Báo cáo giám sát hệ thống phòng ngừa ngộ độc thực phẩm tại Bình Dương

Report on evaluation of food poisoning outbreak system in Binh Duong

1. Statement of the problem
Food poisoning is still a critical public health problem in Viet Nam [1, 2]. It is estimated
that there are 250-500 food poisoning outbreaks (FPO) occur every year with 7,000-10,000 cases
and 100-200 deaths. However, Vietnam still lacks a comprehensive national food safety
surveillance system. Efforts in surveillance by different agencies are fragmented, weakly
coordinated and poorly integrated. However, Vietnam still lacks a comprehensive national food
safety surveillance system. The data collected by different ministries through routine monitoring
are not collated for joint use by ministries for risk-based food safety surveillance and controls.
There still is a need to ensure that surveillance activities are consistent with international
standards and that reliable information exchange systems are developed between provincial and
national organizations. Surveillance systems are expensive, and there are limited possibilities to
recover costs from the private sector. Hence, lack of operational funding is a serious constraint
for setting up an effective surveillance system in Vietnam. Laboratory capacity and funding are
not sufficient for routine surveillance or enforcement of related testing. There are laboratory data
on exports and imports and some data from domestic inspection activities under the different
ministries, but there is no overall plan or collation of national data for analysis and monitoring of
foodborne diseases and food safety.
Binh Duong is one of the largest cities in southern Viet Nam, in which 48 industrial parks
with hundreds of factories located and that leads to a high risk of food poisoning outbreaks
occurring. From 2006-2010, there were 33 FPOs with 1834 cases, while the figure was 11 with
487 cases from 2010-2014.
The food safety surveillance system in Binh Duong is still not effective. At the local
level, management assignments among the health, industry and agriculture sectors are still
overlapping, even tending to push among agencies in the management of small businesses and
food service establishments. Moreover, on-the-spot control has not been paid attention; the
records of food processing establishments are not sufficiently documented, so there is no
database for tracing when the FPOs occur. The inspective worksare carried out regularly but not
frequently; consequently, only 30-40% of the food producers and food processing establishments
have been controlled.

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Although several reports have pointed out these drawbacks, no comprehensive
evaluations of food safety surveillance system are carried out. Therefore, this study is propose to
assess the system from that appropriate policies may be informed to improve effectiveness of the
system.
2.

Objectives
To describe the status of food poisoning surveillance system (FPSS) on the basis of three

components including structure, core functions, and support functions.
To assess the effectiveness of the system on the basis of three components including
structure, core functions, and support functions.
3. Methodology
Study Design
This is a cross-sectional study which will be conducted from July 2017 to December
2017 in Binh Duong province.
Study population
Health facilities involving into food poisoning surveillance system will be targets for
evaluation. According to Decision 01/2006/QĐ-BYT, Vietnamese Food Administration (now
decentralized into provincial Food Administrations (PFA)), provincial Preventive Medicine
Centers (PPMCs), district Preventive Medicine Centers (now renamed as district Medicine
Centers (DMCs), and commune health stations (CHS) relate to identify, investigate and report
FPOs. Therefore, all those facilities will be evaluated in this study.
Data collection methods
Data on status of FPSS will be characterized as indicators on structure (number of
regulations, policies, networks…), core functions (having case definition, having evidence-based

surveillance…), and support functions (number of training courses, number of drills…). Data on
effectiveness of activities are also qualified into indicators on structure (percentage of
compliance to regulations, percentage of activities completed…), core functions (level of
revalence of case definition, percentage of FPOs had lab confirmations…), and support functions
(level of impacts of drills, level of impacts of training courses…) (Annex 1)
To collect indicators on status of FPSS, document review will be used. Key informant
interview may also be deployed in case of some indicators could not be obtained from recorded
documented.

