T I N H H I N H N G O D O C T H t f C P H A M T A I TINH BINH DITONG li! NAM 2000 DEN NAM 2007
NGUYEN KIEU UYEN2, TRAN MINH HOANG1, HONG HUU DUC2
'Chi cue An toan ve sinh thuc phdm Binh Duong
2 Trung tdm Y te du phong vd Phong chdng HNIAIDS tinh Binh Duong
Tom tat:
Dat van de: Ngd dpc thpc pham co the anh hudng xa'u den sue khoe cua con ngudi cung nhu co tac dpng xa'u den ddi song kinh te, an ninh xa hpi va hpi nhap quo'c te. Tai tinh Binh DUOng, tinh hinh ngp dpc thpc pham xay ra ti'nh tU nam 2000 den 2007 co 2991 trudng hpp ngp dpc thpc pham, tU vong khong co trudng hpp nao.
Muc tieu nghien cuu: Danh gia tinh hinh ngp dpc thpc pham tai tinh Binh Duong tU nam 2000 - 2007 de co cai nhin tong the ve tinh hinh ngp dpc thpc pham tU do de xua't cac bien phap phong ngUa trong thoi gian t6i.
Phuong phap: Nghien cuu hoi cUu, mau nghien cuu gom 2991 truong hpp ngp dpc thpc pham tU nam 2000 - 2007 dupe chpn theo phuong phap khong xac suat, chpn tat ca mlu.
Ket qua: Trung binh moi nam co 6.25 vu ngp dpc thpc pham vPi 373.8 ngudi mac va 0
ngudi che't. Co sd nguyen nhan chu yeu cua ngd dpc thuc pham la bep an tap the (90%), bua an gia dinh (8%). Nguyen nhan gay ngd ddc thpc pham chu yeu la ddc td tu nhien (35.8%), vi sinh vat (34.7%), hoa chat (18.5%), 11% cdn lai khdng xac dinh rd nguyen nhan. Sd vu NDTP chu yeu xay ra b 3 huyen Thuan An, DT An, Ben Cat (78%) va sd ca mac chiem 79.9%.
Ket luan ya kien nghi: Vi nhufng ly do tren, trong thdi gian tdi chung ta can cd nhufng
phuong phap de tang cudng cdng tac phan ti'ch d nhiem thuc pham va giam sat cac thpc pham cd nguy co d nhilm vi sinh vat va dpc to tu nhien. Cdng tac giam sat ve sinh an toan thpc pham can dupe tang cudng, nhat la vao qui 1 va qui 4 cua nam.
Abstract:
Background: Food poisoning can harm to consumer's health as well as impact badly on
social-economic development, social security and international integration. The situation of food poisoning in Binh Duong province from 2000 to 2007, there were 2991 reported cases of food poisoning with no death.
Objective: To evaluate the situation of food poisoning in Binh Duong province from 2000-
2007 in order to have an overview of the food poisoning situation and from that propose recommendation some preventive measures in future.
Method: A cross-sectional description with retrospective study of 2991 food poinsoning cases from 2000 to 2007 were selected by non probability and all reported cases.
Results: The annual average was 6.25 food poisoning outbreaks with 373.8 affected
persons and non fatal and mainly happened in canteens (90%) and family meals (8%). The most frequent causative agents were natural toxins (35.8%), microbiological agents (34.7%), chemilcal (18.5%) and 11% still not indentified. Food poisoning outbreaks were mainly happened in Di An, Thuan An and Ben Cat district (78%) and accounted for 79,9% of reported cases.
Conclusion - Recommendation: For that reason, we should have strategies to increase the analysis of food contamination and monitor foods with contaminated risk of microbiological agents and natural toxins. The surveillance of food hygiene and safety needs to increase, especially for the first and the fourth quarter of each year.
