Food safety knowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti

Accepted Manuscript Food safety knowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti S. Samapundo, R. Climat, R. Xhaferi, F. Devlieghere PII:

S0956-7135(14)00516-7

DOI:

10.1016/j.foodcont.2014.09.010

Reference:

JFCO 4059

To appear in:

Food Control

Received Date: 3 June 2014 Revised Date:

4 September 2014

Accepted Date: 9 September 2014

Please cite this article as: Samapundo S., Climat R., Xhaferi R. & Devlieghere F., Food safety knowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti, Food Control (2014), doi: 10.1016/j.foodcont.2014.09.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. 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.

ACCEPTED MANUSCRIPT 1

Food safety knowledge, attitudes and practices of street food vendors and

2

consumers in Port-au-Prince, Haiti

3 Samapundo, S.a*, Climat, R.a, Xhaferi, R.a, Devlieghere, F.a

RI PT

4 5 6

a

7

Food Quality, Faculty of Bioscience Engineering, Ghent University, Member of Food2Know,

8

Coupure Links 653, 9000 Gent, Belgium

M AN U

9

SC

Laboratory of Food Microbiology and Food Preservation, Department of Food Safety and

10

* Corresponding author. Simbarashe Samapundo - Tel.: ++ 32 9 264 9902. Fax: ++ 32 9 225

11

5510. E-mail: [email protected]

12 13

17 18 19 20 21

TE D

16

EP

15

Running title: Food safety knowledge, attitudes and practices in Haiti

AC C

14

22 23 24

1

ACCEPTED MANUSCRIPT 25

Abstract

26 This study had the major objective of determining the food safety knowledge, attitudes and

28

practices of vendors and consumers of street food in Port-au-Prince, Haiti. Haiti currently has

29

no food safety legislation in place. 160 consumers and 80 vendors from four different

30

communes (Tabarre, Delmas, Pétion-ville and downtown Port-au-Prince) volunteered to

31

participate in the study. In general, consumers and vendors exhibited average food safety

32

knowledge and attitude levels. Gender, training, level of education and location did not have a

33

significant effect (p < 0.05) on the level of food safety knowledge of the consumers. Vendors

34

were determined to have higher levels of food safety knowledge than consumers, whilst

35

trained vendors had better food safety knowledge and attitudes compared to untrained

36

vendors. The majority of vendors and consumers were aware of the importance of washing

37

hands and proper cleaning with regards to the prevention of foodborne diseases. However,

38

some other aspects were of concern. Consumers and vendors did not know that Hepatitis A,

39

Salmonella spp. and Staphylococcus spp. are pathogens responsible of foodborne diseases.

40

They also had difficulties in identifying the groups at risk of foodborne diseases and most

41

were unaware of the importance of reheating food to fight against foodborne diseases. In the

42

observational part of the study, it was found that in 60% of the cases, flies and animals were

43

evident around the stall and 65% did not have access to potable water. The majority served

44

food with bare hands and did not wash their hands after handling money. Additionally, 70%

45

of the vendors did not chill pre-cooked food. The conditions in which street food vendors

46

operate in Port-au-Prince are largely unacceptable from a food safety point of view and an

47

effort should be made to provide them with adequate infrastructure including potable water,

48

toilets and waste disposal facilities. The results of this study should be used to generate part of

AC C

EP

TE D

M AN U

SC

RI PT

27

2

ACCEPTED MANUSCRIPT 49

the impetus towards the development of enforcement of appropriate food safety legislation in

50

Haiti.

51 52

Keywords: food safety knowledge, street food, vendors, consumers, Haiti

RI PT

53 54 55

SC

56 57

M AN U

58 59 60 61

65 66 67 68 69

EP

64

AC C

63

TE D

62

70 71 72 73

3

ACCEPTED MANUSCRIPT 74

1

Introduction

75 Street foods are defined as ready-to-eat (RTE) food and beverages prepared and/or sold by

77

vendors and handlers especially in streets and similar public places (FAO, 2013) for

78

immediate consumption or consumption at a later stage without further processing or

79

preparation. Street foods are largely appreciated for their flavours, convenience, low cost and

80

their cultural and social heritage links (Aluko, Ojeremi, Olakele, & Ajidagba, 2014;

81

Chukuezi, 2010; da Silva et al. 2014; Ekanem, 1998). Street foods represent a significant

82

portion of the diet of many inhabitants in many major cities (Ag Bendech, Tefft, Seki, &

83

Nicolo, 2013; FAO, 2010; Suneetha, Manjula, & Depur, 2011). An estimated 2.5 billion

84

people world-wide consume street food each day. In Latin America street food accounts for

85

up to 30% of urban household purchases (FAO, 2007).

M AN U

SC

RI PT

76

86

Many countries have experienced a change in their socio-economic status during the past few

88

decades. These changes have in part led to a significant growth in the popularity of street

89

foods (Chukuezi, 2010; Omemu & Aderoju, 2008). As urban populations are growing,

90

especially in developing countries, it is expected that the street-vended foods sector will

91

continue to expand. Although street vended foods are very common in third world and

92

developing countries such as Haiti, there is paucity in data and studies regarding the safety of

93

these foods. However, it has been recognized that the conditions under which street vendors

94

operate are often unacceptable for the purposes of preparing and selling of food (Aluko et al.

95

2014; da Silva et al. 2014; Hanashiro, Morita, Matté, Matté, & Torres, 2005; Muyanja,

96

Nayiga, Namugumya, & Nasinyama, 2011; Sharma & Mazumdar, 2014). Street food vendors

97

are very often poor, uneducated and show little concern towards the safe handling of foods

98

(Lues, Mpeli, Venter, & Theron, 2006; Mensah, Yeboah-Manu, Owusu-Darko, & Ablordey,

AC C

EP

TE D

87

4

ACCEPTED MANUSCRIPT 2002; WHO, 1996). Consequently, some serious concerns do exist about the safety of street

100

food (FAO, 2013; Muinde & Kuria, 2005; Rheinländer et al. 2008). The concerns have been

101

realized as street-vended foods have dually been implicated in outbreaks of foodborne

102

illnesses all around the world (Aluko et al. 2014; Bryan et al. 1992; Dawson & Canet, 1991).

103

In 1988, 14 deaths were reported in Perek (Malaysia) because of foodborne diseases related to

104

street foods whilst 300 persons became ill in Hong Kong after consumption of street vended

105

foods (FAO, 1990). Associations have been established between the purchasing street food

106

and foodborne illness; in particular Salmonella infections (Vollard et al. 2004). By means of

107

Quantitative Microbial Risk Assessment (QMRA), Barker, Amoah, & Drechsel (2014)

108

recently demonstrated that significant interventions are required to protect the health and

109

safety of street food consumers in Kumasi, Ghana.

M AN U

SC

RI PT

99

110

In different studies conducted to assess the food safety knowledge and attitudes of street food

112

vendors, it has been observed that street food vendors generally have poor levels of food

113

safety knowledge (FAO, 2013; Rane, 2011). Demographic characteristics such as age and

114

gender do not appear to play a role in food safety knowledge of street food vendors (Annor &

115

Baiden, 2011; Soares, Almeida, Cerqueira, Carvalho, & Nunes, 2012). Contrasting results

116

have been reported on the relationship between the level of educational of street food vendors

117

and their food safety knowledge. Soares et al. (2012) reported that a positive correlation

118

occurred between the educational level and food safety knowledge of vendors whilst Annor

119

and Baiden (2011) did not find any significant effect of educational level on the food safety

120

knowledge. Additionally, whilst some studies have found a significant correlation between the

121

level of food safety knowledge and the food safety attitude (Cuprasitrut, Srisorrachatr, &

122

Malai, 2011) others have not reported no correlation between the two (Omemu & Aderoju,

123

2008).

AC C

EP

TE D

111

5

ACCEPTED MANUSCRIPT 124 To date, the food knowledge safety, attitudes and practices of food handlers (including street

126

food vendors) in several countries has been reported in several studies i.e. in Turkey (Bas,

127

Ersun, & Divan, 2006), Bangkok, Thailand (Cuprasitrut et al. 2011), Shijiazhuang City, China

128

(Liu, Zhang, & Zhang, 2014), and Santos City, Brazil (da Cunha, Stedefeldt, & de Rosso,

129

2014). The food knowledge safety and attitudes of consumers have been reported to a lesser

130

extent. Unlike the countries evaluated in studies performed to date, Haiti presents a peculiar

131

and unique case in that it has no food safety legislation. Grandesso et al. (2014) recently

132

evaluated the risk factors for cholera transmission in Haiti during inter-peak periods. They

133

determined that eating street foods and washing disease with untreated water were significant

134

risk factors. Grandesso et al. (2014) also determined that (insufficient) essential hygiene

135

practices are an important issue to tackle in Haiti. The major objective of this study was to

136

establish the levels of food safety knowledge, attitudes and practices of the vendors and

137

consumers of street food in Haiti. The results of this study could potentially provide part of

138

the impetus for development and enforcement of legislation regulating the quality and safety

139

of street foods in Haiti.

