Knowledge Attitude and Practice on Food Hygiene among Food Handlers in Hostels of Bengaluru

Introduction

Food is liable to contamination due to lack of adequate information on food hygiene which can lead to food borne diseases and death of consumers.1 Common infections which are likely to transmit through the food handlers are dysentery, typhoid, paratyphoid fever, entero viruses, viral hepatitis and helminthes.1,6 Food hygiene, which refers to all the conditions and measures that are essential during the production, processing, storage, distribution and preparation of food to ensure that it is safe, wholesome, nutritious and fit for human consumption.2 It is also referred to as ‘from farm to fork’ or ‘from farm to table’, because it includes every stage in the process from growing in the farm, through storage and distribution, to final consumption of food. It also includes the collection and disposal of food waste. Throughout this chain of events there are many points where, directly or indirectly, knowingly or unknowingly, unwanted chemicals and microorganisms may contaminate the food. Therefore, food hygiene is vital for creating and maintaining hygienic and healthy conditions for the production and consumption of food.3 The aim of food hygiene is to prepare and provide hygienic food and consequently prevent food borne illnesses. The specific objectives for food hygiene – 1) Prevent food spoilage. 2) Inform and educate people about simple and practical methods of keeping food safe to protect themselves from food borne diseases. 3) Protect food from adulteration and 4) Ensure proper practice in the food distribution to ensure good quality and value of the food reaching the consumer.3

Several studies have reported with good knowledge and good practices on food hygiene among the food handlers and recommended training in hygiene matters as a means of improving food handling practices and ensuring the safety of food.8-15 For this reason, WHO has stated to educate food handlers about their responsibilities towards food hygiene, and introduced the “five keys” to healthier and pathogen-free food.2 They include the following: keep clean, separate raw and cooked food, cook thoroughly, keep food at safer temperatures, use of safe water and raw materials.2

WHO estimates of the global burden of food borne diseases have shown almost 1 in 10 people fall ill every year from eating contaminated food and 48 million people get sick from food borne illness, 420000 die every year, resulting in the loss of 33 million healthy life years.2,6 In India, majority outbreaks of food borne disease go unrecognized or un-investigated and may be noticed only after any major health or economic damage has occurred. 4 According to IDSP, food poisoning outbreak cases have increased from 50 in 2008 to 312 in 2017 in India.2,6

Therefore, we have to give due emphasis to good hygienic practices to prevent and control food borne diseases. In this regard, the present study helps to assess the knowledge, attitude and practice about food hygiene among the food handlers working in the hostels affiliated to Bengaluru Medical College and Research Institute (BMCRI), Bengaluru.

Materials and methods

A cross sectional study was conducted to determine the knowledge attitude and practice regarding food hygiene among food handlers working in the hostels affiliated to BMCRI, Bengaluru during October to December, 2018. There are 5 hostels affiliated to BMCRI viz. Bheema, Varuna, Kaveri, Sharavathi and Krishna. A total of 47 institutional food-handlers participated in the study. After explaining the study purpose, a face validated, semistructured questionnaire which was translated into local language was self-administered to the participants. The assessment tool was taken from the Food Safety and Standards Authority of India (FSSAI) and the National Institute of Health (NIH).6,12 Questionnaire included various domains like socio-demographic profile, knowledge, attitude, practice on food hygiene. The domain of questionnaire which includes food hygiene knowledge comprised 21 closeended questions with two possible answers: true, false. These questions specifically tested the participant’s knowledge on personal hygiene, cross contamination, food-borne diseases, microorganisms, storage of food and hygienic practices. A scale ranging between 0 and 25 (representing the total number of questions on food hygiene knowledge) was used to evaluate the overall knowledge of the participants in the study. Food-handlers that obtained a total score:

a) ≤ 9 points were considered to have “poor” knowledge,

b) 10 to 14 points were considered to have “moderate knowledge” and

c) 15 to 21 points were considered to have “good” knowledge of food hygiene.

