African Population and Health Research Center, Manga Close, Off Kirawa Road, P.O Box 10787- 00100, Nairobi, Kenya.
Great Lakes University of Kisumu, P.O Box 2224-40100, Kisumu, Kenya.
Matern Child Health J. 2023 May;27(5):824-836. doi: 10.1007/s10995-022-03548-6. Epub 2022 Nov 9.
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.
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.
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.
Future interventions should seek to explicitly target contextual factors such as secondary caregivers and promote food hygiene interventions as independent of each other.
腹泻是导致婴儿死亡的主要原因之一，其主要传播途径是不安全的水和受污染的食物、表面和手。“安全起点”试验评估了在肯尼亚基苏木的一个城市周边定居点实施的一项食品卫生干预措施，旨在减少婴儿腹泻性肠道感染。该干预措施针对四种食品卫生行为：准备和喂养前用肥皂洗手、在喂养前煮沸婴儿食品、将婴儿食品存放在密封容器中以及在喂养过程中专用餐具。
干预措施的过程评估以一个变化理论为指导，该理论描述了干预措施的假设实施和接受情况、变化机制和背景。这些是通过包括与提供团队和社区卫生志愿者（CHV）的汇报会议以及在食品准备过程中的结构化观察在内的定性和定量数据来评估的。
该干预措施实现了高覆盖率和高度的一致性，814 名符合条件的照顾者中有超过 90%参加了该干预措施。干预组的照顾者对干预信息有了理解，与对照组相比，他们在准备食物前洗手的可能性增加了 1.38 倍（95%置信区间：1.02-1.87），使用喂养工具的可能性增加了 3.5 倍（95%置信区间：1.91-6.56）。背景因素，尤其是照顾者在研究区域内外的流动以及照顾者面临的时间限制，影响了一些干预行为的接受度。
未来的干预措施应寻求明确针对次要照顾者等背景因素，并促进食品卫生干预措施彼此独立。
