Faculty of Bioscience Engineering
Academic year 2012-2013
Microbial safety aspects of street foods in Haiti
RUTH CLIMAT
Promoter: Prof. dr. ir. Frank Devlieghere
Co-promoter: Dr. Simbarashe Samapundo
Master’s dissertation submitted in partial fulfillment of the requirements for the
degree of Master of Science in Nutrition and Rural Development
Main subject: Human nutrition
Major: Public health
Copyright
“The author and the promoter give permission to put this Master’s Dissertation to disposal for
consultation and copy parts of it for personal use. Any other use falls under the limitations of
copyright regulations, in particular to explicitly mention the source when citing parts of this
Master’s dissertation”.
Ghent University, 22th May 2013
_____________________
__________________________
Ruth Climat
Dr. Simbarashe Samapundo
_____________________________
Prof. dr. ir. Frank Devlieghere
Acknowledgments
I would like to acknowledge my supervisor Dr. Simbarashe Samapundo for his valuable support,
contribution and assistance all the way in the preparation of that master dissertation. My thanks
also go to my promoter Prof. dr. ir. Frank Devlieghere for giving me that great opportunity to
work in the lab and to analyze my samples. Appreciation is also due to a wonderful lady Mrs.
Ramize Xhaferi1 without whom the realization of the microbiology analysis wouldn’t be
possible.
My gratitude also goes to all my fellow students specially Gwao Omari Gwao whom in one
manner or another have given me their time and encouragements throughout the realization of
my work.
In addition, I would like to think the Human Nutrition and rural development staff: Mrs. ir.
Anne-Marie Remaut-De Winter and Mrs. Marian Mareen2 for being always there for
suggestions, advice and encouragements.
I would also like to express my sincere gratitude to VLIR-UOS for their generous financial
support of this master.
I would also like to thank all the street vendors who kindly gave me their approbation to carry on
the observation for the realization of this Master Dissertation.
Finally, I would like to thank my Family and my God who have never let me down in anything.
1
Laboratory assistant Flanders' Food Department of Food Safety and Food Quality 2
MSc. Nutrition and Rural Development i
Table of Content
1. INTRODUCTION ......................................................................................................................................... ‐ 1 ‐ 1.1. 1.2. 2. LITERATURE REVIEW ................................................................................................................................. ‐ 3 ‐ 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 3. JUSTIFICATION OF THE STUDY ........................................................................................................................... ‐ 1 ‐ MAJOR OBJECTIVES OF THE STUDY .................................................................................................................... ‐ 2 ‐ INTRODUCTION ............................................................................................................................................. ‐ 3 ‐ FOOD SAFETY KNOWLEDGE AND ATTITUDES ........................................................................................................ ‐ 3 ‐ FOOD HANDLING AND PRACTICES ...................................................................................................................... ‐ 6 ‐ OVERVIEW OF STREET‐VENDED FOODS ............................................................................................................... ‐ 7 ‐ MICROBIAL QUALITY OF STREET FOODS .............................................................................................................. ‐ 9 ‐ CONCLUSION .............................................................................................................................................. ‐ 11 ‐ MATERIALS AND METHODS ..................................................................................................................... ‐ 13 ‐ 3.1. MATERIALS ................................................................................................................................................ ‐ 13 ‐ 3.1.1. Food safety knowledge and attitude questionnaire ..................................................................... ‐ 13 ‐ 3.1.2. Food handling observation checklist ............................................................................................ ‐ 14 ‐ 3.1.3. Food samples ................................................................................................................................ ‐ 14 ‐ 3.2. METHODOLOGY .......................................................................................................................................... ‐ 15 ‐ 3.2.1. Food safety knowledge and attitude questionnaire ..................................................................... ‐ 15 ‐ 3.2.2. Food practices observation check list ........................................................................................... ‐ 15 ‐ 3.2.3. Food samples collection and analysis ........................................................................................... ‐ 16 ‐ 3.2.4. Partial Confirmation techniques for pathogens ........................................................................... ‐ 17 ‐ 3.3. DATA ENTRY AND DOCUMENTATION ............................................................................................................... ‐ 18 ‐ 3.4. STATISTICAL ANALYSIS .................................................................................................................................. ‐ 19 ‐ 4. RESULTS AND DISCUSSION ...................................................................................................................... ‐ 21 ‐ 4.1. FOOD SAFETY KNOWLEDGE AND ATTITUDE RESULTS ............................................................................................ ‐ 21 ‐ 4.2. OBSERVED FOOD HANDLING HABITS .................................................................................................................... 37 4.3. MICROBIAL ANALYSIS RESULTS ........................................................................................................................... 42 4.3.1. Description of street foods evaluated in this study ........................................................................... 42 4.3.2. Range of pH and water activity of the street foods ........................................................................... 44 4.3.3. Microbiological quality of Haitian street foods ................................................................................. 47 5. CONCLUSIONS ............................................................................................................................................. 53 REFERENCES ......................................................................................................................................................... 54 ANNEXES ............................................................................................................................................................... 1 ANNEX 1: STUDY LOCATION .......................................................................................................................................... 1 ANNEX 2: FOOD SAFETY KNOWLEDGE AND ATTITUDE QUESTIONNAIRE .................................................................... 2 ANNEX 3: FOOD SAFETY OBSERVATION CHECKLIST ...................................................................................................... 4 ANNEX 4: CONSENT FORM ............................................................................................................................................ 7 ii
Abstract
Street foods are an integral part of the society in the developing world and in Haiti as such.
