English only
|
|
| Agenda Item 9 | Conference Room Document 10 English only |
FAO/WHO Regional Conference on Food Safety for Asia and the Pacific
Seremban, Malaysia, 24-27 May 2004
Country Report
Foodborne Diseases: Situation of Diarrheal Diseases in Thailand
(Food Control Division, Food and Drug Administration, Thailand)
Situation and Problems
Causes of Diarrheal Diseases
Food Safety Implementation in Thailand
Summary
References
Microbial agents and chemical contaminants, including other hazards that may make food injurious to health of the consumers, are among the public concerns and are involved with the global increase in the incidence of food borne diseases.
Food borne diseases do not only affect people's health and well-being, but they also have economic impacts on individuals and countries. In many developing countries, food borne disease outbreaks from bacteria, such as Escherichia coli and Salmonella spp., impose a substantial burden on health care systems and can markedly reduce the economic productivity of the countries.
In addition to food borne diseases from microorganisms, food containing toxic chemical substances, either those occurring naturally (e.g. tetrodotoxin in puffer fish), or those resulting from contamination with chemicals (e.g. toxic metals) can also lead to diseases.
Diarrheal diseases(*) have been a major public health problem in Thailand for many years(1) (see Figure 1). Food is considered as a main route of transmission of microorganisms causing diarrheal diseases. There are approximately a million cases of acute diarrhea reported each year, and the reported cases of food poisoning are more than 120,000 per year(2).
Bureau of Epidemiology reported that, although there was still a high number of acute diarrheal cases, the diarrheal disease incidence started to decrease in 2003. There were 956,313 cases of acute diarrhea (146 deaths); 23,113 cases of dysentery (3 deaths); 126,185 cases of food poisoning (11 deaths); and 9,633 cases of enteric fever (3 deaths)(1). (Data from 1 January to 31 December 2003 as presented in Table 1)
The most recent report from Bureau of Epidemiology indicates that there are 146,325 cases of acute diarrhea; 2,421 cases of dysentery; 17,128 cases of food poisoning; and 797 cases of enteric fever (4 deaths)(2). (Data from 1 January to 29 March 2004)
The investigation of these reported cases show that consumption of microbial contaminated drinking water and food is the major cause of the diseases in Thailand. Diarrheal diseases are usually found among those living in poor environmental sanitation and those with poor personal hygiene. The disease incidence in children under five years of age is also reported high. Inappropriate consumption behaviours among people in some areas, who always consume raw or undercooked food, are one of the major causes of diarrheal diseases in Thailand(2).
In Thailand, bacteria mostly isolated from diarrheal cases are Shigella spp., Salmonella spp., and Escherichia coli. Factors leading to the incidence of diarrheal diseases in the country are described in the following(2,3).
Contaminated food and drinking water is the major cause of diarrheal diseases. Food and drinking water contamination can happen at all stages of the food chain (described as `from-farm-to-table'). It needs to be ensured that contamination of food and drinking water with pathogens leading to diarrheal diseases is minimized in every process involved with the food practice (e.g. food production, food transportation, and food preparation). Source of drinking water and water used in the cooking process, clean cooking utilities, and sanitation in food preparing areas are very important factors need to be focused.
Poor personal hygiene can lead to food contamination and diarrheal diseases. It is not only those who do the cooking or food preparing processes, but it is `everybody' who needs to have a good personal hygiene. Washing hands before cooking/consuming food or preparing milk for children, and washing hands every time after using restrooms are a basic personal hygiene which needs to be emphasized to everybody.
In some regions of Thailand, such as the north-eastern region, people like to consume raw or undercooked meat, which is a cause of diarrheal diseases and other diseases, such as worm diseases, among people in the region. Public education in the region, focusing on consumption of clean and cooked food, is still needed. Also, in a general practice, it is necessary to advise everybody to drink clean or boiled water, consume clean or newly cooked food, reheat the leftovers every time before consumption, and not consume raw food (especially raw meat).
Hence, to minimize the food contamination, hygienic practice in food preparation processes is very important. In addition, behaviours of those preferring to consume raw or undercooked food need to be changed.
Figure 1 Morbidity rate of diarrheal diseases in Thailand, 1992-2003.
Source: Bureau of Epidemiology, 2003
Table 1 Case report of diarrheal diseases in Thailand, 2003.
| Diarrheal Diseases | Reported Cases (persons) | Deaths (persons) | Morbidity Rate (per 100,000 population) |
Mortality Rate (per 100,000 population) |
| Acute diarrhea | 956,313 | 146 | 541.26 | 0.05 |
| Dysentery | 23,113 | 3 | 12.44 | 0 |
| Food poisoning | 126,185 | 11 | 67.79 | 0 |
| Enteric fever | 9,633 | 3 | 3.57 | 0 |
Source: Bureau of Epidemiology, 2003
According to the food safety policy pursued by the Thai Government: "Safe and Clean Food for All in 2004", the Ministry of Public Health is authorized to be responsible for the Food Safety Programme. This programme has been strictly implemented, aiming at keeping the standard and quality of all foods produced and consumed in Thailand high and able to meet the international food standard, which could consequently lead the country to become the kitchen of the world.
