University of Ghana http://ugspace.ug.edu.gh SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA FOOD SAFETY AND HYGIENIC PRACTICES AMONG FOOD VENDORS IN SHUKURA COMMUNITY, ABLE KUMA CENTRAL SUBMETRO BY DELPHINA ANELEY ABBEY (10 NO.:I0272012) THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON 1:'Ii PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH DEGREE .JULY, 2017 University of Ghana http://ugspace.ug.edu.gh DEDICATION This work is dedicated to my wonderful parents, siblings, fiance and all my loved ones who supported me during my entire Master of Public Health Programme, without them I wouldn't have been where I am today. University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT This project could not have been successful but for the effort of many people who in one way or the other made worthwhile contributions. My foremost thanks goes to the Jehovah God for granting me good health and wisdom throughout the period of my study at the School of Public Health. I am heavily indebted to my supervisor, Dr Samuel Sackey, for willingly accepting the burden of supervision and more so, for his patience, fatherly advice, directives, constructive criticisms and cordiality in supervising me. His support gave me hope to pursue this project to its conclusion. I wish to express my indebtedness and profound gratitude to Mr Abdullai Amidu, a resident of the Shukura Community, for his relentless assistance in collecting the field data for this project. A special mention goes to Madam Victoria Afutu who opened her door to me any time I needed her help. The same appreciation is extended to Dr Isaac Adomako, Mr Danielson K warne Klutse and Charles Amankwa, for their immense contribution during my data analysis. I wish to register my appreciation to all food vendors of Shukura Community for their time and participation. Finally, to all persons who in one way or the other contributed to the success of this work, I say thank you. iii University of Ghana http://ugspace.ug.edu.gh ABSTRACT Background The street food industry is one of the means of income generation in most developing countries. Due to the afTordability, accessibility and availability of a wide variety offoods, millions of people depend on street foods on daily basis. For this reason, the safety and hygienic practices adopted during the production -to- consumption stage should not be undermined. Every year, millions of people worldwide suffer from food borne illnesses making it a major public health concern. Many have also linked the consumption of street foods with food poisoning and other food-borne diseases. Approximately 600 million, or almost 1 in 10 people worldwide, fall ill after consuming unsafe street foods yearly. Of these, 420,000 people die, including 125,000 children under the age of 5 years due to lack of practicing good food and personal hygiene (WHO, 2015). A wareness creation therefore plays a key role for food safety and handling amongst street food vendors. Objectives rhe objective of this study was to assess the hygienic and safety practices among street food vendors operating in Shukura Community. Metbods This was a descriptive cross sectional study employing quantitative method of gathering data. It was conducted among all 100 food vendors stationed in Shukura community- Ablekuma Central iv University of Ghana http://ugspace.ug.edu.gh sub metro. This population was obtained from the records of the Environmental Unit of the AMA. The study utilized a semi-structured questionnaire, direct interview and an observational checklist to collect data. STATA 14 and SPSS software were used to analyze the data obtained. Results From the descriptive statistics, it was observed that the street food business in Shukura community is female dominated. 92% were females and 8% were males. Also, amongst the type of foods sold, the commonest was the local Ghanaian dishes which comprised fufu, kokonte, banku, etc. In the final analysis, after adjusting for all other variables, four factors were significantly associated with inappropriate food hygienic practices. These were: educational attainment (AOR=O.S7, 95%CI=0.09 - 3.41), place of residence (AOR= 0.24, 95% CI= 0.06 - 0.97), factors considered when buying foodstuffs (AOR= 0.03, 95%CI= 0.001 - 0.57) and the number of times vendors wash their hands (AOR= 0.15, 95%CI= 0.05 - 0.43). Conclusion It was reported that there was a decreased level of inappropriate food hygienic practices among those with higher education and duration of vending, but the study findings did not confirm this. Findings notable to be significant were: ones educational status, place of residence, factors considered when buying foodstuffs and the number of times vendors wash their hands. v University of Ghana http://ugspace.ug.edu.gh Table of Contents DECLARATION .... ....... .... . ...................................................................................................... . DEDICA TION ........................................................................................................................................ ii ACKNOWLEDGEMENT ...................................................................................................................... iii ABSTRACT. .......................................................................................................................................... iv T ABLE OF CONTENTS ....................................................................................................................... vi LIST OF TABLES ............................................................................................................................... viii LIST OF FIGURES ................................................................................................................................ ix LIST OF DEFINITIONS ......................................................................................................................... x LIST OF ABBREVIATIONS ................................................................................................................ xii CHAPTER ONE ..................................................................................................................................... 1 1.0 INTRODUCTION ................ ..... . ..................................................................................................... 1 1.1 Background ................................................................................................................................... 1.2 Problem Statement.................. . ·. ............................................................................................ 4 1.3 Conceptual Framework. .................................................................................................................................6 1.4 Research Questions ..................................................................................................................... 7 1.5 Justification of the study......... .... . ............................................................................................ 8 1.6 Objectives of the Study ................................................................................................................. 8 1.6.1 General objective ............ . ·· ............ · .... · ...... · .. · .. ······ .. ····· ........................................ 8 1.6.2 Specific objectives ............ .. . .............................................................................. 8 CHAPTER TWO .......................... '" ............ . ..· .. ······ .. · ........ ·· ...... · .......... · .... · .... · ................... 10 2.0 LITERATURE REVIEW ......................... . ···· .... · .... · ...... · .. · .......... ·· .. · ................................ 10 2.1 Common types of foods sold......... ...... ......... .. ....................................................................... 11 2.2 Hygienic practices among food vendors ............... .. ............................................................... 12 2.3 Food safety practices .... ............ .......... .......... .. ................................................................... 14 2.4 Regulations of street food vending ............................................................................................ 16 2.5 Training of food vendors ........................................................................................................... 17 CHAPTER THREE ........................................ . . ······ .... · .. ·· .... · .. · ...... · ............ · .... · ............. · ........... 19 METHODS .................................................. . ··················· .. ····· .. · .. · .... · ........ ·· .. ·. ... · .................. 19 3.1 Study design ... .. ···· ............ ·· ...... ··· .......... · .... · .............................. 19 3.2 Study Area ............ . ..· .... · ........ · .. ····•· .......... · .. · .............. ·· .................. 19 3.3 The Study Variables ················ .. · ...... ······· ........ · .. ·· .. ·· .. · .. · ............ 20 3.4 The Study Population ... ···················· .. ···· .. · .......... · ..................... 20 vi University of Ghana http://ugspace.ug.edu.gh 3.5 Sample size ................................................................................................................................. 20 3.6 Sampling method.................. .. .................................................................................................. 20 3.6.1 Inclusion criteria ................................................................................................................... 20 3.6.2 Exclusion criteria ................................................................................................................. 21 3.7 Data collection tools .................................................................................................................... 21 3.8 Data collection technique ............................................................................................................ 21 3.9 Data Quality controL ................................................................................................................. 22 3.9.1 Pretesting of questionnaires .................................................................................................. 22 3.10 Data processing and analysis ...................................................................................................... 23 3.11 Ethical Consideration .............................................................................................................. 23 CHAPTER FOUR ............................................. . ............................................................................ 26 4.0 RESULTS ................................................................................................................................... 26 4.1 Background characteristics of respondents .................................................................................. 26 4.2 Common types of foods served .................................................................................................... 28 4.3 Hygienic conditions under which foods are prepared and served ................................................ 29 4.4 Factors affecting food safety practices among food vendors ....................................................... 30 ,U.I Bivariate analysis of the factors associated with food safety practices .................................... 30 4.S Strength of Association ................................................................................................................ 34 4.6 Proportion of food vendors who have been medically screened .................................................. 40 CHAPTER FIVE. . ................... 42 5.0 DISCUSSION ................ 42 S.llntroduction ......................................................................... . .. ................................ 42 5.2 Common types of foods served .......................................... . ·.· .................................. 42 5.3 Hygienic conditions under which foods are prepared and sold ...... .. ....................................... 43 5.4 Factors affecting food safety practices among food vendors ........................................................ 43 S.S Proportion offood vendors who have been medically screened .................................................. 44 5.6 Strength and limitation of the study ............................................................................................. 45 CHAPTER SIX..... ................... ....................... .. ........................................................................... 46 6.0 CONCLUSION .. .......................... .. ............................. ················ ........................... 46 REFERENCES .. .. ........................... 47 vii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 4.1.1: Socio-demographic characteristics offood vendors in Shukura community ...... 