BACTERIOLOGICAL QUALITY OF BOTTLE FOOD AND ANTIBIOTIC SUSCEPTIBILITY PROFILES OF PATHOGENIC ISOLATES AMONG WEANING BABIES ATTENDING PEDIATRIC OUTPATIENT CLINICS OF GOVERNMENT HEALTH INSTITUTIONS IN ARBA MINCH TOWN, SOUTHERN ETHIOPIA 2022

Abstract

Background: Despite, microbial contamination was reported as the most common safety related public health risks in the bottle-feeding practice. It has been overlooked and only few studies in Africa assessed the bacteriological quality and safety of bottle food and no recent data were found in Ethiopia, including the current study area. Objective: To assess bacteriological quality of bottle food and antimicrobialsusceptibility profiles of pathogenic isolates among weaning babies attending pediatric outpatient clinics in government health institutions of Arba Minch town, southern Ethiopia 2022. Methods: Institution based cross sectional study was conducted among bottle fed babies from 1st February to April 30, 2022. Bottle food samples and socio-demographic data, bottle food preparation and handling practice of caregiver were collected by trained nurses. The bacteriological quality of the collected bottle food samples and presence of foodborne pathogens was analyzed by conventional microbial culture method. Antimicrobial susceptibility and biofilm forming ability of bacterial isolates was tested by Kirby Bauer disc diffusion and microtiter plate method respectively. Data was processed using SPSS version 20. Mean microbial counts of food samples were compared using one way ANOVA. Chi-square & Fisher’s exact test was done to determine associations between variables. Statistical significance was tested at P (≤ 0.05). Result: The mean total viable bacteria and total coliform count for all bottle food samples were 5.35 ± 2.3 𝑙𝑜𝑔10 𝑐𝑓𝑢/𝑚𝑙 and 4.1 ± 2.6 𝑙𝑜𝑔10 𝑐𝑓𝑢/𝑚𝑙. And 57.3% (126/220) of the bottle food samples had a total viable bacterial count, and 59.1% (130/220) had total coliform count higher than the maximum permitted level respectively. Among the four bottle food types analyzed in this study, cereal based gruel and juice were the most contaminated. In addition, foodborne pathogens were detected in 8.5% of the samples. Precisely 89.6% of tested foodborne bacterial isolates were found to be MDR. All (100%) of these recovered pathogens exhibited biofilm forming ability. Microbial count and presence were observed to be influenced by food handling practice and sociodemographic characteristics of bottle-fed baby and its caregiver. Conclusion: High level of bacterial contamination, isolation of drug resistant and biofilm forming pathogenic bacteria in feeding bottle food indicates a serious food safety risk to bottle fed babies in the study area. Intervention to improv hygienic preparation and handling of feeding bottle food should be sought. Keywords: Bottle feeding, weaning foods, bacterial contamination, Arbaminch, Ethiopia. 1 1. INTRODUCTION 1.1 Background Bottle feeding is the act of providing an infant any liquid food or drink through a feeding bottle with a nipple, regardless of whether they are breastfed or not (1). Powdered infant formula and ready-to-eat food are issued from birth to the first two years of life to feed millions of newborns worldwide. Various cereal-based gruels, cow milk, and fruit products are a common weaning food offered to bottle-fed newborns in underdeveloped nations (1). Being a nutrient-rich medium, this kind of food can support the growth of microbes when favorable conditions of water availability, time and temperature are provided. Therefore, once prepared the only limiting conditions for bacterial growth are storage time and temperature. So, it is considered as an excellent medium to support the microbial growth and carrying potential risk of exposure to food borne pathogens (2). On top of that, their immature immune system and lack of computing intestinal microflora put babies to increased risk of infection when exposed to contaminated food (3). Poor bacteriological quality and safety of infant bottle food are implicated as significant casual factor in the aetiology of weanling diarrhoea (4). In the scientific literature, definitions of food safety and food quality have varied, and the term has often been used to indicate the high-level contamination of food with indicator organisms and the detection of potential food borne pathogens respectively (4). Microbial quality of food from feeding bottles were evaluated in previous studies to determine the microbiological load of hygiene and process indicators organisms per milliliter of food sample. The specific microbial quality indicator organisms tested and their count were compared with the microbiological limit specified by the food safety regulatory bodies and the majority of studies employed coliform and aerobic mesophilic bacteria as their quality indicators. Overall, more than 50 percent of all home-prepared bottle food studied across studies conducted in, IndonesiThailand, South Africa, and Ethiopia were found to be microbiological unsatisfactory for infant consumption (5-8). Apart from domestic environment, contaminated feeding bottles food has been reported as a source of an outbreak of infections in the hospital setting and transmission of antimicrobial resistant food borne pathogens Microorganism of concern for bottle fed babies are diarrhoegenic enteropathogens such as E. coli, Salmonella spp, and Shigella spp and enterotoxigenic bacteria such as Staphylococcus aureus, Bacillus cerrus, and systemic bacterial pathogen such as Cronobacter spp and other bacteria (6- 10). Studies that characterized bacteria isolated from feeding bottle, infant food as well as from the stool of bottle-fed babies showed high prevalence of antimicrobial resistance for the commonly prescribed drugs (8-14). Off these the frequently reporting of multidrug resistant bacteria and their biofilm forming ability is alarming. The source of contamination of bottle food is a multifactorial in origin. Intrinsically or extrinsically contaminated ingredients, unclean feeding bottle, and water used to reconstitute the feed are the common source. Lower educational status of caregivers along with low socio-economic living standard, shortage of water and sanitation facilities have been found to have association with bottle food contamination. In addition, storage duration of the prepared feed is another factor for contamination; studies revealed positive correlation between the length of time from preparation and coliform contamination suggesting that contamination levels would have been higher if samples had been collected at the point of consumption, rather than of preparation, as feeds are often kept for long periods in this population (6-8). The World Health Organization has called for rigorous studies and interventions to improve the safety of complementary foods introduced to infants. Despite these efforts, the investigation of bacteriological quality and safety of bottle food has received little attention in Ethiopia, including the current study area. In light of these issues, the aim of this study was therefore to assess bacteriological quality of bottle food and antibiotic susceptibility profile of pathogenic isolates among weaning babies attending pediatric outpatient clinics of governmental health institutions in Arba Minch town, southern Ethiopia