Public health and food safety in the WHO African region

Contaminated food continues to cause numerous devastating outbreaks in the African Region. In Africa, a large proportion of ready-to-eat foods are sold by the informal sector, especially as street foods. The hygienic aspects of vending operations and the safety of these foods are problematic for food safety regulators. The global food crisis has worsened an already precarious food situation because when food is in short supply people are more concerned about satisfying hunger than the safety of the food. The aetiological agents include various pathogenic bacteria, parasites and viruses. Chemical contaminants are becoming increasingly important. Human factors including: unhygienic practices and deliberate contamination, environmental factors, such as unsafe water, unsafe waste disposal and exposure of food to insects and dust,undercooked food, and prolonged storage of cooked food without refrigeration are the main predisposing factors. WHO’s position is that food safety must be recognised as a public health function and access to safe food as a basic human right. The work of WHO in food safety is in line with its core functions and various global and regional commitments, especially the document entitled “Food Safety and Health: A Strategy for the WHO African Region (AFR/RC57/4) adopted in 2007. WHO has been supporting countries to strengthen food safety systems and partnerships and advocacy; to develop evidence-based food safety policies; strengthen laboratory capacity for foodborne disease surveillance; enhance participation of countries in the standard-setting activities of the Codex Alimentarius Commission; and strengthen food safety education using the WHO Five Keys to Safer Food . The implementation of the Regional Food Safety Strategy adopts a holistic farm-to-fork approach which addresses the entire food control system. Much has been achieved since the adoption of the document Food Safety and health: A Strategy for the WHO African Region, but commitment to food safety still remains low due to competing priorities. In particular, countries are now shifting away from fragmented food control implementation towards multi-agency and coordinated as well as single agency systems. The Codex Trust Fund has facilitated participation and capacity building for Codex work. Although funding for the Food Safety Programme has increased as compared to the levels in 2002, this remains inadequate. WHO will continue to support countries to strengthen food safety systems in line with its core functions and as enshrined in the regional food safety strategy

The WHO five keys to safer food: A tool for food safety health promotion

Foodborne diseases continue to be significant causes of morbidity and mortality within the African Region. Many cases of foodborne disease occur due to basic errors in food preparation or handling either in food service establishments or at home. Educating food handlers, including consumers, therefore, can significantly reduce the chances of contracting food-borne illnesses and the effects of outbreaks, as well as improve public health. Food safety education programmes need to particularly target certain segments of the population who, either directly have a role in food preparation and/or have increased vulnerability to foodborne diseases. In response to the increasing need to educate food handlers, including consumers about their responsibilities for assuring the safety of food, the World Health Organization (WHO) initiated a health promotion campaign around five simple rules, "the five keys to safer food" to help ensure food safety during food handling and preparation. The core messages of the WHO five keys to safer food are: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials. These messages have been adapted to different target audiences and settings such as healthy food markets; emergency situations such as prevention of outbreaks; food safety for travellers; preparation of mass gathering events; streetvended foods; training of women; and growing of safer fruits and vegetables. Educational projects targeting different types of food handlers, high-risk groups andsettings are being implemented in several countries in the African Region. This article discusses how the WHO five keys to safer food have been used as a tool for food safety education. Experiences of selected countries in the African Region in the promotion of the WHO five keys to safer food in different settings are presented. It further discusses opportunities and future perspectives in the promotion of the WHO five keys to safer food in the African Region

Irrigating Africa: policy barriers and opportunities for enhanced productivity of smallholder farmers

African governments have ambitious plans to expand irrigated agriculture, though existing smallholder schemes have largely failed to use land and water sustainably or become profitable. Six government-owned irrigation schemes in Mozambique, Tanzania and Zimbabwe were assessed to identify common policy barriers and opportunities for higher productivity among smallholder farmers. Issues like insecure land tenure systems, unclear institutional arrangements and poor access to markets have contributed to limited profitability. Reform of currently insecure land tenure, strengthening farmer organizations and reforming policies are recommended so that governments step back from scheme management and foster market linkages to enable more profitable irrigated agriculture

Faecal carriage of ESBL producing and colistin resistant Escherichia coli in avian species over a 2-year period (2017-2019) in Zimbabwe

