We measured changes in caregivers’ behavior at the midterm and end point of the intervention and found substantial differences between intervention and control groups (Table 2). The baseline assessment showed that tap water was the usual source of drinking water for the entire refugee households, and 230 (27.3%) of the households had no improved latrines. Less than half, 343 (40.5%) of the HH water containers were clean and only 181 (21.5%) of them were kept covered. The study also showed that 468 (55.5%) of the latrines were not clean and feces were seen in 250 (30%) of the HH compounds. Three-quarters (651, 77.2%) of the caregivers did not safely dispose of their children's feces. At baseline, we observed that 136 (16.1%) of the households had a hand-washing station. However, 31 (22.8%) and 22 (16.2%) of them had no water and soap for hand-washing on the day of data collection, respectively. The great majority of caregivers practiced hand-washing with soap and water before eating (714, 84.7%), followed by hand-washing before preparing food (488, 57.9%), after toilet use (469, 55.6%), after cleaning a child's bottom (463, 54.9%) and before feeding children (406, 48.2%).
Hygiene behaviors of the intervention and control arms at the baseline, midterm and end point in refugee camps in Gambella Region, Ethiopia in 2017
| . | Baseline (n = HHs) . | . | Midterm (n = HHs) . | . | Endpoint (n = HHs) . | . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Behavioral outcome indicators . | Intervene No (%) . | Control No (%) . | P Value . | Intervene No (%) . | Control No (%) . | P Value . | Intervene No (%) . | Control No (%) . | P value . | |
| Point-use of drinking water management | ||||||||||
| Source of drinking water | Tap water | 422 (100) | 421 (100) | NA | 422 (100) | 421 (100) | NA | 422 (100) | 421 (100) | NA |
| Type of water containers | Narrow mouth (≤3 cm diameter) | 262 (62.1) | 257 (61.0) | 0.39 | 313 (74.2) | 271 (64.4) | 0.02 | 357 (84.6) | 265 (63.0) | 0.000 |
| Wide mouth (>3 cm diameter) | 31 (7.4) | 42 (10.0) | 19 (4.5) | 39 (9.3) | 4 (1.0) | 40 (9.5) | ||||
| Both types | 129 (30.6) | 122 (29.0) | 90 (21.3) | 111 (26.4) | 61 (14.4) | 116 (27.5) | ||||
| Are all water containers covered? | Yes | 92 (21.8) | 89 (21.1) | 0.14 | 146 (34.6) | 97 (23.0) | 0.000 | 388 (91.9) | 114 (27.1) | 0.000 |
| Some only | 232 (55.0) | 256 (60.8) | 199 (47.2) | 251 (59.6) | 24 (5.7) | 244 (58) | ||||
| No | 98 (23.2) | 76 (18.1) | 77 (18.2) | 73 (17.3) | 10 (2.4) | 63 (14.9) | ||||
| Does the household use a separate container for drinking water? | Yes | 204 (48.3) | 209 (49.6) | 0.7 | 276 (65.4) | 234 (55.6) | 0.04 | 352 (83.4) | 249 (59.1) | 0.000 |
| No | 218 (51.7) | 212 (50.4) | 146 (34.6) | 187 (44.4) | 70 (16.6) | 172 (40.9) | ||||
| Where is the drinking water container placed? | On floor inside home | 189 (44.8) | 180 (42.8) | 0.8 | 214 (50.7) | 205 (48.7) | 0.001 | 245 (58.1) | 208 (49.4) | 0.000 |
