Sustainability of WASH practices: hygiene behaviour in the rural settings of Bangladesh

Hygiene behaviour is one of the most important conditions for keeping people healthy. To improve the situation in rural areas, BRAC and in collaboration with Govt. of Bangladesh, has been implementing phased water, sanitation and hygiene (WASH) program in 250 sub-districts since the mid-2006. To find out the impact of WASH implementation services in rural households, the BRAC Research and Evaluation Division conducted baseline (in 2006), midline (2009) and end-line (2011) surveys in 50 upazilas (sub-districts) of the first phase. Over 26,000 households were included in the study. Data were collected through face-to-face interview and observation using pre-tested questionnaire, and were analysed using standard method. Analysis revealed an improvement in hygiene behaviour including putting cover on water jar during carrying and storing water for drinking increased across the survey periods were observed, where ultra-poor households were practicing like non-poor households at the endline- a great achievement in the service delivery system of BRAC WASH mainly for the ultra-poor households. Service delivery for improving hygiene behavior related implementation works can be sustainable if community people are involved in the process with proper training and periodic monitoring is ensured even after completion of any project

A community-based cluster randomised controlled trial in rural Bangladesh to evaluate the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality: The Shonjibon trial

Abstract Background Iron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. However, most of the evidence is from observational epidemiological studies except for a very few randomised controlled trials. IFA supplements have also been found to reduce the preterm delivery rate and neonatal mortality attributable to prematurity and birth asphyxia. These results combined indicate that IFA supplements in populations of iron-deficient pregnant women could lead to a decrease in the number of neonatal deaths mediated by reduced rates of preterm delivery. In this paper, we describe the protocol of a community-based cluster randomised controlled trial that aims to evaluate the impact of maternal antenatal IFA supplements on perinatal outcomes. Methods/design The effect of the early use of iron-folic acid supplements on neonatal mortality will be examined using a community based, cluster randomised controlled trial in five districts with 30,000 live births. In intervention clusters trained BRAC village volunteers will identify pregnant women & provide iron-folic acid supplements. Groundwater iron levels will be measured in all study households using a validated test kit. The analysis will follow the intention to treat principle. We will compare neonatal mortality rates & their 95% confidence intervals adjusted for clustering between treatment groups in each groundwater iron-level group. Cox proportional hazards mixed models will be used for mortality outcomes & will include groundwater iron level as an interaction term in the mortality model. Discussion This paper aims to describe the study protocol of a community based randomised controlled trial evaluating the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality. This study is critical because it will determine if antenatal IFA supplements commenced in the first trimester of pregnancy, rather than later, will significantly reduce neonatal deaths in the first month of life, and if this approach is cost-effective. Trial registration This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 31 May 2012. The registration ID is ACTRN12612000588897