Infant Food Samples Research Articles

Health risk assessment of trace metal concentrations in cereal-based infant foods from Arba Minch Town, Ethiopia

The study aimed to determine the trace metal concentrations and assess the associated health risk of consuming cereal-based infant foods sold in supermarkets and local shops (baltena) in Arba Minch town, Ethiopia. Samples were subjected to a microwave digestion process and the trace elements were analyzed using Flame Atomic Absorption Spectrometry (FAAS). The method’s accuracy was validated through a recovery test, yielding optimal results within the range of 94–100 %. The average concentrations of trace elements in the infant food samples were as follows: Iron (36.51–47.58 mg/kg), Copper (1.86–2.57 mg/kg), Zinc (13.90–21.56 mg/kg), Nickel (0.02–0.04 mg/kg), Chromium (0.034–0.10 mg/kg), Cobalt (0.012–0.02 mg/kg). Notably, potentially toxic heavy metals like Cadmium and Lead were not detected in the samples. The hazard quotient (HQ) for (6−9) month old infants was less than one (HQ<1) for all the trace elements analyzed. The same holds good for (9−12) month old infants except few food samples such as Selam, Zini, Mimi and Mulga baltena, which had HQ values greater than one (HQ>1). It is inferred that the continuous consumption of these foods might cause risk over a longer period.

Development of a highly sensitive method based on QuEChERS and GC-MS/MS for the determination of polycyclic aromatic hydrocarbons in infant foods.

Polycyclic aromatic hydrocarbons (PAHs) are environmental contaminants that can be found in various food products, including those intended for infants. Due to their potential health risks, it is crucial to develop sensitive analytical methods for the accurate determination of PAHs in infant foods. This study describes the development and validation of a highly sensitive method for the quantification of European PAH markers, namely benzo[a]pyrene, benzo[a]anthracene, chrysene, and benzo[b]fluoranthene, using gas chromatography-tandem mass spectrometry (GC-MS/MS), in baby food samples. The first step was the optimization of the sample preparation procedure, performed using different methods based on the QuEChERS approach, also testing different extraction solvents. Several factors such as extraction efficiency, selectivity, and recovery were evaluated to choose the most effective procedure for sample preparation. Furthermore, the GC-MS/MS method was optimized, evaluating parameters such as linearity, sensitivity, accuracy, and robustness using spiked infant food samples. The method demonstrated excellent linearities with a correlation coefficient higher than 0.999 over a wide concentration range, and limits of detection and limits of quantification in the range 0.019-0.036 μg/kg and 0.06-0.11 μg/kg, respectively. Extraction recoveries were between 73.1 and 110.7%, with relative standard deviations always lower than 8%. These findings are compliant with the indications of the European Commission (Reg. 836/2011). To assess the applicability of the method to official control activities, a survey was conducted on commercially available infant food products. Four markers were determined in commercial samples belonging to different food categories for infants and young children. The outcome of this monitoring showed that PAH contamination, in all samples, was below the quantification limits. In conclusion, the developed GC-MS/MS method provides a highly sensitive and reliable approach for the determination of PAHs in baby foods. The optimized sample preparation, instrumental parameters, and validation results ensure accurate quantification of 4 PAHs even at trace levels. This method could contribute to the assessment of PAH exposure in infants and it could support regulatory efforts to ensure the safety and quality of infant food products with regular monitoring.

Co-ingestion of Cereals and Legumes during Infant Complementary Feeding: Starch and Protein in vitro Digestion.

This study explores the impact of co-ingesting cereals and legumes on starch and protein during simulated infant in vitro digestion. Various legumes (chickpeas, lentils, peas) were added to cereals (durum wheat, brown rice, white maize), and their effects on starch and protein hydrolysis were analyzed. Substituting 50% of cereal with legumes increased proteins, minerals, and dietary fiber. Infant food with legumes exhibited smoother pasting properties. Legumes in cereal purées led to varying starch hydrolysis trends, with the lowest values in durum wheat with chickpea and all cereal blends with peas. Resistant starch levels exceeding 50% were found in infant food samples. Digested protein hydrolysis increased with legumes in durum wheat, except for peas. Brown rice mixtures decreased significantly compared to the control with chickpeas (61%) and peas (42%), while lentil blends increased by 46%. Legumes generally did not significantly affect starch bioavailability, even with α-amylase inhibitors. Lentil-cereal purées could enhance infant food nutritional value.

