Enteric Pathogen Diversity in Infant Foods in Low-Income Neighborhoods of Kisumu, Kenya

Kevin Tsai,Sheillah Simiyu,Kelly Baker,Jane Mumma,Robert Dreibelbis,Rose Aseyo,Oliver Cumming

doi:10.3390/ijerph16030506

Abstract

Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 infant weaning foods in Kisumu, Kenya, using a multi-pathogen PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoan enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow’s milk was significantly more likely to contain a pathogen (adjusted risk ratio = 14.4; 95% confidence interval (CI) 1.78–116.1) and more likely to have higher number of enteric pathogen species (adjusted risk ratio = 2.35; 95% CI 1.67–3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.

Highlights

Even though the incidence of pediatric diarrheal diseases is declining worldwide, they remain the second most common cause of preventable illness and death among children under the age of five [1], responsible for approximately 800 million illnesses and 800,000 deaths in 2010
Estimates of the importance of food as an enteric infection pathway for young children in low- and middle-income countries (LMICs) are limited by the absence of primary data on food outbreaks and frequency of food contamination by enteric pathogens, especially with respect to weaning foods provided to infants [17]
While we found some domestic food hygiene risk factors were associated with enteric pathogen presence and diversity in bivariate analysis, most of these associations reduced in magnitude and did not improve model fit after adjustment for food type

Summary

Introduction

Even though the incidence of pediatric diarrheal diseases is declining worldwide, they remain the second most common cause of preventable illness and death among children under the age of five [1], responsible for approximately 800 million illnesses and 800,000 deaths in 2010. Of this disease burden is concentrated in children under the age of five in low- and middle-income countries (LMICs) [2,3]. Diarrheal infections are caused by a diverse range of enteric pathogens that infect children as early as birth [4]. There is increasing recognition that consumption of pathogen-contaminated food is an important exposure pathway for diarrheal disease in children in LMICs [7,8].

Objectives

Methods

Results

Discussion

Conclusion