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A semi-structured questionnaire based on WHO Guideline on monitoring and evaluating
for communicable disease surveillance and response systems will be developed to collect all data
about the status and effectiveness of the FPSS. In the questionnaire, items related to status
indicators will be introduced first, followed by items related to effectiveness indicators so that
data will be collected in a contiguous and logical manner (Annex 2) [3].
Key informants will be persons who are responsible for food poisoning activities in
targeted health facilities. They include:
•

PFA: one head of bureau of food poisoning control.

•

PPMC: one head of department of communicable disease control.

•

DMC: seven heads of department of communicable disease control

•

CHS: ten heads of CHS

Data analysis
Data will be entered and analyzed by Stata v13. Stata v13 will be used to generate
frequencies, proportions.
4. Anticipated outcomes
The findings of the study will be used as baseline data to improve effectiveness of the
food poisoning surveillance system.

RESULTS

1. Status of food poisoning surveillance system in Binh Duong
Like other provinces in the whole country, the food poisoning surveillance system
(FPOS) in Binh Duong is solely a passive surveillance system which depends on FPO reporting.
As a food poisoning outbreak (FPO) occurs, the reporting mechanism from lower level to higher

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level is activated and responses and control measures are implemented as well. Other types of
FPOS such as syndromic surveillance, foodborne disease notification systems are not yet
established.
1.1. Legistration for food poisoning surveillance system in Binh Duong
Nationally, although no legal documents deal directly with FFOS, there are several
official documents related to food poisoning management. They include Decision
5327/2003/QĐ-BYT on regulations of specimen collection in food poisoning outbreaks,
Decision 39/2006/QĐ-BYT on regulations of food poisoning outbreak investigation, Decision

48/2005/QĐ-TTg on establishment of the Central Inter-Sector Steering Committee for Food
Hygiene and Safety, and Decision 01/2006/ QĐ-BYT on regulations of reporting and reporting
forms on food hygiene and safety.
Based on the national legal framework, Binh Duong had developed a set of legal
documents related to food poisoning management. At provincial level, legal documents included
Decision 137/2009/NĐTP-ATTP on the process of identification and investigation of the causes
of food poisoning outbreak, Plan 77/KH-BCD on mobilizing commitments to prevent food
poisoning outbreak occurring at cooking establishments and food services, and Decision
11/2013/QĐ-UBND on regulations of decentralized management on food hygiene and safety. On
Decision 11/2013/QĐ-UBND, responsibilities of each agency related to food safety management
at each level are described obviously, while Decision 137/NĐTP-ATTP describes three activities
dealing with food poisoning outbreaks including reporting timely FPO status to People’s
Committee and Provincial Health Service, urgent response and control of FPO cases (screening,
referral to health facilities, and treatment), and FPO investigation (clinical investigation, field
investigation, and food sampling). On the other hand, Plan 77/KH-BCD stated that all industrial
companies, kindergartens and schools those have canteens must establish urgent response units
to deal with FPO. At district level, district medical centers (DMCs) developed decisions of
establishment of FPO investigation teams. All of these legal document enable Binh Duong
establish a comprehensive legal framework for FPO management.
Provincial People’s Committee (PPC)

Provincial Health Service (PHS)

•

•

Regulate provincial Inter-Sector Steering
Committee for Food Hygiene and Safety

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Regular and urgent reporting to PPC
about food safety status

Sub-Vietnam Food Administration
(sub-VFA)
• Food safety management for food
provision businesses, canteens in
industrial parks


Figure 1. Flowchart showing decentralized management of each agency related
to food safety at each level based on Decision 11/2013/QĐ-UBND
1.2. Networking and partnership of food poisoning system in Binh Duong
There are several agencies involving in FPOS in Binh Duong. At provincial
level, these agencies include Provincial People’s Committee (PPC), sub-Vietnam
Food Administration (sub-VFA) and Provincial Preventive Health Center (PPHC).
At district level, District People’s Committee (DPC), District Medical Center
(DMC) and district hospitals or clinics are three agencies related to FPO
management. At commune level, Commune People’s Committee (PPC) and
Commune Health Station (CHS) had responsibility of dealing with FPO. Apart
from those agencies, the Institute of Public Health in Ho Chi Minh City gets
involve in FPO management in Binh Duong as well. Factories and schools those

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have canteens are also a part of FPOS. The roles and cooperation mechanism of all
agencies had been stated in all promulgated legal documents.

