Poor Food Hygiene Practices Research Articles

Food Hygiene, Safety Measures, and Associated Factors among Street Food Vendors in Addis Ababa, Ethiopia: Implications for Intervention Activity Design and Implementation

Background. Foodborne outbreaks and epidemic diseases are common in resource-limited countries. Many people in developing countries are increasing their habit of eating fast foods prepared on the street due to their low cost and accessibility, while most of them get sick due to poor food hygiene practices and safety measures among the street food vendors. Therefore, this research is aimed at assessing food hygiene knowledge, practices, and associated factors among street food vendors. Methods. A community-based cross-sectional study design was conducted among 494 street food vendors in Addis Ababa, Ethiopia. The data were collected using a face-to-face interview with a pretested questionnaire. All precautions for prevention of COVID-19 were followed since the study was conducted during the COVID-19 era. The data were entered into a computer and cleaned using EpiData 3.4 before being exported to SPSS version 23 for analysis. A multivariable logistic regression with a 95% confidence interval was used to identify the factors that were significantly associated with poor hygiene practice. Results. In this study, 78% of street food vendors had poor hygienic practices. Monthly income less than 2000 birr (AOR=1.95, 95% CI (1.36, 11.26), p=0.014), age groups less than 25 years of age (AOR=3.17, 95% CI (1.12, 8.97), p=0.03), food vendors who prepare food while not healthy (AOR=2.07, 95% CI (1.25, 5.93), p=0.025), and lack of toilet facilities (AOR=2.84, 95% CI (1.58, 9.68), p≤0.001) were significantly associated with the poor hygiene practices of street food vendors at a significance level of p≤0.05. Conclusions. The general food hygiene practices and safety measures were poor. Age groups younger than 25 years of age, monthly income less than 2000 birr, preparing food while sick, and lack of access to toilet facilities were significantly associated with poor food hygiene and safety practices. To promote food safety and community health, street food vendors should receive health education and training about proper food hygiene practices through health extension workers and mass media. Basic infrastructure and services like clean water supply and waste disposal facilities should be provided for street vendors to improve food hygiene and safety practices.

A descriptive cross-sectional study of food hygiene practices among informal ethnic food vendors in Gauteng Province, South Africa.

Demand for ethnic foods by the immigrant population has led to proliferation of ethnic food shops (shops selling foods eaten by different ethnic groups). However, the status of the food hygiene practices among these vendors is unknown. This study investigated food hygiene practices among informal ethnic food vendors in Gauteng Province (GP), South Africa. Participants included immigrants managing informal ethnic food shops in GP. Snowball sampling was used to identify participants (n=40). A questionnaire/checklist was used to collect information on hygiene practices. Although majority of ethnic food shops (95%; n=38) operated in permanent structures, just over half (55%; n=22) of these facilities had windows. The remaining 5% (n=2) of the vendors operated from the boot/trunk of cars. None of the participants had a food probe used to monitor the temperature of food. Most of the participants (65%; n=26) did not own freezers, and just above half (55%, n=22) had microwave ovens. Majority (95%; n=38) of the respondents had access to toilet facilities and tap water at their premises. Only two (5%; n=2) respondents brought water from home, and these used public toilets at shopping centers in the vicinity of their businesses. Majority (72.5%; n=29) of the respondents were not aware of the importance of keeping food above 65˚C. Slightly over half (55%, n=22) of the respondents did not reheat the food before serving, and only 10 % (n=4) followed proper food reheating procedures.Poor food hygiene practices and lack of appropriate food handling equipment and facilities are common among ethnic food vendors. The widespread lack of awareness of the importance of holding food above 65˚C, and the high prevalence of not reheating the food before serving, and not following proper food reheating procedures, are a major source of concern as these practices are potentially associated with promoting food contamination with foodborne diseasecausing organisms. It is envisaged that findings reported here can guide policy makers to design policies that promote selling safe food by ethnic food vendors. To enhance compliance, it is recommended that such policies should be user friendly to the operators of informal ethnic food shops.

