RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / DINESH KUMAR JANGIRI YEAR M.SC( NURSING)
2. / NAME OF THE INSTITUTION / NOOR COLLEGE OF NURSING, NO.5, NOOR BUILDING, RMV 2nd STAGE,
BOOPASANDRA MAIN ROAD, BANGALORE-94
3. / COURSE OF THE STUDY AND
SUBJECT / I Year M. Sc (Nursing),
Community Health Nursing.
4. / DATE OF ADMISSION TO THE COURSE / 01.102011
5. / TITLE OF THE STUDY / A Study To Assess The Knowledge And Attitude of Food Handlers Regarding Food Hygiene At selected Urban Areas of Mathikere at Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK
6.0 INTRODUCTION
“Eat hygienic, live healthy”
Health is wealth; Food is one of the basic physiological necessities. Healthy and well balanced diet is essential for good health. Contaminated food represents one of the greatest health risks to a population and is a leading cause of disease out breaks and transmission.
The common man is busy with the life and most often tend to rely on the easily available and cheap food items mostly gathered from the street food vendors and hence are prone for the food borne diseases. Street food vendors are common in urban and peril urban areas, but they also operate in rural areas particularly if there is a market or community fair.
When we try to find out the different reasons of ill health we can find the diseases caused by food contamination which can happen at home and outside the home. It may be because of unhygienic cooking and multiple handling of the food by different food handlers.
Food sanitation is a subject of wide scope for better health and quality of life. It aims to study methods for the production, preparation and presentation of food, which is safe, and of food keeping quality of every variety of foodstuff and drink, and all the utensils and apparatus used in their preparation, service and consumption, but also care and treatment of food known to be contaminated with bacteria.1
Raw food stuffs cannot be kept in safe storage place and are easily contaminated by vermin and insects. The infections which are likely to be transmitted by the food handlers are Diarrhoea, dysenteries, and paratyphoid fever, enteroviruses, viral hepatitis, protozoal cysts, and eggs of helminthes, streptococcal and staphylococcal infections, and salmonellosis. More over, the street vendors often keep cooked food at ambient temperature for prolonged period of time and may heat the food only slightly before serving. This makes the food from street vendors’ dangerous.2
If one recognizes that ensuring food safety is inherently uncertain, food borne illnesses become opportunities to learn rather than failures to predict. Food borne disease will occur and we must be prepared to react quickly to reduce the risk of new food borne hazards.3
Hygiene is the science of preserving and promoting health mainly through individual effort. Every person should follow the rules of hygiene, so as to attain high standard of health.
There are six practices, which are related to food sanitation they are:
1 Practices related to personal hygiene, i.e.
a. How the food handler maintains food hygiene by his appearance
b. keeping nails clean, short, trimmed and unvarnished and by his habits of washing hands before touching food item,
c. Use of disinfectant for hand washing.
2 Practices of habits while cooking, i.e.
a. Testing the food with fingers repeatedly, who smokes, chews tobacco, and has respiration infections
b. Wiping the hands in aprons, or clothes
c. Not covering the hair while cooking.
3 Practices of food hygiene, e.g.
a. Utensils are washed properly
b. Food is covered
c. Floor is not swept while cooking the food
d. Clean water is used for cooking.
4 Pest control that is pests are visible on food and around establishment and if regular pest control measures are carried out.
5 Waste disposal i.e. garbage containers must be adequate in number and emptied frequently.
6 Construction of the kitchen.4
Health training is one of the mechanisms available for preventing food poisoning which is a major health issue in our society The training courses heighten the degree of knowledge regarding food-handling practices. In training course, greater emphasis must be placed on the subject of food preservation, preparation and serving than on those of personal hygiene and cleanliness of the surroundings.5
The national food agency is responsible for controlling and developing the hygiene proficiency system by collecting information, for e.g. from companies, municipal control authorities and proficiency.6
NEED FOR THE STUDY:
Over the past few years Indians are eating more meals outside their houses, the reason being having a busy life style, no time to cook food at home, and living in hostels, having parties with family, friends and relatives. In doing so, they have given up control over the safety of their food and have become dependent on street foods.
