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Role of Hygiene Promotion Campaigns in Disease Prevention: A Case Study of UNICEF Uganda’s WASH Program.

This study evaluated the effectiveness of UNICEF Uganda's hygiene promotion campaigns within its Water,
Sanitation, and Hygiene (WASH) program using a mixed-methods approach. The research employed a
sequential explanatory design across eight Ugandan districts representing the country's four major geographical
regions. Data was collected from 32 communities (16 treatment, 16 control) involving 1,280 households through
surveys, 64 focus group discussions, and 96 key informant interviews between January 2023 and December
2024. Difference-in-difference analysis revealed that communities receiving UNICEF's comprehensive WASH
interventions experienced significantly greater reductions in waterborne disease incidence compared to control
communities (24.1% overall reduction, p<0.001). Multivariate regression identified Community-Led Total
Sanitation (CLTS) approaches (β=0.437, p<0.001) and cultural integration (β=0.382, p<0.001) as the strongest
predictors of hygiene practice adoption. Communities implementing CLTS demonstrated the highest compliance
rates (76.2% ±4.0%) compared to school-based approaches (58.0% ±4.9%) and radio campaigns (46.4%
±4.7%). Longitudinal analysis over 36 months post-intervention showed that communities with high levels of
established ownership maintained 74.7% (±4.4%) compliance, while low ownership communities declined to
20.3% (±4.0%). The Cox proportional hazards model identified local WASH committees (HR=0.418, p<0.001)
and community-led monitoring systems (HR=0.486, p<0.001) as the most effective mechanisms for sustaining
behavioral changes. Qualitative findings highlighted cultural integration (87.5% of discussions), gender
dynamics (82.8%), and practical barriers (79.7%) as critical factors influencing program effectiveness. The
research demonstrated that hygiene promotion campaigns were most effective and sustainable when they
incorporated participatory approaches, integrated with local cultural frameworks, established community
ownership mechanisms, and engaged women in leadership roles. These findings confirmed all three study
hypotheses and addressed significant gaps in understanding which specific elements of hygiene promotion
campaigns yield the most substantial and sustainable impacts on disease prevention in the Ugandan context.
Key Words: Hygiene Promotion Campaigns and Disease Prevention

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