Food, being a source of all the necessary nutrients for human sustenance, serves as the single greatest vehicle for foodborne infections. In the quest to fulfil the bodily requirements for nutrients, consumers find themselves grappling with many challenges to avoid intoxicating themselves in the process. Hygienic handling therefore remains the biggest key in ensuring that the source of nourishment does not serve as a death trap for the eager consumer.
In Africa, foodborne illnesses remain one of the biggest scares to human health and wellbeing. Given the level of poverty that is prevailing across the continent, the vulnerable groups such as children and the elderly as especially disadvantaged (CDC, 2018).
People with compromised immunity (HIV patients) find themselves in precarious situation, with their immunity unable to defend them against any minor attack. This increases the morbidity rates across the continent as a result of diarrhoeal diseases.
World Health Organization estimates that there are approximately 700,000 deaths in Sub Sahara Africa every year due to foodborne diseases. The proportion of children under five who succumb diarrhoeal foodborne illnesses is pegged at 15% by the same findings (WHO, 2008).
Understanding Foodborne Illnesses
Food borne illnesses are described by the world health organization as diseases of infectious or toxic nature caused by consumption of contaminated foods or water. Some chemicals that causes food borne illnesses are natural components of food, while other may be accidentally added during production and processing, either through carelessness or pollution.
The main causes of food borne illnesses are bacteria (66%), chemicals (26%), virus (4%) and parasites (4%) (Hoffmann, et al., 2017). Food borne illnesses comprise the various acute syndromes that result from ingestion of contaminated foods. They are classified as:
- Food Intoxications caused by ingestion of foods containing either poisonous chemicals or toxins produced by microorganisms.
- Toxin mediated infections caused by bacteria that produce enterotoxins (toxins that affect water, glucose, and electrolyte transfer) during their colonization and growth in the intestinal tract.
- Food Infections caused when microorganisms invade and multiply in the intestinal mucosa or other tissues.
Manifestations of food illness
Manifestations range from slight discomfort to acute illness to severe reactions that may lead to death or chronic symptoms, depending on the nature of causative agent, the number of pathogenic microorganisms or concentration of poisonous substances ingested, and the host susceptibility and reaction.
Some microorganisms can use our food as a source of nutrients for their growth. By growing on the food, metabolizing them and producing by-products, they not only render the food inedible but also pose health problems upon consumption (Ibid).
Many of our foods will support the growth of pathogenic microorganisms or at least serve as vector for their transmission. Food can get contaminated from plant surfaces, animals, water, sewage, air, soil or from food handlers during handling and processing.
Typical symptoms of food borne illnesses include diarrhoea, vomiting, abdominal cramps, headaches, nausea, dry mouth, and difficulty swallowing and fluke-like symptoms (such as Fever, chills, backache).
Incidences of Foodborne Illnesses
Despite repeated efforts to improve hygiene across many parts of Sub Sahara Africa, there are still several incidences of foodborne illnesses. Cases of cholera, aflatoxicosis, shigellosis, and konzo (paralysis due to consumption of cyanide in cassava) have been regularly observed.
Cases of contaminated foods are reported on a regular basis and multi drug resistant strains of pathogenic bacteria have been reported and attributed to careless misuse of drugs in animal husbandry.
Ease of access due to rapidly increasing infrastructural developments across the continent has accelerated the transmission of foodborne and zoonotic illnesses. Lax enforcement of policies has been a big promoter of the increasing spread.
New challenges arise in places they never existed before as a result of globalization (Jay, 2000). The residents are found unprepared for the challenge and containment measures are either lacking or non-existent.
Effects of rural-urban migration on foodborne illness occurrence
The shifting population dynamics and rural-urban migration in most parts of the continent has popularized ready to eat foods. They target the low to mid income earners who have little time to prepare their own meals or cannot afford to eat from a decent food outlet.
These foods are mostly prepared under wanting hygienic conditions, which exposes the consumers to dangerous sources of food poisoning agents. In other instances, the food availability depends on the region from which such food is produced.
The process of handling and transformation of the food is a critical control point at which a pathogenic microorganism can gain entry into the food and wreak havoc to the public who eventually gets to consume the food (van-de-Venter, 2000).
