75 Journal homepage: www.fia.usv.ro/fiajournal Journal of Faculty of Food Engineering, Ştefan cel Mare University of Suceava, Romania Volume XVIII, Issue 2 - 2019, pag. 75 - 81 HAND HYGIENE PRACTICES AMONG STREET FOOD VENDORS *Alexander Fiifi GHARTEY 1 , Barima Kwabena ANTWI 2 1School of Medicine and Health Sciences, Central University, P.O. Box 2305, Tema,Miotso, Ghana, xff_ghartey@yahoo.com, 2Faculty of Social Sciences, University of Cape Coast, Ghana, kantwi@ucc.edu.gh. *Corresponding author Received 26th March 2019, accepted 29th June 2019 Abstract: The purpose of this paper is to assess the nature and extent of hand hygiene practices in the street food business in selected districts in Southern Ghana. Though street-vended foods have many health and socio-economic benefits, they often pose significant public health risk to consumers. Codex Alimentarius standards identify the hand of the vendor (or the consumer) as a ‘high-risk’ factor or conduit in street food contamination. The study applied cross-sectional descriptive survey with observation of street food vendor practices using a structured questionnaire in a face to face interview of 413 vendors randomly selected. While almost half of vendors (47.9%) were observed to handle food with their bare hands in the selling process, nearly one-fifth of vendors (18.4%) did not wash their hands with water and soap after visiting the toilet. Vendor fingernail hygiene was however not a major risk factor. It is also revealed that there is a significant positive relationship between food vendor’s educational status and proper hand washing practices. It is recommended that respective local authorities in collaboration with other stakeholders be more proactive in the enforcement of food safety regulations regarding hand hygiene and food handling. Keywords: Street-vended food, Codex Alimentarius, Hand, Contamination, Food-borne Diseases. 1. Introduction Street-vended food (SVF) refers to a wide range of ready-to-eat-food, prepared and sold along streets and several other public places such as lorry stations, parks, schools, construction sites and all locations where there is a high number of potential customers. About 2.5 billion people worldwide patronize SVF on daily basis [1]. In most developing countries including Ghana, SVFs are commonly and widely patronized by public/civil servants, school children, travelers/tourists, market women, petty traders, artisans, and the general public [2,3]. The street-vended food trade thus contributes significantly to food security and nutrition by providing comparatively inexpensive, and easily accessible tasty foods to millions of consumers. Additionally, it provides vast employment opportunities in the private sector, thus guaranteeing a decent livelihood for millions of street-food vendors (SFVs).However, SVF often pose significant public health risk to consumers. Concerns about SVF safety stem from the risk of faecal contamination of street food with the human hand as a conduit, potentially culminating in infection and outbreak of food borne diseases (FBDs) and outcomes of death or personal injury to the consumer. As an endogenous risk factor, contaminated hand thus plays a major role in faeco-oral transmission through food [4,5]. The purpose of this study was to assess the nature and extent of hand hygiene practices in the street food business with the aim of adding on to existing knowledge in food hygiene and safety. Benchmarks of the WHO Codex http://www.fia.usv.ro/fiajournal mailto:mariap@fia.usv.ro Food and Environment Safety - Journal of Faculty of Food Engineering, Ştefan cel Mare University - Suceava Volume XVIII, Issue 2 – 2019 Alexander Fiifi GHARTEY & Barima ANTWI, Hand Hygiene Practices Among Street Food Vendors, Food and Environment Safety, Volume XVIII, Issue 2 – 2019, pag. 75 - 81 76 Alimentarius for street-vended foods constitute the international standards for assessing food safety. WHO Five Keys to Safer Food relate to specific practices including washing the hands before handling food and during food preparation. Others include washing the hands thoroughly with water and soap after visiting the toilet to prevent food contamination from faecal matter; washing the hands after handling raw food such as meat, changing baby’s diaper, blowing the nose and after handling rubbish, maintaining trimmed and clean fingernails and washing the hands thoroughly with water and soap before eating [6]. The individual street-food vendor, the consumer, and respective local authorities are all stakeholders in striving to achieve street-vended food safety [7]. Surveys in Africa, Asia, and Latin America suggest that in developing countries, ready-to-eat food sold along the streets and other public places, pose a significant public health burden to consumers. Poor personal hygiene of street food vendors, especially with respect to hand washing and food handling practices is considered a major preventable ‘high-risk’ factor [8, 9, 10, 11, 12]. Even in advanced