TAP CHl Y DUOC L A M S A N G 108 Tap.6 - 36 4/2011
Hieu qua can thiep cai thien kien thirc, thai do, thyc hanh ve
•> r r r
ve sinh an toan thyc pham cua ngu'di san xuat, che bien thyc pham tai hai xa lang nghe san xuat thyc pham truyen thong
Efficiency of intervention to improve knowledge, attitude and practice about hygiene and food safety of producer in two food traditional villages
Nguyin Thanh Phong', 'Cue An todn ve sinh thuc pham Le Van Bao^, ^Hgc vien Qudn y Nguyen Thj Lam^ ^Vien Dinh duang Quoc gia
Tom tat
Sau hdn hai nam ap dung cac bien phap tang cUdng truyen thdng giad due ve ve sinh an tdan thUc pham (VSATTP) va kiem tra, giam sat cac cd sd san xuat (SX) banh keo va banh day truyen thdng d hai xa lang nghe eua Ha Ndi. Ty le ngudi SX, che bien (CB) thUc pham (TP) ed kien thUe, thai do, thUe hanh (KAP) dung ve VSATTP da tang len ro ret: Trieu chUng ngd ddc TP, trudc can thiep (CT): 56,9%%, sau CT dat 88,9% (chi sd hieu qua - CSHQ=56,2%); Khu SX TP phai each xa ngudn d nhiem la de tranh d nhiem vao TP, trUde CT: 54,6%, sau CT: 82,7% (CSHQ=51,5%); Ban tay ngUdi CB cd the gay d nhiem TP, trUdc CT: 59,2%, sau CT: 92,1%
(CSHQ=55,6%); Thai dp san sang tham gia kham sUc khoe dinh ky khi cd quan y te td chUe kham, trude CT:
95,8%, sau CT: 98,6% (CSHQ=41,6%;ThUc hanh rUa tay bang xa phdng va nUdc sach trudc khi CB TP va sau khi di VS, trudc CT: 52,3%, sau CT: 75,7 (CSHQ=44,4%); Tham gia hpc tap kien thUe ATVSTP, trUde CT: 62,5%, sau CT: 97,7% (CSHQ dat 56,3%)...
Tdl<hod: san xuat thUc pham, kien thUe ve sinh an toan thue pham.
Summary
After more than two years applying measures to strengthen communication and education about hygiene and fddd safety (FSH) and checking and supervising the prdductidn (P) of confectionery facilities and rice cake traditional villages in two communes in Hanoi. The percentage of producer with right knowledge, attitude and practice (KAP) on FSH were significantly increased: Symptoms of fddd poisoning before the intervention (IN): 56.9%%, after IN reached 88.9% (effective rate 56.2%); Manufacturing area must be away from polluted sources td avdid pollution for food, before IN: 54.6%, after IN achieved 82.7% (ER = 51.5%);
Producer hand may pollute the food, before IN: 59.2%, after IN: 92.1% (ER = 55.6%); The available attitude to participate in health checks in term when public health agencies drganizing examinatidn befdre IN 95.8%, after IN: 98.6% (ER = 41.6%); Practice washing hands with sdap dr clean water befdre prdcessing food and after going to the toilet, before IN: 52.3%, after IN reached: 75.7 (ER = 44.4%); Join studying knowledge of hygiene and food safety, before IN: 62.5%, after IN: 97.7% (ER reached 56.3%)...
Keywords: food prdduetion, knowledge of hygiene and food safety.
