FOOD HYGIENE PRACTICES AMONG FOOD HANDLERS IN AHMADU BELLO UNIVERSITY (A.B.U.), ZARIA.
ABSTRACT
Food hygiene is a subject of great concern to anyone who cares about eating healthy and staying alive because the import of food borne illness can occasionally be grave. This research work was carried out among food handlers in Ahmadu Bello University (A.B.U.), Zaria, Kaduna state of Nigeria; it sought to assess the level of knowledge of food hygiene among food handlers, attitude of food handlers towards hygiene, practice of food hygiene by food handlers, the nature and frequency of medical examination(s) the handlers undergo and to also to screen the food handlers to detect those who might be harbouring Salmonella species in their alimentary canal, an organism that can cause food poisoning under favourable conditions.
 A cross-sectional descriptive study was carried out involving 174 food handlers who met the inclusion criteria. Data was collected via the use of pre-tested questionnaires with the aid of research assistants and analysed using statistical package for social sciences (SPSS) version 15.0.
 The mean age of respondents was 34.47 ± 13.92 years. Knowledge of food hygiene was good among the handlers (94.3%) likewise the attitude (75.9%) but good practice was practiced by very few food handlers (0.6%) whereas majority of them had fair practice (76.4%). More food handlers had periodic medical examination than those who had pre-employment medical examination; 67.1% and 28.3% respectively. Stool microscopy and culture revealed that 2 of the handlers were asymptomatic carriers of Salmonella, typhimurium and 1 handler was a carrier of Escherichia, coli. Statistical testing with Chi-square at p<0.05 showed that educational level of the handlers had no direct effect on the practice of food hygiene; likewise attitude of handlers towards food hygiene and duration of stay had no impact on food hygiene practices of food handlers. From observation, only a few of the handlers (36.4%) wash hand frequently in the course of handling food and only 22.7% of the food establishments, had 50% or more food handlers that wore protective over-clothing.
 It was concluded that practice of food hygiene was fair and a lot of effort has to be put in the areas of medical examination of the food handlers and personal hygiene like hand washing and wearing of protective cover-clothing.
      TABLE OF CONTENT    
Chapter One    
1.0    Introduction    
1.1    Definition of terms    
1.2    Problem statement    
1.3    Justification    
1.4    Aim and objectives    
Chapter two    
2.0    Literature review (Introduction)    
2.01    Food hygiene    
 Food handlers‟ knowledge, attitude and practice of food hygiene;
      a review of literatures    
2.1.1   Knowledge of food hygiene    
2.1.2    Attitude of food handlers towards food hygiene    
2.1.3    Food hygiene practices among food handlers    
 2.20   Food poisoning (an overview)    
 Standard food hygiene practices, food handlers‟ hygiene and
     environmental hygiene    
2.40    Food policy    
2.50    Regulatory agencies    
 Future directions for food safety at the World Health Organization (WHO) 35
 Chapter Three
 3.0    Methodology    
3.1    Background information on the study area    
3.2    Study design    
3.3    Study population    
3.3.1    Inclusion criteria    
3.3.2    Exclusion criteria    
3.4    Sample size    
3.5    Tool(s) for data collection    
3.6    Data collection    
3.7    Data analysis    
3.8    Ethical consideration    
3.9    Limitation    
 Chapter four
 4.0    Results                                                                     Chapter five
 5.0    Discussion                                                                 
 Chapter six
 6.1    Summary    
6.2    Conclusion    
6.3    Recommendations    
     References    
     Appendices    
 LIST OF ABBREVIATIONS
  A.B.U.                       Ahmadu Bello University (in Zaria, Kaduna state, Nigeria)
 C.D.C.                       Centre for Disease Control
 F.A.O.                       Food and Agricultural Organization
 FS(GFH)R                   Food Safety (General Food Hygiene) Regulations
 G.A.P.                       Good Agricultural Practice
 H.A.C.C.P.                  Hazard Analysis Critical Control Point
 L.G.A.                        Local Government Area
 N.A.F.D.A.C.               National Agency for Food, Drug Administration and Control
 N.G.O.                       Non Governmental Organization
 S.O.N.                       Standard Organization of Nigeria
 U.S.A.                       United State of America
W.H.O.                      World Health Organization
           LIST OF TABLES                   
Table 1    Socio-demographic characteristics of the food handlers         
Table 2    Knowledge of food hygiene amongst the food handlers         
Table 3    Attitude of food handlers towards food hygiene              
Table 4    Practice of food hygiene among the food handlers              
Table 5    Medical examination of food handlers                   
Table 6    General physical examination of the handlers                   
Table 7    Findings from stool microscopy, culture and sensitivity         
Table 8    Crostabulation between practice of food hygiene and educational level    
Table 9    Crostabulation    between    practice    of    food    hygiene    and
     attitude of food handlers towards food hygiene              
Table 10    Crostabulation between practice of food hygiene and duration of stay in food
     handling business                             
Table 11    Analysis of items in the observational checklist              
Table 12    Observation grading of hygiene practices in the restaurants         
 LIST OF FIGURE(S)
 Fig 1   Length of stay in food handling business among the food handlers    
LIST OF APPENDICES
 Appendix A:  Questionnaire
 Appendix B:  Observational checklist
 Appendix C:  Copy of the letter of approval from the university health department
 Appendix D:  A research assistant interviewing a food handler
  Appendix E:   The   cooking   arena   of   one   of   the   restaurants   in   Kongo   campus.
