Prevalence of antibiotic resistance in Campylobacter isolates from commercial poultry suppliers in KwaZulu-Natal,
14 Nov 2008
Journal of Antimicrobial Chemotherapy 2008 62(6):1298-1300
L. A. Bester, and S. Y. Essack [edited] [iFSN]
Objectives: Campylobacter jejuni isolated from broiler and layer chickens from registered abattoirs in KwaZulu-Natal, South Africa, were tested for their susceptibility to eight antibiotics.
Methods: Using agar dilution, susceptibility to eight antibiotics was determined for C. jejuni recovered from the caeca.
Results: A total of 155 isolates were collected of which 77 were identified as C. jejuni (broilers n = 56 and layers n = 21). Resistance was highest to tetracycline (broilers 98.2% and layers 100%) and ceftriaxone (broilers 96.4% and layers 100%). High susceptibility was found to ciprofloxacin (broilers 91% and layers 76%) and gentamicin (broilers 98% and layers 81%). Susceptibilities to each of the antibiotics for the broilers and layers, respectively, were: 50% and 57% for erythromycin, 45% and 24% for clarithromycin, 68% and 43% for ampicillin and 64% and 48% for nalidixic acid. Statistically significant differences were detected for the MIC50 of gentamicin, ciprofloxacin and tetracycline between broilers and layers (P < 0.001) with the MIC90 of gentamicin also of significant difference (P = 0.01). Multiresistance was detected in 23% and 43% of the isolates from broiler and layer chickens, respectively.
Conclusions: Mass therapy procedures used in animal husbandry have a potential impact on antibiotic resistance development in C. jejuni .

Ghana - 84,000 Die of Diarrhea in 4 Years
21 October 2008
The Ghanaian Times [EatSafeGhana]
A total of 84,000 deaths were caused by diarrhea as recorded in the country since 2004.
And this accounted for 25 per cent of deaths among children under age five. Theodora Adomako-Adjei, Executive Service Coordinator of Community Water and Sanitation Agency, disclosed this at the launch of the Global Handwashing Day in Accra. She said diarrhea infections were caused by the ingestion of excreta and were the second most common cause of death in children. Dubbed: “Saving lives through handwashing with soaps,” the Day, the first of its kind instituted by the United Nations, forms part of this year’s international year of Sanitation.It is to echo and reinforce the call for improved hygienic practices.The programme, which attracted 120 Junior High School pupils in the Accra municipality, highlighted handwashing with soap as the most effective and inexpensive way to prevent diarrheal diseases and pneumonia. Mrs Adomako-Adjei noted that the challenge of the GHD is to transform handwashing with soap from an abstract good idea into an automatic behaviour performed in homes, schools and communities worldwide. “Turning handwashing with soap before eating and after using the toilet into an ingrained habit could save more lives than a single vaccine or medical intervention, cutting deaths from diarrhea by almost half,” she stated. Mrs Adomako-Adjei said physical obstacles to handwashing with soap at schools exist in the country as 61 per cent of schools observed, lack handwashing facilities. The Deputy Regional Director of Education, Mrs Mary Quaye, said handwashing with soap was effective in interrupting the transmission of disease.
She said hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via faeces. “When not washed with soap, hands that have been in contact with human or animal faeces, bodily fluids like nasal excretions and contaminated foods or water can transport bacteria, viruses and parasites to the body,” she said.

Ghana - Accra health workers worried about cholera outbreaks
16 October 2008
Daily Graphic [EatSafeGhana]
Health personnel in the Greater Accra Region are worried about the frequent outbreak of cholera in the region. They have attributed the causes to poor sanitation, including open defecation, poor waste disposal, poor food hygiene and low levels of hand washing practices across the region. Another cause for the disease in the region is the perennial water shortage, which forces residents to use unsafe water.
A report made available to the Daily Graphic by the Greater Accra Regional Director of Health Services, Dr. Irene Agyepong indicated an uneven trend over the last 10 years, which seems to go up in one instance, come down later only to move up again in another year.
The report indicated that between September 4 and October 10, this year, a total of 22 cases suspected to be cholera had been reported in the Accra Metropolitan Area (AMA), with the bulk of the cases coming from the Ashiedu-Keteke and Ablekuma sub-metropolitan areas. Out of the 22 cases, 7 have been confirmed by laboratory testing as cholera, 9 were treated without testing, 2 were confirmed negative while the laboratory results of the remaining 4 are yet to be received by the Regional Directorate.
The report also indicated the statistics of Cholera cases in the Greater Accra Region from 1998 to 2007 as follows:

