Value chain analysis and sanitary risks of the camel milk system supplying Nairobi city, Kenya

The camel milk trade in Kenya has evolved significantly from a small-scale business undertaken in local villages to its current status involving a large number of different stakeholders supplying urban towns, particularly Nairobi City. Despite the evident growth pattern, the supply of camel milk to Nairobi has largely remained informal, with minimal enforcement of regulations. The aim of this study was to characterise the camel milk system supplying Nairobi and assess its governance, main challenges and the potential food safety risk practices. A value chain analysis framework was used to carry out data collection between August 2014 and July 2015. Qualitative and quantitative data were collected through focus group discussions and key informant interviews with stakeholders operating in different nodes of the value chains. Three milk value chains supplying Nairobi were identified and mapped: the Isiolo chain, the Kajiado chain and the camel milk processing company chain. Overall, the results indicate that 94% of the milk supplied to Nairobi city is informally traded (traded without any effective regulation), while 6% originates from a formal milk processing company. In the informal chains, milk traders (mostly women) were reported to play a pivotal role in the organisation and daily functioning of the chains. The processing company had partly integrated activities and reported exporting 5% of their products to regional and international markets. Food safety themes identified were associated with i) lack of cold chain, ii) gaps in hygiene practices, particularly at farm and market levels, iii) consumption of raw camel milk, and iv) lack of food safety training, among other issues. Low level involvement by government agencies in enforcing stipulated food safety measures were reported in the informal chains, as these concentrate efforts in the regulation of dairy milk chains. Isiolo milk traders were identified as the dominant group, setting milk prices and providing sanctions. The framework and findings obtained can help future research and policy makers to reach informed decision about what to regulate, where to target and importantly how to make the camel milk value chain more efficient and safer

Are Food Animals Responsible for Transfer of Antimicrobial-Resistant Escherichia coli or Their Resistance Determinants to Human Populations?:A Systematic Review

The role of farm animals in the emergence and dissemination of both AMR bacteria and their resistance determinants to humans is poorly understood and controversial. Here, we systematically reviewed the current evidence that food animals are responsible for transfer of AMR to humans. We searched PubMed, Web of Science, and EMBASE for literature published between 1940 and 2016. Our results show that eight studies (18%) suggested evidence of transmission of AMR from food animals to humans, 25 studies (56%) suggested transmission between animals and humans with no direction specified and 12 studies (26%) did not support transmission. Quality of evidence was variable among the included studies; one study (2%) used high resolution typing tools, 36 (80%) used intermediate resolution typing tools, six (13%) relied on low resolution typing tools, and two (5%) based conclusions on co-occurrence of resistance. While some studies suggested to provide evidence that transmission of AMR from food animals to humans may occur, robust conclusions on the directionality of transmission cannot be drawn due to limitations in study methodologies. Our findings highlight the need to combine high resolution genomic data analysis with systematically collected epidemiological evidence to reconstruct patterns of AMR transmission between food animals and humans

Quantifying the transmission of antimicrobial resistance at the human and livestock interface with genomics

Background Livestock have been implicated as a reservoir for antimicrobial resistance (AMR) that can spread to humans. Close proximity and ecological interfaces involving livestock have been posited as risk factors for the transmission of AMR. In spite of this, there are sparse data and limited agreement on the transmission dynamics that occur. Objectives To identify how genome sequencing approaches can be used to quantify the dynamics of AMR transmission at the human–livestock interface, and where current knowledge can be improved to better understand the impact of transmission on the spread of AMR. Sources Key articles investigating various aspects of AMR transmission at the human–livestock interface are discussed, with a focus on Escherichia coli. Content We recapitulate the current understanding of the transmission of AMR between humans and livestock based on current genomic and epidemiological approaches. We discuss how the use of well-designed, high-resolution genome sequencing studies can improve our understanding of the human–livestock interface. Implications A better understanding of the human–livestock interface will aid in the development of evidence-based and effective One Health interventions that can ultimately reduce the burden of AMR in humans

Assessing and understanding food safety risk practices in Nairobi pork food system: a value chain approach

In Nairobi the pork food system may represent a major source of zoonotic pathogens. Yet, the system and its public health risks have not been described. The study address this gap by identifying and understanding food safety risks practices in the Nairobi pork food system using a value chain approach.</p

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Middle East respiratory syndrome coronavirus (MERS-CoV) is a recently identified virus causing severe viral respiratory illness in people. Little is known about the reservoir in the Horn of Africa. In Kenya, where no human MERS cases have been reported, our survey of 335 dromedary camels, representing nine herds in Laikipia County, showed a high seroprevalence (46.9%) to MERS-CoV antibodies. Between herd differences were present (14.3%– 82.9%), but was not related to management type or herd isolation. Further research should focus on identifying similarity between MERS-CoV viral isolates in Kenya and clinical isolates from the Middle East and elsewhere

One Health genomic epidemiology of antimicrobial resistant Escherichia coli carriage in sympatric humans and livestock in Nairobi, Kenya

Livestock have been proposed as a reservoir for antibiotic resistant (AMR) bacteria and AMR genetic determinants that may infect humans, yet quantitative evidence regarding their epidemiological role remains lacking. We used a combination of genomics, epidemiology and ecology to investigate patterns of AMR carriage in Escherichia coli, regarded as a sentinel organism. We conducted a structured epidemiological survey of 99 households across Nairobi, Kenya and cultured E. coli from 315 human and 594 livestock faecal samples. We detected high rates of AMR gene carriage, 60 different acquired genes and 14 point mutations, and found that 10/74 of the genes were significantly more common in human than in livestock isolates. Further, AMR genes were not associated with host type or household location, and AMR genes frequently co-occurred, potentially enabling the acquisition of multi-drug resistance in a single step. We found that, whilst AMR gene carriage in humans was not directly associated with the presence of livestock in the household, the impact of keeping livestock on human AMR gene carriage was instead influenced by livestock-keeping practices, in particular the presence or absence of animal manure in the household. In conclusion, we did not find any evidence to support the hypothesis that the keeping of livestock is a risk factor for emergence and dissemination of AMR genes to humans in this setting. Our characterisation of AMR patterns in which co-habiting human and livestock populations were systematically sampled provides new insight into the broader epidemiology of AMR in complex and interconnected urban environments