Behaviour change intervention found effective in improving urban slum hygiene

Hygiene practices and cleanliness of shared toilets within slums in urban Bangladesh have shown improvements due to behaviour change intervention, coupled with better sanitation hardware support for residents.

An icddr,b intervention that counselled people living in urban slums about maintaining hygiene and using simple sanitation tools (provided as part of the intervention) has significantly improved toilet cleanliness over six months.

Of the 15 million inhabitants of Dhaka, an estimated six million people live in Dhaka city’s urban slums and use toilets shared by multiple households.

Urban slums amid high rise buildings in Dhaka city. Photo: Shumon Ahmed / icddr,b

“Extreme water shortage in these densely populated communities greatly affects hygiene and sanitation,” says Mr Mahbub-ul-Alam, icddr,b research investigator and author of the study published in Tropical Medicine and International Health.

On this World Toilet Day, the United Nations is inspiring action to tackle the global sanitation crisis. It notes that sanitation systems are either non-existent or ineffective for billions of people around the world.

Urban slums are temporary settlements and hence deprived of legal provisions and municipal services. The government cannot rapidly provide better water supplies and sanitation facilities for the dwellers. Water is facilitated under private subscription from facility authorities and shared among many inhabitants.

“Populous urban slums are places where people remain vulnerable to waterborne and other infectious diseases due to poor water, hygiene and sanitation,” observes Dr Stephen Luby, senior author of the study and professor of medicine and senior fellow at the Stanford Woods Institute and the Freeman Spogli Institute and a former director at icddr,b.

These limitations of resources put people in urban slums at risk of many health hazards.

“Inappropriate disposal of waste and poor drainage facilities further compromise sanitation and hygiene,” says Ms Farzana Yeasmin, icddr,b research investigator and author of another study that explored whether behaviour change could improve waste disposal based on the same intervention.

The authors of the study published in BMC Public Health recommend that toilet maintenance interventions may be more impactful if community leaders are engaged in promoting intervention behaviours, provide advice on appropriate waste disposal and agree on maintenance routines in the community.

Despite many limitations, behaviour change interventions with a little support and some guidelines for sanitation are an effective way to improve lives and environments in resource-deprived urban settlements, suggests findings from these studies, supported by Water Sanitation for Urban Poor (WSUP) through Stanford University and Stanford's Center for Innovation in Global Health.