Food safety risk prioritization: Case studies from Asia

Food safety risk prioritization:
Case studies from Asia
Hung Nguyen-Viet: Co-leader, ILRI Animal and Human Health Program, Kenya
Sinh Dang-Xuan: Postdoctoral scientist, ILRI Animal and Human Health Program, Vietnam
Delia Grace: Professor at Natural Resources Institute and joint-appointed scientist at ILRI, UK

2
Context of foodborne diseases
Havelaar et al., 2015
Gibb et al., 2019 zoonoses
non zoonoses
Burden LMIC
Cost estimates for 2016 : > US$ 115 billion
Productivity loss 95
Illness treatment 15
Trade loss or cost 5 to 7
Domestic costs may be 20 times trade costs
Years of life lost annually for FBD
31 hazards
• 600 mio illnesses
• 480,000 deaths
• 41 million DALYs

3
Food value chains and informal markets

4
Approaches and solutions to food safety in LMICs
• Generate evidence: hazards and risks
• Develop solutions to improve food safety:
technological and institutional innovations
• Focus: informal markets, animal source food (ASF:
meat, milk and eggs) but also vegetables, pathogens
but also aflatoxin and chemical hazards
• Consideration: gender, nutrition, animal welfare
Risk
communication
Risk
management
Risk
assessment
Risk analysis framework
Risk-based approach

5
Our food safety work
Hung Nguyen Delia Grace
1~ 15 scientists
~~ 5 post docs
~~ 10 PhDs
~~ 12 MSc

7
Microbial and chemical risk assessment
• Salmonella risk pathways developed for producers, slaughterhouse and
consumers, quantitative microbial risk assessment (QMRA) risk for consumer
• Chemical risk assessment: antibiotic residues, banned chemicals, heavy metals
1,275 samples (farms, slaughterhouse, market) collected during 1 year
PigRISK: Pork safety in Vietnam (2012-2017)
Farm Transportation to SH Slaughterhouse Consumers
Retailer
• Feed in bags, remaining feeds
at the cages, environment
• Pork
• Liver
• Kidney
• Consumption
survey

8
• Sample size: 671 raw pork samples
o Traditional pork shops: 266 shops
o Modern pork shops: 123 shops
o Food services: 77 stalls
• Data collection:
o 1-5 pork sample per shop
o Food safety condition
• Laboratory testing
o Salmonella presence: 671 samples
o TBC (colony forming units (CFU)/g):
177 samples
Methodology Result
Salmonella prevalence TBC exceed standard
Traditional 60.5% 97.3%
Modern 50.9% 88%
Food
service
80.5% 94.6%
Overall 58.1% 93.8%
Associated factors to microbial contamination:
• Traditional shops:
o Use separate cloths
o Sewage or stagnant water
o Transportation time
• Modern shops:
o Selling many types of meat
o Storage temperature

9
QMRA for salmonellosis
Age and gender groups
Estimated annual salmonellosis
incidence rate (Mean (90% CI)) (%)
Children (under 5 years old) 11.18 (0 – 45.05)
Adult female (6-60 years old) 16.41 (0.01 – 53.86)
Adult male (6-60 years old) 19.29 (0.04 – 59.06)
Elder (over 60 years old) 20.41 (0.09 – 60.76)
Overall 17.7 (0.89 – 45.96)
Dang Xuan Sinh et al, 2016, IJPH
• 94 million people
• Cases of foodborne diseases by
Salmonella in pork at 17%: 16
million get sick
• $ 107: cost of hospitalization/FBD
case

10
Safe Food, Fair Food for Cambodia (2018-2021)
A nationwide multi-hazard survey in
markets in Cambodia found the
prevalence in meat (pork and chicken)
of Salmonella was 43% and of
Staphylococcus aureus was 31%.
The cost of illness of foodborne diarrhea
was USD 63 per case.
Sample type
N.
Specimen
N. positive both
Salmonella and S. aureus
Salmonella
positive
S. aureus
positive
Chicken 186 38 (20.4%) 84 (45.2%) 78 (41.9%)
Cuttingboard chicken 62 6 (9.7%) 26 (41.9%) 12 (19.4%)
Cuttingboard pork 62 1 (1.6%) 19 (30.6%) 7 (11.3%)
Pork 186 33 (17.7%) 85 (45.7%) 58 (31.2%)
Grand Total 496 78 (15.7%) 214 (43.1%) 155 (31.3%)
Cost National
Hospital
(n=44)
Referral
Hospital
(n=60)
Regiona
l Hosp.
(n=100)
Commu
nity
Clinic
(n=62)
Overall
(n=266)
Direct medical cost
[USD] 125.77 9.42 27.85 4.19 34.38
Direct non-medical
cost
[USD] 40.64 8.36 26.33 0.30 18.58
Indirect cost
[USD] 21.43 6.38 10.89 3.08 9.80
Total cost [USD] 185.88 24.16 65.07 7.57 62.76

