Trends, Determinants, opportunities, challenges and

prevention mechanisms of food borne diseases

Presented to: Mr. Worku Dugassa (MPH, Assistant Professor

Presented by Group One

February 04, 2024

Adama, Ethiopia
Group I Members

1. Aman Haji 8. Kefyalew Worku

2. Amen Dejene 9. Leul Demissie
3. Dechasa Tumsa 10. Melesse Jenbolla
4. Eyerusalem Kefyalew 11. Nefisa Abdella
5. Girma Hordofa 12. Tsion Gerawork
6. Hailemichael Mohammed 13. Yetnayet Mekuria
7. Kaleab Tezera 14. Edao Lemecha

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Presentation outline
－Introduction
－Trends of foodborne diseases
－Classification of foodborne diseases
－Determinants of Foodborne diseases
－Opportunities
－Challenges
－Preventive Mechanisms

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Session Objectives

－Describe foodborne diseases

－To understand the prevalence of some of foodborne disease
－To determine common determinants of foodborne diseases
－To identify what are the common challenges of foodborne diseases
－Understand basic prevention mechanism

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Introduction… Defn of Food-borne Disease

Foodborne diseases also known as foodborne illnesses, are diseases

or infections that result from consuming contaminated food or beverages
which can be caused by
－Bacteria,

－Viruses,

－Parasites or

－ Chemicals present in the food or water

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Introduction…
Food-borne diseases are caused by contamination of food and occur at any
stage of the:
－ Food production,
－Delivery and

－Consumption chain

Food-borne diseases can result from several forms of environmental

contamination including pollution in water, soil or air, as well as unsafe
food storage and processing
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 Introduction…
Food-borne diseases encompass a wide spectrum of illnesses and are a
growing public health problem worldwide

The World Health Organization (WHO) estimated that in developed

countries, up to 30% of the population suffer from food-borne diseases each
year whereas in developing countries up to 2 million deaths are estimated per
year

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Introduction…
Food-borne diseases are common in developing countries including
Ethiopia because of :
－Poor food handling and sanitation practices,

－Inadequate food safety laws,

－Weak regulatory systems,

－Lack of financial resources to invest in safer equipment and

－ lack of education for food-handlers

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 Trends of Food-borne Diseases
Food borne disease causes many serious health problems to human around the
world, for instance, about 4 million people are died due to diarrhea each year

Each year as many as 600 million or almost one in10 people in the world fall
ill after consuming contaminated food

420 000 die every year, resulting in the loss of 33 million healthy life years

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Trends of Food-borne Diseases…
110 billion is lost each year in productivity and medical expenses resulting
from unsafe food in low- and middle-income countries

African region has highest burden of food borne diseases where more than
91million people fall ill and 137, 000 die each year

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Trends of Food-borne Diseases…
Food borne diseases specially gastroenteritis is one of the most common
illnesses in Ethiopia, and it is a leading cause of death among people of all
ages in the country

Most foodborne pathogens are introduced as exogenous contaminants

during handling, processing, and preparation rather than as endogenous
contaminants

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Trends of Food-borne Diseases…
In Ethiopia, the problem of foodborne disease is exacerbated in rural
communities where awareness about the causes, transmission, and
prevention of foodborne infections is generally lower

Furthermore, well-documented information on the extent of foodborne

disease is lacking as many cases are not properly diagnosed or reported,
and foodborne illness patients do not seek medical attention

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Trends of Food-borne Diseases…

In Ethiopia

－ 60% of the disease burden is related to poor hygiene and

sanitation,

－ lack of well-organized epidemiological surveillance systems, and

few studies available,

－ Food-borne illnesses are rarely investigated and under-reported

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Trends of Food-borne Diseases…
According to the study that retrospectively conducted on the prevalence of foodborne
diseases among patients attending health facilities in Addis Ababa by sex
Overall prevalence of Food -borne disease (2008- 2011 EC)
300

261
250 245

200 192 199

178
150 149
122
100 127

50

0
2008 2009 2010 2011

# of Male # of Female
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Trends of Food-borne Diseases…
Similarly the the study that retrospectively conducted in Addis Ababa on the
distribution of foodborne diseases among different age categories
Overall distribution of Foodbone diseases among different age categories from 2008 - 2011 EC.
40.0%
37.1%
35%
35.0% 33%
31% 31%
30.0% 28% 27.0% 27% 27.2%

25.0% 23% 23% 23%

20.0% 19% 19.0%

15.0% 14%
11%
10.0%

5.0%

0.0%
2008 2009 2010 2011

Less than 15 years 15 - 30 years 30 - 45 years Greater than 45 years

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Classification of food borne diseases…

Food borne diseases are classified into:

1. Food borne infections and
2. Food borne intoxications

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Classification of Food Borne Diseases…

