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 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 Objectives To describe the status of food poisoning surveillance system (FPSS) on the basis of three components including structure, core functions, and support functions To assess the effectiveness of the system on the basis of three components including structure, core functions, and support functions Methodology Study Design 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 • CHS: ten heads of CHS Data analysis Data will be entered and analyzed by Stata v13 Stata v13 will be used to generate frequencies, proportions Anticipated outcomes The findings of the study will be used as baseline data to improve effectiveness of the food poisoning surveillance system RESULTS 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) Provincial Health Service (PHS) • • Regulate provincial Inter-Sector Steering Committee for Food Hygiene and Safety Regular and urgent reporting to PPC about food safety status Sub-Vietnam Food Administration (sub-VFA) • Food safety management for food provision businesses, canteens in industrial parks Figure 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 The network and role of agencies involving in FPOS in Binh Duong Facilities Role Institute of Public Health in Ho Chi Support sub-VFA in testing specimens Minh City (IPH) from FPO Provincial People’s Committee (PPC) Direct food hygiene and safety management at provincial level Sub-FA Manage FPO and food safety issues at 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 1.3 Surveillance strategy Planning for FPO management is necessary and it is done by all levels of FPOS The sub-VFA does not make a separate plan for FPO management; instead, it develops a general plan of food hygiene and safety management in which FPO management is one of many activities including food safety inspection, food safety communication and food safety certification At DMCs, the departments of food hygiene and safety are responsible for FPO management; therefore they have their own plans for food hygiene and safety management including FPO management Similarly, CHSs have their FPO management include in a general plan 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 The number of staff responsible for FPO management at all level Health facilities No staff Frequency Sub-FA DMC CHS 4 3 2 Roles and responsibilities of staff related to FPO management were well documented at each level of FPOS Particularly, at sub-FA the roles of each member responsible for FPO management were described apparently in the Decision 88/QĐ-ATTP in which the staff was divided into two teams: team went to health facilities where victims hospitalized and team went to local site where the FPO occurred Each team had its own roles in responding to FPO The role of team included investigate victims and collect specimens from victims (nauseas fluid and stools), while the roles of team 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 involve in keeping and storing food samples and disease samples (nausea fluid of victims), unit involved in first aid support during FPO and unit involved in FPO communication Table The role and responsibilities of FPO staff at all level Health facilities Sub-FA Team Team No staff Role 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 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 CHS Team 2-4 The same as team of sub-FA Team 2-4 The same as team of sub-FA One team Support sampling Local guide Support first aid Support screening probable cases Factories and schools units 1-2 per Keep and store the samples unit FPO communication Support first aid for cases Collecting food and nausea samples 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 • Sub-VFA • District Medicine Center (DMC) • • • • • Factories or companies in the industrial parks Hospitals (public and private) Patients hospitalized in DMC Private hospitals/clinics Workers in factories Media food production and business establishment Commune Health Station (CHS) • Patients admitted to CHS Figure 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 10 ... 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 STT Chỉ sớ Giá trị Ghi Thành... bản/quy định/quyết định liên quan đến giám sát/ điều tra ngộ độc thực phẩm? Quyết định 39/2006/QĐ-BYT Quyết định 1/2006/QĐ-BYT Quyết định 11/2013/QĐ-UBND tỉnh Bình Dương Nếu KHƠNG, chuyển câu Khơng... anh/chị cho biết lý Nếu CÓ đề nghị xem kế hoạch hoạt động năm Nếu KHÔNG chuyển câu Đề nghị xem báo cáo thực ………… kế hoạch