Abstract. We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among... more Abstract. We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds. Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P> 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbio...
Upscaling cost-effective water, sanitation and hygiene interventions such as treating water at po... more Upscaling cost-effective water, sanitation and hygiene interventions such as treating water at point-of-use or improving hygiene behaviour remains difficult despite their proven health benefits. Findings from this thesis could potentially help future researchers to improve selection and implementation of water treatment and hygiene interventions at the community level. Further research is necessary to understand the reasons for poor uptake of the pre-tested effective interventions and how behaviour change interventions with high quality could be delivered at a larger scale. Affordable community-level interventions that reliably separate faeces from the environment, food and water remain important areas for future research.
Health education & behavior : the official publication of the Society for Public Health Education, Feb 1, 2017
Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles... more Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles is a priority for diabetes prevention. The aim of this study was to develop and evaluate measures that can be used to assess the efficacy of behavior change interventions in this group. Measures of psychosocial influences on physical activity and diet were derived from formative research and examination of established instruments. Item reduction by principal components analysis was undertaken following telephone survey administration to 160 women with recent GDM, and the internal reliability and construct validity of the derived scales were assessed. Test-retest reliability was assessed in another sample of 97 women. Scales with acceptable internal reliability were developed for physical activity outcome expectancies (α = .82), perceived barriers (α = .75), encouragement (α = .76) and self-efficacy (α = .82), weight control attitudes (α = .90), and diabetes-related fear (α = .70). Const...
International journal of epidemiology, Dec 2, 2017
Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specif... more Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization. Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households. A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the v...
Abstract. We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among... more Abstract. We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds. Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P> 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbio...
Upscaling cost-effective water, sanitation and hygiene interventions such as treating water at po... more Upscaling cost-effective water, sanitation and hygiene interventions such as treating water at point-of-use or improving hygiene behaviour remains difficult despite their proven health benefits. Findings from this thesis could potentially help future researchers to improve selection and implementation of water treatment and hygiene interventions at the community level. Further research is necessary to understand the reasons for poor uptake of the pre-tested effective interventions and how behaviour change interventions with high quality could be delivered at a larger scale. Affordable community-level interventions that reliably separate faeces from the environment, food and water remain important areas for future research.
Health education & behavior : the official publication of the Society for Public Health Education, Feb 1, 2017
Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles... more Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles is a priority for diabetes prevention. The aim of this study was to develop and evaluate measures that can be used to assess the efficacy of behavior change interventions in this group. Measures of psychosocial influences on physical activity and diet were derived from formative research and examination of established instruments. Item reduction by principal components analysis was undertaken following telephone survey administration to 160 women with recent GDM, and the internal reliability and construct validity of the derived scales were assessed. Test-retest reliability was assessed in another sample of 97 women. Scales with acceptable internal reliability were developed for physical activity outcome expectancies (α = .82), perceived barriers (α = .75), encouragement (α = .76) and self-efficacy (α = .82), weight control attitudes (α = .90), and diabetes-related fear (α = .70). Const...
International journal of epidemiology, Dec 2, 2017
Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specif... more Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization. Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households. A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the v...
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