University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA HYGIENIC PRACTICES OF FOOD VENDORS; EFFECT ON CONSUMER FOOD SAFETY ON THE UNIVERSITY OF GHANA CAMPUS BY NANCY ABENA MANKO (10598384) THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MPHIL HEALTH SERVICES MANAGEMENT DEGREE JULY, 2018 University of Ghana http://ugspace.ug.edu.gh DECLARATION I solemnly declare that this thesis entitled “Hygienic practices of food vendors; effect on consumer food safety on University of Ghana campus, Legon,” submitted to the University of Ghana is a record of an original work done by me under the supervision of Patience Aseweh Abor (PhD). This thesis is submitted in partial fulfilment of the requirement for the award of a degree in MPhil Health Services Management. The results embodied in this thesis have not been submitted to any other University or Institute for the award of any degree. ……………………………….. ... ……………………………. NANCY ABENA MANKO DATE (STUDENT) i University of Ghana http://ugspace.ug.edu.gh CERTIFICATION I hereby certify that this thesis was supervised in accordance with the procedures laid down by the University ………………………………… .. ………………………… DR. PATIENCE ASEWEH ABOR DATE (SUPERVISOR) ii University of Ghana http://ugspace.ug.edu.gh DEDICATION This project work is dedicated to the almighty God for his guidance and protection throughout the study and through whose grace I am alive to present this dissertation. To my wonderful uncle, mother, siblings and all my loved ones need a special mention for their support during my entire MPhil Health Services Management programme. iii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I thank the teaching staff of Graduate Business School, University of Ghana especially my lecturers for their guidance and support during my entire MPhil Health Services Management programme. I wish to express my indebtedness and sincere gratitude to Dr Patience Aseweh Abor my supervisor for her interest and zeal, warmth, patience and hard work. Her support made it possible for this study to be successfully completed. I am also indebted to the authors whose works were consulted in the course of this work and also grateful to all persons who in one way or the other contributed to making this thesis a success. iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS UNIVERSITY OF GHANA ................................................................................................. 1 DECLARATION.................................................................................................................... i CERTIFICATION ................................................................................................................ ii DEDICATION..................................................................................................................... iii ACKNOWLEDGEMENT ................................................................................................... iv LIST OF TABLES ............................................................................................................... xi LIST OF ACRONYMS .................................................................................................... xiii ABSTRACT ........................................................................................................................... 1 CHAPTER ONE ................................................................................................................... 3 1.0 INTRODUCTION........................................................................................................... 3 1.1 Introduction ......................................................................................................................3 1.1 Background of the Study ..................................................................................................3 1.2 Statement of the Problem .................................................................................................5 1.3 Objectives of the study………………………………..………………………………5 1.4 Research Questions ........................................................................................................ 7 1.5 Significance of Study .......................................................................................................8 1.6 Scope of the study ............................................................................................................8 1.7 Operational Definitions ....................................................................................................9 1.8 Organisation of study .....................................................................................................10 1.9 Chapter summary ...........................................................................................................10 v University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO ................................................................................................................ 12 2.0 LITERATURE REVIEW ............................................................................................ 12 2.1 Introduction ....................................................................................................................12 2.2 Review of Theoretical Literature ...................................................................................12 2.3 Concept of Hygiene ........................................................................................................13 2.4 Concept of Food .............................................................................................................14 2.5 Food Safety ....................................................................................................................14 2.6 Food Borne Diseases ......................................................................................................16 2.7 Food Vending .................................................................................................................20 2.8 Hygienic Practices among Food Vendors ......................................................................21 2.9 Effects of Hygienic Practices of Food Vendors on food safety .....................................23 2.10 Training Needs of Vendors ..........................................................................................25 2.11 Review of Empirical Literature ....................................................................................26 2.12 Conceptual Framework ................................................................................................32 Fig 2.1: Diagram Showing Various Stakeholders/Dimensions in Hygienic Food Management ......................................................................................................................... 1 2.13 Chapter summary .........................................................................................................34 CHAPTER THREE ............................................................................................................ 35 3.0 METHODOLOGY ....................................................................................................... 35 3.1 Introduction ....................................................................................................................35 3.2 Research Paradigm .........................................................................................................35 3.3 Research design ..............................................................................................................36 vi University of Ghana http://ugspace.ug.edu.gh 3.4 Research setting/Area .....................................................................................................36 3.5 Research Approach ........................................................................................................37 3.6 Source of data .................................................................................................................38 3.7 Target population ...........................................................................................................38 3.8 Sampling procedure........................................................................................................39 3.8.1 Sampling technique .....................................................................................................39 3.8.2 Sample size determination ..........................................................................................40 3.8.3 Inclusion criteria ..........................................................................................................41 3.8.4 Exclusion criteria.........................................................................................................42 3.9 Instrument.......................................................................................................................42 3.9.1 Observation .................................................................................................................42 3.9.2 Questionnaire ..............................................................................................................43 3.9.3 Interview......................................................................................................................44 3.10 Pre-Testing ...................................................................................................................44 3.11 Validity of the Instrument ............................................................................................45 3.12 Data Gathering Procedure ............................................................................................45 3.13 Instrument for Data Analysis .......................................................................................47 3.14 Ethical considerations ..................................................................................................48 3.15.1 Consent procedures ...................................................................................................48 3.15.2 Confidentiality ...........................................................................................................49 3.15.3 Potential risk ..............................................................................................................49 vii University of Ghana http://ugspace.ug.edu.gh 3.16 Chapter Summary .........................................................................................................49 CHAPTER FOUR ............................................................................................................... 51 4.0 PRESENTATION OF RESULTS ............................................................................... 51 4.1 Introduction ....................................................................................................................51 4.2 Descriptive Information ..............................................................................................51 4.2.1 Socio-demographic characteristics of food vendors (n=31) .......................................51 4.3 Components on observation check-list explained ..........................................................53 4.3.1 (Night market, n= 16) ..................................................................................................53 4.4 Descriptive Statistics ......................................................................................................73 4.4.1 Demographic Characteristics of Respondents (student consumers, n = 300) .............73 4.5 Effect of Hygienic Practices of Food Vendors on Consumer Food Safety ....................89 4.21 Analysis of Interview data for grounds and environmental health services officers on the University of Ghana campus ..........................................................................................94 4.21.1 Socio-demographic characteristics of officers ..........................................................95 CHAPTER FIVE .............................................................................................................. 103 5.0 DISCUSSION OF FINDINGS ................................................................................... 103 5.1 Introduction ..................................................................................................................103 5.2 Hygienic Practices among Food Vendors during food preparation and the selling process ................................................................................................................................103 5.3 Assessment of the Effects of Hygienic Practices of Food Vendors on Consumers‟ Food Safety ..................................................................................................................................105 5.4 The nature and effectiveness of food safety training needs of food vendors ...............106 viii University of Ghana http://ugspace.ug.edu.gh 5.5ChapterSummary……………………………………………………………………104 CHAPTER SIX ................................................................................................................. 109 6.0 SUMMARY, RECOMMENDATION AND CONCLUSION ................................. 109 6.1 Introduction ..................................................................................................................109 6.2 Summary ......................................................................................................................109 6.3 Recommendations ........................................................................................................110 6.3.1 Implications for Policy ..............................................................................................110 6.3.3 Implications for Research..........................................................................................112 6.4 Conclusion ....................................................................................................................112 REFERENCES .................................................................................................................. 114 APPENDICES ................................................................................................................... 129 ix University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Fig 2.1: Diagram Showing Various Stakeholders/Dimensions in Hygienic Food Management .................................................................................................................................................... 1 Fig 4.3 Chart showing respondents linkage of ailment to food patronage .............................. 80 Fig 4.5 Chart showing respondents patronage of food after ailment ....................................... 82 Fig 4.6 Chart showing respondents reasons for still patronizing foods on campus after ailment .................................................................................................................................................. 83 Fig 4.7 Chart showing respondents knowledge on food safety practices ................................ 84 Fig 4.8 Chart showing some of the food safety practices respondents know .......................... 85 Fig 4.9 Chart showing respondents view on if food vendors practice food hygiene ............... 86 Fig 4.10 Chart showing respondents view of acts that shows unhealthy food practices ......... 87 Fig 4.11 Chart showing respondents view on organizing a training program for consuming . 88 Fig 4.12 Chart showing respondents reason for training consumers ....................................... 89 x University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 4.1 Socio-demographic characteristics of food vendors (n=31) .................................... 52 Table 4.2 Table showing Socio-demographic characteristics of student consumers (n= 300) 74 Table 4.3 Food Mostly Patronized by Respondents ................................................................ 76 Table 4.4 How Frequent Respondents buy Food from Vendors ............................................. 77 Table 4.5 respondents reason for buying food outside ............................................................ 77 Fig 4.4 Respondents reasons for attributing ailment to food bought. ...................................... 81 Table 4.6 Gender of respondents who suffered ailment after eating from vendors ................. 90 Table 4.7 Age group in relation to ailment .............................................................................. 91 Table 4.8 complications respondents suffered from, as a result of eating contaminated food (by gender) ............................................................................................................................... 91 Table 4.9 Gender direct link of stomach upset to food ............................................................ 92 Table 4.10 Age of respondents who directly suffered from food contamination .................... 93 Table 4.11 Factors linked to complications after eating food from vendor ............................. 94 xi University of Ghana http://ugspace.ug.edu.gh LIST OF PLATES Plate 4.1 Photograph showing a food vendor with no apron, hair cap nor gloves ................... 71 Plate 4.2 Photograph showing unhygienic refuse disposal at food preparation site ................ 72 Plate 4.3 state of the surrounding of a food outlet where food is cooked. ............................... 72 Plate 4.4 Photograph showing used bowls kept unwashed with a used mobs lying on surfaces food are prepared ..................................................................................................................... 73 xii University of Ghana http://ugspace.ug.edu.gh LIST OF ACRONYMS WHO World Health Organisation FAO Food and Agricultural Organisation FDA Food and Drug Authority MoH Ministry of Health GMP Good Manufacturing Practices GHPS Good Hygienic Practices FERG FBD Epidemiology Reference Group IDSP Integrated Disease Surveillance Programme PDMSD Physical Development Municipal Services Directorate SPSS Statistical Package for Social Scientist CDC Centre for Disease Control xiii University of Ghana http://ugspace.ug.edu.gh ABSTRACT The selling of street foods is regarded as a great aspect of the economies of many developing countries due to its socio-economic benefits. In Ghana, the sector provides numerous job opportunities for people in the country. Despite its importance, many have complained about the hygiene, quality and the safety of street foods as these foods have been associated with food poisoning and other food-borne diseases. This is due to the fact that food vendors are ignorant of basic food safety needs; therefore, exposing these foods to all kinds of dangerous abuses often at all the stages of food handling. The purpose of the study was to examine the hygienic practices of food vendors and its effects on consumer food safety on the University of Ghana campus. The mixed method approach was adopted with the sequential transformative design as the research design. Thirty-one food vendors, 2 Grounds and Environmental Health Services Officers and 300 student consumers at the University of Ghana main campus were sampled for the study using purposive sampling and purposive random sampling technique respectively. To collect the qualitative data, food vendors and Grounds and Environmental Health Services Officers were observed and interviewed respectively using naturalistic observation and structured face-face interview. A semi- structured questionnaire was used to collect quantitative data from student consumers. Qualitative data were analysed in themes and quantitative data were analysed with SPSS version 20 and results presented in frequency distributions and charts. The findings of the study indicate that food vendors at the University of Ghana campus do not engage in safe food practices even though they are knowledgeable about safe food practices. The study again found out that due to their (food vendors) lack of adherence to safe food practices on the University of Ghana campus; most of the students usually suffer from food poisoning. Finally, the study again established that even though training needs are organized for food vendors on the University of Ghana campus, these training needs are not enough and 1 University of Ghana http://ugspace.ug.edu.gh adequate to equip them with all the necessary skills and knowledge they need in ensuring food safety practices. These findings should inform policy, practice and research as far as food safety practices are concerned. 2 University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE 1.0 INTRODUCTION 1.1 Introduction This chapter presents the background of the study, statement of the research problem, research objectives and research questions. The chapter further discusses the significance, the scope, as well as the chapter organization of the study. 1.1 Background of the Study Street foods are ready- to- eat foods and beverages prepared and sold by vendors or hawkers in streets and other public places (FAO, 2013). Street foods contribute significantly to the diet of many people in the developing world (FAO 2010; Sunitha, Manjula, & Depur, 2011). Food sold in the streets by food vendors serves a significant position in low and middle income countries in providing food for those living in the cities. Street foods provide millions of people daily with a wide variety of foods that are relatively cheap and easily accessible (Muinde and Kuria, 2005; Mensah et al., 2002). In most developing countries, the food sector tends to attract people with low level skills, training and educational qualification who could otherwise not get formal sector employment. Low set-up financial requirement and ease of entry into the sector enable most urban and peri-urban poor to enter into the sector as a coping strategy (FAO, 2009). According to the World Health Organization (WHO, 1996:2), the sector offers an opportunity for self-employment and the chance to develop business skills with low capital investment. In Ghana, the street food industry is a million-dollar sector. In 2002, the sector was estimated to employ about 60,000 street food vendors in urban Accra with an annual turnover of US 3 University of Ghana http://ugspace.ug.edu.gh $100million (Tomlins, 2002). The operation of fast food joints, restaurants and chop bars has increased in the Ghanaian community, especially in the urban areas (Ayeh-Kumi et al, 2009). Nonetheless, food safety is a serious concern with street foods, as these foods are most of the times cooked and sold under unsanitary conditions, with limited access to safe water, sanitary services, or waste disposal facilities (Rheinländer et al., 2008). In developing countries, factors such as poverty, lack of adequate health care facilities, lack of adequate food inspectors and other public health workers have led to the issue of foodborne diseases and illness becoming one of the leading causes of morbidity and death among the population (Abelson, Forbes & Hall, 2006). According to FAO (2002) figures, over 1.8 million people from developing and under-developed countries die from foodborne diseases annually. A related study indicated that, only three (1.85%) out of 160 streets food stands owners in Ghana met the requirements for basal hygiene based on a five-point check-list (King et al 2008). The rapid proliferation of cholera epidemic and other hygiene-related diseases coupled with the lives it claims annually has led the call for strict hygienic conditions be maintained at all times especially at places where food vending takes place. It is no secret that the outbreak of foodborne diseases and illness has been increasing at an unprecedented rate in both the developed and developing nations across the globe (Gessner&Beller, 2014). Nonetheless, in developed countries, the existence of strict regulations on food handling and management as well as the effective role of food inspectors and other public health workers have resulted in containing the issues of the negative impact of food contamination in the population. In developing countries like Ghana, the converse is true (FAO, 2013). In Ghana, the story is no more different from other developing nations across the globe. Per the estimates of the Ministry of Food and Agriculture and the World Bank (2006), 1 in every 40 Ghanaian suffers foodborne disease or ailments annually which translates into 420,000 reported cases annually with the death rate of 65,000 which cost the government $69 million 4 University of Ghana http://ugspace.ug.edu.gh annually (World Bank, 2007). It has even been suggested that the figures could be far higher than these as individuals who patronize health facilities with foodborne illness is very low due to poverty and lack of access to medical facilities in some communities across the country and as such, will rely on traditional herbal medications. In view of this, the Food and Drugs Authority (FDA) estimated the loss of productivity in 2006 as a result of foodborne diseases and illness to be approximately 594, 279 (19, 809) months and this loss of productivity is a huge cost to the state and the government aside the money expended in fighting foodborne diseases and illness. This, therefore, makes the issue of food preparation and vending across the streets in the country an issue of monumental national importance. 