142 143 144

SC

M AN U

TE D

EP

141

AC C

140

RI PT

125

145 146 147 148

6

ACCEPTED MANUSCRIPT 149

2

Materials and methods

150 The study was conducted in the capital city of Haiti, Port-au-Prince from July 2012 to

152

September 2012. Four communes - Tabarre, Delmas, Pétion-ville and downtown Port-au-

153

Prince - were selected for the survey. 80 street vendors, 160 consumers and 20 street food

154

vending stalls were involved in the survey. The numbers of street vendors, consumers and

155

vending stalls were evenly distributed between the four communes. Structured written

156

questionnaires were used to assess the food safety knowledge and attitudes of the consumers

157

and vendors whereas a check list was used to evaluate the food handling practices of the street

158

vendors.

M AN U

SC

RI PT

151

159 160

2.1.1

Food safety knowledge and attitude questionnaire

161

The questionnaire used to assess the food safety knowledge and attitudes of the street food

163

vendors and consumers was adopted from Angelillo, Viggiani, Greco, and Rito (2001),

164

Bolton, Meally, Blair, Mcdowell, and Cowan (2008) and Ansari-Lari, Soodbakhsh, and

165

Lakzadeh (2010). These can be seen in Tables 7 to 10. The questionnaire was first translated

166

to French and a pilot test was conducted using twenty people in Tabarre, one of the selected

167

communes. Based on the comments of the respondents, very slight changes were made before

168

adoption of the final version. The questionnaire was organized into three main sections i)

169

demographic information ii) food safety knowledge and iii) food safety attitudes. It was filled

170

in either by the participants themselves or by the researcher for illiterate participants.

AC C

EP

TE D

162

171 172

The demographic section contained information regarding gender, age, educational level and

173

training in food safety. The food safety knowledge section was designed to assess the

174

awareness of the vendors and consumers to food poisoning pathogens, food and personal 7

ACCEPTED MANUSCRIPT hygiene, high risk groups, proper cleaning etc. This section contained 18 questions with 3

176

possible answers – ‘yes’, ‘no’ and ‘do not know’. Each correct answer considered as one point

177

whilst no marks were awarded for incorrect answers or when the respondent indicated that

178

they did not know the answer. The score was then converted to 100 on a basis of maximum

179

possible score of 18 points. A score less than 50 (9 points) was considered as indicating poor

180

food safety knowledge. Scores between 50 to 75 were considered as indicating average

181

(adequate) food safety knowledge, whilst scores >75% were considered as indicating good

182

food safety knowledge. The food safety attitude section was designed to determine the

183

understanding of consumers and vendors about various food safety aspects. This section

184

contained 16 questions with three possible answers as described above. The scoring system

185

described above was also used for evaluation of the food safety attitudes.

M AN U

SC

RI PT

175

186

For selection of the consumers, the researcher frequented markets, schools, parks and highly

188

frequented streets and areas in each of the four communes. All persons from 15 years and

189

older were randomly approached and asked to voluntarily participate in the study. The

190

purpose of the study was fully elaborated to the potential participants after which they were

191

asked to sign an informed ethical consent form before they completed the questionnaire. The

192

study was stopped in each commune when 40 consumers had completed the questionnaire,

193

giving a total of 160 respondents. Vendors operating around markets, schools, bus stations,

194

highly frequented streets and areas in each commune were randomly approached and asked to

195

voluntarily participate in the study. As with the customers the purpose of the study was fully

196

elaborated to the potential participants after which they were asked to sign an informed ethical

197

consent form before they completed the questionnaire. The study was stopped in each

198

commune when 20 vendors had completed the questionnaire, giving a total of 80 respondents.

AC C

EP

TE D

187

199

8

ACCEPTED MANUSCRIPT 200

2.1.2

Food handling observation checklist

201 A checklist was used to assess the food safety practices of street foods vendors. The checklist

203

(see Table 12) was a combination of different checklists used in previous studies by Chukuezi

204

(2010) and Muinde and Kuria (2005). Demographic data such as age, sex, location,

205

educational level and food safety training were also registered. The checklist contained five

206

main sections i) information on facilities ii) the environment around the stall iii) personal

207

hygiene iv) food storage facilities at vending site and v) the maintenance and cleaning of

208

utensils. Absence or presence of each component of the checklist was recorded.

SC

RI PT

202

M AN U

209

The selection of participants for this part of the study was based on the same methodology as

211

for the selection of vendors for the food safety and attitude questionnaire. The objectives of

212

the study were first explained to the vendor. When the vendor volunteered to participate an

213

informed consent form based on ethical norms describing all the different components of the

214

study was provided and signed by each participant prior to the observation. 20 vending stalls

215

(five per commune) were observed.

216

218

2.2

Data entry and statistical analysis

AC C

217

EP

TE D

210

219

The data obtained from the questionnaires and the observation checklists were labelled in Epi

220

Info 7 (CDC, US) after which it was exported to Microsoft Excel version 2013 (Microsoft,

221

Redmond, WA, U.S.A.) where the scores were computed. The data set was then exported

222

from Excel to Spotfire S+ 8_2 (TIBCO Spotfire, Boston, MA, US) for further statistical

223

analysis. Prior to analysis, the age and score parameters were split into different categories.

224

For descriptive analysis of the age, cut-off points of 25, 35, 45, 55 and 60 years were used.

225

Comparisons between different age groups were, however, limited to two groups - ≤ 30 years 9

ACCEPTED MANUSCRIPT 226

and > 30 years – due to the small sample size. For comparisons of the scores, cut-off points of

227

<50, 50-75, and >75 were used.

228 Descriptive analysis (computation of the means, standard deviation, and range of the age, and

230

scores according to age, education, location, sex and training) was performed in Spotfire S+

231

8_2. Comparison of the scores on the basis of gender, age, food safety training and location

232

was performed as follows. Two sample t-Tests were used for comparison of 2-sample data

233

sets such as those for gender, food safety training status and age. Comparison of more than

234

two groups was done by means of fixed effects ANOVA in Spotfire S+ 8_2. Normality was

235

checked by the use of QQ plots and the Kolmogorov-Smirnov Test. Equality of variances was

236

assessed by used of the modified Levene test whilst the normality of residuals was checked by

237

means of QQ plots and the Kolmogorov-Smirnov Test. For samples that were not normally

238

distributed and with a sample size less than 30, analysis was done by the non-parametric

239

Wilcoxon rank-sum test for two sample data sets such as those for gender, food safety training

240

status etc. and Kruskal-Wallis rank sum test was used for data sets with more than two

241

categories such as location (commune) and educational level. Statistical differences were

242

based on an α = 0.05.

244 245 246

SC

M AN U

TE D

EP

AC C

243

RI PT

229

247 248 249 250

10

ACCEPTED MANUSCRIPT 251

3

Results and discussion

252 253

3.1

Demographic characteristics

254 The demographic characteristics of the 160 consumers who participated in this study are

256

shown in Table 1. 60 (37.5%) were female and 100 (62.5%) were male. The mean age of the

257

participants was 29.6 ± 11.3 years, and ages ranged from 15 to 74 years. 91% of the

258

consumers were between 15 and 45 years of age. With regards to the level of education

259

attained, almost a quarter (24%) of the consumers did not have a secondary school education.

260

The majority (76%) were either still in high school or university or had completed either high

261

school and/or university. In addition, the majority of the consumers who participated in this

262

study (88.7 %) did not have any food safety training.

M AN U

SC

RI PT

255

263

The demographic characteristics of the 80 vendors who participated in this study are shown in

265

Table 2. The large majority of the street food vendors who participated in the study were

266

women (88.7%). This reflected our personal observation that the street food stalls were

267

manned by women. The same findings have been observed in other studies conducted in

268

Brazil (Hanashiro et al. 2005, Soares et al. 2012), South Africa (Martins, 2006), Thailand

269

(Cuprasitrut et al. 2011), Nigeria (Omemu & Aderoju, 2008) and the Philippines (Azanza,

270

Gatchalian, & Ortega, 2000). The educational background of the street food vendors in Haiti

271

is quite similar to those reported for vendors in India (Choudhury, Mahanta, Goswami,

272

Mazumder, & Pegoo, 2011), Ghana (Donkor, Kayang, Quaye, & Akyeh, 2009; Mensah et al.

273

2002), Nigeria (Omemu & Aderoju, 2008), Kenya (Muinde & Kuria, 2005) and Sudan

274

(Abdalla, Suliman, & Bakhiet, 2009). The mean age of the vendors was 34.4 ± 11.9 years and

275

the ages ranged between 16 and 66 years. The majority (78.7%) of the vendors did not have

AC C

EP

TE D

264

11

ACCEPTED MANUSCRIPT 276

any food safety training. Other studies have reported even lower levels of trained street food

277

vendors including those in Nigeria (Chukuezi, 2010) and Ghana (Omemu & Aderoju, 2008).

278 279

3.2

Food safety knowledge of consumers and vendors of street food

RI PT

280

The results of the survey to determine the food safety knowledge of the consumers are shown

282

in Table 3. The consumers had a mean food safety knowledge score of 56, indicating that they

283

generally had an average knowledge of food safety. However, 36.9% (59/160) of the

284

consumers had an inadequate level of food safety knowledge (scores <50), whilst only 5%

285

(8/160) of the consumers had a good level of food safety knowledge (scores >75). Therefore,

286

although the consumers in general have an average knowledge of food safety, quite a large

287

have an inadequate level of food safety knowledge. No statistical difference (α = 0.05) was

288

found between the food safety knowledge’s of customers on the basis of gender (p = 0.38),

289

age (p = 0.09), food safety training (or lack thereof) (p = 0.43), level of education (p = 0.32)

290

and location in Port-au-Prince (p = 0.06). In contrast to our findings other studies have

291

indicated that an increase of food safety knowledge occurs with age and that women have

292

higher levels of food safety knowledge compared to men (Bruhn & Schutz, 1998).

