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Diarrhea prevention through food safety education

Sheth M, Obrah M. Diarrhea prevention through food safety education.

Indian J Pediatr 2004;71:879-882

Department of Foods and NutritionM.S. University of Baroda, Vadodara, Gujarat, India

報告學員：余燦華報告日期：94/12/23

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Introduction

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• Diarrhea continues to plague the developing world, resulting in more than 3 million deaths.

• Children especially those who are malnourished remain at a greater risk.

• More than 1.5 billion episodes of diarrhea have been reported in the children below 5 years resulting in over 3 million deaths.

Malik K.R. et al. 1996, 1998

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• Contaminated water and food play an important role in the etiology of diarrhea.

Sheth M. et al. 1983, 2000

• The chances of food contamination and cross contamination, become higher especially in the lower socio-economic due to unsatisfactory environmental conditions, poor personal hygiene, poor quality and insufficient water supplies, unhygienic preparation storage and feeding of foods.

Raymond Isley B. et al. 1985, 1996, 1997, 2000

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• Personal hygiene and environmental sanitation are of utmost importance in the prevention of diarrhea, health education in food safety must receive high priority.

• Education of caretakers particularly mothers in the principles of food safety should be considered as an important intervention in prevention of diarrhoeal diseases in young children.

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• Education by the health workers, from the community can play a vital role in this preventive aspects, as they make regular and frequent home visits that help them to establish close links with mothers, thus enhancing prospects for maternal and child health.

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Goals of study

• In order to reduce the diarrhea morbidity and mortality in children the present study was undertaken in which training of AWW was done on food safety who in turn educated the mothers.

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Methods and materials

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Selection of Subjects

• Eight Anganwadi centers were randomly selected from the urban slums of Baroda.

• 200 households (25 under each Anganwadiworker working in the ICDS set up), were purposively selected with children in the age group of 6-24 months.

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Baseline Survey

• 200 households were collected with respect to their socioeconomic status, diarrhea profile of the children, knowledge, attitudes and practices of mothers (KAP) regarding child feeding practices.

• Microbial detection of hand rinse samples of both mothers and children.

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Diarrhea Profile• At the time of interview, mothers were asked

regarding the episodes of diarrhea that the child underwent and their severity in the past one month.

• Children having diarrhea were categorized into those having mild (3-4 loose watery stools in 24 hours), moderate (5-6 loose watery stools) and severe (more than 6 loose watery stools which resulted in signs of dehydration and required medical attention).

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Knowledge, Attitudes and Practices

• Collected with respect to mothers‘s knowledge on ：

1. What Causes Diarrhea.2. Child feeding practices with an emphasis on

hand washing practices.3. Environmental sanitation and personal

hygiene.• Structured questionnaire and spot observations

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Determination of Enterococci in Hand Rinse Samples

• Samples of 50 mothers and 50 children was done using the 'Hi media' rapid enterococci test kit.

• The mothers and children were asked to rinse their hands into a broad mouth funnel with sterile water into sterile bottles containing the test medium.

• The change in color from yellow to dark green indicated the presence of enterococci.

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Training of the AWW-1• Food safety education was imparted to 8

Anganwadi workers in two sessions using calendars and pamphlets.

• Role play and charts encompassing the key messages of causes of diarrhoea, washing hands, keeping the households and surroundings clean and not to feed the leftovers foods stored at ambient temperatures to children.

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Training of the AWW-2

• Food safety material (calendars and leaflets) was distributed to them to be further distributed to the mothers at the time of home visits.

• It was ensured that the Anganwadi workers educated each mother regarding safe feeding practices and the consequences of severe diarrhea.

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Training of the AWW-3

• Post intervention data was collected after a period of two months from the households as per the baseline.

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Statistical Analysis-1

• Scores were assigned to the practices of personal hygiene and environmental sanitation and were rated as excellent, good, average and poor.

• The effect of intervention was determined using Chi-square test.

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Statistical Analysis-2• The effect of intervention on KAP of mothers

regarding their knowledge on: causes of diarrhea, safe feeding practices, personal hygiene and environmental sanitation was studied using Student's t-test.

• In order to study the impact of intervention on diarrhea profile, percentage of children having diarrhea in varying degree of severity was calculated and compared.

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Results

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Socioeconomic Status-1• Most of the families were nuclear and 59%

children belonged to the family size of 4-6.

• The literacy rate among both mothers (85%) as well as fathers (95%) was found to be high.

• In most of the families the monthly income ranged from Rs.1000/- to Rs.1500/- indicating that they belonged to low-income group.

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Socioeconomic Status-2• A majority of the households were non-vegetarians.

• Large number of families tapped water in their homes from municipal source.

• Individual toilet facilities were available in 59% of the households.

• 40% of them either used public toilets or defecated in open.

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Diarrhea Profile of Children

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Environmental Sanitation and Personal Hygiene

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Detection of Enterococci in Hand Rinse Samples

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KAP of Mothers Regarding the Etiology of Diarrhea, ES and PH

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KAP of Mothers Regarding Environmental Sanitation

• 96.5% of the mothers became aware of the association of child's health with environment.

• households (76.5%) started using a dustbin for household waste disposal as compared to only 6% households prior to FSEI.

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KAP Mothers Regarding Personal Hygiene

• Most of the mothers became aware of the reasons for washing hands prior to feeding, cooking and eating.

• 51% started believing that it is necessary to wash hands to avoid diseases and microorganisms.

• Spot observations revealed that most of the mothers started washing hands with soap and water after activities such as visit to toilot, cleaning child's defections, cleaning child's nose and sweeping and mopping.

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KAP of Mothers Regarding Feeding Leftover Food to Children

• Most of the mother (82.5%) either the leftover food thoroughly as compared to only 13% before intervention.

• Many mothers (50%) became aware of ill effects of feeding leftover moist foods to the children especially if that was stored at ambient temperature for long hours.

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Discussion

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• The success of the present study can be attributed to the cumulative effect of improvement in all the factors such as ES, PH and feeding practices of the mothers.

• The key messages imparted by the AWW during their home visits could be comprehended more effectively by the mothers because of their high literacy rate reported to be quite low in earlier studies.

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• Positive correlation between literacy rate and the knowledge gains has also been reported in some other studies.

Molbak K. et al., 1997

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• Behaviors such as child defecation on the floor, water or rag being used to cleanse the child after defecation and mother not washing the child's hand or her hands with soap and water after defecation or cleansing child's perineum were directly related to high incidence of diarrhea.

Khin-Maung u. et al., 1994

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• The change agents selected from the community formed an effective medium of communication in the education process.

• Generally the education strategies often fail because the practices are selected by the outsiders and proposed to the community.

Pinfold J. et al., 1996

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• Many features of the AWW came up in the study which include, a good rapport between them and community, motivation, genuine interest in bringing about the change, regular reinforcement and follow up of the messages.

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Conclusion

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• Food safety education imparted through motivated change agents can play an important role not only in the reduction of diarrheal morbidities in young children but increasing awareness in the mothers regarding Safe Feeding Practices.

• Thus FSE should receive high priority in the ongoing programmes for improving maternal and child health.

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Thanks for your attention