! T 0 N G QDAN & NGHIEN CltO I
Kien thitc, thai do va thufc hanh cua ngifoTi dSn 4 phtfcTng, thanh phd'Da Nang ve dtf phong
ph(/i nhiim dioxin qua thtfc pham
Lfi Vij Anh(*), Tran Thi Tuye't Hanh(*), Nguyen Ngpc Bich(*), Nguyin Thanh Ha(*), Nguyin Dd'c Minh(**,) Nguydn Kim Ngan(***)
Sdn bay Dd Ndng cUng vdi mgt so sdn bay vd khu cdn cd qudn su cd cda My Id nai diin ra hogt dgng chda, pha, ngp rda.. chdt Da cam vd cdc chdt ldm irui Id khdc (chda tgp chdt dioxin) trong chiin dich Ranch Hand 1962-1971. Ngudi ddn sdng gdn san bay Dd Ndng vd cdc diim ndng nhiim dioxin khdc diu CO nguy ca phdi nhiem vdi dioxin trong moi trudng ddt, nudc, trdm tich, khdng khi vd thuc phdm [4,5,8,9]. Mot sd nghien cdu gdn ddy cho thdy cdc mdu ddt, biin, mgt sdlogi thUc phdm dfa phuang, cdc mdu mdu vd sda me cua ngUdi ddn tgi khu vUc gdn sdn bay Dd Ndng cd hdm lugng dioxin cao han cdc tieu chudn hay hUdng dSn hi$n hdnh ve dioxin irSn thi'gidi [6]. Sau khi md hinh can thiip Y ti cdng cgng (YTCC) triin khai d diim nong sdn bay Bien Hod trong giai dogn 2007-2009 dgt dugc nhdng thdnh cdng budc dau trong viec gidm thieu nguy cdphoi nhiem vdi dioxin trong thuc phdm cho ngudi ddn dia phuang[7]. Hoi YTCC Vi^t Nam dd nhdn dugc h§ tra tdi chinh tU Quy Ford di md rdng mo hinh can thiep ndy ra diim ndng nhiem dioxin d Sdn bay Dd Nang. Ndm 2009, trUdc khi xdy dUng vd triin khai chuang trinh can thifp, mgt nghien ciiu mo td cat ngang dd dugc thuc hi$n vdi muc tiiu tim hiiu kiin thiic, Ihdi dg vd ihuchdnh ve du phong phai nhiem dioxin qua thuc phdm cda 400 ngudi ddn sdng tai 4 phudng duac cho Id bi tdc dgng ldn nhdt cua 6 nhiem dioxin d thdnh phdDd Ndng. Sd lieu dUdc nhap bang phdn mim Epi-data 3.1 vd phdn tich bdng phdn mem thdng ki SPSS 17. Kit qud ciia dieu tra KAP cho thdy mdc dd sdng d khu vuc diim ndng vi 6 nhiim dioxin nhung kiin thdc ve dioxin vd cdc gidi phdp thytc hdnh duphong phai nhiim ciia ngudi ddn trudc can thiip con rdt han chi. Mgt chuang trinh can thiip nham gidm nguy cffphai nhiem dioxin cho ngudi ddn tgi bo'n phudng gdn sdn bay Dd Ndng Id thuc su cdn thiit. Kit qud cua nghiin ciiu ndy dd dugc Hgi YTCC Viit Nam chia se tai H$i thdo xdy dung kihogch can thiip chi tiit vdi su tham gia cda cdc ban ngdnh lien quan tgi dia phuang vdo thdng 5 ndm 2010.
TM" khoa: 6 nhiim Dioxin, sdn bay Dd Ndng, thifc phdm nhiem dioxin, dUphong nhiem dioxin, KAP, kiin thiic - thdi do - thuc hdnh
Knowledge, attitudes and practices of local residents in four wards, Da Nang city
Viet Nam on preventing dioxin exposure through foods
Le Vu Anh (*), Tran Thi Tuyet Hanh {*), Nguyen Ngoc Bich(*), Nguyen Thanh Ha (•), Nguyen Due Minh (**), Nguyen Kim Ngan (***)
h"ap chi Y tfi' Cdng cpng, 7.2011, Sd 20 (20)
I TdNG QUAN & NGHIEN cilu I
DaNangAirbaseser^•edasabulkstorageandsupp^yfacilityforAgentOrangeandotherherbiddes during the Operation Ranch Hand 1962-1971. Local people living in the vicinities ofthe Da Nang Airbase as well as in other dioxin hot spots in Viet Nam have probably been facing with a high risk of exposing to dioxin in soil, water, mud. air and particularly through consuming local contaminated foods [4,5,8,9]. A recent study showed that samples of soil, mud, some local foods, blood and breast
milk had dioxin concentrations exceeded current environmental standards [6]. Continued with the success of the public health intervention program implemented in Bien Hoa dioxin hot spot in the period belM'een 2007-2009 in reducing the risk of dioxin exposure through food for residents [7], the Vietnam Public Health Association (VPHA) has received funding support from the Ford Foundation in Viet Nam to expand this iniervennon model to four wards in the vicinities ofthe Da Nang Airbase.