I. DAT VAN Bt
Thirc pham cung cap cac chat dinh duong dam bao sue khoe cho con nguoi dong thoi cung co the la ngu6n benh neu nhu thuc pham khong dam bao ve sinh. Viec sir dung thuc pham khong v6 sinh an toan trudc mdt co the bi ngp dpc cap tinh vPi cac trieu chirng 6 at dd nhan tha'y, nhung van de nguy hiem hon nua la su tich luy dan cac cha't dpc hai 6 mpt so' bd phan trong co the sau mpt thoi gian mdi phat benh hoac co the gay di tat, di dang cho cac the he mai sau.
An toan thuc p h i m co mpt tdm quan trong dac biet khong chi vdi mdi ca nhan, cpng dong, su phat trien gio'ng noi ma lien quan den su phat trien kinh te, thuong mai, van hoa, an ninh, chinh tri cua mdi dia phuong, mdi quo'c gia.
O nhung nuoc phat tridn co toi 10% dan sP' bi ngp dpc thuc pham va cac benh truyen qua
thuc pham mdi nam; voi nhung nude kem phat trien ty le nay cao hon nhieu. Tai Viet Nam theo thdng ke cua Cue An toan ve sinh thuc phdm - Bp Y te, td nam 2000 tdi 2007, o nude ta da cd 1.616 vu ngp dpc thuc pham vdi 41.898 ngudi mdc va 436 ngudi tu vong. Trong dd khoang 60%
xay ra o cac bep an tap the tai cac nha may, xi nghiep, khu cdng nghiep....
Tai tinh Binh Duong llnh hinh ngd ddc thuc phdm vdn con xay ra va dien tie'n ngay cang phdc tap tinh td nam 2000 den nam 2007 cd 50 vu ngp ddc thuc pham vdi 2991 ngudi mdc. Cd nhieu nguyen nhan gay ra NDTP nhu thuc phdm bi d nhidm, mdi trudng bi 6 nhidm, thuc pham cd ddc, dieu kien san xuat, che bie'n thuc phdm khdng dam bao, nhan thdc - hanh vi dung vd phong chd'ng NDTP cua cdng ddng con nhieu han che.
Nhdm xac dinh mdt sd dac diem dich te hpc cac vu ngp ddc thuc phdm va dd xuat cac bien phap phong chdng ngd ddc thuc pham cho cdng ddng, chung tdi tidn hanh nghien cdu de tai "Tinh hinh ngo doc thuc phdm tai tinh Binh Duong nam 2000-2007".
II. DOI TlTONG VA PHlTONG PHAP NGHIEN CUU 2.1. Ddi tupng, d|a diem va thdi gian
- Toan bp 2991 trudng hpp NDTP dupe ghi nhan tai tinh Binh Duong.
- Thdi gian td nam 2000 - 2007
2.2. Thiet ke nghien cuu va cdng cu nghien cdu
- Hdi cdu toan bp bao cao vu ngd ddc thuc phdm td nam 2000 - 2007.
- Su dung mdu M 3 : Sd thd'ng ke ngd ddc thuc pham (Ban hanh kem theo Quyet dinh sd'Ol/2006/QD-BYT)
2.3. Phan tich so lieu
Sd lieu dieu tra thu thap dupe qua cac phieu didu tra va dupe x u ly bdng phdn mdm Excel.