Food hygiene practices and determinants among food handlers in Ethiopia: a systematic review and meta-analysis

BackgroundFood-borne diseases are a major public health concern worldwide, particularly in low and middle-income countries (LMICs), such as Ethiopia. Poor food hygiene practices primarily exacerbate food-borne illness transmission. Prior studies on the food hygiene practices among food handlers in Ethiopia were inconsistent. Therefore, this meta-analysis and systematic review aimed to estimate the pooled proportion of good food hygiene practices and identify the determinants in Ethiopia.MethodsThe preferred reporting items for systematic review and meta-analysis (PRISMA) instruments were used, and a systematic search was performed in the PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases, and Google Scholar were systematically last searched on the 24th February 2022 for relevant articles. Only the observational studies that reported the proportion of good food hygiene practices and their associated factors among food handlers were included. The quality of the included studies was assessed by two independent authors. Articles with unclear methodologies and did not report the overall proportions of good food hygiene practice were excluded. The effect estimates for pooled proportion and pooled odds ratio (POR) along with a 95% confidence interval (CI) were determined conducting using DerSimonian–Laird's random effect model.ResultsAmong 817 retrieved studies, 23 eligible articles with a total sample size of 7153 study participants were included in the meta-analysis. The pooled proportion of good food hygiene practices among food handlers was 50.5% [95% CI: (41.6, 59.4%]; I2 = 98.7%, p value = 0.001]. Food handlers with formal education (POR = 4.60, 95% CI: 3.05, 6.93), good knowledge (POR = 1.98, 95% CI: 1.26, 3.11), training (POR = 3.52, 95% CI: 2.35, 5.28), and a positive attitude (POR = 3.41, 95% CI: 2.52, 4.61) about food hygiene components, as well as regular medical checkups (POR = 6.75, 95% CI: 4.49) were significantly associated with good food hygiene practice.ConclusionsOnly half of Ethiopia's food handlers had good food hygiene practice.Implication of the studyThe key elements of effective food hygiene practice that will aid in the development of feasible interventions to increase food handler compliance with food hygiene components have been identified.

Food hygiene practice and its associated factors among food handlers working in food establishments during the COVID-19 pandemic in East Gojjam and West Gojjam Zones, North West Ethiopia.

Objectives:This study was aimed to assess the food hygiene practice and associated factors among food handlers working in food establishments during the COVID-19 pandemic in East Gojjam and West Gojjam Zones, North West Ethiopia.Methods:A facility-based cross-sectional study was conducted among 845 food handlers working in 423 selected food establishments of East and West Gojjam Zones from 22 September to 2 November 2020. The food handlers were categorized as a cooker and a waiter based on their responsibility. A data collection tool was adapted from the literature and validated by conducting a pre-test prior to the study. Binary logistic regression was done to identify the factors associated with food hygiene practice among food handlers.Results:The prevalence of poor food hygiene practices among food handlers working in food establishments was 51.2% (95% confidence interval = 47.8, 54.6%). Being both a cooker and waiter (adjusted odds ratio = 2.98; 95% confidence interval = 1.02, 8.66), availability of personal protective equipment (adjusted odds ratio = 2.67; 95% confidence interval = 1.75, 4.08), presence of pipe water in the kitchen (adjusted odds ratio = 2.73; 95% confidence interval = 1.84, 4.06), presence of a supervisor (adjusted odds ratio = 2.26; 95% confidence interval = 1.41, 3.62), and separate dressing room (adjusted odds ratio = 2.69; 95% confidence interval = 1.84, 3.93) were significantly associated with food hygiene practice among food handlers.Conclusion:The prevalence of poor food hygiene practices among food handlers working in food establishments during the COVID-19 pandemic was high. Therefore, improving food hygiene practice focusing on availing personal protective equipment, pipe water in the kitchen, and ensuring the presence of a supervisor as well as a separate dressing room in the food establishment is recommended.

Formative Research for the Design of a Baby Water, Sanitation, and Hygiene Mobile Health Program in Bangladesh (CHoBI7 Mobile Health Program).

