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International Health

November 16, 2020

Johns Hopkins Receives Grant to Evaluate Digital Health Program to Prevent Diarrhea and Stunting in Rural Bangladesh

The program, already found effective in urban settings, will be adapted for expansion into rural areas across the country


The Johns Hopkins Bloomberg School of Public Health received a grant from USAID to test a low-cost digital water, sanitation, and hygiene (WASH) program in rural Bangladesh. In a study published earlier this year, the Cholera Hospital Based Intervention for 7 days (CHoBI7) Mobile Health Program was shown to significantly reduce diarrhea and stunting in young children in Dhaka, Bangladesh. This new 3-year grant provides $1.5 million to evaluate this program’s adaptation for rural areas in health facilities across the country. Christine Marie George, PhD, an associate professor of International Health at the Bloomberg School, will lead the project.

WASH interventions promoting chlorination of drinking water in households and hand hygiene using soap have demonstrated their effectiveness in reducing the burden of diarrheal diseases in children in low- and middle-income countries. However, the major hurdle has been ensuring that users adhere to these practices over time. This has been amplified by the costs and complexities of scaling up WASH interventions in urban, high-risk settings, especially in areas with limited community health worker service coverage. Utilizing digital health programs, such as CHoBI7, provides an avenue to ensure low-cost sustainable scale-up of WASH interventions in such areas. The CHoBI7 program sends weekly mobile phone reminders about the importance of handwashing with soap and boiling drinking water to diarrhea patients admitted to health facilities and members of their households. The program was shown to reduce stunting by as much as 29% and diarrhea by as much as 31% among children under 2 living in households receiving these messages compared to children in households who received no phone reminders.

Already shown to be effective in urban areas, the government of Bangladesh will begin adapting the CHoBI7 for rural areas with the goal of introducing the program nationwide. To assess an approach for CHoBI7 program delivery that can be taken to scale by the government of Bangladesh, a modified diarrhea prevention package that includes only a soapy water bottle and chlorine tablets in both urban and rural areas of Bangladesh will be market tested. The original diarrhea prevention package included a handwashing station, a drinking water vessel, a soapy water bottle, and chlorine tablets. The grant will fund the evaluation of the program in two phases. The first is a year-long formative research phase that will help tailor and market test the program for rural health facilities. Then the study team will conduct a randomized controlled trial to evaluate the effectiveness of delivering CHoBI7 in community clinics, district hospitals, tertiary hospitals, and sub-district health complexes in rural areas in terms of increases in WASH behaviors and decreases in diarrheal disease. The study will be conducted in Dhaka, Narayanganj, Munshiganj, and Manikganj in Bangladesh.

In addition to George, the study team includes investigators with expertise in digital health, clinical trials, and diarrheal disease control in Bangladesh. Other Bloomberg School faculty involved in this study include Jamie Perin, PhD, associate scientist of International Health, who will provide biostatistical expertise; Alain Labrique, PhD, a professor in International Health, who is a global leader in applying information and communication technologies to strengthen health systems in low-resource settings; and David Sack, MD, a professor of International Health, who is a globally renowned expert on enteric infectious diseases.