Effects on childhood infections of promoting safe and hygienic complementary-food handling practices through a community-based programme: A cluster randomised controlled trial in a rural area of The Gambia.
Effects on childhood infections of promoting safe and hygienic complementary-food handling practices through a community-based programme: A cluster randomised controlled trial in a rural area of The Gambia.
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DOI：
10.1371/journal.pmed.1003260
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发表时间：
2021-01
期刊：
影响因子：
15.8
通讯作者：
Cairncross S
中科院分区：
文献类型：
--
作者：
Manaseki-Holland S;Manjang B;Hemming K;Martin JT;Bradley C;Jackson L;Taal M;Gautam OP;Crowe F;Sanneh B;Ensink J;Stokes T;Cairncross S
冈比亚5岁以下儿童死于腹泻和肺炎的比率很高，在补充喂养年龄达到高峰。以社区为基础的干预措施可减少补充食品污染和发病率。在2015年9月至10月和2017年10月至12月分别进行6个月和32个月随访的聚类随机对照试验中，对2015年2月至4月在冈比亚实施的一项利用关键控制点和动机驱动因素的公共卫生干预进行了评估。在同意参与试验并收集基线数据后，按人口规模和地理位置将30个村庄（组）随机分配到干预组或对照组。干预措施包括在第1、2、17和25天进行全社区活动，在5个月时进行提醒访问，以及非正式的社区志愿者家访。它通过表演艺术、公开会议和由当地卫生和村庄机构的一个小组向所有参加活动的村民颁发证书，促进了5种关键的补充食品行为和1种关键的饮用水安全和卫生行为，特别邀请了6至24个月大儿童的母亲参加活动。对照村开展了为期一天的家庭花园用水活动。在试验组之间，母亲和群体（村庄）的背景特征是平衡的。每组随机抽取21-26名母亲，在6个月和32个月时测量结果。在6至32个月期间没有干预措施或研究小组对村庄进行访问。主要结果是观察关键辅食行为的次数与6个月观察期间执行这些行为的机会数量的比例的综合结果。次要结果包括每种推荐行为的比率；辅食和饮用水中的微生物生长（仅6个月）；报告急性呼吸道感染、腹泻和腹泻住院。分析采用意向治疗分析，经聚类调整。(登记:PACTR201410000859336)。我们发现，干预村有394/571（69%）的补充喂养儿童的母亲积极参与了这项运动。没有村庄撤离，干预措施的实施也没有改变。干预显著改善了行为的采用。对于主要结局，对照村的发生率为662/ 4351（发病率[IR] = 0.15），干预村为2861 / 4378（发病率= 0.65）（调整发病率比[aIRR] = 4.44, 95% CI 3.62-5.44, p < 0.001）， 32个月时的aIRR为1.17 （95% CI 1.07-1.29, p = 0.001）。干预也改善了次要健康结果：(1)母亲报告在6个月时腹泻，调整相对危险度(aRR) = 0.39 (95% CI 0.32-0.48, p < 0.001)，在32个月时，aRR = 0.68 (95% CI 0.48-0.96, p = 0.027)；(2)母亲报告在6个月时腹泻住院，aRR = 0.35 (95% CI 0.19-0.66, p = 0.001)，在32个月时，aRR = 0.38 (95% CI 0.18-0.80, p = 0.011)；(3)母亲报告的急性呼吸道感染在6个月时，aRR = 0.67 (95% CI 0.53-0.86, p = 0.001)，尽管在32个月时改善不显著（p = 0.200）。无不良事件报告。主要的限制是只涉及中小型农村。无法从32个月大的食物中获得实验室培养物，也没有调查粪便微生物。我们发现，低成本和文化嵌入的行为改变干预措施为社区所接受，并导致补充食品安全和卫生习惯的短期和长期改善，并报告了腹泻和急性呼吸道感染。该试验于2014年10月17日在南非泛非临床试验注册中心注册，注册号为PACTR201410000859336，并作为试验的修订进行了32个月的随访。Semira Manaseki-Holland及其同事评估了一项旨在改善西非婴儿食品卫生的行为改变干预措施。0-2岁的儿童以辅食喂养，腹泻和食源性疾病的发病率最高。大多数卫生或儿童营养规划并不直接解决补充食品安全和卫生问题。我们进行了一项社区一级补充食品安全和卫生干预的大型集群随机对照试验（RCT），其中测量了中期和长期健康结果。我们在冈比亚农村地区的15个干预村和15个对照村采用了一项聚类随机对照研究来测试一种新型的社区水平运动式干预，并在干预后6个月和32个月对结果进行了评估。通过系统评估行为改变的动机驱动因素和通过危害分析评估确定的辅食制备和处理实践中污染的关键控制点（ccp），确定了目标行为。干预措施在社区一级实施，重点是幼儿的母亲；它通过表演艺术、公众会议、家访、承诺仪式以及母亲和社区的认证等多种方式来传递。有补充喂养年龄儿童的母亲中有69%积极参与了这项运动。干预后6个月，行为采纳率较高；报告的儿童腹泻、因腹泻住院和呼吸道疾病分别减少了60%、60%和30%。在干预后32个月，对照村的母亲采用了干预所促进的一些行为（干预“交叉污染”），但干预村的行为实践仍然明显较高，报告的腹泻减少了30%，因腹泻住院的人数减少了40%。另一个研究小组收集的临床数据证实腹泻就诊减少。5个月后，在没有进一步规划投入的情况下取得了这些成果。在项目实施时没有孩子的母亲随后被社区成员吸引并采纳了这些行为。干预措施进一步增加了价值，因为它是由公共卫生和村庄结构的一个小组提供的，而且强度低，成本低。我们证明，这些低成本、文化嵌入的干预措施在社区层面是可接受、采用和持续的，具有高水平的行为改变，并在短期内报告减少了腹泻和急性呼吸道感染的结果，并具有显著的长期效果。这种形式的干预措施可对预防腹泻作出宝贵贡献；尽管我们的研究结果仅限于小农村，但这在低收入和中等收入国家仍然很常见。我们的结论需要在城市和城郊环境中进行检验。迄今为止，人们对辅食的制备、处理和喂养过程中的食品安全和食品卫生规范关注不够。对文化表演艺术项目的评估也不够充分，这些项目可以让整个社区参与进来，支持改变行为的母亲。
The Gambia has high rates of under-5 mortality from diarrhoea and pneumonia, peaking during complementary-feeding age. Community-based interventions may reduce complementary-food contamination and disease rates. A public health intervention using critical control points and motivational drivers, delivered February–April 2015 in The Gambia, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up in September–October 2015 and October–December 2017, respectively. After consent for trial participation and baseline data were collected, 30 villages (clusters) were randomly assigned to intervention