Mali health project aims to save children from diarrhoea death

University of Birmingham experts are leading a new project in Mali to reduce the fatal threat from diarrhoea to young children and help to improve their growth.

The programme will encourage families to change their food safety and hygiene behaviour - particularly focussing on children transitioning from breastfeeding to eating food, with these youngsters at most risk, as complementary food becomes contaminated.

Experts will use culturally relevant dramatic arts – including drama, songs and stories – as well as public meetings and home visits to engage with tens of thousands of people living in 60 rural villages and 60 urban communities in urban and rural Mali during the three-year project.

Backed by £2 million of UKRI funding, the programme starts in January and builds on University of Birmingham-led research in The Gambia. This revealed that mothers’ food safety and hygiene behaviours were massively improved by low-cost behaviour change community programmes trialled in rural villages.

Co-Chief investigator, Dr Semira Manaseki-Holland, Clinical Senior Lecturer in Public Health at the University of Birmingham, commented: “This seemingly effective, community health intervention could save thousands of young lives in Mali and millions more if replicated in other low-income countries around the world in the years ahead.

“There are thousands of rural villages in sub-Saharan Africa and we believe that these interventions can be applied just as successfully as in The Gambia, where we saw mothers with weaning age children improve their food hygiene practices 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 Mali study is designed to explore whether the interventions work differently in rural and urban contexts, as well as to examining other societal influences such as household poverty, women's work, and education.

Using observations, interviews, discussion groups, surveys and laboratory tests, the researchers will compare what impact the intervention has on diarrhoea, growth and development in urban and rural settings.

The experts have designed the intervention to be sustainable through peer-education and support among mothers and older female volunteers - requiring only small levels of additional input from central government in Mali. Birmingham researchers are working with partners from Loughborough University, London School of Hygiene and Tropical Medicine, International Centre for Diarrhoeal Disease Research (ICDDR), in Bangladesh, and WaterAid, as well as the Ministry or Health in Mali, National Public Health Laboratories of Mali, World Health Organisation and UNICEF.

Mali, like many other Low- and Middle-income Countries (LMICs) faces high rates of under-five deaths due to diarrhoea and pneumonia - after malaria the second and third leading causes of death in children in the country.

Historically, important but 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.

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