1921
Volume 102, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The study evaluated the effectiveness of an intervention to improve complementary food hygiene behaviors among child caregivers in rural Malawi. Formative research and intervention development was grounded in the risk, attitude, norms, ability, and self-regulation (RANAS) model and targeted washing hands and kitchen utensils with soap, safe utensil storage, reheating of leftover food, and feeding of children by caregivers. Longitudinal research was applied at baseline and follow-up surveys among 320 caregivers. Determinants of selected behaviors were found, and interventions were developed based on the behavior change techniques aligned with these determinants in the RANAS model. The intervention was delivered over 9 months through group (cluster) meetings and household visits and included demonstrations, games, rewards, and songs. We randomly assigned villages to the control or intervention group. Follow-up results indicated a significant increase in three targeted behaviors (washing kitchen utensils with soap, safe utensil storage, and handwashing with soap) among intervention recipients. Several psychosocial factors differed significantly between the intervention and control groups. Mediation results showed that the intervention had a significant effect on these three targeted behaviors. For handwashing, feelings, others’ behavior in the household, and remembering; for washing kitchen utensils, others’ behavior in the household and difficulty to get enough soap; for safe utensils storage, others’ behavior in the village and remembering mediated the effect of the intervention on the targeted behaviors. The study demonstrated that targeting food hygiene behaviors with a theory-driven behavior change approach using psychosocial factors can improve the behavior of child caregivers in rural Malawi.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0528
2020-02-24
2020-09-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/5/tpmd190528.html?itemId=/content/journals/10.4269/ajtmh.19-0528&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2017. Causes of Child Mortality. Available at: http://www.who.int/gho/child_health/mortality/causes/en/. Accessed May 10, 2019.
    [Google Scholar]
  2. Motarjemi Y, Kaferstein F, Moy G, Quevedo F, 1994. Contaminated food, a hazard for the very young. World Health Forum 15: 6971.
    [Google Scholar]
  3. Curtis V, Cairncross S, Yonli R, 2000. Review: Domestic Hygiene and Diarrhoea–Pinpointing the Problem, Vol. 5. London, United Kingdom: European Journal of Tropical Medicine and International Health.
    [Google Scholar]
  4. Wolf J, Johnston R, Hunter PR, Gordon B, Medlicott K, Prüss-Ustün A, 2019. A Faecal contamination index for interpreting heterogeneous diarrhoea impacts of water, sanitation and hygiene interventions and overall, regional and country estimates of community sanitation coverage with a focus on low- and middle-income countries. Int J Hyg Environ Health 222: 270282.
    [Google Scholar]
  5. World Health Organization, 2017. Fact Sheet about Food Safety. Available at: http://www.who.int/mediacentre/factsheets/fs399/en/. Accessed January 19, 2017.
    [Google Scholar]
  6. Barrell RAE, Rowland MG, 1979. Infant foods as a potential source of diarrhoeal illness in rural west Africa. Trans R Soc Trop Med Hyg 73: 8590.
    [Google Scholar]
  7. Motarjemi Y, Käferstein F, Moy G, Quevedo F, 1993. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ 71: 7992.
    [Google Scholar]
  8. Imong SM, Rungruengthanakit K, Ruangyuttikarn C, Wongsawasdii L, Jackson DA, Drewett RF, 1989. The bacterial content of infant weaning foods and water in rural northern Thailand. J Trop Pediatr 35: 1418.
    [Google Scholar]
  9. Van Steenbergen WM, Mossel DAA, Kusin JA, Jansen AAJ, 1983. Machakos project studies agents affecting health of mother and child in a rural area of Kenya. XXIII bacterial contamination of foods commonly eaten by young children in Machakos, Kenya. Trop Geogr Med 35: 193197.
    [Google Scholar]
  10. Rahman MJ, Nizame FA, Nuruzzaman M, Akand F, Islam MA, Parvez SM, Stewart CP, Unicomb L, Luby SP, Winch PJ, 2016. Toward a scalable and sustainable intervention for complementary food safety. Food Nutr Bull 37: 186201.
    [Google Scholar]
  11. Rowland MG, Barrell RA, Whitehead RG, 1978. Bacterial contamination in traditional Gambian weaning foods. Lancet 311: 136138.
    [Google Scholar]
  12. Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A, 2011. Hygiene: new hopes, new horizons. Lancet Infect Dis 11: 312321.
    [Google Scholar]
  13. Monte CM, Ashworth A, Nations MK, Lima AA, Barreto A, Huttly SR, 1997. Designing educational messages to improve weaning food hygiene practices of families living in poverty. Soc Sci Med 44: 14531464.
    [Google Scholar]
  14. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB, 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.
    [Google Scholar]
  15. Takanashi K, Chonan Y, Quyen DT, Khan NC, Poudel KC, Jimba M, 2009. Survey of food-hygiene practices at home and childhood diarrhoea in Hanoi, Viet Nam. J Health Popul Nutr 27: 602611.