Poor food hygiene practices, child feces not being disposed of in a latrine, child mouthing of contaminated fomites, and poor hand hygiene of caregivers have been associated with diarrheal diseases, environmental enteropathy, and impaired growth in young children. Mobile health (mHealth) programs present a low-cost approach to delivering water, sanitation, and hygiene (WASH) programs. We conducted a theory-driven and evidence-based approach to formative research and intervention development to design and pilot test a Baby WASH mHealth program targeting food hygiene, child mouthing, and child feces disposal behaviors in urban Dhaka, Bangladesh. Formative research activities included 31 semi-structured interviews, five group discussions, six mHealth workshops, and a three-phase iterative pilot study among 102 households. Findings from semi-structured interviews and group discussions indicate that caregivers of young children have relatively high awareness of the need for safer food hygiene, child mouthing, and child feces disposal practices, but are limited by existing household responsibilities and restricted access to enabling technology that would facilitate practicing recommended behaviors. The piloted Baby WASH mHealth program was well-received by households. This study presents a theory-driven and evidence-based approach for intervention development that can be implemented for the development of future WASH mHealth programs in low-resource settings.

Food Hygiene Practices and Associated Factors Among Food Handlers Working in Food Establishments in the Bole Sub City, Addis Ababa, Ethiopia.

BackgroundConsumers’ health would be at risk unless food preparation and handling hygiene is ensured by food establishments. Literature indicates that poor food handling and sanitation practices are more common among food handlers in developing countries resulting in food-borne illness. Hence, food handlers can play a significant role in ensuring food hygiene. To this end, the paper aims to assess the level of food hygiene practices and its associated factors of food handlers working in food establishments in Bole sub-city, Addis Ababa, Ethiopia.MethodsThrough across-sectional study design, a total of 394 food handlers selected randomly from food establishments have participated in the study. The data were collected between July and December 2017, through interview and observation. Percentage, cross tabulations, and logistic regressions were used to analyze the data.ResultsThe findings show that among 394 study subjects only 27.4% (i.e., 108 food handlers), were found to have good food hygiene practices. In other words, majority of food handlers observed were poor in maintaining food hygiene. Food hygiene practices were highly influenced by level score of favorable attitude (AOR = 3.9, 95% CI = 1.93, 7.87), extensive knowledge towards food hygiene (AOR= 3.33, 95% CI= 1.93, 5.76) and availability of water storage equipment at food establishments (AOR= 2.67, 95% CI= 1.38, 5.15).ConclusionFood handlers had poor food hygiene practices in the study area. Shortages of a continuous water supply at food establishments, poor knowledge, and unfavorable attitude of food handlers towards food hygiene practice were all contributing factors associated with poor food hygiene practice. However, these can be improved through health education programs and environmental health services, such as periodic inspections, effective enforcement of food safety regulations, and enhancing the capacity of food hygiene regulators.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi.

.Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers’ technical know-how of local dish rack and tippy tap construction is essential.

English

Diarrhea episodes among children under five years with its devastating consequences have been a concern to stakeholders in child survival strategy programs. Mothers are key in the prevention of diarrhea among children since they are the care givers. The main aim of this paper is to assess the trend and risk factors of under-five diarrheal disease in the study areas. Descriptive research design was employed for the study. A snowball sampling method was used to select 60 respondents for these study (this include 30 respondents each from a study area) and 19 health professionals were also contacted for the study. Data was analyzed using SPSS and Microsoft Excel and presented descriptively. The findings showed the causes of diarrhea as; contaminated food and poor food hygiene practices (96.7%), lack of personal hygiene (93.3%), poor sanitation (91.7%), and lack of maternal care (86.3%). Findings from expert’s survey showed that; lack of personal hygiene practices, poor food hygiene practices, contaminated food, and poor sanitation with each representing 100% respectively were some of the common determinants for the diarrheal morbidity and mortality. It is recommended that, the District Health Administration initiate health promotion and education programs to sensitize mothers’ on food hygiene practices. Key words: Diarrhea episode, children under-five morbidity and mortality.