Table 1. The network and role of agencies involving in FPOS in Binh Duong
Facilities

Role

Institute of Public Health in Ho Chi Support sub-VFA in testing specimens
Minh City (IPH)

from FPO

Provincial People’s Committee (PPC) Direct

food

hygiene

and

safety

management at provincial level
Sub-FA

Manage FPO and food safety issues at
provincial level

District People’s Committee (DPC)

Direct

food

hygiene

and

safety

management at district level
District Medicine Center (DMC)

Manage FPO and food safety issues at
district level

Hospitals or clinics

Treatment of FPO victims

Commune People’s Committee (CPC) Direct

food

hygiene

and

safety

management at commune level
Commune health station (CHS)

Support sub-VFA and DMC in FPO
management

Factories and schools

Response and control of FPO

It could be said that there were not any official documents concerned about
information sharing mechanism among relevant agencies of FPOS. However,
according to sub-VFA, weekly and monthly meetings were hold among all
stakeholders of FPOS to disseminate information about FPO status in the whole
province. In addition, sub-VFA, industrial companies and schools had an informal
sharing information mechanism via email. It meant that the sub-VFA had an email
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list of all industrial companies and schools and it could send all information or
alerts about FPO to all companies and schools. Moreover, the sub-VFA developed
a website in which all information related to FPO is posted so that all relevant
companies and schools have awareness of FPO status in the province.
1.3. Surveillance strategy
Planning for FPO management is necessary and it is done by all levels of
FPOS. The sub-VFA does not make a separate plan for FPO management; instead,
it develops a general plan of food hygiene and safety management in which FPO
management is one of many activities including food safety inspection, food safety
communication and food safety certification. At DMCs, the departments of food
hygiene and safety are responsible for FPO management; therefore they have their
own plans for food hygiene and safety management including FPO management.
Similarly, CHSs have their FPO management include in a general plan.

As regard the number of staff being in charge of FPO management, there
were four staff at sub-FA including 01 Grade II medical doctor, 01 biochemistry
engineer, and 02 public health workers. At DMCs, the number of staff responsible
for FPO management varied from 03 to 06 and all of them were working at
departments of food hygiene and safety. All the heads of the departments were
Grade I medical doctors, while other members ranged from physicians,
biochemistry or food technological or molecular biological engineers, laboratory
technicians, nurses to public health workers. At CHSs, the number of staff may be
from 01 to 03 and they formed FPO response teams in which the heads of the CHS
(general doctors) was the head of the team. Other members may include physicians
and commune volunteers.
Table 2. The number of staff responsible for FPO management at all level
Health facilities

No. staff

Frequency

Sub-FA

4

1

DMC

6

1

7


CHS

5

2

4

4

3

2

3

2

2

4

1

3

Roles and responsibilities of staff related to FPO management were well

documented at each level of FPOS. Particularly, at sub-FA the roles of each
member responsible for FPO management were described apparently in the
Decision 88/QĐ-ATTP in which the staff was divided into two teams: team 1 went
to health facilities where victims hospitalized and team 2 went to local site where
the FPO occurred. Each team had its own roles in responding to FPO. The role of
team 1 included investigate victims and collect specimens from victims (nauseas
fluid and stools), while the roles of team 2 included epidemiological investigation
with case-control design, suspected food sampling and screening for probable
cases. At DMCs, there were also two teams established with the resemble roles and
responsibilities like those of sub-VFA. Roles and responsibilities of all staff
responsible for FPO management at CHSs also described well. Finally, industrial
companies and schools with canteens had their FPO response units and the roles of
those units were stated apparently in which unit 1 involve in keeping and storing
food samples and disease samples (nausea fluid of victims), unit 2 involved in first
aid support during FPO and unit 3 involved in FPO communication.
Table 3. The role and responsibilities of FPO staff at all level
Health facilities
Sub-FA

Team
Team 1

No. staff
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Role
clinical investigation including investigate patients by
review medical records and ask history of exposure to
suspected foods and collect disease samples (nauseas and
stools)

8


Team 2

4

Epidemiological investigation with case-control design,
food and disease sampling, screening for cases and first aid ,
calling for health facilities to accept patients, check the food
hygiene and safety certificates of those factories.

