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| REVIEW ARTICLE |
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| Year : 2015 | Volume
: 1
| Issue : 3 | Page : 131-135 |
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Food safety in India: An unfinished agenda
Charu Kohli, Suneela Garg
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| Date of Web Publication | 30-Sep-2015 |
Correspondence Address:
Charu Kohli
Department of Community Medicine, Maulana Azad Medical College, New Delhi - 110 002
India
 Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.  | Check |
DOI: 10.4103/2394-7438.166308
Food safety refers to all those hazards which make the food unsafe to health. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden causes of morbidity. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same. Though most of the foodborne diseases are sporadic and often not reported in India, a nationwide study reported an alarming 13.2% prevalence at the household level. Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits. Food Safety and Standards Authority of India established by the Government of India develop the standards for food and regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. The literature review shows that the consumer awareness is not very good in India in relation to food safety. There is a need to initiate the public health surveillance for food safety and foodborne diseases. Legislations related to food safety should be enforced strictly. The consumer awareness should be an important part of all initiatives.
Keywords: Awareness, food handlers, food safety, health, legislations, surveillance
How to cite this article:
Kohli C, Garg S. Food safety in India: An unfinished agenda
. MAMC J Med Sci 2015;1:131-5 |
| Introduction | |  |
Food safety is an important issue in India having great public health implications. Food safety refers to all those hazards which make the food unsafe to health. Hazards can arise at many points from food production to consumption. It can be agricultural practices for crop production, poor hygiene for transportation and handling, food processing, adulteration, distribution, preparation, and serving. Food safety and nutritional status of the population are inextricably linked. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden cause of morbidity. Foodborne disease can be defined as any disease of an infectious or toxic nature caused by or thought to be caused by the consumption of food or water.[1] Foodborne illnesses are the global public health problem. Over 200 diseases are caused by the unsafe food containing harmful bacteria, parasites, viruses, and chemical substances. The causative agents include bacteria such as Salmonella, Shigella, Campylobacter, Enterohemorrhagic Escherichia coli, Vibrio cholera, Clostridium, etc., viruses such as Norovirus, Rotavirus, and hepatitis A and E, and parasites such as Echinococcus, Ascaris, Cryptosporidium, Entamoeba histolytica, or Giardia, etc. Food can also cause diseases due to toxins. These toxins may be naturally occurring like mycotoxins, added unintentionally during the cultivation such as heavy metals or intentionally as malpractices. It is estimated that about 2 million deaths occur every year from the contaminated food or drinking water.[2]
India is not touched by the growing concerns for food safety. Foodborne illnesses occur as frequent outbreaks in all parts of India. Looking at the dismal status of food safety in the world, World Health Organization stated the theme for World Health Day for the year 2015 as "How safe is your food: From farm to plate, make food safe." The main purpose of celebrating this day is to help taking policy decision for food safety, for health of the population, and advocacy for food safety. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same.
| Burden | | |
Worldwide, foodborne diseases carry a high burden of morbidity and mortality. The global burden of infectious diarrhea involves 3–5 billion cases and nearly 1.8 million deaths annually caused by the contaminated food and water.[3] As per the Centers for Diseases Control and Prevention estimates, there are 47.8 million cases of foodborne diseases, resulting in 127,839 hospitalizations and 3037 deaths, transmitted through food every year in the United States of America alone.[4]
Another study assessed the burden of acute gastroenteritis and foodborne diseases in Barbados through a retrospective, cross-sectional population-based survey among one person from each of 1710 randomly selected households. A total of 70 respondents reported having the experienced acute gastroenteritis in 28 days prior to the interview, giving a prevalence of 4.9%, and an annual incidence rate of 0.652 episodes per person-year. Norovirus was the leading foodborne pathogen causing illness. An estimated 44,270 cases of acute gastroenteritis were found to occur during the period of 1-year and, for every case of acute gastroenteritis detected by the surveillance, an additional 204 cases occurred in the community. The economic costs of acute gastroenteritis was huge; about US$ 4.25–8.25 annually.[5]
There has been variable trend in foodborne diseases. The 1990s saw rapid increases in the incidence of food poisoning in the developed world. Several factors were found "critical for a large proportion of foodborne diseases" including the use of contaminated raw food ingredients, contact between the raw and cooked foods, and poor personal hygiene by food handlers. In 2008, European Community Summary Report on foodborne infections cited campylobacteriosis as the most reported animal infection transmitted to humans with 200,507 confirmed cases reported. This was a 12% overall increase as compared to 2006. Currently, the foodborne diseases are on a rise around the world.[6]
Indian scenario is even worse with foodborne illnesses causing outbreaks in almost every part of the country. Though most foodborne diseases are sporadic and often not reported in India, a nationwide study carried out recently reported an alarming prevalence of 13.2% at the household level. The scientific reports on the outbreak of foodborne diseases in India for the past 29 (1980–2009) years indicated that a total of 37 outbreaks involving 3485 persons have been affected due to food poisoning.[7] An outbreak in 1998 in Delhi, India occurred due to the consumption of contaminated mustard oil characterized by pitting edema, skin erythema, limb tenderness, diarrhea, and hepatomegaly with a few others developing open-angle glaucoma and cardiac failure in about 14% of them.[8] The state wise studies were conducted and one study conducted by Sudershan et al. found that from 2003 to 2005 in Hyderabad, 10 outbreaks involving 996 persons were reported. Of the 10 cases investigated, nine were due to Staphylococcus aureus food poisoning and one was due to Salmonella.[9]
| Current Scenario | | |
Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits.