27 Table 4.2.1: Common types of food prepared and sold in Shukura .................. ·········· .... 29 Table 4.4.1: Bivariate analysis of the socio demographic factors associated with inappropriate food hygienic practices........................................ .... .... .................................... 32 Table 4.4.2: Bivariate analysis of the hygienic practices associated with inappropriate food safety measures .... ...................................................................................... 33 Table 4.4.3: Bivariate analysis of the food safety measures .......................................... 33 Table 4.4.4: Bivariate analysis of the external control mechanisms associated with inappropriate food hygienic measures ..................................................................................... 34 Table 4.5.1: Univariable and Multivariable Logistic Regression Analysis for the Association between inappropriate food hygienic practices and Socio-demographic characteristics of food vendors ....................................................................................................... 37 Table 4.5.2: Simple and Multiple Logistic Regression Analysis for the Association between inappropriate food practices and food safety measures ................................................ 38 Table 4.5.3: Simple and multiple Logistic Regression Analysis for the Association between inappropriate food safety practices and hygienic practices ............................................ 39 Table 4.5.4: Simple and multiple Logistic Regression Analysis for the Association between inappropriate food safety practices and external control mechanism ................................. .40 Table 5.1 Educational background of food vendors ............................................... . 44 viii University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure 1: Conceptual framework diagram ............................................................... 6 Figure 2: A pie chart showing proportion of food vendors who practice hygienic practices .....3 0 Figure 3: A Pie chart showing the proportion of vendors who have been medically screened .. .41 ix University of Ghana http://ugspace.ug.edu.gh LIST OF DEFINITIONS I. Street Food Vendor - Is one who sells food along the street without necessarily having a penn anent built-up structure. 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 perfonned for the preservation of health. 4. Street Vended foods -Foods and beverages prepared andlor 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 measures taken to ensure that food is handled, stored, prepared and served under hygienic conditions. 6. Food Safety - A scientific discipline describing handling, preparation and storage of foods in ways that prevent foodbome illness. 7. Food - borne disease I illness -Is an infection or irritation of the gastrointestinal tract caused by food or beverages that contain hannful bacteria, parasites, viruses or chemicals. 8. Personal Hygiene -Involves those practices perfonned by an individual to care for one's bodily health and well-being through cleanliness. University of Ghana http://ugspace.ug.edu.gh 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. xi University of Ghana http://ugspace.ug.edu.gh LIST OF ABBREVIATIONS AMA - Accra Metropolitan Assembly FAO - Food and Agriculture Organization FBI - Food Borne Illnesses FRI - Food Research Institute GHS Ghana Health Service GH-ERC - Ghana Health Service Ethical Review Committee MEST - Ministry of Environment Science and Technology NRI - National Resource Institute PPE - Personal Protective Equipment PHA Public Health Act i SDG Sustainable Development Goal SFV - Street Food Vendors UNICEF - United Nations International Children's Emergency Fund WHO - World Health Organization xii University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE 1.0 INTRODUCTION 1.1 Background The Food and Agriculture Organization (F AO) defines street foods as "ready-to-eat foods and beverages prepared and I or sold by vendors and hawkers on the street and in public places that can be consumed right away or eaten at a later time" (FA O, 1986). Street food is also defined as any minimally processed food sold on the street for immediate consumption (Tinker, 1997). These food items are usually sold by vendors and hawkers in the streets or other similar public places. Street food vendors also known as food hawkers, are people who sell on the street and have no permanent built-up structure (Bhowmik, 2005). In Accra, the capital city of Ghana, there are about 60,000 food vendors of ready-to-eat food (Afele, 2006). Hawkers and vendors can be observed around offices and factories, schools, markets, construction sites, beaches, lorry stations, commercial centres and along virtually every street in the metropolis of Accra. [he contribution of street foods cannot be overemphasized as most people depend entirely on these foods because they are reasonably priced and conveniently available. While street vended foods are appreciated for their unique flavors as well as their convenience, they are also important in contributing to the nutritional status of the population. In cooking for large populations, food passes through various hands, thereby increasing the chances of food contamination due to inappropriate handling. Deliberate or unintentional contamination offood during large production might jeopardize the wellbeing of buyers, and have very expensive repercussions on a country, as such outbreaks, feature prominently in national statistics (Annor & Baiden, 2011). University of Ghana http://ugspace.ug.edu.gh People who depend on such foods are often more interested in its convenience than in questions of its safety, quality and hygiene. Everybody expects to be provided with safe food free of contaminants. Unfortunately this is not always the case and every year, millions of people worldwide suffer from food borne illnesses (WHO, 2007). Good food safety practices lead to safe food while poor food safety practices end up with unsafe or contaminated food which is associated with adverse health and socioeconomic outcomes. In spite of the numerous advantages offered by street foods, there are also several health hazards associated with this sector of the economy. It is recognized that street food vendors are often poor, uneducated, and lack knowledge in safe food handling, environment and sanitation hygiene, mode offood display, food service and hand washing, sources of raw materials, and use of potable water. Consequently, street foods are perceived to be a major public health risk. Food safety has been declared a global concern with street foods as these foods are generally prepared and sold under unhygienic conditions, with limited access to safe water, sanitary services, or garbage disposal facilities. Multiple lines of evidence reveal that street foods pose a high risk of food borne illness due to microbial contamination, as well as environmental contamination (Blaise H., 2014). Vendors of ready-to-eat food constitute a major source of food health risk, especially through faeco-oral transmission of pathogens. The heaviest share of the disease burden occurs in poor countries (UN, 2008). This is due to economic reasons, the lack of adequate health care facilities, and the dearth of data regarding food- borne diseases. This greatly compromises the achievement of the Sustainable Development Goals (particularly SDG 2 and 6). The safety of street foods is therefore one of the most pressing health and safety issues facing most developing countries since it leads to both public health and social consequences. 2 University of Ghana http://ugspace.ug.edu.gh The number of reported outbreaks of food-borne illnesses related to the consumption of street food has been high, both in developed and developing countries. Diarrhoeal diseases are the most common illnesses resulting from the consumption of contaminated foods, causing SSO million people to fall ill and 230,000 deaths every year (WHO, 2017). Statistics obtained from the various food regulatory bodies indicated that: (i) 90,692 deaths were related to lack of food and personal hygiene with 297,104 cases reporting at the various outpatient departments of clinics and hospitals (FDB, 2008) (ii) (ii) 6000 cholera outbreaks with 69 deaths (GHS, 2012) (iii) (iii) 77% of all traceable food borne diseases result from improper handling of food in food establishments (FDA, 2013). In a study on the microbiological quality of street vended foods in Accra, Mensah et al (2002) noted that several main dishes were contaminated with bacteria of various kinds. They 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 foods prepared in advance of consumption. Most cholera outbreaks in Ghana have been linked to the consumption of contaminated street vended foods. For instance, in 2012, there was an outbreak of cholera in the Akwapim South Municipality, and 49 cases were reported. The Food and Drugs Board and the Ghana Health Service formed a combined team to investigate the outbreak. They traced its source to the eating of a contaminated street food called "waakye" (combination of rice and beans) (Ministry of HealthlGhana Health Service Report, 2012). World Health Organization has developed five main keys to safer food, which include ensuring cleanliness, separating raw and cooked food items, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials (WHO 2007). These five keys to safer food 3 University of Ghana http://ugspace.ug.edu.gh are of immense importance in developing countries, and equipping food vendors in such countries with such information could impact significantly on food safety and minimize the chances of FBI outbreaks. However, this can only be realized against a background of adequate food safety knowledge (Knight and Warland, 2005), adherence to recommended food safety practices (USDA, 2006) and the support of appropriate food safety equipment. 1.2 Problem Statement Demand for processed and ready-to-eat foods are increasing on daily basis, due to urbanization. It is becoming a key public health priority, because a large number of people take their meals outside the home, therefore predisposing them to food borne illness (Rahman et aI., 2012). Food vendors are a crucial link between the food served and consumers. Most often, street foods are considered unhygienic and low in quality partly as a result of the poor environmental conditions under which they are cooked or sold, lack of adequate knowledge on food preparation and handling by people involved in the street food business (FAD, 2009; Rheinlander, 2006; Annan-Prah et aI., 2011). According to FAD (2009), the consumption of unhygienic street foods is linked to the outbreak of serious food poisoning in most parts of the world. A large proportion of foodbome illnesses are caused by foods improperly prepared, poor personal hygiene, mishandling of food, sanitation of food preparation and vending sites, poor waste management and improper storage of food (Monney et al.. 2013). In a recent study conducted among an urban slum in Accra, about 60% of 951 mothers supplemented their children's diet with street food. These children had an increased risk of both acute and persistent diarrhea after consumption of street vended foods (Amoah et aI., 2009). It is also sad to see the state of most vending sites or infrastructure. Usually, the vending units are either mobile or stationary, using open or protected crude structures such as push carts, display 4 University of Ghana http://ugspace.ug.edu.gh wooden tables, aluminium trays or roadside chop bars. A study conducted by Rheinllinder (2006) in Kumasi, raised concerns about the poor infrastructure in which street food vendors operate and its impact on the quality and safety levels of most street foods in Ghana. Poor food hygiene practices by food vendors can have a lot of effect on a substantial number of people who patronize their services. It renders the food unsafe for consumption and increases the spread of faeco-oral diseases like Typhoid fever, Cholera, Gastroenteritis, food poisoning among others. If nothing is done about it, it can result in loss of lives, absenteeism from work by affected people and relatives caring for them, impede socioeconomic development by straining health care systems and placing enormous financial strain on families and entire economies. The situation is no different in the Shukura Community. Shukura serves as residence for many people. The population of the community during the 20 10 Population and Housing Census' was 35,215. Street vending is a popular activity. It is very worrisome to observe the safety measures and hygienic practices most food vendors get involved in. Thus there is a need to understand what food safety practices are put in place by food vendors to ensure that the foods sold are safe for consumption. To date, only limited research has been conducted to explore the food vendors' safety measures and hygienic practices observed to ensure quality of food. Hence, the study aims at assessing the food safety and hygienic practices among food vendors in Shukura Community. Findings from this study will provide useful information for policy formulation and improve strategic interventions. 