Assessment of Hygiene Conditions in Sudanese Airlines Catering at Khartoum International Airport

Background: Food safety has been recognized as a matter of importance to the airlines industry and airports must have the capacity to ensure a safe environment for passengers using point of entry facilities, including flight catering and other potential risks. The risk of food getting contaminated depends largely on the knowledge and practice of proper food hygiene measures among food handlers. The study aimed to assess the hygiene conditions in airlines catering services units at Khartoum Airport; to evaluate the level of knowledge and practice of food handlers towards food hygiene in addition to identify the microbial load on food handler’s hands.Methodology: Four airlines catering services units at Khartoum International Airport were studied. The data were collected by using structured questionnaire to assess food handler's knowledge onfood hygiene and their practices including 100 samples (56 samples from catering 1, 22 catering 2, 12 catering 3 and 10 samples from catering 4). Observational check list was used to assess the physical characteristics and hygienic situation in airlines catering premises and food handlers. Microbiological examinations used for Total Plate Count (TPC), isolate and identification Staphylococcus aureus, Escherichia coli and salmonella. Data were analyzed using the Statistical Package for Social Sciences (version 16.0).Results: The study showed that 56% of food handlers have higher secondary school certificate, 83% of food handlers knew causative agent of food borne disease,72% knew when washed their work surfaces and 72% knew how to care with open lesions during food handling. Analysis showed significant difference (p=0.023) between respondents’ knowledge and their educational level. More than half (58%) of food handlers did not report during illness; only 42% received training in food hygiene. seventy five percent of the catering managers were not trained on food safety management system. There was statistically significant difference between trained (professional) handlers and non-trained handlers with regard to food hygiene practices (P =0.038). Fifty percent of catering premises were in bad situation (ventilation, cleaning, lightening, pest control) and poor hand washing facilities; only 25% of these catering have quality control system. The highest bacterial count from the hands samples was 8.5x106 CFU /mland the lowest 1.2x106 CFU /ml; 54.5% of sample tested positive for E. coli; 72.7% for S. aureus and 36.6% for salmonella from food handler’s hands.Conclusion: This study revealed poor sanitary conditions in airlines catering, and poor food hygiene practices of some handlers indicating higher probability of food being contaminated before service. The occurrence of indicator microorganisms in most of the hand samples indicating a need for improvement in the environment hygiene and sanitary facilities. The study recommends hygiene education to improve the knowledge and practices of food handlers.

Association of food-hygiene practices and diarrhea prevalence among Indonesian young children from low socioeconomic urban areas

BackgroundInformation on the part that poor food-hygiene practices play a role in the development of diarrhea in low socioeconomic urban communities is lacking. This study was therefore aimed at assessing the contribution of food-hygiene practice to the prevalence of diarrhea among Indonesian children.MethodsA cross-sectional study was conducted among 274 randomly selected children aged 12–59 months in selected low socioeconomic urban areas of East Jakarta. The prevalence of diarrhea was assessed from 7-day records on frequency and consistency of the child’s defecation pattern. Food-hygiene practices including mother’s and child’s hand washing, food preparation, cleanliness of utensils, water source and safe drinking water, habits of buying cooked food, child’s bottle feeding hygiene, and housing and environmental condition were collected through home visit interviews and observations by fieldworkers. Thirty-six practices were scored and classified into poor (median and below) and better (above median) food-hygiene practices. Nutritional status of children, defined anthropometrically, was measured through height and weight.ResultsAmong the individual food-hygiene practices, children living in a house with less dirty sewage had a significantly lower diarrhea prevalence compared to those who did not [adjusted odds ratio (OR) 0.16, 95% confidence interval (CI) = 0.03-0.73]. The overall food-hygiene practice score was not significantly associated with diarrhea in the total group, but it was in children aged < 2 years (adjusted OR 4.55, 95% CI = 1.08-19.1).ConclusionsOverall poor mother’s food-hygiene practices did not contribute to the occurrence of diarrhea in Indonesian children. However, among children < 2 years from low socioeconomic urban areas they were associated with more diarrhea.

