1921
Volume 101, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Poor hand hygiene and food handling put consumers of restaurant and street food at risk of enteric disease, especially in low-income countries. This study aimed to collect hygiene indicators from a nationally representative sample of restaurants and street food vendors. The field team collected data from 50 rural villages and 50 urban administrative units (). We explored restaurant service staff, cook, and food vendor hygiene practices ( = 300 restaurants and 600 street food vendors), by observing hygiene facilities, food handling, and utensil cleaning. A qualitative assessment explored perceptions of hygiene related to food handling. During restaurant spot checks, 91% (273/300) had soap and water at handwashing location for customers but in only 33% (100) at locations convenient for restaurant staff. Among street food–vending stalls, 11% (68/600) had soap and water when observed. During 90-minute structured observations, cooks used soap to wash hands on 14/514 (3%) of occasions before food preparation, 6/82 (8%) occasions after cutting fish/meat/vegetables, 3/71 (4%) occasions before serving food, and 0/49 (0%) occasions) before hand-mashing food/salad preparation; no street food vendors washed hands with soap during these food-handling events. Most of the qualitative study participants perceived that customers select a vendor based on tastiness of the food, whereas no one mentioned the importance of food hygiene. The study demonstrates widespread poor hygiene and food-handling practices in restaurants and among food vendors. Based on our study findings, we proposed a food premises Hygiene Investigation Model to create action plans to improve food safety.

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References

  1. WHO, 1999. Food Safety: An Essential Public Health Issue for the New Millennium. Geneva, Switzerland: Food Safety Programme, Department of Protection of the Human Environment, Cluster of Sustainable Development and Healthy Environments.
    [Google Scholar]
  2. Havelaar AH et al., 2015. World health organization global estimates and regional comparisons of the burden of foodborne disease in 2010. PLoS Med 12: e1001923.
    [Google Scholar]
  3. Mathee A, Von Schirnding YE, Byrne J, De Beer M, Letlape A, Hobbs C, Swanepoel F, 1996. The greater Johannesburg healthy foods/markets programme. Urban Health Newsl 1996 Mar (28):3947.
    [Google Scholar]
  4. Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR, 2001. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 6: 484490.
    [Google Scholar]
  5. Nasrolahei M, Mirshafiee S, Kholdi S, Salehian M, Nasrolahei M, 2017. Bacterial assessment of food handlers in Sari city, Mazandaran Province, north of Iran. J Infect Public Health 10: 171176.
    [Google Scholar]
  6. Faruque Q, Haque QF, Shekhar HU, Begum S, 2010. Institutionalization of Healthy Street Food System in Bangladesh: A Pilot Study with Three Wards of Dhaka City Corporation as a Model. Dhaka, Bangladesh: National Food Policy Capacity Strengthening Programme (NFPCSP). Available at: http://www.nfpcsp.org/agridrupal/sites/default/files/pR_7_of_04_Final_Techncial_Report_-_Approved.pdf. Accessed February 26, 2015.
    [Google Scholar]
  7. Abdussalam M, Kaferstein FK, 1993. Safety of street foods. World Health Forum 14: 191194.
    [Google Scholar]
  8. Todd EC, Greig JD, Bartleson CA, Michaels BS, 2008. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 5. Sources of contamination and pathogen excretion from infected persons. J Food Prot 71: 25822595.
    [Google Scholar]
  9. Vollaard AM, Ali S, van Asten HA, Ismid IS, Widjaja S, Visser LG, Surjadi C, van Dissel JT, 2004. Risk factors for transmission of foodborne illness in restaurants and street vendors in Jakarta, Indonesia. Epidemiol Infect 132: 863872.
    [Google Scholar]
  10. Rane S, 2011. Street vended food in developing world: hazard analyses. Indian J Microbiol 51: 100106.
    [Google Scholar]
  11. Nizame FA, Nasreen S, Halder AK, Arman S, Winch PJ, Unicomb L, Luby SP, 2015. Observed practices and perceived advantages of different hand cleansing agents in rural Bangladesh: ash, soil, and soap. Am J Trop Med Hyg 92: 11111116.