| Elevated place inside | 42 (10.0) | 46 (10.9) | 88 (20.9) | 49 (11.6) | 139 (32.9) | 48 (11.4) | ||||
| Somewhere outside | 191 (45.2) | 195 (46.3) | 120 (28.4) | 167 (39.7) | 38 (9.0) | 139 (39.2) | ||||
| Method of water takeout | Pouring | 265 (62.8) | 268 (63.7) | 0.89 | 336 (79.6) | 299 (71.0) | 384 (91.0) | 296 (70.3) | 0.000 | |
| Dipping | 42 (10.0) | 44 (10.4) | 14 (3.3) | 37 (8.8) | 11 (2.6) | 35 (8.3) | ||||
| Both methods | 115 (27.2) | 109 (25.9) | 72 (17.1) | 85 (20.2) | 27 (6.4) | 90 (21.4) | ||||
| Water containers cleaned last | Less than a week ago | 115 (27.3) | 108 (25.7) | 0.79 | 210 (49.8) | 141 (33.5) | 0.000 | 269 (63.7) | 148 (35.1) | 0.000 |
| More than a week | 207 (49.0) | 216 (51.3) | 165 (39.1) | 203 (48.2) | 136 (32.3) | 189 (44.9) | ||||
| Do not remember | 100 (23.7) | 97 (23.0) | 47 (11.1) | 77 (18.3) | 17 (4.0) | 84 (20.0) | ||||
| Cleanness of water containers | Yes | 189 (43.4) | 158 (37.5) | 0.084 | 262 (62.1) | 139 (33.0) | 0.000 | 352 (83.4) | 187 (44.4) | 0.000 |
| No | 239 (56.6) | 263 (62.5) | 160 (37.9) | 282 (67.0) | 70 (16.7) | 234 (55.6) | ||||
| Point-use water treatment | Yes | 9 (2.1) | 4 (0.9) | 0.16 | 6 (1.4) | 5 (1.2) | 0.76 | 7 (1.7) | 7 (1.7) | 0.99 |
| No | 413 (97.9) | 417 (99.1) | 416 (98.6) | 416 (98.8) | 415 (98.3) | 414 (98.3) | ||||
| Safe feces disposal | ||||||||||
| Category of sanitation | Open defecation | 86 (20.4) | 73 (18.0) | 87 (20.6) | 79 (18.8) | 87 (20.6) | 83 (19.7) | 0.77 | ||
| Unimproved latrine | 32 (7.6) | 36 (8.6) | 0.64 | 27 (6.4) | 31 (7.4) | 0.71 | 25 (5.9) | 21 (5.0) | ||
| Improved latrine | 304 (72.0) | 313 (73.4) | 308 (73.0) | 311 (73.9) | 310 (73.5) | 317 (75.3) | ||||
| How did you dispose of child feces last time? | In the latrine | 95 (22.5) | 97 (23.0) | 0.37 | 157 (37.2) | 96 (22.8) | 0.000 | 304 (72.0) | 149 (35.4) | 0.000 |
| Somewhere on the ground | 225 (53.3) | 239 (56.8) | 210 (49.8) | 250 (59.4) | 100 (23.7) | 230 (54.6) | ||||
| Bush | 102 (24.2) | 85 (20.2) | 55 (13.0) | 75 (17.8) | 18 (4.2) | 42 (10.0) | ||||
| Clean latrine | Yes | 150 (35.6) | 157 (37.3) | 0.7 | 211 (50.0) | 159 (37.8) | 0.02 | 294 (69.7) | 192 (45.6) | 0.000 |
| No | 240 (56.9) | 228 (54.2) | 186 (44.1) | 231 (54.9) | 107 (25.3) | 210 (49.9) | ||||
| No latrine | 32 (7.6) | 36 (8.6) | 25 (5.9) | 31 (7.4) | 21 (5.0) | 19 (4.5) | ||||
| Presence of flies in the latrine | Yes | 232 (55.0) | 216 (51.3) | 0.56 | 116 (27.5) | 192 (45.7) | 0.000 | 103 (24.4) | 197 (46.9) | 0.000 |
| No | 158 (37.4) | 169 (40.1) | 281 (66.6) | 197 (46.9) | 299 (70.9) | 204 (48.6) | ||||
| No latrine | 32 (7.6) | 36 (8.6) | 25 (5.9) | 31 (7.4) | 20 (4.7) | 19 (4.5) | 0.000 | |||
| Feces on the compound | Yes | 126 (29.9) | 124 (29.4) | 0.898 | 72 (17.1) | 137 (32.5) | 0.000 | 54(12.8) | 128 (30.4) | |
| No | 296 (70.1) | 297 (70.6) | 350 (82.9) | 284 (67.5) | 368 (87.2) | 293 (69.6) | ||||
| Hand-washing practice | ||||||||||