M AN U

TE D

EP

AC C

293

SC

281

294

The results of the survey to determine the food safety knowledge of the vendors is shown in

295

Table 4. The vendors had a significantly higher mean food safety knowledge (score of 60)

296

than the consumers (p = 0.008). The individual scores of the vendors ranged from 16 to 77.

297

27.5% (22/80) of the vendors who participated in the study had an inadequate level of food

298

safety knowledge (score <50) whilst 58.8 % (47) had an average food safety knowledge level

299

(scores >50 and <75. 13.8% (11/80) had a good level of food safety knowledge (scores >75).

300

Amongst the studies that have used the same scoring methods, the mean food safety

12

ACCEPTED MANUSCRIPT knowledge score of the street food vendors in Haiti was found to be higher than that of food

302

handlers from Turkey (Bas et al. 2006) and Thailand (Cuprasitrut et al. 2011). It has also been

303

determined that street vendors in South Africa (Lues, Mpeli, Venter, & Theron, 2006) and the

304

Philippines (Azanza et al. 2000) have a good level of food safety knowledge. No statistical

305

difference (α = 0.05) was found between the food safety knowledge’s of the vendors on the

306

basis of gender (p = 0.092), age (p = 0.75), educational level attained (p = 0.61) and location

307

in Port-au-Prince (p = 0.10). The same findings have also been observed in Accra, Ghana

308

(Annor & Baiden, 2011) and Fars, Iran (Ansari-Lari et al. 2010). However, it was determined

309

in this study that food vendors who had received some training in food safety had a

310

significantly higher level ((p = 0.018) of food safety knowledge than untrained vendors. This

311

finding has to be viewed with caution as none of the vendors could provide a proof (i.e. a

312

certificate or an official document) of the food safety training they had received.

M AN U

SC

RI PT

301

313

315

3.3

Food safety attitudes of consumers and vendors of street food

TE D

314

The results of the survey to determine the food safety attitude of the consumers are shown in

317

Table 5. The consumers had a mean food safety attitude score of 68, which indicated that they

318

generally had an average understanding of food safety. The range of scores was between 18

319

and 93. With regards to distribution of the scores, it can be seen in Table 5 that 90.6%

320

(145/160) of the consumers had at least an average food safety attitude (scores >50). Almost a

321

quarter (24.4%) had a very good food safety attitude as they had scores >75. The food safety

322

attitudes of the consumers were significantly higher than their food safety knowledge (p = 0).

323

No statistical difference was found between the food safety attitudes of the customers on the

324

basis of gender (p = 0.94), training (p = 0.14) and age (p = 0.07). However, statistically

325

significant differences (α = 0.05) occurred between the food safety attitudes of consumers on

AC C

EP

316

13

ACCEPTED MANUSCRIPT the basis of their educational level (p = 0.004). Consumers who only went to primary school

327

were determined to have higher scores than those who went to high (secondary) school and

328

university. This was a very surprising finding as one would expect that education to a higher

329

level would have a positive effect on food safety attitude. In agreement to our results the same

330

findings have also been observed for food safety knowledge in a multi-state study conducted

331

in the US (Altekruse, Yang, Timbo, & Angulo, 1999). However, in difference, the educational

332

level has been determined to have no bearing on the food safety knowledge and attitudes of

333

consumers in Ghana (Annor & Baiden, 2011; Rheinländer et al. 2008). In the context of this

334

study, the higher food safety attitudes of the less educated consumers might be explained by

335

the fact that cooking and household tasks in Haiti are usually reserved for people who are less

336

educated. A significant difference was also observed between the food safety attitudes of

337

consumers on the basis of their location in Port-au-Prince (p = 0.0006). It was observed that

338

consumers from Delmas and down-town Port-au-Prince had higher scores than consumers

339

from Pétion-ville. The inhabitants of Pétion-ville generally have a higher level of income

340

compared to the other communes investigated in the study, which (as discussed above) would

341

partly explain their lower food safety attitudes.

SC

M AN U

TE D

EP

342

RI PT

326

The results of the survey to determine the food safety attitudes of the vendors are shown in

344

Table 6. The mean food safety attitude score of the vendors was 73 and the scores ranged

345

from 25 to 93. Only four (5%) of the vendors had an inadequate food safety attitude (scores

346

<50); whilst 95% had at least an average food safety attitude (scores of ≥50). Even a greater

347

proportion of the vendors (43%) had good food safety attitudes, compared to consumers

348

(24.4%). Statistically, the vendors had significantly better food safety attitudes than food

349

safety knowledge (p = 0) and better food safety attitudes than those of the consumers (p =

350

0.0028). No statistical difference was found in the food safety attitudes of the vendors on the

AC C

343

14

ACCEPTED MANUSCRIPT basis of gender (p = 0.27), level of education (p = 0.43), location (p = 0.12) and age (p =

352

0.61). However, it was determined that food vendors who had received training in food safety

353

had a significantly greater food safety attitudes than untrained vendors (p = 0.01). Some

354

studies have also reported that trained food handlers have higher food safety attitudes

355

compared to untrained food handlers (McIntyre, Vallaster, Wilcott, Henderson, & Kosatsky,

356

2013) while others have reported that no significant differences occur between the two (Bas et

357

al. 2006)

RI PT

351

SC

358

Tables 7 and 8 show the tallied responses of the customers and vendors, respectively, to the

360

food safety knowledge questionnaire. These tables provide greater insight into the areas where

361

the food safety knowledge is strongest and weakest. The results show that the majority of the

362

consumers did not know that hepatitis A virus (88.8%), Salmonella spp. (89.4%) and

363

Staphylococcus aureus (91.9%) are pathogens that are responsible for foodborne diseases and

364

Almost half (44.4%, 77/160) of the consumers failed to identify the demographic groups at

365

greatest risk of foodborne diseases. 53.1% (99/160) of the consumers wrongly believed that

366

washing utensils with detergents leaves them free of contamination, whilst 8.7% did not

367

know. On the positive side 74.4% (119/160) of the consumers knew that bloody diarrhoea can

368

be transmitted by food whilst 77.5% (124/160) recognized that AIDS cannot be transmitted

369

by food. 86.2% (138/160) knew that it is necessary to take leave from work during cases of

370

infectious skin diseases and 88.1% (141/160) knew that microorganisms can be found in the

371

skin, mouth and nose of healthy handlers. The majority of the consumers were also aware of

372

the critical role of washing hands (93.8%) and proper cleaning of utensils (71.9%) with

373

regards to the prevention of foodborne diseases. However, only 61.9% (99/160) knew that the

374

use of gloves is important in reducing the risk of contamination.

AC C

EP

TE D

M AN U

359

375

15

ACCEPTED MANUSCRIPT In comparison to the consumers, almost all vendors did not know that hepatitis A (96.3%)

377

Salmonella (100%) and Staphylococcus aureus (98.8%) were foodborne pathogens. In

378

agreement with this finding, vendors in Brazil (Soares et al. 2012) also failed to identify these

379

foodborne pathogens. However, almost all of the vendors (75/80; 93.8%) knew that bloody

380

diarrhoea can be transmitted through food. Compared to the consumers, a slightly lower

381

proportion of the vendors (68.75 %) knew that AIDS could not be transmitted by food. 88.8 %

382

of the vendors also knew that it is necessary to take leave from work during infectious disease

383

of the skin. 92.5% (74/80) of the vendors knew that microbes could be found in the skin, nose

384

and mouth of healthy handlers. In similarity to the results observed for the consumers, 41.3%

385

of the vendors did not know that abortion could be induced by foodborne diseases. 67.5%

386

wrongly believed that washing utensils with detergent would leave them free of

387

contamination. Most of the vendors were aware of the importance of washing hands (95%),

388

proper cleaning (82.5%) and the use of gloves (72.5%) in the prevention of foodborne

389

diseases. The majority (72.5%) of the vendors in Port-au-Prince were able to identify

390

children, pregnant women and elderly as being at equal risk of foodborne diseases. The

391

majority of the vendors (76.3%) correctly noted that a swollen can is a possible host of

392

microorganisms. Slightly more vendors than consumers knew that the reheating of food could

393

be used to prevent the occurrence of foodborne diseases (63.8 % vs. 58.7) and that the

394

preparation of food in advance could lead to food poisoning (78.8% vs. 60%).

