Improving Safety and Quality Of Complementary Foods for Children Aged 6-23 Months in Rural Areas of Malawi Through the Hazard Analysis and Critical Control Point Strategy

Abstract

The prevalence of stunting is very high in Africa (33.9%) despite global decline from 32.6 to 22.2% between 2000 and 2017; and over 33% of all stunted children live in Sub Saharan Africa. In Malawi, 37.1% of under-five children are stunted, 12% are underweight and 3% are wasted. Dedza district has very high prevalence of stunting (43%) despite various interventions to improve child nutrition. The most mothers do not follow standard practices of ensuring food safety, hygiene and dietary diversity when preparing food. Lack of hygiene may lead to microbial contamination of food. This study targeted mothers, caregivers and children aged 6-23 months with the aim of determining child feeding practices, child nutritional status, prevalence of microbes and aflatoxins in complementary foods and developing a strategy to prevent microbial contamination and growth of moulds in food using the Hazard Analysis and Critical Control Point (HACCP) approach. A cross sectional nutrition survey was conducted to determine child-feeding practices and to assess nutritional status among 303 caregivers and 306 children respectively. Samples of maize flour from 40 households were analysed for moulds, yeasts and coliform presence using culturing laboratory methods. Aflatoxin was analyzed using High performance Liquid Chromatography (HPLC). Focus group discussions were conducted to identify critical control points and sources of food contamination among mothers and caregivers. A training intervention was developed using the HACCP approach and 40 mothers and caregivers randomly selected from the original sample of 303 were trained and evaluated after six months. Data were analysed using Microsoft Excel, SPSS and WHO Anthro to generate descriptive statistics and z scores for anthropometry indices. Results showed that the majority of mothers (82%) were not following recommended child feeding practices. A total of 47.1% of the children were stunted, 15.5% were underweight and 2.3% were wasted. About 86% flour samples were contaminated with moulds (2.04±0.75 log10 CFU/g), yeast (1.38±1.11 log10CFU/g) and coliforms (1.40±1.06 log10CFU/g). Aflatoxin B1 (0.37±0.86 ppb) was detected in 60.6% of the flour samples. After training, more mothers and care givers (82.5%) adopted recommended hygiene practices than at baseline (37.5%) and diarrhea prevalence declined from 28.7% to 8.5% among children. From the results, it can be concluded that child feeding practices are unsatisfactory in rural areas of Malawi and that training of mothers and caregivers may improve food hygiene practices. It is therefore recommended that the role of hygiene in food preparation practices should be integrated into the infant and young child feeding policy in Malawi.