{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:50:51Z","timestamp":1783529451086,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T00:00:00Z","timestamp":1498694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Water & Sanitation for the Urban Poor","award":["GR-01308"],"award-info":[{"award-number":["GR-01308"]}]},{"name":"Stanford's Center for Innovation in Global Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cluster\u2010randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six\u2010month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>) to assess outcomes and accounted for clustering effects using generalised estimating equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: +4.7%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.2, 9.2), access to brush\/broom for cleaning (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: +8.4%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 2, 15) and waste bins (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: +63%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 59, 66), while less likely to have visible faeces inside the pan (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: \u221213%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u221219, \u22125), the smell of faeces (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: \u22127.6%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u221214, \u22121.3) and household waste inside the cubicle (<jats:styled-content style=\"fixed-case\">DID<\/jats:styled-content>: \u22124%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u22127, \u22121).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self\u2010finance toilet maintenance, or employ mass media to reduce per\u2010capita costs of behaviour change.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12902","type":"journal-article","created":{"date-parts":[[2017,5,28]],"date-time":"2017-05-28T11:36:38Z","timestamp":1495971398000},"page":"1000-1011","source":"Crossref","is-referenced-by-count":43,"title":["Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster\u2010randomised controlled trial"],"prefix":"10.1111","volume":"22","author":[{"given":"Mahbub\u2010Ul","family":"Alam","sequence":"first","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Winch","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald E.","family":"Saxton","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fosiul A.","family":"Nizame","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Yeasmin","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Norman","sequence":"additional","affiliation":[{"name":"Water &amp; Sanitation for the Urban Poor London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah\u2010Al","family":"Masud","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Begum","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbubur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Hossain","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Layden","sequence":"additional","affiliation":[{"name":"Water &amp; Sanitation for the Urban Poor London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Unicomb","sequence":"additional","affiliation":[{"name":"Environmental Interventions Unit International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Luby","sequence":"additional","affiliation":[{"name":"Stanford University Stanford CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,29]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"United Nations"},{"key":"e_1_2_6_3_1","unstructured":"WHO UNICEF.Progress on drinking water and sanitation: 2012 update. 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