Food and Waterborne Diseases Prevention and Control Program

Food and Waterborne Diseases Prevention and Control Program

The program covers diseases of a parasitic, fungal, viral, and bacteria in nature, usually acquired through the ingestion of contaminated drinking water or food. The more common of these diseases are bacterial in nature, the most common of which are typhoid fever and cholera. These two organisms had been the cause of major outbreaks in the Philippines in the last two years.

Parasitic organisms are also an important factor, among them capillariasis, Heterophydiasis, and paragonimiasis, which are endemic in Luzon, Visayas, and Mindanao. Cysticercosis is also a major problem since it has a neurologic component to the illness.

The approaches to control and prevention is centered on public health awareness regarding food safety as well as strengthening treatment guidelines.

1. Prevent the occurrence of food and waterborne outbreaks through strategic placement of water purification solutions and tablets at the regional level so that the area coordinators could respond in time if the situation warrants;

2. Procure Intravenous Fluid solutions, venosets and IV cannula for adult and pediatric patients in diarrheal outbreaks and to be stockpiles at the 17 Centers for Health Development (CHD) and the Central Office for emergency response to complement the stocks of HEMS;

3. Place first line and second line antimicrobial and anti-parasitic medicines such as albendazole and praziquantel at selected CHDs for outbreak mitigation as well as emergency stocks at the DOH warehouse located at the Quirino Memorial Medical Center (QMMC) compound;

4. Increase public awareness in preventable food-borne illnesses such as capillaria, which is centered on unsafe cultural practices like eating raw aquatic products;

5. Increase coordination between the National Epidemiology Center (NEC) and Regional epidemiology surveillance Unit (RESU) to adequately respond to outbreaks and provide technical support;

6. Procure Typhidot-M diagnostic kits for the early detection and treatment of typhoid patients;

Beneficiaries/Target Population:

The Food and Waterborne Disease Control Program targets individuals, families, and communities residing in affected areas nationwide. For parasitic infections, endemic areas are more common.

Strategies/Management:

Case monitoring is maintained through the Philippine Integrated Disease Surveillance and Response (PIDSR) framework of NEC and the sentinel sites of the RESU. To add to that, quarterly reports of the regional coordinators supplement the data and the regular updating from NEC Outbreak Surveillance.

Outbreaks are being prevented though public education in print and radio stations. The need for safe food and water intake by adequate cooking and boiling of drinking water is inculcated to the public.

Multi-drug resistant cases of typhoid are monitored through reports from the hospital sentinel site and the data from the Research Institute of Tropical Medicine’s

Antibiotic Resistance & Surveillance Program.

Objectives:

1. To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem

2. To discuss various types of food fortification strategies

3. To provide an update on the current situation of food fortification in the Philippines

Fortification as defined by Codex Alimentarius

“the addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiencyof one or more nutrients in the population or specific population groups”

• ›Vitamin A - an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence

• ›Vitamin A deficiency - a condition characterized by depleted liver stores & low blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor absorption or utilization of vit. A in the body

• ›VAD affects children’s proper growth, resistance to infection, and chances of survival (23 to 35% increased child mortality), severe deficiency results to blindness, night blindness and bitot’s spot

Iron and Iron Deficiency Anemia (IDA) and its consequences

• ›Iron - an essential mineral and is part of hemoglobin, the red protein in red blood cells that carries oxygen from the lungs to the cells

• ›Iron Deficiency Anemia - condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood

• ›IDA results in premature delivery, increased maternal mortality, reduce ability to fight infection and transmittable diseases and low productivity

Iodine and Iodine Deficiency Disorders (IDD)

• ›Iodine -a mineral and a component of the thyroid hormones

• ›Thyroid hormones - needed for the brain and nervous system to develop & function normally

• ›Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various condition e.g. goiter, cretinism, mental retardation, loss of IQ points

Policy on Food Fortification

Republic Act 8172, “An Act Promoting Salt Iodization Nationwide and for other purposes”, Signed into law on Dec. 20, 1995

Republic Act 8976, “An Act Establishing the Philippine Food Fortification Program and for other purposes” mandating fortification of flour, oil and sugar with Vitamin A and flour and rice with iron by November 7, 2004 and promoting voluntary fortification through the SPSP, Signed into law on November 7, 2000

Status of the Philippine Food Fortification Program

Status and Recommendations for the Sangkap Pinoy Seal Program

There are 139 processed food products with SangkapPinoySeal with 83% with vitamin A, 29% with iron and 14% with iodine (2008)