In 2009, before developing and implementing this intervention program, a cross sectional survey on knowledge, altitudes and practices (KAP) was undertaken aiming at assessing the KAP of householders on dioxin and measures lo prevent dioxin exposure through consuming contaminated foods. A sample of 400 households was randomly selected from the list of local households in four most affected wards in Da Nang using the systematic random sampling scheme. 400 food handlers from selected households, aged 16-60 were interviewed. Data was entered using Epi-data 3.1, and analyzed using SPSS 17.0 software. The results show that although living in a severe dioxin hot spot, the knowledge and practices of local residents on dioxin and preventive measures were very limited.
An intervention program to reduce the risk of dioxin exposure for local people living at four wards near Da Nang Airbase was urgently needed. The results of this survey will be presented at the workshop to be organized in early 2010 in Da Nang City lo develop a detail intervention program with active involvement of related local departments and stakeholders.
Key words: Dioxin polluted areas in Da Nang Airbase, Dioxin contaminated foods.
Tic gii:
(•) Trtfdng Dai hpe Y lfi'cong c^ng, 138 Giang Vo - Ba Binh • Hd Nfii.
Lfi Vu Anh • Giio Stf • Tie'n Si - Hifiu trtfdng Trtffing D?i hpe Y te" Cfing cfing.
E.mail: [email protected], vn
Trin Thi Tnyci Hanh - Thae si - Giang vifin Bfi mfin Stfc khfie mfii tnlfing. Email: [email protected] Nguyin Ngpc Bich - Thae si, bic si - GiSng vifin Bfi mfin Sffc khoe nghe nghiep. Email:
Nguyin Thanh Hd - Ti^n si. bie si - Giang vifin Bfi mfin Dinh dtf3ng va An todn vfi sinh tiitfc phim.
Email: [email protected]
(••) Nguyin Dtfc Minh - Thae Si - Vien Y xa hfii hoc.
(•••) Nguyin Kim Ngan • Ctf nhdn - Cin bfi chUOng trinh • Hfii Y le Cfing cfing Vifit Nam, 138 Giing Vo - Ba Dinh - Hk Nfii. Email: [email protected]
Tap chi Y t^ Cong cpng, 7.2011, Sd 20 (20) 51
I TfNG QDAN & NGHIEN BUB I
1. Dat vS'n d l
Nghifin edu do Cdng ly ttf vfn mdi irtfdng Hatfield Canada (Hatfield Consultants 2009) tiitfc hifiu da xie dinh 7 diem ndng thoxin d Vifit Nam.
trong dd sin bay Da Nang dffde cbo li mpt trong ba diem ndng nhfl. Gan 40 nam sau khi viee phun rai kdl thuc, nhQUg ngffdi dan sinb sdng tai khu \-ffc cd DODg do dioxin cao vi du d xung quanh sau bay Da Ndng van dang hang ngay dd'i mat vdi nguy ed eao phdi nhifim ehft ddc ndy \ a dang phai htfng chiu nhihig tac ddng nguy hai trtfc tiep Ifiu stfc khde ctfa hp va cua the^he con, chiu.
Cac boat ddng lay dpe ddi hdi mpt khoan kinh phi rfl Idn vi thtfe hifin ttong thdi gian dai. Hien tai va ttong tffdng lai, nhffng sff bd ttd, bdp tic ttong ntfde va qudc te la rft can Ihiet de giai quyet vfn de d nhifim dioxin d san bay Da Nang eung nhff cic diem ndng nhiem dioxin khie d Viet Nam. Sau khi md hinh ean thifip YTCC d diem ndng san bay Bien Hda dffde Hoi YTCC Vifil Nam va Hpi YTCC Ddng Nai thtfe hifin ttong giai doan 2007-2009 dat dtfdc nhffng thanh cdng bffdc dau ttong viec giam thieu nguy cd phdi nhilm vdi dioxin trong thtfc pham eho ngtfdi dan tai 2 phtfdng Trung Dung va Tan Phong [1.2,3,10], Hpi YTCC Viet Nam da nhan dtfdc hd ttd tai chinh tff Quy Ford de md rpng md hinh can thifip ndy ra didm ndng nhilm dioxin d san bay Di Ning.
Trtfde khi xay dU^g ^ a trien khai ehtfdng trinh can thiep, mot nghifin etfli md ta cat ngang can dtfdc thffc hien vdi mue tieu tim hieu kie'n thffc, thii dp va thffc hanh \e dd pbdng nhiem doe dioxin qua thffc pham ogffdi dan sd'og tai 4 phtfdng dtfdc cho la hi tic dpng Idn nhfi efla d niufim dioxin d thanh phd' Da Nang, dd la An Khfi, Chinb Gian, Hda Khe vd Thanh Khfi Tay. Kfi't qua efla nghien ctfu khao sdt danh gia K.AP irffdc can thiep da dffde Hpi YTCCVN, Iinh hdi YTCC Di Nfng vi cdc ban nganh hfin quan stf dung lam cd sd khoa hoc giflp cho viee lap ke hoach ean thifip Idia tlu va hifiu qua nham giam thieu nguy cd nhifim mdi vdi dioxin trong thffc pham cho ngtfdi dan sdng d 4 phffdng gin sao bay Da Nang. Ngoai ra. ket qua ctfa nghifin ctfU nay eung dffde stf dung Idm sd lifiu nen gitfp cho vific danh gid ket qua eua chtfdng trinh ean thifip.