Microbiological quality of chicken- and pork-based street-vended foods from Taichung, Taiwan, and Laguna, Philippines

The microbiological quality of chicken- and pork-based street-food samples from Taichung, Taiwan's night markets (50) and Laguna, Philippines' public places (69) was evaluated in comparison to a microbiological guideline for ready-to-eat foods. Different bacterial contamination patterns were observed between ‘hot-grilled’ and ‘cold cooked/fried’ food types from the two sampling locations with ‘hot grilled’ foods generally showing better microbiological quality. Several samples were found to be unsatisfactory due to high levels of aerobic plate count, coliform, Escherichia coli, and Staphylococcus aureus. The highest counts obtained were 8.2 log cfu g−1, 5.4 log cfu g−1, 4.4 log cfu g−1, and 3.9 log cfu g−1, respectively, suggesting poor food hygiene practices and poor sanitation. Salmonella was found in 8% and 7% of Taichung and Laguna samples, respectively, which made the samples potentially hazardous. None of the samples was found to be positive for Listeria monocytogenes and E. coli O157, but Bacillus cereus was detected at the unsatisfactory level of 4 log cfu g−1 in one Laguna sample. Antimicrobial resistance was observed for Salmonella, E. coli, and S. aureus isolates. Food preparation, cooking, and food handling practices were considered to be contributors to the unacceptable microbiological quality of the street foods. Hence, providing training on food hygiene for the street vendors should result in the improvement of the microbiological quality of street foods. The data obtained in this study can be used as input to microbial risk assessments and in identifying science-based interventions to control the hazards.

Food Safety: Pathogen Transmission Routes, Hygiene Practices and Prevention

Improvements in food safety require initiatives that address risks identified along the ‘farm-to-fork continuum’. Two papers in this issue of the Journal look at opposite ends of this continuum; an article by Akoachere et al. examines a common foodborne pathogen (Salmonella Typhimurium) in livestock (1) and Takanashi et al. assess the impact of food hygiene in the home on diarrhoea (2). Foodborne disease is defined as illness resulting from consumption of contaminated food; food can be contaminated with microbial pathogens or a toxic substance (3). Many common foodborne pathogens are zoonotic (4). To attribute diarrhoeal disease to zoonotic transmission or other transmission routes, data collected for specific pathogens through investigations of outbreaks, analytical studies, and laboratory-based studies can provide insights. Transmission from animals to humans can occur through direct contact (5), consumption or handling of meat (6), consumption of unpasteuri-zed milk (7), untreated water (8,9) or consumption of contaminated fresh produce (10). In the article by Akoachere et al., microbial subtyping was used as a means to link Salmonella Typhimurium-related disease in humans with animal reservoirs (1). In investigations of outbreaks, the linkage between humans and animals is clear as there is laboratory evidence, along with information for a specific exposure window (11,12). In analytical studies, epidemiological evidence suggests a link by detecting an elevated risk of being an S. Typhimurium case among those exposed to meats (13) or animal contact (14). These data, however, lack accompanying microbiological evidence. In the article by Akoachere et al. (1), microbiological evidence is proposed, in the absence of an epidemiological link. There are limitations to this approach to attributing food-animal exposure to human disease and so the findings should be interpreted with caution. The authors conclude that their findings are circumstantial. Using microbial subtyping data to attribute human disease to a source can be useful for prioritizing intervention strategies. Recent advances in the use of Salmonella subtyping data to attribute human infections to animal reservoirs have been described (15). This may be further assisted by the wider use of multiple-locus variable-number tandem repeat analysis (MLVA) developed for several Salmonella serovars (16–18). The method has the advantages of being rapid, cheap, and reproducible, offering advantages over traditional Salmonella serotyping and phage typing. MLVA has initially been used in outbreak situations and is now being applied as a routine method in some settings (19). The study described by Akoachere et al. also reports antimicrobial resistance of the S. Typhimurium isolates (1). There has been considerable debate on antimicrobial resistance among foodborne pathogens and the role of clinical usage versus antimicrobial use during food-animal rearing. The source of resistance remains controversial and has been the subject of many analytical studies that include human and/or animal isolates and data on antimicrobial agent consumption for humans and animals (20–23). In addition to identifying areas for improvement at the food production and food processing level, collecting evidence of food safety at the point of consumption is warranted. Epidemiological data suggest that poor food-hygiene practices are res-ponsible for a substantial proportion of foodborne disease (24). In this issue, an article by Takanashi et al. examines the role of food-hygiene practices on diarrhoeal disease among children (2). They found limited association between food-hygiene or general hygiene behaviours and diarrhoea. This is consistent with the findings from a systematic review of the effect of domestic kitchen-hygiene practices on diarrhoeal disease in developed countries (25). There is, however, evidence of a role of poor hygiene practices in diarrhoeal disease from investigation of outbreaks and environmental studies (26,27). Collecting accurate information on hygiene practices is challenging. Self-reported food-handling and hygiene practices at home are unreliable compared to observed behaviours (24); this was acknowledged by the authors. For example, they found no association between diarrhoea and handwashing practices, a finding at odds with studies that have demonstrated the effectiveness of handwashing interventions on diarrhoea (28). The study reported in this issue focused on practices important for foodborne transmission, which include handwashing; this can have an impact on person-to-person transmission. Among the age-group of study children, diarrhoea may be due to pathogens acquired by the person-to-person and fomite transmission routes, in addition to the foodborne transmission route. From a disease-prevention perspective, hygiene efforts at both farm and fork-end of the continuum are worth pursuing. Strong evidence of the impact of these initiatives will be required to satisfy the food industry and policy-makers that changes are needed. In addition to addressing animal and human hygiene, continued research to attribute disease to pathways and vehicles to target those of the greatest impact and/or with viable practical solutions is required.

