Improving food hygiene behaviours among child caregivers in rural community households of Malawi

Globally, diarrheal disease accounts for over 90% of foodborne illness, with over 70% of this burden in Sub-Saharan Africa. However, traditional diarrheal prevention interventions focused on water, sanitation, and handwashing, with little integration of food hygiene. This thesis designed and implemented a theory-based complementary food hygiene intervention in rural Malawi and evaluated its impact on food hygiene behaviours. Formative research and intervention development was grounded in the RANAS (Risk, Attitude, Norms, Ability and Self-regulation) Model and targeted five behaviours: cleaning of cooking and feeding utensils, safe utensil storage, reheating of left-over food, child self feeding and handwashing with soap. The intervention was delivered for 9 months through village meetings in 800 household visits. Formative research indicated that risk, norms, ability and self-regulation factors were primary factors of the selected behaviours. Intervention was linked to Behaviour Change Techniques of the RANAS model. Villages were assigned to a control or intervention group and targeted caregivers of children aged five years and below. Intervention outcomes were measured using a before and after study with a control. Changes in food hygiene behaviours between baseline and follow-up data, and between the intervention and control groups were measured using ANOVA and t-test. Mediation models were used to uncover underlying mechanisms and effects of an intervention on changes in target behaviours. At end-line, three behaviours showed a significant difference among intervention recipients: cleaning utensils with soap (P=0.000); safe utensil storage (P=0.000) and handwashing with soap (P=0.000). For the three significant behaviours, psychosocial factors differed significantly between the intervention and control groups. Results showed that perceived risk, norm, ability and self-regulation factors (P=0.000) mediated the effect of the intervention on the significant behaviours among the intervention participants. The study suggests that theory driven behaviour change initiatives using contextual and psychosocial factors effectively improved food hygiene behaviours in rural Malawi.