Milk handling practices and consumption behavior among Borana pastoralists in southern Ethiopia

Perceptions of rural and urban residents in Borana pastoral and agro-pastoral areas in Ethiopia related to milk adulteration

Milk is a nutritious food that plays a great role in the diets of a society largely dependent on livestock production. On the other hand, contaminants can enter milk naturally or intentionally, causing a negative impact on the health of consumers. Milk adulteration is a wide concern in the dairy industry in many countries, including Ethiopia, with a subsequent negative impact on its nutritive value and potentially affecting the health of consumers. This study was designed to assess the perceptions of rural and urban residents in Borana pastoral and agro-pastoral areas in Ethiopia related to milk adulteration. It was also aimed at identifying the potential reasons for milk adulteration in the area. A semi-structured questionnaire and focus group discussions (FGDs) were used to collect quantitative and qualitative data, respectively, focusing on the types of substances added to milk and the reasons for the addition of the substances. In rural and urban areas, 73.1% and 91.7% of respondents reported suspicion of the addition of nonmilk substances or milk of other animal species to cow's milk before selling, respectively. According to the qualitative data, most reported adulterants were water and 'pasta or rice water' (a murky fluid left after boiling rice or pasta). Respondents mentioned that they identify adulterated milk by observation or tasting. Economic gain was the primary perceived reason to adulterate the milk according to the study participants. The respondents had concerns about the quality and safety of milk associated with adulteration in the area. The weak enforcement of regulations related to milk quality and marketing as well as the inadequacy of capacity for the detection of adulteration were mentioned as gaps toward mitigating the problems. Awareness creation about the negative impacts of milk adulteration among the community supported by strategies for regulation, such as improving regular testing of milk and taking actions on adulterated milk, is recommended to tackle consumer concerns around milk adulteration in the area.

Molecular detection and antibiogram of Shiga toxin-producing Escherichia coli (STEC) from raw milk in and around Bahir Dar town dairy farms, Ethiopia

Illnesses associated with consuming infected milk and milk products are a widespread problem in low and middle-income countries. Shiga toxin-producing Escherichia coli (STEC) is a bacterium commonly found in raw milk and causes foodborne diseases ranging from mild diarrhea to severe hemorrhagic colitis and hemolytic uremic syndrome. This study aimed to investigate the virulence gene and antimicrobial resistance profiles of Shiga toxin-producing E. coli strains isolated from raw milk in dairy farms in and around Bahir Dar town. Raw milk samples (n = 128) collected from December 2021 to July 2022 were cultured, and E. coli strains were isolated using standard methods. Shiga toxin-producing E. coli strains were identified genotypically by the presence of the virulence markers using a single-plex polymerase chain reaction. The antibiotic susceptibility testing of Shiga toxin-producing E. coli isolates was done by the agar disk diffusion method. In total, 32 E. coli isolates were recovered from milk samples from lactating animals. PCR screening of these isolates resulted in 19 (59.3%) positives for Shiga toxin-producing E. coli. The stx2 gene was detected in 53% of cases, followed by stx1 (31%) and eae (16%. The STEC isolates were highly sensitive to ciprofloxacin (94.7%) and kanamycin (89.5%), while exhibiting significant resistance to amoxicillin (89.5%) and streptomycin (73.7%). The present study points out the occurrence of virulent and antibiotic-resistant Shiga toxin-producing E. coli strains in raw milk that could pose a potential risk to public health. Further analysis by whole genome sequencing is necessary for an in-depth assessment and understanding of their virulence and resistance factors. Moreover, large-scale studies are needed to identify the prevalence and potential risk factors and to prevent the spread of antibiotic-resistant STEC strains in the milk production chain.

Prevalence and Antimicrobial Resistance of Escherichia coli O157:H7 and Salmonella, and the Prevalence of Staphylococcus aureus in Dairy Cattle and Camels under Pastoral Production System

Escherichia coli O157:H7, Salmonella and Staphylococcus aureus are common foodborne pathogens. We determined the prevalence of E. coli O157:H7 and Salmonella in feces and milk and the prevalence of S. aureus in milk from dairy cattle and camels in the Borana pastoral community in the Southern Oromia Region of Ethiopia. Paired individual cow composite (pooled from all quarters in equal proportions) milk and fecal samples were collected from cows (n = 154) and camels (n = 158). Samples were cultured on bacterial isolation and identification media. E. coli O157:H7 and Salmonella isolates were further tested for susceptibility against nine antimicrobial drugs. Different risk factors associated with hygienic milking practices were recorded and analyzed for their influence on the prevalence of these bacteria in milk and feces. The prevalence of E. coli O157:H7 and Salmonella in feces were 3.9% and 8.4%, respectively, in cows, and 0.6% and 2.5%, respectively, in camels. E. coli O157:H7 and Salmonella were detected in the composite milk samples of 2.6% and 3.9% of the cows, respectively, and 0% and 1.3% of the camels, respectively. S. aureus was detected in composite milk samples of 33.4% of the cows and 41.7% of the camels. All E. coli O157:H7 (n = 11) and Salmonella (n = 25) isolates from both animal species and sample types were resistant to at least one antimicrobial drug. Multidrug resistance was observed in 70% (7/10) of the E. coli O157:H7 fecal and milk isolates from cows and 33.3% (2/6) of the Salmonella fecal and milk isolates from camels. The prevalence of these bacteria in feces and milk was not affected by risk factors associated with milking practices. Given the very close contact between herders and their animals and the limited availability of water for hand washing and udder cleaning, these bacteria are most likely present in all niches in the community. Improving community awareness of the need to boil milk before consumption is a realistic public health approach to reducing the risk of these bacteria.