There are following legislations for ensuring the food safety in India:
- The Prevention of Food Adulteration Act 1954 has been repealed as the Food Safety and Standards Act 2006
- The Fruit Products Order, 1955
- The Meat Food Products Order, 1973
- The Vegetable Oil Products (Control) Order, 1947
- The Edible Oils Packaging (Regulation) Order, 1998
- The Solvent Extracted Oil, De-oiled Meal, and Edible Flour (Control) Order, 1967
- The Milk and Milk Products Order, 1992
- Essential Commodities Act, 1955 (in relation to food).
Food Safety and Standards Authority of India (FSSAI) has been established by the Government of India to develop the standards for food and to regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. FSSAI has laid down separate regulations for different aspects. For packaging and labeling, regulations known as Food Safety and Standards (Packaging and Labeling Regulations, 2011) have been laid down. It lay down specifications for labeling on prepackaged food items with respect to language, a description which is false, misleading or deceptive, or is likely to create an erroneous impression.
Every packaged food items shall also carry the following information on the label: (i) Name of the food; (ii) list of ingredients; (iii) nutritional information; (iv) declaration regarding vegetarian and nonvegetarian; (v) food additives; (vi) name and complete address of the manufacturer; (vii) net quantity; (viii) lot/code/batch identification; (ix) date of manufacturing or packing; and (x) best before, etc.
FSSAI also laid down the guidelines for licensing, registration, and permits. All food business operators in the country are required to be registered or licensed. Hence, no person shall commence any food business unless a valid license is possessed by the operator, and the conditions with regard to safety, sanitation, and hygienic requirements have to be complied with at all times. FSSAI has also issued time to time warnings/alerts regarding the recall of food items due to the contamination such as recall of frozen products and ice creams due to the contamination with listeria monocytogenes recently in 2015.[10]
Food adulteration is also one important aspect to deal with. PFA Act provides the protection against food adulteration/contamination. It deals with fraud that can be perpetrated by dealers, by supplying the cheaper food items. Different definitions of food, adulteration, misbranding, etc., are described under the act. It laid down penalties in violation of the act.[11]
| Literature Review | | |
Food handling
A study was carried out in the public food establishments (hotels) situated in Miraj in District Sangli, Maharashtra, India. It was found that about 38.6% food handlers had one or more addiction. As a whole, 44.07% of the males had some form of addiction. Only 18.75% female respondents had addictions. 26.66% had both - habit of chewing tobacco and betel nut. None of the food handlers surveyed had undergone any form of medical examination at any time during his/her career. On the day of data collection, 20% of the food handlers mentioned having symptoms suggestive of some current disease or infection.[12] Another study was carried out to investigate the food safety knowledge and practices of food handlers and to assess the sanitary conditions of food service establishments in Bahir Dar town. It was stated that 66% of the establishments had flush toilets, whereas 5.9% of the establishment had no toilet. Only 33.6% of the establishments had a proper solid waste collection facility, and there was a statistically significant association between the sanitary conditions and license status of the establishments. The knowledge gap in food hygiene and handling practices was observed. In addition, there was a statistically significant difference between the trained (professional) handlers and nontrained handlers with regard to food hygiene practices.[13]
A cross-sectional study was conducted on randomly selected 160 food handlers in Maharashtra. Stool examination and nail culture were also performed. There was no registration of these food establishments. Point prevalence of morbidity was 33.75% and period prevalence was 26.25%, 21.87% were found to be anemic. The microbial positivity rate for their stool and nail culture was 97%. Only 13.79% were wearing clean clothes, 14.28% were using an overhead cap, 5.71% kept their hair neat and tidy, 7.14% had clean nails, and 16.66% were using footwear. Morbid conditions such as anemia (59.25%), halitosis (11.11%), scabies (9.25%), and phrynoderma (3.75%) were common. Tuberculosis, leprosy, and skin diseases together accounted for 12.96% of diseases.[14]
A study was conducted among the food safety regulators in 23 districts of the South Indian state of Andhra Pradesh to assess their knowledge, perceptions, and practices regarding the food safety. Results showed that respondents' knowledge of basic food microbiology was limited. They attributed their inability to monitor all cases of food poisoning/adulteration to delay in receiving information and lack of laboratory facilities. They had sound knowledge of conventional adulterations but were not equipped to check newer adulterations. Their knowledge of health/nutrition claims on food labels was almost nil.[15]
Street food is most commonly implicated in food poisoning outbreaks. A study was performed to assess the food safety and hygiene practices among 200 street food vendors in Delhi. The results showed that none of the respondents was registered or licensed. Seventy-two percent were disposing the garbage in open lid bins, and 16% were throwing it on the road, only 3% of the vendors were using gloves, and from rest only 2% were washing hands before and after handling raw or cooked food. The majority of respondents had short clean nails, and few (4%) had open wounds present. The presence of flies/mosquitoes was observed in 45% of the vending sites. Nineteen percent were washing utensils in open.[16]
