A randomized trial of community-level mask promotion in rural Bangladesh during COVID-19 shows that the intervention increased mask-use and reduced symptomatic SARS-CoV-2 infections.
We conducted a cluster-randomized trial to measure the effect of community-level mask distribution and promotion on symptomatic SARS-CoV-2 infections in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask type (cloth vs. surgical) and promotion strategies at the village and household level. Proper mask-wearing increased from 13.3% in the control group to 42.3% in the intervention arm (adjusted percentage point difference = 0.29 [0.26, 0.31]). The intervention reduced symptomatic seroprevalence (adjusted prevalence ratio (aPR) = 0.91 [0.82, 1.00]), especially among adults 60+ years in villages where surgical masks were distributed (aPR = 0.65 [0.45, 0.85]). Mask distribution and promotion was a scalable and effective method to reduce symptomatic SARS-CoV-2 infections.