Bacterial
toxins

Figure
04/21/2024 indicate Classification of foodborne
Group I diseases 17
Classification of food borne diseases…
Food borne infections are caused by the entrance of pathogenic
microorganisms contaminating food into the body, and the reaction of
the body tissues to their presence (fungal, bacterial, viral or parasitic)

Food borne infections tend to have long incubation periods and are
usually characterized by fever

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Classification of food borne diseases…
Bacterial food borne
infections include :
－Cholera, －Escherichia coli infection,
－Salmonellosis, －Campylobacteriosis,
－Typhoid fever, －Vibrio parahaemolyticus and
－Shigellosis, －Listeriosis
－Yersiniosis

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 Classification of food borne diseases…

Mycotic food borne infections include Viral food borne infections

－Candida spp., include
－Sporothrix spp. , －hepatitis A ,
－Wangiella spp. Etc. －Norwalk virus and

－poliomyelitis virus

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 Salmonellosis
Constitute a group of organisms with over 2000 different serotypes

is a common bacterial disease that affects the intestinal tract

The bacteria typically live in animal and human intestines and are shed through stool

Humans become infected most frequently through contaminated water or food

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Salmonellosis…
Salmonellae reach food in many different ways;
－Directly from slaughter animals to food
－From human excreta, and transferred to food through hands, utensils,
equipment's, flies etc.

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Salmonellosis…
Foods commonly involved are animal derived foods are:
－Meat and meat products,
－Milk and milk products and
－Egg and egg products

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Salmonellosis…
Based on the findings of a retrospective study conducted at Addisu Gebeya Health
Center in Addis Ababa, Ethiopia from 2008 to 2011 E.C, the prevalence of
Salmonellosis
Prevalence of Salmonellosis
35.0%
31.6%
30.0%
25.6% 26.2%
25.0%

20.0%
14.5%
15.0%

10.0%

5.0%

0.0%
2008 2009 2010 2011

Figure indicate the prevalence of Salmonellosis

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Preventive Measure of Salmonellosis

－Efficient refrigeration and hygienic handling of food.

－Consumption of properly cooked meat,

－Complete thawing of frozen meats and adequate cooking.

－Heat processing of meat, milk , fish and poultry to destroy salmonella

organisms in food

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 Cholera

－Cholera is caused by Vibrio cholera bacterium

－Cholera vibrios are ingested in drink or food.

－In natural infection, the dosage is usually very small.

－The organism multiply in the small intestine to produce a very potent

enterotoxin

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Cholera…

－Man is the only natural host of the cholera vibrios

－Spread of infection is from person-to-person, through contaminated water or

foods

－Cholera is an infection of crowded and economically poor communities and it

tends to persist in such areas

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Table: Prevalence of Cholera among patients attending health facilities from 2008 –
2011EC, Addis Ababa, Ethiopia.
Year Prevalence of Cholera cases Total

# of Male (%) # of Female (%)

2008 16(14.4) 24(21.6) 40(36%)

2009 20(18) 11(9.9) 31(27.9%)
2010 13(11.7) 9(8.1) 22(19.8%)
2011 10(9) 8(7.2) 18(16.2%)

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Preventive Measures of Cholera

－Provision of potable water

－Proper sewage disposal
－Proper cooking and hygienic handling of food
－Observation of personal hygiene

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Escherichia Coli
－Escherichia Coli are potential food poisoning pathogens

－Escherichia coli is a bacterium that is commonly found in the gut of humans and
warm-blooded animals.

－It is transmitted to humans primarily through consumption of contaminated

foods.

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Entero-invasive E. coli
－Cause illness that is characterized by
－watery diarrhea in most patients
－in addition, there is fever, nausea, and abdominal cramps

－Bloody diarrhea may occur in fewer than 10 % of patients

－Illness is usually self-limiting, lasting for 2 to 3 days

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Preventive Measures of E.coli

－Proper cooking of meats

－Avoidance of cross-contamination of foods in the kitchen, and

－Good personal hygiene

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 Shigellosis (Bacillary dysentery)

－Shigellosis is caused by members of the genus Shigella

－The species involved include Shigella dysenteriae, Shigella flexneri,

Shigella boydii and Shigella Sonei

－All strains of shigella posses potent exotoxins which are carbohydrate-

lipid protein complexes.

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Shigellosis…

－Human cases and carriers are the only important sources of infection

－Spread is by fecal-oral route,

－ Person-to-person transmission is common

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Shigellosis…

－The bacteria leaves the body in stool of an infected person and infects
another person through contaminated hands, food, water, or objects

－Any type of food can transmit the shigella pathogens to cause disease
in man

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Preventive measures of Shigellosis

－Practice good hygiene and sanitation.