DMC

CHS

Team 1

2-4

The same as team 1 of sub-FA

Team 2

2-4

The same as team 2 of sub-FA

One team

Support sampling
Local guide
Support first aid
Support screening probable cases

Factories and
schools

3 units

1-2

per Keep and store the samples

unit

FPO communication
Support first aid for cases
Collecting food and nausea samples

2. Core functions of the FPOS
2.1. Detection of food poisoning outbreak
Each agency in FPOS receives information about FPO from different sources. In
particular, the sub-VFA receives information mainly from factories or companies located in
industrial parks and hospitals (both public and private ones). For DMCs, the sources of
information about FPO may come from emergency units of DMC since victims in several FPOs
hospitalized into the emergency units and the heads of emergency unit reported directly to the
directors of DMC. In addition, private hospitals or clinics may be also the second source of FPO
information. Other sources of information that DMCs received included workers working in

factories or companies where FPO occurred, media (newspapers), school teachers, local people
and owners of food production and business establishment. Finally, CHSs may detect FPO from
reporting of victims who admitted to the CHSs for treatment.
•

Sub-VFA

•

District Medicine Center (DMC)

9

•
•
•
•
•

Factories or companies in the
industrial parks
Hospitals (public and private)

Patients hospitalized in DMC
Private hospitals/clinics
Workers in factories
Media
food production and business
establishment

Commune Health Station (CHS)

•

Patients admitted to CHS

Figure 2. Source of information of FPO
The time from occurrence of FPO to receiving information is often over one hour due to
several reasons. Firstly, victims who had food poisoning symptoms would seek health care at
health units in their factories or companies; however, in most FPOs victims did not get better
conditions, making them visited DMCs or hospitals/clinics latter. As a result, it took more time
(1-3 hours) for DMCs or hospitals report the primary cases of FPO. Secondly, victims who are
often workers in the factories ate the suspected meals on the afternoon without any food
poisoning symptoms and then they came back home where they onset the symptoms. Finally,
according to CHS’s staff, victims developed symptoms and they practiced self-treatment at their
homes but did not get better conditions so they then admitted the hospital lately. All of the
reasons mentioned here lead to a delay on detecting FPO in the communities.
2.2. Confirmation of food poisoning outbreak
The laboratory system for FPO testing included a laboratory of Provincial Preventive
Health Center (PPHC), and nine laboratories of DMCs. According to Decision 137/NĐTP-ATTP
in case of FPO, the sub-VFA had the responsibility of collecting specimens, packaging and then
sending the specimens for testing to two different laboratories. In fact, the sub-VFA sent all FPO
specimens for testing to the Institute of Public Health since more than two years ago.
The capacity of laboratory system for FPO had been investigated in the study. The
laboratory of PPHC had a total of nine staff. According to data provided by laboratory staff, the
laboratory had been equipped with all basic testing operators and tools (medium, prime, lab
tubes…). Other testing machines such as HPLC, AAS and GO were also available. In addition,
the laboratory had the ability of testing all biochemical and toxic indexes in food and water, apart
from several heavy metal indexes. Finally, it achieved ISO 17050 certificate in 2013. In general,

the staff of PPHC claimed that their laboratory had sufficient capacities for FPO testing;
although lack of personnel for FPO testing may exist during FPOs occur.