Year	No. of Cholera cases	No of Deaths
1998	319	9
1999	3147	21
2000	1840	8
2001	1387	42
2002	2044	47
2003	156	4
2004	8	0
2005	1812	21
2006	1290	21
2007	7	0

Ghana – Keeping up appearances, perception of street food safety in urban Kumasi
Sep 27 2008
Rheinländer T, Olsen M, Bakang JA, Takyi H, Konradsen F, Samuelsen H.
Department for International Health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, P.O. box 2099, 1014, Copenhagen K., Denmark, thtr@sund.ku.dk.
The growing street food sector in low-income countries offers easy access to inexpensive food as well as new job opportunities for urban residents. While this development is positive in many ways, it also presents new public health challenges for the urban population. Safe food hygiene is difficult to practice at street level, and outbreaks of diarrheal diseases have been linked to street food. This study investigates local perceptions of food safety among street food vendors and their consumers in Kumasi, Ghana in order to identify the most important aspects to be included in future public health interventions concerning street food safety. This qualitative study includes data from a triangulation of various qualitative methods. Observations at several markets and street food vending sites in Kumasi were performed. Fourteen street food vendors were chosen for in-depth studies, and extensive participant observations and several interviews were carried out with case vendors. In addition, street interviews and Focus Group Discussions were carried out with street food customers. The study found that although vendors and consumers demonstrated basic knowledge of food safety, the criteria did not emphasize basic hygiene practices such as hand washing, cleaning of utensils, washing of raw vegetables, and quality of ingredients. Instead, four main food selection criteria could be identified and were related to (1) aesthetic appearance of food and food stand, (2) appearance of the food vendor, (3) interpersonal trust in the vendor, and (4) consumers often chose to prioritize price and accessibility of food-not putting much stress on food safety. Hence, consumers relied on risk avoidance strategies by assessing neatness, appearance, and trustworthiness of vendor. Vendors were also found to emphasize appearance while vending and to ignore core food safety practices while preparing food. These findings are discussed in this paper using social and anthropological theoretical concepts such as 'purity', 'contamination', 'hygiene puzzles', and 'impression behaviors' from Douglas, Van Der Geest, and Goffman. The findings indicate that educating vendors in safe food handling is evidently insufficient. Future public health interventions within the street food sector should give emphasis to the importance of appearance and neatness when designing communication strategies. Neglected aspects of food safety, such as good hand hygiene and cleanliness of kitchen facilities, should be emphasized. Local vendor networks can be an effective point of entry for future food hygiene promotion initiatives.