| Availability of hand-washing device | Yes | 67 (15.9) | 69 (16.4) | 0.84 | 402 (95.5) | 73 (17.3) | 0.000 | 407 (96.7) | 117 (27.8) | |
| No | 355 (84.1) | 362 (83.6) | 19 (4.5) | 348 (82.7) | 14 (3.3) | 304 (72.2) | ||||
| Availability of water (n = 421) | Yes | 14 (3.3) | 17 (4.0) | 0.58 | 328 (77.9) | 27 (6.4) | 0.000 | 366 (86.9) | 48 (11.4) | 0.000 |
| No | 408 (96.7) | 404 (96.0) | 93 (22.1) | 394 (93.6) | 55 (13.1) | 387 (88.6) | ||||
| Availability of soap (n = 421) | Yes | 10 (2.4) | 12 (2.8) | 0.66 | 234 (55.6) | 17 (4.0) | 0.000 | 325 (77.2) | 31 (7.4) | 0.000 |
| No | 412 (97.6) | 409 (97.2) | 187 (44.4) | 404 (96.0) | 96 (22.8) | 390 (92.6) | ||||
| Hand-washing before eating | Yes | 358 (84.8) | 356 (84.6) | 0.91 | 376 (89.1) | 359 (85.3) | 0.097 | 387 (91.7) | 369 (87.7) | 0.053 |
| No | 64 (15.2) | 65 (15.4) | 46 (10.9) | 62 (14.7) | 35 (8.3) | 52 (12.3) | ||||
| Hand-washing by caregiver after toilet use | Yes | 230 (54.5) | 239 (56.8) | 0.51 | 311 (73.7) | 259 (61.5) | 0.000 | 325 (77.0) | 267 (63.4) | 0.000 |
| No | 192 (45.5) | 182 (43.2) | 111 (26.3) | 162 (38.5) | 97 (23.0) | 154 (36.6) | ||||
| Hand-washing after helping child defecate | Yes | 233 (55.2) | 230 (54.6) | 0.87 | 299 (70.9) | 238 (56.5) | 0.000 | 352 (83.4) | 279 (66.3) | 0.000 |
| No | 189 (44.8) | 191 (45.4) | 123 (29.1) | 183 (43.5) | 70 (16.6) | 142 (33.7) | ||||
| Hand-washing before feeding child | Yes | 202 (47.9) | 204 (48.7) | 0.86 | 297 (70.4) | 239 (56.8) | 0.000 | 316 (74.9) | 243 (57.7) | 0.000 |
| No | 220 (52.1) | 217 (51.5) | 125 (29.6) | 182 (43.2) | 106 (25.1) | 178 (42.3) | ||||
| Hand-washing before preparing food | Yes | 242 (57.3) | 246 (58.4) | 0.75 | 261 (85.6) | 253 (60.1) | 0.000 | 372 (88.2) | 264 (62.7) | 0.000 |
| No | 180 (42.7) | 175 (41.6) | 61 (14.4) | 168 (39.9) | 50 (11.8) | 157 (37.3) | ||||
| Proper hand-washing demonstration | Correct | 109 (25.8) | 106 (25.2) | 0.83 | 322 (76.3) | 121 (28.7) | 0.000 | 389 (92.2) | 125 (29.7) | 0.00 |
| Incorrect | 313 (74.2) | 315 (74.8) | 100 (23.7) | 300 (71.3) | 33 (7.8) | 296 (70.3) | ||||
| . | Baseline (n = HHs) . | . | Midterm (n = HHs) . | . | Endpoint (n = HHs) . | . | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Behavioral outcome indicators . | Intervene No (%) . | Control No (%) . | P Value . | Intervene No (%) . | Control No (%) . | P Value . | Intervene No (%) . | Control No (%) . | P value . | |
| Point-use of drinking water management | ||||||||||
| Source of drinking water | Tap water | 422 (100) | 421 (100) | NA | 422 (100) | 421 (100) | NA | 422 (100) | 421 (100) | NA |
| Type of water containers | Narrow mouth (≤3 cm diameter) | 262 (62.1) | 257 (61.0) | 0.39 | 313 (74.2) | 271 (64.4) | 0.02 | 357 (84.6) | 265 (63.0) | 0.000 |
| Wide mouth (>3 cm diameter) | 31 (7.4) | 42 (10.0) | 19 (4.5) | 39 (9.3) | 4 (1.0) | 40 (9.5) | ||||
| Both types | 129 (30.6) | 122 (29.0) | 90 (21.3) | 111 (26.4) | 61 (14.4) | 116 (27.5) | ||||