I I I . KE'T Q U A V A B A N L U A N
3.1. Tinh hinh ngp dpc thuc pham tai Binh Duong so voi ca nude 2000 - 2007 Bdng 1. Tinh hinh ngd ddc thuc phdm tai Binh Duong so vdi cd nuoc 2000 - 2007
Nam So vu So mac S6 c h i t Ca nuoc
S6 vu/mac/cheT
Nam n % n % n %
Ca nuoc S6 vu/mac/cheT
2000 5 10 108 3.6 0 0 213/4233/59
2001 4 8 47 1.6 0 0 245/3901/63
2002 2 4 103 3.4 0 0 218/4984/71
2003 14 28 1065 35.6 0 0 238/6428/37
2004 4 8 328 11.0 0 0 145/3584/41
2005 6 12 283 9.5 0 0 144/4304/53
2006 7 14 470 15.7 0 0 165/7135/57
2007 8 16 587 19.6 0 0 248/7329/55
Tong so 50 100 2991 100 0 0 1616/41898/436
TB 8 nam 6,25 373,8
TB so voi
ca nuoc 3,1 7,14 0
Trung binh mdi nam co 6,25 vu ngp dpc thuc p h i m vdi 373,8 ngudi m i c va khdng cd ngudi tu vong. Cac vu NDTP va ca m i c cd dien tien phdc tap qua cac nam nhung td nam 2004 - 2007 NDTP co xu hudng gia tang day cd the la do su gia tang cua cac nha may x i nghiep keo theo cac dich vu cung cap suat an cdng nghiep va sd ngudi an tai cac bep an cdng nghiep d i n den tang nguy co NDTP. Trong nam 2003, sd ca m i c tang dot bien (35%). So vdi ca nude trong 8 nam qua, sd vu NDTP chiem 3,1%, sd ngudi m i c 7 , 1 % va sd chet 0,0%.
3.2. Tinh hinh ngp dpc thuc pham phan bo theo dia ban huyen
Bdng 2. Tinh hinh NDTP phdn bd theo tdng huyen
T T Huyen So vu So mac So chet
T T Huyen
n % n % n %
1 Thu Dau Mpt 4 8 155 5.2 0 0
2 Thuan An 21 42 954 31.8 0 0
3 DT An 8 16 654 21.8 0 0
4 Ben cat 10 20 778 26.1 0 0
5 Tan Uyen 5 10 362 12.2 0 0
6 Dau Tieng 2 4 88 2.9 0 0
7 Phii Giao 0 0 0 0 0 0
Cong 50 100 2991 100 0 0
So vu NDTP xay ra chu yeu 6 3 huyen Thuan An, DT A n , Ben Cat chiem 78 % tong
so vu va so ca m i c chiem tdi 79.9%, day la cac vu NDTP ldn. Dieu nay cung phu hop vdi tinh hinh phat trien c6ng nghiep cung nhu su da dang cua dan nhap cu cua 3 huyen tren. Cac vu NDTP xay ra tai cac huyen Dau Tieng, Tan Uyen, Thu Dau Mpt la nhung vu NDTP nho le. Rieng tai huyen Phu Giao trong 8 nam qua theo thong ke chua xay ra vu NDTP nao co the do day la huyen chua co phat trien cong nghiep chinh vi vay nen cac vu NDTP tap the tai cac nha may x i nghiep la khong co, ben canh do nhung vu NDTP nho le co the chua thd'ng ke dupe.
3.3. T i n h hinh ngp dpc thuc pham theo tirng nam
Bdng 3. Tinh hinh NDTP phdn bo theo timg nam
Huyen
2000 2001 2002 2003 2004 2005 2006 2007 TS Huyen
V M V M V M V M V M V M V M V M V M TDM 0 0 0 0 0 0 2 95 0 0 0 0 1 25 1 35 4 155 Thuan
An 3 98 2 42 2 103 5 303 1 21 2 134 2 170 3 83 21 954 DT An 0 0 0 0 0 0 6 518 0 0 1 19 0 0 1 117 8 654
Ben
Cat 1 3 1 5 0 0 0 0 3 307 1 96 2 166 2 201 10 778 Tan
Uyen 0 0 0 0 0 0 1 149 0 0 2 34 1 28 1 151 5 362 Dau
Tieng 0 0 0 0 0 0 0 0 0 0 0 0 1 81 0 0 2 88 Phu
Giao 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cong 4 101 3 47 2 103 14 1065 4 328 6 283 7 470 8 587 50 2991
Bat dau tir 2003 - 2007 cac vu NDTP co xu huong xay ra 6 hau het cac huyen trong tinh. Trong 8 nam huyen Thuan A n la huyen luon xay N D T P vdi so lupng ca m i c cao (21/50 vu va 954/2991 ca m i c ) . Dieu nay cho tha'y c i n co nhung phuong an hoac nhung cong trinh nghien cuu ve nhung dac diem dich te hpc tai huyen Thuan A n n h l m han che NDTP.