The domain of attitude statements/questions will determine the understanding of food handlers about food hygiene. Here, attitudes were used to mean “a complex mental state involving beliefs, feelings, values and dispositions to act in certain ways”.13 This section had 20 statements/questions. A 5- point Likert’s scale was adapted, in which the answers were graded on a scale of five, with 1 indicating “strongly disagree” and 5 indicating “strongly agree”. In the evaluation, the foodhandlers that scored:

a) < 44 were measured to have “negative” attitude,

b) 45 to 75 scoring were graded as “neutral” attitude

c) 76 to 100 were marked to have a “positive” attitude.

The domain, which dealt with food hygiene practices, were assessed and evaluated based on personal hygiene and other safe food handling practices.13 The section had 5 questions with close ended replies: Yes or No. Each correct practice reported scored one point. For evaluation, a score ≥ 70% by an individual respondent was considered as having “good” food hygienic practice.

Ethical approval was obtained from the ethical committee of Bengaluru Medical College & Research Institute.

Inclusion criteria: All the food handlers irrespective of age, gender, religion, educational status was included in the study.

Exclusion Criteria: Food handlers who were not present on the day of visit to the mess were excluded.

Sampling: Purposive Sampling.

Data analysis

Data was tabulated in MS Excel & coded. Analysis was done using statistical software SPSS version 20.0. Results were expressed in terms of percentages, tables and graphs using appropriate statistical tests

Results

Demographic details

A cross sectional study was conducted with total number of participants in this study constituted 47 

Figure 1 illustrates the distribution of study participants according to their religion. Majority that is 64% (n=30) of them belong to Hindu caste.

Table 1 presents the summarized demographic profile of study participants in this study. A total of 47 food handlers who participated in the study are all male. A greater number (55.3%) of the participants were in the age group of 20–29 years with the average age of 28.38 + 7.9 years. Majority of the participants were unmarried that is 61.7%. 46.8% of the participants had high school education. A greater number of participants (46.8%) had 1-5 years of duration of service in hostels. Lesser number 19.1% of participants have no habits. Only a few (14.9%) of the respondents self-reported that they have received training in food hygiene.

Food hygiene knowledge of food handlers

Table 2 illustrates that majority of food-handlers in this study knew the importance of general sanitary practices such as regular hand washing at the work place (63.8% correct answers). All the food handlers had knowledge regarding cross contamination. Less than 50% of the participants had proper knowledge regarding storage of food (36.2%) and microorganisms (42.5%).Greater number of participants (74.5%) had knowledge regarding food borne diseases

Figure 2 shows only 48.9% of study participants possess good knowledge and 27.7% and 23.4% possess moderate and poor knowledge respectively. The mean knowledge score (13.34+4.09) of food handler.

FOOD HYGIENE ATTITUDE OF FOOD HANDLERS  

Table 3 shows the attitudes of the food-handlers toward the prevention and control of food-borne diseases. Majority of participants agreed (48.9%) or strongly agreed (25.5%) to attend a seminar on food safety standards. Majority of the participants have positive attitude towards food safety knowledge. Only few participants disagreed (10.6%) that food handlers are responsible to prevent food poisoning while rest of the participants (89.4%) mostly agreed.

Figure 3 shows most (68%) of the participants have positive attitude towards food hygiene and rest of the participants have neutral attitude (32%). None of the participants showed negative attitude towards food hygiene. The resulting mean attitude score of the food handlers is (78.38+12.10).

FOOD HYGIENE PRACTICES OF FOOD HANDLERS  

Table 4 shows the food hygiene practices by institutional food-handlers. 100% reported that participants do not use a cap, mask or gown. Majority (63.8%) of the participants use different chopping boards for meat, fresh vegetables and fruits. As regards the working pattern during sick, majority (91.5%) of the participants do not work when sick. A striking revelation about vaccination status is, only few (14.9%) of the participants have taken Hepatitis B vaccine. 49.0% reported that they do not wash hands before and after touching unwrapped raw foods.

Figure 4 shows Majority (83%) of the participants have unfair practice towards food hygiene with a mean practice score of (2.21+1.2).

