Trial reportThe American journal of tropical medicine and hygiene2018
Effect of a School-Based Hygiene Behavior Change Campaign on Handwashing with Soap in Bihar, India: Cluster-Randomized Trial.
Trial report in The American journal of tropical medicine and hygiene, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment.PLoS neglected tropical diseases · 2021Pooled it
- A systematic review of hand-hygiene and environmental-disinfection interventions in settings with children.BMC public health · 2020Pooled it
- Methodology for measuring behavior change dictates the perceived effectiveness of school-based WASH interventions.Frontiers in public health · 2026Trial
- Cluster-randomised trial to test the effect of a behaviour change intervention on toilet use in rural India: results and methodological considerations.BMC public health · 2020Trial
- Changes in handwashing knowledge, attitudes, and practices among primary schoolchildren in Ulaanbaatar, Mongolia during the COVID-19 pandemic.Frontiers in public health · 2025Article
- Factors associated with hygiene practices among primary school children in southern Ethiopia.Frontiers in public health · 2024Article
- Handwashing Practices and Its Predictors Among Primary School Children in Damote Woide District, South Ethiopia: An Institution Based Cross-Sectional Study.Environmental health insights · 2022Article
- The potential of school-based WASH programming to support children as agents of change in rural Zambian households.BMC public health · 2021Article
- Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya.BMC public health · 2020Article
- Article
- Impact of a teacher-led school handwashing program on children's handwashing with soap at school and home in Bihar, India.PloS one · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Changing hand hygiene behavior at scale in the community remains a challenge. The objective of this study was to estimate the effect of Unilever's school-based "School of 5" handwashing campaign on handwashing with soap (HWWS) in schoolchildren and their mothers in the Indian state of Bihar. We conducted a cluster-randomized trial in two districts. We randomized a total of 32 villages with at least one eligible school to intervention and control groups (1:1) and recruited 338 households in each group for outcome measurement. We used structured observation in households to measure HWWS at target occasions (after defecation, soap use during bathing, and before each main meal) in schoolchildren and their mothers. Observers were blinded to intervention status. We observed 636 target occasions (297 in the intervention arm and 339 in the control arm) in mothers and school-going children. After the intervention, HWWS prevalence at target occasions was 22.4% in the control arm and 26.6% in the intervention arm (prevalence difference +4.4%, 95% confidence interval: -4.0, 12.8). The difference was similar in children and mothers. Observers appeared to be adequately blinded to intervention status, whereas observed households were successfully kept unaware of the purpose of observations. To conclude, we found no evidence for a health-relevant effect of the School of 5 intervention on HWWS in schoolchildren and their mothers. Qualitative research suggested that reasons for the low impact of the intervention included low campaign intensity, ineffective delivery, and a model possibly not well tailored to these challenging physical and social environments.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.