Food Safety Day reflection — SA grapples with food-borne disease, cholera and poor service delivery

8 Jun 2023

South Africa is food insecure and prone to food-borne disease outbreaks, with the most notable being the 2017-18 listeriosis outbreak. Studies show investigations of outbreaks are poor and so are preventative measures by the food industry, government, and citizens.

Over 600 million people fall ill and 420,000 die every year from eating contaminated food across the world. South Africa has over 10 Acts that speak to food safety and yet from 2013 to 2017, 11,155 individuals contracted food-borne diseases, with 8,680 hospital visits, 494 hospital admissions, and 49 deaths.

Needless to say, the numbers have increased since 2017 as 26 people have died from cholera in the past few months. And, with a special set of challenges such as water scarcity and load-shedding, experts have sounded the alarm on increased food safety risks in the country.

Read more in Daily Maverick: Top SA scientists present action plan to fight nationwide cholera outbreak

The government and the food industry held events leading up to World Food Safety Day on 7 June to investigate whether they uphold the plethora of food standards.

Foodborne diseases caused by bacteria include listeriosis, Salmonella Campylobacteriosis, Escherichia Coli, Vibrio cholera, norovirus, and foodborne trematodes.

Common symptoms of foodborne illness are diarrhoea and/or vomiting, typically lasting one to seven days. Other symptoms might include abdominal cramps, nausea, fever, joint/back aches, and fatigue.

Questions such as, “Why are we still getting the basics wrong? How do we fix this? How do you fix the leak in your food safety management system?” came up at the annual Food Safety Summit and during a Department of Health webinar on the role of government in ensuring food safety in South Africa in early June.

“This fifth instalment of World Food Safety Day is an annual effort to bring global awareness to the importance of food safety and inspire action to help prevent, detect, and manage foodborne risks,” said Penny Campbell, director of food control at the Department of Health.

“The Food and Agriculture Organization of the United Nations (FAO) expresses the urgency of ensuring safe food, reporting that foodborne illness is responsible for 42,000 preventable deaths yearly. Established on 20 December, 2018 by the United Nations General Assembly, recognition of World Food Safety Day is the result of the efforts of FAO and the Codex Alimentarius Commission.”

The FAO states there is no food security without food safety. Food safety has a direct impact on health and science is key to sound food safety management. Food safety impacts positively on economies and livelihoods. It helps protect consumers and producers, and science underpins food standards.

South Africa witnessed the world’s largest listeriosis outbreak, characterised by a progressive increase in cases of the disease from January 2017 to July 2018. Of the 1,060 laboratory-confirmed cases of listeriosis reported by the National Institute of Communicable Diseases (NICD) 216 deaths were recorded.

Read more in Daily Maverick: Life after listeriosis: Fighting for justice

“The listeriosis outbreak of 2017 to 2018 in South Africa was an example of how a foodborne disease (FBD) outbreak can have catastrophic consequences and underscored the need for improving food safety control and intervention in the country,” a study by researchers from the Centre for Enteric Diseases, NICD, and the Faculty of Health Science in the University of Pretoria found.

“Africa has the highest burden of FBD per population worldwide, most of which are attributed to diarrhoeal disease agents. Several factors contribute to the high burden of FBD in this region: unsafe water used for the cleaning and processing of food; poor food-production processes and food handling; inadequate food storage infrastructure; inadequate or poorly enforced regulatory standards; and a move to intensive animal husbandry practices as economies develop.”

The study looks at whether reporting and investigation of food-borne diseases have improved since one of the most tragic food-borne disease outbreaks in recent South African history. Researchers looked at cases reported to the NICD and found that cases were poorly investigated.

A total of 338 outbreaks were noted and only 129 were investigated between 2018 and 2020.

“Some investigative reports were left incomplete and only 98 out of 129 (76%) outbreaks had been reported. On average, FBD outbreaks were notified within two days. A total of 2,932 cases were reported, including 316 hospital admissions and 20 deaths. Fifty four out of 129 outbreaks that happened in household settings were most common, followed by outbreaks in institutional settings at 47/129,” the study reads.

Outbreaks were reported throughout the year, but in 2019 more outbreaks were reported in the cooler months.

“Only 14 outbreaks, 11%, 14 out of 129, were comprehensively investigated, with appropriate epidemiological, clinical, food/water, and environmental investigations being conducted. The aetiology and source of the outbreak were identified in only five of the outbreaks which were investigated 4%, 5/129, all of which were due to nontyphoidal Salmonella (NTS) linked to informally slaughtered food animals,” the report reads

Access to safe and affordable food is important to humans and animals. Food that carries potential risks can be harmful to health. Consumers expect and deserve protection against risks found in food and therefore appropriate regulatory systems are important.

The Department of Agriculture, Forestry and Fisheries (DAFF), the National Department of Health, and the Department of Trade and Industry are responsible for food safety and food quality legislation.

The Department of Health requires that all foodstuffs shall be safe for human consumption in terms of the Foodstuffs, Cosmetics, and Disinfectant Act, 1972 (FCD Act). This Act addresses the manufacture, labelling, sale, and importation of foodstuffs. Matters regarding the hygiene of foodstuffs are addressed by the National Health Act, of 2003, and the hygiene requirements at ports and airports including vessels and aircraft are addressed by the International Health Regulations Act, of 1974.

Food legislation is based on the presumption of safety. Where a substance is not naturally present in a food e.g. an additive or contaminant, maximum limits are laid down which in many cases are those determined by Codex Alimentarius.

The Codex Alimentarius

The Codex Alimentarius Commission was created in 1963 by the Food and Agriculture Organization and the Word Health Organization to develop International food standards and guidelines like codes of practice under the Joint FAO/WHO Food Standards Programme. South Africa is a member of Codex and the Codex contact point is with the Department of Health. Government officials represent the country at the meetings of the committees where standards are developed. The Department of Health has committed to giving effect to Codex standards in South African legislation.

The Department of Health’s food safety guide says the buck stops with the consumers: “government cannot protect consumers from the consequences of their actions. Consumers need to take responsibility and strive to become informed and knowledgeable about food issues to make selective food purchases and practice the necessary safety requirements when handling, preparing, and storing food,” the guide reads.

Water and power crisis

Preventing foodborne illness requires one to clean, separate, cook, and chill:

Clean: Wash hands and surfaces often.

Separate: Don’t cross-contaminate.

Cook: Cook to proper temperatures.

Chill: Refrigerate promptly.

According to Greenpeace, 19% of the rural population can’t access a reliable water supply, 33% do not have basic sanitation services, and over 26% of clinics from both rural and urban areas don’t have water along with 45% of clinics.

South Africa is a water-scarce country, which poses a challenge to executing one of the most crucial steps to preventing the spread of food-borne diseases — washing hands and food.

Storing food according to recommended standards can be challenging in a country that experiences rolling blackouts for between 6 and 8 hours a day, for weeks at a time. Food is often not stored in adequate cold temperatures in the fridge, thus creating fertile ground for food-borne diseases.

Without food safety, nutrition and food security can be sorely lacking. The proper handling, processing, and distribution of food to ensure that contaminants are not present is a collective responsibility that extends, beyond government departments. However, businesses and households can’t uphold these standards with limited or no sanitation, water, and electricity. Several think tanks have pointed out that incessant breakouts and deaths from preventable diseases such as Cholera are a sign of a failed state. DM

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South Africa

The Codex Alimentarius

Water and power crisis