Seroprevalence and related risk factors of Brucella spp. in livestock and humans in Garbatula subcounty, Isiolo county, Kenya

BACKGROUND

Brucellosis is a neglected zoonotic disease that affects both animals and humans, causing debilitating illness in humans and socio-economic losses in livestock-keeping households globally. The disease is endemic in many developing countries, including Kenya, but measures to prevent and control the disease are often inadequate among high-risk populations. This study aimed to investigate the human and livestock seroprevalence of brucellosis and associated risk factors of Brucella spp. in a pastoralist region of northern Kenya.

METHODS

A cross-sectional survey was conducted using a two-stage cluster sampling method to select households, livestock, and humans for sampling. Blood samples were collected from 683 humans and 2157 animals, and Brucella immunoglobulin G (IgG) antibodies were detected using enzyme-linked immunosorbent assays. A structured questionnaire was used to collect data on potential risk factors associated with human and animal exposures. Risk factors associated with Brucella spp. exposures in humans and livestock were identified using Multivariate logistic regression.

RESULTS

The results indicated an overall livestock Brucella spp. seroprevalence of 10.4% (95% Confidence Interval (CI): 9.2-11.7). Camels had the highest exposure rates at 19.6% (95% CI: 12.4-27.3), followed by goats at 13.2% (95% CI: 9.3-17.1), cattle at 13.1% (95% CI: 11.1-15.3) and sheep at 5.4% (95% CI: 4.0-6.9). The herd-level seroprevalence was 51.7% (95% CI: 47.9-55.7). Adult animals (Adjusted Odds Ratio (aOR) = 2.3, CI: 1.3-4.0), female animals (aOR = 1.7, CI: 1.1-2.6), and large herd sizes (aOR = 2.3, CI: 1.3-4.0) were significantly associated with anti-brucella antibody detection while sheep had significantly lower odds of Brucella spp. exposure compared to cattle (aOR = 1.3, CI: 0.8-2.1) and camels (aOR = 2.4, CI: 1.2-4.8). Human individual and household seroprevalences were 54.0% (95% CI: 50.2-58.0) and 86.4% (95% CI: 84.0-89.0), respectively. Significant risk factors associated with human seropositivity included being male (aOR = 2.1, CI:1.3-3.2), residing in Sericho ward (aOR = 1.6, CI:1.1-2.5) and having no formal education (aOR = 3.0, CI:1.5-5.9). There was a strong correlation between human seropositivity and herd exposure (aOR = 1.6, CI:1.2-2.3).

CONCLUSIONS

The study provides evidence of high human and livestock exposures to Brucella spp. and identifies important risk factors associated with disease spread. These findings emphasize the need for targeted prevention and control measures to curb the spread of brucellosis and implement a One Health surveillance to ensure early detection of the disease in Isiolo County, Northern Kenya.

Investigating and combatting the key drivers of viral zoonoses in Africa: an analysis of eight epidemics

Investigating the interplay of factors that result in a viral zoonotic outbreak is difficult, though it is increasingly important. As anthropogenic influences shift the delicate balance of ecosystems, new zoonoses emerge in humans. Sub-Saharan Africa is a notable hotspot for zoonotic disease due to abundant competent mammalian reservoir hosts. Furthermore, poverty, corruption, and an overreliance on natural resources play considerable roles in depleting biological resources, exacerbating the population's susceptibility. Unsurprisingly, viral zoonoses have emerged in Africa, including HIV/AIDS, Ebola, Avian influenza, Lassa fever, Zika, and Monkeypox. These diseases are among the principal causes of death in endemic areas. Though typically distinct in their manifestations, viral zoonoses are connected by underlying, definitive factors. This review summarises vital findings on viral zoonoses in Africa using nine notable case studies as a benchmark for future studies. We discuss the importance of ecological recuperation and protection as a central strategy to control zoonotic diseases. Emphasis was made on moderating key drivers of zoonotic diseases to forestall future pandemics. This is in conjunction with attempts to redirect efforts from reactive to pre-emptive through a multidisciplinary "one health" approach.

From farm to table: exploring food handling and hygiene practices of meat and milk value chain actors in Ethiopia

Livestock value chains constitute a source of livelihood for meat and milk value chain actors in Ethiopia, from dairy farmers to other associated value chain actors such as milk traders, abattoir workers, public health officials, veterinarians, butcheries selling meats, milk cooperatives, artisanal milk processors, and transporters. The development of these livestock value chains, however, is constrained by poor food safety and quality, while consumers are also exposed to public health risks due to milk and meat value chain actors' food handling and hygiene practices.This study used Photovoice and participant observation to explore meat and milk value chain actors' food handling and hygiene practices in suburban areas of Addis Ababa and neighbouring Oromia in Ethiopia. The results of this study reveal that milk and meat value chain actors' food handling practices are not aligned with the recommended Ethiopian food safety and quality standards. Low compliance with food safety and quality standards reflected a combination of factors such as lack of incentives, poor road infrastructure and low enforcement of food safety standards.Participatory and visual research methods enable a researcher to collect context-aware data that can lead to the development of policies and intervention strategies that reflect local needs and priorities. The results of this study affirm the need to identify socially acceptable and economically viable policies and intervention strategies that are acceptable to all chain actors; and suggest there is an imperative to train milk and meat value chain actors on good hygiene handling practices, improve road infrastructure, and facilitate access equipment such as fridges and freezers that can contribute to maintaining food safety and quality.

