The CRADLE trial aims to determine whether installing concrete floors in households with dirt floors in rural Bangladesh improves the health of mothers and children. Our primary hypothesis is that replacing soil floors with concrete floors will reduce parasitic worm infections called soil-transmitted helminths in children during their first two years of life. The trial is registered at Clinicaltrials.gov (NCT05372068).

The trial enrolled 800 households with soil floors and a pregnant woman in her second or third trimester. Households were randomly assigned to either the intervention or control group. In intervention homes, soil floors were replaced with concrete floors before the birth of the child the woman was carrying at enrollment. Control households did not receive any interventions. The trial is measuring outcomes when children were 0, 3, 6, 12, 18, and 24 months old. In addition to soil-transmitted helminth infections, the primary outcome, we are measuring a variety of other impacts on maternal and child health. This includes fecal pollution of the household floor, child diarrhea, maternal mental health, and child growth and cognitive development.

Our study is designed to assess whether any health effects occur through an environmental pathway or a maternal pathway. In the environmental pathway, replacing soil floors with concrete floors could reduce children's exposure to and ingestion of harmful germs present in household floors. This could lead to fewer infections in children and, in turn, improved growth and development. In the maternal pathway, concrete floors could make the living environment more comfortable and floors easier to clean. This could give mothers more free time and reduce their mental burden, resulting in lower stress and depression. This could lead to improved child cognitive development.