Implementation of the hazard analysis critical control point (HACCP) method to improve microbiological food safety in peri-urban Mali

Abstract

Diarrhoeal diseases remain a main cause of preventable death, particularly among children under five years of age in developing countries. In addition, many studies related to infant diarrhoea causation have demonstrated that the level of contamination is higher in weaning foods than in drinking water. Furthermore, many studies addressed food microbiological contamination and its role in diarrhoea causation. But few of them resulted in an intervention. Although the Hazard Analysis, Critical Control Point (HACCP) approach has been developed and widely applied to food promotion in industrialised countries, and adapted to small and/or less Developed Businesses, few studies have examined its relevance to domestic preparation of food. However, these latter predicted that the implementation of the approach could lead to an improvement of household bacteriological food safety, but none of them completed the approach to find out how effective it is. Therefore, this study aimed to take that work one step further, and carried out a small-scale intervention developed on the basis of the HACCP approach. This latter has been extended to health district level in order to find out its impact on microbial reduction in weaning food. Experiment: The HACCP approach has been applied step by step, to two selected weaning foods prepared by 15 volunteer mothers in peri urban Mali. After setting Critical Control Point (CCP), actions were taken to control, reduce or eliminate microbial growth at these points. 432 food samples were collected and analysed in local Laboratory for FC count to assess the effectiveness of the approach. Lessons learnt were translated into messages delivered in a pilot study. Pilot study: Sample of 60 volunteer mothers selected randomly was split into two groups of 30, the first undergoing messages directed to actions implementation, and the second standing as a control. Bacteriological samples were taken and analysed and physical parameters were measured,· as in the experiment, in 60 households before the intervention and data collected set as baseline. After three weeks training, alongside with observations, foods samples were taken in both intervention and control households for Fe count in local Laboratory. Flow diag~ams of foods, Moni and Fish Soup indicated that they were exposed to contamination at all steps of their preparation and handling. The hazard analysis confirmed FC contamtnation of all suspected steps except cooking. Four CCPs were identified for each food (cooking, reheating, child service with cooled food after cooking, and child service with cooled food after reheating). The experiment showed that traditional cooking was very effective in FC elimination; reheating was as effective as cooking when adopted, because no difference existed between two operations' temperatures (P<0.0001). Behavioural corrective actions were effective in controlling FC contamination at remaining CCPs (child service after cooking and child service after reheating). In conclusion, the HACCP experiment improved significantly the bacterial safety of the two type of weaning foods studied. Thus its behavioural corrective actions were translated into educational messages for the following phase aiming to confirm the effectiveness of the HACCP approach in improving foods safety at household level. The pilot study data showed the effectiveness of cooking in FC elimination at CCPs considered. A comparison of seasonal variation of FC contamination levels at CCPs showed that these levels were higher at Moni cooking CCP in December (cold season) (P<0.0004) and in August (rainy season) (P<0.0002), compared to June (dry season). They were also higher at Fish Soup storage CCP in December compared to August (P< 0.0098). There was significant difference in FC contamination levels between cooking and storage CCPs, the latter was higher than the former, for both Moni and Fish Soup (P< 0.0001). A comparison of FC contamination levels before and after intervention showed that the intervention was very effective in FC contamination reduction at the two remaining CCPs (service after cooking and service after reheating), (P<0.0001). Indeed, at the end of the intervention, contamination levels were less than 10FC/g in more than 83% of cooled food samples (prior to child service) after cooking and about 96% of cooled food samples (prior to child service) after reheating. An assessment of the intervention mothers' ability to perform actions three months later resulted in a better effect, 83 % to 100% of food samples' FC contam.ination levels met the standard. The present research findings showed that not only was the HACCP approach effective in improving home food safety but also, it was relevant for food hygiene and safety promotion in low income community. Two research questions were highlighted: firstly, could food safety improvement achieved through the HACCP approach result in diarrhoea morbidity and mortality reduction among young children? And secondly, is the approach scalable and cost effective?