Abstract
In low‐ and middle‐income countries, food may be a critical transmission route for pathogens causing childhood diarrhoea, but basic food hygiene is often overlooked in public health strategies. Characterising child food contamination and its risk factors could help prioritise interventions to reduce foodborne diarrhoeal disease, especially in low‐income urban areas where the diarrhoeal disease burden is often high. This cross‐sectional study comprised a caregiver questionnaire coupled with food sampling, and food preparation observations, among the study population of an ongoing sanitation trial in Maputo. The aim was to determine the prevalence of child food contamination and associated risk factors. The prevalence of Enterococcus spp., as an indicator of faecal contamination, was estimated in food samples. Risk factor analyses were performed through zero‐inflated negative binomial regression on colony counts. A modified hazard analysis and critical control point approach was used to determine critical control points (CCPs) that might effectively reduce risk. Fifty‐eight linked caregiver questionnaires and food samples were collected, and 59 food preparation observations were conducted. The prevalence of enterococci in child foods exceeding 10 colony forming units per gram was 53% (95% confidence interval [40%, 67%]). Risk factors for child food contamination were identified, including type of food, food preparation practices, and hygiene behaviours. CCPs included cooking/reheating of food and food storage and handling. This exploratory study highlights the need for more research into diarrhoeagenic pathogens and foodborne risks for children living in these challenging urban environments.
Highlights
In low- and middle-income countries (LMICs), food may be a critical transmission route for the faecal pathogens that cause diarrhoea (Esrey, 1990)
The World Health Organization (WHO) estimates that, in 2010, 230,000 deaths and 18 million disability-adjusted life years worldwide resulted from foodborne diarrhoeal disease (World Health Organization [WHO], 2015), with the burden largely concentrated in LMICs
The aim of this study was to assess the prevalence of faecal contamination of child foods and identify associated food hygiene risk factors that might be targeted in future interventions
Summary
In low- and middle-income countries (LMICs), food may be a critical transmission route for the faecal pathogens that cause diarrhoea (Esrey, 1990). The World Health Organization (WHO) estimates that, in 2010, 230,000 deaths and 18 million disability-adjusted life years worldwide resulted from foodborne diarrhoeal disease (World Health Organization [WHO], 2015), with the burden largely concentrated in LMICs. The World Health Organization (WHO) estimates that, in 2010, 230,000 deaths and 18 million disability-adjusted life years worldwide resulted from foodborne diarrhoeal disease (World Health Organization [WHO], 2015), with the burden largely concentrated in LMICs In these settings, faecal contamination of water (Esrey, 1990; Marino, 2007) and the environment (Curtis et al, 2011; Motarjemi, Käferstein, Moy, & Quevedo, 1993), presence of flies and rodents (Motarjemi et al, 1993), and lack of refrigeration or appropriate storage (Rowland, Barrell, & Whitehead, 1978) contribute to high levels of food contamination. High-risk settings, such as urban “informal neighbourhoods,” where high population density and limited access to water, sanitation, and hygiene could intensify contamination (Baker et al, 2018; Cumming, Elliott, Overbo, & Bartram, 2014; Davis et al, 2018), should be a focus of food safety measures
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