- Email: [email protected]
Food safety knowledge and self-reported practices among school children in the Ga West Municipality in Ghana
Journal Pre-proof Food safety knowledge and self-reported practices among school children in the Ga West district in Ghana Benjamin Osei Tutu, Cynthia Hushie, Rita Asante, Jocelyn Adeline Egyakwa-Amusah PII:
S0956-7135(19)30601-2
DOI:
https://doi.org/10.1016/j.foodcont.2019.107012
Reference:
JFCO 107012
To appear in:
Food Control
Received Date: 16 August 2019 Revised Date:
12 November 2019
Accepted Date: 19 November 2019
Please cite this article as: Osei Tutu B., Hushie C., Asante R. & Egyakwa-Amusah J.A., Food safety knowledge and self-reported practices among school children in the Ga West district in Ghana, Food Control (2019), doi: https://doi.org/10.1016/j.foodcont.2019.107012. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Ltd.
Authors’ contribution OTB developed the research question, supervised the study design, analysis data, interpretation of the results and drafted the manuscript. HC reviewed research question, collected the data and reviewed the manuscript. AR reviewed research question, compiled the data and reviewed the manuscript. AS reviewed research question and the manuscript. All authors read and approved the final manuscript
Food Safety Knowledge and Self-Reported Practices Among School Children in The Ga West District in Ghana
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Benjamin Osei Tutua *, Cynthia Hushieb, Rita Asantec, & Jocelyn Adeline Egyakwa-Amusahd
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Food and Drugs Authority, Accra-Ghana. [email protected]; [email protected] Food and Drugs Authority, Accra-Ghana. [email protected]
Food and Drugs Authority, Accra-Ghana. [email protected] Food and Drugs Authority, Accra-Ghana. [email protected]
*Corresponding author email: [email protected] (B. Osei Tutu) Abstract: Background: Knowledge in food safety influences food safety attitudes of people which could result in behavioural changes. Inadequate knowledge in food safety among consumers, especially children, increase their risk of getting foodborne diseases. Implementing food safety educational programs in schools is key in improving the food safety knowledge of the school children. This study is aimed at assessing the food safety knowledge and practice of students in the Ga West district of Ghana. Method: A cross-sectional study was conducted on food safety knowledge and practices of students in the basic schools in the Ga West District of the Greater Accra Region-Ghana. A total of 1500 questionnaires were self-administrated to students in the 104 schools. Result: Out of the 1343 respondents, 694 (51.7%) of them were female whiles 649 (48.3%) were male. The mean age of the students was 13years (Std Dev of ± 1.9) with their ages ranging from 7 to 21 years. The food safety knowledge level of the students was inadequate with a mean score of 5.8 (std Dev ± 1.6) representing 64.08% of the maximum total food safety knowledge score. 59.6% (801) of the students had adequate level of food safety knowledge. The food safety practice among the respondents was generally appropriate with a mean score of 36.19 (std Dev ± 5.1) representing 80.4% of the maximum total food safety practice score. 90.2% (1211) of the students reported to be engaging in appropriate food safety practice. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of food safety knowledge and practices among the various demographic characteristic of the student. There was a positive correlation between food safety knowledge and practices (coefficient of 0.2 and p-value < 0.001). Most of the students indicated that they first look out for the cleanliness of the surrounding of the vendor and then the vendors neatness before they buy or eat from a food vendor. Conclusion: Even though the food safety knowledge level of the students was inadequate, the food safety practice was generally appropriate especially their hand washing practices. Key words: Food safety, Greater Accra, Knowledge, Practices, School Children, Students.
INTRODUCTION Food safety is increasingly becoming an important public health issue as more and more cases are being reported that are associated with the consumption of unsafe food(Norazmir et al., 2012; Osei1
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Tutu & Anto, 2016; Torgerson et al., 2015; WHO, 2013a). Food Safety is defined by the Codex Alimentarius as the assurance that food will not cause harm to the consumer when it is prepared, served and eaten according to its intended use(Codex, 2011). Over the past decade awareness on the significance of food safety has increased due to the rise in the occurrence of foodborne diseases and its associated media reportage(Osei-Tutu, 2018). Consumption of unsafe food account for 48 million Americans (1 in 6) getting sick, 128,000 being hospitalized, and 3,000 death annually(CDC, 2011). According to the WHO, 1 out of 10 people in the world get ill from eating contaminated food and 420 000 die every year. This account for 33 million healthy life years (DALYs) loss annually. Children under 5 years of age account for 40% of the foodborne disease burden, with 125 000 deaths every year(WHO, 2017). Foodborne disease outbreak occurs when two or more people get sick from eating the same food or from the same food source. These outbreaks sometimes result in lots of people falling sick with some even been hospitalised. Schools have been implicated as one of the sources contributing to foodborne disease outbreak(Ababio & Lovatt, 2015; Gillespie, O'Brien, Adak, Ward, & Smith, 2005; Kunadu, Ofosu, Aboagye, & Tano-Debrah, 2016; Soon, Baines, & Seaman, 2012; Soon, Singh, & Baines, 2011). The risk factors identified for these outbreaks of foodborne diseases include improper time/temperature control, improper food handling practices and poor personal hygiene(Khor et al., 1998; Osei Tutu & Annison, 2017; Wu et al., 2018). These risk factors can however be controlled or managed when food handlers receive food hygiene training and certification, and ultimately putting the knowledge into practice (Hislop & Shaw, 2009; Lee & Greig, 2010). Thus, training of food handlers has been recommended as one of the means for ensuring food safety(Finch & Daniel, 2005; Kunadu et al., 2016). Knowledge in food safety influences food safety attitudes of people which could result in behavioural changes and improved food safety practices(Finch & Daniel, 2005; Rennie, 1995). Inadequate knowledge in food safety among consumers, especially children, increase their risk of getting food safety related health problems, primarily foodborne diseases(Kang, Kim, Kim, & Ha, 2010). Implementing educational programs in food safety and hygiene in schools is key to improving the food safety knowledge of the school children (Shen, Hu, & Sun, 2015; Zhou et al., 2016) and thus could translate into improved food hygiene practices among the population (Takanashi et al.). Baseline information of the food safety knowledge and practices of a population is very useful when designing such an intervention aimed at improving food safety in a population. This study therefore aims at assessing the food safety knowledge and practice of student in the Ga West district of Ghana. The information will help determine the type of invention(s) needed as well as the evaluation of existing interventions on food safety implemented in the district. MATERIAL AND METHODS Research design: A cross-sectional study was conducted from January to August 2019 on food safety knowledge and practices of upper primary and Junior high school students in the Ga West district of the Greater Accra Region in Ghana. A stratified technique was used to randomly select the study population with each school in the district constituting a stratum. A minimum sample size of 14 from each school was calculated using EpiInfo 7 statistical calculator of sample size for population survey (Expect Frequency of 50%; Cluster of 104, Acceptable Margin of Error of 5%; Population Size of 30,000 and Confidence Level of 99.99%). All the 104 schools in the district were enrolled onto the study. Fifteen students were selected randomly from the primary 4 to Junior High School (JHS) 3 classes in each school and selfadministered with the questionnaire. Instrumentation: The research data was collected through a self-administrated questionnaire that divided into four sections which are demographic, food safety knowledge (9 questions), food 2
