Household Problem-Solving to Reduce Children's Exposure to Poultry Feces

Campylobacter spp. infections are the most common bacterial cause of gastroenteritis (Murray et al., 2012). In children under two years of age, Campylobacter spp. infections have been associated with poor linear growth, increased intestinal permeability, and increased intestinal and systemic inflammation (Amour et al., 2016). Causes of campylobacteriosis in humans include consuming contaminated water and food; person-to-person transmission; and exposure to domestic animals, especially poultry, and poultry feces (Kaakoush et al., 2015; Zambrano et al., 2014).

In Bangladesh, 80 percent of rural households raise backyard poultry (Dolberg, 2008). In one study among poultry-raising households, 98 percent reported poultry scavenging in the yard, 93 percent reported poultry roaming freely inside homes during the day, and 37 percent reported children touching, carrying, or playing with poultry in the past two weeks (Shanta et al., 2017). Little is known about acceptable and feasible enabling technologies (hardware) or other strategies that could effectively separate children from poultry and poultry feces. Through a grant from the United States Agency for International Development (USAID) Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project, a team led by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) designed this study to:

1. Identify and improve upon existing behaviors and strategies to separate children and poultry and explore feasibility, acceptability, effectiveness, difficulties, benefits, and costs associated with said behaviors and strategies;
2. Investigate the effectiveness of a behavior change communication and counseling intervention, with and without monetary support, to encourage backyard poultry-raising households to confine poultry in a shed in the courtyard at night (i.e., outside of the household dwelling); and,
3. Develop households’ problem-solving capacities as they work to adopt behavioral recommendations to separate young children from poultry/poultry feces.

We undertook this study in two phases. In Phase I, we conducted formative research to identify and refine existing local strategies intended to separate children from poultry feces (Objective 1). The Phase I report contains a description of the formative research methodology and findings. To respond to Phase I findings, we designed a neighborhood-based behavior change and counseling intervention promoting improved nighttime poultry housing practices and poultry feces management, and in Phase II, we conducted a pilot study to investigate the intervention’s effectiveness, with and without monetary support. Objectives of the intervention were to encourage backyard poultry-raising households to (a) build a night shed for poultry confinement (Objective 2) and (b) confine all poultry separately from the household dwelling at night (Objective 3). We hypothesized that an improved poultry shed would enable households to keep all of their poultry outside of the household dwelling at night and thereby reduce fecal contamination inside the household dwelling. We also hypothesized that monetary support would increase the likelihood of a household building, using, and maintaining an improved poultry shed. The midline reports present a description of the intervention development and methods of the pilot study. This report provides an overview of the Phase II pilot study methods and presents the main findings.