Traditional performing arts could be used in some countries to improve food safety and hygiene, according to a recently published study.

Researchers in The Gambia discovered that mothers’ food safety and hygiene behaviors were improved by a low-cost behavior change community program trialed in rural villages.

After six months, researchers observed that hospital admissions had reduced by 60 percent for diarrhea. After 32 months, the mothers continued improved food safety and hygiene practices, informing and encouraging new mothers to do the same. Findings were published in the journal PLOS Medicine.

The Gambia, like other low- and middle-income countries (LMICs), faces high rates of deaths due to diarrhea in children younger than 5 years. Children transitioning from breastfeeding to eating food are most at risk of foodborne illnesses, as complementary food becomes contaminated.

Using stories and songs
Lead researcher, Semira Manaseki-Holland, clinical senior lecturer in public health at the University of Birmingham in England, said the community health intervention could save thousands or millions of lives in the future if replicated in other countries.

“Gambian rural villages are similar to thousands in sub-Saharan Africa and these methods can be used in many countries across Africa and Asia. We saw the food hygiene practices of Gambian mothers with weaning age children improve dramatically,” Manaseki-Holland said.

A randomized trial in 30 Gambian villages from February to April 2015 was used, with 15 getting the program to identify and correct behavior around critical points in food preparation and handling when contamination can occur. Others received messages about household gardens.

Researchers translated food safety and hygiene information into stories and songs with a central figure called “MaaChampian.” Five community visits included performances and music.

The World Health Organization estimates on the foodborne disease burden published in 2015 highlighted the need for ways to improve food safety to prevent infections in children of complementary-feeding age. Researchers said the study describes such a strategy.

At six months, the intervention was effective in improving mothers’ complementary-food preparation and handling practices, reducing microbiological contamination of food and water, and increasing the availability of soap in kitchens and latrines.

At 32 months, because of a lack of funds, quality-assured E. coli laboratory tests on food and water and clinic data collection could not be completed.

Alternatives and further work
Buba Manjang, director of the public health directorate at the Ministry of Health of The Gambia, said communities and mothers know most of the correct behaviors but don’t do them even if the means are available.

“This research offers a low-cost, effective solution for The Gambia and other countries to use cultural performing arts in similar behavioral change interventions,” Manjang said.

Expensive and resource intensive water, sanitation, and hygiene (WASH) interventions have been the main way of addressing diarrhea — involving building toilets, providing safe water and creating sewage systems.

Researchers said changing behavior is as important as large infrastructure programs as without involving communities and local people, these new developments can be ignored or do not suit the community. Many programs rely on home visits to the mother encouraging her to change practices without addressing the community support element.

The research builds on smaller scale development studies in Mali and Bangladesh in 2014, and Nepal in 2016. It was funded by the Islamic Development Bank, the Medical Research Council, the UK Department for International Development through the SHARE Consortium, and the UNICEF Gambia Office.

The team also received a £2 million grant for a similar community intervention to reduce diarrhea and improve the growth of young children in urban and rural Mali. Recently started, the project will look at children transitioning out of breastfeeding in 120 communities and villages across the country.