SC

M AN U

TE D

EP

AC C

395

RI PT

376

396

Tables 9 and 10 show the tallied responses of the customers and vendors, respectively, to food

397

safety attitudes questionnaire. As mentioned above for food safety knowledge, these tables

398

provide greater insight into the areas where the food safety attitudes are strongest and

399

weakest. More than half of the customers (62.5%) wrongly believed that a well-cooked food

400

is free of contamination and that the ideal place to store raw meat was the bottom shelf of the

16

ACCEPTED MANUSCRIPT refrigerator (48.8%). Most of consumers thought that eggs should be washed as soon as

402

possible after purchase (88.8%) whilst 60% thought that chicken should not be thawed in a

403

bowl of cold water. 35% of the customers incorrectly agreed thought that defrosted foods can

404

be refrozen and only half of them (51.3%) were able to identify wearing masks as an

405

important practice to reduce the risk of food contamination. The results observed in this study

406

point out the need to emphasize the importance of cold temperatures to retard growth of

407

microorganisms particularly refrigerating during defrosting. The vendors generally had the

408

same difficulties in answering the same questions that the consumers answered poorly. The

409

lowest percentage of correct answers (22.5%) was observed for the question concerning

410

whether or not well-cooked food is free of contamination. In agreement with the findings of

411

other studies conducted in Ghana (Donkor et al. 2009) and South Africa (Lues et al. 2006), a

412

high percentage of the street food vendors (84.4%) who participated in this study were aware

413

of the importance of separating cooked and raw foods in order to prevent foodborne diseases.

M AN U

SC

RI PT

401

415 416

3.4

TE D

414 Observed food handling habits

The demographic characteristics of the vendors manning the 20 street food vending stalls that

418

were observed in this study are shown in Table 11. 18 (90%) of the stalls were manned by a

419

woman. The mean age of the vendors manning the stalls that were observed was 42.4 ± 10.3

420

years. The ages ranged from 28 to 68 years. The level of education was very low as 15 (75%)

421

of the participants had not attended high (secondary) school and none of them had gone to

422

university. In addition, 14 (70%) of them did not have any food safety training.

AC C

EP

417

423 424

Table 12 shows the characteristics of the observed stalls. 45% (9/20) of the stalls observed

425

consisted of a canopy (in most cases a parasol) and 35% (7/20) consisted simply of a table set

426

alongside the street. As observed in this study other studies have also reported that street 17

ACCEPTED MANUSCRIPT vending stalls are most often made of tables and canopies (Chukuezi, 2010). Contrary to our

428

study where 85% of the food was prepared on site, only 10% and 14% of the food was

429

prepared on site in South Africa (Lues et al. 2006) and Mauritius (Subratty et al. 2004),

430

respectively. 65% (13/20) of the stalls did not have access to potable water and 80% (16/20)

431

did not have adequate hand washing and waste disposal facilities. These findings were similar

432

to the ones observed by Muyanja et al. (2011), Muinde and Kuria (2005), and Badrie, Joseph,

433

and Chen (2004) in studies carried out in Uganda, Kenya and Trinidad, respectively. Because

434

of the lack of adequate waste disposal facilities, street vendors have a tendency to dispose of

435

their waste in the street. This in turn attracts flies and insects which are potential vectors of

436

pathogens. Animals, flies and insects were indeed evident around the stall in 60% (12/20) of

437

the cases, which was also the case in studies conducted in Uganda (Muyanja et al. 2011),

438

Kenya (Muinde & Kuria, 2005) and Trinidad (Badrie et al. 2004). 85% (17/20) of the stalls

439

were not protected from the sun, dust and wind. These findings are in agreement with the

440

observations that have been made in Uganda (Muyanja et al. 2011), Sudan (Abdalla et al.

441

2009), Nigeria (Chukuezi, 2010) and Kenya (Muinde & Kuria, 2005). 75% (15/20) of the

442

stalls had a clean environment i.e. far from rubbish, waste water, toilet facilities and open

443

drains. In contrast Muinde and Kuria (2005) reported that only 15% of street food stalls in

444

Kenya were clean.

SC

M AN U

TE D

EP

AC C

445

RI PT

427

446

Only 45% (9/20) of the vendors were observed to wash their hands in clean potable water

447

each time before handling, preparing and serving food. Although all of the vendors said that

448

they washed their hands each time after visiting the toilet this was not confirmed as the

449

researcher did not follow the vendors into the toilets. This finding is therefore highly

450

questionable. Moreover, it has been observed in some studies that the washing of hands after

451

visiting the toilet by street food vendors is not always as a result of the lack of public toilets in

18

ACCEPTED MANUSCRIPT many developing countries (Bryan, 1988). When they do exist, most of the time they have no

453

hand washing facilities, no running water and paper (Bryan, 1988). In a study conducted in

454

Abeokuta (Nigeria), it was found that vendors relieved themselves on dunghills and in bushes

455

and used sheets of paper to clean up after defecation without washing their hands (Idowu &

456

Rowland, 2006). Although all the vendors who participated in this part of the study were

457

observed to be wearing clean and presentable clothes, only 40% (8/20) actually wore an apron

458

while handling, preparing and serving food. Other studies in various developing countries

459

have also observed that a low percentage of street food vendors use aprons and gloves while

460

handling, preparing and serving food (Chukuezi, 2010; Subratty, Beeharry, & Chan, 2004;

461

Lues et al. 2006; Muinde & Kuria, 2005).

M AN U

SC

RI PT

452

462

In agreement to the observations that have been made in Kenya (Muinde & Kuria, 2005) and

464

Nigeria (Chukuezi, 2010; Omemu & Aderoju, 2008), 80 % (16/20) of the vendors in Haiti

465

handled food with bare hands and handled money while serving the food. Only 6.3% (1/16)

466

washed their hands thereafter. These findings are a concern as hands are vectors for pathogens

467

such as S. aureus. It has already been advised by E.C. (1997) that food handlers should avoid

468

handling food with bare hands and handling money at the same time. Additionally, according

469

to the WHO, food should be preferably handled with clean tongs, forks, spoons or disposable

470

gloves (FAO/WHO, 1999). The hair of 65% (13/20) of the vendors was covered, whilst 90%

471

(18/20) had clean and short nails. However, it has to be noted that the use of hair covers by

472

the street food vendors in Haiti might not be primarily for food safety reasons. Most of for

473

traditional reasons women usually cover their hair irrespective of what they are doing. In 55%

474

(11/20) of the cases a clean cloth was used to remove dirt and dust. 20% (4/20) of the

475

operators wore jewellery and only 2 (25%) of these 8 operators covered the jewellery

AC C

EP

TE D

463

19

ACCEPTED MANUSCRIPT 476

adequately. None of the vendors smoked during the handling and serving of food. In 20%

477

(4/20) of the cases, the same knives and boards were used to prepare raw and cooked food.

478 The ingredients were stored in sealed containers, whilst raw, partially cooked and cooked

480

food products were kept separate at all 20 stalls evaluated. In 70% (14/20) of the cases

481

previously cooked food products were not kept cool. The same observations have been

482

reported by Muinde and Kuria (2005) in Kenya and Badrie et al. (2004) in Trinidad. This is an

483

important finding as it has been shown that inadequate cooling is one of the key factors that

484

contribute to the occurrence of food poisoning outbreaks (Roberts, 1982; WHO, 1989). In

485

almost half of the stalls (9/20), the utensils were not covered whilst 95% (19/20) of the

486

vendors cleaned the utensils every time after use in soapy cold water. This practice of

487

washing the dishes seems to be common in other countries as well such as the Philippines

488

(Azanza et al. 2000), Indonesia (Van Kampen, Gross, Schultnik, & Usfar, 1998) and South

489

Africa (Lues et al. 2006).

493 494 495 496 497 498 499

SC

M AN U

TE D

492

EP

491

AC C

490

RI PT

479

500 501 502 503 504 20

ACCEPTED MANUSCRIPT 505

4

Conclusions

506 This study had the major objective of determining the food safety knowledge, attitudes and

508

practices of street food consumers and vendors in Haiti. The study was the first of its nature

509

that has been done in Haiti.

RI PT

507

510

Some findings of concern were consumers and vendors did not know that Hepatitis A,

512

Salmonella spp. and Staphylococcus spp. are pathogens responsible of foodborne diseases.

513

They also had difficulties in identifying the groups at risk of foodborne diseases and most

514

were unaware of the importance of reheating food to fight against foodborne diseases. In the

515

observational part of the study, it was found that in 60% of the cases, flies and animals were

516

evident around the stall and 65% did not have access to potable water. The majority served

517

food with bare hands and did not wash their hands after handling money. Additionally, 70%

518

of the vendors did not keep pre-cooked food at an appropriate temperature. The conditions in

519

which street food vendors operate in Port-au-Prince are mostly unacceptable from a food

520

safety point of view and an effort should be made to improve their conditions by development

521

of appropriate infrastructure i.e. potable water, toilets and waste disposal facilities. The

522

majority of the vendors did not have any food safety training. Therefore there is an urgent

523

need to organize formal training in food hygiene and food safety.

M AN U

TE D

EP

AC C

524

SC

511

525

Importantly, Haiti currently has no food safety legislation and some of the findings obtained

526

in this study are a result of the status quo. These results should therefore provide part of the

527

impetus for such legislation to be developed for regulation of this sector and the food industry

528

in general. Due to the limits of the research mentioned above, one should be careful in

529

generalizing the results of the study and there is a need for more studies in the street food

21

ACCEPTED MANUSCRIPT 530

sector and perhaps it might also be interesting to extend that study to other cities and towns in

531

Haiti.