However, questions marks remain on their safety especially microbiologically. In Haiti, there are
no specific regulations of the street food business and no study has been done yet to evaluate
their quality. This study was a survey to assess the microbial quality of Haitian street foods in the
metropolitan area of Port-au-Prince. It contained three main aspects. The first part focused on
assessing the food safety knowledge and attitudes of vendors and consumers of street foods, the
second part assessed the food handling practices of the street vendors in Port-au-Prince, whilst
the last part analysed the microbial quality of the food sold in the streets. Materials and
methods: consumers, street food vendors, stalls and samples of street foods were selected
randomly in four different areas in the metropolitan area of Port-au-Prince with the criteria based
on voluntary participation and recruitment in the most frequented places (crossroads, close to
school, markets, and parks). A Questionnaire and a checklist were used to collect the data from
July to August 2012. In total, 160 consumers and 80 vendors participated in the study; 20 stalls
were observed and 77 food samples were collected. Results: Of the 160 consumers, who
participated in the study, 62.5% were male and 88.7% did not have any training in food safety
while 88.7% of the vendors were women, the majority (78.7%) did not have any food safety
training and 67.5% did not have a middle school education. In general consumers and vendors
exhibited average food safety knowledge and attitude although they had a better food safety
attitude compare to knowledge. No statistical difference was found on the basis of gender,
training, level of education and location for consumers ‘food safety knowledge. However, for
vendors, their scores were higher compared to consumers and trained vendors also demonstrated
better food safety knowledge and attitude compare to untrained vendors. A surprizing finding
was that consumers with primary education showed better food safety attitude than those who
went to high school and university. It was observed as well that consumers from the districts of
Delmas and Port-au-Prince had a higher score compared to the district of Pétion-ville.
Consumers and vendors did not know that hepatitis A, Salmonella spp. and Staphylococcus spp.
are pathogens responsible of foodborne diseases. They also had some difficulties in identifying
the groups at risk of foodborne diseases and most importantly they were not aware of the
importance of reheating food to fight against foodborne diseases. On the other hand the majority
of vendors and consumers were aware of the importance of hand washing and proper cleaning in
prevention of foodborne diseases. In the observational part of the study, it was found that most of
the stalls consisted of parasol or a table set in the middle of the street. In 85% of the cases the
food was prepared on site. In 60% of the cases, flies and animals were evident around the stall
and 65% did not have access to potable water. The majority served the food with bare hands and
did not wash their hands after touching money. 70% of the vendors did not keep pre-cooked food
at an appropriate temperature. The microbial analysis of the food samples that were collected
revealed that anaerobes and acid lactic bacteria were present in 53% of the samples. 62% were
contaminated with aerobes bacteria. 12.5%, 7.3% and 7% of the samples had total aerobic,
iii
anaerobic and lactic acid bacteria counts above the acceptable limit (107CFU/g), respectively.
Presumptive B. cereus group spp. were identified in 13% (10) of the samples, however, the
presence of B. cereus was confirmed in only one sample. The other ones consisted of Bacillus
pumilus and Bacillus megaterium. Only one of the 9 selected presumptive S. aureus isolates
(11.1%) was identified as S. aureus. The presence of Listeria monocytogenes was not confirmed
in the samples evaluated. E. coli was confirmed in two samples and none of the presumptive
positive Salmonella isolates was confirmed as Salmonella spp. In conclusion, although the
majority of consumers and vendors exhibited average food safety knowledge and attitude, only
few of them had a score higher than 75% which means food safety knowledge and attitude still
need to be addressed in the country. The conditions in which street vendors operated in Port-auPrince are precarious with no access to potable water and toilet facilities and an effort should be
made to improve their conditions. Although foodborne pathogens were confirmed in only a few
samples, the high count of total aerobes, anaerobes and acid lactic acid bacteria observed in the
samples correlate to the low hygienic conditions in which the food is prepared.
Key words
Street foods, attitude, knowledge, handling, practice, food safety, consumer, vendor, microbial
analysis, observation
iv
Listoftables
Table 3-1 Selective media for microbial analysis .................................................................................. - 17 - Table 4-1 Demographic characteristics of street food consumers in Haiti ............................................ - 21 - Table 4-2 Demographic characteristics of vendors ................................................................................ - 22 - Table 4-3 Consumer food safety knowledge .............................................................................................. 26 Table 4-4 Vendor food safety knowledge score ........................................................................................ 27 Table 4-5 Consumer food safety attitudes score ........................................................................................ 27 Table 4-6 Vendor food safety attitudes ....................................................................................................... 29 Table 4-7 Assessment of consumers' food safety knowledge ..................................................................... 33 Table 4-8 Assessment of vendors' food safety knowledge ......................................................................... 34 Table 4-9 Assessment of consumers' food safety attitude .......................................................................... 35 Table 4-10 Assessment of vendors' food safety attitude ............................................................................. 36 Table 4-11 Demographic characteristics of stall' vendors .......................................................................... 37 Table 4-12 Food safety observation checklist............................................................................................. 40 Table 4-13 Summary of the street foods evaluated in this thesis ................................................................ 42 Table 4-14 Overview of cooking methods, handling and possible sources of contamination of collected
food ............................................................................................................................................................. 43 Table 4-15 pH and water activity (aw) of the street foods evaluated in this thesis...................................... 45 Table 4-16 General microbial quality of Haitian street foods..................................................................... 45 Table 4-17 Microbial quality of different groups of Haitian street foods ................................................... 46 Table 4-18
Confirmed microorganisms in positive plates ....................................................................... 48 v
Acronymsandabbreviations
CDC
Center for Disease Control
CFU
Colony Forming Units
EFSA
European Food Safety Authority
FAO
Food and Agriculture Organization
FBD
Food Borne Disease
ICMSF
International Commission on Microbiological Specifications for Foods
IHSI
Institut Haïtien de Statistique et d’Informatique
MRS
Man, Rogosa and Sharpe agar
MSA
Mannitol Salt Agar
MSPP
Ministère de la Santé Publique et de la Population
MYP
Mannitol egg Yolk Polymyxin agar
PAHO
Pan American Health Organization
PCA
Plate Count Agar
PPS
Physiological Peptone Saline solution
RTE
Ready To Eat food
TSA
Tryptone Salt agar
USA
United States of America
USDA
United States Department of Agriculture
VRBA
Violet Red Bile Agar
WHO
World Health Organization
vi
1.