2. Phtfffng phap nghifin c i ^
Day li nghifin etfu trtfde ean thifip do Hpi YTCC Viet Nam vd Hpi YTCC Da Nang thtfe hifin ttong
giai doan ttf thing 9/2009 dfin thing 1/2010 vdi muc tifiu tim hieu kifi'n thtfc, thai dd vd ihffc hinh vl dff pbdng phdi nhifim dioxin qua thffc pham efla 400 ngtfdi din (ltfa chpn theo phffdng phap ngau nhien hfi thdng) so'ng tai 4 phtfdng dtfdc cho la bi tic ddng Idn nhft ve d nhiem dioxin d thinh phd' Dd Ning, bao gdm An Khfi, Chinh Gian, Hoa Khfi va Thanh Khfi Tay. 400 dd'i ttfdng nghifin ctfu ttong dp tudi 16 - 60 dtfdc ebon Id ngffdi chiu ttach nhiem ehinh ve mua vi che bie'n thtfc phfm efla 400 hd gia dinh dtfdc ltfa chpn Iff bd'n phffdng theo phffdng phip chpn mlu ngdu nhien he thd'ng. Sd lifiu 6\J(ic phan tich bdng phfn mim thd'ng kfi SPSS 13 va Stata 9.
Kfi't qua efla nghifin cffu khao sal ddnh gii KAP irffdc can thifip se dffde sff dung dd Idm cd sd khoa hoc giup cho viec lap kfi'hoach can thifip kha thi va hifiu qua nham giam thifi'u nguy cd phdi nhiem mdi vdi dioxin trong thtfc phfm cho ngtfdi ddn sd'ng d 4 phtfdng gin san bay Da Nang cung nhtf cung cd'p sd' Ufiu nen eho muc dich dinh gid chtfdng trinh can thifip. Sd hfiu da dtfde nhap bang phin mim Epi- data 3.1. Phan tieh thdng ke thieh hdp da dtfde thtfc hifin bang phan mim SPSS 17.0. Ca thd'ng kfi mo la vd thd'ng ke suy luan diu dtfde tifi'n hinh. Cic kiem dinh thd'ng kfi ihicb hdp dtfdc stf dung nham tim bieu thtfc ttang kifi'n thtfc, thai dp va Ihffc hinh cua ngffdi dan ve dtf phdng phdi nhiem dioxin qua Ihtfc pham va nhong yfi'u td' lifin quan.
3. Kd^t qua nghiin cifli 3.1. Kie'n thttc chung ve dioxin
Kel qua efla dilu tta KAP trtfdc can thiep cho ihfy mgc du smig d khu vtfc didm ndng vl 6 nhilm dioxin nhUhg kifi'n thtfe vl stf ldn lai efla dioxin ttong mdi trtfdng efla ngffdi dan tttfdc can thifip cdn rft han chfi', dac bifit la kifi'n thtfc ve stf tdn tai efla dioxin ttong thtfe pham. Hdn nffa, ngtfdi dan chffa cd kidn thtfc day dtf ve eic dffdng nham nhap efla dioxin tff mdi trtfdng vao ed the eung nhtf nhffng anh hffdng sffc khde do phdi nhifim vdi dioxin. Phin ldn ngtfdi dan eho rang dioxin tdn lai trong nffdc 76% va ttODg dft 54,9% trong khi dd ehi cd 15,9%
sd ngffdi dtfdc hdi bie't dioxin ed the ton lai ttong thtfe pham va chi cd mot ngtfdi bidt dioxin cd the ton lai trong ca dft, nffdc, khdng khi va thffc pbam (0.25'7f). Ve kie'n thffc lifin quan dfi'n dffdng phdi nbiem dioxin, chi 1,3% ddi tffdng phdng vd'n bifi't dioxin cd the xam nhap vao cd the con ngffdi qua.ca 3 con dffdng la qua da. qua dffdng hd hfp va qua
52 Tap chi 1' te Cdng cdng, 7.2011, So 20 (20)
I TfiNG QUAN & NGHIEN N I B i
dffdng an udng. T> le tra ldi khdng bie't la 20,9%.
Nhffng anh hffdng dffde chtfng minh la cd lifin quan dfi'n phdi nhilm dioxin nhff ung thff, ban eio it dtfde quan tam tdi vdi chi 22,3% vi 1,4% sd ngffdi dtfdc hdi bie't tdi nhffng anb hffdng ndy.
