteria:
-
BRAC, Bangladesh
Dhaka, Bangladesh