Phiin bien khoa hoc: PGS.TS. N G U Y £ N V A N HUNG
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011 1. Dat van de
Sau khi ed ket q u i dieu tra KAP ve VSATTP cua ngUdi SX, CB thUe pham tai 3 xa lang nghe SX TP truyen thdng (blnh keo, banh day va gid chi) d Ha Ndi, da phat hien thUe trang ty le ngudi SX, CB thUe pham dat yeu eau ve kien thUe, thai dp, thUc hanh ve VSATTP ddi vdi mdt sd ndi dung, ehi tieu edn thl'p, dly la mpt trong nhUng nguyen nhln quan trpng cd the g l y d nhiem TP trong q u i trinh SX, CB, ed the dan den nguy ca ngd ddc TP eho ngudi sUdung [4], [5].TUthUctrang KAP, nhdm t i e g i l nghien cUu d l phdi hpp vdi chinh quyen dja phuang sdtai v l coquan chuyen mdn q u i n ly VSATTP hai x l lang nghe La Phu (huyen Hoai DUc) v l Nhj Khe (huyen ThUdng Tin) tien hanh I p dung mdt sd bien phIp tang cUdng tap hul'n, van ddng, truyen thdng gilo due VSATTP eho ngudi trUe tiep SX TP, ket hpp vdi cac bien phIp tang cUdng quin ly cac ca sd SX TP... nhlm muc tieu t i n g ty le ngUdi SX, CB thUc pham cd kien thUc, t h i i dp, thUe hanh dung, tdt ve VSATTP.
2. Ddi tifc'ng va phUo^ng phap nghien cufu 2.1. Doi tuang nghiin edu
216 ngudi trUe tiep SX, CB thUe pham tai 2 x l lang nghe SX banh keo d La Phu, Hoai DUc va
SX banh d l y d Nhj Khe, ThUdng Tin, H I Ndi. Thdi gian nghien cUu, tU t h i n g 4/2008 den t h i n g
10/2010.
2.2. Phuang phap nghiin cdu
Tien eUu, dieu tra md ta ngang (trUde - sau can thiep) ket hpp vdi phuong p h I p hdi cUu va nghien eUu can thiep (khdng cd nhdm chUng).
Phuang p h I p can thiep: td ehUc van ddng, tang cUdng elc ndi dung va bien p h I p truyen thdng, g i l o due ve VSATTP eho cle chu co sd, ngudi trUe tiep SX, CB thUe pham va ngUdi d i n trong cdng ddng; ket hpp vdi viec tang eUdng q u i n ly, kiem tra, giam s i t VSATTP tai cle co sd SX thue pham.
Phdng van ddi tupng nghien cUu bang bang hdi, ket hpp quan sit true tiep bang b l n g kiem de danh g i l cae ddng t i e thue hanh ve VSATTP eua ngUdi SX trong khi dang CB thUc pham (trUde sau can thiep).
Danh g i l KAP eua ngUdi SX TP theo quy djnh trong Quyet djnh 39/2005/QD-BYT ngay 28/ 11/
2005 eua Bd Y te [1]. Danh g i l hieu q u i can thiep bang CSHQ.
3. Ket qua va ban luan
3.1. Thay doi ve kien thde vi sinh an toan thUc pham
Bang 1. Kien thUeve trieu ehUng ngd ddc thUe pham
Trieu ehUng
Ndn, dau bung di ngoai Co giat, hdn me, liet, khd thd Cd the xay ra mdt trdng hai tinh trang tren
Khdng biet, khdng tra Idi
Trude can thiep (n=216) SL
166 98 123
8
% 76,9 45,4 56,9 3,7
Sau can thiep (n=216) SL
212 185 192 0
% 98,1 85,6 88,9 0,0
P
<0,05
<0,05
<0,05
CSHQ (%) 27,6 88,5 56,2
Sau can thiep, ty le ngUdi SX, CB TP ed kien thUe dung ve cle trieu ehUng ngd ddc TP d l tang len rd ret, vdi p<0,05; CSHQ dat 56,2%.
TAP CHi Y DL/OC LAM SANG 108 Tap 6 - 36 4/2011
Trudc can thiep y
100-t^
80 5^ 60-
••>> 40- 1- "
20 0-
CSHQ - ob,,i7o
C i 4 n / 0 1 , 4 70
-y
y y
X
1 ^85,6%
/ /
^L_
^ / l
H^IH
"I
i
y
Sau can thiep Hmh I.Tyle ngUdi SX, CB TP ed kien thUe dung ve ly da khu SX thue pham phdi cdeh xa ngudn d nhiem (n=216)
Sau can thiep, ty le cd kien thUe dung ve ly do khu SX TP p h l i eleh xa ngudn d nhiem la de t r i n h d nhiem vao TP da t i n g len rd ret, vdi p<0,01 va CSHQ=86,2%.
