Current Topics in Microbiology

and Immunology

Volume 366

Series Editors

Klaus Aktories
Medizinische Fakultät, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Abt. I Albert-Lud-
wigs-Universität Freiburg, Albertstr. 25, 79104 Freiburg, Germany
Richard W. Compans
Department of Microbiology and Immunology, Emory University, 1518 Clifton Road, CNR 5005, Atlanta, GA 30322,
USA
Max D. Cooper
Department of Pathology and Laboratory Medicine, Georgia Research Alliance, Emory University, 1462 Clifton
Road, Atlanta, GA 30322, USA

Jorge E. Galan
Boyer Ctr. for Molecular Medicine, School of Medicine, Yale University, 295 Congress Avenue, room 343, New
Haven, CT 06536-0812, USA

Yuri Y. Gleba
ICON Genetics AG, Biozentrum Halle, Weinbergweg 22, 06120 Halle, Germany

Tasuku Honjo
Department of Medical Chemistry, Faculty of Medicine, Kyoto University, Sakyo-ku, Yoshida, Kyoto 606-8501, Japan
Yoshihiro Kawaoka
School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA

Bernard Malissen
Centre d’Immunologie de Marseille-Luminy, Parc Scientifique de Luminy, Case 906, 13288 Marseille Cedex 9, France

Fritz Melchers
Max Planck Institute for Infection Biology, Charitéplatz 1, 10117 Berlin, Germany
Michael B. A. Oldstone
Department of Immunology and Microbial Science, The Scripps Research Institute, 10550 North Torrey Pines Road,
La Jolla, CA 92037, USA
Rino Rappuoli
Novartis Vaccines, Via Fiorentina 1, Siena 53100, Italy

Peter K. Vogt
Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines
Road, BCC-239, La Jolla, CA 92037, USA

Honorary Editor: Hilary Koprowski

Biotechnology Foundation, Inc., Ardmore, PA, USA (deceased)

For further volumes:

http://www.springer.com/series/82
John S. Mackenzie Martyn Jeggo
•

Peter Daszak Juergen A. Richt

•

Editors

One Health: The Human–

Animal–Environment
Interfaces in Emerging
Infectious Diseases
Food Safety and Security, and International
and National Plans for Implementation
of One Health Activities

Responsible Series Editor: Richard W. Compans

123
Editors
John S. Mackenzie Peter Daszak
Faculty of Health Sciences EcoHealth Alliance
Curtin University New York, NY
Perth, WA USA
Australia
Juergen A. Richt
Martyn Jeggo Department of Diagnostic
CSIRO Australian Animal Health Medicine/Pathobiology
Laboratory Kansas State University College
East Geelong, VIC of Veterinary Medicine
Australia Manhattan, KS
USA

ISSN 0070-217X
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DOI 10.1007/978-3-642-35846-3
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Preface

Global health security has become a major international concern. Our population
faces imminent threats to human and animal health from the emergence and
re-emergence of epidemic-prone infectious diseases, linked to the significant
impact that these outbreaks are already having on national and international
economies. The concept and drivers of disease emergence were clearly docu-
mented 20 years ago in the Institute of Medicine’s seminal 1992 report, Emerging
Infections: Microbial Threats to Health in the United States. (www.nap.edu/
catalog.php?record_id=2008). This volume described the mechanisms leading to
infectious disease emergence and highlighted possible strategies for recognizing
and counteracting the threats. It has long been known that many of these diseases
can cross the species barrier between humans, wildlife, and domestic animals; and
indeed over 70 % of novel emerging infectious diseases are zoonotic, that is, they
have their origins in animal reservoirs. There have been many examples of this
since the Institute of Medicine’s report two decades ago, including the emergence
of H1N1 pandemic influenza virus, the SARS coronavirus, Nipah and Hendra
viruses, Australian bat lyssavirus, Malaka virus, and avian influenza H5N1, to
name but a few.
These diseases remind us that the health of humans, animals, and ecosystems
are interconnected, and that to better understand and respond rapidly to zoonotic
diseases at the human–animal–environment interfaces requires coordinated, col-
laborative, multidisciplinary, and cross-sectoral approaches. This holistic approach
has been referred to as ‘One Health’, indicative of the commonality of human and
animal medicine, and their connection to the environment. Although the concept is
not new, ‘One Health’ has gained added momentum in the aftermath of the SARS
epidemic of 2003 which posed the first major threat to human health and global
economy of the new millennium. These concerns added to the mounting fears that
highly pathogenic avian influenza H5N1 could develop into the next severe
influenza pandemic. Not only would such a pandemic lead to significant mortality
and morbidity, but the World Bank has estimated that it could cause a decline of
up to 5% of global GDP (damages of US$3 trillion), causing far-reaching dis-
ruptions in the lives of people, communities, and countries. There are currently
other potential threats from the new SARS-like coronavirus and H7N9 avian
influenza virus. Thus there are compelling reasons to develop new approaches
that will improve the detection, prevention, and control of zoonotic diseases.

