Food borne illnesses and Bangladesh situation
Food borne illnesses and Bangladesh situation
Food safety is a major concern in Bangladesh from the public health point of view. Food borne illness is the ultimate outcome of failure in the management of good food safety practices. Each year a remarkable number of people are suffered from food borne illnesses. Food borne illness is not only due to the presence of pathogenic microorganisms but also the presence of toxic and hazardous chemical present in the food. Lack of personal hygiene and sanitation is mainly responsible for food borne illnesses caused by the contamination of microorganisms.
Understanding Food borne illnesses:
Food borne disease is the sickness caused by dangerous microorganisms and/or toxic chemicals due to the ingestion of food. Food borne diseases severely affects infants, young children, elderly people which ultimately creates a vicious cycle of diarrhoea and malnutrition, damages the national economy, delay development and reduces international trade.
Microorganisms (MOs) are very small living things and they cannot be seen with the naked eye. There are broadly three different types of microorganisms in aspect of food safety: the good, the bad and the dangerous. Good microorganisms are useful which are use to make food and drinks (e.g. cheese, yoghurt, beer and wine); medicine (e.g. penicillin); and to digest food in the gut. Bad microorganisms, or spoilage microorganisms, do not usually make people sick, but they cause our food to smell bad, taste horrible and look disgusting. Dangerous microorganisms make people sick and can even kill and these are called “pathogens”. Most of these microorganisms do not change the appearance of the food.
An example is the green mould on bread which can produce toxins. Some common dangerous foodborne microorganisms are Bacteria – Salmonella, Shigella, Campylobacter and E. coli; Parasites – Giardia, Trichinella; and Viruses – Hepatitis A, Norovirus. Microorganisms are mostly found in Faeces; Soil and water; rats, mice, insects and pests; domestic, marine and farm animals (e.g. dogs, fish, cows, chickens and pigs); and People (bowel, mouth, nose, intestines, hands, fingernails and skin).
Microorganisms depend on someone or something to move them around. The transfer of microorganisms from one place to another is called “contamination”. Human body especially hands are the most common way of moving MOs. Microorganisms can be spread easily through contaminated food and water; Pets and domestic animals.
When a food handler is contaminated with microorganisms, some MOs may be passed to the food during food processing and ultimately infects the consumer through the ingestion of food. Hepatitis are example of viruses which are transmitted like this. Avian influenza and infections with E. coli 0157 are the best examples of zoonoses, transmitted by animals/birds. Direct contact with an infected bird or objects or their faeces contaminated with Avian influenza virus can transmit to humans.
Most microorganisms are grown by multiplication. MOs need food (Meat, seafood, cooked rice, cooked pasta, milk, cheese and eggs); water; time; and warmth conditions for multiplication. One bacterium can become 2 in just 15 minutes. This means that within 6 hours, 1 bacterium can multiply to over 16 million. To be harmful, some bacteria need to grow to high levels. Other bacteria can cause illness when they are present in very low numbers. Viruses are many times smaller than bacteria. They do not grow in food or water, but these are vehicles for transmission.
Every year, billions of people experience one or more episodes of food borne illnesses, without ever knowing that their illness was caused by food. The most common symptoms of food borne disease are: Stomach pains; vomiting; and Diarrhoea. The symptoms depend on the cause of the disease. Symptoms may occur very quickly after eating the food, or may take days or even weeks to appear. For most foodborne diseases, symptoms occur 24 -72 hours after the food has been eaten. Food borne disease can lead to long-term health problems. Very severe diseases, including cancer, arthritis and neurological disorders can be caused by contaminated food.
The consequences of food borne disease are usually more severe and more often fatal for infants, the sick, pregnant women and the elderly. Drinking plenty of fluids will maintain hydration during diarrhoea. While handling food, mouth masks are recommended for people who may cough or sneeze. Gloves can be used to cover any cuts or lesions and should be changed frequently. Advice on treatment of food borne illness differs between countries and should be adapted to the local region. Moreover, one should look for medical suggestion when bowel movements are very frequent, very watery or contain blood, or last beyond 3 days. Someone should not handle or prepare food for at least 48 hours after the illness symptoms are over. However, if this situation cannot be avoided, hands should be washed with soap and water first and frequently during food preparation. When symptoms are severe seek medical advice immediately.
Food industry workers need to notify their employers of the following: Hepatitis A, diarrhoea, vomiting, fever, sore throat, skin rash, other skin lesions (e.g. boils, cuts, etc.) or discharge from ears, eyes or nose.
Microorganisms are not the only reason of food borne illness. People also suffer from toxic chemicals, like Natural toxins; Metals and environmental pollutants; Chemicals used for treating animal (antibiotics/hormones); inappropriately used pesticides; Chemicals used for cleaning; and improper use of food additives (preservative, color, flavor, sweetener etc). Simple measures such as washing and peeling may reduce the risk from chemicals that are found on the surface of foods. Appropriate storage can avoid or reduce the formation of some natural toxins. Some natural toxins (e.g. aflatoxin) are produced by moulds growing on the food like nut, wheat etc. and the ingestion of aflatoxins may cause harmful effects on the liver which may leads to cancer. Some chemicals are a threat to populations (e.g. methylmercury, arsenic). It is very important to understand the instructions on the labels of chemicals used for cleaning as well as using cookware and utensils glazed with materials containing heavy metals (e.g. lead, cadmium), may cause chemical poisoning through food.
