**4. Public health interventions**

Food poisoning is a health condition that is multifactorial; it therefore requires a multi-sectoral approach in addressing it. The interventions should be targeted to address the risk factors discussed above. For food poisoning, the youth, from teenagers to young adults, particularly those with any psychiatric or psychological disorder, those with history of child abuse and those who are addicted to any substance, constitute a high-risk group for deliberate selfpoisoning, whereas the children, the elderly and pregnant women constitute a high-risk group for accidental events with a high fatality potential [211, 212]. Thus, the two public health approaches, namely the individual-centred approach or 'high-risk strategy', and the popula‐ tion-based approach or 'population-based strategy' need to be implemented synchronically to address food poisoning [213].

In order to reduce the prevalence and incidence of food poisoning as well as its related mortality, multiple approaches ought to be implemented. Based on the population-based strategy, these include legislative measures, public educational programmes and establish‐ ment of poison or toxicological information centres and services and the establishment of surveillance systems [78, 214, 215]. Reports from several other settings have shown that legislative measures that restricted access to toxic agents resulted in a decrease in mortality associated with the targeted agents [212, 215–217].

In addition, good agricultural, manufacturing or processing practices can help in preventing and addressing food poisoning. For instance, in the case of aflatoxins, the risk of contamination of food and feed in Africa is increased by environmental and agronomic factors. Environmental conditions especially high humidity and temperature favour fungal proliferation as well as drought conditions. In the same vein, some inappropriate agricultural practices such as extended field drying and leaving the harvested crop in the field prior to storage facilitate fungal infection and insect infestation [218, 219].

For the above reasons, agronomic management practices that can reduce the risk of aflatoxin development such as the use of resistant varieties, crop rotation, well-timed planting, weed control, pest control especially control of insect pests and avoiding drought and nutritional stress through fertilization and irrigation should be implemented. Similarly, measures to control aflatoxins through the use of appropriate pesticides and the implementation of effective post-harvest initiatives, such as rapid and proper drying, proper transportation, adequate packaging and insect control during storage, should also be considered [220, 221].

Other practical approaches include the reduction of the frequency of consumption of 'high risk' foods (especially maize and groundnut) by consuming a more varied diet and diverting aflatoxin-contaminated foods to animals using clay-locking systems [222]. Of even more programmatic interest is the health education of the public and millers who should avoid blending visibly contaminated products to reduce the overall risk of spreading mycotoxins [218, 223].

Similarly, in order to reduce pesticides related poisoning from the food chain, several measures can also be contemplated such as encouraging the use of less hazardous and cost-effective pesticides currently available; establishing a national programme to monitor applicators' exposure and use of personal protective equipment; ensuring the respect of the correct time lag of crops that have been sprayed; and ensure proper disposal of obsolete, unused or unwanted pesticides and wastes [224].

Based on high-risk strategy, managerial decisions at facilities' level can be implemented such as assessment of the health status of food handlers, the audit of food-serving facilities based on the Hazard Analysis Critical Control Point (HACCP) approach. This approach is well known for its use in identifying points where controls could be applied to prevent or eliminate these microbiological hazards or reduce them to acceptable levels [225].

The implementation of HACCP has been reported in some settings on the African continent but it is not widely used particularly in food outlets frequented by the majority of people or businesses [226–228]. This failure is reflective of the general lack of enforcement of regulatory and legislative texts relating to foodstuffs in Africa [168, 214]. This is an area where advocacy is required from the civil society and other community voices to ensure that authorities are called upon to enforce existing legislation [96, 229].

Some authors have suggested the ' four Cs' namely cleaning, cooking, chilling and avoiding cross contamination as the backbone for basic hygiene, food preparation and storage. This suggestion is supported by findings from surveys that reported that at least three-quarters of the public had never heard of the most common causes of food poisoning and believe they are unlikely to get food poisoning from food cooked at home; yet the majority of them did not store raw meat properly and/ or wash their hands after handling raw meat or fish [230–233].

With regard to epidemiological surveillance, it is necessary to assess the magnitude of the food poisoning problem and its major risk factors in defined contexts. Based on the findings, evidence-based interventions could then be designed and implemented [90]. Together with the establishment of a food poisoning surveillance system, national or regional toxicovigilance centres should be funded so that they can collect, aggregate, analyse, and report on food and other causes of acute and chronic poisoning with specific focus on deliberate poisoning. These centres should serve both the public and clinicians with relevant information for the manage‐ ment of poisoning events [78].

With regard to academic training, there is a need to create awareness on the issues of food production, processing, distribution, handling and cooking among all people studying towards a degree in any field of science, particularly for those in agricultural and health sciences. Public education and awareness campaigns aimed at the whole population are required so that risks about various types, sources and consequences of food poisoning are communicated regularly to influence behaviour change [234–238]. Public education programs should also strive to increase the population's awareness of the general risks of poisoning at home. This includes designing messages dealing with appropriate storage of foods and other products in the home, and explaining what to do in case of a suspected poisoning incident.
