Food Poisoning among Zonal Games Participants, Kadoma, Zimbabwe, 2015

  

T. P. Juru,  D. Chirundu, N.T Gombe, R. Chikodzore

ZiMA CONFERENCE 19-23 August 2015 

Introduction • Foodborne illness is caused by eating

contaminated food (WHO,2014).

• Improper handling, preparation and food storage.

• Microorganisms such Salmonellae spp, E. Coli.

are causative agents

• At risk populations include:

– Young, old, immuno suppressed

Introduction 

• Students and teachers camped for sporting

competition.

• Gastrointestinal illness was reported among

participants.

• Admissions at Kadoma General Hospital

– More than 30 cases by 27/02/15

Specific Objectives • Describe the outbreak in terms of person, place

and time.

• Establish signs and symptoms

• Identify the source of infection

• Identify the possible causative agent.

• Audit Kadoma City Health’s response

Materials and Methods

• Study Type: – Retrospective Cohort Study

• Study Setting: – Kadoma City ,Zimbabwe

• Study Population: – Participants who attended camp (N=90) – Those who had shared food(n=7)

• Data Collection:– Interviewer administered questionnaires– Checklists– Swabbing

Materials and Methods

• Data Capture and Processing:– Epi Info 7TM used

- Generated frequencies, means, proportions

– Google Earth for Spot map– Food Pathogen Advisor Software

• Permission and Ethical considerations– Kadoma City Health Department – Ministry of Education – Health Studies Office

• Written Informed consent obtained• Confidentiality maintained

RESULTS

Characteristic   Frequency (%)

(N=92)

Status of Respondent Teachers

Students

Others

18 (20)

67( 73)

7 (7)

Grade

Grade

Grade

Grade

Grade

3

4

5

6

7

1(1)

6( 9)

8(12)

31(46)

22(32.8)

Religion Apostolic

Non- apostolic

Traditional

33(35.9)

57(62)

2(2.2)

Demographic Characteristics of Respondents, Kadoma, 2015

Age of Respondents, Food Poisoning, Kadoma ,2015

Student Teacher Other0

10

20

30

40

50

60

Designation of Respondents

Ag

e in

Yea

rs

Description of the Outbreak by Person

– Of the Respondents 76 fell ill• Female 35( 46%)• Male 41(54)

– Attack rate • Teachers was 68.4% • Students was 85.3% (p>0.03)• Female students 93%• Male students 79%

Clinical Presentation of Food Poisoning Cases by Sex, Kadoma City, 2015(n=76)

Spot Map of Kadoma showing the Distribution of Schools and Attack Rates

Epi Curve for Food Poisoning Cases, Kadoma, February, 2015

Foods Items associated with Illness, Kadoma, February 2015 (n=92)

Food

Type

Consumed Not Consumed Risk

Ratio

RR

 

95% CI

  Ill Not

ill

% AR Ill Not ill % AR  

Marinated

chicken

71 8 90 4 8 33 2.70 1.21-6.02

Chips 71 12 86 4 4 50 1.71 0.85 -3.44

Diluted

Drink

61 11 85 11 4 73 1.16 0.84-1.60

Bread

with Jam

58 11 84 14 4 78 1.08 0.82-1.41

Independents Factors associated with Food Poisoning among Participants, Kadoma, 2015

Factor Adjusted Odds Ratio

(95%CI)

p-value

 

Eating Bread with jam 0.27 (0.4170 -5.4429) 0.40

Drinking Diluted Drink 3.32 (0.2274 48.3973) 0.31

Eating Cold Chips 5.59 (1.1847 -26.3995 ) 0.37

Eating Cold Marinated

Chicken

13.16 (2.7356 -63.3361) 0.0013

Measures of Impact for those who ate Marinated Chicken, Kadoma City,

Zimbabwe, 2015Food Type Measure of Impact

Attributable Risk Percentage (%)

Population Attributable Risk 

Population Attributable Risk Percentage (%)

Marinated

Chicken

71.3 49.1 per 100 59.5

Laboratory Investigations

• Salmonella typhi isolated from 7/11 stool specimen

• No other enteric organisms were isolated

Environmental Assessment• Open shelves for non-

perishable storage• No hand washing facility

in restaurant• Hand operated bin in the

kitchen• Two functional toilets

– One had dirty sink and toilet

City Health Preparedness and Response

Preparedness– EPR plan available– City health not involved in planning gathering– Adequate oral rehydration sachets– Under stock of ciprofloxacin and metronidazole

Response– Initial investigation within two hours of reporting– Coordination meeting held on the 2nd and 5thMarch

2015– Multi-disciplinary approach – Inter sectorial collaboration – No notification from District Hospital

Discussion • All cases fell within one incubation period • Similar median incubation period for students

and teachers– Time of exposure the same– Common food source

• Clinical presentation suggestive of bacterial infection– Typical of non-typhoid salmonellosis (WHO,2008 )– Supported by incubation period of 4 - 84 hours– Incubation period of non-typhoid salmonella ~ 6 –

48 hours (4days)

Discussion

• Salmonella typhi isolated not consistent with :– clinical presentation– Incubation period (7-28 days)– Mutation

• Eating cold marinated chicken was a risk factor– Time lapse between preparation and consumption– Salmonella serotypes are mainly found in poultry, egg

and beef ( WHO,2008)

• Good coordination fostered timely response– Aided by EPR plan– Collaboration ensured patients were treated despite

shortages

Limitations of the study

• Left over food was not available for culture

• Water and Chemical analysis not done

• Minimal recall bias cannot be excluded

Conclusion• This was a point source foodborne outbreak.• The incubation period and clinical

presentation are suggestive of non-typhoid salmonellosis

• Whilst S. typhi was isolated, it could not have caused this food poisoning.

• Cold Marinated Chicken served as a vehicle of transmission.

• The City health department was prepared to manage events related to mass gatherings

Recommendations

• Inter collaboration between schools and City Health – Ministry of Education & Assistant Director Health

• food preparation at place of event and served hot – School heads

• Purchase foot operated bins and also avail hand washing facilities.– Restaurant owner

• Health Education on promotion of food and personal hygiene should be provided -EHT.

• Training of District Hospital personnel on disease notification - DMO

Public Health Actions Taken

Public Health Actions

•Health Education was given

• IEC material was distributed

•Health education talk to camped secondary

school teacher and students

•Procurement of Hand washing facilities at

restaurant

Acknowledgments

• CDC• Study Participants• School Heads. • Health Studies Office• Kadoma City Council• MPH-FETP Colleagues

Thank you