Bang I trinh bay sd lifiu so sinh kifi'n tiiffc ve sff tdn tai efla dioxin irong mdi Irtfdng trong khao sit trtfde can thifip d Da Ndng 2009 vdi kfi't qua cua khao sat trtfdc vd sau ean thifip d Bifin Hoa (2007, 2009). Sd hfiu trong Bang 1 eho thfy, ngoai trff kien thtfc lien quan ddn thtfc pham, nbin chung kien Ihtfc lifin quan ddn stf ldn tai efla dioxin trong dat, ntfde, khdng khi efla ngtfdi dan d 4 phtfdng Ihudc Ihanh phd'Da Nang 2009 li tdt hdn ed;? nghia tiid'ng ke so vdl kidn thffc cua ngtfdi dan Bifin Hoa trong khao sdt trtfdc can tiiifip 2007. Tuy nhifin, do cupe khao sat trtfdc can thifip d Da Nang dien ra 2 nim sau khao sit trtfdc can thifip d Bifin Hoa nen trong 2 nim qua, ngtfdi dan d Da Nang cd the da dffde tidp can vdi mot sd thdng tin hen quan de'n dioxin tten cie phffdng lien Iruyen thong dai chung nen kidn Ihtfc ctfa hp cd thd idl hdn. Neu so vdi kfi't qua sau can thifip d Bifin Hda tiii kien thffc efla ngffdi dan d 4 phffdng tai Di Nfng vl stf Ion tai efla dioxin ttong thffc pham, trong ea 4 mdi trffdng thanh pbln Id tha'p bdn ed ^ nghia ihdng kfi, ti lfi tra Idi khdng bifi't cung cao hdn cd i? nghia thdng kfi so vdi d lfi d Bien Hda sau can thifip 2009. Rifing kifi'n thtfc ve stf ton tai efla dioxin trong ntfde d ttong khao sit trtfdc can thifip d Da Nang la tdt hdn ed ^ nghia thong kfi so vdi ke't qua ttong ea 2 cupc khao sil ttffdc va sau can thifip d Bifin Hda (Bang I).
3.2. Kie'n thiic velhtfcphdm nguycdcao nhiem dioxin
Nhin thffc efla ngtfdi dan ve nhffng loai thffc phfm cd nguy cd cao nhiem dioxin nfi'u dffde nudi trdng d vung d nhilm Irong khao sdi trffde can thifip edn rft ban chfi' (Hmh I). 22,5% ddi ttfdng biet ed, thfly san ntfde ngpt la thtfc phfm nguy ed cao nfi'u dffde nuoi d khu vtfe d nhilm; 6,1 % ddi ttfdng bifi't thil md dpng vat la thtfc pbam nguy cd eao nfi'u dtfdc nuoi d khu vtfc fi nhiem; chi cd 2 ngffdi bidt bp dd ldng la thffc pham nguy cd cao nfi'u dpng vat in thffc pbam d khu vtfc d nhifim vi khdng cd ddi ttfdng ndo bifi't trtfng, stfa dpng vdi Id thtfc pham nguy cd cao nhiem dioxin.
So sdnh kfi't qua ve nhan thtfc cua ngtfdi dan tai 4 phffdng ttong khao sat irtfdc can thilp d Dd Ndng
Bdng 1. So sdnh kiin thdc vi sif tin tgi cda dioxin trong moi tridng, Ba Ndng 2009, Bien Hoa 2007, 2009
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Hinh 1. Nhan thdc ve cdc logi thifc phdm co nguy cd nhiim dioxin cao, khdo sdt tn^ can thifp, Dd Ndng 2009
vl nguy cd nhiem ddc dioxin qua thffc pham vdi khao sat trffde va sau can thifip d Bifin Hda cho Uify nhan thffc ctfa ngffdi din 4 pbtfdng d Di Ndng (2009) li tdt hdn nhan thffc ctfa ngffdi dan d 2 phffdng cua Bifin Hda ttong khao sit trtfdc can thifip (2007) vi khdng td't bang nhdn thtfc efla ngtfdi ddn trong khao sdi sau can tiiifip d Bien Hda vao ciing ihdi dilm dilu tta (2009). Tuy nhifin, stf khie bifit niy deu khdng CO y nghia Ihdng ke (xem Bang 2).