Introduction
Foodborne diseases (FBDs) comprise a large group of illnesses that are caused by the ingestion
of contaminated food (WHO, 2013). The infectious agents range from a multitude of
microorganisms to some chemical hazards.
It has been shown that Street-vended foods have been implicated in outbreaks of foodborne
illnesses all around the world (Dawson and Canet, 1991; Bryan et al., 1992b; CNN, 1999). In
1988, 14 deaths were reported in Malaysia because of foodborne diseases related to street foods,
same year 300 persons became ill in Hong Kong after consumption of street vended foods; in
1981 a cholera epidemic in Pune, India was linked to consumption of street vended juice; In
1987 in Singapore, an outbreak of cholera has been also attributed to street foods (FAO, 1990).
According to Rane (2011), the poor knowledge and improper food handling of street vendors in
basic food safety measures and poor knowledge and awareness among consumers on the
potential hazards associated with certain foods could explain the health and safety issues that
street foods may pose (Rane, 2011).
1.1.
Justification of the study
Foodborne diseases represent a major concern in developing countries and Haiti is no exception.
Infectious intestinal diseases represent the third leading cause of death in Haiti (PAHO, 2007).
Typhoid fever is responsible for 2.8% of deaths in children aged 5–9 years, 8.9% in the 10–14
age group, 3.2% in the 15–19 age group, and 1.5% in the 20–49 age group (MSPP, 2007). In
addition, in November 2010, Haiti has endured a cholera epidemic and since then the disease
became endemic in the country.
Street foods contribute significantly to the diet of many people in the developing world (FAO,
2007). Although there were no specific studies that have been performed in Haiti, there are no
reasons not to assume that the scenario is different. Despite the high prevalence of diarrheal
diseases, Haiti has no specific laws or regulations for the quality of street foods. The lack of
regulations could also be conversely seen as a reason why the prevalence of diarrheal diseases is
high in Haiti. The Ministry of Agriculture has a laboratory which is used for the purposes of
diagnosis of animal diseases, zoonosis; determination of environmental pollutants and quality of
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food control. However, it has been observed major weaknesses in the legislation and regulations
of the system (FAO, 2002). As a result the microbial quality of street vended foods in Haiti is
still unknown and until now no study has been done to evaluate their safety.
The study reported in this thesis was conducted in order to provide relevant information that
could be used to generate policy and actions by the Haitian government regarding food safety. In
order to do so, according to the World Health Organization (WHO, 2000), it is crucial to gain
more information on the attitudes, knowledge and practices of the food handlers. The study has
addressed this need in part by investigating the food safety knowledge and attitudes of vendors
and consumers of street foods in Port-au-Prince, the capital city of Haiti. The food handling and
hygiene practices of the vendors were also evaluated. In addition, an assessment of the
microbiological quality of the foods sold in the streets was carried out.
1.2.
Major objectives of the study
The main objective of the study was to use qualitative and quantitative methodology approach in order to
assess the microbiological safety aspect of foods sold in the streets of Port-au-Prince. The specific
objectives were:
•
Evaluation of consumers’ food safety knowledge and attitude,
•
Evaluation of vendors’ food safety knowledge and attitude,
•
Observation of food preparation in order to see if the preparation methods respect the standard
requirements,
•
Evaluation of the microbiological quality of the foods sold in the streets.
Achieving these objectives would enable two hypotheses to be tested:
•
Foods sold in the streets are assumed to be microbiologically unsafe,
•
The consumers and vendors of street food have poor hygiene practices and limited food safety
knowledge
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2.
Literaturereview
2.1.
Introduction
It is estimated that 48 million cases of foodborne diseases occur each year in the United States of
America (USA) alone, resulting in 128,000 hospitalizations and 3,000 deaths (CDC, 2013). In
Europe a total of 5,262 foodborne diseases outbreaks were reported in 2011, causing 43,473
human cases, 4,695 hospitalizations and 25 deaths (EFSA, 2012).
Unfortunately, in most of the developing countries, data regarding foodborne illnesses remain
scarce (WHO, 2007). However, according to the World Health Organization (WHO), diarrheal
diseases were the third leading cause of death in low income countries resulting in 1.8 million
deaths around the world in 2005 alone (WHO, 2013). In general most of the cases result from
the consumption of contaminated food and water (WHO, 2013).
Although street vended foods are very common in developing countries, there is a paucity in data
and studies regarding the incidence of foodborne diseases related to these foods. However, it has
been recognized that the conditions under which street vendors operate are often unacceptable
for the purposes of preparing and selling of food (Bryan et al., 1988; Mosupye and Holy, 2000).
Street food vendors are very often poor, uneducated and show little concern towards the safe
handling of foods, and food safety knowledge and practice (WHO, 1996). Consequently, some
serious concerns do exist about the safety of street food (FAO, 2013).
This chapter presents a review of the studies that have been performed to evaluate food safety
knowledge, attitudes and food handling practices of street food vendors. In addition, the review
incorporated the results of the studies that have reported the microbial quality of street foods and
their potential role in causing foodborne diseases.
2.2.
