Peer-reviewed article
Study protocol for a multi-arm, parallel group randomised controlled trial evaluating the isolated and combined effects of behavioural promotion and hardware provision on handwashing with soap in peri-urban Lusaka, Zambia.
Davies K, Chipungu J, Mwila-Kazimbaya K, Bick S, Nyirenda HC et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a study protocol for a randomised controlled trial in Lusaka, Zambia, testing how to improve handwashing with soap among households. The trial will compare four approaches: providing handwashing facilities and supplies only, providing behaviour change promotion only, combining both approaches, and a control group with no intervention. The study aims to understand which combination of hardware and behaviour change is most effective at reducing diarrhoea and respiratory infections in children.
Key points
- The trial involves 1,800 households in peri-urban Lusaka randomly assigned to four arms of 450 households each
- Handwashing with soap is a cost-effective intervention for preventing under-five mortality from diarrhoea and lower respiratory infections, yet adherence remains low
- The hardware intervention includes provision of a handwashing facility and supplies with a maintenance check after 3 months
- The behaviour promotion intervention consists of five bi-weekly visits with a follow-up visit 5 weeks later
- Handwashing behaviour will be measured through structured observations at baseline and 6 months after intervention delivery begins
Limitations
This is a study protocol, not a results paper, so it describes planned methods rather than actual findings. The document does not provide data on intervention effectiveness, outcomes achieved, or any evidence of impact on child health.
Abstract
Introduction Diarrhoea and lower respiratory infections remain leading causes of under-five mortality in sub-Saharan Africa. Handwashing with soap (HWWS) is a cost-effective intervention, yet adherence remains low. Effective interventions must address multiple behavioural influences, as knowledge alone is insufficient without supportive environments. Multi-component handwashing interventions target diverse behavioural determinants, yet few studies disentangle the isolated and combined effects of different components. This multi-arm randomised-controlled trial in Lusaka, Zambia, aims to assess the isolated and combined effects of hand hygiene behaviour promotion and handwashing hardware and supply provision on HWWS at handwashing opportunities, strengthening the evidence base for designing sustainable handwashing interventions. Methods and analysis This superiority, multi-arm, parallel group randomised-controlled trial will be conducted in five peri-urban communities in Lusaka, Zambia, with 1800 households randomly assigned to four arms (450 households per arm; 1:1:1:1): (A) handwashing hardware and supply provision only, (B) hand hygiene behavioural promotion only, (AB) hand hygiene behavioural promotion+hardware and supply provision, and (C) control (no intervention). Households receiving the hardware and supply intervention (A, AB) will receive a handwashing facility and supplies to make liquid soap solution with a maintenance check after 3 months. Households receiving the hand hygiene behaviour promotion intervention (B, AB) will receive five bi-weekly visits with a sixth follow-up visit 5 weeks later. HWWS behaviour of one household member will be assessed through structured observations at baseline and endline (6 months after intervention delivery begins). Ethics and dissemination Ethical approval was obtained from London School of Hygiene & Tropical Medicine, Research Ethics Committee, London, UK (Ref: 31387), the University of Zambia Biomedical Research Ethics Committee (Ref: UNZABREC 5834-2024) and the Zambia National Health Research Authority (NHRA -1823/23/12/2024). Results of the main trial will be submitted for publication in a peer-reviewed journal. Trial registration number NCT06865495.