This document provides an update on a project aimed at reducing foodborne disease in Ethiopia and Burkina Faso by improving food safety through a demand-driven 'pull-push' approach. It outlines various work packages focused on assessing foodborne illness burdens, understanding poultry and vegetable value chains, implementing consumer campaigns, and building capacity among regulators and value chain actors. The project seeks to engage consumers in recognizing and demanding safer food, alongside empowering stakeholders in the food supply chain to respond to this demand.

1. Better lives through livestock
Urban food markets in Africa: Incentivizing food
safety – Project implementation update
Kebede Amenu, Coen van Wagenberg, Claudia Ganser, James Noah Ssemanda, Arie Havelaar,
Kristine Roesel, Biruk Alemu Gemeda, Lina Mego, Donya Madjdian, Theo Knight-Jones and the
project team
Bill & Melinda Gates Foundation – UK Government Ethiopia food safety research projects
Stakeholder update workshop, Addis Ababa, Ethiopia, 20 May 2021

2. Project purpose
To help to sustainably reduce the burden
of foodborne disease
in Ethiopia (and Burkina Faso)
Assess if consumer demand for safer food
can be generated and used to drive
improvements in the safety of foods sold
in food markets
Combined with
building capacity of food chain actors and
regulators
Salmonella spp. and Campylobacter spp.
Salmonella spp. and enterotoxigenic E. coli

3. Pull approach (demand for safe food) Push approach (supply of safe food)
Reduced burden FBD, professionalizing
informal sector, appropriate governance
ENABLING
ENVIRONMENT
Consumers recognize &
demand safer food
VC actors respond to
demand & incentives
Inform, monitor &
legitimize VC actors
(Primary Outcome 2)
Build capacity &
motivation of regulators
(Primary Outcome 1)
Consumer campaign for
empowered consumers
(Primary Outcome 3)
Gather baseline information for detailed intervention planning and advocacy
Key
innovation
Pull-push approach

4. Project Working packages
• WP1: Estimating burden and cost of foodborne illness
• WP2: Understanding poultry meat and
vegetable value chains
• WP3: QMRA and cost-effectiveness analysis of candidate
interventions
• WP4: Build capacity and motivation of regulators to manage food
safety
• WP5: Empower value chain actors
to manage food safety
• WP6: Design and implement
a consumer campaign
• WP7: Impact assessment

5. WP1: Burden of disease
• Estimate burden of foodborne disease for Ethiopia and
Burkina Faso
– Permission to use Ethiopia data used for Global burden of FBD
FERG updated to 2017
• Pull-Push and TARTARE pathogen burden results out soon
5

6. WP1: Attribution
• Disease attribution to food
groups, food types and food
products
• e.g. Suggest abut half Ethiopia
NTS burden from chicken and
eggs
6

7. WP1 Cost-of-Illness
Salmonella, Campylobacter and ETEC
• Costs of illness for a patient collected
– patient records & interviews
• Combined with burden of disease to derive Cost-of-Illness
• Results expected in 2021
7

8. WP2: Understanding poultry meat and
vegetable value chains
1.SystematicLiteratureReview-FBDHazardsandburden (1990-2019)
• Gapsinfoodsafetyforthemajorfoodvaluechains
• Highlevelsofcontaminationwithbacterialandparasites
• PrevalenceofNTSinchickenmeatandcarcasses:8.3%-15.4% various
samples
• Campylobacter:16.7%and26.7%
• E.coli:20.0-52.4%indifferentvegetablessamples
• Salmonellainvegetables:4.8-30.0%
2.FoodsafetyinterventionsinAfricareview –ongoing

9. Food safety value chain assessment
producers, traders, consumers
• Focus group discussions, in-depth interviews
• DespiteFBDbeingmostlymicrobialsourceconsumersconcernedabout
chemicalcontamination
• Rawvegetablesinsaladariskypractice
• Chickenslaughteredandeateninthehome–homehygieneimportant
• Highincomegroups
• Makefairlygoodfoodchoicesandknowledgeable
• Eatchickenweekly
• Low-incomegroups
• Littlechoiceinwhattheyeat–cheap,lowquality
• Eatchickenonceeverythreemonths

10. Some of the food safety problems
• Dirty wash water
• Muddy
environment
• Flies
• Veg often damaged
and dirty
• …
10

11. Quantitative Knowledge Attitudes Practices
survey
• Survey of 151 tomato retailers Harar and Dire Dawa
• Quantify marketing and hygienic practices and views on
food safety – early results
• 40% reported insufficient quantity of water, 15% poor water quality
• 40% lacked access to adequate toilets, with 30% not having soap
for handwashing
• 15% regularly washed tomatoes with dirty water
• 13% unaware of the importance of water quality and cleanliness
for food safety
11

12. Quantitative Knowledge Attitudes Practices
surveys
• Quarter reported that damaged produce and food waste
was a problem
– About 10% of tomatoes for sale had some damage, 5% moderate
to severely damaged
• Food loss plus microbial growth greatly increase if tomatoes are damaged
• Most retailers changed their washing and hygiene practices
in response to COVID (62%)
– But only 37% for vendors selling on the street
• Retailers showed variable interest in implementing simple
food safety interventions
12

13. Upcoming WP2 activities
- Food survey of pathogen (chicken carcass in home and tomatoes at
market) and pesticide prevalence (tomatoes, veg)
- Chicken and vegetable home consumption, food safety practices survey

14. WP3 – Quantitative Risk Assessment Tomatoes
• Assess tomato, flows,
quality and food loss
along the value chain
• Used as backbone for
Quantitative Microbial
Risk Assessment (QMRA)
model
• To estimate
contamination, risk and
used to assess
interventions
14

15. WP3: Poultry QMRA and CE
1. QMRA:
2. Cost effectiveness of food safety interventions
Salmonella spp.
Campylobacter spp.
Outputs
- Probability of getting sick
- Number of sick people per year
- List of interventions to reduce
food safety risks
Outputs
- List of feasible and affordable
interventions to reduce food
safety risks
15

16. Upcoming
16

17. WP6 Consumer communications campaign
• Campaign to generate consumer awareness of the importance of
buying safe foods
• Based on project findings and local and national stakeholder
consultation
• Agencies bid to run the campaign (variety of media, platforms
considered)
• Ethiopian campaign will promote the purchase of quality
vegetables, specifically clean, undamaged, intact tomatoes,
especially if used in salads
• Will also promote hygiene within the household particularly for
home slaughter and preparation of chicken
• Will consumer demand drive improved safety of foods in
markets?
17

18. WP4 Regulator training in food safety
ILRI developing part-time online course with RVC, London
– Will look for Gov nominations for participants soon
18

19. WP4 Regulator training in food safety
Module 1: Introduction [6 weeks] (initially run as a one week intro course)
Global food safety overview [1 week]
Food safety and sustainable development goals (SDGs) and other development considerations [1 week]
Global, regional and national food safety systems (including formal and informal systems) [1 week]
Food safety hazards and risks [2 week]
Food safety indices – e.g. Africa Food Safety index, DALYs, Cost of illness [1 week]
Module 2: Risk assessment [6 weeks]
Introduction to risk analysis; Risk assess; risk communication; risk management; history, development, utility [1 week]
Risk assessment frameworks-Codex, OIE, Quantitative microbial risk assessment; fault trees [1 week]
Qualitative risk assessment – focus on learning how to conduct one [2 week]
Quantitative, semi-quantitative risk assessment- focus on principles and interpreting [1 week]
Participatory risk assessment in practice, rapid risk appraisals – [1 weeks]
Module 3: Food safety management [6 weeks]
Assurance programmes; GHP, GMP, GAP [1 week]
HACCP and industry programmes; modified HACCP for informal sector and small and medium enterprises [1 week]
Food safety system performance [1 week]
Traceability and recall [1 week]
Food safety laws [1 week]
Surveillance [1 week]
ILRI developing part-time online course with RVC, London
– Will look for Gov nominations for participants soon
19

20. WP5 Value chain actor support
• Retailer support (Ethiopia tomato)
• Basic food safety training
• Provide simple intervention
• Equipment for cleaning, keeping produce clean
• Sanitiser wash for foods or water purifier, filter
• Better packaging for reducing damage to tomatoes
• Other options?
• Also food safety training of local regulators
20

21. • RQ: What is the combined impact of regulator trainings, VC
actors support (push), and a consumer campaign (pull) in
changing knowledge, attitudes & practices towards controlling
food safety risks for chicken meat and/or tomatoes
• Planned data collection: September 2021 – March 2022
• Study design: mixed-methods combining focus group
discussions with regulators, an RCT with VC actors and
consumer surveys (quasi-experimental), combined with
photovoice
WP7: Impact evaluation studies (KAP)
21

22. 22

23. Thank you!
Funders: Bill & Melinda Gates Foundation, UK aid from the UK Government and the
CGIAR Research Program on Agriculture for Nutrition and Health
Ethiopia Consortium: ILRI, Addis Ababa University, Haramaya University, Wageningen ,
University of Florida, WorldVeg

24. THANK YOU