There are hundreds of millions of cases of foodborne illness worldwide every year, costing billions of dollars. It’s believed that low- and middle-income countries bear the brunt of these illnesses. Evidence is limited, but the author of a new report believes this to be the case because of the high level of hazards often reported in these countries, the high prevalence of foodborne pathogens in surveys of people with diarrhea, the lack of clean water for washing food and utensils, and the use of human sewage or animal waste in agriculture. The literature review was written by Delia Grace of the International Livestock Research Institute. It was commissioned by the U.K.’s Department of International Development and published in the International Journal of Environmental Research and Public Health. Food systems in low- and middle-income countries, such as China, Kenya, Vietnam and India, are often fragmented into a majority of informal actors that are difficult to monitor and a few large companies that have incentives to escape regulation. And there are plenty of governmental challenges that impede food safety. Recent studies suggest that consumers in developing countries are concerned with foodborne disease. This, along with new technologies and an increased emphasis on food system governance, can improve food safety, the report states. One interesting point of the report was that foodborne disease can have important impacts on women’s resilience and vulnerability. Grace suggested that more research on the gender and food safety is important for designing interventions. And because there is a risk that increasing food safety standards can displace poor producers, interventions should not be anti-poor. “There is limited evidence on effective, sustainable and scalable interventions to improve food safety in domestic markets,” Grace wrote. “Training farmers on input use and good practices often benefits those farmers trained, but has not been scalable or sustainable, except where good practices are linked to eligibility for export.” As for the source of foodborne diseases, the information is “prone to error and under-estimation.” Microbial pathogens are responsible for the majority, but parasites are an important cause of disease. Traditionally, most diarrhea has been attributed to unsafe water, but as much as 40 percent of these illnesses can’t be attributed to water, and a certain portion of them due to food. Seafood poisoning, illicit alcohol, and food adulteration are some of the other sources of illness in low- and middle-income countries. Grace wrote that most foodborne illnesses are caused by fresh, perishable foods sold in informal markets. Low- and middle-income countries might eat less of it, but it’s more contaminated. And meat consumption seems to be a strong predictor of foodborne illness deaths. One cross-country found that for every additional metric ton of meat consumed per 100 people, foodborne illness mortality increased by 6 percent. Grace noted that foodborne illnesses are likely to increase in some low- and middle-income countries because of increased consumption of risky foods and lengthening food supply chains. Climate change could also have an impact. (To sign up for a free subscription to Food Safety News, click here.)