Meatsafe Food Storage and Diarrhea Prevention Trial in Urban Bangladesh

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

The goal of this clinical trial was to evaluate whether a simple household food storage cabinet called a "meatsafe" could reduce bacterial contamination of complementary foods and decrease diarrhea among children aged 6 to 24 months living in low-income settlements of Dhaka, Bangladesh.The study compared households that received a meatsafe and one-time food storage education with households that continued their usual practices. Participating caregivers completed surveys; provided stored food samples for microbiological testing; answered questions about recent child illness; and took part in spot checks of household hygiene and meatsafe use. The trial generated evidence on whether a low-cost and practical tool could help keep children's food safer and reduce diarrheal disease in settings without reliable refrigeration.

Study Overview

• Status: Completed
• Conditions: Diarrhea
• Intervention / Treatment: Device: Meatsafe Food Storage Cabinet

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 290
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Bangladesh
  • Dhaka, Bangladesh, 1212
    • International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Household had at least one child aged 6 to 24 months.
• Adult caregiver aged 18 years or older, responsible for child feeding, provided informed consent.
• Household had lived in the study area for at least 6 months and expected to remain for at least 6 additional months.
• Caregiver demonstrated willingness to comply with the assigned intervention or control.

Exclusion Criteria:

• Household owned a functional meatsafe or refrigerator.
• Household planned relocation outside the study area within 6 months.
• Caregiver did not provide informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Meatsafe Arm; Households received a low-cost, mesh-covered food storage cabinet ("meatsafe") and one-time, in-person education on safe food storage and hygiene. Caregivers also received an illustrated handout to display in the home.	Device: Meatsafe Food Storage Cabinet; A wire-mesh cabinet for storing cooked food. Designed to prevent contamination from flies, dust, animals, and handling. Distributed with an educational handout and verbal instruction on safe food storage.
No Intervention: Control Arm; Households did not receive a meatsafe or safe storage education and continued their usual food preparation and storage practices.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of high-level E. coli contamination (>=100 colony-forming units per gram of food, cfu/g) in complementary food samples	Food samples were collected from stored complementary foods and tested using standard culture plating. Colony counts were recorded as colony-forming units per gram (CFU/g). Samples with >=100 CFU/g were classified as unsafe per international microbiological standards. Safety Issue: No	Baseline; Weeks 2, 4, 6, 8, and 10

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
7-day caregiver-reported diarrhea in children less than 23 months old	Diarrhea was defined per World Health Organization (WHO) criteria as >=3 loose stools within a 24-hour period in the past 7 days.	Baseline; Weeks 2, 4, 6, 8, and 10
Duration of food storage	Data collectors will record the duration that prepared complementary foods are stored using the following defined categories: <=4 hours, >4 to 8 hours and >8 hours.	Weeks 2, 4, 6, 8, and 10
Temperature of food storage location	Ambient temperature of the food storage area was measured in degrees Celsius using a digital thermometer.	Weeks 2, 4, 6, 8, and 10
Humidity of food storage location	Relative humidity of the food storage environment was recorded as a percentage (%) using a digital hygrometer.	Weeks 2, 4, 6, 8, and 10
Recall of food hygiene and meatsafe behavior-change messages	Caregivers were asked to recall and describe key hygiene and storage messages from the educational handout.	Week 10
Meatsafe functionality	Spot checks observation of functionality of the food storage cabinet assessed using a 3-category rating: does not close / difficult to close / closes easily. These categories do not represent a numerical or ordinal scale.	Weeks 2, 4, 6, 8, and 10.
Meatsafe Cleanliness	Spot checks observation of cleanliness assessed using a 3-category rating: considerable dirt / some dirt / very clean. These categories do not represent a numerical or ordinal scale.	Weeks 2, 4, 6, 8, and 10
Meatsafe screen condition	Spot checks observation of screen condition assessed using a 3-category rating: multiple holes / one hole / no holes. These categories do not represent a numerical or ordinal scale.	Weeks 2, 4, 6, 8, and 10

Collaborators and Investigators

• Sponsor: University of California, Berkeley
• Collaborators: Johns Hopkins Bloomberg School of Public Health; International Centre for Diarrhoeal Disease Research, Bangladesh

Study record dates

Study Major Dates

• Study Start (Actual): August 11, 2024
• Primary Completion (Actual): October 20, 2024
• Study Completion (Actual): November 30, 2024

Study Registration Dates

• First Submitted: November 18, 2025
• First Submitted That Met QC Criteria: December 31, 2025
• First Posted (Estimated): January 12, 2026

Study Record Updates

• Last Update Posted (Estimated): January 12, 2026
• Last Update Submitted That Met QC Criteria: December 31, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Nutrition; Bangladesh; Randomized Controlled Trial (RCT); Child Health; Hygiene; Complementary Feeding; Escherichia coli (E. coli); Public Health Intervention; Food Safety; Low- and Middle-Income Countries (LMICs); Complementary Foods; Food Hygiene; Safe Food Storage; Meatsafe; Urban Slum; WASH (Water, Sanitation, and Hygiene); Enteric Pathogens; Low-Cost Intervention; Foodborne Pathogens; Enteric Infection; Diarrheal Disease; Fecal-Oral Transmission; Microbial Contamination; Foodborne Illness; Childhood Diarrhea Prevention
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Infections; Chemically-Induced Disorders; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Negative Bacterial Infections; Poisoning; Enterobacteriaceae Infections; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Diarrhea; Escherichia coli Infections; Foodborne Diseases
• Other Study ID Numbers: 092000310-UCB-0310

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (IPD), including household survey responses and microbiological food sample results, may be shared upon reasonable request. Only de-identified data will be shared, with all personal identifiers removed, and use will be consistent with participant consent and approvals by the relevant institutional review boards: UC Berkeley Committee for Protection of Human Subjects (CPHS) and icddr,b Ethical Review Committee (ERC).
• IPD Sharing Time Frame: Beginning 6 months after publication of primary findings and continuing for 3 years.
• IPD Sharing Access Criteria: Researchers with a methodologically sound proposal may request access to de-identified IPD and supporting documents. Requests must be reviewed and approved by the principal investigators and the relevant institutional review boards (UC Berkeley CPHS and icddr,b ERC). Data will be shared under a data use agreement and transferred through secure systems.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No