532 533

RI PT

534 535 536

SC

537 538

M AN U

539 540 541 542

546 547 548 549 550

EP

545

AC C

544

TE D

543

551 552 553 554

22

ACCEPTED MANUSCRIPT 555

5

Acknowledgement

556 The authors are very grateful to co-author Dr. Ruth Climat for her invaluable contribution to

558

the study by conducting the interviews, questionnaires and observation study in Port-au-

559

Prince, Haiti.

RI PT

557

560 561

SC

562 563

M AN U

564 565 566 567

571 572 573 574 575

EP

570

AC C

569

TE D

568

576 577 578 579

23

ACCEPTED MANUSCRIPT 580

6

References

581 Abdalla, M. A., Suliman

S. E., & Bakhiet, A. O. (2009). Food safety knowledge and

583

practices of street foodvendors in Atbara City (Naher Elneel State Sudan). African Journal of

584

Biotechnology, 8, 6967-6971.

RI PT

582

585

Ag Bendech, M., Tefft, J., Seki, R., & Nicolo, G. F. (2013). Street food vending in urban

587

Ghana: moving from an informal to formal sector. GhanaWeb article 292956. Food and

588

Agriculture Organisation of the United Nations, Regional Office for Africa. URL:

589

http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=292956

SC

586

590

Altekruse, S. F., Yang, S., Timbo, B. B., & Angulo, F. J. (1999). A multi-state survey of

592

consumer food-handling and food consumption practices. American Journal of Preventive

593

Medicine, 16, 216-221.

M AN U

591

594

Aluko, O. O., Ojeremi, T. T., Olakele, D. A., & Ajidagba, E. B. (2014). Evaluation of food

596

safety and sanitary practices among food vendors at car parks in Ile Ife, southwestern Nigeria.

597

Food Control, 40, 165-171.

TE D

595

598

Angelillo, I. F., Viggiani, N. M. A., Greco, R. M., & Rito, D. (2001). HACCP and food

600

hygiene in hospital: knowledge, attitudes, and practices of food services staff in Calabri, Italy.

601

Infection Control Hospital Epidemiology, 22, 1-7.

EP

599

AC C

602 603

Annor, G., & Baiden, E. A. (2011). Evaluation of Food Hygiene Knowledge Attitudes and

604

Practices of Food Handlers in Food Businesses in Accra, Ghana. Food and Nutrition

605

Sciences, 2, 830-836.

606 607

Ansari-Lari, M., Soodbakhsh, S., & Lakzadeh, L. (2010). Knowledge, attitudes and practices

608

of workers on food hygienic practices in meat processing plants in Fars, Iran. Food Control,

609

21, 260-263.

610

24

ACCEPTED MANUSCRIPT 611

Azanza, P. V., Gatchalian C. F., & Ortega, M. (2000). Food safety knowledge and practices of

612

street food vendors in a Philippines university campus. International Journal of Food Science

613

and Nutrition, 51, 235-246.

614 Badrie, N., Joseph, A., & Chen, A. (2004). An observational study of food safety practices by

616

street vendors and microbiological quality of street-purchased hamburger beef patties in

617

Trinidad, West Indies. Internet Journal of Food Safety, 3, 25-31.

618

RI PT

615

Barker, F. S., Amoah, P., & Drechsel, P. (2014). A probabilistic model of gastroenteritis risks

620

associated with the consumption of street food salads in Kumasi, Ghana: Evaluation of

621

methods to estimate pathogen dose from water, produce or food quality.

SC

619

622

Bas, M., Ersun, A. S. A., & Divan, G. (2006). The Evaluation of Food Hygiene Knowledge,

624

Attitudes, and Practices of Food Handlers in Food Businesses in Turkey. Food Control, 17,

625

317 322.

M AN U

623

626

Bolton, D. J., Meally, A., Blair, I. S., Mcdowell, D. A., & Cowan, C. (2008). Food safety

628

knowledge of head chefs and catering managers in Ireland. Food Control, 19, 291-300.

TE D

627

629 630

Bruhn, C. M., & Schutz, H. G. (1998). Consumer food safety knowledge and practices.

631

Journal of Food Safety, 19, 73-87.

EP

632 Bryan,

634

Republic. Journal of Food Protection, 51, 373-383.

635

F. L. (1988). Critical Control Points of Street-vended Foods in the Dominican

AC C

633

636

Bryan, F. L., Teufel, P., Riaz, S., Roohi, S., Qadar, F., & Malik, Z. (1992). Hazards and

637

critical control points of street-vending in a mountain resort town in Pakistan. Journal of Food

638

Protection, 55, 701-707.

639 640

Choudhury, M., Mahanta, L., Goswami, J., Mazumder, M., & Pegoo, B. (2011). Socio-

641

economic profile and food safety knowledge and practice of street food vendors in the city of

642

Guwahati, Assam, India. Food Control, 22, 196-203.

643

25

ACCEPTED MANUSCRIPT 644

Chukuezi, C. O. (2010). Safety and Hygienic Practices of Street Food Vendors in Owerri,

645

Nigeria. Studies in Sociology of Science, 1, 50-57.

646 Cuprasitrut, T., Srisorrachatr, S., & Malai, D. (2011). Food safety knowledge, attitude and

648

practice of food handlers and microbiological and chemical food quality assessment of food

649

for making merit for monks in Ratchathewi District, Bangkok. Asia Journal of Public Health,

650

2, 27-34.

RI PT

647

651

Dawson, R. J., & Canet, C. (1991). International activities in street foods. Food Control, 2,

653

135-139.

SC

652

654

da Cunha, D. T., Stedefeldt, E., & de Rosso, V. V. (2014). The role of theoretical food safety

656

training on Brazilian food handlers’ knowledge, attitude and practice. Food Control, 43, 167-

657

174.

M AN U

655

658

da Silva, S. A., de Cassia Vierira Cardoso, R., Góes, J., A., W., Santos, J. N., Ramos, F. P., de

660

Jesus, R. B., et al. (2014). Street food on the coast of Salvador, Bahia, Brazil: A study from

661

the socioeconomic and food safety perspectives. Food Control, 40, 78-84.

TE D

659

662

Donkor, E. S., Kayang, B. B., Quaye, J., & Akyeh, M. L. (2009). Application of the WHO

664

keys of safer food to improve food handling practices of food vendors in a poor resource

665

community in Ghana. Int. J. Environ. Res. Public Health, 6, 2833-2842.

666

EP

663

E. C. (European Commission). (1997). Trends and sources of zoonotic agents in animals,

668

feedstuffs, food and man in the European Union in 1997. Part 1. Document No. VI/8495/98 –

669

Rev. 2 of the European Commission, Community Reference Laboratory on the Epidemiology

670

of Zoonoses, Berlin, Germany.

671

AC C

667

672

Ekanem, E. O. (1998). The street food trade in Africa: safety and socio-environmental issues.

673

Food Control, 9, 211-215.

674 675

FAO (1990). Street foods: report of an FAO Expert Consultation (Yogyakarta, Indonesia, 5-9

676

December 1988). FAO Food and Nutrition Paper 46, Rome.

677 26

ACCEPTED MANUSCRIPT 678

FAO (Food and Agricultural Organisation of the United Nations). (2007). School kids and

679

street food. URL: http://www.fao.org/AG/magazine/0702sp1.htm

680 681

FAO (Food and Agricultural Organisation of the United Nations). (2010). INFOSAN

682

Information

683

http://www.who.int/foodsafety/fs_management/No_03_StreetFood_Jun10_en.pdf

No.

3/2010

-

Safety

of

street

vended

food.

URL:

RI PT

Note

684 685

FAO (Food and Agricultural Organisation of the United Nations). (2013). Food for the cities:

686

street foods. URL: http://www.fao.org/fcit/food-processing/street-foods/en/

SC

687

FAO/WHO (Food and Agricultural Organisation of the United Nations/World Health

689

Organization). 1999. Recommended international code of practice: general principles of food

690

hygiene. CAC/RCP 1, Rome.

691

M AN U

688

692

Grandesso, F., Allan, M., Jean-Simon, P. S. J., Boncy, J., Blake, A., Pierre, R., et al. (2014).

693

Epidemiology and Infection, 142, 1625-1635.

694

Hanashiro, A., Morita, M., Matté, G. R., Matté, M. H., & Torres, E. F. A. S. (2005).

696

Microbiological quality of selected street foods from a restricted area of Sao Paulo city,

697

Brazil. Food Control, 16, 439-444.

698

TE D

695

Idowu, O. A., & Rowland, S. A. (2006). Oral fecal parasites and personal hygiene of food

700

handlers in Abeokuta, Nigeria. African Health Science, 6, 160-164.

701

EP

699

Liu, Z., Zhang, G., & Zhang, X. (2014). Urban street foods in Shijiazhuang city, China:

703

Current status, safety practices and risk mitigating strategies. Food Control, 41, 212-218.

704

AC C

702

705

Lues, J. F. R., Mpeli, R. R., Venter, P., & Theron, M. M. (2006). Assessing Food Safety and

706

Associated Food Handling Practices in Street Food Vending. International Journal of

707

Environmental Health Research, 6, 319-328.

708 709

Martins, J. H. (2006). Socio-economic and hygiene features of street food vending in

710

Gauteng, South African Journal of Clinical Nutrition, 19, 18-25.

711 27

ACCEPTED MANUSCRIPT 712

Sharma, I., & Mazumdar, J. A. (2014). Assessment of bacteriological quality of ready to eat

713

food vended in streets of Silchar city, Assam, India. Indian Journal of Medical Microbiology,

714

32, 169-171.

715 McIntyre, L., Vallaster, L., Wilcott, L., Henderson, S. B., & Kosatsky, T. (2013). Evaluation

717

of food safety knowledge, attitudes and self-reported hand washing practices in FOODSAFE

718

trained and untrained food handlers in British Columbia, Canada. Food Control, 30, 150-156.

RI PT

716

719

Mensah, P., Yeboah-Manu, D., Owusu-Darko, K., & Ablordey A. (2002). Street foods in

721

Accra, Ghana: how safe are they? Bulletin of the World Health Organization, 80, 546-554.

SC

720

722

Mosupye, F. M., & Holy, A. (2000). Microbiological hazard identification and exposure

724

assessment of street food vending in Johannesburg, South Africa. International Journal of

725

Food Microbiology, 61, 137-145.

726

M AN U

723

727

Muinde, O. K., & Kuria, E. (2005). Hygienic and sanitary practices of vendors of street foods

728

in Nairobi, Kenya. African Journal of Food Agriculture & Nutritional Development, 5, 1-14.

TE D

729 730

Muyanja, C., Nayiga, L., Brenda, N., & Nasinyama, G. (2011). Practices, knowledge and risk

731

factors of street food vendors in Uganda. Food Control, 22, 1551-1558.

732

Omemu, A., & Aderoju, S. T. (2008). Food safety knowledge and practices of street food

734

vendors in the city of Abeokuta, Nigeria. Food Control, 19, 396-402.

735

EP

733

Rane, S. (2011). Street Vended Food in Developing World: Hazard, Indian Journal of

737

Microbiology, 51, 100-106.

738

AC C

736

739

Rheinländer, T., Olsen, M., Bakang, J. A., Takyi, F., Konradsen, H., & Samuelsen, L. (2008).

740

Keeping Up Appearances: Perceptions of Street Food Safety in Urban Kumasi, Ghana.

741

Journal of Urban Health, 85, 952-964.

742 743

Roberts, D. (1982). Factors contributing to outbreaks of food poisoning in England and Wales

744

1970–1979. Journal of Hygiene, 89, 491-498.

745 28

ACCEPTED MANUSCRIPT 746

Soares, L. S., Almeida, R. C. C., Cerqueira, E. S., Carvalho, J. S., & Nunes, I. L. (2012).

747

Knowledge, attitudes and practices in food safety and the presence of coagulase positive,

748

staphylococci on hands of food handlers in the schools of Camaçari, Brazil. Food Control, 27,

749

206-213.

750 Subratty, A. H., Beeharry, P., & Chan, S. M. (2004). A survey of hygiene practices among

752

food vendors in rural areas in Mauritius. Nutrition & Food Science, 34, 203-205.

RI PT

751

753

Suneetha, C., Manjula, K., & Depur, B. (2011). Quality Assessment of Street Foods in

755

Tirumala. Asian Journal of Experimental Biological Sciences, 2, 207-211.

SC

754

756

Van Kampen, J., Gross, R., Schultnik, W., & Usfar, A. (1998). The microbiological quality of

758

street foods in Jakarta as compared to home prepared foods and foods from tourist hotels. Int.

759

Journal of Food Science and Nutrition, 49, 17–26.

M AN U

757

760

Vollard, A. M., Ali, S., van Asten, H. A. G. H., Suhariah Ismid, I., Widjaja, S., Visser, L. G.,

762

et al. (2004). Risk factors for transmission of foodborne illness in restaurants and street

763

vendors in Jakarta, Indonesia. Epidemiology and Infection, 132, 863-872.

764

TE D

761

WHO (World Health Organization). (1996). Essential safety requirements for street-vended

766

foods. URL: http://apps.who.int/iris/bitstream/10665/63265/1/WHO_FNU_FOS_96.7.pdf

AC C

EP

765

29

ACCEPTED MANUSCRIPT 1

TABLES Samapundo et al.

2 3

Table 1. Demographic characteristics of street food consumers in Port-au-Prince, Haiti

4

7 8 9 10 11 12 13 14 15 16

15 - 74

M AN U

SC

29.6 ± 11.3

Range

RI PT

Mean ± standard deviation

TE D

EP

6

AC C

5

Characteristics Number (%) Sex Female 60 (37.5%) Male 100 (62.5%) Age (years) 15-25 74 (46.2%) 26-35 49 (30.6%) 36-45 23 (14.4%) 46-55 6 (3.8%) 56-60 5 (3.1%) >60 3 (1.9%) Education Illiterate 13 (8.2%) Primary school 25 (15.6%) High school 69 (43.1%) University 53 (33.1%) Food safety training Yes 18 (11.3%) No 142 (88.7%) Location Port-au-Prince 40 (25%) Pétion-ville 40 (25%) Delmas 40 (25%) Tabarre 40 (25%) Total 160 *stdev = standard deviation

ACCEPTED MANUSCRIPT Table 2. Demographic characteristics of street food vendors in Port-au-Prince, Haiti Characteristics

Numbers

34.4±11.9

16-66

18 (22.5%) 36 (45%) 21 (26.2%) 5 (6.3%) 17 (21.3%) 63 (78.7%)

TE D

20 (25%) 20 (25%) 20 (25%) 20 (25%) 80

RI PT SC

25 (31.3%) 22 (27.5%) 18 (22.5%) 9 (11.2%) 4 (5%) 2 (2.5%)

AC C

18

Range

71 (88.7%) 9 (11.3%)

EP

Sex Female Male Age (years) 15-25 26-35 36-45 46-55 56-60 >60 Education Illiterate Primary school High school University Food safety training Yes No Location Port-au-Prince Pétion-ville Delmas Tabarre TOTAL

Mean ± standard deviation

M AN U

17

ACCEPTED MANUSCRIPT

19

Table 3. Effect of gender, age, education level, food safety training and location on the food safety knowledge of consumers 20

33 (21) 60 (38)

Mean score ± stdev*

2 (1.3) 6 (3.8)

55 ± 13 56 ± 12

Range

RI PT

25 (16) 34 (21)

21

22 - 9422 27 - 83

2 (1.3) 5 (3.1) 0 (0) 0 (0) 1 (0.6) 0 (0)

6 (3.8) 6 (3.8) 29 (18) 18 (11)

7 (4.4) 17 (11) 38 (24) 31 (19)

0 (0) 2 (1.3) 2 (1.3) 4 (2.5)

7 (4.4) 52 (33)

10 (6.3) 83 (52)

11 (6.9) 18 (11) 10 (6.3) 20 (13) 59 (36.9)

28 (18) 21 (13) 26 (16) 18 (11) 93 (58.1)

53 ± 12 59 ± 13 56 ± 7 64 ± 3 61 ± 13 40 ± 11

22 - 83 28 - 9424 38 - 66 25 61 - 66 50 - 7726 27 - 50

55 ± 12 58 ± 11 54 ± 11 57 ± 13

27 - 72 38 - 7728 27 - 83 22 - 9429

M AN U

36 (23) 31 (19) 18 (11) 6 (3.8) 2 (1.3) 0 (0)

TE D

36 (23) 13 (8.1) 5 (3.1) 0 (0) 2 (1.3) 3 (1.9)

SC

23

27

30

1 (0.6) 7 (4.4)

54 ± 8 55 ± 12

38 - 77 31 22 - 94

1 (0.6) 1 (0.6) 4 (2.5) 2 (0.3) 8 (5)

57 ± 10 52 ± 13 0.59 ± 11 53 ± 11 56 ± 12

27 - 77 22 - 8333 27 - 94 33 - 8334 22 - 94

EP

Sex Female Male Age (years) 15-25 26-35 36-45 46-55 56-60 >60 Education Illiterate Primary school High school University Food safety training Yes No Location Port-au-Prince Pétion-ville Delmas Tabarre TOTAL

AC C

Characteristics

Number of respondents (%) <50 50-75 >75

32

35 36

*stdev = standard deviation

ACCEPTED MANUSCRIPT

37

Table 4. Effect of gender, age, education level, food safety training and location on the food safety knowledge of street food vendors 38

42 (52.5) 5 (6.3)

Mean score ± stdev*

10 (12.5) 1 (1.3)

60 ± 13 60 ± 13

Range

RI PT

19 (23.8) 3 (3.8)

39

16 - 7740 44 - 77

2 (2.5) 3 (3.8) 2 (2.5) 3 (3.8) 0 (0) 1 (1.3)

3 (3.8) 13 (16.3) 5 (6.3) 1 (1.3)

15 (18.8) 16 (20) 14 (17.5) 2 (2.5)

0 (0) 7 (8.8) 2 (2.5) 2 (2.5)

3 (3.8) 19 (23.8)

9 (11.3) 38 (47.5)

7 (8.8) 6 (7.5) 3 (3.8) 6 (7.5) 22 (27.5%)

12 (15) 14 (17.5) 12 (15) 9 (11.3) 47 (58.8)

57 ± 10 61 ± 15 59 ± 12 64 ± 12 59 ± 8 72 ± 7

38 - 78 16 - 7742 33 - 77 43 50 - 77 50 - 6644 66 - 77

58 ± 12 59 ± 13 62 ± 10 65 ± 12

16 - 72 33 - 7746 44 - 77 50 - 7747

M AN U

13 (16.3) 15 (18.8) 11 (13.8) 4 (5) 3 (3.8) 1 (1.3)

