Know Thine Enemy & Know Thyself

Know Thyself & Know Thine Enemy

Sun Tzu

In the fight against food-borne illness, *Sun Tzu’s quote “know thine enemy and know thyself” is a good dictum to follow.

Why? Because in numerous kitchens (commercial kitchens, domestic kitchens in homes, and even communal village open-space kitchens) across the length and breadth of this country, the bugs that cause food-borne illness have been doing a lot of damage to the health and well-being of the public, and places considerable burden on the public health in Nigeria. Aided by ignorance of the populace, these pathogens seem to be having a field day. To turn the tide of this fight, folks need to know these germs, know how they infect, know the foods they are commonly associated with, know how they affect human health, and know how they can be curbed.

I have tried to profile five important food borne illness causative bugs in Nigeria in simple layman’s language as part of increasing awareness of these bugs, how they operate, and how they can be checkmated.

1. Vibrio Cholerae – Count for count, this food borne & water-borne bug has done more damage to public health in Nigeria than any other food borne illness bug.

To understand this check out my posts of 7th December and 22nd December titled 2013 Cholera Outbreak and Chronicling Cholera’s Carnage Parts 1 & 2 respectively.

Vibrio cholerae, the bug that causes cholera, is transmitted by consuming contaminated water or food washed or prepared with contaminated water or food prepared by a person sick with cholera.

Once the bug gets into the intestine of its victims it multiplies rapidly and secretes cholera toxin, it’s the toxin that does the damage by causing the intestine to release plenty of fluid that leads to its trademark symptoms; a sudden onset of watery stools and diarrhea. If not quickly treated the victims loose a lot of fluid from the body and die from dehydration. The suddenness of the watery stools and diarrhea is the characteristic of vibrio cholerae.

Hand-washing practices, properly boiling water before use, cooking food thoroughly, proper environment sanitation, use of latrines and toilets instead of open defecating are all ways of countering this bug.

2. Salmonella Spp – Salmonella bacterium is another major cause of food borne illness in Nigeria. The bug is transmitted by eating contaminated foods especially food of animal origin  i.e meat, poultry, eggs, milk. However fresh produce and vegetables have also been implicated in salmonella outbreaks. The bug gets into the food chain from infected livestock and animals where the livestock has been fed with salmonella contaminated animal feed. Fresh produce are contaminated when they are irrigated with sewage water containing salmonella or fertilized with animal manure of infected animals.

Food implicated in salmonella food borne illness in Nigeria are eggs (cracked eggs & eggs smeared with feaces), edible snails, roasted chicken sold by roadside vendors, improperly cooked chicken, local soft cheese “wara”, unpasteurized (raw) milk sold as fura-de-nunu, local sandwich and local salad. The salmonella bug was isolated in fillings from sandwiches that caused an outbreak of food borne illness in Ibadan that claimed about 20 lives some years ago.

In healthy adults the bugs needs to be consumed in large numbers to cause illness, but in the young and elderly a small dose is enough to cause trouble. Even though majority of the ingested bug gets destroyed in the stomach by gastric acid, the ones that survive and pass into the intestine and multiplies there resulting in the symptoms of diarrhea, fever, nausea, vomiting and stomach cramps usually between 12 – 72 hours after ingesting the bug. The illness may last 4-7 days. Serious forms of the illness can lead to fatality when the bugs spread from the intestines to the blood stream and then to other body organs especially in the young, elderly, or the sick.

Cooking food at temperatures at 75C for is sufficient to kill the bugs. Other means of preventing the bug from infecting is by avoiding cross contamination of the bug from raw food to other food i.e. not using same utensils (chopping boards, knives, work surface) for raw foods and ready to eat foods without thoroughly washing with soap and hot water, separating raw foods from ready to eat food in storage in fridge, ensuring proper cleanliness in the kitchen, and thorough washing and sanitizing fresh produce before eating.

3. Listeria monocytogenes – A contaminant found in Nigerian foods like smoked fish, kilishi (sun-dried & partially roasted seasoned meat slices), kununzaki (fermented sorghum drink), wara (local soft cheese popular in South West Nigeria), and unpasteurized (raw) milk sold as fura-de-nunu, Listeria monocytogenes, the bug that causes Listeriosis also referred to as L.Mono, is an uncanny food borne illness bug. Uncanny in the sense that unlike most food borne illness causing bugs, L.Mono can survive and even grow at temperature as low as 0C such that it multiplies even when food is refrigerated.

Naturally existing in soil, water and vegetation from where it gets into the food chain, L.Mono can be destroyed in food by proper cooking and pasteurizing. It’s symptoms are diarrhea, vomiting, nausea, fever, and muscle aches which may begin to manifest as short as few hours to as long as 3 months after ingestion (for the very severe type). Where you see the normal symptoms of food borne illness accompanied with aches at the knees and elbows as well as stiff neck, it’s probably L.Mono at work.

Healthy adults are rarely affected by L.Mono, it’s aged/elderly persons, pregnant women, newborns, and adults with weakened immune systems that are the groups mostly at risk of this bug. And of this group pregnant women are the highest number of its victims where the bug passes from the intestine into the blood and becomes blood borne affecting the fetus resulting in miscarriage or stillbirth.

Infection by L.mono can be prevented by cooking food thoroughly to safe temperatures, by washing and proper handling of food before eating, keeping kitchen environment clean, proper handwashing, separating raw food from ready to eat food, avoiding cross contamination, and avoid eating the high risks foods as listed above.

4. Staphylococcus aureus – This bug by itself is harmless and occurs naturally on skin, hair as well as nose and throats of humans and animals. However when it gets into food it rapidly multiplies and secretes very potent toxins into the food. The major source of contamination is from food handlers and food preparers.

Once it has multiplied and produced the toxins into the food, heating treatment or cooking of the food makes no difference anymore because the toxins are very heat stable and are not easily destroyed by heat. So cooking food that has been colonized by staph aureus may destroy the bugs themselves but the toxins survive and when the food is eaten the toxins cause the illness with symptoms of vomiting, diarrhea, nausea and stomach pains typically one to six hours after ingestion of the toxin and this may last between 24 – 48 hours before it subsides.

