Refugee camps provide basic necessities such as food, water, shelter, and medical treatment for displaced persons. Unsanitary conditions in refugee camps due to overcrowding, poor sanitation systems, lack of clean water, minimal ways to cook and store food can lead to an increased risk of foodborne illness. This article reviews the limited literature on the epidemiology of foodborne illness in refugee camps, effective risk mitigation strategies and opportunities for future research. Eleven articles were identified, suggesting that research in this area is limited. Identified research focused on three pathogens — Vibrio cholerae , Salmonella spp. and hepatitis E virus — that can lead to serious diseases including cholera, salmonellosis, typhoid fever, and hepatitis E. The research demonstrated that storage and handling of clean water for personal hygiene as well as food preparation were critical components to ensuring food safety. Additionally, knowledge pertaining to best practices for hygiene and food preparation were also identified as important. Gaps in current research include the determination of the prevalence of pathogens in food sold in refugee camps as well as development of culturally relevant food safety supply chain quality management systems. More research that focuses on burden and attribution of foodborne illness as well as food safety interventions in refugee camps is necessary.

Previous research has demonstrated human exposure to mycotoxins among Guatemalans, with high levels of mycotoxins being found in blood and urine samples as well as in maize for human consumption. Mishandling of crops such as maize during pre- and post-harvest has been associated with mycotoxin contamination. The overarching goal of this study was to identify risk factors for aflatoxin and fumonisin exposure in Guatemala. A cross-sectional survey of 141 women tortilla makers was conducted in the departments of Guatemala, Sololá, Suchitepéquez, Izabal, and Zacapa in February 2022. Maize and tortilla samples were collected and analyzed for aflatoxin B₁ (AFB₁) and fumonisin B₁, B₂, and B₃ contamination (FB₁, FB₂, FB₃). Urine samples were collected and analyzed for urinary FB₁ (uFB₁) contamination. A questionnaire was administered to collect data on sociodemographic characteristics, dietary intake of maize-based foods the week prior to the study, and maize handling practices. Descriptive statistics were used to describe common maize handling practices. A univariable analysis was conducted to identify predictors of low/high AFB₁, total fumonisins, and uFB₁. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). During tortilla processing, a reduction in the AFB₁ and total fumonisin levels was observed. The presence of AFB₁ in maize was associated with department and mean total fumonisin level in maize (OR: 1.705, 95% CI: 1.113–2.613). The department where the tortilleria was located was significantly associated with the presence of fumonisins in tortillas. Increased consumption of Tortrix was significantly associated with the presence of FB₁ in urine (OR: 1.652, 95% CI: 1.072–2.546). Results of this study can be used in the development and implementation of supply chain management practices that mitigate mycotoxin production, reduce food waste and economic loss, and promote food security.

Traditional food markets are a key node of resilient food systems worldwide. However, improper food handling and limitations in market structures may result in foodborne disease. This study assessed the decision-making of consumers and vendors in traditional markets to identify opportunities to reduce foodborne contamination and exposure. A cross-sectional survey of 150 consumers and 150 vendors was conducted in Sidama, Ethiopia, in July–August 2022 to investigate practices, behavior drivers, and enabling environment factors relevant to food safety. Descriptive statistics were used to summarize demographics and behavior variables, and the Poverty Probability Index for socioeconomic status. Women consumers were the primary deciders for what food to buy. Of those surveyed, 26% of vendors and 19% of consumers lived below $3.20 USD/day. Consumers choose to purchase food based on price, food quality, vendor personality, and food safety (assessed using visual and sensory cues). Vendors were unconcerned about foodborne disease (73%) and attributed business success to food quality, their personality, and offering discounts. Salience and demand for food quality, as well as trusted relationships, could be leveraged as business incentives for vendors to adopt food safety practices and to increase consumers’ preference for safer food and ability to identify it.

