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Study Overview

A Cluster Randomized Control Trial Evaluating the Effectiveness of an Integrated Sanitation and Nutrition Program in Kitui County, Kenya.
Study ID:
Initial Registration Date:
Last Update Date:
Study Status:
While sanitation and nutrition interventions are both associated with better sanitation and nutrition outcomes, these interventions are usually implemented separately. There is limited evidence of programming that has jointly impacted both sanitation and nutrition outcomes. This study seeks to identify the causal impact of an integrated sanitation and nutrition program on knowledge and practices of sanitation and nutrition behaviours in Kitui County, Kenya. Villages will be randomly assigned to either receive the standard Community Led Total Sanitation (CLTS) program or an integrated CLTS+Nutrition intervention. Outcomes of interest include household-level observations of: 1) sanitation practices, including toilet use, handwashing, courtyard cleanliness, child diarrhoea and correct disposal of child faeces; and 2) nutrition practices, including proper breastfeeding and visits to health facilities.
Health, Nutrition, and Population
Water and Sanitation
Additional Keywords:
CLTS, WASH, Nutrition
Secondary ID Number(s):
Bill & Melinda Gates Foundation Grant Investment ID: OPP1124645, KEMRI Protocol No. Non-KEMRI 547

Principal Investigator(s)

Name of First PI:
Lilian Lehmann
Name of Second PI:
Gerishom Gimaiyo

Study Sponsor

Bill and Melinda Gates Foundation
Study Sponsor Location:
United States
Funding Proposal:

Research Partner

Name of Partner Institution:
Type of Organization:
Foreign or Multilateral Aid Agency

Intervention Overview

The Sannut intervention is a modified form of the Kenya National Protocol for Community Led Total Sanitation (CLTS). The intervention clarifies with the community the link between open defecation and child malnutrition through (1) the addition of two meetings that sensitize caregivers on toddler hygiene and nutrition, and (2) household visits that reinforce these messages. The evaluation is testing the hypothesis of whether additional focus on toddler hygiene and nutrition via community level messaging leads to change in caregiver behaviours/practices that will ultimately reduce the risk of a child becoming malnourished during their first 1000 days. CLTS is occurring in both treatment and control villages. The added activities of Sannut (occurring only in the treatment group) that are overlaid on top of traditional CLTS are: 1. Addition of two caregiver meetings following the CLTS trigger session to sensitize mothers and other caregivers of children under 2 on the importance of toddler hygiene and nutrition for the health of their children 2. Household follow-up visits that include, in addition to standard CLTS messages, the supplemental messages covered in the caregiver meetings
Theory of Change:
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
Kitui County Government’s Ministry of Health and Sanitation Services. (Kitui County is a devolved administrative unit in Kenya). UNICEF is a supporting partner
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:
Kitui County Government
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Intervention Timing

Intervention or Program Started at time of Registration?
Start Date:
End Date:
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Other (specify)
Other (not Listed) Method:
Process Evaluation

Method Details

Details of Evaluation Approach:
This evaluation is a cluster Randomized Control Trial (RCT) at the level of the village (“kijiji”), where key outcome indicators in the intervention group (receiving supplemental sanitation and nutrition messaging, as an add-on to the standard CLTS) will be compared to a control group (receiving only standard CLTS). Knowledge and practices of both sanitation and nutrition behaviours will be measured. The RCT will yield causal estimates of the impact of supplemental nutrition messaging on outcomes of interest. Kijijis are stratified at the ward level (unit of administration below the county and above the kijiji) to improve treatment/control balance and facilitate implementation.
Outcomes (Endpoints):
1. Latrine use 2. Latrine structure maintenance 3. Courtyard cleanliness 4. Self-reported disposal of child feces 5. Proper breastfeeding practice 6. Health facility access 7. Handwashing infrastructure 8. Handwashing practice 9. Child diarrhea 10. Sanitation knowledge 11. Nutrition knowledge
1. Latrine use. Binary outcome for whether the respondent uses latrine 2. Latrine structure maintenance. Score based on observer’s checklist, standardized by control group mean and SD 3. Courtyard cleanliness. Standardized checklist score 4. Self-reported disposal of child feces. Binary outcome for whether child feces are disposed of correctly 5. Proper breastfeeding practice. Binary outcome for whether caregiver is properly breastfeeding toddler based on toddler age 6. Health facility access. a) Health facility visit in past 2 months, b) youngest child received Vitamin A supplement in past 6 months, c) youngest child received deworming treatment in past 6 months 7. Handwashing infrastructure. Binary outcome for whether household has a stocked handwashing facility 8. Handwashing practice. Binary outcome for whether respondent and children are properly washing hands 9. Child diarrhea. Fraction of the children older than 6 months in the household that showed symptoms of diarrhea in the past 2 weeks 10. Sanitation & nutrition knowledge. Standardized checklist score
Unit of Analysis:
The unit of analysis in this intervention is the household. The primary caregiver of the youngest child will be interviewed in each household.
Null hypothesis: Sanitation and nutrition outcomes in the Sannut intervention group are the same as the outcomes for the comparison group receiving traditional CLTS activities.
Unit of Intervention or Assignment:
Village (kijiji).
Number of Clusters in Sample:
There are 627 kijijis included in the evaluation, 317 in the treatment group and 310 in the control group.
Number of Individuals in Sample:
There will be a maximum of 8 households per cluster for a possible total of 5,016 individuals.
Size of Treatment, Control, or Comparison Subsamples:

Supplementary Files

Analysis Plan:
Sannut Pre-Analysis Plan FINAL.docx
Other Documents:

Outcomes Data

The data for this evaluation will be a household survey conducted at endline by IDinsight. This will be collected at the household-level from a sample of all eligible caregivers (caregivers with children under 5 years) in both treatment and control kijijis.
Data Already Collected?
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Treatment Assignment Data

Participation or Assignment Information:
Data Obtained by the Study Researchers?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Data Analysis

Data Analysis Status:

Study Materials

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Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

Intervention Completion Date:
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Unit of Analysis:
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Total Observations in Final Sample:
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Preliminary Report:
Preliminary Report URL:
Summary of Findings:
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Data Availability

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Other Materials

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Description of Changes:

Study Stopped