－Wash hands well with water and soap

－The home and surroundings should be kept clean to prevent contamination of

food and water supply

－Proper disposal of human waste or sewage

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Preventive measures cont..

－Keep kitchen work surfaces clean

－Use boiled or chlorinated water

－Eat properly cooked of food, and

－Drink properly pasteurized milk and other liquid foods such as juices.

－Reconstitute juice with potable water

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Viral Foodborne Infections

－Viruses are common pathogens transmitted through food

－Hepatitis A and Norwalk-like virus are the most important viral food

borne pathogens.

－These viruses are highly infectious and may lead to widespread

outbreaks during water shortage

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Viral Foodborne Infections…
－ Only a few viral particles are necessary for the disease to develop

－ High numbers of viral particles are further transmitted via feces of infected
persons

－ Specific lining cells are necessary for virus replication. Accordingly they
cannot multiply in foods or water.

－ Food borne virus are relatively stable and acid resistant outside host cells

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 Foodborne Intoxications

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 Foodborne Intoxications

Caused by consumption of food containing:

Bio-toxicants which are found in tissues of certain plants and animals

Metabolic products (toxins) formed and excreted by microorganisms while they

multiply in food, or in gastrointestinal tract of man

Poisonous substances, which may be intentionally or unintentionally added to food

during production, processing, transportation
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or storage. 41
Foodborne Intoxications...
Food borne intoxications have short incubation periods (minutes to hours) and
are characterized by lack of fever

Food borne intoxications can be classified into:

1. Bacterial intoxications
2. Fungal intoxications
3. Chemical intoxication
4. Plant toxicants, and
5.04/21/2024
Poisonous animals. Group I 42
Bacterial Intoxications
Clostridium botulinum foodborne Intoxication
－Clostridium botulinum food borne intoxication (botulism) is a type of food
poisoning caused by consumption of enterotoxins produced by strains of
Clostridium botulinum

－Clostridium botulinum is an obligate, spore-forming anaerobe, and Gram

positive bacilli

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 Fungal intoxications

－Caused by consumption of metabolites produced by fungi, when growing in food

－These metabolites are called mycotoxins

－Grains, oilseeds, fruits and vegetables are mostly involved

－Poor dry storage practices of grains and other foods

－It is significance to public health is aflatoxicosis

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Aflatoxicosis
－Aflatoxicosis is caused by aflatoxins produced by the fungi, e.g. Aspergillus flavus

－Four types of aflatoxins have been described i.e. aflatoxin B1, B2, G1 and G2

－Animals consuming feeds contaminated with aflatoxin B1 leads to secretion in the

milk of aflatoxin M1 and M2

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Chemical Intoxication

－This is a type of food borne intoxication arising from consumption of food

containing poisonous chemicals,

－These may be intentionally or unintentionally added to foods as a result of

producing, processing, transporting or storage

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 Bio-toxications

－ are disorders resulting from ingestion of a poisonous substance (a biotoxin)

present in the body of a plant or animal

－Only a small proportion of the species of fish and shellfish taken for human

consumption throughout the world contain biotoxins

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Determinants of Foodborne disease
－Poor Personal Hygiene: Poor personal hygiene practices serve as the
leading cause of foodborne illnesses

－Improper Holding Temperatures: Cold foods shall maintain ≤41°F and

hot foods shall maintain ≥135°F.

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 Determinants of Foodborne …
－Improper Cooking Temperatures: establish minimum internal cooking
temperatures for foods

－Food from Unsafe Sources: All foods distributed in licensed food establishments

－Contaminated Equipment/Cross-Contamination: Cross-contamination can

occur from a variety of sources,

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Determinants of Foodborne disease…
According to the study among food handlers employed by catering establishments
within public institutions in three towns of the Dawuro Zone in Southwestern Ethiopia,
factors were notably linked to the presence of Salmonella species or intestinal parasites
Age greater or equal to 40 years

Lack of formal education

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Determinants of Foodborne disease…

Failure to wash hands after using the latrine

Not covering the mouth with a tissue when coughing or sneezing

during food preparation

Improper storage of foods that support microorganism growth Absence

of a medical checkup in the last four months
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Opportunities for controlling foodborne diseases

－Advances in food science and technology

－Improved food safety education and training
－Invest in food safety research and development
－Promote sustainable agriculture practices
－Empower consumers to make safe food choices

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Opportunities for controlling foodborne disease…
－National Food and Nutrition Policy, FMOH 2021
－Seqota Declaration Implementation Plan 2016 – 2030, FMOH 2016
－Baby Food Control Directive Number 840/2021, October 2021
－National Guideline for Management of Acute Malnutrition in Ethiopia, 2019
－HSTP-II (2020 – 2025)

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Challenges of Food-borne Diseases
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

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Challenges of Food-borne Diseases…
－Poor food handling procedures,
－Lack of basic infrastructure,
－Lack of potable water,
－Lack of financial resources to invest in safer equipment,
－ Lack of training for food handlers have all been reported and
－Sanitation and hygienic status of food and drink establishment in many part
of Ethiopia was below the standard.

