Enteric Pathogen Diversity in Infant Foods in Low-income Neighborhoods Of Kisumu, Kenya

Abstract

23Pediatric diarrheal disease remains the 2nd most common cause of preventable illness 24 and death among children under the age of five, especially in Low and Middle-Income Countries 25 (LMICs). However, there is limited information regarding the role of food in pathogen 26 transmission due to measuring infant food contaminations in LMICs. For this study, we 27 examined the frequency of enteric pathogen occurrence and co-occurrence in 127 weaning infant 28 foods in Kisumu, Kenya using a multi-pathogen rt-PCR diagnostic tool, and assessed household 29 food hygiene risk factors for contamination. Bacterial, viral, and protozoa enteric pathogen DNA 30 and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods 31 containing more than one pathogen type. Multivariable generalized linear mixed model analysis 32 indicated type of infant food best explained the presence and diversity of enteric pathogens in 33 infant food, while most household food hygiene risk factors considered in this study were not 34 significantly associated with pathogen contamination. Specifically, cow's milk was significantly 35 more likely to contain a pathogen (adjusted Risk Ratio=14.4; 95% Confidence Interval (CI) 1.78-36 116.1) and contained 2.35 more types of pathogens (adjusted Risk Ratio=2.35; 95% CI 1.67-37 3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are 38 frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are 39 needed to prevent foodborne transmission of pathogens to infants. 40 41 Importance. 42Food is acknowledged as an important pathway for enteric pathogen infection in young 43children. Yet, information on enteric pathogen contamination in food in low-and-middle income 44 settings is lacking, especially with respect to weaning foods given to young infants. This study 45Page 3 of 37 assessed which food-related risk factors were associated with increased presence of and diversity 46 in twenty-seven types of enteric pathogens in a variety of foods provided to infants between 47 three and nine months of age in a low-income neighborhood of Kisumu, Kenya. Feeding infants 48 cow milk emerged as the most important risk factor for food contamination by one or more 49 enteric pathogens. The results indicate public health interventions should focus on improving 50 cow milk safety to prevent foodborne pathogen transmission to infants. However, more research 51 is needed to determine whether infant milk contamination was caused by caregiver hygiene 52 practices versus food contamination passed from upstream sources. 53 54 Introduction. 55

Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group

“…Examples of recent environmental applications of the TAC method include the simultaneous detection of a number of enteric pathogens in surface water, soil, and infant weaning food in Kenya. 134 , 135 Pholwat et al developed a custom environmental surveillance TAC to identify antimicrobial resistance genes, poliovirus, and enteric pathogens in environmental samples such as fecal sludge, food, sewage, soil, and water in low resource settings. 136 Advantages of TAC are the ability to test 48+ targets/pathogens simultaneously, to obtain quantitative results relatively quickly, and to utilize the same method for both environmental and human samples.…”

The Safe Start Trial: A Cluster Randomized Controlled Trial for the Effect of an Infant Hygiene Intervention on Enteric Infections and Diarrhoea in Low-Income Informal Settlements of Kisumu, Kenya

“…Caregiver attitudes and practices in this population and the emotional and environmental drivers of food hygiene behaviours were assessed through structured observation and in-depth interviews with primary and secondary caregivers (25). Microbiological and molecular analysis of infant food samples was used to determine the prevalence and intensity of infant food contamination with specific enteric pathogens implicated in childhood diarrhoeal (5). Various known diarrhoeagenic agents, including bacteria, viruses and protozoa, were frequently detected with at least one enteric pathogen identified in 62% of infant food samples and multiple pathogens identified 37% of infant food.…”

“…Food is likely to be an important source of exposure to enteric pathogens in early childhood. Recent studies have shown that food given to children in early childhood can be highly contaminated with faecal indicator bacteria (14)(15)(16)(17) as well as specific diarrhoeagenic enteric pathogens (5).…”

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

“…Caregiver attitudes and practices in this population and the emotional and environmental drivers of food hygiene behaviours were assessed through structured observation and in-depth interviews with primary and secondary caregivers (25). Microbiological and molecular analysis of infant food samples was used to determine the prevalence and intensity of infant food contamination with specific enteric pathogens implicated in childhood diarrhoea (5). Various known diarrhoeagenic agents, including bacteria, viruses and protozoa, were frequently detected with at least one enteric pathogen identified in 62% of infant food samples and multiple pathogens identified in 37% of infant food.…”

“…Food is likely to be an important source of exposure to enteric pathogens in early childhood. Recent studies have shown that food given to children in early childhood can be highly contaminated with faecal indicator bacteria (33) as well as specific diarrhoeagenic enteric pathogens (5). Environmental interventions to reduce exposure to these pathogens and reduce diarrhoea have traditionally focused on improving the quality and distribution of drinking water, the management of excreta through sanitation systems and the promotion of handwashing with soap at critical times (6) but generally not on food hygiene related behaviours and infrastructure.…”