    [Google Scholar]
  16. Taulo S, Wetlesen A, Abrahamsen R, Kululanga G, Mkakosya R, Grimason A, 2008. Microbiological hazard identification and exposure assessment of food prepared and served in rural households of Lungwena, Malawi. Int J Food Microbiol 125: 111116.
    [Google Scholar]
  17. Taulo S, Wetlesen A, Abrahamsen RK, Narvhus JA, Mkakosya R, 2009. Quantification and variability of Escherichia coli and Staphylococcus aureus cross-contamination during serving and consumption of cooked thick porridge in Lungwena rural households, Malawi. Food Control 20: 11581166.
    [Google Scholar]
  18. Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R, 2010. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 125: e473e480.
    [Google Scholar]
  19. Lin A et al., 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130137.
    [Google Scholar]
  20. Ngure F, 2012. Environmental Hygiene, Food Safety and Growth in Less Than Five Year Old Children in Zimbabwe and Ethiopia. Available at: https://ecommons.cornell.edu/handle/1813/31033. Accessed July 5, 2019.
    [Google Scholar]
  21. Merchant AT, Jones C, Kiure A, Kupka R, Fitzmaurice G, Herrera MG, Fawzi WW, 2003. Water and sanitation associated with improved child growth. Eur J Clin Nutr 57: 15621568.
    [Google Scholar]
  22. Henry FJ, 1991. Combating childhood diarrhoea through international collaborative research. J Diarrhoeal Dis Res 9: 165167.
    [Google Scholar]
  23. Ehiri JE, Azubuike MC, Ubbaonu CN, Anyanwu EC, Ibe KM, Ogbonna MO, 2001. Critical control points of complementary food preparation and handling in eastern Nigeria. Bull World Health Organ 79: 423433.
    [Google Scholar]
  24. Iroegbu CU, Ene-Obong HN, Uwaegbute AC, Amazigo UV, 2000. Bacteriological quality of weaning food and drinking water given to children of market women in Nigeria: implications for control of diarrhoea. J Health Popul Nutr 18: 157162.
    [Google Scholar]
  25. Schmitt R, Bryan FL, Jermini M, Chilufya EN, Hakalima AT, Zyuulu M, Mfume E, Mwandwe C, Mullungushi E, Lubasi D, 1997. Hazards and critical control points of food preparation in homes in which persons had diarrhea in Zambia. J Food Prot 60: 161171.
    [Google Scholar]
  26. Imong SM, Jackson DA, Rungruengthanakit K, Wongsawasdii L, Amatayakul K, Drewett RF, Baum JD, 1995. Maternal behaviour and socio-economic influences on the bacterial content of infant weaning foods in rural northern Thailand. J Trop Pediatr 41: 234240.
    [Google Scholar]
  27. Sheth M, Obrah M, 2004. Diarrhea prevention through food safety education. Indian J Pediatr 71: 879882.
    [Google Scholar]
  28. Islam MS et al., 2013. Hygiene intervention reduces contamination of weaning food in Bangladesh. Trop Med Int Health 18: 250258.
    [Google Scholar]
  29. Touré O, Coulibaly S, Arby A, Maiga F, Cairncross S, 2013. Piloting an intervention to improve microbiological food safety in peri-urban Mali. Int J Hyg Environ Health 216: 138145.
    [Google Scholar]
  30. Kraemer SM, Mosler HJ, 2011. Effectiveness and effects of promotion strategies for behaviour change: solar water disinfection in Zimbabwe. Appl Psychol 61: 392414.
    [Google Scholar]
  31. Contzen N, Mosler HJ, 2015. Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia. Am J Infect Control 43: 826832.
    [Google Scholar]
  32. Mosler H-J, 2012. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res 22: 431449.
    [Google Scholar]
  33. Lilje J, Kessely H, Mosler HJ, 2015. Factors determining water treatment behavior for the prevention of cholera in Chad. Am J Trop Med Hyg 93: 5765.
    [Google Scholar]
  34. Friedrich MND, Binkert ME, Mosler HJ, 2017. Contextual and psychosocial determinants of effective handwashing technique: recommendations for interventions from a case study in Harare, Zimbabwe. Am J Trop Med Hyg 96: 430436.
    [Google Scholar]
  35. Slekiene J, Mosler H-J, 2018. Characterizing the last latrine nonowners in rural Malawi. Am J Trop Med Hyg 98: 295299.
    [Google Scholar]
  36. Lilje J, Mosler H-J, 2018. Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach. Sci Total Environ 619–620: 15991607.
    [Google Scholar]
  37. Chidziwisano K, Slekiene J, Kumwenda S, Mosler H-J, Morse T, 2019. Toward complementary food hygiene practices among child caregivers in rural Malawi. Am J Trop Med Hyg 101: 294303.
    [Google Scholar]
  38. Morse T, Chidziwisano K, Tilley E, Malolo R, Kumwenda S, Musaya J, Cairncross S, 2019. Developing a contextually appropriate integrated hygiene intervention to achieve sustained reductions in diarrheal diseases. Sustainability 11: 4656.