Food safety knowledge and attitudes
In 2000, WHO has recognized food safety as an essential public health function. Food safety has
been defined by Henson and Traill (1993) as the inverse of food risk—“the probability of not
suffering some hazard from consuming a specific food”. If one is not aware of the origin and
severity of foodborne diseases, it’s clear that they will be less motivated to change. it’s therefore
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necessary to believe that someone can get sick by some bad food handling attitudes and by
changing the behaviour, one can prevent illnesses (Schafer et al., 1993). Consequently, food
safety knowledge is important in prevention of foodborne illnesses although gain of knowledge
doesn’t necessarily lead to change in behaviour. That’s why attitude is also very important
(Henson and Traill, 1993).
Knowledge is defined as “a complex process of remembering, relating, or judging an idea or
abstract phenomenon (cognitive abilities)” (Gotsch et al., 2012). On the other hand attitude is
defined “as a state of mind, feelings, or beliefs about a particular matter (affective abilities)
(Gotsch et al., 2012). In other words attitude is the mental state in which someone is ready and
motivated to move to action. Attitude is shaped by knowledge, which itself is a product of
exposure to sources of information and personal willing in obtaining information (McIntosh et
al., 1994). Knowledge, attitude and practice can also be shaped by habits and other perceptions
that result from social, cultural, and economic influences (Rozin and Fallon, 1980).In a nationwide study conducted in the UK in 1993 (FDF-IEHO, 1993), it was observed that 45% of
consumers were discouraged from eating some types of food because they knew the possible risk
of food poisoning.
Many studies have been done to assess food safety knowledge and attitude of street food
vendors; in comparison to developed countries, very few studies have been conducted in the
third world countries on the consumer’s food safety knowledge and attitudes in general and no
studies could be found regarding street food consumers. Although it was observed that an
unknown proportion of foodborne diseases could be prevented by actions taken by the
consumers themselves (Medeiros et al., 2001).
According the food agriculture organization (FAO), when selecting a street food
vendor,consumers attach importance to hygiene; however they are often unaware of the health
hazards associated with street vended foods (FAO, 2013). Many people do not know the basic
rules of food hygiene (Sockett, 1995). It has been shown in available literature that attitudes and
knowledge of consumers in general differ according to their demographic and socio-economic
(e.g. gender, age, sex and educational level) background (Wilcock et al., 2004). According to
Altekruse et al. (1999), men were more likely to report risky attitudes than women and the
prevalence of risky behavior also increased with increasing socioeconomic status. McIntrye et al.
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(2013) reported contradicting findings. In their study it was observed that food handlers with
college and university education had a higher score in food safety knowledge compare to those
with incomplete or completed high-school education, trained workers scored significantly higher
also than untrained workers (McIntrye et al., 2013). Another study conducted in Belgium
indicated as well that male consumers attached more importance to safety compared to female
(Verbeke and Viaene, 1999). Unklesbay et al. (1998) in a study conducted in the US found that
students enrolled in a type of program that included food safety information had higher food
safety knowledge compare to others. Change in lifestyle has been also shown to have an
influence on consumer’s attitudes toward safe handling of food. In a nation-wide postal survey
conducted in the US, it has been shown that consumers had poor knowledge on the organisms
responsible for food poisoning, which type of foods were associated with these microorganisms,
the need of avoidance of cross contamination and the importance of proper cooking (Williamson
et al., 1992). Woodburn and Raab (1997) also reported that respondents could not identify which
groups of people were particularly at risk of food poisoning and what a foodborne illness was.
There is more interest of consumers in convenience and saving time than in proper food handling
and preparation (American Meat Institute, 1996) and consumers often use their senses in their
descriptions of safe food, and feel that food that looks or smells bad should not be eaten (Seward,
2003).
In different studies conducted on food safety knowledge and attitudes of street food vendors, it
was observed that in general street food vendors have poor food safety knowledge (PAHO, 1992;
FAO, 2013; WHO, 1996, Rane, 2009). Demographic characteristics such as age and gender
don’t seem to play a role in food safety knowledge of vendors (Soares et al., 2012; Annor and
Baiden, 2011). Regarding the role of educational level and food safety knowledge, the results are
quite different. Soares et al. (2012) reported that there was a positive link between educational
levels and food safety knowledge of vendors while Annor and Baiden (2011) didn’t find any
significant difference. In some studies, it was found that there was a significant relation between
knowledge and attitude (Cuprasitrut et al., 2011) while others found no difference (Omemu and
Aderoju, 2008).
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2.3.
Food handling and practices
Three main factors play a role in the occurrence of food poisoning with regard to food handlers:
knowledge, attitude and practice (Sharif and Al-Malki, 2009). Food handlers are defined as
‘persons who prepare food and those who sell it, if they are different persons” (WHO, 1989).
According to the WHO, food handling is a key factor during production, processing, storage and
preparation in order to ensure food safety (WHO, 1989). Although knowledge and attitude are
important, there is a gap between food safety knowledge and self-reported practices (Woodburn
and Raab, 1997). Woodburn and Raab (1997) found during a telephone survey that 20% of
respondents reported unsafe practices in their food preparation even though they had a high
awareness of foodborne illnesses. Altekruse et al. (1996) found that 86% of respondents knew
that hand washing reduced the risk of food poisoning, however only 66% washed their hands
after handling raw meat or poultry.
In an attempt to determine the risk factors for foodborne diseases it has been found that most of
the outbreaks resulted from improper food handling practices (Ehiri and Morris, 1996).
According to different studies, it has been estimated that a considerable number of illnesses are
caused by improper food handling practices in the domestic kitchen (Flint et al., 2005). In
another study conducted in the US, it was determined that improper food handling practices
contributed to approximately (Howes et al., 1996). It has been observed that most of street
vendors have poor food handling practices and expose the food to dangerous conditions such as
cross contamination (Ekanem, 1998).
