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Infant Mortality in Nigeria: Assessing Knowledge of Predisposing Risk Factors among Mothers and Bacteriological Profile of the Weaning Foods

Ossai Ochonogor Samuel

Department of Vocational Education (Home Economics Units), Delta State University, Abraka, Nigeria

Abstract: A survey was conducted to evaluate the risk factors for persistent diarrhea and to ascertain the bacteriological profile of weaning foods given to less than 2 years of age children in Nigeria. Thirty nursing mothers were selected for the study and nine weaning foods sampled. Low education, unhygienic practices and poor knowledge about basic food safety issues were responsible for gross weaning foods contamination and frequent diarrheal episodes. All the examined weaning foods were contaminated with more than two bacterial species. Eight bacterial species namely E. coli, Klebsiella sp., Enterococcus sp., Bacillus sp., Pseudomonas sp., Staphylococcus sp., Micrococcus sp., Proteus sp., Citrobacter sp., were isolated. Staphylococcus sp. were isolated. The average bacterial load ranged from 2.2 x 10⁴ to 3.7 x 10⁶.cfu/g. Staphylococcus sp., was the most frequent isolates followed by Bacillus sp., E.coli and Micrococcus sp., while Citrobacter sp. and Klebsiella sp., were the least frequent isolates. Only two weaning foods; rice and yam/oil had bacterial count within the acceptable limit of less than or equal to 4 log10 cfu/g while three weaning foods; yam/oil, rice and noodles had Enterobacteriaceae count less than or equal to 3.0 log10 cfu g⁻¹. Food safety education of the target population and enforcement of existing laws on environmental sanitation and hygiene as a basic preventive strategy is hereby recommended.

Keywords: infant mortality, weaning foods, bacterial contamination, food safety education

Received May 14, 2013; Revised June 07, 2013; Accepted July 10, 2013

Citation: Ossai Ochonogor Samuel, Infant Mortality in Nigeria: Assessing Knowledge of Predisposing Risk Factors among Mothers and Bacteriological Profile of the Weaning Foods. American Journal of Food and Nutrition, 1 (3). 22-26. January 2013. doi:10.12691/ajfn-1-3-1

1. Introduction

Infancy is a period of rapid growth and increased demand for calories and proteins. In Nigeria infant mortality is a major public health concerns as debilitating picture of poverty, diseases and malnutrition still constitutes an unholy decimal in the country landscape. Presently demographic data on Infant Mortality Rate (IMR) are still hugely inadequate as many deaths occur at home and are not recorded in official statistics [1]. However it is estimated that over 157 children per 1,000 live births or approximately 1 child out of 6 dies before reaching age five [2].

This devastating and long standing health care crunch is influenced by combination of interrelated factors which includes high numbers of births per mother with short spacing between births, poor weaning foods, use of infants formulas (cow's milk), inadequate healthcare delivery system, unhygienic practices and sanitations, poor feeding practices and low educational attainment [3,4]. A number of observational studies and survey has shown that children are particularly vulnerable to infections, malnutrition and deaths during the transition from breast milk as the chief source of nourishment to solid foods termed the weaning process [5,6,7]. Study in poor areas of Ghana, India and Peru revealed 10.5 times the number of deaths for those not breast fed compared to infants that are exclusively breast-fed while partially breastfed infants had 2.5 times the risk of death versus those exclusively breastfed [8].

Table 1. Nigeria under-five mortality level and trends (1990- 2009)

In Nigeria there is an increasing early introduction to complementary food as a result of changing status of mothers as family bread winners, transient nature of the population and changing lifestyle. Presently 40% of infant’s ages 2-3 months are already on transition to solid foods such as yam (Dioscorea spp.), rice (Oryza sativa), gari (fermented cassava grits), and cocoyam (Xanthosoma sagittifolium) and locally sourced weaning foods such as pap, akamu, ogi, or koko made from maize (Zea mays), millet (Pennisetum americanum), or guinea corn (Sorghum spp) or other food sources like moi-moi, akara, biscuits etc [9,10]. Although weaning foods present additional poll of nutrients to support the child rapid growth and development, regrettably the period is marked by high prevalence of gastrointestinal disorders, malnutrition and deaths due to woeful lack of basic hygienic and sanitary practices, illiteracy, poor feeding practices like pre-mastication, poor weaning foods and knowledge of basic food safety issues [11]. The consequence is not only poor nutrition but persistent episodes of diarrhea and growth faltering [11,12].

