This study aimed to assess the status of food-borne AD in Thai Nguyen city. The results showed that the incidence of diarrhea in two weeks is rather high (1,39%), of which 94% of cases were AD transmitted by food. Hospital statistics only represented partly its reality, every one case of AD in hospitals was equivalent to 18 cases in the community, one case of AD transmitted by food in hospital was equivalent to 40 cases in the community.
Trang 1REALITY OF FOOD POISONING WITH Acute Diarrhea
AT COMMUMNITY OF THAI NGUYEN 2011
Nguyen Hung Long*
summary
Food-borne acute diarrhea (AD) or food poisoning is one of the leading causes of hospitalization However, the actual number of foodborne diarrhea is many times bigger than the reporting system data This study aimed to assess the status of food-borne AD in Thai Nguyen city The results showed that the incidence of diarrhea in two weeks is rather high (1,39%), of which 94% of cases were AD transmitted by food Hospital statistics only represented partly its reality, every one case of
AD in hospitals was equivalent to 18 cases in the community, one case of AD transmitted by food in hospital was equivalent to 40 cases in the community The majority of patients with AD had home treatment (84.69%) and bought pharmacy without prescription (85.29%) whereas hospital treatment accouted for a small percentage (12.5%)
* Key words: Food-borne AD; Food poisoning
INTRODUCTION
According to the World Health Organization,
food-borne disease is a globally important
cause of morbidity and mortality [1] The
incidence increased rapidly due to changes
in agricultural production, food processing
methods, globalization of food distribution
and other factors related to the changes in
social behavior and population WHO report
(2008), diarrhea alone resulted in 2.2 million
deaths annually, accounting for 3.7% of all
deaths in 2004 and ranked 5th of 10 death
causes worldwide [2]
However, the burden of disease and its
cost due to unsafe food is not currently
sufficient to estimate, especially in developing
countries Using available data from the regular
reporting system to estimate is incorrect and
incomplete Even in developed countries, data from the monitoring system proved the fact that a Salmonella cases from reporting system, corresponding to 38 cases in communities in the United States, 15 cases in Australia and 3 cases in the UK and Wales [3] This figure may be higher in developing countries such as Vietnam, for example, in
Jordan, one case of Salmonella reported by
health care system equivalent to 273 cases
in the community [4] This suggests that in countries where there are no systems of monitoring food-borne illnesses, statistics from the hospital or from the reports of food poisoning cases can only be as "freeboard"
of the "iceberg "and if you use the data from the above sources to estimate the burden of disease in general of food-borne illness in particular, many more complex factors need
* Ministry of Health
Address correspondence to Nguyen Hung Long: Ministry of Health
E.mail: nguyen _ hung _ long@yahoo.com
Trang 2to be considered The statistics from hospitals
reveal that diarrhea comes 4th in the 10
leading causes of hospitalization [5] Due to
the accuracy of the data depending on
factors such as case definition, acts seeking
medical care, detecting tests [7], the data
collected from patients institutions as well
as statistical reporting system of the health
sector represents only a tiny fraction of the
problem [1, 3, 5, 6]
SUBJECTS AND METHOD
1 Subjects
The incidence of food-borne disease was
investigated from the selected population in
the ward/community
The system collecting information about
patients’diarrhea is managed by local treatment
2 Location and time study
Research location: the facility of medical
ward/commune, county/district/city (health
centers, district hospitals/district preventive
medicine centers country/District), Thainguyen
City
Study period: 06/2011 to 11/2011
3 Research methodology
* Study design:
Descriptive studies, cross-sectional study
used to determine the incidence of AD
syndrome, the proportion of people search
for and use of health services for the diagnosis
and treatment of AD in 2 weeks before the
investigation of Thainguyen people
* The sample size:
The sample size for the cross-sectional
study was to estimate the incidence of AD
syndrome and the proportion of people
seeking medical treatment
The sample size was calculated with an
average incidence rate (the average number
of visits) 2 weeks about 4%/26 = 0.154% [7], the absolute accuracy of 0.01%, 95%, system due to the cluster sampling design was 2
The minimum number of people surveyed who is n = 8,272
𝑛 = 𝐷 𝑍1−∝/22 𝑝(1−𝑝)
𝑑2 = 8,272 people
p = 0.154%, d: absolute accuracy (0.1%),
Z = 1.96, D: the design (2.0)
* Sampling studies:
Samples were selected by PPS method (probability proportionate to size), through 2 stages:
- Stage 1: 30 clusters selected by systematic random technique, the sampling frame from the list of towns/villages/hamlets included population, town/village/hamlet is the first sample In each province, cluster will be encoded 01 - 30
- Stage 2: In a cluster randomized 1 - 2 group/neighborhood/village and make a list
of the organizations to encrypt households,
80 households randomly selected from the same group/neighborhood/village
RESULTS
1 The incidence of AD due to food
Table 1: Incidence and AD General AD as
food for 2 weeks (n = 7,347)
AD sorting Total
turn
Total sufferers
Rate (%) 95% CI
Diarrhea
1,121 - 1,656 Diarrhea
1,047 - 1,566 Diarrhea due to
0,016 - 0,147
Trang 3From the survey, AD was found in 1.31%
Most cases of AD are attributable to food
accounting for 97/103 = 94.17%
* Incidence of foodborne AD according
to age, sex (n = 7.347):
Men (n = 3,566): 1.15% (CI: 0,75 - 1,44%);
women (n = 3,781): 1.51 (CI: 1,12 - 1,90%);
age group: (n = 7,347); 6 months - < 5 years
of age (n = 606): 1,16% (0,30 - 2,01%);
5 - 18 years (n = 917): 0,55% (0,07 - 1,02%);
19 - 59 years (n = 4,963): 1,27% (0,96 -
1,69%); ≥ 60 years (n = 861): 2,44%
(CI: 1,41 - 3,47%)
In terms of sex, female outnumbered
male In terms of age group, people ranging