Sandwich assay for β-lactoglobulin in infant food formula based on a hierarchically architectured antifouling capture probe and fluorescent recognition probe

Tracing the presence of allergenic β-lactoglobulin (β-Lg) in infant foods is an urgent need, but the interference from the protein-rich matrix often hampered the detection accuracy. Here, we developed a sandwich assay for β-Lg in infant food formula based on a hierarchically architectured antifouling capture probe and fluorescent recognition probe. The antifouling capture probe was constructed from the polydopamine-coated magnetic particles (Fe3O4@PDA), which was modified with repeated glutamic acid-lysine (EK) antifouling peptide and aptamer towards β-Lg. The spatial arrangement of these ligands on the Fe3O4@PDA surface was carefully tailored. Furthermore, a fluorescent recognition probe based on aptamer-modified silica-doped carbon quantum dot was developed to explore a sandwich assay for β-Lg with the capture probe. The sandwich assay was proved to have high potential in detecting β-Lg in commercially available infant food samples. The work provided a new approach to developing detection methods with matrix interference-resistant properties.

Exploration of Infant Food Microbial Composition from Formal and Informal Settings Using Viable Counts and 16S rRNA Gene Amplicon Sequencing in Johannesburg, South Africa.

Diarrhoea is a considerable agent of disease and loss of life in children below age five in South Africa. Soweto, South Africa is an urban township in Johannesburg, with most of its population living in informal settlements. Informal settlements in areas such as Soweto are often impoverished communities that do not get water easily, inadequate sanitation is pervasive, and poor hygiene common (risk factors for diarrhoeal diseases). Among the age groups, infants are most vulnerable to diarrhoeal infection, mainly through the ingestion of food and water. The presence of undesirable microbiota is a food safety and health challenge. This study investigated the microbiome of infant food samples collected from formal (n = 19) and informal (n = 11) households in Soweto. A non-culture-dependent technique was used to characterise the bacterial diversity and composition of the infant food samples. The results indicated that household type did not influence microbial diversity and composition in Soweto. South Africa. Firmicutes, Proteobacteria, Cyanobacteria, and Tenericutes dominated the phyla rank in food samples from formal and informal households. Potential pathogens of public health significance, including diarrhoeal disease agents such as Salmonella spp., E. coli, and Campylobacter spp., were detected within the foods. We concluded that the infant food samples showed rich bacterial diversity, and the presence of potential pathogens of public health significance suggests a disease risk that infants may face upon consuming the foods.

Determination of fluoride content in infant food samples by sample stacking capillary electrophoresis-indirect UV detection and the estimation of daily-fluoride-intake

Fluoride ion plays a major role in the decline of the prevalence and severity of dental caries. However, exposure to a high level of fluoride causes dental and skeletal fluorosis and reduced levels of intelligence quotient (IQ) in children. This study reports a rapid, selective, sensitive, and economic capillary electrophoresis-sample stacking technique for fluoride analysis in infant food samples. Indirect UV detection of fluoride was performed by 10 mmol/L chromate in the separation electrolyte and 0.1 mmol/L cetyltrimethylammonium bromide (CTAB) was added to the separation medium as an electroosmotic flow modifier. The buffer pH was adjusted to 9.37. The conductivity of the separation electrolyte was increased with 10 mmol/L Na2SO4 and sample stacking was performed. The injections were administered throughout 200 s duration. The limit of detection of the method was 0.0079 mg/L. The method was applied to 7 various commercially available infant food samples which are in puree and powdered form. The fluoride concentrations ranged from 2.28 – 3.85 µg fluoride/g infant food. The proposed method is suitable for the rapid and sensitive determination of fluoride content in infant formulas, and it is recommended that fluoride content be determined by reliable methods in all commercial infant food samples.