Exploring the composition and structure of milk and meat value chains, food safety risks and governance in the Addis Ababa and Oromia regions of Ethiopia

Demand for animal-source foods (ASF) is increasing globally, driven by population growth and changing dietary preferences. In global south countries, low compliance with good agricultural practices (GAPs) and food safety standards in the production of ASF is a major public health concern due to the high prevalence of foodborne diseases. This study examines the composition and structure of milk and meat value chains and explores food safety risks and governance in the Addis Ababa and Oromia regions of Ethiopia. Stakeholder discussions, key informant interviews and participant observation were undertaken to collect data on milk and meat value chain actors' perceptions of opportunities and constraints to improving access to safe, high-quality milk and meat products. The results reveal low compliance with rules and standards by milk and meat value chain actors which could compromise food safety and quality and expose consumers to public health risks. There was stricter enforcement of GAPs and food safety standards in the case of milk and meat products destined for export compared to products sold in the local market. The main barriers to compliance with food safety regulations were actors' low knowledge, small profit margins, absence of critical food safety infrastructure such as electricity and road and low access to capital to invest in the recommended equipment such as aluminum containers, coolers and fridges. This paper concludes there is a need for targeted efforts to support the adoption of low-cost technologies that could mitigate food safety risks. Additionally, there is a need for improved communication and tailored training for value chain actors that reflect local social, cultural and economic context to incentivise compliance with rules governing food safety and quality.

Foodborne disease hazards and burden in Ethiopia: A systematic literature review, 1990–2019

Background

Foodborne disease (FBD) affects millions of people each year, posing a health burden similar to malaria, tuberculosis or HIV. A recent World Bank study estimated the productivity losses alone attributed to unsafe food within Africa at $20 billion in 2016, and the cost of treating these illnesses at an additional $3.5 billion. Ethiopia faces multiple food safety challenges due to lack of infrastructure and basic pre-requisites for food safety such as clean water and environment, washing facilities, compounded by limited implementation of food safety regulations, and a lack of incentives for producers to improve food safety. A consolidation of our understanding and evidence of the source, nature and scale of FBD in Ethiopia is needed to inform policy and future research. We performed a Systematic Literature Review (SLR) of publications on FBD occurrence in Ethiopia including hazard presence and impact.

Method

The SLR followed Cochrane and PRISMA guidelines. We searched PubMed and CAB-Direct for relevant publications between 1990 and 2019 (inclusive). Observational studies and reviews were included. Two reviewers screened titles and abstracts, and retained publications were reviewed in full for quality and data extraction.

Result

In total 128 articles met the inclusion criteria. Most articles focused on the identification of biological hazards in food. High levels of microbial contamination in different food value chains were often found in the small, ad hoc, observational studies that dominated the literature. Raw milk (22/128, 17.0%) and raw beef (21/128, 16.4%) were the most studied food products. Foodborne (FB) parasites were often found at higher rates in food than bacterial and viral pathogens, possibly due to differences in ease of identification. High levels of bacterial contamination on the hands of food handlers were widely reported. There were no reports on the incidence of human FBDs or resulting health and economic impacts.

Conclusion

Our findings reflect existing concerns around food safety in Ethiopia. A lack of substantial, coordinated studies with robust methodologies means fundamental gaps remain in our knowledge of FBD in Ethiopia, particularly regarding FBD burden and impact. Greater investment in food safety is needed, with enhanced and coordinated research and interventions.

Exposure and Health Risk Assessment of Aflatoxin M1 in Raw Milk and Cottage Cheese in Adults in Ethiopia

Aflatoxin M₁ (milk toxin) found in milk is formed from the hepatic biotransformation of AFB₁ (aflatoxin B₁) and poses a risk to human health when consumed. The risk assessment of AFM₁ exposure due to milk consumption is a valuable way to assess health risk. The objective of the present work was to determine an exposure and risk assessment of AFM₁ in raw milk and cheese, and it is the first of its kind in Ethiopia. Determination of AFM₁ was conducted using an enzyme-linked immunosorbent assay (ELISA). The results indicated that AFM₁ was positive in all samples of milk products. The risk assessment was determined using margin of exposure (MOE), estimated daily intake (EDI), hazard index (HI), and cancer risk. The mean EDIs for raw milk and cheese consumers were 0.70 and 0.16 ng/kg bw/day, respectively. Our results showed that almost all mean MOE values were <10,000, which suggests a potential health issue. The mean HI values obtained were 3.50 and 0.79 for raw milk and cheese consumers, respectively, which indicates adverse health effects for large consumers of raw milk. For milk and cheese consumers, the mean cancer risk was 1.29 × 10^-6 and 2.9 × 10^-6 cases/100,000 person/year, respectively, which indicates a low risk for cancer. Therefore, a risk assessment of AFM₁ in children should be investigated further as they consume more milk than adults.

Antimicrobial Resistance of Staphylococci at Animal Human Interface in Smallholders and Dairy Farms in Central Oromia, Ethiopia

Purpose

Staphylococcus species come from a variety of sources and can contaminate milk during milking, cause mastitis and other diseases in animals and humans. The enterotoxins they produce cause food poisoning. Our objectives were to isolate, biochemically characterize, and determine antimicrobial susceptibility profiles of Staphylococcus species from dairy farms in central Oromia, Ethiopia.

Methods

A total of 339 samples (n = 135 [raw milk], n = 135 [udders’ swabs], n = 25 [milkers’ hands swabs], n = 44 [pooled milking utensils’ swabs]) were collected from smallholders and dairy farms. Bacteriological culture and biochemical tests were performed to isolate and identify Staphylococcus species, and the Kirby Bauer disk diffusion method was used for antimicrobial susceptibility testing.

Results

Across all sample types and dairy farms, 247 (72.9%) Staphylococcus isolates were obtained which comprised of 101 (74.8%) isolates from raw milk, 98 (72.6%) from udder swabs, 30 (68.2%) from pooled utensil swabs, and 18 (72%) from milkers’ hand swabs. Fifty coagulase-positive Staphylococcus isolates (20 S. aureus, 20 S. hyicus and 10 S. intermedius) subjected to antimicrobial susceptibility tests have shown various degrees of resistance. All S. aureus isolates were 100% resistant to ampicillin and penicillin. Out of 20 S. hyicus isolates, 90% were resistant to ampicillin and 85% to penicillin. S. intermedius isolates (n=10) were 70% resistant to nalidixic acid and penicillin whilst remaining 100% resistant to ampicillin. Five S. aureus, three S. intermedius and two S. hyicus isolates from raw milk, milk utensil swabs and milkers’ hand swabs were multidrug-resistant (resistance to at least three classes of antimicrobials).

