TARTARE: The Assessment and Management of Risk from Non-typhoidal Salmonella, Diarrheagenic Escherichia coli and Campylobacter in Raw Beef and Dairy in Ethiopia

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Foodborne diseases are important public health problems in developing countries, causing considerable morbidity and mortality and, thus, having a substantial social and economic impact. Even so, the burden of foodborne disease and its impact on development is not well investigated in low and middle-income countries (LMICs) such as Ethiopia.

TARTARE will use a risk-based framework to address important knowledge gaps in understanding the burden of foodborne disease in Ethiopia and develop cost-effective, gender-sensitive and socio-culturally appropriate approaches for mitigating the impact of foodborne disease, with the goal of improving food safety governance in low and middle-income countries.

TARTARE’s overarching goal is to reduce morbidity and mortality from foodborne diseases. Our work focuses on three major food safety pathogenic hazards in raw beef and dairy products in Ethiopia as a model for other low and middle income countries (LMICs) to follow in their efforts to implement risk-based approaches to improving food safety. TARTARE will achieve this goal by:

1.  Determining the public health burden and costs associated with non-typhoidal Salmonella (NTS), diarrheagenic Escherichia coli (DEC), and Campylobacter (CAMPY) in Ethiopia;

2.  Identifying and testing cost-effective, gender sensitive and socio-culturally acceptable approaches to mitigating public health risks associated with NTS, DEC and CAMPY in raw beef and dairy products;

3.  Providing framework for determining where resources should be allocated nationally to effectively reduce risk of foodborne disease from all pathogens, including NTS, DEC and CAMPY, and  all foods, including beef and dairy.

See TARTARE Framework Diagram Here

Incidence of illness, public health burden and costs associated with NTS, DEC, and CAMPY in Ethiopia will be estimated through a combination of epidemiologic studies. A descriptive epidemiologic study of laboratory data from Addis Ababa University, Haramaya University and University of Gondar will be used to estimate the number of laboratory-confirmed cases in Ethiopia. Healthcare worker and community cross-sectional surveys will be conducted to develop multipliers for estimating the incidence of illness and cost estimates of the targeted pathogens in Ethiopia. A case-control study of children under the age of 15 will be conducted to estimate the proportion of diarrheal cases that can be attributed to NTS, DEC and CAMPY.

Training interventions for food producers will be coupled with processing interventions aimed at improving the safety of raw beef and dairy products. A jerky processing procedure that provides at least a five log reduction in NTS, DEC, and CAMPY will be validated and starter cultures which improve safety and quality of naturally fermented dairy products will be developed using local strains. Quantitative microbial risk assessment will be coupled with economic analyses to evaluate effectiveness of interventions in changing behaviors and reducing microbial contamination.

Finally, stakeholders will be engaged in risk-ranking and risk-prioritization activities to inform decisions of where resources should be allocated nationally to reduce risk from foodborne disease.

Funding: This project is supported by the Bill & Melinda Gates Foundation, and UK aid from the UK Department for International Development (Grant Agreement Investment ID OPP1195603).