Design of an intervention to minimize ingestion of fecal microbes by young children in Rural Zimbabwe

Mduduzi N.N. Mbuya, Naume V. Tavengwa, Rebecca J. Stoltzfus, Valerie Curtis, Gretel H. Pelto, Robert Ntozini, Rukundo A. Kambarami, Dadirai Fundira, Thokozile R. Malaba, Diana Maunze, Peter Morgan, Goldberg Mangwadu, Jean H. Humphrey

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


We sought to develop a water, sanitation, and hygiene (WASH) intervention to minimize fecal-oral transmission among children aged 0-18 months in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. We undertook 4 phases of formative research, comprising in-depth interviews, focus group discussions, behavior trials, and a combination of observations and microbiological sampling methods. The resulting WASH intervention comprises material inputs and behavior change communication to promote stool disposal, handwashing with soap, water treatment, protected exploratory play, and hygienic infant feeding. Nurture and disgust were found to be key motivators, and are used as emotional triggers. The concept of a safe play space for young children was particularly novel, and families were eager to implement this after learning about the risks of unprotected exploratory play. An iterative process of formative research was essential to create a sequenced and integrated longitudinal intervention for a SHINE household as it expects (during pregnancy) and then cares for a new child.

Original languageEnglish (US)
Pages (from-to)S703-S709
JournalClinical Infectious Diseases
StatePublished - Dec 15 2015


  • environmental enteric dysfunction
  • formative research
  • intervention design research
  • stunting
  • water, sanitation and hygiene

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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