Photo Credit Goes Here
Delia Grace, Kristina Roesel, Sothyra Tum, Chhay Ty, Hung Nguyen-Viet, Fred Unger, Hardisman
Dasman, Nicoline de Haan, Melissa Fox Young, Johanna Lindahl, Silvia Alonso
Animal health and sustainable intensification:
Towards systematic and holistic prioritization
of disease associated with consumption of
livestock foods
First International Sustainable Agricultural Intensification and Nutrition Conference,
Royal University of Agriculture, Phnom Penh, Cambodia January 10-13, 2018
NAHPRI

• Why prioritize?
– People are poor judges of risk
– The vital few and the trivial many
• Prioritization of FBD in Cambodia
– Literature and health metrics
– Stakeholder consultation and participatory processes

What you worry about and what kills you are not the
same
3
Vietnam chemical risk assessment
• 366 kidney, liver and pork samples analysed for
antibiotic residues, β-agonists, and heavy metals
• ~1% over MRL with minor implications for human
health
Quantitative microbial risk assessment
• QMRA for salmonellosis acquired from
pork
• Annual incidence rate estimated to be
12.6%

Experts get it wrong
4
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Importance Burden

5
0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1800000
2000000
Top 13
zoonoses
Next 43
The top 10 human disease cause 90% burden
Illnesses
WHO, 2014Grace et al., 2012
Pareto principle: the vital few
and the trivial many

• Nutrition: the most risky foods are also the most nutritious
• Gender: Women have a major role in informal food markets at risk from
FBD
• Economic loss: FBD has high economic costs: health, agriculture &
economy-wide
• Pathways out of poverty blocked: FBD limits access of poor farmers to
export markets and threatens access to domestic markets
• Equity: FBD discriminates: the YOMPI are most at risk
FBD has many implications beyond health

0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Microbes Helminths Aflatoxins Other toxins
zoonoses
non zoonoses
Havelaar et al., 2015
Burden-based

8
Annual benefit Annual cost Confidence in
investment
Sharing resources 4 billion 1 billion ++
Controllable
zoonoses
60 billion 20 billion +++
Timely response 6 billion
3.4 billion
++
Averting
pandemics
30 billion +
Generating
insights
? ? +++
Bottom line 100 billion 25 billion +++
Benefit-based

• Why prioritize?
– People are poor judges of risk
– The vital few and the trivial many
• Prioritization of FBD in Cambodia
– Literature and health metrics
– Stakeholder consultation and participatory processes

• Health metrics
0
200000
400000
600000
800000
1000000

• Stakeholder consultation

• Systems effect modelling

Unique records
identified
Included records
Full text
Data
extracted
Excluded
(titles/abstract
s)
Other exclusion
criteria*
*books, book chapters, duplicates, full paper not available
**reviews excluded but if original source available added if not already in the list
#additional ISI articles identified through other sources (i.e. grey literature) but not SLR algorithm
Excluded
quality
Excluded exclusion/inclusion criteria**
27
15
Data
extracted
72
2 duplicates
10 full papers not (yet)
available
0
6 not relevant
99
4
Included
additional#

0 1 0 1 1 0 0 1 1 1
4
1
2
1
4
0
6
1
1 Jan
1990 -
31 Dec
2000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
(until
30
June)
International, peer-reviewed journal
publications between 1990 and June 2017
n= 25
which foods???
FBD: noodles, rice, seafood, dog meat, water spinach, rice wine, raw game meat
Chemicals: sausage, dry fish, seafood, noodles and meat balls produced from beef and pork
which hazards???
Vibrio spp., Salmonella spp., Staphylococcus aureus, Bacillus cereus
borax, formalin

• Conclusion
– Very little information on health burden of FBD in Cambodia
– Almost no information on other burdens
– Systematic, holistic approach can generate better
information
– This will allow us to prioritise hazards for biological survey
and subsequent intervention

Safe Food Fair Food for Cambodia
NAHPRI

www.feedthefuture.gov