Huda 2012 BGD.
| Methods | Controlled cohort study | |
| Participants | Number: 1699 HHs for structured observations and 1000 HHs for diarrhoea surveillance. Inclusion criteria: HH with a child aged < 5 years and a guardian of the child agreed to participate in the study. |
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| Interventions | Intervention (50 communities): SHEWA‐B, a large‐scale hygiene promotion intervention which engaged 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 were 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 HH visits, courtyard meetings, and different activities, e.g. hygiene fairs, village theatre, group discussions in tea stalls. Promoters used flip charts and flash cards. Control (50 communities): no major water, sanitation, hygiene programme ongoing. |
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| Outcomes | Diarrhoea prevalence. Diarrhoea: passage of ≥ 3 loose or watery stools in 24‐hour period. Monthly visits to ask about episodes of diarrhoea in previous 2 days. Acute respiratory illness Observed hygiene behaviours including child faeces disposal, considered appropriate if faeces were observed to be disposed in a toilet or in a specific pit. |
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| Notes | Location: 100 rural villages across Bangladesh Length of study: 24 months (October 2007 to September 2009) Publication status: journal |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Intervention not randomly allocated. |
| Allocation concealment (selection bias) | High risk | Intervention communities were allocated prior to enrolment. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | NA |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | NA |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Numbers of respondents not reported for the health outcomes. |
| Selective reporting (reporting bias) | Low risk | Reported all outcomes prespecified in the methods. |
| Other bias | Unclear risk | — |
| Similarity of baseline outcome measurements | Unclear risk | From figure it appears the baseline diarrhoea prevalence was slightly different but no data presented. |
| Similarity of baseline characteristics | Low risk | No major differences at baseline. |
| Adequate allocation of intervention concealment during the study | High risk | Although the community monitors were not aware of the hypothesis, they were aware of allocation to intervention/control group. |
| Adequate protection against contamination | Low risk | Selected subdistricts in which (quote) "Department of Public Health Engineering of the Government of Bangladesh, who were responsible for implementing SHEWA‐B and confirmed that there was no similar intervention ongoing." |
| Confounders adequately adjusted for in analysis/design | High risk | No confounders adjusted for in analyses. |
| Recruitment bias | Unclear risk | NA |
| Baseline imbalance | Unclear risk | NA |
| Loss of clusters | Unclear risk | NA |
| Incorrect analysis | Unclear risk | NA |