Understanding the Disease Burden of Dairy Products in Rwanda
This post is written by Saskia Hendrickx, Andrea Bohn, and Dr. Arie Havelaar, the Feed the Future Innovation Lab for Livestock Systems.
As highlighted in a recent report issued by the Food and Agriculture Organization of the United Nations (FAO), meat, eggs and milk offer crucial sources of much-needed nutrients that cannot easily be obtained from plant-based foods. These findings echo research from the Feed the Future Innovation Lab for Livestock Systems, which works in several sub-Saharan countries and Nepal.
Research in Rwanda showed that the frequency of cow’s milk consumption by children aged 12-29 months was limited by inadequate household milk production or selling the milk produced instead of using it for home consumption. This 2021 study by Valerie Flax and colleagues tested the impact of a social and behavior change communication (SBCC) intervention promoting the consumption of animal-source foods on maternal knowledge of animal-source foods and on child milk consumption and dietary diversity. The SBCC intervention was associated with increased odds of children consuming cow’s milk two or more times per week.
However, although these results are promising, dairy products can be hazardous to health, potentially transmitting diseases such as bovine brucellosis, tuberculosis, and causing diarrhea. While data on foodborne diseases exist at the global and regional levels, information at the national level is scarce. To address this shortcoming, researchers from the Innovation Lab for Livestock Systems extracted national-level data for Rwanda on five dairy-associated pathogens from the 2010 World Health Organization (WHO) Foodborne Disease Burden Epidemiology Reference Group (FERG) database and merged them with the data on the proportion of foodborne disease attributable to consuming dairy products from FERG and an additional study zooming in on attribution to raw and processed milk. The findings were published in April 2023.
There were 57,500 illnesses occurring annually in Rwanda due to the consumption of dairy products overall, causing 55 deaths and a loss of 3,870 Disability Adjusted Life Years (DALYs), resulting in a cost-of-illness estimate of $3.2 million. One DALY can be considered as one healthy life-year lost. The DALY metric integrates the impacts of morbidity (refers to illness) and mortality (refers to death) in a single metric. Of the five pathogenic microorganisms included in this assessment, Campylobacter spp., non-typhoidal Salmonella enterica and Cryptosporidium spp. contributed most to the number of cases. Mycobacterium bovis, non-typhoidal Salmonella enterica and Campylobacter spp. contributed most to deaths and DALYs. The disease burden of Brucella spp. was low across all metrics.
Of the overall burden of dairy consumption, 13,300 illnesses, 26 deaths, 1,700 DALYs and $1.4 million were attributed to drinking raw milk. Thus, the burden of drinking raw milk constituted 44 percent of the DALY burden of dairy products. Sizable proportions of the overall burden were also attributable to the drinking of traditionally (16-23 percent) or industrially (6-22 percent) fermented milk. Transitioning from consuming raw to processed milk (fermented, heat treated or otherwise) may prevent a considerable disease burden and cost-of-illness, but the full benefits will only be achieved if there is a simultaneous improvement in processing and prevention of recontamination of processed products.
A research brief provides additional recommendations on how to reduce the burden of consuming unsafe dairy products ranging from stricter enforcement of existing regulations to increasing cold storage capacity at milk collection centers, as well as sensitizing consumers about boiling raw milk before consumption.