DATA AVAILABILITY STATEMENT : The data presented in this study are deposited in the NCBI BioProject Number PRJNA 799483 with accession numbers listed in the Supplementary Datasheet 1.INTRODUCTION : Extended spectrum beta-lactamase (ESBL) producing Escherichia coli have become widespread among food producing animals. These strains serve as a reservoir of antibiotic resistance genes (ARGs) and act as a possible source of infection to humans as transmission can occur by direct or indirect contact. METHODS : This study investigated the faecal carriage of ESBL producing and colistin resistant E. coli in poultry over a 2-year period (2017-2019) from Zimbabwe. A total of 21 ESBL positive isolates from poultry cloacal specimens were selected for whole genome sequencing from animal E. coli isolates biobanked at the National Microbiology Reference laboratory using phenotypic susceptibility testing results from the National Escherichia coli Surveillance Program to provide representation of different geographical regions and year of isolation. Cloacal swabs were collected from 3000 broiler live birds from farm 1 and fromfarm2, 40 backyard chickens and 10 duckswere sampled. Antimicrobial susceptibility and ESBL testing were performed as per Clinical Laboratory Standards Institute guidelines. Whole genome sequencing of ESBL producing isolates was used to determine sequence types (STs), ARGs, and phylogroups. RESULTS : Twenty-one of the included E. coli isolates were confirmed as ESBL producers. Three defined sequence type clonal complexes (CCs) were identified (ST10CC, ST155CC and ST23CC), with ST10CC associated with the most antibiotic resistant profile. The ESBL phenotype was linked to the presence of either cefotaximase-Munich-14 (CTX-M-14) or CTX-M-79. Plasmid mediated quinolone resistant determinants identified were qnrB19 and qnrS1 and one ST10CC isolate from farm 1 broiler chickens harbored a mobile colistin resistance gene (mcr-1). Phylogenetic groups most identified were B1, A and unknown. DISCUSSIONS : The avian ESBL producing E. coli belonged to a diverse group of strains. The detection of several ARGs highlights the importance of implementing enhanced control measures to limit the spread in animals, environment, and humans. This is the first report of mcr-1 in Zimbabwe, which further underscores the importance of the One Health approach to control the spread and development of AMR.The National Health Laboratory Service (NHLS) and the University of Pretoria, South Africa, a strategic partnership between National Microbiology Reference Laboratory and Quadram BioSciences Institute.https://www.frontiersin.org/journals/cellular-and-infection-microbiologyam2023Medical Microbiolog

PUBLIC HEALTH AND FOOD SAFETY IN THE WHO AFRICAN REGION

ABSTRACT Contaminated food continues to cause numerous devastating outbreaks in the African Region. In Africa, a large proportion of ready-to-eat foods are sold by the informal sector, especially as street foods. The hygienic aspects of vending operations and the safety of these foods are problematic for food safety regulators. The global food crisis has worsened an already precarious food situation because when food is in short supply people are more concerned about satisfying hunger than the safety of the food. The aetiological agents include various pathogenic bacteria, parasites and viruses. Chemical contaminants are becoming increasingly important. Human factors including: unhygienic practices and deliberate contamination, environmental factors, such as unsafe water, unsafe waste disposal and exposure of food to insects and dust,undercooked food, and prolonged storage of cooked food without refrigeration are the main predisposing factors. WHO's position is that food safety must be recognised as a public health function and access to safe food as a basic human right

Interventions prioritaires en Afrique de l’ouest pour l’estimation des dépenses en nutrition

