Báo cáo giám sát hệ thống phòng ngừa ngộ độc thực phẩm tại Bình Dương

Đây là một báo cáo giám sát hệ thống phòng ngừa ngộ độc thực phẩm tại Bình Dương. Kết quả cho thấy Bình Dương có một hệ thống phòng ngừa ngộ độc thực phẩm khá hiệu quả. Số vụ ngộ độc thực phẩm của Bình Dương giảm dần theo năm. Sự kết hợp giữa các tuyến trong phòng ngừa ngộ độc thực phẩm tại Bình Dương được đánh giá rất cao.

Report on evaluation of food poisoning outbreak system in Binh Duong

1 Statement of the problem

Food poisoning is still a critical public health problem in Viet Nam [1, 2] It is estimated that there are 250-500 food poisoning outbreaks (FPO) occur every year with 7,000-10,000 cases and 100-200 deaths However, Vietnam still lacks a comprehensive national food safety surveillance system Efforts in surveillance by different agencies are fragmented, weakly coordinated and poorly integrated However, Vietnam still lacks a comprehensive national food safety surveillance system The data collected by different ministries through routine monitoring are not collated for joint use by ministries for risk-based food safety surveillance and controls There still is a need to ensure that surveillance activities are consistent with international standards and that reliable information exchange systems are developed between provincial and national organizations Surveillance systems are expensive, and there are limited possibilities to recover costs from the private sector Hence, lack of operational funding is a serious constraint for setting up an effective surveillance system in Vietnam Laboratory capacity and funding are not sufficient for routine surveillance or enforcement of related testing There are laboratory data

on exports and imports and some data from domestic inspection activities under the different ministries, but there is no overall plan or collation of national data for analysis and monitoring of foodborne diseases and food safety

Binh Duong is one of the largest cities in southern Viet Nam, in which 48 industrial parks with hundreds of factories located and that leads to a high risk of food poisoning outbreaks occurring From 2006-2010, there were 33 FPOs with 1834 cases, while the figure was 11 with

487 cases from 2010-2014

The food safety surveillance system in Binh Duong is still not effective At the local level, management assignments among the health, industry and agriculture sectors are still overlapping, even tending to push among agencies in the management of small businesses and food service establishments Moreover, on-the-spot control has not been paid attention; the records of food processing establishments are not sufficiently documented, so there is no database for tracing when the FPOs occur The inspective worksare carried out regularly but not frequently; consequently, only 30-40% of the food producers and food processing establishments have been controlled

Although several reports have pointed out these drawbacks, no comprehensive evaluations of food safety surveillance system are carried out Therefore, this study is propose to assess the system from that appropriate policies may be informed to improve effectiveness of the system

This is a cross-sectional study which will be conducted from July 2017 to December

2017 in Binh Duong province

Study population

Health facilities involving into food poisoning surveillance system will be targets for evaluation According to Decision 01/2006/QĐ-BYT, Vietnamese Food Administration (now decentralized into provincial Food Administrations (PFA)), provincial Preventive Medicine Centers (PPMCs), district Preventive Medicine Centers (now renamed as district Medicine Centers (DMCs), and commune health stations (CHS) relate to identify, investigate and report FPOs Therefore, all those facilities will be evaluated in this study

Data collection methods

Data on status of FPSS will be characterized as indicators on structure (number of regulations, policies, networks…), core functions (having case definition, having evidence-based surveillance…), and support functions (number of training courses, number of drills…) Data on effectiveness of activities are also qualified into indicators on structure (percentage of compliance to regulations, percentage of activities completed…), core functions (level of revalence of case definition, percentage of FPOs had lab confirmations…), and support functions (level of impacts of drills, level of impacts of training courses…) (Annex 1)

To collect indicators on status of FPSS, document review will be used Key informant interview may also be deployed in case of some indicators could not be obtained from recorded documented

A semi-structured questionnaire based on WHO Guideline on monitoring and evaluating for communicable disease surveillance and response systems will be developed to collect all data about the status and effectiveness of the FPSS In the questionnaire, items related to status indicators will be introduced first, followed by items related to effectiveness indicators so that data will be collected in a contiguous and logical manner (Annex 2) [3]