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safety practices section (9 questions) and ranking of conditions that influence purchasing of food. For food safety knowledge questions, answers were scored by awarding 1 point for the right answers and 0 point for the incorrect or ‘I don’t know’ answers. The total Score for this part ranges from 0 to 9 with the highest score meaning the highest level of knowledge. For the food safety practices section, the points were awarded positive practices as follows: ‘Always’= 5 points, ‘Most of The Time’ = 4 points, ‘Some of The Time’=3 points, ‘Once A While’=2 points, ‘Never’=1points. However, points were awarded in the reverse order for question depicting negative practices. The total Score for this part ranges from 1 to 45 with the highest score meaning the highest level of practice. Knowledge and practices in food safety were considered as “inadequate” and ‘Inappropriate’ respectively when the total points for those sections were less than 65% of the total score for those sections. The respondents were considered as having “adequate” and “appropriate” knowledge and practices respectively if their total points for those sections were greater than or equal to 65% of the total score for those sections. This scoring system was adapted from a similar study by Kunadu et al (2016) Pilot study: The questionnaire was pilot tested using 25 students from various Basic Schools in Ga South District of Greater Accra to assess the comprehensibility of the question and also confirm question reliability and validity. Data collection: A total of 1500 questionnaires were distributed in the 104 schools, however only 1343 sets were returned (response rate of 89.5%). The assistance of some classroom teachers was sought to explain and distribute the survey forms to their students randomly and returned prior to each session of the Basic Education in Food Safety (BEFS) programme by the Food and Drugs Authority-Ghana in each school. Each questionnaire returned was marked with a unique identification number. Statistical analysis Data was analysed statistically using both Epi Info 7 software and Microsoft Excel 2016. Simple descriptive methods such as frequency distribution were used to explore the baseline characteristics of the population. Descriptive statistics (means, percentages, standard deviations and frequencies) were used for knowledge and practices scores of respondents. Predictors of knowledge and practices were examined by bivariate logistic regression analyses. Independent variables included age, gender, religion and ethnicity. Spearman's correlation coefficient was also used to test the association between knowledge and practices of the respondents (p < 0.05).
RESULTS AND DISCUSSION Demographic characteristics of students In all, a total of 1343 students responded to the questionnaire submitted (response rate of 89.5%). 694 (51.7%) of the respondents were female whiles 649 (48.3%) were male (Table 1). The mean age of the students was 13years (Std Dev of ± 1.9) with their ages ranging from 7 to 21 years. Majority of the respondents were Akans and Christians, 40.5% and 88.2% respectively. The demographic characteristics of respondents are similar to that of Ghana’s population as reported in the 2010 Population and Housing Census, where the population is predominantly Christian by religion (71.2%) and Akans ethnic group (47.5%), with more females than males (GSS, 2012). The age group greater than 12years were the highest respondents (63.5%). Most of the respondents were also from the JHS 2 class (24.9%). 3
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Food safety knowledge The food safety knowledge level of the students was inadequate with a mean score of 5.8 (std Dev ± 1.6) representing 64.1% of the maximum total food safety knowledge score. 59.6% (801) of the students had adequate level of food safety knowledge. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of food safety knowledge among the various demographic characteristic of the student (Table 1). The level of food safety knowledge increased across the age groups, with the age group greater than 12years having the highest percentage of students with adequate level of food safety knowledge (66.9% and mean score of 6.0 ± 1.5). The trend was similar as you move from the lower class to the upper class, with the JHS Class having the highest percentage of students with adequate level of food safety knowledge (75.5% and mean score of 6.4 ± 1.3). Most of the student answered correctly the food safety knowledge questions on expire foods, handwashing and washing of fruits and vegetables (Table. 2). However, the questions related to food safety knowledge on food storage practices were wrongly answered by most of the student. This trend suggest that most of the student have knowledge on the implications of hand washing and washing of fruit and vegetables on food safety but don’t understand the implications of poor food storage practices on food safety. Similar observation was made in a study conducted among university students of King Saud University, Saudi Arabia when assessing their level of food safety concerns, knowledge and practices(AlShabib, Husain, & Khan, 2017). The study noted that most students were most knowledgeable about the cleanliness of cooking utensils and area, prevention of cross contamination and hand hygiene but demonstrated inadequate knowledge on heat treatment of food and temperature controls. Food Safety Practice Children are among the vulnerable group with regard to foodborne illness(FDA, 2005; VlasinMarty, Ritter-Gooder, & Albrecht, 2016). To prevent foodborne illness among children, practice that ensure the safety of food purchased and consumed by the student is an important factor. This study assessed the self-reported food safety practice of students and their responses have been presented in Figure 1. The food safety practice among the respondents was generally appropriate with a mean score of 36.2 (std Dev ± 5.1) representing 80.4% of the maximum total food safety practice score. The responses from 90.2% (1211) of the students indicated that they have been engaging in appropriate food safety practice. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of appropriate food safety practice among the various demographic characteristic of the student (Table 1). Most of the students (70.0) indicated they wash their hands with soap and under running water before eating. Handwashing has been identified as one of the key measures in preventing most infectious diseases including foodborne diseases(Group, 1999; Hashi, Kumie, & Gasana, 2017; Larson & Committee, 1995; Luby et al., 2005). Handwashing education is part of the School Health Education Programme (SHEP) and this is being implemented together with the WASH programme in school in the District. Hence the improved knowledge and practice on handwashing by the respondents. Poor food safety practice responses were report on issues related to storage of leftovers and food items in the fridge. This trend might be influence by the poor food safety knowledge in those area as evident by the low food safety knowledge score in the areas related to food storage.
