Reality of food poisoning with acute diarrhea at commumnity of Thai Nguyen 2011

Nội dung text: Reality of food poisoning with acute diarrhea at commumnity of Thai Nguyen 2011

1. 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 incomplete. Even in developed countries, data from the monitoring system proved the According to the World Health Organization, fact that a Salmonella cases from reporting food-borne disease is a globally important system, corresponding to 38 cases in cause of morbidity and mortality [1]. The communities in the United States, 15 cases in incidence increased rapidly due to changes Australia and 3 cases in the UK and Wales in agricultural production, food processing [3]. This figure may be higher in developing methods, globalization of food distribution countries such as Vietnam, for example, in and other factors related to the changes in Jordan, one case of Salmonella reported by social behavior and population. WHO report health care system equivalent to 273 cases (2008), diarrhea alone resulted in 2.2 million in the community [4]. This suggests that in deaths annually, accounting for 3.7% of all countries where there are no systems of th deaths in 2004 and ranked 5 of 10 death monitoring food-borne illnesses, statistics causes worldwide [2]. from the hospital or from the reports of food However, the burden of disease and its poisoning cases can only be as "freeboard" cost due to unsafe food is not currently of the "iceberg "and if you use the data from sufficient to estimate, especially in developing the above sources to estimate the burden of countries. Using available data from the regular disease in general of food-borne illness in reporting system to estimate is incorrect and 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
2. Journal of military pharmaco-medicine 7-2013 to be considered. The statistics from hospitals of visits) 2 weeks about 4%/26 = 0.154% reveal that diarrhea comes 4th in the 10 [7], the absolute accuracy of 0.01%, 95%, leading causes of hospitalization [5]. Due to system due to the cluster sampling design the accuracy of the data depending on was 2. factors such as case definition, acts seeking The minimum number of people surveyed medical care, detecting tests [7], the data who is n = 8,272. collected from patients institutions as well as statistical reporting system of the health 2 (1− ) 푛 = . 푍1−∝/2 2 = 8,272 people. sector represents only a tiny fraction of the problem [1, 3, 5, 6]. p = 0.154%, d: absolute accuracy (0.1%), Z = 1.96, D: the design (2.0). SUBJECTS AND METHOD * Sampling studies: 1. Subjects. Samples were selected by PPS method The incidence of food-borne disease was (probability proportionate to size), through 2 investigated from the selected population in stages: the ward/community. - Stage 1: 30 clusters selected by systematic The system collecting information about random technique, the sampling frame from patients’diarrhea is managed by local treatment. the list of towns/villages/hamlets included 2. Location and time study population, town/village/hamlet is the first Research location: the facility of medical sample. In each province, cluster will be ward/commune, county/district/city (health encoded 01 - 30. centers, district hospitals/district preventive - Stage 2: In a cluster randomized 1 - 2 medicine centers country/District), Thainguyen group/neighborhood/village and make a list City. of the organizations to encrypt households, Study period: 06/2011 to 11/2011. 80 households randomly selected from the 3. Research methodology. same group/neighborhood/village. * Study design: RESULTS Descriptive studies, cross-sectional study used to determine the incidence of AD 1. The incidence of AD due to food. syndrome, the proportion of people search Table 1: Incidence and AD General AD as for and use of health services for the diagnosis food for 2 weeks (n = 7,347). and treatment of AD in 2 weeks before the investigation of Thainguyen people. AD sorting Total Total Rate 95% CI * The sample size: turn sufferers (%) Diarrhea 1,121 - The sample size for the cross-sectional 103 102 1,39 general 1,656 study was to estimate the incidence of AD Diarrhea 1,047 - syndrome and the proportion of people 97 96 1,31 seeking medical treatment. caused by food 1,566 Diarrhea due to 0,016 - The sample size was calculated with an 6 6 0,08 other causes 0,147 average incidence rate (the average number
3. Journal of military pharmaco-medicine 7-2013 From the survey, AD was found in 1.31%. (1) (2) Most cases of AD are attributable to food Fever, chills 17.17 (9.93 - 25.48) accounting for 97/103 = 94.17%. Myalgia or arthralgia 0,00 * Incidence of foodborne AD according to age, sex (n = 7.347): Weight loss (Excluding MS) 2.08 (0.83 - 4.99) Men (n = 3,566): 1.15% (CI: 0,75 - 1,44%); No accompanied symptoms 16.67 (9.08 - 24.26) women (n = 3,781): 1.51 (CI: 1,12 - 1,90%); Tingling/pain as the needle 2.08 (0.83 - 4.99) age group: (n = 7,347); 6 months - < 5 years on the skin of age (n = 606): 1,16% (0,30 - 2,01%); O ther symptoms (irritability, 2.08 (0.83 - 4.99) 5 - 18 years (n = 917): 0,55% (0,07 - 1,02%); fatigue, abdominal distention) 19 - 59 years (n = 4,963): 1,27% (0,96 - Muscle cramps/ cramping 1.04 (1.03 - 3.11) 1,69%); ≥ 60 years (n = 861): 2,44% (CI: 1,41 - 3,47%). The symptoms