    [Google Scholar]
  12. Nizame FA, Unicomb L, Sanghvi T, Roy S, Nuruzzaman M, Ghosh PK, Winch PJ, Luby SP, 2013. Handwashing before food preparation and child feeding: a missed opportunity for hygiene promotion. Am J Trop Med Hyg 89: 11791185.
    [Google Scholar]
  13. Luby SP, Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston RB, 2009. Household characteristics associated with handwashing with soap in rural Bangladesh. Am J Trop Med Hyg 81: 882887.
    [Google Scholar]
  14. Manes MR, Kuganantham P, Jagadeesan M, Laxmidevi M, Dworkin MS, 2016. A step towards improving food safety in India: determining baseline knowledge and behaviors among restaurant food handlers in Chennai. J Environ Health 78: 1825.
    [Google Scholar]
  15. Onyeneho SN, Hedberg CW, 2013. An assessment of food safety needs of restaurants in Owerri, Imo state, Nigeria. Int J Environ Res Public Health 10: 32963309.
    [Google Scholar]
  16. Bryan FL, Bartleson CA, Christopherson N, 1981. Hazard analyses, in reference to Bacillus cereus, of boiled and fried rice in Cantonese-style restaurants. J Food Prot 44: 500512.
    [Google Scholar]
  17. Barro N, Bello AR, Savadogo A, Ouattara CAT, Iiboudo AJ, Traoré AS, 2006. Hygienic status assessment of dish washing waters, utensils, hands and pieces of money from street food processing sites in Ouagadougou (Burkina Faso). Afr J Biotechnol 5: 11071112.
    [Google Scholar]
  18. WHO/UNICEF. Joint Monitoring Programme (JMP) for Water Supply and Sanitation. Improved Unimproved Water Sources Sanitation Facilities. Available at: http://www.wssinfo.org/definitions-methods/watsan-categories/. Accessed November 30, 2015.
    [Google Scholar]
  19. Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, 2013. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.
    [Google Scholar]
  20. Bangladesh Bureau of Statistics, 2011. 2011 Population & Housing Census: Preliminary Results. Dhaka, Bangladesh: Bangladesh Bureau of Statistics.
    [Google Scholar]
  21. NIPROT, 2016. Bangladesh Urban Health Survey 2014. Dhaka, Bangladesh: National Institute of Population Research and Training (NIPORT), Associates for Community and Population Research (ACPR), and ICF International.
    [Google Scholar]
  22. Government of the People’s of Republic of Bangladesh MoLG, Rural Development and Cooperatives, Local Government Division, 2012. National Hygiene Promotion Strategy for Water Supply and Sanitation Sector in Bangladesh 2012. Available at: https://itn.buet.ac.bd/publications/sector-documents/documents/nhps.pdf. Accessed January 9, 2016.
    [Google Scholar]
  23. Keller H; NSP, IPHN, 2003. Life in the Chars in bangladesh, Nutritional Surveillance Project Bulletin no. 14. Dhaka, Bangladesh: Helen Keller. Available at: http://socialprotection.gov.bd/wp-content/uploads/2017/06/Nutrition-Livelihoods-in-Chars.pdf.
    [Google Scholar]
  24. Guest G, Bunce A, Johnson L, 2006. How many interviews are enough?: an experiment with data saturation and variability. Field Methods 18: 5982.
    [Google Scholar]
  25. Rabe-Hesketh SA, 2006. Multilevel modelling of complex survey data.J R Statist. Soc 169: 805827.
    [Google Scholar]
  26. United Nations, 2018. Sustainable Developement Goal 6. Available at: https://sustainabledevelopment.un.org/content/documents/19901SDG6_SR2018_web_3.pdf. Accessed June 30, 2018.
    [Google Scholar]
  27. WHO/UNICEF, 2017. WASH in the 2030 Agenda. New global Indicators for Drinking Water, Sanitation and Hygiene. Geneva, Switzerland: World Health Organization and the United Nations Children’s Fund (UNICEF).