Ty le nay d HIi Phdng dat 85,21%; ThUa Thien-Hue: 63,10%; QuIng Ngli: 77,85%; Vinh Long: 48,40%
(dieutra 12/2009) [3].
Bang 2. Kien thUe ve t i e n h l n cd the gay d nhiem TP
Tac nhan
Nude khdng sach
Dung eu CB, bad gdi khdng dam bad VS Khdng khi
Hdi thd, bui
Ban tay ngudi che bien Quan ad dd, ban Khdng biet
Trude can thiep (n=216) SL
107 118 30 110 128 104 11
% 49,5 54,6 13,8 50,9 59,2 48,1 5,1
Sau can thiep (n=216) SL
185 201 120 204 199 190 0
% 85,6 93,1 55,6 94,4 92,1 88,0 0,0
P
<0,01
<0,01
<0,01
<0,01
<0,01
<0,01
CSHQ (%) 72,9 70,5 302,9
85,5 55,6 83,0
Sau can thiep, ty le ngUdi SX, CB TP ed kien thUe dung ve nhUng t i e n h l n ed the gay d nhiem TP d l t i n g len mdt elch rd ret, vdi p<0,01; CSHQ dat 55,6% den 302,9%.
100-1
80
^ 60 .•^ 40 1-
20 0-
X
CSHQ - 90,5%
52,5%
'-' Tn
y^
idc can thie /
/
D 8
100,0%
y
au can thiei
j^i
D
/
Hmh 2. Ty le ngUdi SX, CB thUc pham hieu dung ve ly do phdi tigc tap kien thde VSATTP (n=216)
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 6 - N°4/2011 Sau can thiep, ty le ngUdi SX, CB TP hieu biet dung ve ly do p h l i hpc tap kien thUe VSATTP la de biet elch phdng ngUa d nhiem TP da tang len rd ret, vdi p<0,01 va CSHQ = 90,5%.
80 r 60 i32- 40 I -
20
,—•
1
y^
y '
p Q H O -Z l « AO/,
47.7%
^ / -y
1
70 [
y
^ %
/
Trudc can thiep Sau can thiep
Hinh 3. Ty le ngUdi SX, CB TP hieu dung ve bien phdpxdiy khi mde benh ngodi da hade benh truyen nhiem (n=216)
Sau can thiep, ty le hieu biet dung ve bien phIp xU ly khi m i c benh ngoai da hole benh truyen nhiem I I p h l i dieu trj khdi han mdi dugc tiep tuc CB TP d l t i n g len rd ret, vdi p<0,01 v l CSHQ=48,4%.
Ty le nay d HIi Phdng dat 52,95%; ThUa Thien-Hue: 61,05%; QuIng Ngli: 73,35%; Vinh Long: 69,15%
(dieutra 12/2009) [3].
100- 80 . 60
"^ 40-
20 0-
/
•^ j
1
Tr
CSHQ = 66,5%
b1,4% . y
Udc can thi(
/
/
JP <^
85,byo ^
/ y
A
"•1 can thie
/
Hinh 4. Ty le ngUdi SX, CB TP hieu dung ve ly da
phdi mde qudn da bdo hd, deo gdng tay, khau trang khi CB TP (n=216)
Sau can thiep, ty le hieu biet dung ve ly do p h l i mac quan l o b i o hd, deo g I n g tay, khau trang khi CB TP I I de phdng ngUa vi khuan l l y benh tU co the d nhiem vao TP d l t i n g len rd ret, vdi p<0,01 va CSHQ=66,5%.
