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Geographic location of study countries in Africa. Source: https://hub.worldpop.org/geodata/summary?id=29691. https://doi.org/10.1371/journal.pntd.0010663.g001
Source publication
Background
According to the World Health Organization, 600 million cases of foodborne disease occurred in 2010. To inform risk management strategies aimed at reducing this burden, attribution to specific foods is necessary.
Objective
We present attribution estimates for foodborne pathogens ( Campylobacter spp., enterotoxigenic Escherichia coli (ET...
Context in source publication
Context 1
... three projects consider food safety in Burkina Faso, Ethiopia and Rwanda (Fig 1). Based on infant and adult mortality, Burkina Faso (2017 population 15,605,210) was assigned to the AFRD subregion and Ethiopia (2017 population 106,399,926) and Rwanda (2017 population 11,980,960) to the AFRE sub-region by FERG [12]. ...
Citations
... urban-food-markets-africa-incentivizing-food-safety-using-pullpush-approach AFRD subregion (high child and high adult mortality) and Ethiopia to the AFRE subregion (high child and very high adult mortality). The project partners selected the foods and hazards while designing the study based on the results from Havelaar et al. (2015) and specific concerns in the target countries [for details, see Sapp et al. (2022)]. ...
... Table 3 shows the part of the disease burden in Table 2 that was attributed to consumption of chicken meat and of tomatoes. These data were obtained from the WHO and a dedicated Structured Expert Judgement study Sapp et al., 2022). In Burkina Faso, the disease burden caused by NTS in tomatoes exceeded the disease burden caused by ETEC in tomatoes, whereas in Ethiopia this was reverse. ...
Introduction
Foodborne diseases (FBD) are a significant problem in low- and middle-income countries, especially in Africa. Country-specific estimates of the economic costs related to FBD caused by different hazards in different food products can inform decision makers about this problem’s magnitude. This aids policy makers in prioritising actions to mitigate risks and prevent illness. Although estimates exist for many high-income countries, they are lacking for African countries.
Methods
This study estimates economic cost in Burkina Faso and Ethiopia related to FBD caused by non-typhoidal Salmonella enterica (NTS), Campylobacter spp. (CAMP) and enterotoxigenic Escherichia coli (ETEC) in all foods, chicken meat and tomatoes. The World Health Organization’s estimates of FBD burden, updated from 2010 to 2017, were used as a basis. Economic cost estimates were the sum of estimates of willingness-to-pay (WTP) to reduce risk of death and of pain and suffering, and lost productivity. WTP was based on value of statistical life (VSL) and value of statistical life year (VSLY), extrapolated from USA data. We used sensitivity options to account for uncertainty in these values.
Results
Mean economic costs related to FBD caused by NTS, CAMP and ETEC in 2017 were estimated at 391 million constant 2017 international dollars in Burkina Faso and 723 million in Ethiopia. These represent 3.0% of gross national income in Burkina Faso and 0.9% in Ethiopia. Lost productivity contributed 70%, WTP to reduce risk of death 30%, and WTP to reduce risk of pain and suffering 1-2%. NTS caused the highest costs, followed by ETEC and CAMP. Chicken meat caused 9-12 times higher costs than tomatoes. Children under five years (14.6-17.1% of populations) bore 20-75% of the costs. Due to uncertainty in disease burden and economic data, costs could be four times higher than mean estimates.
Discussion
Policies to control FBD likely result in substantial benefits, especially efforts aiming at this study’s hazards in chicken meat and children under 5 years. Efforts to reduce uncertainty in VSL, VSLY and disease burden estimates, estimate costs for other countries, attribute costs to other food products and hazards, further standardise estimation methodologies, and estimate treatment costs and illness prevention expenditures are recommended.
... Attribution of the burden of the dairy food group to different dairy types (milk from cattle and milk from other animals) and to different cattle milk products (raw milk, milk fermented by traditional processes, milk fermented by industrial processes, heat treated milk and other milk products) were based on a structured expert judgment (SEJ) analysis organized specifically for this study. This analysis, also applied to food attribution questions in two other African countries (Ethiopia and Burkina Faso) is described in detail elsewhere [18]. Briefly, the SEJ analysis was done according to Cooke's Classical Model [19,20]. ...
... The FERG data, combined with new attribution estimates generated for this study and published separately [18], suggest a considerable burden of campylobacteriosis, salmonellosis and tuberculosis from dairy in Rwanda. In comparison, the burden of cryptosporidiosis and brucellosis was relatively small. ...
Background
The Girinka program in Rwanda has contributed to an increase in milk production, as well as to reduced malnutrition and increased incomes. But dairy products can be hazardous to health, potentially transmitting diseases such as bovine brucellosis, tuberculosis, and cause diarrhea. We analyzed the burden of foodborne disease due to consumption of raw milk and other dairy products in Rwanda to support the development of policy options for the improvement of the quality and safety of milk.
Methods
Disease burden data for five pathogens (Campylobacter spp., nontyphoidal Salmonella enterica, Cryptosporidium spp., Brucella spp., and Mycobacterium bovis) were extracted from the 2010 WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) database and merged with data of the proportion of foodborne disease attributable to consuming dairy products from FERG and a separately published Structured Expert Elicitation study to generate estimates of the uncertainty distributions of the disease burden by Monte Carlo simulation.
Results
According to WHO, the foodborne disease burden (all foods) of these five pathogens in Rwanda in 2010 was like or lower than in the Africa E subregion as defined by FERG. There were 57,500 illnesses occurring in Rwanda owing to consumption of dairy products, 55 deaths and 3,870 Disability Adjusted Life Years (DALYs) causing a cost-of-illness of $3.2 million. 44% of the burden (in DALYs) was attributed to drinking raw milk and sizeable proportions were also attributed to traditionally (16–23%) or industrially (6–22%) fermented milk. More recent data are not available, but the burden (in DALYs) of tuberculosis and diarrheal disease by all causes in Rwanda has declined between 2010 and 2019 by 33% and 46%, respectively.
