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Application of Risk Analysis / HACCP: Case of Milk-Borne Public Health Risks Analysis in Milk Markets in Kenya. Presentation at Workshop on Impacts of Urban and Peri-urban Livestock Systems on Public and Ecosystem Health in Nigeria 18-19 Sept 2002 ILRI-IBADAN, NIGERIA. A. Omore ILRI-Kenya.

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Application of risk analysis haccp

Application of Risk Analysis / HACCP:

Case of Milk-Borne Public Health Risks Analysis in Milk Markets in Kenya

Presentation at Workshop on Impacts of Urban and Peri-urban Livestock Systems on Public and Ecosystem Health in Nigeria

18-19 Sept 2002

ILRI-IBADAN, NIGERIA

A. Omore

ILRI-Kenya


Application of risk analysis haccp

Major issues in regulation for food safety in dairy markets in Kenya

Limited information base for policy formulation, therefore reliance on Western models

However, raw milk markets dominate mainly because most consumers refuse to pay higher costs that pasteurisation and packaging incurs

Need for risk information to balance trade-offs between food safety and economics

Risk analysis is the right approach


Application of risk analysis haccp

Percent milk marketed informally in selected countries in Africa & elsewhere

Sub-Saharan Africa Percent

Kenya 88

Tanzania 98

Uganda 90

Central America

Nicaragua 86

Costa Rica 44

South Asia

India 83

Sri Lanka 40

Typical Small milk trader

in Kenya


Application of risk analysis haccp

Assessment of risks

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Study sites and Dairy Density

  • Nakuru/

  • Narok:

  • Extensive production

  • Medium market access

  • Exotic &

  • Zebu cattle

  • Nairobi/

  • Kiambu:

  • Intensive production

  • High market access

  • Exotic cattle

Sites differentiated between levels of market access and production system


Application of risk analysis haccp

Study methods

Participatory research and structured data collected between 1999 and 2001

Data included milk pathways, handling practices by market agents and consumers, laboratory hazard assessments, economic & GIS


Application of risk analysis haccp

Analytical approaches

Health Risk Analysis for each hazard using HACCP as a tool/guideline

What is Risk analysis?

What is HACCP?


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: Risk and Hazard

Risk = Fn of both probability (likelihood) & magnitude (impact) of an adverse effect from a hazard

Hazard = A biological, chemical or physical agent in food that may have adverse health effect


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: Risk Analysis Components

Risk Analysis is a process consisting of three components:

1. Risk Assessment

2. Risk Management

3. Risk Communication


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: Risk Assessment

  • 1. Risk Assessment = The scientific evaluation of adverse health effects from exposure to a food-borne hazard. It involves these steps:

  • Hazard identification

  • Hazard characterisation: qualitative / quantitative / dose-response

  • Exposure assessment: evaluation of degree of intake

  • Risk characterisation: integration of above and reference to a population and uncertainties


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: Risk Mgt & Communication

2. Risk Management: The process of weighing policy alternatives to accept, minimise or reduce assessed risks and to select and implement appropriate options

3. Risk Communication: An interactive process of productive exchange of information with stakeholders


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: HACCP

Hazard Analysis Critical Control Points (HACCP) is a tool/guideline for risk analysis.

Originally applied to food for astronauts

HACCP is designed to prevent problems before they occur and to correct deviations as soon as they are detected. Such preventive control systems with documentation and verification are widely recognized as the most effective approach for ensuring food safety.

HACCP reduces regulatory enforcement costs


Application of risk analysis haccp

Analytical approaches (cont’d)

Definitions: HACCP Steps/principles

  • Assessment of risks in the food chain (use conceptual flow-diagrams)

  • Determination of critical control points (CCPs): Points for remedial action

  • Determination of Critical Limits (CL)

  • Development of monitoring systems

  • Implementation of monitoring procedures

    • - Corrective action, Documentation & Verification

Challenge: Adapting HACCP concept to informal food market situations


Application of risk analysis haccp

Analytical approaches (cont’d)

Laboratory Hazard Assessment in Kenya

  • Total & Coliforms Bacteria.