Quantitative analysis and carcinogenic/non-carcinogenic risk assessment of aflatoxin M1 in milk-based baby food and infant formula milk – a case study in Iran

In this study, solid-phase extraction (SPE) combined with the dispersive liquid–liquid microextraction based on novel hydrophobic deep eutectic solvent (DLLME − DES) has been developed as an ultra-pre-concentration technique for the extraction of aflatoxin M1 (AFM1) in milk-based baby food (MBBF) and infant formula milk (IFM) samples followed by HPLC combined with fluorescence detection (HPLC − FL). In addition, carcinogenic and non-carcinogenic risk assessment was performed by health-related risk factors including liver cancer risk (LCR), margin of exposure (MOE) and target hazard quotient (THQ) were calculated using the mean of AFM1 in different infant food samples. The results of the study showed that the mean of AFM1 was statistically significant different between various brands and types of IFM and MBBF. The results of the study showed that the percentage of positive samples higher than the allowable limit of AFM1 in 36 samples of domestic infant formula milk (DIFM), 24 samples of imported infant formula milk (IIFM), 36 samples of domestic milk-based baby food (DMBBF) and 18 samples of imported milk-based baby food (IMBBF) were 41.6, 12.5, 66.7 and 33.3%, respectively. In addition, estimated values for health risk-related factors including LCR, MOE and THQ indicated that for most infants less than one-year-old were higher than the acceptable levels. Based on the results, it can be concluded that the quality of IFM and MBBF consumed in Iran in terms of AFM1 is poor. Therefore, it is necessary to take appropriate measures to reduce the amount of AFM1 in DIFM and DMBBF, and in addition, the IIFM and IMBBF should be controlled qualitatively before supplying the market.

Exposure to short-, medium-, and long-chain chlorinated paraffins for infant via cow infant formula, goat infant formula and baby food

Dietary exposure is an important pathway for many pollutants from external exposure to human beings. In this study, we investigated the exposure to short-chain chlorinated paraffins (SCCPs), medium-chain chlorinated paraffins (MCCPs) and long-chain chlorinated paraffins (LCCPs), which are a class of industrial compounds that are of significant concern, in different infant foods (cow infant formula, goat infant formula and baby food are collectively called infant food in this study) in Chinese market. The concentrations of ∑SCCPs, ∑MCCPs and ∑LCCPs in infant foods were in the ranges of 6.22–273 ng/g, 13.1–2020 ng/g and 0.80–1280 ng/g, respectively. Especially, for the first time, we found that the proportion of ∑LCCPs (22.0%) in goat infant formula is almost equivalent to that of ∑SCCPs (25.0%), implying that LCCPs should also be further concerned since the related information is very scarce. There were differences between CP profiles among imported cow infant formula and Chinese cow infant formula due to the different sources of CPs to the infant formula. Imported infant foods were characterized by higher proportion of SCCPs, while Chinese infant foods were characterized by higher proportion on LCCPs. Margin of exposure results demonstrated that there was no significant health concern for the infant, but that large variation of CP concentrations and excessive feeding in practice may cause potential health threats to the infant. LCCPs were detected in all infant food samples, and to our knowledge, this is the first report of LCCPs in cow infant formula, goat infant formula and baby food. This study could provide important data of infant exposure to CPs, especially, LCCPs.

Organophosphate ester concentrations in infant food and dietary risk assessment for the infant population in China

Organophosphate esters (OPEs) are extensively used as plasticizers and flame retardants, whereas information on OPEs in infant foods is limited. In this study, twelve OPEs were investigated in 207 infant food samples collected from ten provinces in China. Mean concentrations of ∑OPEs found in cereal-based complementary foods (5.59 ± 5.54 ng/g) were higher than in infant formulas (2.68 ± 1.86 ng/g) under the upper bound (UB) hypothesis (unpaired t-test, p < 0.05). TEP, EHDPP, TCEP, and TDCPP were found to be the dominant OPEs in infant foods. The mean estimated dietary intakes (EDIs) of the OPEs were 50.2 ng/kg bw/day for infants aged under three years. The mean and 95th percentile hazard index (HI) of OPEs under the UB hypothesis were 6.6 × 10−3 and 1.9 × 10−2, respectively. The dietary risk assessment results showed that the exposure of Chinese infants to OPEs does not indicate a health concern.

Natural Occurrence of Deoxynivalenol in Cereal-Based Baby Foods for Infants from Western Poland.

