Effects of a community-driven water, sanitation and hygiene intervention on water and sanitation infrastructure, access, behaviour, and governance: a cluster-randomised controlled trial in rural Democratic Republic of Congo

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Abstract

Introduction

Inadequate water and sanitation is a central challenge in global health. Since 2008, the Democratic Republic of Congo government has implemented a national programme, Healthy Villages and Schools ( Villages et Ecoles Assainis (VEA), with support from UNICEF, financed by UK’s Foreign, Commonwealth and Development Office.

Methods

A cluster-level randomised controlled trial of VEA was implemented throughout 2019 across 332 rural villages, grouped into 50 treatment and 71 control clusters. Primary outcomes included time spent collecting water; quantity of water collected; prevalence of improved primary source of drinking water; and prevalence of improved primary defecation site. Secondary outcomes included child health, water governance, water satisfaction, handwashing practices, sanitation practices, financial cost of water, school attendance and water storage practices. All outcomes were self-reported. The primary analysis was on an intention-to-treat basis, using linear models. Outcomes were measured October–December 2019, median 5 months post-intervention.

Results

The programme increased access to improved water sources by 33 percentage points (pp) (95% CI 22 to 45), to improved sanitation facilities by 26 pp (95% CI 14 to 37), and improved water governance by 1.3 SDs (95% CI 1.1 to 1.5), water satisfaction by 0.6 SD (95% CI 0.4 to 0.9), handwashing practices by 0.5 SD (95% CI 0.3 to 0.7) and sanitation practices by 0.3 SD (95% CI 0.1 to 0.4). There was no significant difference in financial cost of water, school attendance, child health or water storage practices.

Conclusion

VEA produced large increases in access to and satisfaction with water and sanitation services, in self-reported hygiene and sanitation behaviour, and in measures of water governance.

Trial registration number

AEARCTR-0004648; American Economic Association RCT registry.

Related collections

Most cited references 34

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Early childhood development coming of age: science through the life course

Maureen M Black, Susan P Walker, Lia C H Fernald … (2017)

Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.

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Experimental Analysis of Neighborhood Effects

Jeffrey Kling, Jeffrey B Liebman, Lawrence F. Katz (2007)

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Developmental potential in the first 5 years for children in developing countries

Sally Grantham-McGregor, Yin Cheung, Santiago Cueto … (2007)

Summary Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data—the prevalence of early childhood stunting and the number of people living in absolute poverty—to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Glob Health

Journal ID (iso-abbrev): BMJ Glob Health

Journal ID (hwp): bmjgh

Journal ID (publisher-id): bmjgh

Title: BMJ Global Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7908

Publication date Collection: 2021

Publication date (Electronic): 17 May 2021

Volume: 6

Issue: 5

Electronic Location Identifier: e005030

Affiliations

[1 ] departmentPublic Health Department , Simmons University , Boston, Massachusetts, USA

[2 ] departmentDevelopment Impact Evaluation Department , World Bank Group , Washington, District of Columbia, USA

[3 ] departmentDevelopment Impact Evaluation Department , The World Bank Group , Kinshasa, Democratic Republic of Congo

[4 ] departmentResearch, Assessment, and Monitoring Department , World Food Programme , Rome, Italy

[5 ] departmentDepartment of Global Health and Population , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA

Author notes

[Correspondence to ] Professor John Paul Quattrochi; john.quattrochi@ 123456simmons.edu

Author information

John Paul Quattrochi http://orcid.org/0000-0003-0591-5931

Byron Cohen http://orcid.org/0000-0002-6356-7966

Kevin Croke http://orcid.org/0000-0002-4750-9280

Article

Publisher ID: bmjgh-2021-005030

DOI: 10.1136/bmjgh-2021-005030

PMC ID: 8130731

PubMed ID: 34001519

SO-VID: 4494cce5-1a86-4b68-9534-fa35c4a7c640

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 16 January 2021

Date revision received : 27 March 2021

Date accepted : 16 April 2021

Funding

Funded by: UK Foreign, Commonwealth, and Development Office;

Award ID: NA

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Keywords: randomised control trial,public health,health systems,health policy,environmental health

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Keywords: randomised control trial, public health, health systems, health policy, environmental health

Effects of a community-driven water, sanitation and hygiene intervention on water and sanitation infrastructure, access, behaviour, and governance: a cluster-randomised controlled trial in rural Democratic Republic of Congo

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Abstract

Introduction

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Conclusion

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Climate Change and Human Health

Most cited references 34

Early childhood development coming of age: science through the life course

Experimental Analysis of Neighborhood Effects

Developmental potential in the first 5 years for children in developing countries

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