Association Between the Food Safety Knowledge and Practices of The Students 4
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There was significant positive correlation between food safety knowledge and practices (coefficient of 0.2 and p-value < 0.001). This suggests that food safety knowledge of respondents will most likely influence their food safety practices. This correlation is further revealed in the significant observation of increasing food safety knowledge among the age groups and class with its similar increasing trend in the food safety practice among the age group and class. This suggest that as the student age and gets to higher class level, their food safety knowledge increases and this influence their practices in handling food safely. Thus, instituting education programmes at the Junior High classes will better influence the food safety practice of the students than when implemented in the primary classes. Similar studies have also suggested that education improve the food safety knowledge and behaviour of students. These studies indicated that food safety education at basic stage of school life is effective in improving the knowledge and practice of students(Kang et al., 2010; Norazmir et al., 2012; Ovca, Jevšnik, & Raspor, 2014; Shen et al., 2015; Zhou et al., 2016). Conditions That Inform Students to Buy/Eat from A Food Vendor Various conditions influence student’s choice of the food vendor to buy or eat food from. The students were asked to rank the conditions (cleanliness of surroundings of vendor, taste of food, Neatness of vendor and price of food) that influence their decision to buy or eat food from a food vendor. 0.7% of the students indicated that they had no preference when buying from food vendors. 68.3% of the students indicated that they first look out for the cleanliness of the surrounding of the vendor and 59.4% indicated ‘Neatness of the food vendor’ as the second condition they check before buying or eating from such a vendor. These conditions have food safety implication and for most students to select them as their first and second conditions that influence their decision to buy from a vendor indicate the level of hygiene or food safety consciousness when buying from food vendors.
CONCLUSION Even though the food safety knowledge level of the students was inadequate, the food safety practice among the respondents was generally appropriate especially their hand washing practices. There were significant positive correlations between food safety knowledge and practices. As the student age and gets to higher class level, their food safety knowledge increases. This influence their practices in handling food safely. Thus, instituting education programmes at the Junior High classes will better influence the food safety practice of the students than when implemented in the primary classes. Acknowledgement The authors are most grateful to the Food and Drugs Authority-Ghana and the teaching staff of the various Basic Schools in the Ga West Municipality for their time and support. Competing Interests The authors declare that they have no competing interest as far as this work is concerned. All views expressed in this work are views of the authors and does not represent the views or position of any institution. REFERENCES Ababio, P. F., & Lovatt, P. (2015). A review on food safety and food hygiene studies in Ghana. Food Control, 47, 92-97. doi: https://doi.org/10.1016/j.foodcont.2014.06.041
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Al-Shabib, N. A., Husain, F. M., & Khan, J. M. (2017). Study on food safety concerns, knowledge and practices among university students in Saudi Arabia. Food Control, 73, 202-208. doi: https://doi.org/10.1016/j.foodcont.2016.08.005 CDC. (2011). CDC Estimates of Foodborne Illness in the United States. foodborneburden. Retrieved 4th October, 2013, from www.cdc.gov/foodborneburden Codex. (2011). GENERAL PRINCIPLES OF FOOD HYGIENE Definations (pp. 4): Codex Alimentarius. FDA. (2005). Bad Bug Book: Handbook of Microorganisms, Foodborne Pathogenic, Natural Toxins. US Food and Drug Administration: Silver Spring, MD, USA.[(accessed on 1 July 2014)]. Finch, C., & Daniel, E. (2005). Food safety knowledge and behavior of emergency food relief organization workers: effects of food safety training intervention. J Environ Health, 67(9), 30-34, 58; quiz 63-34. Gillespie, I. A., O'Brien, S. J., Adak, G. K., Ward, L. R., & Smith, H. R. (2005). Foodborne general outbreaks of Salmonella Enteritidis phage type 4 infection, England and Wales, 1992-2002: where are the risks? Epidemiology and Infection, 133(5), 795-801. doi: 10.1017/S0950268805004474 Group, H. L. (1999). Hand washing: a modest measure—with big effects. BMJ: British Medical Journal, 318(7185), 686. GSS. (2012, May 2012). 