(P17-050-23) Improved WASH Knowledge and Practices, and Reduced Water Contamination Through Social Behavior Change, in Uganda

Objectives: Poor water quality and hygiene practices contribute to diarrheal disease which can impair growth and development, increasing risk of stunting and wasting among children under-2. This study evaluates the impact of a social behavior change communication (SBCC) program on water quality and hygiene practices in northern Uganda.

Methods: A three-arm cluster randomized controlled trial (cRCT) - the One Nutrition in Complex Environments (ONCE) study - evaluated the Nutrition Impact and Positive Practice (NIPP) program and an enhanced (NIPP+) program with added exposure to WASH and agricultural technologies compared to controls in households with children under-2.

Data were collected pre- and post-intervention for 3 arms (n=900). Water was collected at households and community sources on a random subsample (n=360). E. coli were quantified with membrane filtration (CFU/100 mL) and converted to a binary indicator (< = 10 | >10 CFU/ 100ml). We computed an overall WASH score (out of 13) with 13 positive WASH indicators. Generalized linear models (GLMs) were used to generate effect estimates, adjusting for social-demographic characteristics, water source characteristics and contamination, and baseline contamination.

Results: NIPP and NIPP+ participants had higher probability of boiling water, cleaning water containers, and having a hand washing facility compared to controls at endline. They also had higher cumulative WASH knowledge and practice scores. There was no difference in effects by socioeconomic status or education.

There was no significant difference in risk of E. coli contamination for NIPP compared to control. However, NIPP+ had a 24% lower risk (RR=0.76; p=0.02) of having E. coli in water compared to control.

If all households had the NIPP+ intervention, fewer (49%) would have E. coli contaminated water than with no intervention (64%).

Conclusions: Improvements in WASH knowledge and practices were reported for intervention households, along with a reduced risk of E. coli for NIPP+. While the NIPP+ intervention reduced contamination, about 50% of NIPP+ households still used contaminated water. Further analysis to determine the specific aspects responsible for contamination risk reduction and subsequent effects on malnutrition is needed.

Funding Sources: U.S. Agency for International Development (USAID) and the USAID Feed the Future Initiative