Different food handling problems by handlers have been identified: unsafe sources, inadequate
cooking or heating, improper cooling, long interval between preparation and eating, poor
hygiene or handlers colonized by pathogens (Bryan, 1988).
Several foodborne diseases
outbreaks have been determined to be a result of poor food handling practices, such as the cross
contamination between raw and cooked products, temperature abuse, and poor personal hygiene
of food handlers i.e. failure to wash hands after using the toilet (Todd et al., 2007). In a study
conducted by Bryan (1988), it has been observed that the same knife without being clean was
used to cut raw meat and poultry as well as gravy and salad.
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Food handlers can contaminate food either passively or actively. The biological hazards may be
introduced from a sick handler, from organisms on the food handlers skin or faeces, from their
respiratory tract or by cross contamination after handling raw materials (WHO, 1989). Physical
hazards may also be introduced by food handlers wearing jewelry, bandages or by careless food
handling practices (WHO, 1989). The microorganisms are transferred from the faeces, nose and
skin mostly by the hands of the food handlers (WHO, 1989).
It has been determined that Salmonella, non typhi Salmonella, Campylobacter and E. coli can
survive on finger tips and other surfaces for different days (Pethers and Gilbert, 1971), from
which they can contaminate food. Sometimes they were able to survive even after washing;
supporting the fact that food handling can lead to contamination of street vended foods (ICMSF,
1998).
2.4.
Overview of street-vended foods
Street foods are defined by the Food and Agriculture Organization (FAO) as ready-to-eat (RTE)
food and beverages prepared and or sold by vendors and handlers especially in streets and other
similar places for immediate consumption or consumption at a later stage without further
processing or preparation (FAO, 1989). Street foods represent a significant portion of the diet of
many inhabitants in many major cities (Suneetha et al., 2011). An estimated 2.5 billion people
world-wide consume street food each day. In Latin America street food accounts for up to 30%
of urban household purchases (FAO, 2007).
Many countries have experienced a change in their socio-economic status during the past few
decades. These changes have in part led to a significant growth in the popularity of street foods
(WHO, 1996). As urbanization and population are growing, especially in developing countries, it
is expected that the street-vended foods sector, which is mainly but not exclusively an urban
phenomenon, will continue to expand (WHO, 1996). There are several benefits of street-vended
foods: i) this sector provides a regular source of income for millions of people specially women
and contributes to local and national growth ii) street foods represent a source of inexpensive,
convenient and often nutritious food for urban and rural poor iii) street foods also provide an
opportunity to develop business skills with low capital investment while giving a chance for selfemployment at the same time (WHO, 1996).
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Beside the fact that they may pose a problem of pollution by waste accumulation and traffic
congestion in the city, the major concern about street foods is related to their safeness. They
remain a potential cause of serious food poisoning outbreaks in many countries all over the
world, especially via microbiological hazards (WHO, 1996). In support of this, it has been
determined that 691 food poisoning cases and 49 deaths from 1983 to 1992 in Shandong (China)
were caused by street foods (Lianghui et al., 1993).
Street foods are considered to be a major public health risk due to the fact that the operations
tend to lack basic infrastructure and services, difficulties in monitoring and law enforcement,
difficulty in controlling due to not only the large numbers of street food vending operations but
also because of their diversity, mobility and temporary nature (Ghosh et al., 2007).
In a survey conducted by the WHO (WHO, 1993), almost all countries have reported a large
variety of street foods, types of preparation, facilities and infrastructure. Some keys findings of
the survey were:
i.
In 74% of countries street-vended foods were a significant part of the urban food supply,
ii.
Diverse type of foods such as meat, fish, fruits, cereals, frozen products and beverages
were sold in the street,
iii.
There were different methods of preparation varying from foods without any preparation
(65%), ready-to-eat food (97%) and food cooked on site (82%),
iv.
Vending facilities were also different, going from mobile carts to fixed stalls and food
centers,
v.
There were limited infrastructures development with restricted access to potable water
(47%), toilets (15%), refrigeration (43%) and washing and waste disposal facilities,
vi.
The majority of the countries reported contamination of food (coming from raw food,
infected handlers and inadequately cleaned equipment),
vii.
Time and temperature abuse were the major factors contributing to foodborne disease;
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viii.
Most countries reported that there was insufficient inspection of the personnel,
insufficient application of the HACCP concept and noted that registration, training and medical
examinations were not part of the management strategies of street vended foods.
One of the biggest problems which play a role in the contamination of street vended foods is the
water supply. The local water supply may not have an acceptable quality, may be in insufficient
quantities for drinking, washing, cleaning and other operations. Stationary stalls as well as
ambulatory vendors may not have direct access to water supply. There is also a need to take into
account that there is in general a scarcity of water in developing countries and tap water is not
always available. Many vendors re-use water that has been already used to clean and wash their
utensils (WHO, 1999).
Beside water, the places where the food is prepared are often not clean and are often located
close to potential sources of contamination such as waste, toilets etc. In 70 to 90 % of the cases,
insects, animals and liquid waste have been observed in area were street-vended foods were
being prepared (FAO, 1988). Most of the foods are not protected against insects, dust etc. which
may harbor foodborne pathogens (Rane, 2011). It was observed that street foods were not
covered appropriately and the safe storage temperature was difficult to maintain (Bryan et al.,
1988; Ekanem, 1998). The surfaces where the food is prepared sometimes have remains of food
prepared earlier which can become sources of cross contamination. Leftovers after spending the
entire day exposed in the sun are usually stored overnight at unacceptably high temperatures and
are reheated the day after before being sold (WHO, 1989). It has been observed also that the
same knives are often used during food preparation without any cleaning between uses (Mensah
et al., 2002). The food is sometimes prepared long before its consumption; stored at ambient
temperature, and undergo inadequate cooling and reheating processes leading to contamination
of the food (WHO, 1989).In addition, as mentioned earlier street food vendors are most often
uneducated and have poor knowledge and awareness regarding food safety.