Conclusion

This study revealed a high prevalence of staphylococci in the dairy cattle, milkers and milking utensils with multidrug-resistant coagulase-positive Staphylococcus species suggesting the significance of pasteurization. Further research is encouraged on the factors leading to antibiotic resistance in Staphylococcus species.

Food safety-related perspectives and practices of consumers and vendors in Ethiopia: A scoping review

Despite being one of the first African countries to prioritize food safety, foodborne diseases are of acute concern in Ethiopia. This review aims to understand food safety-related perspectives and practices among consumers and food vendors in Ethiopia to identify motivations, beliefs, and values that shape and/or drive their practices. A well-defined search and review identified 116 relevant articles. These spanned eight of the ten regional states and two chartered cities, with most work focusing on urban areas and on a sample within one state or chartered city. Ninety-four studies focused on vendors or food handlers; fifteen articles examined both consumers and vendors, but only four assessed interactions between the groups. Meat, dairy products, and ready-to-eat (street) foods were the most studied food groups. Food service establishments were the most examined outlets. Forty-six studies examined generic food safety issues or concerns. Overall, 102 studies assessed food safety practices; 53 studies examined knowledge, and 19 studies assessed attitudes. A gap in vendors' observed practices versus knowledge and attitudes was noted. Consumer deductions of food safety were based on vendor practices. Both groups used physical attributes based on senses to assess quality and safety of animal-source foods, had their own 'coping' strategies to address food safety-related concerns, and had similar views on consumer choice motives. Analysis of food and the food handling environment revealed a high level of contamination. An additional study, included after the original search, identified training to be effective in influencing knowledge, attitudes, and practices - though results for attitudes and practices were not sustained in the long term. Future research should address consumers and consumer-vendor interactions and include the full triad of knowledge-attitudes-practices. It is also recommended to focus on nutrient-rich foods as well as on traditional markets and local eateries. Improving the quality of research will be critical to improve food safety in Ethiopia.

Vendor Knowledge, Attitudes, and Practices Related to Food Safety in Low- and Middle-Income Countries: A Scoping Review

ABSTRACT

Foodborne diseases are a significant cause of illness in low- and middle-income countries (LMICs). Poor infrastructure, lack of regulatory oversight, and environmental conditions can increase food safety risks, particularly in traditional markets. Food vendors in traditional markets shoulder a heavy responsibility to keep food safe under often challenging conditions. The ability of these vendors to ensure food is safe is shaped by their knowledge, attitudes, and practices (KAP). Hence, understanding vendor KAP is important when designing interventions to improve food safety. To date most research on food vendors in LMICs has focused on vendors of ready-to-eat street foods and not on vendors of fresh food commodities. To fill this gap, a scoping review was undertaken to compile existing research on food safety KAP of vendors of food commodities in LMICs. PubMed, Google Scholar, Ovid Medline, and institutional Web sites of major research organizations were searched for original research articles and reports. Of 17,483 titles screened, 84 relevant studies were identified. Of the studies included, most were conducted after 2014 and focused on urban and periurban Africa. Most studies had a cross-sectional design with mixed methods (e.g., quantitative and qualitative analyses of vendor KAP through interviews and observations) and had small sample sizes (<50 participants). Common food value chains studied were dairy, meat, and fruits and vegetables. Very few studies included more than one type of commodity or value chain. Food vendor knowledge typically ranged from little to none, which was evident from observations of vendors operating under unsafe and unhygienic conditions, such as poor food handling and storage practices. Poor compliance with existing food safety policies, laws, and regulations was evident in some cases primarily due to either limited awareness of their existence or limited knowledge of how to implement them. However, vendors generally had positive attitudes toward food safety. No significant gaps were found between food safety knowledge and actual practices, although this correlation was not always examined rigorously in the reviewed studies. KAP and gaps between food safety behavior did not differ with vendor age or gender, type of product sold, or geography. Local government staff were identified as key enabling actors, interacting with food market vendors to foster improved food safety practices.

HIGHLIGHTS

Detection of mecA gene and methicillin-resistant Staphylococcus aureus (MRSA) isolated from milk and risk factors from farms in Probolinggo, Indonesia

Background: Staphylococcus aureus is commonly found in dairy cows and is a source of contamination in milk. S. aureus that are resistant to beta-lactam antibiotics (especially cefoxitin) are referred to as methicillin-resistant Staphylococcus aureus (MRSA).  The spread of MRSA cannot be separated from sanitation management during milking; it can originate from milk collected from the udder or from the hands of farmers during the milking process. The purpose of this study was to examine the level of MRSA contamination in dairy cow's milk and farmer's hand. Methods: A total of 109 samples of dairy cow's milk and 41 samples of farmer's hand swabs were collected at a dairy farm in Probolinggo, East Java, Indonesia. Samples were cultured and purified using mannitol salt agar (MSA). The profile of S. aureus resistance was established by disk diffusion test using a disk of beta-lactam antibiotics, namely oxacillin and cefoxitin. Results: The S. aureus isolates that were resistant to oxacillin and cefoxitin antibiotics were then tested for oxacillin resistance screening agar base (ORSAB) as a confirmation test for MRSA identity. S. aureus isolates suspected to be MRSA were then tested genotypically by polymerase chain reaction (PCR) method to detect the presence of the mecA gene. The results of the isolation and identification found 80 isolates (53.33%) of S. aureus. The results of the resistance test found that 42 isolates (15%) of S. aureus were resistant to oxacillin and 10 isolates (12.5%) were resistant to cefoxitin. The ORSAB test found as many as 20 isolates (47.62%) were positive for MRSA. In PCR testing to detect the presence of the mecA gene, three isolates (30%) were positive for the mecA gene. Conclusions: This study shows that several S. aureus isolates were MRSA and had the gene encoding mecA in dairy farms.