Perceptions of food hygiene risk in a group of Tamil food handlers living in the UK

AbstractIn this study, two groups of people were asked about their perceptions of the public health risks associated with poor food hygiene practices. One group consisted of commercial food handlers (n = 60) who had undergone food hygiene training; the other group consisted of people (n = 60) who only handled food at home. Data were gathered using a self‐completed questionnaire based upon those parameters commonly believed to determine public perceptions of risk. It was found that general awareness of the risk of food‐borne disease was elevated in the commercial food handlers and optimistic bias was reduced. These two factors might be expected to militate towards positive food hygiene behaviour. However, the respondents also reported a marked increase in their perception of the degree of control available concerning their vulnerability and the vulnerability of others to food‐borne disease. This increase in perceived control would be expected to reduce their overall perception of the importance of the risk of food‐borne disease. The relevance of the two potentially conflicting outcomes of training, described previously, is discussed.

Raising food hygiene standards--could customer power and the new laws hold the key?

In September 1995 new general food hygiene regulations came into force. The new law, quite rightly, requires proprietors of food businesses to focus their thoughts and actions on risks to food safety. Proprietors are required to identify and assess risks and ensure that adequate management procedures are put into place to ensure food safety. This is a welcome move as contributing factors in most cases of food poisoning involve poor food hygiene practices. At the same time there has been a large increase in the amount of advice and guidance to local authority enforcement officers, particularly to assess risks to food safety when considering what action to take in any situation - the lower the risk the less appropriate it is to take legal action. However, there are many conditions found in food premises which present little or no risk to health, such as routine cleanliness in non-high risk areas, but lower standards on these might be viewed by the public as inappropriate for food businesses. With an increasing amount of choice available to customers, proprietors and managers of food businesses need to be more aware than ever of the complex pattern of consumer demands including that of supplying a clean and safe product in its broadest sense. The notion of consumer sovereignty is not a new concept. Combined with the new laws could it hold the key to genuine improved standards in food hygiene? This article reviews the subject and draws attention to a research programme being undertaken at the University of Brighton to identify, compare and contrast factors which the public perceive as important in terms of food hygiene in public eating places with those considered important by professionals with an interest in the subject. The results could bring benefits to the catering industry and customers.