Game (wildlife) meat safety: understanding the game meat supply chain and the roles of role-players in a multifaceted control environment

Moderator: Lyle Renecker.Presented at the 8th international congress for wildlife and livelihoods on private and communal lands: livestock, tourism, and spirit, that was held on September 7-12, 2014 in Estes Park, Colorado.As in other parts of the world, the South African game industry is expanding and game meat is finding its way in the local and international food supply chain. In order to do effective game meat control, one must have an understanding of the game meat supply chain and the stakeholders therein. The term 'food supply chain' refers to the total supply process from agricultural production, harvest / slaughter, through processing and handling of a food and its ingredients, storage and distribution up to consumption. In the case of game meat, the supply chain will include the relevant food and meat control authorities, primary producers (farmers), suppliers of feed and veterinary drugs to farmers, hunters, abattoirs, small and large scale processors, wholesale and retail, suppliers of processing materials, import and export agencies, transport and the consumer. From this it is clear that several role-players are involved, which leads to a multifaceted and fragmented food control environment. It was necessary to determine the control points essential for meat safety and the responsibilities of the role-players for the execution of these control points along the game meat supply chain. Information regarding the study was obtained through a desk top study and analysis of questionnaire responses from game farmers, hunters and national, provincial and municipal control authorities. Game meat is often entering the supply chain in an uncontrolled manner while there is a lack of a single formal framework for its operation amongst the stakeholders. To address this issue, the research looked for insight into the game meat supply chain; the differences between the game meat supply chain and the conventional meat supply chain; the respective role-players in the supply chain; and the essential meat safety control points along the supply chain. The crucial meat safety link between the supply chain and the roles of stakeholders in ensuring that safe meat is supplied to the consumer is often vague. The introduction of a mechanism to reduce the indistinctness is essential for this growing industry. The mechanism suggested relates to the establishment of a game meat safety forum whereby all role-players are involved

Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Background The purpose of this systematic review (PROSPERO Ref: CRD42017053264) was to describe and interpret the qualitative research on parent’s decision-making and informed choice about their pregnancy and birth care. Given the growing evidence on the benefits of different models of maternity care and the prominence of informed choice in health policy, the review aimed to shed light on the research to date and what the findings indicate. Methods a systematic search and screening of qualitative research concerning parents’ decision-making and informed choice experiences about pregnancy and birth care was conducted using PRISMA guidelines. A meta-synthesis approach was taken for the extraction and analysis of data and generation of the findings. Studies from 1990s onwards were included to reflect an era of policies promoting choice in maternity care in high-income countries. Results Thirty-seven original studies were included in the review. A multi-dimensional conceptual framework was developed, consisting of three analytical themes (‘Uncertainty’, ‘Bodily autonomy and integrity’ and ‘Performing good motherhood’) and three inter-linking actions (‘Information gathering,’ ‘Aligning with a birth philosophy,’ and ‘Balancing aspects of a choice’). Conclusions Despite the increasing research on decision-making, informed choice is not often a primary research aim, and its development in literature published since the 1990s was difficult to ascertain. The meta-synthesis suggests that decision-making is a dynamic and temporal process, in that it is made within a defined period and invokes both the past, whether this is personal, familial, social or historical, and the future. Our findings also highlighted the importance of embodiment in maternal health experiences, particularly when it comes to decision-making about care. Policymakers and practitioners alike should examine critically current choice frameworks to ascertain whether they truly allow for flexibility in decision-making. Health systems should embrace more fluid, personalised models of care to augment service users’ decision-making agency

Perception of the Millennial generation (Y-generation) consumer of game (wildlife) meat and game meat safety, The

Moderator: Lyle Renecker.Presented at the 8th international congress for wildlife and livelihoods on private and communal lands: livestock, tourism, and spirit, that was held on September 7-12, 2014 in Estes Park, Colorado.As in other parts of the world, one of the options for conservationists and game farmers is to channel the meat as a result of harvesting or hunting activities into the local and international food markets. Game meat is however foreign to many, especially urbanised consumers and therefore they tend not to try it as an alternative source of meat. On the other hand, younger consumers such as the millennial generation (Y generation) are seeking for healthier meat products that are free from hormones and other substances and that are more "natural". Game meat mostly provides for these requirements. According to most reports, Generation Y (Gen Y) was born between 1977 and 1994. This timeframe identifies millinial consumers between 19 and 36 years old in 2013. The millinial generation is expected to be as large and influential as the Baby Boomers, which was the generation prior to Gen Y. Information regarding the study was obtained through a desk top study and analysis of questionnaire responses from young South African meat consumers (millinials) with regards to the abovementioned topics. Millinials are the current and future consumer and have a role to play in meat choices. They are however more informed due to higher exposure to media. The research looked for insights in the millinial generations perception about hunting and the use of the meat as a source of meat and concerns regarding meat safety issues such as zoonotic diseases, microbiological contamination and meat inspection practices. The research revealed that consumers do have concerns, especially with regards to animal welfare, hunting practices, exposure to zoonotic diseases, and contamination of the meat by microorganisms and other biological, chemical and physical matter that may cause harm to the consumer. Millinials (Generation Y) are young meat consumers who are especially important for the industry because they offer an opportunity for growth in the industry. If their experience with game meat is positive, these younger consumers will develop a taste for game meat that are likely to last as over years. These younger consumers care more about brand name, quality (including safety) and will typically spend more money to purchase it. It is therefore important to understand their concerns and to use it to the benefit of the wildlife industry

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated