Rajiv Gandhi University of Health Sciences s143

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE Mr. ABRAHAM KURUVILLA AND ADDRESS I YEAR M Sc NURSING BGS COLLEGE OF NURSING, KUVEMPUNAGAR, MYSORE.

2. NAME OF THE BGS COLLEGE OF NURSING, INSTITUTION MYSORE

3. COURSE OF STUDY AND M Sc NURSING, SUBJECT COMMUNITY HEALTH NURSING

4. DATE OF ADMISSION OF 30/6/2011 COURSE 5. TITLE OF THE TOPIC A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION GUIDE SHEET ON KNOWLEDGE REGARDING FOOD HYGIENE AMONG FOOD HAWKERS IN SELECTED AREAS AT MYSORE.

1 6. A BRIFE RESUME OF INTENDED STUDY

INTRODUCTION

“Hygiene is two third of health”

Lebanese proverb

The term street food refers to a wide variety of ready to eat food and beverages sold and sometimes prepared in public places. Street food may be consumed where it was purchased or can be taken away and eaten elsewhere. The established food safety know how among the surveyed street food vendors regarding food contamination, types and symptoms of food disease was significant since several pathogenic microorganisms had also been isolated from many street vended foods. According to World Health Organization (WHO) food handling personnel play important role in ensuring food safety throughout the chain of food production and storage.1

Inspite of numerous advantages offered by street foods, there are several health hazards associated with this sector of economy. Multiple lines of evidences reveal that foods exposed for sale on the roadsides may become contaminated either by spoilage or pathogenic micro-organisms. Food and Agricultural Organization (FAO) further stipulates that street foods raise concern with respect to their potential for serious food poisoning outbreaks. The rise of street food vending has created health problems like improper and unhygienic handling of food.2

Food safety has emerged as an important global issue with international trade and public health implications. In response to the increasing number of food borne illnesses, governments all over the world are intensifying their efforts to improve food safety. The World Health Assembly adopted a resolution in which, the World Health Organization (WHO) was asked “to give greater emphasis on food safety, with the goal of developing suitable, integrated food safety systems for the reduction in health risk along the entire food chain, from primary producer to the consumers”.3

Food sanitation rests directly upon the state of personal hygiene and habits of the personnel working in the food establishments. Proper handling of foods, utensils and

2 dishes together with emphasis upon the necessity for good personal hygiene are of great importance. Although people enjoy food from these vendors, in many cases the food is of poor quality and it represent a serious health risk. In part, this is because the street vendors have little or no access to safe water supply or sanitation facilities, and they commonly cook and handle food with dirty hands. Raw foods stuffs cannot be kept in safe storage place and are easily contaminated by vermin and insects. The infections which are likely to be transmitted by the food handlers are Diarrhea, dysenteries, and paratyphoid fever, entero viruses, viral hepatitis, protozoal cysts, eggs of helminthes, streptococcal and staphylococcal infections, and salmonellosis. Moreover, the street vendors often kept cooked food at ambient temperature for prolonged period of time and may heat the food only slightly before serving. This makes the food from street vendors dangerous.4

6.1 Need for the study

Food borne illnesses are prevalent in all parts of the world and the toll in terms of human life and suffering is enormous. Contaminated food contributes to 1.5 billion cases of diarrhea in children each year, resulting in more than three million premature deaths, according to the World Health Organization. Those deaths and illnesses are shared by both develop and developing nations. In the United State, the centers for disease control and prevention(CDC) estimates that food borne disease cause approximately 76 million illness annually among the country’s 290 million residents, as well as 325,000 hospitalization and 5,000 death. In South East Asia, approximately one million children under five years of age die each year from diarrheal diseases after consuming contamin ated food and water.5

Food borne illnesses are a widespread public health problem globally. Developing countries bear the brunt of the problem due to the presence of a wide range of food-borne disease. In India an estimated 4,00,000 children below five years age die each year due to diarrhea. In India, the street food trade is a growing sector with its expansion linked with urbanization and the need of urban populations for both employment and food. However, the microbiological status of popularly consumed raw street foods, general hygiene and vending practices are not known. 6

