BACKGROUND AND OBJECTIVES: Malnutrition is a significant contributor to child morbidity and mortality globally. Egg consumption has been associated with improved child nutrition yet is rare in rural, resource-poor settings. We test the effects of a culturally tailored behavior change intervention to increase child egg consumption. METHODS: A 3-arm cluster randomized controlled trial was conducted in rural Burkina Faso with 260 mother-child dyads. Children aged 4 to 17 months from 18 villages were included; those with reported history of malnutrition or egg allergy were excluded. Each child in the full intervention arm received 4 chickens, and mothers received the 10-month behavior change package. Participants in the partial intervention arm received only the behavior change package. RESULTS: In this analysis of 250 children, the full (β = 4.3; P = 6.6 × 10−12) and the partial (β = 1.0; P = .02) interventions significantly increased egg consumption. The full intervention also significantly increased poultry production (β = 11.6; 95% confidence interval 8.3–15; P = 1.1 × 10−5) and women’s decision-making about eggs (β = .66; P = .02), and significantly decreased wasting (β = .58; P = .03) and underweight (β = .47; P = .02). CONCLUSIONS: The culturally tailored behavior change package significantly increased child egg consumption. When coupled with the gift of chickens, the behavior change intervention yielded a greater increase in egg consumption and significantly reduced wasting and underweight. Behavior change strategies to increase egg consumption should be considered among nutrition and health programs in resource-poor settings where poultry is available.

The Florida Complaint and Outbreak Reporting System (FL-CORS) database is used by the Florida Department of Health’s Food and Waterborne Disease Program (FWDP) as one of the tools to detect foodborne disease outbreaks. We present a descriptive and spatial network analysis of the FL-CORS data collected during 2015-2018. We also quantified foodborne disease outbreaks (FBO) which were investigated and confirmed due to a filed complaint and the etiological agents involved in these outbreaks.An increasing number of unique complaints filed in FL-CORS was observed during 2015 to 2018, with a sharp increase during 2017-2018 and a different seasonal pattern in 2018. The preferred mechanism of reporting varied by age group with younger people more frequently filing complaints online and older persons preferring reporting in-person or by phone. Spatial network analysis revealed that 87% of complaints had the same county of residence and county of presumed exposure. Frequency of complaints was negatively associated with linear distance between place of residence and place of exposure at zip code level. Counties located in North and Central Florida, as well as some coastal areas in South Florida had higher incidence rates of complaints. Those counties tend to have a larger population density, and some are popular vacation destinations. On average, 96 FBO were reported in Florida annually, of which 60% were confirmed with successful identification of the causative agent. 56% of the confirmed FBO were triggered by a complaint. Throughout the years, 2.4 - 2.8 FBO and 1.4 confirmed FBO were identified per 100 complaints. Ciguatera toxin was cause of 40% of all FBO in Florida, and only 28% were detected through complaints. In contrast, complaints were the main source of identifying outbreaks of Norovirus, non-typhoidal Salmonella enterica and scombroid food poisoning, as well as rare outbreaks of Clostridium perfringens, Cryptosporidium spp., Shigella spp., and Vibrio vulnificus.

In many low‐income countries, such as Burkina Faso, rates of malnutrition are high among children. Research indicates that animal source foods may provide important elements to improve growth and development of young children, especially during periods of rapid development, such as the first 1,000 days of life. The Un Oeuf study is designed to test an innovative behaviour change communication strategy to increase egg consumption in children 6–24 months in Burkina Faso, thereby improving dietary diversity and nutritional outcomes. This 1‐year cluster randomised controlled trial tests whether the gifting of chickens by a community champion directly to a child, combined with a behaviour change package of integrated poultry management and human nutrition trainings, can significantly increase egg consumption among children under 2 years in rural communities where egg consumption is very low. The nutrition‐sensitive behaviour change package is designed to increase egg consumption through improving livestock production, women's empowerment and food security at the household level. This paper presents a detailed account of the study design and protocol for the Un Oeuf study, alongside a description of the study population. Baseline data show a study population with high rates of malnutrition (stunting 21.6%, wasting 10.8% and underweight 20.4%) and a very low rate of egg consumption—less than 10% among children. Although poultry production is quite common, egg consumption is low reportedly because of cultural norms, including widespread practice of allowing eggs to hatch and a lack of knowledge about the nutritional benefits of egg consumption.