Tbeo khuyen eao efla Vifin Nghifin ctfu Y khoa My (Institute of Medical Research 2004) tiu Uitfc phfm, die biet li eac chat bfio no (saturated fats) cd trong cac san pham tii sffa, tiiit va mot sdloii cd Id ngudn phdi nhilm dioxin chinh. Nhff vay nhan Ibtfc ve nguy cd nhilm ddc dioxin qua thffc phfm bi d nhifim d 4 phtfdng cua Di Nfng trong khao sil in/dc ean thiep la khi tdt. Tuy nhifin, itfdng ttf nhtf nhffng khao sit irtfdc day da dtfdc thtfc hien d Bien Hda thi nhffng cau hdi trtfde vl dioxin trong bp cau
Tap chi Y tf Cong cong, 7.2011, 56' 20 (20) 53
iTfi'NG QDAN & NGHIEN Cliu I
Bang 2. So sdnh nh4n thdc vi nguy cd nhiim dgc dioxin qua thifi: phdm, Dd Ndng 2009, Bien Hda 2007, 2009
NhtDibdCvd agny cO Diulm dlDIin qua TP CiSo nhlfm KhAoganlDeai
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D l M n g 2009
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Bien Hbi 2007 D(%) 330 (82.7) 27 (6,8) 42(10.5) .199(100)
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BieoHba 2009 n l * ) 384 (906) 1714,01) 2315,4) 424(1001
K'.P 3.4] (0.06) 1.75(0.19) 1.49 (0.221 J.45 (0.181
hdi phdng vfn cd the anh hffdng phin nio den can tra Idi efla ngtfdi dffde phdng vfn eho vfn de nay.
Thtfe td kfi'l qua dilu tta irtfdc can thifip d Da Ndng 2009 cho thfy mdc dil chi ed 15,9% tdng sd ngtfdi dffde phdng vfn biet dioxins tin tai trong thffc phfm vd 79,1% biel dioxin cd the tham nhap vio cd the qua dffdng i n udng nhffng lai ed tdi 86,5% cho biet ndu in thffc pham bj d nhifim dioxin thi con ngffdi ed nguy ed bi nhiem dpe.
3.3. Kien thdc ve cdc biin phdp dtf phong Nhin ehung, kifi'n Ihtfc ve cde bifin phip dff phdng phdi nhifim dioxin iff thtfc phfm tai bd'n phffdng gan san bay Da Nang ttong dieu tra trffde ean thifip la edn rft han cbe' (Hinh 2). 74.4% cbo rang bifin phip dtf phdng phdi nhiem dioxin tff Ihtfe pbam la rtfa sach rau, 31,5% cho rang cin dun nau thtfe pham th$t ky de loai bd bdt dioxin (la bifin phip khdng hifiu qua), 12,9% cho rang khdng nfin stf dung cic thffc phfm nufii/tting Iai dia phtfdng. Cac giai phdp dff phdng dflng hau nhff cdn rd't xa la ddi vdi ngtfdi dan tai bd'n phtfdng d gan san bay Dd Nang, vdi li lfi ngtfdi tra Idi dtfng chi tff 0% (bu il sffa me trong I vdi tuin diu sau sinh) ddn 4,1% (khdng dung ntfde 6 nhilm), 15%
tdng sd ngtfdi dffde hdi tra ldi "khdng bifi'l" ba't ky mot
giai phdp nao cd ihl ip dung de phdng ngffa phdi nhifim dioxin qua thtfe pham.
Kfi't qua so sanh sinb kifi'n thffc dff phdng nhifim ddc dioxin tff thtfc pbam trong khao sit ndy so vdi khao sdt KAP ttffdc vd sau can thifip d Bifin Hda 2007, 2009 dtfdc ttmh biy irong Bang 3.
Bdng 3. So sdnh kiin thdc difphbng nhiem dgc dioxin tdthifcphdm, Dd Ndng2009, Biin Hoa 2007, 2009
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KhbiflUll K h t n i tU ibpt cic ITnrc phdn nai\ uing Ifl «)• chunrig An n >ii> Rhkn tnmg, t O i « i | ^ n m « lnltc4.nluv«nlh( \
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Hinh 2. Nhqn thitc vi cdc giai phdp phong ngUa phdi nhiim dioxin qua thifc phdm, dieu tra KAP trUdc can thifp, Bd Ndng 2009.
Kfi't qua ttong Bang 3 eho thfy, so vdi kdt qui khao sdt ttffdc can thifip d Bifin Hda (2007), nh$n ibtfc cua ngffdi ddn tai 4 phtfdng d gin san bay Da Nfng ttong khao sit trtfdc can thifip (2009) vl cie giai phip dtf phdng nhifim dpe dioxin qua thtfc pham la to't hdn ed ^ nghia Ihdng kfi so vdi 2 phtfdng gin san bay Bifin Hda. Cdc giai phdp dflng nhff rtfa sach rau (74,7%). an it ci, nhuyln thd nffdc ngpt dia pbtfdng (2,6%), an it san phfm trffng, sffa dia phffdng (2,1%) deu eao bdn cd ^ nghia thdng kfi so vdi kdl qua ctfa khao sit d Bien Hda 2007, vdi cie ti le ttfdng ffng li 57,5%, 0,7% va 0,25%). Tuy nhien, so vdi ket qua sau can thifip d Bifin Hda 2009, thi ri le tra ldi dung ve loai bd md ddng V4t, hay dn it ca, nhuyen the nffdc ngpt dia phtfdng deu thap hdn ed y nghia thdng kfi.