v
vi Preface

In particular, it is essential that we breakdown the old concepts of professional

silos and encourage a new era built around trust and multidisciplinary, cross-
sectoral approaches.
The present momentum of ‘One Health’ can also be traced in part to the 2004
meeting of the Wildlife Conservation Society on ‘One World, One Health: Building
Inter-disciplinary Bridges to Health in a Globalized World’. The outcomes of the
meeting were encapsulated in a series of 12 recommendations known as the
Manhattan Principles that set priorities for an international, interdisciplinary
strategy for combating threats to the health of life on Earth (www.
oneworldonehealth.org). The momentum since 2004 has been maintained
through a number of international ministerial meetings, including the International
Ministerial Conferences on Avian and Pandemic Influenza (IMCAPI), which have
been held to discuss issues relating to the spread, transmission, and possible con-
tainment of highly pathogenic avian influenza (H5N1), culminating at the 2010
meeting in Hanoi with the agreement between the Food and Agriculture Organi-
zation (FAO), the World Organization for Animal Health (OIE), and World Health
Organization (WHO), entitled ‘The FAO–OIE–WHO Collaboration: Sharing
Responsibilities and Coordinating Global Activities at the Animal–Human–Eco-
systems Interfaces’. The coordination between these three international organiza-
tions has also led to the formation of the Global Early Warning System for Major
Animal Diseases including Zoonoses (GLEWS) which provides the intelligence
essential to identify and ameliorate both human and animal diseases (www.
glews.net) through sharing of information of disease events, epidemiological
analyses, and risk assessments. In addition, it is highly probable that any new
zoonotic disease would be detected through WHO’s new International Health
Regulations (2005) which are aimed at assisting countries in working together to
save lives and livelihoods through a legal requirement for countries to rapidly
detect and report outbreaks of disease of international concern.
This leadership is an essential component to operationalize ‘One Health’ ideals.
Major scientific meetings have been held in Winnipeg through Health Canada and
at Stone Mountain, Georgia through the Centers for Disease Control and Preven-
tion, and by a wide variety of other interested groups such as the European Com-
mission, joint meetings of FAO–OIE–WHO, Global Risk Forum (Davos), Institute
of Medicine, the World Bank, APEC, and the Asian Development Bank. Many
smaller, national, and regional meetings have also been held to further local ‘One
Health’ planning. Of particular importance has been the information dissemination
by the ‘One Health’ Initiative website (www.onehealthinitiative.com) and the more
recently established ‘One Health’ Global Network’s web portal (www.
onehealthglobal.net) which have continued to build and sustain this momentum
by providing a rapid means of communication and sharing data and news. As the
field of ‘One Health’ matures, we have also begun to see the growing involvement
of ecologists, wildlife biologists, environmental scientists, and the fusion of the
fields of ‘EcoHealth’ and ‘One Health’. There has also been considerable support
for the ‘One Health’ approach in the United States through a partnership of major
professional organizations that have formed the ‘One Health’ Commission, which
Preface vii