Staph aereus need time to multiply in food to the dangerous levels that are sufficient to cause illness. Leaving food unrefrigerated for a short period gives it the chance to do this.

Moi-Moi (bean pudding), Agidi (Fermented Corn Meal), Abacha (African Salad), Suya (Roasted Meat) and similar hand prepared meals are examples of Nigerian foods implicated in staph food borne illness.

Ways to prevent staph infection are avoiding time and temperature abuse of food, proper handwashing before food preparation, not allowing food handlers (and children’s nannies & caregivers) with open sores/boils/wounds/long fingernails/skin infections/nose & eye infection to prepare food, avoid coughing and sneezing unto food, eating food immediately after preparation, rapid chilling and cold storage of food to prevent multiplication of the bug in food.

5. Aspergillus flavus – Aspergillus flavus, unlike the previous four bugs above, is not a bacteria but a fungus found in food like maize, groundnuts, sorghum, groundnuts that produce poisonous toxin. This toxin can be very dangerous when ingested and cause aflatoxicosis. It has been reported to causes liver cancer, suppresses the immune system, and retards the growth and development of children.

Even though the toxin is invisible to the naked eye, the bugs can be discerned in crops by a characteristic mould green color.

Prevention of aflatoxicosis begins at the farm by treating the crops to kill the bugs and also during storage. Infected crops are usually destroyed to prevent human consumption. However some of these infected crops inevitably enters the food chain as Agidi, the peanut paste used to prepare Kilishi, Kuli-Kuli (local snack made from fermented groundnut), Yaji (the spice that accompanies Suya) and when livestock eat feed contaminated with Aspergillus flavus.

The toxins produced by the Aspergillus bug are not affected by routine cooking temperatures, but simple food preparation methods such as sorting, washing, crushing, and dehulling may reduce aflatoxin levels (Public Health Strategies for Preventing Aflatoxin Exposure 2005).

These five food borne illness pathogens, along with other such pathogens not profiled in this post, have collectively brought a huge burden on the public health system of this country.

*Sun Tzu was a Chinese general, military strategist, and author of The Art of War, an immensely influential ancient Chinese book on military strategy. (Source: http://www.wikiquote.org)

Advertisements

Blood In Cooked Chicken

The christmas celebration didn’t go uneventful food safety wise for me. I was at a place yesterday where I was offered rice and chicken as part of the xmas celebration. As I was eating I cut a part of the chicken into two and I observed a taint of pinkish color near the core of the chicken part, on peering closely I realized it was blood. It occurred to me that the chicken was not well cooked, a standard recipe for full blown food poisoning. I cut the chicken up into pieces and played around with it on the plate but avoided eating it for my own good.

Bloody parts in cooked chicken is an indication of poor cooking which means the pathogens in the raw chicken have not been destroyed and if consumed, will certainly result in food-borne illness, typically salmonellosis. Photo below is of cooked chicken with bloody inner parts.

Blood In Cooked Chicken.  source: barfblog.com

Blood In Cooked Chicken.
source: barfblog.com

Chronicling Cholera’s Carnage Part 2

Continuing from last post, it’s evident that the sheer scale of the reported number of lives lost to cholera outbreaks from 2007 – 2013 is a show of the public health burden that food-borne illness places on Nigeria. Again, I need to mention that the mortality and incident reports below and in the previous posts are not official government statistics, they are media reports nevertheless they are good indications of the scale of the problem.

The problem of food-borne illness is real, very real, even if it’s not getting the attention it deserves in public discourse and government policy making when compared to the attention other public health issues like Cancer, Malaria & HIV/AIDS get. A lot of work needs to be done, a lot of ground needs to be covered in reducing the public health burden of food-borne illness in this country starting from creating more awareness about the existence of the problem and encouraging discussion in the public domain about it.

All Reports Sourced From: Safe Food International http://www.safefoodinternational.org

January 2009 – At least 3 people were killed and 35 others hospitalized following the suspected outbreak of cholera at Dokogi village in Nigeria’s Niger state, the News Agency of Nigeria reported on Sunday [11 Jan 2009]. The villagers had alerted the authorities after a resident died from diarrhea and vomiting. An eyewitness claimed that more people reported their cases as the situation worsened, leading to the death of 2 more people. He said the council later mobilized its medical personnel, including those of the Federal Medical Center, Bida, to control the spread of the disease.

January 2009 – No fewer than 27 children between the ages of 4 and 10 years were reported dead on Tuesday [14 Jan 2009] at Ndiagu-Anagu in Ikwo Local Government Area of Ebonyi State as a result of suspected outbreak of severe gastroenteritis, otherwise known as cholera.According to a reliable source, the mysterious deaths which started few weeks ago have ravaged the rural community where children between the ages of 1 to 10 years were said to have been affected and are in critical condition.

January 2009 – Sunday Nwangele, Ebonyi state commissioner for health announced in Abakaliki that 6 of the dead were male and 9 female including 5 children. He attributed the outbreak, which infected some 120 persons, to intake of contaminated water following the breakdown of the three boreholes in the area.Local last week [week of 12 Jan 2009] reported that at least 41 children died of gastroenteritis in another community in southeastern Nigeria’s Ebonyi State. The disease was said to have started some weeks ago and to have gradually grown into epidemic with children between one to 10 being the most affected, with some in critical condition.

August 2009 – A cholera outbreak has claimed 39 lives in northern Nigeria’s Adamawa state in the past week, a senior local official said on Tuesday [18 Aug 2009].
The official was quoted as saying the outbreak killed a family, including a 52-year-old man, his wife and child, and that 36 other people also died.

August 2009 – A cholera outbreak in Adamawa State, northern Nigeria has killed 13 more people, taking the death toll to 52, the health commissioner said on Saturday. 39 people were reported killed by the disease in Maiha, according to a local government official. He said “scores of people” had been hospitalized as a result of the disease, stressing that an ongoing strike by medical workers in the state was hampering efforts to assist the sick.

