The WASH Benefits Bangladesh study was a cluster-randomised trial conducted in rural villages in Gazipur, Kishoreganj, Mymensingh, and Tangail districts of Bangladesh (appendix p 2 ). We grouped pregnant women who lived near enough to each other into a cluster to allow delivery of interventions by a single community promoter. We hypothesised that the interventions would improve the health of the index child in each household. Each measurement round lasted about 1 year and was balanced across treatment arms and geography to minimise seasonal or geographical confounding when comparing outcomes across groups. We chose areas with low groundwater iron and arsenic (because these affect chlorine demand) and where no major water, sanitation, or nutrition programmes were ongoing or planned by the government or large non-government organisations. The study design and rationale have been published previously.10
The latrine component of the sanitation intervention was a compound level intervention. The drinking water and handwashing interventions were household level interventions. The nutrition intervention was a child-specific intervention. We assessed the diarrhoea outcome among all children in the compound who were younger than 3 years at enrolment, which could underestimate the effect of interventions targeted only to index households (drinking water, and handwashing) or index children (nutrition). After the study results were unmasked, we analysed diarrhoea prevalence restricted to index children (ie, children directly targeted by each intervention).
The study protocol was approved by the Ethical Review Committee at The International Centre for Diarrhoeal Disease Research, Bangladesh (PR-11063), the Committee for the Protection of Human Subjects at the University of California, Berkeley (2011-09-3652), and the institutional review board at Stanford University (25863).
The latrine component of the sanitation intervention was a compound level intervention. The drinking water and handwashing interventions were household level interventions. The nutrition intervention was a child-specific intervention. We assessed the diarrhoea outcome among all children in the compound who were younger than 3 years at enrolment, which could underestimate the effect of interventions targeted only to index households (drinking water, and handwashing) or index children (nutrition). After the study results were unmasked, we analysed diarrhoea prevalence restricted to index children (ie, children directly targeted by each intervention).
The study protocol was approved by the Ethical Review Committee at The International Centre for Diarrhoeal Disease Research, Bangladesh (PR-11063), the Committee for the Protection of Human Subjects at the University of California, Berkeley (2011-09-3652), and the institutional review board at Stanford University (25863).
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