3.4. Hoan canh xay ra ngp dpc
Co so nguyen nhan chu yeu cua cac vu ngp dpc thuc pham la bep ah tap the chiem 90%,
bua an gia dinh chiem 8%, dam gid chiem 2%. NDTP do an tai bep ah tap the la cao nhat nguyen nhan co the la do sP' lupng suat an tai cac be'p an tap the la ldn nen qua trinh che' bie'n, bao quin va van chuyen cd the7 i n h hudng deh cha't lupng cua cac suat an.
Bdng 4. Hoan canh xdy ra ngd ddc riieo sdvu, sd mac, sd'chei
T T Hoan canh So vu % So mac % So c h i t %
1 A n tai gia dinh 4 8 30 1.0 0 0
2 A n tai dam gio 1 2 25 0.8 0 0
3 An tai bep an tap the 45 90 2936 98.2 0 0
Tong cong 50 100 2991 100 0 0
3.5. Nguyen nhan gay ngo dpc thuc pham Trong 8 nam tu
2000 den 2007 nguyen nhan gay ngp dpc thuc phim chu yeu la do vi sinh v | t (34.7%) va dpc to tu nhien (35.8%). Dpc tP' tu nhien co trong thuc an nhu ca, nam dai, m i m khoai tay, san dpc, mang dpc dau dP xanh, la ngon, coc, bach tupt xanh v.v... vi dan tri con tha'p chua nhan
thuc dupe thuc an co chat dpc tu nhien, viec chpn lpc ngu6n thuc phdm khong ky nen d i n den ngp dpc. Con tir vi khuin la do bi nhiim tir q u i trinh van chuyen, che bie'n va bao quan cung nhu ve sinh ca nhan ciia nguoi che bien thiic an.
• Do vi khuan I I DO hoa chat • Doc to tuf nhien • khong xac dinh Bieu do 1. Nguyen nhdn gay ngd ddc thifc phdm (%)
Bieu do 2. Tyle mdc vd vu theo nguyen nhdn gay ngd ddc
Ngp dpc thuc phim do vi sinh vat co so' vu mic chidm ti le cao nhat chiem 50%
nhung so m i c chiem 34,7%. NDTP do dpc to tu nhien chiem 26% tong so' vu nhung so' ca m i c chiem toi 35,8%. Dieu nay cho thay NDTP do dpc tP' tu nhien la nhirng vu ngp dpc thuc pham len voi so' lupng ngudi m i c cao.
3.6. Nguyen nhan gay ngp dpc theo dja ban
16 14 • 12 - 10 - 8 6 4 2 0
15
TDM Thuan An VSV
3 3,
m , u 1 1 1 1 2
0 0[~[0 0 0 0 Dl An Ben Cat Tan Uyen Dau Tieng Phu Giao I HCBVTV • DTTN El KRNN
Bieu do 3. Vu ngo doc thuc phdm theo dia ban
Ngp dpc thpc p h i m xay ra chu yeu tren dia ban cac huyen thi la do vi sinh vat va dpc to' tp nhien. Thuan A n la huyen co sd vu NDTP do VSV cao nhat chiem 15/25 vu, NDTP do dpc tP' tp nhidn xay d huyen Ben Cat la cao nhat 5/12 vu.