September 2009 – At least 76 persons have been confirmed dead from a suspected outbreak of an epidemic of cholera in about 7 local government councils of Adamawa state.
The disease, which manifests with symptoms of vomiting, diarrhea, and mild fever, is ravaging communities in 7 local government areas of Mubi, north and south, Maiha, Michika, Madagali, Girie, and Hong in the northern part of the state.
So far, 76 people have died, while 846 are receiving treatment at the various state health establishments.

September 2009 – Nine people died and several others were hospitalized this week following a cholera outbreak in Nigeria’s northern Taraba State, bringing the death toll in the region to 97, an official was quoted as saying.
On Wednesday [31 Sep 2009] health officials in Jigawa State, also in the region, announced the death of 11 people following an outbreak of cholera in Bashuri village where 400 cases emerged in under a fortnight.
Cholera has claimed 77 lives in recent weeks in Adamawa State, leaving nearly 1000 people hospitalized.

September 2009 – 23 of the 600 people who recently contracted cholera in the Biu Local Government area of Borno State are dead, the director of disease control in the Borno State ministry of health was quoted as saying. A source at the ministry of health said the disease has spread to 6 out of the 9 local government areas of southern Borno. The state has also recorded a total of 32 death from it.

October 2009 – Some 300 people died and many more are hospitalized due to an outbreak of cholera reported since mid-month in Adamawa State in northern Nigeria, sources were quoted as saying.

October 2009 – The toll in a cholera outbreak in northern Nigeria rose to 149 Friday [16 Oct 2009] with 52 more deaths, a provincial health official said. He said Biu local government on the border with Chad was the worst affected area where 650 were infected, forcing health officials to open a camp for the victims.

October 2009 – Cholera has claimed 77 lives in recent weeks in Adamawa State, leaving nearly 1000 people hospitalized.

October 2009 – Late September 2009, officials in Jigawa State announced the death of 11 people in a cholera outbreak which affected 400 others at a village outside the state capital.

October 2009 – In Taraba state, a neighbor of Adamawa, another cholera outbreak killed 9 people and infected 120 others.

November 2009 – A fresh cholera outbreak has killed 20 people and left 200 others infected in northern Nigeria’s Adamawa State in the past week, a senior health official said Wednesday [4 Nov 2009]. The latest deaths take to 169 the number of those killed by the disease in 4 northern states, Adamawa, Jigawa, Taraba, and Borno, in the past 3 months.

January 2010 – Six persons were confirmed dead on 18 Jan 2010, while 78 others were hospitalized following an outbreak of cholera at Opobo town in Opobo/Nkoro Local Government of Rivers State.

August 2011 – Cases of cholera have been reported in Oyo State, with 4 deaths and 16 hospitalizations.

August 2011 – The people of Osun State are living in fear due to the outbreak of cholera that has claimed 8 lives in the state. It has been reported that there are no medical officials that could come aid the people because of the ongoing strike by medical practitioners in the state.

September 2011 – The Health Commissioner announced that 6 deaths from cholera in the past 2 weeks that infected 182 people. Local media reports 234 deaths occurred in 15 Nigerian states in 2011. The rainy seasons are generally responsible for the occurrence of the disease in Nigeria.

June 2013 – The Nigerian Ministry of Health reports, that in the second week of June, 2013, there were 22 new cases of cholera in the country: seven cholera cases were suspected in Kwara, and 15 cases were reported in Kaduna and Zamfara. No deaths were reported.

August 2013 – Cholera is endemic in Ogun State, Nigeria, and outbreaks are common in the rainy season; this summer is no exception. In the month of July, outbreaks have been confirmed throughout the state including 104 cases in Soyinka, 76 cases in Abeokuta South, 25 cases in Abeokuta North, 2 cases in Odeda, and 1 case in Obafemi Owode. In total, three deaths have been recorded. Government health officials have implemented control efforts to contain the epidemic, but outbreaks show little sign of slowing.

September 2013 – Nigeria regularly experiences cholera outbreaks during the rainy season, and 2013 has been no different. Currently, 8 people have died from the disease in Oyo State, while 10 more are hospitalized with the disease. Nigeria’s sanitation infrastructure is often overwhelmed by rainy seasons rains, spreading contaminated water.

October 2013 – States across Nigeria have begun to report new cases of cholera, overwhelming hospitals and raising concern for large-scale casualties. In the past two weeks, Zamfara case has recorded 1,117 cases of the disease and 72 deaths. Sources caution that these numbers are underestimations, and do not properly reflect the extent of the outbreak in Zamfara; other states, such as Gusau and Zurmi, Maradun and Bakura, report as many as 90 new cases a day, per state—although such reports are unconfirmed by government sources.

October 2013 – As many as 130 people are ill, and two have died, as a recent cholera outbreak continues in Zamfara, Nigeria, reports Doctors without Borders.

Chronicling Cholera’s Carnage Part 1

Few days ago I put up a post about the cholera outbreak that occurred this year. Knowing that cholera outbreak is a seasonal self-repeating vicious cycle I made further checks to uncover how bad the cholera cycles has been. Below are some of the media reports for cholera outbreaks from 2007 – 2012 that my checks turned up:

These are not official statistics, they are only reports in the news relating to cholera outbreaks but they are indicative of the sheer scale of recurring casualties we suffer in this country from cholera outbreaks.

All Reports Sourced From: Safe Food International http://www.safefoodinternational.org

October 2007 – A total of 5 persons have lost their lives from a suspected outbreak of cholera in parts of Makurdi, the Benue state capital. The News Agency of Nigeria (NAN) reports that communities where deaths have been recorded included Idye Village, Logo 2, and Wadata suburb of Makurdi, areas where pipe-borne-water could be regarded as “liquid gold.” At a hospital in Wadata suburb, which is host to Hausa community resident in Makurdi, a medical doctor told newsmen that the hospital recorded the death of a 12-year-old girl on Sat 6 Oct 2007. The doctor added that the hospital was inundated on a daily basis with people who might have contracted the disease and warned people to be cautious about the water they drank and food they ate.