y
•lOO-j-^
80
^ 60- '>: 40-
20 0
y\
1 y\
i Tn
CSHQ = 36,3%
70.0%
y
/dcca n thif
/
/
?P 3,
y y
^ ^ H R ^ ^ H S ^ ^ ™ ^ ^
au can thie p
1 ^ 1— A r\ 1
95,4%
y
Hinh 5. Ty le ngUdi SX, CB TP hieu dung
ve tde dung cua viec quy dinh trong khu CB TPphdi cd dung cu dUng chdt thdi (n=216)
TAP CHi Y DU'OC LAM SANG 108 Tap 6 - 36 4/2011 Sau can thiep, ty le hieu biet dung ve t i e dung eua viec quy djnh trong khu CB TP p h l i ed dung eu dung chat t h i i II de khdng vUt rac bUa bai ra san, g l y d nhiem mdi trudng da tang len rd ret, vdi p<0,01 va CSHQ=36,3%.
3.2. Thai dp ve vi sinh an toan thUe pham
<<]).
"^
Trudc can thiep Sau can thiep Hinh 6. Ty le ngUdi SX, CB TP ed thdi do dung
ve sUedn thiet phdi quy djnh sddung phu gia TP trong danh muc cho phep eua Bd Y te
Sau can thiep, ty le ed thai dp dung ve sU can thiet phli quy djnh sU dung phu gia TP trong danh muc cho phep eua Bd Y te d l tang rd ret, vdi p<0,001 v l CSHQ=41,4%.
Ty le nay d HIi Phdng dat 71,67%; ThUa Thien-Hue: 50,96%; QuIng Ngli: 72,33%; Vinh Long: 46,0% (dieu tra 12/2009) [3].
100 80
<2 60
p 40 20
0
A
CSHQ = 40,1%
/U,47o
MK0
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98,6%
z:„-., y
ymmmmmK^
y ,
^K
^ H F /
Trudc can thiep Sau can thiep
Hmh 7. Thdi do eua ngUdi SX, CB TP sdn sdng tham gia khi caquan y teto ehUc khdm sUe khoe djnh ky (n=216)
Thii dp san sang tham gia cua ngudi SX,CB TP khi ca quan y te td chUe khIm sUe khoe dinh ky da tang tu 70,4% len 98,6%.
-'^' 89,4%^
Trudc can thiep Sau can thiep Hmh 8. Thdi do cua ngUdi SX, CB TP
vesuedn thiet phdi cd dung cu dedung chdt thdi bdo ddm kfn, khdng dd rid khu vUc CB TP
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011 Sau can thiep, t h i i dp tha'y can thiet phli cd dung cu de dung ehl't t h i i b i o d i m kin, khdng dd ri d khu vuc CB TP d l t i n g len rd ret, vdi p<0,05 v l CSHQ dat 32,2%.
3.3. ThUc hanh ve ve sinh an toan thUe pham
88,9%
Trudc can thiep Sau can thiep
Hinh 9. Ty le ngUdi SX, CB TP sddung bdo hd sgch khf SX TP
Sau can thiep, ty le sU dung bao hd sach khi SX TP da tang len rd ret, vdi p<0,01 va CSHQ dat 40,2%.
80 y 70 60 g? 50
<0- 40.
;2r 30
20- 10 0
CSHQ - 44,4%
5?, 3%
^ HHRr'
" - " " - ' " " • y -
y
i^r^'-f iriMp'--——-"
''^^;^
75,5%
y
Trudc can thiep Sau can thiep
Hinh 10. Ty le ngudi SX, CB TP rda tay bdng xd phdng vd nUdc sgch trude khi CB TP vd sau khi di VS hade tiep xue vdi vdt d nhiem
Sau can thiep, ty le rUa tay bang xa phdng va nUde sach trude khi CB TP va sau khi di VS hole tiep xue vdi v l t d nhiem da tang len mdt elch rd ret, vdi p<0,05 va CSHQ dat 44,4%.
