Impact of a demand-side integrated WASH and nutrition community-based care group intervention on behavioural change: a randomised controlled trial in western Kenya

• Type of Material: Article
• Authors: Matthew Freeman, Emory University; Anna S. Ellis, Emory University; Emily Awino Ogutu, Emory University; Bethany Caruso, Emory University; Molly Linabarger, Emory University; Katie Micek, Emory University; Richard Muga, Uzima University; Amy Girard, Emory University; Breanna K. Wodnik, Emory University; Kimberly Jacob Arriola, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2020.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjgh-2020-002806
• Title of Journal or Parent Work: BMJ GLOBAL HEALTH
• Volume: 5
• Issue: 11
• Grant/Funding Information: Catholic Relief Services was the main implementing partner and funded the study.
• Keywords: Public, Environmental & Occupational Health; LOW-INCOME; YOUNG-CHILDREN; nutrition; hygiene; cluster randomized trial; CHILD UNDERNUTRITION; SANITATION; WATER-QUALITY; stunting; HYGIENE; environmental health; Science & Technology; LINEAR GROWTH; ADULT HEALTH; DIARRHEA; DEVELOPING-COUNTRIES; Life Sciences & Biomedicine
• Research Categories: Environmental Sciences; Health Sciences, Public Health

Abstract

Introduction Growth shortfalls and diarrhoeal diseases remain a major cause of morbidity and mortality in low-income settings. Due to the multifaceted causes of undernutrition and the identified limitations of siloed nutrition programmes, improving the delivery of integrated water, sanitation, hygiene (WASH) and nutrition programming could improve child health. Methods We conducted a cluster randomised trial in western Kenya to assess the impact on household behaviours of a novel, theory-informed and integrated WASH and nutrition intervention delivered through care groups as compared with the standard care group approach. We developed an intervention targeting practices relating to food hygiene, mealtime and feeding, and compound cleanliness, each using various behavioural change techniques to influence the uptake of targeted behaviours. Prespecified behavioural outcomes were verified through direct observation, 24 hours recall, and self-reported picture-based methods. Results Compared with control households, a greater proportion of intervention households had a hygienic food preparation area (Risk double difference (RDD) 0.81, 95% CI 0.68 to 0.96), had stored food hygienically (RDD 0.76, 95% CI 0.58 to 1.00), had a functional handwashing station (RDD 0.64, 95% CI 0.56 to 0.74), provided a safe space for their child to play (RDD 0.73, 95% CI 0.56 to 0.96), and who fed their children thickened porridge (RDD 0.56, 95% CI 0.51 to 0.63) at endline. The proportion of children 6-24 months in intervention households consuming a sufficient diversity of foods (RDD 0.81, 95% CI 0.64 to 1.04) was higher than in control households; however, there was a non-significant increase in the percentage of pregnant and lactating women receiving an adequate diversity of foods in their diets (RDD 0.86, 95% CI 0.70 to 1.05) among intervention compared with control households at endline. Conclusion Our integrated WASH and nutrition intervention resulted in important changes in behaviours. This theory-informed intervention could be added to existing care group programmes to considerable advantage.