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

FECAL analysis; DIARRHEA prevention; DIARRHEA; CAREGIVERS; PATIENT participation; CONFIDENCE intervals; RESEARCH methodology; MOTIVATION (Psychology); HYGIENE; QUANTITATIVE research; COGNITION; COOKING; FAMILIES; SANITATION; QUALITATIVE research; SURVEYS; WATER supply; FOOD; INTESTINAL diseases; COMMUNICATION; BODY movement; THEORY; RESEARCH funding; FOOD handling; DESCRIPTIVE statistics; POVERTY; INFANT mortality; FOOD storage; ODDS ratio; HAND washing; LOGISTIC regression analysis; DATA analysis software; NEIGHBORHOOD characteristics; DISEASE complications; CHILDREN

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. Significance: What is already known on this subject. Diarrhoea is known to be a significant cause of infant morbidity and mortality, mainly through unsafe water and food, and mainly from rural areas. What this study adds. This study describes the implementation of a novel food hygiene intervention to reduce diarrhoea causing enteric infections among children in low income peri urban settlements. The manuscript details the delivery of the intervention, describes the context, and explores associations influencing adoption of the intervention. Findings of the evaluation are meant to support the results of the trial. [ABSTRACT FROM AUTHOR]

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