1.
ISVEE16 – Halifax, Canada
16th International Symposium of Veterinary
Epidemiology and Economics (ISVEE 16)
Connecting Animals, People, and their shared environments
The first large scale randomized control trial (RCT) in Cambodia
animal sourced food systems: rationale and process
Fred Unger1, Sothyra Tum2, Rortana Chea2, Sinh Dang Xuan1, Hung Nguyen-Viet1, Chhay Ty3, Delia Randolph1
7-12 August 2022
1International Livestock Research Institute (ILRI)
2National Animal Health and Production Research Institute (NAHPRI)
3Livestock Development for Community Livelihood (LDC)

2.
ISVEE16 – Halifax, Canada
Why we used a randomized control trial (RCT)
✓Recognized tool to demonstrate the effectiveness of interventions
✓To provide solid evidence to policy makers (& managers) that
intervention in traditional retail can work
decisions will be more likely made!
✓We piloted similar intervention (e.g. Vietnam) but doubt remained
by regulatory bodies those may not work when scaled or under
RCT condition
RCT – rationality

3.
ISVEE16 – Halifax, Canada
Background information on RCT
Project:
Safe Food Fair Food (SFFF)
Aim:
To test low-costs food safety interventions for improvement of traditional animal
sourced food retail
Components:
Risk profiling, market & nutrition survey, risk assessment, RCT, communication
Location & time:
Cambodia & 2020

4.
ISVEE16 – Halifax, Canada
Background cont.
Costs of RCT: approximately 90K
- Preparations & scoping: 18k
- Minor equipment: 10k
- Trial including training: 24k
- Lab costs: 18k
- Admin/staff/overheads 20k
(excluding ILRI team & related travel)

5.
ISVEE16 – Halifax, Canada
METHODOLOGY
• RCT was designed in 12 trial markets (15
retailers each, 180) and 12 control
markets (15 retailers each, 180) across 6
provinces.
• Intervention package for trial retailers included:
- Training on good hygiene practices,
- Providing “incentive” in form of cheap equipment
support good hygiene practice
- Follow up and monitoring retailers’ practices
• After one month, pork samples were collected to analyse Total bacteria count-TBC
and Salmonella contamination and evaluate KAP of retailers from both trial and
control groups.

6.
ISVEE16 – Halifax, Canada
Steps in designing and executing the trial
Feb-Mar 2020 Apr-May 2020 Jul-Aug 2020 Sep-Oct 2020
Develop tools and
intervention
package, provincial
selection
Consultative
workshop
from 6
province &
scoping visits
TOT training for selected
markets (2 vet officers &
market managers (1-2)
Nov-Dec 2020
Jun2020
Team to
finalize
schedule and
logistics (e.g.,
training)
Start Trial
(train retailer/
equipment in
trial group by the
team.
Validate,
finalize RCT
tools and
intervention
packages
Evaluation:
Sampling and
KAP (both
groups)
Media campaign to
communicate the
intervention to consumers
Analysis
Preparation/formative research & scoping
(RCT tools, site selection, lab, logistic/field arrangement)
Intervention stage (follow
up in 1.5-2 month)
Reporting
stage
Personnel involved: Research team Officers (vet/PH) Market manager VC actors Total
8 30 (3-4 province) 40 (1-2 market) 360 >400

7.
ISVEE16 – Halifax, Canada
Retailer training
Participation
Sampling (biological and
observations)(+1 month)
Hygienic equipment
Inox tray, easy to clean surface,
disinfectant, apron, banner …

8.
ISVEE16 – Halifax, Canada
Control:
Current surface
(carton board)
Washing
detergent
Trial: Vendor who received training and equipment
Easy to clean
table surface
Signpost
And Training
certificate
Apron
Tray
Trial retailers:
- The KAP scores of retailers in the
intervention significantly improved.
- Improved food safety outcomes
(TBC & Salmonella)
RESULTS

9.
ISVEE16 – Halifax, Canada
Challenges encountered
• Prolonged preparatory phase
✓Required, but could be managed through a consultative process
• Identification of sufficient number of markets and retailers, high
complexity and variation of markets
✓Scoping required, info on markets & vendors isn’t updated
✓List of criteria for markets to be included (e.g. exclude not permanent retail)
• RCT design was new for local research team
• Ownership of market authorities & incentive for change (retailers)
✓Addressed through participatory diagnostic and high level support (DG NAFPRI)
• Limited funding, did not allow extended monitoring after RCT
• COVID emergence

10.
ISVEE16 – Halifax, Canada
RCT related
• Ensure strong support from authorities (higher and local)
• Participatory process is key to get support from all actors
• Provide sufficient time for preparations and have room for some flexibility
(e.g. interventions might be modified to local context)
• Clear plan and measures for quality control
More generic on intervention
• Clear strategy to include consumers and signal retailer improvement to them
• Ensure incentive schemes for retailers and an enabling policy environment to
sustainable influence the improvement of both food hygiene practices.
Which advice can be given

11.
ISVEE16 – Halifax, Canada
Acknowledgement
Local authorities
Value chain actors & market managers
Project partners