TE D

10 (12.5) 4 (5) 5 (6.3) 2 (2.5) 1 (1.3) 0 (0)

SC

41

45

48

5 (6.3) 6 (7.5)

66 ± 13 58 ± 11

38 - 77 49 16 - 77

1 (1.3) 0 (0) 5 (6.3) 5 (6.3) 11 (13.8)

58 ± 11 57 ± 12 66 ± 10 60 ± 14 60 ± 12

38 - 77 16 - 7251 50 - 77 33 - 7752 16 - 78

EP

Sex Female Male Age (years) 15-25 26-35 36-45 46-55 56-60 >60 Education Illiterate Primary school High school University Food safety training Yes No Location Port-au-Prince Pétion-ville Delmas Tabarre TOTAL

AC C

Characteristics

Number of respondents (%) <50 50-75 >75

50

53 54

*stdev = standard deviation

ACCEPTED MANUSCRIPT

55

Table 5. Effect of gender, age, education level, food safety training and location on the food safety attitudes of street food consumers 56

Characteristics

71 72

40 (25) 66 (41.3)

14 (8.8) 25 (15.6)

69 ± 11 69 ± 14

Range

57

44 - 94 58 18 - 94 59

49 (30.6) 31 (19.4) 16 (10) 4 (2.5) 3 (1.9) 3 (1.9)

15 (9.4) 15 (9.4) 5 (3.1) 2 (1.3) 2 (1.3) 0 (0)

66 ± 14 69 ± 14 70 ± 12 72 ± 10 76 ± 9 71 ± 7

19 - 93 19 - 94 60 44 - 94 61 56 - 81 62 - 88 62 62 - 75

7 (4.4) 0 (0) 1 (0.1) 7 (4.4)

51 (31.9) 10 (6.3) 11 (6.9) 34 (21.3)

11 (6.9) 3 (1.9) 13 (8.1) 12 (7.5)

75 ± 9 76 ± 11 67 ± 13 66 ± 14

62 - 94 43 - 94 64 18 - 87 18 - 94 65

1 (0.1) 14 (8.8)

11 (6.9) 95 (59.4)

6 (3.8) 33 (20.6)

73 ± 11 68 ± 13

44 - 87 66 18 - 94

2 (1.3) 7 (4.4) 3 (1.9) 3 (1.9) 15 (9.4)

24 (15) 29 (18.1) 22 (13.8) 31 (19.4) 106 (66.3)

14 (8.8) 4 (2.5) 15 (9.4) 6 (3.8) 39 (24.4)

73 ± 12 62 ± 16 72 ± 12 67 ± 10 68 ± 13

37 - 94 68 18 - 87 43 - 94 69 43 - 81 18 - 93 70

*stdev = standard deviation

EP

TE D

M AN U

10 (6.3) 3 (1.9) 2 (1.3) 0 (0) 0 (0) 0 (0)

SC

6 (3.8) 9 (5.6)

AC C

Sex Female Male Age (years) 15-25 26-35 36-45 46-55 56-60 >60 Education Illiterate Primary school High school University Food safety training Yes No Location Port-au-Prince Pétion-ville Delmas Tabarre TOTAL

Mean score ± stdev*

RI PT

Number of respondents (%) <50 50-75 >75

63

67

ACCEPTED MANUSCRIPT

73

Table 6. Effect of gender, age, education level, food safety training and location on the food safety attitudes of street food vendors 74

91

*stdev = standard deviation

29 (36.3) 5 (6.3)

1 (1.25) 1 (1.25) 1 (1.25) 1 (1.25) 0 (0) 0 (0)

13 (16.3) 13 (16.3) 10 (12.5) 3 (3.8) 3 (3.8) 0 (0)

11 (13.8) 8 (10) 7 (8.8) 5 (6.3) 1 (1.25) 2 (2.5)

0 1 (1.25) 3 (3.8) 0 (0)

9 (11.3) 9 (11.3) 21 (26.3) 3 (3.8)

0 (0) 4 (5) 2 (2.5) 2 (2.5) 0 (0) 0 (0) 4 (5%)

9 (11.3) 13 (16.3) 10 (12.5) 10 (12.5) 42 (52.5%)

73 ± 11 78 ± 9

Range

75

25 - 9376 62 - 94 77

50 - 8778 25 - 93 50 - 8779 50 - 9480 62 - 81 87 81

11 (13.8) 8 (10) 13 (16.3) 2 (2.5)

72 ± 15 72 ± 12 77 ± 8 77 ± 3

25 - 87 50 - 9383 56 - 87 75 - 8184

11 (13.8%) 23 (28.8)

80 ± 7 72 ± 12

62 - 94 25 - 9486

9 (11.3) 5 (6.3) 10 (12.5) 10 (12.5) 34 (42.5%)

74 ± 13 68 ± 14 76 ± 8 76 ± 9 73 ± 11

50 - 94 25 - 8788 56 - 87 89 62 - 94 25 - 9390

M AN U

74 ± 9 70 ± 15 75 ± 10 77 ± 11 71 ± 8 87

TE D

5 (6.3) 37 (46.3)

RI PT

38 (47.5) 4 (5)

Mean score ± stdev*

SC

4 (5) 0 (0)

EP

Sex Female Male Age (years) 15-25 26-35 36-45 46-55 56-60 >60 Education Illiterate Primary school High school University Food safety training Yes No Location Port-au-Prince Pétion-ville Delmas Tabarre TOTAL

<50

AC C

Characteristics

Number of respondents (%) 50-75 >75

82

85

87

ACCEPTED MANUSCRIPT

92

Table 7. Assessment of the food safety knowledge of street food consumers Number of responses (%)

Question

Wrong

Do not know

68 (42.5)

38 (23.7)

54 (33.7)

119 (74.4)

24 (15)

17 (10.6)

119 (74.4)

15 (9.4)

26 (16.2)

138 (86.2)

14 (8.7)

8 (5)

72 (45)

73 (45.6)

15 (9.4)

18 (11.2)

11 (6.9)

131 (81.9)

141 (88.1)

9 (5.6)

10 (6.2)

17 (10.6)

3 (1.9)

140 (87.5)

13 (8.1)

12 (7.5)

135 (84.4)

75 (46.9)

47 (29.4)

38 (23.7)

11. Using gloves while handling food reduces the risk of food contamination

99 (61.9)

49 (30.6)

12 (7.5)

12. Washing hands before work reduces the risk of food contamination

150 (93.7)

9 (5.6)

1 (0.6)

13. AIDS can be transmitted by food

124 (77.5)

18 (11.2)

18 (11.2)

89 (55.6)

60 (37.5)

11 (6.9)

96 (60)

51 (31.9)

13 (8.1)

16. Proper cleaning and sanitization of utensils increase the risk of food contamination.

115 (71.9)

41 (25.6)

4 (2.5)

17. Reheating cooked foods can contribute to food contamination

94 (58.7)

48 (30)

18 (11.2)

18. Washing utensils with detergent leaves them free of contamination

61 (38.1)

85 (53.1)

14 (8.7)

RI PT

Correct

1. Abortion in pregnant women can be induced by food-borne disease. 2. Bloody diarrhoea can be transmitted by food

4. During infectious disease of the skin, it is necessary to take leave from work.

6. Hepatitis A virus is a food-borne pathogens 7. Microbes are in the skin, nose and mouth of healthy handlers 8. Salmonella is among the food-borne pathogens 9. Staphylococcus is among the food-borne pathogens

TE D

10. Typhoid fever can be transmitted by food

M AN U

5. Eating and drinking in the work place increase the risk of food contamination

SC

3. Swollen cans can contain microorganisms

poisoning

EP

14. Children, healthy adults, pregnant women and older individuals are at equal risk for food

AC C

15. Food prepared in advance reduces the risk of food contamination

93 94

ACCEPTED MANUSCRIPT

Table 8. Assessment of the food safety knowledge of street food vendors Number of responses (%)

Question

Wrong

Do not know

47 (58.7)

15 (18.7)

18 (22.5)

75 (93.7)

1(1.2)

4(5)

61 (76.3)

11(13.7)

8 (10)

71 (88.7)

7 (8.7)

2 (2.5)

36 (45)

37 (46.2)

7 (8.7)

3 (3.7)

1 (1.2)

76 (95)

74 (92.5)

3 (3.7)

3 (3.7)

0 (0)

1 (1.2)

79 (98.7)

1 (1.2)

0 (0)

79 (98.7)

48 (60)

17 (21.2)

15 (18.7)

58 (72.5)

19 (23.7)

3 (3.7)

76 (95)

3 (3.7)

1 (1.2)

55 (68.7)

16 (20)

9 (11.2 )

58 (72.5)

15 (18.7)

7 (8.7)

63 (78.7)

11 (13.7)

6 (7.5)

16. Proper cleaning and sanitization of utensils increase the risk of food contamination.

66 (82.5)

14 (17.5)

0 (0)

17. Reheating cooked foods can contribute to food contamination

51 (63.8)

21 (26.2)

8 (10)

18. Washing utensils with detergent leaves them free of contamination

26 (32.5)

53 (66.2)