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Challenges of Food-borne Diseases…
－Widespread habit of raw beef consumption

－Lack of coordinated epidemiological surveillance systems

－Under-reporting cases and high priority for other disease may have
overshadowed the problem of foodborne pathogens

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Preventive Mechanisms
－Avoidance of food contamination, destruction or prevention of contaminants,
prevention of further spread or multiplication of contaminants

－Food items like minced beef should be cooked to specified temperatures to kill
microorganisms associated with bacterial food borne disease

－Creating awareness among the consumers, farmers and those raising farm animals

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Preventive Mechanisms…
－Hygienic measures are required throughout the continuum from farm
to fork

－Proper processing of food is necessary to ensure the reduction of or

elimination of the growth of harmful microorganisms

－The consumers should also take precautions to prevent food-borne

illness

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Preventive Mechanisms…
－Good agriculture practice and good manufacturing practice
－Following Golden rules of WHO for safe food preparation

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References
1. WHO, 2012. Initiative to estimate the Global Burden of food-borne diseases. http://www.who.int/ food
safety/food-borne disease/ferg/en/.
2. WHO, 2007. Food Safety Food-borne Diseases and value chain management for food safety. "Forging links
between Agriculture and Health" CGIAR on Agriculture and Health Meeting in WHO/HQ.
3. WHO, 2021. Estimating the burden of foodborne diseases: A practical handbook for countries: A guide for
planning, implementing, and reporting country-level burden of foodborne disease
4. A. Aklilu, D. Kahase, M. Dessalegn et al., “Prevalence of intestinal parasites, Salmonella and Shigella
among apparently health food handlers of addis ababa university student’s cafeteria, addis ababa, Ethiopia,”
BMC Research Notes, vol. 8, no. 1, p. 17, 2015.
5. WHO. (2014). Golden ruler safety food preparations .http.www role of food contamination

04/21/2024 Group I 60
References..
6. Girma G. Prevalence, Antibiogram and growth potential of Salmonella and Shigella in Ethiopia: implications for public
health. A Review. Prevalence. 2015;33:45.
7. Keba A, Rolon ML, Tamene A, et al. Review of the prevalence of foodborne pathogens in milk and dairy products in
Ethiopia. Int Dairy j. 2020;109:104762.
Chen L, Alali W. recent discoveries in human serious foodborne pathogenic Bacteria: resurgence, pathogenesis, and control
strategies. Front Microbial. 2018;9:2412. doi:10.3389/fmicb.2018.02412
8. Linscott AJ. Food-borne illnesses. Clin Microbiol Newsletter. 2011;33(6):41–45.
9. T Asfaw T, D Genetu, D Shenkute , T Tesfaye., Y Eshetie and B Yitayew B (2022): Food borne pathogens and
antimicrobial resistance in Ethiopia: An urgent call for action on One Health.
10. Habtamu Tedila & Daniel AlemuA Retrospective Prevalence of Food Borne Diseases Among Patients Attending Adissu
Gebya Health Center Addis Ababa, Ethiopia From (2008 – 2011 E.C), 2021.
11. WHO. World Health Organization global strategy for food safety: safer food for better health. Geneva, Switzerland. 2002.
04/21/2024 Group I 61
References
12. Gerald K., Environmental Health for East Africa Rural Health Service, No. 16.
13. Gebre Amanuel T., Food Hygiene, Principles and Methods of Food borne Disease Control with Special Reference to Ethiopa,
1997.
14. Drug Adminsitration and Control Authority of Ethiopia, Standard Treatment Guidelines for the District Hospital, 2004
15. Abera Kumalo , Eyasu Gambura,Terfe Dodicho, Khawaja Shakeel Ahmed, Tamrat Balcha, Bahailu Beshir, and Misrak Abraham
(2021), Prevalence of Intestinal Parasites and Salmonella typhi among Food Handlers Working in Catering Establishments of Public
Institutes Found in Dawuro Zone, South-Western Ethiopia
16. Girmay AderajewMekonnen, Gari, SirakRobele, Mengistie Alemu, Bezatu, Evans,MartinR, and Gebremariam, Azage
Gebreyohannes (2019):Determinants of Sanitationa nd Hygiene status among Food Establishments in Addis Ababa Ethiopia
17. Fresenbet Fanta, Meseret Azene, Kifle Habte, Hanna Samson and Aweke Kebede (2019): Determinants of safe food handling
practice among food handlers in food establishments, Yeka sub city, Addis Ababa, Ethiopia

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 Thank you

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