Abstract
Introduction: 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.
Methods: The intervention included a community-wide campaign on days 1, 2, 17, and 25, a reminder visits 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 localhealth 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. Outcomes were measured at 6 and 32months in a random sample of 21–26 mothers per cluster. 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. (Registration: PACTR201410000859336).
Results: The composite behaviour score on the primary outcome was 65% versus 15% for intervention against control(p<0.001). At 6 months the 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: mother-reported diarrhoea hospitalization 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%CI0.18–0.80, p=0.011).
Conclusion: We found that low-cost and culturally embedded behavior change interventions were acceptable to communities and led to short- and long-term improvements in complementary-food safety and hygiene practices, and reported diarrhea and acute respiratory tract infections.
Poster presentation.