1 (1.2)

RI PT

Correct

1. Abortion in pregnant women can be induce by foodborne disease 2. Bloody diarrhoea can be transmitted by food 4. During infectious disease of the skin, it is necessary to take leave from work. 6. Hepatitis A virus is among the foodborne pathogens 7. Microbes are in the skin, nose and mouth of healthy handlers 8. Salmonella is among the foodborne pathogens 9. Staphylococcus aureus is among the foodborne pathogens

TE D

10. Typhoid fever can be transmitted by food

M AN U

5. Eating and drinking in the work place increase the risk of food contamination

SC

3. Can swollen cans contain microorganisms

11. Using gloves while handling food reduces the risk of food contamination 12. Washing hands before work reduces the risk of food contamination 13. AIDS can be transmitted by food

EP

14. Children, healthy adults, pregnant women and older individuals are at equal risk for food poisoning 15. Food prepared in advance reduces the risk of food contamination

AC C

95

ACCEPTED MANUSCRIPT

Table 9. Assessment of food safety attitudes of street food consumers Number of responses (%)

Question

Wrong

Do not know

132 (82.5)

25 (15.6)

3 (1.9)

2. Raw and cooked foods should be stored separately to reduce the risk of food contamination.

135 (84.4)

21 (13.1)

4 (2.5)

3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk

125 (78.1)

16 (10)

19 (11.9)

149 (93.1)

5 (3.1)

6 (3.7)

64 (40)

73 (45.6)

23 (14.4)

6. Wearing masks is an important practice to reduce the risk of food contamination

82 (51.2)

58 (36.2)

20 (12.5)

7. Wearing gloves is an important practice to reduce the risk of food contamination

112 (70)

45 (28.1)

3 (1.9)

8. Wearing caps is an important practice to reduce the risk of food contamination

134 (83.7)

22 (13.7)

4 (2.5)

9. Dish towels can be a source of food contamination

154 (96.2)

4 (2.5)

2 (1.2)

10. Knives and cutting boards should be properly sanitized to prevent cross contamination

154 (96.2)

3 (1.9)

3 (1.9)

11. Food handlers who have abrasions or cuts on their hands should not touch foods without gloves

142 (88.7)

9 (5.6)

9 (5.6)

12. Well-cooked foods are free of contamination

60 (37.5)

97 (60.6)

3 (1.9)

116 (72.5)

30 (18.7)

14 (8.7)

104 (65)

40 (25)

16 (10)

15. The ideal place to store raw meat in the refrigerator is on the bottom shelf

82 (51.2)

69 (43.1)

9 (5.6)

16. Eggs must be washed after purchase as soon as possible

18 (11.2)

134 (83.7)

8 (5)

RI PT

Correct

of food contamination

TE D

5. The best way to thaw a chicken is in a bowl of cold water

M AN U

4. The health status of workers should be evaluated before employment

SC

1. Proper hand hygiene can prevent food-borne diseases

14. Defrosted foods can be refrozen

AC C

products

EP

13. Can a closed can/jar of cleaning product be stored together with closed cans and jars of food

ACCEPTED MANUSCRIPT

Table 10. Assessment of food safety attitudes of street food vendors Number of responses (%)

RI PT

Question

Correct

Wrong

Do not know

75(93.75)

5(6.25)

0(0.00)

66(82.50)

14(17.50)

0(0.00)

71(88.75)

4(5.00)

5(6.25)

76(95.00)

1(1.25)

3(3.75)

41(51.25)

34(42.50)

5(6.25)

6. Wearing masks is an important practice to reduce the risk of food contamination

46(57.50)

30(37.50)

4(5.00)

7. Wearing gloves is an important practice to reduce the risk of food contamination

67(83.75)

13(16.25)

0(0.00)

8. Wearing caps is an important practice to reduce the risk of food contamination

77(96.25)

3(3.75)

0(0.00)

78(97.50)

2(2.5)

0(0.00)

80(100)

0(0)

0(0.00)

11. Food handlers who have abrasions or cuts on their hands should not touch foods without gloves.

74(92.50)

6(7.5)

0(0.00)

12. Well-cooked foods are free of contamination

18(22.5)

60(75)

2(2.5)

13. Can a closed can/jar of cleaning product be stored together with closed cans and jars of food products 14. Defrosted foods can be refrozen

62(77.50)

15(18.75)

3(3.75)

69(86.25)

9(11.25)

2(2.50)

15. The ideal place to store raw meat in the refrigerator is on the bottom shelf

39(48.75)

38(47.50)

3(3.75)

8(10)

71(88.75)

1(1.25)

1. Proper hand hygiene can prevent food-borne diseases

SC

2. Raw and cooked foods should be stored separately to reduce the risk of food contamination.

9. Dish towels can be a source of food contamination

TE D

5. The best way to thaw a chicken is in a bowl of cold water

M AN U

3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk of food contamination 4. The health status of workers should be evaluated before employment

AC C

EP

10. Knives and cutting boards should be properly sanitized to prevent cross contamination

16. Eggs must be washed after purchase as soon as possible

ACCEPTED MANUSCRIPT Table 11. Demographic characteristics of stall vendors who participated in the food practices observational study Characteristics

Number (%)

Mean ± standard deviation

Range

Male

2 (10%)

Female

18 (90%)

Age (years) 4 (20%)

30-50

12 (60%)

51-60

3 (15%)

>60

1 (5%)

42.4 ± 10.3

SC

<30

2 (10%)

Primary school

13 (65%)

Secondary school

5 (25%)

University

0 (0%)

Food safety training 6 (30%) 14 (70%)

Location Delmas Port-au-Prince Pétion-ville

AC C

Tabarre

5 (25%)

TOTAL

5 (25%)

EP

No

TE D

Yes

M AN U

Education Illiterate

5 (25%)

5 (25%)

20 (100%)

RI PT

Sex

28 - 68

ACCEPTED MANUSCRIPT

Table 12. Facilities and observed food safety practices of street food vendors

RI PT

Observation checklist item

AC C

EP

TE D

M AN U

SC

Facilities 1. What material is the structure made of were the food sold: Zinc/iron Canopy Container Wooden table 2. Where is the food prepared : At home On site 3. Is vending stall protected from sun Animals or pests flies etc. evident around the vending stall 4. Is the vending stall maintained in a clean condition 5. Is there access to potable water at the site or close to the site 6. Are there adequate hand washing facilities available 7. Are there adequate waste water or food disposal facilities available Environment around the stall 8. Is the environment around the stall clean i.e. far from rubbish, waste water, toilet facilities, open drains and animals Personal hygiene 9. Does the operator wash their hands in clean water each time before the handling, preparation and serving of food 10. Does the operator wash their hands each time after visiting the toilet 11. Are the operators clothes clean and presentable 12. Does the operator use an apron when handling, preparing and serving of food 13. Does the operator handle food with bare hands 14. Are the nails of the operator clean and short 15. Is the hair of the operator covered when handling preparing and serving of food 16. Does the operator handle money while serving food

Observation (%) Yes No

2 (10) 9 (45) 1 (5) 7 (35)

0 (0) 0 (0) 0 (0) 0 (0)

3 (15) 17 (85) 3 (15) 12 (60) 15 (75) 7 (35) 4 (20) 4 (20)

(0) (0) 17 (85) 8 (40) 5 (25) 13 (65) 16 (80) 16 (80)

15 (75)

5 (25)

9 (45)

11 (55)

20 (100) 20 (100) 8 (40) 16 (80) 18 (90) 13 (65) 16 (80)

(0) (0) 12 (60) 4 (20) 2 (10) 7 (35) 4 (20)

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

If answer to Q14 is yes: are the hands washed after handling money before handling food again? 17. Is dirt or dust is removed by means of: An apron Bare (uncovered) hands Dirty cloth Clean cloth 18. Does the operator wear jewellery during the handling of food If answer to Q18 is yes: is the jewellery adequately covered 19. Does vendor smoke during the handling of food 20. Does the operator use the same utensil knives and boards to prepare raw and cooked food Food storage 21. Is the food stored/displayed in sealed containers 22. Are raw, partially cooked and cooked food products kept separate 23. Are previously cooked foods kept cool i.e. in an ice box or refrigerator Utensils 24. Are utensils covered 25. Are utensils cleaned adequately every time after use 26. Are the utensils cleaned with soapy water

1 (6.3)

15 (93.8)

2 (10%) 1 (5%) 6 (30%) 11 (55%) 4 (20) 1 (25) 0 (0) 4 (20)

(0) (0) (0) (0) 16 (80) 3 (75) 20 (100) 16 (80)

12 (60) 20 (100) 6 (30)

(0) (0) 14 (70)

11 (55) 19 (95) 20 (100)

9 (45) 1 (5) 0 (0)

ACCEPTED MANUSCRIPT 1

HIGHLIGHTS Samapundo et al.

2

-

Food safety knowledge, attitudes, and practices were evaluated in Port-au-Prince

4

-

160 consumers and 80 vendors from four different communes participated

5

-

Consumers and vendors exhibited average food safety knowledge and attitude levels

6

-

Vendors generally have higher levels of food safety knowledge than consumers

7

-

Street food vendors in Port-au-Prince operate under largely unhygienic conditions

RI PT

3

SC

8 9

AC C

EP

TE D

M AN U

10