3 A random survey conducted by metropolis healthcare Ltd, India’s only malnutritional chain of diagnostics centers, to examine the hygiene levels of food served on the street of Bangalore, found that 90 percent of it is unfit for human consumption. The quantitative bacterial analysis test, conducted between October 2010 and November 2010, by using ‘Food Pathogen Screening’ found that of 50 street food samples tested 47 were contaminated with bacteria. The food samples were screened for the presence of the food borne pathogens. The study result showed that more than 90% of food that was screened were heavily contaminated with enteric bacteria. According to Dr. Indumathi, Head of Department for Microbiology and Serology at Gokula Metropolis Clinical Laboratory, the risk factors for food contamination in this study were found to be the poor hygienic practice and lack of awareness among the street vendor and she recommended an awareness programme on food hygiene for them.7 Therefore it is essential to assess the knowledge and help them understand the importance of hygiene and teach regarding food hygiene. The researcher had direct experiences of such incidences of food poisoning from the food of food hawkers and also he had seen several cases of food poisoning at hospital due to street food. So the researcher felt a need to take up the study on knowledge of food hawkers and educate them regarding proper hygiene during preparation, serving and waste management of food to prevent the occurrence of such conditions.

6.2 Review of literature

A study was conducted to assess the quality of street foods by analyzing 4 breakfast items and 2 fruit juices collected from 6 areas, by using standard procedure. The study result shows that there is high load of bacterial pathogens such as total bacterial count (12.6-25.8cfu/g), yeast/moul, staphylococcus aureus and bacillus(3.93- 8.0cfu/g) cereus in street foods and the study suggest that proper hygienic and sanitary condition has to maintain both personally and institutionally and a continuous monitoring in each activity that is from pre preparation to cleaning is required in street food centers to avoid any food borne pathogenic outbreaks in future.8

A study conducted on Bacteriological analysis of street foods with an aim to analyze the bacteriological profile of street foods sold with the 75 randomly collected

4 food samples. The study result shows that about 88% of the food samples is having the presence of bacterial pathogens and study recommended a strict implementation of food sanitation practices to reduce the possible risk of transmission of infection on consumption of this foods.9 A cross sectional study was conducted to assess the effectiveness of training intervention on food hygiene among 80 street vendors. The study result shows that knowledge level of food vendors increased from an average 24.35% to 66.2% after training intervention and overall performance rating of full adoption of good hygiene practices by the vendors ranged from 37.5% to 50.8% in post training period.10 A study was conducted on safety of vendor-prepared foods, among 4100 processing mobile food vendors. The study result shows that over half of all vendors (67 %) were found to contact served foods with bare hands, four vendors were observed vending with visibly dirty hands or gloves and no vendor once washed his or her hands or changed gloves in the 20-minute observation period, seven vendors had previously cooked meat products stored at unsafe temperatures on non-heating or non-cooking portions of the vendor cart for the duration of the observation and four vendors were observed to contaminate served foods with uncooked meat or poultry and study concluded that more stringent adherence to food safety regulation should be promoted.11

A study was conducted to assess safety of street foods among 511 food items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes. The study result shows that Mesophilic bacteria were detected in 356 foods (69.7 %), 28 contained Bacillus cereus (5.5 %), 163 contained Staphylococcus aureus (31.9 %) and 172 contained Enterobacteriaceae (33.7 %), the microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni and red pepper had unacceptable levels of contamination. The study concluded that Street foods can be sources of enteropathogens. The study recommended that vendors should therefore receive education in food hygiene and special attention should be given to the causes of diarrhea, the transmission of diarrheal pathogens, the handling of equipment and cooked food, hand-washing practices and environmental hygiene.12

5 A study was conducted to assess food safety and associated food handling practices in street food vending with the objective to assess the microbiological quality of the food being sold as well as the level of hygiene conditions under which these food stalls operate. The study result shows that overall microbiological quality of the foods served by the street vendors was within acceptable safety limits, although the presence of sspecific microorganisms such as Escherichia coli, Staphylococcus aureus, Salmonella and yeasts is indicative of a degree of ignorance on the part of the food handlers towards proper hygienic practices.13