3.4. Thdi dg vd thifc hdnh dUphong phdi nhiem dioxin qua thtic phdm
Neu xet ttfin todn bd bdn phtfdng, hlu hdt eae gia dinh da stf dung ntfde may de udng vd chd bidn thffc an (chidm 85,5%), Trong sd'46hd gia dinh chtfa cd nffdc miy de dung eho muc dieh an ud'ng ma van phai stfdung nffdc gidng khoan, gifing dio... Ihi cd tdi 38
54 Tap chl Y tfi' Cdng cdng, 7.2011, So' 20 (20)
I T6~Me QUftN & NGHIEN etiU I
h p (chifi'm 82,6%) khdng i p dung b f t ky phffdng p h i p xtf ly ntfde nao. T h e o k e t qua d i l u tta KAP Utfdc can thifip, p h i n Idn ngtfdi dan d bdn phffdng (97,7%) khdng dung thffc p h a m ttf nuoi ttong, ttong dd ri Ifi d phtfdng Chinb Gidn la 100%, phtfdng Hda Khfi l i 98,9%, pbtfdng Thanh Khfi T i y la 97,7% va tiifp nhft la phtfdng An Khfi vdi 94.9Tf. Trong todn bp 400 hp khao sat thi cd 9 h o v i n nfiu thu cdc thffc phfm ttf nufii ttong. Da s d c a e ddi ttfdng dtfdc hdi hiem khi quan t i m tdi ngudn gdc ihrfc pham ma hp mua v l . K d l qua khao s a t v e thffc hdnh bidi v l ngudn gdc ihffc p h f m tifiu dffng h i n g n g a y cho tha'y chi cd 22,6% ddi tffdng bidt nguon gde thtfc pham che' bidn ihtfe a n hang n g a y , 34,8% chi bidt mot sd, cdn 4 2 , 6 % ddi tffdng tra Idi khong bidt. 69,6% ddi tffdng dieu tra tta Idi la cd quan t i m dfi'n ngudn gdc thffc pham khi mua; nhffng ngtfdi cdn lai (chiem 15,1%) tra Idi khdng bie't. Y e u id ngtfdi dan quan lam nhft khi mua thffc p h f m chinb l i "s^ch/ltfdi/an lodn" vdi 86.7% long so'ngtfdi dtfdc hdi, tifi'p dfi'n la
"ngon" chidm 8%, cdc yeu i d ' k h i c khdng nh^n dtfde nhieu stf quan lam. Mdc du dang dd'i m a t vdi nguy ed c a o phdi n h i l m dioxin ttong thtfc p h a m . nhtfng chi cd mpt ty le r f t nhd ngtfdi d a n cho bifi'l bo stf dung c a c bifin p h i p dff phdng (chidm 39,8%). Ba thffc h i n h phdng ngffa phdi n h i l m dtfdc nhae ldi nhieu nhfl l i ttinh mua Ihffc phfm khdng rd nguon gdc (52.8%), h a n chfi' i n tdm, cua, cd ntfde ngpt chidm 15,7% v i Ipe ntfde kbi stfdung dat 11.9%,
Ngoai ra, ket qua efla d i l u tta KAP v l mffe do tifiu tbu ihtfe pham eho thfy nhffng thffc phdm cd nguy ed eao dtfde ngtfdi ddn tifiu thu b i n g t u i n k h i phd bifi'n I i trffng gd vit (77%), thit ttau/bd (65%), thil n a c lan m d (61,7%) va c i nffdc ngpt (51,6%).
C i e Ihffc pham nguy cd c a o dffde ngtfdi dan tifiu thu hSng ngay la ldm, cua, dc ntfde ngpt (52,5%), thil ttau bd (24,0%), c i ntfde ngpt (19.5%) va tttfng gd vil (9,8%) (Hinb 3). Bfin canh dd, rau an l i l i loai thtfc pham ed nguy cd d nhifim thdp hdn cung la loai ihffc p h a m lieu thu hdng ngdy ctfa da sd' ngtfdi dan (86,5%). Mtfc dp tieu thu c i c Ioai thtfc phfm theo ngay khd gidng nhau gitfa edc phtfdng dtfde dieu tra.
Ty lfi ngffdi dan tai e i e phffdng dffcfc d i l u Ira tai Da N f n g tifiu Ihu 1 s d Ihtfc p b a m ed nguy ed d n h i l m cao nhieu bdn d Bifin Hda (2007). eu the nhff thit irdu bd (24.0% so vdi 3 , 5 % ; p<0,001); tdm cua dc v i n h u y l n the (52.2% so vdi 5.0%). trffng gia e l m (p<0,05) 7. Ddy cung the hien thdi quen a n ud'ng ddc thu tiieo dia phtfdng khdc nhau giffa bai khu vtfc
Da Ndng \ a Bifin H o a .