Marginal success has been recorded in infant mortality reduction over the years with under five prevalence rate felling by 22% from 201 deaths per 1000 live births in 2003 to 157 deaths per 1000 live births in 2008 [12] (UNICEF, 2010), nevertheless meeting the Millennium Development Goal (MDG)-4 of two thirds reduction in child mortality (on 1990 levels) by 2015 remains a mirage as several studies reveals a shocking pictures of infants deaths [11] (UNICEF, 2010), and endemic potential risk factors leading to diarrhea among nursing mothers [3,10,13]. It is against this background that this study was initiated to consolidate on previous works on weaning food contamination and its bacteriological profile. The distinct point of this study was the sampling of the weaning food items for bacteriological analyses at the point of feeding.

2. Materials and Methods

2.1. Study Setting and Population

The study was conducted in Ukwuani Local Government Area of Delta State, Nigeria. The communities in Ukwuani Local Government Area are predominantly rural and agrarian. The objective of the study was explained to the nursing mothers before the investigation. 30 nursing mothers were randomly selected from the Primary Health-care Centre to form the sample for the study. Study was conducted between March 2011 and February 2012.

2.2. Data Collection

A structured and self-administered questionnaire was used for data collection. The questionnaire included socio-demographic variables like age and educational background; knowledge of food pathogens and mode of transmission, basic food safety issues and personal hygiene. About 50 grams portion of each weaning food given to the children under 2 years was carefully collected and placed in sterile containers. A total of 30 analyses were carried out on 9 weaning food items (Table 4). The weaning food items were collected in sterile disposable containers, labeled appropriately and transported to the laboratory on ice-pack for examination within 6 hours. 3. Bacteriological Quality Determination.

3. Bacteriological Quality Determination

3.1. Bacterial Counts

10 grams portion of each prepared weaning foods given to <2 years infants were collected from 30 mothers selected for the study and macerated in 90mL of Phosphate buffered saline to make a 1:10 dilution. Further 10-fold serial dilution were made and examined by the pour plate technique as described by [14]. The culture media was nutrient agar for total bacterial count (International Diagnostic Group Plc, BC96AU, U. K). Mannitol salt for Staphylococcal count. Salmonella/Shigella agar for Salmonella/Shigella detection. Suspected bacterial colonies from all the plates were sub-cultured in MacConkey agar a differential medium for the detection of Salomenella sp., Shigella sp., E. coli and other Enterobacteriacea to obtain a pure cultures for morphological and biochemical identification. All the plates were incubated at 37°C under aerobic conditions. After incubation overnight, counts were made using a digital colony counter. The average colonies obtained from the countable duplicate plates were expressed as colony forming unit per gram (cfu/g) of sample. Obtained results were compared with literature standards using diagnostic tables showing the biochemical reactions identifying many genera and species of bacteria [15].

3.2. Data Analysis

All cfu/g values were converted to log10 to easy data analysis. Food items were classified as acceptable if the aerobic colony counts was less than or equal to 4 log10 cfu g-1 while for Enterobacteriaceae it is acceptable if the count was less than or equal to 3.0 log10 cfu g-1. Foods items with counts above these limits were classified as unsafe and potential channel for enteric pathogens.

4. Results

The study assessed the knowledge of predisposing risk factors for weaning foods contamination and its possible contribution to endemic high Infant Mortality Rate (IMR) in Nigeria. The study x-rays this persistent healthcare quagmire using randomly selected 30 nursing mothers.

Table 2 shows the socio-demographic profile of the randomly selected participants (nursing mothers). Majority of the participants 18 (60%) were within the age range of 21-30 years. 17 (56.7%) of the participants representing majority are rural dwellers, 13 (43.3%) lived in semi urban area while non live in urban area. The number of participants who had Senior School Certificate of Education (SSCE) or Ordinary Level (O/L) was 50% (15), followed by National Certificate of Education (NCE)/ Ordinary Diploma (OND) to Degree 26.7% (8) while below SSCE was 23.3% (7).