brings together the American Medical Association, the American Veterinary

Medical Association, the American Public Health Association, the Infectious
Diseases Society of America, the Association of American Medical Colleges, and
the Association of American Veterinary Medical Colleges. The inclusion of the
latter two organizations is particularly relevant, breaking down professional bar-
riers or silos through education. A number of universities and colleges are starting
to respond with new ‘One Health’ courses; and one university, the University of
Edinburgh, has developed a Masters postgraduate degree course.
More than 200 years ago, the German writer, artist, and politician, Johann
Wolfgang von Goethe, reminded us that: ‘‘Knowing is not enough; we must apply.
Willing is not enough; we must do.’’ That epithet applies well to the ‘One Health’
movement, because in the midst of all the information that has been gathered about
the health of humans, animals, and ecosystems, as well as the desire of many
people in many nations and organizations to implement viable public health
solutions, application, and action are essential. In this context, ‘One Health’ is not
a new form of governance or a critique of existing patterns of governance. Rather,
‘One Health’ is a movement dedicated to building new levels of trust and trans-
parency between disciplines, nations, organizations, and people. Such trust and
transparency must begin with inspirational educational curriculums, teaching the
next generation of clinicians and veterinarians how to apply and do their own work
in such a way that many others come to appreciate the necessity of ‘‘One Health’’
in tackling difficult problems.
As these two volumes of Current Topics in Microbiology and Immunology go
to press, many countries have established their own national ‘One Health’ policies
and/or committees, recognizing the need to integrate and coordinate their human
and animal surveillance to empower a more effective and rapid cross-sectoral
response to zoonotic disease threats. There is little doubt that the ‘One Health’
concept will continue to develop and provide the coordinated, collaborative,
multidisciplinary and cross-sectoral approaches essential to develop the rapid
detection, and better predictive ability necessary for rapid response to future
threats. In particular, we envisage a greater collaboration among environmental
and ecological scientists with the animal and human health sectors of the ‘One
Health’ movement. The linkages between the underlying socioeconomic and
environmental drivers of emerging diseases, and the threat of pandemic emergence
will likely be one area in particular where collaboration will be fruitful.
The purpose of these volumes is to present an overview of the ‘One Health’
movement, and in doing so, demonstrate the breadth and depth of its recent global
development. The first volume has been divided into two Parts. The first part
entitled ‘‘The Concept and Examples of a One Health Approach’’ examines ‘One
Health’ from different perspectives especially that of human health and veterinary
medicine, whether domestic or wildlife, the importance of understanding the
different interfaces, the role of ecological science, and the compelling economics
driving their cooperation and coordination. This is then followed by a series of
examples where a ‘One Health’ approach has been useful in responding to specific
diseases in the field. The second volume entitled ‘‘Food Safety and Security, and
viii Preface

International and National Plans for Implementation of One Health Activities’’

explores the importance of ‘One Health’ in food safety and food security. These
are crucially important issues that are often not given the prominence they require
and deserve as the world seeks to feed a growing population. This second volume
also describes some of the international, regional, and national activities and plans
to implement ‘One Health’ approaches. The final Part describes additional activ-
ities and approaches to strengthen the ‘One Health’ movement and increase its
momentum in different ways. By reading, reflecting, and acting on the scale and
depth of ‘One Health’ as set out in these volumes, you will be making your own
contribution to the movement. Do not underestimate the importance of that
contribution.
Contents

Part I Food Safety and Food Security: A One Health Paradigm

Food Safety: At the Center of a One Health Approach

for Combating Zoonoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Peter R. Wielinga and Jørgen Schlundt

The Importance of a One Health Approach to Preventing

the Development and Spread of Antibiotic Resistance . . . . . . . . . . . . . 19
Peter Collignon

