Abstract
Diarrhoeal disease remains one of the leading causes of morbidity and mortality in the under-five population, particularly in low income settings such as sub-Saharan Africa. Despite significant progress in sanitation and water access, faecal-oral infections persist in these populations. Therefore, a better understanding of these transmission pathways, and how potential risk factors can be reduced within low income contexts is needed. This study, conducted in Southern Malawi from June to October 2017, used a mixed methods approach to collect data from household surveys (n = 323), checklists (n = 31), structured observations (n = 80), and microbiological food samples (n = 20). Results showed that food prepared for immediate consumption (primarily porridge for children) posed a low health risk. Poor hygiene practices increased the risk of contamination from shared family meals. Faecal and Staphylococcal bacteria were associated with poor hand hygiene and unhygienic eating conditions. Leftover food storage and inadequate pre-consumption heating increased the risk of contamination. Improvements in food hygiene and hand hygiene practices at critical points could reduce the risk of diarrhoeal disease for children under 2 years but must consider the contextual structural barriers to improved practice like access to handwashing facilities, soap, food and water storage.
Highlights
Diarrhoeal disease remains one of the leading causes of morbidity and mortality in the under-five population globally, with approximately 424,000 deaths annually [1]
We found that 30% of children within the sampled households had suffered from diarrhoea in the 2 weeks preceding, which was consistent with responses from the household survey (27%)
This study examines the risk factors for faecal-oral routes of infection for children under the age of two years in rural Malawi
Summary
Diarrhoeal disease remains one of the leading causes of morbidity and mortality in the under-five population globally, with approximately 424,000 deaths annually [1]. The Malawi Demographic and Health Survey (2016) indicated that 22% of children under the age of five years had diarrhoea two weeks before the survey, a slight increase from the 17.5% reported in 2010 [2,3]. The high prevalence of childhood diarrhoea could be one of the contributing factors to the high under-five mortality rate (62 deaths per 1000 births) experienced in Malawi [2]. Primary sources of direct and indirect contamination have been clearly outlined in the F-diagram for decades [4], highlighting the key transmission routes for pathogenic organisms. Recent research undertaken in low income countries [5,6,7,8,9] has expanded on the F-diagram to better illustrate the links between under-five behaviours, daily activities, and. Public Health 2019, 16, 2146; doi:10.3390/ijerph16122146 www.mdpi.com/journal/ijerph
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
