A Mixed Methods Process Evaluation of a Food Hygiene Intervention in Low-Income Informal Neighbourhoods of Kisumu, Kenya

Abstract

Objectives Diarrhoea is a leading cause of infant mortality with the main transmission pathways being unsafe water and contaminated food, surfaces and hands. The ‘Safe Start’ trial evaluated a food hygiene intervention implemented in a peri-urban settlement of Kisumu, Kenya, with the aim of reducing diarrhoeagenic enteric infections among infants. Four food hygiene behaviours were targeted: handwashing with soap before preparation and feeding, boiling infant food before feeding, storing infant food in sealed containers, and exclusive use of designated utensils during feeding. Methods A process evaluation of the intervention was guided by a theory of change describing the hypothesised implementation and receipt of the intervention, mechanisms of change, and the context. These were assessed by qualitative and quantitative data that included debriefing sessions with the delivery teams and Community Health Volunteers (CHVs), and structured observations during food preparation. Results The intervention achieved high coverage and fidelity with over 90% of 814 eligible caregivers participating in the intervention. Caregivers in the intervention arm demonstrated an understanding of the intervention messages, and had 1.38 (95% CI: 1.02–1.87) times the odds of washing hands before food preparation and 3.5 (95% CI: 1.91–6.56) times the odds of using a feeding utensil compared to caregivers in the control group. Contextual factors, especially the movement of caregivers within and outside the study area and time constraints faced by caregivers influenced uptake of some intervention behaviours. Conclusion Future interventions should seek to explicitly target contextual factors such as secondary caregivers and promote food hygiene interventions as independent of each other.

Risk factors for food contamination among children 6-59 months discharged from community management of acute malnutrition (CMAM) programmes for severe acute malnutrition (SAM) in Aweil East, South Sudan

“…Feeding the child with a spoon was found to be a protective factor against TFC contamination. A very low proportion of households used a spoon to feed their child compared with other studies such as in Kenya, in which 92% of caregivers used a feeding utensil (spoon, bowl or cup) (Simiyu et al, 2022). A high proportion of households were recorded to have washed their utensils before feeding (93%), although whether this was with soap and water was not recorded.…”

Risk factors for diarrheagenic Escherichia coli infection in children aged 6–24 months in peri-urban community, Nairobi, Kenya

“…Optimal culture condition for E. coli include incubation at 37˚C, thus warming food (and not reheating to boiling) before feeding the infant could be providing an optimal growth condition for DEC. These hygienic practices are likely to be influenced by the household socioeconomic status, therefore recommended intervention strategies should be context specific [22,[49][50][51].…”

Prevalence and risk factors associated with the occurrence of Campylobacter sp. in children aged 6–24 months in peri-urban Nairobi, Kenya

“…Interventions for improving food hygiene and to reduce contamination of complementary foods for weaning children may target caregiver practices such as boiling milk, treating water, handwashing with soap, and food storage practices (37). However these practices are likely to be determined by the social and economic status of the caregiver so recommendations need to be context specific (37)(38)(39).…”