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

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  • Tracy Morse

    (Centre for Water, Environment, Sustainability and Public Health, Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow G1 1XJ, UK
    Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre, Malawi)

  • Elizabeth Tilley

    (Department of Environmental Health, University of Malawi (Polytechnic), Blantyre, Malawi
    Swiss Federal Institute of Aquatic Science and Technology (Eawag), CH-8600 Duebendorf, Switzerland)

  • Kondwani Chidziwisano

    (Centre for Water, Environment, Sustainability and Public Health, Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow G1 1XJ, UK
    Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre, Malawi
    Department of Environmental Health, University of Malawi (Polytechnic), Blantyre, Malawi)

  • Rossanie Malolo

    (Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre, Malawi)

  • Janelisa Musaya

    (Department of Biochemical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi)

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.

Suggested Citation

  • Tracy Morse & Elizabeth Tilley & Kondwani Chidziwisano & Rossanie Malolo & Janelisa Musaya, 2020. "Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention–A Randomised before and after Trial," IJERPH, MDPI, vol. 17(8), pages 1-19, April.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:8:p:2648-:d:344720
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    References listed on IDEAS

    as
    1. Amy J. Pickering & Habiba Djebbari & Carolina Lopez & Massa Coulibaly & Maria Laura Alzua, 2015. "Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial," Post-Print hal-01456117, HAL.
    2. Danielle Medgyesi & Daniel Sewell & Reid Senesac & Oliver Cumming & Jane Mumma & Kelly K Baker, 2019. "The landscape of enteric pathogen exposure of young children in public domains of low-income, urban Kenya: The influence of exposure pathway and spatial range of play on multi-pathogen exposure risks," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 13(3), pages 1-21, March.
    3. Kondwani Chidziwisano & Elizabeth Tilley & Rossanie Malolo & Save Kumwenda & Janelisa Musaya & Tracy Morse, 2019. "Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi—A Formative Study," IJERPH, MDPI, vol. 16(12), pages 1-21, June.
    4. Aiello, A.E. & Coulborn, R.M. & Perez, V. & Larson, E.L., 2008. "Effect of hand hygiene on infectious disease risk in the community setting: A meta-analysis," American Journal of Public Health, American Public Health Association, vol. 98(8), pages 1372-1381.
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    Cited by:

    1. Hugo Legge & Shahana Fedele & Florian Preusser & Patrycja Stys & Papy Muzuri & Moritz Schuberth & Robert Dreibelbis, 2022. "Urban Water Access and Use in the Kivus: Evaluating Behavioural Outcomes Following an Integrated WASH Intervention in Goma and Bukavu, Democratic Republic of Congo," IJERPH, MDPI, vol. 19(3), pages 1-15, January.
    2. Mindy Panulo & Kondwani Chidziwisano & Tara K. Beattie & Elizabeth Tilley & Christabel Kambala & Tracy Morse, 2022. "Process Evaluation of “The Hygienic Family” Intervention: A Community-Based Water, Sanitation, and Hygiene Project in Rural Malawi," IJERPH, MDPI, vol. 19(11), pages 1-19, June.
    3. Limbani R. Kalumbi & Chisomo Thaulo & Eleanor E. MacPherson & Tracy Morse, 2020. "Perspectives and Practices on Water, Sanitation, and Hygiene from a Fishing Community along Lake Malombe, Southern Malawi," IJERPH, MDPI, vol. 17(18), pages 1-17, September.
    4. Arielle Sandrine Rafanomezantsoa & Claudia Coral & Narilala Randrianarison & Christoph Kubitza & Denis Randriamampionona & Harilala Andriamaniraka & Stefan Sieber & Sarah Tojo-Mandaharisoa & Jonathan , 2023. "Identifying nutrition-sensitive development options in Madagascar through a positive deviance approach," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 15(2), pages 519-534, April.
    5. Jurgita Slekiene & Kondwani Chidziwisano & Tracy Morse, 2022. "Does Poor Mental Health Impair the Effectiveness of Complementary Food Hygiene Behavior Change Intervention in Rural Malawi?," IJERPH, MDPI, vol. 19(17), pages 1-12, August.
    6. Yunho Ji & Won Seok Lee & Joonho Moon, 2023. "Café Food Safety and Its Impacts on Intention to Reuse and Switch Cafés during the COVID-19 Pandemic: The Case of Starbucks," IJERPH, MDPI, vol. 20(3), pages 1-11, February.
    7. Kondwani Chidziwisano & Elizabeth Tilley & Tracy Morse, 2020. "Self-Reported Versus Observed Measures: Validation of Child Caregiver Food Hygiene Practices in Rural Malawi," IJERPH, MDPI, vol. 17(12), pages 1-14, June.

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