KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY, KUMASI, GHANA Assessment of food hygiene practices by street food vendors and microbial quality of selected foods sold. A study at Dunkwa-On-Offin, Upper Denkyira East municipality of the Central Region. by Boateng Acheampong Emmanuel (B.A Nursing and Psychology). A thesis submitted to the Department Of Community Health, College Of Health Sciences in partial fulfillment of the requirements for the degree of MSc. PUBLIC HEALTH NOVEMBER, 2014 KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH BOATENG ACHEAMPONG EMMANUEL. PG (20251004) A THEIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES, KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE DEGREE OF MASTER OF SCIENCE IN HEALTH EDUCATION AND PROMOTION NOVEMBER, 2014 ii DECLARATION I hereby declare that this project work is the result of my own original research and that no part of it has been presented for another degree in this university or elsewhere. Emmanuel Acheampong Boateng ………………… ………………… PG (20251004) Signature Date Dr. Ellis Owusu -Dabo ………………… ………………… (Supervisor) Signature Date Dr. Anthony K. Edusei ………………… ………………. The Head of Department Signature Date iii ABSTRACT Globally, the estimated amount of food found to be contaminated from street vendors particularly in developing countries is on the ascendancy. It is however unclear, the contribution unhygienic practices make to food contamination. This study sought to assess knowledge and practices of food vendors as well as the microbial quality of selected food sold by street food vendors in Upper Denkyira East Municipality in the Central region of Ghana. The study was cross sectional and systematically recruited 423 food vendors using a systematic sampling method. A structured questionnaire was administered and an observational checklist was used to gather data on the environmental and personal hygiene status of food vendors. Data collected on 423 respondents were entered into an SPSS version 16.0 software, edited and subsequently used for multivariate analysis. The Student t-test was used to compare continuous variables and the Pearson Chi- square test for discrete variables. Logistic regression was done to establish association between variables and food contamination. This study among other findings showed that there was a statistically significant association between considerations for choosing food stuff, where food is prepared, medical examination of food vendors, constant supply of water, use of food additives and microbial quality. There was also a significant association between place of storing cooked food, frequency of washing eating plates, frequency of changing water for washing plates and microbial quality. It was also observed that 84.0% of food vendors used the same hands to serve and collect money, 30.3% had not been given certificate to sell and 89% used their bare hands to serve or dish out food. The study revealed that of the 216 food samples collected, fecal coliforms were isolated in 128 (59.3%), iv Escherichia coli in 90 (41.7%), Salmonella typhi in 26 (12.0%) and Staphylococcus aureus in 134 (62.0%). The study confirmed that there was a problem with contamination of street foods within Dunkwa-On-Offin and regular training and medical examination of street food vendors within the municipality should be done to ensure food hygiene. v ACKNOWLEDGEMENTS I would like to thank and acknowledge the following parties for the generous support and kind assistance they provided me with during the course of my study at the Kwame Nkrumah University of Science and Technology:  the Upper Denkyira East Municipal Assembly for their immense support and contribution  the Upper Denkyira East Municipal Health Directorate  Study participants  Research assistants  the Ghana Standard Authority –Kumasi office  the Ghana Standard Authority –Accra office  Upper Denkyira East -Environmental Health Officers  the KATH Research Unit  the Laboratory Technicians at the Biological Science Department of Kwame Nkrumah University Technology vi DEDICATION This study is dedicated to my supervisor, Dr. Ellis Owusu-Dabo for providing me with the support and encouragement to complete the research work. I wish to gratefully thank the Lord God for all His blessings, generosity and mercy upon me. vii ABBREVIATIONS CDC Centers for Disease Control CPHP Centre for Public Health Practice EHP Environmental Health Practitioner FAO The Food and Agriculture Organization GHS The Ghana Health Service GSA The Ghana Standard Authority HACCP Hazard Analysis & Critical Control Point HAM Health Action Model JHS/SHS Junior High School/ Senior High School KAP Knowledge, Attitude & Practices MOH The Ministry of Health NGO Non Governmental Organizations SFVs Street Food Vendors SPSS Statistical Package for Social Solutions UDE Upper Denkyira East WHO The World Health Organization of the United Nations viii TABLE OF CONTENT DECLARATION .......................................................................................................... iii ABSTRACT ................................................................................................................... iv ACKNOWLEDGEMENTS .......................................................................................... vi DEDICATION .............................................................................................................. vii ABBREVIATIONS .................................................................................................... viii TABLE OF CONTENT ................................................................................................ ix LIST OF TABLES ....................................................................................................... xii LIST OF FIGURES ................................................................................................... xiii CHAPTER ONE ............................................................................................................. 1 Introduction .................................................................................................................... 1 1.1 Statement of problem ................................................................................................. 2 1.2 Research Questions .................................................................................................... 4 1.3 Main objective ............................................................................................................ 5 1.4 Specific objectives ...................................................................................................... 5 1.5 Conceptual Framework .............................................................................................. 6 1.6. The significance of the study .................................................................................... 6 CHAPTER TWO ............................................................................................................ 7 Literature review ............................................................................................................ 7 2.1 Microbial quality ........................................................................................................ 7 2.1.1 The potential of food-handling personnel to transmit diseases via food. .............. 11 2.1.2. Classification of food-handling personnel according to the potential risk ........... 12 2.1.3 Excretion of pathogens .......................................................................................... 13 2.1.4 Transmission of pathogens - Environmental hygiene ........................................... 14 2.1.5 Personal Hygiene ................................................................................................... 16 2.1.6 Food and Quality ................................................................................................... 17 2.2 Source of food contamination .................................................................................. 20 2.3 Food hygiene knowledge and practices ................................................................... 26 ix CHAPTER THREE ..................................................................................................... 37 Methodology ................................................................................................................. 37 3.1 Introduction .............................................................................................................. 37 3.2 Background of the Study Area ................................................................................. 37 3.3 Research Design: ...................................................................................................... 39 3.4 Data Collection Techniques ..................................................................................... 39 3.5 Study population, sample size and sampling technique ........................................... 40 3.5.1 Sampling of food vendors ..................................................................................... 40 3.5.2 Food sampling ....................................................................................................... 41 3.6 Laboratory materials and methods ........................................................................... 42 3.6.1 Quality checks / controls ....................................................................................... 43 3.7 Study variables ......................................................................................................... 44 3.8 Pre-testing of instruments ......................................................................................... 45 3.9 Data analysis method ............................................................................................... 46 3.10 Ethical consideration .............................................................................................. 46 3.11 Limitation of the study ........................................................................................... 46 3.12 Justification and description of selected foods ....................................................... 47 3.13 Assumptions ........................................................................................................... 48 3.14 Operational Definitions .......................................................................................... 48 CHAPTER FOUR ........................................................................................................ 50 Results ........................................................................................................................... 50 CHAPTER FIVE .......................................................................................................... 66 Discussion of findings ................................................................................................... 66 5.1 Relevant background of food vendors ..................................................................... 66 5.1.1 Medical examination and food vendors ................................................................ 68 5.1.2 Mandate to Sell ...................................................................................................... 69 5.2 Proportion of food vendors trained .......................................................................... 70 5.3 Means of contaminating food ................................................................................... 70 5.3.1 Means of contaminating ........................................................................................ 70 5.3.2 Preparation of food ................................................................................................ 71 5.3.3 Source of meat ....................................................................................................... 71 5.3.4 Water supply ......................................................................................................... 72 x