![]() A core set of interventions was implemented in all intervention villages. The intervention started in different villages at different times, rolling out over a six-week period from November 2020 to January 2021. The intervention was designed to last eight weeks in each village. Comparison villages continued mask-wearing as usual. All villages are at least 2 km apart to minimize spillover risk. Paired villages were similar in terms of (limited) Covid-19 case data, population size, and population density. ![]() They used a pair-wise randomization to select 300 intervention and 300 comparison villages within the same upazila (Bangladesh is divided into 492 upazilas). To select participating villages, the research team chose 1,000 rural and peri-urban villages based on population data and in-person scoping. Researchers partnered with the Ministry of Health and Family Welfare, the Bangladesh Medical Research Council, a2i (a data-focused arm of the government), Green Voice (a local NGO), IPA, and North South University to evaluate the effectiveness of various strategies on increasing mask-wearing and assess the impact of community mask wearing on rates of Covid-19. The dual goals of the randomized evaluation were to identify strategies to encourage community-wide mask-wearing and to track changes in symptomatic SARS CoV-2 infections as a result of the intervention. This research aimed to fill these gaps with the first large-scale cluster-randomized evaluation of the impact of masks to reduce Covid-19. Third, critics argue that such adoption may lead to compensatory risky behaviors such as reducing physical distancing. Second, there is limited evidence on effective ways to rapidly promote mask usage in community settings. First, while laboratory evidence shows that masks can reduce exhaled viral load and thus the probability of transmitting the virus, 2 the extent to which this effect manifests at a community level in the real world, where masks may be worn imperfectly and inconsistently, is uncertain. ![]() ![]() Prior evidence to comprehensively answer policymakers’ questions is limited. Yet conversations with scientific advisors and institutions such as WHO and the United Kingdom government indicated that high-quality evidence on the effectiveness of mask-wearing would likely influence policy decisions about mask use. Currently, institutions such as the World Health Organization (WHO) recommend masks as part of an overall portfolio of protective behaviors against Covid-19. Determining scalable and effective means of combating Covid-19 is thus of first-order policy importance. 1 While vaccines may contain the spread of SARS-CoV-2 in the long-term, it is unlikely that a substantial fraction of the population in low- and middle-income countries will have access to vaccines by the end of 2021. As of August 2021, the Covid-19 pandemic has taken the lives of more than 4.4 million people. ![]()
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