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Can child-focused sanitation and nutrition programming improve health practices and outcomes? Evidence from a randomised controlled trial in Kitui County, Kenya
  1. Gerishom Gimaiyo1,
  2. Jeffery McManus2,
  3. Matt Yarri3,
  4. Shiva Singh4,
  5. Andrew Trevett5,
  6. Grainne Moloney6,
  7. Ann Robins7,
  8. Lilian Lehmann8
  1. 1 East Africa Department, IDinsight, Nairobi, Kenya
  2. 2 Technical Team Department, IDinsight, San Francisco, USA
  3. 3 Data Analytics Department, Lyft, San Francisco, USA
  4. 4 WASH Department, UNICEF, Kampala, Uganda
  5. 5 WASH Department, UNICEF, Nairobi, Kenya
  6. 6 Regional Office for Eastern and Southern Africa (ESARO) - Nutrition Department, UNICEF, Nairobi, Kenya
  7. 7 Nutrition Department, UNICEF, Nairobi, Kenya
  8. 8 Southeast Asia Department, IDinsight, Manila, Philippines
  1. Correspondence to Gerishom Gimaiyo; gerishom.gimaiyo{at}


Introduction In Kenya’s Kitui County, 46% of children under 5 years are stunted. Sanitation and nutrition programmes have sought to reduce child undernutrition, though they are typically implemented separately. We evaluate the effectiveness of an integrated sanitation and nutrition (SanNut) intervention in improving caregiver sanitation and nutrition knowledge and behaviours.

Methods We conducted a cluster-randomised controlled trial to evaluate the impact of the SanNut intervention on caregiver knowledge, sanitary and hygiene practices, sanitation outcomes and nutrition outcomes. The evaluation included caregivers of children under 5 years across 604 villages in Kitui County. 309 treatment villages were randomly assigned to receive both the SanNut intervention and the standard Community-Led Total Sanitation (CLTS) intervention, while 295 control villages only received the CLTS intervention. 8 households with children under 5 years were randomly selected from each evaluation village to participate in the endline survey, for a total of 4322 households.

Results SanNut led to modest improvements in sanitary knowledge and practices emphasised by the programme. Caregivers in treatment villages were 3.3 pp (+32%) more likely to mention lack of handwashing after handling child faeces as a potential cause of diarrhoea, and 4.9 pp (+7.8%) more likely to report safe disposal of child faeces than caregivers in control villages. Treatment households were 1.9 pp (+79%) more likely to have a stocked handwashing station and 2.9 pp (−16%) less likely to report incidences of child diarrhoea. However, SanNut appears to have had no impact on nutritional practices, such as breastfeeding, vitamin A supplementation or deworming. Non-child outcomes traditionally associated with CLTS, including latrine use and homestead sanitary conditions, were similar in treatment and control groups.

Conclusion Child-focused messaging can potentially be integrated into CLTS programming, though this integration was more successful for topics closer to CLTS objectives (sanitation practices, including limiting faecal contamination and handwashing) than for more disparate topics (nutritional practices).

Trial registration Pan-African Clinical Trials Registry (PACTR201803003159346) and American Economic Association registry for randomised controlled trials (AEARCTR-0002019).

  • community-led total sanitation (clts)
  • nutrition
  • stunting
  • sanitation and hygiene
  • child health
  • diarrhoea

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  • Handling editor Seye Abimbola

  • Contributors MY, SS, AT, GM, AR and LL contributed towards designing the SanNut program and GG, JM, MY and LL contributed towards designing of the evaluation. GG, JM and LL contributed towards data acquisition, cleaning and analysis and prepared the first draft of the manuscript. All authors provided comments towards drafts of the article and approved the final version for publication. The opinion expressed in the article is a personal opinion of the authors (SS, AT, GM and AR) and does not reflect UNICEF’s policy.

  • Funding Funding for the intervention was provided by the Kitui County Public Health Office with additional support from UNICEF, Kenya. Funding for the evaluation was provided by The Bill and Melinda Gates Foundation (ID: OPP1124645) to IDinsight. The BMGF had no role in intervention or study design, data collection, data analysis or writing of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Kenya Medical Research Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study protocol and deidentified data underlying this article can be shared upon request to the corresponding author. The preanalysis plan is available online on The American Economic Association’s registry for randomised controlled trials.

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