Detection of mecA gene and methicillin-resistant Staphylococcus aureus (MRSA) isolated from milk and risk factors from farms in Probolinggo, Indonesia

Background: Staphylococcus aureus is commonly found in dairy cows and is a source of contamination in milk. S. aureus that are resistant to beta-lactam antibiotics (especially cefoxitin) are referred to as methicillin-resistant Staphylococcus aureus (MRSA). The spread of MRSA cannot be separated from sanitation management during milking; it can originate from milk collected from the udder or from the hands of farmers during the milking process. The purpose of this study was to examine the level of MRSA contamination in dairy cow's milk and farmer's hand. Methods: A total of 109 samples of dairy cow's milk and 41 samples of farmer's hand swabs were collected at a dairy farm in Probolinggo, East Java, Indonesia. Samples were cultured and purified using mannitol salt agar (MSA). The profile of S. aureus resistance was established by disk diffusion test using a disk of beta-lactam antibiotics, namely oxacillin and cefoxitin. Results: The S. aureus isolates that were resistant to oxacillin and cefoxitin antibiotics were then tested for oxacillin resistance screening agar base (ORSAB) as a confirmation test for MRSA identity. S. aureus isolates suspected to be MRSA were then tested genotypically by polymerase chain reaction (PCR) method to detect the presence of the mecA gene. The results of the isolation and identification found 80 isolates (53.33%) of S. aureus. The results of the resistance test found that 42 isolates (15%) of S. aureus were resistant to oxacillin and 10 isolates (12.5%) were resistant to cefoxitin. The ORSAB test found as many as 20 isolates (47.62%) were positive for MRSA. In PCR testing to detect the presence of the mecA gene, three isolates (30%) were positive for the mecA gene. Conclusions: This study shows that several S. aureus isolates were MRSA and had the gene encoding mecA in dairy farms.

Detection of mecA gene and methicillin-resistant Staphylococcus aureus (MRSA) isolated from milk and risk factors from farms in Probolinggo, Indonesia

Background: Staphylococcus aureus is commonly found in dairy cows and is a source of contamination in milk. S. aureus that are resistant to beta-lactam antibiotics are referred to as methicillin-resistant Staphylococcus aureus (MRSA). The spread of MRSA cannot be separated from sanitation management during milking; it can originate from milk collected from the udder or from the hands of farmers during the milking process. The purpose of this study was to examine the level of MRSA contamination in dairy cow's milk and farmer's hand swabs. Methods: A total of 109 samples of dairy cow's milk and 41 samples of farmers' hand swabs were collected at a dairy farm in Probolinggo, East Java, Indonesia. Samples were cultured and purified using mannitol salt agar (MSA). The profile of S. aureus resistance was established by disk diffusion test using a disk of beta-lactam antibiotics, namely oxacillin and cefoxitin. Results: The S. aureus isolates that were resistant to oxacillin and cefoxitin antibiotics were then tested for oxacillin resistance screening agar base (ORSAB) as a confirmation test for MRSA identity. S. aureus isolates suspected to be MRSA were then tested genotypically by polymerase chain reaction (PCR) method to detect the presence of the mecA gene. The results of the isolation and identification found 80 isolates (53.33%) of S. aureus. The results of the resistance test found that 42 isolates (15%) of S. aureus were resistant to oxacillin and 10 isolates (12.5%) were resistant to cefoxitin. The ORSAB test found as many as 20 isolates (47.62%) were positive for MRSA. In PCR testing to detect the presence of the mecA gene, three isolates (30%) were positive for the mecA gene. Conclusions: This study shows that several S. aureus isolates were MRSA and had the gene encoding mecA in dairy farms.

Brucellosis in Ethiopia: A comprehensive review of literature from the year 2000-2020 and the way forward

Brucellosis is a zoonotic disease of considerable economic and public health significance globally. Despite the limited bacteriological evidence, a large number of serological works revealed that it is prevalent both in livestock and humans in Ethiopia. The current comprehensive review was carried out to provide apparent pooled seroprevalence (APS) estimates at individual animal and herd levels in livestock, and identify factors causing variability between studies conducted over the last two decades, show the spatial distribution, as well as summarizes Brucella species reported from livestock. It also provides APS of brucellosis in humans and evaluates the public health awareness of zoonotic brucellosis. In this review, systematic and synthetic review approaches were followed to summarize the available information. For the systematic review and meta-analysis, articles were selected based on predefined criteria. Data extracted from these articles were analyzed using meta-analytical approaches to provide APS estimates and in-between study variations for humans and all livestock species considered. Sensitivity analyses and bias assessments were conducted using influence plot analysis and, Egger's and Begg's statistics along with funnel plots, respectively. Synthetic review approaches were used to summarize data on isolates and public health awareness. Pooled seroprevalence estimate of brucellosis at national level was 2.6% (95% CI, 2.2-3.0) in cattle, 4% (95% CI, 3.1-5.1) in goats, 3% (95% CI, 2.3-3.9) in sheep and 3% (95% CI, 2.4-3.7) in camels. At a herd level, 16.3% (95% CI, 12.9, 20.5) of cattle, 12.1% (7.1, 19.9) of goat, 13.3% (7.6, 22.1) of sheep and 19.7% (13.8, 27.4) of camel herds in the country had at least one seropositive animal. Cattle in the pastoral/agropastoral production systems had significantly higher (p < 0.05) APS compared to mixed crop-livestock and urban/peri-urban dairy production systems. Pooled seroprevalence of brucellosis in small ruminants (8.3%, 95% CI, 6.3, 10.8) and camels (4.4%, 95% CI, 3.5, 5.6) in Afar were significantly higher (p<0.05) than in other regions. Reports conducted using ELISA and serial Rose Bengal plate test (RBPT)-ELISA had higher (p<0.05) APS estimates than serial RBPT and complement fixation test. Brucella melitensis and B. abortus were reported from goats and cattle, respectively, from three available reports. The APS of brucellosis in humans was 5% (95% CI: 3.3, 7.3). Public awareness of brucellosis was low (18.4%), while, practices that expose humans to Brucella infection were high. Scenario-based control interventions on regions and production systems using one health approach are suggested. This article is protected by copyright. All rights reserved.

