Fatal health threat to young African children reduced by innovative artistic intervention

Please note that, due to production issues, publication of the PLOS Medicine paper cited in this release has been delayed. It will be included in this release when a new publication date is confirmed.

The fatal threat from diarrhoea and pneumonia to young children in the world's poorer countries can be drastically reduced by using traditional performing arts to encourage mothers to provide youngsters with safe food and water, a new study reveals.

The Gambia, like many other Low- and Middle-income Countries (LMICs) faces high rates of under-five deaths due to diarrhoea and pneumonia - the two highest causes of death in this age group in this country and globally.

Children transitioning from breastfeeding to eating food are at most risk, as complementary food becomes contaminated. Researchers working in The Gambia discovered that mothers' food safety and hygiene behaviours were massively improved by a low-cost behaviour change community programs trialled in rural villages.

After six months, researchers observed that hospital admissions had reduced by 60% for diarrhoea and 30% for respiratory infection. After 32 months, the mothers continued to practice improved food safety and hygiene practices, informing and encouraging new mothers to do the same.

Led by experts from the University of Birmingham, the international research team has now published its findings in PLOS Medicine.

Lead researcher, Dr Semira Manaseki-Holland, Clinical Senior Lecturer in Public Health at the University of Birmingham, commented: "We developed a low-cost, but seemingly effective, community health intervention that if replicated in countries around the globe could save thousands, if not millions, of lives in the years ahead.

"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. Although we could not measure death rates, since diarrhoea and pneumonia is a leading cause of death in young children, we can deduce that the program can result in fewer young children dying from diarrhoea and pneumonia."

The research programme used a randomised trial across 30 Gambian villages (15 got the program and 15 instead got messages about household gardens) to identify and correct behaviour around critical points in food preparation and handling when contamination can occur.

Researchers translated food safety and hygiene information into stories and songs with a central figure called 'MaaChampian' - a role model mother with behaviours that mothers and families strived to achieve. Five community visits included performances and music -honouring the achievements of mothers and other community members towards becoming mentoring figures themselves.

Dr Buba Manjang, Gambian lead researcher and Director of Public Health Directorate of the Ministry of Health of the Gambia, commented: "Communities and mothers know most of the correct behaviours, but for some reason they 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 behavioural change interventions. This will help to reduce the fatal impact of diarrhoea and pneumonia by involving whole communities to support the mothers and improve child health."

Historically, expensive and resource intensive water, sanitation, and hygiene (WASH) interventions were and still are the main accepted way of addressing diarrhoea and pneumonia - involving building toilets, providing safe water, creating sewage systems.

However, changing behaviour of communities is as important as these large infrastructure programs. Without involving communities and local people, these new developments can either be ignored or not adequately suit the life of people they are intended for.

Many of these programs rely on home visits to the mother informing and encouraging her to change her practices without adequately addressing the community support that she needs to do this.

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This research builds on smaller scale development studies that began in Mali and Bangladesh in 2014, as well as Nepal in 2016. The latest study in Gambia developed this early work into a scalable, low-cost, easy-to-deliver locally-sourced program.

Funded by Islamic Development Bank, the Medical Research Council (MRC), DFID/SHARE Consortium and UNICEF Gambia Office, the programme directly addresses a number of UN Sustainable Development Goals: Good health and well-being (SDG 3); Clean water and sanitation (SDG6); and Partnerships for the Goals (SDG 17).

The team has also secured a £2 million MRC grant to run a similar community intervention to reduce diarrhoea and improve the growth of young children in urban and rural Mali. Due to start in January, the Mali project will assess children transitioning out of breast feeding in 120 communities and villages across the country.

For media enquiries please contact Tony Moran, International Communications Manager, University of Birmingham, tel: +44 (0)7827 832312: email: t.moran@bham.ac.uk

• The University of Birmingham is ranked amongst the world's top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries.
• 'Effects of promoting safe and hygienic complementary-food handling practices through a community-based program on childhood infections: a cluster randomised controlled trial in a rural area of the Gambia' - Semira Manaseki-Holland, Buba Manjang, Karla Hemming, James T. Martin, Christopher Bradley, Louise Jackson, Makie Taal, Om Prasad Gautam, Francesca Crowe, Bakary Sanneh, Jeroen Ensink, Tim Stokes, Sandy Cairncross is published in PLoS Medicine.
• Partner institutions involved include: American International University of West Africa, The Gambia; National Nutrition Agency of the Gambia; National Public Health Laboratories of the Gambia, MRC Gambia Office; UNICEF Gambia Office; and Water Aid, London.