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Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia (SanDem)

Primary Purpose

Diarrhea

Status
Completed
Phase
Not Applicable
Locations
Zambia
Study Type
Interventional
Intervention
Bauleni Secret
Sponsored by
London School of Hygiene and Tropical Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Diarrhea focused on measuring Sanitation, Demand, Peri-urban, Behavior Change, Lusaka, Zambia

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Plots will be selected for inclusion in the study based on meeting the inclusion criteria. The intervention will be delivered to the landlord on each plot assigned to the intervention arm.

Intervention Inclusion Criteria:

  • Plot located in Bauleni compound
  • Adult landlord (age 18 or higher) resides on plot

Intervention Exclusion Criteria:

* None

Data will be collected from the landlord and one randomly selected tenant from all eligible adult tenants on each plot.

Data Collection Inclusion Criteria:

* Adult landlord or tenant (age 18 or higher) resides on selected plot most of the time

Data Collection Exclusion Criteria:

* None

Sites / Locations

  • Bauleni Compound

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Intervention

Control

Arm Description

Landlords on selected plots will receive the "Bauleni Secret" intervention. Landlords and selected tenants will be surveyed in baseline/end-line data collection.

Landlords and selected tenants will be surveyed in baseline/end-line data collection only.

Outcomes

Primary Outcome Measures

Having a hole-cover or water-sealed pan
Reduces spread of pathogens by creating barrier between containment and above-ground environment
Having a latrine door that locks from the inside
Provide safety and privacy for toilet users
Having a latrine door that locks from the outside
Exclude those not living on the plot from the toilet
Having a rotational cleaning system in place
To maintain hygienic condition of the toilet interface

Secondary Outcome Measures

Willingness to pay
Change in landlord stated willingness to pay for toilet improvements
Attitudes towards sanitation
Scales measuring landlord attitudes towards the importance of sanitation
Financial preparation for toilet improvement
Landlords report saving money, either individually or by participating in a rotating savings scheme, for toilet improvement
Partial construction progress towards toilet improvement
Landlords have either amassed raw materials on the plot (concrete blocks, wood, etc.) for toilet improvement or new construction/upgrading of toilet began (hole dug for new toilet, new slab poured for flushing toilet, etc.)
Peri-urban Healthy Toilet Index
A theory-based comprehensive index of on-site peri-urban sanitation status including hygienicity, accessibility, desirability, and sustainability of sanitation systems
Cleaning rota initiated
Landlord reports taking any action directed at establishing a rotational cleaning system (e.g., holding a plot meeting explicitly for this purpose, posting a written rota, or otherwise tangibly indicating rota responsibilities)

Full Information

First Posted
February 22, 2017
Last Updated
April 24, 2019
Sponsor
London School of Hygiene and Tropical Medicine
Collaborators
Centre for Infectious Disease Research in Zambia
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1. Study Identification

Unique Protocol Identification Number
NCT03174015
Brief Title
Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia
Acronym
SanDem
Official Title
Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
August 7, 2017 (Actual)
Primary Completion Date
March 5, 2018 (Actual)
Study Completion Date
March 5, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
London School of Hygiene and Tropical Medicine
Collaborators
Centre for Infectious Disease Research in Zambia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This intervention will experimentally test the hypothesis that sanitation can be improved in a peri-urban setting using state-of-the-art behaviour change communications. Formative research indicated that landlords are the effective decision-makers about investments in sanitation on their plots (which can include a number of tenant households as well). Landlords will therefore be the primary targets of the intervention. The study will take the form of a randomized controlled trial of the intervention evaluated at the plot level. The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s). The desired improvements will be measured via multiple primary outcomes that measure aspects of changes to hardware and software components, including indicators of hygienic quality, psychological desirability, accessibility, and ecological sustainability. This is because the investigators argue that, to have a significant impact on population-level diarrheal disease indicators, any sanitation solution must be: effective at reducing exposure to pathogens (i.e., hygienic), desirable (i.e., seen as valuable or humane), and accessible (i.e., no one excluded), so that it can be used by all for a reasonably long time (i.e., sustainable)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diarrhea
Keywords
Sanitation, Demand, Peri-urban, Behavior Change, Lusaka, Zambia