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The capacity of DMC laboratories varied on the basis of personnel, testing machine and
equipment. The number of staff ranged from 2 to 14 workers depending on the scale of the
DMC. Most of laboratories had been equipped with basic testing machines used to test
biochemical and chemical indexes. One laboratory even had advanced testing machines such as
centrifuge and automatic biochemical machines. However, none of laboratories had acquired
quality control certificates, except for one with Grade II safety laboratory certificate. Asked
about equipment for collection, packaging and transportation of FPO specimen, most of staff
stated that their laboratories had sufficient equipment. Nevertheless, few staff claimed that
because of establishment currently their DMCs were lack of equipment for FPO specimen
collection, packaging and transportation.
2.3. Reporting
According to Decision 39/2006/QĐ-BYT on regulations of food poisoning outbreak
investigation, there were three types of report in FPOS including urgent report, periodic report
(monthly and yearly) and statistical report. Lower agencies had to report FPO to higher agencies
at the beginning, during and at end of the FPO. The contents of urgent report must include
district occurred the outbreak, time of occurrence the outbreak, the causal food, the causal meal,
the site of FPO, the symptoms of cases, specimen collecting and testing, number of people eating
the meal, number of morbidity, and mortality of FPO, the index case and the last case, the ending
time of FPO, and recommendation. On the other hand, the periodic report of FPO covered the
number of FPO by causes (biological, chemical, contaminant food, and toxic types), number of
morbidity and mortality due to FPO. For statistical report, the contents included the number of
FPO, morbidity and mortality by months, laboratory confirmation of contaminant food,
geographical distribution of FPO, causes of FPO, number of FPO having specimen from patients,
from healthy people, from food and food containers, and distribution of FPO by age group (0-4,

5-14, 15-49, ≥ 50).
The mechanism of reporting FPOs was described apparently in the Decision
137/2009/NĐTP-ATTP. In case of FPO detected by CHS, the CHS had the responsibility of
reporting to CPC and DMC, and the DMC then reports to DPC, sub-VFA, and PHS. The subVFA in turn would report to PPC, Vietnam Food Administration (VFA), and IPH. On the other
hand, if the FPO is identified by DMC, the DMC has to report to DPC, sub-VFA and PHS, while
it also has to rely to CHS about the FPO. In addition, if the FPO is detected by sub-VFA, the
sub-VFA relies to DMC, and then DMC rely to CHS for response to the FPO.

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The mechanism of periodically and statistical reporting was well described in Decision
39/2006/QĐ-BYT as well. Lower agencies of FPOS must have reports monthly, quarterly and
yearly. Similarly, they make statistical reports in second quarter and fourth quarter.
VFA

IPH

PPC

•

Receive
information of
FPO

•

Receive
information of

FPO

•

Receive
information of
FPO

Sub-VFA

HS
District Medicine Center (DMC)
DPC

CPC

Commune Health Station (CHS)

Figure 3. The reporting mechanism of FPO in Binh Duong

The timeliness of FPO urgent reporting and relying was recognized as perfect (100%) at
all level. The sub-VFA reported FPO status every day from the beginning to the end of FPO to
higher agencies. The reports were always completed and sent to higher agencies within 24 hours.
The same procedure was applied by DMCs and CHSs. All interviewees at all level claimed that
timely reporting of FPO is an obligation regulated in Decision 137/2009/NĐTP-ATTP because
FPO is an urgent situation in which a promptly reporting is vital to have quick responses to FPO.
Unlike urgent reports, the timeliness of periodic reports was relatively good, according to
most of interviewees. The proportion of reporting timely from DMCs to sub-VFA was 100%,

