Australian Centre for International Agricultural Researc

Duong Van Nhiem

Grace, Delia

Hung Nguyen-Viet

Lapar, Ma. Lucila

Marshall, Karen

Pham Van Hung

Phuc Pham Duc

Sinh Dang Xuan

Unger, Fred

CGSpace

Food safety from a global perspective to a country perspective addressing challenges along smallholder pig systems in Vietnam Fred Unger1, Hung Nguyen-Viet1, Sinh Dang-Xuan2, Phuc Pham Duc2, Pham Van Hung3, Lucila Lapar1, Karen Marshall5, Duong Van Nhiem4, Delia Grace51 International Livestock Research Institute, Hanoi, Vietnam2 Center for Public Health and Ecosystem Research, Hanoi School of Public Health, Vietnam3 Faculty of Economics & Rural Development, Vietnam National University of Agriculture, Hanoi, Vietnam4 Faculty of Vet Med, Vietnam National University of Agriculture, Hanoi, Vietnam5 International Livestock Research Institute, Nairobi, KenyaGlobal Health Institute scientific conference, Chiang Mai, Thailand, 19 February 2016Outline• Global health from a food safety perspective– Trends over time and by region• Food safety in Vietnam • ILRI work along the pig/pork value chain in Vietnam• Search for feasible interventions Health constraints and causes in developing and developed countries Measured as DALY (Disability Adjusted Life Years)• Quantifying the burden of disease from mortality and morbidity• Expressed in health statistics as the number of years lost due to ill-health, disability and early death or one lost year of healthy life Leading causes of DALY in developed countries 1990 2013Ischemic heart disease Ischemic heart diseaseStroke StrokeBack and neck Back and neckRoad injury Lung cancerLung cancer Depression (MDD)Depression (MDD) COPDCOPD (Chronic obstructive pulmonary d.) DiabetesSelf harm Sense related diseases Other musculoskeletal diseases Self harm Diabetes FallsSource: IHME, 2016. http://vizhub.healthdata.org/gbd-compare/ Modified from HaesslerHealth constraints and causes in developed countries Only minor changes over 23 years:• Cardiovascular including stroke diseases on top (16%*)• Minor role of infectious diseases  (HIV 0.52%*)including diarrhoeal diseases (0.12%*) Risk factors for leading diseases: • Lifestyle and dietary issues *Percentage of total DALYsLeading causes of DALY in developing countries 1990 2013Lower respiratory infections Ischaemic heart disease (IHD)Diarrhoeal diseases Lower respiratory infections Neonatal pre-term complications StrokeCOPD Back and neckMalaria Diarrhea diseases (3.5%*)(8.7%**)Stroke Neonatal pre-term complicationsProtein energy malnutrition HIVTB Road accidents Neonatal encephalopathy MalariaIschaemic heart disease TB*Percentage of total DALYsHealth constraints and causes in developing and developed countries Some changes over 23 years others remain unchanged:• Cardiovascular diseases has come up as the leading cause (1990 no. 10) • No. 2 still: respiratory infections (often preventable by vaccine)• Infectious diseases still a major cause• Diarrhoeal diseases still among first 5Risk factors for diarrhoeal diseases: • Poor sanitation, poor food safety standards Leading causes of DALY in central sub-Saharan Africa 1990 2013Malaria (13%*) Lower respiratory infections (11%*)Lower respiratory infections (12%*) Diarrhoeal diseases (11%*)(15%**)Diarrhoeal diseases (11%*)(14%**) MalariaMalnutrition Malnutrition Neonatal pre-term complications HIVAlmost no change over 23 years:Lower reparatory infections and infectious diseases the major causeDiarrheal disease and malnutrition unchanged but still highly ranked *Percentage of total DALYs **< 5 years Leading causes of DALY in Vietnam & Laos Vietnam1990 2013War StrokePre-term birth complication Road accidents (6.1%*)Stroke Back and neckMeasles Sense organ diseasesDrowning Lower respiratory infectionsConsiderable changes over 23 years:• Cardiovascular and/or stroke but also road injuries (Vietnam) jumped up • Diarrhoeal disease, depends on country  Laos1990 2013Diarrhoeal diseases Lower respiratory infectionsLower respiratory infectionsPreterm birth complication Pre-term birth complication IHDMeasles StrokeTetanus Diarrhoeal diseases*Percentage of total DALYsHealth constraints and causes in developing and developed countries • Clear differences between developed and developing countries• Cardiovascular related diseases main cause in developed countries• Infectious diseases including diarrhoeal diseases still a major problem in developing countries with regional and country differences Food safety – global perspectiveWHO report: Global estimates of foodborne diseases• First ever estimates of the global burden of foodborne diseases• For the global estimates, 31 foodborne hazards causing 32 diseases were included, being diarrhoeal disease agents, invasive infectious disease agents, helminths and chemicals• Estimated global burden of foodborne disease by these 31 hazards was 33 million DALYs in 2010Food safety – global perspective• Demonstrated that almost 1 in 10 people fall ill every year from eating contaminated food and 420,000 die as a result- Children under 5 years of age from low-income countries are at particularly high risk- Highest burden observed for Africa (East and Central) followed by Southeast Asian region Food safety – global perspective• Diarrhoeal diseases responsible for more than half of the global burden of foodborne diseases, with 230,000 deaths every year. • Major causes of diarrhoea: norovirus, Campylobacter, non-typhoidal Salmonella and pathogenic E. coli.