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.
Journal of military pharmaco-medicine 7-2013 REALITY 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 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 _ _ long@yahoo.com Journal of military pharmaco-medicine 7-2013 to 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 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 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 Research methodology of visits) weeks about 4%/26 = 0.154% [7], the absolute accuracy of 0.01%, 95%, system due to the cluster sampling design was The minimum number of people surveyed who is n = 8,272 𝑛 = 𝐷 𝑍1−∝/2 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 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 - group/neighborhood/village and make a list of the organizations to encrypt households, 80 households randomly selected from the same group/neighborhood/village * 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 weeks before the investigation of Thainguyen people RESULTS The incidence of AD due to food Table 1: Incidence and AD General AD as food for weeks (n = 7,347) AD sorting * The sample size: Total Total Rate turn sufferers (%) 95% CI The sample size for the cross-sectional study was to estimate the incidence of AD syndrome and the proportion of people seeking medical treatment Diarrhea general 103 102 1,39 1,121 1,656 Diarrhea caused by food 97 96 1,31 1,047 1,566 The sample size was calculated with an average incidence rate (the average number Diarrhea due to other causes 6 0,08 0,016 0,147 Journal of military pharmaco-medicine 7-2013 From 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 (1) Fever, chills Myalgia or arthralgia Weight loss (Excluding MS) to age, sex (n = 7.347): (2) 17.17 (9.93 - 25.48) 0,00 2.08 (0.83 - 4.99) No accompanied symptoms 16.67 (9.08 - 24.26) women (n = 3,781): 1.51 (CI: 1,12 - 1,90%); age group: (n = 7,347); months - < years Tingling/pain as the needle on the skin 2.08 (0.83 - 4.99) of age (n = 606): 1,16% (0,30 - 2,01%); - 18 years (n = 917): 0,55% (0,07 - 1,02%); 19 - 59 years (n = 4,963): 1,27% (0,96 - Other symptoms (irritability, fatigue, abdominal distention) 2.08 (0.83 - 4.99) Muscle cramps/ cramping 1.04 (1.03 - 3.11) Men (n = 3,566): 1.15% (CI: 0,75 - 1,44%); 1,69%); ≥ 60 years (n = 861): 2,44% (CI: 1,41 - 3,47%) The symptoms appeared with decreasing In terms of sex, female outnumbered frequency as follows: abdominal pain/severe abdominal pain (60.42%), nausea, vomiting 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) Time The incubation period Diarrhea duration time Mean (SD) 1.80 days (1.55) 13,146 hours (14,292) Median (25th -75th) chills (17.17%) and weight loss (2.08%) Table 4: Characteristics of exposure risk factors for food poisoning in the last days in patients with food-borne AD (n = 97) Exposure hazard Ratio% (95% CI) Food of the party/parties (family, wedding) 45.88 (39.99 - 51.76) No special features 22.58 (17.64 - 27.51) day (1,2) hours (2,24) The average incubation period was 1.8 days, but the median was day and the median duration of diarrhea was hours Table 3: Symptoms of foodborne AD (n = 97) Symptoms (34.38%), thirst, sunken eyes (23.96%), fever, Ratio% (95% CI) Abdominal pain/severe abdominal pain 60.42 (50.46 - 70.38) Nausea or vomiting 34.38 (24.70 - 44.05) Thirst, sunken 23.96 (15.27 - 32.65) Food not cooked (not cook well) 7.17 (4.12 - 10.21) Unknown/not recall 7.17 (4.12 - 10.21) Street food 7.17 (4.12 - 10.21) Water, ice 1.08 (0.14 - 2.290 Fresh food 4.66 (2.17 - 7.15) Other 7.17 (4.12 - 10.21) 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%) Journal of military pharmaco-medicine 7-2013 How to manage diarrhea Table 5: The management of people with AD due to food (n = 97) (one or more treatment) How to treat Ratio% (95% CI) Hospital 4.17 (0.10 - 8.24) 7.29 (2.00 - 12.59) Public clinics 1.04 (1.03 - 3.11) Private clinics 84.67 (76.04 - 87.30) Self-treatment 0,00 Self-recovery 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) How to treat Ratio% (95% CI) Pharmacy self-buying 85.29 (80.45 - 94.55) Using pharmacy available at home 11.76 (5.45 - 19.55) Traditional medicine buying 2.61 (1.42 - 6.16) Using traditional herbal available at home The other folk methods (drugs alcohol, oils ) Self-management by pharmacy self-buying was found in 85.29% of the patients or selfusing of available pharmacy at home accounted for 11.76% 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) Location Thainguyen sufferer Food-borne Stool cases suspected cases test 197 84 Causes Hospitalized Death 66 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 weeks survey report Journal of military pharmaco-medicine 7-2013 Content Data from sample Community data Hospital data Difference ratio Sufferer cases 103 3,571 197 18.13 Food-borne suspected cases 97 3,361 84 40.01 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 evaluate the effectiveness programs and reduce mortality due to community future policy planning of intervention morbidity and diseases in the Data from the investigation showed a large gap in the reporting system of foodborne 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 antibioticresistant strains of pathogenic bacteria, causing severe consequences [1] CONCLUSIONS Journal of military pharmaco-medicine 7-2013 Survey 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%) REFERENCES WHO The global burden of disease: 2004 update WHO Press Geneva 2008 CDC CDC Estimates of Foodborne Illness in the United States 2011 estimates Friis H R Essentials of environmental health: food safety Johns and Barlett Publishers, 2007 Sudbury: pp.264-302 WHO Food safety and Foodborne illness 2007 http://www.who.int/mediacentre/factsheets/ fs237/en/index.html Truy cập ngày 09 tháng 09, 2011 WHO WHO initiative to estimate the global burden of foodborne disease Second formal meeting of the Foodborne Disease Burden 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 Scallan E National Burden of Foodborne Diseases Studies - Current Country Protocols CDC, Geneva (2006) Lorenz von Seidlein, Kim DR, Ali, M, Lee H, Wang XY, et al A multicentre study of Shigella diarrhea in six Asian countries: Disease Burden, Clinical Manifestations, and Microbiology (2006) PLoS Med 3(9): e353 DOI: 10.1371/journal.pmed.0030353 Journal of military pharmaco-medicine 7-2013 ... This difference was statistically significant with p < 0.001 Table 2: Incubation period and duration of diarrhea due to food (n = 97) Time The incubation period Diarrhea duration time Mean (SD)... 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. .. 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