Foodborne illness in the context of Bangladesh:
Food borne illnesses are one of the most serious public health problems in Bangladesh. Food borne illnesses are generally either infectious or toxic in nature, which may cause by agents that enter the body through the ingestion of food. The initial symptoms often take place in the gastrointestinal (GI) tract with recurrent symptoms of nausea, vomiting, abdominal cramps and diarrhoea. Fast and unplanned urbanization, inadequate water and sanitation infrastructure, insufficient health services and lack of food safety practices are the most important issues for food borne illnesses in Bangladesh. Strengthening food safety practice will help to minimize the food borne illnesses. Several food borne illnesses have been controlled over the past years in Bangladesh due to Cholera, Anthrax, Nipah, Hepatitis E or Pesticide contamination.
The food contamination and food adulteration situation of Bangladesh is a serious health concern. Unsafe as well as contaminated food is the foundation of many acute and chronic diseases, like diarrhoeal diseases to various forms of cancer. According to WHO, globally about 2.2 million people annually, of them 1.9 million are children are killed by food borne and waterborne diarrhoeal diseases. General scenario on food contamination is due to the lack of hygienic practice in food processing, storage, distribution and serves.
This term is defined according to WHO as the passage of three or more than three loose or watery stool in 24 h. Diarrhoea is three types as follows: Acute watery diarrhea (AWD), Persistent diarrhea and Dysentery. It is one of the leading cause of malnutrition, illness and death among children in developing countries like Bangladesh. The treatment of diarrhea is simple and easy. Children’s are usually admitted in hospitals for acute watery diarrhea. Diarrhea sometimes presents with dehydration. If the diarrhea is severe and persisting for many days, the baby will be dehydrated. Vomiting is also common with AWD. It causes more damage to the babies.
AWD refers to diarrhoea starts acutely, lasts less than 14 days ( most episodes last less than 7 days), & involves the passage of frequent loose or watery stools without visible blood. Acute watery diarrhoea causes dehydration which may kill the patient. The cause of death in diarrhea is acute dehydration. If blood is present in the stool, it is called dysentery. The infectious agents that cause diarrhoea are usually spread by the faecal-oral route.The most important causes of acute watery diarrhoea in young children in developing countries are rotavirus, enterotoxigenic Escherichia coli, Shigella, Campylobacter jejuni, and Cryptosporidium.
Person suffering from Acute Watery Diarrhoea (AWD) on the year of 2015 in 7 division of Bangladesh:Source: http://www.iedcr.gov.bd/images/PDF/foodborne_illness/AWD-2015.pdf
Approximately 0.3 million people are suffering from Acute Watery Diarrhoea (AWD) in Bangladesh in 2015 according to Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh surveillance report.
Fig.1: Monthly trend of AWD frequency (person) in different division of Bangladesh on the year 2015
Fig.2: Monthly distribution of AWD frequency (person) in Bangladesh on the year 2015
Fig.3: Divisional distribution of AWD frequency (person) in Bangladesh on the year 2015
Typhoid (Enteric) fever:
Typhoid fever is also known as enteric fever, which is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. S typhi has been a major human pathogen, thriving in conditions of poor sanitation, crowding, and social chaos. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.
Person suffering from Enteric Fever (Ent. Fev.) on the year of 2015 in 7 division of Bangladesh:Source: http://www.iedcr.gov.bd/images/PDF/foodborne_illness/EF-2015.pdf
Approximately 0.03 million people are suffering from Enteric Fever in Bangladesh in 2015 according to Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh surveillance report.
Fig.1: Monthly trend of Ent. Fev. frequency (person) in different division of Bangladesh on the year 2015
Fig.2: Monthly distribution of Ent. Fev. frequency (person) in Bangladesh on the year 2015
Fig.3: Divisional distribution of Ent. Fev. frequency (person) in Bangladesh on the year 2015
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation and poor personal hygiene.Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal.The hepatitis A virus is one of the most frequent causes of foodborne infection. The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life.
Person suffering from Acute Hepatitis (A. Hep.) on the year of 2015 in 7 division of Bangladesh:
Approximately 5 hundred people are suffering from Acute Hepatitis A (A. Hep.) in Bangladesh in 2015 according to Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh surveillance report.
Fig.1: Monthly trend of A. Hep. frequency (person) in different division of Bangladesh on the year 2015
Fig.2: Monthly distribution of A. Hep. frequency (person) in Bangladesh on the year 2015
Fig.3: Divisional distribution of A. Hep. frequency (person) in Bangladesh on the year 2015
In Bangladesh, there is well-known evidence of food adulteration with harmful chemicals. The chronic effect of chemical hazard like cancer, kidney disorders and birth defects only occurs after long-term, low-level exposure. Food contamination and consumers exposure to food hazards have major implication on the food security and consumers heath in Bangladesh. Lack of the execution of existing Food laws and regulation (Bangladesh Safe Food Act-2013, English/ Bengali) and low level of awareness are also contributing to aggravating the country’s food safety situation. A comprehensive risk analysis and risk management approach of food safety from production to consumption is required to protect public health from such hazards. Raising awareness, ensuring safe water, sanitation and improved hygiene practice will play a important role in reducing food borne illness. Most food borne disease is preventable with proper food handling.