Key informants will be persons who are responsible for food poisoning activities in targeted health facilities They include:

• PFA: one head of bureau of food poisoning control

• PPMC: one head of department of communicable disease control

• DMC: seven heads of department of communicable disease control

1 Status of food poisoning surveillance system in Binh Duong

Like other provinces in the whole country, the food poisoning surveillance system (FPOS) in Binh Duong is solely a passive surveillance system which depends on FPO reporting

As a food poisoning outbreak (FPO) occurs, the reporting mechanism from lower level to higher

level is activated and responses and control measures are implemented as well Other types of FPOS such as syndromic surveillance, foodborne disease notification systems are not yet established

1.1 Legistration for food poisoning surveillance system in Binh Duong

Nationally, although no legal documents deal directly with FFOS, there are several official documents related to food poisoning management They include Decision 5327/2003/QĐ-BYT on regulations of specimen collection in food poisoning outbreaks, Decision 39/2006/QĐ-BYT on regulations of food poisoning outbreak investigation, Decision 48/2005/QĐ-TTg on establishment of the Central Inter-Sector Steering Committee for Food Hygiene and Safety, and Decision 01/2006/ QĐ-BYT on regulations of reporting and reporting forms on food hygiene and safety

Based on the national legal framework, Binh Duong had developed a set of legal documents related to food poisoning management At provincial level, legal documents included Decision 137/2009/NĐTP-ATTP on the process of identification and investigation of the causes

of food poisoning outbreak, Plan 77/KH-BCD on mobilizing commitments to prevent food poisoning outbreak occurring at cooking establishments and food services, and Decision 11/2013/QĐ-UBND on regulations of decentralized management on food hygiene and safety On Decision 11/2013/QĐ-UBND, responsibilities of each agency related to food safety management

at each level are described obviously, while Decision 137/NĐTP-ATTP describes three activities dealing with food poisoning outbreaks including reporting timely FPO status to People’s Committee and Provincial Health Service, urgent response and control of FPO cases (screening, referral to health facilities, and treatment), and FPO investigation (clinical investigation, field investigation, and food sampling) On the other hand, Plan 77/KH-BCD stated that all industrial companies, kindergartens and schools those have canteens must establish urgent response units

to deal with FPO At district level, district medical centers (DMCs) developed decisions of establishment of FPO investigation teams All of these legal document enable Binh Duong establish a comprehensive legal framework for FPO management

Provincial People’s Committee (PPC)

• Regulate provincial Inter-Sector Steering

Committee for Food Hygiene and Safety

Provincial Health Service (PHS)

• Regular and urgent reporting to PPC about food safety status

Sub-Vietnam Food Administration (sub-VFA)

• Food safety management for food

Figure 1 Flowchart showing decentralized management of each agency related

to food safety at each level based on Decision 11/2013/QĐ-UBND

1.2 Networking and partnership of food poisoning system in Binh Duong

There are several agencies involving in FPOS in Binh Duong At provincial level, these agencies include Provincial People’s Committee (PPC), sub-Vietnam Food Administration (sub-VFA) and Provincial Preventive Health Center (PPHC)

At district level, District People’s Committee (DPC), District Medical Center (DMC) and district hospitals or clinics are three agencies related to FPO management At commune level, Commune People’s Committee (PPC) and Commune Health Station (CHS) had responsibility of dealing with FPO Apart from those agencies, the Institute of Public Health in Ho Chi Minh City gets involve in FPO management in Binh Duong as well Factories and schools those

have canteens are also a part of FPOS The roles and cooperation mechanism of all agencies had been stated in all promulgated legal documents

Table 1 The network and role of agencies involving in FPOS in Binh Duong

Institute of Public Health in Ho Chi

Minh City (IPH)

