Food safety considerations for commercial complementary foods from global operational guidance on infant and young child feeding in emergencies

The use of commercial complementary food (CCF) in humanitarian emergencies is an emerging topic in nutrition policy. Food safety guidance is helpful for the prevention of foodborne illnesses in infants and young children, but whether current global operational guidance on infant and young child feeding in emergencies (IYCF-E) adequately addresses food safety for CCF in humanitarian emergencies is unknown. The aim of this review was to identify and synthesize available food safety guidance on the use of CCF in humanitarian emergencies. A narrative review that included a systematic content analysis and thematic synthesis of global operational guidance on IYCF-E was conducted. Fourteen global guidance documents were selected. Forty-nine excerpts specific to CCF were identified, of which 10 (20%) were rated as relevant to the prevention of foodborne illness. Assessment of interrater reliability showed 80% agreement, with a Cohen's kappa coefficient (kappa) of 0.52 (moderate agreement). Content was synthesized in 3 themes: donations of CCF, quality assurance and quality control, and water, sanitation, and hygiene principles. Little salient guidance for the safe use of CCF in emergencies was identified. Global operational guidance on IYCF-E should be updated by incorporating food safety considerations for the use of CCF.