Background: Targeted water treatment and hygiene (WASH) programs for those residing near to diarrhea patients can serve as a cost-effective approach during outbreaks to reduce the spread of diarrhea by targeting those at highest risk. Our research team designed the WASHmobile mobile health (mHealth) program for those at high risk of diarrhea. In our randomized controlled trials in the Democratic Republic of the Congo (DRC) (PICHA7) and Bangladesh (CHoBI7), delivery of WASHmobile to diarrhea patient households through a healthcare facility visit and voice and SMS messages from a doctor significantly reduced diarrhea and improved child growth. Methods: Building on this work, we adapted WASHmobile to serve millions more beneficiaries through a mHealth and e-voucher program delivered in diarrhea outbreak areas. A program evaluation of this approach was conducted in health areas (health administrative unit) with ongoing diarrhea outbreaks in the DRC among 2022 participants. Voice and SMS messages were sent to those within 500 meters of diarrhea patients from a doctor stating that there was a diarrhea outbreak in their health area and emphasized the importance of treating and safely storing household drinking water and washing handwashing with soap for the next 7-day high-risk period. The SMS messages contained an e-voucher to redeem for free chlorine tablets at a pharmacy. Unannounced spot checks assessed WASH behaviors a week after program initiation. Results: Fifty-seven percent of WASHmobile households redeemed e-vouchers for chlorine tablets at pharmacies. Compared to control households, WASHmobile households that redeemed e-vouchers had higher stored drinking water with free chlorine concentrations >0.2 mg/L (Odds Ratio [OR]: 6.93, [95% Confidence Interval [CI]: 1.76, 27.24]) (64% [WASHmobile] vs. 20% [control]) and stored drinking water completely covered (OR: 4.55, 95% CI: 2.68, 7.70) (73% vs. 38%). Presence of a cleansing agent within 10 steps of latrine and cooking areas was also significantly higher in WASHmobile households (latrine: OR: 3.64, 95% CI: 1.47, 9.02 [70% vs. 39%] and cooking: OR: 2.50, 95% CI: 1.31, 4.77 [70% vs. 49%]). Conclusions: The WASHmobile PICHA7 mHealth and e-voucher program significantly increased water treatment, safe water storage, and hygiene behaviors in diarrhea outbreak areas in the DRC.

The authors have declared no competing interest.

IRB00019728

This study was funded by the Reckitt Global Hygiene Institute.

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Ethical approval was obtained from the institutional review boards of the Johns Hopkins School of Public Health and Catholic University of Bukavu. Written informed consent was obtained from all individuals or their guardians participating in data collection activities.

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