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

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)

Study Overview

• Status: Completed
• Conditions: Diarrhea
• Intervention / Treatment: Behavioral: Bauleni Secret

• Study Type: Interventional
• Enrollment (Actual): 1085
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Zambia
  • Lusaka, Zambia
    • Bauleni Compound

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Landlords on selected plots will receive the "Bauleni Secret" intervention. Landlords and selected tenants will be surveyed in baseline/end-line data collection.	Behavioral: Bauleni Secret; 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).
No Intervention: Control; Landlords and selected tenants will be surveyed in baseline/end-line data collection only.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Having a hole-cover or water-sealed pan	Reduces spread of pathogens by creating barrier between containment and above-ground environment	5 months after intervention begins
Having a latrine door that locks from the inside	Provide safety and privacy for toilet users	5 months after intervention begins
Having a latrine door that locks from the outside	Exclude those not living on the plot from the toilet	5 months after intervention begins
Having a rotational cleaning system in place	To maintain hygienic condition of the toilet interface	5 months after intervention begins

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Willingness to pay	Change in landlord stated willingness to pay for toilet improvements	5 months after intervention begins
Attitudes towards sanitation	Scales measuring landlord attitudes towards the importance of sanitation	5 months after intervention begins
Financial preparation for toilet improvement	Landlords report saving money, either individually or by participating in a rotating savings scheme, for toilet improvement	5 months after intervention begins
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.)	5 months after intervention begins
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	5 months after intervention begins
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)	5 months after intervention begins

Collaborators and Investigators

• Sponsor: London School of Hygiene and Tropical Medicine
• Collaborators: Centre for Infectious Disease Research in Zambia
• Investigators: Principal Investigator: Robert Aunger, PhD, London School of Hygiene and Tropical Medicine; Principal Investigator: Roma Chilengi, MD, Center for Infectious Disease Research in Zambia; Principal Investigator: Valerie Curtis, PhD, London School of Hygiene and Tropical Medicine

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): August 7, 2017
• Primary Completion (Actual): March 5, 2018
• Study Completion (Actual): March 5, 2018

Study Registration Dates

• First Submitted: February 22, 2017
• First Submitted That Met QC Criteria: May 30, 2017
• First Posted (Actual): June 2, 2017

Study Record Updates

• Last Update Posted (Actual): April 25, 2019
• Last Update Submitted That Met QC Criteria: April 24, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: Behavior Change; Zambia; Sanitation; Demand; Peri-urban; Lusaka
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Diarrhea
• Other Study ID Numbers: QA_840

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD 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 Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No