2010 Population & Housing Census: Summary Report of Final Results. Censuses and Surveys. Retrieved 12 March, 2014, from http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf Hashi, A., Kumie, A., & Gasana, J. (2017). Hand washing with soap and WASH educational intervention reduces underfive childhood diarrhoea incidence in Jigjiga District, Eastern Ethiopia: A community-based cluster randomized controlled trial. Preventive Medicine Reports, 6, 361-368. doi: https://doi.org/10.1016/j.pmedr.2017.04.011 Hislop, N., & Shaw, K. (2009). Food safety knowledge retention study. J Food Prot, 72(2), 431-435. Kang, N. E., Kim, J. H., Kim, Y. S., & Ha, A. W. (2010). Food safety knowledge and practice by the stages of change model in school children. Nutr Res Pract, 4(6), 535-540. doi: 10.4162/nrp.2010.4.6.535 Khor, G. L., Taib, M. N. M., Kandiah, M., Hashim, N., Hashim, J. K., Nor, S. M., & Don, R. (1998). Appraising the current food and nutrition situation with policy implications. Malaysian Journal of Nutrition, 4(1 & 2), 91-106. Kunadu, A. P.-H., Ofosu, D. B., Aboagye, E., & Tano-Debrah, K. (2016). Food safety knowledge, attitudes and selfreported practices of food handlers in institutional foodservice in Accra, Ghana. Food Control, 69. doi: 10.1016/j.foodcont.2016.05.011 Larson, E. L., & Committee, A. G. (1995). APIC guidelines for handwashing and hand antisepsis in health care settings. American journal of infection control, 23(4), 251-269. Lee, M. B., & Greig, J. D. (2010). A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions. Journal of School Health, 80(12), 588-598. doi: 10.1111/j.1746-1561.2010.00546.x Luby, S. P., Agboatwalla, M., Feikin, D. R., Painter, J., Billhimer, W., Altaf, A., & Hoekstra, R. M. (2005). Effect of handwashing on child health: a randomised controlled trial. The Lancet, 366(9481), 225-233. Norazmir, M., Hasyimah, M. N., Shafurah, A. S., Sabariah, B. S., Ajau, D., & Norazlanshah, H. (2012). Knowledge and practices on food safety among secondary school students in Johor Bahru, Johor, Malaysia. Pakistan Journal of Nutrition, 11(2), 110. Osei-Tutu, B. (2018). Evaluation of Food Safety Management Systems of Food Service Establishments within the Greater Accra Region. International Journal of Biological, Biomolecular, Agricultural, Food and Biotechnological Engineering, 12, 16-21. Osei-Tutu, B., & Anto, F. (2016). Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013. BMC Infect Dis, 16(1), 139. doi: 10.1186/s12879-0161472-8 Osei Tutu, B., & Annison, S. (2017). A Retrospective Cohort Study on an Outbreak of Gastroenteritis Linked to a Buffet Lunch Served during a Conference in Accra. World Academy of Science, Engineering and Technology, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering, 11(7), 345-348. Ovca, A., Jevšnik, M., & Raspor, P. (2014). Food safety awareness, knowledge and practices among students in Slovenia. Food Control, 42, 144-151. doi: https://doi.org/10.1016/j.foodcont.2014.01.036 Rennie, D. M. (1995). Health education models and food hygiene education. Journal of the Royal Society of Health, 115(2), 75-79. doi: 10.1177/146642409511500203 Shen, M., Hu, M., & Sun, Z. (2015). Assessment of School-Based Quasi-Experimental Nutrition and Food Safety Health Education for Primary School Students in Two Poverty-Stricken Counties of West China. PLoS One, 10(12), e0145090. doi: 10.1371/journal.pone.0145090 Soon, J. M., Baines, R., & Seaman, P. (2012). Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers. J Food Prot, 75(4), 793-804. doi: 10.4315/0362-028X.JFP-11-502 Soon, J. M., Singh, H., & Baines, R. (2011). Foodborne diseases in Malaysia: A review. Food Control, 22(6), 823-830. doi: https://doi.org/10.1016/j.foodcont.2010.12.011 Takanashi, K., Quyen, D. T., Nguyen Thi Le, H., Khan, N. C., Yasuoka, J., & Jimba, M. Long-term impact of communitybased information, education and communication activities on food hygiene and food safety behaviors in Vietnam: a longitudinal study. PLoS One, 8(8), e70654. doi: 10.1371/journal.pone.0070654 Torgerson, P. R., Devleesschauwer, B., Praet, N., Speybroeck, N., Willingham, A. L., Kasuga, F., . . . de Silva, N. (2015). World Health Organization Estimates of the Global and Regional Disease Burden of 11 Foodborne Parasitic Diseases, 2010: A Data Synthesis. PLoS Med, 12(12), e1001920. doi: 10.1371/journal.pmed.1001920 Vlasin-Marty, K., Ritter-Gooder, P., & Albrecht, J. A. (2016). Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study. J Racial Ethn Health Disparities, 3(4), 713-
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723. doi: 10.1007/s40615-015-0190-z WHO. (2013a). Estimating the Global Burden of Foodborne Diseases. Food borne diseases. Retrieved 4 october, 2013, from http://www.who.int/foodsafety/foodborne_disease/ferg/ WHO. (2017). Food Safety. key Fact Retrieved 3 JUNE, 2019, from https://www.who.int/news-room/factsheets/detail/food-safety Wu, G., Yuan, Q., Wang, L., Zhao, J., Chu, Z., Zhuang, M., . . . Du, Z. (2018). Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China. Medicine, 97(45), e13142. doi: 10.1097/MD.0000000000013142 Zhou, W.-j., Xu, X.-l., Li, G., Sharma, M., Qie, Y.-L., & Zhao, Y. (2016). Effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in Chongqing, China. Global Health Promotion, 23(1), 37-49. doi: 10.1177/1757975914552914
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The food safety knowledge level of the students was inadequate. Students had food safety knowledge mean score of 5.77 (64.08% of the total score). The food safety practice among the respondents was generally appropriate. There was a positive correlation between food safety knowledge and practices.
