Assessing Food Safety Interventions Relevant to Foodborne Zoonoses in Low- and Middle-Income Countries

It is estimated that 75% of all emerging diseases are zoonotic in origin. Globally, foodborne zoonoses are associated with approximately one third of the foodborne disease burden, though this is likely an underestimation. Some regions, particularly Africa, have a higher attribution of disease burden to foodborne zoonoses. As the population, urbanization, and expendable incomes of low- and middle-income countries (LMIC) increase, the demand for ASF is also projected to rise, bringing with it the risk of foodborne zoonoses. If the consumption of ASF continues to increase without adequate attention to risk mitigation strategies, the burden of foodborne zoonoses is likely to worsen. The majority of ASF in LMIC are sold in informal markets, which represent highly important nodes that can be targeted for risk mitigation. The nature of zoonoses, however, requires that, where possible, a 'farm to fork' approach is adopted; an approach guided by robust risk assessment techniques to address risk in the most effective and cost-effective way. A holistic vision of foodborne zoonoses control requires multi-sectoral collaboration, within surveillance, response, and prevention functions. The nature of pathogen transmission between human and animal hosts and make collecting data on their prevalence, distribution, and risk factors a common goal between the human health and veterinary science communities. This report highlights the multiple and complex factors involved in mitigating foodborne zoonoses in ASF sold at informal markets in resource-poor settings. Many of those factors may also be relevant to pathogens in non-ASF. The evidence discussed here is meant to inform the design of interventions to potentially be tested in phase two of the EatSafe project, as well as the design of other food safety programs. Given that most food safety interventions (ASF and non-ASF) require a "farm to fork" approach, this report discusses interventions implemented at the market and consumer level, as well as at the farm and processing stages. In addition, factors that previous interventions have identified as inhibitory or enabling to effective food safety strategies, such as cultural settings, governance policies, or infrastructure, are highlighted and recommendations for intervention design discussed. The case studies reviewed here highlight several lessons to consider when designing interventions to mitigate foodborne zoonoses in food markets. For instance, accounting for the local socio-economic and cultural context and how it shapes attitudes and behaviors is key to intervention effectiveness. While one-off education and training interventions have had short-term success, evidence is lacking for long-term interventions. Also, knowledge alone does not usually result in changed behaviors. Appropriate equipment and infrastructure, as well as other factors, are often necessary to enable a new practice. Participatory approaches can be effective, at least in part, because they account for and leverage key behavior drivers. Establishing draconian standards, on the other hand, has often failed. Overall, strategies to control zoonotic and non-zoonotic pathogens at food marketplaces exist and are generally similar. However, the role of other critical control points throughout the supply chain is particularly important for the control of zoonoses and should be considered for the effective application of food safety interventions. Vertebrate animal species are natural reservoirs for many pathogens of animal origin that cause human infections (zoonoses). Zoonotic pathogens can be transmitted through ASF, and secondarily via non-ASF that become contaminated during their production process. The importance of these pathogens is hugely significant; 75% of all emerging diseases are zoonotic in origin, which puts consumers of ASF at increased risk. Consumption of animal source food (ASF) is rapidly increasing, especially in low- middle-income countries (LMIC) where consumers are increasing consumption of higher-protein diets. Rapid population growth, urbanization, and increased income drives demand for ASF, resulting in an intensified risk of foodborne zoonoses. The majority of ASF in LMIC are sold in informal markets, which represent highly important nodes that can be targeted for risk mitigation. A 'farm to fork' approach is essential for addressing risk in the most effective and cost-effective way. This approach requires multi-sectoral collaboration, within surveillance, response, and prevention functions. The nature of pathogen transmission between human and animal hosts makes collecting data on their prevalence, distribution, and risk factors a common goal between the human health and veterinary science communities. The evidence discussed in this report highlights the multiple and complex factors involved in mitigating foodborne zoonoses in ASF sold at informal markets in resource-poor settings. Many of those factors may also be relevant to pathogens in non-ASF. The report discusses interventions implemented at the market and consumer level, as well as at the farm and processing stages. In addition, factors that previous interventions have identified as inhibitory or enabling to effective food safety strategies, such as cultural settings, governance policies, or infrastructure, are highlighted and recommendations for intervention design discussed. The case studies reviewed here highlight several lessons to consider