{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T02:44:50Z","timestamp":1773801890014,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010663","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000}}],"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000617","name":"Foreign and Commonwealth Office","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000617","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1195588; OPP1195643"],"award-info":[{"award-number":["OPP1195588; OPP1195643"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006928","name":"Ohio State University","doi-asserted-by":"publisher","award":["OPP1195643, TARTARE"],"award-info":[{"award-number":["OPP1195643, TARTARE"]}],"id":[{"id":"10.13039\/100006928","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OAA-L-15-00003"],"award-info":[{"award-number":["AID-OAA-L-15-00003"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>According to the World Health Organization, 600 million cases of foodborne disease occurred in 2010. To inform risk management strategies aimed at reducing this burden, attribution to specific foods is necessary.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We present attribution estimates for foodborne pathogens (<jats:italic>Campylobacter<\/jats:italic> spp., enterotoxigenic <jats:italic>Escherichia coli<\/jats:italic> (ETEC), Shiga-toxin producing <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>, nontyphoidal <jats:italic>Salmonella enterica<\/jats:italic>, <jats:italic>Cryptosporidium<\/jats:italic> spp., <jats:italic>Brucella<\/jats:italic> spp., and <jats:italic>Mycobacterium bovis<\/jats:italic>) in three African countries (Burkina Faso, Ethiopia, Rwanda) to support risk assessment and cost-benefit analysis in three projects aimed at increasing safety of beef, dairy, poultry meat and vegetables in these countries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used the same methodology as the World Health Organization, i.e., Structured Expert Judgment according to Cooke\u2019s Classical Model, using three different panels for the three countries. Experts were interviewed remotely and completed calibration questions during the interview without access to any resources. They then completed target questions after the interview, using resources as considered necessary. Expert data were validated using two objective measures, calibration score or statistical accuracy, and information score. Performance-based weights were derived from the two measures to aggregate experts\u2019 distributions into a so-called decision maker. The analysis was made using Excalibur software, and resulting distributions were normalized using Monte Carlo simulation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Individual experts\u2019 uncertainty assessments resulted in modest statistical accuracy and high information scores, suggesting overconfident assessments. Nevertheless, the optimized item-weighted decision maker was statistically accurate and informative. While there is no evidence that animal pathogenic ETEC strains are infectious to humans, a sizeable proportion of ETEC illness was attributed to animal source foods as experts considered contamination of food products by infected food handlers can occur at any step in the food chain. For all pathogens, a major share of the burden was attributed to food groups of interest. Within food groups, the highest attribution was to products consumed raw, but processed products were also considered important sources of infection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Cooke\u2019s Classical Model with performance-based weighting provided robust uncertainty estimates of the attribution of foodborne disease in three African countries. Attribution estimates will be combined with country-level estimates of the burden of foodborne disease to inform decision making by national authorities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010663","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T17:42:54Z","timestamp":1663004574000},"page":"e0010663","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Attribution of country level foodborne disease to food group and food types in three African countries: Conclusions from a structured expert judgment study"],"prefix":"10.1371","volume":"16","author":[{"given":"Amanda C.","family":"Sapp","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirna P.","family":"Amaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6456-5460","authenticated-orcid":true,"given":"Arie H.","family":"Havelaar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela F.","family":"Nane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"key":"pntd.0010663.ref001","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0140-6736(02)11403-6","article-title":"Selected major risk factors and global and regional burden of disease","volume":"360","author":"M Ezzati","year":"2002","journal-title":"The Lancet"},{"key":"pntd.0010663.ref002","author":"RM Cooke","year":"1992"},{"key":"pntd.0010663.ref003","doi-asserted-by":"crossref","first-page":"e0145839","DOI":"10.1371\/journal.pone.0145839","article-title":"World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation","volume":"11","author":"T Hald","year":"2016","journal-title":"PLOS ONE."