Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study

doi:10.3390/ijerph16122146

. 2019 Jun 17;16(12):2146.

doi: 10.3390/ijerph16122146.

Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study

Kondwani Chidziwisano^{1

2

3}, Elizabeth Tilley^{4

5}, Rossanie Malolo⁶, Save Kumwenda^{7

8}, Janelisa Musaya⁹, Tracy Morse¹⁰

Affiliations

¹ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. kchidziwisano@poly.ac.mw.
² Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. kchidziwisano@poly.ac.mw.
³ Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, G1 1XQ, Glasgow, UK. kchidziwisano@poly.ac.mw.
⁴ Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. Elizabeth.Tilley@eawag.ch.
⁵ EAWAG: Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland. Elizabeth.Tilley@eawag.ch.
⁶ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. rossaniedaudi@yahoo.com.
⁷ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. skumwenda@poly.ac.mw.
⁸ Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. skumwenda@poly.ac.mw.
⁹ Department of Pathology, College of Medicine, University of Malawi, P.O Box 360, Chichiri, Blantyre 3, Malawi. jmusaya@medcol.mw.
¹⁰ Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, G1 1XQ, Glasgow, UK. tracy.thomson@strath.ac.uk.

PMID: 31213008
PMCID: PMC6616994
DOI: 10.3390/ijerph16122146

Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study

Kondwani Chidziwisano et al. Int J Environ Res Public Health. 2019.

. 2019 Jun 17;16(12):2146.

doi: 10.3390/ijerph16122146.

Authors

Kondwani Chidziwisano^{1

2

3}, Elizabeth Tilley^{4

5}, Rossanie Malolo⁶, Save Kumwenda^{7

8}, Janelisa Musaya⁹, Tracy Morse¹⁰

Affiliations

¹ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. kchidziwisano@poly.ac.mw.
² Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. kchidziwisano@poly.ac.mw.
³ Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, G1 1XQ, Glasgow, UK. kchidziwisano@poly.ac.mw.
⁴ Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. Elizabeth.Tilley@eawag.ch.
⁵ EAWAG: Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland. Elizabeth.Tilley@eawag.ch.
⁶ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. rossaniedaudi@yahoo.com.
⁷ Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. skumwenda@poly.ac.mw.
⁸ Department of Environmental Health, Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi. skumwenda@poly.ac.mw.
⁹ Department of Pathology, College of Medicine, University of Malawi, P.O Box 360, Chichiri, Blantyre 3, Malawi. jmusaya@medcol.mw.
¹⁰ Department of Civil and Environmental Engineering, University of Strathclyde, Level 5 James Weir Building, G1 1XQ, Glasgow, UK. tracy.thomson@strath.ac.uk.

PMID: 31213008
PMCID: PMC6616994
DOI: 10.3390/ijerph16122146

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.

Keywords: Malawi; child feeding; complementary food; food hygiene; food safety.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Summary of sampling plan for microbiological testing of foods consumed by targeted children.

**Scheme 1**
Dishes of nsima and relish (beans) after serving in Chikwawa, rural Malawi.

**Figure 2**
Percentage of food samples containing total and faecal coliforms.

**Figure 3**
(a) Total and faecal coliform colony forming unit (CFU) changes in freshly prepared, stored and reheated relish; (b) Total and faecal coliform (CFU) changes in freshly prepared, stored and reheated nsima.

**Figure 4**
(a) Flow diagram of porridge preparation and consumption; (b) Flow diagram of nsima and relish preparation, storage and consumption.

See this image and copyright information in PMC

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References

1. World Health Organization Causes of Child Mortality. [(accessed on 10 May 2019)]; Available online: http://www.who.int/gho/child_health/mortality/causes/en/
1. Government of Malawi . Malawi Demographic and Health Survey 2015–2016. National Statistical Office; Zomba, Malawi: 2016.
1. The DHS Program-Malawi: DHS, 2010-Final Report (English) [(accessed on 5 May 2019)]; Available online: https://dhsprogram.com/publications/publication-FR247-DHS-Final-Reports.cfm.
1. Wagner E.G., Lanoix J.N. Excreta Disposal for Rural Areas and Small Communities. WHO Monogr. Ser. 1958;31:39. - PubMed
1. Wodnik B.K., Freeman M.C., Ellis A.S., Awino Ogutu E., Webb Girard A., Caruso B.A. Development and Application of Novel Caregiver Hygiene Behavior Measures Relating to Food Preparation, Handwashing, and Play Environments in Rural Kenya. Int. J. Environ. Res. Public Health. 2018;15:1994. doi: 10.3390/ijerph15091994. - DOI - PMC - PubMed

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[1] World Health Organization Causes of Child Mortality. [(accessed on 10 May 2019)]; Available online: http://www.who.int/gho/child_health/mortality/causes/en/

[2] World Health Organization Causes of Child Mortality. [(accessed on 10 May 2019)]; Available online: http://www.who.int/gho/child_health/mortality/causes/en/

[3] Government of Malawi . Malawi Demographic and Health Survey 2015–2016. National Statistical Office; Zomba, Malawi: 2016.

[4] Government of Malawi . Malawi Demographic and Health Survey 2015–2016. National Statistical Office; Zomba, Malawi: 2016.

[5] The DHS Program-Malawi: DHS, 2010-Final Report (English) [(accessed on 5 May 2019)]; Available online: https://dhsprogram.com/publications/publication-FR247-DHS-Final-Reports.cfm.

[6] The DHS Program-Malawi: DHS, 2010-Final Report (English) [(accessed on 5 May 2019)]; Available online: https://dhsprogram.com/publications/publication-FR247-DHS-Final-Reports.cfm.

[7] Wagner E.G., Lanoix J.N. Excreta Disposal for Rural Areas and Small Communities. WHO Monogr. Ser. 1958;31:39. - PubMed

[8] Wagner E.G., Lanoix J.N. Excreta Disposal for Rural Areas and Small Communities. WHO Monogr. Ser. 1958;31:39. - PubMed

[9] Wodnik B.K., Freeman M.C., Ellis A.S., Awino Ogutu E., Webb Girard A., Caruso B.A. Development and Application of Novel Caregiver Hygiene Behavior Measures Relating to Food Preparation, Handwashing, and Play Environments in Rural Kenya. Int. J. Environ. Res. Public Health. 2018;15:1994. doi: 10.3390/ijerph15091994. - DOI - PMC - PubMed

[10] Wodnik B.K., Freeman M.C., Ellis A.S., Awino Ogutu E., Webb Girard A., Caruso B.A. Development and Application of Novel Caregiver Hygiene Behavior Measures Relating to Food Preparation, Handwashing, and Play Environments in Rural Kenya. Int. J. Environ. Res. Public Health. 2018;15:1994. doi: 10.3390/ijerph15091994. - DOI - PMC - PubMed

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Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study

Affiliations

Risk Factors Associated with Feeding Children under 2 Years in Rural Malawi-A Formative Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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