The study examined 110 samples of baby products based on rice, wheat, maize and multi-grains available on the western Polish market in order to detect the level of deoxynivalenol (DON) by means of HPLC (high-performance liquid chromatography) with a fluorescence detector (HPLC-FLD). DON was detected in 9.09% of the infant food samples, with an average and maximum level of 107.8 ± 30 and 148 μg/kg, respectively. The highest concentration of DON was detected in food for infants: wheat-based (mean 121 ± 7.07, 4.8%), multi-grain (mean 118 ± 5.65, 4.25%) and maize-based (mean 100 ± 37.96; 35.30%). No high DON content and high estimated daily intake were observed in the analyzed products. However, in order to minimize the harmfulness associated with the presence of DON in food for infants and young children, a risk assessment should be performed based on the monitoring results.

Rapid and absolute quantification of VBNC Cronobacter sakazakii by PMAxx combined with single intact cell droplet digital PCR in infant foods

Cronobacter sakazakii (C. sakazakii) in viable but nonculturable (VBNC) state might evade traditional culture detection, and pose a serious threat to food safety. The objective of this study was to establish an improved propidium monoazide (PMAxx), combined with a single intact cell droplet digital PCR (SIC ddPCR) method for rapid and absolute quantification of VBNC C. sakazakii and apply it to the detection of several infant foods. In this study, we optimized the detection conditions for C. sakazakii, and determined the optimal PMAxx final concentration (8 μM), light exposure times (10 min), annealing temperature (58 °C) and elongation time (1 min). In addition, PMAxx-SIC ddPCR demonstrated a higher detection sensitivity and accuracy relative to real-time PCR (qPCR), with 23 CFU/mL in pure culture. Furthermore, PMAxx-SIC ddPCR was used to detect VBNC C. sakazakii in the actual infant food samples. A total of 240 samples were analyzed, out of which 6 samples turned out to be positive by the traditional culture method, whereas 11 samples were found as positive by PMAxx-SIC ddPCR. These results demonstrate that the presence of VBNC may cause the conventional culture-based method to underestimate the size of microbial population.

Determination of Macro, Micro and Toxic Elements using Argon-Based Plasma Spectroanalytical Methods in order to support Brazilian Regulations on Inorganic Constituents in Infant Foods

Children's cereal-based foods and supplements are widely consumed by newborn and infant population. The Resolution RDC no. 193/2017 of the Brazilian National Health Surveillance Agency (ANVISA) established maximum tolerated limits (MTL) for toxic elements in infant foods aiming to control health risks. Complementarily, the determination of macro and microelements based on values of recommended daily intake (RDI) is regulated by Resolution RDC no. 269/2005. Two analytical procedures were developed using inductively coupled plasma mass spectrometry (ICP-MS) for determination of As, Cd, Sn and Pb and inductively coupled plasma optical emission spectrometry (ICP OES) for determination of Ca, Fe, K, Mg, Mn, Na, P and Zn attending both Brazilian regulations. Microwave-assisted acid digestion of solid samples was carried out in closed vessels using 7 mol L-1 HNO3. Two rice flours reference materials as well as addition and recovery experiments were applied to check accuracy. Recoveries ranged from 70 to 128% for ICP OES and from 82 to 128% for ICP-MS using internal standardization. The analytical procedure presented LOQs lower than maximum limits allowed by both regulations. Fifteen samples of cereal-based infant foods were analyzed and all analyte concentrations were lower than the respective MTLs recommended by RDC no. 193, except to Pb concentration in one milk flour sample. According to the RDI established by RDC no. 269 and the average concentrations of Ca, Fe, K, Mg, Mn, P and Zn in samples, it was possible to assign a minimum mass value of food that meets the recommendations of the Brazilian resolution for different population groups.

Pesticide active substances in infant food in Serbia and risk assessment.

ABSTRACT Risks posed by pesticide residues in infant food urge for protection of the most vulnerable part of our population. In the current study a total of 54 samples of infant food (juice and purée) were collected on the Serbian market. Liquid chromatography-tandem mass spectrometry with electrospray ionization method detected 18 out of 69 analyzed pesticide active substances in 55.6% of the samples, most frequently carbendazim and acetamiprid. Domestic products as opposed to the imported ones showed a substantially higher proportion of positive (85% vs 38%) and noncompliant (10% vs 0%) samples, a number of pesticides detected (15 vs 8), the proportion of the samples with multiple residues (85% vs 15%), the maximum number of residues in an individual sample (7 vs 2). Risk assessment was performed for the present pesticide active substances, which was estimated to remain below the level of concern for both acute and chronic adverse health effects.