L’objectif de l’étude visait à identifier par ordre de priorité les interventions de nutrition pour l’estimation des dépenses. La méthodologie utilisée a consisté à établir une liste de 37 interventions du secteur de la santé et d’autres secteurs à partir des interventions proposées par l’OMS et celles de la série Lancet de 2008. Au cours des réunions de consultations des pays couverts par l’OMS/AFRO sur le projet du Plan d’application exhaustif de nutrition chez la mère, le nourrisson et le jeune enfant, la liste a été soumise aux représentants des pays composés du directeur du programme ou de la direction nationale pour la nutrition et du représentant du secteur de l’agriculture des pays de la CEDAO et la Mauritanie pour sélection des interventions prioritaires, qui ont étés classées par fréquence de sélection et comparées à celles des comptes de la santé. L’étude a aboutit aux résultats suivants sur les 37 interventions : huit (21,6 %) furent retenues par moins de 50 % des équipes pays et les 29 autres (78,4 %) sélectionnées par plus de 50 %, dont 72,4 % étaient du secteur de la santé. Des 21 interventions (56,8 %) qui avaient un niveau de consensus élevé (³ 75 %), 71,4 % étaient du secteur de la santé et 28,6 % relevaient d’autres secteurs. Des interventions du secteur de la santé, 76 % se retrouvaient dans les comptes de santé. En conclusion, une liste consensuelle d’interventions prioritaires pour l’estimation des dépenses de nutrition est proposée pour la sousrégion ouest africaine dont 76 % relevant, du secteur de la santé sont comprises dans les comptes santé et pourraient servir à l’estimation des dépenses de nutrition.Mots-clés : Interventions de nutrition, malnutrition, estimation des dépenses.West Africa priority interventions for nutrition expenditure estimationThe study objective was to identify the interventions to use for estimating nutrition expenditure in health sector. For this to be achieved a list of 37 interventions from health and non-health sector were elaborated based on lancet series 2008 and on WHO proposed nutrition interventions. The list was then submitted to West Africa countries’ team of nutrition and agriculture resource persons for selection. The interventions were classified using a percentage of occurrences. The reflection of the selected interventions was analysed in health account. The results showed that from the 37 interventions concerned by the survey, 8 (21.6%) were selected by less than 50% of country teams and 29 interventions (78.4%) were selected by more than 50% of country teams. From the 29 interventions 72.4% of them were from health sector. From the 21 interventions  (56.8%) selected by at least 75% of country teams, 71.4% of them were from health sector and 28.6% from non-health sector. In addition 76% of the interventions selected by more than 50% of  countries were reflected in health account. From these results it can conclude that there is a proposed health and non-health set of interventions identified by West African countries to be used for estimating nutrition expenditures. These  interventions can probably be appreciated in health account to have a reliable trend since at least 76% of them are reflected in.Keywords: nutrition interventions, malnutrition, expenditure estimation

Strengthening Foodborne Diseases Surveillance In The Who African Region: An Essential Need For Disease Control And Food Safety Assurance

Several devastating outbreaks of foodborne diseases have been reported in the African region including acute aflatoxicosis in Kenya in 2004 and bromide poisoning in Angola in 2007. There are concerns about transmission of multiple antibiotic resistant bacteria and pesticide residues in foods. The globalization of the food trade which could increase the spread of food contaminants internationally is an emerging issue. The new International Health Regulations (IHR) (2005) cover events of international importance including contaminated food and outbreaks of foodborne disease. The IHR (2005) and other international as well as regional agreements require Member States to strengthen surveillance systems including surveillance for foodborne diseases. WHO has been supporting countries to strengthen foodborne disease surveillance since 2003. This paper reports on the work of WHO and partners in the area of foodborne disease surveillance, the challenges and opportunities and provides perspectives for the area of its work. The paper shows that laboratory-based surveillance is the preferred system for foodborne disease surveillance since it allows early detection of outbreak strains and identification of risk factors with laboratory services as the cornerstone. Foodborne disease surveillance has been included in the revised Integrated Disease Surveillance and Response (IDSR) Strategy and there are guidelines for use by countries. WHO in collaboration with partners, especially the Global Food Infections Network (GFN), has been supporting countries to strengthen national analytical capacity for foodborne disease surveillance and research. Training for countries to detect, control and prevent foodborne and other enteric infections from farm to table has been conducted. The training for microbiologists and epidemiologists from public health, veterinary and food sectors involved in isolation, identification and typing of Salmonella sp, Campylobacter sp., Vibrio cholerae , Vibrio sp. and Shigella from human and food samples have been carried out. Research into specific topics in microbiology and chemical contaminants has been conducted. Three institutions in Cameroun, Mali and Nigeria have been designated as centres of excellence for chemical contaminants. Despite these significant achievements, a number of challenges remain. Most food safety programmes and food safety systems remain fragmented resulting in duplication of efforts and inefficient use of resources; and most laboratories in the African Region are poorly resourced. In countries where facilities exist, there is underutilization and lack of synergy among laboratories. Countries should, therefore, conduct audits of existing laboratories to determine their strengths and weaknesses and strategize as appropriate. It is also imperative to continue to strengthen partnerships and forge new ones and increase resources for food safety, in general, and for foodborne disease surveillance, in particular, and continue capacity building, both human and institutional