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while the figure from CHSs to DMCs ranged from 80% to 90%. Some DMC staff argued that not
all CHSs report timely because the CHS staff responsible for FPO management had to do so
many works, so sometimes they forgot to send the reports on time.
As regard the completeness of reporting agencies, all lower agencies had sent their
reports, both urgent and periodic reports, to higher agencies. According to sub-VFA staff, nine
DMCs always sent their reports monthly, quarterly and yearly. Similarly, all CHSs in nine
districts sent their reports to DMCs.
The completeness of case reporting was also investigated. For urgent reports, the
reporting case was often not compatible with the actual cases at the beginning and during the
FPO. For most of FPO occurring for 2010-2016 period, the reporting cases were higher than the
actual cases. There was a consensus among interviewees at all level about the reason for that
incompatibility in which at the beginning off the FPO, a large amount of non-cases were also
included as probable cases, making the number of actual cases increased significantly. However,
after screening and classification, the actual cases went down and the reporting cases were
matched with the actual cases. For periodic reports, because frequently checked by the sub-VFA,
the reporting cases resemble the actual cases in FPOS.
We also evaluated reporting function of FPOS through the completeness of surveillance
data. It turned out to be that most of data in reports, both urgent and periodic, were sufficiently
reported, except for data about symptoms of cases. According to sub-VFA staff, it was hard for
health facilities where victims hospitalized to record symptoms of all cases since there may have
numerous cases hospitalized at the same time.
Asked about the simplicity of reporting mechanism and report forms, most of
interviewees confirmed that the reporting mechanism was not complicated to them since each
agency had its higher agencies to report, based on clear statements in the Decision
137/2009/NĐTP-ATTP. Moreover, the reporting forms were also evaluated as simple since they
had been modified by sub-VFA so that lower agencies could facilitate data analysis.
Nevertheless, one DMC staff complaint that the reporting forms were so long and detailed,
making them hardly be completed by the staff.

2.4. Data analysis and interpretation
The statistical report, one type of compulsory reports in FPOS, is actually an
epidemiological analysis of FPO since it covers all aspects of FPO from socioeconomic features
of FPO cases to laboratory confirmation of contaminant food. In fact, sub-VFA had conducted
statistical reports quarterly and yearly and sent them to higher agencies, whereas DMCs and

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CHSs did not make that type of report since they did not have that function. Data of FPO was
often analyzed in a period of three to five years. Stata software was used as the analysis tool and
the time for data analysis was around 1 week. Asked about the helpfulness of the statistical
report, the sub-VFA staff claimed that it was useful on the basis that it can help sub-VFA access
the FPO data easier and more promptly.
2.5. Epidemic preparedness for FPO
It could be claimed that the sub-VFA had a well epidemic preparedness for FPO. It had a
plan for quickly response to FPO. It also had a decision on team establishment for FPO
investigation and response. Moreover, it had a separate fund for FPO response and control
although the fund may not be sufficient for the FPO control and response, according to sub-VFA
staff. The sub-VFA staff was equipped well with safety equipment such as rubber gloves, safety
masks, apart from medical protective clothing which was recognized as not enough for sub-VFA
staff (2 units/year).
For all DMCs, a quick-response plan was very necessary and always made prior to any
FPOs occur. Some DMCs had a separate fund for FPO response and control, whereas others used
the fund supplied by DPC. However, in general interviewees argued that the fund for FPO
response was not enough for all activities. On the contrast, all interviewees agreed that they
received enough safety equipment for FPO response. Those equipment included rubber gloves,
safety masks, medical protective clothing.
Most of CHSs did not have their own quick-response plane since as many interviewees
said they received phone calls from DMCs or sub-VFA telling them that there was a FPO in their

locals, so they response immediately without any plan. Furthermore, for some CHSs since only
one staff responsible for FPO management, none of quick-responses plan was necessary. About
the fund for FPO response, none of CHSs had separate funds because FPO response and control
were mostly done by higher agencies, meaning that CHSs need not a fund to spend for FPO
response and control. All of safety equipment used by CHSs were delivered by DMCs; therefore
most of CHSs staff claimed that the number of safety equipment was satisfied their demand on
responding to FPO. Nevertheless, some CHSs where staff joined with specimen sampling
thought that they need more equipment on storing food samples from FPO.
FPO drill is an important activity which helps agencies improving their capacity of FPO
response. Unfortunately, there were no FPO drills held for DMCs and CHS staff since 2010.
Instead, the sub-VFA held FPO drills regularly for schools and factories with large canteens in
all areas of Binh Duong. It was estimated an average of 15 drills per year were held for those