This paper looks at the cases of foodborne illnesses in the Sub Sahara African region. It discusses the disease burden, major agents of disease, their aetiology, the risk factors and possible containment measures.
Foodborne Illness Outbreak Incidents in sub-Sahara Africa
One of the biggest challenges in addressing food safety issues in Africa is the inadequacy of conclusive surveillance and epidemiological data. Most outbreaks that occur in this region are not properly documented to give researchers a clear picture of the situation on the ground.
This leaves researchers with the option of relying on the available limited data, usually on infant morbidity. Even though insufficient, this serves as the baseline for many studies across the region.
In South Africa, there was an outbreak of bloody diarrhoea caused by Escherichia coli 0157. It was a serious case with up to 42% infection rate after the residents of the 157 townships consumed beef and untreated water. Strains of E, coli O157 were isolated by gel electrophoresis from the faecal matter as well as from the suspected sources. The high infection rate was attributed to heavy rains after a prolonged period of drought (Cowman, et al., 2017).
Outbreaks in Refugee Camps and Other Parts of Kenya
The first cholera outbreak reported in 2017 was in Tana River County. The outbreak started on 10 October 2016 and was controlled by April 2017. A second wave of cholera outbreaks started in Garissa County on 2 April 2017 and was reported later in nine other counties including Nairobi, Murang’a, Vihiga, Mombasa, Turkana, Kericho, Nakuru, Kiambu, and Narok.
In Garissa County, the outbreak is affecting mainly Dadaab refugee camps and cases and deaths are being reported from Hagadera, Dagahaleh, and IFO2 camps. In Turkana County, the disease is also affecting Kakuma and Kalobeyei refugee camps (Cowman, et al., 2017).
In addition to the outbreak reported in the general population, there have been two-point source cholera outbreaks in Nairobi County. One occurred among participants attending a conference in a Nairobi hotel on 22 June 2017. A total of 146 patients associated with this outbreak have been treated in different hospitals in Nairobi. A second outbreak occurred at the China Trade Fair held at the KICC Tsavo Ball between 10 and 12 July 2017. A total of 136 cases were reported and one death (Ibid).
Currently, the outbreak is active in two counties, namely Garissa and Nairobi. As of 17 July 2017, a total of 1216 suspected cases including 14 deaths (case fatality rate: 1.2%) have been reported since 1 January 2017. In the week ending 16 July 2017, a total of 38 cases with no deaths were reported ( Ibid; CDC, 2018).
A total of 124 cases tested positive for Vibrio cholerae in the reference laboratory. In the week ending 25 June 2017, 18 samples out of 25 tested positive for Vibrio cholerae Ogawa by culture at the National Public Health Laboratory in Nairobi (CDC, 2018).
The main causative factors of the current outbreak include the high population density that is conducive to the propagation and spread of the disease, mass gatherings (a wedding party held in Karen and in a hotel during an international conference), low access to safe water and proper sanitation and the massive population movements in country and with neighbouring countries (WHO, 2017).
Historical Outbreaks and Outbreak Agents of Interest
Between 1970 and 1993, 42 Kenyan districts were examined for food borne illnesses. Foodborne disease outbreak episodes due to
Staphylococcus aureus, Clostridium perfringens, Clostridium botulinum, Bacillus cereus, Escherichia coli, Campylobacter jejuni, Yersinia enterocolitica, Listera monocytogenes, chemicals, aflatoxin, plant and animal poisons were of special interest during this study. Outcome parameters were the number of victims and aetiological causes of foodborne disease outbreaks reported in the study period showed.
Thirty-seven food poisoning outbreaks were reported to the Ministry of Health from various parts of the country in the study period 1970 to 1993, and only 13 of these involving a total of 926 people were confirmed to be due to particular aetiological agents.
Foods that were involved included milk and milk products, meat and meat products, maize flour, bread, scones and other wheat products, vegetables and lemon pie pudding. A high number of food poisoning cases were treated as outpatients in various health facilities.