countries, street- food vendors contact-serve foods with bare hands [13]. In Ghana, foods mainly prone to contamination are foods “handled excessively after cooking” and that the risk of “contamination was reduced where vendors sold food from the cooking pots” [14]. In Ghana between 70% and 95% of food vendors wash their hands regularly in the process of vending [15,16,17]. This assertion is however contradicted by some recent studies in Northern Ghana [18] hence the justification for this study. A principal contamination risk factor of public health concern linked to food handling is the concurrent handling of food and money because of the presence of certain pathogens such as E. coli, S. aureus and Salmonella spp. on banknotes or currencies [19-21].Similarly, food handler nasal carriage of Staphylococcus aureus is a potential food contaminant through nose picking[22]. On the other hand, fingernail hygiene practices differ from one geographical area to the other [23-25]. The tendency of food vendors to properly wash their hands also depends on access to improved water sources [26-28]. Ultimately deficiencies in food safety and hygiene practices may be attributable to inadequate food regulation enforcement by the local authorities [29]. 2. Materials and Methods 2.1 Study Area The study was carried out in two selected districts of the Central Region of Ghana, namely Komenda Edina Eguafo Abrem (KEEA) municipal district (Figure 1) and the Ajumako Enyan Essiam (AEE) (Figure 2) district between January and May 2015. The KEEA municipality is located along the coast of Southern Ghana. The KEEA, whose capital Elmina, houses the St George Castle, a UNESCO designated world heritage site, is a major tourist destination. Notable socio-economic activities in the municipality are petty trading including food vending. On the other hand, the AEE District with Ajumako as its capital is located inland away from the coast. This district, predominantly rural, covers an area of about 521.3sq.km. Dominating the district economy is agriculture and the sales sectors consisting of a large number of street-food vendors operating at various market centers and public places. Food and Environment Safety - Journal of Faculty of Food Engineering, Ştefan cel Mare University - Suceava Volume XVIII, Issue 2 – 2019 Alexander Fiifi GHARTEY & Barima ANTWI, Hand Hygiene Practices Among Street Food Vendors, Food and Environment Safety, Volume XVIII, Issue 2 – 2019, pag. 75 - 81 77 Figure 1: Map of the KEEA Municipal District. Methods & Sample Size The main objective of this survey was to study the role of the hand of food vendor as a risk factor to food safety. A cross- sectional survey of food vendors selling along streets and other public places was used. A study sample size of 413 food vendors was performed. In all a number of 266 food vendors were interviewed in the KEEA, and 147 in the AEE District using a structured questionnaire. The selected food vendors were obtained from one-third of localities in each district randomly sampled from a sampling frame of localities for each district. The sampling frame for the KEEA municipality had 36 localities while that of the AEE District had 45 localities. Food vendors were mainly interviewed at low peak hours (in- between breakfast, lunch and dinner hours) to minimize interruptions of interviews by customers. Alongside the interview process was the observation of vendor food safety practices and behaviors. Data Analysis Data entry and analysis were conducted using SPSS Version 21 software. The validity and reliability of the data were enhanced by pre-testing the instruments and the constructs revised appropriately before data collection. Averagely seven minutes were used in keying each questionnaire data into the SPSS data editor. 3. Results and Discussion 3.1 Vendor Socio-Demographic Profile Overwhelming majority (97.3%) of street- food vendors in the study area were females (Table 1). The study thus confirms street-food vending as a major source of income and livelihood for middle-aged women in the private sector. Additionally, Table 2 reveals that majority of food vendors were illiterates. Overall, 84.5 per cent of vendors had education below the senior high school level. Whereas only 1.2 percent had tertiary education, 15.3 percent of vendors had had no formal schooling. Majority (39.2%) of vendors also fell within the age bracket of 30 to 39 years with an arithmetic mean age of 34.98 years (Table 2). It was also found that majority of food vendors (83.3%) plied their trade at a stationary public place whiles 16.7 per cent were mobile vendors usually called hawkers. This finding has a major implication for town and urban planning. In the main it was found that designated food vending areas lacked adequate sanitary facilities. Food and Environment Safety - Journal of Faculty of Food Engineering, Ştefan cel Mare University - Suceava Volume XVIII, Issue 2 – 2019 Alexander Fiifi GHARTEY & Barima ANTWI, Hand Hygiene Practices Among Street Food