| Are all water containers covered? | Yes | 92 (21.8) | 89 (21.1) | 0.14 | 146 (34.6) | 97 (23.0) | 0.000 | 388 (91.9) | 114 (27.1) | 0.000 |
| Some only | 232 (55.0) | 256 (60.8) | 199 (47.2) | 251 (59.6) | 24 (5.7) | 244 (58) | ||||
| No | 98 (23.2) | 76 (18.1) | 77 (18.2) | 73 (17.3) | 10 (2.4) | 63 (14.9) | ||||
| Does the household use a separate container for drinking water? | Yes | 204 (48.3) | 209 (49.6) | 0.7 | 276 (65.4) | 234 (55.6) | 0.04 | 352 (83.4) | 249 (59.1) | 0.000 |
| No | 218 (51.7) | 212 (50.4) | 146 (34.6) | 187 (44.4) | 70 (16.6) | 172 (40.9) | ||||
| Where is the drinking water container placed? | On floor inside home | 189 (44.8) | 180 (42.8) | 0.8 | 214 (50.7) | 205 (48.7) | 0.001 | 245 (58.1) | 208 (49.4) | 0.000 |
| Elevated place inside | 42 (10.0) | 46 (10.9) | 88 (20.9) | 49 (11.6) | 139 (32.9) | 48 (11.4) | ||||
| Somewhere outside | 191 (45.2) | 195 (46.3) | 120 (28.4) | 167 (39.7) | 38 (9.0) | 139 (39.2) | ||||
| Method of water takeout | Pouring | 265 (62.8) | 268 (63.7) | 0.89 | 336 (79.6) | 299 (71.0) | 384 (91.0) | 296 (70.3) | 0.000 | |
| Dipping | 42 (10.0) | 44 (10.4) | 14 (3.3) | 37 (8.8) | 11 (2.6) | 35 (8.3) | ||||
| Both methods | 115 (27.2) | 109 (25.9) | 72 (17.1) | 85 (20.2) | 27 (6.4) | 90 (21.4) | ||||
| Water containers cleaned last | Less than a week ago | 115 (27.3) | 108 (25.7) | 0.79 | 210 (49.8) | 141 (33.5) | 0.000 | 269 (63.7) | 148 (35.1) | 0.000 |
| More than a week | 207 (49.0) | 216 (51.3) | 165 (39.1) | 203 (48.2) | 136 (32.3) | 189 (44.9) | ||||
| Do not remember | 100 (23.7) | 97 (23.0) | 47 (11.1) | 77 (18.3) | 17 (4.0) | 84 (20.0) | ||||
| Cleanness of water containers | Yes | 189 (43.4) | 158 (37.5) | 0.084 | 262 (62.1) | 139 (33.0) | 0.000 | 352 (83.4) | 187 (44.4) | 0.000 |
| No | 239 (56.6) | 263 (62.5) | 160 (37.9) | 282 (67.0) | 70 (16.7) | 234 (55.6) | ||||
| Point-use water treatment | Yes | 9 (2.1) | 4 (0.9) | 0.16 | 6 (1.4) | 5 (1.2) | 0.76 | 7 (1.7) | 7 (1.7) | 0.99 |
| No | 413 (97.9) | 417 (99.1) | 416 (98.6) | 416 (98.8) | 415 (98.3) | 414 (98.3) | ||||
| Safe feces disposal | ||||||||||
| Category of sanitation | Open defecation | 86 (20.4) | 73 (18.0) | 87 (20.6) | 79 (18.8) | 87 (20.6) | 83 (19.7) | 0.77 | ||
| Unimproved latrine | 32 (7.6) | 36 (8.6) | 0.64 | 27 (6.4) | 31 (7.4) | 0.71 | 25 (5.9) | 21 (5.0) | ||
| Improved latrine | 304 (72.0) | 313 (73.4) | 308 (73.0) | 311 (73.9) | 310 (73.5) | 317 (75.3) | ||||
| How did you dispose of child feces last time? | In the latrine | 95 (22.5) | 97 (23.0) | 0.37 | 157 (37.2) | 96 (22.8) | 0.000 | 304 (72.0) | 149 (35.4) | 0.000 |
| Somewhere on the ground | 225 (53.3) | 239 (56.8) | 210 (49.8) | 250 (59.4) | 100 (23.7) | 230 (54.6) | ||||
| Bush | 102 (24.2) | 85 (20.2) | 55 (13.0) | 75 (17.8) | 18 (4.2) | 42 (10.0) | ||||
| Clean latrine | Yes | 150 (35.6) | 157 (37.3) | 0.7 | 211 (50.0) | 159 (37.8) | 0.02 | 294 (69.7) | 192 (45.6) | 0.000 |
| No | 240 (56.9) | 228 (54.2) | 186 (44.1) | 231 (54.9) | 107 (25.3) | 210 (49.9) | ||||