Competing Interests We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from
Signed by all authors as follows: Benjamin Osei Tutu Cynthia Hushie Rita Asante Jocelyn Adeline Egyakwa-Amusah
S0956-7135(19)30601-2
DOI:
https://doi.org/10.1016/j.foodcont.2019.107012
Reference:
JFCO 107012
To appear in:
Food Control
Received Date: 16 August 2019 Revised Date:
12 November 2019
Accepted Date: 19 November 2019
Please cite this article as: Osei Tutu B., Hushie C., Asante R. & Egyakwa-Amusah J.A., Food safety knowledge and self-reported practices among school children in the Ga West district in Ghana, Food Control (2019), doi: https://doi.org/10.1016/j.foodcont.2019.107012. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Ltd.
Authors’ contribution OTB developed the research question, supervised the study design, analysis data, interpretation of the results and drafted the manuscript. HC reviewed research question, collected the data and reviewed the manuscript. AR reviewed research question, compiled the data and reviewed the manuscript. AS reviewed research question and the manuscript. All authors read and approved the final manuscript
Food Safety Knowledge and Self-Reported Practices Among School Children in The Ga West District in Ghana
1 2 3 4
Benjamin Osei Tutua *, Cynthia Hushieb, Rita Asantec, & Jocelyn Adeline Egyakwa-Amusahd
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a
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b
8
c
9
d
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Food and Drugs Authority, Accra-Ghana. [email protected]; [email protected] Food and Drugs Authority, Accra-Ghana. [email protected]
Food and Drugs Authority, Accra-Ghana. [email protected] Food and Drugs Authority, Accra-Ghana. [email protected]
*Corresponding author email: [email protected] (B. Osei Tutu) Abstract: Background: Knowledge in food safety influences food safety attitudes of people which could result in behavioural changes. Inadequate knowledge in food safety among consumers, especially children, increase their risk of getting foodborne diseases. Implementing food safety educational programs in schools is key in improving the food safety knowledge of the school children. This study is aimed at assessing the food safety knowledge and practice of students in the Ga West district of Ghana. Method: A cross-sectional study was conducted on food safety knowledge and practices of students in the basic schools in the Ga West District of the Greater Accra Region-Ghana. A total of 1500 questionnaires were self-administrated to students in the 104 schools. Result: Out of the 1343 respondents, 694 (51.7%) of them were female whiles 649 (48.3%) were male. The mean age of the students was 13years (Std Dev of ± 1.9) with their ages ranging from 7 to 21 years. The food safety knowledge level of the students was inadequate with a mean score of 5.8 (std Dev ± 1.6) representing 64.08% of the maximum total food safety knowledge score. 59.6% (801) of the students had adequate level of food safety knowledge. The food safety practice among the respondents was generally appropriate with a mean score of 36.19 (std Dev ± 5.1) representing 80.4% of the maximum total food safety practice score. 90.2% (1211) of the students reported to be engaging in appropriate food safety practice. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of food safety knowledge and practices among the various demographic characteristic of the student. There was a positive correlation between food safety knowledge and practices (coefficient of 0.2 and p-value < 0.001). Most of the students indicated that they first look out for the cleanliness of the surrounding of the vendor and then the vendors neatness before they buy or eat from a food vendor. Conclusion: Even though the food safety knowledge level of the students was inadequate, the food safety practice was generally appropriate especially their hand washing practices. Key words: Food safety, Greater Accra, Knowledge, Practices, School Children, Students.
INTRODUCTION Food safety is increasingly becoming an important public health issue as more and more cases are being reported that are associated with the consumption of unsafe food(Norazmir et al., 2012; Osei1
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Tutu & Anto, 2016; Torgerson et al., 2015; WHO, 2013a). Food Safety is defined by the Codex Alimentarius as the assurance that food will not cause harm to the consumer when it is prepared, served and eaten according to its intended use(Codex, 2011). Over the past decade awareness on the significance of food safety has increased due to the rise in the occurrence of foodborne diseases and its associated media reportage(Osei-Tutu, 2018). Consumption of unsafe food account for 48 million Americans (1 in 6) getting sick, 128,000 being hospitalized, and 3,000 death annually(CDC, 2011). According to the WHO, 1 out of 10 people in the world get ill from eating contaminated food and 420 000 die every year. This account for 33 million healthy life years (DALYs) loss annually. Children under 5 years of age account for 40% of the foodborne disease burden, with 125 000 deaths every year(WHO, 2017). Foodborne disease outbreak occurs when two or more people get sick from eating the same food or from the same food source. These outbreaks sometimes result in lots of people falling sick with some even been hospitalised. Schools have been implicated as one of the sources contributing to foodborne disease outbreak(Ababio & Lovatt, 2015; Gillespie, O'Brien, Adak, Ward, & Smith, 2005; Kunadu, Ofosu, Aboagye, & Tano-Debrah, 2016; Soon, Baines, & Seaman, 2012; Soon, Singh, & Baines, 2011). The risk factors identified for these outbreaks of foodborne diseases include improper time/temperature control, improper food handling practices and poor personal hygiene(Khor et al., 1998; Osei Tutu & Annison, 2017; Wu et al., 2018). These risk factors can however be controlled or managed when food handlers receive food hygiene training and certification, and ultimately putting the knowledge into practice (Hislop & Shaw, 2009; Lee & Greig, 2010). Thus, training of food handlers has been recommended as one of the means for ensuring food safety(Finch & Daniel, 2005; Kunadu et al., 2016). Knowledge in food safety influences food safety attitudes of people which could result in behavioural changes and improved food safety practices(Finch & Daniel, 2005; Rennie, 1995). Inadequate knowledge in food safety among consumers, especially children, increase their risk of getting food safety related health problems, primarily foodborne diseases(Kang, Kim, Kim, & Ha, 2010). Implementing educational programs in food safety and hygiene in schools is key to improving the food safety knowledge of the school children (Shen, Hu, & Sun, 2015; Zhou et al., 2016) and thus could translate into improved food hygiene practices among the population (Takanashi et al.). Baseline information of the food safety knowledge and practices of a population is very useful when designing such an intervention aimed at improving food safety in a population. This study therefore aims at assessing the food safety knowledge and practice of student in the Ga West district of Ghana. The information will help determine the type of invention(s) needed as well as the evaluation of existing interventions on food safety implemented in the district. MATERIAL AND METHODS Research design: A cross-sectional study was conducted from January to August 2019 on food safety knowledge and practices of upper primary and Junior high school students in the Ga West district of the Greater Accra Region in Ghana. A stratified technique was used to randomly select the study population with each school in the district constituting a stratum. A minimum sample size of 14 from each school was calculated using EpiInfo 7 statistical calculator of sample size for population survey (Expect Frequency of 50%; Cluster of 104, Acceptable Margin of Error of 5%; Population Size of 30,000 and Confidence Level of 99.99%). All the 104 schools in the district were enrolled onto the study. Fifteen students were selected randomly from the primary 4 to Junior High School (JHS) 3 classes in each school and selfadministered with the questionnaire. Instrumentation: The research data was collected through a self-administrated questionnaire that divided into four sections which are demographic, food safety knowledge (9 questions), food 2