Ghana - Food adulteration on the increase - FDB survey
29 August 2008
news.myjoyonline.com [edited] [EatSafeGhana]
Food researchers have warned that adulterants added to food are injurious to human health and urged consumers to report any unusual changes in their food to the Food and Drugs Board (FDB).
A survey conducted by FDB and the Food Research Institute (FRI) of the Council for Scientific and Industrial Research (CSIR) showed that various substances were added to various foods by those who prepared them and warned that this was an offence and liable to imprisonment. Mrs. Isabella Mansa Agra, Head of Hood Registration and Nutrition of the FDB, in a document copied to the Ghana News Agency, said food adulteration is on the increase and common in Ghanaian urban markets with the perpetrators playing on the ignorance of innocent buyers.
She said the survey revealed that alum and chalk were added to bread to whiten it, while for stale flour, ammonium carbonate was added to disguise its sour taste.
Mashed potatoes, sawdust and Plaster of Paris were also added to increase the weight of the bread. Mrs. Agra noted that food dyes, colours and miscellaneous compounds were added to food to impart certain properties to disguise deteriorated or spoiled food and give an idea of freshness. The study, conducted in eight regions, sought to provide some leads for the relevant authorities to work with.
It indicated that saccharine was also added to maize porridge, sugar bread and doughnuts to sweeten the taste of the products whilst cassava flour, roasted maize meal, maize flour, dried, grinded pear seed, cooking oil, water and fresh cassava chips were added to groundnut paste to increase its weight.
The regions selected for the study were Greater Accra, Volta, Eastern, Central, Brong Ahafo Western, Northern and Ashanti. Food adulteration is an act of adding or mixing something inferior, harmful, useless and unnecessary to food.
It is intended to reduce manufacturing cost, increase bulk or weight, make it appear better and conceal inferiority. Mrs. Agra noted that maize flour, milled fresh groundnuts, gari and wheat flour were added to grinded agushie to increase its weight and this act was common in Eastern, Northern, Western, Central and Greater Accra regions.
For fruits and vegetables, bixa, pear seeds and discarded kola nuts were found in ground pepper and fresh tomatoes before it is grinded whilst wood ash was also found in dried okro powder.
Meat, poultry, fish and shrimps were not out. Bixa seeds are also used for grilled meat popularly known as khebab and fried turkey tails and these were common in the Central and Greater Accra regions. For fat and oils like palm oil, dzomi, coconut oil, groundnut oil and soyabean oil; palm kernel oils, Sudan Dyes, were added and these were found in Greater Accra, Volta, Eastern, Ashanti, Central and Western regions.
"It is also shocking to know that beverages like palm wine and pito are also adulterated and surprisingly, for palm wine, water, sugar, saccharine, miracle berry monosodium glutamate, baking soda and tobacco leaves were added to sweeten them."
Tobacco leaves and marijuana were also found in pito to enhance its stimulant effects.
For miscellaneous foods, sugar, honey, baking powder, curry powder, soups and stews, water, caramel, wheat flour, granulated salt, maize flour and bixa seeds were added to enhance their sweetness.
Mrs. Agra explained that the adulterants such as saccharine and aspartame could cause cancer whilst monosodium glutamate used in soups, stews and meat could damage the brain, cause mental retardation in infants and other food flavours also had the chance of causing cancer of the liver.
Cola nuts, cassava flour and Sudan dyes used in pepper, groundnut paste and palm oil could increase anxiety and nervousness at high doses, decrease nutritive value of products and cause cancer.
"Potassium bromate (E924) used in bread has the chance of causing cancer and nitrate used in tendering meat and beans could cause cancer and tumours in the liver, kidney, trachea esophagus and lungs," she added.
Mrs. Agra cautioned that the Food and Drugs law prohibited the sale of unwholesome, poisonous or adulterated food and any person found violating the law would be punished.

South Africa - Dirty water used on fruit, vegetables
18 Aug 2008
Business Day - Tamar Kahn [edited] [iFSN]
Stellenbosch University scientists are investigating the levels of harmful bacteria on locally grown fruit and vegetables, hoping to establish a link between the bugs on the food and contaminated river water used for irrigating crops. It is reported that the research is important because it is likely to increase pressure on local municipalities to improve their water-treatment management. According to this story, fruit- and vegetable-growing businesses risk losing key customers if there are unacceptably high levels of dangerous bacteria on their crops but had limited scope to clean up the water they obtained from local rivers since setting up their own water treatment plants would be impractical and unaffordable, said an epidemiologist from the university’s community health department. Most of the dangerous bugs came from improperly treated sewage discharged into rivers by municipalities, but a small amount came directly from communities living along river banks, she said.

Kenya - Cholera - (Nyanza)
29 Jul 2008
UN Office for the Coordination of Humanitarian Affairs (OCHA), Integrated Regional Information Networks (IRIN) [edited] [Promed]
Recurrent outbreaks of cholera in the western province of Nyanza are caused by widespread water contamination, including seepage from latrines, health officials said. "The major contributor to the recent outbreaks in the area was unsafe water," the senior deputy director of medical services in Kenya's health ministry, said. "In Kisumu, many wells are built near the latrine; eventually the sewage seeps into the wells." The high water table in the area was a contributing factor, the senior deputy director said. Tests done on water samples from Kisumu and Nyando, two of the most affected districts in the province, indicated that 75 percent of sources were contaminated. "People need to be made aware of water safety, by fetching their water from a safe source and boiling it," the emergency health manager at the Kenya Red Cross Society (KRCS) said. At least 80 percent of cholera transmissions are attributed to a lack of access to safe water. The KRCS, in partnership with the Ministry of Health and other NGOs (non-governmental organizations), was sensitizing people in the affected areas to the importance of good sanitation and discouraging practices such as bathing and washing clothes in the rivers. According to the emergency health manager, this "was a tall order," since many people in the region used Lake Victoria and the rivers as their main sources of water. However, he added, the number of cholera cases had fallen. "Last week, we only reported four cases; four weeks ago, there were more than 100 cases," he said.