Support sub-VFA in testing specimens from FPO

Provincial People’s Committee (PPC) Direct food hygiene and safety

management at provincial level

provincial level District People’s Committee (DPC) Direct food hygiene and safety

management at district level District Medicine Center (DMC) Manage FPO and food safety issues at

district level Hospitals or clinics Treatment of FPO victims

Commune People’s Committee (CPC) Direct food hygiene and safety

management at commune level Commune health station (CHS) Support sub-VFA and DMC in FPO

management Factories and schools Response and control of FPO

It could be said that there were not any official documents concerned about information sharing mechanism among relevant agencies of FPOS However, according to sub-VFA, weekly and monthly meetings were hold among all stakeholders of FPOS to disseminate information about FPO status in the whole province In addition, sub-VFA, industrial companies and schools had an informal sharing information mechanism via email It meant that the sub-VFA had an email

list of all industrial companies and schools and it could send all information or alerts about FPO to all companies and schools Moreover, the sub-VFA developed

a website in which all information related to FPO is posted so that all relevant companies and schools have awareness of FPO status in the province

As regard the number of staff being in charge of FPO management, there were four staff at sub-FA including 01 Grade II medical doctor, 01 biochemistry engineer, and 02 public health workers At DMCs, the number of staff responsible for FPO management varied from 03 to 06 and all of them were working at departments of food hygiene and safety All the heads of the departments were Grade I medical doctors, while other members ranged from physicians, biochemistry or food technological or molecular biological engineers, laboratory technicians, nurses to public health workers At CHSs, the number of staff may be from 01 to 03 and they formed FPO response teams in which the heads of the CHS (general doctors) was the head of the team Other members may include physicians and commune volunteers

Table 2 The number of staff responsible for FPO management at all level

Health facilities No staff Frequency

to health facilities where victims hospitalized and team 2 went to local site where the FPO occurred Each team had its own roles in responding to FPO The role of team 1 included investigate victims and collect specimens from victims (nauseas fluid and stools), while the roles of team 2 included epidemiological investigation with case-control design, suspected food sampling and screening for probable cases At DMCs, there were also two teams established with the resemble roles and responsibilities like those of sub-VFA Roles and responsibilities of all staff responsible for FPO management at CHSs also described well Finally, industrial companies and schools with canteens had their FPO response units and the roles of those units were stated apparently in which unit 1 involve in keeping and storing food samples and disease samples (nausea fluid of victims), unit 2 involved in first aid support during FPO and unit 3 involved in FPO communication

Table 3 The role and responsibilities of FPO staff at all level

Sub-FA Team 1 8 clinical investigation including investigate patients by

review medical records and ask history of exposure to suspected foods and collect disease samples (nauseas and stools)

Team 2 4 Epidemiological investigation with case-control design,

food and disease sampling, screening for cases and first aid , calling for health facilities to accept patients, check the food hygiene and safety certificates of those factories

DMC Team 1 2-4 The same as team 1 of sub-FA

Team 2 2-4 The same as team 2 of sub-FA CHS One team Support sampling

Local guide Support first aid Support screening probable cases

2 Core functions of the FPOS

2.1 Detection of food poisoning outbreak

Each agency in FPOS receives information about FPO from different sources In particular, the sub-VFA receives information mainly from factories or companies located in industrial parks and hospitals (both public and private ones) For DMCs, the sources of information about FPO may come from emergency units of DMC since victims in several FPOs hospitalized into the emergency units and the heads of emergency unit reported directly to the directors of DMC In addition, private hospitals or clinics may be also the second source of FPO information Other sources of information that DMCs received included workers working in factories or companies where FPO occurred, media (newspapers), school teachers, local people and owners of food production and business establishment Finally, CHSs may detect FPO from reporting of victims who admitted to the CHSs for treatment

• Factories or companies in the

District Medicine Center (DMC)

Figure 2 Source of information of FPO The time from occurrence of FPO to receiving information is often over one hour due to several reasons Firstly, victims who had food poisoning symptoms would seek health care at health units in their factories or companies; however, in most FPOs victims did not get better conditions, making them visited DMCs or hospitals/clinics latter As a result, it took more time (1-3 hours) for DMCs or hospitals report the primary cases of FPO Secondly, victims who are often workers in the factories ate the suspected meals on the afternoon without any food poisoning symptoms and then they came back home where they onset the symptoms Finally, according to CHS’s staff, victims developed symptoms and they practiced self-treatment at their homes but did not get better conditions so they then admitted the hospital lately All of the reasons mentioned here lead to a delay on detecting FPO in the communities

