Presentation by Theo Knight-Jones, Kebede Amenu, Gemma Tacken, Guy Ilboudo, Donya Madjdian, Sisay Girma, Abdulmuen Mohammed Ibrahim, Delia Grace, Emely de Vet and Michel Dione at the 16th International Symposium of Veterinary Epidemiology and Economics, Halifax, Canada, 12 August 2022.

1. Pull-Push: Market and consumer interventions to
improve food safety in Ethiopia and Burkina Faso
Theo Knight-Jones1, Kebede Amenu1, Gemma Tacken2, Guy Ilboudo1, Donya Madjdian2, Sisay Girma3,
Abdulmuen Mohammed Ibrahim3, Delia Grace1,4, Emely de Vet2 and Michel Dione1
1International Livestock Research Institute
2Wageningen University & Research
3Haramaya University
4Natural Resources Institute, University of Greenwich
22nd International Symposium of Veterinary Epidemiology and Economics
Halifax, Canada, 12 August 2022

2. Background
Animal source foods in SSA
• important for human nutrition
• production and processing give
jobs to millions
• single most important cause of
(zoonotic) foodborne diseases
(FBD)
• Previous efforts to control FBD
focused at primary production
• This neglects risk of cross-
contamination closer to the
consumer
Havelaar et al., 2015 http://dx.doi.org/10.1371/journal.pmed.1001923
Foods implicated according to FERG (WHO, 2017)

3. Details
• Project: Urban food markets in Africa: Incentivizing food safety using a pull-push approach
• “Can consumer demand for safer food be generated to drive
improved food safety in informal market value chains in Africa?”
• Ouagadougou, Burkina Faso and Dire Dawa and Harar, Ethiopia
• Multicomponent food safety interventions with mixed method evaluations
• Tomato and chicken value chains
• Example Burkina Faso

4. Chicken consumption in Ouagadougou
FARM
TRANSPORT
MARKET
SLAB SLAUGHTER
Carcass:
50% Salmonella
70% Campy
Wash water:
100% Salmonella (Kagambega, 2018)

5. Chicken consumption in Ouagadougou
FARM
TRANSPORT
MARKET
SLAB SLAUGHTER/
RESTAURANT
STREET RESTAURANTS
75% OF CONSUMPTION-
mostly men
40% unacceptable
bacterial load (Somda
et al. 2018)

6. Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
VC actor
Knowledge, Attitudes,
Practices
Social Behaviour
Change
Communication
Campaign
Vendor
training
Intervention
Package
(RCT)
Local Regulator
Training
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Surveys &
observations VC
actors
“After” group discussions
Knowledge, Attitudes &
Practices
Photovoice/FGD
s
Triangulation
Burkina Faso - Chicken
Midline
Treatment
Group
Control
Group
Observation
s VC actors
Booster
training
KIIs/FGDs

7. Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
VC actor
Knowledge, Attitudes,
Practices
Social Behaviour
Change
Communication
Campaign
Vendor
training
Intervention
Package
(RCT)
Local Regulator
Training
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Surveys &
observations VC
actors
“After” group discussions
Knowledge, Attitudes &
Practices
Photovoice/FGD
s
Triangulation
Burkina Faso - Chicken
Midline
Treatment
Group
Control
Group
Observation
s VC actors
Booster
training
KIIs/FGDs

8. Consumer food safety awareness campaign
• Example Burkina Faso: Cost – US$100,000 – implemented by advertising agency
• Campaign goals
• To empower consumers in Ouagadougou to make safe choices regarding choosing chicken for
out-of-home and home consumption
• Key approach: emphasize with a positive message that there is a safe choice available that
reduces foodborne diseases in their family
• TV and radio adverts
• 30 billboards around city
• Facebook capsules by an influencer “Moussa Petit Sergent” >700,000 views and climbing

9. Evaluation
• Consumer food safety campaign – Ouagadougou, Burkina Faso Example Burkina Faso
• Before and after consumer KAP surveys 2022/3
• Impact in changing knowledge, attitudes & practices around controlling food safety risks for
chicken meat and/or tomatoes
• Cost per survey US$20,000 – n=1,100 participants per survey – 20 for endline photovoice
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
I. Pre-intervention II. Intervention III. Post-Intervention
Baseline Endline
Social Behaviour
Change
Communication
Campaign
Consumer surveys
(longitudinal)
Knowledge, Attitudes,
Practices
Photovoice/FGD
s
Photovoice

10. Why this design?
• RCT not possible as campaign broadcast to whole city (2 million population)
• Trying a cluster trial would require different sites and still not possible to broadcast in such a focused way
• Will include double difference (difference in trends)
Results
• Not available

11. Main challenges
• Implementing and evaluating many things at the same time in multicomponent intervention with
multiple evaluation methods in resource limited setting
• Laboratory work is almost always challenging in this setting due to difficulties with partners,
procurement, obtaining supplies, quality, cost… but can bring valuable capacity building and insights
• No great separation of the intervention implementers and the evaluators – we lead both!
Advice for research in informal markets
• Work with established quality partners and allow a lot of time for laboratory studies

12. THANK YOU
THANK YOU
Urb an food markets in A frica: In c entivizin g food safety u sin g a p u ll -p u sh ap p roac h