    [Google Scholar]
  39. Government of Malawi, 2018. 2018 Population and Housing Census Preliminary Report. Gov Print, Zomba, 55.
    [Google Scholar]
  40. Fullerton DG, Semple S, Kalambo F, Suseno A, Malamba R, Henderson G, Ayres JG, Gordon SB, 2009. Biomass fuel use and indoor air pollution in homes in Malawi. Occup Environ Med 66: 777783.
    [Google Scholar]
  41. Chidziwisano KR, Rivett MO, Tadsanaprasittipol A, McGregor LA, Kalin RM, 2019. Exploratory study of polycyclic aromatic hydrocarbon (PAH) contributions to household air pollution arising from improved cookstove use in rural Malawi. Afr J Environ Sci Technol 13: 3651.
    [Google Scholar]
  42. Cohen J, 1992. Quantitative methods in psychology: a power primer. Psychol Bull 112: 11551159.
    [Google Scholar]
  43. Cohen J, 2013. Statistical Power Analysis for the Behavioural Sciences, Revised edition. New York, NY: Routledge, Taylor & Francis.
    [Google Scholar]
  44. Chidziwisano K, Tilley E, Malolo R, Kumwenda S, Musaya J, Morse T, 2019. Risk factors associated with feeding children under 2 years in rural Malawi—a formative study. Int J Environ Res Public Health 16: 2146.
    [Google Scholar]
  45. Contzen N, Mosler H-J, 2013. Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response. J Public Health 21: 559573.
    [Google Scholar]
  46. Tamas A, Tobias R, Mosler H-J, 2009. Promotion of solar water disinfection: comparing the effectiveness of different strategies in a longitudinal field study in Bolivia. Health Commun 24: 711722.
    [Google Scholar]
  47. Pickering AJ et al., 2019. The WASH benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea. Lancet Glob Health 7: e1139e1146.
    [Google Scholar]
  48. Mosler H, Contzen N, 2016. Systematic Behavior Change in Water, Sanitation and Hygiene. A Practical Guide Using the RANAS Approach. Dubendorf, Switzerland: Eawag.
    [Google Scholar]
  49. [Google Scholar]
  50. World Bank, 2019. World Bank Overview. Washington, DC: World Bank. Available at: https://www.worldbank.org/en/topic/poverty/overview. Accessed July 5, 2019.
    [Google Scholar]
  51. Contzen N, Meili IH, Mosler H-J, 2015. Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions. Soc Sci Med 124: 103114.
    [Google Scholar]
  52. Gamma AE, Slekiene J, Mosler H-J, 2019. The impact of various promotional activities on Ebola prevention behaviors and psychosocial factors predicting Ebola prevention behaviors in the Gambia evaluation of Ebola prevention promotions. Int J Environ Res Public Health 16: E2020.
    [Google Scholar]
  53. Friedrich MND, Kappler A, Mosler H-J, 2018. Enhancing handwashing frequency and technique of primary caregivers in Harare, Zimbabwe: a cluster-randomized controlled trial using behavioral and microbial outcomes. Soc Sci Med 196: 6676.
    [Google Scholar]
  54. Seimetz E, Boyayo A-M, Mosler H-J, 2016. The influence of contextual and psychosocial factors on handwashing. Am J Trop Med Hyg 94: 14071417.
    [Google Scholar]
  55. Mosler H-J, Mosch S, Harter M, 2018. Is community-led total sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique. PLoS One 13: e0197483.
    [Google Scholar]
  56. Hashi A, Kumie A, Gasana J, 2017. Hand washing with soap and WASH educational intervention reduces under-five childhood diarrhoea incidence in Jigjiga district, eastern Ethiopia: a community-based cluster randomized controlled trial. Prev Med Rep 6: 361368.
    [Google Scholar]
  57. Brown J, Cairncross S, Ensink JHJ, 2013. Water, sanitation, hygiene and enteric infections in children. Arch Dis Child 98: 629634.
    [Google Scholar]
  58. Johnson SS, Paiva AL, Mauriello L, Prochaska JO, Redding CA, Velicer WF, 2014. Coaction in multiple behavior change interventions: consistency across multiple studies on weight management and obesity prevention. Health Psychol 33: 475480.
    [Google Scholar]
  59. Luby SP et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial. Lancet Glob Health 6: e302e315.
    [Google Scholar]
  60. Null C et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. Lancet Glob Health 6: e316e329.
    [Google Scholar]
  61. Curtis V, Cousens S, Mertens T, Traore E, Kanki B, Diallo I, 1993. Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility. Bull World Health Organ 71: 2332.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0528
Loading
/content/journals/10.4269/ajtmh.19-0528
Loading

Data & Media loading...

Supplemental annexes

  • Received : 17 Jul 2019
  • Accepted : 16 Jan 2020
  • Published online : 24 Feb 2020
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error