Microbiological Quality of Weaning Foods and Hygiene-Related Risk Factors in Peri-Urban, Lusaka Zambia

Food contamination contributes to 40% of childhood diarrhoea cases globally. It occurs when pathogens are transmitted from faecal matter to food through the faecal oral route. Food hygiene can prevent food contamination and improve the microbial quality of weaning foods in domestic settings. However, context specific evidence is needed to identify risk factors associated with food contamination, especially in complex low-income communities. Our study used a modified Hazard Analysis Critical Control Point approach to assess the quality of weaning foods and identify associated risk factors in a low income setting of Lusaka, Zambia. We enrolled 60 caregivers of children aged <1 year who had begun complementary feeding and collected data on household characteristics and food hygiene behaviours using surveys and structured observations. We collected samples of complimentary foods prepared for the child and tested them for Escherichia coli (E. coli) using the IDEXX Colilert-18 method. Multivariable logistic regression was performed to determine risk factors associated with food contamination. Of 59 food samples, 17 (29%) were contaminated with E. coli. Porridge (AOR = 0.04; 95% CI: 0.01, 0.28; p = 0.001) and non-animal source foods (AOR = 0.11; 95% CI: 0.02, 0.69; p = 0.019) were associated with lower odds of contamination compared with animal source foods. Heating of food was also associated with lower odds of contamination but was not significant. Food hygiene behaviours including utensil and surface cleaning were low (17% and 15%, respectively), and handwashing with soap before food preparation was not practiced. Our study identifies the microbiological risk associated with animal source foods and the potential health risk posed to weaning children. Nutrition guidelines should take into consideration this risk as programs promote an increased uptake of animal source foods in child diets.