A study was conducted to identify the microbiological hazards and safety of ready to eat food vended among 55 samples. The study result shows the presence of P. aeruginosa (39%), E.coli (21%), S. aureus (16%), Salmonella sp. (12%) and Proteus sp. (12%). The highest frequencies of occurrence of bacterial pathogens were P. aeruginosa in samosa (25%), E. coli in kachori (32%), S. aureus in kachori (27%), Proteus sp. in palakwada (45%) and 36% Salmonella sp. in samosa. The study concluded that food contamination is mainly due to poor water quality and hygiene during food preparation, washing of utensils, poor personal and domestic hygiene, peeling of fruits long before consumption, and crowded, dusty and poorly maintained shopping areas, the location of shops alongside busy roads with heavy vehicular traffic, which increase airborne particles, or beside waste disposal sites and overcrowded dwellings, adds to the contamination and the study suggest that provision of health education to the vendors and enforcing implementation of appropriate hygienic practices would improve food quality.14 A study was conducted to assess the microbiological quality of street vendor ice cream among 313 samples. The study result shows that microbiological quality of 45% of tested samples was unsatisfactory because of large population of aerobic mesophilic organisms, (36.7%) thermotolerant coliforms bacteria (21.4%) and sometime E.Coli (10.6%). The study conclude that vendors showed a lack of eduction and training and recommended an education and training about food preparation and storage practice that reduce microbiological contamination of food.15

6 6.3 Statement of problem

A study to evaluate the effectiveness of information guide sheet on knowledge regarding food hygiene among food hawkers in selected areas at Mysore.

6.4 Objectives

1) To assess the pre test level of knowledge regarding food hygiene among food hawkers.

2) To assess the post test level of knowledge regarding food hygiene among food hawkers.

3) To evaluate the effectiveness of information guide sheet on knowledge regarding food hygiene among food hawkers.

4) To find out the association between knowledge score with selected demographic variables.

6.5 Operational definition

1. Evaluate

In this study evaluate refers to the way of identifying the level of knowledge of food hawkers and is done by structured knowledge questionnaires.

2. Effectiveness

In this study effectiveness refers to the extent to which information guide sheet has brought about result intended and is measured in terms of gain in knowledge.

3. Information guide sheet

In this study information guide sheet refers to systematically organized materials regarding food hygiene on aspects like preparation, storage, handling and distribution of foods.

7 4. Knowledge

In this study knowledge refers to the correct response of food hawkers with regards to food hygiene measures.

5. Food hygiene

In this study food hygiene refers to cleanliness that are necessary during the preparation, storage, handling and distribution of foods.

6. Food hawkers

In this study food hawker refers to person who prepare a wide variety of ready to eat foods, beverages and serves them in public places through an open air food shop, coffee shop or stall. They are also called as street vendors.

6.6 Conceptual framework

In this study “Leavell and Clark’s” ecological model will be used.

6.7 Hypothesis

 H1: There will be a significant difference in mean pre test and post test score on knowledge regarding food hygiene among food hawkers of selected areas at Mysore.

 H2: There will be a significant association between knowledge score regarding food hygiene with selected demographic variables.

6.8 Assumptions

Researcher assumes that

 food hawkers may have inadequate knowledge regarding food hygiene.

8  information guide sheet may enhance the knowledge of food hawkers regarding food hygiene.

6.9 Delimitations

The study is limited to the food hawkers who are

 ready to participate in the study

 having stalls in Kuvempunagar

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Data will be collected from food hawkers regarding food hygiene in selected areas of Mysore.

7.1.1 Research design

In this study pre experimental designs with one group pre test and post test designs will be used.

Pre-test Intervention Post test

01 X 02

01 = Assessing pre test level of knowledge on food hygiene by interview method using structured knowledge questionnaires.

X= Administration of information guide sheet on food hygiene.

02= Assessing post test level of knowledge by interview method using same structured questionnaire.

7.1.2 Research approach

9 In this study educative and evaluative approach will be used.

7.1.3 Variables

Dependent variable: In this study, the dependent variable is knowledge regarding food hygiene.

Independent variable: In this study independent variable is information guide sheet on food hygiene.

7.1.4 Setting

In this study setting consists of selected food stalls at kuvempunagar, Mysore.

7.1.5 Population

In this study population consist of all the food hawkers at Mysore.

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling procedure

Samples: Samples consists of food hawkers based on inclusion and exclusion criteria.

Sampling techniques: In this study non probability convenient sampling will be used.

