Abstract
Diarrhoeal diseases remain a significant cause of morbidity and mortality, particularly in poor urban communities in the Global South. Studies on food access and safety have however not considered the sources of discrete food categories and their propensity to harbour and transmit diarrhoeal disease pathogens in poor urban settings. We sought to contribute to knowledge on urban food environment and enteric infections by interrogating the sources and categories of common foods and their tendency to transmit diarrhoea in low-income communities in Accra. We modelled the likelihood of diarrhoea transmission through specific food categories sourced from home or out of home after controlling for alternate transmission pathways and barriers. We used structured interviews where households that participated in the study were selected through a multi-stage systematic sampling approach. We utilized data on 506 households from 3 low-income settlements in Accra. These settlements have socio-economic characteristics mimicking typical low-income communities in the Global South. The results showed that the incidence of diarrhoea in a household is explained by type and source of food, source of drinking water, wealth and the presence of children below five years in the household. Rice-based staples which were consumed by 94.5% of respondents in the week preceding the survey had a higher likelihood of transmitting diarrhoeal diseases when consumed out of home than when eaten at home. Sources of hand-served dumpling-type foods categorized as "staple balls" had a nuanced relationship with incidence of diarrhoea. These findings reinforce the need for due diligence in addressing peculiar needs of people in vulnerable conditions of food environment in poor urban settlements in order to reap a co-benefit of reduced incidence of diarrhoea while striving to achieve the global development goal on ending hunger.
Highlights
Diarrhoea is a major food-borne infectious disease that contributes significantly to the global disease burden
With regards to food types and place of consumption, within the week preceding the survey about two-fifths of households consumed staple rice or staple balls both at home and outside, about a third ate staple rice or staple balls out of home and about a fifth ate rice-based meals or staple balls only prepared at home
We examined the relationship between sources of different types of household foods and diarrhoeal disease incidence
Summary
The study was conducted in three densely populated poor urban communities in Accra: James Town, Ussher Town and Agbogbloshie. These were purposely selected based on their indigeneity, geographical location and a migrant settlement that has less threat of eviction, so that the research team would be able to compare the characteristics and effects of urban poverty between communities of different migratory and natal circumstances. The combination of poor sanitation and inadequate drainage systems make some areas of the study sites flood-prone, which poses an additional threat to residents’ health [35]. Life in these three settlements typifies experiences in informal settlements in subSaharan Africa [39]
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