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targets. All staff of response units in schools and factories were expected to attend one-week
classes on FPO response and one to two weeks later they would join on FPO drills at their
schools or factories. Interestingly, the contents of FPO drills included screening probable cases at
first sight, collecting specimen (nausea fluid and potential contaminated food), and controlling
the site during the FPO.
2.6. Response and control of FPO
After receiving the information about FPO, four staff responsible for FPO management
and other staff of sub-VFA split into two teams: one team went to the FPO site and one team
went to the health facilities where victims hospitalized. Two cars with well-equipped tools
(sample collection tool kit, sample storing tool kit, and safety equipment) were used to take two
teams to the FPO sites and health facilities.
At the FPO sites, the sub-VFA team was expected to collect nausea fluid of victim and
contaminant food samples; however, in most of FPO the response unit at factories or schools had
already collected, stored the specimen and handed them to sub-VFA team. Other activities were

also taken including screening probable cases, investigate close contacts and checking conditions
of food hygiene and safety of the canteens of schools and factories. For screening probable cases,
the sub-VFA team along with response team of schools or factories would exam people who had
clinical symptoms of food poisoning. If the probable cases were detected, they would be referral
to the nearest health facilities for treatment. For investigating close contacts, the sub-VFA used
the standard forms that regulated in Decision 39/2006/QĐ-BYT to interview close contacts. The
ratio cases:close contacts was often 1:3. For checking conditions of food hygiene and safety, the
sub-VFA checked the certificate of food hygiene and safety and the conditions of canteens
during the FPO.
The second team of sub-VFA also did several activities in health facilities. They went to
every health facilities where victims hospitalized and reviewed medical records of victims and
received nausea fluid samples from health facilities. In case of nausea fluid samples could not be
collected, the sub-VFA may take stool samples of victims. Moreover, the team asked cases about
time of symptoms onset, time of hospitalization, symptoms and history of potential food
exposure. The data of cases then would be compared with those of close contacts to find out the
causal foods. All of samples collected from the FPO sites and health facilities after all would be
sent to the Institute of Public Health in Ho Chi Minh City for testing in the same day.
Like sub-VFA, DMCs staff who were staff of department of food hygiene and safety and
other departments split into two teams those went to FPO sites and health facilities. Since DMCs

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were often nearer FPO sites and health facilities compared to sub-VFA, DMC teams were often
the first teams going to FPO sites and health facilities to investigate FPO.
At the health facilities, the DMC team did the activities just like those done by sub-VFA.
In some FPOs, a part of cases hospitalized into DMCs, so the DMC team by themselves
collected nauseas or stool samples of cases. As the sub-VFA team went to the health facilities,
the DMC team reported all what it had done to the sub-VFA team. Depend on data that the DMC
team had collected, the sub-VFA team would decide whether or not further collecting specimen

and investigating cases to get more information.
The activities of DMC team at FPO sites depended completely to the places where FPOs
occurred. Particularly, if the FPO occurred in a school or a factory outside industrial parks the
DMC team had the authorities to conduct investigation activities including screening probable
cases, interviewing close contacts and collecting food and nausea fluid samples. If the FPO
occurred in a factory inside industrial parks, the DMC team had to wait the sub-VFA coming
because only sub-VFA had the authorities to investigate factories in industrial parks, based on
regulations of Decision 11/2013/QĐ-UBND. In such cases, the sub-VFA team would play the
main role in screening probable cases, interviewing close contacts and collecting specimen.
The CHSs also took part in response and control of FPO. There was one staff of CHS
would go to all health facilities to collect information about probable cases hospitalized and then
reported to higher agencies. Others would join to DMC team and sub-VFA team going to FPO
sites and support them in investigation activities.
It is important to note that three response units in factories or schools have a vital role in
response and control FPO. As the FPO occurred, response units would be the units dealing
directly and quickly with FPO cases. One unit was expected to support health office of the
factory or school do first aid for all probable cases and suspected cases. It also supported DMC
and sub-VFA team in screening probable cases. Another unit had the responsibility of collecting
nausea fluid and food samples, keeping and storing samples until the DMC and sub-VFA
coming, and the last one would protect the FPO site and communicate to others about the FPO
situation.
The timeliness of response and control FPO was evaluated in the study. It was concluded
that all agencies had quick responses as FPO occur. After receiving information about FPO, the
sub-VFA teams would go to health facilities and FPO site immediately. Depend on the distances
between the center of province where sub-VFA located to the FPO sites where located in district
areas, it took from fifteen to forty five minutes for sub-VFA to come FPO sites. On the other