• ›37% of the products are snack foods

• ›Most of the products FDA analyzed are within the standard

• ›Based on 2003 NNS Households’ awareness of SPS- and FF-products is 11% and 14%, respectively, in 2008 awareness is 11.6%

• ›Although awareness is low, usage of SPS-products is 99.2%

Recommendations:

• ›Review voluntary fortification standards as standards were developed prior to mandatory fortification

• ›Conduct in-depth analysis of the coverage of SangkapPinoySeal of the 2008 NNS

• ›Update list of Sangkap Pinoy Seal products as some companies have stopped using the seal in their products

• ›Intensify promotions of Sangkap Pinoy Seal

Status and Recommendation on Flour Fortification with Vitamin A and Iron

Status:

• ›Based on FDA monitoring all local flour millers are fortifying with vitamin A and iron

• ›94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A and iron respectively while 77% and 99% were fortified with vitamin A and iron respectively. In 2010 decrease in vitamin A due to non-fortified imported and market samples flour.

• ›58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified according to standards.

Recommendations:

• ›Review fortificantsfor iron and possible other micronutrients to be added to wheat flour

• Continue monitoring wheat fortification

• ›Assist flour millers to improve quality of fortification

• ›Need to show impact of flour fortification

Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A

Status:

• ›Non – fortification by industry due to the unresolved issue of who will bear the cost of fortification brought about by the quedansystem of transferable certificates of sugar ownership.

• ›Lack of premix production

• ›Fortification of refined sugar would benefit mainly those in the high income group.

Recommendations:

• ›Continue discussions with sugar industry to explore a compromise for fortification ie. fortification of washed sugar

• ›Review policy on mandatory fortification of refined sugar

Status and Recommendations on Rice Fortification with Iron

Status:

• ›NFA is fortifying 50% of its rice in 2009 and 2010

• ›With the non – fortification of NFA rice, private sector has an excuse for non – fortification of its rice.

• ›There is limited commercial/private sector iron rice premix and iron fortified rice production and distribution mostly in Mindanao (Region XII and XI) with Gen San having the only commercial iron rice premix plant in the Philippines and Davao City implementing mandatory rice fortification in food outlets

• ›NFA conducted communications campaign for its iron fortified rice thru the so called “I-rice” campaign though issues remain on the acceptability of its product

Recommendation:

• ›Review of mandatory fortification of rice with iron

Status and Recommendations on Cooking Oil Fortification with Vitamin A

Status:

• ›Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in 2009 and 94% in 2010)

• ›Samples monitored were labeled and packed

• FDA is not monitoring "takal"

Recommendations:

• To increase frequency of monitoring by FDA and other agencies such as PCA and LGU’s, to ensure all oil refiners and repackersare monitored at least once a year

• ›Monitoring of “takal” oil, use of test kit

• ›Monitoring imported oil, FDA and BOC to coordinate

• ›Review policy of mandatory fortification of oil to possibly limit to those mostly used by at risk population (coconut and palm oil)

Status and Recommendations on Salt Iodization

Status:

• Based on the 2008 NNS, 81.1% of households were positive for iodine using Rapid Test Kit (RTK)

• In the same survey for Region III, 55.7% were positive for RTK but only 34.2% and 24.2% have iodine content >5ppm and >15ppm respectively using WYD Tester

• For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm

• FDA started implementing localization of ASIN Law with General Santos City as the 1stto have a MOA with FDA on localization

Recommendation:

• FDA to expand localization of ASIN Law

• Set – up iodine titration for testing iodine in salt

• Continue to intensify monitoring particularly imported and takal salt

Food Fortification Day Theme 2010:

EO 382 declares November 7 as the National Food Fortification Day

Food and Waterborne Diseases Prevention and Control Program

And

Food Fortification Program

END

Goal and Objectives:

The program aims to:

7. Procure Typhoid vaccine and oral cholera vaccine to reduce the number of cases seen after severe flooding;

8. Provide training to local government unit (LGU) laboratory and allied medical personnel on the Accurate laboratory diagnosis of common parasites and proper culture techniques in the isolation of bacterial food pathogens; and

9. Provide guidance to field medical personnel with regard to the correct treatment protocols vis-à-vis various parasitic, bacterial, and viral pathogens involved in food and waterborne diseases.

Vitamin A, Vitamin A Deficiency (VAD) and its Consequences

Progress in the Philippines towards the Elimination of IDD, 1998-2008

Prevalence of Vitamin A Deficiency:

1993, 1998, 2003, 2008

(DOST – FNRI, NNS)

• ASIN LAW

• Food Fortification Law

WHO Cut – off Point to be considered a public health problem = >15%

*ICC-IDD 2007

Food Fortification Program