Pull-Push: Market and consumer interventions to
improve food safety in Ethiopia and Burkina Faso
Theo Knight-Jones1, Kebede Amenu1, Gemma Tacken2, Guy Ilboudo1, Donya Madjdian2, Sisay Girma3,
Abdulmuen Mohammed Ibrahim3, Delia Grace1,4, Emely de Vet2 and Michel Dione1
1International Livestock Research Institute
2Wageningen University & Research
3Haramaya University
4Natural Resources Institute, University of Greenwich
22nd International Symposium of Veterinary Epidemiology and Economics
Halifax, Canada, 12 August 2022

Background
Animal source foods in SSA
• important for human nutrition
• production and processing give
jobs to millions
• single most important cause of
(zoonotic) foodborne diseases
(FBD)
• Previous efforts to control FBD
focused at primary production
• This neglects risk of cross-
contamination closer to the
consumer
Havelaar et al., 2015 http://dx.doi.org/10.1371/journal.pmed.1001923
Foods implicated according to FERG (WHO, 2017)

Details
• Project: Urban food markets in Africa: Incentivizing food safety using a pull-push approach
• “Can consumer demand for safer food be generated to drive
improved food safety in informal market value chains in Africa?”
• Ouagadougou, Burkina Faso and Dire Dawa and Harar, Ethiopia
• Multicomponent food safety interventions with mixed method evaluations
• Tomato and chicken value chains
• Example Burkina Faso

Chicken consumption in Ouagadougou
FARM
TRANSPORT
MARKET
SLAB SLAUGHTER
Carcass:
50% Salmonella
70% Campy
Wash water:
100% Salmonella (Kagambega, 2018)

Chicken consumption in Ouagadougou
FARM
TRANSPORT
MARKET
SLAB SLAUGHTER/
RESTAURANT
STREET RESTAURANTS
75% OF CONSUMPTION-
mostly men
40% unacceptable
bacterial load (Somda
et al. 2018)

Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
VC actor
Knowledge, Attitudes,
Practices
Social Behaviour
Change
Communication
Campaign
Vendor
training
Intervention
Package
(RCT)
Local Regulator
Training
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Surveys &
observations VC
actors
“After” group discussions
Knowledge, Attitudes &
Practices
Photovoice/FGD
s
Triangulation
Burkina Faso - Chicken
Midline
Treatment
Group
Control
Group
Observation
s VC actors
Booster
training
KIIs/FGDs

Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
VC actor
Knowledge, Attitudes,
Practices
Social Behaviour
Change
Communication
Campaign
Vendor
training
Intervention
Package
(RCT)
Local Regulator
Training
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Surveys &
observations VC
actors
“After” group discussions
Knowledge, Attitudes &
Practices
Photovoice/FGD
s
Triangulation
Burkina Faso - Chicken
Midline
Treatment
Group
Control
Group
Observation
s VC actors
Booster
training
KIIs/FGDs

Consumer food safety awareness campaign
• Example Burkina Faso: Cost – US$100,000 – implemented by advertising agency
• Campaign goals
• To empower consumers in Ouagadougou to make safe choices regarding choosing chicken for
out-of-home and home consumption
• Key approach: emphasize with a positive message that there is a safe choice available that
reduces foodborne diseases in their family
• TV and radio adverts
• 30 billboards around city
• Facebook capsules by an influencer “Moussa Petit Sergent” >700,000 views and climbing

Evaluation
• Consumer food safety campaign – Ouagadougou, Burkina Faso Example Burkina Faso
• Before and after consumer KAP surveys 2022/3
• Impact in changing knowledge, attitudes & practices around controlling food safety risks for
chicken meat and/or tomatoes
• Cost per survey US$20,000 – n=1,100 participants per survey – 20 for endline photovoice
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
Social Behaviour
Change
Communication
Campaign
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Photovoice/FGD
s
Photovoice

Why this design?
• RCT not possible as campaign broadcast to whole city (2 million population)
• Trying a cluster trial would require different sites and still not possible to broadcast in such a focused way
• Will include double difference (difference in trends)
Results
• Not available

Main challenges
• Implementing and evaluating many things at the same time in multicomponent intervention with
multiple evaluation methods in resource limited setting
• Laboratory work is almost always challenging in this setting due to difficulties with partners,
procurement, obtaining supplies, quality, cost… but can bring valuable capacity building and insights
• No great separation of the intervention implementers and the evaluators – we lead both!
Advice for research in informal markets
• Work with established quality partners and allow a lot of time for laboratory studies

THANK YOU
THANK YOU
Urb an food markets in A frica: In c entivizin g food safety u sin g a p u ll -p u sh ap p roac h