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Challenge of One Health and Global Health Strategies in Africa: An Experience of North-South, South-South Collaboration

This article explores the challenges and strategies of One Health and global health in Africa through collaboration between North-South and South-South regions. It focuses on sustainable food safety and the prevention of foodborne diseases, with a particular emphasis on the impact on women and children. The article discusses the determinants of dietary exposure and the need for an intersectoral and transnational approach to address foodborne zoonoses. It also highlights the importance of data collection and proactive involvement of scientists, students, and citizens in addressing these challenges. The article suggests tools such as a risk analysis gallery and a journal for scientific dissemination.

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Challenge of One Health and Global Health Strategies in Africa: An Experience of North-South, South-South Collaboration

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  1. Challenge of One Health and Global Health strategies in Africa: an experience of North-South, South-South collaboration Chiara Frazzoli, R. Esposito, Rachel Cheng Emails: Esposito: ure.project@iss.it Cheng: rachel.cheng@unitus.it

  2. NOODLES Networking The Network “Nutrition & food safety and wholesomeness - Prevention, education and research network” NOODLESis a non Lucrative Organization of Social Utility. http://www.noodlesonlus.org

  3. MISSION STATEMENT With the main public health objective of Sustainable Food Safety, NOODLES has the mission of promoting nutrition, food safety and wholesomeness by protecting and promoting local food chains and environments, food security and food sovereignty in an increasingly interconnected, “globalized”, food production system.

  4. Objective: Sustainable Food Safety (SFS) • SFS is defined as the complex of actions intended to minimize adverse health impact on future generation associated to today's safety of foods and nutritional quality of diet. • Impact on: • mitigation of infant morbidity and mortality • increase of healthy life expectancy at birth Frazzoli et al. (2009) Sustainable development and next generation’s health: a long-term perspective about the consequences of today's activities for food safety. Annali dell’Istituto Superiore di Sanità, 45:65-75

  5. Sustainable Food Safety Women in childbearingage 1 5 Exposure starts during life in uterus . Adverse health outcomes: 5: Found in adults e.g. cardiovascular diseases 3:Found in newborns e.g. congenital malformations Exposure 2 4 Exposure Exposure 2 and 4: Carry over from maternaltoxicants body burden (placenta and breast milk) and toxicants body burden of the child (Transgenerationaldiet ) 3 Toxicants body burden in the mother

  6. Sustainable Food Safety and Foodborne diseases One step for SFS is the prevention and control of “foodborne diseases”. Definition (WHO): Foodborne diseases are “diseases of an infectious (e.g. microorganisms) or toxic (e.g. chemicals)nature caused by, or thought to be caused by, the consumption of food or water”.

  7. Exposure and body burden: Health outcomes • Contamination happens from Farm to Fork. • Unsafe food, can contain • harmful bacteria, • viruses, parasites or • chemical substances e.g. Endocrine disrupting chemicals, • Unsafe food causes more than 200 diseases – ranging from diarrhoea to cancers.

  8. Determinants impacting on dietary exposure • Population growth and socio-economic factors (increase of chemical, microbiological and other hazards on health) • Intensification/industrialization (e.g. massive use of pesticides, antibiotics) • Urbanization (e.g. street food) • Globalization (e.g. longer food chain) • Climate change and risks influence food production, storage and distribution (e.g. mycotoxin, shelf-life)

  9. Many foodborne diseases are zoonotic: foodborne zoonosis According to the definition of “foodborn zoonosis” proposed by Adriano Mantovani (a well-respected Italian veterinarian): “Any detriment to the health and/or quality of human life deriving from relationships with (other) vertebrate or edible or toxic invertebrate animals.” Toxicologically relevant chemical exposures through foods of animal origin are also foodborne zoonoses.

  10. Toxicant zoonoses need:1. Intersectoral approach as One Health Management and reduction of health risks derived from foodborne zoonoses must consider the complexity of interactions among • humans, • animals and • the various environments they live in; as well as communication and collaboration among the sectors responsible for • human health, • animal health, • and the environment.

  11. Toxicant zoonoses need:2. Transnational approach as Global Health “Global health is an area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide”.(Koplan, et al. 2009) R. Beaglehole (2010) includes some relevant elements that clarify the definition: • Health care actions across all sectors, and multiple disciplines; • Collaborative actions among different actors and institutions addressing healthtopics with a wide range of determinants; • Actions that go beyond national boundaries; • Research and evidence based actions; • Actions focused on prevention and public health initiatives; • “Health for all” referring to equity issues and primary health care”.

  12. PROBLEM: Africa is overall a data-poor continent NOODLES proposal: • Importance of the proactiverole of scientists, students, citizens • Creative participation • Risk Analysis

  13. gallery@noodlesonlus.org Possible tools: • Photos and video galleries • The Gallery collects photos and videos related to diet, food and food productions in areas of the world where limited coverage on these topics exists. • 2. Journal • The journal servesastool for scientificdisseminationlinkingsocietal and scientificcomponents of the Network and isconstructed in fiveareas: • Primary production • Kitchen toxicology • Diet • High riskscenarios • Dissemination

  14. Some experiences of the Network in south-Sahara Africa the E-WASTE CASE-STUDY has highlighted the health long-term risk for breastfed infants the ENQUIRY ON ALTERNATIVE FEEDING has highlighted the risk of dumping of Bisphenol A-baby bottles REFLECTIONS ON TRADITIONAL CENTRAL-WEST AFRICA STREET FOOD has allowed to discuss some toxicological hazards related to food processing and preparation