Knowledge, Attitudes, and Practices towards Food Poisoning among Parents in Aseer Region, Southwestern Saudi Arabia

Background: Food poisoning is caused by eating contaminated food. Improper food safety knowledge, poor food handling, and inadequate personal hygiene may allow microbes to grow in sufficient numbers to cause a food-borne illness. The aim of this paper was to assess the knowledge, attitudes, and practices regarding food poisoning and its determinants of parents in the Aseer region of Saudi Arabia. Methodology: This is a descriptive cross-sectional study conducted on 3011 parents in the Aseer region in the southwest region of Saudi Arabia. An online questionnaire was used to collect the data. The level of knowledge of the participants was scored as a percentage and further classified as “good” or “poor”. Attitudes were classified as “positive”, “neutral”, or “negative” based on a calculated composite mean score. The participants were asked about standard food hygiene practices, and the practices were recorded based on how often they were performed, with the results recorded as “usually”, “sometimes”, or “never”. Results: The age range of the parents was between 18 and 65 years old, with a mean age of 28.9 ± 10.4 years. Among the participants, 96.2% were Saudi, and 81.8% were female. Almost 53% of the fathers and 41% of the mothers were university graduates. About 55% of the mothers were housewives. Almost equal proportions of the parents had “good” and “poor” levels of knowledge on food poisoning. Around 41% of the parents had positive attitudes towards safe food consumption. Older parents (defined as above 30 years of age), males, university graduates, and urban residents had significantly higher levels of knowledge regarding food poisoning. Conclusions: This study provided much needed information on the knowledge, attitudes, and practices related to food poisoning among parents in the Aseer region of Saudi Arabia. Although most respondents reported satisfactory practices, gaps were identified in knowledge and attitudes. This suggests a need for further investigation focused on the observed practices and strengthening health education activities for the community.

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.

Understanding the dairy production systems in rural settlements in the Brazilian semi-arid region: characterization, typology, and holistic perception

The objective of this study was to characterize and typify dairy farms and to evaluate society's perception of dairy production in rural settlements in the Brazilian semi-arid region. A questionnaire containing questions related to socioeconomic, livestock, physical, herd management, and production indicators was applied to 17 milk farmers for typological analysis. A second questionnaire was subsequently applied to the same 17 farmers for the holistic perception of dairy farming in rural settlements, in addition to 47 technicians in the area of animal science and 140 laypeople. Milk samples were collected in the settlement's community cooling tank, while the water used for milking management was collected in the milking parlor at the 17 farms. Multivariate analysis techniques and thematic analysis were performed. Three dairy production systems were identified: low production group (0-25 L), medium production group (25-50 L), and high production group (50-100 L). The physicochemical properties (composition, density, and cryoscopy) of milk attended the Brazilian regulation values. The microbiological parameters of milk and water used for milking are at odds with regulations. Regarding the typology, the indicators, livestock, and productivity showed discriminatory power (P < 0.05) between the productive systems. The responses from the segments of society showed different views on dairy production in rural settlements. It is concluded that the dairy farmers have low education and the cleaning product and water used in milking are out of regulation. The livestock and production indicators typified mainly dairy farms, while the holistic perception showed a lack of efficiency in rural extension, ignorance of the potential of the productive system. Finally, the creation of public policies focusing on the development of the milk production system in settlements is recommended.

Knowledge, attitude, and practices to zoonotic disease risks from livestock birth products among smallholder communities in Ethiopia

Many causes of abortion in livestock are due to zoonotic pathogens that pose serious infection risks for humans. Carefully designed, empirical One Health research allows to untangle the complexity around these risks and guides the development of practical health education guidelines and best prevention practices for veterinary public health interventions. To support this, the study presented here aimed at understanding knowledge, attitudes, and practices (KAP) on zoonotic risks from livestock birth products among rural communities in Ethiopia. From July 2018 to February 2019, a cross-sectional study design was conducted with 327 randomly selected farmers and pastoralists in five districts in three regions in Ethiopia. The structured questionnaire consisted of 48 items to evaluate knowledge (24), attitude (9), and prevention practices (15) related to zoonotic diseases risks from livestock birth products. A unidimensional two-parameter logistic (2-PL) Item Response Theory (IRT) model was used for zoonotic disease risk KAP scale construction and evaluation. The 2-PL IRT model was fitted to determine the probability of a person to appropriately respond to an item with a provided zoonotic disease KAP level. We then examined differential item functioning (DIF) concerning to five important covariates. The attitude subscale had the highest total mean score (37.3, ± 28.92%) and the knowledge subscale had the lowest mean score (22.4, ± 33.6%) among the three subscales. The mixed model regression analysis indicated that region was the only apparent factor explaining differences in zoonotic diseases knowledge, attitude, and practice total mean scores. The knowledge and attitude subscales had good internal consistency with a Cronbach's α at 0.83 and 0.81, respectively, whereas the practice subscale had lower internal consistency with 0.51. There was a positive association between responding to knowledge questions correctly and a positive attitude (r2 = 0.44, p < 0.0001) and self-reported good practice (r2 = 0.307, p < 0.0001). The differential item functioning test showed that 19 of 37 (51.35%) and 12 of 37 (32.43%) items of the retained KAPs survey items had non-uniform and uniform DIF linked to at least one covariate respectively and all the covariates were related with DIF in at least one item. This study found substantial knowledge gaps, a low level of the desired attitude, and high-risk behavioural practices regarding zoonotic disease from livestock birth products. Consequently, livestock keepers are likely exposed to pathogens and thus these practices are an important contributing factor for zoonotic disease infection in people.