Diarrheal illness remains a major global health challenge, causing millions of deaths annually. Non-typhoidal Salmonella (NTS), Shiga toxin-producing Escherichia coli (STEC), and Campylobacter species (CAMPY) significantly contribute to this burden. Given the limited information on these pathogens in Ethiopia, this study aimed to estimate their prevalence among diarrhea patients in Ethiopia and identify risk factors for infection. A cross-sectional study was conducted from October 2021 to November 2022 in three hospitals in Ethiopia (Addis Ababa, Gondar, and Harar). Sociodemographic characteristics, clinical signs and symptoms were collected from study participants using a structured questionnaire. Stool samples were tested for NTS, STEC, and CAMPY using standardized methods. The prevalence of targeted pathogens was estimated overall and by study sites. Univariable and multivariable logistic regression were used to identify associated factors. A total of 2,331 patients were enrolled. The overall prevalence of NTS, STEC (stx only), STEC (stx + eae), and CAMPY was 1.29% (95%CI: 0.91, 1.84), 12.56% (95%CI: 11.29, 13.98), 3.43% (95%CI: 2.77, 4.25), and 4.46% (95%CI: 4.61, 8.00), respectively. Harar had the highest prevalence of all the pathogens compared to Addis Ababa and Gondar. Odds of NTS in Harar were over 10 (AOR: 10.43: 95%CI: 2.95, 69.20) and 3.5 times (AOR: 3.57: 95%CI: 1.50, 9.90) higher than that in Addis Ababa and Gondar, respectively. Odds of STEC (stx only) in the dry (AOR: 1.97: 95%CI: 1.37, 2.90) and long rainy (AOR: 1.80: 95%CI: 1.20, 2.69) seasons were nearly twice the odds in the short rainy season. Odds of CAMPY infection decreased by 3.29% (AOR: 0.97: 95%CI: 0.95, 0.98) with every one-year increase in age. Moreover, the odds of CAMPY infection for rural residents (AOR: 1.93, 95%CI: 1.15, 3.19) were nearly twice that of urban residents. This is the first study to estimate the prevalence of NTS, STEC, and CAMPY simultaneously across all age groups and diverse regions in Ethiopia, revealing significant variations. Results can be used to understand the burden of disease, inform clinical management and risk mitigation strategies to reduce illness in Ethiopia.

Fumonisin exposure is common in populations where maize is a dietary staple, such as in Guatemala, and has been associated with negative health outcomes including neural tube defects. The objective of this study was to estimate fumonisin B₁ (FB₁) exposure among Guatemalan reproductive-age women and develop a better understanding of the dietary and sociodemographic risk factors for exposure. A cross-sectional study in 18 municipalities in Guatemala was conducted. Midwives and study nurses enrolled consenting women and collected individual and household demographic and socioeconomic data. A food frequency questionnaire was administered to estimate quantity and types of food products consumed. A urine sample was collected and urinary fumonisin B₁ (uFB₁) concentration was measured. A univariable analysis was conducted to identify predictors of low/high uFB₁. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). In total, 775 women had analyzable urine samples. Higher uFB₁ levels were associated with speaking Mayan (OR = 2.33, 95% CI:1.44–3.77), less than high school education (OR = 1.61, 95% CI:1.12–2.30), increasing dietary proportion of maize-based foods (OR = 1.02, 95% CI:1.01–1.03), and consumption of tostadas (fried tortillas) (OR = 1.11, 95% CI:1.02–1.22). Lower uFB₁ levels were associated with consumption of highly processed maize-based foods (OR = 0.93, 95% CI:0.87–0.99). Tortillas were the most frequently consumed maize-based food among study participants and significantly associated with high uFB₁ exposure in the univariable but not multivariable analysis. Consumption of >4,750 grams/week of maize-based foods, >5,184 g/week of locally produced maize-based foods, and >110 servings/week of tortillas were also significantly associated with high uFB₁ exposure in univariable analysis. Populations with low socioeconomic status/education levels and high consumption of maize-based foods had higher fumonisin exposure. Interventions aimed at reducing the risk of exposure to mycotoxins through maize in Guatemala, including the increased consumption of non-maize-based foods, should be further explored.