2.5.
Microbial quality of street foods
Potential hazards vary from natural and environmental contaminant to chemicals from the
agriculture field, veterinary drugs growth hormones, food packaging, physical foreign bodies etc.
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However, microbiological hazards are considered as a greater challenge to food safety because
harmful microorganisms can either proliferate in the food or in the human body once ingested
(Tent, 1999). As mentioned earlier, insufficient knowledge, poor practices and operation in
unsanitary environments are considered as the major risk factors leading to the production of
microbiologically unsafe street foods.
According to the Centers for Disease Control and prevention (CDC) 31 pathogens are known to
cause foodborne illnesses (CDC, 2013). Among the pathogens found in street vended food
Bacillus cereus, Clostridium perfringens, Salmonella and Staphylococcus aureus are the most
common ones (Bryan et al., 1988,; Mosupye and Holy, 2000; Umoh and Odaba, 1999).
In Several studies carried out in Brazil, foodborne pathogens and high microbial counts have
been found in different street foods in the country (Hanashiro et al., 2005). In Sao Paulo city (
Brazil), more spefically, Approximately 35% of the street food samples were inappropriate for
consumption and in 12.5%, 2.5% and 22.5% of street food samples, B. cereus, S. aureus and E.
coli were present respectively (Hanashiro et al., 2005). In another study conducted in
Johannesburg, B. cereus was the most prevalent bacteria detected in 23 (17%) out of 132 street
food samples (Mosupye, et al., 2000). In the same study, C. perfringens was detected in one raw
chicken sample, S. aureus in two raw beef and two stew samples of street vended foods
(Mosupye et al., 2000).
In some Latin American cities, the frequency of fecal contamination in street foods ranged from
9.4% to as high as 56.7% above the considered standard (Almeida et al., 1996).The most
implicated type of food (87.5%) regards to coliforms in a study in Latin America contained meat
or fish (Almeida et al., 1996). In another study carried out on street foods in Zaria, 26.3 % and
15% of the samples were contaminated with B. cereus and S. aureus respectively (Umoh and
Odoba, 1999). It has been observed in Ghana that a large proportion of street food dishes are
contaminated with unacceptable levels of bacteria (Mensah, et al., 2002). In a study carried out
on street foods in 13 towns, 41% of the samples did not meet the bacteriological criteria and
4.5% to 70.2% were contaminated with E.coli while 0.4% to 3% and 1.9% to 10.1% were
contaminated with B. cereus and S. aureus respectively (Garin et al., 2002) .In another study
conducted in Johannesburg, B. cereus was detected in 17% of the street food samples while S.
- 10 -
aureus was present in 3% of the samples (Mosupye and Holy, 2000). In Bangkok, out of the 92
street food samples collected, 14(15.2%) had an unacceptable total bacteria count and 38(41.3%)
an unacceptable total coliform count (Cuprasitrut et al., 2011).
Pathogens present in street vended foods come from different sources and practices. Improper
food handling can lead to transfer of pathogens such as Salmonella, E.coli and S. aureus from
human body and environment into foods (Rane, 2011). Improper waste disposal have been
associated with transmission of enteric pathogens like Salmonella, Shigella and E.coli.
Contaminated water has been associated with pathogens such as E. coli, fecal streptococci,
Salmonella and Vibrio cholera while vegetables and spices are associated with introduction of
spore formers like Bacilli and Clostridium and pathogens like L. monocytogenes, Shigella,
Salmonella etc (Rane, 2011). Improper storage temperature and reheating of food have been
associated with production of heat stable toxins produced by pathogens like C. perfringens and
B. cereus (Rane, 2011). A study performed in the Dominican Republic showed that the aerobic
mesophilic colony counts exceeded 8 logs CFU/g in beans collected from a vendor after being
left overnight at ambient temperature (Bryan et al., 1988). In another study carried out in the
Pakistan, aerobic mesophilic counts greater than 7 log CFU/g were observed in leftover beef and
rice collected from a vendor at a bus station (Bryan et al., 1992 b). It has been also reported in
these studies that the average food holding temperatures were ranged from 26⁰ C to 50⁰ C which
is ideal for the rapid growth of bacteria (Bryan et al., 1988, 1992 b). Utensils and equipment may
also lead to microbial cross contamination of food with S. aureus, E. coli and Shigella due to
contaminated water, dish cloth and handlers (WHO, 1996).
2.6.
Conclusion
Because street vended foods are of great importance in the community, governments should consider their
official recognition. But in order to do so they should develop guidelines or regulations for this specific
food service sector. Many governments consider a Code of Hygienic Practice as an essential tool in this
regard. The code needs to focus on hygienic handling from preparation to sale of the food and should take
into account the principles of the Codex document (WHO, 1996). Preparation and processing should be
adequate to eliminate or reduce hazards to an acceptable level, prevent growth of pathogens, production
of toxic chemicals and the introduction of physical hazards; and to ensure that foods are not
recontaminated (WHO,1996). Because biological, chemical and physical hazards may be
- 11 -
introduced to the vending operation and may persist through preparation and processing, raw
materials are therefore important to the safety of street-vended food (FAO, 1996). Several
scientific studies suggested that if good communication strategies are to be developed they
should take into account not only technical risk assessments such as those reporting microbial
content and their level but also consumers and vendors risk perception of food safety and
contamination (Altekruse et al., 1999). Therefore it’s important to educate people on the
importance of food safety issues from the general public to stakeholders and regulatory
authorities (Wilcock et al., 2004).