The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial

BackgroundSymptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya.MethodsThis is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean.ResultsThe primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination.ConclusionTo our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children.Trial registrationThe trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).

The distribution and characterization of Staphylococci in infant foods

Food poisoning microbial agent can cause diarrhoel disease and ill-health in infant. Staphylococcal organisms constitute a very important group of pathogens which is the great significance because these are the most common bacteria causing food poisoning. Being Iquitos in nature, staphylococci are usually present in raw milk and some strains may turn out to be exterotoxigonic S.aureus . The current investigation revealed significance variations in the staphylococcal counts of infant food. A total eight brands of infant milk food and three brands of weaning food samples were collected around from Meerut city in U.P. in the year 2009-10. The collected samples were analysed for staphylococcal counts and their characterization. Staphylococci were recovered from almost all brands of infant foods. Among positive samples, approximately, 3.28 per cent contained more than 5000 staphylococci per gram, while, 11.47 per cent had a count between 501 and 5000 and further observed that 26.23 per cent were considered to be of good quality as they contained less than 10 staphylococci per gram of samples. During the present study, 142 isolates of staphylococci were recovered from infant food samples. All these isolates produced catalase and fermented glucose anaerobically based on additional characters of production of coagulase, phosphatase and anaerobic fermentation of mannitol, 53 strains were identified as S.aureus . Therefore, there is a likelihood of incidence of these organisims in the finished products. The chance contamination during processing cannot also be ignored, because these are the most common bacteria causing food poisoning.

An Isomer-Specific Approach to Endocrine-Disrupting Nonylphenol in Infant Food

Nonylphenols (NPs) are persistent endocrine disruptors that are priority hazardous substances of the European Union Water Framework Directive. Their presence in the environment has caused growing concern regarding their impact on human health. Recent studies have shown that nonylphenol is ubiquitous in commercially available foodstuffs and is also present in human blood. The isomer distribution of 4-nonylphenol was analyzed by gas chromatography - mass spectrometry in 44 samples of infant food. Our study shows that the distribution of nonylphenol isomers is dependent on the foodstuff analyzed. Although some isomer groups prevail, different distributions are frequent. Variations are even found in the same food group. Nonylphenol is a complex mixture of isomers, and the estrogenic potentials of each of these isomers are very different. Consequently, to determine the potential toxicological impact of NP in food, an isomer-specific approach is necessary.

Vitamins A and E content of commercial infant foods in the UK: A cause for concern?

According to the European Food Safety Authority, currently, there are no reliable data or robust guidelines available in relation to the micronutrient composition of infant foods. This study evaluated the intake of vitamins A and E of infants from ‘ready-to-feed’ foods and formulas. Normal phase high performance liquid chromatography was employed for simultaneous quantification of retinyl acetate, retinyl palmitate, α-tocopherol and γ-tocopherol, reverse phase high performance liquid chromatography for the quantification of β-carotene, and UV spectrophotometry for the quantification of carotenoids from selected infant food samples. Based on the results of this study, the estimated total daily intake of vitamin A (retinol equivalents) and vitamin E (α-tocopherol equivalents) from both infant food and formula milk exceed recommendations set by the UK Department of Health. This requires further analysis of risk of exposure, whilst a cause for concern over deficiency might arise when the intake of milk is compromised.

Prevalence and Characterization of Cronobacter sakazakii in Retail Milk-Based Infant and Baby Foods in Shaanxi, China.