2.2 Confirmation of food poisoning outbreak

The laboratory system for FPO testing included a laboratory of Provincial Preventive Health Center (PPHC), and nine laboratories of DMCs According to Decision 137/NĐTP-ATTP

in case of FPO, the sub-VFA had the responsibility of collecting specimens, packaging and then sending the specimens for testing to two different laboratories In fact, the sub-VFA sent all FPO specimens for testing to the Institute of Public Health since more than two years ago

The capacity of laboratory system for FPO had been investigated in the study The laboratory of PPHC had a total of nine staff According to data provided by laboratory staff, the laboratory had been equipped with all basic testing operators and tools (medium, prime, lab tubes…) Other testing machines such as HPLC, AAS and GO were also available In addition, the laboratory had the ability of testing all biochemical and toxic indexes in food and water, apart from several heavy metal indexes Finally, it achieved ISO 17050 certificate in 2013 In general, the staff of PPHC claimed that their laboratory had sufficient capacities for FPO testing; although lack of personnel for FPO testing may exist during FPOs occur

• Patients admitted to CHS Commune Health Station (CHS)

The capacity of DMC laboratories varied on the basis of personnel, testing machine and equipment The number of staff ranged from 2 to 14 workers depending on the scale of the DMC Most of laboratories had been equipped with basic testing machines used to test biochemical and chemical indexes One laboratory even had advanced testing machines such as centrifuge and automatic biochemical machines However, none of laboratories had acquired quality control certificates, except for one with Grade II safety laboratory certificate Asked about equipment for collection, packaging and transportation of FPO specimen, most of staff stated that their laboratories had sufficient equipment Nevertheless, few staff claimed that because of establishment currently their DMCs were lack of equipment for FPO specimen collection, packaging and transportation

2.3 Reporting

According to Decision 39/2006/QĐ-BYT on regulations of food poisoning outbreak investigation, there were three types of report in FPOS including urgent report, periodic report (monthly and yearly) and statistical report Lower agencies had to report FPO to higher agencies

at the beginning, during and at end of the FPO The contents of urgent report must include district occurred the outbreak, time of occurrence the outbreak, the causal food, the causal meal, the site of FPO, the symptoms of cases, specimen collecting and testing, number of people eating the meal, number of morbidity, and mortality of FPO, the index case and the last case, the ending time of FPO, and recommendation On the other hand, the periodic report of FPO covered the number of FPO by causes (biological, chemical, contaminant food, and toxic types), number of morbidity and mortality due to FPO For statistical report, the contents included the number of FPO, morbidity and mortality by months, laboratory confirmation of contaminant food, geographical distribution of FPO, causes of FPO, number of FPO having specimen from patients, from healthy people, from food and food containers, and distribution of FPO by age group (0-4, 5-14, 15-49, ≥ 50)

The mechanism of reporting FPOs was described apparently in the Decision 137/2009/NĐTP-ATTP In case of FPO detected by CHS, the CHS had the responsibility of reporting to CPC and DMC, and the DMC then reports to DPC, sub-VFA, and PHS The sub-VFA in turn would report to PPC, Vietnam Food Administration (VFA), and IPH On the other hand, if the FPO is identified by DMC, the DMC has to report to DPC, sub-VFA and PHS, while

it also has to rely to CHS about the FPO In addition, if the FPO is detected by sub-VFA, the sub-VFA relies to DMC, and then DMC rely to CHS for response to the FPO

The mechanism of periodically and statistical reporting was well described in Decision 39/2006/QĐ-BYT as well Lower agencies of FPOS must have reports monthly, quarterly and yearly Similarly, they make statistical reports in second quarter and fourth quarter

Figure 3 The reporting mechanism of FPO in Binh Duong

The timeliness of FPO urgent reporting and relying was recognized as perfect (100%) at all level The sub-VFA reported FPO status every day from the beginning to the end of FPO to higher agencies The reports were always completed and sent to higher agencies within 24 hours The same procedure was applied by DMCs and CHSs All interviewees at all level claimed that timely reporting of FPO is an obligation regulated in Decision 137/2009/NĐTP-ATTP because FPO is an urgent situation in which a promptly reporting is vital to have quick responses to FPO

Unlike urgent reports, the timeliness of periodic reports was relatively good, according to most of interviewees The proportion of reporting timely from DMCs to sub-VFA was 100%,