 CHAPTER ONE
 INTRODUCTION
 Food hygiene practices is a subject of wide scope and it is a broad term used to describe the preservation and preparation of foods in a manner that ensures the food is safe for human consumption.1 Food hygiene deals with the prevention of contamination of food stuffs at all stages of production, collection, transportation, storage, preparation, sale and consumption. Food borne illness is defined as a disease, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food.2 This process of kitchen safety includes proper storage of food items prior to use, maintaining a clean environment when preparing the food, and making sure that all serving dishes are clean and free of bacteria that could lead to some type of contamination. The food storage aspect of food hygiene is focused on maintaining the quality of the food, so that it will be fresh when used in different recipes. Food safety is a scientific discipline describing handling, preparation, and storage of food in ways that prevent foodborne illnesses.3 This include the number of routines that should be followed to avoid potentially severe health hazards. Food can transmit diseases from one person to the other as well as serve as a growth medium for bacteria that can cause food poisoning.
 Debates on genetic food safety include such issues as impact of genetically modified food on health of further generations and genetic pollution of environment, which can destroy natural biological diversity. In developed countries, there are intricate standards for food preparation, whereas in lesser developed countries, the main issue is simply the availability of adequate safe water, which is usually a critical item. In theory, food poisoning is hundred percent (100 %) preventable.3 Food sanitation also extends to keeping the preparation area clean and relatively germ-free. Mixing bowls, spoons, paring knives and any other tools used in the
kitchen should be washed thoroughly before use. Kitchen countertops and cutting boards should also be cleaned and sterilized from time to time. Keeping a sanitary workplace will also cut down on the chances of some type of foodborne illnesses from developing when people consume a prepared food.
 Food contamination occurs most commonly from excreta on people‟s fingers, flies etc (i.e. faeco-oral transmission). Food contamination may also occur by skin infection especially the hands of food-handlers (staphylococcal food poisoning), consumption of diseased animals (tape worm, brucellosis etc) or chemicals used as pesticides on crops.
 Every person is at risk of foodborne illness. It is a widespread and growing public health problem both in developed and developing countries; the effect being more devastating in developing countries.2 Consumers have a reasonable expectation that the foods they purchase have been produced and processed under hygienic condition and that the food has not been adulterated by addition of any biological, chemical, or physical hazard. These expectations are regularly enforced by regulations that govern production, processing, distribution and retailing of foods and drugs in any country. In Nigeria for example, this task is performed by National Agency for Food Drug Administration and Control (NAFDAC).
 So much emphasis is placed on food safety that necessitated the World Health Organization (WHO) formulating a general principle2 of food hygiene which basically are:
 Prevent contaminating food with pathogens spreading from people, pets and pests.
 Separate raw from cooked foods to prevent contaminating the cooked food.
 Cook food for the appropriate length of time and at the appropriate temperature to kill pathogens.
 Store food at the proper temperature.
 Use safe water and raw materials.
 DEFINITION OF TERMS
 Cleaning- The removal of soil, food residue, dirt, grease or other objectionable matters from surfaces of plates, spoons, cutleries, utensils etc.
 Contaminant- Any biological or chemical agent, foreign matter, or other substances not intentionally added to food which may compromise food safety or suitability.
 Contamination-  The  introduction  or  occurrence  of  a  contaminant  in  food  or  food environment.
 Disinfection- The reduction, by means of chemical agents and/or physical methods, of the number of micro-organisms in the environment, to a level that does not compromise food safety or suitability.
 Establishment- Any building or area in which food is handled and the surroundings under the control of the same management.
 Food hygiene- All conditions and measures necessary to ensure the safety and suitability of food at all stages of the food chain.
 Hazard- A biological, chemical or physical agent in, or condition of, food with the potential to cause an adverse health effect.
 HACCP (Hazard Analysis and Critical Control Point) - A system that identifies, evaluates, and controls hazards which are significant for food safety.
 Food handler - Any person who directly handles packaged or unpackaged food, food equipment and utensils, or food contact surfaces and is therefore expected to comply with food hygiene requirements.
 Food safety- Assurance that food will not cause harm to the consumer when it is prepared and/or eaten according to its intended use.
 Food suitability- Assurance that food is acceptable for human consumption according to its
 intended use.
 Primary production - Those steps in the food chain up to and including harvesting, slaughtering, milking, fishing etc.
 Food premise - Any permanent or semi permanent facility that stores, prepares or handles
 food.
