WASH Benefits Bangladesh
WASH Benefits Bangladesh
Brief Summary:

 The purpose of this study is to measure the independent and combined effects of interventions
 that improve water quality, sanitation, hand washing, and nutrition on child growth and
 development in the first years of life.
Detailed Description:

 Infection and inadequate diet are proximate risk factors for under-nutrition and early life
 growth faltering; the two processes likely act reciprocally in a vicious cycle that
 perpetuates physiologic and metabolic deficits and increases the risk of mortality. Children
 who exhibit growth faltering are more likely to have deficits in cognitive development and
 long-term human capital, and are more likely to have children who also suffer from growth
 deficits - perpetuating the cycle into the next generation.

 There are two probable interdependent pathways that link enteric infections to child growth
 and development. The first pathway includes repeated infections the lead to acute illness or
 parasitic infection in the first years of life, which increase the risk of stunting and
 subsequent cognitive deficits in childhood and later in life. The second pathway is through a
 subclinical condition called environmental enteropathy (EE).

 There is limited evidence to demonstrate whether or not water quality, sanitation, and hand
 washing (WASH) interventions can improve measures of EE, child growth and development, and
 whether nutritional interventions could be enhanced if provided concurrently with WASH
 interventions. To help fill this evidence gap, the WASH Benefits study will deliver
 randomized interventions designed to reduce infection and improve nutrition, and will measure
 intervention effects on child illness, growth and development. WASH Benefits includes two,
 comparable but standalone trials in Bangladesh and Kenya that are registered under separate
 protocols.

 In Bangladesh, the study will include 720 clusters, and each cluster will enroll 8 household
 compounds (baris) with pregnant women in their second or third trimester. The study will
 randomize 90 clusters to each of 6 active intervention arms (water quality, sanitation, hand
 washing, combined WSH, nutrition, nutrition+WSH), and 180 clusters to a standard practices
 non-intervention arm. Children born into the cohort will be followed for 2 years after the
 intervention, with measurements at 12 and 24 months after intervention delivery. (anticipated
 age range: 20 - 27 months old at the final measurement). At the 12- and 24-month follow-up
 visits, the study will collect child anthropometric measurements and caregiver-reported
 diarrhea. In the final visit the study will administer a test to measure child development
 outcomes. The study will collect urine, blood, and stool specimens from a subsample of 1,500
 children distributed across four arms of the study (Control, combined WSH, Nutrition,
 Nutrition+WSH) to measure biomarkers of gut function and intestinal parasitic infections at
 the 12- and 24-month follow-up visits. In addition, the study will collect specimens (blood,
 stool) from children 18 - 27 months old at baseline who are living in the same compound as
 target children to test for intestinal parasitic infections. At 24-months in all arms, the
 study will collect specimens stool from target children, children 18 - 27 months old at
 baseline, a school-aged child, and an adult who are living in the same compound as target
 children to test for intestinal parasitic infections. At 36-months in all arms, the study
 will collect specimens stool from target children, a school-aged child, and an adult who are
 living in the same compound as target children to test for intestinal parasitic infections.
Inclusion Criteria:

 (1) Infants (target child) will be eligible to participate in the study if they are:

 1. They are in utero at the baseline survey

 2. Their parents/guardians are planning to stay in the study village for the next 12
 months (if a mother is planning to give birth at her natal home and then return, she
 will still be a candidate for enrollment)

 (2) Children < 36 months old at baseline that are living in the compound of a target child
 will be eligible to participate in diarrhea measurement if:

 1. They are < 36 months old at the baseline survey

 2. Their parents/guardians are planning to stay in the study village for the next 12
 months

 (3) Children 18 - 27 months old at baseline that are living in the compound of a target
 child will be eligible to participate in intestinal parasite specimen collection if:

 1. They are 18 - 27 months old at the baseline survey

 2. Their parents/guardians are planning to stay in the study village for the next 12
 months