Effect of Behavior Change Intervention on Complementary Food Contamination in Rural Bangladesh: A Cluster-Randomized Controlled Trial

Children in low-resource settings often consume microbially contaminated food, risking their health. We evaluated the impact of a food hygiene intervention on complementary food contamination in Bangladesh. A 3-year homestead food production intervention was complemented by an 8-month behavior change module to improve household food hygiene practices and evaluated in a cluster-randomized controlled trial, including a dedicated study measuring outcomes along the hygiene pathway to intestinal health. We used multilevel regression to assess the intervention’s impact on microbial food contamination as well as food hygiene knowledge ( n = 518) and reported practices ( n = 531) among mothers of children 6–23 months of age. Complementary food samples were collected from 342 households with children 6–18 months of age and tested for Escherichia coli . Overall, 46% of food samples were contaminated with E. coli (43% intervention, 51% control), and there was no evidence that the intervention reduced food contamination (odds ratio: 0.65, 95% CI: 0.35–1.21). A higher proportion of intervention mothers could name all key food hygiene practices (23% intervention versus 1% control), had access to a basic handwashing station near the kitchen (24% versus 14%), reported washing hands before food preparation and child feeding (21% versus 8%), reported washing and storing feeding utensils safely (61% versus 49%), and reported preparing food fresh or reheating stored food (88% versus 79%) compared with control mothers. The intervention thus improved knowledge and reported food hygiene practices among mothers, but this improvement did not result in a substantial reduction of complementary food contamination.