Nigeria - Food poisoning: How many more will have to die?
22 July 2008
This Day Online - Segun Awofadeji [edited] [iFSN]
With the increasing reported cases of food poisoning in the country as a result of preserving food items with harmful chemicals, there is a new and sustainable sensitisation and education of farmers and food dealers on the danger of using harmful agrochemicals. According to this story, worried by the prevalence and reckless sale and use of banned toxic agrochemicals nationwide for preserving foods like beans and other grains, the National Agency for Food, Drugs and Administrative Control [NAFDAC] has taken decisive steps to check the ugly practice and restore order to the non-observance of the withholding period of storage after application of the appropriate agrochemicals before consumption of the grains. The agency’s move is also meant to restore order to the chaotic agrochemicals distribution network across the country. The report said there is a rapid annual increase in sales, use and dependence on pesticides in developing countries including Nigeria.
The recent rise in food prices, especially with cereal has increased the need for production of more food in short terms so that food is not out of the reach of the ordinary Nigerian. After production, it is estimated that up to 40 percent of harvested food can be lost if adequate storage and preservation measures are not employed. The need to store and preserve food which has been harvested is therefore as important as its production. However, the storage and preservation of grains and pulses is only valuable in meeting food storages, if after storage the harvested produce is still fit for human consumption and poses no health hazard.

Ghana - Mining destroys water in Obuasi
3 July 2008
Daily Graphic [EatSafe Ghana]
A study conducted by the Third World Network-Africa (TWN-Af) into the environmental impact of mining activities at the AngloGold Ashanti Obuasi mine has revealed that a protracted period of historic mining and the more recent extensive surface mining operations have damaged the quality of water in the area. The study conducted in 2007 indicated that the water in the area was more acidic than the Environmental Protection Agency (EPA) and World Health Organization (WHO) range of standards for potable water. Total suspended solids far exceeded accepted national and international standards.The study showed that the levels of heavy metals such as Iron, Arsenic and Manganese were particularly high in most streams sampled. Arsenic values were between 10 and 38 times higher than levels permitted by EPA general guidelines, and more than 1,800 times higher than the WHO allowable values. Levels of Manganese were up to 26 times higher than the EPA allowable limts while levels of Iron were between 1.7 and 15 times higher than the EPA limits. Mercury levels were up to 5 times higher than the EPA limits and 26 times more than the WHO limits. Other metals which were present in higher concentrations than the WHO and EPA limits were zinc and Arsenic. The study revealed further that concentration of metals in fruits such as oranges grown in the area was higher than the corresponding levels in water. Temporary and spatial analysis of disease prevalence patterns showed that malaria, acute respiratory infections, diarrhoea, skin diseases, acute eye infections and schistosomiasis constitute the top six causes of Out-Patient Department (OPD) attendance in the area. The most impacted communities were Kwabrafoso, Sansu, Anyinam, Dokyiwa and Binsere, which were all situated near sites of past and present mining activities. The study recommended that prevalence of mining-related diseases should be a matter of public concern which should spur institutions, in particular the Ghana Health Service and the EPA, to investigate the causal relationship between mining and diseases prevalence in the area.

