Competitions, performing arts and songs were used to minimise the risk of bacterial diarrhoea.
Focus group discussion with Gambian grandmothers.
Diarrhoeal disease remains a leading cause of illness and death worldwide, particularly in low- and middle-income countries. While many hygiene programmes focus on infant feeding, families in rural settings often prepare food for all members at once, meaning poor food handling practices can increase the spread of harmful pathogens throughout the household.
To tackle this, a community-based food hygiene initiative was developed by researchers at the University of Birmingham and partners in The Gambia, which led to sustained improvements in safe food preparation practices among families nearly three years after the programme was delivered.
The study, a cluster randomised controlled trial conducted across 30 rural villages, is the first to show that an intervention originally designed to improve the safety of complementary foods for infants can also deliver lasting benefits for family‑wide food hygiene, which is a key factor in reducing diarrhoeal disease across all age groups.
The research team, led by Professor Semira Manaseki-Holland and colleagues in Birmingham and The Gambia, set out to evaluate whether a behavioural intervention targeting complementary‑food hygiene could also influence broader family‑food preparation behaviours in the long term.
The four-day intervention used traditional performing arts, emotional motivators, and community peer-support, peer-teaching and role-modelling to encourage caregivers to adopt safe food hygiene practices. Local public health officers and traditional communicators worked alongside respected “MaaChampion” mothers to deliver songs, dramas, demonstrations and household visits designed to shift social norms around hygiene.
When researchers returned 32 months after the intervention, they observed meaningful and statistically significant improvements among caregivers in intervention villages compared with controls. These included:
We hope this study encourages other research using cultural arts and peer-support to not only improve knowledge but also practices towards better household food safety and hygiene in the most deprived communities where these diseases are a real problem.”
"We know from research that majority of diarrhoeal and other food-born diseases are spread through unsafe household preparations", says Professor Manaseki-Holland. "Household food safety and hygiene has implications for child health since most children, including vulnerable young ones, eat family food. We hope this study encourages other research using cultural arts and peer-support to not only improve knowledge but also practices towards better household food safety and hygiene in the most deprived communities where these diseases are a real problem."
The study highlights several features that make the programme well‑suited for scaling across low-resource settings such as:
The authors note that future studies or programming should consider targeting both complementary‑food and family‑food hygiene directly, given the clear benefits observed across whole households, including young children. Additionally, the research team emphasise the importance of replicating and expanding this work in larger studies, including in other regions and contexts, highlighting the need to integrate explicitly food hygiene focussed interventions more systematically into public health programmes, beyond the traditional focus on handwashing and better nutrition.
Read the published article on the BMJ Global Health website.
Professor of Public Health
Staff profile for Semira Manaseki-Holland who is a Reader in Public Health at the Department of Applied Health Sciences, University of Birmingham