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
A random sample of plots will be selected in Bauleni Compound and invited to participate. Intervention allocation will also be randomized, with approximately equal numbers of plots allocated to the intervention and control arms. Within the chosen plots, resident landlord households will receive the intervention and resident landlord households and one randomly selected tenant household will be chosen for data collection for both intervention and control plots.
Masking
Outcomes Assessor
Masking Description
The study will be partially single blinded. Participants and investigators cannot be masked to the intervention but outcome assessors will not know where the intervention has taken place and will be given only minimal information to enable assessment of intervention exposure at the end of the survey.
Allocation
Randomized
Enrollment
1085 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intervention
Arm Type
Experimental
Arm Description
Landlords on selected plots will receive the "Bauleni Secret" intervention. Landlords and selected tenants will be surveyed in baseline/end-line data collection.
Arm Title
Control
Arm Type
No Intervention
Arm Description
Landlords and selected tenants will be surveyed in baseline/end-line data collection only.
Intervention Type
Behavioral
Intervention Name(s)
Bauleni Secret
Intervention Description
The intervention will invite enrolled landlords to a series of meetings in which various mechanisms will be used, each designed to increase their likelihood of improving the toilet(s) on their plot. These meetings will be the main vehicle for a status-building campaign associated with increasing wealth by improving plot sanitation, understanding tenants' implicit demand, understanding the processes by which toilets can be improved, and a competition rewarding landlords that make the greatest improvements to the improvement of their toilet(s).
Primary Outcome Measure Information:
Title
Having a hole-cover or water-sealed pan
Description
Reduces spread of pathogens by creating barrier between containment and above-ground environment
Time Frame
5 months after intervention begins
Title
Having a latrine door that locks from the inside
Description
Provide safety and privacy for toilet users
Time Frame
5 months after intervention begins
Title
Having a latrine door that locks from the outside
Description
Exclude those not living on the plot from the toilet
Time Frame
5 months after intervention begins
Title
Having a rotational cleaning system in place
Description
To maintain hygienic condition of the toilet interface
Time Frame
5 months after intervention begins
Secondary Outcome Measure Information:
Title
Willingness to pay
Description
Change in landlord stated willingness to pay for toilet improvements
Time Frame
5 months after intervention begins
Title
Attitudes towards sanitation
Description
Scales measuring landlord attitudes towards the importance of sanitation
Time Frame
5 months after intervention begins
Title
Financial preparation for toilet improvement
Description
Landlords report saving money, either individually or by participating in a rotating savings scheme, for toilet improvement
Time Frame
5 months after intervention begins
Title
Partial construction progress towards toilet improvement
Description
Landlords have either amassed raw materials on the plot (concrete blocks, wood, etc.) for toilet improvement or new construction/upgrading of toilet began (hole dug for new toilet, new slab poured for flushing toilet, etc.)
Time Frame
5 months after intervention begins
Title
Peri-urban Healthy Toilet Index
Description
A theory-based comprehensive index of on-site peri-urban sanitation status including hygienicity, accessibility, desirability, and sustainability of sanitation systems
Time Frame
5 months after intervention begins
Title
Cleaning rota initiated
Description
Landlord reports taking any action directed at establishing a rotational cleaning system (e.g., holding a plot meeting explicitly for this purpose, posting a written rota, or otherwise tangibly indicating rota responsibilities)
Time Frame
5 months after intervention begins

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Plots will be selected for inclusion in the study based on meeting the inclusion criteria. The intervention will be delivered to the landlord on each plot assigned to the intervention arm. Intervention Inclusion Criteria: Plot located in Bauleni compound Adult landlord (age 18 or higher) resides on plot Intervention Exclusion Criteria: * None Data will be collected from the landlord and one randomly selected tenant from all eligible adult tenants on each plot. Data Collection Inclusion Criteria: * Adult landlord or tenant (age 18 or higher) resides on selected plot most of the time Data Collection Exclusion Criteria: * None
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Aunger, PhD
Organizational Affiliation
London School of Hygiene and Tropical Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Roma Chilengi, MD
Organizational Affiliation
Center for Infectious Disease Research in Zambia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Valerie Curtis, PhD
Organizational Affiliation
London School of Hygiene and Tropical Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Bauleni Compound
City
Lusaka
Country
Zambia

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
De-identified individual participant data (IPD) will be available with consent from the principal investigators. The study will collect only basic demographic information on individuals along with knowledge/attitudes/preferences data, so there will be little to identify individuals from the shared IPD and little that is very sensitive.
IPD Sharing Time Frame
Data will be available from approximately June 2018 for at least 5 year on study website.
IPD Sharing Access Criteria
Data will be accessible with consent from study PIs per submitted proposals and protocols.
IPD Sharing URL
http://www.shareresearch.org/project/san-dem
Citations:
PubMed Identifier
31029230
Citation
Tidwell JB, Chipungu J, Bosomprah S, Aunger R, Curtis V, Chilengi R. Effect of a behaviour change intervention on the quality of peri-urban sanitation in Lusaka, Zambia: a randomised controlled trial. Lancet Planet Health. 2019 Apr;3(4):e187-e196. doi: 10.1016/S2542-5196(19)30036-1.
Results Reference
derived

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Sanitation Demand Creation in Peri-Urban Slums of Lusaka, Zambia

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