Cronobacter sakazakii (formerly Enterobacter sakazakii) is an opportunistic pathogen that causes meningitis, sepsis, and necrotizing enterocolitis in neonates and infants through consumption of contaminated milk-based foods. In this study, the prevalence of C. sakazakii in 705 retail milk-based infant and baby food samples was investigated in 12 cities in Shaanxi, China, in 2010 and 2012. One hundred and nineteen samples (16.9%) were C. sakazakii positive. The isolates were further characterized for antimicrobial susceptibility to 14 antibiotics, pulsed-field gel electrophoresis profiles, and presence of the virulence genes. Samples of brand W, Y, A, and G in 2010 and 2012 were C. sakazakii positive. All isolates recovered in 2010 and 2012 were susceptible to levofloxacin and cefoperazone. In 2012, no isolate was resistant to gentamicin, cefoxitin, chloramphenicol, gatifloxacin, ciprofloxacin, and ceftriaxone. Antibiotic resistance of the isolates was most commonly found to rifampicin, amoxicillin-clavulanic acid, streptomycin, tetracycline, and ampicillin in both 2010 and 2012, except to trimethoprim/sulfamethoxazole in 2012. Pulsed-field gel electrophoresis profiles indicated that C. sakazakii isolates were genotypically diverse, although these isolates were prevalent in infant and baby foods with the same brand. A total of 34 virulence gene profiles of the C. sakazakii isolates in 2010 and 2012 were detected. Isolates that co-carried hly-ompX-eitCBAD-iucABCD/iutA genes in 2012 were significantly (p < 0.05) more prevalent than those in 2010. The results added new epidemiological evidence for the widespread occurrence of C. sakazakii in retail milk-based infant and baby foods and this should be an indicator of potential health risk for consumers.

Short communication: Investigation of aflatoxin M1 levels in infant follow-on milks and infant formulas sold in the markets of Ankara, Turkey

Aflatoxins are fungal toxins known to be carcinogenic and are classified as food contaminants. This study was performed to investigate aflatoxin (AF) M1 levels in baby foods sold in Ankara (Turkey) and to evaluate the obtained results according to the Turkish Food Codex (TFC). For this purpose, a total of 84 baby food samples (50 follow-on milks and 34 infant formulas) were obtained from different markets in Ankara and the presence of AFM1 in the samples was analyzed by ELISA. In 32 (38.1%) of 84 infant food samples, the presence of AFM1 was detected in concentrations ranging between 0.0055 and 0.0201µg/kg. The mean level (±standard error) of AFM1 was found to be 0.0089±0.0006µg/kg in positive infant follow-on milks. Aflatoxin M1 was detected in only 1 infant formula sample (2.94%) at a concentration of 0.0061µg/kg. The extrapolated levels of AFB1 contamination in feedstuffs were calculated based on levels of AFM1 in baby food samples. The data estimating AFB1 contamination in dairy cattle feedstuff indicate that contamination may range from 0.3410 to 1.2580µg/kg, with the mean level (±standard error) being 0.5499±0.0385µg/kg, which is lower than the level set by the TFC and European Union regulations (5µg/kg). According to the obtained results, the levels of AFM1 in analyzed samples were within the allowed limit (0.025µg/kg) set in the TFC. Low levels of AFM1 in infant follow-on milks and infant formula samples obtained during the study do not pose a health risk to infants.

Formative research on hygiene behaviors and geophagy as part of interventions to improve infant growth

The predominant pathways for fecal‐oral transmission of bacteria for infants may differ from adults and these have not been studied. We conducted direct observation of 23 caregiver‐infant pairs for a total of 130 hours and recorded WASH related behaviors. We identified “potential key vectors” for fecal‐oral transmission of bacteria and enumerated Escherichia coli, Total coliforms, Enterobacteriaceae and total aerobic counts. In addition to infant's fingers, food, and drinking water, three infants actively ingested soil 11.3 ±9.2 times (mean ±SD) and two ingested chicken feces 2± 1.4 times in 6 hours. Infants’ hands were rarely washed and never with soap unless as part of a bath. Drinking water was contaminated with E. coli in 12/22 (54.5 %) households, while no infant food samples tested positive for E coli. Quantitatively, a year old infant ingesting 1 gram chicken feces in a day, 20 grams of soil from a laundry area of the kitchen yard and 400 ml of contaminated water consumes 4,700,000 to 23,000,000, 440 to 4,240 and 400 to 1,200 E. coli counts, respectively, from these sources. These findings suggest that predominant pathways for fecal‐oral transmission of bacteria among infants include direct ingestion of soil and chicken. Behavior change education should include breaking socio‐cultural beliefs that soil ingestion is beneficial for infant health, which are common throughout the world.Grant Funding Source : Department for International Development (DFID), United Kingdom