Ghana - Contaminated Food Killed 90,692 In 2006
08 May 2008
The Ghanaian Times - Francis Asamoah Tuffuor [edited] [Eatsafe Ghana]
It is reported in this story that the Food and Drugs Board (FDB) Report of 2006 shows that 90,692 people died from food and personal hygiene-related illnesses in the country. During the same period, an estimated 297,104 people were recorded as having reported at the various Out-Patients Departments of clinics and hospitals with food and hygiene-related cases. According to this story, the Deputy Chief Executive in charge of Food at the board said the situation is worrying and requires intensive education of all to help control it, saying that the high incidence of food-borne illnesses in the country is unacceptable. He said that the treatment of food and personal hygiene-related diseases alone in 2006 cost the government GH¢594,208.00, and an approximately 594,279 productive days. He also expressed the need for continuous education, particularly of traditional caterers who play crucial roles in the lives of people especially of low-income earners and the urban population. He said most of the traditional caterers are females, often relatively poor, uneducated and therefore lack appreciation for safe food handling. For instance, it is common to see fufu being pounded in the open or banku being prepared at street corners in open and near dirty drains, he said. He disclosed that 60,000 people are engaged in food vending in Accra alone, with an annual turnover of over GH¢100 million and a profit of GH¢24 million, equivalent to the average daily profit of GH¢1 per day per person. He said if a community is to have the full benefit of street vending-food with minimal risks, the government’s intervention is required to ensure that the standard of safety for such foods is the best attainable in the context of the prevailing local condition.

Ghana - EPA Probes Cause Of River Pollution
16 April 2007
The Ghanaian Times - Clement Adzei Boye, Sekondi [edited] [Eatsafe Ghana]
Some three months after 11 people died from eating fish from River Ankobra, but the Environmental Protection Agency (EPA) has not established the cause of death. The EPA collected samples from Tumantu village in Nzema East District, two months ago to ascertain the cause of death. In February, the Executive Director of EPA told journalists that preliminary investigations by the agency could not determine the cause of death, but he gave the assurance that the EPA was taking more samples received through to establish reasons for the disaster. Investigations by the local newspaper reporting the story revealed that EPA has made no breakthrough in its investigations. One official said that previously fishermen used DDT for fishing but because the residual scent remained in the smoked fish, they had resorted to another chemical called "condemn". He said that such bad practices were very common in some parts of the Western Region." According to this story, in January people started to die instantly, after eating fish from the River Ankroba, then five others died later. The dead included three children aged between four and six. Four others were treated in hospital for diarrhea and discharged.

Ghana – A pilot microbial assessment of beef sold in the Ashaiman market, a suburb of Accra
March 2008
Soyiri IN1*, Agbogli HK2 and JT Dongdem3
Abstract
Food safety is a matter of great public health concern worldwide and particularly crucial if the environment in which the food is handled is heavily contaminated
Most fresh foods, particularly that of animal origin like beef, is highly susceptible to microbial invasion and food poisoning. In poorly managed market environment particularly in Ghana, unhygienic practice is the major cause for food contamination. This study observed the hygienic practices and microbiological food safety standards of butchers who specifically sold beef in the Ashaiman market in Accra, Ghana. Hygienic practices of 16 butchers were randomly selected in a cross sectional study using an eight point scale checklist weekly over a period of four weeks. The microbial quality of 128 fresh beef samples were aseptically collected and analysed using standard microbiological techniques. It was observed that majority of the butchers did not practice safe hygiene standards as recommended by the Ghana Food and Drugs Board and the Ghana Standards Board. The beef samples were contaminated with Aerobic mesophiles (189-23000 cfu/g), Staphylococcus aureus (22-59 cfu/g), Bacillus cereus (17-41 cfu/g), Clostridium perfringens (21-48 cfu/g) and Escherichia coli (31-2200 cfu/g). The pH of the beef samples were between 6.50 and 6.90. The butchers in Ashaiman market supplied fairly contaminated beef to the general public. Escherichia coli, which is a sign of faecal contamination, was the predominant microbial contaminant in the samples examined. The result of unhygienic practices and poor handling of beef by butchers in the Ashaiman market is the major cause of contaminated beef. There are chances that other meat sold by virtually the same group of persons could equally or even more be contaminated by food borne pathogens. Hence food industry and consumers should be made aware of the potential risk of food borne pathogens in beef sold by butchers in Ashaiman market.

