Academic journal article Journal of Health Population and Nutrition

Bacterial Populations in Complementary Foods and Drinking-Water in Households with Children Aged 10-15 Months in Zanzibar, Tanzania

Academic journal article Journal of Health Population and Nutrition

Bacterial Populations in Complementary Foods and Drinking-Water in Households with Children Aged 10-15 Months in Zanzibar, Tanzania

Article excerpt


Beyond the age of six months, breastmilk alone is no longer sufficient to meet the nutritional demands of the growing infant, and other foods and liquids (complementary foods) should, therefore, be introduced (1,2). Empirical evidence, however, demonstrates that introduction of complementary foods in resource-poor settings can result in diets that are nutritionally inadequate and microbiologically unsafe, which can lead to multiple nutrient deficiencies (3-5) and the risk of exposure to foodborne pathogens and, consequently, to gastrointestinal illnesses (6-10).

Foodborne microbial agents can cause diarrhoeal diseases and ill-health in infants (9,11,12). Worldwide, diarrhoea is the second leading cause of death in children (after neonatal disorders) (13) and is a leading cause of growth-faltering and malnutrition (6). A great proportion (~70%) of diarrhoeal episodes occur due to foodborne pathogens transmitted by unhygienic preparation of foods in households (6). Sociocultural constraints, such as social infrastructure, ignorance, incorrect beliefs and practices, taboos, poverty, insufficient food, lack of safe water and sanitation, and shortage of fuel and time may aggravate the situation (6). One possible strategy for overcoming inadequate resources, such as water and fuel, which are necessary to ensure adequate food handling, is the use of pre-prepared food mixtures (2).

In Zanzibar of the Tanzanian Republic and many other low-income countries, foods made from local grains predominate in the diet of children. At 10-15 months, food made from local tubers and green vegetables also may be incorporated, but to a small extent. Although breastfeeding may progress to 18 months, complementary foods are introduced as early as 0-3 month(s) in contrast to the recommended practice of exclusive breastfeeding for six months (14). This departure from the current recommendation is common in developing countries and has been attributed to cultural beliefs and ecological and socioeconomic constraints, including the work patterns of women (15,16). Consequently, malnutrition and disease rates in young children are high. For example, in Zanzibar, the site of this study, the prevalence of growth-faltering in this age-group is 46.2% for stunting, 9.5% for wasting, and 36% for underweight (14). These figures are higher than the sub-Saharan Africa averages of 41%, 7%, and 29% respectively (17). Malaria, diarrhoea, and pneumonia are the major causes of mortality among children aged less than five years in Zanzibar. Malaria due to Plasmodium falciparum is holoendemic with year-round transmission (18).

It is a great challenge, generally, to meet the micronutrient needs of children from feeding traditional local complementary foods in resource-poor settings. We, therefore, reasoned that introduction of alternative micronutrient-fortified complementary foods could reduce rates of stunting and micronutrient deficiencies in these areas. One such food is an instant soy-rice porridge (SRP), fortified with vitamin A, iron, and zinc, among other micronutrients.

During an initial acceptability trial of the SRP in Zanzibar, concern was raised regarding the microbiological quality of water used for reconstituting it. Although mothers were instructed to add cool, boiled water to the product to their desired consistency and feed without cooking, the field staff discovered that most mothers were not complying with the instruction for boiling water but were instead using water from taps, wells, or rainwater that was also used for drinking. Therefore, we measured bacterial populations to assess the hygienic condition of various infant-foods (19). Bacterial populations were measured in domestic drinking-water stored in household containers, SRP, and Lishe bora (LB), a commercial porridge available in this setting that is cooked prior to serving. Specifically, (a) bacterial populations were quantified in drinking-water, SRP, and LB given to infants in the households, (b) bacterial numbers were measured again in the same porridges at four hours post-preparation to provide an indication of the resulting bacterial quality of these foods if not consumed in one feeding, and (c) bacterial populations were measured in various complementary foods collected from the same households to enable benchmarking of the microbiological profiles of drinking-water, SRP, and LB within the context of the complementary foods typically fed to infants in Zanzibar. …

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