The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

BACKGROUND: The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers. METHODS: This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted. RESULTS: Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system. CONCLUSION: The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.

Mapping the pork value chain in Vietnam: a systematic review.

In Vietnam, pork is the most commonly consumed type of meat, and the demand is expected to rise even further. Nevertheless, food safety is a major concern, as the country bears a high burden of food-borne diseases, including these caused by pork products. Knowledge of the flows of pigs and pork from producers up to the consumers is important; however, up to now, a comprehensive overview is lacking. We addressed this by conducting a systematic review on the pork value chain (PVC) mapping for the country. Four international and three Vietnamese databases were searched for data on the pork value chain in Vietnam, and the results were reported according to the PRISMA guidelines. Data obtained from the retained records showed that 10 main PVC types are present in Vietnam, comprising of five main actors including: producers, middlemen, slaughter men, retailers and consumers. Among the identified chains, the one involving producers, slaughter men, retailers and consumers is the most common one, with up to 75% of pork following this route. In cities or export routes to other countries, middlemen and/or traders are important additional actors in the PVCs. The small scale of PVC linkages is prominent. The presence of middlemen, pig traders and pork traders is contributing to further distribution of pork products in geographical terms. Transactions between actors in the traditional PVCs in Vietnam are characterized by the absence of official contracts; therefore, the linkages in the chains are loose and the origin of pork is not traceable. More industrial forms of PVCs are slowly developing; however, the traditional PVCs are still prevailing in Vietnam. The weak linkages between actors and poor hygienic practices in these chains form a risk to pork safety.

Carbon and water footprint of pork supply chain in Catalonia: From feed to final products.

A systematic tool to assess the Carbon Footprint (CF) and Water Footprint (WF) of pork production companies was developed and applied to representative Catalan companies. To do so, a cradle-to-gate environmental assessment was carried out by means of the LCA methodology, taking into account all the stages involved in the pork chain, from feed production to the processing of final products, ready for distribution. In this approach, the environmental results are reported based on eight different functional units (FUs) according to the main pork products obtained. With the aim of ensuring the reliability of the results and facilitating the comparison with other available reports, the Product Category Rules (PCR) for Catalan pork sector were also defined as a basis for calculations. The characterization results show fodder production as the main contributor to the global environmental burdens, with contributions higher than 76% regardless the environmental indicator or the life cycle stage considered, which is in agreement with other published data. In contrast, the results in terms of CF and WF lay above the range of values reported elsewhere. However, major discrepancies are mainly due to the differences in the co-products allocation criteria. In this sense, economic/physical allocation and/or system expansion have been mostly considered in literature. In contrast, no allocation was considered appropriate in this study, according to the characteristics of the industries and products under assessment; thus, the major impacts fall on the main product, which derives on comparatively higher environmental burdens. Finally, due to the relevance of fodder production in the overall impact assessment results, strategies to reduce greenhouse gases (GHG) emissions as well as water use associated to this stage were proposed in the pork supply chain.

Effect of light-touch intervention and associated factors to microbial contamination at small-scale pig slaughterhouses and traditional pork shops in Vietnam.

Traditional pork value chains dominate the production and distribution of pork in Vietnam; however, the high level of microbiological contamination in pork may increase the risk of food-borne disease for consumers. There is limited evidence about how to feasibly and scalably reduce microbial contamination in pork sold in traditional markets. This study aimed to assess the effectiveness of light-touch interventions for changing worker behaviour in small-scale slaughterhouses and vendors at traditional pork shops, as well as to identify risk factors for pork contamination. The intervention packages consisted of providing hygiene tools and delivering a food safety training which had been designed in a participatory way and covered 10 small-scale slaughterhouses and 29 pork shops. Pig carcasses, retailed pork, contact surfaces, and hands were sampled to measure the total bacterial count (TBC) and Salmonella contamination before, three and six weeks after the intervention, and trainee practices were observed at the same time. Linear and generalized linear mixed effects models were constructed to identify risk factors for TBC and Salmonella contamination at the slaughterhouses and pork shops. The interventions at slaughterhouses and pork shops both showed a slight reduction of TBC contamination in pig carcasses and Salmonella prevalence in retailed pork, while the TBC in retailed pork decreased only marginally. For slaughterhouses, the regression model indicated that smoking or eating during slaughtering (indicating poor hygienic practices) was associated with TBC increasing, while cleaning floors and wearing boots reduced TBC contamination. For pork shops, using rough materials (cardboard or wood) to display pork was the only factor increasing TBC contamination in pork, whereas cleaning knives was associated with lower TBC. Besides, the presence of supporters and wearing aprons reduced the probability of Salmonella contamination in pork. The findings highlight the effectiveness of light-touch interventions in reducing microbial contamination in pig carcasses at small-scale slaughterhouses and pork at traditional shops over the study period.