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safety practices section (9 questions) and ranking of conditions that influence purchasing of food. For food safety knowledge questions, answers were scored by awarding 1 point for the right answers and 0 point for the incorrect or ‘I don’t know’ answers. The total Score for this part ranges from 0 to 9 with the highest score meaning the highest level of knowledge. For the food safety practices section, the points were awarded positive practices as follows: ‘Always’= 5 points, ‘Most of The Time’ = 4 points, ‘Some of The Time’=3 points, ‘Once A While’=2 points, ‘Never’=1points. However, points were awarded in the reverse order for question depicting negative practices. The total Score for this part ranges from 1 to 45 with the highest score meaning the highest level of practice. Knowledge and practices in food safety were considered as “inadequate” and ‘Inappropriate’ respectively when the total points for those sections were less than 65% of the total score for those sections. The respondents were considered as having “adequate” and “appropriate” knowledge and practices respectively if their total points for those sections were greater than or equal to 65% of the total score for those sections. This scoring system was adapted from a similar study by Kunadu et al (2016) Pilot study: The questionnaire was pilot tested using 25 students from various Basic Schools in Ga South District of Greater Accra to assess the comprehensibility of the question and also confirm question reliability and validity. Data collection: A total of 1500 questionnaires were distributed in the 104 schools, however only 1343 sets were returned (response rate of 89.5%). The assistance of some classroom teachers was sought to explain and distribute the survey forms to their students randomly and returned prior to each session of the Basic Education in Food Safety (BEFS) programme by the Food and Drugs Authority-Ghana in each school. Each questionnaire returned was marked with a unique identification number. Statistical analysis Data was analysed statistically using both Epi Info 7 software and Microsoft Excel 2016. Simple descriptive methods such as frequency distribution were used to explore the baseline characteristics of the population. Descriptive statistics (means, percentages, standard deviations and frequencies) were used for knowledge and practices scores of respondents. Predictors of knowledge and practices were examined by bivariate logistic regression analyses. Independent variables included age, gender, religion and ethnicity. Spearman's correlation coefficient was also used to test the association between knowledge and practices of the respondents (p < 0.05).
RESULTS AND DISCUSSION Demographic characteristics of students In all, a total of 1343 students responded to the questionnaire submitted (response rate of 89.5%). 694 (51.7%) of the respondents were female whiles 649 (48.3%) were male (Table 1). The mean age of the students was 13years (Std Dev of ± 1.9) with their ages ranging from 7 to 21 years. Majority of the respondents were Akans and Christians, 40.5% and 88.2% respectively. The demographic characteristics of respondents are similar to that of Ghana’s population as reported in the 2010 Population and Housing Census, where the population is predominantly Christian by religion (71.2%) and Akans ethnic group (47.5%), with more females than males (GSS, 2012). The age group greater than 12years were the highest respondents (63.5%). Most of the respondents were also from the JHS 2 class (24.9%). 3
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Food safety knowledge The food safety knowledge level of the students was inadequate with a mean score of 5.8 (std Dev ± 1.6) representing 64.1% of the maximum total food safety knowledge score. 59.6% (801) of the students had adequate level of food safety knowledge. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of food safety knowledge among the various demographic characteristic of the student (Table 1). The level of food safety knowledge increased across the age groups, with the age group greater than 12years having the highest percentage of students with adequate level of food safety knowledge (66.9% and mean score of 6.0 ± 1.5). The trend was similar as you move from the lower class to the upper class, with the JHS Class having the highest percentage of students with adequate level of food safety knowledge (75.5% and mean score of 6.4 ± 1.3). Most of the student answered correctly the food safety knowledge questions on expire foods, handwashing and washing of fruits and vegetables (Table. 2). However, the questions related to food safety knowledge on food storage practices were wrongly answered by most of the student. This trend suggest that most of the student have knowledge on the implications of hand washing and washing of fruit and vegetables on food safety but don’t understand the implications of poor food storage practices on food safety. Similar observation was made in a study conducted among university students of King Saud University, Saudi Arabia when assessing their level of food safety concerns, knowledge and practices(AlShabib, Husain, & Khan, 2017). The study noted that most students were most knowledgeable about the cleanliness of cooking utensils and area, prevention of cross contamination and hand hygiene but demonstrated inadequate knowledge on heat treatment of food and temperature controls. Food Safety Practice Children are among the vulnerable group with regard to foodborne illness(FDA, 2005; VlasinMarty, Ritter-Gooder, & Albrecht, 2016). To prevent foodborne illness among children, practice that ensure the safety of food purchased and consumed by the student is an important factor. This study assessed the self-reported food safety practice of students and their responses have been presented in Figure 1. The food safety practice among the respondents was generally appropriate with a mean score of 36.2 (std Dev ± 5.1) representing 80.4% of the maximum total food safety practice score. The responses from 90.2% (1211) of the students indicated that they have been engaging in appropriate food safety practice. With the exception of the demographic characteristic ‘age’ and ‘class’ (p-value < 0.001), no statistical difference was observed in the level of appropriate food safety practice among the various demographic characteristic of the student (Table 1). Most of the students (70.0) indicated they wash their hands with soap and under running water before eating. Handwashing has been identified as one of the key measures in preventing most infectious diseases including foodborne diseases(Group, 1999; Hashi, Kumie, & Gasana, 2017; Larson & Committee, 1995; Luby et al., 2005). Handwashing education is part of the School Health Education Programme (SHEP) and this is being implemented together with the WASH programme in school in the District. Hence the improved knowledge and practice on handwashing by the respondents. Poor food safety practice responses were report on issues related to storage of leftovers and food items in the fridge. This trend might be influence by the poor food safety knowledge in those area as evident by the low food safety knowledge score in the areas related to food storage.
