Microbial contamination of complementary foods puts young children at risk of developing intestinal infections and could be reduced by improved handwashing and food hygiene practices. We aimed to identify which promoted food hygiene practices are associated with reduced complementary food contamination in a rural population in Bangladesh. We collected cross-sectional data on reported and observed maternal food hygiene behaviors and measured Escherichia coli counts as an indicator of microbial contamination in complementary food samples from 342 children of women enrolled in the Food and Agricultural Approaches to Reducing Malnutrition trial in Sylhet, Bangladesh. We used multivariable logistic regression to examine associations of food hygiene behaviors with food contamination. Approximately 46% of complementary food samples had detectable levels of E. coli. Handwashing with soap at critical times and fresh preparation of food before feeding were strongly associated with reduced odds of food sample contamination (odds ratio [OR]: 0.8, 95% confidence interval [CI]: 0.6–0.9 and OR: 0.3, 95% CI: 0.1–0.7, respectively); in contrast, there was no or only weak evidence that reheating of stored food, safe food storage, and cleanliness of feeding utensils reduced contamination. Reduction in food contamination could be more than halved only when several food hygiene behaviors were practiced in combination. In conclusion, single food hygiene practices showed limited potential and a combined practice of multiple food hygiene behaviors may be needed to achieve a substantial reduction of complementary food contamination.
Address correspondence to Anna A. Müller-Hauser, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany. E-mail: firstname.lastname@example.org
Financial support: The German Federal Ministry of Education and Research (BMBF) is the primary funder for the FAARM trial (grant no. 01ER1201). The Food Hygiene to reduce Environmental Enteric Dysfunction (FHEED) study, nested within Food and Agricultural Approaches to Reducing Malnutrition (FAARM), is financially supported by a project grant from Deutsche Forschungsgemeinschaft (German Research Foundation; project no. 413269709). FHEED’s research work was further supported by Foundation Fiat Panis. A. S. W. was supported by the Alexander von Humboldt Research Fellowship for Postdoctoral Researchers grant 3.1-1163387-USA-HFST-P. S. G. received funding through a Recruiting Grant from Stiftung Charité.
Authors’ addresses: Anna A. Müller-Hauser and Shafinaz Sobhan, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany, E-mails: email@example.com and firstname.lastname@example.org. Tarique Md. Nurul Huda and Md. Mahbubur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: email@example.com and firstname.lastname@example.org. Jillian L. Waid, Amanda S. Wendt, and Sabine Gabrysch, Potsdam Institute for Climate Impact Research, member of the Leibniz Association, Potsdam, Germany, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Mohammad Aminul Islam, Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, E-mail: firstname.lastname@example.org.