Developing a Contextually Appropriate Integrated Hygiene Intervention to Achieve Sustained Reductions in Diarrheal Diseases

Tracy Morse, Kondwani Chidziwisano, Elizabeth Tilley, Rossanie Malolo, Save Kumwenda, Janelisa Musaya and Sandy Cairncross
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Tracy Morse: Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow G1 1XJ, UK
Kondwani Chidziwisano: Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow G1 1XJ, UK
Elizabeth Tilley: Center for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre 3, Malawi
Rossanie Malolo: Center for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre 3, Malawi
Save Kumwenda: Center for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), University of Malawi (Polytechnic), Blantyre 3, Malawi
Janelisa Musaya: Department of Biomedical Sciences, University of Malawi (College of Medicine), Blantyre 3, Malawi
Sandy Cairncross: Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

Sustainability, 2019, vol. 11, issue 17, 1-17

Abstract: Diarrheal disease in under-five children remains high in Sub-Saharan Africa; primarily attributed to environmental pathogen exposure through poorly managed water, sanitation, and hygiene (WASH) pathways, including foods. This formative study in rural Malawi used a theoretical base to determine the personal, social, environmental, and psychosocial factors that are to be considered in the development of an integrated intervention for WASH and food hygiene. Using a mixed methods approach, a stakeholder analysis was followed by data collection pertaining to 1079 children between the ages of four to 90 weeks: observations ( n = 79); assessment of risks, attitudes, norms and self-regulation (RANAS) model ( n = 323); structured questionnaires ( n = 1000); focus group discussions ( n = 9); and, in-depth interviews ( n = 9) (PACTR201703002084166). We identified four thematic areas for the diarrheal disease intervention: hand washing with soap; food hygiene; feces management (human and animal); and, water management. The contextual issues included: the high level of knowledge on good hygiene practices not reflected in observed habits; inclusion of all family members incorporating primary caregivers (female) and financial controllers (male); and, endemic poverty as a significant barrier to hygiene infrastructure and consumable availability. The psychosocial factors identified for intervention development included social norms, abilities, and self-regulation. The resulting eight-month context specific intervention to be evaluated is described.

Keywords: WASH; food hygiene; complementary foods; RANAS; Malawi (search for similar items in EconPapers)
JEL-codes: O13 Q Q0 Q2 Q3 Q5 Q56 (search for similar items in EconPapers)
Date: 2019
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