5 University of Ghana http://ugspace.ug.edu.gh 1.3 CODceptual Framework SOCIODEMO- GRAPHIC FACTORS Inappropriate FACTORS 'Personal hygiene Hygienic Practices 'Sex 'Health status :~':;tal such as: improper stalUS .Duration offood vending ·Educallonailltamment waste disposal, not ·Natlonallty 'l 'se ofprotectivc clothing washing of hands :~I~:!'~; ---.:~~~==. .- .--.. 'Knowledge on hygienic ~ practices frequently, not wearing PPE's EXTERNAL CONTROL MECHANISM 1. ..- -, 'Periodic supervIsIon 'LIcensing 'Food training workshop 'Health screening 'Health education ---- ------, FOOD PREPARATION PROCESS 'Stonge ofleflovers. . ·Constanl '-'"8kr ... uppl~ 'SlIlitation of Slles for cooking 'Proper hand washmg hcfure and Wmtc: m"l!l.'m~nt and vending after vlsltmg the toilet 'Samtallon of cook'n~ .md 'Food not properl) cooked ,cndlng SItes ·Handling of food 'Intake of warm foods 'Nearness of vending Sites to 'Frequency ofchlllging waler publIc lolla. exposed for wa,hlng foodstuffil and 'Washmg of pia les before usc rubbISh. ClC utensils 'Thorough washmg of nUlts and vegelables under runDlng water before consumption Figure I: CODceptual Framework University of Ghana http://ugspace.ug.edu.gh 1.3.1: The Narrative of the conceptual framework The conceptual framework addresses factors that can influence the hygienic practices of a food vendor. For a food vendor to be considered as observing good or bad hygienic practices, certain factors would have to be looked at. The diagram above depicts the independent variables that can affect the dependent variable (inappropriate food hygiene practices). The independent variables identified were: socio demographic factors of the food vendors (this consisted of age, sex, educational status, religion and many others). This could directly influence the food vendor factors which included maintenance of personal hygiene by the food vendor, health status, duration and the use of PPE' s. Periodic supervision, licensing, food training workshops, health screening and education were some key external control mechanisms identified to influence the food safety and hygienic practices. This external controls when practiced keeps the food vendors updated and equipped with new cooking and hygienic skills. Environmental factors including storage of left overs, foods not properly cooked well and frequency with which water is changed, directly influence both the food safety and hygienic practices as well as the food preparation process. 1.4 Research Questions I . What are the common types of foods served by street food vendors? 2. Under what hygienic conditions are foods prepared and sold within the Shukura Community? 3. What are the factors affecting food safety among food vendors? 7 University of Ghana http://ugspace.ug.edu.gh 4. What proportion of the food vendors in the Shukura community have undergone medical screening? I.S JustUJCatioD oftbe study Currently, most researches conducted in Ghana on street food safety, quality and hygienic practices among vendors has concentrated on urban areas (for example, Annan-Prah et aI., 2011; Mensah et aI., 2002). Similar studies conducted from other developing countries equally reflect this phenomenon. Due to this, there is very scarce data on the current hygienic practices of street food vendors in the fast growing peri-urban areas. It is in the light of this that the present study was carried out in Shukura community. The study presented an opportunity to assess the food safety and hygienic practices among street food vendors in Shukura. In order to add different perspectives of knowledge on the subject in Ghana, this setting was found ideal since it had limited infrastructure and social amenities. Findings from this study will add on to literature and provide the basis for further research in the sector within the peri-urban context. It will also help in formulating effective hygiene communication strategies targeted at promoting street food safety in Ghana. 1.6 Objectives ortbe Study 1.6.1 General objective To assess the hygienic practices among street food vendors operating in Shukura Community and their implications for food safety. 1.6.2 Specific objectives I. To identify the common types offood served. 2. To assess the hygienic conditions under which foods are prepared and sold. 8 University of Ghana http://ugspace.ug.edu.gh 3. To identify factors affecting food safety practices among food vendors. 4. To assess the proportion of food vendors who have been medically screened. 9 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO 2.0 LITERATURE REVIEW For the developing and a few developed countries, street foods serve as major sources of sustenance for most people. The United Nations Food and Agriculture Organization (FA O, 2007) estimates the consumers of street foods worldwide to be over 2.5 billion. Street food vending has seen tremendous growth in most parts of the developing world and Ghana is no exception. This is because there has been rapid population growth post-independence (Bobodu 2010). This could also be attributed to the industrial and economic development that has been taking place in urban Ghana, with its accompanied changes in the nature of the work and lifestyles of people. Street foods serve as a source of affordable nutrients to majority of people especially, the low- income group in the developing countries (Muzaffar et aI., 2009). Notwithstanding the number of people who tend to rely on consuming streetfoods, one cannot discount the concerns arising on the hygienic quality of street food vending, its safety and nutritional value. It is an important public health issue and of great concern to everybody since they alone have influence on the health of thousands of people every day. Some authors have further questioned the nutritional value of street foods (Busccm i et aI., 20 II) and some countries are doing their best to improve upon the nutritional values of street foods (Steyn et aI., 20 II) Street foods have in many studies been associated with microbiological contamination and low hygienic standards (WHO, 2006). An assessment of some street foods widely consumed in Ouagadogou, Burkina Faso showed that vendors did not observe hygienic practices (WHO, 2006). In Accra-Ghana, a study to evaluate the role of street food vendors in the transmission of diarrhoeal 10 University of Ghana http://ugspace.ug.edu.gh pathogens showed that, 35 percent of the vending sites had their foods exposed to flies whereas 17.1 percent of the vendors handled food at ground level (WHO, 2006). In Mumbai, India, the Food safety Act, 2011 required hawkers, food vendors including vegetable and fruit vendors to follow basic hygiene rules such as wearing an apron and gloves and using clean utensils and potable water. 2.1 Common types offoods sold Street foods provide consumers with an array of choices which commonly vary across countries. Knowledge. attitudes, beliefs, economic, environmental and religious circumstances affect the intake of a particular type of food (Nam et aI., 2010). In developing countries, culture plays a crucial role in determining food patterns (Kebede, 2010). Street foods are of different varieties and consist of various meals, drinks and snacks. A study conducted on the streets of Bogor (Indonesia) and Iloilo (the Philippines) identified over 200 foods compared to the 335 found in Ife (in Nigeria). Street foods in Ghana are mainly based on local cuisine. Bododu (2010) clustered foods into categories. and he found that one - third (29%) of street food vendors in Accra sold rice/ waakye/ beans. 26% maize-based foods, 16% beverages or snacks, 11 % roasted plantain/yam and 8% boiled plantain/yam. Another study by Hiamey et al. (2015) revealed that, the most popular street food was rice with stew / bean sauce (23.5%), followed by bankuletsew with stew/okro/pepper sauce (17.5%), then fufu / kokonte with soup (14.4%), fried rice (1 %), tuozaafi (0.7%) and akyeke with tilapia (0.3%). Although fruits are also popular street foods which range from banana to oranges to seasonal fruits like mangoes and watermelon, it is sad to know that the level of its consumption appeared to be as low as only 2.4%. 11 University of Ghana http://ugspace.ug.edu.gh 2.2 Hygienic practices among food vendors Food hygiene is the set of basic principles used to control the environmental conditions during production, packaging, delivery I transportation, storage, processing, preparation, selling and serving of food in such a way to ensure that food eaten is safe and of good keeping quality (lfeadike et aI., 2014). Food vendors are involved in preparing, serving and even packaging foods and therefore are required to use proper hygiene and sanitation methods when working with foods. In developing countries, most vendors have difficulties in securing optimal hygienic food handling practices and this is attributable to the occurrence of food borne illnesses. As reported by a research conducted by Okojie et a!. (2005), among food vendors in a Nigerian university campus, the knowledge and practice of food hygiene and safety measures was poor. Only 30.4% of the respondents had medical examination done prior to employment, whereas 48% had been educated on food hygiene and safety. Pescwu et al. (2014) and Amponsah - Doku et al. (2011) also agreed on the fact that the significant persistence and proliferation of bacteria from production to consumption is a reflection of poor hygienic and food handling practices and conditions at all stages of the chain. More systematically, these contamination factors can be classified under two categories: endogenous factors (implying the direct responsibility of vendors) and exogenous factors (outside the control of the vendors). The former ones include poor hygienic practices (eg. irregular hand washing), unsafe handling offood (eg. Concurrent handling of money and food), poor compliance with use of protective clothing (eg. Apron, head covering, rubber gloves), poor cleanliness of kitchen utensils, poor transportation and storage conditions, indiscriminate disposal of waste, exposure of food to flies and pests and faeco-oral parasitic infections. Lack of adequate supply of clean water may also push vendors to wash their utensils in water which has been used many times. 12 University of Ghana http://ugspace.ug.edu.gh It is sad to observe that, water used for washing hands, utensils and dishes are often done in a common bowl of water and not changed frequently (Kok & Balkaran, 2014). Lack of public infrastructures (eg. Clean water source, public toilets), lack of public waste disposal service, poor hygienic conditions of vending sites (eg. Open- air sewages, dust from dirt roads, nearness to open drains and refuse dumps) poor storage conditions, unclean transportation conditions and poor food handling are exogenous factors that result in food contamination. Several studies on hygienic practices of street food vending confirmed WHO reported that, most street food vendors have knowledge of hygienic practices but concluded that majority of them do not put the knowledge into practice. Isara and colleagues (2009) reported good knowledge and practice offood hygiene and safety measures among food handlers in fast food restaurants in Benin City, Edo State. The study however showed that knowledge and practices were influenced by previous training (P=O.002), whereas food handlers who had worked for longer years in restaurants had bener practices of food hygiene and safety (P=O.036). There was no significant association between ones educational level and the practicing of good hygienic measures. Inadequacy of basic facilities at the vending sites were mostly attributable for non-compliance to basic hygienic principles. For instance, lack of toilet facilities at the vending sites forced most street food hawkers to excrete indiscriminately within the vicinity at secluded areas like bushes and uncompleted buildings. It's been generally observed that open bins were commonly used for garbage collection. Several studies reported that overflowing of garbage bins was a common problem in most vending points \'-hile the final garbage disposals are usually far away from vending sites. Heaps of garbage around the vending sites usually served as breeding points for rodents, insects and flies which promote 13 University of Ghana http://ugspace.ug.edu.gh proliferation of microorganisms and increase the risk of food contamination and its accompanying diseases. 