Special focus on nutrition-sensitive programming

Research
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Complementary food hygiene:
An overlooked opportunity
in the WASH, nutrition and
health sectors
Summary of research 1
Location: Global
What we know: Poor food hygiene may account for a substantial proportion of diarrhoeal diseases
and contribute to malnutrition among infants and young children in developing countries.
What this article adds: A recent review highlights that public health interventions have not
adequately addressed the food contamination pathway, a risk heightened during the complementary
feeding period (6-24 months). Evidenced risk factors for food contamination concern unhygienic
food preparation and feeding, and environmental contamination due to lack of sanitation and
contaminated water. ree SHARE funded studies are contributing evidence (Bangladesh, Nepal and
Gambia); however, major knowledge gaps remain regarding behaviour change, transmission
pathways, effects on child health and how to scale up successful interventions. Recommendations
include better integration across the nutrition, health and WASH sectors, mainstreaming of food
hygiene, and more consistent monitoring and surveillance of complementary food contamination.
Poor food hygiene may account for a
substantial proportion of diarrhoeal
diseases among infants and young
children in developing countries. However,
most of the information on food hygiene
in low-income countries derives from expert
opinion and biological plausibility rather than
robust epidemiological evidence. is briefing
paper documents the contribution of Sanitation
and Hygiene Applied Research for Equity
(SHARE) to narrowing the evidence gap, highlights
opportunities for future research, and
offers insights that could influence policy and
improve programming in the water, sanitation
and hygiene (WASH), nutrition and health sectors
globally.
origin. is is supported by evidence that the
incidence of diarrhoeal disease is higher in
children aer complementary feeding is initiated
(Barrel and Rowland, 1997).
Interventions to improve public health have
not adequately addressed this food contamination
pathway; although hygiene is high on the WASH
sector agenda, interventions have oen been
limited to hand-washing with soap. e authors
suggest that this neglect is down to the prioritising
by health institutions of vertical disease-management
programmes over horizontally-integrated
public health efforts; the greater emphasis
placed by the nutrition sector on dietary intake
than on food hygiene; the lack of solid evidence
on the effect of food hygiene interventions on
child health outcomes; and the lack of guidance
on best practice for securing sustainable food
hygiene behaviour change in various settings.
time, time elapsed between meal preparation
and feeding, and use of unsterilised and dirty
feeding bottles for children. ere is also some
evidence identifying risk factors and associated
behaviours including environmental contamination
due to lack of sanitation; use of contaminated
water to wash serving utensils; not
washing hands prior to cooking and feeding;
consumption of food that has been spilled on
the floor; and use of dirty cloths for wiping
hands and utensils. e hygiene practices of
mothers have been found to be related to a
high level of bacterial contamination of drinking
water and complementary foods, and the home
has been identified as an important location
for acquiring food-borne diseases. Evidence
also shows that improving socially or culturally
engrained practices is challenging and requires
going beyond purely supply-led interventions
and addressing structural determinants of hygiene
practices.
Diarrhoeal diseases are the second leading
cause of death for children under the age of
five globally (Liu et al, 2012). Diarrhoeal diseases
also increase the risk of malnutrition. While it
e authors lay out existing evidence that
is important for an infant’s development to
links unhygienic food preparation and feeding
complement breastmilk with appropriate solid
Clear gaps remain in the literature. In particular,
there is a lack of epidemiological studies
to an increase in the level of microbiological
foods from the age of six months, complementary
contamination in food and increased risk of
feeding can provide a key transmission pathway
diarrhoeal disease. Factors that may lead to 1
to diarrhoeal disease through unhygienic preparation
and feeding of complementary food,
Guatam, O.P., Esteves Mills, J., Chitty, A. and Curtis, V. (2015).
food-borne contamination include hot climate, Policy Brief: Complementary Food Hygiene: An overlooked
poor storage practices, insufficient cooking
opportunity in the WASH, nutrition and health sectors,
which exposes infants to pathogens of faecal
March 2015. LSHTM and SHARE.
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