Conclusion
This is the first study examining the WHO estimates of the burden of foodborne disease on a national level in Rwanda. Transitioning from consuming raw to processed milk (fermented, heat treated or otherwise) may prevent a considerable disease burden and cost-of-illness, but the full benefits will only be achieved if there is a simultaneous improvement of pathogen inactivation during processing, and prevention of recontamination of processed products.
... In the United States, among 466 reported STEC outbreaks between 2010 and 2017 affecting 4769 persons, 20% of the outbreaks were linked to beef, and 71% of the outbreaks were caused by E. coli O157 [14]. Recently, in Ethiopia, a Structured Expert Elicitation study attributed about 60% of the burden of STEC in beef to red meat and about 31% to beef consumed raw [17]. ...
E. coli O157:H7 is a known Shiga toxin-producing Escherichia coli (STEC), causing foodborne disease globally. Cattle are the main reservoir and consumption of beef and beef products contaminated with E. coli O157:H7 is an important source of STEC infections in humans. To emphasize the cattle-to-human transmission through the consumption of contaminated beef in Bishoftu, Ethiopia, whole-genome sequencing (WGS) was performed on E. coli O157 strains isolated from three sources (cattle, beef, and humans). Forty-four E. coli O157:H7 isolates originating from 23 cattle rectal contents, three cattle hides, five beef carcasses, seven beef cuts at retail shops, and six human stools in Bishoftu between June 2017 and May 2019 were included. This study identified six clusters of closely related E. coli O157:H7 isolates based on core genome multilocus sequence typing (cgMLST) by targeting 2,513 loci. A genetic linkage was observed among the isolate genomes from the cattle rectal contents, cattle hides, beef carcasses at slaughterhouses, beef at retail shops, and human stool within a time frame of 20 months. All the strains carried practically the same repertoire of virulence genes except for the stx2 gene, which was present in all but eight of the closely related isolates. All the strains carried the mdfA gene, encoding for the MdfA multi-drug efflux pump. CgMLST analysis revealed genetically linked E. coli O157:H7 isolates circulating in the area, with a potential transmission from cattle to humans through the consumption of contaminated beef and beef products.
... The objectives of this study are to update estimates of the burden of FBD for the pathogens selected by two projects in Ethiopia and Burkina Faso-TARTARE (TARTARE, 2018) and Pull-Push (International Livestock Research Institute, 2018) and estimate the burden associated with consuming food products selected for intervention in these projects. Further details on the objectives of these projects can be found in Sapp et al. (2022). ...
... Estimates of the proportion of FBD incidence associated with CAMP and NTS were attributed to beef, dairy, poultry meat and vegetables based on FERG attribution results for the AFRD and AFRE subregions (Hoffmann et al., 2017) as described by Li et al. (2019). Attribution to food types and food products (see Sapp et al., 2022 for details) were based on a structured expert judgment study organized specifically for this study according to Cooke's Classical Model (Cooke, 1992;Hald et al., 2016). This study also included food group attribution for ETEC as these have not been provided by FERG, who focused their food group attribution on zoonotic pathogens. ...
... Attribution estimates are described in detail in Sapp et al. (2022). In this paper, we summarize the results for the four food groups of interest in the TARTARE and Pull Push projects: beef (Ethiopia), dairy (Ethiopia), poultry meat (Burkina Faso and Ethiopia) and vegetables (Burkina Faso and Ethiopia). ...
Foodborne disease is a significant global health problem, with low- and middle-income countries disproportionately affected. Given that most fresh animal and vegetable foods in LMICs are bought in informal food systems, much the burden of foodborne disease in LMIC is also linked to informal markets. Developing estimates of the national burden of foodborne disease and attribution to specific food products will inform decision-makers about the size of the problem and motivate action to mitigate risks and prevent illness. This study provides estimates for the burden of foodborne disease caused by selected hazards in two African countries (Burkina Faso and Ethiopia) and attribution to specific foods. Country-specific estimates of the burden of disease in 2010 for Campylobacter spp., enterotoxigenic Escherichia coli (ETEC), Shiga-toxin producing E. coli and non-typhoidal Salmonella enterica were obtained from WHO and updated to 2017 using data from the Global Burden of Disease study. Attribution data obtained from WHO were complemented with a dedicated Structured Expert Judgement study to estimate the burden attributable to specific foods. Monte Carlo simulation methods were used to propagate uncertainty. The burden of foodborne disease in the two countries in 2010 was largely similar to the burden in the region except for higher mortality and disability-adjusted life years (DALYs) due to Salmonella in Burkina Faso. In both countries, Campylobacter caused the largest number of cases, while Salmonella caused the largest number of deaths and DALYs. In Burkina Faso, the burden of Campylobacter and ETEC increased from 2010 to 2017, while the burden of Salmonella decreased. In Ethiopia, the burden of all hazards decreased. Mortality decreased relative to incidence in both countries. In both countries, the burden of poultry meat (in DALYs) was larger than the burden of vegetables. In Ethiopia, the burdens of beef and dairy were similar, and somewhat lower than the burden of vegetables. The burden of foodborne disease by the selected pathogens and foods in both countries was substantial. Uncertainty distributions around the estimates spanned several orders of magnitude. This reflects data limitations, as well as variability in the transmission and burden of foodborne disease associated with the pathogens considered.