Structure of the pork value chain in Northern Uganda: implications for Taenia solium control interventions.

Introduction: This study characterizes the pork value chain in Agago, Kitgum, Lamwo, and Pader districts of Northern Uganda and analyzes its implications on the transmission and control of Taenia solium infections. Methodology: Data were collected through focus group discussions (FGDs) with farmers and pig and pork traders, key informant interviews (KIIs) with local government officials and consumers, and district-level multi-stakeholder mini workshops organized in the study area. The value chain actors identified include input and services providers, pig farmers, live pig traders, pork traders, and consumers. Results: Most of the pig production, marketing and consumption was found to occur through informal channels. Pig production in this area is dominated by smallholder extensive systems, with most producers keeping less than 10 pigs. The production segment of the pig value chain is characterized by low use of inputs and services such as veterinary extension, drugs and improved feeds. Pigs scavenge for food under free-range systems and are at risk of parasitic infections such as the zoonotic helminth Taenia solium. This risk is exacerbated by the inherent contextual aspects of the study sites including low latrine coverage, open defecation, and high poverty. In addition, some respondents viewed pigs as "sanitation policemen" where they leave them to roam around and eat dirt including feaces thereby cleaning the environment. T. solium was recognized as an important pig health constraint in this value chain alongside African swine fever (ASF). Unlike ASF that was associated with the pig mortalities, the cysts were associated with rejection of pigs by traders at purchase, condemnation of pig carcasses by meat inspectors and rejection of raw pork by consumers at points of sale. Discussion: Poor organization of the value chain and lack veterinary extension and meat inspection services results in some pigs infected with T. solium entering the food chain, exposing consumers to infection with the parasite. To reduce the pig production losses and public health impact from T. solium infections, there is need for control and prevention interventions targeting specific nodes of the value chain where the risk of transmission is highest.

The Nairobi Pork Value Chain: Mapping and Assessment of Governance, Challenges, and Food Safety Issues.

The Nairobi pork food system is a growing livestock sub-sector which serves as a source of food and livelihood to its inhabitants. The study aimed to map Nairobi's pork value chains, assess their governance, operational challenges and their impacts on food safety risks and management practices. Qualitative data were collected in seven focus group discussions and 10 key informants' interviews on animal movements and product flows, stakeholders' interactions, perceptions on system governance and challenges, and on their potential impact on food safety management. Quantitative data were obtained to show the importance of flows, business operations and market share. Thematic analysis was conducted to identify themes that provide understanding on the governance, challenges and food safety practices in each profile. The predominant chains identified were [1] The "large integrated company" profile which accounted for 83.6% of pork marketed through abattoirs, and was based on a well-structured supply system, with owned farms (representing 50% of their supply), contract farms and semi-contract farms and [2] Local independent abattoirs, accounting for 16.4%, are privately owned small-scale production, supplied mainly (70%) by small farmers from the immediate neighboring areas. The main challenges associated with governance themes included; (i) Inadequate/lack of enforcement of existing regulation (ii) Negative effect of devolution system of governance (iii) Pig traders' dominance (iii) Lack of association at all system nodes, and (iv) Male dominance across the pig system. The main challenges reported included; (i) Lack of capital to upscale (ii) Poor infrastructure (iii) Pig shortage (iv) Excessive regulation (v) Lack of training (vi) Diseases (v) Lack of knowledge (vi) Unfair competition. Food safety themes were associated with (i) Inadequate slaughter facilities forcing traders/farmers to undertake home slaughter (ii) Lack of knowledge on disease management (iii) Lack of training on hygienic practices in the slaughterhouse and (iv) Lack/insufficient capital to purchase equipment's to ensure proper hygiene e.g., boilers. The study provides insights into the structure of the pork system supplying Nairobi, the governance issues important to the stakeholders, challenges and food safety issues. The framework obtained can be used by policy makers and researchers to investigate and develop pork industry and for food safety and disease control programmes.

