1
|
Wells J, Abugo DG, Angong J, Lamwaka NG, Gallandat K, Hassan JL, Deng L, Save D, Braun L, Gose M, Amanya J, Ayoub K, King S, Stobaugh H, Cumming O, D'Mello‐Guyett L. Risk factors for food contamination among children discharged from community management of acute malnutrition programmes in South Sudan: A cross-sectional study and hazard analysis critical control point approach. MATERNAL & CHILD NUTRITION 2024; 20:e13612. [PMID: 38143422 PMCID: PMC10981483 DOI: 10.1111/mcn.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023]
Abstract
Children under-5 years of age are particularly vulnerable to severe acute malnutrition (SAM), and the risk factors associated with relapse to SAM are poorly understood. Possible causes are asymptomatic or symptomatic infection with enteric pathogens, with contaminated food as a critical transmission route. This cross-sectional study comprised a household survey with samples of child food (n = 382) and structured observations of food preparation (n = 197) among children aged 6-59 months that were discharged from treatment in community management of acute malnutrition (CMAM) programmes in South Sudan. We quantified Escherichia coli and total coliforms (TCs), measured in colony forming units per g of food (CFU/g), as indicators of microbial contamination of child food. A modified hazard analysis critical control point (HACCP) approach was utilised to determine critical control points (CCPs) followed by multivariate logistic regression analysis to understand the risk factors associated with contamination. Over 40% (n = 164) of samples were contaminated with E. coli (43% >0 E. coli CFU/g, 95% CI 38%-48%), and 90% (n = 343) had >10 TCs (CFU/g) (>10 TC CFU/g, 95% CI 87%-93%). Risk factors associated (p < 0.05) with child food contamination included if the child fed themselves (9.05 RR, 95% CI [3.18, 31.16]) and exposure to animals (2.63 RR, 95% CI [1.33, 5.34]). This study highlights the risk factors and potential control strategies that can support interventions that reduce food contamination exposure in young children and help further protect those that are highly vulnerable to recurrent exposure to enteric pathogens.
Collapse
Affiliation(s)
- Joseph Wells
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUK
| | - David Gama Abugo
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUK
- Action Against Hunger (ACF)JubaSouth Sudan
| | | | | | - Karin Gallandat
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Lino Deng
- Action Against Hunger (ACF)JubaSouth Sudan
| | | | - Laura Braun
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUK
| | - Mesfin Gose
- Action Against Hunger (ACF)New YorkNew YorkUSA
| | | | | | - Sarah King
- Action Against Hunger (ACF)New YorkNew YorkUSA
| | - Heather Stobaugh
- Action Against Hunger (ACF)New YorkNew YorkUSA
- Tufts UniversityMedfordMassachusettsUSA
| | - Oliver Cumming
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUK
| | | |
Collapse
|
2
|
Sobhan S, Müller-Hauser AA, Gon G, Nurul Huda TM, Waid JL, Wendt AS, Rahman M, Gabrysch S. Effect of a behaviour change intervention on household food hygiene practices in rural Bangladesh: A cluster-randomised controlled trial. Int J Hyg Environ Health 2024; 255:114291. [PMID: 37983985 DOI: 10.1016/j.ijheh.2023.114291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Behavioural interventions could improve caregivers' food hygiene practices in low-resource settings. So far, evidence is limited to small-scale and short-term studies, and few have evaluated the long-term maintenance of promoted behaviours. We evaluated the effect of a relatively large-scale behaviour change intervention on medium and long-term maintenance of household food hygiene practices in Bangladesh. METHODS We analyse a secondary outcome of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomised trial and its sub-study Food Hygiene to reduce Environmental Enteric Dysfunction (FHEED), conducted in Habiganj district, Sylhet division, Bangladesh. The FAARM trial used a 1:1 parallel arm design and included 2705 women in 96 settlements: 48 intervention and 48 control. Women in the intervention settlements received training in homestead gardening, poultry rearing and nutrition over three years (2015-2018), complemented by an eight-month (mid-2017 to early-2018) behaviour change component on food hygiene using motivational drivers. Nested within the FAARM trial, the FHEED sub-study evaluated several outcomes along the hygiene pathway. For this article, we evaluated household food hygiene behaviours by analysing structured observation data collected in two cross-sectional surveys, four and 16 months after the food hygiene promotion ended, from two independent subsamples of FAARM women with children aged 6-18 months. We assessed intervention effects on food hygiene practices using mixed-effects logistic regression, accounting for clustering. In exploratory analyses, we further assessed behaviour patterns - how often critical food hygiene behaviours were performed individually, in combination and consistently across events. RESULTS Based on the analysis of 524 complementary feeding and 800 food preparation events in households from 571 participant women, we found that intervention households practised better food hygiene than controls four months post-intervention, with somewhat smaller differences after 16 months. Overall, the intervention positively affected food hygiene, particularly around child feeding: using soap for handwashing (odds ratio 5·8, 95% CI 2·2-15·2), cleaning feeding utensils (3·8, 1·9-7·7), and cooking fresh/reheating food (1·8, 1·1-2·8). However, the simultaneous practice of several behaviours was rare, occurring in only 10% of feeding events (intervention: 15%; control: 4%), and the practice of safe food hygiene behaviours was inconsistent between events. CONCLUSION Our findings suggest that a motivational behaviour change intervention encouraged caregivers to maintain certain safe food hygiene practices in a rural setting. However, substantial physical changes in the household environment are likely needed to make these behaviours habitual. TRIAL REGISTRATION NUMBER NCT02505711.