},{"key":"pntd.0010663.ref004","doi-asserted-by":"crossref","first-page":"e1001923","DOI":"10.1371\/journal.pmed.1001923","article-title":"World Health Organization Global Estimates and Regional Comparisons of the Burden of Foodborne Disease in 2010","volume":"12","author":"AH Havelaar","year":"2015","journal-title":"PLOS Med"},{"key":"pntd.0010663.ref005","doi-asserted-by":"crossref","first-page":"e0183641","DOI":"10.1371\/journal.pone.0183641","article-title":"Attribution of global foodborne disease to specific foods: Findings from a World Health Organization structured expert elicitation","volume":"12","author":"S Hoffmann","year":"2017","journal-title":"PLOS ONE"},{"key":"pntd.0010663.ref006","doi-asserted-by":"crossref","first-page":"e0216545","DOI":"10.1371\/journal.pone.0216545","article-title":"Global disease burden of pathogens in animal source foods, 2010","volume":"14","author":"M Li","year":"2019","journal-title":"PLOS ONE"},{"key":"pntd.0010663.ref007","unstructured":"TARTARE: The Assessment and Management of Risk from Non-typhoidal Salmonella, Diarrheagenic Escherichia coli and Campylobacter in Raw Beef and Dairy in Ethiopia | CFI. [cited 3 Jan 2022]. Available: https:\/\/foodsafety.osu.edu\/research\/international-research-shifting-food-safety-paradigm\/tartare"},{"key":"pntd.0010663.ref008","unstructured":"Urban food markets in Africa: Incentivizing food safety using a pull-push approach | International Livestock Research Institute. [cited 3 Jan 2022]. Available: https:\/\/www.ilri.org\/research\/projects\/urban-food-markets-africa-incentivizing-food-safety-using-pull-push-approach"},{"key":"pntd.0010663.ref009","unstructured":"ENHANCE Gordon\u2014Feed the Future Innovation Lab for Livestock Systems\u2014University of Florida, Institute of Food and Agricultural Sciences\u2014UF\/IFAS. [cited 3 Jan 2022]. Available: https:\/\/livestocklab.ifas.ufl.edu\/projects\/enhance-gordon\/"},{"key":"pntd.0010663.ref010","article-title":"Burden of foodborne disease due to bacterial hazards associated with beef, dairy, poultry meat and vegetables in Ethiopia and Burkina Faso","author":"AH Havelaar","year":"2017"},{"key":"pntd.0010663.ref011","author":"AC Sapp","year":"2010","journal-title":"Estimates of disease burden caused by foodborne pathogens in contaminated dairy products in Rwanda"},{"key":"pntd.0010663.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12688\/f1000research.7340.1","article-title":"World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: A data synthesis","volume":"4","author":"H Gibb","year":"2015","journal-title":"F1000Research"},{"key":"pntd.0010663.ref013","first-page":"225","volume-title":"Expert Judgement in Risk and Decision Analysis","author":"Springer","year":"2021"},{"key":"pntd.0010663.ref014","unstructured":"Cooke RM. Excalibur. In: TU Delft [Internet]. [cited 2 Jan 2022]. Available: https:\/\/www.tudelft.nl\/en\/eemcs\/the-faculty\/departments\/applied-mathematics\/applied-probability\/research\/research-themes\/risk\/software\/excalibur\/excalibur"},{"key":"pntd.0010663.ref015","author":"R Core Team","year":"2021"},{"key":"pntd.0010663.ref016","article-title":"treemapify: Draw Treemaps in \u201cggplot2.\u201d","author":"D. Wilkins","year":"2021"},{"key":"pntd.0010663.ref017","article-title":"Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States\u2014Volume 27, Number 1\u2014January 2021\u2014Emerging Infectious Diseases journal\u2014CDC","author":"E Beshearse"},{"key":"pntd.0010663.ref018","doi-asserted-by":"crossref","first-page":"e22998","DOI":"10.1371\/journal.pone.0022998","article-title":"Expert Status and Performance","volume":"6","author":"MA Burgman","year":"2011","journal-title":"PLOS ONE"},{"key":"pntd.0010663.ref019","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.ijheh.2018.03.005","article-title":"Pathogens transmitted in animal feces in low- and middle-income countries","volume":"221","author":"MJ Delahoy","year":"2018","journal-title":"Int J Hyg Environ Health"},{"key":"pntd.0010663.ref020","author":"K Amenu","year":"2021"},{"key":"pntd.0010663.ref021","unstructured":"Value chain assessment of animal source foods and vegetables in Ouagadougou, Burkina Faso: Food safety, quality and hygiene perceptions and practices. In: International Livestock Research Institute [Internet]. 16 Nov 2020 [cited 3 Jan 2022]. Available: https:\/\/www.ilri.org\/publications\/value-chain-assessment-animal-source-foods-and-vegetables-ouagadougou-burkina-faso-food"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0010663","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010663","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T18:37:56Z","timestamp":1663871876000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010663"}},"subtitle":[],"editor":[{"given":"Paul J.","family":"Brindley","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,12]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010663","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0010663","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,12]]}}}