Association Between the Food Safety Knowledge and Practices of The Students 4
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There was significant positive correlation between food safety knowledge and practices (coefficient of 0.2 and p-value < 0.001). This suggests that food safety knowledge of respondents will most likely influence their food safety practices. This correlation is further revealed in the significant observation of increasing food safety knowledge among the age groups and class with its similar increasing trend in the food safety practice among the age group and class. This suggest that as the student age and gets to higher class level, their food safety knowledge increases and this influence their practices in handling food safely. Thus, instituting education programmes at the Junior High classes will better influence the food safety practice of the students than when implemented in the primary classes. Similar studies have also suggested that education improve the food safety knowledge and behaviour of students. These studies indicated that food safety education at basic stage of school life is effective in improving the knowledge and practice of students(Kang et al., 2010; Norazmir et al., 2012; Ovca, Jevšnik, & Raspor, 2014; Shen et al., 2015; Zhou et al., 2016). Conditions That Inform Students to Buy/Eat from A Food Vendor Various conditions influence student’s choice of the food vendor to buy or eat food from. The students were asked to rank the conditions (cleanliness of surroundings of vendor, taste of food, Neatness of vendor and price of food) that influence their decision to buy or eat food from a food vendor. 0.7% of the students indicated that they had no preference when buying from food vendors. 68.3% of the students indicated that they first look out for the cleanliness of the surrounding of the vendor and 59.4% indicated ‘Neatness of the food vendor’ as the second condition they check before buying or eating from such a vendor. These conditions have food safety implication and for most students to select them as their first and second conditions that influence their decision to buy from a vendor indicate the level of hygiene or food safety consciousness when buying from food vendors.
CONCLUSION Even though the food safety knowledge level of the students was inadequate, the food safety practice among the respondents was generally appropriate especially their hand washing practices. There were significant positive correlations between food safety knowledge and practices. As the student age and gets to higher class level, their food safety knowledge increases. This influence their practices in handling food safely. Thus, instituting education programmes at the Junior High classes will better influence the food safety practice of the students than when implemented in the primary classes. Acknowledgement The authors are most grateful to the Food and Drugs Authority-Ghana and the teaching staff of the various Basic Schools in the Ga West Municipality for their time and support. Competing Interests The authors declare that they have no competing interest as far as this work is concerned. All views expressed in this work are views of the authors and does not represent the views or position of any institution. REFERENCES Ababio, P. F., & Lovatt, P. (2015). A review on food safety and food hygiene studies in Ghana. Food Control, 47, 92-97. doi: https://doi.org/10.1016/j.foodcont.2014.06.041
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Al-Shabib, N. A., Husain, F. M., & Khan, J. M. (2017). Study on food safety concerns, knowledge and practices among university students in Saudi Arabia. Food Control, 73, 202-208. doi: https://doi.org/10.1016/j.foodcont.2016.08.005 CDC. (2011). CDC Estimates of Foodborne Illness in the United States. foodborneburden. Retrieved 4th October, 2013, from www.cdc.gov/foodborneburden Codex. (2011). GENERAL PRINCIPLES OF FOOD HYGIENE Definations (pp. 4): Codex Alimentarius. FDA. (2005). Bad Bug Book: Handbook of Microorganisms, Foodborne Pathogenic, Natural Toxins. US Food and Drug Administration: Silver Spring, MD, USA.[(accessed on 1 July 2014)]. Finch, C., & Daniel, E. (2005). Food safety knowledge and behavior of emergency food relief organization workers: effects of food safety training intervention. J Environ Health, 67(9), 30-34, 58; quiz 63-34. Gillespie, I. A., O'Brien, S. J., Adak, G. K., Ward, L. R., & Smith, H. R. (2005). Foodborne general outbreaks of Salmonella Enteritidis phage type 4 infection, England and Wales, 1992-2002: where are the risks? Epidemiology and Infection, 133(5), 795-801. doi: 10.1017/S0950268805004474 Group, H. L. (1999). Hand washing: a modest measure—with big effects. BMJ: British Medical Journal, 318(7185), 686. GSS. (2012, May 2012). 2010 Population & Housing Census: Summary Report of Final Results. Censuses and Surveys. Retrieved 12 March, 2014, from http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf Hashi, A., Kumie, A., & Gasana, J. (2017). Hand washing with soap and WASH educational intervention reduces underfive childhood diarrhoea incidence in Jigjiga District, Eastern Ethiopia: A community-based cluster randomized controlled trial. Preventive Medicine Reports, 6, 361-368. doi: https://doi.org/10.1016/j.pmedr.2017.04.011 Hislop, N., & Shaw, K. (2009). Food safety knowledge retention study. J Food Prot, 72(2), 431-435. Kang, N. E., Kim, J. H., Kim, Y. S., & Ha, A. W. (2010). Food safety knowledge and practice by the stages of change model in school children. Nutr Res Pract, 4(6), 535-540. doi: 10.4162/nrp.2010.4.6.535 Khor, G. L., Taib, M. N. M., Kandiah, M., Hashim, N., Hashim, J. K., Nor, S. M., & Don, R. (1998). Appraising the current food and nutrition situation with policy implications. Malaysian Journal of Nutrition, 4(1 & 2), 91-106. Kunadu, A. P.