2. Summary of the study designs, settings, and outcome measures of the education and hygiene promotion interventions.

Study (setting)	Summary of the intervention	Outcomes used in reviewa
		Diarrhoea	Anthropometry	Behaviour change	Other
RCTs
Altmann 2018 TCD (not specified)	Intervention in health centres to children admitted for OTP. The intervention group received routine OTP services (as the control group) plus WASH kit and promotion, which included messaging to bury children's stool. The household WASH kit given at admission contained a safe drinking water storage container with a lid, water disinfection consumables (180 chlorine tablets), 12 bars of soap for hand washing, a plastic cup with handle (to be reserved for the child to facilitate safe drinking water practice), and a laminated leaflet with pictures representing the main hygiene messages. They also received a promotion session on the kit use at each weekly visit to the health centre and 2 extra home visits for assessing and reinforcing adherence. Promotion at health centre included key messages on: a protected space for children to play; washing the child with soap; cleaning and rapid burial of children's stools; hand washing at key times; safe storage of water; exclusive breastfeeding of children aged < 6 months; and water treatment and food hygiene. The household WASH kit was designed to last for 3 months (2 months during treatment in the OTP and 1 month after the end of the treatment).	Longitudinal prevalence (narratively)	Recovery rate from SAM (narratively)	—	Death rate (narratively)
Barrios 2008 PHI (rural)	Hygiene promotion programme that focused on improving hand washing and stool disposal behaviours. Delivered by midwives and health workers in small group meetings and in home visits. For the disposal of child faeces, caretakers were encouraged to use toilets (any type) as the final site of faeces disposal. When a toilet was not available, burying faeces ≥ 10 m away from water sources and living areas was discussed. The main message was the sanitary disposal of faeces, regardless of where a child defecated.	—	—	Observed faeces in the yard	—
Haggerty 1994 DRC (rural)	Education intervention to improve personal and domestic hygiene behaviours including: disposal of animal faeces, hand washing before meal preparation and after defecation/washing hands and buttocks of young children after defecation, disposal of children's faeces (emphasized digging or improving pit latrines). The messages were delivered by female community volunteers in village‐wide meetings and small group discussions.	7‐day recall ≥ 1 episodes of diarrhoea at any time during the surveillance period.	—	—	—
Hashi 2017 ETH (rural)	Health education and provision of soap (white bars). The health education consisted of 12 sessions on key WASH messages (hand washing with soap, water storage behaviour, latrine availability and use, safe waste disposal) and demonstration of hand washing with soap. Messages to dispose of children's waste properly were delivered via demonstrations and instructions. The messages were to dispose of children's waste properly in the waste disposal site (in a waste container at the corner/back of the house) as opposed to the garbage (uncollected waste) and in a latrine (if they had 1) but never in the open field, garbage, or around utensils and kitchen.	Incidence (2‐week recall)	—	—	—
Jinadu 2007 NGR (rural)	Educational intervention programme to promote the hygienic disposal of children's faeces: educating mothers about the hygienic use of chamber pots for the disposal of children faeces; discouraging children from defecation around households; educating the heads of households about the construction and use of cheap, affordable, ventilated improved latrines by members of the communities; educating mothers to wash hands with soap and water after going to toilet and after cleaning up children's faeces.	—	—	Potty use Faeces observed in the yard/house Latrine use by children	—
Nair 2017 IND (rural)	Intervention involving community‐based female worker (Suposhan Karyakarta, or SPK) carrying home visits with individual families and participatory meetings with groups of women, to improve health and nutrition in the first 1000 days of life. The training to prepare SPK to home visits included: advising caregivers to place the child's faeces in a pit latrine, or if no latrines are available (the case for > 90% of households in the trial areas), to bury them in a shallow hole away from their living area and any waterway rather than disposing of them in the open field or the household compound.	—	LAZ at 18 months Other anthropometry measures (WHZ, WAZ, MUAC, stunting, wasting, underweight) (narratively)	—	Mortality (narratively)
