MaaCiwara Study

african mother with baby on backInfant diarrhoea is globally the second highest cause of death in under-fives. Children who are transitioning from being breastfed to eating foods, are at particular risk from diarrhoea.

We are examining interventions aimed at reducing the burden of diarrhoea among children eating complementary food, particularly behavioural interventions that influence food hygiene, food content and safe play.

Diarrhoea causes one in nine under-five deaths worldwide, and is a contributing factor to stunting and cognitive impairment.

Particularly at risk of diarrhoea are children starting to eat complementary food, due to unhygienic feeding practices; poor nutritional content of food; and unsafe play.

Behavioural interventions to improve food hygiene have been shown to be effective in rural areas, however, such interventions have not been examined in urban areas, and have not address food nutritional content and unsafe play. We aim to address those knowledge gaps through a cluster RCT in urban and rural Mali. The study uses a mixed methods evaluation to examine a food hygiene, content, and safe play intervention which has been adapted to the local context through formative research, paying particular attention to contextual differences. The study also contains several parallel projects on stool microbiology, health economics, and attitudes to safe food.

This project draws on the growing strengths of the Institute of Applied Health Research in health informatics research (including policy evaluation using routine electronic healthcare data), biostatistics and maternal and child health. The project is led by the University of Birmingham, with strong collaboration with Malian Governmental and Academic organizations, as well as international organizations such as the WHO, UNICEF, ICDDR,B, and WaterAid; and other British academic partners.

Our Aim

We propose a low-cost, scalable and adaptable community intervention to reduce diarrhoea and improve the growth of young children in urban and rural Mali. We will assess the effects in both settings, to inform replication and scaling of the intervention, because the dynamics of community life vary in each.

Our Work Plan

After adaptation with communities, our intervention will empower local families to implement behaviour change. It will include campaign-like activities such as culturally relevant dramatic arts (drama, songs, stories), public meetings, certifications, and home visits. Delivery will be by a small team over 5 days of community campaign visits dispersed over 40 days, and includes home visits by trained female volunteers, plus a reminder campaign day at 9 months. We will allocate by chance 120 urban and rural sites in Mali to receive the intervention, or not, and assess 27 households in each site after 15 months. This study is designed to explore whether the interventions works differently in rural and urban contexts, and to examine other societal influences (e.g. household poverty, women's work, and education, etc). Using observations, interviews, discussion groups, surveys and laboratory tests we will compare the implementation of the intervention and key outcomes of diarrhoea, growth and development in urban and rural settings. Importantly, the intervention is designed to be sustainable through peer-education/support among mothers and older female volunteers, thus requiring only small levels of additional input from the central government.

This project is primarily funded by the Medical Research Council UKRI GCRF Health and Context and the University of Birmingham Institute for Global Innovation. Co-funding in kind has been received from the University of Birmingham and the University of Science, Techniques and Technology Bamako.
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The views expressed are those of the authors and not necessarily those of the funders.