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Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study
Kondwani Chidziwisano1,2,3, Elizabeth Tilley4,5, Rossanie Malolo6
1Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. kchidziwisano@poly.ac.mw.
Insights
Diarrhoeal disease in children under five is a major health issue in sub-Saharan Africa. Improving food and hand hygiene practices, while addressing barriers like access to facilities, can reduce infection risks.
Area of Science:
- Public Health
- Infectious Diseases
- Environmental Health
Background:
- Diarrhoeal disease is a leading cause of death in children under five, especially in low-income regions like sub-Saharan Africa.
- Despite improvements in sanitation and water access, faecal-oral infections remain prevalent, necessitating a deeper understanding of transmission pathways.
- Identifying and mitigating risk factors within low-income contexts is crucial for reducing disease burden.
Purpose of the Study:
- To investigate food hygiene and hand hygiene practices influencing diarrhoeal disease transmission in Southern Malawi.
- To identify specific risk factors associated with food preparation, storage, and consumption in households with young children.
- To explore contextual barriers affecting the implementation of improved hygiene practices.
Main Methods:
- A mixed-methods approach was employed in Southern Malawi from June to October 2017.
- Data collection included household surveys (n=323), checklists (n=31), structured observations (n=80), and microbiological food sampling (n=20).
Main Results:
- Food prepared for immediate consumption, like children's porridge, presented a low health risk.
- Poor hygiene practices, particularly concerning shared family meals and leftover food storage, increased contamination risks.
- Faecal and nosocomial bacteria were linked to inadequate hand hygiene and unhygienic eating environments.
- Inadequate pre-consumption heating of food also elevated contamination risks.
Conclusions:
- Improvements in food and hand hygiene at critical control points can significantly reduce diarrhoeal disease risk in children under two.
- Addressing structural barriers, such as limited access to handwashing facilities, soap, and proper food/water storage, is essential for effective intervention.
- Context-specific strategies are required to overcome barriers and promote sustainable hygiene practice improvements.
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 nosocomial 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.
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