October 2007 – No fewer than 5 persons, including 2 women, 2 children and a middle-aged man, were killed in Bauchi Sun 7 Oct 2007, by cholera. The Secretary to the state’s branch of the Nigerian Red Cross confirmed the deaths. He told newsmen in Bauchi that about 35 other persons had been infected by the epidemic, adding that the victims were currently responding to treatment at the Specialist Hospital, Bauchi. The Secretary said also that a special unit had been created at the hospital for the treatment of infected persons. He added that the epidemic was more pronounced in Gwallaga, Korar Ran, Kofar Durmi, and Bakin Kura areas of the metropolis. He attributed the outbreak to poor sanitary condition in the metropolis, adding that the various flood disasters experienced in the area in 2007, had also contributed to the outbreak.

November 2007 – According to this story, at least 14 people have died and scores of others are hospitalized following an outbreak of cholera in the central Nigerian state of Plateau, a government official said on Thu 29 Nov 2007. The Commissioner for Health said the waterborne disease broke out in the remote district of Bokkos last week [19-25 Nov 2007] but was reported late to the authorities as when it started, the affected people thought it was a strange ailment and refused to go to hospital.

December 2007 – According to this story, the people of Ajakajak community in Andoni Local Government Area of Rivers State have cried out to the state government to rescue them from a cholera outbreak, which has claimed the lives of more than 11 children. A local source reported that the outbreak was spreading to some other communities in the area. Other sources from Ajakajak informed that records at the community’s health centre confirmed that the figure given was for last week alone and that more cases had come in this week. It was gathered that the epidemic was spreading very fast and that about 30 persons had died so far. “It was on Nov. 30 this year when 72 pupils started purging and vomiting after eating the relief food,” said the commissioner who added that samples of the relief food had been taken to the government chief chemist in Dar es Salaam for analysis.

January 2008 – as a result of an outbreak of cholera in Gbajimba, Guma Local Government Area of Benue State, 10 persons have been confirmed dead. The state Ministry of Health on Tuesday [1 Jan 2008] confirmed the outbreak of the epidemic and the number of lives lost to it.

February 2008 – Scores of children have been hospitalized in various hospitals in Asaba, Delta State and neighboring towns following an outbreak of cholera especially in riverine communities of the state

February 2008 – over 60 children between the ages of 1-2 have reportedly died of a cholera epidemic in northern Cross River state. The incident, which occurred 3 weeks ago, has been attributed to drinking of contaminated water. The deaths occurred in Ogoja and its environs. The epidemic in Yala, Obudu, Mbube, Bekwara, and Ogoja main towns is attributable to shortage of water supply to the people resulting to the use of water from ponds, streams, and gutters for domestic use and drinking. The Medical Superintendent of General Hospital in Ogoja confirmed the epidemic.

March 2008 – According to this story, around 50 people have died in recent weeks of cholera in central Nigeria’s Benue state out of some 150 infected, the press quoted health officials as saying Sunday [30 Mar 2008]. Local newspapers said that the state capital Makurdi was worst hit by the disease which broke out in February 2008. A State health commissioner attributed the cause of the disease to drinking contaminated water. He said medical officials and drugs had been sent to the affected areas to treat the victims as well as contain the spread of the disease.

April 2008 – According to this story, at least 116 female students in northern Nigeria have been hospitalized with cholera after consuming contaminated beans, a health official said Monday [21 Apr 2008].The affected students, who attend a secondary boarding school in Gombe state, [developed symptoms] hours after eating lunch, said the permanent secretary in the Gombe state health ministry. State authorities reacted by banning beans at all boarding schools, pending the outcome of laboratory tests of the contaminated beans by Nigeria’s food and drug regulatory agency NAFDAC (National Agency for Food, Drug Administration and Control).

July 2008 – A medical source at Gambo Sawaba General Hospital said that six persons reportedly died from cholera, while no fewer than 30 were currently receiving treatment. The affected areas were Gyallesu, Tudun Wada, Unguwar Alfadarai, and Kusfa in Zaria council area. The head of the health department in the Zaria local government confirmed that only two persons died as a result of the outbreak and quoting from official records, he added that in Zaria six people were being treated in the hospital. According to local sources, the cholera outbreak can be attributed to lack of good drinking water and poor health services in the affected communities.

September 2008 – Local government officials say cholera outbreaks across Katsina, Zamfara, Bauchi, and Kano states in northern Nigeria have killed 97 people in the past 2 weeks, making it the worst outbreak in the north for several years, according to an official from National Primary Healthcare Agency (NPHA) in Abuja. More than 60 people have died in Zamfara state in the past 2 weeks, according to the Zamfara’s state commissioner for religious affairs. He said the death toll may be higher as reports of new infections are still coming in. In Katsina state in the villages of Makadawa and Kagadama, 20 people, mostly women and children, have died while 30 others have been hospitalized according to local government chairman Masur Usman Murnai. Another 9 people have died in Nabardo village in Bauchi state since 13 Sep [2008], with 40 more affected, according to a primary health care coordinator. The Kano State’s health told IRIN 5 people have died of cholera in the state within the past week.

September 2008 – no fewer than 5 people were feared dead as a result of an outbreak of cholera in some local government areas of Kano state. Although the disease is yet to assume epidemic status, the State Commissioner for Health said her ministry had swung into action to tackle the situation. She attributed the development to the consumption of unhygienic foods or drinks, describing such foods to include vegetable salads and fruits and contaminated food and water, which, if not properly prepared, could become vehicles for the infection and spread of cholera.

October 2008 – no fewer than 21 people have been reported dead in some villages in Kware and Wamakko local government areas of Sokoto State. The breakdown from health officials in the affected local government areas shows that 14 people died in Kware while 7 died in Wamakko local government area. It is reported that in Maruda village of Kware, 13 children and an adult died from the disease while the director of health in Wamakko local government confirmed the death of 7 people in the area. Meanwhile, the state commissioner of information has confirmed that only 2 people lost their lives at the hospital “and that is the only figure we have officially but I am not overruling a number of deaths outside the hospital.” The commissioner said the outbreak was reported in 12 local government areas of the state “but only 3 are now having reported cases.” The 3 local governments are, Kware, Dange Shuni, and Wamakko.