    [Google Scholar]
  28. WHO, 2016. Monitoring WASH in Health Care Facilities. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  29. Huda TM, Unicomb L, Johnston RB, Halder AK, Yushuf Sharker MA, Luby SP, 2012. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med 75: 604611.
    [Google Scholar]
  30. Story M, Neumark-Sztainer D, French S, 2002. Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 102: S40S51.
    [Google Scholar]
  31. Gielen AC, Sleet D, 2003. Application of behavior-change theories and methods to injury prevention. Epidemiol Rev 25: 6576.
    [Google Scholar]
  32. Mensah P, Yeboah-Manu D, Darko KO-, Ablordey A, 2002. Street foods in Accra, Ghana: how safe are they? Bull World Health Organ 80: 546553.
    [Google Scholar]
  33. Nizame FA, Leontsini E, Luby SP, Nuruzzaman M, Parveen S, Winch PJ, Ram PK, Unicomb L, 2016. Hygiene practices during food preparation in rural Bangladesh: opportunities to improve the impact of handwashing interventions. Am J Trop Med Hyg 95: 288297.
    [Google Scholar]
  34. Amin N, Pickering AJ, Ram PK, Unicomb L, Najnin N, Homaira N, Ashraf S, Abedin J, Islam MS, Luby SP, 2014. Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. Am J Trop Med Hyg 91: 415423.
    [Google Scholar]
  35. BBS-UNICEF, 2010. Multiple Indicator Cluster Survey Bangladesh 2009. Dhaka, Bangladesh: Bangladesh Bureau of Statistics (BBS)-United Nation’s Children Fund (UNICEF).
    [Google Scholar]
  36. Ercumen A, Naser AM, Unicomb L, Arnold BF, Colford JM Jr., Luby SP, 2015. Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial. PLoS One 10: e0121907.
    [Google Scholar]
  37. Angulo FJ et al., 1997. A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order. Am J Public Health 87: 580584.
    [Google Scholar]
  38. PAHO, 1994. PAHO (Pan American health organization) Drinking Water Supply. Health Conditions in the Americas. Washington, DC: Scientific Publications vol. 54, 274277.
    [Google Scholar]
  39. Mankee A et al., 2003. Bacteriological quality of “doubles” sold by street vendors in Trinidad and the attitudes, knowledge and perceptions of the public about its consumption and health risk. Food Microbiol 20: 631639.
    [Google Scholar]
  40. Cousens S, Kanki B, Toure S, Diallo I, Curtis V, 1996. Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso. Soc Sci Med 43: 12991308.
    [Google Scholar]
  41. Islam MS, Hasan MK, Khan SI, 1993. Growth and survival of Shigella flexneri in common Bangladeshi foods under various conditions of time and temperature. Appl Environ Microbiol 59: 652654.
    [Google Scholar]
  42. Parvez SM, Kwong L, Rahman MJ, Ercumen A, Pickering AJ, Ghosh PK, Rahman MZ, Das KK, Luby SP, Unicomb L, 2017. Escherichia coli contamination of child complementary foods and association with domestic hygiene in rural Bangladesh. Trop Med Int Health 22: 547557.
    [Google Scholar]
  43. Alam M-U et al., 2017. A behavior change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a randomized control trial. Trop Med Int Health 22: 10001011.
    [Google Scholar]
  44. Ashraf S et al., 2017. Nonrandomized trial of feasibility and acceptability of strategies for promotion of soapy water as a handwashing agent in rural Bangladesh. Am J Trop Med Hyg 96: 421429.
    [Google Scholar]
  45. Draeger CL, Akutsu R, de Oliveira KES, da Silva ICR, Botelho RBA, Zandonadi RP, 2019. Unhygienic practices of health professionals in Brazilian public hospital restaurants: an alert to promote new policies and hygiene practices in the hospitals. Int J Environ Res Public Health 16: E1224.
    [Google Scholar]
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Supplemental appendix

  • Received : 11 Nov 2018
  • Accepted : 15 Jun 2019
  • Published online : 22 Jul 2019
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