11
Incentives Technology &
training
ENABLING
ENVIRONMENT
Moral, Social,
Material
Capacitate VC actors
Inform, monitor &
legitimize VC actors
Build capacity &
motivation of regulators
Nudges
Interventions: the 3 legged stool
Policy,
infrastructure
Motivate & facilitate
behaviour change
Innovation

INTERVENTION
Results at SH
Grid
Hand disinfection liquid
Faucet
Installed grid
Re-organized water and
electrical system
Training for SH owners &
workers
Food safety intervention at slaughter in Vietnam
Photo credit: Sinh Dang Xuan/Chi Nguyen ILRI 2020

Handbooks
INTERVENTION
Development of Instruction & Training materials
Food safety intervention at slaughterhouse and retail (2018-2022)
Approach:
• Participatory risk-assessment
• Supportive formative research with model
retailers
• Risk communication
Key content*:
-Grid slaughter
-Frequent washing
(and disinfection)
-Training
-Separation
clean/dirty
-Branding
Key content:
-Easy to clean surface
-Frequent washing (and
disinfection)
-Separation (fresh/cooked)
-Training
-Hygienic cutting board
-Branding
*only Vietnam

Control: Vendors who practice
and operate their selling as usual
Current surface
(carton board)
Washing
detergent
Trial: Vendor who get our incentive and used
Easy to clean
table surface
Signpost
And Training
certificate
Apron
Tray
Trial retailers:
- 84% of the trial retailers had a good
knowledge of safe meat handling
compared to the control group
(44%)
- The KAP scores of retailers in the
intervention significantly improved.
MARKET VENDORS IN CAMBODIA

Impact of bacterial reduction from simple interventions at SH & MK
Pig slaughterhouse in Vietnam Baseline Middle Endline
Floor (Log CFU/cm2) 6.0 4.4* 4.6*
Worker hand (Log CFU/hand) 7.2 7.1 7.0
Pig carcass (Log CFU/cm2) 4.5 4.2 4.4
Pork shop in SFFF-Cambodia Control (n=180) Trial (n=180)
Marketed pork (Log CFU/g) 6.9 6.3*
Salmonella prevalence (%) in pork at traditional markets
Total bacterial count in pig slaughterhouses and marketed pork
Before After

+ Missing ingredient: Enabling Environment

17
Next generation of food safety workers
Capacity building in meat inspection in Vietnam, Laos, Cambodia

18
Net benefit of
seller
Net benefit of
consumer
Premium price x Pork sale Cost of intervention x Pork sale
–
=
– Premium price x Pork consumption
x
Cost of
salmonellosis
for each
severity
Reduction of
salmonellosis
probability
Prevalence
of severity
x
=
0.077 USD/kg
14,936 USD/case 6.3%/year
8.98 USD/year
(93%>0)
1,196 USD/year
(61.2% >0)

19
Global One Health: Quadripartite and OHHLEP

20
World Food Safety Day
7 June 2023

21
Key messages
1. Food safety in informal/wet markets: high level of microbial
contamination along the value chains and high public concern
2. Risk based approach (hazard vs. risks) helps identify targeted
interventions and key stakeholders to improve food safety
3. Interventions: 3-legged stool/ECM to improve food safety, it
works!
4. Capacity building: trainings at different levels are key to improve
food safety
5. Strong engagement of high level ‘taskforce’, and other actors
(animal health workers, market managers, retailers) made
intervention implementation successful

Food safety risk prioritization: Case studies from Asia

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Food safety risk prioritization: Case studies from Asia