• Receive information of

FPO

• Receive information of FPO

Sub-VFA

• Receive information of

FPO

District Medicine Center (DMC)

Commune Health Station (CHS) CPC

DPC

HS

PPC

while the figure from CHSs to DMCs ranged from 80% to 90% Some DMC staff argued that not all CHSs report timely because the CHS staff responsible for FPO management had to do so many works, so sometimes they forgot to send the reports on time

As regard the completeness of reporting agencies, all lower agencies had sent their reports, both urgent and periodic reports, to higher agencies According to sub-VFA staff, nine DMCs always sent their reports monthly, quarterly and yearly Similarly, all CHSs in nine districts sent their reports to DMCs

The completeness of case reporting was also investigated For urgent reports, the reporting case was often not compatible with the actual cases at the beginning and during the FPO For most of FPO occurring for 2010-2016 period, the reporting cases were higher than the actual cases There was a consensus among interviewees at all level about the reason for that incompatibility in which at the beginning off the FPO, a large amount of non-cases were also included as probable cases, making the number of actual cases increased significantly However, after screening and classification, the actual cases went down and the reporting cases were matched with the actual cases For periodic reports, because frequently checked by the sub-VFA, the reporting cases resemble the actual cases in FPOS

We also evaluated reporting function of FPOS through the completeness of surveillance data It turned out to be that most of data in reports, both urgent and periodic, were sufficiently reported, except for data about symptoms of cases According to sub-VFA staff, it was hard for health facilities where victims hospitalized to record symptoms of all cases since there may have numerous cases hospitalized at the same time

Asked about the simplicity of reporting mechanism and report forms, most of interviewees confirmed that the reporting mechanism was not complicated to them since each agency had its higher agencies to report, based on clear statements in the Decision 137/2009/NĐTP-ATTP Moreover, the reporting forms were also evaluated as simple since they had been modified by sub-VFA so that lower agencies could facilitate data analysis Nevertheless, one DMC staff complaint that the reporting forms were so long and detailed, making them hardly be completed by the staff

2.4 Data analysis and interpretation

The statistical report, one type of compulsory reports in FPOS, is actually an epidemiological analysis of FPO since it covers all aspects of FPO from socioeconomic features

of FPO cases to laboratory confirmation of contaminant food In fact, sub-VFA had conducted statistical reports quarterly and yearly and sent them to higher agencies, whereas DMCs and

CHSs did not make that type of report since they did not have that function Data of FPO was often analyzed in a period of three to five years Stata software was used as the analysis tool and the time for data analysis was around 1 week Asked about the helpfulness of the statistical report, the sub-VFA staff claimed that it was useful on the basis that it can help sub-VFA access the FPO data easier and more promptly

2.5 Epidemic preparedness for FPO

It could be claimed that the sub-VFA had a well epidemic preparedness for FPO It had a plan for quickly response to FPO It also had a decision on team establishment for FPO investigation and response Moreover, it had a separate fund for FPO response and control although the fund may not be sufficient for the FPO control and response, according to sub-VFA staff The sub-VFA staff was equipped well with safety equipment such as rubber gloves, safety masks, apart from medical protective clothing which was recognized as not enough for sub-VFA staff (2 units/year)

For all DMCs, a quick-response plan was very necessary and always made prior to any FPOs occur Some DMCs had a separate fund for FPO response and control, whereas others used the fund supplied by DPC However, in general interviewees argued that the fund for FPO response was not enough for all activities On the contrast, all interviewees agreed that they received enough safety equipment for FPO response Those equipment included rubber gloves, safety masks, medical protective clothing

Most of CHSs did not have their own quick-response plane since as many interviewees said they received phone calls from DMCs or sub-VFA telling them that there was a FPO in their locals, so they response immediately without any plan Furthermore, for some CHSs since only one staff responsible for FPO management, none of quick-responses plan was necessary About the fund for FPO response, none of CHSs had separate funds because FPO response and control were mostly done by higher agencies, meaning that CHSs need not a fund to spend for FPO response and control All of safety equipment used by CHSs were delivered by DMCs; therefore most of CHSs staff claimed that the number of safety equipment was satisfied their demand on responding to FPO Nevertheless, some CHSs where staff joined with specimen sampling thought that they need more equipment on storing food samples from FPO