Exploring the potential of using nudges to promote food hygiene in the pork value chain in Vietnam.

Interventions designed to reduce the burden of foodborne illness often require value chain actors to alter undesired and risky behaviours. This desired behavioural change may be supported by 'nudge theory', a sub-field of behavioural economics, which describes how individuals can be encouraged, or 'nudged', to act in ways which produce net societal benefits without restricting freedom of choice. This research aimed to investigate the use of nudges in the pork value chain in Vietnam. Key informant interviews (n = 12) were initially utilised to document the type of nudges being used within existing food safety interventions, followed by a questionnaire-based survey (n = 132) to describe the behavioural elements of pork value chain actors which could be amenable to nudging. Finally, a workshop was conducted to measure the response of stakeholders (n = 30) to various nudge elements which could be used to support future food safety interventions. Key informant interviews demonstrated that the use of behavioural nudges were a common aspect of food safety interventions in the pork value chain in Hanoi and Hung Yen Province. Survey participants reported that when considering food safety, veterinarians and actors' peers were highly trusted, and reputation was thought to be an effective incentive to illicit behavioural change. During the workshop, stakeholders appeared aware of the major slaughter and retail contamination points and cited lack of access to improved infrastructure as the limiting factor in their ability to improve hygiene. Value chain actors reported positive responses to the concept of using posters containing photographic images as nudges and stipulated that media should reflect the local context and contain language framed to suit the target audience. We suggest that the findings of this study are used to create site specific nudges for the Vietnamese pork industry targeting key value chain actors, such slaughterhouse workers and traditional retailers, which should be tested in the field to investigate their effectiveness.

Unraveling the contact patterns and network structure of pig shipments in the United States and its association with porcine reproductive and respiratory syndrome virus (PRRSV) outbreaks.

The analysis of the pork value chain is becoming key to understanding the risk of infectious disease dissemination in the swine industry. In this study, we used social network analysis to characterize the swine shipment network structure and properties in a typical multisite swine production system in the US. We also aimed to evaluate the association between network properties and porcine respiratory and reproductive syndrome virus (PRRSV) transmission between production sites. We analyzed the 109,868 swine shipments transporting over 93 million swine between more than 500 production sites from 2012 to 2014. A total of 248 PRRSV positive occurrences were reported from 79 production sites during those 3 years. The temporal dynamics of swine shipments was evaluated by computing network properties in one-month and three-month networks. The association of PRRS occurrence in sow farms with centrality properties from one-month and three-month networks was assessed by using the multilevel logistic regression. All monthly networks showed a scale-free network topology with positive degree assortativity. The regression model revealed that out-degree centrality had a negative association with PRRS occurrence in sow farms in both one-month and three-month networks [OR=0.79 (95% CI, 0.63-0.99) in one-month network and 0.56 (95% CI, 0.36, 0.88) in three-month network] and in-closeness centrality model was positively associated with PRRS occurrence in sow farms in the three-month network [OR=2.45 (95% CI, 1.14-5.26)]. We also describe how the occurrence of porcine epidemic diarrheac (PED) outbreaks severely affected the network structure as well as the PRRS occurrence reports and its association with centrality measures in sow farms. The structure of the swine shipment network and the connectivity between production sites influenced on the PRRSV transmission. The use of network topology and characteristics combining with spatial analysis based on fine scale geographical location of production sites will be useful to inform the design of more cost-efficient, risk-based surveillance and control measures for PRRSV as well as other diseases in the US swine industry.