1.2 Statement of the Problem Over the years and in recent times the street food sub sector has gained a lot of attention from public health practitioners, local and international organizations as well as social science researchers (Zeru et al., 2007). Even though the food chain industry is considered an important part of the economies of many developing countries by providing employment and readily accessible cooked meal at relatively cheaper prices, there have been major concerns over the quality and safety of street foods (Wuliyeng, 2013). Street food is often regarded unhygienic and of low quality, sometimes due to the poor environmental conditions under which food is prepared or sold, and also due to inadequate knowledge in food safety regarding food preparation and handling by food vendors (Rheinlander, 2006; FAO, 2009; Annan-Prah et al., 2011). According to Zeru et al. (2007) and Mukhopadhyay et al. (2012), in low and middle income countries, approximately 70% of cases of diarrheal disease are linked to the eating of unwholesome food. This is because most handlers of street foods in Africa and the developing world at large, to a great extent are lacking in knowledge, education or training on basic food safety issues. As a result, street foods are often susceptible to unsafe 5 University of Ghana http://ugspace.ug.edu.gh abuses, in many cases at all stages of handling products (from the raw material to the finished stage) are often laid open to sources of contamination (Annor et al, 2011). Various factors have been said to be associated with unhygienic practice among street food vendors which include inefficient or lack of effective education, training of food vendors on health and hygiene, non-provision of needed infrastructure as well as non-regulation and enforcement of by-laws governing street food vending by local authorities ( ISSER, 2002; Wuliyeng, 2013) ). According to FAO (2009), unhygienic street food is linked to an outbreak of serious food poisoning in most parts of the world. In a research conducted on the microbiological quality of street food in Accra, Mensah et al (2002) found that some of the main dishes were contaminated with bacteria of various kinds. The researchers attributed the contamination to improper handling of cooked food by vendors, poor storage of cooked food, serving of food with bare hands, and inadequate reheating of food cooked in advance of consumption. An investigation was carried out by the Food and Drugs Authority ( FDA) and the Ghana Health Service to trace the source of a cholera outbreak involving 49 cases in the Akwapim South Municipality in 2012. The team revealed that the cholera outbreak was a result of eating a contaminated street food called “waakye” (rice and beans) from Nsawam (Ministry of Health/Ghana Health Service Report, 2012) as cited in Wuliyeng (2013, p3). Major risk factors identified by the team of investigators were unhygienic food handling practices and unavailability of adequate toilet facilities around where food was sold (Ministry of Health/Ghana Health Service Report, 2012). In Kumasi, a similar study by Rheinlander (2006) raised concerns about the poor infrastructure with which street food vendors work and how that influenced the quality and safety levels of most street foods in Ghana. Another study conducted in the Niger Delta University in Nigeria showed how traditional methods of processing and packaging food are evident in improper holding and temperature by food handlers (Oghenekohwo, 2015). 6 University of Ghana http://ugspace.ug.edu.gh A significant number of studies regarding food hygiene have been done in Ghana. These studies over the years have focused on street food vendors at the large and open markets in the cities, towns and other urban areas. However, an insignificant number has looked at examining food vendors that operate in educational institutions (Rheilander, 2006; Annor and Baiden, 2011; Monney et al., 2013; Addison 2015). Furthermore, a holistic approach or studies that look at the dimension or perspectives of the food vendor, food consumer and regulatory bodies appear to be limited and few have been carried out in the study area. It was based on these research gaps that this study was conducted. 1.3 Objectives of the study The main objective of the study was to examine the hygienic practices of food vendors; effects on consumer food safety and health on the University of Ghana campus. Specific objectives of Study include: i. To examine the hygienic practices among food vendors during food preparation and the selling process. ii. To assess the effects of hygienic practices of food vendors on consumer food safety. iii. To examine the nature and effectiveness of food safety training needs of food vendors. 1.4 Research Questions The following research questions were answered by the findings of the study. i. How hygienic are food vendors during food preparation and the selling process? ii. What are the effects of hygienic practices of food vendors on consumer food safety? iii. How is the nature and effectiveness of food safety training needs of food vendors? 7 University of Ghana http://ugspace.ug.edu.gh 1.5 Significance of Study The findings of this research would be of great importance to practitioners, students of the University of Ghana, Researchers and the government in general. To the students, it will serve as a source of reference for future studies on any topic related to hygienic practices. The study will add to existing empirical literature on food hygiene and contribute to academia as well. To the practitioners, it will help them make informed decisions. To the government and Researchers; including policymakers, it will assist them as to the right set of regulations and exercises that should be formulated and implemented to ensure good hygienic practices by food vendors and also provide evidence-based information that will inform policy directions. The findings of the study will also guide policy and practice on hygienic food management and its practices across various educational and non-educational institutions in the country so that the right measures will be taken and implemented in order to reduce the debilitating effect that foodborne diseases and illness have on student and non-student populations in the country. 1.6 Scope of the study The topic under study selected food vendors, student consumers and grounds and environmental health services officers who were within the confines of the University of Ghana main campus. The study was limited to only University of Ghana main campus, Legon and did not cover any other branches of the University. The study targeted food vendors from „„Night market‟‟ and „„Bush canteen‟‟ which is the main food outlets established by the University. Food vendors who did not operate at night market or Bush canteen were excluded from the study. Grounds and environmental health services officers who are a staff of the university (supervise food vendors on campus) and student consumers who purchase food 8 University of Ghana http://ugspace.ug.edu.gh from the food outlet mentioned above were included in the study. Consumers who were not students of the University and officers who were not a staff of the University were also excluded from the study. 1.7 Operational Definitions 1. Food Vendor: A food vendor is an individual who sells food. However, a food vendor could also be a food handler or vice-versa. 2. Food Handler: A food handler is a person who works with packaged or unpackaged food, food equipment or utensil, or food- contact surfaces for a food service establishment. 3. Hygienic Practices: A set of practices performed for the preservation of health. 4. Street Vended foods: Foods and beverages prepared and/or sold by vendors on streets and other public places for immediate consumption or consumption at a later time without further processing or preparation. 5. Food Hygiene: It is the action taken to ensure that food is handled, stored, prepared and served under hygienic conditions, as to prevent as far as possible the contamination of food. 6. Food Safety: A scientific discipline describing handling, preparation and storage of foods in ways that prevent foodborne illness. 7. Foodborne disease: Is an infection or irritation of the gastrointestinal tract caused by food or beverages that contain harmful bacteria, parasites, viruses or chemicals. 9 University of Ghana http://ugspace.ug.edu.gh 8. Personal Hygiene: The act of preserving or maintaining the body and clothing to preserve overall health and well-being through cleanliness. 9. Environmental Hygiene: Measures undertaken to keep the human environment safe and healthy to live in, including waste disposal, clean water supplies, food safety controls and good housing. 1.8 Organisation of study The study was categorised into six main chapters. Chapter one contains background, the problem statement, the purpose of the study, specific objectives, research questions, the scope of the study, operational definitions and organisation of the study. Chapter two consists of an introduction, review of the existing literature, both theoretical and empirical, a conceptual framework and a summary. Chapter three is made of an introduction, research paradigm, research design, research area, research method, the source of data, target population, sampling, research instruments and data gathering procedure, inclusion and exclusion criteria, instruments for data analysis, ethical considerations and a chapter summary. Chapter four focuses on the presentation of results. Chapter five consists of a summary of key findings, discussion of findings in relation to existing literature and a chapter summary. Chapter six which is the final chapter contains the recommendations, implication of the study to policy, practice and future studies, limitations of the study and conclusion. 1.9 Chapter summary Street foods is an import aspect of the economies of many developing countries because the sector provides a lot of jobs for people and also provide ready-to-eat food to consumers at relatively cheaper prices. Nonetheless, the sector has attracted a lot of attention because of its 10 University of Ghana http://ugspace.ug.edu.gh high association with foodborne diseases. A holistic approach that looks at the perspective of food vendors, food consumers and regulatory bodies are limited and none have been carried out at the research area. The aim of the research was to examine the hygienic practices of food vendors and assess its effects on consumer food safety and explore possible solutions. 11 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO 2.0 LITERATURE REVIEW 2.1 Introduction This chapter looks at the review of the theoretical literature, review of related studies and the development of a conceptual framework. The theoretical review looked at the perspectives underlining hygiene behaviour.The study went on to look at food safety, foodborne diseases as well as food vending and hygienic practices among food vendors to enable the researcher to delve deep into what constitute hygienic practices among food vendors and what does not pass as hygienic practices. The chapter further considered the effects of hygienic practices of food vendors on consumer food safety not excluding the training needs of food vendors to ascertain the importance of these training in ensuring good hygiene behaviour. The chapter ended by reviewing some of the empirical literature that has been done on hygienic food practices by other scholars and academicians. All these were done in order to put the study in the right perspective and to relate the aims and objectives of the study. 2.2 Review of Theoretical Literature Social research on health and hygiene behaviour has been dominated by two main perspectives namely; the Emic and Etic perspectives. Other behavioural theories have attempted to explain the hygiene behaviour of people/individuals; their applicability appears far less compared with that of the Emic and Etic perspectives. The Emic perspective tends to focus on the socio-cultural factors which motivate hygiene behaviour or the lack of it among a group of people; whereas the Etic perspective of hygiene focuses on studying hygiene behaviour from the scientist's point of view (Rheinländer, 2006). The terms Emic and Etic was created in the Linguistics and Anthropology during the 1950‟s and1960‟s and over the 12 University of Ghana http://ugspace.ug.edu.gh years, they have been adopted by researchers in various fields, including public health to their areas of study (Headland, 1990). The perspectives have been explained by Rheinländer (2006): The Emic perspective also referred to as the insider‟s view focuses on understanding hygiene behaviour from the viewpoint of those involved. It seeks to understand the socio- cultural factors that influence hygiene practices among a group of people and argue that motivations for hygienic behaviours are socially rooted. The Etic perspective of hygiene also referred to as the outsider‟s view focuses on observing and assessing performed hygiene practices from a scientist‟s outside view. It places emphasis on sources of contamination and risk of infection. Etic Hygiene from this point of view involves the practice of keeping one's self and surroundings clean, especially to avoid illness and the spread of infection The Etic perspective of hygiene was greatly influenced by two dominant 19th century theories; the Miasma theories; the idea that poor sanitation and waste management caused diseases and contributed to its spread, and the Germ theory of Louis Pasteur and others which discovered the significance of microorganisms and their role in the transmission of diseases (Janie and Marie, 2010). Those who hold this view assume that issues of hygiene can be studied objectively. It is argued that when people become aware of how water and sanitation diseases are caused and transmitted, they would replace unhygienic practices with improved ones. This study was influenced by the Etic perspective of hygiene behaviour. 2.3 Concept of Hygiene Hygiene is an old idea associated with medicine, as well as to self and professional care practices related to most aspects of living. In medicine and in the home (domestic) and everyday life settings, hygiene practices are used as hindering measures to reduce the incidence and spreading of disease (Monney et al., 2013). According to Fosket and Ceserani (2007), hygiene is the science and practice of maintaining health and preventing diseases in 13 University of Ghana http://ugspace.ug.edu.gh every catering establishment that provides food. Suffice it to mention that conscious effort must always be put in place to protect people as well as the environment from bacteria in order to eliminate contamination of the food that people eat (WHO, 2010) Therefore hygiene can be defined as all the necessary practices and conditions that are exhibited by individuals in their daily activities to ensure the prevention of diseases and to maintain good health. 2.4 Concept of Food Food is any liquid or solid substance that supplies the body with all the essential materials for heat and energy, growth and repair and for putting the body processes in order (Fosket and Ceserani, 2007). It is also any edible substance comprising of health promoting and nutritive components such as carbohydrates, proteins, fats, vitamins and minerals which when eaten and through digestion sustains the body (FAO/WHO, 2002). Kitagwa, Bekker, and Onyango (2006) also define food as a composite of natural ingredients normally referred to as nutrients, example protein and carbohydrates, that is needed by humans for the maintenance of the body. Food, therefore, serves a satisfying biological need as captured in the very popular hierarchy pyramid developed by Abraham Maslow (1954). It is buttressed by Moon (2010) that food consumption is considered as a simple act of satisfying biological needs and as such, every human being seeks for the gratification of this need. 2.5 Food Safety Food safety is a vital issue both in developed and developing countries; given that foodborne illnesses cause a lot of distress and thousands of deaths each year (Pilling et al, 2008). In view of this, the issue of food safety is becoming a key public health priority considering a 14 University of Ghana http://ugspace.ug.edu.gh large number of people who take their meals outside the home. As a result of this change in lifestyle, many people have exposed to foodborne illnesses that originate from food stands, restaurants and other food outlets. Food service employees are a very crucial link between food and consumers Haapala and Probart, 2004) as there are high contamination tendencies on their part. Considering the numerous people who patronize food from vendors worldwide, that is about 2.5 billion people (as identified by Nyarango et al., 2008), the World Health Organization (WHO) has established five important keys to safer food including ensuring the hands are clean, separating raw food from cooked food, making sure food is cooked completely and carefully, keeping food at safe temperatures, and using safe water and raw materials (WHO, 2007). These five keys to safer food are of great significance in developing countries, and furnishing food vendors in countries with such knowledge could impact significantly on food safety. Food poisoning occurs from different places, this could be from their homes, workplaces, schools, hospitals or other catering services patronized. Commercial catering services included restaurants, hotels, finished products from retailers and food vendors. The most crucial food safety problem is a microbial foodborne illness. All those who come in contact with food, not excluding farmers, food producers, individuals who work in markets and food service establishments, and other food handlers, are obliged to keep food as safe as possible(Fogli et al., 2005). To keep food safe, food handlers should make sure their hands and food contact surfaces are cleaned, and clean fruits and vegetables thoroughly; separate raw, cooked, and ready-to-eat foods; cook foods to a safe internal temperature; chill perishable food promptly; and defrost food properly. The Food and Drugs Authority (FDA) is the national regulatory body under the Ministry of Health and are obliged to implement food policies and ensure the safety and wholesomeness of food for consumers. FDA roles include food production and processing site inspections, 15 University of Ghana http://ugspace.ug.edu.gh licensing, product registration and monitoring. They also make sure food handlers go through training on good hygiene practices. In the light of these efforts, it appears that foods served within the canteens of some educational institutions still do not meet health standards. Attempts have been made severally to classify food-borne disease outbreaks into those contracted from home-made meals and those contracted from street food. In the United States, for example, research has implicated food from commercial or institutional establishments to cause food-borne diseases to be (79%) and 20% from homes. Aproximately, 25% of these reports could have been prevented by safe food handling practices (Haapala and Probart, 2004). However, as popularly proposed by researchers, identifying the exact number of cases has proven a difficult task as incidents of illnesses are usually underreported (McCarthy, 2007). 2.6 Food Borne Diseases Various studies conducted in Africa on street foods has showed that, their boundless and unregulated growth has placed a serious strain on city resources, such as water, sewage systems and interference with the city plans through overcrowding and littering adversely affecting daily life (Oghenekohwo, 2015). FAO states that street foods raise concern with respect to their capability for serious food poisoning outbreaks due to improper use of additives, the presence of adulterants and environmental contaminants and improper food handling practices amongst street food vendors (FAO, 1997). The food handler has a vital responsibility to play in food trades, and that is to assure that meals served are hygienic to eat. Suffice it to mention that conscious or unintentional contamination of such foods, places buyers in a dangerous situation of suffering from foodborne illnesses (Annor&Baiden, 2011). Foods that are usually related with foodborne diseases include salads, raw vegetables, bakery products (e.g., cream-filled pastries), sandwich fillings, milk, dairy products and poultry. 16 University of Ghana http://ugspace.ug.edu.gh Majority of foodborne illness are caused by eating food or drinking water which is contaminated by faeces. In the case of food, the key cause of impurity is often poor personal hygiene among food handlers (Esena&Owusu, 2013). Reliable statistical proof reveals that 70% of all bacterial food poisoning is caused by food handlers whilst the remaining thirty per cent can be attributed to cross-contamination (Wilson, 1997). Over 200 different diseases have been found to be spread by food. Several factors have been identified as contributory to the transmission of such foodborne diseases. The main ones are as proposed by Paiva de Sousa, (2008) include: i) inadequate food manipulation; ii) improper holding temperatures; iii) inadequate cooking; iv) contaminated equipment (failure to clean and disinfect kitchen or processing plant equipment) and v) poor personal hygiene. Other factors that may contribute to the foodborne illness include: vi) preparing food a day or more before serving with improper holding and reheating; vii) cross- contamination (from raw to cooked products) and viii) adding contaminated ingredients to previously cooked food. The food service worker could probably infect food either in the preparation stage or the service point. Personal hygiene with robust importance on hand washing is one of the most significant practices in the deterrence of foodborne illnesses. Poor hand hygiene has been known as a critical threat factor in increasing food-borne il lnesses (Kassa, 2001).In a related study, Lah (2016) found that there is a high possibility of food service workers to transmit pathogens to food with hands that are polluted with organisms from their gastrointestinal tract which would lead to foodborne illness. This makes it very crucial to ensure that food service workers take hand washing practices serious in the fight against foodborne illnesses. It is important to note that poor personal hygiene of food handlers and inappropriate temperature control are the two most substantial factors leading to foodborne illness (Center for Disease Control and Prevention, 2013). 