3.7. Nguyen nhan ngp dpc theo q u i Bdng 5. Nguyen nhdn gdy ngd ddc theo qui
T T Q u i
Nguyen nhan~~-~-^^
Q u i 1 Q u i 2 Q u i 3 Q u i 4
T T Q u i
Nguyen nhan~~-~-^^ n % n % n % n %
1 V i khuan 101 29.7 351 35.5 118 24.1 322 29.4 2 Do hoa chat 170 50.0 73 7.4 161 32.9 149 13.6 3 Dpc to tu nhien 69 20.3 420 42.4 26 5.3 623 56.9 4 Khong xac dinh 0 0.0 146 14.7 185 37.8 0 0.0
Ngp dpc do vi khuan phan bo' ddu trong cac qui trong nam, nguyen nhan la do tinh Binh Duong la khu vuc co nhiet dp it bie'n dpng nhiet dp trung binh trong nam tir 30- 32°C thuan lpi cho vi k h u i n p h i t Uien quanh nam. Ngp dpc do hoa chit x i y ra d qui 1 thuong co the do la thoi diem chuan bi cho te't Nguyen dan nen sir dung nhidu hon hda chat trong rau q u i , b i n h keo, nude giai khat, nem c h i v.v... nen ngp ddc x i y ra cao hon.
Ngd dpc thuc pham do dpc td tu nhien histamin x i y ra nhieu vao qui 4, thdi diem nay thudng la mua mua bao do dd cd thd anh hudng nhieu hon den qua trinh van chuydn va bao quan c i bien.
3.8. Ty le mac va che't do ngo doc thirc pham/100.000 dan h i nam 2000 den 2007
[1*— Tyle mlc/100.000dan _ - — T» * chftnOO^OOjan j
• 124.4 . . / \ / \
•~ii5 ^_ 12.7
g-0-i ft D'.', g—O-i m 0 i • 0 i » 0-i w—i • u 1 m u ' Nam 2000 2001 2002 2003 2004 2005 2006 2007 Trung
binh Bieu do 5. Ty le mdc vd chet do ngd ddc thuc phdml100.000 dan
tit nam 2000-2007
Trong 8 nam tit nam 2000-2007 ti le mac NDTP trung binh/100.000 dan la 41.0/100.000 dan, ty le nay la kha cao. Ty le chet do ngo dpc thpc pham la 0/100.000 dan.
IV. KET LUAN VA KIEN NGHI 4.1. Ket luan
- Cac vu NDTP va ca mac co dien tie'n phuc tap nhung t u nam 2004 deh 2007 NDTP co xu huong gia tang. Trong nam 2003 so ca m i c tang dpt bie'n (35.%). So vol ca nude trong 8 nam qua so vu NDTP chiem 3,09%, sd ngudi m i c 7,14% va sd chet 0%. Trung binh mdi nam cd 6,25 vu vdi 337,8 ngudi m i c va 0 ngudi t u vong.
- Sd vu ngp ddc thuc phim xay ra chu yeu d 3 huydn Thuan A n , D i A n , Ben Cat chiem 78% tdng so vu, sd ca m i c chiem 79.9%.
- Co sd nguyen nhan chii yeu cua cic vu ngd ddc thuc pham chu yeu la cic bep an tap thd chiem 90%.
- Trong 8 nam td 2000 den 2007 nguyen nhan gay ngp ddc thuc pham chu yeu la do vi sinh vat (35.8%) va dpc td tu nhien (34.7%).
- Ngd ddc thuc pham do vi sinh vat cd so vu m i c chiem ti Id cao nhit chidm 50%
nhung sd m i c chiem 34,7%. Ngd ddc thuc phim do ddc t d t u nhien chiem 26% tdng so vu va 35,8% so ca m i c .
- Ngd ddc do vi k h u i n phan bd ddu trong cac t h i n g trong nam. Ngd ddc do hda chat xiy ra nhieu d qui 1. Ngd dpc thuc phim do ddc to tu nhien histamin xay ra nhieu vao qui 4.
- Ti le m i c , chet do ngd ddc thuc pham trung binh/100.000 dan trong 8 nam la 41,00 va 0,00.