Tuy kifi'n Ihffc v l dioxin v a dtf phdng phdi nhifim dioxin cdn rat b a n c h e . k e t qua d i l u tta KAP
ThK l?n RK Iir miWlhit ion TW
^ I " ^ ^
STTI
20 . 6
4= «0 H I H
Hinh 3. Tan sudt lieu thu thifc pham theo ngdy, Dd Ndng 2009
trtfdc can thifip gbi nhin phan ldn ngffdi ddn deu cd thii dd tich cffc v l thtfc binh phong ngffa phdi nhifim dioxin cho ban than va gia dinh. 97% ngtfdi ddn cho bie't hp san sfng ttf bd loai thtfe phfm tfa thich nfi'u bie't chflng ed nguy ed bi nhilm dioxin.
97% ngtfdi ddn sf n sang nghe theo cac thdng tin ttf van ve phdng ttdnh phdi nhilm dioxin. Ngoai cdc nfi Itfc lay dde d khu san bay ihi mdt chtfdng trinh can thifip YTCC nang cao kie'n thffc, ihii dfi vi thffc hanh efla ngffdi ddn sd'ng gan san bay Da Nang nham giam tiiieu nguy cd phdi nhiem dioxin cho epng ddng la ihffc sff clu thifi'l. Sau khi nghifin cffu nay dffde trie'n khai, thdng 5 ndm 2010 HOi YTCC Vifit Nam cung vdi Hdi YTCC Da Nang da id chtfc hdi thao chia se kdt qua nghien efl^i, xay dffng kf hoach can thifip chi tidt vdi sff tham gia efla eac ban nganh lifin quan tai dia phtfdng.
4. Ban lufn
Md hlnh eau thiep vdi cich tidp e§n y te edng epng ttien khai Iai Ddng Nai da cho nhffng ket qua ban dau rfl kha quan Irong vific ning eao kifi'n thffc, thai dp va ihffc banh cho ngtfdi dan sdng tai diem ndng dioxin gin san bay Bifin Hda. Do dd md binh nay ein dtfde md rpng vd ap dung tai 4 phffdng gan sin bay Da Nfng gdp pban ndng eao nhin thffc vd thtfc hanh cua ngtfdi dan ve dff pbdng phdi nhifim didxin qua ibtfc pbam.
Thong tin Iruyen tiidng cin tap trung vao cde loai thffc phfm cd nguy cd cao, tam quan trpng efla vific tim hieu xua't xff thtfc pham tieu thu, khdng tifiu thu thtfc phfm nguy cd eao nudi ttong tai dia ban 4 phffdng nghifin ctfU nhtf: ci va thfly san nffdc ngpt (die bifit la cic ddng vat an d Iang diy), ihit ga vit, irau bd, Idn... nudi theo phtfdng thffc truyin thdng,
Tap chi Y te Cong cong, 7.2011, Sd 20 (20) 55
I TiNG «BAN & NGHliN CUD I
bi n g d va ca rdt.. cung nhff c i c giai phdp thffc h i n h dff p h d n g nhifim d p e dioxin.
Chffdng trinh t r u y i n thdng eung can n h f n m a n h nguy ed phdi nhifim vdi dipxin ndu stf dung ngudn ntfde khdng saeh (chtfa cae hat cdn Id Iffng) v i c i c bifin p h d p xtf ly ntfde cd tiie i p dung tai hd gia dinh.
Ngffdi lao dpng ttong khu vtfe d n h i e m nfin sff dung dung cu b a o hd lao dpng khi Idm cdc cdng vific cd tidp xue trtfc tidp v d i bun d f t iai dia phtfdng.
Tridn khai e i e hoat ddng t r u y i n tbdng v l Itha n a n g n h i e m dpe dioxin tbdng qua Ihtfc p h f m tifiu thu, ddc bifit Ii nhffng loai thtfc p h f m cd nguy cd eao nhtf c i ntfde ngpt ( c i q u a , cd t r a m , e a c d d n g v i t a n d tang d a y ) , thit ngan, vit, g i , cde va m d efla cae loai d p n g vat n a y nfi'u dtfde e h i n nufii d khu vtfe d n h i e m , d i e biet Id khu vtfc Irong va g a n san bay D i N a n g . Ngffdi d a n tuyfit ddi khdng n e n d i n h bat c i tai e i e a o , bd ttong dia bdn 4 phtfdng nghifin cdU d e l a m thtfe p h f m .
P h i n Idn e a c h p hifin v i n dang tieu thu thtfe p h a m ttf nudi trdng t i p ttung d phffdng An Khfi, do dd e i e boat dfing I r u y i n thdng thay ddi h a n h vi nguy cd ndy can d i e bifil chtf trpng d phtfdng ndy.
D e d a m b a o hieu q u a . c i n phd'i h d p vdi c i e ban nganh lien quan d dia phtfdng dd d a m bao ngffdi dan tai dia pbtfdng, d i e bifit l i phffdng An K h e khdng Iifiu thu (an/bin/bifi'u,.,) thffc p h f m ho iff nudi trdng trfin dia bdn.