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hand, the time may be less for DMC teams to come to FPO sites and health facilities. For
response units in factories or schools, quick responses, meaning quick report to higher agencies,
first aid, screening, and collecting samples, were important so that they could reduce minimal of
morbidity and even mortality due to FPO.

17


GDFS

IPH

VFA

Three response units
(5)

(1)

PPC
(1)

•
(2)

Site of FPO (business,
schools)

(1)
Sub-VFA

(3)
(1)

(1)
(2)

HS
District Medicine Center (DMC)

(3)

DPC
(1)
CPC

(1)

Health facilities
(clinics/hospital/DMC/CHS)

(2)

Commune Health Station (CHS)

(4)

Figure 4. The flowchart of FPO response and control in Binh Duong province
(1): report and rely
(2): screening probable cases, collecting food and nausea fluid samples, interviewing close contacts
(3): collecting nausea fluid or stool samples, interviewing cases

(4): collecting information about number of cases hospitalized in all health facilities
(5): first aid, screening probable cases, collecting food and nausea fluid, protecting the sites.

18


Annex 2: Questionnare
BỘ CÂU HỎI
KHẢO SÁT THÔNG TIN VỀ HỆ THỐNG GIÁM SÁT NGỘ ĐỘC THỰC PHẨM
ĐƠN VỊ KHẢO SÁT: CHI CỤC AN TỒN VỆ SINH THỰC PHẨM TỈNH BÌNH DƯƠNG

STT

Chỉ số

Giá trị

Ghi chú

Thành phần: Cấu trúc hệ thống
Thành tố: Quy chế, quy định về giám sát
1. Quyết định 5327/2003/QĐ-BYT
Theo anh/chị, hiện nay có các loại văn bản/quy
1.

định/quyết định nào liên quan đến giám sát/điều tra
ngộ độc thực phẩm?

2. Quyết định 39/2006/QĐ-BYT
3. Quyết định 1/2006/QĐ-BYT

4. Quyết định 11/2013/QĐ-UBND tỉnh Bình Dương

Nếu KHƠNG, chuyển câu 4

5. Khơng có văn bản
6. Khơng biết

2.

Nếu biết thì theo anh/chị mức độ tuân thủ của CC
đối với các văn bản này ở mức độ nào?

…………………………………

19

Nếu ĐẠT 100%, chuyển câu 4


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------3.

Nếu khơng đạt 100%, anh/chị có thể nêu lý do

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Thành phần: Cấu trúc hệ thống
Thành tố: Chiến lược giám sát
1. Có kế hoạch riêng

4.

CC có kế hoạch hoạt động dành cho cơng tác giám 2. Có nhưng lồng ghép vào kế hoạch chung của CC

sát NĐTP hay không?

3. Không
4. Không biết

5.

6.

Nếu CĨ, thì tỷ lệ phần trăm các hoạt động trong kế
hoạch năm 2016 đã được triển khai?
Nếu Không đạt 100% theo kế hoạch, anh/chị có
thể cho biết lý do

Nếu CÓ đề nghị xem kế
hoạch hoạt động năm
Nếu KHÔNG chuyển câu 7
Đề nghị xem báo cáo thực

………….

hiện kế hoạch

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

20