High rates of food borne illness indicate that street food vendors do not maintain appropriate levels of sanitation and suggest a need for a different approach to ensure food sanitation. The health department should examine such action as requiring training and food safety certification for food handlers and encouraging managers to take more responsibility for ensuring safe standards. Food borne bacterial gastrointestinal infections are important cause of morbidity and mortality worldwide, and despite successful control programme in some developed countries, these infections continue to have a major impact on public health and economy.7
Street vending as a profession has been in existence in India since time immemorial. However, their number has increased manifold in the recent years. According to one study Mumbai has the largest number of street vendors numbering around 250,000, while Delhi has around 200,000. Calcutta has more than 150,000 street vendors Ahmedabad and Bangalore has around 100,000. Women constitute a large number of street vendors in almost every city. Some studies estimate that street vendors constitute approximately 2 percentage of the population of a metropolis. The total number of street vendors in the country is estimated at around 1million.8
A study on Safety of vendor-prepared foods evaluation of 10 processing mobile food vendors in Manhattan was disserved unsanitary food handling was a major public health hazard. Over half of all vendors (67%) were found to contact served foods with bare hands. Four vendors were observed vending with visibly dirty hands or gloves and no vendor once washed his or her hands or changed gloves in the 20-minute observation period. Seven vendors had previously cooked meat products stored at unsafe temperatures on non-heating or non-cooking portions of the vendor cart for the duration of the observation. Four vendors were observed to contaminate served foods with uncooked meat or poultry. Each of these actions violates the New York City Code of Health and potentially jeopardizes the safety of these vendor-prepared foods and suggested for more stringent adherence to food safety regulations.9
Street food vendors in Indian cities have increased sharply during the past few years, especially after 1991 when the policies relating to structural adjustment and liberalization were introduced. It is now estimated that around 2.5 per cent of the urban population is engaged in this occupation. Studies on street vendors/hawkers are few and are focused mainly on some cities. In 2000, the National Alliance of Street Vendors in India (NASVI) organized a study on hawkers in
Seven cities which included Mumbai, Kolkata, Bangalore, Bhubaneswar, Patna, Ahmadabad and Imphal.10
Food when produced, stored, transported or served should be free from all sorts of contamination with germs or any harmful material, the workers should observe strict cleanliness, the utensil should be clean, and the kitchen should be insect free, rodent free, dust free and otherwise clean. Medical examination of workers should be done to find if they carry some diseases like typhoid or dysentery. If so, they should be stopped from handling food and given appropriate treatment.11
In India, the microbiological status of popularly consumed raw street foods, general hygiene and vending practices were not known. Vendors (having fixed stalls and with mobile stalls) operating in three major locations were listed mandi (open market place), bus terminus and railway station in New Delhi and Patiala City. Street vendors lacked access to potable water, toilet facilities and operated under poor hygienic conditions and presents of microbial organisms. The results of their study suggested that street vended coconut slices, coriander sauce and ready-to-eat salads could be important potential vehicles for food-borne diseases. 12
Commercially prepared foods such as meat, poultry and egg products are considered to be the primary source of salmonellosis. Most of these foods become contaminated during slaughter. Every food that is produced or processed in a contaminated environment may become contaminated. Cross-contamination of cooked foods from raw ingredients, kitchen utensils or surfaces has been described frequently as a cause of salmonellosis. Eggs may be infected directly through shell-cracks. Recent investigations suggest that salmonellae may penetrate the ovaries of egg-laying chickens. 13
Illness due to contaminated food was perhaps the most widespread health problem in the contemporary world and an important cause of reduced economic productivity. The researcher intends to inculcate better hygienic practices among the unregistered food handlers. Suggesting measures which would provide a degree of protection against microbial proliferation and cross contamination will help to improve the hygiene habits of the vendors. Finally educating the unregistered food handlers regarding personal hygiene so as to remain healthy themselves and not to carry diseases through their hands. 14
Reviewing the current situation of unregistered food handlers, it is therefore essential to assess the knowledge and practices of unregistered food handlers and help them understand the importance of hygiene and teach regarding food hygiene.
6.2 REVIEW OF LITERATURE
A review of related literature gives an insight in to the various aspects of the problems under study. The reviewed literature is organized into:
· Health problems resulting from food.