• Others causes of foodborne disease related to Salmonella typhi, Taenia solium, hepatitis A virus and aflatoxins.http://www.who.int/foodsafety/publications/foodborne_disease/fergreport/en/Food safety – Vietnam • Limited number of food safety studies• Focus on assessment of hazards and often focusing on slaughter process • Lack of• Value chain approach • Investigating the related risk for consumers, impact and intervention studies• Risky consumption habits are common• Raw pork sausage, blood pudding, common in slaughterhouse workers • Increasing consumer concerns on animal diseases and food safety• Disease in pigs, hormones, antibiotics and grow promoters and slaughter hygieneFood safety Vietnam Consumer preferences for purchasing pork Pork purchasing sourcesProportion of purchased pork types by consumer groupsILRI PigRISK Unpublished resultsFood safety – Vietnam Legal framework • Various ministries involved, MoH (VFA), MoA (Nafiqad)• New single institutional body needed?• Food safety law from 2010, currently revised, 2016 amendment expected• Enforcement limited• Mainly based on importer demands• Very limited or absence in small-scale sectorFood safety Vietnam  • Majority of pork distributed through informal market chains– traditional processing, and retail practices (e.g. wet markets, temporally and/or permanent)– escape effective health and safety regulation (lack of regular inspection)– affordable, accessible, addressing local demands (e.g. fresh pork, meat pie, blood pudding)• Approximately 30,000 small-scale pig slaughter units− Implementation of existing food safety law a challenge− Regular inspections (if any) focus on medium to large scale slaughterhouses  Background - pigs in Vietnam • Pork is an important component of the Vietnamese diet• More than 70% of consumed meat is pork• More than 80% supplied by small scale sector• Preference for chilled pork provided by traditional market chains (90%)• Strong dominance of smallholders in pig production, significant contribution to household incomeBackground - pigs in Vietnam • Various challenges to increase production of smallholders from an animal health perspective• Limited biosecurity, poor on-farm hygiene• Poor reproductive management • Very limited resources of farmers to change • Pig diseases are common, wide range of notifiable diseases are endemic• Vaccines available but efficacy often not clear • Limited surveillance and response capacity• Pig vets rather used by large-scale sector Food safety issues along the pork value chain Pork-related foodborne hazardsParasitic Cysticercosis Trichinellosis ToxoplasmosisBacterial e.g.  Bacillus cereus Brucella suis Campylobacter spp. Salmonella spp. Streptococcus suis Shiga toxin producing E. coli Yersinia enterocoliticaChemical Antibiotic residues Aflatoxins Steroids/growth promoters Heavy metalsSource: PigRISK Project proposal Salmonella spp. Streptococcus suis Antibiotic residues Growth promoters •Trichinellosis•CysticercosisILRI food safety research related pig systems in Vietnam - an overview• Pig risk project (2012–17)– ACIAR-funded• Cross-CGIAR Research Program (2014–15)Scoping study to evaluate the potential of indigenous pig systems • Lab diagnostic review (related to pork)• Evaluation of large scale interventions related to food safety along the pork value chain (LIFSAP)PigRISK project (2012–17) To assess impacts of pork-borne diseases on human health and the livestock and identify control points for risk management.  Key components: Assessment (qualitative/quantitative risk assessments) and interventionIntegrated approach • Interdisciplinary team: vets, public health, economics, animal science, modeller• Data collected along entire pork value chainStudy sites – PigRiskHung YenNghe AnPiglet originWastewater / manure treatmentHygiene (pig keepers, PPE, floor, materials...)Water(drinking, cleaning)FeedFarmFood residues(vegetable, food…)Pest/rodentPigRisk: Selected results Food safetyRisk assessment (RA): • Salmonella risk pathways developed for producers, slaughterhouse and consumers• Quantitative risk assessment (risk for consumer) currently finalised PigRisk: Selected key results on food safety25Sampling for biological hazards (Salmonella spp.)