17 University of Ghana http://ugspace.ug.edu.gh In rare cases where infected people seek medical care and give specimens, bacteria are more probable than other pathogens to be recognised as causal agents. Bacterial agents most often known in patients with foodborne illness are Campylobacter, Salmonella, and Shigella species, with sizable difference occurring by geographic area and season. Testing for viral etiologies of diarrheal disease is seldom done in clinical practice, but viruses are well thought-out to be the most common cause of foodborne illness (CDC, 2013). This account corroborates with that of Rheinländer (2006) whose study in Kumasi found that the absence of potable water and lavatory facilities as well as dustbins negatively affected good hygienic practices among the vendors. Hygienic practices such as washing hands after using the toilet, proper cleaning of dishes and reheating of cold food among were also observed by vendors. It is further supported by the account of Stephenson (2002) that the relatively high presence of parasites transmissible by faecal matter is representative of high levels of environmental faecal contamination and poor sanitation standards. Constant hot weather conditions and poor environmental conditions in Ghana such as the dusty roads along which food vendors operate offer good settings for bacterial growth. Several factors have been found to impact the risk of food contamination. These include but are not limited to food type, pH, a process of preparation, water availability, the degree of handling, exposure temperature, and holding time (Campbell, 2011). It is therefore recommended that food service workers desist from the use of fabrics, cloths, dish towel or apron for hand drying because it can quickly accumulate a large population of micro- organism, especially when left moist and their use can actually increase food contamination rather than reduce it (Lah, 2016). Also, preparation of food long before its consumption, storing at ambient temperature, insufficient cooling and reheating, contaminated processed food, and undercooking are identified as the key factors that contribute to food poisoning 18 University of Ghana http://ugspace.ug.edu.gh outbreaks. Holding foods at high ambient temperatures for long periods of time has been reported to be a major contributor to the occurrence of food poisoning outbreaks (Rane, 2011). The WHO (2000) attributed the causes of food contamination in developing countries to factors including traditional food processing methods, unsuitable holding temperatures, and poor personal hygiene of food handlers. Lending support to the above, the pervasiveness of food-borne illnesses in less-developed countries is entwined with other economic and developmental issues including legislation, infrastructure and enforcement mechanisms (Lah, 2016). A study conducted in Abeokuta, Nigeria, established that different parasites and the degree of worm infections depended largely on the area in which food was sold (Idowu, 2006). Considering the similarity in environmental conditions between Ghana and Nigeria, it could be deduced that the high humidity levels may contribute to the transmission and maintenance of infective stages of these intestinal parasites in food in both communities (Ayeh-Kumi, 2009). The presence of litter and domestic animals in and around vending areas has been observed in some of these areas where food tested showed parasitic contaminations. Food vendors who did not have adequate means of disposing of refuse dumped them in nearby gutters; the end result is the presence of flies at the vending site with inadequate food protection. On issues relating to the use of raw vegetables, it is known that some food vendors treat them with vinegar or salt solution; but most of the time these vegetables are washed with only water or cleaned with napkins. Under such conditions, most of the disease-causing organisms still remain on the fresh vegetables and cause foodborne diseases once they are ingested. In most cases, these food vendors usually do not have training in food handling and on hygienic ways of handling food. This trend of affairs might be attributed to the fact that the majority of the food vendors were only trained at home from parents or guardians (Esena&Owusu, 19 University of Ghana http://ugspace.ug.edu.gh 2013). Besides, the source of contamination was the transfer of germs from money to food as vendors in an attempt to multi-task ended up contaminating food with bacteria on currency notes and coins (Ayeh-Kumi, 2009). 2.7 Food Vending Food vendors are street food sellers who sell ready-to-eat foods or drinks in a street or other public place, often from a portable stall. While some street foods are regional, many are not, having spread beyond their region of origin. Tinker (1997) defines street food as any minimally processed food sold on the street for immediate consumption. The FAO/WHO Codex Alimentarius Commission also describes “street-vendor foods” or its shorter correspondent “street foods” as ready-to-eat foods prepared and/or sold by vendors and hawkers especially in the streets and other public places. Most street foods are also classed as both finger food and fast food and are inexpensive on average than restaurant meals. Food and Agricultural Organization (FAO, 2007) reported that 2.5 billion people eat street food every day. Today, people could buy street food for a number of reasons, such as to obtain rationally priced and flavorful food in sociable scenery, to familiarised oneself with ethnic cuisines and also for nostalgia. Global and local street vendors are a vital source of cheap food (De Waal and Rober, 2009). But street foods often do not meet proper hygiene standards, in large part because of weak regulatory systems, inadequate food safety laws, lack of financial resources to invest in safer equipment, and lack of education for food-handlers. Research on foodborne illness risk factors indicates that most outbreaks in food service establishments can be attributed to the improper food preparation practices by food workers (Bryan, 1988). In most towns and cities in Ghana, vending of snacks and complete meals on the streets is a key way to obtain income, mainly among the poor women. Street foods, therefore, have a 20 University of Ghana http://ugspace.ug.edu.gh long practice in the country. The role of this sector in the urbanisation process and the urban economy mirrors the way of life and the survival and coping strategies adopted in most African cities (Gnammon-Adiko 1996). Rapid urbanisation is breaking down traditional family ties throughout the world and the street food sector is extensively understood as an unavoidable phenomenon tied to urban growth. This urbanisation and the associated social and structural changes have caused the demand for street food to increase. Longer travelling times between living and working places are likely to lead to further increases in demand. Accra with a current population of about 3 million is the capital of Ghana and is hampered by an inadequate transportation system linking the suburban areas with the commercial and industrial centres where men and women work. Street food accounts for a part of the daily diet and so contributes towards meeting nutritional requirements, even though the contribution differs (Ayeh-Kumi, 2009). 2.8 Hygienic Practices among Food Vendors Food hygiene is the set of basic propositions used to check environmental factors during production, preparation, selling and serving food in such a way to ensure that food eaten is of good quality. Food hygiene depends largely on the personal hygiene practices of food vendors (Ifeadike et al., 2014). Gordon (2011) also interprets hygiene as the preservation of health involving all measures that ensure the safety and quality of food during its handling and identifies these measures as adequate storage of both raw and cooked foods including the right preparation and cooking procedures. Food hygiene according to Iragunima (2006) represents those factors which influence the health and wellbeing of an individual. The factors include observance of simple rules about health behaviours including cleanliness among others. Foods cooked under unhygienic conditions provide plenty of opportunity for transfer of bacteria as well as growth or survival of bacteria and other pathogens. The 21 University of Ghana http://ugspace.ug.edu.gh hygiene and sanitation aspect is the most important factor that could possibly have a negative impact on food quality (Gordon, 2011). According to Kok&Balkaran (2014), street food stands are made of simple structures where running water, toilets and washing facilities are rarely available in most countries around the world. Washing of hands, utensils and dishes are often done in bowls or pots of water. It is worth noting that disinfection is occasionally carried out and this eventually attracts pests to the vending sites especially when there is inadequate refuse disposal (Kok&Balkaran, 2014). Furthermore, foods prepared at these sites put consumers‟ health at risk as food is often not refrigerated at the right temperatures. In a research conducted by Annor and Baiden (2011), it was found that despite the efforts of the government to regulate the activities of vendors and other catering institutions, some hotels in Accra were not compliant. The microbial count from the hotel with the worst food hygiene checks, that is; no headgears or gloves are worn by food handlers were the highest but were least at the hotel with the best-observed food hygiene checks. This observation suggests that when food hygiene checks are strictly followed, contamination could be reduced and the efforts of the government in this regard could prove beneficial if adhered to. Most studies conducted in Ghana concerning various aspects of food hygiene over the past decade have revealed poor food hygiene knowledge and attitudes of street food vendors, with personal hygiene least observed by the least educated (Acheampong, 2005). Most of the vendors have either no formal education or few years of schooling and therefore are simply ignorant of proper food handling and their tendency to transmit pathogens is higher (Mensah et al., 2002). It is not entirely possible to pinpoint the exact causes of such incidences arising from food contamination. According to Annor (2011), there is strong statistical evidence that 70% of all bacterial food poisoning is caused by caterers. This is greater than occurrences reported from any other food sector. 22 University of Ghana http://ugspace.ug.edu.gh Most of these food poison outbreaks are due to the inadequate time and temperature control of food, whereas the remaining thirty per cent is as a result of cross-contamination (Annor&Baiden, 2011). A number of studies have found that such foods are sometimes held at improper temperatures, or mishandled by food vendors and sold in dirty environs (WHO, 2001, 2003; Muinde and Kuria, 2005; Ghosh et al., 2007). All these contribute to the infection of seemingly tasty food by different disease-causing parasites. Hygiene practices among food handlers, mostly food vendors and catering services, have been found to be below standard. Research covering the hospitality industry has been around hotels, restaurants and street food vendors mostly in the capital city, Accra. Levels of total bacterial counts in street vendor food are significantly beyond the acceptable reference levels set by the Ghana Standards Authority for Ready to Eat Foods (Ababio &Lovatt, 2015). In Ghana‟s capital, the Greater Accra Region, it is estimated that there are about 60,000 vendors of ready-to-eat foods (Odonkor et al., 2011) with an estimated annual revenue of about 100 million dollars and a profit of 24 million dollars ( Agyei-Takyi, 2012). 2.9 Effects of Hygienic Practices of Food Vendors on food safety More frequently than not, street food vendors are constantly at the end of accusatory fingers of the spread of food-borne diseases, mostly cholera outbreaks, across the country and are occasionally banned briefly as a distressed measure to manage the epidemic (Ansah, 2014; Gadugah, 2014). Street foods are often associated with diarrhoeal diseases which occur due to inappropriate use of condiments, the presence of pathogenic bacteria, environmental contaminants and disregard of good manufacturing practices (GMP) and good hygiene practices (GHPs) (Ansah, 2014). So, a requirement for food vendors to observe high ideals of hygiene and preserve clean vending environments cannot be overemphasised. 23 University of Ghana http://ugspace.ug.edu.gh Inadequate food hygiene can lead to food-borne illnesses due to improper food handling practices and in extreme events, even the death of a customer (Tavonga, 2014). Even though not all foodborne disease cases are reported or documented, FBD (Foodborne Disease) Burden Epidemiology Reference Group (FERG) of WHO provided an estimated 582 million cases of 22 different enteric FBDs and 351,000 associated deaths at the global level. African countries recorded highest FBD burden followed by the South East Asian Region (WHO, 2005). In India, National Centre for Disease Control under Integrated Disease Surveillance Programme (IDSP) recounted more than 200 food poisoning cases till the 36th week of 2015 and this is the second highest cause of outbreaks of diseases repeatedly for last 4 years (Singh et al, 2016). Avoiding foods that are contaminated with harmful bacteria, viruses, parasites, toxins, and chemical and physical contaminants are vital for healthful eating. The signs and symptoms of foodborne illness range from gastrointestinal symptoms, such as upset stomach, diarrhoea, fever, vomiting, abdominal cramps, and dehydration, to more severe systemic illness, such as paralysis and meningitis (Fogli et al., 2006). It is estimated that every year about 76 million people in the United States become ill from pathogens in food; of these, about 5,000 dies. Consumers can take simple measures to reduce their risk of foodborne illness, especially in the home. According to Osei and Duker, (2008), Africa alone accounts for 90% of cholera cases worldwide. Mayo Clinic (2014) reported that all foods naturally contain small amounts of bacteria but poor handling of food, improper cooking or inadequate storage can result in bacteria multiplying in large enough numbers to cause illness. Parasites, viruses, toxins and chemicals also can contaminate food and cause illness. According to Chapman et al. (2010), around 70% of disease outbreaks have been connected to street-vendor foods while evidence provided by Mensah et al., (2002) point to the fact that, street foods are possible bases of pathogens. The Ghana Medical Journal (2006) and the World Bank Food Safety Action Plan 24 University of Ghana http://ugspace.ug.edu.gh (2006) also pegged the total number of persons affected by foodborne illnesses in Ghana at 420,000 per annum with a yearly death rate of about 65,000 and a total cost to the Ghanaian economy at the US $ 69 million. They also indicated that an estimated 25% of these reported food-borne illness outbreaks are avoidable by safe food handling practices. 2.10 Training Needs of Vendors Nowadays, food safety is a vital issue that has to be taken into consideration when talking about public health. Tons of hard works have been made by health ministries of developing countries in the arena of food safety and hygiene education amongst street food vendors. While these efforts have led to an increase in awareness and knowledge levels of food safety and hygienic practices, this knowledge is however not always interpreted into real practice (Apanga et al., 2014). The WHO (1996) identified insufficient resources for assessment and laboratory analysis as well as low consumer education leading to poor public awareness on the hazards posed by certain street foods as contributing to the public health risk related to street vendor food. Practising good personal hygiene is very useful in averting foodborne diseases. Good personal hygiene encompasses all measures that ensure the safety and quality of food during its handling (Jay, 2000). Training is an important tool needed to create awareness among food service workers about the hazards associated with foods and the food safety practices that must be used to prevent foodborne illness (Bryan, Caroline &Madelon, 2003). The safety of street-vendor food can be improved on the provided majority of the vendors undergo or acquire training in basic hygiene skills. A study has revealed that one of the best means of averting foodborne disease is through education and training of food handlers (Clayton & Griffith, 2008). Research by Gettings and Kiernan (2001) corroborates previous research stressing the crucial role 25 University of Ghana http://ugspace.ug.edu.gh educators can play in food safety education and extends the consequences to the high-risk population (Finch & Daniel, 2005). A study, however, in Oklahoma County by Lynch, et al (2005) established no significant difference between the number of hours of training and improvement of food safety practice. Numerous studies have indicated that most of the food-related illnesses and death could have been controlled or avoided through the use of appropriate food handling techniques (Hapala&Probart, 2004). Food vendors, therefore, are under obligation to undergo basic training in food hygiene before licensing and further training as required by the appropriate authorities (FAO/WHO, 2006; and Chukuezi, 2010). A mention can be made to the fact that the failure of regulated institutions or authorities to ensure that food service workers or providers receive adequate training in basic hygiene practices would invariably jeopardise the lives of those who patronize street foods. It is quite evident that poor personal hygiene, cross- contamination, and time-temperature abuse are the three main causes of foodborne diseases hence the need for food safety and sanitation training to be regularly conducted, monitored and maintained on an in foodservice establishments (Pilling, Brannon, Shanklin, Howells, & Roberts, 2008). Lending credence to the above Barro et al. (2007) posited that street food vendors normally have little or education, unlicensed, untrained in food hygiene, and they work under crude unsanitary conditions with little or no knowledge about the causes of foodborne illnesses. 2.11 Review of Empirical Literature This section reviews some studies that have been conducted on hygienic food management within and outside the country in order to know what other scholars have already done as far as the research topic is concerned. 26 University of Ghana http://ugspace.ug.edu.gh In India, a study by Singh and Marwaha (2017) established that Mumbai has the highest number of street vendors of about 250,000, Delhi 200,000; Calcutta more than 150,000 street vendors and Ahmadabad and Bangalore about 100,000. The study also revealed that women form the greatest portion of the food vendors. The study further established that more of the vendors (thus 67%) served food with bare hands. Similarly, a study by Burt, Volel and Finkel 2016) assessing food handling practice of 10 processing street food vendors operating in Manhattan, New York City established that more than half of the vendors (67%) approached served food with bare hands. Addo et al (2007), in their study found that most food vendors have barely any formal education which are also important factors contributing to foodborne related diseases as they are considered to be of very little or no educational background and hence have low understanding of food safety issues and as such the need for training of food vendors about proper ways of handling food to prevent food contamination. However, other scholars have proposed that even though training leads to increased knowledge of food safety, it does not necessarily imply positive food handling behaviour (Apanga, 2014). Nurudeen et al (2014) established that some food vendors did not practice hygienic practices during food service even though they had an idea about hygienic practices. Even though epidemiological data are lacking, most African street foods appear to pose public health hazards because they produced and delivered food under unhygienic conditions (Ekanem 1998). Studies in Ghana on various aspects of food hygiene over the last decade revealed that most food vendors have inadequate food hygiene knowledge and attitudes that affect the personal hygiene of the vendors (Annor and Baiden, 2011). 27 University of Ghana http://ugspace.ug.edu.gh A study by Nee et al, (2011) found that, in Malaysia, lack of food safety awareness was a significant contributor to the increased numbers of foodborne illnesses. A study conducted by Afolaranmi et al (2015) revealed that, even though food vendors had training in food hygiene, these hygiene practices were not conducted by some of the food vendors. Which means the need to reinforce training needs and the effort taken to teach food vendors how significant this training is beneficial to their business. In 2009, Azanza, Corazon and Melba investigated food safety knowledge and practice of street food vendors from a representative urban university campus in Quezon City, Philippines. The study established that among the 54 street foods, concepts were established particularly on topics that dealt with health and personal hygiene, food contamination and good manufacturing procedures. Nevertheless, vendors seemed not to be well-informed in terms of food legislation and waste management. The study established a significant gap between knowledge and practice on these topics and this was fundamentally attributed to the inclinations of street food vendors to compromise food safety for financial issues. This suggests that in order to solve issues of unhygienic food vending either on the street or specially designed or designated areas; there is the need to educate the food vendors on good hygiene practices. In a study conducted by Bhaskar, Usman, Smitha and Bhat(2004) and Mosupye and Holy (2000) revealed that bacteria from dirty dishwashing waters and other sources on utensil surfaces constitute a risk for contamination during food vending. A similar study was undertaken in India by Singh, Dudeju, Kaushal, and Mukherji (2016) on the impact of health education intervention on food safety and hygiene of street vendors revealed that only a small number of the street food vendors (12%) used soapy water for washing of utensils. It was further observed that the vendors washing utensils using bucket water but the utensils were 28 University of Ghana http://ugspace.ug.edu.gh rinsed only once. The dirty water was continually used for the washing of the utensils. Under such conditions, certain foodborne organisms could be transmitted and cause cross- contamination. This is supported by a study by Thakur, Mehra, Narula, Mahapatra and Kalita (2013) which revealed that only 36% of vendor used soapy water for cleaning of utensils. These observations are in line with other studies which have reported that street food is prepared at very dirty surroundings with wastewater and garbage disposed of nearby, providing nutrient and breeding ground for rodents and vermin. Monney et al., (2013) in their study on hygienic practices among food vendors in educational institutions in Ghana using Konongo as a case study found out that almost 86.7% of the vendors acquired their trading skills from their own personal intuition and informal education from friends and parents whilst 13.3% acquired their skills formally from vocational institutions and senior high school. Most of the food vendors (65%) indicated that they had acquired on-the-job training on food hygiene by the Food and Drugs Authority and the Municipal Assembly whiles 35% had not received any training on food hygiene. The researchers however intimated that taking into account the various means through which most of the food vendors (86.7%) acquire their vending skills, there is the need for further training on food hygiene which is extremely crucial because they may not have adequate knowledge on hygienic practices as regards their trade. A comparative analysis from the chi-square test by Monney et al (2013) reveals that the cleanliness of vendors‟ fingernails, as well as the adequacy of food protection from flies, is linked to the training of food vendors on food hygiene and safety since it indicated a statistically significant difference. Suffice it to mention that food vendors trained in food hygiene and safety would possibly keep their fingernails clean and adequately protect their food from flies and dust. The study also demonstrated that training of food vendors on food hygiene and safety had a significant association with crucial food hygiene and safety 29 University of Ghana http://ugspace.ug.edu.gh practices such as medical examination, hand hygiene and protection of food from flies and dust. This stresses the importance of training among food vendors to ensure the continuation of best practices