Urban Infant Foodscape Phase Two - pilot testing a food hygiene intervention in Kenya

There is strong evidence to suggest that food systems in low and middle-income countries (LMICs) carry substantial health risks due to the microbial contamination of foods. The majority of the global foodborne disease (FBD) burden is attributable to gastro-enteric infections associated with diarrhoea. Most of this burden is borne by young children for whom the consequences can be dire in terms of repeated bouts of illness and the longer-term impacts on growth and development. Despite this, we lack evidence to guide the design and implementation of comprehensive strategies to mitigate the risks to child health and development posed by contaminated food in low-income, high-burden settings and populations. The Urban Infant Foodscape (UIF) project addresses this issue. UIF focuses on a population where the FBD burden is highest – young children, age 6-24 months in low-income communities within two low-income countries (Mozambique and Kenya) - and where effective strategies may bring the greatest gains. Both Mozambique and Kenya have high child mortality rates of 71 and 49 deaths per 1000 live births respectively, and diarrhoea remains a leading cause of child deaths in both countries. The East African region, where Mozambique and Kenya are situated, is reported to have the second highest level of FBD globally. Data from the Mozambican and Kenyan sites of the Global Enteric Multicenter Study (GEMS) shows that a number of potentially foodborne enteric pathogens, such as Shigella spp, rotavirus, adenovirus 40/41, ST-ETEC, Cryptosporidium spp, and Campylobacter spp., are responsible for a large fraction of the childhood diarrhoeal disease burden. Food is likely an important transmission pathway for diarrhoeal diseases in this population. The UIF project was designed to be undertaken in two phases. In Phase One of the study under three “work packages” (WP1-3), we collected data on the burden of enteric infection among children aged 6-24months in the Dagoretti area of Nairobi, Kenya, and on levels of food contamination at the household level, in the local marketplace, and at the production/supply chain level, as well associated risk behaviours across these three domains. We are currently collecting this data in Mozambique. In Phase Two of the UIF study, to which this registration pertains, we aim to assess whether a food hygiene intervention (which was informed by data collected in Phase One) delivered to caregivers living in Dagoretti can result in improved caregiver food hygiene and infant feeding behaviours, and to lower levels of infant food contamination.