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Promotion of Food Safety

Consuming unsafe foods exposes humans to viruses, bacteria, parasites, and fungi that can cause infections, inflammation or micronutrient deficiency by reducing the micronutrient absorption; they can all contribute to anemia. Governments may regulate the processes of production, processing, and selling foods to decrease these risks. Within the home, consumers can practice the World Health Organization’s (WHO) five key steps for safer food to further decrease the risk of foodborne illness or disease:

  1. Keep clean.
  2. Separate raw and cooked foods.
  3. Cook thoroughly.
  4. Keep food at safe temperatures.
  5. Use safe water and safe raw materials.

Meat, eggs, milk, fish, and fresh fruits and vegetables, often produced by smallholder farmers and sold in informal markets, are high-risk products for consumers (Grace et al. 2015). Crops, such as maize and peanuts, harbor mycotoxins, which compromise immune responses (Turner 2013). Parasites acquired from eating raw fish are associated with anemia (Villazanakretzer et al. 2016); uncooked milk may transmit listeria (Grace et al. 2015); and feces-contaminated food or water often transmit E. coli bacteria that can result in severe and bloody diarrhea—followed by nutrient and blood loss (Betz et al. 2016). Salmonella and hepatitis E infections, caused by consuming contaminated food and water, are also a problem (Odey, Okomo, and Oyo-Ita 2015).

Measurement and data sources

WHO’s Five Keys to Safer Food series recommends safe food production and marketing, including keeping fishpond sites clean, protecting fields from fecal contamination, treating fecal waste when using it as fertilizer, managing water quality and irrigation water risks, and using clean equipment for harvesting. Any monitoring data on those indicators would also be useful. Additionally, data on the following government policies and guidelines for food safety, if available, can provide important information on how well this intervention is being implemented.

These data can be difficult to identify. Proxy indicators that measure rates of food safety issues may identify when these efforts are not taking place. At the production level, these could include a prevalence of outbreaks of foodborne illnesses in animals, or levels of aflatoxin and other mycotoxins in crops. At the consumption level, data on outbreaks of salmonella, hepatitis E, and other illnesses from consuming high-risk products may also be maintained.

The Ministry of Health, or the ministry responsible for food industry regulation, may have data on foodborne illness outbreaks and preventive practices. WHO has estimates of the global burden of foodborne diseases, but they are global rather than country specific (Foodborne Disease Burden Epidemiology Reference Group 2007-2015 2015) and they may track some of the food safety indicators mentioned above (Foodborne 2015).

Methodological issues

  • Little information is available about foodborne illnesses. But, given their ubiquity and their impact on food producers and food consumers alike, they are an important area to consider.


Betz, Josefine, Isabel Dorn, Ivan U. Kouzel, Andreas Bauwens, Iris Meisen, Björn Kemper, Martina Bielaszewska. 2016. “Shiga Toxin of Enterohemorrhagic Escherichia Coli Directly Injures Developing Human Erythrocytes.” Cellular Microbiology 18: 1339–48. doi:10.1111/cmi.12592.

WHO and Foodborne Disease Burden Epidemiology Reference Group. 2015. WHO Estimates of the Global Burden of Foodborne Diseases. Geneva, Switzerland: WHO.

Grace, D., Kristina Roesel, Erastus Kang’ethe, Bassirou Bonfoh, and Sophie Theis. 2015. “Gender Roles and Food Safety in 20 Informal Livestock and Fish Value Chains.” IFPRI Discussion Paper 1489. Washington, DC: International Food Policy Research Institute (IFPRI).

Odey, Friday, Uduak Okomo, and Angela Oyo-Ita. 2015. “Vaccines for Preventing Invasive Salmonella Infections in People with Sickle Cell Disease.” Cochrane Database of Systematic Reviews, no. 6: CD006975. doi:10.1002/14651858.CD006975.pub3.

Turner, Paul Craig. 2013. “The Molecular Epidemiology of Chronic Aflatoxin Driven Impaired Child Growth.” Scientifica 2013: 152879. doi:10.1155/2013/152879.

Villazanakretzer, Diana L., Peter G. Napolitano, Kelly F. Cummings, and Everett F. Magann. 2016. “Fish Parasites: A Growing Concern During Pregnancy.” Obstetrical and Gynecological Survey 71 (4): 253–59. doi:10.1097/OGX.0000000000000303.