Bovine Spongiform Encephalopathy: A Tipping Point in One Health

and Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
James Hope

Pathogenic Escherichia coli and One Health Implications . . . . . . . . . . 49

Narelle Fegan and Kari S. Gobius

Part II National Plans for Developing a One Health Approach

FAO and the One Health Approach. . . . . . . . . . . . . . . . . . . . . . . . . . 65

Juan Lubroth

Development of a One Health National Capacity in Africa . . . . . . . . . 73

Mark Rweyemamu, Dominic Kambarage, Esron Karimuribo,
Philemon Wambura, Mecky Matee, Jean-Marie Kayembe,
Aaron Mweene, Luis Neves, Justin Masumu, Christopher Kasanga,
Bernard Hang’ombe, Kim Kayunze, Gerald Misinzo,
Martin Simuunza and Janusz T. Paweska

The Development of One Health Approaches

in the Western Pacific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Ben Coghlan and David Hall

ix
x Contents

One Health Approach in the South East Asia Region:

Opportunities and Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Gyanendra Gongal

One Health in Mongolia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Zayat Batsukh, B. Tsolmon, Dashdavaa Otgonbaatar, Baatar Undraa,
Adyadorj Dolgorkhand and Ochirpurev Ariuntuya

Part III One Health New Technologies, New Approaches

and How to Implement

Climate Change and Human Health: A One Health Approach . . . . . . 141

Jonathan A. Patz and Micah B. Hahn

Operationalizing One Health: Stone Mountain and Beyond . . . . . . . . 173

Carol S. Rubin

Building a Foundation for ‘One Health’: An Education Strategy

for Enhancing and Sustaining National and Regional Capacity
in Endemic and Emerging Zoonotic Disease Management. . . . . . . . . . 185
W. D. Vink, Joanna S. McKenzie, Naomi Cogger,
Barry Borman and Petra Muellner

Infections at the Animal/Human Interface: Shifting the Paradigm

from Emergency Response to Prevention at Source . . . . . . . . . . . . . . 207
David L. Heymann and Mathew Dixon

One Health from a Social–Ecological Systems Perspective:

Enriching Social and Cultural Dimensions . . . . . . . . . . . . . . . . . . . . . 217
Helen Ross

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Contents of Volume 1: The Concept
and Examples of a One Health Approach

One Health: Its Origins and Future . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Ronald M. Atlas

Part I The Concept of One Health

One Health and Emerging Infectious Diseases:

Clinical Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Peter Rabinowitz and Lisa Conti

The Historical, Present, and Future Role of Veterinarians

in One Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Samantha E. J. Gibbs and E. Paul J. Gibbs

The Importance of Understanding the Human–Animal Interface . . . . 47

Leslie A. Reperant, Giuseppe Cornaglia and Albert D. M. E. Osterhaus

The Human Environment Interface: Applying Ecosystem

Concepts to Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Nicholas D. Preston, Peter Daszak and Rita R. Colwell

Wildlife: The Need to Better Understand the Linkages . . . . . . . . . . . . 99

Melinda K. Rostal, Kevin J. Olival, Elizabeth H. Loh
and William B. Karesh

The Economic Value of One Health in Relation to the Mitigation

of Zoonotic Disease Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Barbara Häsler, William Gilbert, Bryony Anne Jones,
Dirk Udo Pfeiffer, Jonathan Rushton and Martin Joachim Otte

xi
xii Contents of Volume 1: The Concept and Examples of a One Health Approach

Part II Examples of a One Health approach to specific diseases

from the field

The Application of One Health Approaches

to Henipavirus Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
David T. S. Hayman, Emily S. Gurley, Juliet R. C. Pulliam
and Hume E. Field

H5N1 Highly Pathogenic Avian Influenza in Indonesia:

Retrospective Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Peter Daniels, Agus Wiyono, Elly Sawitri, Bagoes Poermadjaja
and L. D. Sims

Rabies in Asia: The Classical Zoonosis. . . . . . . . . . . . . . . . . . . . . . . . 181

