J.S. Crowther, L.J. Cox, R. Gross & F.A. Kaferstein
A course on safety for nutritionists has been developed in Indonesia through collaboration between government, industry, academia and international agencies. By teaching the basic principles of the subject it equips the participants to recommend foods that are safe as well as nutritious.
More than three million children die annually from diarrhoeal diseases, while hundreds of millions suffer from frequent episodes of diarrhoea and its debilitating consequences1. The incidence of these diseases is increasing in the industrialized countries, despite the advances made in water quality and sanitation. The kinds of gastroenteritis occurring in these countries are predominantly campylobacteriosis and salmonellosis, caused respectively by Campylobacter jejuni and Salmonella species. The epidemiology of diarrhoeal diseases in developed countries is linked to contaminated food2, and it is likely that this is also a factor in developing countries. Contaminated weaning foods can be a source of Escherichia coli3. Changing patterns of foodborne diseases have linked to altered food consumption practices (4). Additional problems are presented by food adulteration and chemicals in the environment, particularly in developing countries.
A knowledge of food safety provides a basis for the development of intervention strategies at all staged between production and consumption, with the aim of preventing foodborne diseases. These strategies include inspection by government agencies and educational campaigns directed at food handlers, process operators and people preparing food. The points of intervention vary in accordance with the nature of the food chain in different countries. In Indonesia, for instance, a significant proportion of the food consumed is purchased from street vendors.
Nutritionists need information about local conditions that influence food safety, and have to be able to identify points where contamination can occur or where the survival and growth of microorganisms are favored. In developed countries their skills are applied through adoption of the hazard analysis and critical control point system5.
Guidelines on food safety have been developed for governments acting in partnership with nongovernmental organizations, the private sector, local communities and international community6. In 1991 the Industry Council for Development of the Food and Allied Industries (ICD) was approached by WHO and the German Technical Cooperation Agency (GTZ) for assistance with integrating food safety into the Master of Science degree programme in nutrition of the South East Asia Regional Centre for Community Nutrition, located in Jakarta, Indonesia. The Centre, financed by the Indonesian Government, receives technical support form GTZ and the Canadian International Development Agency. The progamme now includes a short course on food safety which is intended to enable nutritionists to raise general awareness of this subject.
Objectives, Design and Structure
On completing the course, participants are expected to:
- Understand what safe foods are and how they can be produced;
- Recognize unsafe foods and preparation practices;
- Understand the affect of infection on nutrition;
- Be capable of intervening to prevent foodborne diseases;
- Know how to teach the principles of food safety.
The course, comprising eight modules (see table), was designed for nutritionists in Indonesia but it can readily be adapted for public health inspectors and other professionals, and for other countries. It gives special attention to the practical knowledge and skills needed for recognizing unsafe food and food preparation practices and for developing intervention strategies.
The objectives of the course are achieved by means of lectures, tutorials, syndicate groups, the use of videos, a field exercise among street vendors, and a visit to a food factory or large catering operation. Group work, including field studies and classroom exercises, encourages the students and helps them to acquire skills. The students are asked to read a recent paper or book each evening and to comment on it the next morning.
The presenters are drawn from ICD member companies, the University of Indonesia, and government departments. Speakers have been invited form Bogor University, the Indonesian Consumers’ Organization and WHO.
The course, intended primarily for nutritionists working for the MSc degree, accommodates 20-25 participants and allows affective interaction between students and teachers. Other professionals in the field, for instance government officials and managers from food companies, have been invited to attend as observers. This helps to disseminate the message about the preventive approach to food safety among various sectors and thus promotes intersectoral collaboration. Between 1993 and 1997, 105 people attended the course, of whom 58 were MSc students in the nutrition programme and 47 were short-course participants. The countries represented were Ghana, Indonesia, Lao People’s Democratic Republic, Malaysia, the Philippines, Thailand, the United Republic of Tanzania and Viet Nam.
Evaluation and Peer Review
Feedback was obtained from students, observers, course facilitators and tutors, the Director and Staff of the Department of Medicine at the University of Indonesia, and the GTZ team leader. Each module was scored on a scale of 1 to 5 for:
- Presentation of subject matter;
- The extent to which teaching activities increased participants’ knowledge and skills;
- Relevance, as indicated by the degree to which teaching activities helped to develop problem-solving capacities;
- The degree of difficulty encountered in following the subject matter;
- The time allotted for study of specific subjects.