in the street food vending business thereby protecting public health. Monney et al (2013) reasoned that there is the need to form local food vendor groups and these groups would, in turn, make sure that food vendors adhere to appropriate codes of practice in street food vending and also serve as a vehicle to efficiently train and relay information to food vendors. The failure of governmental institutions to enforce laws that ensure that food vendors adhere to high standards of hygienic practices is sometimes the cause of an outbreak of foodborne diseases. For instance, between 2011 and 2012 FAO conducted a study in the capital city of four West African countries (Bamako, Abidjan, Freetown and Accra) and found that though there are some regulations governing street food vending activities, these laws and regulations are hardly enforced. The study mentioned overlapping functions and unclear guidance on functions among regulatory institutions as well as cumbersome and complex procedures for obtaining permits, as factors contributing to weak enforcement of bye-laws and regulations. In addition, it was revealed that because of these difficulties, most vendors operated without formal permits and certificates to operate as food vendors (83% in Abidjan and 8% in Accra). There abound epidemiological research findings on the occurrences of foodborne diseases in the destination with popular street vending foods (Ekanem, 1998), and these finding also imply that the foods prepared and sold by street vendors were responsible for the spread of zoonoses (diseases spread from animals to people), particularly in developing countries (King, Awumbila, Canacoo, &Ofosu-Amaah, 2000). Rheinländer et al. (2008) reported that the increase in popularity of street food presents public health challenges due to the fact that safety of food is difficult to practice at street levels. For instance, in Taiwan, the Food and 30 University of Ghana http://ugspace.ug.edu.gh Drug Administration of the Department of Health of Taiwan during the period of 1981-2009 reported 4460 foodborne illness cases (Sun et al., 2012). The Taiwan FDA also indicated that from 1981 to 1990 homes were the major places where the foodborne illnesses occurred but from 1991-2009, food vending places such as restaurants, food markets among others have become the major places of food poisoning occurrences. A significant number of research on street food vending indicated lack of sanitary vending environments, lack of food preparation knowledge, and lack of food safety monitoring as major problems of street foods (Ekanem, 1998; Lucca, &Ferraz da Silva Torres, 2006; Lues, Rasephei, Venter, &Theron, 2006; Toh&Birchenough, 2000). Studies have also shown that most government agencies lacked definite regulations for the safety of street food vending (Muinde&Kuri, 2005; Omemu&Aderoju, 2008). Majority of the street food vendors and handlers in Africa, as well as other developing countries, were mostly ignorant of basic food safety issues, unlicensed, and untrained in food hygiene while working under crude unhygienic conditions, vending unregulated food items and operating without any monitoring of the foods they sold (Shu-Tai, Yi-Mei, and Kuo-Wei, 2012). A study by Shu-Tai, Yi-Mei, and Kuo-Wei (2012) in Taiwan revealed that few vendors (19.2%) acquired their knowledge of food preparation through prescribed training while the largest part (41.7%) of the food vendors developed their knowledge from family businesses. It was also revealed that vendors with valid health certificates and food-related certificates or chef licenses displayed better hygiene knowledge and practices than those without. Missouri Department of Health and Senior Services (2016) indicated that foodborne diseases cause an estimated 48 million illnesses (roughly 1 in 6 Americans), 128,000 hospitalizations, and 3,000 deaths in the United States each year. 31 University of Ghana http://ugspace.ug.edu.gh So as to lessen the burden of food-borne illnesses, developing countries should strengthen the role of street food vendors by providing training, guidelines, legislation and infrastructure to ensure food security and nutrition (Ababio and Adi, 2012). Diarrhoeal diseases, mostly caused by foodborne microbial pathogens, are the leading causes of illness and deaths in the developing countries, killing an estimated 1.9 million persons annually at the global level (Schlundt et al., 2004). 2.12 Conceptual Framework The study examines the hygienic practices of food vendors and its effects on consumer food safety on the University of Ghana campus. A number of studies (Mensa et al, 2002; Janie and Marie, 2010; Laryea, 2012) conducted in Ghana and beyond have all identified some three key factors that influence the quality of street foods. These are; the Regulatory Dimension, Food Vendor‟s Dimension and the Consumers Dimension. Concerning regulatory dimension, institutions at the local levels such as Municipal Environmental Units, Health Service Unit, Food and Drugs Authority amongst others by virtue of their mandate are required to provide training, provide permits and standards as well as regulate and monitor food vendors in order to ensure that they comply with all the necessary health requirements needed in vending food and food products. Local government authorities are also expected to provide the necessary social amenities such as potable water, toilet facilities and even serene and hygienic vending points so that food vendors after acquiring adequate knowledge on hygienic food practices can put their knowledge to practical use. Food vendors‟ dimension: Street food hygiene can be enhanced when the necessary mechanisms are put in place by food vendors in order to prevent food contamination. Some 32 University of Ghana http://ugspace.ug.edu.gh of the mechanism that vendors can put in place to prevent contamination are; good and hygienic food preparation and vending environments, good and effective food management and handling methods, prioritization of vendors personal hygiene among others. It has also been identified that factors such as vendors‟ knowledge and awareness of good hygienic practices, vendors level of formal education and other similar conditions affect how vendors approach and practice good hygiene during their food preparation and vending (Wuliyeng, 2013). Consumers dimension: Consumers are also known to contribute significantly as to whether food vendors will engage in hygienic practices or not. Since consumers are the customers to be served by these vendors, they can decide not to patronize the food of unhygienic vendors and this will invariably compel the vendors to engage in hygienic practices or fold up the business. In view of this, it has been postulated that when consumers have full awareness on the effect of unhygienic food on their health, it will go a long way to impact on their level and kind of interaction with food vendors and also demand quality food. The interaction between these three dimensions can ensure good hygiene behavior or bad hygiene behavior. Each dimension performing their roles effectively can ensure good hygiene behaviour. The converse is also true. Based on this, any quest to ensure hygienic food practices and management must take into consideration all these three (3) different dimensions that affect food management and its vending in the country. This is presented in Fig 2.1 overleaf 33 University of Ghana http://ugspace.ug.edu.gh Fig 2.1: Diagram Showing Various Stakeholders/Dimensions in Hygienic Food Management Vendors’ Dimension Regulatory Food Hygienic Consumers‟ Dimension Practices Dimension Source: Author‟s construct (2018) 2.13 Chapter summary This chapter reviewed a number of literature pertaining to hygiene, food safety and training needs of food vendors. A conceptual framework was designed to guide the study. Component of the conceptual framework includes; Food Vendor‟s Dimension, Regulatory Dimensions and Consumers Dimension which was explained to better understand the purpose of the study. 34 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE 3.0 METHODOLOGY 3.1 Introduction This chapter describes the methods and procedures of the study for the collection of relevant data for the purpose of addressing the research questions. Areas to be covered include research paradigm, research design, research approach, the target population, sample size, sampling procedure and technique, the research instruments used, data collection procedure, ethical procedures, test for validity and reliability, data analysis procedure and limitation of the study. 3.2 Research Paradigm A research paradigm is “ a set of beliefs, values and techniques which are shared by members of a scientific community and which acts as a guide discovering the kind of research problems scientists should address and the type of explorations that are acceptable to them” (Kuhn, 1970) cited in Boateng (2014) and Anaba (2016). The identification of philosophical ideas in research is very significant. Even though it remains largely hidden, the research can be influenced by it (Anaba, 2016). Therefore, it is very essential research work relates to a specific scientific community and share in its‟ body of ideas. The study was supported by the Pragmatic paradigm. The Pragmatists debate that in carrying out a research; emphasis should be placed on the problem and outcomes and should aim at changing phenomena not focus on the methods and procedures. 35 University of Ghana http://ugspace.ug.edu.gh The Pragmatic worldview gives researchers the opportunity to choose the methods that best fit their study. The Pragmatic philosophy has been recommended for mixed methods studies (Creswell, 2009). 3.3 Research design The study adopted a descriptive research design. According to Labree (2103), descriptive design best aims at describing, observing and documenting situations as they naturally occur rather than explaining them. Descriptive design attempts to establish the range and distri- bution of some social characteristics and to discover how these characteristics may be related to certain behaviour patterns or attitudes (Zainal, 2007; Labree, 2013). A descriptive design was appropriate to examine the hygienic practices of food vendors and its effects on consumers‟ food safety. 3.4 Research setting/Area The University of Ghana, Legon campus is the oldest and largest tertiary institution in Ghana. It was founded in 1948, in the then British colony of the Gold Coast, as the University College of the Gold Coast which was affiliated to the University of London, which supervised its academic programmes and awarded degrees. It gained full university status in 1961 and now has nearly 40,000 students. The university is mainly based at Legon, about 12 kilometres northeast of the centre of Accra. Due to its excellent reputation, the institution attracts foreign students globally due to its excellent reputation. The medical school is in Korle Bu, with a teaching hospital and secondary campus in the city of Accra. It also has a graduate school of nuclear and allied sciences at the Ghana Atomic Energy Commission, making it one of the few universities on the Africa continent offering programmes in nuclear physics and nuclear engineering. The University has various divisions that supervise the 36 University of Ghana http://ugspace.ug.edu.gh institution, execution and maintenance of health issues such as the hospital and its facilities, the Students clinic and the Environmental and Sanitation Unit. Food vendors in the University of Ghana are however under the Grounds and Environmental Health services unit which is also under the Physical Development & Municipal services Directorate (PDMSD) on University of Ghana campus. 3.5 Research Approach In conducting research, three main methods are involved; these are the qualitative method, quantitative method and mixed method (Creswell & Plano, 2007). Qualitative methods basically explain how people‟s thoughts and feelings influence their behaviour (Creswell, 2008). Qualitative research is aimed at gaining a deep understanding of a specific organization or event rather than a surface description of the large sample of a population (Creswell, 2008). A quantitative method, on the other hand, helps to identify the number of people who exhibit certain behaviours (Sutton & Austin 2015). Alvesson and Skoldberg (2017) and Harwell (2011) explain that the quantitative study consists of standardized variables which describe people‟s experiences or opinions that are given numbers through the usage of response alternatives that are determined before-hand. A mixed method, however, combines both the qualitative and quantitative methods to explain social phenomena (Creswell et al, 2003). Mixed method approach was adopted in conducting the research. The value of mixed methods is the integration component. Integration gives readers more confidence in the results and the conclusions they draw from the study (O‟Cathain, Murphy, &Nicholl, 2010). This approach was also adopted based on the assumption that collecting both data will help in understanding the research problem better. Moreover, knowing that all approaches have 37 University of Ghana http://ugspace.ug.edu.gh limitations, Johnson and Onwuegbuzie, (2004) argue that mixed methods approach help researchers to avoid the limitations of qualitative and quantitative approaches. 3.6 Source of data For the purpose of this study primary data was used. The primary data, made up of qualitative and quantitative data was used to elicit information from food vendors, grounds and environmental health services officers and student consumers on the hygienic practices of food vendors and its effect on consumer food safety on University of Ghana campus. The primary data was collected to cover every aspect of the study which helped to achieve the purpose of the study. 3.7 Target population The study was confined to the University of Ghana main campus at Legon. The study population consisted of food vendors in the University of Ghana main campus, precisely food vendors at „„Night market‟‟ and „„Bush canteen‟‟ which are the main food sites established by the university authorities to cook and serve food to consumers. This population was also targeted because people served are regarded as high-risk populations; which are at a higher risk of suffering from foodborne illnesses if food safety practices are not followed (Paolo & Allen, 2010). The target population also included grounds and environmental health services officers on campus. This population was recruited to identify the nature and effectiveness of the training needs of food vendors on campus. The target population also included student consumers. This population was chosen because they are regarded as high-risk populations; which are at a higher risk of suffering foodborne illnesses if food safety practices are not followed by food vendors. All the target population chose also focused on the purpose of the 38 University of Ghana http://ugspace.ug.edu.gh study to determine the hygienic practices of food vendors; effects on consumer food safety on the University of Ghana campus. 3.8 Sampling procedure The estimated number of food vendors that operate at the Night market and Bush canteen on University of Ghana main campus is 55( source; from the physical development municipal service directorate on campus). A sample size of 31 food vendors ( 16 vendors from the Night market and 15 vendors from Bush canteen) was selected from 10 food outlets from the Night market and Bush canteen (5 outlets from each site). The researcher targeted 10 food outlets where vendors cook and sell. The researcher also targeted 300 consumers who are students of the university and specifically buy food from Night Market and Bush Canteen was selected out of about 40,000 students on campus and 2 out of 4 grounds and environmental health services officers who oversee the activities of the food vendors on campus to respond to questionnaires and interviews designed for the study. 3.8.1 Sampling technique The study employed the non-probability sampling technique with specific reference to the purposive sampling and purposive random sampling technique. Nonprobability sampling refers to procedures in which researchers select their sample elements based on the purpose of research, the subjects available, the judgment of the researcher, or other non-statistical criteria (Guo & Hussey, 2004). The purposive sampling technique was used to select food vendors from 10 food outlets from the Night market and Bush canteen (5 food outlets from each site) and grounds and environmental health services officers. Student consumers on campus were also included in the study and were selected using the purposive random sampling. Purposive sampling 39 University of Ghana http://ugspace.ug.edu.gh technique was used to select food vendors and officers. According to Palinkas et al. (2015), a purposive sampling helps to select individuals with in-depth information related to the issue of interest. Thus purposive sampling method was suitable for obtaining data from only these selected groups for the study. In the case of student consumers, 300 out of 40,000 students were calculated because, the researcher found it very difficult if not impossible to get data on all the students on campus considering the huge number of students A purposive random sampling technique was further used to select only student consumers that purchase food from the Night market or Bush canteen. According to Boateng (2016), a purposive random sampling technique is useful in selecting participants for the study when the purposive sample is too numerous to include all in the study. Therefore students who only buy food from Night market and Bush canteen were selected for the study. 3.8.2 Sample size determination For food vendors: 31 food vendors who prepare and sell their food on campus were selected out of 55 food vendors using purposive sampling technique. Purposive sampling was used to target those who only prepare and sell their food on campus. For student consumers A Confidence Interval for a finite population was used to calculate the sample size. Calculation was done by a pi phase calculator. Formula- n= Z² * P * (1 - P) d² n – Population of student consumers on the University of Ghana campus 40,000 Z - Standard normal deviation=1.65 (90%) 40 University of Ghana http://ugspace.ug.edu.gh p - Prevalence 0.5 that is 50% d- Standard error=0.05 w (Margin of error or level of precision or maximum error to committed) = 5% Sample size = 271 300 students were needed for the study therefore, 29 more were added 300 student consumers were then selected using the purposive random sampling. For grounds and environmental health services officers, Two grounds and environmental health services officers were selected from 4 officers at PDMSD using purposive sampling technique. 3.8.3 Inclusion criteria  Food vendors who sell food on University of Ghana main campus and have direct contact with food and food contact surfaces.  A food vendor who sells at either Night market or Bush canteen.  Consumers who had bought food or consume food from the Night market and Bush canteen on campus.  Consumers who are students of the university.  Environmental sanitation officers who are the staff of the University and who worked directly with food vendors on campus. 41 University of Ghana http://ugspace.ug.edu.gh 3.8.4 Exclusion criteria  Food vendors who did not sell food at the Night market or Bush canteen and did not have direct contact with food and food contact surfaces.  Consumers who had not bought food or consume food from food vendors on campus.  Consumers who were not students were excluded.  Grounds and environmental health services officers who were not the staff of the University and do not work directly with food vendors on campus. 3.9 Instrument This research made use of observation, questionnaire and interview as the main source of instruments for data collection. 3.9.1 Observation According to Creswell and Plano (2007), Observation helps to describe activities as they naturally occur in their environment. One strength of observation is that it allows the researcher to directly observe the many nuances and contingencies of human behaviour as they become manifest in a „natural‟ setting. Observation can also serve as a stand-alone tool for examining participants experiences, whether or not the researcher is inclusive in the process (Patton, 2002). Besides, it allows the researcher to see things that routinely may escape the awareness of the researcher using a different method (Jackson, 2014) the researcher specifically adopted a naturalistic observation to examine the hygienic practices of food vendors during their food preparation and the selling process at the Night market and Bush canteen. According to Boateng (2016), naturalistic observation is the act of observing the individual in their natural environment, making no effort to manipulate or control the activities of the participants, but simply to observe and record. An observation check-list 42 University of Ghana http://ugspace.ug.edu.gh made up of 32 items, categorized under environmental hygiene which consisted, personal hygiene and food hygiene was used (see Appendix 1). The construction of the observation check-list was guided by WHO‟s rules and guidelines for ensuring food safety. This approach was useful to the study because the researcher needed to observe how food vendors practice hygiene in their activities. The naturalistic observation helped the study to throw more light on the information gathered from the questionnaire and the interview. 3.9.2 Questionnaire Taking objective two into consideration, the appropriate research instrument was a questionnaire to assess the effects of hygienic practices of food vendors on consumer food safety. Collis and Hussey (2003) contend that the questionnaire is made to come out with the doing, thinking or feeling of a selected group of individuals. For the purpose of this study, a structured questionnaire made up of 19 questions was administered to student consumers. The questionnaire was structured into two (2) areas, namely: socio-demographic characteristics of respondents which were close-ended. The socio-demographic section asked questions about respondents‟ gender, age, marital status and level in education. The second section asked questions on effects participants had experienced in consuming food from the Night market or Bush canteen. This section included both closed-ended and open-ended questions. The questionnaire had an introductory section. There was a section for ethical assurance and consent. An open-ended questionnaire made up of 5 items was also used to elicit information on food vendors‟ demographic characteristics which included gender, age, and level of education, marital status and number of years working on campus. 43 University of Ghana http://ugspace.ug.edu.gh 3.9.3 Interview The researcher conducted a face-to-face interview with the grounds and environmental health services officers to gather essential information that the observation was not able to provide. Boyce et al. (2006) describe interview as an open-ended question and thorough investigation yielding in-depth responses about people‟s experiences. Researchers may use structured and unstructured or semi-structured interview approach (Creswell & Plano, 2017). Unstructured or semi-structured interviews may begin with some questions, but the interviewer has the ability to adapt questions to the specific direction of responses. Structured interviews rely upon an advanced list of questions set systematically to guide the interviewer. This approach has the advantage of ensuring uniformity among participants (Patton, 2002). In view of that, a structured interview guide was designed to elicit vital information from the officers at the physical development municipal and service directorate. The face-to-face interview with the officers was important in order to examine the nature and effectiveness of food safety training needs of food vendors. The interview guide consisted of 16 questions which covered areas such as; what qualifies food vendors prior to food vending, food safety training, food poisoning and challenges in training food vendors. 