Vendors, Food and Environment Safety, Volume XVIII, Issue 2 – 2019, pag. 75 - 81 78 Table 1 Socio-Demographic Profile of Vendors KEEA AEE Total Freq (266) % Freq (147) % Freq (413) % Types of Vendors Stationary 198 74.4 146 99.3 344 83.3 Mobile 68 25.6 1 0.7 69 16.7 Sex Male 9 3.4 2 1.4 11 2.7 Female 257 96.6 145 98.6 402 97.3 Education No Schooling 42 15.8 21 14.3 63 15.3 Primary 24 9 35 23.8 59 14.3 JHS Middle 128 48.1 75 51 203 49.2 Voc Tech 11 4.1 5 3.4 16 3.9 SHS 49 18.4 10 6.8 59 14.3 Tertiary 4 1.5 1 0.7 5 1.2 Arabic 8 3 0 0 8 1.9 Table 2 Age (Years) Distribution of Street-Food Vendors N Range Minimum Maximum Mean Std Dev Variance Ages in years 413 50 15 65 34.98 8.958 80.138 As shown in Table 3, majority of vendors in the study area (61.3%) said they washed their hands with water and soap before preparing food and during vending (even though this could not be verified). Overall, over one-third of vendors (38.7 percent) conceded to not washing their hands with water and soap during the vending process while nearly half of vendors (47.9%) handled food with their bare hands in the vending process. Also 81.6 percent of vendors intimated that they washed their hands with water and soap after visiting the toilet. This implies that overall nearly one- fifth of vendors (18.4%) did not wash their hands with water and soap after visiting the toilet. Table 3 also reveals that over one- third of food vendors (35.1%) were caring for children at the time of the study. And of all food vendors studied, 16.7 percent who were carriers of children said they handled food with their bare hands. These findings suggest that nearly one-fifth of vendors who changed used children dippers, handled vended food with bare hands thus making ‘child care’ an indirect risk factor to food handling and food safety. This makes food handling a key risk factor in food vending in the study area and brings to question the effectiveness of regulation enforcement practices. The length and cleanliness of vendor fingernails is also an important consideration in hand hygiene practices because safe hand washing practices includes keeping clean and trimmed fingernails. Food and Environment Safety - Journal of Faculty of Food Engineering, Ştefan cel Mare University - Suceava Volume XVIII, Issue 2 – 2019 Alexander Fiifi GHARTEY & Barima ANTWI, Hand Hygiene Practices Among Street Food Vendors, Food and Environment Safety, Volume XVIII, Issue 2 – 2019, pag. 75 - 81 79 Figure 2: Map of Ajumako Enyan Essiam District Table 3 suggests that vendor fingernail hygiene was not a major risk factor in the study area. Only 9 (2.2%) of food vendors were observed to wear long fingernails. The tendency for food vendors to properly wash their hands may depend on access to improved water sources. Table 3 Food Vendor Hand Hygiene Practices KEEA AEE Total Freq (266) % Freq (147) % Freq (413) % Fingernail hygiene Long nails 2 0.8 7 4.8 9 2.2 Short nails 264 99.2 140 95.2 404 97.8 Handling of food Bare hands 125 47.0 73 49.7 198 47.9 Protected hand 141 53.0 74 50.3 215 52.1 Vendor Handwashing No hand washing 40 15.0 4 2.7 44 10.7 Only water 35 13.2 79 53.7 114 27.6 Muddy water 0 0 1 0.7 1 0.2 Water and soap 191 71.8 62 42.2 253 61.3 Wiping with cloth/napkin 0 0 1 0.7 1 0.2 Handwashing after Toilet Don’t wash hands 3 1.1 0 0 3 0.7 Wash hand with water 33 12.4 39 26.5 72 17.4 Wash hands/ water & soap 230 86.5 107 72.8 337 81.6 Bath before vending 0 0 1 0.7 1 0.2 Child care Yes 83 31.2 62 42.2 145 35.1 No 183 68.8 85 57.8 268 64.9 A Chi-Square hypothesis test (Table 4) conducted shows that there is a significant positive relationship between food vendor educational status and hand washing Food and Environment Safety - Journal of Faculty of Food Engineering, Ştefan cel Mare University - Suceava Volume XVIII, Issue 2 – 2019 Alexander Fiifi GHARTEY & Barima ANTWI, Hand Hygiene Practices Among Street Food Vendors, Food and Environment Safety, Volume XVIII, Issue 2 – 2019, pag. 75 - 81 80 practices in the study area. Chi-Square Pearson’s Correlation Coefficient (R= 69.349, df= 20, P-value= 0.000. P- value of 0.000 < statistical significance of 0.05, i.e. 5%). This finding signals the importance of education and schooling to food safety. Significantly, access to potable water sources was not a major challenge. Table 4 Chi-Square Hypothesis Tests- Education status and Hand Washing Practices Value df Asymp. Sig. (2-sided) Pearson Chi-Square 69.349 a 20 .000 Likelihood Ratio 52.210 20 .000 Linear-by-Linear Association 12.972 1 .000 N of Valid Cases 413 4. Conclusion Hand hygiene is one of the most important strategies for infection control. Proper hand washing is necessary because hands frequently transport microorganisms and could be a major source of food contamination. Scrupulous hand-washing by food handlers results in the prevention of the spread of pathogenic microorganisms. The study reveals an unsatisfactory handwashing practices among food vendors. 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Introduction