4.2. Kien nghi Trudc mat
- Cin tang cudng cdng tie phong ngda ngd ddc thuc phim chu trong den cac co sd
nguyen nhan la bep an tap thd Uen dia tinh, dac biet la cic huydn: Thuan An, DT An, Ben Cit.
- Tang cudng cdng tic phan tich mdi nguy co d nhidm thuc pham va g i i m sit chit lupng cic mat hang trdn thi trudng dac bidt chu trong deh cac thuc p h i m cd nguy co 6 nhidm vi sinh vat va ddc to tu nhien.
- Tiep rue trien khai Chi thi 06/2007/CT-TTg cua Thu tuong Chinh phu ngay 28 thang 3 nam 2007 vd viec trien khai cac bien phap cap bach bao dam ve sinh an toan thuc phdm
v a Quyet dinh 3537/QD-UBND cua U B N D tinh Binh Duong ngay 17 thang 8 nam 2007 ve viec phd duyet Ke hoach tridn khai cac bien phap cap bach bao dam ve sinh an toan thuc phdm tinh Binh Duong.
- Cong tac thdng ke bao cao can dupe cung cd, thdng nhat theo theo m l u qui dinh Bp Yte.
- Tang cudng kidm tra giam sat cac ngudn thuc phdm cd nguy co d nhiem, chu y hoa chat vao qui 1 va cac loai thuc pham cd d nhidm ddc to tu nhien, dac biet la ca bidn vao qui 4 trong nam.
Lau dai
- Cd chinh sach vay vdn hd trp cho viec chuyen ddi cdng nghe lac h&u, khdng bao dam ve sinh an toan thuc pham ddi vdi bep an tap the quy md vda va nhd.
- Nganh y td va cac sd ban nganh lien quan cd ke hoach phdi hpp chat che, phan cdng hpp ly trong quan ly nguyen lieu thuc pham "tit trang trai den ban an" de tranh su chdng cheo trong cdng tac kiem tra cung nhu khdng de bd sot cac khau quan trong trong cdng tac quan ly chdt lupng ve sinh an toan thuc pham.
- Cdn cd luc lupng thanh tra chuyen nganh ve ve sinh an toan thuc phdm.
- Can cd chuong trinh danh gia mdi nguy ve sinh an toan thuc tren dia ban tinh td dd cd dinh hudng cho cdng tac phong ngda ngd ddc thuc phdm.
- Trung tam Y te du phong tham muu Sd Y te" cung vdi cac nganh lien quan xay dung ban kd hoach bao dam v6 sinh an toan thuc phdm giai doan 3-5 nam trinh Uy ban nhan dan tinh phe duyet. Trong dd cdn de ra Id trinh nhdm tao ra cac budc ddt pha, tao chuyen bien co ban de ngay mdt quan ly tdt hon cdng tac ATVSTP ndi chung va han chd cac vu ngd ddc ndi rieng.
T A I L I E U T H A M K H A O 1. Cue An toan ve sinh thitc phdm, ca sd du lieu ngd ddc thuc phdm.
http:llvfa.gov.vnl ngodoc llogin.asp.
2. Thdng ke ngd ddc thuc phdm tinh Binh Duong 2000-2007 (Luu hanh ndi bd).
3. Quyet dinh sd01I2006IQD-BYT ngay 09 thdng 01 nam 2006 ciia Bd trudng Bd Y tequy dinh ve man bdo cdo ve sinh an toan thuc phdm.
4. Nguyin Dd Nguyen, Phuong phap nghien cuu khoa hoc trong y khoa, Bd mdn Dich te, Khoa Y te cdng cdng - Trudng Dai hoc Y Dupe TP. Ho Chi Minh (Luu hanh ndi bp).
5. Tdi lieu hpi nghi tdng ket chuong trinh muc tieu y te qudc gia nam 2007 vd trien khai Chuong trinh Muc tieu y te Qudc gia 2008 ve ve sinh an toan thuc phdm.
