Publication: Trend and associated factors of food poisoning outbreaks in secondary schools in Kelantan, from 2022 to 2024
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Date
2025-06
Authors
Sha’ari, Ahmad Zulfahmi
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Abstract
Background: Food poisoning is a recurring challenge in Malaysia’s public health system, consistently ranking among the nation’s top five communicable diseases. In Kelantan, the concern over the increasing trend of food poisoning involving school settings has been growing.
Objective: This study aimed to describe the trend of food poisoning outbreak cases, to describe the proportion of food poisoning outbreak cases and to determine the factors associated with food poisoning cases during outbreaks among secondary school students in Kelantan within the same period.
Methodology: This study conducted a cross-sectional design to describe the trend and proportion of food poisoning outbreaks reported among secondary school students in Kelantan from 2022 to 2024. For the analysis of associated risk factors, a case-control design with a 1:3 ratio was applied, where student cases from selected outbreaks were compared with matched controls. Data were extracted from the final outbreak reports using the “Borang Siasatan Keracunan Makanan (FWBD/KRM/BG 001), Revision 2008”.
Result: The findings showed an upward trend in food poisoning outbreaks from 2022 to 2023, followed by a plateau in 2024. The proportion of outbreaks involving secondary schools was 90.9% in 2022, 44.4% in 2023, and 33.3% in 2024, with an overall combined proportion of 45.9% across the three years. The mean age of affected students was 14.77 years (SD = 1.38), with 62.5% in the lower secondary age group (13-15 years). Schools under the Ministry of Education (MOE) accounted for 73.5% of the cases, and 55.9% of outbreaks occurred in rural areas. Notably, 85.3% of incidents were linked to hostel canteens. Poultry was identified as the leading food vehicle (50.0%), while Salmonella spp. emerged as the most common microbial agent (64.7%). Inadequate cooking and reheating and improper storage were the most frequent critical control point (CCP) failures (64.7%). Male students were found to have a lower likelihood of being affected (AOR = 0.76; 95% CI: 0.60,0.96; p = 0.023). Conversely, consumption of red meat significantly increased the risk of food poisoning (AOR = 4.45; 95% CI: 3.25,6.08; p < 0.001), as did exposure to inadequate cooking and reheating (AOR = 1.50; 95% CI: 1.20,1.89; p < 0.001).
Conclusion This study revealed a clear link between food poisoning outbreaks in Kelantan’s secondary schools and specific operational practices within school. While non-modifiable factors like student’s sex influenced susceptibility, the more concerning aspects were preventable factors particularly in cooking, reheating, and storage of high-risk foods such as red meat. These findings highlighted the need for strengthening food safety training for canteen personnel, enforcing strict CCP monitoring, and integrating targeted health literacy for students in preventing future outbreaks.
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Keywords
food poisoning , outbreak