C i n ed t i p hufn cho cdn bd dia phtfdng v i cdc
epng tac vifin v l ltfa chpn v i sff dung thffc p h a m an toan dd giam nguy cd n h i l m ddc dioxin cung nhff cdc ky n a n g truyen thong tai cdng ddng. C i c hoat d p n g t i p hufn, luyfin truyen ngoai sff Iham gia cua c i c tuyfin truyen vien nen cd stf tham gia tieh cffc efla Hdi phu nff.
Can ed Itfu y khi trien khai c i c Idi khuyfin dinh dtfdng hdp ly tai dia phtfdng, d i e bifit Id nhffng khi i n n h i l u c i , nudi con bang sffa m e .
Pbdt buy hifiu qua trong chtfdng ttinh can t h i e p lai Ddng Nai, c i e k e n h truyen ihdng dia phtfdng (nhff h p p td dan pbd', can bp y t d p h i t Id rdi v i ttf v f n lai hd gia dlnh, d i n td ttanh tai hp gia dinh...) n e n dffde tidp tuc sff dung trong chffdng n i n h ean thifip d D i N f n g . Tuy nhifin, ttong ehtfdng ttinh can thifip ndy cung nfin cdn nhf e them k e n h truyen hinh dja phffdng ( l i m o t trong 3 kfinh thdng tin dffde ngtfdi dan yfiu thich nhft).
Ldi cam dn
Chung tdi xm ttan ttpng cam dn Quy Ford, TS.
Charles Bailey, da bd trd iai chinh cho vific thtfc hifin nghien eflU va cam dn sff tham gia vi hd trd efla Hpi YTCC Da Nang va tram y td 4 phtfdng An Khe, Hda Khfi, Chlnh Giin va Thanh Khfi Tiy ttong giai doan thu th|lp so'hfiu. Chflng tdi cung mud'n bay td ldi cam dn tdi Van pbdng 33 di hd tri? vi cung ea'p eae thdng tin khoa hpe ttong qui ttinh xay dtfng de etfdng va bao cao kfi't qua nghifin cffu ban diu tai Da Nang.
56 Tap chi Y te Cdng c^ng, 7.2011, S6' 20 (20)
I T 6 N G DUAN & NGHIIN eon I
Tii li^u tham khao
Tirng Vi^l
1. Lfi Va Anh, Trin Thi Toyet Hanh, Nguyen Ngoc Bieh, Nguyin Dtfc Minh. Nguyin Kim Ngan (2010). "Chtftfng trinh can thiep ning cao KAP ciia ngtfdi din TP Bifin Hoi ve di^ phfingphdi nhiem dioxin qoa thtfc pham - nhOng thanh cfing ban Oia sau 1 nam can thifip'. Tap chl Y hoc Thinh phfi HoChiMinh. 14(2): 380-865.
2. Le Vfl Anh, Tran Thi Tuyfi'i Hanh, Nguygn Ngpc Bich, Nguyen Dtfc Minh. Nguyen Thanh Hi, E)6 Minb Stfn 2009,
"KAP ciSa ngtffli dSn TP Bien Hoi vi D]f phong phdi nhilm dioxin qua thtfe pfalm". Tap chi Y if cfing cfing 11:13-18.
3. Ttia Th} Tuyfi^t H^nb, Nguyin Ngoc Bich, Nguyin Dtfc Minh Nguyin Thanh Hi, Tran Vfi, Nguyin Thi Qiiy (2010).
"Dinh gii stf tbay ddi kifi'n thffc, thii dfi vi thtfc hinh dir phdng phdi nhilm dioxin qua diilc pham fi phtfdng Trung Dung v i Tin Phong. Bien Hoi - 1 nim sau can thifip". Tap chl Nghifin cilu Y hoc. 68 (3): 447-451.
n ^ n g A n h
4. Dwemychuk LW, Cau HD, Hatfield CT, et al (2002).
Chemosphere. 47:117-137
5. Dwemychuk LW (2005), Chemosphere. 60:998-999 6. Hatfield Consultants and 10-80 Committee 2000, Preliminary Assessment of Enviroamental Impacts Related to Spraying of Agent Orange Herbicide During the Viet Nam War, West Vancouver Halfield Consultants Ltd.
7. Le VA, Nguyen NB, Nguyen DM, Nguyen TH. Do MS, Tran TTH 2008, Organobalogen Compoonds; 70: 000535- 00538.
8. Schecter, A„ Cao Dai, L.. Papke, O.. et al (2001). Joumal of Occupanonal and Environmental Medicine. 43:435- 443, 9. Schecter A., Quynh H.T., Pavuk M., Papke O., Malish R„
Constable J D. (2003). Joumal of Occupational and Environmental Medicine. 45 (8)' 781-88.
10. Tuyet-Hanh, T.T, Vo-Anh, L. Ngoc-Bich, N. Tenkate, T (2010). "EovironmentalHealthRisk Assessment of Dioxin Exposure through Foods in a Dioxin Hot Spot-Bien Hoa City, Vietnam" Intemational Journal of Environmental Research and PubUc Health. 7: 2395-2406.
Tap chi Y te' C d n g c p n g , 7.2011, So 20 (20) 57