Table 2. socio-demographic characteristics of the participants

Table 3 shows the basic hygienic assessment and knowledge of diarrhea symptoms among the participants (nursing mothers). The variables evaluated under basic hygiene practices (Table 3a) revealed poor understanding of basic food safety issues and hygienic practices by nursing mothers. Only 26.7% (8) of the nursing mothers wash their hands before and after food preparation while the remaining participants exhibited poor observance; 23.3% (7) of the nursing mothers reheated the infant food before feeding, 26.7% (8) do not reheat their foods while 50% (15) do not always reheat their food; 53.3% (16) of the participants do not always sterilized infant feeding bottles/flasks while only 30% (9) regularly sterilizes infant food bottles/flasks; 46.7% (14) representing majority tastes food with infants spoons before using the same spoon to feed the child; nevertheless, the participants exhibited a fair knowledge of diarrhea symptoms (Table 3b) while the knowledge of transmission vehicles (Table 3c) were also fair.

Table 3. Assessment of basic hygienic practices and knowledge of diarrhea symptoms

Table 4 shows the infants weaning food profile. A total of 30 weaning foods were sampled, one sample from each nursing mother. The results (Table 4) shows that akamu (pap) was the most commonly used infants weaning food among the randomly selected participants (nursing mothers); accounting for 23.3% (7) of the total sampled weaning foods, followed by noodles 16.6% (5) and rice 13.3% (4) while yam/oil and moi-moi were least on the ladder accounting for 3.3% (1) each of the total sampled food.

Table 4. Randomly selected infants weaning food items

Table 5 shows the bacterial counts of the sampled weaning foods given to the children. A total of 30 weaning foods items were analyzed for bacteriological contamination. All the weaning food samples were contaminated with more than three bacterial species. Eight bacterial species namely E. coli, Klebsiella sp., Enterococcus sp., Bacillus sp., Pseudomonas sp., Staphylococcus sp., Micrococcus sp., Proteus sp., Citrobacter sp., were isolated. Staphylococcus sp., was the most frequent isolates followed by the others in descending order, namely Bacillus sp., E.coli and Micrococcus sp., while Citrobacter sp. and Klebsiella sp., were least frequent isolates. Weaning food Samples collected from 13 (43.3%) of the mothers from semi-urban areas lower bacterial counts (Figure 1). Only two weaning foods; rice and yam/oil had bacterial count within the acceptable limit of less than or equal to 4 log10 cfu/g and three weaning foods; yam/oil, rice and noodles had Enterobacteriaceae count less than or equal to 3.0 log10 cfu g-1

Table 5. Bacterial counts of the weaning foods sampled

5. Discussion

Infant Mortality Rate (IMR) reveals sensitive index of the total health status of a nation and a barometer to gauge the level of socio-economic development of a nation. This study assessed the knowledge of basic food safety practices and bacteriological profile of the weaning foods items given to infants undergoing transition breast milk to solid foods in Nigeria.

Results of the demo-graphic profile on Table 2c revealed low educational profile of the participants (Table 2c) with only 26.7% (8/30) possessing NCE/OND and University degree. Education is a principal instrument for generating appropriate value and behavioral modification. Proper information dissemination on knowledge of food borne diseases, their mode of transmission and prevention among the vulnerable population represents an inexpensive channel for developing familiarity and positive attribute towards food safety issues. Similar study on food safety education impart on nursing mothers for diarrhea prevention in Indian revealed a significant improvement in the knowledge, attitude and practices on potential risks factors leading to diarrhea in infants in the fully educated mothers [16]. The low educational attainment of the nursing mothers observed in this study with 73.3% (22/30) of the participants having less than NCE/OND and University degree maybe attributable to the observed poor basic food safety principles and consequently increased risks of food contamination and persistent diarrheal episodes among infants. The value of education in bringing about behavioral changes, improved feeding practices and child nutrition has been reported also in a previous study in which educational intervention program targeted at mothers significantly improved complementary feeding practices [17]. A similar study in Indian on food safety education impart on mothers confirms the very importance of education in bringing about personal hygiene improvement and reduction microbial count [18]. The observed rural and semi-urban residence of the participants (Table 2c) has been reported in similar study to be a contributing factor for weaning foods contamination [3]. Rural and semi urban area lack basic infrastructures such as electricity, portable water and good sewage disposal facilities; consequently most household wastes are dumped indiscriminately and serves as harborage for rodents, insects and pathogenic micro-organisms. Furthermore unsanitary scenario compounded by poverty such as hand, dish and utensil washing without soaps and exposure of food materials to sources of contaminations like soil, sand and dust are more endemic in the rural areas. Evidently leading to gross contamination of weaning foods and increased risk of childhood mortality in rural area. Previous survey in Nigeria on diarrheal episodes among five children revealed that the proportion of children with diarrhea is higher in rural area than in urban area [19].

