Article Category:
Research Article

Effect of Behavior Change Intervention on Complementary Food Contamination in Rural Bangladesh: A Cluster-Randomized Controlled Trial

Tarique Md. Nurul Huda Department of Public Health, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia;
Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Anna A. Müller-Hauser Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany;
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;

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Shafinaz Sobhan Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany;
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;

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Shaheen Hossain Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Jesmin Sultana Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Mahbubur Rahman Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;
Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden;

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Mohammad Aminul Islam Paul G. Allen School for Global Health, Washington State University, Pullman, Washington;
Food Microbiology Laboratory, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Om Prasad Gautam WaterAid United Kingdom, London, United Kingdom;

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Amanda S. Wendt Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;

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Jillian L. Waid Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany;
Helen Keller International, Bangladesh Country Office, Research, Learning and Evaluation, Dhaka, Bangladesh

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Sabine Gabrysch Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany;
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;

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DOI:
https://doi.org/10.4269/ajtmh.24-0336
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Ahead of Print
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Children in low-resource settings often consume microbially contaminated food, risking their health. We evaluated the impact of a food hygiene intervention on complementary food contamination in Bangladesh. A 3-year homestead food production intervention was complemented by an 8-month behavior change module to improve household food hygiene practices and evaluated in a cluster-randomized controlled trial, including a dedicated study measuring outcomes along the hygiene pathway to intestinal health. We used multilevel regression to assess the intervention’s impact on microbial food contamination as well as food hygiene knowledge (n = 518) and reported practices (n = 531) among mothers of children 6–23 months of age. Complementary food samples were collected from 342 households with children 6–18 months of age and tested for Escherichia coli. Overall, 46% of food samples were contaminated with E. coli (43% intervention, 51% control), and there was no evidence that the intervention reduced food contamination (odds ratio: 0.65, 95% CI: 0.35–1.21). A higher proportion of intervention mothers could name all key food hygiene practices (23% intervention versus 1% control), had access to a basic handwashing station near the kitchen (24% versus 14%), reported washing hands before food preparation and child feeding (21% versus 8%), reported washing and storing feeding utensils safely (61% versus 49%), and reported preparing food fresh or reheating stored food (88% versus 79%) compared with control mothers. The intervention thus improved knowledge and reported food hygiene practices among mothers, but this improvement did not result in a substantial reduction of complementary food contamination.

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Author Notes

Financial support: The Food and Agricultural Approaches to Reducing Malnutrition trial was primarily funded by the German Federal Ministry of Education and Research (Grant no. 01ER1201). The Food Hygiene to Reduce Environmental Enteric Dysfunction (FHEED) study was financially supported by a project grant from Deutsche Forschungsgemeinschaft (German Research Foundation; Project no. 413269709). Foundation Fiat Panis further supported FHEED’s research work. Helen Keller International received additional support from the Carrefour social responsibility program and other charitable donations for implementing the homestead food production program. S. Gabrysch received funding through a Recruiting Grant from Stiftung Charité. Funding organizations had no role in the trial design, the intervention or its implementation, training, data collection, analysis, or interpretation of results.

Disclosures: This trial is registered at ClinicalTrials.gov (#NCT02505711). The Food and Agricultural Approaches to Reducing Malnutrition trial protocol was positively reviewed by the ethics committees of the Medical Faculty at Heidelberg University in Germany (reference S-121/2014) and by the James P. Grant School of Public Health, BRAC University in Bangladesh (reference 37A). The Food Hygiene to Reduce Environmental Enteric Dysfunction study protocol was positively reviewed by the Medical Faculty at Heidelberg University (reference S-606/2017) and by the International Centre for Diarrhoeal Disease Research, Bangladesh (reference PR-17126). All participants provided informed written consent by signature or thumbprint.

Current contact information: Tarique Md. Nurul Huda, Department of Public Health, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia, E-mail: t.huda@qu.edu.sa. Anna A. Müller-Hauser, Shafinaz Sobhan, Amanda S. Wendt, Jillian L. Waid and Sabine Gabrysch, Potsdam Institute for Climate Impact Research, Potsdam, Germany, E-mails: anna.mueller@pik-potsdam.de, shafinaz.sobhan@pik-potsdam.de, amanda.wendt@pik-potsdam.de, jillian.waid@pik-potsdam.de, and sabine.gabrysch@pik-potsdam.de. Shaheen Hossain, Jesmin Sultana, and Mahbubur Rahman, Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: saheenhossen@icddrb.org, jesmin.sultana@icddrb.org, and mahbubr@icddrb.org. Mohammad Aminul Islam, Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, E-mail: amin.islam@wsu.edu. Om Prasad Gautam, WaterAid United Kingdom, London, United Kingdom, E-mail: OmPrasadGautam@wateraid.org.

Address correspondence to Tarique Md. Nurul Huda, Department of Public Health, College of Applied Medical Sciences, Qassim University, PO Box 6666, Buraydah 51452, Saudi Arabia. E-mail: t.huda@qu.edu.sa
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
20 May 2024
|
Accepted:
16 Nov 2024
|
Published Online:
18 Feb 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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