- 12 -
3.
Materialsandmethods
3.1.
Materials
This study is a cross sectional study based on primary data. The survey was conducted in the
capital city of Haiti, Port-au-Prince from July 2012 to September 2012. Four (4) popular districts
were selected for the survey - Tabarre, Delmas, Pétion-ville and downtown Port-au-Prince (see
Annex 1). 80 street vendors, 160 consumers and 20 food street vending stalls were involved in
the survey with 20, 40 and 5 street vendors, consumers and vending stalls respectively from each
commune. A structured written questionnaire was used to assess the food safety knowledge and
attitudes of the consumers and vendors whereas a check list was used for evaluation of the food
handling practices of the street vendors. During this period, 77 food samples were also collected
in the four communes on three different days. Upon collection, the samples were immediately
stored in a cooler box for a maximum of six hours after which they were kept frozen until their
microbial quality was evaluated at the Laboratory of Food Microbiology and Food Preservation
of Ghent University.
3.1.1.
Food safety knowledge and attitude questionnaire
The questionnaire that was used was adopted from Angelillo, et al. (2001), Bolton et al. (2008)
and Ansari-Lari et al. (2010). The same questionnaire was also used in a previous study made in
the municipal schools of Camaçari, Bahia in the northeast of Brazil (Soares et. al., 2012). The
questionnaire was first translated to French and a pilot test was conducted using 20 people in one
of the selected commune, Tabarre. Based on the comments of the respondents, slight changes
were made before adoption of the final version for the study. The questionnaire was organized
into the following three (3) main sections i) demographic information ii) food safety knowledge
and iii) food safety attitudes. It was filled in either by the participants themselves or by the
researcher for participants with limited education.
The demographic section contained information regarding gender, location, age, educational
level and training in food safety.
The knowledge section was designed to evaluate the food safety knowledge of vendors and
consumers of food poisoning pathogens, hygiene, high risk groups and proper cleaning. This
- 13 -
section contained 18 questions with 3 possible answers “yes”, “no” and “do not know”. For
evaluation a score between 0 and 18 was used with a correct answer considered as one point
while an incorrect answer or a “do not know” answer was regarded as zero points. The score was
then converted to its equivalent on a basis of 18 = 100. A score less than 50 was considered as
poor knowledge, 50 to 75 was considered as median (adequate food safety knowledge) and more
than 75 was considered as having a good level of food safety knowledge.
The food safety attitude section was designed to determine the understanding of consumers and
vendors about food safety. This section contained 16 questions with three possible answers as
described above. The same procedure used for evaluation in the knowledge section has been
applied. (See Annex 2)
3.1.2.
Food handling observation checklist
A checklist was used to assess the food safety practices of street foods vendors. The checklist
was a combination of different checklists used in previous studies (Chukuezi, 2010; Dirks, 2010;
Muinde and Kuria, 2005). Demographic data such as age, sex, location, educational level and
food safety training were registered. The checklist contained five main components i)
information on facilities (source of potable running water versus stored water in containers,
availability of toilets, adequate washing facilities) ii) the environment around the stall (presence
of flies, animals, and litter) iii) personal hygiene - whether or not head gear and aprons were
worn iv) food storage (cool/refrigeration storage at vending site and v) utensils (the use of soap
and clean water). Absence (no) or presence (yes) of each component has been recorded and a
frequency table for all components has been computed and used for description of food handling
practices by vendors (see Annex 3).
3.1.3.
Food samples
Food samples were collected from the different communes selected for the study. The types of
food collected consisted mostly of spaghettis, boiled eggs, paté (wheat dough with meat and
vegetables inside), fried plantains, fried pork meat (griot), deep fried malanga (akra), fried or
grilled hotdogs, fried salami and more conventional dishes such as rice with beans (black, red
etc.) or peas, maize with beans, meat (chicken, pork and beef) with sauce and vegetables or
- 14 -
salads. 77 food samples of approximately 100 g were collected with 12, 23,17and 24 samples
coming from downtown Port-au-Prince, Delmas, Pétion-ville and Tabarre respectively. The
samples were analyzed in the Laboratory of Food microbiology and Food Preservation of Ghent
University (Gent, Belgium). The following general microbial parameters were analyzed i) total
anaerobes ii) total aerobes and iii) coliforms. The presence of the following five pathogens was
also assessed: Listeria monocytogenes, Escherichia coli, Bacillus cereus spp., Salmonella spp.,
and Staphylococcus aureus.
3.2.
3.2.1.
Methodology
Food safety knowledge and attitude questionnaire
For selection of consumers, the researcher stood at the cross sections of highly frequented areas
in each district selected. All persons passing from 15 years and older were asked to voluntary
participate. Places around markets, schools, parks and highly frequented streets were considered.
The places of investigation were Pétion-ville (center), downtown Port-au-Prince (city center),
Delmas (center) and Tabarre (center). In total 160 consumers participated in the study with 40
from each selected commune.
For selection of the vendors, places around markets, schools, bus station, highly frequented
streets and places with an agglomeration of vendors were considered. The researcher has
randomly selected the first vendor and to select the next one, the researcher has spun a bottle and
walked in the direction pointed by the bottle until the nearest vendor. Same process has been
repeated over and over. The vendors were asked to voluntary answer the questions. The places of
investigation were Pétion-ville (center), downtown Port-au-Prince (city center), Delmas (center)
and Tabarre (center). A total of 80 vendors participated in the study comprising 20 vendors from
each selected commune.
3.2.2.
Food practices observation check list
The selection of participants for this part of the study was based on the same methodology as for
the selection of vendors for the food safety and attitude questionnaire. The aim of the study was
first explained to the vendor or the responsible of the stall or the food shop. An informed consent
form based on ethical norms describing all the different components of the study was provided
- 15 -
and signed by each participant prior to the observation (see Annex 4). Due to limited time in
which the study had to be completed, 20 food shops (5 per commune) were observed.