appeared with decreasing frequency as follows: abdominal pain/severe In terms of sex, female outnumbered abdominal pain (60.42%), nausea, vomiting male. In terms of age group, people ranging (34.38%), thirst, sunken eyes (23.96%), fever, from 19 to 59 accounted for the highest chills (17.17%) and weight loss (2.08%). proportion. This difference was statistically significant with p < 0.001. Table 4: Characteristics of exposure risk factors for food poisoning in the last 3 days Table 2: Incubation period and duration of in patients with food-borne AD (n = 97). diarrhea due to food (n = 97). Exposure hazard Ratio% (95% CI) Median Time Mean (SD) th th) (25 -75 Food of the party/parties 45.88 (39.99 - 51.76) The incubation (family, wedding) 1.80 days (1.55) 1 day (1,2) period No special features 22.58 (17.64 - 27.51) Diarrhea 13,146 hours (14,292) 5 hours (2,24) duration time Food not cooked (not cook well) 7.17 (4.12 - 10.21) The average incubation period was 1.8 Unknown/not recall 7.17 (4.12 - 10.21) days, but the median was 1 day and the Street food 7.17 (4.12 - 10.21) median duration of diarrhea was 5 hours. Water, ice 1.08 (0.14 - 2.290 Table 3: Symptoms of foodborne AD Fresh food 4.66 (2.17 - 7.15) (n = 97). Other 7.17 (4.12 - 10.21) Symptoms Ratio% (95% CI) Abdominal pain/severe 60.42 (50.46 - 70.38) Food from banquets, festivals causing AD abdominal pain came first (45.88%), followed by non-specific Nausea or vomiting 34.38 (24.70 - 44.05) features (22.58%), food cooked (7.17%), not quite (7.17%), street food (7.17%) and fresh Thirst, sunken 23.96 (15.27 - 32.65) food (4.66%).
4. Journal of military pharmaco-medicine 7-2013 2. 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 0 Using traditional herbal available at home 2.61 (1.42 - 6.16) The other folk methods (drugs alcohol, oils ...) 0 Self-management by pharmacy self-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). sufferer Food-borne Stool Location Causes Hospitalized Death cases suspected cases test Thainguyen 197 84 0 0 66 0 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.
5. 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 97 3,361 84 40.01 suspected cases Food-borne 0.94 0.94 0.42 diagnosed ratio 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 decision-makers of health policy planning evaluate the effectiveness of intervention The issue of food borne diseases is not programs and reduce morbidity and new, but health problem associated with the mortality due to community diseases in the shifting of population from the provinces of future. big cities, export processing zones along Data from the investigation showed a the supply system Catering industry as well large gap in the reporting system of food- as street food which does not ensure food borne AD cases in the community. Data safety for this population also contributes to from the health care system reflected in part changes in the structure, scale and form of the actual numbers in the population, every food poisoning here. one food-borne AD in city, there were 40 This study evaluated the status of AD reported cases in the community. Thus, caused by food in Thainguyen through reality of AD is much larger than it was community surveys. Besides determining reported by Health system. the proportion of people with seeking medical The study also showed the majority of services when suffering AD, the study will self-treatment cases at home (84.67%). offer estimated coefficients on the incidence In terms of treatment choices, most of them of this syndrome by comparing results from bought pharmacy without prescription. the community survey with data from Therefore, blood culture will be less effective, reporting system of public health facilities in which makes it difficult for clinicians not to some areas due to food-borne illness which indicate pathological findings because patients is partly influenced by the degree of used antibiotics before hospitalization. Overuse urbanization. The findings can be of the of antibiotics also increases the risk of antibiotic- initial scientific evidence on disease burden resistant strains of pathogenic bacteria, causing and costs of food-borne diseases, as a severe consequences [1]. basis for developing a model of monitoring CONCLUSIONS and collecting information, which helps
6. Journal of military pharmaco-medicine 7-2013 Survey of 7,347 people living in the Burden, Clinical Manifestations, and community of Thai Nguyen City showed that Microbiology. (2006) PLoS Med 3(9): e353. DOI: the incidence of AD in two week makes up 10.1371/journal.pmed.0030353. 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 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. 3. Friis H R. Essentials of environmental health: food safety. Johns and Barlett Publishers, 2007. Sudbury: pp.264-302. 4. WHO. Food safety and Foodborne illness. 2007. fs237/en/index.html. Truy cập ngày 09 tháng 09, 2011. 5. 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. orne_disease/burden_nov08/en. 6. Scallan E. National Burden of Foodborne Diseases Studies - Current Country Protocols. CDC, Geneva (2006). 7. Lorenz von Seidlein, Kim DR, Ali, M, Lee H, Wang XY, et al. A multicentre study of Shigella diarrhea in six Asian countries: Disease
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