2.3 Food safety practic:es These refer to practices put in place to preserve the quality of food. When considering food safety, food vendors are a point of focus. The safety measures they ensure can in a larger way affect the population who depend on them for their daily meals. It is therefore imperative that vendors adhere to high standards of safety when dealing with food. Iffood is not properly cooked or processed the pathogens cannot be destroyed. Bryan et al (1997) reported that major contamination of street foods occurred at vending sites as a result of cross contamination during the cooking process. A comparative study by Mensah et al (2002) on the risks involved in the use of hands and cutleries to serve street foods in Ghana showed that the use of bare hands to serve foods, increased the level of contamination. The study recognized serving stage as a critical point in the street food industry. Enteropathogens, such as Salmonella typhi that can survive on human hands for more than three hours have been isolated in vendor's hands in Ghana. Food displayed at the vending point are either safe by using glass containers to protect them from environmental contaminants (flies, pests, dust, etc) or ensuring that they are covered with well- fining lids. Most of the vendors, who often live far away from their vending points, use tro-tros to convey their foods to the vending sites, while only a few use taxis (Nicolo, 2012; Annan-Prah et aI., 2011). In the course of transportation, the food might be exposed to dust particles in the atmosphere. 14 University of Ghana http://ugspace.ug.edu.gh Leftover foods at the end of the day, should be properly refrigerated. Donkor et al. (2009) found that more than half (56%) of street food vendors in Accra stored the food in a fridge. The use of non-approved utensils, pots and pans made of unsafe materials are a further source of contamination. Cooking pots produced by informal manufacturers contained high concentrations of lead (419mglkg) that could leach into foods at levels slightly above the maximum permitted level recommended by WHO and FA O. Usually, food passes through many hands during the preparation stage, thereby increasing the chances of food contamination. As recommended by Annor and Baiden (2011), food must never be defrosted at room temperature. Foods thawed at room temperature poses a greater danger of bacterial growth and food spoilage, hence the best way to safely thaw meat and poultry is in the refrigerator. In spite of these useful directives, food vendors in Ghana have been found to refrigerate food stuffs at inadequate temperatures exposing them to the risk of contamination. Also. hot cooked food should be maintained at 140 degree Fahrenheit or above. Cooked foods should be reheated to 165 degree Fahrenheit. Microorganisms maybe present on food products purchased and thus vendors must ensure that all food stuffs are washed thoroughly under running water before use. The health status of the food handlers largely predispose the consumer to diseases. Vendors who experience or are carriers of some form of diseases such as typhoid fever, and go unscreened, may end up infecting consumers. This process may be slow, but the cycle of public health prevention begins with the critical first step of surveillance and medical screening. It was revealed in the Ghana Street food project conducted in Kumasi Metropolitan Assembly and Tamale Municipal Area (2012 - 2016) that, the clothes worn by workers during food preparation 15 University of Ghana http://ugspace.ug.edu.gh were dirty and diverse as compared to those worn during vending. Most preparation sites were generally dirty and different from vending sites. In this same project, Madam Gloria Ankar Brewoo, noted that "fried rice and fufu were highly patronized foods in the area. She observed that fufu had a high level of microbiological contamination from the pounding to the vending stages mostly due to poor hygiene, improper storage of foods and contaminated hands. In addition, most vendors of fried rice, had the habit of preparing and storing large volumes of rice and vegetables for long hours. Also, the plastic films used in covering foods during cooking, leached into the food. She also discovered that Napthalene balls were used in purifying the water. All these practices, she noted, had serious health consequences." 2.4 Regulations of street food vending In Ghana. as well as in many countries in Africa, there is an abundance of national legislation but limited resources to control street food safety. Institutions such as the Ghana Standards Authority and the Food and Drugs Board are committed to the work of regulating food standards and training the general populace on food safety issues. In Ghana, national and municipal administrators regulate the street food sector in the cities. These controls take various forms. FAO (1996) states that the regulatory authorities fail to carry out their roles effectively mainly because of poor institutional capacity, lack of coordination, shortage of personnels and funds. Public health regulations have stated specific requirements for vendors, including medical screening and certification before vending. There is the need for continuous monitoring to ensure that vendors renew all expired certificates (Ababio and Adi, 2012). However, this health demand seems unsuccessful. 16 University of Ghana http://ugspace.ug.edu.gh The country's laws frown on the sale. preparation, package and storage of food under insanitary conditions to the public (Public Health Act 2012, Act 851, 52). Article 97 of the same Act forbids the manufacturing. distribution and supply of food, unless the Authority has registered the food. Varying penalties are allocated for breaching the Law. 2.5 Training of food vendors In Ghana, the Chief Director of MEST during the DFIDINRIIFRI Street vended foods Project (2000), recognized that "street foods are produced by those with limited knowledge of food safety practices and in environments that can compromise the hygienic preparation, storage and sale of the food. Also, street food vendors are usually unlicensed and untrained in food hygiene or sanitation and work under crude and unsanitary conditions." Training offood vendors is an effective way to improve the perceptions and practices of the street food handlers. Every vendor, helper or food handler shall be required to undergo basic training. Lots of efforts have been made by health ministries of developing countries 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 (Apanga et aI., 2014). Similarly, Annor and Baiden (2011) who conducted a research on the hotel industry in Accra found through a microbial analysis though respondents were found to have satisfactory food hygiene attitudes it did not produce strict food hygiene practices. Likewise, (Donkor et al. 2009) hold the same opinion about this relationship between education and food safety practices among vendors. A research conducted by some polytechnic students to assess the level of hygienic practices among street food vendors in Sunyani revealed that large numbers of the vendors practiced minimal 17 University of Ghana http://ugspace.ug.edu.gh hygiene. It was also found that most of the vendors did not receive any training on personal, food and kitchen hygiene. Ideally, trainings should be carried out at no cost to food vendors or subsidized (Ababio and Lovatt, 2015). A certificate can be awarded at the end of each training programme to motivate participation (Monney et aI., 2013). 18 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODS 3.1 Study design A descriptive cross-sectional study design was used in this study. It gave a snapshot of the population under study. This study design was preferred because it could be done within the shortest possible time and at a minimum cost. It drew on data from: .:. Semi- structured Questionnaire .:. Direct interview .:. Observation 3.2 Study Area Shukura is a community located in the Ablekuma Central sub-Metropolitan, which is part of the Accra Metropolitan Assembly. It has a total population of35,215 with approximately 9029 females between ages 15 to 45 years. The inhabitants are mainly small-to-medium scale business owners, traders, artisans, civil servants and students. The people are a combination of Christians and Muslims. The majority of the people speak Hausa, Twi and Ga. Most of the houses do not have toilet facilities and therefore community members resort to using the commercial public toilets available. Although there are two big waste collection points in the community, the people are known to be disposing their waste indiscriminately resulting in choking the gutters. Virtually every street within the community serves as a point of preparation and sale of street foods. Popularly vended street foods include rice, waakye, banku and soup, amongst others. 19 University of Ghana http://ugspace.ug.edu.gh 3.3 The Study Variables The main dependent variable was 'Inappropriate food hygiene practice.' The independent variables of interest were stratified into three main categories: I. Food Vendor Factors- comprised socio demographic factors, personal hygiene, duration of vending and use of personal protective clothing's like aprons. 2. External Control Mechanism- included periodic supervision, food training workshop, licensing, health screening and education. 3. Food Preparation Process- comprised storage of food leftovers, frequency of changing water for washing utensils and food stuffs, constant water supply and sanitation of cooking and vending sites. 3.4 Study Population The study involved all 100 street food vendors present in Shukura Community. 3.5 Sam pie size Based on the data obtained from the Environmental unit of the AMA, there were 100 food vendors. Thus. due to the population of the food vendors in the community, there was no need to sample. Therefore, all the food vendors were interviewed. 3.6 Sampling method A purposive sampling technique was employed in sampling all participants in the population. This technique was chosen because the participants' selection was based on the judgment of the researcher who was interested in specific characteristics amongst the individual members of the population. 3.6.1 Inclusion criteria Stationary food vending units used for preparation/sales of street food. 20 University of Ghana http://ugspace.ug.edu.gh 3.6.2 Exclusion criteria • All mobile food vending units such as push carts or carrying of food in trays. Street vendors who did not sell foods that required additional cooking such as fruits, drinks, etc. 3.7 Data collection tools Data was separately collected from the morning, afternoon and evening vendors' using: (i) a direct observation checklist and (ii) a semi- structured questionnaire. The direct observation checklist was used primarily at the point of sale with close-ended questions to monitor food safety and sanitation practices. It consisted of four (4) parts: Personal hygiene of food vendor, hygienic practices, point of sale observation and food preparation process. The semi- structured questionnaire consisted of six (6) sections; Socio demographic data, food vendor characteristics, food safety measures, food hygiene practices, consumer factors and external control mechanism. 3.8 Data collection technique Data was separately collected from the morning, afternoon and evening vendors' respectively. All the food vendors were divided into four folds for convenience. The purpose of the study was explained in simple language to the respondents and all questions or doubts they had were addressed before the questionnaires were read out. All the respondents were made to sign the consent form individually prior to commencement. For each quarter, the questionnaires were administered by face-to-face interviews to support more accuracy and completeness of the questionnaire. The questions on the questionnaire were read out to the participants and each response said was ticked appropriately. 21 University of Ghana http://ugspace.ug.edu.gh Also, an observational checklist adapted from the WHO essential requirement for the safety of street vended foods was used to observe the environmental and hygienic practices engaged in by food vendors at their respective vending sites. 3.9 Data Quality control All data gathered was audited and verified to check for authenticity and reliability. Data was further examined to check for any deviations from the normality and also to assess if there were any missing or misleading information. A two day training session was organized for four field assistants, where they were briefed and trained on the collection of data. All questions or ambiguities were also addressed. Either of the research assistants could speak English, Hausa, Twi or Ga. Two of the assistants recruited for the study were university graduates from the University Of Ghana whereas the other two were community volunteers. Each question on the questionnaire was read out and detailed explanation of what each of them meant was given. 3.9.1 Pretesting of questionnaires: The questionnaires were pretested among food vendors in Glefe since it (the Glefe community) shares similar bearings with Shukura. The pretesting was done to detennine the accuracy and the appropriateness of each question as well as the average duration needed to complete the questionnaires for each respondent. Some few corrections were made after pretesting the questionnaires on seven participants. For instance, age, was initially considered a continuous variable but after the pretest, it was categorized, when it was realized that, most of the participants could only give their ages in ranges. 