· Knowledge and practice of unregistered food handlers.
LITERATURE RELATED TO HEALTH PROBLEMS RESULTING FROM FOOD
A retrospective cohort study was conducted in U.S. for identifying the source of a gastroenteritis outbreak with 325 samples. The overall attack rate was 56%. Of the four working days of possible food borne exposure to norovirus (Monday till Thursday), Wednesday (risk ratio RR: 18.82; 95% CI 11.82-29.96) and Thursday (RR 2.14; 95%, CI 1.65-2.79) turned out to be the most likely days on which infections with norovirus occurred. The day-by-day food specific cohort analysis yielded consumption of salad on Wednesday (adjusted RR 2.82; 95 percent CI 1.0-7.94) to be associated with highest risk of illness. The most likely source of food contamination is a kitchen assistant having prepared salad manually. 17
A study on Street foods was conducted in Accra, Ghana: How safe are they? Most vendors were educated and exhibited good hygiene behavior. Examinations were made of 511 menu items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes. Mesophilic bacteria were detected in 356 foods (69.7 percent): 28 contained Bacillus cereus (5.5 percent), 163 contained Staphylococcus aureus (31.9 percent) and 172 contained Enterobacteriaceae (33.7 percent). The microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni, and red pepper had unacceptable levels of contamination.18
A study conducted on Bacteriological analysis of street foods in Pune with an aim to analyze the bacteriological profile of street foods sold in various parts of Pune city with 75 randomly collected food samples. Samples were processed for the presence of bacterial pathogens only. 88% of the food samples analyzed confirmed the presence of bacterial pathogens, indicating the need for stricter implementation of food sanitation practices to reduce the possible risk of transmission of infection on consumption of these foods.19
A study conducted on Prevalence of enterotoxigenic Staphylococcus aureus and Shigella in some raw street a total of 150 samples. Enterotoxigenic Staphylococcus aureus were detected in 91 (60%) samples of coriander sauce, 87 (58 %) samples of coconut slices and 129 (86 percent) samples of ready-to-eat salads. Twenty-three (15 percent) samples of coconut slices contained Shigella 13 (8%) samples of ready-to-eat salads and 10 (6%) samples of coriander sauce contained Shigella. Street vendors lacked access to potable water, toilet facilities and operated under poor hygiene conditions. 20
A study on Risk factors for transmission of food borne illness in restaurants and street vendors in Jakarta in Indonesia. Faecal contamination of drinking water (65%), dishwater (91%) and ice cubes (100%) was frequent. Directly transmittable pathogens including S. typhi and non-typhoidal Salmonella were isolated in faecal samples in 13 (7%) vendors; the groups did not differ, however, in contamination rates of drinking water and Salmonella isolation rates in stools. 21
LITERATURE RELATED TO KNOWLEDGE AND PRACTICE OF FOOD HANDLERS.
A descriptive cross-sectional study was carried out to assess the knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State using a semi-structured researcher-administered questionnaire. A majority (98%) of the respondents had formal education. Knowledge was significantly influenced by previous training in food hygiene and safety (p = 0.002). Food handlers who had worked for longer years in the fast food restaurants had better practice of food hygiene and safety (p = 0.036). The level of education of respondents did not significantly influenced their practice of food hygiene and safety (p = 0.084). Although, 299 (85.4%) food handlers were generally clean, skin lesions was seen in 4 (7.3%) of them. This study showed there is need for improvement through training and retraining of food handlers by the management of the restaurants and the local government authorities.22
A study was conducted to assess the cleanliness of food preparation areas, cleaning and disinfection methods used, and the microbiological quality of potable and/or bottled water used by traders with 4607 samples. Samples collected included water samples (1102), cleaning clothes (801), chopping boards (834), tap nozzles (569), food containers (508), water container bottle neck (463), work topsurfaces (232), and serving counters (98). Cleaning clothes were more heavily contaminated with bacteria (Aerobic Colony Count, Enterobacteriaceae, Escherichia coli, and Staphylococcus aureus) compared to the surfaces sampled. Surfaces that were visually dirty, wet, and chopping boards that were plastic scored or damaged were also found to have higher levels of these bacteria.23