Another study conducted among the food handlers in Dangila town found that 52.5% had good food handling practices. 78.6% used to wear a gown. 8.5% and 97.8% were working in an establishment which had a private pipe and toilet within the establishment, respectively. The majority of food handlers, 71.2%, had poor knowledge score on food handling practices. Most of the food handlers; 88.9% had heard about foodborne diseases of which 32.4% had a good knowledge. Marital status, monthly income, knowledge, presence of insects and rodents, the existence of shower facility, and separate dressing room were found to be significantly associated with food handling practices.[17]
A cross-sectional observational study was conducted among 83 food handlers working in various canteens and messes in a medical college in Solapur. Only 28.9% were having good personal hygiene, whereas 32.5% had poor personal hygiene. Commonly, the observed dermatological morbidities were fungal infection (21.4%), dermatitis (20.4%), and scabies (9.3%). Ninety five percent were aware about foodborne diseases. 86.7% responded that contaminated foods transmit disease. About 56.6% responded role of vectors in disease transmission.[18]
A similar study was conducted in a medical college in Delhi among 13 eating establishments. It was found that there was no provision for separate washbasin for washing of hands in kitchen area other than those used for cleaning utensils in four establishments. Exhaust fans were present, and all were in working condition in the kitchen areas of all the establishments, but the majority (91.7%) were not clean. Soap was present in all except one establishment; there was no facility to dry hands near washbasin, except towel at one place. Hygienic practices in kitchen area were not satisfactory such as dirty exhaust fans, soap availability in only two-third of kitchens, no display of poster/notice regarding hygiene, nonusage of hot water, and use of cloth for drying dishes with dishes kept on the floor.[19]
Consumer awareness
A number of studies have been performed in India with relation to awareness regarding the food safety among consumers. A study was conducted in Tamil Nadu among 529 randomly selected house holders. It was revealed that majority of the respondents were aware about the damaged food items. Most of the respondents did not know the correct temperature of the refrigerator. The study found that there was no significant difference among different education levels of consumers toward food safety knowledge. Most of the respondents did not keep the food items in the refrigerator.[20]
Another study conducted in South India included 123 people. The majority of the people were aware about the presence of food preservatives (91.7%) and food flavoring agents (84.9%), though their knowledge was inadequate. Breakup of the study subjects according to the level of awareness about preservatives was (%): Good (37.4), satisfactory (40.6), poor (22), and additives (%): Good (49.6), satisfactory (36), and poor (14). There was a gap found between the knowledge and practices.[21]
A study was conducted in Hyderabad to assess the perceptions and practices of mothers on food safety. Results showed that over 90% wash hands before feeding children, eating, serving or cooking food, but the usage of soap was very limited. Over 60% stored leftover cooked food at room temperature. The high incidence of foodborne illnesses was reported in the families (21%) and the community (12%). Though 48% buy packed food, a majority (78%) do not recognize the symbols on food labels. Significant associations were found between the standard of living/literacy and certain food safety practices.[22]
| Vision for Future | | |
Public health surveillance
The purpose of public health surveillance is to define the magnitude and burden of a disease, to identify the causative factors, predisposing factors, and to investigate outbreaks, so that the control measures can be rapidly implemented and to measure the impact of control and prevention efforts. The public health surveillance of foodborne diseases is important so that common causative agents can be identified, all outbreaks to be reported and investigated. It will be followed by clear guidelines for future prevention and control. There should be a clearly defined organizational structure which looks after the surveillance all over the country with state and district nodal officers. The standardized reporting formats should be prepared and capacity building should be performed.
Consumer awareness
Community participation in terms of raising the awareness of community regarding the safe food and hygiene should be an integral part. All efforts should be made to involve school children, parents, college students, and others in joining hands to fight food adulteration and promoting safe and hygienic food.
Legislations
Legislations related to food safety should be enforced strictly. Issues such as lack of manpower, laboratory services, and technical support should be addressed. People should be made aware of such legislations and their right to safe food.
Research and data
There is a relative paucity of reliable literature on risk assessment, hazard analysis in relation to food safety. Thus, the research should be promoted at all levels, so that evidence-based decision making can be performed. Another problem in India is that foodborne diseases are not categorized separately in the Health Information of India. For example, in the official document of health information, the Government of India for 2004, 9,575,112 cases of acute diarrheal diseases including the gastroenteritis with 2855 deaths have been recorded and cases of foodborne disease may have been categorized under gastroenteritis.[23]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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