22 University of Ghana http://ugspace.ug.edu.gh 3.10 nata processing and analysis Data were entered with excel spreadsheet, after checking for completeness and accuracy of the infonnation. The data was then cleaned by identifying all wrong entries and correcting them using the codes to trace the questionnaire. All the variables were double checked for all the respondents to ensure their correct entry, before importing to SPSS for labelling and identification of any strange entries. The SPSS data was then saved as a STATA file, where all analyses were done. Descriptive statistics was done for all the socio-demographic characteristics of respondents. Frequency distributions were summarized in tables and charts as well. Bivariate analysis using Pearson's chi-square was used to test for the association between inappropriate food hygienic measures and independent variables. Univariate analysis was perfonned for all the variables to determine the magnitude and the strength of the association between each individual variable and the practicing ofinappropriate food safety measures. The final model was the multivariate analysis of the statistically significant variables from the crude analysis, to obtain the adjusted odds ratio. Selected variables were also analyzed, controlling for some known confounders. The analysis also produced frequency tables and charts which provided pictorial explanation to the data. Tables and charts were further modified with the aid of Microsoft Office Excel 2010. 3.11 Ethical Consideration Ethical clearance was obtained from the Ghana Health Service Ethics Review Committee, District Assembly and the Community chiefs. The participants were duly informed that their participation in the study was purely voluntary and as such they could choose to partake or not or drop out without any penalty. Risks and Benefits of Being in the Study: 23 University of Ghana http://ugspace.ug.edu.gh Participants involved in this study might encounter some minor discomforts that could be encountered in daily life, such as questions that may make them uneasy, stress related to completing the questionnaire, because they may not know some of the answers. Being in this study was unlikely to pose any risk to one's safety or wellbeing. However, the participants personally benefitted by deriving better knowledge which will equip them to serve safer food to the public. Confidentiality and privacy were respected during the course of the study: Any information provided was kept anonymous. The researcher did not use personal information for any purposes outside of this research project. Also, the researcher did not include names or anything else that could identify participants in the study reports. Serial numbers rather than names were used to identify each respondent. Names and addresses of food premises were not used, but rather codes were used. Data storage: After the questionnaires were pre-tested and filled, they were kept safely in a cabinet under lock and key. All analyzed data were transferred to a laptop and password protected. Another copy was kept on an external hard drive which was securely kept in a cabinet, with access limited to the principal investigator. After a year, the data would be deleted. Compensation: After completing the questionnaire, light refreshment was served. Conflict of interest: 24 University of Ghana http://ugspace.ug.edu.gh There was no conflict of interest on the part of the Principal investigator or any member of the team. 25 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR 4.0 RESULTS This chapter presents all the analyses and the interpretation of the important findings from the study. This chapter has been organized in thematic areas as follows: 4.1 Background eharacteri1tics of respondents Table 4.1.1 shows the socio-demographic characteristics of all 100 respondents who participated in the study. Females made up 92% of the total population whereas males were 8%. The percentage ofrespondents aged less than 20 years was 23% and those between ages 20 to 30 years were 12%. Majority of the respondents were Junior High graduates (32%) and only 5% had tertiary level of education. Again, majority (71%) of the food vendors were married or cohabiting and 22% constituted single vendors. In terms of religion, Christians constituted 45% of the participants and Muslims made up 55%. With regards to localities of the vendors, a large proportion (84%) of them lived within Shukura whereas 16% resided outside Shukura. 40% were Hausa's, 34% Akan's, Ga's formed 11% whereas 15% belonged to other tribes. 89% of the participants engaged solely in food vending as their main occupation and 11 % were artisans who engaged in other activities including hairdressing, dressmaking and many others. In terms of length or duration of vending, 32% of the participants had worked for less than a year, 30% had operated for 1 to 3 years, 23% constituted the vendors who had worked for 4 to 6 years and 15% had worked for more than 6 years. Out of the 100 food vendors, 35% sold food in the mornings, 40% in the afternoons and 25% sold in the evenings. 26 University of Ghana http://ugspace.ug.edu.gh When asked if they had undergone any medical examination, 79% responded positively, whereas the remaining 21 % had never had any medical screening. All 100 vendors attested to the fact that they do not belong to any food vending association as there was no association like that existing in the community or district. Table 4.1.1 Socio-demographic characteristics of food vendors in Shukura community Characteristics Frequency (N=I00) Percentage (%) Sex Male 8 8.0 Female 92 92.0 Age group (years) Less than 20 23 23.0 20-30 12 12.0 31-40 59 59.0 41- 50 3 3.0 More than 50 3 3.0 Place of residence Within Shukura 84 84.0 Outside Shukura 16 16.0 Marital Status Single 22 22.0 Married / Cohabiting 71 71.0 Widowed 3 3.0 Divorced 4 4.0 Educational Level None 30 Primary 30.0 21 Junior High 21.0 32 32.0 Secondary / Vocational 12 Tertiary 12.0 5 5.0 Nationality Ghanaian 95 95.0 Non Ghanaian 5 5.0 Religion Islam 55 Christian 55.0 45 45.0 27 University of Ghana http://ugspace.ug.edu.gh Ethnicity 40 40.0 Hausa 34 34.0 Akan 11.0 Ga/Adangme 11 15 15.0 Others Occupation Solely food vending 89 89.0 Artisan 11 11.0 Duration of vending (year) Less than I 32 32.0 1-3 30 30.0 4-6 23 23.0 More than 6 15 15.0 Medical Examination Yes 79 79.0 No 21 21.0 Time food is sold Morning 35 35.0 Afternoon 40 40.0 Evening 25 25.0 Membership to a Food Vending Association Yes No 100 100.0 4.2 Common types of foods served The type of street food consumed were explored. Respondents reported consuming a variety of street foods highlighted in table 4.2.1. Based on the data collected, it was observed that majority of the vendors (24%) prepared and sold local dishes. This included fufu, kokonte, banku, omotuo accompanied by various soups including palmnut soup, light soup, groundnut soup and many others. 18% of them sold Waakye. 16% of the vendors sold various varieties of rice- jollof rice, plain rice, etc. It was noticed that most of the male vendors sold fried rice. The least sold foods were fried yam (5%) and Indomie (3%) respectively. 28 University of Ghana http://ugspace.ug.edu.gh Table 4.2.1: Common types offood prepared and sold in Shukura Type of food served Frequency n 100 Percentage Local dishes 24 24.0 Waakye 18 18.0 Varieties of rice 16 16.0 Hausa koko and koose IO 10.0 Kenkey and fish 9 9.0 Beans and plantain 8 8.0 Fried rice 7 7.0 Fried yam 5 5.0 Indomie 3 3.0 ·Local dishes consist of Ghanaian foods such as fufu, banku, kokonto, tuozaafi, omotuo ·Varieties of rice includes jollof rice, plain rice and other varieties of rice 4.3 Hygienic conditions under which foods are prepared and served The study took into account eight (8) relevant variables that defined hygienic practices. These variables were: covering of waste bins, hand washing after visiting the toilet, hand washing after handling money, scooping out of food with clean spoon, how utensils are washed, thorough washing of raw vegetables, appropriate times for washing hands and storage of plates and cutleries. A score of six (6) and above was classified as good hygienic practices, whereas a vendor who scores below six (6) indulges in poor hygienic practices. Out of a 100 vendors used for the study, only 29% engaged in good hygienic measures. It is however sad to note that the majority of the vendors (71%) practiced poor hygiene. As shown in the pie chart below, hygienic practice was assessed as a composite score of some key variables as presented: 29 University of Ghana http://ugspace.ug.edu.gh Figures 2: A pie cbart showing proportion of food vendors who practice hygienic practices HYGIENIC PRACTICES • POOR HYGIENIC PRCTICES • GOOD HYGIENIC PRACTICES 4.4 Factors affecting food safety practices among food vendors 4.4.1 Bivariate analysis oftbe factors associated witb food safety practices The Chi-square test of association was performed to determine associations between the independent variables (socio demographic data, hygienic practices indulged in, safety measures and external control mechanism) against the outcome variable (inappropriate food hygienic practices) at a 95% confidence interval. Chi-squares are reported to two decimal points, while the p-values are reported to three (3) decimal points. Among the variables examined in module I, there was a statistically significant association between inappropriate food hygienic practices and the following variables: place of residence of food vendors (Chi= 5.30, p-value=0.021) and educational status (Chi= 65.33, p-value=O.OO I). Also, how food vendors acquired knowledge (Chi=1 0.11, p-value=0.006) was observed to have a significant relationship ~ ith inappropriate food hygienic practices. 30 University of Ghana http://ugspace.ug.edu.gh In module 2, factors considered before selecting food stuffs (Chi=6.48, p-value=O.039), place where food is prepared (Chi=6.75, p-value=O.034) and management of leftovers (Chi=9.05, p- value=O.029) were among the significant safety measures associated with inappropriate food hygienic practices. Storage of washed plates (Chi=9.64, p-value=O.008), number of times hands are washed (Chi=11.99, p-value=O.002) and quality offoods served to clients (Chi=4.59, p-value=O.032) were also found to be significantly related to inappropriate food hygienic practices in module 3. However, it was observed in module 4 that, there was no significant relationship between inappropriate food hygienic practices and the external control mechanism factors. 31 University of Ghana http://ugspace.ug.edu.gh Table 4.4.1 Module 1: Bivariate analysis oftbe socio demograpbic fadors associated witb inappropriate food bygienic practices Outcome of food safety pnctices Appropriate Inappropriate Variables Frequency % Frequency % Xl p-value Age group (yean) Less than 20 12 21.82 11 24.44 2.12 0.715 20-30 5 9.09 7 15.56 31-40 35 63.64 24 53.33 41 -50 2 3.64 2.22 More than 50 1.82 2 4.44 Sex Male 6 10.91 2 4.44 1.41 0.236 Female 49 89.09 43 94.56 Place of residence Within Shukura 42 76.36 42 93.33 5.30 0.021' Outside Shukura 13 23.64 6.67 Educatioual Attainment None 4 7.27 26 57.78 65.33 0.001' Primary 4 7.27 17 37.78 Junior High 30 54.55 2 4.44 Secondary I Vocational 12 21.82 0 0.00 Tertiary 5 9.09 0 0.00 Occupation ~{' Solely food vending 49 89.09 40 88.89 0.001 0.974 Artisan 6 10.91 5 11.11 Duration offood vending (year) Less than I 17 30.91 15 33.33 1.47 1-3 0.689 16 29.09 14 31.11 4-6 15 27.27 17.78 More than 6 7 12.73 8 17.78 Source of knowledge From relatives 44 80.0 45 100.00 Self-taught 10.11 0.006' 7.27 0 0 eaterin school 12.73 0 0 ·Statistically significant associations 32 University of Ghana http://ugspace.ug.edu.gh Table 4.4.2 Module 2: Bivariate aaalysis of the hygieaic practices associated with iaappropriate food safety measures Variable p-value 6.48 0.03" Factors considered when buying foodstuffs Place for food preparation 6.75 0.034' Place of preparing food at home 5.10 0.024' Means of transporting cooked foods 2.67 0.102 Constant supply of water 2.40 0.122 Management of leftovers 9.05 0.02" Building structure for vending 2.80 0.424 Take leave offwork when sick 0.51 0.474 Wearing of personal protective equipment 3.12 0.373 Table 4.4.3 Model 3: Bivariate aDalysis of the food safety measures Variable 'X. 2 p-value Storage of washed plates and cutleries 9.64 O.OOS' Number of times hands are washed 11.98 0.002· Handling food and money with bare hands 2.84 at the same time 0.241 Hand washing after visiting the toilet 3.41 0.065 Covering of waste bins 2.63 0.11 Quality of foods served to consumers 4.59 0.032* 33 University of Ghana http://ugspace.ug.edu.gh Table 4.4.4 Model 4: Bivariate analysis of the external control mechanisms associated with inappropriate food hygienic measures Variable X2 p-value Health screening 1.46 0.227 Mandate to prepare I sell food 0.97 0.325 Acquisition of health certificate 1.01 0.315 Renewal of health certificate 0.63 0.429 Visited by an environmental officer 2.79 0.095 Number of times visited 2.11 0.551 Education by an environmental officer 0.53 0.466 4.5 Strengtb of Association The significantly associated independent variables (socio demographic factors, hygienic practices, food safety measures and