BHUBANESWAR: Three tribal women of Mandipanka village in Odisha’s Kandhamal district recently died after they consumed a gruel made of mango kernel. The gruel had gone stale as it was kept without proper preservation, and resulted in fungal infection which led to advanced liver failure. “One of the three women succumbed while undergoing treatment. She suffered multi-organ failure and died due to fulminant hepatitis, which is a severe form of acute liver failure found in people without prior liver problems or chronic hepatitis. It developed in those who had the gruel after two or three days of its preparation. The gruel became toxic, leading to fungal growth among those who consumed it,” said Odisha director of public health Dr Nilakantha Mishra.
This is not an isolated case as one in 10 people fall sick from something they eat or drink every year globally, as per World Health Organisation (WHO) estimates. Foodborne diseases cause over 600 million illnesses and 4.2 lakh deaths worldwide. Children are affected most, with over 1.25 lakh kids under five falling victim to foodborne diseases annually.
A study on food-related death rates in the world published in the Lancet journal in 2019 ranked India second only after China with the most number of deaths due to poor quality food or adulterated diet. In fact, India scores way higher than the US in terms of poor food choices. “Food, the essence of life, often becomes the vector for disease and death. Food poisoning, food adulteration, and foodborne diseases are pervasive, posing severe public health challenges in the country, crippling the economy and hampering development efforts,” said noted microbiologist and ICMR former member Dr Tribhuvan Mohan Mohapatra.
Contamination and adulteration
Consumption of contaminated food or water results in food poisoning and food borne diseases. The contamination could be due to microorganisms (bacteria, viruses, parasites) or their toxins. Several forms of contamination include pollution in water, soil or air, as well as unsafe food storage and processing.
Then there is food adulteration, which is a major challenge the country is facing nowadays. Common adulterants include lead chromate in turmeric, detergents in milk, and poisonous colouring agents. These substances not only diminish nutritional value but also lead to chronic health problems, including cancer, kidney damage, and developmental disorders in children.
Dr Ashutosh Mohapatra, director of Sai Institute of Gastroenterology and Liver Sciences, Bhubaneswar, says FSSAI Act stipulates that no cooked food item can be prepared using a colouring agent. “Only items such as cakes, ice-creams and sweets can be prepared using colouring, that too within permissible limits. But who cares? The lack of robust food safety practices and unhygienic handling during food production and distribution are significant contributors to foodborne diseases in the country,” he said.
Causes and symptoms
Foodborne illness and food poisoning are caused by germs, harmful bacteria or parasites that grow in foods or beverages. A review of recorded foodborne disease outbreaks in India by WHO shows staphylococcus aureus, vibrio sp, salmonella sp, e-coli, yersinia enteroclitica, and Norwalk-like virus as some important microbial pathogens responsible for foodborne illnesses.
“Salmonella bacteria is the most common cause of foodborne illnesses that occurs due to consumption of contaminated food. Street food is a known contributor. Poor sanitation and use of substandard ingredients create a breeding ground for the pathogens. The rising consumption of processed and packaged foods, often inadequately regulated, has increased the risk of contamination,” Dr Ashutosh said.
“Sometimes, both the bacteria and their toxins can make the patient sick. Soon after the person consumes the food, the person becomes ill, maybe in hours or within a day. Unlike typhoid fever and hepatitis A, that also spread through the same route, food poisoning is an acute illness, which means fast onset,” said Dr Rajeev Jayadevan, chairman of IMA research cell.
Although many people with mild illness get better without treatment, sometimes food poisoning leads to severe illness or complications. Though less often, food poisoning affects the nervous system and can cause severe illness.
Symptoms vary depending on the pathogens, toxins and contaminants involved, says senior gastroenterologist Dr Sonmoon Mohapatra. “Common symptoms are upset stomach, vomiting, diarrhoea, stomach pain and cramps, fever and headache,” she said.
Management and prevention
“There is a misconception that food poisoning occurs only from eating food from outside. It can occur at home as well. Using the same cutting board for everything can be a problem. The meat might be contaminated from source, and fish always contains bacteria. When we use the same board to cut vegetables and fruits, cross-contamination occurs and the bacteria find an easy way to enter our body, bypassing the cooking process. So it is better to keep two separate cutting boards for vegetarian and non-vegetarian items, and must be thoroughly cleaned and dried after use,” said Dr Rajeev.
Foodborne illnesses can cause symptoms ranging from diarrhoea and vomiting to severe dehydration, organ damage, or death. Acute viral hepatitis may result in jaundice, liver inflammation, and, in severe cases, liver failure leaving vulnerable sections such as children, pregnant women and the elderly at high risk.
Delaying treatment can lead to serious health issues including kidney shutdown and sepsis. “What makes people really weak are dehydration and electrolyte imbalance. So people with significant diarrhoea and/or vomiting should consult a doctor immediately,” added Dr Rajeev.
Healthcare providers say hydration is the cornerstone treatment for both food poisoning and waterborne diseases. Oral rehydration solutions (ORS) and intravenous fluids are the first line of treatment to combat dehydration caused by severe diarrhoea and vomiting, apart from anti-diarrhoeal medications and pain relievers prescribed to manage symptoms. Food ordered from outside should not be kept at room temperature for long before consuming. “Keeping food at room temperature can help bacteria multiply. When we consume that food, infection occurs. There is a similar problem with fried rice as well, because bacillus cereus can grow in half-cooked rice kept on the kitchen counter and make toxins,” Dr Rajeev said, adding that food, if cooked for several days’ use, should promptly be stored in the refrigerator.
People need to be careful while eating outside as well. “Make sure the restaurant is clean, the staff wash their hands, and check if there are enough customers, as this usually means the food is fresh,” he said, adding that people who consume shawarma should ensure that the meat is cooked properly.
FSSAI former CEO Pawan Agarwal stressed that food safety must go beyond regulations through enhanced public awareness and transform food systems for a future where healthy and sustainable food is accessible to all.
Kerala, Tamil Nadu top in food safety
Widespread awareness on food safety and food adulteration notwithstanding, only three states could score more than 60 in the rankings for food safety index (2023-24) by FSSAI. Among the big states, Kerala emerged as the top performer, followed closely by Tamil Nadu, and Gujarat, scoring 73.75, 67, and 61.75 points respectively. Jammu and Kashmir recorded the highest score of 64.25 among UTs. Many states including Madhya Pradesh, Uttar Pradesh, Rajasthan, Maharashtra, Odisha, Jharkhand, and Uttarakhand have recorded decline in safety standards.
“Only three states and one UT managed to achieve the standard set by FSSAI. The need for immediate intervention with enhanced investments in infrastructure, training, stringent enforcement and punishment against violators, provisioning of safe drinking water in every household and consumer awareness are key to reversing these trends,” said health and nutrition expert Basanta Kumar Kar.
(With inputs from Anna Jose @ Kochi)