The prevalence of contamination and nutritional inadequacies in feeds introduced to weaning infants in the Bloemfontein region

Abstract

From the late 1950s through the 1960s, the greater availability, ease of feeding, high safety, and relatively low cost of infant formulae in the United States and other developed countries led to most infants being fed artificially from birth. Now, particularly during the past 5 years, more mothers are initially breast-feeding. However, infant formulae have continued to playa major role in infant nutrition. In Sub-Saharan Africa, United Nations (UN) agencies estimated that approximately 40% of children under 5 years of age were stunted; about 30% underweight; and about 7% wasted. One of the most common causes of child morbidity and mortality in developing countries is diarrhoea. It is estimated that across the world, but excluding China, 1400 million episodes of diarrhoea occur annually in children under the age of 5 years. An estimated 70% of the diarrhoeal episodes could be due to pathogens transmitted through food. The Republic of South Africa has a population with a large variety of cultural backgrounds. Each of these cultures has different views regarding the weaning of infants. The total number of deaths in the Free State for 1999 was approximately 6870. The mortality rate for infants in the age group 0-5 years in the Free State comprises 15.6% of this total. Deaths in this age group are considered to be an accurate indicator of access to essential child health and environmental health services. Infections were the next most common cause of death in children under five years old, with diarrhoea and gastro-enteritis as the most common causes. The contribution of weaning malpractice to this figure is unknown. The main objective of this study was to determine the nutritional and microbial quality of bottle contents given to weaning infants, by their caregivers, in the Mangaung area of Bloemfontein. The study was that of a randomised descriptive design. Both qualitative and quantitative data were collected. The study population included a randomly selected population, from four of the neighbourhoods in the Mangaung region, proportional to the population size of the particular neighbourhood. Mangaung is one of the traditionally black townships in Bloemfontein, the capital city of the Free State. Samples were obtained randomly, according to geographical information gathered from the Bloemfontein municipality. A total of two hundred caregivers of weaning infants were each requested to provide a sample of the infants bottle feed . There were a great variety of feeds which included cereal mixtures, infant formula feeds, gruels, pasteurised and unpasteurised cow's milk, tea, coffee and fruit juices. Chemical analysis performed on the bottle feeds included vitamins A, C and E, lactose, fat, protein, solids, calcium, magnesium, zinc and iron. The contents were measured using standardised accepted techniques. Microbiological analyses were performed according to the procedures as described in Annex A of Regulation 1555 of 1997 of the Foodstuffs, Cosmetics and Disinfectants Act 54 of 1972. Counts recorded were minimum counts as no provision was made for fastidious bacteria. The data is described by frequencies and percentages for categorical data and means and standard deviations or medians and percentiles for continuous data for the whole group as well as for the different beverage groups. The measured intake of each respondent is categorised and described as percentages of the RDA and CODEX for each nutrient. The CODEX standards provide prescribed standards that every commercial company must meet regarding the nutritional quality of its product, before marketing. Evaluation of the mean values of the nutritional variables in comparison with the CODEX standards could be used to assess whether the bottle feeds were adequate in nutritional content. For the group data as a whole vitamin A, vitamin E, fat, protein and lactose were above the recommendations set by CODEX. The nutritional variables that did not meet the prescribed CODEX standards included vitamin C, calcium, magnesium, zinc, and iron. Evaluation of the contamination level of the infant feeds elicits serious concern. The contamination level was determined by evaluating the standard plate and total coliform counts. Of the 188 feeds analysed, 145 had standard plate counts above 50 000 organisms/ml (Foodstuffs, Cosmetics and Disinfectant Act 54, 1972 standards for human consumption). Depending on the immune status of the infant, feeds with counts as high as this will definitely lead to diarrhoea and disease. When evaluating the coliform counts, the Foodstuffs, Cosmetics and Disinfectant Act 54, 1972 states that counts higher than 10 coliforms/ml are not fit for human consumption. A percentage of 12.2 were tested positive for E. coli confirmed by the Indole test. The presence of E. coli in the bottle feeds accompanied by the high standard plate and coliform counts often results in severe diarrhoea. It is evident that there is certainly a great deal of concern regarding the quality of bottle feeds introduced to weaning infants. According to the standards set by the Foodstuffs, Cosmetics, and Disinfectants Act 54, 1972, 84.6% of the counts from the bottle feeds exceeded the standards. This indicates that these infants were susceptible to diarrhoea. Therefore, this emphasises the existence of definite factors protecting the infants from infantile diarrhoea. Further investigation regarding these protective factors is recommended.