Incidents of Aflatoxin Poisoning
An aflatoxicosis outbreak in Oloitokitok District of Kajiado County, happened. A total of twenty-seven suspected aflatoxicosis case patients were reported, ten of whom died, for a case fatality rate of 40%. Findings from this investigation indicated a high case-fatality rate similar to that observed in in the most extreme aflatoxicosis outbreak in Eastern Kenya in 2014.
Cases were also reported in Lenkisem Division; however, they were suggestive of a point source exposure as the affected cases reported having consumed maize which had been rained on during transportation from the market.
Economic Burden of Foodborne Illness
Foodborne pathogens in any given food supply chain affects the health of the consumers of that particular food, whether local or abroad. The burden of the disease on health and economy is great due to the lost man hours and investment in health systems to manage the conditions and treat the sick.
The families of the victims are affected directly due to the lost opportunity to make an income and they are forced to use their little resources to treat the sick, further deteriorating their quality of life.
The compounded cost of illness arising Campylobacter jejuni, Clostridium perfringens, E coli 0157:H7, Listeria monocytogenes, Salmonella, Staphylococcus aureus and Toxoplasma gondii is estimated to range between US$ 6 – 35 million annually with 3.3 – 12.3 million cases and up to 39,00 deaths annually (CDC, 2011). The figure has since gone up and the global economic growth cannot keep up with the escalation.
Victim countries also lose out on trade opportunities as the importing countries put trade embargoes on them. They cancel food imports due to food safety concerns, which further robs these countries of development opportunities.
Fish imports from Tanzania into the UK was cancelled, beef from Kenya is no longer accepted into Europe. Aflatoxin contaminated maize have been intercepted in Kenya, Nigeria and other countries within the Sub-Sahara Africa (Yard, et al., 2013).
Implementing the Food Safety Strategy in SSA
There is need to adopt a holistic approach to the implementation of the food safety strategy in Sub-Sahara Africa. Through initiatives like the African Centres of Excellence, human resources will be trained to adopt a unified strategy to problem solving. This can be implemented across the board since the region faces fairly similar challenges.
The information needs to be communicated in simple language that every actor in the food value chain can understand and implement without the need for sophisticated equipment or advanced schooling.
Surveillance of foodborne diseases needs to be heightened to ensure outbreaks are reported in time and containment measures adopted immediately to arrest the spread of foodborne illnesses.
HACCP systems need to be adopted across the food value chain to eliminate opportunistic pathogens that cause foodborne diseases. Regulators need to improve on inspection of food outlets to ensure there is a strict adherence to the food safety regulations and policy provisions.
Funding for the food safety programs need to cater for implementation costs as well. There is need to adopt unified standards, which should be set by consenting regional partners, to ensure that every player will follow through with the program.
Codex Alimentarius Commission, through the Codex Trust Fund, needs to come in and help the developing countries with standards development and implementation to ensure that no single country is discriminated against using punitive and impractical standards that have been set up in a secluded boardroom.
Human Resource and Training Requirements to Combat Foodborne Illnesses in SSA
In the implementation of food safety policies, human resources remain a key ingredient, Due to the dynamism of the process, there is need for continuous capacity development to meet the ever-present needs. Sub-Sahara African countries need to allocate funds for this purpose.
The African Centres of Excellence (ACEs) are setting the pace in human capacity development by training high level human resources that will be handy in addressing the challenges of food safety. Through research and development, these centres are committed to producing applicable science to address the unique challenges of the region.
The data produced from these centres of excellence will need to be shared across the region to help in reducing associated costs while driving development through high quality research and development programs.
Given that the personnel hail from the local regions, they will be conducting research that directly affects them and they will be the most important people in dissemination of the research findings to the community for adoption.
This means that the communities will easily adopt the research findings as their own. This is an ongoing process in the quest to improve quality. As a result, different institutions of learning are constantly realigning their courses to address the current problems of food safety.
Foodborne Illnesses in SSA - Challenges and Opportunities
Inadequate human resources and funding for the food safety programmes remains to be the key challenge in addressing food safety issues in Sub-Sahara Africa. Governments have competing development priorities which divert attention from the pressing need to address food safety.