Discussion

The aim of the current study was to investigate the KAP level of food hygiene among food handlers working in the hostels. Out of the 47 food-handlers who participated in this study, all the participants were male 100% (n=47) (Table no 1). Most studies have reported higher proportion of female’s involvement in food handling.8,9,13 A greater number (55.3%) of the participants were in the age group of 20–29 years with mean age of 28.38 ± 7.9 years. Several studies showed that workers in older age group had better hygiene scores than their younger food handlers.9,13 46.8% of the participants in this study have formal education (Table 1). However, a many study demonstrated that with respective educational level, food handler’s performance in food hygiene knowledge was not satisfactory if they do not have formal education.9-13 A greater number of participants (46.8%) had 1-5 years of experience working in the foodservice industry. Only 10.6% were full time workers in the institutions whiles the rest were part time workers (Table 1). But others studies show that majority of the participants had more number years of experience in the institution.13 Only a few (8.1%) of the respondents reported that they have received training in food safety. Several studies have shown that training may contribute to upgrading the food hygiene knowledge of foodhandlers, this translate into a positive change in food handling attitude and practice.

With regard to knowledge, in this study, the foodhandlers were knowledgeable with mean score of 13.34+4.09, namely in personal hygiene, cross contamination, food-borne diseases (Table 2). 

When comparing our results with other studies, one conducted in Bengaluru by Divya V et al, to assess knowledge among house wives of selected urban area showed that approximately 62.20% as having moderate knowledge of proper hygiene namely hand wash technique, cutting of nails, wearing caps and gowns, can help in minimize the risk of diarrhea and other food borne diseases.8 On the other hand, other studies conducted in Ghanaby Akabanda Fortune et al for assessing KAP levels in food handler, showing high levels of knowledge among food handlers regards to hygiene level it is 98.2%, 81.7% regarding food borne diseases, 76.2% regarding microorganisms’ knowledge, indicates some of important factors for prevention of food borne diseases.13 On the other hand, in our study only few food handlers (36.8%) had knowledge regarding storage (Table 2) and microorganisms such as salmonella, hepatitis, shigella (57.4%). Indicates proper storage food and knowing about organisms that causes food borne diseases is also important factor for practicing good hygiene.

Attitude levels in our study also showed higher level (68%) with mean attitude score 78.38+12.10 of food handlers (Table 3), also in study done in Ghana by Akabanda Fortune et al food handlers were also found to have higher levels regarding attitude (67.26%).13 Similarly, in other study conducted in Nigeria in the City of Abeokuta by Iwu A et al food vendors had positive attitude (71%) about food hygiene .17 A reduction in the incidence of food-borne illnesses is strongly influenced by the attitudes of food-handlers towards the implementation of food safety plans. Thus, there is a strong linkage between positive behavior, attitudes and education of food-handlers in maintaining safe food handling practice.18

Regarding practice, participants had unfair level (83%) with mean practice score (2.21+1.2) of food hygiene (Table 4). The participants scored highest (91.5%) while not working, when they are sick and but performed poorly for not wearing the gowns, mask, caps at work place (Table 4).In other study, conducted in Kuala Lumpur University, Malaysia by Hui Key Lee et al showed self-reported practice has much higher (88.66%), the participants had reported that they frequently practiced safe food handling during food preparation, scoring an average of 53.2 ± 5.5 of the total score of 6018 after intervention regarding food safety practices. On the other hand, study done in Ghana by Akabanda Fortune et al, majority (61.7%) of the food-handlers do not use aprons or wear mask when necessary.13 This implies that food-handlers might not necessarily be practicing strict food safety procedures during food handling, even when they provide answers to show that they are knowledgeable in a survey.

Conclusion

The study provides valuable information about institutional food-handlers in BMCRI, Bengaluru had satisfactory knowledge in the areas of personal hygiene, sanitation procedures and food borne diseases but performed poorly in the areas of storage and microorganism. But this did not translate into strict food hygiene practices. Therefore, continuous food safety education, motivation and training for food handlers which will affect attitudes and subsequently food-safety practices. The high level of attitude scores of food handlers on food hygiene implies their awareness for prevention of food borne diseases

Recommendation

Regular health check-up of food handlers should be carried out once in six months. Health education sessions regarding food hygiene, hand hygiene, personal hygiene & sanitation for food handlers should be conducted. Food handlers have to be vaccinated after their recruitment and before they start up with their work.

Limitations of the study

A study was carried out in one institution only with small sample size thus results cannot be generalized. The study was cross sectional study and does not capture the changes in KAP over a longer duration.

Source of funding: None.

Conflict of interest: None.