Transforming raw milk safety in Ethiopia through an integrated tiered strategy to address public health threats and economic losses

Abstract Ethiopia’s widespread raw milk consumption, coupled with regulatory gaps, inadequate infrastructure, and dysfunctional market incentives, creates public health and economic crisis. While individual studies and recent systematic reviews have documented these crises separately, an integrated analytical synthesis that explicitly connects these distinct technical, economic, and policy dimensions and critically appraises context-specific interventions is limited. This review addresses that gap by synthesizing fifty Ethiopian dairy safety articles spanning 1995–2026, with a core focus on 2015–2026 publications. National systematic reviews estimate pooled pathogen prevalence in raw milk at 21.4% for Staphylococcus aureus and 6.2% for Escherichia coli O157:H7. AMR rates among pathogenic isolates reach 86.2%, with 50.6% exhibiting multidrug resistance a crisis driven by the confluence of on‑farm antimicrobial use for calf disease management, mastitis treatment, disease prevention, and routine veterinary practices. Concurrently, 21.6% of total annual milk production is lost post-harvest, representing an annual economic loss exceeding 22 million Ethiopian Birr. Critically, these technical failures are perpetuated by a “low-quality equilibrium trap”: the market fails to reward safety and quality with price premiums, disincentivizing investment in hygiene and cooling infrastructure. To escape this trap, the review proposes an integrated, multi-tiered strategy comprising foundational hygiene and simple quality testing; structural market reforms including quality-based payment systems and shared cooling; and strategic adoption of context-appropriate technologies such as the Lactoperoxidase System and N₂ gas flushing, alongside a long-term vision for genomic surveillance. This evidence-based, tiered approach provides a transferable blueprint for transforming dairy sectors in Ethiopia and comparable low-income settings.