3.10 Pre-Testing The researcher embarked on separate pre-testing to check for the clarity of expressions and appropriateness of the research instruments. The aim of the pre-test was mainly to eliminate ambiguity and ensure that respondents understood the questions as intended by the researcher. Pre-testing in this study was done in two phases. The first phase which was the initial draft of the research instruments were reviewed by two MPhil students in the health 44 University of Ghana http://ugspace.ug.edu.gh services management department to access the content and constructions. They checked whether the instrument was clearly worded, free from major biases, and appropriate for the type of information needed. The second phase of the pre-testing was performed with five food vendors, 20 student consumers and an environmental sanitation officer on the University of Professional Studies in order to improve the research instruments. The final instruments were administered to selected food vendors who prepare and sell food on University of Ghana campus, student consumers and environmental sanitation officers on the University of Ghana campus. 3.11 Validity of the Instrument An instrument is said to be valid when it has the ability to measure what it is designed for. Instruments for data collection were carefully designed taking into consideration the objectives and purpose of the study. Pre-testing the research instruments also led to revision and refinement of the instruments. This ensured accuracy in data collection. 3.12 Data Gathering Procedure Data collection is an essential part of the research process in education and the humanities. Data collection techniques allow the researcher to methodically collect information about their object of study and of the setting they occur (Cln, 2013). Data collection was done on the University of Ghana main campus at Legon. A period of four (4) weeks was used to collect the entire data. The study consisted of four phases. The first phase included the use of an observation checklist to observe food vendors activities. Food vendors were not willing to participate, but after explaining to them the ethics involved, they consented. Each outlet that was observed had 2, 3 or 4 food vendors operating in it. Each 45 University of Ghana http://ugspace.ug.edu.gh outlet had those preparing food different from those selling. Those who were involved in the cooking process were observed at a go in each outlet; one outlet at a time followed by an individual or individuals who were selling the food after food preparation. Food vendors were observed for 4 hours during food preparation and 5 hours during the selling process. The second phase of the study involved the use of a questionnaire to gather information on food vendors‟ demographic characteristics. The third phase of the study involved the use of a questionnaire to elicit information from student consumers on campus after seeking their consent. Student consumers were given between 15-20minutes to answer the questions. The questionnaire distribution was done by the researcher with the help of a field assistant who was trained in that regard. The fourth phase involved the use of a structured interview guide to elicit information on the training needs of food vendors on campus from grounds and environmental health services officers with their consent which lasted for an hour. This is summarized as follows: Phase I: Examine hygienic practices of food vendors during food preparation and selling process. Developed hygienic practices of food vendors‟ observation form. Pre-tested observation form Examined the hygienic practices of food vendors using observation form. Phase II: Socio-demographic characteristics of food vendors. Developed a questionnaire. Gather data on food vendors‟ demographic characteristics. Phase III: Questionnaire for student consumers. 46 University of Ghana http://ugspace.ug.edu.gh Developed demographic characteristics of student consumers. Developed questions on the effect of hygienic practices on food safety. Pre-tested questionnaire Administered corrected and approved questionnaire. Phase IV: Gather data on the nature and effectiveness of food safety training needs of food vendors from Grounds and Environmental Health services officers. Developed an interview guide. Pre-tested interview guide. Examined the nature and effectiveness of food safety training needs of food vendors through an interview with two environmental sanitation officers. 3.13 Instrument for Data Analysis The data were analysed both quantitatively and qualitatively. Quantitative data in the form of answered questionnaires were checked, verified and then entered into the computer. Completed questionnaires were entered into the computer for final analysis. Data were entered into Excel statistical software and later exported to Statistical Package for the Social Science (SPSS) version 20 for further analysis. The quantitative data were analysed and interpreted with the use of descriptive statistics. The descriptive statistics was made up of frequencies and percentages derived from the structured questionnaire to analyse and interpret the findings. Statistical parameters: pie charts and graphs were also used to present quantitative data. The use of pie charts and bar graphs helped the researcher to provide pictorial evidence of the statistics. Data gathered from the observation was examined, described and analysed using thematic analysis. 47 University of Ghana http://ugspace.ug.edu.gh Data from the face-to-face interview was transcribed verbatim to reflect the expressions and explanations giving by the officers to analyse the data. Thematic content analysis was done to analyse and discuss the responses of the officers. This method of qualitative data analysis is the procedure for identifying, analysing and reporting patterns within data (Braun and Clarke, 2006). It helped the researcher to address the objectives in a non-statistical way. 3.14 Ethical considerations The study was purely for academic purposes and in no way endangered the profession of food vendors, ground and environmental health services officers or consumers that were included in the study. All data gathered was treated with high-level confidentiality. Ethical clearance was obtained from the office of Research, Innovation and Development, Ethics Committee for Humanities (ECH) at the Institute of Statistical, Social and Economic Research. Permission to conduct the study was also sought from the grounds and environmental health services unit of the university. Also, individual food vendors and student consumers selected were made to give a written or verbal consent if they agreed to participate (see Appendix1for consent form). The study was solely for academic purposes; hence participants were not identified by names but rather coded during the dissemination of results. 3.15.1 Consent procedures Participation in this study was by will. The purpose of the study was clearly explained to respondents and consent was sought from the participant before the commencement of data collection. Participants had the right to withdraw from the study at any point. Participants equally had the right to skip questions without any penalty. 48 University of Ghana http://ugspace.ug.edu.gh 3.15.2 Confidentiality A high level of confidentiality was assured to all potential study participants. Personal identifiers such as names were not included in the data collection procedure. Participant‟s information was not altered. 3.15.3 Potential risk This study had no form of risk associated with it. Maximum care was ensured during the process of data collection to prevent any possible harm to participants. 3.16 Chapter Summary Pragmatic paradigm, mixed method approach and a Sequential Exploratory Design was used for the study. Non-probability sampling with specific reference to Purposive sampling technique and purposive random sampling technique was used to select respondents for the study. Food vendors, grounds and environmental health services officers and student consumers on University of Ghana main campus formed the study population with the University of Ghana, Legon as the study area. Observation checklist, an interview guide and a questionnaire were the research instruments used in collecting data. All ethical considerations concerning a research were respected during the entire study. 49 University of Ghana http://ugspace.ug.edu.gh 50 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR 4.0 PRESENTATION OF RESULTS 4.1 Introduction This chapter presents results of analysed data. Data were presented in the form of descriptive statistics, charts and graphs. Qualitative data were thematically analysed. The analyses of the collected data are presented below. 4.2 Descriptive Information 4.2.1 Socio-demographic characteristics of food vendors (n=31) The total sample size of food vendors observed during the study was 31. Both females and males were involved in the study; however, females formed majority. Out of the 31 food vendors, 28 were females and 3 were males. Respondents‟ age ranged between 25 and 40 years. Regarding the educational status of respondents, 11 had a basic education, 7 had secondary education, 1 had tertiary education, precisely polytechnic with the remaining (12) respondents having no education. A majority 21 of the respondents were married while 9) were single with only 1 divorced. On the number of years food vendors have worked on campus, 11 vendors have worked on campus for 5 years, 5 vendors have worked on campus for 8 years, 5 vendors have also worked on campus for 11 years 10 of the remaining vendors have worked on campus for 15 years. See Table 4.1 overleaf. 51 University of Ghana http://ugspace.ug.edu.gh Table 4.1 Socio-demographic characteristics of food vendors (n=31) Variable Frequency Percentage Gender Male 3 9.7 Female 28 90.3 Total 31 100 Age 25 3 9.7 28 4 12.9 32 6 19.4 35 9 29.0 38 5 16.1 40 4 12.9 Total 31 100 Marital status Married 21 67.7 Single 9 29.0 Divorced 1 3.3 Total 31 100 Educational status Basic 11 35.5 Secondary 3 22.6 Tertiary 1 3.3 No education 12 38.7 Total 31 100 Number of years working 5 11 35.5 8 5 16.1 11 5 16.1 15 10 32.3 Total 31 100 Source: Author’s field data 52 University of Ghana http://ugspace.ug.edu.gh 4.3 Components on observation check-list explained This section assesses the hygiene practices of food vendors on campus precisely „Night market‟ and „Bush canteen‟ by observing their food preparation and selling activities, and benchmarking their activities against a specially designed checklist for the study which can be found at Appendix 1. Ten food outlets were observed from the two markets. To avoid the use of names, vendors observed at Night market were given excerpts. For example, BC 1, BC2 up to BC5 for vendors at Bush canteen; and NM1 to NM5 for vendors at the Night market. The observation checklist was subsequently separated into two parts which were observed during food preparation and observation during the selling of food, since those who prepared the food were different from those who did the selling. The categorisation was done under environmental hygiene, personal hygiene and food hygiene. In all, 31 food vendors were observed from 10 food stands. Various components on the observation check-list were thematically analysed. 4.3.1 (Night market, n= 16) 4.3.1.1 (NM1) During Food Preparation Environmental hygiene In regarding the state of the surroundings where food was being cooked; it was observed that the place was swept before food preparation began. Nonetheless, the place was not swept or cleaned again until after the food preparation which made the place look messy. Food handlers disposed their waste in designated dustbins but on the number of times this refuse were disposed of during food preparation, it was seen that waste was not disposed of until after cooking which made a lot of flies‟ troop to the food preparation site. 53 University of Ghana http://ugspace.ug.edu.gh Personal hygiene Two individuals were involved in the preparation of food. Food handlers assembled their ingredients for cooking before washing of hands. The two food handlers had no apron or other protective clothing on during the time of cooking. They all had a polish free nail. There was no open wound on either of the vendors. Food hygiene Rice used in the cooking was not washed before use. Other raw foodstuffs like vegetables and legumes were washed once with just water prior to usage. Utensils used for cooking, on the other hand, were clean. Their key source of water for culinary was pipe-borne. Water was mainly collected from the pipe and kept in a barrel during food preparation but these barrels containing water were not covered during the entire time of cooking. Stews were left uncovered throughout the cooking process. It was again observed that most of the cooking utensils of the vendors were left with water in them after cooking and cleaned when they were done the selling. Since there was a close proximity between where the food is prepared and where they are sold, salespersons just carried them to the sales points without covering the food. On the changing of clothing prior to food sale, it was observed that, those who did the cooking were different from those who did the selling. 4.3.1.2 at Sales Point Environmental hygiene On the state of the surroundings where food was sold, it was observed that the surrounding was clean and tidy unlike where the food was prepared. There was no dustbin present instead; a polythene bag was used to collect waste which was not tied up causing flies to troop around 54 University of Ghana http://ugspace.ug.edu.gh it. There were flies hovering around especially where the polythene bag containing the refuse was kept. Personal hygiene Two individuals were involved in the selling of food at the sales point. All the vendors washed their hands prior to food sales. Food vendors had an apron on but had neither headgear nor gloves on during food sales. One of the vendors had her left fingernails polished. The other vendor, on the other hand, had no polish on her nails. There was no open wound on either of the vendors. Food hygiene Foods sold were mainly rice dishes and the instrument used for serving as a metal ladle for fetching the rice and the stew whilst a tong was used in fetching salads and other accompaniments. All instruments used for serving were clean. Foods were covered during sales. Bowls for serving customers were cleaned immediately after use with soap and water but the water used for cleaning the bowls was used almost throughout the selling process. Food vendors served and took money from consumers with the same hand; a habit that can cause cross contamination. 4.3.1.3 (NM2) During food preparation Environmental hygiene With regard to the state of the surroundings where food was being cooked; it was observed that the place was swept before food preparation began and the cleaning continued throughout the cooking process. food handlers disposed their waste in designated dustbins but on the number of times this refuse was disposed of during food preparation, it was seen that waste was not disposed of until after cooking was done this attracted a lot of flies. 55 University of Ghana http://ugspace.ug.edu.gh Personal hygiene Two individuals were involved in the food preparation. On the washing of hands; it was observed that both food handlers just started with the arrangement of utensils and raw materials for food preparation without washing their hand. The two food handlers had no apron or other protective clothing on during the time of cooking. On the polished of nails, it was observed that they all had a polish free nail. On the changing of clothing prior to food sale, it was observed that those who did the cooking were different from those selling. Food hygiene Raw foodstuffs like ripe plantain and beans were not washed before using them. Vegetables, including onion and tomatoes among others, were washed with just water before incorporating it in the cooking process. Utensils used for cooking, on the other hand, were clean. Their main source of water for cooking was a pipe-borne. Water was mainly collected from the pipe and kept in a barrel during food preparation but these barrels were not covered. Cooking utensils were kept and cleaned at a later time and not right after cooking. On the mode of transferring cooked foods to sales points, it was observed that since there is a close range between where the food is prepared and where they are sold, salespersons just carry them to the sales points but the food was carried to the sales point without any cover. 4.3.1.4 at Sales Point Environmental hygiene The surrounding where food was sold was clean. There was a dustbin present but with no cover throughout the selling process. Regarding the presence of flies, there were a few hovering around but no other insects or rodents were seen. 56 University of Ghana http://ugspace.ug.edu.gh Personal hygiene One person was involved in the selling process. The food vendor did not wash her hands prior to food sales. The food vendor had an apron on but had neither headgear nor gloves on during food sales. The vendor had a polish free nail with no open wound. Food hygiene Food sold was gari and beans with fried plantain popularly known as „Red Red‟ and the instrument used for serving as a metal ladle and a fork which were clean. Cooked beans were covered during sales except for the gari, plantain and the palm oil being used to sell. Bowls for serving customers were clean immediately after use with soap and water but the same water for cleaning the bowls was used almost throughout the selling process. Vendor handled food and money with the same hands. 4.3.1.5 NM3 During food preparation Environmental hygiene A place where food was being prepared was clean but dusty since the place was neither cemented nor tiled. Refuse and other residuals from the cooking were not collected till after the food preparation which made the place look untidy. Food handler had no dustbin so waste produced was kept around till the cooking was done and disposed of in a designated dustbin provided for the market. Personal hygiene The food preparation aspect had just one food handler. The food handler did not wash her hands prior to cooking. Handler had no apron or other protective clothing on during the time of cooking. There were neither polished nails nor open wounds. 57 University of Ghana http://ugspace.ug.edu.gh Food hygiene Raw foodstuffs like yam and potatoes were not cleaned before cooking even though they had a lot of dirt on them. Fish and other meat, on the other hand, were cleaned before frying. Other raw foodstuffs like pepper, tomatoes and onions were washed ones with just water before grinding. Utensils used for cooking, on the other hand, were clean. The main source of water for cooking was a pipe-borne which she fetched directly from the pipe anytime she needed it. On the cleanliness of cooking utensils after food preparation, it was again observed that cooking utensils that were not in use again were cleaned and kept while the rest were used throughout the cooking and the selling process. On the mode of transferring cooked foods to sales points, it was observed that since there is a close proximity between where the food is prepared and where they are sold, salespersons just carry them to the sales points with food uncovered. 4.3.1.6 at Sales Point Environmental hygiene Surrounding where food was sold was observed to be clean and tidy unlike where the food was prepared. There was no dustbin present during sales. Personal hygiene One person did the selling during the selling process. Food vendor did not wash her hand prior to food sales. The vendor had an apron on but had neither headgear nor gloves on during food sales. The vendor had no polished nails. There was no open wound on the vendor. 58 University of Ghana http://ugspace.ug.edu.gh Food hygiene Foods sold were mainly fried yam, potatoes with fried fish and chicken and the instrument used for serving as the food vendor‟s bare hand for serving fried products and metal spoon for taking the pepper sauce. Fried products were kept in airtight sieves but the pepper sauce was left uncovered. Bowls for serving customers were clean immediately after use with soap and water but the same water for cleaning the bowls was used almost throughout the selling process. Food and money were handled with the same hands. There were hard flies around nonetheless there were few that settled on the utensil containing the uncovered pepper sauce. 4.3.1.7 NM4 During food preparation Environmental hygiene Regarding the state of the surroundings where food was being cooked; it was observed that the place was swept before food preparation began. Nonetheless, waste products generated during the cooking process were not collected until after the food preparation. Dustbin was available to collect waste which was disposed of when full. Personal hygiene Two individuals were involved in the food preparation.Food vendors zoomed into the cooking process after the sweeping of the place without washing their hands. The two food handlers had no apron or gloves but had a hair cap on during the time of cooking. They all had a polish free nail. Nonetheless, they did not wash their hands after disposing of refuse. On the changing of clothing prior to food sale, the individuals that did the cooking were different from those who did the selling. 59 University of Ghana http://ugspace.ug.edu.gh Food hygiene All ingredients that needed to be washed were cleaned with just water. Utensils used for cooking were clean. Their main source of water for cooking was a pipe-borne. Water was mainly collected from the pipe and kept in a barrel during food preparation. Barrels had a fitting lid. All utensils were cleaned after use. On the mode of transferring cooked foods to sales points, food vendors carried cooked food on trays to the vending site since it was just a walking distance. Food being carried was covered. 4.3.1.8 at Sales Point Environmental hygiene On the state of the surrounding where food was sold, it was observed that the surrounding was clean and tidy. There was a dustbin present but had no lid. Personal hygiene Food vendors did not wash hands prior to food sales. All the two food vendors had an apron and head gears but no gloves during food sales. One of the vendors had her nails polished. The other vendor selling fufu, on the other hand, had no polish on her nails. There was no open wound on either of the vendors. Food hygiene Two individuals were involved in the selling of food at the sales point Foods sold were mainly banku, kokonte and fufu (locally made foods). In the case of fufu, the vendor used her bare hand to serve; which is the right way for serving it nonetheless the vendor did not wash her hands before handling this food which is unhealthy and can cause contamination. Banku and kokonte were served using a locally designed product purposely made for serving these foods and the soup was served with metal ladles. Bowls for serving customers were clean immediately after use with soap and water for cleaning bowls were changed from time to 60 University of Ghana http://ugspace.ug.edu.gh time. On how money is handled during sales, there was a third person that consumer paid money to after buying so food vendors did not handle money themselves. 4.3.1.9 NM5 During food preparation Environmental hygiene The environment in which food was being prepared was swept but since it had rained and the place was not cemented, it made the surrounding muddy and messy. Food handlers disposed of their waste in a dustbin provided to the market but they personally did not have one present where they were cooking. Refuse were collected from time to time and deposited at the nearby dustbin Personal hygiene Two individuals were involved in the food preparation. Food vendors did not wash their hands prior to the cooking of food. The two food handlers had no apron or other protective clothing on during the time of cooking. On the polished of nails, it was observed that they all had polish free nails. Vendors did not wash their hands each time refuse was disposed of. None had an open wound. Food hygiene Raw foodstuffs were washed with just water before cooking. Utensils used for cooking, on the other hand, were clean. Their main source of water for cooking was a pipe-borne. Water for cooking was fetched into buckets and barrels but was not covered during the entire cooking period. On the cleanliness of cooking utensils after food preparation, it was again observed that some of the cooking utensils of the vendors were left with water in it to be cleaned at a later time. On the mode of transferring cooked foods to sales points, it was 61 University of Ghana http://ugspace.ug.edu.gh observed that since there is a close proximity between where the food is prepared and where they are sold, salespersons just carry them to the sales points. 