Sarrassat 2018 BUR (rural)	Mass radio campaign targeted at women of reproductive age and caregivers of children aged < 5 years, on 17 childcare behaviours, including safe child faeces disposal. The radio campaign included short spots (1 minute' duration, broadcast approximately 10 times per day) and interactive long‐format programmes (2 hours' duration, broadcast 5 days per week, followed by phone‐ins to allow listeners to comment). All materials were produced in the predominant local languages of each intervention cluster. Behaviours covered by spots changed weekly. The long‐format programme covered 2 behaviours a day and changed daily. Safe child stool disposal was covered in 3 weeks of spots and 94 long‐format modules. The recommendation was for all faeces (including the faeces of babies and small children) to be disposed of after defecation in a hygienic way. Either by using latrines or by using pots for young children or burying the stools outside the house/compound.	—	—	Safe disposal of last children's stools	All‐cause postneonatal mortality in children aged < 5 years (narratively) All‐cause mortality in children aged < 5 years (narratively)
Sinharoy 2017 RWA (rural)	Community‐Based Environmental Health Promotion Programme, which used the community health club approach to promote healthy practices. The study evaluated 2 versions of the programme: a lite (8 education sessions) and classic (20 sessions). Education sessions include: personal hygiene, handwashing, diarrhoea, water sources, safe storage of drinking water, treatment of drinking water, and sanitation. Both lite and classic interventions included messages on child sanitation under the topic of sanitation ("zero open defecation"). The participants were recommended the following: children should defecate into a chamber pot; children's faeces should be buried if there was no latrine (cat sanitation) – but always emphasized throwing the faeces in the latrine; never let dogs or pigs eat children's faeces.	Prevalence, 7‐day recall	HAZ (used in analysis) WHZ	Safe child (aged < 3 years) faeces disposal Presence of faeces (human or animal) in compound	—
Stanton 1987 BGD (urban)	Educational intervention emphasizing 3 messages: proper hand washing before food preparation; defecation away from the house and in a proper site; suitable disposal of waste and faeces. The intervention was delivered in the community over 8 weeks through small group discussions, larger demonstrations, community wide planning and action meeting, posters, games, pictorial stories, and flexi flans (flannel board with movable characters).	Incidence (2‐week recall)	Weight for age Height for age Weight for height (narratively)	Open defecation of children aged < 5 years	Mortality (narratively)
Yeager 2002 PER (urban)	Hygiene promotion for potty use and keeping the home environment free from faeces. The intervention was delivered through routine health services, and using video presentations, leaflets including 4 steps to potty training and counselling by health staff during consultations	—	—	Potty use Latrine use by children Safe disposal of child faeces	—
CBA studies
Ahmed 1993 BGD (rural)	Participatory behaviour change intervention "Porichchhanna Jibon" (clean life). The campaign was developed in partnership with the community. The intervention involved teaching the germ theory of disease then encouraging mothers to identify their problems and to find solutions through group participation and discussion. The interventions developed were: theme I: ground sanitation – keeping babies from touching and eating disease‐causing matter on the dirt surface of the compound: sweep the baby's play area 4 times a day. use a dirt thrower (similar to a flat garden trowel provided by the project at USD 0.30) to immediately remove the baby's or animal faeces from the compound surface, so that the crawling baby could not be contaminated by faeces from the ground. construct a faeces pit to dispose of faeces and other filthy matter from the compound. The faeces pit was about 2 feet deep, with a narrow neck. wash babies in a particular place after defecation so that germ‐contaminated water did not spread everywhere. keep crawling babies in a playpen (locally constructed, provided by the project at a cost of USD 1.0) instead of permitting them to crawl in the dirt; theme II: personal hygiene – reducing the transmission of germs from defecation and other personal hygiene behaviours (hand washing with ashes or soap, anal cleaning, clean baby after defecation, cut nails, clean rag to dry hands, clean baby rug/mat); theme III: food hygiene – reducing the transmission of germs during supplementary and bottle feeding (do not use any feeding bottle if possible, clean bottle, prepare small amount, use tube well water for drinking and baby food, wash hands before eating, cover food, do not eat leftovers, store plates and pans upside down, cover water pitchers).	Trends in daily diarrhoea prevalence (narratively)	Weight for age (narratively)	—	—
Controlled cohort studies
