Diarrhea Clinical Trial
Official title:
The Safe Start Trial: a Cluster Randomised Controlled Trial for the Effect of a Food Hygiene Intervention on Infant Enteric Infections and Diarrhoeal Disease in Low-income Informal Settlements of Kisumu, Kenya.
This a cluster randomised controlled trial (cRCT) to evaluate the effect of a novel food hygiene intervention on infant health.
Enteric infections remain a major threat to child health and development in many low and
middle-income countries. Globally, diarrhoeal disease - a key health consequence of enteric
infection - is ranked as the fourth leading cause of disability globally, after ischaemic
heart disease, lower respiratory tract infections and strokes. Diarrhoeal disease persists as
the second leading cause of child deaths in the world, and in sub-Saharan Africa is the
leading cause of child deaths.
Public health efforts to address diarrhoeal disease have largely focused on improving access
to safe drinking water and sanitation and promoting hand washing with soap to address
faecal-oral routes of transmission. These interventions though may not effectively address
all exposure pathways during early life, when young children are most susceptible to
infection and the diarrhoeal disease burden is greatest. One potentially important exposure
pathway is infant food which recent studies conducted in low income, high burden settings
suggest may be highly contaminated and may be amenable to simple behaviour change
interventions.
The Safe Start trial will evaluate the effect of a novel food hygiene intervention on infant
health implemented in low income urban neighbourhoods of Kisumu, Kenya. The intervention is
designed to target early childhood exposure to enteric pathogens through contaminated food
and was developed through an earlier phase of formative behavioural and microbiological
research. The intervention will target infant caregivers and be delivered through the
Community Health Volunteer (CHV) health extension system. Four key behaviours will be
addressed by the intervention:
1. Safe hand hygiene: handwashing with soap before infant food preparation and feeding
2. Safe food preparation: bringing all infant food to the boil before feeding, including
when reheating
3. Safe storage of food: storing all infant food in sealed containers
4. Safe feeding: reserving specific feeding utensils for the infant and keeping these
separate and clean
A cluster randomized controlled trial (cRCT) design will be used to evaluate the intervention
with each CHV catchment area forming one cluster. The outcomes of interest for this study are
as follows: (1) the prevalence of enteric infections among infants at 37 weeks of age
(primary); (2) the longitudinal prevalence of diarrhoea between 22-37 weeks of age (primary);
and (3) incidence of all-cause mortality between 22-37 weeks of age. Infants will be
recruited on a rolling basis at 22 weeks of age (+/- 1 week), and data and/or samples
collected at 3 points: baseline at 22 weeks of age (+/- 1 week); midline at 33 weeks of age
(+/- 1 week); and endline at 37 weeks of age (+/- 1 week). Stool samples will be collected at
baseline and endline and analysed for 23 genetic sequences indicating the presence of enteric
pathogens known to cause childhood diarrhoea in low income, high burden settings.
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