  • Butter-fat

  • Added water

  • Brucella abortus

  • E. coli 0157:H7

  • Antibiotics & antibacterials

  • Bovine TB (M. bovis) in humans

: SPC

: Gerber Method

: Specific gravity

: MRT, ELISA

: Culture & typing

: Charm tests

: Culture and PCR

Hazards to be investigated were identified at the initial stakeholder consultation


Application of risk analysis haccp

Analytical approaches (cont’d)

Risk factors (Risk characterisation) in Kenya

Consumer preference, market structure, conduct and performance

Market margins

Spatial factors affecting marketing behaviour and performance

Regression, principal component and clustering of milk quality indicators & profit parameters


Application of risk analysis haccp

Highlights of Results of Risk Characterisation

Percent of Households Buying Raw and Pasteurised Milk in Kenya

100

Raw

80

Pasteurised

% hh

80

93

78

60

40

34

29

20

5

0

Nairobi

Nakuru urban

Nakuru rural


Application of risk analysis haccp

Raw milk preferred due to its low price

Milk prices (1999)

Mean Price (KSh/Litre

Area

Raw milk

Pasteurised milk

Nairobi

31.5

40.0

Nakuru urban

25.3

41.0

Nakuru rural

18.4

41.0

Lower prices for raw milk in rural areas and as distance

·

from Nairobi increases


Application of risk analysis haccp

Quantity of pasteurised and raw milk purchased in Nairobi, by income groups

40

Raw

Pasteurised

30

Lts

20

10

0

<2500

2500-

5000-

10000-

20000-

>30000

4999

9999

19999

29999

Income Groups (KSh)

  • Higher quantities consumed as income increases

  • Price is not the only determinant of raw milk consumption. Tastes and preferences also count


Application of risk analysis haccp

Overview of lab. results

Adulteration

  • KEBS standards for specific gravity <1.026kg/l (added water) & >1.032kg/l (added solids) applied

    • Added Water %Added solids %

  • Consumer hh56

  • Mkt agents101

  • Adulteration highly variable by season & area

  • All traders had some adulterated milk

  • Tendency to add water during periods of low milk supply and high milk prices


  • Application of risk analysis haccp

    Bacterial counts (cfu/ml):% bad/very bad(KEBS)

    Raw: TC>2M, CC>50,000; Pasteurised: TC>30,000, CC>10

    Total Bacteria

    Coliform Bacteria

    100

    80

    %

    60

    Samples

    40

    20

    0

    Farmer grp

    Milk Bar

    Shop/Kiosk

    Mobile

    Pasteurised-

    Supermkts

    Pasteurised-

    Kiosks

    Trader type

    • High counts in urban; low counts in rural areas

    • Lack of effective preservation e.g., cooling. Standards?

    • Significant deterioration before first transaction


    Application of risk analysis haccp

    Zoonoses

    Brucella abortus antibodies %

    30

    20

    Season 1

    % hh/

    Season 2

    agents

    10

    0

    MRT

    ELISA

    MRT

    ELISA

    Urban hh

    Rural hh

    Informal agents

    Pasteurized milk

    • Bulking of raw milk  higher risk of brucellosis

    • 6% of rural hh consume home-made fermented milk

    • E. coli 0157:H7 2 out of 264 (<1%)

    • No M. bovis


    Application of risk analysis haccp

    % Health awareness of milk-borne hazards

    100

    100

    100

    96

    80

    65

    60

    %

    40

    44

    20

    23

    0

    Nairobi urb

    Nakuru urb

    Nakuru rural

    Aware

    Boiling

    • Nearly all hh boiled marketed milk prior to consumption but some naturally fermented milk also consumed


    Application of risk analysis haccp

    Antibiotics & antibacterials (Charm AIM-96 Test)

    % above acceptable limits

    (EU/Codex Alimentarius MRLs)

    20

    15

    % hh /

    10

    agents

    5

    0

    Milk bars

    Past.

    Coops

    Shops /

    Small

    Urban hh

    Rural hh

    Kiosks

    traders

    • All common antibiotics & antibacterials tested (penicillins, tetracyclines, sulphonamides, aminoglycosides & macrolides)

    • The major health risk found.

    • An average Kenyan consumer is exposed to milk with unacceptable residue levels twice every month!


