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Study Overview

Implementing and Evaluating Low Cost Interventions to Improve Latrine Use Among Rural Households in Odisha, India
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Aim: The overall aim of this study is to evaluate a sanitation behavior change intervention and its impact on latrine use and safe disposal of child feces among villages in Puri District, Orissa, India. Background: The research is being carried out in Puri district of Odisha state where only 36.8% of households have an improved sanitation facility (NFHS-4, district fact sheet). As in other states in India, and noted by previous research in Odisha from our team, latrine use remains low even among households with access. The government has aimed to have India be ‘open defecation free’ by October 2019, which requires not only intensive latrine construction efforts, but initiatives to change open defecation behaviour and encourage consistent latrine use by all. We are carrying out a 66 village cluster randomized trial to evaluate a multi-level, theoretically-informed intervention (33 receiving the intervention, 33 controls). In six additional villages, we will carry out qualitative research to evaluate perceptions of latrine use, facets of the intervention, and other sanitation-related research. Three of these six villages will receive the intervention while three will not.
Water and Sanitation
Additional Keywords:
sanitation, behavior change, child feces, India, rural, latrine use
Secondary ID Number(s): ID: NCT03274245

Principal Investigator(s)

Name of First PI:
Bethany Caruso
Emory University
Name of Second PI:
Thomas Clasen
Emory University

Study Sponsor

3ie [International initiative for Impact Evaluation]
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Research Partner


Intervention Overview

In treatment villages, a local NGO, will deliver an intervention package that includes activities at the community and household levels, with additional activities and hardware for mothers of children under five. For households with non-functional latrines, repairs will be provided.
Theory of Change:
Based on our formative research and a thorough literature review, latrine use in rural Puri District of Odisha State is influenced by: Risk perceptions, ability to use a latrine, Social Norms, Motivations, Self-regulation of the behaviour, and Physical Opportunity (i.e. the presence of a functional latrine in the household). We expect that the various interventions we propose will impact these noted behavioural determinants and therefore encourage latrine use. Specifically, the intervention aims to make people aware of risks associated with open defecation and the health benefits of latrine use; instruct individuals as to how to use latrines and potties for safe child faeces disposal; shift social norms around latrine use; motivate latrine use; encourage continued use; and provide facilities (latrine repairs) and hardware (potties, scoops) to enable use by all.
Multiple Treatment Arms Evaluated?

Implementing Agency

Type of Organization:
NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:
3ie [International Initiative for Impact Evaluation]
Type of Organization:
NGO (International)

Intervention Timing

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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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Method Details

Details of Evaluation Approach:
We will conduct a cluster-randomized control trial to test assumptions and make causal claims. We will engage 66 villages; 33 will receive the intervention and 33 will be the control. At baseline and endline, we will conduct a census in all 66 villages to determine latrine coverage. Households with latrines will be asked further survey questions about the latrines (i.e. age, funding source) and to determine use among all household members. Latrines will also be observed to verify conditions and use claims. A subset of 20 households with latrines per village will receive additional questions about determinants of latrines use (i.e. social norms, risk perceptions, etc.). A process evaluation will be conducted while the intervention is being rolled out to understand intervention fidelity, reach, dose, and satisfaction. To make sure we are learning from the intervention roll-out but also not interfering with the trial itself, we will engage 6 additional villages (3 intervention and 3 control) in which to carry out qualitative work soon after intervention delivery. We also will employ qualitative methods (interviews, discussions) after endline to help explain quantitative outcomes.
Outcomes (Endpoints):
Primary outcome: Latrine Use Secondary Outcomes: Latrine use determinants, latrine coverage
Unit of Analysis:
We will assess individual latrine use
Main research question: H1: Latrine use among people who own a functional latrine in communities that received the intervention will be significantly higher compared to latrine owning households in control communities. Secondary research question 1: H2: Latrine construction among non-latrine owners in communities that received the intervention will be significantly higher compared to controls. Secondary research question 2: H3: Latrine use behavioral determinant scores are significantly higher at endline among latrine owners in intervention villages compared to latrine owners in control villages.
Unit of Intervention or Assignment:
Villages will be randomly assigned to treatment or control arms
Number of Clusters in Sample:
Number of Individuals in Sample:
We anticipate collecting latrine use data on 15,840 individuals (estimated 3,960 latrine owning households across 66 villages * 4 persons per household).
Size of Treatment, Control, or Comparison Subsamples:
33 villages will receive the intervention and 33 will serve as controls.

Supplementary Files

Analysis Plan:
Emory 3ie PAP for RIDIE 15NOV17.docx
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Outcomes Data

All households will be engaged in a census at baseline and endline. Non-latrine owning households will provide basic demographic information. Latrine owning households will provide expanded information on demographics, their latrine, and latrine use information for all household members. Observations of latrines will be conducted. Households with children under five will be asked about child feces practices. 20 randomly selected households per village will be asked latrine use questions.
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Treatment Assignment Data

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Data Analysis

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Study Materials

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Registration Category

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

Completion Overview

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Preliminary Report:
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Data Availability

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Study Stopped