Improved Health and Behaviour through Integration of Food Hygiene and WASH

Diarrhoeal disease remains one of the leading causes of death and illness in children under five, with approximately 424,000 deaths worldwide annually (Walker et al., 2013; WHO, 2019). Malawi has a diarrhoeal disease prevalence of 22% in children under five (NSO, 2017), which is often associated with poor water, sanitation, and hygiene practices, and the contamination of the environment with faeces from poor practices in which children live and play (Pickering et al., 2019). Interventions that aim to reduce child exposure to faeces (both human and animal) have traditionally focused on infrastructure, (e.g. toilets, drinking water and hand washing facilities) and handwashing with soap. However, there is growing evidence contaminated foods also have an important role to play (Woldt, 2015; Chidziwisano, et al., 2019a; 2019b), with 40% of the foodborne disease burden falling on children under the age of five (WHO, 2015). However, there has been little integration of food hygiene in traditional WASH or nutrition programmes despite its important place in potentially reducing diarrhoea (Null et al., 2018; Gautam et al., 2017). To assess this potential route for controlling diarrhoea, the Hygienic Family (Banja la Ukhondo) study was conducted in rural Malawi by the WASHTED centre based at the Malawi Polytechnic in collaboration with the University of Strathclyde. This behaviour-centred, context-appropriate intervention integrated improved food hygiene and WASH practices, addressing both infrastructure and behaviour to achieve reductions in childhood diarrhoea (Morse, et al., 2019).