Paper Information

The WASH Upgrades for Health in Amhara (WUHA) trial was a two-arm, parallel-group, cluster-randomized trial carried out in three districts of the Wag Hemra Zone of Amhara from 2016 to 2019 (ClinicalTrials.gov #NCT02754583). The intervention consisted of hygiene infrastructure improvements and hygiene promotion at the household, community, and school level. Height and weight were pre-specified secondary outcomes that were measured annually in the longitudinal cohort of children aged 0-5 years at baseline.

Child growth faltering contributes significantly to global morbidity and mortality, with a disproportionate impact on low- and middle-income countries. Poor quality water, sanitation, and hygiene (WASH) has been identified as a risk factor, though prior studies have found mixed evidence for the effectiveness of WASH interventions.

Twenty communities were randomized to the WASH intervention and 20 to the control (delayed WASH) arm. Anthropometric measurements were done at baseline for a random sample of 613 children in the WASH intervention arm and 644 children in the control arm. There was no statistically significant difference over the 3-year study period for either height (0.1 cm lower in the WASH arm, 95 %CI -0.5 to 0.2, P = 0.45) or weight (0.02 kg higher in the WASH arm, 95 %CI -0.06 to 0.10, P = 0.64).

A comprehensive WASH intervention implemented for three years in rural Ethiopia did not improve growth among children 0-5 years old.