Huda 2012 BGD (rural)	SHEWA‐B, a large‐scale hygiene promotion intervention which engages local residents to develop their own community action plans, including targets for improvements in latrine coverage and use, access to arsenic‐free water and improved hygiene practices. Community hygiene promoters are trained to deliver 11 key messages including "use hygienic latrine by all family members including children" and "dispose of children's faeces into hygienic latrines" using household visits, courtyard meetings and different activities for example hygiene fairs, village theatre, and group discussions in tea stalls. Promoters used flip charts and flash cards.	Diarrhoea prevalence (2‐day recall)	—	Safe disposal of child faeces (observed)	—
Luby 2014 BGD (rural and urban)	Improved SHEWA‐B. Changes in the intervention included a mass media campaign including radio spots across 6 regional channels from November 2011 to February 2012 encouraging HWWS before food, after defecation, and after cleaning a child and video spots on 5 television stations (November–February 2012) encouraging HWWS, using sanitary latrines for defecation, discarding child faeces, and keeping latrines clean to reduce bad smells and flies. A second series of videos encouraged testing tube‐wells for arsenic and using arsenic free water for cooking and drinking. The intervention target population also expanded to include urban households.	Diarrhoea prevalence (2‐day recall)	HAZ WAZ WHZ (narratively)	Safe disposal of child faeces (observed)	—
Controlled cross‐sectional studies
Berhe 2014 ETH (rural)	The HEP is implemented by full‐time female health extension workers who provide training to households. The packages include interventions in 4 main categories: family health services, infectious disease prevention and control, hygiene and environmental sanitation, and health education and communication. The maternal and child health package (in the family health services category) includes safe child stool disposal (the stool should be cleaned and disposed in a pit latrine, or shall be covered with a leaf or paper and be buried) (HEP 2003).	Diarrhoea prevalence (2‐week recall)	—	Safe disposal of child faeces	—
Fisher 2011 BGD (rural)	BRAC hygiene education intervention, trained field workers provide WASH education to separate clusters of men, women, adolescents, and children at least once every 3 months. The education uses pictorial flip chart with a total of 39 messages covering multiple aspects of cleanliness, clean water, and sanitation. Villagers are also encouraged to learn the '19 Messages to Remember', concerning hand washing, sanitation (includes child faeces disposal in latrine), and safe water.	Diarrhoea prevalence in last month (narratively)	—	Safe disposal of child faeces	—
Gebru 2014 ETH (rural)	HEP intervention, as in Berhe 2014 ETH.	Diarrhoea prevalence (2‐week recall)	—	Safe disposal of child faeces	—
Mathew 2004 ZIM (rural)	Community health clubs – structured weekly course of participatory health education classes. 15 health topics covered using PHAST techniques, within the hygiene lesson covering disposal of toddler's faeces in a latrine.	—	—	Percentage of children (aged < 5 years) present at the time of observations not using a latrine (narratively)	—
Oguro 2016 MYA (rural)	WVGs were established by organizing women and training them using a participatory approach. The activities of the WVGs after 3 years of being established included: educating pregnant women and mothers regarding the necessity of health checks and immunizations and helping them attend these appointments; early detection of abnormal signs and symptoms during the perinatal period; managing the family planning fund, which allowed women who could not afford contraception to borrow money at no interest; providing first aid to injured people (e.g. for injuries that were sustained during agricultural work); and educating women regarding appropriate sanitation and malaria prevention. The WVG encouraged latrine use by children aged < 5 years to villagers as part of a programme to promote sanitation education and promoted appropriate disposal (flushing in a latrine) of child faeces.	—	—	Appropriate disposal of child stool (narratively)	—
Waterkeyn 2005 ZIM (rural)	CHC intervention, as Mathew 2004 ZIM.	—	—	Observed child faeces in the yard (narratively)	—

CBA: controlled before‐and‐after; HAZ: height‐for‐age Z score; HEP: Health Extension Package; HWWS: handwashing with soap; PHAST: Participatory Hygiene and Sanitation Transformation; OTP: Outpatient Therapeutic feeding Program; LAZ: length‐for‐age Z score; MUAC: mid‐upper‐arm‐circumference; RCT: randomized controlled trial; SAM: severe acute malnutrition; SHEWA‐B: Sanitation Hygiene Education and Water Supply in Bangladesh; WASH: water, sanitation, and hygiene; WAZ: weight‐for‐age Z score; WHZ: weight‐for‐height Z score; WVG: Women's Health Volunteer Group.
 ^aNone of the education and hygiene promotion interventions measured soil‐transmitted helminth outcomes.