FPO drill is an important activity which helps agencies improving their capacity of FPO response Unfortunately, there were no FPO drills held for DMCs and CHS staff since 2010 Instead, the sub-VFA held FPO drills regularly for schools and factories with large canteens in all areas of Binh Duong It was estimated an average of 15 drills per year were held for those

targets All staff of response units in schools and factories were expected to attend one-week classes on FPO response and one to two weeks later they would join on FPO drills at their schools or factories Interestingly, the contents of FPO drills included screening probable cases at first sight, collecting specimen (nausea fluid and potential contaminated food), and controlling the site during the FPO

2.6 Response and control of FPO

After receiving the information about FPO, four staff responsible for FPO management and other staff of sub-VFA split into two teams: one team went to the FPO site and one team went to the health facilities where victims hospitalized Two cars with well-equipped tools (sample collection tool kit, sample storing tool kit, and safety equipment) were used to take two teams to the FPO sites and health facilities

At the FPO sites, the sub-VFA team was expected to collect nausea fluid of victim and contaminant food samples; however, in most of FPO the response unit at factories or schools had already collected, stored the specimen and handed them to sub-VFA team Other activities were also taken including screening probable cases, investigate close contacts and checking conditions

of food hygiene and safety of the canteens of schools and factories For screening probable cases, the sub-VFA team along with response team of schools or factories would exam people who had clinical symptoms of food poisoning If the probable cases were detected, they would be referral

to the nearest health facilities for treatment For investigating close contacts, the sub-VFA used the standard forms that regulated in Decision 39/2006/QĐ-BYT to interview close contacts The ratio cases:close contacts was often 1:3 For checking conditions of food hygiene and safety, the sub-VFA checked the certificate of food hygiene and safety and the conditions of canteens during the FPO

The second team of sub-VFA also did several activities in health facilities They went to every health facilities where victims hospitalized and reviewed medical records of victims and received nausea fluid samples from health facilities In case of nausea fluid samples could not be collected, the sub-VFA may take stool samples of victims Moreover, the team asked cases about time of symptoms onset, time of hospitalization, symptoms and history of potential food exposure The data of cases then would be compared with those of close contacts to find out the causal foods All of samples collected from the FPO sites and health facilities after all would be sent to the Institute of Public Health in Ho Chi Minh City for testing in the same day

Like sub-VFA, DMCs staff who were staff of department of food hygiene and safety and other departments split into two teams those went to FPO sites and health facilities Since DMCs

were often nearer FPO sites and health facilities compared to sub-VFA, DMC teams were often the first teams going to FPO sites and health facilities to investigate FPO

At the health facilities, the DMC team did the activities just like those done by sub-VFA

In some FPOs, a part of cases hospitalized into DMCs, so the DMC team by themselves collected nauseas or stool samples of cases As the sub-VFA team went to the health facilities, the DMC team reported all what it had done to the sub-VFA team Depend on data that the DMC team had collected, the sub-VFA team would decide whether or not further collecting specimen and investigating cases to get more information

The activities of DMC team at FPO sites depended completely to the places where FPOs occurred Particularly, if the FPO occurred in a school or a factory outside industrial parks the DMC team had the authorities to conduct investigation activities including screening probable cases, interviewing close contacts and collecting food and nausea fluid samples If the FPO occurred in a factory inside industrial parks, the DMC team had to wait the sub-VFA coming because only sub-VFA had the authorities to investigate factories in industrial parks, based on regulations of Decision 11/2013/QĐ-UBND In such cases, the sub-VFA team would play the main role in screening probable cases, interviewing close contacts and collecting specimen

The CHSs also took part in response and control of FPO There was one staff of CHS would go to all health facilities to collect information about probable cases hospitalized and then reported to higher agencies Others would join to DMC team and sub-VFA team going to FPO sites and support them in investigation activities

It is important to note that three response units in factories or schools have a vital role in response and control FPO As the FPO occurred, response units would be the units dealing directly and quickly with FPO cases One unit was expected to support health office of the factory or school do first aid for all probable cases and suspected cases It also supported DMC and sub-VFA team in screening probable cases Another unit had the responsibility of collecting nausea fluid and food samples, keeping and storing samples until the DMC and sub-VFA coming, and the last one would protect the FPO site and communicate to others about the FPO situation

