Evaluating the Impact of a Low-Cost Food Storage Cabinet ("Meatsafe") on Complementary Food Contamination and Diarrheal Disease in Low-Income Urban Households: A Randomized Controlled Trial in Dhaka, Bangladesh

Diarrhea remained a major cause of illness and death among children under five years old in low- and middle-income countries (LMICs). In Bangladesh, complementary foods for young children were frequently contaminated with Escherichia coli (E. coli). Storing food uncovered exposed it to contamination from flies, dust, animals, and hands. Existing water, sanitation, and hygiene (WASH) programs did not directly address food hygiene within the home. This randomized controlled trial (RCT) tested whether a low-cost, mesh-covered food storage cabinet ("meatsafe") could reduce microbial contamination of cooked food in urban settlements in Dhaka. Meatsafes were commercially available in local markets and familiar to many households. A total of 290 households living in the Mirpur and Korail settlements were enrolled. Each household had at least one child aged 6 to 24 months. The protocol originally anticipated enrolling 252 households, but 290 were enrolled to maintain balanced allocation and mitigate attrition. Households were randomly assigned to the intervention or control group. Study staff completed follow-up visits every two weeks through Week 10 (five post-intervention follow-ups). Households in the control group did not receive a meatsafe or food hygiene education and continued their usual food storage practices. Households in the intervention group received a free meatsafe and one-time, in-person education on safe food storage and hygiene, along with an illustrated handout to display in the home. Participating households completed surveys on demographics, hygiene behaviors, child feeding, and health; provided stored food samples that were tested for E. coli using culture plating with colony-forming units per gram (CFU/g) enumeration; reported any child diarrhea in the previous seven days; and participated in spot checks of household hygiene and meatsafe use. The primary outcome was the prevalence of complementary food samples with >= 100 CFU/g of E. coli. Secondary outcomes included caregiver-reported diarrhea, dietary diversity, snack and street-food consumption, and measures of meatsafe use and functionality. This study produced evidence on whether providing meatsafes could improve food safety and reduce diarrheal disease among young children in dense urban communities.