An effective epidemiological system focusing on active surveillance on food borne diseases in the high-risk areas has been implemented. Thailand has a special team composed of epidemiologists, sanitation personnel, health education personnel, and personnel from Department of Disease Control, working cooperatively in both district and provincial levels to effectively prevent and control the diseases. This team will give a prompt response to investigate the source of diarrheal disease cases and/or outbreaks, and try to control the outbreaks within 10 days(3).
`Programme for Prevention and Control of Diarrheal Diseases' is aimed for the reduction of morbidity and mortality rate of the diseases, especially the incident rate of diarrheal diseases in children under five years of age. Oral rehydration therapy (ORT), which can prevent the electrolyte loss, shock, and subsequent death, is aimed to be used in more than 95 percent of diarrheal cases in the country. This programme has been effectively implemented together with other programmes, such as sanitation, environmental health, mother and child health care, nutrition, and communicable diseases control programmes, in order to reduce the chance of disease transmission, particularly among young children.
The following operation strategies have been used in the Programme for Prevention and Control of Diarrheal Diseases in Thailand(3):
The diarrheal disease prevention programme is focused in the high-risk areas. Public education on diarrheal disease prevention is provided by health care personnel and other authorities involved, emphasizing on hygienic-sanitary cooking utilities, sanitation in food preparing areas, personal hygiene, and appropriate consumption behaviours.
In case of an outbreak or incidence, sources of diarrheal diseases would be immediately investigated and eradicated. Monitoring of the outbreak or incidence in the reported area would be conducted for 10 consecutive days after the cases reported.
Routine reporting data, data collected in households, and data from health facility surveys are used to monitor and evaluate the programme.
The community can also participate in the programme by working with health care personnel in planning and implementing on diarrheal disease monitoring, reporting, and controlling activities.
It is essential to encourage the health care personnel to use ORT, which is a proper treatment for diarrheal diseases, as the first line treatment for diarrhea instead of jumping for antidiarrheal drugs and antibiotics. It is necessary to ensure that all public health facilities and pharmacies have a sufficient supply of oral rehydration salts (ORS). In Thailand, the training programme on ORT provided for health care personnel emphasizes on the importance of an increase in fluid intake, the continued feeding and breast feeding during diarrhea, intravenous therapy for patients with severe dehydration, the use of ORS in the treatment or prevention of dehydration, and the dangers of misused antidiarrheal drugs and antibiotics.
Home management of diarrhea using the recommended home fluids is also emphasized. Caretakers are trained for a better care providing for diarrheal patients at home, especially child patients.
Additionally to the regular programme for prevention and control of diarrheal diseases in the country, following five strategies have been implemented in Thailand in order to accomplish the goals of the food safety policy(4):
Laws and regulations related to food control have been revised and amended for complying with the international food regulations. It must be ensured that the enforcement of laws and regulations in Thailand provides an equity in consumer protection on all food products (including all foods produced, imported, and exported).
The Ministry of Public Health, Thailand, has implemented measures for a strict and regular surveillance, and monitoring on chemical and microbial contaminants, including toxins in food. All food production sites, distribution sites, and restaurants are regularly inspected on its good manufacturing practice (GMP) or Hazard Analysis And Critical Control Point (HACCP), hygiene, and food sanitary system.
The consumer power is developed by providing public education through the media (e.g., television, radio, leaflets, pamphlets, newspapers, etc.) in order to make the consumers know how to select and buy safe food for themselves and to increase a consumer awareness on food consumption. In addition, organizations in central and local areas are pushed to set up responsible groups (including responsible groups at schools) for the increase in consumer protection on food.
Training and education programmes related to food safety have been provided for food safety personnel by responsible organizations. Also, the information system linkage and the cooperation between related organizations have been focused in order to develop and strengthen the working capability, and to ensure that working processes are going in the same direction.
The Thai Government has developed the capability of analysis by supporting on necessary equipment and facilities in laboratories and food testing mobile units.
Among food borne diseases, diarrheal diseases in those living in poor environmental sanitation and those with poor personal hygiene have been a major public health problem in Thailand for many years. Major causes of the diseases include contaminated food and drinking water, poor personal hygiene, and poor consumption behaviours. Thailand has implemented a programme for prevention and control of diarrheal diseases in the country, focusing on prevention, investigation, monitoring, reporting, and treatment of the diarrheal cases. According to the programme, it is reported a decrease in the diarrheal disease incidence in 2003.
In addition to diarrheal diseases control programme, the prevention of food borne diseases generated from contamination with other microbiological agents (e.g. worm diseases and hepatitis-A), toxins, and chemical agents (e.g. pesticides and toxic metals) is also a strategy included in the `Food Safety Programme' in Thailand. This programme is emphasized and implemented by the Ministry of Public Health cooperated with other related organizations, aiming at making all foods produced and consumed in Thailand safe and able to meet the international food standard, which could consequently lead the country to become the kitchen of the world.
* Thailand defines diarrheal diseases as a group of diseases including acute diarrhea, dysentery, food poisoning, and enteric fever.