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BackgroundFoodborne 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.MethodThe 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.ResultIn 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.ConclusionOur 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.

Background: In 2011, Benin introduced the 13-valent pneumococcal conjugated vaccine (PCV13), in a single-dose vial, into its Expanded Programme for Immunisation (EPI) with support from Gavi. In April 2018, with the support of the Agence de Médecine Préventive Afrique (AMP) and other technical and financial partners, the single-dose vial was transitioned to a four-dose vial. Here we describe the decision-making process and the experience of the vaccinators during the change. Methods: We carried out semi-structured, individual interviews with 61 participants individuals involved in the EPI: 7 from central level, 5 from regional level, 7 from township level and 42 from district level. The interviews were recorded and transcribed, and the information categorised, using Nvivo software, and then analysed. Results: The Inter-agency Coordination Committee (ICC), the Benin National Advisory Committee for Vaccines and Vaccination, (BNACVV) and the World Health Organisation (WHO) (i.e., the traditional governance structures involved in vaccination decisions) were not involved in the decision to change to the four-dose vial for PCV13. The decision was taken by the EPI, supported by Gavi. The vaccination errors observed in the first months following the change in presentation were due to the absence of guidelines for changes in vaccine presentation and the central-level actors' perception that it was 'only a change in the vial', and therefore that the communication and training for a new vaccine were not required since the vaccine itself and its administration mode were unchanged.

IntroductionIn low- and middle-income countries, chicken serves as a cheap source of protein and an income source for many households. It is particularly important in the capital, Ouagadougou, Burkina Faso, where chicken is regularly consumed. However, hygiene standards are very low, posing a significant public health risk.MethodsTo better understand the food safety situation, we conducted a cross-sectional survey of the hygienic practices of 155 randomly selected chicken slaughter outlets and carcass shops with a semi-structured questionnaire.Results and discussionOf the outlets visited, 59% are not licensed, and 63% are not regularly inspected, operating in the dominant, largely unregulated informal sector. More than 80% of the chickens are sourced from village production systems, but around 6% of the birds die during transport. The monetary loss due to chicken death during transportation is around four million USD annually. Market hygiene is poor; 86% of the holding pens have no hard floor and are not washed regularly. Almost all (92%) chickens are slaughtered on bare earth floors; bleeding, plucking, and evisceration are done on a wooden table that is rarely washed. On average, the same scalding water is used for 33 birds, seven scalded at a time. Most respondents (49%) thought that plucking and evisceration were the major cause of contamination of carcasses with foodborne pathogens. Most operators only washed their hands and knives with tap water at the beginning of the slaughtering process. Some shops use refrigerators and freezers to store carcasses before selling. However, they store carcasses with other foods like fish, beef and vegetables, facilitating further cross-contamination. There were rats (26%), cats (39%) and dogs (30%) present at outlets, roaming for food, especially roadside outlets. Training schemes on hygienic food handling practices were favoured by outlets as an approach to improve matters; however, improvements in food safety will be limited without significant upgrades in infrastructure and facilities. Slaughter slabs need a standard house with stable energy, adequate airflow, clean water, toilets, detergents and freezers. Also, they need equipment like knives, tables and dishes made of high-quality, easy-to-clean materials.