Promoting hygienic weaning food handling practices through a community-based programme: intervention implementation and baseline characteristics for a cluster randomised controlled trial in rural Gambia.
Promoting hygienic weaning food handling practices through a community-based programme: intervention implementation and baseline characteristics for a cluster randomised controlled trial in rural Gambia.
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DOI：
10.1136/bmjopen-2017-017573
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发表时间：
2018-08-05
期刊：
影响因子：
2.9
通讯作者：
Manaseki-Holland S
中科院分区：
文献类型：
--
作者：
Manjang B;Hemming K;Bradley C;Ensink J;Martin JT;Sowe J;Jarju A;Cairncross S;Manaseki-Holland S
断奶食品污染导致5岁以下儿童腹泻。在低收入和中等收入国家，改善做法的公共卫生干预措施很少，而且往往没有使用随机方法进行评估。我们描述了一种干预措施的实施，并提供了这样一个试验的基线数据。随机对照试验。冈比亚农村。15个村庄/集群，每个村庄/集群有20名随机选择的母亲，每个手臂有6-24个月的孩子。为了制定公共卫生干预措施，我们使用：（A）形成性研究结果，以确定基于理论的关键控制点纠正措施和动机驱动器，以改变母亲的行为;（B）尼泊尔社区断奶食品卫生方案和印度洗手干预方案的经验教训;（C）基于文化的表演艺术、竞赛和环境线索。每个村庄四个强化干预日涉及现有的卫生系统和村庄/文化结构，使整个村民社区能够按协议执行和参与。随机化后，两组基线村庄和母亲特征平衡。大多数村庄是农村，可在10英里范围内获得保健中心，没有学校，但有许多村委会，代表冈比亚所有三个主要族裔群体。母亲主要是文盲（60%）和农民（92%）;据报告，在过去7天（旱季），5岁以下儿童中分别有24%和10%出现腹泻和呼吸道症状。整个村庄的成员都参与了干预进程，并为今后的实施提供了经验教训;适应文化的表演艺术是一个重要因素。这项研究有可能成为一个新的低成本和广泛提供的公共卫生计划，以减少通过断奶食品感染。在冈比亚广泛征求了基于理论的干预措施的意见，并征求了专家的意见，得到了社区的广泛接受。基线分析提供了社会经济数据，并证实了儿童基金会关于冈比亚最贫穷地区旱季腹泻和呼吸道症状流行率的多指标类集调查数据。PACTR 201410000859336;预结果。
Contamination of weaning food leads to diarrhoea in children under 5 years. Public health interventions to improve practices in low-income and middle-income countries are rare and often not evaluated using a randomised method. We describe an intervention implementation and provide baseline data for such a trial. Clustered randomised controlled trial. Rural Gambia. 15 villages/clusters each with 20 randomly selected mothers with children aged 6–24 months per arm. To develop the public health intervention, we used: (A) formative research findings to determine theoretically based critical control point corrective measures and motivational drives for behaviour change of mothers; (B) lessons from a community-based weaning food hygiene programme in Nepal and a handwashing intervention programme in India; and (C) culturally based performing arts, competitions and environmental clues. Four intensive intervention days per village involved the existing health systems and village/cultural structures that enabled per-protocol implementation and engagement of whole villager communities. Baseline village and mother’s characteristics were balanced between the arms after randomisation. Most villages were farming villages accessing health centres within 10 miles, with no schools but numerous village committees and representing all Gambia’s three main ethnic groups. Mothers were mainly illiterate (60%) and farmers (92%); 24% and 10% of children under 5 years were reported to have diarrhoea and respiratory symptoms, respectively, in the last 7 days (dry season). Intervention process engaged whole village members and provided lessons for future implementation; culturally adapted performing arts were an important element. This research has potential as a new low-cost and broadly available public health programme to reduce infection through weaning food. The theory-based intervention was widely consulted in the Gambia and with experts and was well accepted by the communities. Baseline analysis provides socioeconomic data and confirmation of Unicefs Multiple Indicator Cluster Survey (MICS) data on the prevalence of diarrhoea and respiratory symptoms in the dry season in the poorest region of Gambia. PACTR201410000859336; Pre-results.
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