The Who Five Keys To Safer Food: A Tool For Food Safety Health Promotion

Foodborne diseases continue to be significant causes of morbidity and mortality within the African Region. Many cases of foodborne disease occur due to basic errors in food preparation or handling either in food service establishments or at home. Educating food handlers, including consumers, therefore, can significantly reduce the chances of contracting food-borne illnesses and the effects of outbreaks, as well as improve public health. Food safety education programmes need to particularly target certain segments of the population who, either directly have a role in food preparation and/or have increased vulnerability to foodborne diseases. In response to the increasing need to educate food handlers, including consumers about their responsibilities for assuring the safety of food, the World Health Organization (WHO) initiated a health promotion campaign around five simple rules, "the five keys to safer food" to help ensure food safety during food handling and preparation. The core messages of the WHO five keys to safer food are: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials. These messages have been adapted to different target audiences and settings such as healthy food markets; emergency situations such as prevention of outbreaks; food safety for travellers; preparation of mass gathering events; street- vended foods; training of women; and growing of safer fruits and vegetables. Educational projects targeting different types of food handlers, high-risk groups and settings are being implemented in several countries in the African Region. This article discusses how the WHO five keys to safer food have been used as a tool for food safety education. Experiences of selected countries in the African Region in the promotion of the WHO five keys to safer food in different settings are presented. It further discusses opportunities and future perspectives in the promotion of the WHO five keys to safer food in the African Region

Developing And Maintaining National Food Safety Control Systems: Experiences From The Who African Region

The establishment of effective food safety systems is pivotal to ensuring the safety of the national food supply as well as food products for regional and international trade. The development, structure and implementation of modern food safety systems have been driven over the years by a number of developments. These developments include: a reorientation of quality assurance protocols; emphasis on the development of integrated and holistic food safety systems with a farm-to-table approach; increased recognition of the respective roles of the different stakeholders along the food chain; increased food trade coupled with obligations under trade agreements; and advances in the control of foodborne hazards. At its core, a modern food safety system includes enabling food laws, policies, regulations and standards; mechanisms for coordination; operational food inspection and laboratory services as well as national information, education and communication programmes. While progress has been made in some countries in the WHO African Region at modernizing their food safety systems, many others are still grappling with the basics for development of effective food control systems. The traditional food control systems in a number of African countries do not provide the concerned agencies with a clear mandate and authority to prevent food safety problems. Effective food control in a number of these countries is undermined by a number of challenges including limited awareness about food safety, inadequate enabling policy, outdated legislation and regulations; inadequate coordination; and inadequate capacity and resources for food safety. This paper reviews the components of a modern national food safety control system and examines efforts at strengthening national food safety control systems in the African Region. It includes experiences from countries that have made efforts at strengthening their national food safety control systems in view of current developments. The paper further discusses some of the challenges of food control systems in the Region and prospects for improvements. It concludes by suggesting the way forward for improving national food safety control systems in the Region

Molecular epidemiology of extended-spectrum beta-lactamase–producing extra-intestinal pathogenic Escherichia coli strains over a 2-year period (2017–2019) from Zimbabwe

This study was designed to characterize extended-spectrum beta-lactamase (ESBL)–producing extra-intestinal pathogenic Escherichia coli (E.coli) (ExPEC) associated with urinary tract infections in nine different geographic regions of Zimbabwe over a 2-year period (2017–2019). A total of 48 ESBL-positive isolates from urine specimen were selected for whole-genome sequencing from 1246 Escherichia coli isolates biobanked at the National Microbiology Reference laboratory using phenotypic susceptibility testing results from the National Escherichia coli Surveillance Programme to provide representation of different geographical regions and year of isolation. The majority of ESBL E. coli isolates produced cefotaximase-Munich (CTX-M)-15, CTX-M-27, and CTX-M-14. In this study, sequence types (ST) 131 and ST410 were the most predominant antimicrobial-resistant clones and responsible for the increase in ESBL–producing E. coli strains since 2017. Novel ST131 complex strains were recorded during the period 2017 to 2018, thus showing the establishment and evolution of this antimicrobial-resistant ESBL clone in Zimbabwe posing an important public health threat. Incompatibility group F plasmids were predominant among ST131 and ST410 isolates with the following replicons recorded most frequently: F1:A2:B20 (9/19, 47%), F2:A1: B (5/19, 26%), and F1:A1:B49 (8/13, 62%). The results indicate the need for continuous tracking of different ESBL ExPEC clones on a global scale, while targeting specific STs (e.g. ST131 and ST410) through control programs will substantially decrease the spread of ESBLs among ExPEC.The National Health Laboratory Service (NHLS), the University of Pretoria, South Africa, and a strategic partnership between National Microbiology Reference Laboratory and Quadrum Institute Biosciences.http://link.springer.com/journal/100962022-11-15hj2022Medical Microbiolog