October 2008 – Following an outbreak of cholera in Zonkwa, headquarters of Zangon Kataf local government area of Kaduna State, about 9 persons have reportedly lost their lives within one week; and it is reported that the number might have increased.

October 2008 – According to this story, cholera and diarrhea have hit Zone ‘F’ preliminary games camp of the 16th Nigeria College of Education Games (NICEGA) being held at the Federal College of Education in Gombe, with no fewer than 5 participants in serious condition.

December 2008 – It is reported that an outbreak of cholera in the riverine community of Kula in Nigeria’s Rivers state killed 10 people, a health official said. “We have already dispatched a medical team to the area with the necessary drugs and materials to curtail the spread of the disease” Dr. Samson Parker, Rivers state’s commissioner for health, said in an interview in Port Harcourt today. Residents have been told to boil water for drinking until other arrangements can be made, he said.

December 2008 – an outbreak of cholera in the Egbagi Majin village in Kede district of Mokwa Local Government Area of Niger State has reportedly claimed 8 lives, one of them being the wife of the village head. A majority of those who died, according to a report from the village, were women. Nigerian Tribune has learned that about 15 others were hospitalized as a result of the outbreak. According to a source in the area, the outbreak could have been as a result of contaminated water being drunk by the villagers who were just relocating after a flood disaster 2 months ago.

Continues on Next Post.

Don’t Mishandle Me

If food could speak, these three words would probably be their motto. On a daily basis in this country, food is regularly mishandled. When I talk of mishandling food I mean carelessly handling food before eating.

I read about an outbreak of food-borne illness that occurred years ago in Ibadan, Nigeria, that claimed 20 lives. The outbreak resulted from sandwiches that were poorly handled. It was reported that the sandwiches were prepared in Lagos and kept without refrigeration until consumption the next day at Ibadan. When food is mishandled like this, it responds by baring its fangs with disastrous and often fatal consequences.

Mishandling of food occurs in many forms in homes and food businesses:

  • Leaving left-over food unrefrigerated to eat the next day or even several days after.
  • Defrosting frozen food on the kitchen shelf at room temperature.
  • Buying frozen food from the market (or supermarket) and not heading home straight to store in freezer.
  • Inadequate and improper heating of food.
  • Leaving food exposed and uncovered.
  • Preparing food with unwashed hands.
  • Preparing food too far in advance.
  • Using same utensils to prepare raw food and ready to eat food.
  • Keeping or storing ready-to-eat foods like cold sandwiches and salads at room temperature

These are all examples of poor food handling. Many folks do these things inadvertently and unknowingly but this doesn’t spare them the heart ache and ill health that results from it.

At a time when I was handling inflight catering for an airline, we served onboard an egg & mayo sandwich option on the breakfast menu. Nicely packaged in plastic sandwich packs it was a hit with passengers on the early morning domestic flights out of Lagos. But there was a problem; passengers were actually taking the sandwiches off with them when they disembarked at their destination. Why this was a problem was that egg & mayonnaise are highly perishable and high risk food that needs to be held in the chill chain to keep safe to eat and we weren’t sure how passengers were handling the sandwiches after the flight. We were concerned that someone would turn up later on to claim that he got food poisoning from the airline’s sandwich. My boss at that time, Paul Sharp (am certain he will get to read this post soon) decided we had to include a caveat note on the packaging of the sandwich strongly advising passengers that the sandwich be consumed on board during the flight.

Don’t Mishandle Me…that’s a warning that is wise to heed from food & drinks.

No Difference Between The Rich & The Poor

Consume food that is contaminated with germs, regardless of the status of the kitchen in which it was prepared, and you will be down with a bout of food-borne illness in a matter of time (hours, days, weeks depending on the germs involved), it’s as simple as that.

One universal truth about food-borne illness is that it doesn’t differentiate between the rich and the poor.

Whether you are living in the opulence of Asokoro in the Federal Capital Territory Abuja or in the squalor of the slums and shanties of Ajegunle in Lagos it makes no difference. Consume food that is contaminated with germs, regardless of the status of the kitchen in which it was prepared, and you will be down with a bout of food-borne illness in a matter of time (hours, days, weeks depending on the germs involved), it’s as simple as that.

However to effectively prevent foods-borne illness there is need to have some understanding of the dynamics of the germs that cause it.

These germs (permit me to use this term) need, amongst many other things, two very important requirements to thrive in food:

TIME & TEMPERATURE.

Temperature – germs that cause food-borne illness need the right temperature to germinate and multiply in food.
Time – they also need time to propagate (multiply) in food up to the levels capable of causing harm when consumed.

So two of the several ways of effectively “outflanking” these germs is to deny them the time they need to multiply to dangerous levels in the food and to deny them the right temperature that they need to be active. The flip side of the coin is that these bugs can be helped to do the damage they are known for by giving them enough time they need to propagate rapidly in the food and the right temperature they need to be actively metabolize in the food.

Food-borne illness causing germs are optimally active within the temperature range 4 Celsius – 60 Celsius (this temperature range is termed Danger Zone in food safety parlance) and they multiply rapidly in food within this temperature range. Outside this range the germs kind-of go to sleep at temperatures below 4 Celsius and they are essentially destroyed at temperatures above 60 Celsius (typically 76Celsius) or the spore forming ones sporulate and remain inactive until the temperature decreases to favourable levels.

To prevent food-borne illness, the temperature of food needs to be kept out of this range. Cold foods like salad needs to be kept chilled at less than 4 Celsius and hot food needs to be kept at temperature above 60 Celsius.

Example of an easy way to cause food-borne illness is to prepare salad by 8 A.M in the morning and leave it out on a shelf in the kitchen at room temperature 36 Celsius to be served at a party at 4 P.M later in the evening. In this way the bugs have the right temperature and enough time to multiply to dangerous levels in the salad. The proper thing to do would have been to prepare the salad not too far in advance to the time of the party (two hours before it’s required will be fine rather than six hours in advance) and to keep it refrigerated at temperature less than 4 Celsius instead of leaving it out on the kitchen shelf. In the event that the food has to be prepared well in advance, then the safest thing to do is hold the food at temperature outside of the danger zone for the time being until it’s consumed either by using a hot cupboard or food warmer or Bain Marie to hold hot cooked food and using the refrigerator for salads and fruits. In this way the germs are denied the right temperature to propagate even though the time is available for them to do so.

