Table 2.

Summary of the integrated study methods and tools used to assess WASH and food safety at the household level

Tool	Description	Sample size
Questionnaire-based interview	Mothers are asked about infant and young child feeding practices, household food expenditure and the main household decision-makers and influencers of these activities. Physical activity questionnaires ask mothers about the times spent on work and housekeeping including collecting water, fodder and fuel. Furthermore, there are questions on water sources, water security, sanitation and handwashing. Other questions focus on the practices of acquisition, transport, storage, preparation of ASF and the points of potential contamination in the household. Finally, other questions refer to the presence and behaviour of animals and potential transmission pathways associated with close proximity to animals, such as direct contact between animals and children or food. The hazards and risks prior to arrival of ASFs in the household are elucidated in a separate component, at the value chain level (see Cooper et al in this supplement).	Whole cohort (500 households per country)
Spot-check	Enumerators observe behavioural issues alongside the interview questionnaire. The data are recorded using a check list on the availability and type of sanitation facilities available at the households (eg, the place for defecation and proximity), handwashing infrastructure (eg, location, availability of water and soap), presence of animals (eg, livestock, pests), food storage facilities and practices (eg, functioning refrigerator) and food preparation (eg, easy to clean equipment).	Whole cohort (500 households per country)
Direct observation	Enumerators stay at the household for 3 hours around a feeding event, observing the mothers perform their daily activities and taking a passive approach to blend into the background in order to better observe hygiene related behaviours. Structured observation include activities related to water collection and storage, as well as personal, environmental and food hygiene (food preparation, storage, child feeding, handwashing and animal contact). This data collection method is a gold standard for actual observation of behavioural practices.	Subsample (approximately one-third of full cohort in each country)
Biological sampling and testing	Enumerators collect samples of stored water, foods to be consumed by the children (as close to the feeding of the child as possible) and a swab of the main food preparation area at the households. Samples of hands rinse are optional. The samples are stored in a coolbox and transported to a specialised laboratory for analysis. The samples are processed in-country and tested for overall contamination and for selected pathogens (such as Salmonella, Shigella, Escherichia coli and Campylobacter for food and E. coli/faecal indicators for surfaces and water), using standard laboratory protocols (of conventional culture and PCR). Part of the samples collected are used for lab analysis and the remaining part stored under −20°C for future analysis and crosschecking.	Subsample (approximately one-third of full cohort in each country)

ASF, animal source foods; WASH, water, sanitation and hygiene.