| No latrine | 32 (7.6) | 36 (8.6) | 25 (5.9) | 31 (7.4) | 21 (5.0) | 19 (4.5) | ||||
| Presence of flies in the latrine | Yes | 232 (55.0) | 216 (51.3) | 0.56 | 116 (27.5) | 192 (45.7) | 0.000 | 103 (24.4) | 197 (46.9) | 0.000 |
| No | 158 (37.4) | 169 (40.1) | 281 (66.6) | 197 (46.9) | 299 (70.9) | 204 (48.6) | ||||
| No latrine | 32 (7.6) | 36 (8.6) | 25 (5.9) | 31 (7.4) | 20 (4.7) | 19 (4.5) | 0.000 | |||
| Feces on the compound | Yes | 126 (29.9) | 124 (29.4) | 0.898 | 72 (17.1) | 137 (32.5) | 0.000 | 54(12.8) | 128 (30.4) | |
| No | 296 (70.1) | 297 (70.6) | 350 (82.9) | 284 (67.5) | 368 (87.2) | 293 (69.6) | ||||
| Hand-washing practice | ||||||||||
| Availability of hand-washing device | Yes | 67 (15.9) | 69 (16.4) | 0.84 | 402 (95.5) | 73 (17.3) | 0.000 | 407 (96.7) | 117 (27.8) | |
| No | 355 (84.1) | 362 (83.6) | 19 (4.5) | 348 (82.7) | 14 (3.3) | 304 (72.2) | ||||
| Availability of water (n = 421) | Yes | 14 (3.3) | 17 (4.0) | 0.58 | 328 (77.9) | 27 (6.4) | 0.000 | 366 (86.9) | 48 (11.4) | 0.000 |
| No | 408 (96.7) | 404 (96.0) | 93 (22.1) | 394 (93.6) | 55 (13.1) | 387 (88.6) | ||||
| Availability of soap (n = 421) | Yes | 10 (2.4) | 12 (2.8) | 0.66 | 234 (55.6) | 17 (4.0) | 0.000 | 325 (77.2) | 31 (7.4) | 0.000 |
| No | 412 (97.6) | 409 (97.2) | 187 (44.4) | 404 (96.0) | 96 (22.8) | 390 (92.6) | ||||
| Hand-washing before eating | Yes | 358 (84.8) | 356 (84.6) | 0.91 | 376 (89.1) | 359 (85.3) | 0.097 | 387 (91.7) | 369 (87.7) | 0.053 |
| No | 64 (15.2) | 65 (15.4) | 46 (10.9) | 62 (14.7) | 35 (8.3) | 52 (12.3) | ||||
| Hand-washing by caregiver after toilet use | Yes | 230 (54.5) | 239 (56.8) | 0.51 | 311 (73.7) | 259 (61.5) | 0.000 | 325 (77.0) | 267 (63.4) | 0.000 |
| No | 192 (45.5) | 182 (43.2) | 111 (26.3) | 162 (38.5) | 97 (23.0) | 154 (36.6) | ||||
| Hand-washing after helping child defecate | Yes | 233 (55.2) | 230 (54.6) | 0.87 | 299 (70.9) | 238 (56.5) | 0.000 | 352 (83.4) | 279 (66.3) | 0.000 |
| No | 189 (44.8) | 191 (45.4) | 123 (29.1) | 183 (43.5) | 70 (16.6) | 142 (33.7) | ||||
| Hand-washing before feeding child | Yes | 202 (47.9) | 204 (48.7) | 0.86 | 297 (70.4) | 239 (56.8) | 0.000 | 316 (74.9) | 243 (57.7) | 0.000 |
| No | 220 (52.1) | 217 (51.5) | 125 (29.6) | 182 (43.2) | 106 (25.1) | 178 (42.3) | ||||
| Hand-washing before preparing food | Yes | 242 (57.3) | 246 (58.4) | 0.75 | 261 (85.6) | 253 (60.1) | 0.000 | 372 (88.2) | 264 (62.7) | 0.000 |
| No | 180 (42.7) | 175 (41.6) | 61 (14.4) | 168 (39.9) | 50 (11.8) | 157 (37.3) | ||||
| Proper hand-washing demonstration | Correct | 109 (25.8) | 106 (25.2) | 0.83 | 322 (76.3) | 121 (28.7) | 0.000 | 389 (92.2) | 125 (29.7) | 0.00 |
| Incorrect | 313 (74.2) | 315 (74.8) | 100 (23.7) | 300 (71.3) | 33 (7.8) | 296 (70.3) | ||||
We found that measuring the prevalence ratio and its difference among the intervention and control group at points in time is important for readers to easily visualize when the statistically significant change is seen in diarrhea prevalence