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Randomized Controlled Trial
. 2020 Apr 13;17(8):2648.
doi: 10.3390/ijerph17082648.

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention-A Randomised before and after Trial

Tracy Morse  1   2 , Elizabeth Tilley  3   4 , Kondwani Chidziwisano  1   2   3 , Rossanie Malolo  2 , Janelisa Musaya  5
Affiliations
Randomized Controlled Trial

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention-A Randomised before and after Trial

Tracy Morse et al. Int J Environ Res Public Health. .

Abstract

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene intervention (food hygiene + handwashing) relative to a food hygiene and water, sanitation and hygiene (WASH) intervention (food hygiene + handwashing + faeces management + water management). The 31-week intervention was delivered by community-based coordinators through community events (n = 2), cluster group meetings (n = 17) and household visits (n = 14). Diarrhoeal disease was self-reported and measured through an end line survey, and daily diaries completed by caregivers. Difference-in-differences results show a 13-percentage point reduction in self-reported diarrhoea compared to the control group. There were also significant increases in the presence of proxy measures in each of the treatment groups (e.g., the presence of soap). We conclude that food hygiene interventions (including hand washing with soap) can significantly reduce diarrhoeal disease prevalence in children under five years in a low-income setting. Therefore, the promotion of food hygiene practices using a behaviour-centred approach should be embedded in nutrition and WASH policies and programming.

Keywords: behaviour change; diarrhoeal disease; food hygiene; low and middle income countries; sanitation and hygiene; water.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An outline of the intervention modules delivered within two treatment arms over the 31-week programme.
Figure 2
Figure 2
The intervention profile and analysis populations for primary outcomes (CONSORT diagram).
Figure 3
Figure 3
The percentage of the sample in each age category at baseline and end line of the intervention (baseline: 2017; end line: 2018).
Figure 4
Figure 4
A summary of the percentage cases of diarrhoeal disease by age compared to national trends (baseline: 2017; end line: 2018).
Figure 5
Figure 5
(a) Continuous diarrhoeal disease cases reported in terms of at least one per household (2018); (b) Continuous respiratory disease cases reported in terms of at least one per household (2018).
Figure 5
Figure 5
(a) Continuous diarrhoeal disease cases reported in terms of at least one per household (2018); (b) Continuous respiratory disease cases reported in terms of at least one per household (2018).
See this image and copyright information in PMC

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