Students, observers and presenters were also asked to suggest ways of improving the course. Good scores were obtained for presentation, knowledge increase, relevance to nutritionists and time allotment, and the course was considered to be pitched at the right level of difficulty. Some of the comments offered are indicated below.
- The course represented a breakthrough in graduate training because, for the first time in Indonesia, food safety was treated as an important subject for nutritionists.
- The involvement of the food industry was significant, helping the students to appreciate that scientific knowledge alone was not enough and that it had to be combined with technical knowledge and skills.
- The interactive approach to teaching, the fieldwork and the outside visits were highly beneficial.
Member firms of ICD, although commercial competitors, shared information on food safety and helped to build the course in an impressive manner.
After the course had been tested three times and improved in the light of experience, a review of the material was conducted by experts in food safety or nutrition on a worldwide basis. Their comments were generally very positive and their suggestions for further improvement were adopted for the fourth course in 1996. This led to official WHO approval of the material. The teaching package includes overhead transparencies and textbooks, which are available on diskette and can be modified and updated to requirements in different regions.
When the course had been running successfully for five years in Indonesia a two-day module was added for training trainers to set it up in other countries, especially in Thailand and Viet Nam. A newsletter entitled Food Safety Matters has been launched in order to :
- Keep food safety messages before people who have completed the course;
- Help maintain a high level of awareness of food safety issues among nutritionists and other professionals in South East Asia;
- Encourage nutritionists to share information on food safety;
- Remind them that almost all foodborne diseases are preventable;
- Remind them of the expertise that can be called upon.
Table 1: Food Safety Course for Nutritionists
|Basic food microbiology||Nature of microorganisms, including harmful ones. Beneficial microorganisms and how they grow. Microbiology, including pathogens likely to be present in raw food materials.|
|Foodborne pathogens||Infectious pathogens, where they came from, and the diseases they cause. Toxigenic pathogens, the nature of the toxins they produce, and the symptoms of the illness caused.|
|Significance of foodborne disease||Impact of diarrhoea on nutritional status, especially in young children. Clinical, social and economic impact of foodborne disease.|
|Chemical contaminants||Synthetic chemical contaminants such as pesticides and antibiotics, and naturally occurring toxicants such as mycotoxins.|
|Factors affecting survival and growth of microorganisms||Main factors in traditional food preservation aimed at preventing survival and growth of undesirable microorganisms Basis principles of thermal processing and irradiation.|
|Epidemiology of foodborne disease||Distribution and occurrence of foodborne diseases and factors that promote their spread.|
|Potential local problems of significance for foodborne disease|| Local food preparation practices, traditions, and beliefs, including safety of street foods.
Epidemiological considerations in relation to street food in Indonesia.
Gratitude is expressed to: the experts who kindly reviewed the present material; Mars Confectionery, Nestle and Unilever for the support given through ICD; and Dr. C. Geisler of WHO’s Jakarta Office for his support and encouragement.
- Käiferstein F. Food safety; a commonly underestimated public health issue. World Health statistics quarterly, 1997, 50: 3-4.
- The role of food safety in health and development. Geneva, World Health Organization, 1984 (WHO Technical Report Series. No. 705).
- Black RE et al. Contamination of weaning foods and transmission of enterotoxic Escherichia coli diarrhoea in children in rural Bangladesh. Transactions of the Royal Society for Tropical Medicine and Hygiene, 1982, 76: 259 264.
- Van Schothorst M. Cox L. “Newer” or emerging pathogenic micro-organisms in meat and meat products. In: Proceedings of the international Conference on Meat Science and Technology. Copenhagen, 1989: 55-67.
- International Commission for Microbiological Specifications in Foods. Miicroorganisms in foods. 4. Application of the hazard analysis critical control point (HACCP) system to ensure microbiological safety and quality. London, Blackweil Scientific Publications, 1988.
- World declaration and plan of action for nutrition. Pome, FAO/WHO, International Conference on Nutrition, 1992.