or control, stratified by population size and geography. The intervention included a community-wide campaign on days 1, 2, 17, and 25, a reminder visit at 5 months, plus informal community-volunteer home visits. It promoted 5 key complementary-food and 1 key drinking-water safety and hygiene behaviours through performing arts, public meetings, and certifications delivered by a team from local health and village structures to all villagers who attended the activities, to which mothers of 6- to 24-month-old children were specifically invited. Control villages received a 1-day campaign on domestic-garden water use. The background characteristics of mother and clusters (villages) were balanced between the trial arms. Outcomes were measured at 6 and 32 months in a random sample of 21–26 mothers per cluster. There were no intervention or research team visits to villages between 6 and 32 months. The primary outcome was a composite outcome of the number of times key complementary-food behaviours were observed as a proportion of the number of opportunities to perform the behaviours during the observation period at 6 months. Secondary outcomes included the rate of each recommended behaviour; microbiological growth from complementary food and drinking water (6 months only); and reported acute respiratory infections, diarrhoea, and diarrhoea hospitalisation. Analysis was by intention-to-treat analysis adjusted by clustering. (Registration: PACTR201410000859336). We found that 394/571 (69%) of mothers with complementary-feeding children in the intervention villages were actively involved in the campaign. No villages withdrew, and there were no changes in the implementation of the intervention. The intervention improved behaviour adoption significantly. For the primary outcome, the rate was 662/4,351(incidence rate [IR] = 0.15) in control villages versus 2,861/4,378 (IR = 0.65) in intervention villages (adjusted incidence rate ratio [aIRR] = 4.44, 95% CI 3.62–5.44, p < 0.001), and at 32 months the aIRR was 1.17 (95% CI 1.07–1.29, p = 0.001). Secondary health outcomes also improved with the intervention: (1) mother-reported diarrhoea at 6 months, with adjusted relative risk (aRR) = 0.39 (95% CI 0.32–0.48, p < 0.001), and at 32 months, with aRR = 0.68 (95% CI 0.48–0.96, p = 0.027); (2) mother-reported diarrhoea hospitalisation at 6 months, with aRR = 0.35 (95% CI 0.19–0.66, p = 0.001), and at 32 months, with aRR = 0.38 (95% CI 0.18–0.80, p = 0.011); and (3) mother-reported acute respiratory tract infections at 6 months, with aRR = 0.67 (95% CI 0.53–0.86, p = 0.001), though at 32 months improvement was not significant (p = 0.200). No adverse events were reported. The main limitations were that only medium to small rural villages were involved. Obtaining laboratory cultures from food at 32 months was not possible, and no stool microorganisms were investigated. We found that low-cost and culturally embedded behaviour change interventions were acceptable to communities and led to short- and long-term improvements in complementary-food safety and hygiene practices, and reported diarrhoea and acute respiratory tract infections. The trial was registered on the 17th October 2014 with the Pan African Clinical Trial Registry in South Africa with number (PACTR201410000859336) and 32-month follow-up as an amendment to the trial. Semira Manaseki-Holland and co-workers evaluate a behaviour-change intervention aimed at improving food hygiene for infants in West Africa. Children aged 0–2 years are fed complementary foods and have the highest rates of diarrhoea