4.3.1.10 at Sales Point Environmental hygiene On the state of the surrounding where food was sold, it was observed that the surrounding was clean and tidy compared to where the food was prepared. There was no dustbin present and consumers had to put used water sachets and tissues in a polybag provided which attracted flies. Personal hygiene At the sales point, only one person did the selling. Food vendor did not wash her hands prior to food sales. The vendor had an apron and cap on but had no gloves on during food sales. The vendor had no polished nails and open wounds. Food hygiene Foods sold was fried rice and the instrument used for serving was a plastic ladle for fetching the rice and the pepper sauce( shito) whilst a tong was used in fetching salads and other accompaniments. Foods were covered during sales. Bowls for serving customers were clean immediately after use with soap and water but the same water for cleaning the bowls was used almost throughout the selling process. Food vendor handled food and money at the same time. 62 University of Ghana http://ugspace.ug.edu.gh 4.3.2 (Bush Canteen, n= 15) 4.3.2.1 (BC1) During Food Preparation Environmental hygiene On the state of the surroundings where food was being cooked; it was observed that the place was swept before food preparation began. Food handlers disposed their waste in dustbins but on the number of times this refuse was disposed of during food preparation; it was observed that waste was not disposed of until after cooking which made a lot of flies‟ troop to the food preparation site. Personal hygiene The first food vendor to be observed at Bush Canteen had two people involved in the food preparation. It was again observed that those preparing the food washed their hands and changed their attires before going for the ingredients for the food. On the polished of nails, it was observed that only one of them had a polish free nail with the other one having polished nails Food hygiene All the ingredients were washed before cooking. Utensils used for cooking were clean. Their main source of water for cooking was a pipe-borne supplied at the kitchen. Water was mainly collected from the pipe and kept in a barrel during food preparation but these barrels containing water were not covered during the entire time of cooking. Utensils for cooking were cleaned after food preparation. On the mode of transferring cooked foods to sales points, it was observed that since there is a close proximity between where the food is prepared and where they are sold, salespersons just carry them to the sales points. 63 University of Ghana http://ugspace.ug.edu.gh 4.3.2.2 at Sales Point Environmental hygiene The surrounding where the food was being sold was clean and tidy. There was a dustbin which had a cover present at the sales point. It was again observed that foods were covered during sales. Personal hygiene At the sales point, two people were involved in the selling of food. Food vendors did not wash their hands prior to food sales. The food vendors had their aprons on throughout the food sale period and they also had their head gear but had no gloves on. Salespersons had their nails polished. There was no open wound on either of the vendors. Food hygiene Banku and rice balls were the main food being sold. Vendors were using plastic and metal ladles to serve food to customers. Bowls for serving customers were cleaned immediately after use with soap and water and were changed frequently as and when it becomes dirty. On how money is handled during sales, vendors handled food and money at the same time. 4.3.2.3 BC2 During food preparation Environmental hygiene On the state of the surroundings where food was being cooked; it was observed that the place was swept before food preparation began. Nonetheless, waste products generated during the cooking process was not collected until after the food preparation. It was again observed that they had a dustbin where refuse was kept and which was disposed of when full. Personal hygiene For the second observation, two individuals were involved in the food preparation. The two food handlers had no protective clothing on during the time of cooking. On the polished of 64 University of Ghana http://ugspace.ug.edu.gh nails, it was observed that they all had a polish free nail but they did not wash their hand any time refuse was disposed of. On the changing of clothing prior to food sale, the individuals that did the cooking were different from those who did the selling. Food hygiene Ingredients that needed to be washed were cleaned with just water. Utensils used for cooking were also thoroughly cleaned. Their main source of water for cooking was a pipe-borne. Water was mainly collected from the pipe and kept in a barrel during food preparation. Barrels had a fitting lid. Utensils were cleaned after use. On the mode of transferring cooked foods to sales points, food vendors carried cooked food on trays to the vending site due to the closeness of the cooking site to the sales point. Food being carried was covered. 4.3.2.4 at Sales Point Environmental hygiene On the state of the surrounding where food was sold, it was observed that the surrounding was clean and tidy. There was no dustbin present and customers had to carry their waste to a dustbin nearby. Personal hygiene Only one person was involved in the selling of food at the sales point. There was no washing of hands prior to food sales. The food vendor had an apron on and a headgear as well but no gloves. On the issue of polished nails, it was observed that the vendor had no polished nail. There was no open wound on the vendor. Food hygiene Rice was the food that was being sold precisely fried rice with fried fish and chicken and the instrument used for serving was a metal ladle for fetching the rice and the stew whilst a tong was used in fetching salads and other accompaniments. Foods were covered during sales. It 65 University of Ghana http://ugspace.ug.edu.gh was also observed that bowls for serving customers were clean immediately after use with soap and water and the water for cleaning bowls were changed from time to time with the same vendor handling money and serving food at the same time. 4.3.2.5 BC3 During food preparation Environmental hygiene The place where food was being prepared was swept clean. During the course of food preparation, Refuse and other residuals from the cooking were not collected until after the food preparation which made the place look untidy. Scales of fish were left unattended to which attracted a lot of flies to the cooking area. On the disposal of waste, it was again observed that they had no dustbin so refuse was kept around till the cooking was done; refuse was gathered and put in a designated dustbin provided for the market. Personal hygiene There were two individuals who handled the food preparation aspect. Food preparation began without the washing of hands. The food handlers had no apron or other protective clothing on during the time of cooking. None of them had polished nails and open wounds. Food hygiene Raw foodstuffs like tomatoes, pepper and onions among others were washed once without salt before using them. Utensils used for cooking, on the other hand, were cleaned. The main source of water for cooking was a pipe-borne which was fetched directly from the tap anytime it was needed. On the cleanliness of cooking utensils after food preparation, it was again observed that cooking utensils that were not in use again were cleaned and kept while the rest were used throughout the cooking and the selling process. Foods were carried to the vending site since it was close. 66 University of Ghana http://ugspace.ug.edu.gh 4.3.2.6 at Sales Point Environmental hygiene On the state of the surrounding where food was sold, it was observed that the surrounding was clean and tidy unlike where the food was prepared. There was also no dustbin present at the sale point and customers had to leave used tissues around where they ate. Regarding the presence of flies and other insects, a lot of flies were observed around due to the way waste was handled by the vendor. Personal hygiene One person did the selling during the selling process. It was observed that the food vendor did not wash her hands prior to food sales. The vendor had an apron as well as headgear but no gloves on during food sales. The vendor had no polished nails. There was no open wound on the vendor. Food hygiene Foods sold were mainly kenkey with fried fish and pepper sauce and the instrument used for serving kenkey and fish was the bare hand and a metal spoon for fetching the pepper sauce. Foods were covered during sales. Bowls for serving customers were not cleaned immediately after use since the same vendor was the one doing the washing. Even though the bowls were eventually cleaned with soap and water, the same water for cleaning the bowls was used almost throughout the selling process. The vendor handled food and money with the same hands. 67 University of Ghana http://ugspace.ug.edu.gh 4.3.2.7 BC4 During food preparation Environmental hygiene A place where food was being prepared was clean but refuse and other residuals from the cooking were not collected until after the food preparation which made the place look untidy. Personal hygiene The food preparation aspect had just one food handler. The food handler did not wash her hands before starting with the food preparation. The food handler had no apron but had hair scarf on during the time of cooking. There were no polished nails and open wounds. Food hygiene Yam to be fried was not washed before peeling. Vegetables were washed once with just water before use in the cooking process. Utensils used for cooking, on the other hand, were clean. The main source of water for cooking was pipe-borne which was fetched and kept in plastic buckets for use but this bucket had no covers. On the cleanliness of cooking utensils after food preparation, it was observed that cooking utensils that were not in use again were cleaned and kept while the rest were used throughout the cooking and the selling process. On the mode of transferring cooked foods to sales points, it was observed that since there is a close proximity between where the food is prepared and where they are sold, salespersons just carry them to the sales points with food uncovered. 4.3.2.8 at Sales Point Environmental hygiene The surrounding where food was sold was clean and tidy. There was no dustbin present. 68 University of Ghana http://ugspace.ug.edu.gh Personal hygiene Food vendor did not wash her hand prior to food sales. The vendor had an apron on but neither headgear nor proper gloves on during food sales. The vendor had no polished nails. There was no open wound on the vendor. Food hygiene Foods sold were mainly fried yam, potatoes with fried fish and chicken and the instrument used for serving was the food vendor‟s hand covered with a transparent polythene bag instead of a proper glove for serving fried products. Metal spoon was used for fetching the pepper sauce. Fried products were kept in airtight sieves and the pepper sauce kept in a plastic bowl with a lid. Bowls for serving customers were clean immediately after use with soap and water and the water was changed from time to time. On how money is handled during sales, the vendor handled food and money with the same hands. 4.3.2.9 BC5 During food preparation Environmental hygiene A place where food was being prepared was clean but refuse and other residuals from the cooking were not collected until after the food preparation which made the place look untidy. On how waste is disposed of during food preparation, food handlers had dustbins around with a tight-fitting lid to dispose of refuse and other waste produced during cooking. Personal hygiene The food preparation aspect had two food handlers. On washing of hands, the food handlers did not wash their hands before starting with the food preparation. The food handlers had their apron and hair cap on but no gloves during the time of cooking. Both food handlers had 69 University of Ghana http://ugspace.ug.edu.gh no polished nails. Nonetheless, food handlers did not wash their hands after disposing of waste any time the dustbin was full. Food hygiene Raw ingredients like rice were washed twice before cooking, other vegetables for cooking were washed once without salt or vinegar. Utensils used for cooking, on the other hand, were clean and their main source of water for cooking was a pipe-borne which was fetched and kept in uncovered barrels. Cooking utensils were cleaned after food preparation. Foods placed on trays and sent to the vending site for sale. 4.3.2.10 at Sales Point Environmental hygiene The surrounding where food was sold was clean and tidy. There was a dustbin present to collect waste. Personal hygiene One person did the selling during the selling process Food vendor did not wash her hand prior to food sales. The vendor had an apron and hair cap on but had no gloves on during food sales. The vendor had no polished nails. There was no open wound on the vendors. Food hygiene Foods sold were rice dishes and the instruments used for serving were ladles and tongs. The rice dishes were covered with exception of the stews and salads. Bowls for serving customers were cleaned immediately after use with soap and water and the water was changed from time to time when dirty. On how money is handled during sales, the vendor handled food and money with the same hands. Photographs of some of these developments were taken in other to lay credence to the development. Plate 4.1 shows a food vendor preparing food with no apron, hair cup or gloves 70 University of Ghana http://ugspace.ug.edu.gh on. Plate 4.2 shows unhygienic disposal of refuse at food preparation site. Plate 4.3 reveals the state of the surroundings where food is cooked. While plate 4.4 shows how used bowls are kept unwashed with used mops lying on surfaces where food are prepared. Plate 4.1 Photograph showing a food vendor with no apron, hair cap or gloves 71 University of Ghana http://ugspace.ug.edu.gh Plate 4.2 Photograph showing unhygienic refuse disposal at food preparation site Plate 4.3 state of the surrounding area of a food outlet where food is cooked. 72 University of Ghana http://ugspace.ug.edu.gh Plate 4.4 Photograph showing used bowls kept unwashed with used mops lying on surfaces where food is prepared 4.4 Descriptive Statistics 4.4.1 Demographic Characteristics of Respondents (student consumers, n = 300) Presented below are the demographic characteristics of the respondents. The demographic characteristics considered by the study are; gender, age, marital status and the level of the participants in their university education. The presentations of the demographic characteristics of the participants of the study are presented in Table 4.2 overleaf 73 University of Ghana http://ugspace.ug.edu.gh Table 4.2 Table showing Socio-demographic characteristics of student consumers (n= 300) Variables Frequency (N) Percentage (%) Gender Male 186 62.0 Female 114 17.0 Total 300 100 Age Below 18 - - 18-30 243 81.0 31-45 51 17.0 46-60 6 2.0 60 Above - - Total 300 100 Marital Status Married 84 28.0 Single 208 69.3 Divorced 8 2.7 Widowed - - Total 300 100 Level 100 68 22.7 200 97 32.3 300 74 24.7 400 26 8.7 600 21 7.0 700 14 4.7 Source: Author’s field data 2018 In Table 4.1, it can be seen that 186 of the respondents representing 62% are males and 114 of them representing 38% are females. This shows that the university has a large number of male populations as compared to females. On the ages of the respondents, the study found out that 243 of the respondents representing 81% are between the ages 18-30 years, 51 of them representing 17% are between the ages of 31-45 years, and 6 of them representing 2% are 74 University of Ghana http://ugspace.ug.edu.gh between the ages of 46-60 years. On the marital status of the respondents, the study again found out that 84 of them representing 28% are married, 208 of them representing 69.3% are single and 8 of them representing 2.7% of them are divorced. On their level of study on campus, the study found out that 68 of the respondents representing 22.7% are in their first year (Level 100), 97 of them representing 32.2% of them are in their second year (Level 200), 74 of them representing 24.7% of them are in their third year (Level 300), 26 of them representing 8.7% are in their fourth year (Level 400), 21 of them representing 7% are pursuing master‟s programs (Level 600) and 14 of them representing 4.7% of them are pursuing PhD programs (Level 700). From the presentation of the demographic information of the respondents, it can be observed that the participants of the study were drawn from diverse sections of the student population and do not represent any single section of the student body on campus. In view of this, the sampled respondents of the study can be said to be representative of the student population sampled for the study and as such, their views and opinions as far as the study is concerned are relevant to the stated aims and objectives of the study. 4.5 Food normally bought from food vendors On the type of food they normally buy from food vendors on various authorized food selling points on campus, 27% of them stated that they normally buy kenkey, 42.2% stated that they mostly buy rice, 20.7% said they buy banku and 9.7% said they buy fufu. Looking at the data, it can be observed that rice and kenkey are the foods that are mostly patronized by students on campus with fufu being the least patronized food on campus. This is presented in Table 4.3 overleaf 75 University of Ghana http://ugspace.ug.edu.gh Table 4.3 Food Mostly Patronized by Respondents Variable Frequency Per cent Kenkey 81 27.0 Rice 128 42.7 Banku 62 20.7 Fufu 29 9.7 Total 300 100.0 Source: Author‟s field data, 2018 4.6 How often food is bought When asked how often they buy their named foods on campus, 80.3% of them stated that they buy the food every day on campus with 12.3% stating they buy the food once a week, 7.3% also stating they buy the food twice a week on campus. A large number of respondents (80.3%) who stated that they buy the food every day show that buying food from these vendors may be their main source of food acquisition on campus. See Table 4.4 overleaf 76 University of Ghana http://ugspace.ug.edu.gh Table 4.4 How Frequent Respondents buy Food from Vendors Variable Frequency Per cent Everyday 241 80.3 once a week 37 12.3 twice a week 22 7.3 Total 300 100.0 Source: Author‟s field data, 2018 4.7 Why do you buy food outside? When asked why they buy food outside, 63% of the respondents stated that it is more convenient compared to cooking yourself. 18.7% also stated that due to their busy schedules, they hardly find time to cook thereby resorting to food vendors. The remaining 18.3% also stated that food outside is mostly cheap and affordable. See Table 4.5 Table 4.5 respondents reason for buying food outside Variable Frequency Per cent 63.0 It is more convenient compared to cooking yourself 189 Because of busy schedules 56 18.7 It is cheap and affordable 55 18.3 Total 300 100.0 Source: Author‟s field data, 2018 77 University of Ghana http://ugspace.ug.edu.gh 4.8 Ailment after eating food purchased On whether they have ever had any ailment after eating any of those foods, 97.7% of them answered yes meaning they have had an ailment after eating those foods bought from the food vendors. 2.3% of them also answered no saying they have never had issues with a stomach upset after eating those foods. A large number of respondents (97.7%) who answered yes means that most of the students who patronize food from vendors from campus do suffer from one stomach upset or another as a result of the food they buy from those vendors. This is presented in Fig 4.1 Fig 4.1 Chart showing responds of respondents on the issue of an ailment from foods bought Source: Author‟s field data, 2018 78 University of Ghana http://ugspace.ug.edu.gh 4.9 Symptoms present after eating food purchased (for those who chose yes to the previous question) When asked what the symptoms of that ailment they suffered as a result of the food they bought, 39% of them said the symptoms they suffered as a result of consuming those foods they bought from the food vendors was vomiting, 28.67% of them also said they also suffered from diarrhea and 32.33% said they suffered from stomach cramps. It is worthy to note that all the respondents of the study stated that they have suffered from one symptom of food poisoning or another as a result of consuming food from the food vendors on campus. This is presented in Fig 4.2 Fig 4.2 Chart showing symptoms respondents suffered from food patronage Source: Author‟s field data, 2018 79 University of Ghana http://ugspace.ug.edu.gh 4.10 Direct link between food purchased and ailment When asked if their ailment had a direct link to the food they ate from a vendor on campus, 96.3% of them answered yes meaning they are very sure their stomach upset was as a direct result of the food they ate whilst 3.7% of them answered „no‟ meaning the stomach upset they suffered had no direct link with the food they ate from the food vendors on campus. The majority of the respondents (96.3%) who answered in the affirmative shows that most students on campus directly link their stomach upset issues with the food they patronize on campus. This is presented in Fig 4.3 Fig 4.3 Chart showing respondents linkage of ailment to food patronage Source: Author‟s field data, 2018 80 University of Ghana http://ugspace.ug.edu.gh 4.11 If yes, why will you attribute it to the food you bought? On how they were able to attribute their ailment directly to the food they patronized on campus, 6.3% said there were a lot of flies around. On the same question, 12.3% also said the environment where the food was being sold was not properly cleaned thus their suspicion that they got their stomach upset issues from there, and 81.3% of them also said their doctor told them their condition was as a result of food poisoning. The majority (81.3%) who stated their doctors told them their condition was as a result of food poisoning means that a lot of students on campus do suffer from food poisoning as a direct result of the food they patronize on campus. This is presented in figure 4.4. Fig 4.4 Respondents reasons for attributing ailment to food bought. Source: Author’s field data, 2018 4.12 Do you still buy food from these places even after the ailment? When asked whether they still buy food from those places after the ailment, 40.33% of them answered yes meaning they still patronize food from those places even after the stomach 81 University of Ghana http://ugspace.ug.edu.gh upset and 59.67% also answered no meaning they no longer patronize food from those places after suffering from stomach upset as a direct result of the food they patronize. This is presented in Fig 4.5. Fig 4.5 Chart showing respondents patronage of food after ailment Source: Author‟s field data, 2018 4.13 If ‘yes’, why? When asked why they still patronize food from those places even after their ailment as a direct result of buying food from those places, 48.3% of them said they still patronize food from those places because that is their only source of food on campus, 24.7% said they still patronize those foods because they do not have time to cook themselves and 27% said those foods are always readily available for consumption thus their quest to keep on patronizing after suffering from stomach upset as a result. This shows that even though most students suffer from unhygienic foods, a number of factors compel them to keep on patronizing those foods in the absence of better alternatives. This is presented in Fig 4.6 overleaf. 