A systematic literature review of milk consumption and associated bacterial zoonoses in East Africa.

Consumption of unsafe animal-source foods is the major cause of foodborne disease outbreaks in low-income countries. Despite current knowledge of the threat posed by raw milk consumption to human health, people in many countries in East Africa still consume unboiled milk. This literature review explored the association between milk consumption and the occurrence of five milk-borne bacterial zoonoses: brucellosis, salmonellosis, campylobacteriosis, Escherichia coli infections, and tuberculosis. A search for literature published up to October 1, 2021 was conducted through the Web of Science, PubMed, and Scopus databases, using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The selection process yielded 65 articles describing studies conducted in East Africa 2010-2021, which were carefully scrutinized. The most investigated pathogen was Brucella spp. (54.5%), followed by Escherichia coli (18.2%), Salmonella spp. (12.1%), Mycobacterium spp. (6.1%), and Escherichia coli O157: H7 (6.1%). The most common predisposing factors for potential milk-borne disease outbreaks were consumption of contaminated raw milk, inadequate cold storage along the milk value chain, poor milk handling practices, and lack of awareness of the health risks of consuming unpasteurized milk. Thus a tailor-made training program is needed for all milk value chain actors to enhance the safety of milk sold in informal markets, and a One Health approach should be applied. Future studies should employ more advanced diagnostic techniques and countries in East Africa should invest in modern diagnostic tools and equipment, both in hospitals and in local rural settings where most cases occur.