Faith-based programmes were successful to improve general health maintenance, cholesterol and blood pressure levels, weight, and cardiovascular health previously, but have been unheeded to improve water, sanitation, and hygiene (WASH) status. We designed a Before-After-Control-Impact (BACI) to evaluate the effectiveness of a faith-based intervention.

We designed a faith-based WASH Behaviour change intervention to improve the WASH situation in Islamic schools, their associated mosques and corresponding Muslim communities in Bangladesh, Indonesia and Nepal. We included two Christian communities from Bangladesh and two from Indonesia. We selected ten villages from Bangladesh, six from Indonesia and two from Nepal as study clusters. Half of the villages received the intervention and remaining were set to control. We conducted a baseline survey in all clusters and delivered the intervention for six months and then conducted the endline survey among 192 respondents from Bangladesh, 236 from Indonesia and 248 from Nepal. A structured questionnaire was used for the data collection to determine current hygiene practices, facilities and knowledge. The data collector conducted face-to-face interviews, spot checks and hand washing demonstration and data was analyzed using STATA (version 13).

Using the Islamic and Christian textbooks, the intervention package was developed and was reviewed by community representatives before finalization. The dissemination protocol allowed teacher and students groups in Islamic schools, preachers in the mosque, and peer educators in the Muslim community and Priest and WASH leaders in the Christian community to deliver the BCC package. All of these people delivering the intervention were trained through formal sessions on effective WASH awareness dissemination. The students’ groups were trained to arrange monthly students’ meetings; teachers were requested to conduct the monthly session, and preacher to talk during Friday prayers on WASH. The peer educators conducted one community meeting using flip charts in each community among adult and adolescent women focusing on safe water, hygienic toilet, child faeces management and menstrual hygiene management. We conducted training of trainers session for Christian communities where we described the importance of WASH, and procedure of proper hand washing.

In Bangladesh, our intervention improved the hand washing behaviour, increased the use of improved toilet, increased the knowledge on safe water and increased the practice of washing rag with soap which was used for managing menstruation. In Indonesia, our intervention increased the use of improved toilets, increased the use of potty for children of <3years age, caregivers were more likely to dispose child faeces into pit or toilet and increased the knowledge on safe water. In Nepal, more children of <3years age used a potty, more people gained knowledge on safe water due to our intervention and women and adolescent girls significantly reduced the use of old cloth as absorbent during menstruation. Our intervention improved the perception of safe water, perception on water borne disease, knowledge on importance of hand washing among beneficiaries. Our community meetings and adolescent student group meeting increased knowledge, awareness, and practice on proper menstrual hygiene management among adolescent girls and adult women.

The results suggested improvement in knowledge, attitude and practices in the communities which indicates that this mechanism of using mosques and Islamic schools could be effective for improving hand washing practices and child faeces management. This is the first study focused on the Islamic faith-based approach to design and promote WASH interventions, which could be further tested as part of a broader intervention.