Many a food-borne illness outbreak at parties have resulted from time and temperature abuse of the food. That is preparing food to far in advance and not storing at safe temperatures.

Two of the rules of thumb in preventing food-borne illness is to KEEP HOT FOOD HOT & COLD FOOD COLD and COOK IT JUST BEFORE ITS NEEDED.

Food-Borne Illness On The Road

Food-borne illness and the symptoms that come with it, even in its mildest form, is a terrible experience to have. The uncontrollable urge to defecate, the turmoil in the tummy, the vomiting, the nausea and fever and chills, the weakness in the body and in many cases the inability to do anything productive (office work, business activity, school work are usually part of the casualties of a food-borne illness experience).

One of the worst scenarios to be hit by food-borne illness, particularly in this part of the world, is when traveling by road especially with public transport. Having food-borne illness when traveling by road in Nigeria can be very tricky. I know a man who openly confessed to me that he once had to quietly empty his bowels again and again on himself where he sat in a bus stuck in the middle of Lagos’ notorious traffic gridlock on his way to the airport to catch an early morning flight one Monday morning. He had tried to hold the urge on till he got to the airport but he couldn’t make it. He narrated how he had to disembark from the bus in front of a petrol station (gas station) halfway into the journey and shuffled towards the toilet facility where he managed to clean himself up and change into a new set of clothes from the packed clothes for his trip. He put this humiliating experience down to the Egusi soup he had for Sunday dinner, that was the last meal he had before the incident.

On interstate long distance trips, FBI (food-borne illness) can be a most unpleasant experience because many times the bus driver will not stop to allow a passenger to relief himself when driving in-between urban areas for security reasons. Truth is, a passenger having food-borne illness on such trips would elicit more of suspicion than sympathy from fellow passengers who will, in all probability, urge the bus driver on. Some luxurious buses now have onboard toilet facilities to cater for passengers needs, whereas many do not.

The assumptions I am portraying is where the FBI is mild. Where the symptoms of the illness are very severe and involves severe stomach cramps and, worse still, vomiting, then that’s bad news altogether for the passenger and other passengers onboard because the bug can be spread easily within the confined space of the vehicle.

Ironically located in most motor parks and bus stations are dodgy canteens and dubious roadside food sellers operating under the most unhygienic conditions where one can effortlessly pick up food-borne illness germs from patronizing them before proceeding on the trip.

The Christmas and New Year period in this country is usually accompanied with a lot of traveling from West to East, North to East, and North to West. Regardless of direction of travel, taking personal responsibility to protect oneself from food-borne illness before during and after the festivities should be paramount in everyone’s mind.

Celebrating The Year’s End With Care and Caution.

The end of each year is usually associated with lots of celebration and merriment. Christmas parties, New Year parties, Corporate End of Year Parties etc. But with the opportunity to celebrate comes the need for care and caution about what is being eaten.

About this time last December a company in Benin City, Nigeria chose to host the company end of year party and long service award with staff and their families in attendance.

Speeches were given, toasts were given, awards were given to outstanding staff and long serving staff, and retirees were recognized.

A reputable caterer (name withheld) in Benin City was contracted to provide food and drinks for the occasion and there was enough merriment and fun for everyone.

However hours after the party several staff and their family members were down with food-borne illness and with many being admitted to hospital for treatment.

What was meant to be a moment of celebration ended up to be terrifying moments of pain and discomfort. Fortunately there were no fatalities.

Quoting what was reported in the media:

“Staff participated at the occasion and ate the food irrespective of the type eaten some reacted later that day. Some reportedly had issues of recurring stool, while others experienced vomiting alongside the stool. It was obvious from the number of people involved that food poisoning could not be ruled out, though this has not been officially stated to be the case.”

What interested me from the entire episode was that the company management were quick to “suspect foul play” in the aftermath of the incident. That is to say rather than consider the food safety/food hygiene competency of the caterer and investigate if due diligence was carried out by the caterer to prevent an outbreak of food-borne illness, the company management began a witch-sniffing.

Perhaps the only foul play to be considered is inadequate time and temperature control of the food, poor HandWashing practices, insufficient sanitizing and disinfecting of utensils, using same utensils to prepare raw food and ready-to-eat food. Who knows.

As we gear up for this year’s end several parties and celebrations, we need to have it at the back of our minds that a food-borne bacteria may be lurking around the corner. When selecting caterers do not focus only on the kind of delicacies they can provide, or how reliable they are in getting the food ready on time before guests arrive…also ask about their food safety records and competency. Get your catering from a food safety assured source. So you can celebrate the season with peace of mind.

“Germs No Dey Kill Africans”

I once had a chat with a lady who works as a kitchen staff in an hotel here in Eket. In the course of our discussion about food safety practices & food-borne illness she told me, with a wide grin on her mouth, “oga, germs no dey kill Africans” (literally translated “boss, germs do not kill Africans”). I shot back at her “germs no dey do wetin?” (“germs do not do what?”), she replied with certitude “e no dey kill Africans now” (“it doesn’t kill Africans”). O dear, I thought…where did she get this hypothesis from? In my mind I couldn’t help thinking that observing proper food safety practices when preparing meals for customers would be the least of her worries if she really believes that germs don’t kill Africans. So I asked her if she had ever seen or heard of folks who fall ill or die as a result of eating contaminated food. She replied curtly “dat one fit happen…if dem put something for food for the person” (“it’s possible…if the food is poisoned by someone of malicious intent”). As far as she was concerned, food-borne illness can only occur where food is deliberately contaminated or poisoned. The opinion of this individual is actually an exception and not the rule, I haven’t come across anyone with such thoughts before and after my encounter with her. Nevertheless this false conception that the African race is immune to germs gave me a cause of concern, especially that it was coming from a food handler who ought to have been trained in basic food safety, and demonstrated how much work still needs to be done in educating the public about the danger of food-borne illness and as a matter of fact, other communicable diseases.

