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HYGIENE INTERVENTION REDUCES CONTAMINATION OF WEANING FOOD
By Dr Ousmane TOURE, M Sc., MPH, PhDHead, Department of Community HealthNational Institute for Research in Public HealthBamako- MaliE-mail: oussou_toure@hotmail,comTel/Mobile: (00223) 66729013/78122991
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PRESENTATION OULTINE
I. CONTEXT/JUSTIFICATION
II. DEVELOPMENT USING HACCP
III. TESTING THE INTERVENTION
IV. REPLICATION; BANGLADESH & NEPAL
V. RECENT DEVELOPMENTS/PERSPECTIVES
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CONTEXT/JUSTIFICATION
• Diarrhoeal diseases mainly kill children underfive years in developing countries;
• Diarrhoea control thus needs to stop young achildren ingesting pathogens;
• Weaning foods are usually more heavilycontaminated than drinking water;
• Weaning food hygiene deserves high priority.
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EXPERIMENTAL STUDY, TO DEVELOP INTERVENTION
• 15 mothers of children aged 6 to 36 months;
• Selection of 2 commonest weaning foods - moni& fish soup;
• intensive observation of food preparation and handling hygiene;
• Implementation of HACCP Method.
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Fish Soup flow diagram
Legend
Initial contamination Hand contamination Utensils contamination Ingredient contamination Water contamination
Purchasing fish and
vegetables
Washing and cleaning fish
and vegetables at home
Cooking soup
Cooling soup
Meal storage Feeding child
Feeding child
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PILOT STUDY, TO TEST THE INTERVENTION
Intervention key messages:• Reheating meals to boiling point, even if for only a few seconds;• Handwashing with soap after faecal contact and before handling food;• Running water and soap to wash dishes
60 mothers; 30 lntervention, 30 control;3 weeks’training for intervention group;samples examined for faecal coliforms.
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FC CONTAMINATION OF INTERVENTION GROUP’S FOODS AT THE END OF THE INTERVENTION
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LESSONS LEARNT FROM THE INTERVENTION
• The intervention was very effective in FCcontamination reduction; it resulted in a veryhigh performance in meeting the qualitystandard of less than 10 fcu/g;
• Behaviours acquired lasted for at least threemonths after the intervention.
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REPLICATION STUDY• Bangladesh, rural setting;• Copied Bamako protocol with 2 local
weaning foods (Suzi & Khishuri)• Same result!• The method has already been
integrated into the National DiarrhoeaPrevention Strategy of Bangladesh (DrS. Islam, ICDDR,B)
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INTERVENTION IMPACT ON BACTERIOLOGICAL WEANING FOODS SAFETY
BS AI BS AI BS AI BS 1AB BS 1AB BS 1AB
Faecal Coliforms FaecalStreptococci Clostridium Perfringens
Before 1st
feedng
Before 2nd feeding
Before 3rdfeedng
Study Households Control Households
3,5
3
2,5
2
1,5
1
0,5
0
(Lo
g 10
fcu
/g)
Mea
nco
un
t o
f b
acte
ria
Before 1st feeding
Before 2nd feeding
Before 3rd feeding
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Recent developments, future perspectives
• Replication in Nepal:- at District scale, reduced cost to US$ 17 per
mother (Om Gautam);- Impact on diarrhoea incidence discernible,
though study under-powered.• In the Gambia:- Similar study due soon (Buba Manjang, Ministry
of Health) & University of Birmimgham;- Unicef Gambia considering implementation at
national level.
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“Disgust exercise” using glo-germs in mother’s hands during “Safe Food, Healthy Child” campaign in Nepal, 2013.
Photo credit: Om Pd Gautam, DCD/ITD, LSHTM
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CONCLUSION/RECOMMANDATION
• The HACCP Approach is effective in FCcontamination reduction through hygieneintervention;
• Behaviours acquired last for at least three monthsafter the intervention.
• These very encouraging findings need to betranslated into Health Education Programs’guidelines;
• The Approach reserves to be scaled up to assessits impact in diarrhoea prevention/reduction.
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THANK YOU VERY MUCH FOR YOUR KIND ATTENTION