from 19 to 59 accounted for the highest
proportion This difference was statistically
significant with p < 0.001
Table 2: Incubation period and duration of
diarrhea due to food (n = 97)
(25th -75th) The incubation
Diarrhea
The average incubation period was 1.8
days, but the median was 1 day and the
median duration of diarrhea was 5 hours
Table 3: Symptoms of foodborne AD
(n = 97)
Abdominal pain/severe
abdominal pain
60.42 (50.46 - 70.38)
Tingling/pain as the needle
Other symptoms (irritability,
The symptoms appeared with decreasing frequency as follows: abdominal pain/severe abdominal pain (60.42%), nausea, vomiting (34.38%), thirst, sunken eyes (23.96%), fever, chills (17.17%) and weight loss (2.08%)
Table 4: Characteristics of exposure risk
factors for food poisoning in the last 3 days
in patients with food-borne AD (n = 97)
Food of the party/parties
Food from banquets, festivals causing AD came first (45.88%), followed by non-specific features (22.58%), food cooked (7.17%), not quite (7.17%), street food (7.17%) and fresh food (4.66%)
Trang 42 How to manage diarrhea
Table 5: The management of people with AD due to food (n = 97) (one or more treatment)
Public clinics 7.29 (2.00 - 12.59)
Private clinics 1.04 (1.03 - 3.11)
Self-treatment 84.67 (76.04 - 87.30)
Generally, a great number of patients had self-treatment at home (84.67%) Only 4.17%
of patients with AD admitted to hospital Public clinics had much higher proportion of patients than private ones (7.29% vs 1.04%)
Table 6: The self-management of people with AD (n = 363)
Pharmacy self-buying 85.29 (80.45 - 94.55)
Using pharmacy available at home 11.76 (5.45 - 19.55)
Using traditional herbal available at home 2.61 (1.42 - 6.16)
The other folk methods (drugs alcohol, oils ) 0
Self-management by pharmacy buying was found in 85.29% of the patients or self-using of available pharmacy at home accounted for 11.76%
3 Statistical comparisons AD in the health care system and community surveys
Table 7: Statistics of cases of AD and diarrhea due to food suspected to care at public
health system (hospitals and clinics)
cases
Food-borne suspected cases
Stool test
The rate of food suspected AD was 42.64% There were 66 hospitalizations but no stool tests were specified
Table 8: Comparison of the AD and the 2 weeks survey report
Trang 5Content Data from sample Community data Hospital data Difference ratio
Food-borne
Food-borne
diagnosed ratio 0.94 0.94 0.42
According to an AD estimated, every 01 case examined at the medical system was
equivalent to 18 cases of AD in the community; similarly 01 food-borne suspected AD case
at public health facilities corresponding to 40 cases in the community There was a disparity ratio between the number of food-borne AD in hospital and community data: AD rate was attributed to community food, 2.2 times higher than the rate in the hospital
DISCUSSION
The issue of food borne diseases is not
new, but health problem associated with the
shifting of population from the provinces of
big cities, export processing zones along
the supply system Catering industry as well
as street food which does not ensure food
safety for this population also contributes to
changes in the structure, scale and form of
food poisoning here
This study evaluated the status of AD
caused by food in Thainguyen through
community surveys Besides determining
the proportion of people with seeking medical
services when suffering AD, the study will
offer estimated coefficients on the incidence
of this syndrome by comparing results from
the community survey with data from
reporting system of public health facilities in
some areas due to food-borne illness which
is partly influenced by the degree of
urbanization The findings can be of the
initial scientific evidence on disease burden
and costs of food-borne diseases, as a
basis for developing a model of monitoring
and collecting information, which helps
decision-makers of health policy planning evaluate the effectiveness of intervention
mortality due to community diseases in the future
Data from the investigation showed a large gap in the reporting system of food-borne AD cases in the community Data from the health care system reflected in part the actual numbers in the population, every one food-borne AD in city, there were 40 reported cases in the community Thus, reality of AD is much larger than it was reported by Health system
The study also showed the majority of self-treatment cases at home (84.67%)
In terms of treatment choices, most of them bought pharmacy without prescription Therefore, blood culture will be less effective, which makes it difficult for clinicians not to indicate pathological findings because patients used antibiotics before hospitalization Overuse
of antibiotics also increases the risk of antibiotic- resistant strains of pathogenic bacteria, causing severe consequences [1]
CONCLUSIONS
Trang 6Survey of 7,347 people living in the
community of Thai Nguyen City showed that
the incidence of AD in two week makes up
1.39%; AD due to unsafe food is 1.31%
Food-borne ratio of the general AD is 94%
The results show that every one case of
AD was statistically monitored in the hospital
responding to 18 cases with the same illness
in the community Similarly, every one case
of AD caused by food in hospitals is also
equivalent to 40 cases of illness in the
community
Some risk factors that cause food-borne AD
include food from banquets, festivals (45.88%),
cooked food (7.17%), street food (7.17%)
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1 WHO The global burden of disease: 2004
update WHO Press Geneva 2008
2 CDC CDC Estimates of Foodborne Illness
in the United States 2011 estimates
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Sudbury: pp.264-302
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2011
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Epidemiology Reference Group (FERG) Geneva,
2009 Truy cập ngày 12 tháng 06 năm 2011
http://www.who.int/foodsafety/publications/foodb
orne_disease/burden_nov08/en
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Diseases Studies - Current Country Protocols
CDC, Geneva (2006)
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