Brucellosis risk factors and milk hygiene handling practices in pastoral communities in Isiolo county, Kenya

The study was conducted from June to August 2014 in Isiolo Central division of Isiolo Sub‐County and Sericho division of Garbatulla Sub‐County and comprised two components: (i) a cross‐sectional study on the milk‐handling hygiene practices, where milk traders’ households were the study units and (ii) a case‐control study on the risk factors for Brucella spp. infection in humans. Results of the cross‐sectional study showed that 26.74% of the respondents never washed their hands before milking, 60.47% never washed the udder before milking and 54.65% never withhold consumption of milk from animals under treatment with antibiotics. The case–control study included household units with previous cases of brucellosis (53.33%) and those without (46.67%) over the previous 5 years and identified drinking of raw milk as the main risk factor for infection (OR = 26.44; 95% CI: 8.04–86.99). Pastoralists’ unhygienic handling of milk from production to market is suboptimal and this is due to poor knowledge on hygienic practices, poor knowledge on the risks associated with poor milk hygiene and lack of sufficient and potable water for cleaning of milk containers. Many pastoralists still consume milk raw and this is a major public health risk for milk‐borne diseases.

Estimation of Brucella and Mycobacterium bovis contamination in bovine milk in Africa

Background and Aim: Bovine brucellosis and tuberculosis are zoonotic bacterial diseases transmitted through the consumption of raw milk and dairy products. Many developed countries have eliminated bovine brucellosis and tuberculosis in their cattle herds, however, the diseases are still endemic in Africa. Despite the public health risk of these pathogens, the sale and consumption of unpasteurized milk are still common in some African countries. This study aimed to estimate the prevalence of Brucella and Mycobacterium bovis in bovine milk. Materials and Methods: A conceptual model for milk contamination was constructed and 1 million simulations were performed using data from published articles. Results: Brucella milk contamination was estimated at a median of 8.68% (interquartile range [IQR]: 5.95-11.97%; range: 2.41-25.16%). The median prevalence of M. bovis was estimated at 6.86% (IQR: 4.25-9.40%; range: 0.01-15.16%). Conclusion: These results indicate that there is a risk of Brucella and M. bovis transmission through the consumption of unpasteurized milk. The findings of this study highlight the need to improve the safety and quality of informally marketed milk in the region.

Isolation and Characterization of Gram-Negative Bacterial Species from Pasteurized Dairy Products: Potential Risk to Consumer Health

Pathogenic bacterial contaminants of dairy products cause economic and human life losses if not destroyed by pasteurization. Gram-negative bacteria are among such major contaminants. Contamination persists because of faulty pasteurization or occurs during postpasteurization processing. Many factors, including presence of asymptomatic healthy carriers, existence of broad-range host pathogens, and resistance of pathogens to ordinary disinfectants, hamper the control of such pathogens. Here, samples of pasteurized dairy products were subjected to enrichment/selective cultures to test for possible Salmonella contamination, followed by growth on/in various media to test for phenotypic properties and some virulence characteristics of isolates (catalase, urease, oxidase, gelatinase, etc.). Isolates were characterized by phenotypic and genotypic tests for identification and resistance to clinically relevant antibiotics, including disk diffusion and for β-lactamase production. All milk samples harbored Gram-negative bacilli, which constitute a public health hazard. All of the isolates exhibited intermediate-level or higher resistance to ≥2 clinically relevant antibiotics, while some were susceptible. None tested positive for phenotypic gelatin hydrolysis but exhibited alpha- or beta-hemolysis. Sequence alignments of 16S rRNA gene partial sequences suggested up to 99% sequence similarities to subspecies of Salmonella enterica. Most isolates were also β-lactamase producers, especially blaTEM. In conclusion, high contamination rates were found in all Ethiopian pasteurized milk samples. The reasons for this burden of contamination need to be elucidated for meaningful and targeted control. Larger studies are needed, specifically to reveal points of entry of potential pathogens into dairy products. Information from this work will help to address and control previously unrecognized health hazards associated with consumption of pasteurized dairy products.

MILK Symposium review: Community-tailored training to improve the knowledge, attitudes, and practices of women regarding hygienic milk production and handling in Borana pastoral area of southern Ethiopia

Milk and milk products are essential in the diets of the Borana pastoral community in Ethiopia. Traditional handling and processing of dairy products using basic equipment and infrastructure coupled with a preference for raw milk consumption pose potential health risks to consumers. We tested the effect of an intervention designed to improve the hygienic handling and safe consumption of milk on the knowledge, attitudes, and practices (KAP) of women who produce and sell dairy products. The intervention consisted of 16 h of training on good milk production practices and prevention of milk-borne diseases. A total of 120 women were trained and their KAP assessed at baseline (pretraining), immediately after training, and 6 mo after training. Overall, training increased the knowledge score of the participants from 75.6 to 91.4% in the immediate post-training assessment, and to 90.0% at 6 mo post-training. Compared with pretraining (58.8%), we found a statistically significant difference in the overall attitude score at the immediate post-training evaluation (64.7%) but not 6 mo after (61.4%). We observed a similar increase in the understanding of correct practices from 49.5% at pretraining to 64.7% 6 mo following the training. For some desirable attitudes and practices, the proportion of women reporting adoption at pretraining was low and the change derived from training still left one-third of respondents displaying a negative attitude and a quarter of them reporting wrong practices. We recommend that future training interventions be complemented with locally adaptable technologies, provision of incentives, and creation of an enabling environment including improved access to clean water and sanitation facilities to affect not only knowledge, but also attitudes and ultimately practices in the long term.