    Application of risk analysis haccp

    Antibiotics & antibacterials (Charm AIM-96 Test)

    Detection levels of Charm-AIMtest, MRLs and ADI

    DrugMin. testEU/Codex Codex ADI

    Range g/kgMRLs g/kg

    Penicillin G3-4 4 30 g/day

    Oxytetracycline150-30010030g/kg bwt


    Application of risk analysis haccp

    Factors associated with milk quality (OLS)

    Total bacteriaColiformsSNF

    Nairobi/Kiambu Strong (+++)Strong (+++)

    Wet season Strong (+++)Medium(--)Medium (--)

    SNF Medium(+++)N/A

    Market Pathways (relative to Farm-coop)

    Farm-Shops/kiosk Weak (+)Medium (--)

    Coop-Shop/kioskWeak (+)

    Mobile trader-Milk bar Medium (--)

    Milk handling

    Milk preservationWeak (-)

    Plastic containerMedium (++)

    Scooping vs pouringMedium (++)

    Piped waterMedium (++)

    Other covariates

    Time since collection Strong (+++)

    Profit Margin/ltStrong (---)


    Application of risk analysis haccp

    Major risk factors (CCPs) in milk handling and critical points

    • Antibiotics & antibacterials

      Major risk that heat treatment cannot address

      Long term issue to be addressed mainly at farm level

    • Bacterial risks: Can be addressed by boiling/pasteurization

      • Total Bacteria

        Wet season, Time before and after first transaction, Pathways from farms to shops/kiosks and milk bars

      • Coliform Bacteria

        • Lack of training, Scooping vs. pouring, Plastic containers

      • Zoonoses

        • Fermented milk is a potential source; No Bovine TB


    Application of risk analysis haccp

    Current licensing requirements do not promote good milk quality in Kenya

    Summary of means of new variables & major clusters (principal component and cluster analysis)

    ClusterLarge scaleLow High LongSCALE

    Freq./Experiencequalitymargin Time

    22-0.310.29-1.470.48Small: 44 l/d

    158-0.25-0.06 -0.19 0.06Small: 126 l/d

    120-0.37-0.01 0.58 0.08Small: 108 l/d

    252.74-0.29 0.11 0.07Large: 5,536 l/d

    22 0.89-0.36-0.21 -0.03Medium: 367 l/d

    • Small traders grouped together irrespective of licensing

    • Quality is not a problem for majority of small traders (relatively)

    • Training/experience helps to significantly improve milk quality

    • Can target specific groups and market pathways


    Application of risk analysis haccp

    Conclusions (risk assessment)

    Consumers generally prefer whole raw milk but this fact is currently ignored by policy makers

    More than 50% of samples exceed current hygiene standards

    Nearly all consumers who purchase milk boil it before consumption

    Antimicrobials are the major public health risk

    Some risk from consumption of naturally fermented milk

    Small traders use cheap and poor quality containers mainly due to policies that exclude them


    Application of risk analysis haccp

    Conclusions (risk management)

    Policy is ineffective since the quality of traded but unlicensed milk does not differ significantly from licensed milk

    Tradeoffs should consider actual risks, consumer preference and ‘safety’ as perceived by them

    Appropriate public intervention should be through consumer education

    Alternative approach of training and certification of market agents should result in better milk quality and better service to consumer preferences

    Role for self-regulation?


    Application of risk analysis haccp

    Conclusions (risk communication)

    Communicating the risk information has largely been productive with some positive changes in mindsets

    Policy was/is important and policy-makers were therefore directly included in research and testing of interventions.

    Private sector and NGOs also included

    Stakeholders gathered in early 2001 mandated policy makers to form a committee to refine recommendations and oversee their implementation


    Application of risk analysis haccp

    Conclusions (risk communication cont’d)

    Engage in public debate

    Contribution to changing policy environment: Drafts of Policy & Bill explicitly recognize the predominance of small scale raw milk markets and are supportive

    However, additional changes in legislation and institutions will be required to realize the desired changes in the new DDP


    Application of risk analysis haccp

    Acknowledgements

    Co-investigators and Institutional Collaborators

    University of Nairobi: S. Arimi, E. Kangethe

    Graduate Students:A. Mwangi, G. Aboge, R. Koech,

    E. Koroti

    KEMRI:J. Odhiambo, E. Juma

    Egerton University:Dept. of Dairy Techn. & Food Sci

    ILRIMOSD staff + J. McDermott

    MoARDH. Muriuki

    DFID bilateralSupport to SDP


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