Love this.Has there really not been an RCT on floor replacements yet? That surprises me as it would be a relatively easy RCT to do. EarthEnable from Rwanda just won the 2 million dollar Skoll award doing this at scale.
GiveWell must have considered it I would have thought?
Deena’s post only mentioned “of at least one large RCT underway, with results expected in a few years” without further reference, but on cursory googling it might be the CRADLE trial?
The Cement-based flooRs AnD chiLd hEalth trial is an individually randomised trial in Sirajganj and Tangail districts, Bangladesh. Households with a pregnant woman, a soil floor, walls that are not made of mud and no plan to relocate for 3 years will be eligible. We will randomise 800 households to intervention or control (1:1) within geographical blocks of 10 households to account for strong geographical clustering of enteric infection. Laboratory staff and data analysts will be blinded; participants will be unblinded. We will instal concrete floors when the birth cohort is in utero and measure outcomes at child ages 3, 6, 12, 18 and 24 months.
The primary outcome is prevalence of any STH infection (Ascaris lumbricoides, Necator americanus or Trichuris trichiura) detected by quantitative PCR at 6, 12, 18 or 24 months follow-up in the birth cohort. Secondary outcomes include household floor and child hand contamination with Escherichia coli, extended-spectrum beta-lactamase producing E. coli and STH DNA; child diarrhoea, growth and cognitive development; and maternal stress and depression.
We will report findings on ClinicalTrials.gov, in peer-reviewed publications and in stakeholder workshops in Bangladesh.
While GiveWell doesn’t seem to have looked into this specifically, this 2015 review of GiveDirectly mentioned that lack of cement floors was in one of GiveDirectly’s two sets of eligibility criteria for its standard campaigns:
Thatched roofs: To date, GiveDirectly has used housing materials to select recipients in all of its standard campaigns, enrolling households who live in a house made of organic materials (thatched roof, mud walls, and a mud floor) and excluding households with iron roofs, cement walls, or cement floors.170 In GiveDirectly’s campaigns in Kenya, about 35-45% of households have been eligible based on these criteria, while in Uganda about 80% of households have been found to be eligible.171…
Happier Lives Institute’s 2021 annual review did mention cement flooring among the “micro-interventions” they wanted to look into (alongside deworming, cataract surgery, digital mental health interventions, etc), but I haven’t seen anything by them since on this, so I assume it didn’t pass their internal review for further analysis.
Happier Lives Institute made an analysis of EarthEnable which was in their chapter in the latest World Happiness report. I guess they will make a report about it in the near future but I am not sure. So they have looked at flooring and housing. :)
Ah, I missed this, thanks! And I appreciate the pointer to EarthEnable in particular. Although it looks like their analysis stopped at the shallow level, so maybe no future report…
EarthEnable looks quite impressive by their own lights: 35,000+ “housing solution projects” completed or in progress benefiting 200,000+ people, and over 1,000 jobs created in East Africa (they “developed training curriculum for masons to learn to build our products to earn a livelihood of 2-3x the median income”). I also appreciate how most of their senior team seems local at a glance.
Just posting HLI’s chart here for others’ benefit:
Quoting their qualifier too:
Note that our task was to bring together all the work that had already been done. All the research had the same output (WELLBYs per dollar) but the inputs were ‘lumpy’: some analyses were much deeper than others. It was out of scope to re-analyse and update all the pre-existing estimates. So take this as the first word on the topic, not the last!
Love this.Has there really not been an RCT on floor replacements yet? That surprises me as it would be a relatively easy RCT to do. EarthEnable from Rwanda just won the 2 million dollar Skoll award doing this at scale.
GiveWell must have considered it I would have thought?
Deena’s post only mentioned “of at least one large RCT underway, with results expected in a few years” without further reference, but on cursory googling it might be the CRADLE trial?
While GiveWell doesn’t seem to have looked into this specifically, this 2015 review of GiveDirectly mentioned that lack of cement floors was in one of GiveDirectly’s two sets of eligibility criteria for its standard campaigns:
Happier Lives Institute’s 2021 annual review did mention cement flooring among the “micro-interventions” they wanted to look into (alongside deworming, cataract surgery, digital mental health interventions, etc), but I haven’t seen anything by them since on this, so I assume it didn’t pass their internal review for further analysis.
Happier Lives Institute made an analysis of EarthEnable which was in their chapter in the latest World Happiness report. I guess they will make a report about it in the near future but I am not sure. So they have looked at flooring and housing. :)
Ah, I missed this, thanks! And I appreciate the pointer to EarthEnable in particular. Although it looks like their analysis stopped at the shallow level, so maybe no future report…
EarthEnable looks quite impressive by their own lights: 35,000+ “housing solution projects” completed or in progress benefiting 200,000+ people, and over 1,000 jobs created in East Africa (they “developed training curriculum for masons to learn to build our products to earn a livelihood of 2-3x the median income”). I also appreciate how most of their senior team seems local at a glance.
Just posting HLI’s chart here for others’ benefit:
Quoting their qualifier too: