Suchergebnisse

Introduction: Campylobacter are zoonotic bacteria that cause gastroenteritis worldwide with the species, Campylobacter jejuni and Campylobacter coli commonly associated with human diarrhea. Transmission is mainly through direct contact with farm animals, consumption of chicken and contaminated water. There is paucity of data on the epidemiology of Campylobacter in developing countries despite its global widespread and expansion of poultry farming; hence there is the need to explore and build on the available data. This study aimed at determining prevalence and homestead risk practices associated with Campylobacter infection in diarrheal patients in Busia County. Methods: A cross-sectional study was conducted from February, 2017 to April, 2019. Stool samples were collected from patients of all ages attending Busia County referral Hospital and structured questionnaires on homestead associated risk practices administered. Isolation and identification of Campylobacter species was performed using standard culture method on Modified Charcoal Cefoperazone Deoxycholate medium and confirmed by mPCR. Factors associated with Campylobacter infection were evaluated using logistic regression analysis. Results: A total of 132 (11.6%) Campylobacter comprising 89.2% C. jejuni and 10.8% C. coli were isolated from 1200 diarrhoegenic patients sampled. Isolation rate was higher in children aged 5 years (9.4%). Multilevel logistic models showed that homestead poultry farming was a significant risk associated with Campylobacter infection in 5 years (OR 10.05; 95% CI: 2.60 - 24.29, P 5 years respectively. Conclusion: Campylobacter jejuni is the leading cause of Campylobacter infections in diarrheal patients. Personal hygiene awareness of mothers/caregivers and proper animal husbandry especially where livestock-human interaction is common are important practices which require the County government support. Further studies are required on sex specific age difference, other social economic factors, domestic animals and the role played by the environment in the transmission of Campylobacter infection. These would advance knowledge and understanding on source attribution and transmission dynamics for effective control and management of the infection.

Background: Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Kenya has been at the forefront of embracing a collaborative approach in Africa with the inception of the Zoonotic Disease Unit in 2011. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level. Methods: Key informant interviews were conducted with 28 disease surveillance officers from the human and animal health sectors in three counties in western Kenya. An inductive process of thematic analysis was used to identify themes relating to barriers and drivers for cross-sectoral collaboration. Results: The study identified four interlinking themes related to drivers and barriers for cross-sectoral collaboration. To drive collaboration at the sub-national level there needs to be a clear identification of "common objectives," as currently exemplified by the response to suspected rabies and anthrax cases and routine meat hygiene activities. The action of collaboration, be it integrated responses to outbreaks or communication and data sharing, require "operational structures" to facilitate them, including the formalisation of reporting lines, supporting legislation and the physical infrastructure, from lab equipment to mobile phones, to facilitate the activities. These structures in turn require "appropriate resources" to support them, which will be allocated based on the "political will" of those who control the resources. Conclusions: Ongoing collaborations between human and animal disease surveillance officers at the sub-national level were identified, driven by common objectives such as routine meat hygiene and response to suspected rabies and anthrax cases. In these areas a suitable operational structure is present, including a supportive ...

Background: Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Kenya has been at the forefront of embracing a collaborative approach in Africa with the inception of the Zoonotic Disease Unit in 2011. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level. Methods: Key informant interviews were conducted with 28 disease surveillance officers from the human and animal health sectors in three counties in western Kenya. An inductive process of thematic analysis was used to identify themes relating to barriers and drivers for cross-sectoral collaboration. Results: The study identified four interlinking themes related to drivers and barriers for cross-sectoral collaboration. To drive collaboration at the sub-national level there needs to be a clear identification of "common objectives," as currently exemplified by the response to suspected rabies and anthrax cases and routine meat hygiene activities. The action of collaboration, be it integrated responses to outbreaks or communication and data sharing, require "operational structures" to facilitate them, including the formalisation of reporting lines, supporting legislation and the physical infrastructure, from lab equipment to mobile phones, to facilitate the activities. These structures in turn require "appropriate resources" to support them, which will be allocated based on the "political will" of those who control the resources. Conclusions: Ongoing collaborations between human and animal disease surveillance officers at the sub-national level were identified, driven by common objectives such as routine meat hygiene and response to suspected rabies and anthrax cases. In these areas a suitable operational structure is present, including a supportive legislative framework and clearly designated roles for officers within both sectors. There was support from disease surveillance officers to increase their collaboration, communication and data sharing across sectors, yet this is currently hindered by the lack of these formal operational structures and poor allocation of resources to disease surveillance. It was acknowledged that improving this resource allocation will require political will at the sub-national, national and international levels.

Urban livestock keeping in developing cities have an important role in food security and livelihoods, but can also pose a significant threat to the environment and health of urban dwellers. The aim of this study was to identify the different livestock systems in Nairobi, their supply chains and their management and food safety risks. Seven focus group discussions with Livestock production officers in charge of each major Nairobi subcounty were conducted. Data were collected on the type of systems existing for each livestock species and their supply chains, disease management, food safety risks, and general husbandry and gender factors. Supply chain flow diagrams and thematic analysis of the data was done. Results of the study show a large variability of livestock keeping in Nairobi. The majority were small scale with: <5 dairy cows, 1-6 dairy goats, <10 small ruminants, <20 pigs, 200-500 broilers, 300-500 layers, <10 indigenous chickens or <20 rabbits. Beef keeping was mainly described as a 'by the way' system or done by traders to fatten animals for 3 month. Supply chain analysis indicated that most dairy farmers sold milk directly to consumers due to 'lack of trust' of these in traders. Broiler and pig farmers sold mainly to traders, but are dependent on few large dominating companies for their replacement or distribution of products. Selling directly to retailers or consumers (including own consumption), with backyard slaughtering, were important chains for small scale pig, sheep and goat and indigenous chicken keepers. Important disease risk practices identified were associated to consumption of dead and sick animals, with underground network of brokers operating for ruminant products. Qualified trained health managers were used mainly by dairy farmers, and large commercial poultry and pig farmers, while use of unqualified health managers or no treatment were common in small scale farming. Control of urban livestock keepers was reported difficult due to their 'feeling of being outlaws', 'lack of trust' in government, 'inaccessibility' in informal settlements, 'lack of government funding' or 'understaffing'. Findings are useful for designing policies to help to control urban livestock production and minimize its associated health and environment risks. ; Medical Research Council, United Kingdom ; Natural Environment Research Council, United Kingdom ; Economic and Social Research Council, United Kingdom ; Biotechnology and Biological Sciences Research Council, United Kingdom ; Peer Review

Urban livestock keeping in developing cities have an important role in food security and livelihoods, but can also pose a significant threat to the environment and health of urban dwellers. The aim of this study was to identify the different livestock systems in Nairobi, their supply chains and their management and food safety risks. Seven focus group discussions with Livestock production officers in charge of each major Nairobi subcounty were conducted. Data were collected on the type of systems existing for each livestock species and their supply chains, disease management, food safety risks, and general husbandry and gender factors. Supply chain flow diagrams and thematic analysis of the data was done. Results of the study show a large variability of livestock keeping in Nairobi. The majority were small scale with: <5 dairy cows, 1-6 dairy goats, <10 small ruminants, <20 pigs, 200-500 broilers, 300-500 layers, <10 indigenous chickens or <20 rabbits. Beef keeping was mainly described as a 'by the way' system or done by traders to fatten animals for 3 month. Supply chain analysis indicated that most dairy farmers sold milk directly to consumers due to 'lack of trust' of these in traders. Broiler and pig farmers sold mainly to traders, but are dependent on few large dominating companies for their replacement or distribution of products. Selling directly to retailers or consumers (including own consumption), with backyard slaughtering, were important chains for small scale pig, sheep and goat and indigenous chicken keepers. Important disease risk practices identified were associated to consumption of dead and sick animals, with underground network of brokers operating for ruminant products. Qualified trained health managers were used mainly by dairy farmers, and large commercial poultry and pig farmers, while use of unqualified health managers or no treatment were common in small scale farming. Control of urban livestock keepers was reported difficult due to their 'feeling of being outlaws', 'lack of trust' in government, 'inaccessibility' in informal settlements, 'lack of government funding' or 'understaffing'. Findings are useful for designing policies to help to control urban livestock production and minimize its associated health and environment risks.

Most emerging diseases of humans originate in animals, and zoonotic emerging infectious diseases (EIDs) threaten human, animal, and environment health. We report on a scoping study to assess actors, linkages, priorities, and needs related to management of these diseases from the perspective of key stakeholders in three countries in Southeast Asia. A comprehensive interview guide was developed and in-depth interviews completed with 21 key stakeholders in Vietnam, Lao People's Democratic Republic, and Cambodia. We found numerous relevant actors with a predominance of public sector and medical disciplines. More capacity weaknesses than strengths were reported, with risk analysis and research skills most lacking. Social network analysis of information flows showed policy-makers were regarded as mainly information recipients, research institutes as more information providers, and universities as both. Veterinary and livestock disciplines emerged as an important "boundary-spanning" organization with linkages to both human health and rural development. Avian influenza was regarded as the most important zoonotic EID, perhaps reflecting the priority-setting influence of actors outside the region. Stakeholders reported a high awareness of the ecological and socioeconomic drivers of disease emergence and a demand for disease prioritization, epidemiological skills, and economic and qualitative studies. Evaluated from an ecohealth perspective, human health is weakly integrated with socioeconomics, linkages to policy are stronger than to communities, participation occurs mainly at lower levels, and equity considerations are not fully considered. However, stakeholders have awareness of ecological and social determinants of health, and a basis exists on which transdisciplinarity, equity, and participation can be strengthened.

The camel milk trade in Kenya has evolved significantly from a small-scale business undertaken in local villages to its current status involving a large number of different stakeholders supplying urban towns, particularly Nairobi City. Despite the evident growth pattern, the supply of camel milk to Nairobi has largely remained informal, with minimal enforcement of regulations. The aim of this study was to characterise the camel milk system supplying Nairobi and assess its governance, main challenges and the potential food safety risk practices. A value chain analysis framework was used to carry out data collection between August 2014 and July 2015. Qualitative and quantitative data were collected through focus group discussions and key informant interviews with stakeholders operating in different nodes of the value chains. Three milk value chains supplying Nairobi were identified and mapped: the Isiolo chain, the Kajiado chain and the camel milk processing company chain. Overall, the results indicate that 94% of the milk supplied to Nairobi city is informally traded (traded without any effective regulation), while 6% originates from a formal milk processing company. In the informal chains, milk traders (mostly women) were reported to play a pivotal role in the organisation and daily functioning of the chains. The processing company had partly integrated activities and reported exporting 5% of their products to regional and international markets. Food safety themes identified were associated with i) lack of cold chain, ii) gaps in hygiene practices, particularly at farm and market levels, iii) consumption of raw camel milk, and iv) lack of food safety training, among other issues. Low level involvement by government agencies in enforcing stipulated food safety measures were reported in the informal chains, as these concentrate efforts in the regulation of dairy milk chains. Isiolo milk traders were identified as the dominant group, setting milk prices and providing sanctions. The framework and findings obtained can help future research and policy makers to reach informed decision about what to regulate, where to target and importantly how to make the camel milk value chain more efficient and safer.

Introduction: Adequate and balanced nutrition is key for poverty reduction, maternal and child health and the achievement of the Sustainable Development Goals. Malnutrition, particularly micronutrient deficiencies, can be alleviated with nutrient-dense animal-source foods (1). In Nairobi, Kenya, poor informal settlements represent a challenge to the food supply. The purpose of the reported study is to understand the dynamics of: 1) food systems supplying animal source foods using value chain analysis; and 2) consumption patterns of animal-source foods in deprived households. These two components were then linked to facilitate realistic and proportionate interventions and inform food policies. Methods: We conducted two parallel investigations in Nairobi: a cross-sectional nutrition survey in consumers of 205 randomly selected low-income households, in Korogocho and deprived areas of West Dagoretti; and a large-scale characterisation and analysis of the different animal-source food systems of the city. Retailers were the linkage node between consumers and food systems data. In the household survey, dietary (24-hour recall), anthropometric (weight, height and length), and biochemical (haemoglobin) data were collected from non-pregnant women of reproductive age and children (1-3 years). The questionnaire also included quantitative data on animal-source food consumption patterns and choice drivers, and purchase prices that were used to calculate demand elasticities. In the food systems study quantitative and qualitative data were collected using value chain analysis that included constraints, barriers and potential, and the assessment of the involved food safety and nutritional risks. This analysis included: key informant interviews (e.g. government officers), focus groups, interviews of all the stakeholder types along the chains (farmers, abattoir/market owners and workers, transporters, and retailers) and researchers' observations. Linear programming (in Optifood) was used to formulate population-specific food-based recommendations, and model the effect of incorporating different animal-source foods in the diet. Findings and interpretations: Results in children showed 42% were stunted and 74% were anaemic; in women, 7.4% had a low and 29% a high- body-mass index and 26% were anaemic. The linear programming analysis identified specific food-based interventions that would ensure, for example, dietary adequacy for all nutrients except for iron in women, requiring among others increases of intake of milk and other animal sources. The consumption and food systems datasets on animal-source foods were combined to assess availability, affordability, accessibility, preference, and upscaling potential. For example, beef was consumed by most households (81%) at an average of 1.5 times per week. Its demand was principally based on 'taste' and 'nutrition' indicating that consumption would be responsive to nutrition education. The reasons why households did not consume beef were either "price" (71%) and/or 'unknown' (74%). Own-price elasticity of beef was relatively inelastic at -0.68. Food system analysis showed that most beef was destined for higher-income areas Slums were limited to stale, low quality carcases with infrastructure issues producing problems of poor hygiene, food safety and traceability. The combination of approaches and methods provides a holistic picture of the food systems and its limitations, which allows more informed decision on interventions for poor people.

Livestock keeping in urban areas is a source of livelihoods for poor urban families, but it also poses public health challenges. Purpose This included mapping of value chains for products from commercial layers (CL) and indigenous layers (IL) kept in peri-urban areas of Nairobi City, prioritization of barriers to entry into layer farming and assessment of disease and food safety management. Methods Data on interaction between people and poultry products, barriers to entry and disease and food safety management were collected through key informant interviews, focus group discussions (FGD) and administration of questionnaires. Twelve FGD were conducted and 250 questionnaires administered to individual farmers. Additional data was obtained from retailers of poultry products and government officers. Results The CL farms kept between 100 and 1,000 birds per flock while for IL farms, flock sizes were between 1 and 50 birds. CL farms obtained day old chicks from distributors of large and small-scale hatcheries and from hawkers, while IL farms obtained chicks from small-scale hatcheries and neighbouring farms. Products from these farms were eggs, spent hens and poultry manure. Eggs from CL farms were sold to shops, consumers and hawkers, while those from IL farms were sold to neighbours, bakeries and restaurants, while some were consumed at home. Spent layers were sold to brokers, neighbours and households. Poultry manure was used on crop farms and as feed for dairy cattle. The barriers to entry included poor quality feeds, poultry diseases, seasonality and scarcity of water and land. The diseases included coccidiosis, Newcastle disease and respiratory problems and these were managed by personnel from "agrovets", while in slums sick birds were slaughtered and consumed. Furthermore, hawkers and personnel from restaurants and shops were reported to lack training in food safety. Conclusion and relevance Risk for zoonoses exists along poultry value chains and hence with increasing urbanization in developing countries, investigation of food systems in cities should adopt this framework to better understand public health risks.

Purpose: Research on livestock food systems in developing countries remains limited, yet this context needs to be understood to investigate the epidemiology of zoonoses. The aim of this study was to use a value chain framework to characterize the broiler and indigenous chicken meat systems of Nairobi and their food safety risks. Methods: Using such a framework for food safety characterisation at system level is novel and has significant potential in developing countries. Data collection involved 18 focus group discussions and 236 interviews with various poultry meat value chain stakeholders in Nairobi. Analysis included chain mapping and identification of governance and food safety challenges. Results: The study identified 10 chain profiles, characterising the broiler and indigenous chicken systems, and production-retailing continuum. Food safety risks identified were related to lack of biosecurity, cold chain and access to water, poor cleaning and hygiene practices, consumption of sick animals, significant environmental contamination of by-products, and lack of inspection at farm slaughter. Large companies dominated the governance of the broiler system through the control of day-old chick production. Overall government control was relatively weak leading to minimal official regulatory enforcement. Large companies and brokers were identified as dominant groups in market information dissemination and price setting. No dominant group was identified for indigenous chicken profiles, farming being at household level for local consumption, with quasi non-existent regulations. Lack of industry association was system-wide, creating a barrier for access to capital. Other system barriers included lack of space and expertise, leading to poor infrastructure and limited ability to implement effective hygienic measures. Conclusions and relevance: Optimal food safety and disease control strategies should consider the structure of the poultry meat system and stakeholder interactions to ensure effective programmes. This study provides a new perspective for epidemiologists and public health officers to address food safety risks in full understanding of the food system context.

In Nairobi, with 3.1 million consumers and 30,000 pigs, the pork system may represents a major source of zoonotic pathogens. Yet, this system and its public health risks have not been described. The study used value chain analysis, a well-known method in economics, to investigate zoonosis and food safety risks practices in the Nairobi pork food system. A cross-sectional study of the Nairobi pork system collected data through 25 focus group discussions and 436 individual interviews with farmers, traders, abattoir owners, large companies' managers, retailers, government officers and consumers. Data were analysed to identify, describe and quantify the main pork chain profiles, their associated zoonosis and food safety risks practices and their link to governance, the distribution of benefits and barriers to improving the system. Six pork chain profiles were identified with the 'large integrated company' profile accounting for 62% of pork marketed through abattoirs. Pigs in slums were channelled directly to consumers and butchers or through less integrated markets. Main zoonosis and food safety risk practices for city pig keepers were: handling and consumption of sick pigs; and swill and scavenging feeding. In less integrated abattoirs these risks were: lack of traceability, cold chain systems and adequate cleaning and sterilising practices and equipment. For the retailers, there was a lack of hygiene linked to poor infrastructure, scarcity of water and cleaning practices. Large companies govern the high end market for pork where barriers to improvements were less. In the lower end poor profit margins and unequal benefit distribution led to issues on around investments in infrastructure, cold chains and human capacity building plus difficulties with meeting feeding and animal health costs. Conclusions This study identified the main zoonoses and food safety risk practices and the people involved in risk taking activities to help future control programmes in the Nairobi pork system. The integration of value chain and analysis of risks practices proved useful and represent the way forward for epidemiologist working in developing countries.

In Nairobi the pork food system may represent a major source of zoonotic pathogens. Yet, the system and its public health risks have not been described. The study address this gap by identifying and understanding food safety risks practices in the Nairobi pork food system using a value chain approach. A cross-sectional study of the Nairobi pork system collected data through focus group discussions and individual interviews with farmers, traders, abattoir owners, large companies' managers, retailers, government officers and consumers. Data were analysed to identify, describe and quantify the main pork chains, their food safety risk practices and explore their link with chain governance, distribution of benefits and barriers to improving the system. Main food safety risk practices for 'city pig keepers' were: handling and consumption of sick pigs; and swill and scavenging feeding. Pigs in slums were channelled directly to consumers and butchers or through less integrated markets. In 'less integrated abattoirs', risk practices were: lack of traceability, cold chain and adequate cleaning and sterilising practices and equipment. These, with chains of pork from on-farm slaughtering, governed the lower end market. One 'large integrated company' accounted for 83.6% of pork marketed through abattoirs and governed the high-end market where barriers to improvements were less. Among retailers, there was a lack of hygiene due to poor infrastructure, scarcity of water and deficient cleaning practices. Poor profit margins and unequal benefit distribution in the lower-end market hinder investments in infrastructure, cold chains and human capacity building and make it difficult to meet feeding and animal health costs. This study identified the main food safety risk practices and the people involved in risk-taking activities in the Nairobi pork system. The understanding obtained on chain governance, barriers and system inequalities associated to these risks provide a foundation to design effective control strategies.

Background Efficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true' incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting. Methods Within the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens. Results MFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-, country-, age-, and sex-specific. Conclusions When routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation. MFs can be used to adjust notification and surveillance data to provide more realistic estimates of incidence.