The timeliness of response and control FPO was evaluated in the study It was concluded that all agencies had quick responses as FPO occur After receiving information about FPO, the sub-VFA teams would go to health facilities and FPO site immediately Depend on the distances between the center of province where sub-VFA located to the FPO sites where located in district areas, it took from fifteen to forty five minutes for sub-VFA to come FPO sites On the other

hand, the time may be less for DMC teams to come to FPO sites and health facilities For response units in factories or schools, quick responses, meaning quick report to higher agencies, first aid, screening, and collecting samples, were important so that they could reduce minimal of morbidity and even mortality due to FPO

Figure 4 The flowchart of FPO response and control in Binh Duong province (1): report and rely

(2): screening probable cases, collecting food and nausea fluid samples, interviewing close contacts

(3): collecting nausea fluid or stool samples, interviewing cases

(4): collecting information about number of cases hospitalized in all health facilities

(5): first aid, screening probable cases, collecting food and nausea fluid, protecting the sites

• Site of FPO (business,

schools)

Health facilities (clinics/hospital/DMC/CHS)

Sub-VFA

District Medicine Center (DMC)

Commune Health Station (CHS) CPC

Annex 2: Questionnare

BỘ CÂU HỎI KHẢO SÁT THÔNG TIN VỀ HỆ THỐNG GIÁM SÁT NGỘ ĐỘC THỰC PHẨM ĐƠN VỊ KHẢO SÁT: CHI CỤC AN TOÀN VỆ SINH THỰC PHẨM TỈNH BÌNH DƯƠNG

Thành phần: Cấu trúc hệ thống Thành tố: Quy chế, quy định về giám sát

1

Theo anh/chị, hiện nay có các loại văn bản/quy

định/quyết định nào liên quan đến giám sát/điều tra

Nếu KHÔNG, chuyển câu 4

2 Nếu biết thì theo anh/chị mức độ tuân thủ của CC

3 Nếu không đạt 100%, anh/chị có thể nêu lý do

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Thành phần: Cấu trúc hệ thống Thành tố: Chiến lược giám sát 4 CC có kế hoạch hoạt động dành cho công tác giám sát NĐTP hay không? 1 Có kế hoạch riêng 2 Có nhưng lồng ghép vào kế hoạch chung của CC 3 Không 4 Không biết Nếu CÓ đề nghị xem kế hoạch hoạt động năm Nếu KHÔNG chuyển câu 7 5 Nếu CÓ, thì tỷ lệ phần trăm các hoạt động trong kế hoạch năm 2016 đã được triển khai? ………… Đề nghị xem báo cáo thực hiện kế hoạch 6 Nếu Không đạt 100% theo kế hoạch, anh/chị có thể cho biết lý do -

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7 CC có nhân viên phụ trách giám sát ATVSTP/ NĐTP

hay không?

1 Có Số lượng………

2 Không 3 Không biết Nếu KHÔNG chuyển câu 10 8 Nếu CÓ, trình độ chuyên môn của nhân viên phụ trách ATVSTP/NĐTP? 1………

2………

3………

9 Có bảng phân công trách nhiệm/vai trò của các nhân viên phụ trách ATVSTP/NĐTP hay không? 1 Có 2 Không 3 Không biết Nếu CÓ, đề nghị xem bảng phân công Thành phần: Cấu trúc hệ thống Thành tố: Mạng lưới giám sát và cơ chế phối hợp 10 Anh/chị có thể cho biết về hệ thống báo cáo NĐTP của tỉnh -

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11 Theo anh/chị đánh giá mức độ phù hợp của hệ thống báo cáo NĐTP của tỉnh

12 Nếu không đạt 100%, anh/chị có thể nêu lý do

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13 Anh/chị có thể cho biết về hệ thống điều tra NĐTP của tỉnh

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14 Theo anh/chị mức độ phù hợp của hệ thống điều tra NĐTP với tình hình thực tế

15 Nếu không đạt 100%, anh/chị có thể nêu lý do

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16 Anh/chị có thể cho biết về hệ thống kiểm tra cơ sở

chế biến, bếp ăn tập thể của tỉnh

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