Knowledge of diarrhea symptoms and assessment of basic hygienic practices revealed an abysmal result (Table 3b). The poor understanding of basic hygienic practices observed in this study has been reported in similar studies [4,10,12]. Poor hygienic practices such as pre-mastication of foods, poor personal hygiene, use of unsafe water, inadequate storage facilities and non-reheating of weaning foods before infants feeding are potential risk factors leading to diarrhea in infants [11]. Previous survey on diarrheal prevalence among children under five years in Nigeria revealed a harmonious trend as diarrhea was more prevalent among children whose households lacked assess to potable water [2]. High bacterial contamination of indigenous weaning foods items analyzed in this study is a direct correlation of gross poor observance of simple rule of basic hygiene among mothers such as un-sterilization of feeding bottles and utensils, poor personal hygiene, use of unsafe water and exposure of the foods to possible contaminants.

The bacterial count (cfu/g) and their percentage frequency of occurrence in weaning foods are shown in Table 5 and Figure 1 respectively. Although Shigella sp. and Salmonella sp were not detected in the weaning food samples, the isolation of E.coli and other enterbacteriaceae (Klebsiella and Citrobacter sp) in the weaning foods are indicative of faecal contamination [20]. E coli is a major enteric pathogen, particularly in developing countries compare to other enterobacteriaceae. The principal groups of E.coli. include the classical enteropathogenic serotypes (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), enterohemorrhagic (EHEC), and enteroggregative (EAEC) strains [21,22]. Sources of these contaminations are excreta, wastewater, sludge, septage or bio-solids. Contaminating microorganism present in a food material is directly a function of the environment, handling, processing, packaging and storage condition [4]. Thus the isolation of diverse bacterial species in this study is explained by poor knowledge of basic food safety issues, abuse and unsanitary practices among the nursing mothers, which correspondingly increased the potential risk factors leading to diarrhea and deaths in infants [4]. The bacterial count (cfu/g) recorded in this study as well as the bacterial distribution was consistent with previous study [10].

Figure 1. Frequency of bacteria isolates from analyzed weaning foods items

Furthermore the isolation of gram positive cocci namely Staphylococcus aureus, Enterococcus faecalis. and Micrococcus sp. in the weaning food items are evident of huge unhygienic practices and exposure of the weaning foods to multiple contamination. Staphylococcus sp an enterotoxin producer [23], had the highest frequency of isolation from the weaning foods. Staphylococcal enterotoxin results in gastroenteritis syndrome namely vomiting, headache, vomiting, loss of appetite, abdominal cramps, prostration and mild fever [24]. Presence of Enterococcus faecalis in large number in the weaning foods is indicative also of faecal contamination [24]. Additionally Enterococcus faecalis has been implicated in food spoilage and souring [24]. Micrococcus sp. is widely distributed in nature and could have been introduced into the food through poor hygiene and sanitary practices. Bacillus sp. which was second to Staphylococcus sp. in frequency of bacterial isolation is an aerobic; spore forming rods found in soil, dust and water and have been implicated in food poisoning [25]. The spores of Bacillus bacteria commonly contaminate raw foods and food materials, particularly foods in contact with the soil or of vegetable origin. The spores survive cooking and can subsequently germinate and grow under favorable condition provided by warm ambient storage condition. The result of this study reveals a synergistic relationship between the examined risks factors responsible for food contamination and childhood mortality in Nigeria.

6. Conclusion

Result obtained in this study shows a direct correlation between frequent diarrheal episodes and childhood mortality. Several interrelated risk factors that encourage food contaminations were prevalent. Food safety education among mothers on the major determinants of persistent diarrhea episodes and stricter adherence to basic hygienic practices and sanitation will significantly improves the nutritional and health status of infants in Nigeria.

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