7.2.2 Sample size: The sample consists of 40 food hawkers.

7.2.3 Inclusion criteria:

Food hawkers who are:

1. present during the period of data collection

2. willing to participate in the study

10 3. able to read and write kannada

7.2.4 Exclusion criteria:

Food hawkers who are:

1. physically handicapped

2. deaf and dumb

7.2.5 Instruments used

The tool was organized into two sections:

Section I- Socio demographic performa of food hawkers

Section II- Structured knowledge questionnaire regarding food hygiene

7.2.6 Data collection methods

Data will be collected by interview method using structured knowledge questionnaire regarding food hygiene and demographic Performa.

7.2.7 Data analysis plan: In this study descriptive and inferential statistical test will be used.

1. Demographic data will be analyzed using frequency and percentage. 2. Knowledge of food hawkers will be analyzed in terms of frequency, percentage, mean and standard deviation. 3. Effectiveness of information guide sheet will be analyzed by using paired’t’ test. 4. Association between the knowledge scores of food hawkers and selected demographic variables will be analyzed by using chi-square test. 7.3 Does the study require any investigations or interventions to be conducted on patients, or other humans or animals? If so please describe briefly?

Yes, information guide sheet on food hygiene will be provided to selected food hawkers.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

11 Yes, ethical clearance has been obtained from the ethical committee.

8. BIBLIOGRAPHY

1) Abdalla MA,Suliman SE,Bakahiet AO.Food safety knowledge and practices of street food vendors in Atbara city.African journal of biotechnology.2009Dec15;8(24):6967-71.

2) Chukuezi O Comfort.Food safety and hygienic practices of street food vendors in Owerri,Nigeria. Studies in sociology of science.2010;1(1):50-57.

3) Sudershan RV,Rao Pratima,Polassa Kalpagam.Food safety research in India:a review.Asian journal of food and agro industry.2009;2(3):412-33

4) Park K.Preventive and social medicine.Jabalpur:M/S Banarasidas Bhanot; (19):523.

5) Waal De Smith Caroline,Robert Nadine.Food safety around the worlds. Center for science in public interest.2005 Jun.Available at: http://wwwcspinet.org/new/pdf/global.pdf.

6) Dewal,CS,Dhal. Dine at your own risk center for science in the public interest:1-16.

7) Nanditha vijay. Metropolis healthcare Ltd survey on street food. Bangalore.

12 2011 Nov23.Available at: http://www.fnbnews.com/article/detarative.

8) Suneetha C,Manjula K,Depur Baby.Quality assessment of street foods in Tirumala.Asiasn J.Exp. Biol.Sci.2011;2(2):207-11

9) Chumber SK,Kaushik K,Savy S.Bacteriological analysis of street foods in Pune.Indian journal public health.2007Apri-Jun;51(2);114-16.

10) Choudhury Manisha,Mahanta B Lipi,Goswami Sarmah Jayashree,Mazumder Dutta Meenakshi.Will capacity building training intervention given to street food vendors give us safer food?:A cross-sectional study from India. Food control.2011Aug;22(8):1233-39

11) Burt BM,Volel C,Finkel M.Safety of vendor prepared food:evaluation of 10 processing mobile food vendors in Manhattan.Public Health Rep.2003Sep- Oct;118(5):470-78.

12) Mensah P,Yeboah Manu D,Owusu Darko K,Ablordey A.Street foods in Accra,Ghana:how safe are they?.Bull World Healtn=h Organ.2002 Jul;80(7):546-54.

13) Lues JF,Rasephei MR,Venter P,Theron MM.Assessing food safety and associated food handling practice in street food vending in the city of Bloemfontein.Internatinal journal of environ health.2006Oct;16(5):319-28.

14) Tambekar DH,Jaiswal VJ,Dhanorkar DV,Gulhane PB,Dudhane MN.Identification of microbiological hazards and safety of ready to eat food vended in streets of Amravati city, India. Journal of applied biosciences.2008;7:195-201

15) Kane Aidara A, Ranaivo A,Spiegel A,Catteau M.Microbiological quality of street vendor ice cream in Dakar. Dakar med.2000;45(1):20-22

13 9 Signature of the candidate

10 Remarks of the guide

14 11 Name and designation of (in block letters)

11.1 Guide Mrs KOMALA HK

ASST PROFESSOR

BGS COLLEGE OF NURSING,

MYSORE

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the department Mrs KOMALA HK

HOD COMMUNITY HEALTH NURSING

BGS COLLEGE OF NURSING,

MYSORE

12.2 Signature

13 13.1 Remarks of the chairman and principal

13.2 Signature