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Ethiopia: The Impact of Enhanced, Demand-Side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

Neglected tropical diseases are a diverse group of parasitic, bacterial, and viral diseases affecting more than one billion people around the world, primarily those in poor regions without adequate sanitation. Some of the diseases, namely soil-transmitted helminthiasis, schistosomiasis, and trachoma, can be controlled with preventive drug treatments, but reinfection can rapidly occur. Eliminating these conditions requires that people have access to and use sanitation and hygiene infrastructure. In Ethiopia, millions of people are at risk of neglected tropical diseases and the Government of Ethiopia has made control and elimination a priority. Researchers will study the impact of an intervention that integrates specific sanitation and hygiene behavior change components into current government supported programming to encourage improved personal hygiene and sanitation practices. The evidence will help Ethiopia develop more effective programs, while providing researchers worldwide with new information on how to improve sanitation and hygiene.


Research area:Water Supply, Sanitation and Hygiene
Evaluation Sample:76 kebeles (each kebele consists of one or two gotts, which are  communities of 60 to 90 households).  
Intervention:Community-led total sanitation and hygiene program
Researchers:Matthew Freeman, Emory University
Partners:Amhara Regional Health Bureau 


In Ethiopia, millions of people are at risk of neglected tropical diseases (NTDs) and the Government of Ethiopia has made control and elimination a priority. In the Amhara region of Ethiopia, where the evaluation is taking place, several neglected tropical diseases are prevalent – including trachoma, soil-transmitted helminths, and schistosomiasis – and the spread of these diseases is exacerbated by people’s poor water, sanitation, and hygiene practices.

The SIEF-supported research team, working together with the local health authority, developed a program for encouraging sustained behavior change around sanitation, personal hygiene, and keeping living areas free of animal and children’s feces. The intervention is designed to complement existing government approaches for promoting use of improved water and sanitation actions to reduce transmission of neglected tropical diseases in the area. The activities are delivered through local volunteers, known as the Women’s Development Army, and include community celebrations, public commitment ceremonies, and repeated household visits. The campaign is called Andilaye (which means togetherness in Amharic) and offers an aspirational message that emphasizes the need for collective action to make positive change in one’s community.

Evaluation design
Cluster-randomized controlled trial. The unit of randomization is the kebele, which is a group of gotts (gotts are communities of around 60 to 90 households). The study sample include 50 kebeles (each kebele has 1-2 gotts), with 25 kebeles randomly assigned to the intervention group that received the Andilaye intervention, and the remaining 25 assigned to the control, which receives the government’s standard sanitation improvement package. 

Rural and peri-urban households in the Amhara region of Ethiopia.   

Evaluation is ongoing

Next steps
The team has completed the midline survey as of April 2018 and plans the endline survey in 2019.

Policy impacts
The program is being implemented together with the Amhara Regional Health Bureau, which is paying the salaries of the health workers.