  15. E-waste: a problem for the general population, with a more vulnerable target group

  16. « Diagnostic » risk assessment E-wasteenvironmentalpollution and human exposure are known. Riskanalysisispoor on the actualrisks for healthsustainability of the general population. SFS is in risk due to ilicit dumping, crude recycling and improper treatment and disposal. Toxicological information havebeenconsideredalong with available data on environmental and foodcontamination and human internalexposure. Frazzoli C., Orisakwe O.E. et al. (2010) Diagnostic health risk assessment of e-waste on the general population in developing countries’ scenarios. Environmental Impact Assessment Review, 30:388–399

  17. Further to occupational and directlocalexposure, e-wastescenariosmay impact on the environment-to-foodchain, locally and globally (longerfood production and distributionchains)

  18. Breast-fed infants in e-waste areas E-waste exposure is an actual public health emergency. Carry over of e-waste lipophilic substances in breast-milk: The need for a risk-to-benefit assessment of breast-feeding, is a highly recommended practice, could be considered as a further adverse implication of e-waste pollution.

  19. Stepsforward • One Health: • Mitigation measures in the short and medium period • Tolerabledistance of living environments and rearing/agriculturallands from e-wastesites. • Researches on: • body burdendetoxification (humans and animals) systems • possibleprotectivedietaryfactors • cost-effectivebiomarkers for environmentalmonitoring • Global Health: • Identification of local and global actorsand sectors for the e-wasterisk management and communication • Networking for scientific-basedboostinge.g. • COST Action funded by the EC: Network on technology-critical elements - from environmental processes to human health threats

  20. Use of Bisphenol A (BPA)-containing baby bottles: potential infant exposure in Cameroon and Nigeria

  21. Field survey (2011) OBJECTIVES Investigate current risk scenario of BPA exposure of bottle-fed children, from availability, accessibility and affordability of plastic bottles with and without BPA to use customary pattern and risk perception. METHODS Setting:pharmacies, local markets and shops around hospitals were visited in three cities (Yaoundé, Foumbot, Bafoussam) in two different regions in Cameroon, and two cities (Lagos and Port Harcourt) in two States in Nigeria. Design: Observational survey in a randomized group of vending sites (34 pharmacies; 87 shops and markets), qualitative information based on interviews and group discussion from 48 mothers.

  22. Major findings Plastic baby bottles labeled and unlabelled as BPA-free are available, but the unlabelled are more accessible and affordable, due to presence in shops and lower costs. Customary use patterns (e.g., temperature and duration of heating) associated with lack of information on BPA-related risks may increase intake by infants. No legislation exists to regulate production, import and market of food contact materials, including baby bottles. Pouokam G.B., Ajaezi G.C., Mantovani A., Orisakwe O.E., Frazzoli C.(2014) Use of Bisphenol A-containing baby bottles in Cameroon and Nigeria and possible risk manage’ment and mitigation measures: community as milestone for prevention. Science of the Total Environment 481:296–302

  23. Stepsforward Global Health:Identification of local and global actorsand sectors for the risk management and communication. Examples: Risk communication to policy makers, sellers and citizens is paramount both to mitigate BPA intake and oppose possible dumping phenomena from countries where BPA-containing materials are banned. Research: Estimate infants exposure in Africans settings Governmental initiatives in Africa so far: South-Africa. BPA bottles phase out project: “BPA Baby Bottle Exchange & Recycling Project”

  24. Street cookery: an emerging hot issue for health

  25. Perspective: streetcookery • Location • Safety of raw materials • Storage • Utensils • Cooking equipment • Handling • Processing Street foodsare defined asready-to-eat foods prepared and/or sold by vendors and hawkers especially in the streets and other public places (FAO, 1989) Foods cooked on the street deserve special attention for chemical/toxicological hazards – with the following points of particular attentions:

  26. Food processing and vending place may be exposed to airborne toxicants, such as lead and other heavy metals, polycyclic aromatic hydrocarbons (PAHs) and persistent organic pollutants (POPs) as dioxins and polychlorinated biphenyls (PCBs). The majority of processing and vending sites are poorly constructed, determining the lack of proper protection of foods from pollution. Proietti I., Frazzoli C., Mantovani A. (2014) Identification and management of toxicological hazards of street foods in developing countries. Food and Chemical Toxicology 63:143–152

  27. Steps forward Global Health: Identification of local and global factorsand sectorsfor the risk management and communication Even the fact that is an important source of affordable food street food sector not being officially recognized in many countries, i.e. it does not meet adequate standards neither there is public awareness of risksposed. PPAs (Points of particular attentions) are needed e.g.: The HACCP (Hazard Analysis and Critical Control Point) is a preventive proactive approach which allows identifying potential risk factors before they occur. HACCP strategy is generally mainly applied to hygienic/microbiological risks and also necessity of a systematic and comprehensive extension of HACCP approach to factors associated with chemical/toxicological hazards.

  28. The first report of the network Frazzoli C, Asongalem EA, Orisakwe OE (Ed.). Cameroon-Nigeria-Italy scientific cooperation: veterinary public health and sustainable food safety to promote “one health/one prevention Roma: Istituto Superiore di Sanità; 2012. (Rapporti ISTISAN 12/49) Free download from the web

  29. Implementation of the One Health approach in the Global scenario in Africa is challenging and complex, but feasible. Thank you for the attention We look forward to welcome your proactive interaction on the NOODLES website & Facebook

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