Henry Wilde, Thiravat Hemachudha, Supaporn Wacharapluesadee,
Boonlert Lumlertdacha and Veera Tepsumethanon

Japanese Encephalitis: On the One Health Agenda. . . . . . . . . . . . . . . 201

Daniel E. Impoinvil, Matthew Baylis and Tom Solomon

Cost Estimate of Bovine Tuberculosis to Ethiopia. . . . . . . . . . . . . . . . 245

Rea Tschopp, Jan Hattendorf, Felix Roth, Adnan Choudhoury,
Alexandra Shaw, Abraham Aseffa and Jakob Zinsstag

The Pandemic H1N1 Influenza Experience . . . . . . . . . . . . . . . . . . . . . 265

Juergen A. Richt, Richard J. Webby and Robert E. Kahn

One Health: The Hong Kong Experience with Avian Influenza . . . . . . 277
L. D. Sims and Malik Peiris

Clostridium difficile Infection in Humans and Piglets:

A ‘One Health’ Opportunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Michele M. Squire and Thomas V. Riley

Cysticercosis and Echinococcosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

M. W. Lightowlers

Men, Primates, and Germs: An Ongoing Affair . . . . . . . . . . . . . . . . . 333

Jean Paul Gonzalez, Frank Prugnolle and Eric Leroy
Contents of Volume 1: The Concept and Examples of a One Health Approach xiii

Erratum To: Cost Estimate of Bovine Tuberculosis to Ethiopia . . . . E1

Rea Tschopp, Jan Hattendorf, Felix Roth, Adnan Choudhoury,
Alexandra Shaw, Abraham Aseffa and Jakob Zinsstag

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Contributors

Ochirpurev Ariuntuya WHO, P.O. Box 46/78, Ulaanbaatar, Mongolia, e-mail:

[email protected]; [email protected]
Zayat Batsukh Government Implementation Agency for Veterinary and Animal
Breeding, MoFA and Light Industry, Peace avenue-16a, SPB-IX, Ulaanbaatar,
Mongolia, e-mail: [email protected]
Barry Borman Centre for Public Health Research, College of Humanities and
Social Sciences, Massey University, Private Box 756, Wellington, New Zealand
Naomi Cogger EpiCentre Institute of Veterinary, Animal and Biomedical Sci-
ences, Massey University, Private Bag 11 222, Palmerston North, New Zealand
Ben Coghlan Burnet Institute, Melbourne, Australia, e-mail: coghlan@burnet.
edu.au
Peter Collignon Infectious Diseases Unit and Microbiology Department, The
Canberra Hospital, Canberra Clinical School, Australian National University, P.O.
Box 11, Woden, ACT 2607, Australia, e-mail: [email protected]
Mathew Dixon Chatham House, London, UK
Adyadorj Dolgorkhand National Center for Infectious Diseases with Natural
Foci, 20 Khoroo, Songinokhairkhan district, Central post office box 582, 18131
Ulaanbaatar, Mongolia, e-mail: [email protected]
Narelle Fegan CSIRO Animal, Food and Health Sciences, 671 Sneydes Rd,
Werribee, VIC 3030, Australia, e-mail: [email protected]
Kari S. Gobius CSIRO Animal, Food and Health Sciences, 39 Kessels Rd,
Coopers Plains, QLD 4108, Australia, e-mail: [email protected]
Gyanendra Gongal Disease Surveillance and Epidemiology, WHO Regional
Office for South East Asia, New Delhi 110 002, India, e-mail: Gongalg@
SEARO.WHO.INT

