Effects of a Water, Sanitation and Hygiene Mobile Health Program on Respiratory Illness in Democratic Republic of Congo ( DRC ): WASHmobile PICHA7 Program

BACKGROUND: Globally, acute respiratory infections are a major cause of morbidity and mortality, particularly among young children. Water, sanitation and hygiene (WASH) interventions when combined with mobile health (mHealth) have the potential to reduce the burden of respiratory illness. The WASHmobile mHealth program is a targeted WASH program promoting handwashing with soap, drinking water treatment, and safe water storage to reduce diarrhoea and respiratory illness. METHODS: The WASHmobile PICHA7 program delivers weekly voice and SMS messages and quarterly home visits to diarrhoea patient households. In a two-arm cluster randomized controlled trial of the WASHmobile PICHA7 program conducted in Bukavu, South Kivu province, eastern Democratic Republic of the Congo, 2334 participants were randomized to two study arms: a standard arm, which received a standard message on oral rehydration solution and a basic WASH message delivered at the healthcare facility, and the WASHmobile PICHA7 arm (NCT05166850). During the 12-month surveillance period, self-reported respiratory symptoms were assessed through monthly clinical surveillance. Acute lower respiratory illness (ALRI) was defined as cough and rapid breathing or rapid breathing and difficulty breathing in the past 2 weeks. RESULTS: In total, 699 children under 5 years of age were included in the analysis. Compared to the standard arm, children under 5 years in the WASHmobile PICHA7 arm had significantly lower ALRI during the 12-month study period (Prevalence Ratio: 0.46, 95% Confidence Interval: 0.22, 0.94). Four percent (14/360) of children in the WASHmobile PICHA7 arm reported ALRI during the study period compared to 12% (39/339) of children in the standard arm. CONCLUSION: These results demonstrate that the WASHmobile PICHA7 mHealth program reduced ALRI among children under 5 years old in diarrhoea patient households.