Foodborne disease is a significant global health problem, with low- and middle-income countries disproportionately affected. Given that most fresh animal and vegetable foods in LMICs are bought in informal food systems, much the burden of foodborne disease in LMIC is also linked to informal markets. Developing estimates of the national burden of foodborne disease and attribution to specific food products will inform decision-makers about the size of the problem and motivate action to mitigate risks and prevent illness. This study provides estimates for the burden of foodborne disease caused by selected hazards in two African countries (Burkina Faso and Ethiopia) and attribution to specific foods. Country-specific estimates of the burden of disease in 2010 for Campylobacter spp., enterotoxigenic Escherichia coli (ETEC), Shiga-toxin producing E. coli and non-typhoidal Salmonella enterica were obtained from WHO and updated to 2017 using data from the Global Burden of Disease study. Attribution data obtained from WHO were complemented with a dedicated Structured Expert Judgement study to estimate the burden attributable to specific foods. Monte Carlo simulation methods were used to propagate uncertainty. The burden of foodborne disease in the two countries in 2010 was largely similar to the burden in the region except for higher mortality and disability-adjusted life years (DALYs) due to Salmonella in Burkina Faso. In both countries, Campylobacter caused the largest number of cases, while Salmonella caused the largest number of deaths and DALYs. In Burkina Faso, the burden of Campylobacter and ETEC increased from 2010 to 2017, while the burden of Salmonella decreased. In Ethiopia, the burden of all hazards decreased. Mortality decreased relative to incidence in both countries. In both countries, the burden of poultry meat (in DALYs) was larger than the burden of vegetables. In Ethiopia, the burdens of beef and dairy were similar, and somewhat lower than the burden of vegetables. The burden of foodborne disease by the selected pathogens and foods in both countries was substantial. Uncertainty distributions around the estimates spanned several orders of magnitude. This reflects data limitations, as well as variability in the transmission and burden of foodborne disease associated with the pathogens considered.

Background According to the World Health Organization, 600 million cases of foodborne disease occurred in 2010. To inform risk management strategies aimed at reducing this burden, attribution to specific foods is necessary. Objective We present attribution estimates for foodborne pathogens (Campylobacter spp., enterotoxigenic Escherichia coli (ETEC), Shiga-toxin producing E. coli, nontyphoidal Salmonella spp., Cryptosporidium spp., Brucella spp., and Mycobacterium bovis) in three African countries (Burkina Faso, Ethiopia, Rwanda) to support risk assessment and cost-benefit analysis in three projects aimed at increasing safety of beef, dairy, poultry meat and vegetables in these countries. Methods We used the same methodology as the World Health Organization, i.e., Structured Expert Judgment according to Cooke’s Classical Model, using three different panels for the three countries. Experts were interviewed remotely and completed calibration questions during the interview without access to any resources. They then completed target questions after the interview, using resources as considered necessary. Expert data were validated using two objective measures, calibration score or statistical accuracy, and information score. Performance-based weights were derived from the two measures to aggregate experts’ distributions into a so-called decision maker. The analysis was made using Excalibur software, and resulting distributions were normalized using Monte Carlo simulation. Results Individual experts’ uncertainty assessments resulted in modest statistical accuracy and high information scores, suggesting overconfident assessments. Nevertheless, the optimized item-weighted decision maker was statistically accurate and informative. While there is no evidence that animal pathogenic ETEC strains are infectious to humans, a sizeable proportion of ETEC illness was attributed to animal source foods as experts considered contamination of food products by infected food handlers can occur at any step in the food chain. For all pathogens, a major share of the burden was attributed to food groups of interest. Within food groups, the highest attribution was to products consumed raw, but processed products were also considered important sources of infection. Conclusions Cooke’s Classical Model with performance-based weighting provided robust uncertainty estimates of the attribution of foodborne disease in three African countries. Attribution estimates will be combined with country-level estimates of the burden of foodborne disease to inform decision making by national authorities.