xv
xvi Contributors

Micah B. Hahn Nelson Institute, Center for Sustainability and the Global
Environment (SAGE), University of Wisconsin, 1710 University Avenue, Madi-
son, WI 53726, USA, e-mail: [email protected]
David Hall University of Calgary, Calgary, Canada, e-mail: [email protected]
Bernard Hang’ombe SACIDS at School of Veterinary Medicine, University of
Zambia, Lusaka, Zambia
David L. Heymann Chatham House Centre on Global Health Security, London,
UK; Infectious Disease Epidemiology, London School of Hygiene and Tropical
Medicine, London, UK, e-mail: [email protected]
James Hope Animal Health and Veterinary Laboratories Agency Weybridge,
Woodham Lane, New Haw, Addlestone KT15 3NB, Surrey, UK, e-mail:
[email protected]
Dominic Kambarage SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania
Esron Karimuribo SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania
Christopher Kasanga SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania
Jean-Marie Kayembe SACIDS at School of Public Health, University of Kin-
shasa, Kinshasa, Democratic Republic of Congo
Kim Kayunze SACIDS at Muhimbili University for Health and Allied Sciences,
Dar es Salaam, Tanzania
Juan Lubroth Animal Health Service, Food and Agriculture Organization, Viale
delle Terme di Caracalla, 00153 Rome, Italy, e-mail: [email protected]
Justin Masumu SACIDS at School of Public Health, University of Kinshasa,
Kinshasa, Democratic Republic of Congo
Mecky Matee SACIDS at Muhimbili University for Health and Allied Sciences,
Dar es Salaam, Tanzania
Joanna S. McKenzie EpiCentre Institute of Veterinary, Animal and Biomedical
Sciences, Massey University, Private Bag 11 222, Palmerston North, New Zealand
Gerald Misinzo SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania
Petra Muellner EpiCentre Institute of Veterinary, Animal and Biomedical Sci-
ences, Massey University, Private Bag 11 222, Palmerston North, New Zealand
Aaron Mweene SACIDS at School of Veterinary Medicine, University of
Zambia, Lusaka, Zambia
Contributors xvii

Luis Neves SACIDS at Faculty of Veterinary Medicine, Eduardo Mondlane

University, Maputo, Mozambique
Dashdavaa Otgonbaatar National Centre for Zoonotic Diseases, Ministry of
Health, 20 Khoroo, Songinokhairkhan district, 18131 Ulaanbaatar-211137, Mon-
golia, e-mail: [email protected]
Jonathan A. Patz Nelson Institute, Center for Sustainability and the Global
Environment (SAGE), University of Wisconsin, 1710 University Avenue, Madi-
son, WI 53726, USA, e-mail: [email protected]
Janusz T. Paweska SACIDS at National Institute for Communicable Diseases of
the National Health Laboratory Services, Sandringham, Johannesburg, South
Africa
Helen Ross The University of Queensland, St Lucia, Brisbane, QLD, Australia,
e-mail: [email protected]
Carol S. Rubin National Center for Emerging and Zoonotic Infectious Diseases,
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA, e-mail:
[email protected]
Mark Rweyemamu SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania, e-mail: [email protected]
Jørgen Schlundt National Food Institute, Technical University of Denmark,
Morkhoj Bygade 19, 2860 Soborg, Denmark, e-mail: [email protected]
Martin Simuunza SACIDS at School of Veterinary Medicine, University of
Zambia, Lusaka, Zambia
B. Tsolmon Government Implementation Agency for Veterinary and Animal
Breeding, MoFA and Light Industry, Peace avenue-16a, SPB-IX, Ulaanbaatar,
Mongolia
Baatar Undraa National Center for Infectious Diseases with Natural Foci, 20
Khoroo, Songinokhairkhan district, Central post office box 582, 18131 Ulaanba-
atar, Mongolia, e-mail: [email protected]
W. D. Vink EpiCentre Institute of Veterinary, Animal and Biomedical Sciences,
Massey University, Private Bag 11 222, Palmerston North, New Zealand, e-mail:
[email protected]
Philemon Wambura SACIDS at Sokoine University of Agriculture, Morogoro,
Tanzania
Peter R. Wielinga National Food Institute, Technical University of Denmark
(DTU), Copenhagen, Denmark