Abstract
.Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers’ technical know-how of local dish rack and tippy tap construction is essential.
Highlights
Worldwide, the lives of approximately 525,000 children are lost each year from 1.7 billion cases of childhood diarrhea with the highest mortality rates reported among children aged less than 2 years in south Asia and sub-Saharan Africa.[1,2] it has been reported that 550 million people fall ill, whereas 230,000 die every year globally because of diarrheal diseases associated with food contamination.[3]
Epidemiological data indicate that food could be more important than water in transmitting diarrheal disease,[4,5,6] and it is estimated that 40% of the burden of foodborne disease lies with children aged less than 5 years in low- and middle-income countries
Forty percent of children were introduced to complementary food when they were between 3 and 6 months old, and 27% of the targeted children were reported to have had diarrhea in the 2 weeks before the survey
Summary
The lives of approximately 525,000 children are lost each year from 1.7 billion cases of childhood diarrhea with the highest mortality rates reported among children aged less than 2 years in south Asia and sub-Saharan Africa.[1,2] it has been reported that 550 million people fall ill, whereas 230,000 die every year globally because of diarrheal diseases associated with food contamination.[3] Epidemiological data indicate that food could be more important than water in transmitting diarrheal disease,[4,5,6] and it is estimated that 40% of the burden of foodborne disease lies with children aged less than 5 years in low- and middle-income countries This corresponds with reports that at least 70% of diarrhearelated pathogens among children could be caused by contaminated food.[7,8]. Such protection is temporary because children are subsequently exposed to pathogens when introduced to complementary food between the ages of 4 and 6 months.[9,10] This exposure together with increased environmental interaction have been linked to the high incidence of diarrhea among children aged between 6 and 24 months.[2,11,12,13] To reduce diarrhea among children, the WHO has indicated important parameters that need to be implemented at the household level, including access to safe water, improved sanitation facilities, exclusive breast feeding, hygienic weaning practices, and improved personal and household hygiene.[14]
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