and food-borne illnesses. Most hygiene or child nutrition programmes do not directly address complementary-food safety and hygiene. We performed a large cluster randomised controlled trial (RCT) of a community-level complementary-food safety and hygiene intervention in which medium- and long-term health outcomes were measured. We used a cluster RCT study to test a novel community-level campaign-like intervention in 15 intervention and 15 control villages in rural Gambia and evaluated outcomes at 6 and 32 months post-intervention. Target behaviours were identified through systematic assessment of motivational drivers for behaviour change and critical control points (CCPs) for contamination in complementary-food preparation and handling practices identified through a hazard analysis assessment. The intervention was implemented at the community level and focussed on mothers of young children; it was delivered by a combination of performing arts, public meetings, household visits, commitment ceremonies, and certifications of mothers and communities. Sixty-nine percent of mothers with complementary-feeding-age children were actively involved in the campaign. At 6 months post-intervention, adoption of behaviours was high; child’s reported diarrhoea, hospital admission for diarrhoea, and respiratory disease were reduced by 60%, 60%, and 30%, respectively. At 32 months post-intervention, mothers in control villages had adopted some of the behaviours promoted by the intervention (intervention ‘cross-contamination’), but practice of the behaviours in the intervention villages remained significantly higher, with a 30% reduction in reported diarrhoea and a 40% reduction in hospital admissions for diarrhoea. Clinic data collected by another research team confirmed reduced diarrhoea visits. These outcomes were achieved without further programmatic input after 5 months. Mothers without babies at the time of the programme were subsequently engaged by community members and adopted the behaviours. The intervention adds further value as it was delivered by a team from the public health and village structures, and was low intensity and low cost. We demonstrate that these low-cost, culturally embedded interventions are acceptable, adopted, and sustained at the community level, with high levels of behaviour change and reported reduction in diarrhoea and acute respiratory infection outcomes in the short term, and significant long-term effects. Interventions of this form could make an invaluable contribution to diarrhoea prevention; although our findings are limited to small rural villages, these are nonetheless common in low- and middle-income countries. Our conclusions need to be tested in urban and peri-urban settings. To date, insufficient attention has been devoted to food safety and food hygiene practices aimed at preparing, handling, and feeding complementary food. There have also been insufficient assessments of programmes with cultural performing arts that can engage whole communities to support mothers with behaviour change.
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影响因子：
2.9
作者：
Manjang B;Hemming K;Bradley C;Ensink J;Martin JT;Sowe J;Jarju A;Cairncross S;Manaseki-Holland S
通讯作者：
Manaseki-Holland S
影响因子：
2
作者：
BRYAN, FL;MICHANIE, S;REQUEJO, EG
通讯作者：
REQUEJO, EG
影响因子：
3.3
作者：
Gautam, Om Prasad;Schmidt, Wolf-Peter;Curtis, Valerie
通讯作者：
Curtis, Valerie
影响因子：
3.3
作者：
Islam, Mohammad Sirajul;Mahmud, Zahid Hayat;Cairncross, Sandy
通讯作者：
Cairncross, Sandy
影响因子：
56.3
作者：
Mackenzie, Grant A.;Hill, Philip C.;Corrah, Tumani
通讯作者：
Corrah, Tumani