Complementary food handling practices associated with food safety, health and nutritional status of children in Adyel division, Lira district

Abstract

Efforts to reduce illnesses and undernutrition among children in developing countries are partly hampered by a continual existence of childhood infections. The objective of this study was to identify the complementary food and water handling practices affecting the safety of food and contributing to the poor nutritional status of children (6 to 23 months) in Adyel division, Lira district. The study population comprised of caretaker-child pairs selected by multistage sampling from the semi-urban and sub-urban areas of Adyel Division in Lira district. This was a cross-sectional study that was largely descriptive and quantitative in nature and was conducted in 2 phases. Phase 1 comprised of collecting quantitative data, which was obtained from the 127 caretaker-child pairs to determine children’s dietary patterns, nutritional (anthropometrical) status, and their risk of diarrheal infections. Phase 2 focused on microbial analyses of food and water obtained from a sub-sample of 30 households to determine the relationship between food handling practices and children’s risk of diarrhea. The results indicated that the majority (over 95%) of caretakers were following recommended WHO child-feeding guidelines with regards to feeding frequency and meal diversity. However, handling practices of complementary food deviated from the IYCF and WHO recommendations. Three quarters of the caretakers did not treat their drinking water at the point of use, 84% did not wash children’s hands before eating, while 85% used food carried over from the previous meal (commonly referred to as leftovers) to feed their children. Analyses of food samples revealed that freshly cooked food was contaminated with fecal coliforms (4.88±1.87 log cfu/g); and the levels of fecal coliforms in stored food increased with prolonged storage period (5.49b±1.86 log cfu/g). Drinking water too was contaminated with E.coli (2.86 log cfu/ml). Water in storage containers had total coliform counts of up to 3.14 log cfu/ml. In over half of the households (56.7%), the microbial counts in household drinking water containers (4.48E+03cfu E.coli) were more than those found at the respective water sources (4.46E+02cfu E.coli). Water treatment accounted for 25% of the variation (p=0.005) in E.coli counts in drinking water that was found in water storage containers. About 32.5% of the frequency or recurrence of diarrhea episodes in a two weeks’ time period among children was explained for by the presence of fecal coliforms in freshly cooked complementary food (p=0.001). Overall, diarrheal infections (p=0.030), inappropriate child-feeding practices (p=0.048), and poor hand-washing (p=0.011) played a significant role in influencing child health. Generally, feeding practices were adequate with regards to the FCS and CFI, although handling practices of complementary food deviated from the recommended IYCF and WHO recommendations. The children in Adyel division were eating unsafe food (as it had fecal coliforms which is an indicator of fecal contamination). This was associated with water treatment method, water source used for cooking, and the duration utensils were shelved before use. Diarrhea frequency was associated with consumption of contaminated freshly cooked complementary food. This study found that both diet and infections played a role in influencing the nutritional status of the children, hence the need to address both concurrently in health and nutrition education interventions to achieve better child health and development outcomes.