Collapse
Affiliation(s)
- Shafinaz Sobhan
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany.
| | - Anna A Müller-Hauser
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tarique Md Nurul Huda
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia; Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
3
|
Müller-Hauser AA, Huda TMN, Sobhan S, Lambrecht NJ, Waid JL, Wendt AS, Ali S, Rahman M, Gabrysch S. Effect of a Homestead Food Production and Food Hygiene Intervention on Biomarkers of Environmental Enteric Dysfunction in Children Younger Than 24 Months in Rural Bangladesh: A Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2023; 109:1166-1176. [PMID: 37783459 PMCID: PMC10622486 DOI: 10.4269/ajtmh.23-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/08/2023] [Indexed: 10/04/2023] Open
Abstract
Poor sanitation and hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED). We evaluated the impact of a combined homestead food production and food hygiene intervention on EED biomarkers in young children in rural Bangladesh. The analysis was conducted within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in Sylhet, Bangladesh. The FAARM trial enrolled 2,705 married women and their children younger than 3 years of age in 96 settlements (geographic clusters): 48 intervention and 48 control. The 3-year intervention (2015-2018) included training on gardening, poultry rearing, and improved nutrition practices and was supplemented by an 8-month food hygiene behavior change component, implemented from mid-2017. We analyzed data on 574 children age 0 to 24 months with multilevel linear regression. We assessed fecal myeloperoxidase (MPO), neopterin (NEO), and alpha-1-antitrypsin (AAT) as biomarkers of EED, and serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) as biomarkers of systemic inflammation, using ELISA. There was no intervention effect on NEO, AAT, CRP, and AGP concentrations, but, surprisingly, MPO levels were increased in children of the intervention group (0.11 log ng/mL; 95% CI, 0.001-0.22). This increase was greater with increasing child age and among intervention households with poultry that were not kept in a shed. A combined homestead food production and food hygiene intervention did not decrease EED in children in our study setting. Small-scale poultry rearing promoted by the intervention might be a risk factor for EED.
Collapse
Affiliation(s)
- Anna A. Müller-Hauser
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Tarique Md. Nurul Huda
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shafinaz Sobhan
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Nathalie J. Lambrecht
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Jillian L. Waid
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Amanda S. Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Shahjahan Ali
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
4
|
Marege A, Regassa B, Seid M, Tadesse D, Siraj M, Manilal A. Bacteriological quality and safety of bottle food and associated factors among bottle-fed babies attending pediatric outpatient clinics of Government Health Institutions in Arba Minch, southern Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:46. [PMID: 37231498 DOI: 10.1186/s41043-023-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Microbial contamination of baby bottle food has been identified as a significant public health concern, especially in developing countries, but it remains overlooked. Therefore, this study aimed to determine microbiological hazards, compliance with hygiene practices, and critical control points of contamination in baby bottle food in Arba Minch, southern Ethiopia. OBJECTIVE To evaluate the bacteriological quality and prevalence of foodborne pathogens in baby bottle food and to identify associated factors among bottle-fed babies attending three government health institutions in Arba Minch, southern Ethiopia. METHODS A cross-sectional study was conducted between February 24 and March 30, 2022. A total of 220 food samples, comprising four types prepared with different sources of materials, were collected from systematically selected bottle-fed babies attending health facilities. The data on sociodemographic characteristics, food hygiene, and handling practices were solicited by face-to-face interview using a semi-structured questionnaire. Food samples (10 mL) were quantitatively analyzed for total viable counts (TVC) and total coliform count (TCC) and qualitatively for the presence of common foodborne bacterial pathogens. Data were analyzed using SPSS; ANOVA and multiple linear regression analyses were done to identify factors influencing microbial counts. RESULTS Results revealed that the means and standard deviations of TVC and TCC were 5.3 ± 2.3 log10 colony forming units (CFU)/mL and 4.1 ± 2.6 log10 CFU/mL, respectively. Of the various food samples analyzed, 57.3 and 60.5% had a TVC and TCC above the maximum acceptable limits, respectively. The result of the ANOVA showed that there was a significant difference in the mean score of TCV and TCC among the four types of food samples (p < 0.001). Enterobacteriaceae were found in the majority of positive food samples (79.13%), followed by Gram-positive cocci (20.8%). Salmonella spp., diarrheagenic Escherichia coli, and Staphylococcus aureus were the common foodborne pathogens detected in 8.6% of tested foods. The regression result revealed that the type of baby food, hand washing practices of mothers or caregivers, and sterilizing and disinfecting procedures of feeding bottles are independent determinants of bacterial contamination (p < 0.001). CONCLUSION The high microbial load and the presence of potential foodborne bacterial pathogens in the bottle food samples analyzed indicate unsanitary practices and the potential risk of exposure to foodborne pathogens in bottle-fed babies. Thus, interventions such as educating parents about proper hygiene practices, sterilizing feeding bottles and limiting bottle feeding practices are critical to reducing the risk of foodborne to bottle-fed infants.
Collapse
Affiliation(s)
- Alebachew Marege
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belayneh Regassa
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mohammed Seid
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Dagimawie Tadesse
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Munira Siraj
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| |
Collapse
|