Pathogen Contamination of Infant Feeding Implements in Low-and Middle-Income Countries: A Systematic Review Open Access
Chari, Rithika (Spring 2024)
Abstract
Background/Objective: Infant feeding practices and nutrition are important for infant health, and pathogen contamination of feeding implements can have dire consequences related infant morbidity and mortality. The purpose of this systematic review is to synthesize evidence regarding pathogen contamination of infant feeding implements, highlighting the types of pathogens and implements tested in LMICs.
Methods: A systematic literature review was conducted through Covidence using CINAHL, Web of Science, CABI Global Health, EMBASE, and PubMed databases and the Google search engine. Studies were eligible for inclusion if they discussed pathogen contamination of feeding implements in LMICs. Title and abstract screening and full-text screening were completed in duplicate by two independent reviewers and five (23.8%) of the 21 studies were extracted for data in duplicate.
Results: There were 3725 studies imported for initial screening, 21 studies met the eligibility criteria for inclusion, and data from these 21 studies was extracted. Thirteen of the 21 studies that are set in nine LMICs are included in this systematic review. There were seven categories of implements tested and 18 pathogen types tested. Infant feeding bottles were the most tested implement, with 11 (84.6%) of 13 studies testing bottles, and Escherichia coli was tested the most in nine of the 13 studies (69.2%). Five (100.0%) of the five studies that tested E. coli in bottles detected E. coli, and two (100.0%) of the two studies that tested E. coli in utensils detected E. coli. Two (66.7%) of the three studies that tested E. coli in nipples detected E. coli.
Discussion/Conclusions: There is evidence of pathogen contamination in infant feeding implements in LMICs with gram-negative bacteria most commonly detected and bottles/nipples most commonly tested. Additionally, many of the pathogens examined among the studies included in this review are associated with high global mortality. A significant limitation to this review is the lack of studies available, especially in recent years. Thus, future studies must be conducted to bridge the gap in data, increase awareness of implement contamination, and to improve feeding and sanitation guidelines.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 5
2.1: Consequences of early-life pathogen exposures 5
2.2: Breastfeeding versus Bottle Feeding 8
2.3: Infant Formula Composition 9
2.4: Structural Drivers to Breastfeeding vs Formula Feeding 10
2.5: Pathogen Contamination of Feeding Implements 12
2.6: Cleaning Infant Feeding Implements 13
2.7: Research Gaps 14
Chapter 3: Methods 15
3.1: Eligibility Criteria 15
3.2: Data Extraction and Synthesis Methods 16
Chapter 4: Results 17
Chapter 5: Discussion and Conclusion 27
5.1: Burden of Pathogens 27
5.2: Testing of Feeding Implements 28
5.3: Strengths and Limitations 30
5.4: Implications/Future Steps 31
5.5: Conclusion 33
References 45
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