97,7%
Trudc can thiep Sau can thiep
Hinh 11. Tyle ngUdi SX Cb TP dd dugc hgc tap, tap huan kien thde ve VSATTP (n=216)
TAP CHi Y DLTOC LAM S A N G 108 Tap 6-86 4/2011 Sau can thiep, ty le dUpc hpc tap kien thUe ATVSTP da t i n g len rd ret, vdi p<0,05 va CSHQ dat 56,3%.
8 0 - | ^
''S' 5^
<©• 70-
P
RO-
Tri
CSHQ = 18,7%
66,7%
y' -
' '-'-' -
y
y
fdc can thiep
/£-. -
Sau can thiep
^9,2%
y
Hinh 12. ThUe hdnh do rac vd chdt thdi vda thung rdc ed nap cua ngUdi SX, CB thUc pham (n=216) Sau can thiep, ty le do ric va ehl't t h i i vao thung
rac (cd nip, khdng dd ri) d l tang len rd ret, vdi p<0,05 va CSHQ dat 18,7%.
TU ket q u i tren ed the I p dung eae g i l l phIp can thiep ra cle lang nghe SX thue pham truyen thdng cd dieu kien, hoan eInh tuong tu.
4. Ket luan
Sau hon hai n l m can thiep bang cle bien phap tang cUdng truyen thdng, giao due VSATTP cho ngUdi SX b l n h keo va b l n h d l y d hai xa lang nghe SX thUe pham truyen thdng. Ty le ngudi SX, CB thUe pham cd kien thUc, t h i i dp, thUe hanh (KAP) dung ve VSATTP d l t i n g len rd ret so vdi trUde can thiep (CT):
Trieu chUng ngd ddc TP, tU 56,9% (trUde CT) t i n g len 88,9% (sau CT) (CSHQ=56,2%); Khu SX TP p h l i elch xa ngudn d nhiem II de tranh d nhiem vao TP, tU 54,6% tang len 82,7% (CSHQ=51,5%); Bin tay ngUdi CB cd the g l y d nhiem TP, tU 59,2% tang len 92,1%
(CSHQ=55,6%); Thii dp sin sang tham gia kham sUc khoe djnh ky khi cP quan y te td chUe kham, tU 70,4% t i n g len 98,6% (CSHQ=41,6%; ThUe hanh rUa tay bang xa phdng va nUde sach trUdc khi CB TP va sau khi di VS, tU 52,3% t i n g len 75,7 (CSHQ=44,4%);
Tham gia hpc tap kien thUe ATVSTP, tU 62,5% tang len 97,7% (CSHQ dat 56,3%)...
Tai lieuthamkhao
1. Bd Y te (2005), Quyet dinh sd 39/2005/QD-BYT ngay 28/11/2005 ve viec ban hanh "Quy dinh ve cac dieu kien ve sinh chung ddi vdi cd sd san xuat thue pham''. Ha Ndi.
2. Le Van Bad, Nguyen Van HUng, Hdang Hai (2006), Dieu tra kien thUe VSATTP cua 4 nhdm ddi tUdng tai 6 tinh (Lad Cai, Phu Thp, Ha Tay, Thanh Hoa, Dac Lac, Tien Giang), Cue ATVSTP, Bd Y te.
3. Le Van Bao, Pham Van Thao va CS (2001), ThUe trang kien thUc VSATTP cua ngudi san xua, che bien thUc pham tai Hai Phdng, ThUa Thien-Hue, Quang Ngai va Vinh Ldng, nam 2009, Tap chi Y hpc Viet Nam, tap 363, sd 1/11/2009.
4. Tran Dang (2004), O nhiem thUc pham. Cue An tdan ve sinh thue pham, Bd Y te. Ha Ndi.
5. Le Khac OUc, Nguyen Thanh Phong va cs (2005), Dieu tra kien thUc VSATTP cua 4 nhdm ddi tUdng tai thanh phd Thai Binh, thj xa Ha Tinh va thanh phd Ha Ndi, Cue ATVSTP, Bd Y te.
