There are issues with how the impact and success of food safety projects are measured in developing countries, according to a review.

The study summarizes interventions evaluated in some low- and middle-income countries in Asia between 2000 and 2020 and the outcome on knowledge, attitude and practice, hazard presence, and effects on health. 

Overall, 25 studies were considered. A ‘before and after’ study design was the most frequently used.

Methods focused on training to improve knowledge, attitudes, and practices (KAP) towards safe food or on specific technologies. Nine studies were specific as they looked at cattle, poultry, pigs, and fish value chains. All but one reported some level of success. Some food safety work targeted dedicated hazards, including Taenia solium, E. coli, zoonotic fish trematodes, fecal coliforms, and fecal Streptococcus.

How to judge success
However, there is a clear evidence gap for the efficacy and cost-effectiveness of food safety interventions in market settings, said researchers.

“A rigorous and standardized assessment of intervention effectiveness and sustainability is recommended, to not only identify areas of improvement but also to ensure scaling of interventions with demonstrated evidence of success and sustainability.”

Findings will be used to inform the design of tools implemented as part of the EatSafe: Evidence and Action Towards Safe, Nutritious Food project. The review of interventions may help with decisions on what can be scaled up and what modifications may be needed in different contexts, found in the study published in the journal Zoonoses and Public Health.

The 25 studies were done in India, Vietnam, Indonesia, Bangladesh, Laos, Malaysia, Thailand, and Nepal.

In ‘before and after’ studies, the outcome of interest was measured before and after the implementation of the intervention. Five studies used randomized control trials. Two groups were considered, one group received the intervention while the other did not and acted as a control. Two studies measured adoption.

Most interventions were applied at the household or food vendor level and focused on consumer safety. Sixteen studies involved informal food vendors and seven were in formal sector settings.

Training and technology
Sector-specific studies covered the household or vendor level; market and retail; farm and production or the processing stage.

An increase in knowledge through training and the provision of food safety information was the main outcome measured in most studies. In some cases, this was shown to lead to improved food handling practices and a reduction in the occurrence of foodborne hazards.

Most training interventions evaluated changes in knowledge, attitudes, and practices. All those with technology measured hazard, health or hazard, and health outcomes. While learning fades with time and requires refreshment; new technologies, once adopted can be integrated into normal working. In terms of costs and complexity, some technologies were simpler and cheaper than training but others were more complex and expensive.

Interventions in the review did not provide sufficient information to evaluate the cost-effectiveness of the programs. More studies are needed to assess the effectiveness of different food safety intervention strategies and factors influencing their uptake and sustainability, said scientists.

All the studies used different definitions of success, not always based on clear targets. Due to the lack of standardized measures or indicators of efficacy and lack of data on the costs incurred or avoided, scientists said no evaluations can be made on the cost-effectiveness of different studies. The success of the interventions was subject to the reviewer’s judgment.