Improving handwashing and food hygiene behaviors for infant and young child feeding in rural Malawi

This United States Agency for International Development (USAID) Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) #2 study focused on handwashing (HW) and food hygiene (FH) during complementary feeding, an under-researched area critical to infant and young child (IYC) health, with little existing evidence on effective interventions. The formative research study aimed to identify an acceptable, feasible, and desirable intervention package to support caregivers’ improved performance of HW and FH behaviors concerning preparation and feeding of complementary foods for IYC. The study had two objectives: Objective 1 was to validate the points in food preparation and consumption that are critical to reducing the consumption of pathogens both directly and indirectly by IYC. Objective 2 aimed to use co-design methods to identify and field test acceptable, feasible, and desirable HW and FH hardware products and behavior change communication (BCC) approaches to address the critical control points identified under the first objective to support HW and FH behaviors by caregivers. The WASHPaLS #2 team conducted this mixed-methods study in Mpama and Onga traditional authorities (TAs) of Chiradzulu district, Malawi. Data collection was implemented in three complementary and sequential steps. Focus Group Discussions (FGDs), in-depth interviews (IDIs), and observations addressed the first objective of validating the Hazard Analysis and Critical Control Points (HACCP) (Step 1), while FGDs with product fairs and community workshops (Step 2) and a trial of improved practices (TIPs; Step 3) addressed the second objective of co-designing and testing the feasible and acceptable intervention package. We present quantitative data from Step 3—TIPs, here. The study was approved by the FHI 360’s Office of International Research Ethics and the National Committee on Research in the Social Sciences & Humanities in Malawi.