 Food poisoning - Is an illness affecting our digestive system that result from eating food or drinking water contaminated by bacteria, bacterial toxins, or less commonly by residues of insecticides (on fruits and vegetables), or poisonous chemical such as lead, mercury, etc. it can also be caused by ingestion of fungi, berries, etc. that irritates the digestive system.4
 PROBLEM STATEMENT
 Food, being the most important and only substance that is universally consumed by all humans and animals to stay alive, need to be handled or safe guarded properly because contamination anywhere along the food chain can have far reaching effects and sometimes fatal consequences. Food borne illnesses is a burden in terms of incapacitating people, causing discomfort, cost of pain, grief and suffering, disruption to industry and commerce and strain on the health service.5
 On 11th of August 2010, the Minister of Health of the Caribbean stated that during the years 2000-2005, over 55 outbreaks of food and water borne illnesses involving over 26,000 guests and staff from 14 Caribbean island countries were reported to the Caribbean Epidemiology Centre.
 The global incidence of foodborne disease is difficult to estimate, but it has been reported that in 2005 alone, 1.8 million people died from diarrhoeal diseases.2 A great proportion of these cases can be attributed to contamination of food and drinking water. Diarrhoea is a major cause of malnutrition in infants and young children. About 30% of populations of industrialized countries suffer from foodborne disease yearly.2
 Globally, food contamination creates an enormous social and economic burden on communities and their health systems. In USA, diseases caused by major food pathogens are estimated to cost up to 35 billion US Dollar annually in medical cost and lost productivity. The re-emergence of cholera in Peru in 1991 resulted in the loss of 500 million US Dollars in fish and fishery product export that year.2
 A 2003 WHO report concluded that about 40% of reported food poisoning outbreaks in WHO European region occur in private homes.2 According to the WHO and Centre for Disease Control (CDC), in the USA alone annually there are 76 million cases of foodborne illnesses leading to 325,000 hospitalization and 5,000 deaths.2 In 1994, an outbreak of Salmonella food poisoning due to contaminated ice cream occurred in the USA affecting an estimated 224,000 persons.2 In 1988, an outbreak of Hepatitis A, resulting from the consumption of contaminated clams, affected some 300,000 individuals in China. While less well documented, developing countries bear the brunt of the problem due to the presence of a wide range of foodborne diseases, including those caused by parasites. The high prevalence of diarrhoeal disease in many developing countries suggests major underlying food safety problems.2 In Nigeria, it was stated in 2008 that over 20,000 Nigerians die annually and over 3 million cases of acute food poisoning are recorded yearly due to exposure of food to pesticides that are wrongly used by farmers.6
JUSTIFICATION
 Food hygiene is a business of serious concern not only to developing countries but also to developed countries because the ill-effect of contaminated food, when ingested, may be so devastating. In the event of an outbreak of food borne illness, not only do humans suffer, the economy, useful manpower, the health facilities etc are all strained; this is evidenced from the few examples above whereby huge amount of wealth is being sunk in managing food poisoning.
 A survey to find out the food safety knowledge of street food vendors in Abeokuta, Ogun state was carried out involving 87 vendors.7 Only 12% had formal knowledge on food preparation; 31% had annual medical health certificate. Most of them only consider volume and price rather than freshness and cleanliness when buying raw materials for cooking. Some of the food safety knowledge cannot be translated to practice due to the absence of basic facilities such as water and toilets at their vending sites.7
 Food poisoning killed ten (10) secondary school teachers and hospitalized several others in the northern Nigeria town of Katsina on June 1st, 2011. The teachers became ill shortly after eating lunch during a weekend workshop for some six hundred and fifty (650) teachers organized by the state Ministry of Education, reported the Nigerian Tribune on Wednesday, 1st of June, 2011.8
 In Nigeria, food and water borne diarrheal disease does occur in epidemic proportion, resulting in large number of avoidable deaths. An institution like Ahmadu Bello University can‟t afford to be caught napping as far as food hygiene is concerned looking at its position in the committee of tertiary institutions. She has a huge responsibility in keeping both her students and staff safe from the adverse consequences of food poisoning. There has not been proper documentation of cases of food borne diseases in Ahmadu Bello University (ABU),
 Zaria, in the last few years. For the reasons noted earlier on, a study into ABU‟s food handlers‟ hygiene practices seems highly justifiable.
 AIM AND OBJECTIVES
 The general aim of this research is to determine the type and level of food hygiene practices adopted by food handlers in ABU, Zaria, Kaduna state, Nigeria.
 The specific objectives are:
  To assess the level of knowledge of food hygiene among the food handlers in A.B.U, Zaria;
 To assess the attitude of food handlers towards food hygiene;
 To assess the practice of food hygiene the food handlers adopt while running their business;
 To investigate the type of medical examination that is being done before a new food handler is taken and periodic examination being done;
 To screen the food handlers for asymptomatic carriers of Salmonella specie(s); important pathogen(s) that could cause food poisoning.