Piloting an intervention to improve microbiological food safety in peri-urban Mali

Diarrhoeal diseases remain a major cause of preventable death among children under five years old in developing countries. Studies related to infant diarrhoea causation have demonstrated a higher level of faecal contamination in weaning foods than in drinking water. Many studies have examined the microbiological quality of such foods, but few of them have resulted in an intervention. The present study builds upon an experiment in which the HACCP approach was applied to preparation of two common weaning foods (moni and fish soup) and used to develop simple hygiene measures which mothers could take in preparing and serving foods to their children, to prevent contamination. A randomly selected sample of 60 volunteer mothers was split into two groups of 30, the first receiving messages promoting implementation of the hygiene measures, and the second as a control. Samples of the food were taken in all 60 households at the point where they would have been served to a child. These were examined microbiologically, and physical parameters were measured. The process was repeated after the mothers had received three weeks' training in the preventive measures, and again three months later on an unannounced visit. Before the intervention, thermotolerant coliform (TTC) contamination levels exceeded 100 per gram in 55% of food samples cooled after cooking (prior to child service) and in 86% of samples of food stored prior to child service. After the intervention, the contamination was detected (i.e. >10TTC/g) in less than 17% of food samples cooled (prior to child service) after cooking and in only 4% of food samples reheated after storage and cooled prior to child service. The reduction in faecal contamination was highly significant (P<0.0001). The follow-up visit three months later produced still better results; only 0% to 17% of food samples failed to meet our standard of <10TTC/g. The HACCP approach can lead to effective measures for improving home food safety, and is applicable with modest resources for promotion of food hygiene and safety in a low-income community. [authors abstract]