• Overall 1275 samples (farm, slaughterhouse, market) over 12 months – Increasing prevalence along chain – final product, meat for sell: 45% • Quantitative risk assessment completed• Systems dynamic model (potential interventions ex-ante evaluated) completed Streptococcus suis in slaughter pigs (N=147): • Presence of S. suis type 2 Potential risky behaviour ‘Tiet canh’– common in slaughterhouse workers (43%) Chemical hazards • Presence of banned substances (e.g. chloramphenicol and the growth promoter salbutamol in pig feed and sold pork)PigRIsk - Results of microbial analysisActor Sample type Pos/Total Prev (%)Producer Drink-FA 14/72 19.4Producer FloSwab-FA 26/72 36.1Producer WasteW-FA 28/72 38.9Slaughterhouse CarcassSwab 58/149 38.9Slaughterhouse Feces 50/149 33.6Slaughterhouse Mesenteric LN 53/149 35.6Slaughterhouse SwabFlo-SH 11/49 22.4Slaughterhouse Water-SH 10/49 20.4Market Pork 97/217 44.7Market Pork-Gr 33/80 41.3Market CutSwab 55/217 25.3Market Overall 435/1275 34.1PigRisk - Results of microbial analysis20253035404550Mesenteric LN Feces CarcassSwab PorkSlaughter house Slaughter house Slaughter house MarketSalmonella prevalence Selected risk factors for Salmonella contamination  Slaughterhouse • Urban and peri-urban versus rural• Hot season versus cold season• Using of hot water kettle for scalding versus open hot water basin• Not washing floor after each pig• Hand, knife freely washed in open water tank • Floor slaughter versus elevated Market• Hot season versus cold season • Wipe hand on cloth using for wipe pork/equipment• Shop is next to the sewerage or presence of stagnant waterValue chain approachInputs & Services ProductionSlaughter ProcessingMarket ConsumersFrom farm to fork  Pig Risk - Best bet selection – Value chain approach Placed at specific actor along value chain based on RA results FeedWater, Biosecurity …Water, floor slaughter …Hygienic management Food handling and preparation sampling Randomized control trials: Pilot and RCT Feb 2016 onwards Intervention development  Consideration: • Based on evidence • Investment cost• Feasibility/compliance• Effect on specific actor or entire chain• Effect can be measured• LIFSAP experience (USD 80 million World Bank)• Adoption rate and time and after 6 months• Systems dynamic model used to test effect of intervention• Incentives (cash, social recognition)Challenges:• Lack of enforcement of regulations • Behaviour change required • What are the incentives to change current practice• No prime price for ‘safer’ pork Source: Sinh, Handlos and Unger (2014)Intervention development:  Pig slaughterhouseInvestment USD 700 – 800Source: Unger (2016)Intervention development: Pig slaughterhousePilot trial to practical test:• LIFSAP table not accepted by workers as too high to handle a pig aloneSource: Unger (2015)Intervention development: Pig slaughterhouseInvestment USD 400Grit has to have sufficient size to allow to handle 2 pigs and adapted to the existing slaughterhouse structure Source: Unger (2015)Intervention development: Pig slaughterhouseSource: Unger (2016)Pig slaughterhouse: challenges observedBehaviour/practice change is neededSource: Unger (2016)Market – challenges  Source: Unger (2016)Market – trader  Interventions – final reflections We aim for:• Feasible interventions towards ‘more hygienic’ pork with intervention at slaughterhouse, markets, and consumers • Means not hazard free; possible develop a store brandSlaughterhouse:• Avoid floor slaughter (implemented and scientific evidence) • Water source (planned)• Dirty versus clean zone (greatest challenge)Market: • Avoid use of towel to dry pork (planned)• Storage place for knife with cleaning/disinfection (planned)• Reduce number of flies  Consumer: • Meat auction survey (what do they relate to safe pork)(planned)• Test of dissemination options (poster, video, flyer, photos)(planned)Scoping study on indigenous pig systems (2014–15)Central Highlands of Vietnam  Source: Unger, 2015Scoping study on indigenous pig systems (2014–15) Scoping study to evaluate the potential of integratedindigenous pig systems to improve livelihoods and safe porkconsumption for poor ethnic minority smallholders in theCentral Highlands of Vietnam.Integrated focus• Components: • Market access/opportunity study• Value chain study • Breeding component • Gender study• Food safety • Economist, vets, public health, breeding, crop/livestock  system expertsSource: Unger (2015)Free range versus pen use, among HH with indigenous pigs  (N=262)Knowledge of targeted zoonotic parasitoses (N=262)Among those 10% none of them aware about mode of transmission from pig to human Central Highlandsnative pig studyConclusions • Food safety an important concern, in particular in developing countries (and highest in children under 5 years) but also for Vietnamese consumers• Presence of various hazards along the pork chain shown in Vietnam but related risk and impact unclear• Various challenges found in Vietnam (all levels including policy) • Intervention development must consider feasibility questions but also requires a behaviour change of all involved actors• Suitable incentives: greatest challenge is how to find in a resource-poor contextThe presentation has a Creative Commons licence. You are free to re-use or distribute this work, provided credit is given to ILRI.better lives through livestockilri.orgSpecial thanks to: Hanoi School of Public HealthVietnam National University of Agriculture, WASI,MARD, DARDVC actors and groups HP2, healthy pigs, healthy people Scientific evidence (2015): 8 journal articles, 27 presentations at international fora 

Food safety from a global perspective to a country perspective addressing challenges along smallholder pig systems in Vietnam

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Food safety from a global perspective to a country perspective addressing challenges along smallholder pig systems in Vietnam

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