Unsafe food is a major contributor to hunger because it wastes the limited food resources by making them unsafe for both human and animal consumption.
Most participant countries in standard setting committees have little scientific outputs to present in the conferences. This has led to adoption of foreign scientific inputs that have little consideration of the local challenges. A majority of the Sub-Sahara African countries do not have prescribed standards for microbial safety and chemical adulterants in foods.
Despite these challenges, there is increased participation in the food safety network. This has provided a headway for increasing awareness to the challenges and the pressing need to adopt standards that will ensure a unified way of looking at food safety in the region.
Funding for food safety programmes have also been increasing gradually. This trend ought to continue at an accelerated pace so that countries that are still lagging behind can catch up and implement strategies that will ensure the citizens access safe and nutritious food.
Way Forward
Even though countries are rushing to increase the awareness on food safety and implementing policies to ensure the population remains safe, there remains the challenges in capacity development.
- Limitation in human resources and financing is a major challenge to most of the food safety policy regulators around the world. This is attributed to the unique nature of the cases as well as the emerging trends that makes it difficult to say with certainty that a particular pathogen should be controlled using a given strategy.
- The agents are living organisms and mutate from time to time. This means that a dynamic approach needs to be adopted and continuous surveillance needs to be put in place to address the challenges.
- Even with the development challenges, governments In Sub-Sahara Africa need to adopt strategies that prioritize food safety to ensure that no produced food goes to waste as a result of food contamination.
- Keeping the citizens from illnesses and infection will ensure a more productive population hence the government will gain more from the increased labour hours. Food safety affects all sectors hence the need to shift away from the traditional fragmented approach to food safety.
- A multi-sectorial approach needs to be adopted so that all the departments contribute their effort in addressing the problem that is food safety.
- Through the African Centres of Excellence (ACEs), Sub-Sahara Africa can address food safety challenges by concentrating its resources on a few effective centres that are mandated to train high quality human resources and conduct research on these emerging trends. The output of these centres should be implemented with a direct impact on the ground where their effects are felt most.
- In the food value chain, no player should be left out. The street food vendors need to be encouraged to adopt a holistic approach to food safety so that no loophole remains for the opportunistic agents. Consumers need to be enlightened on food safety as well so that they can make informed choices regarding their food.
- Both government and non-governmental agencies need to collaborate in the quest to address food safety issues. Data collected by these agencies should be shared and the information used to enlighten the public on the best ways to ensure food safety. There should be continuous allocation of resources for capacity building and enhancement to ensure a perpetual culture is propagated within the value chain.
- Every person everywhere should be able to access safe and nutritious food, whether produced locally or imported. The holistic approach to food safety management is the only hope for countries in Sub-Sahara Africa to catch up with the developed nations in the quest to implement a lasting food safety strategy.
References
- CDC. (2011). Estimates of Foodborne Illnesses in the United States. New York: Centers of Disease Control.
- CDC. (2018). Centers for Disease Control and Prevention: Kenya Annual Report 2017. Nairobi, Kenya: Centers for Disease Control and Prevention.
- Cowman, G., Otipo, S., Njeru, I., Achia, T., Thirumurthy, H., Bartram, J., & Kioko, J. (2017). Factors associated with cholera in Kenya, 2008-2013. Pan African Medical Journal, 28, 101.
- Jay, J. (2000). Modern Food Microbiology (6th ed.). Gaithersburg, Maryland: Aspen Publications.
- Yard, E. E., Daniel, J. H., Lewis, L. S., Rybak, M. E., Paliakov, E. M., Kim, A. A., . . . Shahnaaz, K. S. (2013). Human Aflatoxin Exposure in Kenya, 2007: A Cross-sectional Study. Food Additives and Contaminants: Part A, Chemistry, Analysis, Control, Exposure and Risk Assessmentt, 30, 1322-31.
- van-de-Venter, T. (2000). Emerging food-borne diseases: A Global Responsibility. Durban: Department of Health, Republic of South Africa.
- WHO. (2008). Foodborne Disease Outbreaks: Guidelines for Investigation and Control. Geneva, Switzerland: World Health Organization.
