Second Environmental Performance Review of Albania

Chapter 10: Human health and environment141There is a significant burden of ill health associatedwith the water pollution risks. As already noted,levels of shigellosis and typhoid fever are still high inAlbania (Figure 10.1). In addition, the monthlydynamics of selected food- and waterborne diseasesin 2009 show that shigellosis infections persist in thecountry throughout the entire year, and demonstratethe relative importance of the disease (Figure 10.2).The total number of notified cases of food- andwaterborne diseases in 2008 was 2,764, with thehighest number of cases of infection in the town ofBerat (591 cases) and, in the north-east of thecountry, in the towns of Kukës (1,070) and Tropojë(566). Common reasons for the outbreaks weremicrobiological water contaminated from untreatedsewage, poor hygiene and contaminated animal byproducts.In 2009, one local outbreak of Hepatitis Ain the Tirana region was laboratory confirmed. As itis not possible to determine the proportion ofbackground cases of acute gastrointestinal infectionsand outbreaks associated with poor water andsanitation, it is likely that the vast majority ofwaterborne infections remain undiagnosed and manyoutbreaks undetected. Furthermore, the specificcausal pathogen in the water supplies or foodproducts cannot be identified and neither, therefore,can the source of the outbreak.Food safety and nutritionFoodborne infections continue to take their toll onpublic health in Albania: recorded foodbornepoisonings were on the rise in the second half of thelast decade, partly due to improved surveillance andreporting but also to the occurrence of large-scaleoutbreaks (Figure 10.3). The underlying infection is,in most cases, of microbiological origin.Microbiological food safety has shown high rates ofcompliance, in particular for selected bacteriologicalanalyses (Table 10.4). The number of samplesanalysed, however, is relatively low, mostly due to alack of re-agents, laboratory equipment problems,etc. Furthermore, the share of food samples takenwithin the framework of projects and studies isgrowing, which may not show the real situation asthe objectives of projects and studies have their ownspecifics. Capacity for pesticide residue controls infood and feed of plant and animal origin is not yet inplace.Salmonellosis is a common underlying infectionacross Europe. Two foodborne outbreaks have beenreported with salmonellosis as the underlyingdisease: in 2007, a smaller outbreak among schoolchildren in Tirana, and in 2008, a larger outbreak inthe general population of Librazhd. The mostcommon causes include contaminated poultryproducts, and poor hygiene during food handling andmanufacturing. Launching of the national salmonellacontrol programme is underway and will enableAlbania to build capacity for managing public healthrisks at the human–animal interface.In contrast to the European situation, the highlycontagious, epizoonotic disease brucellosis stillremains a problem in Albania. As already noted,though incidence rates are decreasing, they remainhigh by order of magnitude as compared with the EUand CEEC averages. Brucellosis also persiststhroughout the year at relatively high levels. In 2009,for example, it climbed rapidly during the first half ofthe year to peak at a very high level before decliningsteadily (Figure 10.2). Measures for control anderadication have been undertaken but progress isinsufficient owing to the existence of many smallfarms which sell their food products illegally on thestreets, and overall weak control.Food safety and consumer protection is considered apriority in the Government’s reform agenda and thefood safety policy has been subject to importantdevelopments in recent years with assistance fromthe EU. The National Food Authority (NFA) wascreated in 2010 to consolidate all responsibilities forinspection, risk assessment and communication. Afood hygiene package has been adopted and feedhygiene legislation has been prepared for the placingof food and feed and animal by-products on themarket.Enforcement of the legislation is weak and moreeffort is needed to strengthen the organization ofofficial controls on animal products intended forhuman consumption, improve laboratory capacity,enhance coordination between central and locallevels, and enhance intersectoral communication andcooperation. Currently, only a few establishments inthe meat, fish and dairy sectors apply the modernhazard analysis and critical control point (HACCP)system and self-controls for food safety assurance.Albanians have a healthier diet than do people inother European countries: the proportion of energyfrom fat is lower than that of the EU and CEECcountries and that available from protein is higher.Albanians consume more fruits and vegetables thanother Europeans and fruit and vegetable consumptionhas more than doubled since the 1990s. As regardsprogress in combating iodine deficiency in thepopulation, about 60 per cent of households inAlbania were reported to have adequate consumptionof iodized salt during the period 2003-2008.