Review of the prevalence of foodborne pathogens in milk and dairy products in Ethiopia

Food safety is a significant barrier to social and economic development throughout the world, particularly in developing countries. Here, we reviewed the prevalence of major bacterial foodborne pathogens (Salmonella spp., Listeria monocytogenes, Escherichia coli O157:H7 and Campylobacter spp.) in the rapidly growing Ethiopian dairy supply-chain. We identified 15, 9, 5 and 0 studies that had reported the prevalence of Salmonella spp., L. monocytogenes, E. coli O157:H7, and Campylobacter spp. in dairy foods, respectively. The studies reviewed reported a median prevalence of Salmonella, L. monocytogenes, and E. coli O157:H7 of 6, 9 and 10%, respectively, in raw cow milk in Ethiopia, indicating a concerning occurrence of bacterial foodborne pathogens in raw milk. Implementation of good hygiene and production practices and assessment of interventions targeting the reduction of contamination in the dairy supply chain is needed to inform coordinated efforts focused on improvement of dairy food safety in Ethiopia.

Review on Epidemiology and Public Health Importance of Goat Tuberculosis in Ethiopia

Small ruminant is an important and integral part of livestock in Ethiopia. Especially, goats are attractive to people of Ethiopia because of the ability to resist challenges, easily adapt to different ecological regions, and need small land to rearing and small initial capital in which poor people can engaged in the production system. In spite of the presence of large number of goat population in Ethiopia, it fails to utilize expected productivity due to many factors. Among the factors, which limit the economic returns of goats, diseases stand frontline. Tuberculosis is one the diseases that affect goats' health and production in Ethiopia. Goat tuberculosis is a chronic disease, which is characterized by the development of granulomas, essentially in the respiratory tract and related lymph nodes, from which the mycobacteria are discharged and contaminate other susceptible animals. Goat tuberculosis has a public health implication in Ethiopia because of the farmers' habit of consuming raw goat milk and its products, and they do have consistent or day-to-day contact with their goats. The etiological agents also transmitted to humans through the aerogenous route from those animals with active cases in the herd. The infection has been reported from several parts of different areas of the country dependent on the abattoir inspections. Therefore, attention should be given towards the control of tuberculosis in livestock; public health education on zoonotic importance of the disease or awareness creation and the national tuberculosis control needs to consider the one health approach, and further epidemiological studies should be undertaken.

Pastoral community practices, microbial quality and associated health risks of raw milk in the milk value chain of Nakasongola District, Uganda

The informal milk value chain in Uganda controls most of the raw marketed milk, albeit of poor quality. A study was conducted to assess the milk handling practices, the bacterial quality and the associated health concerns of raw milk along the informal milk value in Nakasongola District. The cross-sectional study used both qualitative and quantitative methods to obtain information from key players. The qualitative data was categorized and presented into emerging themes. Bacterial contamination of 200 milk samples was determined by morphological and biochemical tests. The antibiotic susceptibility test was done by the disc diffusion method.

Hand milking was carried out mainly by men (92.5%), and most never or rarely practised hand washing (67.5%) during milking. Milk was mainly delivered to mobile milk-collecting centres located under tree shades (50%). The quality of raw milk was affected by poor hygienic, handling and transportation practices. Most participants (75%) were aware of the dangers of drinking raw milk and the requirements to transport milk in metallic cans. Viable bacterial counts above the recommended limit were recorded in 76 samples (38%) that included Staphylococcus aureus (46%), coagulase-negative Staphylococcus (29%), Escherichia coli (12%), Streptococcus agalactiae (8%) and Salmonella spp. (5%). The overall antibiotic resistance was 45% (34/76), which included resistant isolates of S. aureus (17/34), coagulase-negative Staphylococcus (11/22), S. agalactiae (3/6), Salmonella spp. (2/4) and E. coli (2/9).

The raw milk contaminated with antibiotic drug-resistant bacterial pathogens is of public health concern. Thus, measures to improve the quality of milk need to be designed for the pastoral community in Nakasongola district.

Human campylobacteriosis: A public health concern of global importance

Campylobacter species are among the leading cause of bacterial foodborne and waterborne infections. In addition, Campylobacter is one of the major causative agent of bacterial gastrointestinal infections and the rise in the incidence of Campylobacter infections have been reported worldwide. Also, the emergence of some Campylobacter species as one of the main causative agent of diarrhea and the propensity of these bacteria species to resist the actions of antimicrobial agents; position them as a serious threat to the public health. This paper reviews Campylobacter pathogenicity, infections, isolation and diagnosis, their reservoirs, transmission pathways, epidemiology of Campylobacter outbreaks, prevention and treatment option, antibiotics resistance and control of antibiotics use.

Bacteriological quality and safety of ready-to-consume milk and naturally fermented milk in Borana pastoral area, southern Ethiopia

Milk and milk products play an important role in the diet of pastoralists in Ethiopia. However, only few studies have been conducted on the microbial contamination of milk and milk products in pastoral areas. Therefore, the objective of the present study was to assess the hygiene and safety of ready-to-consume milk and traditionally produced fermented milk products (yogurt) in Borana. A total of 203 raw milk and milk product samples collected from different points along the milk production and handling chains were tested for Escherichia coli, E. coli O157:H7, and Staphylococcus aureus. E. coli was detected in 51.7% of the analyzed samples with a mean count of 2.5 logCFU/ml. The study revealed that 10.8% and 2.5% of the milk and dairy product samples harbor S. aureus and E. coli O157:H7, respectively. Detection of E. coli O157:H7 in ready-to-consume milk has potential health implications for consumers in an area where raw milk consumption is common. To our knowledge, this is the first report of the isolation of E. coli O157:H7 from milk in pastoral systems in Ethiopia.