82 University of Ghana http://ugspace.ug.edu.gh Fig 4.6 Chart showing respondents reasons for still patronizing foods on campus after ailment Source: Author‟s field data, 2018 4.14 Do you have any knowledge on food safety practices? On whether they have any knowledge on food safety practices, 59% of them answered yes and 41% of them answered no. Even though a majority (59%) of the respondents answered in the affirmative showing that most of the students on campus know about food safety practices and that they are conversant with the concept of food safety practices, still a significant number (41%) of them also stated that they have no knowledge of food safety practices. This is also presented in Fig 4.7 overleaf 83 University of Ghana http://ugspace.ug.edu.gh Fig 4.7 Chart showing respondents knowledge on food safety practices Source: Author‟s field data, 2018 4.15 If ‘yes’, what are some of the practices you know? When asked some of the food safety practices they are aware of, 6.7% of them said they are aware that leftover foods need to be heated before eating, 28.7% said they are also aware that food should be covered by flies and 64.7% said they are aware that practicing personal hygiene can help in food safety. This shows that all the respondents of the study are fully aware of one food safety practices or another. This is presented in Fig 4.8 overleaf 84 University of Ghana http://ugspace.ug.edu.gh Fig 4.8 Chart showing some of the food safety practices respondents know Source: Author‟s field data, 2018 4.16 In your opinion, do you think food vendors practice good hygiene in selling food? On whether they think food vendors practice good hygiene in selling, 9.7% of them answered yes meaning they are of the view that food vendors practice good hygiene in selling and 90.3% also answered no saying they are also of the view that food vendors do not practice good hygiene in their selling of food. A large number of respondents (90.3%) who answered in the negative shows that most of the students are of the view that food vendors on campus do not practice good hygiene in selling. This is presented in Fig 4.9 overleaf. 85 University of Ghana http://ugspace.ug.edu.gh Fig 4.9 Chart showing respondents view on if food vendors practice food hygiene Source: Author‟s field data, 2018 4.17 If ‘no’ why? When asked the reason why they think food vendors on campus do not practice good hygiene in their selling of foods, 38.6% of them stated that they see a lot of flies around the food anytime they go to buy food. 32% also said that the foods for sale are most of the time not properly protected from flies and dust whilst 29.4% said the food vendors do not have any protective clothing (apron, cap, gloves, etc.) whenever they are selling food to consumers. This is presented in Fig 4.10 overleaf 86 University of Ghana http://ugspace.ug.edu.gh Fig 4.10 Chart showing respondents view of acts that shows unhealthy food practices Source; Author‟s field data, 2018 4.18 Should there be any organized training or program for consumers on campus? When asked whether there is the need to organize training or program for consumers on campus, 87% of the respondents answered yes meaning that there is the need to organize a training program for food consumers on campus whilst 13% of them also answered no meaning there is no need for organizing training program for consumers on campus. The majority (87%) of the respondents who answered in the positive means that, there is the need to organise training programmes for consumers on campus. This is presented in Fig 4.11 overleaf. 87 University of Ghana http://ugspace.ug.edu.gh Fig 4.11 Chart showing respondents view on organizing a training program for consuming Source: Author‟s field data, 2018 4.19 If ‘yes’ why? Finally, when asked why there is the need to organize a training program for consumers on campus, 30% of them stated that to make consumers more aware of the hygienic practices of food vendors, 27% also stated that to help consumers practice good hygiene themselves and 43% of them also stated that there is the need to organize training program for consumers in order to let consumers have facts to educate vendors who are not adhering to good practices. This is also presented in Fig 4.12 overleaf. 88 University of Ghana http://ugspace.ug.edu.gh Fig 4.12 Chart showing respondents reason for training consumers Source; Author‟s field data, 2018 4.20 Effect of Hygienic Practices of Food Vendors on Consumer Food Safety This section sought to find out the effect that the practices or otherwise of hygienic measures in food preparation has on the health of the consumers. In that regard, questions were asked of the consumers regarding the effect that food vendors engagement in hygienic practices or otherwise has had on them. The cross-tabulation of that analysis is presented below. On whether they have had any stomach upset after eating any of the foods they bought from vendors on campus, 186 of males answered yes and 107 of the female respondents also answered yes. Only 7 females‟ respondents answered no meaning they have never experienced any stomach upset after eating foods from food vendors on campus. The large number (293) of the respondents who answered yes means that stomach upset after eating food from vendors on campus is very rampant. Again, it was observed that more male respondents (186) suffered from a stomach upset from stomach upset than their female 89 University of Ghana http://ugspace.ug.edu.gh colleagues (107). This is because males are more likely to patronize food from vendors as compared to females since females are more likely to prepare their own food thus not patronizing much food from vendors as males. This is presented in Table 4.6. Table 4.6 Gender of respondents who suffered ailment after eating from vendors Variables Gender Male Female Total Stomach upset after Yes 186 107 293 eating foods No 0 7 7 Total 186 114 300 Source: Author‟s field data, 2018 On whether they have had any stomach upset after eating any of the foods they bought from vendors on campus in relation to the ages of the respondents, 243 of those between the ages of 18-30 answered yes, 50 of those between the ages of 31-45 also answered yes with only 1 respondent answering no. None of those between the ages of 46-60 years answered yes with 6 of them answering no meaning any of them had had such an experience before. Nonetheless, a large number of respondents (243) of them who answered yes in the age group of 18-30 years show that most of the respondents in that age group suffer more from effects of food contamination than other groups. This can be due to the fact that they are more on campus than the other age groups and as a result, had more representation as could be seen in the demographic analysis. This is presented in Table 4.7 overleaf. 90 University of Ghana http://ugspace.ug.edu.gh Table 4.7 Age group in relation to ailment Variables Age 18-30 31-45 46-60 Total Ailment after eating foods Yes 243 50 0 293 No 0 1 6 7 Total 243 51 6 300 Source; Author‟s field data, 2018 On the symptoms of ailment that they suffered after eating those foods, 50 of the males said they suffered from vomiting whilst 67 of the females reported the same symptom. On the same question, 69 of the males reported diarrhoea and 17 of the females also reported the same malady. 97 of the females reported suffering from stomach cramps with none of the males reporting of this condition. This is presented in Table 4.8. Table 4.8 complications respondents suffered from, as a result of eating contaminated food (by gender) Variables Gender Male Female Total Complications Vomiting 50 67 117 Diarrhoea 69 17 86 stomach cramps 0 97 97 Total 186 114 300 Source: Author‟s field data, 2018 91 University of Ghana http://ugspace.ug.edu.gh On whether their stomach upset had a direct link with the food they ate from the vendor on campus, 186 of the male respondents answered yes with 103 of the females also answering yes. None of the males answered no and only 11 of the females answered no. A large number of respondents (289) who answered yes means that the stomach upset of the respondents had a direct link to the food they ate from the food vendors on campus. This is presented in Table 4.9. Table 4.9 Gender direct link of stomach upset to food Variables Gender Male Female Total Yes 186 103 289 No 0 11 11 Total 186 114 300 Source: Author‟s field data, 2018 On the same issue in relation to the ages of the respondents, the study found out that 243 of the respondents between the ages of 18-30 years directly linked their stomach upset to the food they ate from the vendors whilst 46 of those between the ages of 31-45 years also linked it to the food with none of those between the ages of 46-60 years linking it to the food. Only 5 of those between the ages of 31-45 years and 6 of those between the ages of 46-60 years did not link their stomach upset to the food they ate from the vendors. A large number of respondents (289) who answered yes means that most of the respondents blamed their ailment on the food they ate from the food vendors on campus. This is presented in Table 4.10 overleaf. 92 University of Ghana http://ugspace.ug.edu.gh Table 4.10 Age of respondents who directly suffered from food contamination Variables Age 18-30 31-45 46-60 Total Yes 243 46 0 289 No 0 5 6 11 Total 243 51 6 300 Source: Author‟s field data, 2018 On the reasons why they blamed their stomach upset on the food they bought from vendors on campus, 19 of the male respondents said there were a lot of flies around when buying the food, 37 of them also said the environment in which the food was being sold was not properly cleaned whilst none of the females agreed to any of these. 130 of the male respondents said their doctors told them it was food contamination and 114 of the female respondents also stated that their doctors also told them. A large number of respondents (244) who stated that they were told by their doctors show that most of the ailment cases are as a result of food contamination. This is a very bad development and calls for strict attention. This is presented in Table 4.11 overleaf. 93 University of Ghana http://ugspace.ug.edu.gh Table 4.11 Factors linked to complications after eating food from vendor Variables Gender Male Female Total There were a lot of flies 19 0 19 around when I was buying the food The environment was not 37 0 37 properly cleaned My doctor said it was 130 114 244 food poison Total 186 114 300 Source: Author‟s field data, 2018 4.21 Analysis of Interview data for grounds and environmental health services officers on the University of Ghana campus This section presents the interview data collected from the Grounds and Environmental Health Services Officers on the University of Ghana campus, Legon. The interview was conducted for these officers with the view of finding out if food vendors undergo any training on food safety before and during their food vending career and how effective it is if they undergo training. In view of that, two (2) resident Officers from Grounds and Environmental Health Services Office under the Physical Development Municipal and Service Directorate were selected for the study. The researcher in analysing first transcribed the recorded interview verbatim, read thoroughly through the transcripts of the interviews and identified important words and essential narratives through coding. 94 University of Ghana http://ugspace.ug.edu.gh In order not to confuse the responses of the two interviewees and also, not to reveal their identities which is in violation of the ethical consideration of any study, they will be given the pseudonyms of; Interviewee A = A Male Senior Grounds and Environmental Health Services Officer. Interviewee B = A Male Junior Grounds and Environmental Health Services Officer These are the identities that will be used throughout the analysis of the qualitative data of the study in order to avoid ambiguity and enhance the understanding of the analysis of the qualitative data. 4.21.1 Socio-demographic characteristics of officers Health services officers interviewed were males; both were married with a tertiary qualification in education. In terms of age, interviewee, A and B were 47years and 32 years o respectively. Both officers chose to speak English during the course of the interview. Qualification When asked what qualifies one to sell food on campus? Interviewee A said, “One will first have to go and see the deputy director of Estate at P.D.M.S.D and pick a health screening forms and fill. After that, he/she sends it to the University of Ghana hospital for medical screening. Some of the screening includes Tuberculosis, heart-related diseases and other communicable diseases. After the screening, the supposed to be vendor will be given feedback on the medical screening report to be given to the deputy director. If the doctors declare the person is fit or satisfied are satisfied with the medical results, then the person is given license to operate on campus. If the report states that you are not qualified, 95 University of Ghana http://ugspace.ug.edu.gh you do not issue any license to operate. The license is also subjected to renewal every year”. On the same question, Interviewee B also added that, “One has to be declared medically fit and free from all forms of communicable diseases and infections before one can be issued with a license to operate as a food vendor on campus. This certification has to also come from only the University’s hospital and nowhere else”. Looking at the response from these officers, it can be seen that the University put a lot of premium on the health of food vendors thereby requesting them to seek and provide a medically filed report from the University‟s hospital before they are issued a license to operate which is subject to renewal annually. In-service training On whether they provide in-service training for food vendors, both Interviewees answered “yes” Meaning they organize in-service training for food vendors on campus. How often training is done When asked how often that they do organize the training programme for food vendors, Interviewee A said, “Actually, training is done for food vendors once a year but what we normally do is normal inspection that is done regularly to make sure they are doing the right thing, then quarterly, we organize a health talk for them”. Interviewee B also said, “As my boss has said, the training programme is actually organized once a year but when issues come up and there is the need to conduct an impromptu training programme for them, we do that. Sometimes, some issues come up that need immediate address like the Swine Flu 96 University of Ghana http://ugspace.ug.edu.gh and Ebola issue so we needed to engage with the food vendors immediately in order to protect the student and the staff of the institution”. This shows that even though training programmes are required to be organized annually for the food vendors, other factors can call for immediate training programmes and they also organize inspection to ensure compliance with safe food practices. Time allocated for training When asked whether, in their opinion, they think the number of times the training is done is enough to equip food vendors with the information they need to ensure proper hygiene, Interviewee B said, “Not really but the regular inspection helps to control bad habits”. Interviewee A also added that “I think the number of times the training is done is not enough. It is done just once a year then we try to add regular inspections”. From these responses, it can be observed that all the interviewees do agree that the number of training organized for food vendors on campus is not enough but they try to supplement it with regular inspections in order to ensure that food vendors do comply with safe food practices. This means that there is the need to regularly engage food vendors in training programmes since it has been found that it help in ensuring their adherence to safety food practices. Topics treated during training Pertaining to some of the topics that are treated during the training of food vendors, Interviewee A said, “Some of the topics include how to wash your hand, food safety, proper disposal of waste, personal hygiene”. 97 University of Ghana http://ugspace.ug.edu.gh Interviewee B said, “How to make sure the environment where food is prepared and sold is clean, how to keep flies away from food among others”. This shows that the training for food vendors basically teach them about how to engage in safe food practices in the preparation and selling of food. Monitoring When asked whether there is the existence of a monitoring or assessment tool to assess if food vendors are working under hygienic conditions, Interviewee B said, “We just do the inspection then we advise you, if we find out you are not doing the right thing”. Interviewee A also added that “the only thing we do to monitor is to go for inspection which we try to do from time to time to ensure they are doing the right thing’’ This shows that the only form of monitoring is by inspection to assess if food vendors are working under hygienic conditions or not and inspectors do inspect based on their subjective views. Additional measures When asked about additional measures they take to enforce good hygienic practices among food vendors on campus, Interviewee B said, There are no additional measures apart from the one we told you earlier which the inspections. 98 University of Ghana http://ugspace.ug.edu.gh Interviewee A again said, “Basically, as he said its routine inspection that we do and the quarterly health talk we organize for food vendors”. This shows that the only measures they have in place to enforce good hygienic practices among food vendors on campus is regular inspections and quarterly health talks. Food poisoning When asked whether they have ever had any issue of food poisoning among students on campus, Interviewee A said, “Oh yes, we have had cases of where students had encountered food poisoning from eating at either Bush Canteen or Night Market which means some people are not practicing what we teach them which makes our work difficult. Another issue is that some people are selling at some places that are not authorized by us. We have not given them any license to operate but they are operating. We approached one and we saw that she had a dirty environment while selling food but she told us that a Lecturer gave her permission to sell so we cannot do anything to her”. Interviewee B also added that “Yes, we sometimes encounter such issues which are very bad”. This shows that the officers are fully aware of some the issue of food poisoning occurring among students after patronizing food on campus even though these officers have been mandated to prevent this. Penalty On the penalty measures that food vendors who do not practice good hygiene face, Interviewee A said, 99 University of Ghana http://ugspace.ug.edu.gh “We first advice and give warning to any vendor not practicing good hygiene, if a vendor does not adhere to advice, we suspend the vendor for a while and finally, we sack the vendor from campus if after coming back from suspension, still continues to misbehave” Interviewee B said, “To add to what my boss said, after advising you, you are also given a notice before the suspension then ejection if all fails”. This shows that the officers have the right to suspend and subsequently revoke the license of food vendors who do not comply with good hygienic practices in their preparation and sale of food on campus. Challenges On the challenges they face in discharging their duty, Interviewee A said, “Our first challenge has to do with funding for organizing training for food vendors. Our problem is that food vendors pay rent, yet we have to rely on outsiders which we have to take contributions from food vendors to pay them before they can get proper training on food. Secondly, in terms of food safety, Bush Canteen is not fortunate. The place is not well structured, where they cook and where they sell is very crowded, they need to expand the place. In the case of Night Market, the place has no washroom that is a bigger problem, it can cause so many health hazards, and food contamination can also be very high”. Interviewee B also added that “The school authorities do not give us the full power to operate and prosecute and it feels like other bodies are involved which makes our work very difficult. All our annual reports become paper works and are not enforced; this negatively affects our work in ensuring food safety on campus”. 100 University of Ghana http://ugspace.ug.edu.gh This shows that the officers in the quest to discharge their mandated duties are met with a number of challenges which hamper the effective and efficient discharge of their duties. Recommendations When asked about the recommendations to help improve hygienic practice among food vendors on campus, Interviewee A said, “Reports are written at the end of every academic year yet nothing is said or done about it. There is no feedback from authorities leaving some of our demands hanging and not addressed. The school authorities should try and recruit more staffs since we need more hands to do this work. Since food vendors pay money to the school, we will be glad if the authorities help to improve the food vending site. The school should also help us organize frequent training for vendors since once a year is not enough and this has to do with money so we will be glad to get help” Interviewee B also said, “You know, Bush canteen is crowded and Night market has no washrooms and the place is somehow dusty too. All these contribute to food contamination. We will be very glad if the school can do something to improve the situation since food vendors pay money to the school. The school authorities must also give us the powers to carry out our duties without any fear or favour because whenever any food poisoning issue occurs, we are the ones they blame.” This clearly shows that both the interviewees have comprehensive knowledge and ideas about what needs to be done in order to enhance their work. 101 University of Ghana http://ugspace.ug.edu.gh 4.22 Recommendations by Respondents The following recommendations were suggested by respondents Grounds and environmental health services officers and the food vendors recommended that management of the University construct washrooms at the Night Market since they do not have one available for use. Food vendors requested the University authorities to help them tar or cement places where they cook their meals or better still construct Night market to make it more suitable for buying and selling since, in the raining season, the place becomes so muddy. The officers recommended further that the University authorities must make more funds available so that they can engage the food vendors with adequate training. The grounds and environmental health services officers also requested for full support and power from the University authorities so that they can sanction non-abiding food vendors without fear or favour. 4.22 Chapter Summary This section presented the findings according to the set objectives. The presentation was structured into demographic characteristics, hygienic practices among food vendors during food preparation and the selling process, effects of hygienic practices of food vendors on consumer food safety and the nature and effectiveness of food safety training needs of food vendors. 102 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE 5.0 DISCUSSION OF FINDINGS 5.1 Introduction This chapter of the thesis discusses the findings of the study in relation to existing literature and research objectives to ascertain if there are contradictions or confirmations of the extant literature and a chapter summary. The outline of the discussion follows that of the presentation of results. 5.2 Hygienic Practices among Food Vendors during food preparation and the selling process The extant literature reveals that street food hygiene can be enhanced when the necessary mechanisms are put in place by food vendors in order to prevent food contamination. Some of the mechanism that vendors can put in place to prevent contamination are; good and hygienic food preparation and vending environments, good and effective food management and handling methods, prioritization of vendors personal hygiene among others. In view of that, the study tried to examine the hygienic practices among food vendors during their food preparation and the selling process on the University of Ghana main campus with specific reference to vendors at the Night market and Bush canteen. The most significant finding was that the performance of food vendors on campus, regardless of their food safety and sanitation knowledge (based on the interview results), was less than stellar. Food vendors one way or the other knew what proper procedures were (from environmental officers during the interview) but failed to follow them either during food preparation or the selling process. These findings were similar to that of Monney et al. (2013) who also observed that employees‟ food safety knowledge does not always translate into good food safety practices. 