external control mechanism) were analyzed with the outcome variable (inappropriate food hygienic practices) to assess the strength of the associations. Crude analysis of the association between the outcome variable (inappropriate food hygienic practices) and the covariates showed that educational level, place of residence, location for food preparation and number of times food vendors wash their hands were significantly associated with the practice of inappropriate food hygienic measures. For education (Table 4.5.1), the odds of a respondent with primary education practicing inappropriate food hygienic measures was 0.65 times that of a respondent with no formal education (COR= 0.65 95%CI=0.14-2.97), whereas the odds of a respondent with Junior High School education practicing inappropriate food hygienic measures was 0.01 times that of a respondent 34 University of Ghana http://ugspace.ug.edu.gh with no fonnal education (COR=O.OI 95%CI=O.001-0.06). There was no significant difference between secondary and tertiary education. For place of residence (Table 4.5.1), the odds a respondent living outside Shukura practicing inappropriate food hygienic measures was 0.23 times that of a respondent who lived within Shukura (COR=0.23 95%CJ=O.06-0.87). Compared to respondents who prepared food at home (Table 4.5.2), the odds of practicing inappropriate food hygienic measures was 48% decreased in those who prepared food at the vending site (COR=O.52 95%CI=0.22-1.22). The odds of a vendor who prepares food both at home and site of vending practicing inappropriate food hygienic measures was 0.16 times that of a respondent who prepared food at home (COR=0.16 95%CI=O.30-0.79). From the table (4.5.3), the odds of practicing inappropriate food hygienic measures was 0.83 times higher amongst vendors who washed their hands (more than 4 times) than in those who never washed their hands (COR=0.83 950/oCI=0.20-3.49), whereas the odds of practicing inappropriate food hygienic measures was 0.22 times higher amongst vendors who washed their hands anytime it was necessary to do so, than in those who never washed their hands (COR=0.22 95%CI=0.09 - O.S:l). After adjusting for all other variables, educational attainment, place of residence, factors considered when buying food stuffs and the number of times hands are washed were significantly associated with practicing inappropriate food hygienic measures. After controlling for all other variables, the odds of a vendor being a primary school graduate to practice inappropriate food hygienic measures is 43% less likely the odds compared to those with no fonnal education (AOR=0.57, 950/oCl=0.09 - 3.41). For junior high school graduate vendors, 35 University of Ghana http://ugspace.ug.edu.gh the odds of practicing inappropriate food hygienic measures is 99.996% less likely the odds compared to those with no formal education, controlling for all other variables(AOR=0.004, 95o/oCJ=0.00 - 0.44) (Table 4.5.1). Among food vendors who live outside Shukura (Table 4.5.1), the odds of practicing inappropriate food hygienic measures was 0.24 times higher the odds among those who live within Shukura, after controlling for all other variables (AOR: 0.24, 95% CI 0.06 - 0.97). A food vendor who considers quantity when buying food stuff had a 99.97% decreased odds of practicing inappropriate food hygienic measures compared to those who consider the cost of the food stuff, after controlling for all other variables (AOR: 0.03, 95%CJ 0.001 - 0.57). Food vendors who consider quality when buying foodstuffs had a 39% decreased odds of practicing inappropriate food hygienic measures compared to those who consider the cost of the food stuffs, after adjusting for all other variables (AOR:0.61, 95%CI 0.08 - 4.80) (Table 4.5.2). Vendors who washed their hands anytime it was necessary to do so (Table 4.5.3) were found to have an 85% decreased odds of practicing inappropriate food hygienic measures compared to those who never washed their hands after adjusting for all other variables (AOR: 0.15 95%CJ 0.05 _ 0.43). Whereas vendors who washed their hands more than 4 times (Table 4.5.3) were found to have a 49% decreased odds of practicing inappropriate food hygienic measures compared to those who never washed their hands after adjusting for all other variables (AOR: 0.51 95%CI 0.10 _ 2.58). 36 University of Ghana http://ugspace.ug.edu.gh Table 4.5.1: Univariable and Multivariable Logistic Regression Analysis for the Association between inappropriate food hygienic practices and Socio-demographic characteristics of food vendors Crude OR Adjusted OR Characteristics p-value p-value (95"CI, (95" CI, Age Group 0.726 Less than 20 (reference) 0.593 20-30 1.53 (0.37 - 6.25) 1.49 (0.34 - 6.46) 0.432 31-40 0.75 (0.28 -1.97) 0.67 (0.24 -1.84) 0.694 41-50 0.55 (0.43 - 6.89) 0.59 (0.04 - 8.25) More than 50 years 2.18 (0.17 -27.56) 1.60 (0.12 -20.64) 0.719 Sex Male (reference) Female 2.63 (0.50-13.73) 0.251 1.73 (0.29 -10.24) 0.544 Educational Level <0.000' <0.001" None (reference) Primary 0.65 (0.14 - 2.97) 0.57 (0.09 - 3.41) Junior High 0.01 (0.001 - 0.06) 0.004 (0.00-0.44) Secondary Tertiary Place of residence Within Shukura (reference) Outside Shukura 0.23 (0.06-0.87) 0.03" 0.24 (0.06-0.97) 0.045" 11- overall p-value for variables with more than two levels *- Shows statistically significant variables 37 University of Ghana http://ugspace.ug.edu.gh Table 4.5.2 Simple and Multiple Logistic Regression Analysis for the Association betweeD inappropriate food practices and food safety measures Crude OR Adjusted OR Characteristics p-value p-vaJae (95~o CI) (95% CI) Facton considered 0.021· when buying food stuffs 0.101 Cost (reference) Quantity 0.11 (0.01 -1.05) 0.03 (0.001-0.57) Quality 1.11 (0.40 - 3.07) 0.61 (0.08 - 4.80) Place where food is prepared 0.048· Prepared at home (reference) Prepared at the vending site 0.52 (0.22 - 1.22) 0.42 (0.08 - 2.16) 0.297 Prepared at both home and vending site 0.16 (0.30 - 0.79) 5.25 (0.24 -115.21) 0.293 Manalement of leftoven Refrigerated for next day's use (reference) 0.071 Reheat for sale 4.5 (0.77- 26.29) 3.47 (0.51 - 23.81) 0.206 Consumed by family and friends 6.52 (1.30 - 32.71) 4.58 (0.77 - 27.13) 0.094 Throwaway Wearing PPE's 0.406 Apron only (reference) Head covering only 3.27 (0.55-19.25) 2.30 (0.16-34.08) 0.545 Both apron and head covering 1.16 (0.32 - 4.24) 0.58 (0.10 - 3.58) 0.562 None 0.89 (0.24 - 3.36) 0.28 (0.04 1.76) 0.174 Take leave off work when sick No (reference) Yes 0.70 (0.26 - 1.87) 0.475 0.72 (0.19 - 2.72) 0.626 38 University of Ghana http://ugspace.ug.edu.gh Table 4.5.3 Simple and multiple Logistic Regression Analysis for the Association between inappropriate food safety practices and hygienic practices Crude OR Adjusted OR po value Cbaracteristics p-value (95% CI) (95% CI) Number of times bands are wasbed 0.004· <0.00.· ]\jever (reference) More than 4 times 0.83 (0.20 - 3.49) 0.51 (0.10 - 2.58) Anytime it is necessary 10 do so 0.22 (0.09 - 0.53) 0.15 (0.05 - 0.43) Storage of wasbed plates and cutleries Covered in a bowl 0.068 (reference) Kept in an uncovered bowl 7.33 (0.86 - 62.17) 14.4 7(0.82 - 254.48) 0.82 Placed on the ground Hand wubing after Yisiting tbe toilet Never (reference) Sometimes Always Covered waste bins Never (reference) Always 2.48 (0.81 - 7.58) 0.112 2.13 (0.58 7.79) 0.251 Foods served to clients Always hot (reference) Sometimes hot 0.13 (0.016 - 1.11) 0.063 1.37 (0.07 27.86) 0.838 39 University of Ghana http://ugspace.ug.edu.gh Tab 4.5.4 Simple and multiple Logistic Regression Analysis for the Association between inappropriate food safety practices and external control mechanism Variable Crude or (95% p-value Adjusted or (95% p-value CJ) CI) Medical examination No Ref Yes 1.85 (0.68 - 5.08) 0.231 3.09 (0.50-18.98) 0.223 Mandate to start business Started on your Ref 0.329 own Continued from a 1.78 (0.56 - 5.64) 0.85(0.12-5.87) 0.869 friend or relative Health screening prior to selling No Ref Yes 1.96 (0.52 -7.43) 0.322 8.44(0.73-96.97) 0.087 Supervisory visit over last 12 month No Ref Yes 0.51 (0.23 - 1.12) 0.096 Number of supervisory visits Once a week Ref 0.096 2-3 times a week 1.45 (0.36 - 5.94) 0.83(0.16-4.27) 0.824 Once a month 1.33 (0.26 - 7.01) 1.44 (0.21-9.95) 0.713 Every six months ) 1 Education on food safety practices No Ref Yes 0.44 (0.04 - 4.26) 0.476 0.41 (0.03-4.95) 0.482 4.6 Proportion of food vendors who have been medically screened From the data. it was revealed that 79% of the food vendors had undergone medical examination, whereas the remaining 21 % have not been medically screened. 40 University of Ghana http://ugspace.ug.edu.gh Figure 3: A pie cbart sbowing the proportion of food vendors who have been medically screened [_yes _nol 41 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE 5.0 DISCUSSION S.l Introduction The study aimed at assessing the hygienic practices and food safety measures among street food vendors operating in Shukura Community. In this chapter, the findings were discussed highlighting those that directly answered the objectives. S.2 Common types of foods served Majority of the vendors (24%) prepared and sold local dishes. This included fufu, kokonte, banku, omotuo, tuo-zaafi accompanied by various soups including palmnut soup, light soup, groundnut soup and many others. 18% of them sold Waakye. 16% of the vendors sold various varieties of rice- jollofrice, plain rice, etc. The least number of vendors (3%) sold indomie and this is usually sold in the evenings. Results from a similar study by Hiamey et al. (2015) in Takoradi revealed that, the most popular street food was rice with stew I bean sauce (23.5%), followed by Bankulstew with stew/okro/pepper sauce (17.5%), then Fufu / Kokonte with soup (14.4%), Fried rice (I %), Tuo/aafi (0.7%) and Akyeke with tilapia (0.3%). The difference in proportions examined from this study could largely be attributed to the study locations and the methods used. Hiamey's study captured (23.5%) rice with stew I bean sauce as the predominantly consumed meal. In this study however, local dishes were found to have been the most consumed meal. Rice, on the other hand was consumed by only 16% of the study population. Another school of thought, according to a paper reviewed in Ethiopia, suggested that the culture of a group influences their food choices. (Kebede, 20 I 0). The variation in the choice 42 University of Ghana http://ugspace.ug.edu.gh of food can also be attributed to the cultural beliefs of a community or country and this is evidenced in a study conducted by Kebede (2010). 5.3 Hygienic conditions under which foods are prepared and sold Findings from this study showed that only 29% of the vendors practiced good hygienic measures whereas the larger proportion (71%) observed poor hygienic measures. A study by Okojie et al. (2005), among food vendors in a Nigerian university campus, also indicated that the knowledge and practice of food hygiene and safety measures were poor. This may seem to contradict a study conducted by Isara and colleagues (2009) which reported a large number of vendors having good knowledge and practice of food hygiene and safety in fast food restaurants in Benin City, Edo State. Concerning the low observance of personal hygiene by street food vendors, Ayeh-Kumi et al (2009) observed that, there is the likelihood of more people in the study area being exposed to food borne illnesses. The study identified multiple reasons attributing to having majority (71 %) of the food vendors maintaining poor hygienic practices and this ranged from lack of trainings on maintaining appropriate hygienic practices, poor hygienic conditions of vending site, lack of toilet facility, and poor waste disposal services to nearness to open drains. 5.4 Factors affecting food safety practices among food vendors The educational level, place of residence, location for food preparation and number of times food vendors washed their hands were major factors affecting food safety practices among food vendors. 