Sub – Saharan Africa – Hepatitis E virus
5 Mar 2008
The Gideon Database [edited]
Communicated by:Steve Berger - Geographic Medicine - Tel Aviv Medical Center Israel
Notwithstanding the recent episode in Uganda, outbreaks of hepatitis E in Sub-Saharan Africa are rarely reported. The following summary was abstracted from the Gideon database.
Botswana:
1985 - An outbreak (245 cases) in Maun was ascribed to possible water contamination.
Central African Republic:
2002 - An outbreak (48 confirmed cases) in Bangui may have been caused by contaminated drinking water.
2004 - An outbreak (10 cases) in Bangui was caused by contaminated water sold by a street vendor.
Chad:
2004 - An outbreak (1442 cases, 46 fatal) was reported in Goz Amer and Goz Beida - Sudanese refugee camps.
2005 - An outbreak (50 or more fatal cases) was reported in the area of Goz Beida (eastern Chad).
Democratic Republic of Congo:
2006 - An outbreak (341 cases, 13 fatal) was reported in Equateur Province.
Djibouti:
1993 - An outbreak of mixed hepatitis A and hepatitis E infection in Djibouti City was caused by contaminated water.
Ethiopia:
1988 to 1989 - An outbreak (423 hospitalized) of acute hepatitis E was reported among military personnel in the north.
Ivory Coast :
1986 - An outbreak was reported in Tortiya (northwestern region), the 1st well-documented outbreak of hepatitis E in Africa.
Namibia:
1983 - An outbreak (201 known cases, 7 fatal - 6 of these pregnant) was reported in the Kavango region.
1995 - An outbreak of presumed water-borne hepatitis E was reported (no details given).
Somalia:
1985 to 1986 - Outbreaks (2000 cases or more, 87 fatal) were reported in 4 refugee camps. 40 (46 percent) of the persons who died were pregnant women.
1988 to 1989 - An outbreak (11 413 cases, 346 fatal) was reported in the Shebeli River in the Lower Shebeli region.
Sudan:
1985 - An outbreak (63 fatal, including 11 pregnant women) was reported among refugees.
2004 - An outbreak (6 861 cases, 87 fatal) was reported among refugees in the Darfur region. In-hospital mortality rates as high as 17.8 percent were reported.

Risk assessment for Escherichia coli O157:H7 in marketed unpasteurized milk in Selected East African countries
01 Feb 2008
Journal of Food Protection
Grace, D.; Omore, A.; Randolph, T.; Kang'ethe, E.; Nasinyama, G.W.; Mohammed, H.O.
Researchers carried out a study to assess the risk associated with the presence of Shiga toxigenic Escherichia coli (STEC) in informally marketed unpasteurized milk in urban East Africa. Researchers used a probabilistic approach with Monte Carlo simulation and inputs from farm and household surveys. The qualitative analysis suggested a low to moderate risk of infection from consuming milk and that the widespread consumer practice of boiling milk before consumption was an important risk mitigator. Quantitative analysis revealed that two to three symptomatic STEC infections could be expected for every 10,000 unpasteurized milk portions consumed, with a possible range of 0 to 22 symptomatic cases. Sensitivity analyses to assess the uncertainty and variability associated with the model revealed that the factor with the greatest influence on disease incidence was the prevalence of STEC in dairy cattle. Risk assessment is a potentially useful method for managing food safety in informal markets.

Zimbabwe - The microbiological quality of informally vended foods in Harare
Food Control , Vol, 19, Issue 8 - Tendekayi H. Gadagaa, Bernard K. Samendeb, Cabinet Musunac and Dombo Chibandad
The aim of the present study was to evaluate the microbial quality of the informally (street) vended foods in Harare. The food samples were tested for the presence of Bacillus cereus and Salmonella sp ., while the water samples were tested for Escherichia coli . Hand and surface swabs were also taken and tested for the presence of Staphylococcus aureus and E. coli . The results suggest that some of the vendors’ hands were unacceptably contaminated, indicating poor hygienic practices. A comparison of surface and hand swabs between vending sites showed that the highly crowded markets had difficulties in meeting good hygienic standards. The training of vendors in food hygiene and provision of appropriate infrastructure were identified as key issues to the improvement of the safety of informally vended foods in Harare.