title: Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe.
abstract: We sought to develop a water, sanitation, and hygiene (WASH) intervention to minimize fecal-oral transmission among children aged 0-18 months in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. We undertook 4 phases of formative research, comprising in-depth interviews, focus group discussions, behavior trials, and a combination of observations and microbiological sampling methods. The resulting WASH intervention comprises material inputs and behavior change communication to promote stool disposal, handwashing with soap, water treatment, protected exploratory play, and hygienic infant feeding. Nurture and disgust were found to be key motivators, and are used as emotional triggers. The concept of a safe play space for young children was particularly novel, and families were eager to implement this after learning about the risks of unprotected exploratory play. An iterative process of formative research was essential to create a sequenced and integrated longitudinal intervention for a SHINE household as it expects (during pregnancy) and then cares for a new child.
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe Division of Nutritional Sciences, Cornell University, Ithaca, New York Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Mduduzi N N
authors.initials: MN
authors.lastname: Mbuya
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
authors.forename: Naume V
authors.initials: NV
authors.lastname: Tavengwa
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.affiliation: London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Valerie
authors.initials: V
authors.lastname: Curtis
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Gretel H
authors.initials: GH
authors.lastname: Pelto
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
authors.forename: Robert
authors.initials: R
authors.lastname: Ntozini
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Rukundo A
authors.initials: RA
authors.lastname: Kambarami
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
authors.forename: Dadirai
authors.initials: D
authors.lastname: Fundira
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
authors.forename: Thokozile R
authors.initials: TR
authors.lastname: Malaba
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
authors.forename: Diana
authors.initials: D
authors.lastname: Maunze
authors.affiliation: Aquamor Private Limited.
authors.forename: Peter
authors.initials: P
authors.lastname: Morgan
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Goldberg
authors.initials: G
authors.lastname: Mangwadu
authors.affiliation: Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods; D004435:Eating; D005243:Feces / Q000382:microbiology*; D005260:Female; D006235:Hand Disinfection; D015438:Health Behavior; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000503:physiopathology*; D008297:Male; D012107:Research Design; D012424:Rural Population; D012499:Sanitation; D014881:Water Supply; D015030:Zimbabwe
chemical_list: D006454:Hemoglobins
keywords: environmental enteric dysfunction; formative research; intervention design research; stunting; water, sanitation and hygiene