$3.6 Billion!!!

$3.6 Billion!!! That’s a lot money you’ll be inclined to agree with me. As a matter of fact, in this country Nigeria, money of this magnitude brings to mind the public funds that were recently reported missing from SURE-P (Petroleum Subsidy Reinvestment and Empowerment Programme). But this is no missing government money. This was the estimated yearly economic cost of food-borne illness in Nigeria according to a study conducted by the International Livestock Research Institute (ILRI) in 2010.

The report stated that the study was conducted by using data from a systematic literature review, value chain survey of the livestock sector, and hospital survey as well as estimating the cost of medical treatment and lost productivity using Monte Carlo stochastic simulation to take into account uncertainty and variability.

According to the report, this amount covered cost of treating food-borne illness in the country (cost of private and public health services, cost of medication), cost of preventing food-borne illness (risk mitigation, water treatment/fluoridation/filters, vaccination of livestock/poultry, disease surveillance research, public awareness campaigns), cost to the livestock sector and veterinary public health system (practices and procedures to control disease along the value chain, cost of treatment of livestock, herd slaughter, product recall), loss of productive man hours through absenteeism from work place, cost of investigation, as well as more intangible costs to the ecosystem.

Follow this link to read the full report ILRI

Considering that this report is four years old, we can correctly assume that it is somewhat outdated and the current economic cost of food-borne illness to the country needs to be ascertained.

But the bottom line is that food-borne illness is not just hurting the health and pockets of individuals and families, it’s hurting the nation’s economy too at a cost that isn’t sustainable.

FIPI Conducts Food-Borne Illness Survey

Some months ago the Food-Borne Illness Prevention Initiative conducted a survey on food-borne illness risk perception and awareness at Ikot-Usekong, a semi-urban community in Eket LGA, using a mixture of face-to-face administered and self-administered questionnaires. Participants were selected using a non-probability convenience sampling strategy.

Findings from the survey showed that majority of the participants have a high risk perception of food-borne illness. It also emerged that most participants simply rely on cleanliness and good sanitation as the sole means of preventing food-borne illness. There seemed to be little or no knowledge about other food safety practices like separation of raw foods and ready-to-eat foods to prevent cross contamination, temperature control of food during storage, cooking food at right temperature and time to destroy pathogenic microflora, and so on and so forth.

What this implies is that a false sense of being secured from food-borne illness is assumed by the participants simply by maintaining good sanitation and cleanliness whereas as good as this practice is, in itself alone its unable to completely prevent food-borne illness from occurring.

This finding is consistent with similar social research work conducted in other parts of the country recently by other independent researchers using different research tools.

Below are photographs of FIPI volunteers administering questionnaires to participants.

20131206-231727.jpg

20131206-231758.jpg

20131206-231817.jpg

20131206-231830.jpg

20131206-231843.jpg

2013 Cholera Outbreak

th-46 th-47

For weeks I have been following the trend of the recent cholera outbreak in this country.

Cholera is a water-borne illness that can be transmitted mostly by consuming contaminated water or when contaminated water comes in contact with food materials and is ingested.

This year’s cholera outbreak, which is reported as the worst in recent years, peaked in October/November and now appears to be on the decline. But sadly it has left in its wake 124 deaths from 2771 cases nationwide as reported by the Federal Ministry of Health. That’s 124 meaningful lives cut short by a preventable food-borne illness, 124 persons that have left behind loved ones to mourn their loss.

Another sad episode of the devastating tale of food-borne illness in Nigeria.

More sad is the fact that this is bound to repeat itself again.

Why do I say so.

Because you only need to follow the trend of occurrence and see that the hardest hit communities are almost always the rural areas where government footprints in terms of the basic infrastructures required to stave of this food-borne and water-borne illness are either completely inadequate or almost non-existent.

Like someone wrote online recently “Put in simple terms. Show me a community where people are dying of cholera, I will show you one where there is neither access to portable drinking water nor proper sanitation.”

What this means is that as long as adequate safe water and proper sanitation facilities/services are not  available in these rural areas, the residents of these areas might as well begin to brace up for another bout of cholera outbreak even as they are yet  counting their losses from the one that just subsided.

However NGOs like Food-Borne Illness Prevention Initiative can blunt the edge of the inevitable sword of another cholera outbreak through educating the populace on proper household/personal hygiene practices and other food-borne illness prevention practices.

I Am A Second Generation Food-Borne Illness Victim.

I am a second generation food-borne illness victim. Many will wonder what is this guy talking about?!? But that’s correct, I AM A SECOND GENERATION FOOD-BORNE ILLNESS VICTIM.

Let me explain.

My father, a septuagenerian who still drives himself around the busy roads of Ibadan without any hassles, once told me of his experience with food-borne illness in the mid-summer of 1964 while living in England as a young man.

He had visited some Nigerian friends in Holloway, North London that fateful day and in order to beat the feeling of home sickness they conjured up a meal of Egusi soup with Chicken and Ground Rice for lunch using whatever substitute ingredient they could lay their hands on to make the Egusi as original as possible. Savoy Spinach for Nigerian Efò, milled Gourd Seed for Egusi, etc etc.

After lunch, they tucked into some drinks and chatted off about Akintola and Awolowo and Western Region politics back home. Few hours after, his travails began. He recalled vividly that it started with stomach ache, nausea and repeated trips to the toilet to loose his bowels which was characterized by watery stools. By the third or fourth time that he went to the toilet, he collapsed right there. His mates promptly called the GP who examined him and called in the ambulance. He was whisked off by ambulance to Western Hospital, Seagrave Road, Fulham where he was admitted and ended up staying for four days receiving various treatment before being finally discharged. The chicken he ate with his mates was fingered as the likely culprit by the medical team. To him its a mystery why he was the sole victim of a meal he shared with others, to me from a food safety point of view it is not an impossibility and I will put up a post that looks into this kind of scenario at some future date.

