Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA.
Food for the Hungry, Phoenix, USA.
BMC Public Health. 2021 Mar 1;21(1):427. doi: 10.1186/s12889-021-10246-5.
Research exploring the unique exposure pathways to fecal pathogens for young children and innovative water, sanitation, and hygiene (WASH) interventions for susceptible pediatric populations is needed to reduce the burden of diarrheal diseases and stunting globally. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to 1) identify exposure pathways to fecal pathogens that are significant contributors to morbidity for young children in South Kivu, Democratic Republic of the Congo, and 2) develop and evaluate scalable interventions that reduce fecal contamination and exposure from these pathways. The formative research portion of the project sought to identify feasible and acceptable WASH interventions to modify behaviors found to be associated with diarrheal disease and impaired growth in our REDUCE cohort study.
Ninety-one semi-structured interviews, 6 focus group discussions, and a pilot study of 102 households were conducted during 24 months of formative research. Thirty-one interviews and six focus group discussions were conducted with caregivers, community health workers, and village leaders to explore existing WASH practices and to identify barriers and facilitators to WASH behaviors. Findings were organized using the Integrated Behavioral Model for Water, Sanitation and Hygiene to facilitate interpretation and identify determinants to Baby WASH behaviors in this setting. Care Group modules and enabling technology were developed based on exploratory findings and then revised during a two-part, iterative pilot study. Sixty interviews were conducted with participants in a pilot study of the REDUCE Baby WASH Care Group modules to learn about their experiences with the intervention.
Six REDUCE Baby WASH Care Group modules were developed based on formative research findings and covered the following topics: 1) living with animals; 2) child mouthing of fomites and feces; 3) composting animal feces; 4) child feces disposal; 5) handwashing with soap; and 6) water treatment.
This study took a theory-driven and evidence-based approach to formative research and the development of the REDUCE Baby WASH Care Group modules. Intervention design focused on interrupting the exposure routes for infants and young children to fecal pathogens in the environment and promoting low-cost, low-burden Baby WASH behavioral recommendations and enabling technology. These developed REDUCE Baby WASH Care Group modules are currently being rolled out to over 1,000,000 beneficiaries in Democratic Republic of the Congo.
为了降低全球腹泻病和发育迟缓的负担，需要研究探索幼儿接触粪便病原体的独特途径，以及针对易感儿科人群的创新性水、环境卫生和个人卫生（WASH）干预措施。减少肠道疾病、腹泻、营养不良和环境中污染（REDUCE）项目旨在：1）确定导致刚果民主共和国南基伍地区幼儿发病的粪便病原体暴露途径，以及 2）开发和评估可减少这些途径中粪便污染和暴露的可扩展干预措施。该项目的形成性研究部分旨在确定可行且可接受的 WASH 干预措施，以改变我们在 REDUCE 队列研究中发现与腹泻病和生长受损相关的行为。
在 24 个月的形成性研究中，进行了 91 次半结构化访谈、6 次焦点小组讨论和 102 户家庭的试点研究。与照顾者、社区卫生工作者和村长进行了 31 次访谈和 6 次焦点小组讨论，以探讨现有的 WASH 做法，并确定 WASH 行为的障碍和促进因素。使用综合水、环境卫生和个人卫生行为模型组织研究结果，以促进对这一环境中婴儿 WASH 行为的解释，并确定决定因素。根据探索性研究结果开发了关怀小组模块和使能技术，然后在两部分迭代试点研究中进行修订。对 REDUCE 婴儿 WASH 关怀小组模块的试点研究中的参与者进行了 60 次访谈，以了解他们对干预措施的体验。
基于形成性研究结果开发了六个 REDUCE 婴儿 WASH 关怀小组模块，涵盖以下主题：1）与动物一起生活；2）儿童口含污物和粪便；3）动物粪便堆肥；4）儿童粪便处理；5）用肥皂洗手；6）水处理。
本研究采用理论驱动和基于证据的方法进行形成性研究和 REDUCE 婴儿 WASH 关怀小组模块的开发。干预设计侧重于阻断幼儿接触环境中粪便病原体的暴露途径，并促进低成本、低负担的婴儿 WASH 行为建议和使能技术。这些开发的 REDUCE 婴儿 WASH 关怀小组模块目前正在刚果民主共和国向 100 多万受益人推出。
