A community-level complementary-food safety and hygiene intervention improves family-food preparation behaviours in rural Gambia: a follow-up of a cluster randomised controlled trial

Introduction: Infectious diarrhoea causes millions of deaths annually in low-income countries. Prevention strategies minimising transmission of diarrhoeal pathogens could include adopting better food hygiene practices. The objective was to assess whether a complementary-food hygiene intervention improved family-food hygiene practices in rural Gambian households.

Methods: A parallel cluster randomised controlled trial was conducted in central Gambia. 30 villages were randomised within strata (north/south of the river, population quartiles) to intervention or control (1:1 ratio) by a UK statistician using a computer-generated sequence. Clusters had a population of 200–450, two health workers and were more than 5 km apart. The 4-day community-based intervention occurred over 1 month, with a reminder visit 4 months later. Competitions, performing arts and songs encouraged caregivers to practice five target complementary-food hygiene behaviours using emotional drivers and social norms. Control villages received a 1 day campaign on water usage in gardening. Caregivers lived in the same village during the intervention and had a 6–36 month old child, though some were new mothers. Findings reported here were secondary outcomes analysed as intention-to-treat. This included the proportion of occasions caregivers practiced five food hygiene behaviours for family-food preparation (three handwashing, one dishes/utensils washing and one re-heating food), measured by direct observation 32 months post intervention. Observers did not deliver the intervention and were masked/blinded to the group allocation of the villages.

Results: At 32 months (20 September 2017 to 26 October 2017), 371 and 376 caregivers were analysed from 15 intervention and 15 control villages, respectively. There was greater adherence to the five behaviours in the intervention group; intervention 2073/4425 (47.0%), control 1827/4559 (40.1%), rate ratio (RR) 1.17 (95% CI 1.08 to 1.27, p<0.001), driven by better adherence to handwashing behaviours.

Conclusion: This community-based complementary-food hygiene intervention additionally improved family-food hygiene behaviours 32 months post intervention.

Trial registration number: PACTR201410000859336.