Risk factors for enteric pathogen detection in food consumed by children aged 6–24 months in informal urban neighbourhoods of Nairobi, Kenya: a cross-sectional study

Background

Food is an important transmission route for symptomatic and asymptomatic enteric infections in early childhood. Chronic carriage of enteric pathogens may lastingly impact gut health and childhood growth and development. This cross-sectional study aims to describe the detection frequencies of 30 enteric pathogens in food samples using TaqMan Array Cards and their associated risk factors among children aged 6–24 months living in a low-income, densely populated urban area of Nairobi, Kenya.

Methods

We conducted a cross-sectional study among 569 households in the Dagoretti Division of Nairobi, Kenya. We collected one food sample from each household and tested each sample for 30 enteric pathogens by custom TaqMan Array Card. The relationship between potential food-related risk factors and the detection of enteric pathogens in food was explored using multivariable logistic regression.

Results

The prevalence of detection of ≥1 enteric pathogen found in children’s food was 21.4% (n=122/569). The most prevalent pathogens were Aeromonas (9%, n=51/569) and Cryptosporidium (5.3%, n=30/569). Caregivers selecting food vendors based on hygiene was associated with decreased odds of detecting ≥1 protozoan pathogen (OR 0.55, 95% CI 0.30, 0.99, p=0.049). Preparing food in a container was found to be associated with decreased odds of bacterial detection (OR 0.56, 95% CI 0.33, 0.96, p=0.033), largely driven by detecting Aeromonas (OR 0.37, 95% CI 0.19, 0.71, p=0.003). Rodent sightings in the household within the last week were associated with increased odds of detecting Cryptosporidium in child food (adjusted odds ratio [OR] 2.64, 95% confidence interval [CI] 1.10, 7.37, p=0.042). Conversely, rodent sightings were associated with a reduced risk of detecting bacteria in food (adjusted odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36, 0.99, p=0.044.

Mixtures of cereal, meat, fish, vegetables, and legumes were weakly associated with increased odds of detecting bacteria (OR 1.69, 95% CI 0.97, 2.94, p=0.063) in child food, mostly driven by the detection of Aeromonas (OR 2.25, 95% CI 1.18, 4.35, p=0.015). Food containing dairy was associated with decreased odds of detecting ≥1 enteric pathogen in the sample (OR 0.42, 95% CI 0.21, 0.78, p=0.009) even though the numbers were small.

Conclusion

We detected a range of enteric pathogens in food consumed by children aged 6-24 months of age in this setting. Our results suggest that contaminated food may be an important pathway of disease transmission among young children. Targeted food hygiene interventions are needed to address these specific foodborne risks for young children in complex urban settings such as this.