EatSafe: Evidence and Action Towards Safe, Nutritious Food

The program will design and test consumer-centered food safety interventions in informal markets through the EatSafe program. The EatSafe Cohort Methodology and Protocol report presents evidence to inform the design and implementation of these interventions. The study objectives are to gather evidence on food safety knowledge, attitudes, and practices (KAPs) in traditional markets in low- and middle-income countries (LMICs), specifically in Nigeria. The study will assess knowledge, attitudes, or feelings, and actions or behaviors related to food-related choices and food safety among both consumers and vendors in traditional markets in the city of Birnin-Kebbi, Kebbi state, Nigeria. The study will take a broad dietary and market hygiene approach, including the seven commodity categories addressed by the EatSafe risk assessment and focused ethnographic study for Nigeria. The main data collection tools will be semi-structured surveys, complemented by direct observations. Data will be collected before and after the implementation of a behavior change intervention, and if appropriate during the implementation of the intervention. The intervention aims to improve consumer and vendor awareness of food safety, increase its salience as an issue for them, increase motivation to demand or provide safer food, and influence attitudes and practices related to food safety, with focus on behaviors related to purchasing and selling nutritious food in traditional food markets. Foodborne disease is a significant public health concern in Nigeria, with an estimated 600 million illnesses and 420,000 premature deaths annually worldwide. The majority of the foodborne burden falls on those living in LMICs, who make up about 75% of deaths from foodborne illness. Young children are particularly susceptible, shouldering about 40% of the burden. Improving food safety in informal markets in Nigeria will require understanding and potentially shaping the motivations, attitudes, beliefs, and practices that shape the decisions of both consumers and food vendors. The region containing Nigeria (AFR-D) has the highest per capita burden of foodborne illness, in disability-adjusted life years (DALYs), with most of this being due to diarrheal disease agents, followed by helminths. Nigeria, as a transitioning lower-middle-income country with considerable urbanisation, falls into the category of country for which food safety concerns are generally at their most critical due to rapid economic, demographic, and dietary change but limited food safety management capacities. Informal markets, where a large share of consumers in LMICs purchase their foods, can be especially risky for foodborne hazards due to poor market infrastructure, including limited access to potable water, poor hygienic conditions, and poor storage practices. Several studies in Nigeria have concluded that vendors have poor food hygiene knowledge and/or practices. For example, a 2010 study found that 23.8% of street food vendors in Owerri prepared food in unhygienic conditions, 42.86% did not use aprons, 47.62% handled food with bare hands, and 61.9% handled money while serving food. Others have found that vendors have moderate to good knowledge and/or practices. Improving food safety in informal markets in Nigeria will require understanding and potentially shaping the motivations, attitudes, beliefs, and practices that shape the decisions of both consumers and food vendors. The EatSafe program aims to address the critical food safety concerns in Nigeria by designing and testing consumer-centered food safety interventions in informal markets. The program will gather evidence on food safety knowledge, attitudes, and practices among consumers and vendors in traditional markets in Nigeria. The study will assess knowledge, attitudes, or feelings, and actions or behaviors related to food-related choices and food safety among both consumers and vendors. The study will take a broad dietary and market hygiene approach, including the seven commodity categories addressed by the EatSafe risk assessment and focused ethnographic study for Nigeria.