Piloting an intervention to improve microbiological food safety in Peri-Urban Mali

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions

“…Communities from other low-income countries also practiced similar food preparation processes with direct hand contact. 9,23,28 Unwashed hands, contaminated from contact with other foods (crosscontamination) during cooking or through fecal contact (e.g., defecation, handling cow dung, cleaning the household) that occurred during cooking, can be sources of enteric pathogens. On the basis of frequency of hand contact, crosscontamination opportunities, and level of moisture content, Food preparer went to toilet Food preparer was cutting vegetables for cooking.…”

“…22 One study that we could identified, conducted in Mali, described the process of preparation for two food items and related hygiene practices. 23 However, generally, there are limited data on food preparation steps and related handwashing practices that can inform behavior change interventions and pinpoint when hands should be washed during food preparation, especially from low-income contexts where easy access to running water is uncommon. 24 We examined community practices, related perceptions, and constraints to washing hands with soap during food preparation to aid development of an acceptable and feasible food preparation component to integrate into hand hygiene interventions.…”

Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal

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Step A (assess): The first step involved the collection and analysis of published and local knowledge concerning food hygiene behavior to define target behaviors, the parameters of the intervention, and the questions to be answered in the Formative Research. We carried out a systematic review of literature on food hygiene (presented elsewhere), examined past experience, in particular small-scale weaning food studies in Mali,37 Brazil,45 and Bangladesh,36 other hygiene interventions, learning particularly from the World Health Organization five key behaviors for safer food46 and the successful SuperAmma handwashing trial in India 38. We consulted colleagues in government and non-governmental organizations to establish that the intervention would be replicable and scalable in the context of Nepal.

Step B (build): Formative research was conducted to investigate specific behaviors; target audiences, and behavioral determinants including habits, motives and plans, and social, physical, and biological factors in the kitchen and village environment (the key elements of the BCD model42,43).

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“…Poor practices include long gaps between meal preparation and feeding,16,27,28 the use of unclean utensils,29,30 the washing of utensils in contaminated water,26 allowing flies to access foods, not washing hands before food handling and feeding,31 and the use of dirty clothes for wiping hands/utensils. A number of studies to date have assessed risk factors and microbial contamination in food in developing countries12,32–35; but few have developed or tested interventions to counter this problem in domestic settings 36,37…”

Water, sanitation, hygiene and enteric infections in children

“…Weaning food hygiene may be among the most important determinants of diarrhoeal disease risk in young children,54 55 although the current evidence is insufficient to arrive at conclusions about its relative importance in control of infections. It has been shown to be important in some contexts, with estimates of up to 70% of all diarrhoea caused by contaminated foods,54 and microbial counts that may exceed those found in drinking water 54–60.…”