103 University of Ghana http://ugspace.ug.edu.gh One reason for not performing the proper food safety practices may be that the vendors were so busy trying to complete basic preparation and provide service to consumers, either consciously or subconsciously, decided not to follow proper food safety and sanitation practices or because of lack of proper supervision from food inspectors. Green and Selman (2005) also found that there were a number of factors that impacted foodservice employees‟ ability to prepare food safely, including time pressure; equipment and resource availability; food safety emphasis by management and co-workers; and food safety education and training. The researcher found the most significant error made by the food vendors was the lack of personal hygiene practices; more specifically, the lack of proper hand washing. This is disturbing as many researchers (Paiva de Sousa, 2008; Annor Baiden, 2011; Monney et al. 2013; Esena & Owusu, 2013; Lah, 2016) found that proper hand washing was the single most important means of preventing the spread of foodborne illness. During observation, food vendors hardly washed their raw foodstuffs before cooking and those who washed it barely did it well. Some foods were left uncovered throughout the cooking process and waste generated in most of the cases was left unattended to. This confirms a study by Annor and Baiden (2011) emphasizing that food vendors more often than not expose food to all kinds of dangerous abuses often during all the stages of handling food (from preparation to selling). Also of concern was the fact that when moving food, the majority of the vendors carried foods to the selling site without covering them exposing the food to all kinds of contaminations. Almost all the food vendors handled money with same hands used in serving food to customers. This is in line with a study by Ayeh-Kumi (2009) stating that the source of contamination was the transfer of germs from money to food as vendors in an attempt to multi-task ended up contaminating food with bacteria on currency notes and coins. 104 University of Ghana http://ugspace.ug.edu.gh During the observation, none of the food vendors had complete apparel. Wearing of aprons, caps and gloves are one of the ways of reducing food contamination. Unfortunately, even knowing that the researcher was observing them for proper food safety and sanitation practices, the food vendors did not attempt to follow these practices. 5.3 Assessment of the Effects of Hygienic Practices of Food Vendors on Consumers’ Food Safety The study found out that due to lack of positive food handling behaviour among food vendors on campus, majority of the students who patronized their foods suffered from food poisoning (Fig 4.4, Fig 4.5 and Fig 4.6). This reflects a study by Tavoga (2014) that, inadequate food hygiene can lead to food-borne illnesses due to improper food handling practices and in extreme events, even death. From the results, it can be established that student consumers continue to suffer food poisoning as a result of negative food handling behaviours of vendors. when students were asked why they continue to buy food from these places after ailment, they said it is largely due to the fact that the food is readily available, convenient and cheap and due to the fact that they do not always have the time to cook as a result of busy schedules so they have to fall on food vendors for food. This makes food safety a bigger concern as food prepared and sold in an unhygienic manner can put the lives of these students at stake. From the questionnaire administered, it was obvious majority knew what food safety was and knew the right things that needed to be done to ensure it. Nonetheless, a significant number did not have enough information on what constitutes food safety and how this affects their health. This could be one of the reasons why they could not demand quality food from food vendors leading to their ailment as a result of eating unwholesome foods. The issue of food poisoning on campus was also confirmed by the Grounds and Environmental Health Services Officers who were interviewed for the study. 105 University of Ghana http://ugspace.ug.edu.gh According to the Ministry of Food and Agriculture and the World Bank (2007), in Ghana, per the estimates, 1 in every 40 Ghanaians suffer serious foodborne disease or illness annually which translates into 420,000 reported cases annually, which cost the government $69 million annually. In view of these developments, safety food practices have been emphasized strongly in recent times since it has been found that most foods prepared and sold outside the home may generally be prepared and sold under unhygienic conditions, with limited access to safe water, sanitary services, or garbage disposal facilities (Rheinländer et al., 2008). 5.4 The nature and effectiveness of food safety training needs of food vendors According to the FAO and WHO, food vendors are required to undergo basic training in food hygiene before licensing and further training as required by the relevant authorities In line with this, food vendors in the University of Ghana were required to undergo health screening before licensing. On the food training needs of the food vendors on campus, the grounds and environmental health services officers who were interviewed for the study all stated that they do organise training for food vendors on campus and how regular these trainings are organised, they stated that; “Actually, training is done for food vendors once a year but what we normally do is normal inspection to make sure they are doing the right thing.. Interviewee B also said, “As my boss has said, the training programme is actually organized once a year but when issues come up and there is the need to conduct an impromptu training programme for them, we do that. Sometimes, some issues come up that need immediate address like the Swine Flu and Ebola issue so we needed to engage with the food vendors immediately in order to protect the student and the staff of the institution”. This clearly shows that even though training is organised for food vendors on campus, the training is really not enough to equip and 106 University of Ghana http://ugspace.ug.edu.gh empower the food vendors due to the inefficiency of how such training is organised. Training is said to be an important tool needed to create awareness among food service workers about the hazards associated with foods and the food safety practices that must be used to prevent foodborne illness (Bryan, Caroline & Madelon, 2003). The safety of street-vendor food can be improved on provided food vendors undergo or acquire training in basic hygiene skills. Clayton & Griffith (2008) in a study have revealed that one of the best means of averting foodborne disease is through education and training of food handlers. From the interview, it was obvious that food vendors go through training but the major problem was that it was not efficient. From their socio-demographic data collected, the majority of the vendors had no formal education and a significant number just had basic education and knowing that the food sector is an informal sector in the country and it is mostly the job of the uneducated, there is the need to ensure not only training but efficient and effective training to help food vendors produce wholesome foods for consumption. The converse will result in food contamination leading to inevitable food poisoning. Findings from the interview revealed that food vendors, due to gross disobedience do not practice good hygiene even though they are educated on how to ensure it. This confirms a study by Apanga et al. (2014) stating that a number of efforts have been made in the field of food safety and hygiene education amongst street food vendors. Although these efforts have led to an increase in awareness and knowledge levels of food safety and hygienic practices, this knowledge is however not always translated into actual practice. Other researchers also proposed that even though training leads to increased knowledge it does not necessarily lead to increased knowledge on food safety and positive food handling behaviour (Annor & Baiden, 2011) therefore the need for food inspectors and other authorised bodies to embark on regular and effective monitoring and supervision. Findings of the study also revealed that, since officers in charge of the food vendors on campus were limited, engaging in regular and frequent monitoring and inspection was a 107 University of Ghana http://ugspace.ug.edu.gh challenge. This could be one of the reasons why food vendors were relaxed doing what they deemed fit in their activities since they were hardly monitored and supervised. Another challenge from the findings was due to poor infrastructure and lack of washrooms at the markets on campus as emphasized by the officers; these issues when well addressed by the university authorities can go a long way to reduce the burden of food-borne diseases as confirmed by (Ababio and Adi, 2012). 5.5 Chapter Summary The findings of the study were discussed in relation to the extant literature and the objectives of the study. 108 University of Ghana http://ugspace.ug.edu.gh CHAPTER SIX 6.0 SUMMARY, RECOMMENDATION AND CONCLUSION 6.1 Introduction This concluding chapter of the thesis looks at recommendations that were suggested by the respondents of the study concerning what can be done to enhance food safety practices on the University of Ghana campus, implications of the study taking into consideration the researcher‟s perspective as to what can be done as far as policy, practice and research are concerned to enhance food safety practices on the University of Ghana campus, The limitations and conclusion of the study. 6.2 Summary The specific objectives of the study was to examine the hygienic practices among food vendors during food preparation and the selling process, to assess the effects of hygienic practices of food vendors on consumer food safety and to examine the nature and effectiveness of food safety training needs of food vendors. The mixed method approach was used to collect data for the study. The study established that food vendors did not practice positive food handling behaviour which affected the quality and sanity of food consumed by student consumers on campus resulting in food-borne diseases. The negative attitudes of food vendors in their food preparation and service was due to but not limited to lack of regular monitoring and supervision, inefficient training, gross disobedience of food vendors among others. 109 University of Ghana http://ugspace.ug.edu.gh 6.3 Recommendations Stated below are the implications of the study which looked at implications for policy, implications on research and implications on a practice that if adhered to, will enhance safety food practices and reduce food poisoning on the University of Ghana campus and other campuses across the country. 6.3.1 Implications for Policy On the implications on policy, the researcher suggests that; 1. The University authorities in collaboration with grounds and environmental health services officers must come out with a comprehensive food safety policy and guidelines to guide food vendors on campus on the do‟s and don‟ts on food preparation and sales with their roles and responsibilities clearly stated and the grounds and environmental health services should take it upon themselves to teach explain these rules and roles to food vendors on campus to ensure a positive food handling behavior. 2. The roles of grounds and environmental health services officers should also be clearly defined to enable them to carry out their duties without fear or favour. 6.3.2 Implications for Practice On the implications of the study based on practice, the following suggestions are made; 1. Food vendors need to be taken through regular and thorough training programmes for them to be abreast with new developments in food safety practices since they hold the lives of millions of people across the globe and their activities can cause unprecedented death and misery. Once a year training is not enough to help vendors especially vendors who are recruited before the time of training. 110 University of Ghana http://ugspace.ug.edu.gh 2. The University should make the effort to employ more grounds and environmental health services officers and further train them extensively on environmental and on food safety and food management. When this is done, food vendors can be broken into cells and effectively trained and monitored by supervisors or officers assigned to them. This process can ensure effective training and monitoring at the same time and can effectively cause a behavioural change among food vendors. 3. All food vendors must be required to get a sanitary permit from the health and school authorities. The regulation could compel the food vendors to comply with sanitation standards and requirements related to sanitary practices in food services to forestall or avoid foodborne and waterborne illness due to food contamination or poisoning. The imposition of sanitary permits ensures inspection of the quality of food served by street vendors. Strict compliance with getting a sanitary permit by street food vendors doing business should be regularly monitored by the University authorities. 4. Training should be done at no cost to the food vendor and a certificate should be awarded at the end of each training programme to serve as a motivation. 5. The University in collaboration with the grounds and environmental health services officers on campus should hold an expert seminar with student consumers at least once a semester to create awareness in food safety in order to help them demand quality food from food vendors and to stand the chance of advising vendors when they are not doing the right things when they go to purchase food and alert authorities where necessary. 111 University of Ghana http://ugspace.ug.edu.gh 6.3.3 Implications for Research 1. Based on the outcome of the present study, future researches can also focus on how non-cooked food sellers such as fruit and vegetable sellers also engage in hygienic practices in the preparations of their fruits and vegetables (which are eaten raw). 2. Future studies can also look at the knowledge, perception and attitude among food vendors on the University of Ghana campus. 6.4 Conclusion The study sought to find out the hygienic practices of food vendors; effect on consumer food safety on University of Ghana campus, Legon. 300 student consumers, 31 food vendors and 2 grounds and environmental health services officers on University of Ghana main campus in the Greater Accra region were selected for the study. The study revealed that food vendors at Night market and Bush canteen on the University of Ghana campus do not engage in safe and hygienic food practices which lead to cases of food poisoning among student consumers; this was confirmed by majority of the student population engaged in the study, and also by Grounds and environmental health services officers when they were interviewed. These unhygienic practices by food vendors during their activities is as a results of factors including but not limited to, inadequate training sections, not enough health services officers to embark on regular inspections to make sure vendors are adhering to proper hygiene and refusal of some vendors to put what they have learnt into use even though they have acquired knowledge about hygienic practices. Better and more efficient hygienic practices can prevail among food vendors if frequent and adequate training is given to ensure they are well equipped with the right set of information to ensure proper food safety habits. 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Yes, I agree/ No, I disagree CONTENT BEHAVIOUR OF FOOD VENDOR DURING FOOD PREPARATION  Environmental hygiene 1. State of surroundings where food is cooked 2. How waste is disposed of during food 129 University of Ghana http://ugspace.ug.edu.gh preparation 3. How often waste is disposed of during food preparation 4. Check for insects and other domestic animals  Personal hygiene 5. Washing of hands before food preparation 6. Wearing the apron and other protective clothing whilst cooking 7. Check for polished nails 8. Check for an open wound 9. Change of clothing prior to food sale  Food hygiene 10. Washing of raw foodstuffs before use 11. Source of water supply 12. Storage of water during food preparation 13. Cleanliness of utensils for cooking 14. Cleaning of utensils after food preparation 15. How food is handled during cooking 16. Mode of transferring cooked food to the sales point 130 University of Ghana http://ugspace.ug.edu.gh AT SALES POINT  Environmental hygiene 17. State of surroundings where food is sold 18. Presence of dustbin 19. Covering of dustbin 20. A number of times refuse is disposed of during sales. 21. Check for insects and other domestic animals  Personal hygiene 22. Washing of hand prior to food sale 23. Wearing gloves and aprons when selling 24. Check for polished nails 25. Check for an open wound 26. washing of hands after each refuse disposal  Food hygiene 27. Covering food when selling 28. An instrument for serving food 29. How money is handled during sales 30. Washing of bowls after use 31. Use of soap for washing bowls 131 University of Ghana http://ugspace.ug.edu.gh 32. Number of times water for washing bowls is changed 132 University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA BUSINESS SCHOOL UNIVERSITY OF GHANA, LEGON RESEARCH WORK: HYGIENIC PRACTICE OF FOOD VENDORS; EFFECTS ON CONSUMER FOOD SAFETY ON UNIVERSITY OF GHANA CAMPUS. THE UNIVERSITY OF GHANA QUESTIONNAIRE FOR FOOD VENDORS Date: ………………………………………… Unique ID No.: ………………….. Dear respondents, This research seeks to study the hygienic practice of food vendors: effects on consumer food safety on University of Ghana campus and you happen to be one of my respondents who will help me answer some questions on the issue. Confidentiality of this conversation is assured. But before I start I need to seek your permission and time to go ahead. Do you agree to be part of the study? Yes, I agree/ No, I disagree 133 University of Ghana http://ugspace.ug.edu.gh Demographic characteristics of food vendors 1) Gender ………………………….. 2) What is your age? ……………………………… 3) What is your highest educational level? ……………………….. 4) What is your Marital Status? …………………………. 5) How long have you worked at Legon campus? …………………………… 134 University of Ghana http://ugspace.ug.edu.gh APPENDIX TWO UNIVERSITY OF GHANA BUSINESS SCHOOL UNIVERSITY OF GHANA, LEGON RESEARCH WORK: HYGIENIC PRACTICE OF FOOD VENDORS; EFFECTS ON FOOD SAFETY ON THE UNIVERSITY OF GHANA CAMPUS. QUESTIONNAIRE FOR CONSUMERS. Date: ………………………………………… Unique ID No.: ………………….. Dear respondents, This research seeks to study the hygienic practice of food vendors: effect on food safety on University of Ghana campus, Legon. Please indicate your responses by ticking against your preferred choice(s) or fill in the boxes where required. It is of utmost importance that you give clear and concise responses that would facilitate smooth data analysis. All information provided will be treated as confidential. 135 University of Ghana http://ugspace.ug.edu.gh SECTION A: DEMOGRAPHIC INFORMATION. Please tick the appropriate responses. Characteristics 1. Age Below 18 [ ] 18-30 [ ] 31-45 [ ] 46-60 [ ] 60 and above [ ]. 2. Gender Male [ ] Female [ ]. 3. Marital status Married [ ] single [ ] divorced [ ] Widowed [ ] 4. Level 100 [ ] 200 [ ] 300 [ ] 400 [ ] 600 [ ] SECTION B: EFFECT OF HYGIENIC PRACTICES ON FOOD SAFETY 5. What type of food do you Kenkey [ ] rice [ ] banku [ ] fufu [ ] normally buy from Night market other (specify)…………………. or Bush canteen? 6. How often do you buy food on Everyday [ ] once a week [ ] twice a campus? week [ ] other ( specify) 7. Why do you buy food outside? It is more convenient compared to cooking yourself [ ] because of busy schedules [ ] it is cheap and affordable [ ] other (specify)……………………… 8. Have you ever had any ailment Yes [ ] No [ ] after eating any of these foods 9. If yes what symptoms were Vomiting [ ] diarrhea [ ] stomach present? cramps [ ] other (specify)………………. 136 University of Ghana http://ugspace.ug.edu.gh 10. Would you say your ailment has Yes [ ] N o [ ] a direct link with the food you ate from a vendor on campus? 11. If yes why will you attribute it to There were a lot of flies around when I the food bought from a vendor? was buying the food [ ] the environment was not properly cleaned [ ] my doctor said it was food poison [ ] Other (specify)………………………… 12. Do you still buy food from these Yes [ ] No [ ] places even after the ailment? 13. If yes, why? Because that is my only source of food on campus [ ] I don‟t have time to cook always. [ ] it is readily available for consumption [ ] other specify…………………………. 14. Do you have any knowledge of Yes [ ] No [ ] food safety practices? 15. If yes what are some of the Leftover food should be heated before practices you know? eating [ ] food should be covered from flies [ ] practicing personal hygiene can help in food safety [ ] other (specify)…………………………. 16. In your opinion do you think Yes [ ] No [ ] food vendors practice good 137 University of Ghana http://ugspace.ug.edu.gh hygiene in selling food? 17. If no, why? Because I see a lot of flies around any time I go to buy food [ ] food for sale is not properly protected from dust and flies [ ] they don‟t have any protective clothing on (apron, cup, gloves etc.) [ ] Other (specify)………………………. 18. Should there be any organized Yes [ ] No [ ] training or program for consumers on campus? 19. If yes why? To make consumers more aware of the hygienic practices of food vendors [ ] to help consumers practice good hygiene themselves [ ] to have facts to educate vendors who are not adhering to good practices [ ]. 138 University of Ghana http://ugspace.ug.edu.gh APPENDIX THREE INTERVIEW GUIDE FOR GROUNDS AND ENVIRONMENTAL HEALTH SERVICES OFFICERS AT THE UNIVERSITY OF GHANA CAMPUS, LEGON. I am ………………………………………………. From the School of Business, University of Ghana. I am conducting a research as part of my academic work in trying to assess hygienic practices of food vendors: effect on food safety on the University of Ghana campus. I am selecting Grounds Environmental health services officers on the University campus and you happen to be one of my respondents who will help me answer some questions on the issue. Confidentiality of this conversation is assured. But before I start I need to seek your permission and time to go ahead. Do you agree to be part of the study? Yes, I agree/ No, I disagree 1. What qualifies one to sell food on campus? 2. Do you provide in-service training for the food vendors? Yes { }No { } 3. If yes how often is the training done? 4. In your opinion is the time allocated for training enough to equip sellers with the information they need to ensure proper hygiene? 5. What are some of the topics treated during the training? 6. How are food vendors monitored to ensure they are practising good hygiene during food handling? 7. What additional measures do you take to enforce good hygienic practices among food vendors? 139 University of Ghana http://ugspace.ug.edu.gh 8. Have you had any issue or cases of food poisoning among students on campus? 9. What penalty measures are in place for vendors who do not practice good hygiene? 10. What challenges do you face in discharging your duties? 11. What recommendations are available to help improve the hygienic practices of food vendors? Demographic characteristics of officers. 12 gender …………………….. 13 Age ………………………………. 14 Marital status …………………………………… 15. Level of education 16. A number of years working …………….. as an officer. 140