-H., Ofosu, D. B., Aboagye, E., & Tano-Debrah, K. (2016). Food safety knowledge, attitudes and selfreported practices of food handlers in institutional foodservice in Accra, Ghana. Food Control, 69. doi: 10.1016/j.foodcont.2016.05.011 Larson, E. L., & Committee, A. G. (1995). APIC guidelines for handwashing and hand antisepsis in health care settings. American journal of infection control, 23(4), 251-269. Lee, M. B., & Greig, J. D. (2010). A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions. Journal of School Health, 80(12), 588-598. doi: 10.1111/j.1746-1561.2010.00546.x Luby, S. P., Agboatwalla, M., Feikin, D. R., Painter, J., Billhimer, W., Altaf, A., & Hoekstra, R. M. (2005). Effect of handwashing on child health: a randomised controlled trial. The Lancet, 366(9481), 225-233. Norazmir, M., Hasyimah, M. N., Shafurah, A. S., Sabariah, B. S., Ajau, D., & Norazlanshah, H. (2012). Knowledge and practices on food safety among secondary school students in Johor Bahru, Johor, Malaysia. Pakistan Journal of Nutrition, 11(2), 110. Osei-Tutu, B. (2018). Evaluation of Food Safety Management Systems of Food Service Establishments within the Greater Accra Region. International Journal of Biological, Biomolecular, Agricultural, Food and Biotechnological Engineering, 12, 16-21. Osei-Tutu, B., & Anto, F. (2016). Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013. BMC Infect Dis, 16(1), 139. doi: 10.1186/s12879-0161472-8 Osei Tutu, B., & Annison, S. (2017). A Retrospective Cohort Study on an Outbreak of Gastroenteritis Linked to a Buffet Lunch Served during a Conference in Accra. World Academy of Science, Engineering and Technology, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering, 11(7), 345-348. Ovca, A., Jevšnik, M., & Raspor, P. (2014). Food safety awareness, knowledge and practices among students in Slovenia. Food Control, 42, 144-151. doi: https://doi.org/10.1016/j.foodcont.2014.01.036 Rennie, D. M. (1995). Health education models and food hygiene education. Journal of the Royal Society of Health, 115(2), 75-79. doi: 10.1177/146642409511500203 Shen, M., Hu, M., & Sun, Z. (2015). Assessment of School-Based Quasi-Experimental Nutrition and Food Safety Health Education for Primary School Students in Two Poverty-Stricken Counties of West China. PLoS One, 10(12), e0145090. doi: 10.1371/journal.pone.0145090 Soon, J. M., Baines, R., & Seaman, P. (2012). Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers. J Food Prot, 75(4), 793-804. doi: 10.4315/0362-028X.JFP-11-502 Soon, J. M., Singh, H., & Baines, R. (2011). Foodborne diseases in Malaysia: A review. Food Control, 22(6), 823-830. doi: https://doi.org/10.1016/j.foodcont.2010.12.011 Takanashi, K., Quyen, D. T., Nguyen Thi Le, H., Khan, N. C., Yasuoka, J., & Jimba, M. Long-term impact of communitybased information, education and communication activities on food hygiene and food safety behaviors in Vietnam: a longitudinal study. PLoS One, 8(8), e70654. doi: 10.1371/journal.pone.0070654 Torgerson, P. R., Devleesschauwer, B., Praet, N., Speybroeck, N., Willingham, A. L., Kasuga, F., . . . de Silva, N. (2015). World Health Organization Estimates of the Global and Regional Disease Burden of 11 Foodborne Parasitic Diseases, 2010: A Data Synthesis. PLoS Med, 12(12), e1001920. doi: 10.1371/journal.pmed.1001920 Vlasin-Marty, K., Ritter-Gooder, P., & Albrecht, J. A. (2016). Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study. J Racial Ethn Health Disparities, 3(4), 713-
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723. doi: 10.1007/s40615-015-0190-z WHO. (2013a). Estimating the Global Burden of Foodborne Diseases. Food borne diseases. Retrieved 4 october, 2013, from http://www.who.int/foodsafety/foodborne_disease/ferg/ WHO. (2017). Food Safety. key Fact Retrieved 3 JUNE, 2019, from https://www.who.int/news-room/factsheets/detail/food-safety Wu, G., Yuan, Q., Wang, L., Zhao, J., Chu, Z., Zhuang, M., . . . Du, Z. (2018). Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China. Medicine, 97(45), e13142. doi: 10.1097/MD.0000000000013142 Zhou, W.-j., Xu, X.-l., Li, G., Sharma, M., Qie, Y.-L., & Zhao, Y. (2016). Effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in Chongqing, China. Global Health Promotion, 23(1), 37-49. doi: 10.1177/1757975914552914
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The food safety knowledge level of the students was inadequate. Students had food safety knowledge mean score of 5.77 (64.08% of the total score). The food safety practice among the respondents was generally appropriate. There was a positive correlation between food safety knowledge and practices.
Competing Interests We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from
Signed by all authors as follows: Benjamin Osei Tutu Cynthia Hushie Rita Asante Jocelyn Adeline Egyakwa-Amusah