43 University of Ghana http://ugspace.ug.edu.gh With regards to education, the findings from this study as presented in table 5.1, showed that 30% of the food vendors had no formal education, 21 % were Primary school graduates, 32% were Junior High school graduates, 12% and 5% had secondary/vocational and tertiary education respectively. This corresponds to previous works from WHO (1996) and Annan-Prah et ai, (201l) which suggest that most street food vendors in developing countries have no formal education. The findings from a study conducted by Donkor et aI (2009), on the contrary showed that, out of 50 respondents, 54% of them were Senior High graduates, 18% were HND holders, 14% were JHS graduates, 10% had never been to school and only 4% had been to the university. Table 5.1 Educational background of food vendors Food Vendor Frequency Percentage No fonnal education 30 30.0% Primary education 21 21.0% Junior high education 32 32.0% SecondaryNo cational education 12 12.0% Tertiary 5 5.0% Total 100 100.0% Source. FIeld Data, _') 017 s.s Proportion of food vendors who have been medically screened Prior to selling of foods, the municipal environmental health directorate expects all food vendors to undergo a thorough medical screening that will help in the early detection and management of diseases such as Typhoid and Hepatitis A. Once declared fit after being screened, the vendor is given a certificate and penn it to commence business. Data from the field indicated that, majority 44 University of Ghana http://ugspace.ug.edu.gh of the vendors (79%) had undergone regular medical screening (this included: history taking, head- toe- examination, sample taking (urine, blood, etc.) and examination for signs and symptoms of medical conditions such as diarrhoea, dysentery, typhoid, sore throat) whereas 21% have never had any medical examination done for them. The finding is further confirmed by the safety concerns pointed out by some researchers regarding street vended foods (Muinde and Kuria, 2005). A research conducted by Okojie et al (2005) revealed that only 30.4% of the respondents had medical examination done prior to employment. It is clear from the data that, there were some people selling who have never been screened before and thus pose a risk to the general people. This further confirms that there is a weak enforcement of rules governing the activities of food vendors. 5.6 STRENGTH AND LIMITATION OF THE STUDY The major strength of this study include: It was relatively quick and easy to conduct Data on all variables were collected only once from each respondent. Some of the limitations of this study include: The time for collecting the data was short and therefore certain critical food safety practices were either not performed or seen during the time period of the study. A longer period of time was necessary to capture more applicable food safety practices within the food service premises. Only a small number was involved in the study and thus no formal sample size calculation was performed to provide the statistical power for the study. 45 University of Ghana http://ugspace.ug.edu.gh CHAPTER SIX 6.0 CONCLUSION The current study has amply demonstrated that majority of the food vendors in the Ghanaian community are females. 21 % of the food vendors have never undergone annual medical screening which clearly poses a major health risk to consumers. The four main factors identified as having a direct association with the inappropriate food hygienic practices were: educational level of food vendors, place of residence, factors considered before buying food stutTs and hand washing when necessary. RECOMMENDATION Ihis study clearly established that the street food vendors in Shukura community practiced poor hygienic and safety measures at both the preparation and selling stages. Therefore to reduce the risk of food contamination and food borne diseases, the following recommendations are offered. The public health officials in the Ablekuma Central Sub-Metro should: Educate the public on the safety of street foods. Medically screen food vendors at least once every year. Educate the food vendors on food safety and good hygienic practices by organising refresher courses, in-service training, seminars and workshops. Regularly inspect the food premises, to ensure compliance with minimum standards in tenns of care of equipmcnt and materials. Finally, there is a need for further studies to be carried out to enhance the practice of appropriate food safety and hygienic measures. 46 University of Ghana http://ugspace.ug.edu.gh REFERENCES Ababio, P. F., & Adi, D.D. (2012). Evaluating Food Hygiene Awareness and Practices of Food Handlers in the Kumasi Metropolis. Internet Journal of Food Safety,14, 35- 43. Ababio, P. F., & Lovatt, P. (2015). A review on food safety and food hygiene studies in Ghana. Food Control, 47, 92-97. Addison, I.E. (2015). Hygienic Practices among Food Vendors in the University of Ghana (Doctoral dissertation, University of Ghana). Afele, M. (2006) Street food boom in Ghana spurs calls for better hygiene. Bull. World Health Organisation, 84, 772-773. Amoah, P., Drechsel, P., Schuetz, T., Berisavjevie, G., Manning-Thomas, N. (2009) From world cafes to read show: Using a mix knowledge shaving approaches to improve wastewater use in urban agriculture. Knowledge management for Development Journal 5(3): 246 - 262. Amponsah-Doku, F., Obiri-Danso, K., Abaidoo, R. C., Drechsel, P., & Kondrasen, F. (20 10). Bacterial contamination oflettuce and associated risk factors at production sites, markets and street food restaurants in urban and peri-urban Kumasi, Ghana. Scientific Research and Essays, 5 (2), 217-223. Annan-Prah, A., Amewowor, D. H. A. K., Osei-Kofi, J., Amoono, S. E., Akorli, S. Y., Saka, E., & Ndadi, H. A. (2011). Street foods: "Handling, hygiene and client expectations in a World Heritage Site Town, Cape Coast, Ghana". African Journal of Microbiology Research, 5( 13), 629-1634. 47 University of Ghana http://ugspace.ug.edu.gh Annor. G. A .. & Baiden, E. A. (2011). Evaluation of Food Hygiene Knowledge Attitudes and Practices of Food Handlers in Food Businesses in Accra, Ghana, 2011 (October), 830-836. http://doi.orglI0.4236/fns.2011.28 114 Apanga, S., Addah, J., & Sey, D. R. (2014). Food Safety Knowledge and Practice of Street Food Vendors in Rural Northern Ghana. Food and Public Health, 4(3),99103. Ayeh-Kumi, P. F., Quarcoo, S., Kwakye-Nuako, G., Kretchy, J. P., Osafo-Kantanka, A., & Mortu, S. (2009). Prevalence of intestinal parasitic infections among food vendors in Accra, Ghana. The Journal of Tropical Medicine and Parasitology, 32(1),1-8 Banson. K. E. (2015). Food Safety and Consumer Perception to irradiated food products in Ghana. Bhowmik, S. K. (2005, May 28 - June 4) Street Vendors in Asia. A Review Economic and Political Weekly, p.2257-64 Blaise H. (2014) An assessment of hygiene practices and health status of street food vendors in Yaounde, Cameroon. Bobodu, D.E. (2010). Small scale business: A case study of stagnation amongst street food vendors in Accra. Retrieved from: http://air.ashesi.edu.ghihandle/123456789/28 Bryan F.L., Jermini M., Schmit R., Chilufya E.N., Michael M., Matoba A., Mfume E. Chibiya H. (1997) Hazards associated with holding and reheating foods at vending sites in a small town in Zambia. Buscemi S., A. Barie, V. Maniaci, J.A.Batsis, A. Mattinsa, S. Verga. Characterization of street food consumption in Palermo: possible effects on health. Nutrition Journal, 10 (2011), P 1 19 48 University of Ghana http://ugspace.ug.edu.gh Donkor E. S., Kayang B.B., Quaye J., Akyeh M.L. (2009). Application of the WHO keys of safer food to improve food handling practices of food vendors in a poor resource community in Ghana. International Journal of Environmental Research and Public Health, 6 (II), pp.2833 - 2842 Food and Drugs Board (2008). Contaminated food killed 90,692 in 2006. w\\w.modemghana.com. Viewed: 29/4/13 Food and Drugs Board (2013). FDA School caterers on good hygiene practice. Ghana News Agency Food Control 47 (2015) 92 - 97 Food and Agriculture Organization (1986). Regional workshop on street foods in Asia. Food Agriculture Organization. 1997. State of the World's Forests. FAa, Rome. FAa (2009). Good Hygienic Practices in the preparation and sale of street food in Africa. Tools for Training. Food and Agriculture Organization of the United Nations, Rome. Food and Agricultural Organization of the United Nations (FAa). (2012). Street Food Vending in West African Cities; Potentials and Challenges. Available online: www.fao.org/africa (12/06/2013). Foriwaa, P., & Lovatt, P. (2015). A review on food safety and food hygiene studies in Ghana. Food Control, 47, 92-97. http://doi.orglI0.1016/Lfoodcont.2014.06.041 GHS (2012) Ghana: Cholera DREF operation. Final report from International Federation of Red Cross and Red Crescent societies. http://www.ifrc.org/do cs!appcalsl Active/MAA 00010 2012 pdf 49 University of Ghana http://ugspace.ug.edu.gh Hiarney. S.E .. Arnuquandoh. F.E., & Boison, G.A. (2015). Are we indeed what we eat? Street food consumption in the Market Circle area of Takoradi, Ghana. Nutrition and health. Ifeadike, C. 0., lronkwe, O. c., Adogu, P.O., & Nnebue, C. C. (2014). Assessment of the food hygiene practices offood handlers in the Federal Capital Territory ofN igeria. Tropical Journal of Medical Research, 17(1), 10. Isara, A. R., & Isah, E. C. (2009). Knowledge and practice of food hygiene and safety among foodhandlers in fast food restaurants in Benin City, Edo State. The Nigerian postgraduate medical journal, 16(3),207-212. Johnson, P-N, T & Yawson (2000) Proceedings of workshop for stakeholders, policy makers and regulators of street-food vending in Accra, at Miklin Hotel, Accra. DFIDI NRII FRI Crop Post Harvest Programme Project. Kebede G. Branding Ethiopia: opportunities and challenges. Univ. of South Africa; Unisa, South Africa: (2010). A research report (43089488). Knight A. J. and Warland, R. (2005); Determinants of Food Safety risks: A Multi- Disciplinary Approach; Rural Sociology] 70(2): 253-275 Kok, R., & Balkaran, R. (2014). Street food vending and Hygiene Practices and Implications for consumers. Journal of Economics and Behavioural Studies, 6 (3), 188 - 193 Mayo Clinic (2014). Disease and Conditions: Food Poisoning Mensah. P., Yeboah-Manu. D., Owusu - Darko, K., & Ablordey, A. (2002). Street Foods in Accra, Ghana: how safe are they? Bulletin of the World Health Organization, 80 (7): 546-554. so University of Ghana http://ugspace.ug.edu.gh Ministry of Heal thiGh ana Health Service (2012): Report on Cholera outbreak investigation in the Akwapem South Municipality, Eastern Region: 19th to 20th June, 2012. Monney,l., Agyei, D., & Owusu, W. (2013). Hygienic Practices among Food Vendors in Educational Institutions in Ghana: The Case of Konongo, 282-294. Muinde, O. K., & Kuria, E. (2005). Hygienic and Sanitary Practices of vendors of Street Foods in Nairobi Kenya. African Journal of Food Agriculture and Nutritional Development, 5 (I) Available from: www.ajfand.netIVolume5INo I IMuinde I 060.pdf (20/12/20 12) Muzaffar, A. T., Huq., I.. & Mallik, B. A. (2009). Entrepreneurs of the Streets: An Analytical Work on the Street Food Vendors of Dhaka City. International Journal of Business and Management, 4 (2): 80 - 88. Nam K. c., Jo C., Lee M. Meat products and consumption culture in the East. Meat Sci. (2010); 86:95-102. doi:IO.lOI6/j.meatsci.2010.04.026. Nicolo G. (2012). Report on the Study of street food vending in Ghana 2012. FAO RAF, Accra (Ghana.) Unpublished. Odonkor, S. T., Adorn, T., Boatin, R., Bansa, D., & Odonkor, C. J. (2011). Evaluation of hygiene practices among street food vendors in Accra Metropolis, Ghana, 41, 5807-5811. Okojie O. H., Wagbatsoma V. A. and Ighoroge A. D. (2005); An Assessment of Food Hygiene Among Food Handlers in a Nigerian University Campus; Nigerian Postgraduate Medical Journal, 12(2): 93-96. Pesewu, G. A., Agyei, 1. N., Gyimah, K.I., Olu-Taiwo, M.A., Osei-Djarbeng, S., Cudjoe, F. S., ... & Ayeh-Kumi, P.F. (2014). Bacteriological Assessment of the Quality of 51 University of Ghana http://ugspace.ug.edu.gh Raw -mixed Vegetable Salads Prepared and sold by street food vendors in Korle- Gonno, Accra Metropolis, Ghana. Journal of Health Science, 2, 560-566. Public Health Act 2012, Act no. 851 & 852. Rahman, M., Arif, M. T., Bakar, K., & Tambi, Z. (2012). Food safety knowledge, attitude and hygiene practices among the street food vendors in northern kuching city, sarawak, (September), 95-103. Rane, S. Street vended food in developing world: Hazard analyses. Indian J. Microbiol. 2011, 51,100-106. Rheinlander, T. (2006). Street Food Quality, a Matter of Neatness and Trust: A Qualitative Study of Local Practices and Perceptions of Food Quality, Food Hygiene and Food Safety in Urban Kumasi, Ghana". Denmark: University of Copenhagen. Soriyi, I., Agbogli, H.K., & Dongdem, J. T. (2008). A pilot microbial assessment of beef sold in the Ashaiman market, a suburb of Accra, Ghana. African Journal of Food, Agriculture. Nutrition and Development, 8 (I), 91 -103 Steyn et al.. (2014) N.P. Steyn, Z. McHiza, J.HiIl, Y.D. Davids, I.Venter, E. Hinrichsen. Nutritional contribution of street foods to the diet of a people in developing countries: a systematic review. Public Health Nutrition, 17 (6) (2014), pp. 1363- 1374. Tinker, I. (1997). Street foods urban food and employment in developing countries. New York: Oxford University Press. University Institute of Statistical Social & Economic Research (ISSER). 2002. Street foods in Ghana: Types, Environment, Patronage, Laws and Regulations. Proceedings of a Roundtable Conference: ISSER, University of Ghana S2 University of Ghana http://ugspace.ug.edu.gh tf~DA.(2006). Food safety for people living with cancer. World HeaIdt Orpniation (2006); Report on WHO Initiative to Estimate the Global Burden of Foodbome Diseases; Geneva. AvaiJable from: J:mp:lJwww.who.intlfoodsafety/publications/foodbome_diseaselburden_nov071 enlindex.html World Health Organization (2007); Five keys to Safer Food Manual; WHO: Geneva, Switzerland. 