Now fast forward almost 40 years and in 2003 I paid a visit to a cousin of mine and his family while I was living in Sango-Ota at the outskirts of Lagos. After the social visit, my cousin’s wife, who had a poultry at their backyard, gave me a gift of fresh eggs harvested directly from her poultry. When I got home I observed that some of the eggs were smeared with feaces from the birds which is consistent with most eggs from subsistent poultries in our part of the world but I took no action about it. Next day I proceeded to treat myself to boiled fresh eggs from my cousins poultry for breakfast and I believe in the midst of this preparation, one way or the other I must have cross-contaminated my meal with deadly salmonella bacteria from the birds poo-poo on the shell of the eggs and that was it. Barely six hours later my whole world seemed to turn upside down with severe cramps, nausea, watery stools, and physical weakness. Being a food technologist, albeit a careless one at that instance, I immediately understood what was going on…SALMONELLOSIS!!! I only needed to join the dots from the poo-poo on the eggs to my hastiness in preparing breakfast to know the culprit behind my illness. But in my own case there was no ambulance to call and so I had to find my way to the hospital by myself where I was admitted and ended up staying 2 days before I was well enough to be discharged.

Now my goal is to ensure things stay this way in my genealogy. There shall be no third generation food-borne illness victim in my lineage. I hope.

A Mother’s Angst

I received this email (posted below unedited except for deleting the name and contact of the person that sent it out) in my Outlook Inbox few weeks ago while at work. It was forwarded by a colleague to everyone in my department as a lesson to be shared. When I read it I couldn’t help but imagine the frustration of this mother.

The brand name of the packet juice implicated in this incident is a well known household brand in Nigeria, the product was bought from an upscale outlet which ordinarily one would expect to have excellent QA/QC practices on the consumables they stock for sale, and much more exasperating was that the product was within best before/expiry dates when consumed. So inspite of the brand quality assurance of the juice and the expected confidence of shopping from an assured source, she found herself in a predicament with her dear daughter down with a bout of food-borne illness.
This incident is a classic example of the troubles that can occur when consuming packaged food or drink directly from the package without getting to visually observing the content of the package, whether it’s canned, bottled or tetra packed food or drink. Although it’s an established food safety norm that one cannot determine that a food item is safe to consume or not by visual inspection, but there are few times you can get telltale signs that something is not quite right with this stuff by looking at it…before it goes in your mouth!
It’s also important to note that this isn’t the first time that a well known food and drink brand has let its customers down in terms of food safety, it happens again and again even in the very developed countries. So the final consumer has an important due diligence role to play to keep safe from food-borne illness.
My advice to this loving mother, and to all my readers, is to set a rule of thumb for her kids to always decant the juice from the package into a glass before drinking it. In this way she secures a win-win situation. Her kids get to keep enjoying their favorite drink (which she admitted it was for her daughter) and while she (or the nanny) is able to maintain good due diligence in ensuring that any juice that is in doubt is thrown out!
Happy Reading.

“Two Sundays ago, my second child was ill and taken to the hospital for treatment, she stayed home during the week afterwards to properly recover. Last Friday, she asked for one of the packet juice Capri Sonne we had at home purchased from a Major supermarket (please note that this shop has huge customer base so no risk of stock having overstayed). On taking the juice, she started to complain of tummy ache and almost immediately started to vomit without finishing the drink. My nanny took the packet away from her and noticed some black stuff on the straw and proceeded to cut open the packet. Her observation was that the juice appeared whitish with an off look from what the juice should normally look like.

 

We immediately kept the remaining packets left in the carton away and as soon as I got home from work yesterday, proceeded to cut open all the rest left in the carton, the attached pictures tell the rest of the story. Bottom line for me is are the following:

Ø  with immediate effect no more packet juice for my kids, water and fruits to school is just fine along with their lunch.

Ø  Checking expiry date is no longer a guarantee of safe food any longer, the carton and each individual packs had June 2014 as the expiry date

 

Please let us pay more attention to what our kids eat and drink either imported or made in Nigeria, let us send messages to their school either via text message to their class teachers or via their home work diaries to instruct what and what not should be given to our kids in school because this particular drink became a favourite for my kids due to party pack from school etc, because if we don’t things that we don’t normally give to our kids may be shared at school for them to consume.

 

My daughter is fine now, the vomiting stopped Friday night and we all went back to the hospital for further review the following Saturday. It could have been worse but for timely intervention!!!

 

Regards”

Welcome To Our Blog

In our society, to a lot of people, food-borne illness, commonly called “food poisoning”, is simply having a troubling stomach ache that sends them repeatedly to the toilet a few hours of the day after which the pain and discomfort subsides and they move on with life. If you are really unlucky, you get a few bouts of vomiting alongside with the tummy ache. Indeed many people never seek any proper medical attention when they fall victims of food-borne illness beyond taking unrecommended self-medication using over the counter non-prescription drugs to address the symptoms.
While it is true that the common symptoms of food-borne illness are stomach pains, vomiting and diarrhea, what many folks do not realize is that food-borne illness exerts a tremendous toll in terms of human life and suffering, mainly among infants and young children, the elderly and other vulnerable groups like people recovering from surgery, HIV/AIDS patients etc. This toll in-turn places a heavy burden on the public health system and the economy of the country.

Although the full and accurate extent of the food-borne illness burden in Nigeria is largely unknown, what is known is that the WHO estimated that there are 200,000 deaths from diarrhea every year in Nigeria of which as many as 70% is attributed to contaminated food and water. There is a general consensus amongst public health experts that figures like this are just the tip of the clinical iceberg and that the actual number of cases are expected to far exceed the figure given due to lack of adequate monitoring and evaluation mechanism of food borne illness occurrences in the country and also because of underreporting, since a large number of food-borne illnesses are clinically mild and are less likely to be reported and also due to prevalent religious and superstitious beliefs that attributes food-borne illnesses to supernatural causes like witchcraft etc.

This blog is expected to be a means of increasing the awareness about the largely ignored burden that food-borne illness places on the public health system in this country.

Comments, feedback and contributions are welcome.

Cheers

TAAkanji

Founder, Food-Borne Illness Prevention Initiative