2007. World Health Orpnization (2008); Foodbome Disease outbreaks: Guidelines for control; Geneva. Available from: ,~ , hg;//www.wbo,intlirislhandlell0665/43771 World Health OrganiZll$ien (2017); Food safety. Available tiom: bUyJIwww.who.intlmediacentrelfactsheetslfs399/en1 University of Ghana http://ugspace.ug.edu.gh APPENDICES Appendix 1: Consent Form Title of Research: Food Safety and Hygienic practices among food vendors in Shukura Community, Ablekuma Central Sub-Metro Principal Investigator: Delphina Aneley Abbey Address: P. O. Box LG 13, School of Public Health, College of Health Sciences, University of Ghana, Legon Email: delphina.abbey@gmail.com Mobile: 0243113225 Introduction: The study was conducted by Delphina Aneley Abbey, a Master of Public Health student at the School of Public Health, University of Ghana. This study aimed at determining th~ safety measures as well as the hygienic practices of food vendors in Shukura Community. It further assessed certain factors that contaminate vended foods, predisposing one to food-related diseases. The consent form contained all the information needed to enable a respondent to decide whether to partake or refuse. Confidentiality and Anonymity: Respondents were invited to take part in this study and their participation was voluntary. They were given the opportunity to ask questions before deciding to take part in the study. Once one S4 University of Ghana http://ugspace.ug.edu.gh agreed to take part in the study, he or she was required to provide some personal information. All the information provided were kept confidential. Names and identity were not needed for the study. The information provided was only identified by a code number and treated strictly confidential. Your name shall not appear or be mentioned in any part of the report that will come out of this study. Risks and Benefits of Being in the Study: Being in this study will involve some risk ofthe minor discomforts that can be encountered in daily life, such as stress related to completing the questionnaire, because you may not know some of the answers. Being in this study will not pose risk to one's safety or wellbeing. However, you will derive a better training from participation in this study which will equip you to serve safer food to the public. Payment: After completing the questionnaire, light refreshment ~iIl be served. Privacy: Any information you provide will be kept anonymous. The researcher will not use your personal infonnation for any purposes outside of this research project. Also, the researcher will not include your name or anything else that could identify you in the study reports. Data will be kept secure by storing paper questionnaires in locked filing cabinets and in electronic form on password protected computers. Contacts and Questions: For further questions and clarification about the study, kindly contact the principal investigator. 55 University of Ghana http://ugspace.ug.edu.gh Statement of Consent: I have read the above information and I feel I understand the study well enough to make a decision about my involvement. By returning a completed survey, I understand that I am agreeing to the terms described above. Signature of Respondent: ...................... . Date: ................................... Statement by the Researcher The researcher will clearly read out the information sheet to the participant and answer any question about the study to the satisfaction of the respondent. The researcher will con finn that the respondent was not in any way forced into giving consent and that the consent will be given freely and voluntarily. Signature of Researcher: ....... . Date: ......................... . 56 University of Ghana http://ugspace.ug.edu.gh QUESTIONNAIRE This questionnaire is designed to examine the hygienic pra~tices ad~pted b~ street .food Vendors in Shukura community to ensure food safety. All infOrmatIon provIded wIll be held confidential. Names are not required on this questionnaire. Please tick ( ...J ), fill in the blank or write as appropriate to each question. SERIAL NUMBER'--______ SECTION A SOCIO - DEMOGRAPHIC INFORMATION 1. Sex Male [1 Female [1 2. Age Less than 20 years [] 20 - 30 years [1 31 - 40 years [ 1 41 - 50 years [] More than 50 years [1 3. Place of residence Within Shukura [] Outside Shukura [ ] 4. Educational Attainment None [1 Primary school [] Junior High school [] Secondary I Vocational school [1 Tertiary school [ ] 5. Religion Christian [ ] Islam [ ] Traditional ] Others 6. Marital status Single [ ] Married [] Widowed [ ] Divorced [ ] 7. Nationality Ghanaian [ 1 Non Ghanaian [ 8. Tribe Hausa Akan [ ] Ga [ Others, specify ____ 9. What is your primary occupation? Solely food vending [ ] Professional [ ] Artisan [] Specify, ________ SECTION B FOOD VENDOR CHARACTERISTICS 10. For how long have you been selling or preparing food for sale? Less than I year [ ] I - 3 years [] 4 - 6 years [ ] More than 6 years [ ] 11. How many varieties of food do you sell and specify? One [] Two [] Three [ Four or more [ 12. What time of the day do you sell? Morning [ ] Afternoon [ ] Evening [ 13. How did you acquire your knowledge on food preparation? From relatives [] Self - taught [] Catering school 14. How did you gain knowledge on food safety practices? Health officials [] Media [] Others, ---------- SECTION C FOOD SAFETY MEASURES University of Ghana http://ugspace.ug.edu.gh 15. Where do you get your food stuffs and vegetables from? Farm [] Market [] Other, _______ 16. What do you consider most important before you select food stuffs? Cost [] Quantity [] Quality [] Cultural background [] Specify, if others, ________ 17. Where do you prepare your food before selling? Prepared at home and transported here for sale Prepared here at the vending site [ ] Prepared it at home / sometimes at the vending site when the ones brought from home gets finished [ ] 18. If at home, is it in an; Open space [ Kitchen 19. How do you transport foodstuff to cooking site? By carrying [] By car [ ] By carriage truck 20. Who prepares the food? Seller [ ] Other people apart from seller If others, specify_ __________ 21. What is your main source of cooking water? Pipe borne water [] Well [ Treated water from a plant Tanker service ] Other __________ 22. Is there constant supply of water at the place of cooking? Yes [] No [ ] 23. What is the means of water storage at sales point? In a tank (uncovered) in tank (covered) [] Others _______- --'-___ 24. Do you sometimes get food leftovers (unsold foods including stews, meat, fish, etc)? Yes [] No [ ] 25. (Jfyes, ask)When you get leftovers, how do you manage / preserve them? Refrigerated for next day's use [] Reheat for sale ] Consumed by family and friends [] Throw it away ] Poured into a container and covered to be used the next day [ ] Other, _____ 26. How do you identify safe foods? By smell [] Change in colour Change in taste [ 27. What kind of building is the stall / structure were the food is prepared and sold? Wooden [] Block [] Under a shed [] Other,~ ____ 28. Do you check the expiry dates of all products? Always [] Sometimes [ ] Never [ ] 29. Where do you store your perishable products? (Interviewer explains the term perishable). Tick all that apply. Fridge [] Basket Polythene bags Dry places [) Newspaper [] Other, 30. Do you work when you are sick (cough, diarrhoea or cold/flu-)?-------- University of Ghana http://ugspace.ug.edu.gh Take off-duty till well [ ] Relocate to areas not in contact with clients [ ] Continue working while treating yourself [] Don't know [ ] Other (specify)_--------- 31. Which personal protective equipment do you wear when selling? Apron [] Boots [] Face mask Head covering [] Hand gloves None ] 32. Do you wear long nails with nail polish when handling food? Yes [ ] No[ SECTIOND FOOD HYGIENE PRACTICES 33. Do you wash raw foodstuffs thoroughly before cooking them? Always [] Sometimes [] Never [ ] 34. How do you wash your hands? With plain water [] With soap and water [ ] 35. How do you wash your utensils? Rinse only with water [] Using washing soap, then rinse twice with water [ ] Clean with a cloth [] 36. How do you store your washed plates and cutleries? Covered in a bowl [ ] Kept in an uncovered bowl [ ] Placed on the ground [ ] 37. How often do you wash plates used to serve foods to customers? At the end of the day [] After each use [] At the beginning of sales [ ] 38. On the average, how many times do you wash your hands while serving, selling or handling food? Never [] Once a day 2-4 times daily ] More than 4 times daily [ ] Anytime it is necessary to do so [ If never, state reason _________________ INSTRUCTION: Ple'lSe place a tick under the appropriate column to indicate whether you carry out these activities always sometimes or never NO. ACTIVITY ALWAYS SOMETIMES NEVER 39. Handwashing after handling money before serving food I 40. Hand washing after visiting the toilet/urinal 41. Handwashing before and after handling food 42. Waste bins should be well covered : 43. Do you scoop out food with: i. a spoon ii. glove I iii. bare hands University of Ghana http://ugspace.ug.edu.gh SECTIONE CONSUMER FACTORS 44. How do customers wash their hands before eating? No water available [] Water provided in a common bo~l [ ] Improvised running water provided [] Water and soap prOVIded [ ] 45. How do you serve food to customers? Always hot [ ] Sometimes hot Always cold SECTIONF EXTERNAL CONTROL MECHANISM 46. Do you think medical screening is important? Yes [ ] No ] 47. How often do you undergo health screening? No screening [ ] Monthly [ ] Every 6 months [] Yearly [] 2-5 years [ ] 48. How did you get mandate to prepare and sell food? Through application to environmental officer [] Started on your own Contacting a health inspector [] Continued from a friend or relative [ 49. Are you registered with any food vending society/ association? Yes [] No [ 50. Uyes, how often do you meet? Once a week [] 2-3 times monthly [ ] Once a month [] Every 6 months [] Once in a year [] 51. Before you started selling here, were you required by the Assembly to go through a health screening? Yes [] No [] 52. Did you obtain a health certificate or license prior to starting? Yes [] No [ ] 53. Uyes, have you ever renewed your health certificate? Yes [] No [ ] 54. if yes, when was the last time you renewed it? Less than 6 months ago [ ] 6 - 12 months ago [] 1 - 2 years [] More than 2 years ago [ ] 55. Uyou have never renewed, why haven't you renewed it? No money [] Cost of renewal is high [] Cumbersome procedure Authorities don't check [] Don't know renewal date [] 56. Has an environmental officer or sanitary inspector visited your business for any inspection during the last 12 months? Yes [] No [ ] 57. Uyes, how often do they visit? Once a week [] 2-3 times monthly [ ] Once a month [] Every 6 months ] Once in a year [] 58. Has any environmental officer /sanitary inspector or health worker visited your business to educate you on food safety / hygiene? Yes [ ] No [ Thank you very much for the time you took for answering these questions! Have a good day! University of Ghana http://ugspace.ug.edu.gh OBSERVER CHECKLIST Serial Number_ _________ Date_ _______ Directions: Complete this checklist to monitor food safety and sanitation practices. NO. PERSONAL HYGIENE YES NO NA 1. Food vendor wears clean presentable personal clothing 2. Food vendor effectively wears PPE's such as apron, hair coverings, closed-toe shoes, etc 3. Food vendor has clean, short trimmed fingernails without varnish 4. Vendor does not use jewelries 5. Hands are washed properly, frequently, and at appropriate times 6. Vendors use disposable tissues when coughing or sneezing, and immediately wash hands or change gloves 7. Food vendors' illness: i. Coughing ii. Wounds iii. Diarrhoea iv. Cold I v. Skin rashes NO. HYGIENIC PRACTICES YES NO NA ! 8. Vendor washes hands after: i. Visiting the toilet / urinal ii. After handling money with bare hands iii. Combing hair i iv. Blowing nose i v. Handling garbage I vi. After touching exposed body part vii. Changing little children who may have soiled themselves 9. UtenSils, plates and cutleries are: i. Pre-rinsed ii. Washed with soap iii. Rinsed twice with water iv. Dried [lO. Garbage bins are properly covered with well-fitting lids University of Ghana http://ugspace.ug.edu.gh NO. NA POINT OF SALE YES NO 1 1I. Surrounding area free of sources of contamination I 12. Working surfaces are clean I 13. Adequate lighting in the food preparation and selling area I 14. Availability and accessibility to good water supply 15. Suitable water storage container I ~ 16. Is vending site near an open drain? 17. Food cart or container used to transport food is cleaned daily 18. Proper waste management system 19. Clean water is used for hand washing, dishwashing, etc. 20. Availability of single use paper tissues -- NO. FOOD PREPARATION YES NO NA I 21. Food equipment, utensils and food contact surfaces are properly I washed, rinsed, and clean before each use +----~-, 22. Foods for sale are properly covered --- - 23. Foods served are hot 24. Food Is adequately protected from flies and dust 25. All food is stored 6-8 inches off the floor 126. Chemicals are clearly labeled and stored away from food -,------ University of Ghana http://ugspace.ug.edu.gh GHANA HEALTH SERVICE ETIllCSREVIEW COMMITTEE . . .. hcose ojreply the ¢".LT".. • Research & Development DIvIsIon fI/lTIber and date ojt his