3.2.3.
Food samples collection and analysis
The same methodology used for selection of vendors for the food safety questionnaire was used
for the collection of food samples. The food was collected over 3 days. The food was bought and
packaged in either a plastic or paper bag or in a foam plate. From the purchased food, 100g were
transposed to a sterile stomacher bag using a spoon previously sterilized by flaming (immerse in
ethanol and flame). The sterile bag was then labelled (date of sample collection, place of
collection and sample number) and placed in an ice cooler. All samples were kept on ice during
transportation for approximately five hours from the place of purchase to the storage room where
they were placed in a freezer at -10 ⁰ C until the day of examination.
The samples were then transported frozen to the Laboratory of Food Microbiology and Food
Preservation of Ghent University where they were stored again in a freezer at -18⁰ C.
One day prior to analysis, the food samples were removed from the freezer and placed in a
refrigerator at 4⁰ C in order to thaw. The next day, ca. 20 ± 1-g amount of each sample was
aseptically taken from the original bag (with ca. ~ 100g), using a sterile spoon. The food was
then placed in a stomacher bag, decimally diluted with physiological peptone saline solution
(PPS, 0.1% peptone and 0.85% NaCl)
and thereafter homogenized for 1 min in a stomacher
(Stomacher, Lab blender model Tekmar 80, Seward) in a 1/10 ml of buffer solution (0.1%
peptone and 0.85% NaCl) for 1 min. Serial decimal dilutions in PPS were then prepared up to -6
(1/106) dilution. For enumeration of the total anaerobic and lactic acid bacteria counts the
decimal dilutions of samples were pour plated in plate count agar (PCA, Oxoid, Hampshire, UK)
and de Man Rogosa Sharpe agar (MRS agar, Oxoid, Hampshire, UK). Enumeration of the total
aerobes and all the pathogens groups evaluated was done by spread plating the decimal dilutions.
Table 3-1 shows the microbiological media, plating method, incubation temperature and
durations used for all the microbial parameters investigated. In addition, the pH and water
activity of each sample was measured using a SevenEasy pH meter (Mettler Toledo, GmbH,
Schwerzenbach, Switzerland) and a Novasina Labmaster respectively. For solid products the
- 16 -
counted plate colony counts were reported as either CFU/g and converted to log10 CFU/g, or
CFU/ml or log10 CFU/ml for liquid products. The calculation method used was as followed:
X= (A*V)/ I
Where X = Colony Forming Units (CFU) per g or ml of products,
A = Numbers of colonies,
V = Reciprocal of dilution factor and
I = Inoculum volume (ml)
Table 3-1 Selective media for microbial analysis
Parameters
Media
Incubation
temp.
&
time
General microbial quality
Total aerobic counts
Total anaerobic counts
Lactic acid bacteria
Pathogens
Plate count agar (spread plate)
Plate count agar (pour plate + over-layer)
MRS agar (pour plate + over-layer)
30°C for up to 48 hours
Escherichia coli
Staphylococcus aureus
Bacillus cereus spp.
Rapid E. coli agar (spread plate)
Mannitol salt agar (spread plate)
Mannitol egg yolk polymyxin agar (spread
plate)
Rapid salmonella agar (spread plate)
Violet red bile agar (pour plate + overlayer)
Aloa enriched agar(spread plates)
37°C, 24-48 hours
37°C, 24-48 hours
30°C, 24-48 hours
Salmonella spp.
Total coliforms
Listeria monocytogenes
3.2.4.
22°C, up to 48 hours
37°C, 24 hours
37°C, 24hours
30°C, up to 48 hours
Partial confirmation techniques for pathogens
The plates on which the pathogens were enumerated were first examined for typical colonies of
the target pathogens on the basis of the morphological features described by the manufacturer of
the media used. These were then considered as presumptive, Bacillus cereus spp., presumptive
- 17 -
Salmonella spp. etc. The plates used for the enumeration were then kept until more (partial)
confirmation tests were carried out. These are described below.
For Bacillus cereus spp. two separated colonies aseptically were picked from each MYP plate
used for enumeration of presumptive Bacillus cereus spp. of a particular sample. These were
resuscitated overnight in 5 ml of BHI broth at 37°C. A serial dilution was prepared in PPS and
plated out on tryptone soy agar (TSA, Oxoid, Hampshire, UK). Isolated colonies were then
picked from these plates and an API 50 CHB/E kit (Biomerieux, Durham NC, USA) was used
for identification of the presumptive Bacillus cereus spp. This kit is used for the identification of
Bacillus spp. and related genera. Positive plates were reported with percentage of identification.
For identification of the presumptive Staphylococcus aureus isolates a similar approach as for
Bacillus cereus spp. was used for resuscitation of the colonies. Finally an API Staph kit
(Biomerieux, Durham NC, USA) was used for identification of the genera Staphylococcus.
Positive plates were reported with percentage of identification.
For identification of the presumptive Escherichia coli isolates, the first step was also similar to
the one used for presumptive Bacillus cereus spp. A Chrome ID E. coli kit (Biomerieux, Durham
NC, USA) was used for confirmation. The number of positive plates was counted.
For the presumptive Salmonella spp., the same approach was used for resuscitation after which
the ID Chrome Salmonella agar (Biomerieux, Durham NC, USA) was used for confirmation.
The number of positive plates was counted.
For the presumptive Listeria monocytogenes isolates, two colonies were resuscitated in 5 ml of
BHI as described above. Then a catalase test using a 3% solution of hydrogen peroxide (H2O2)
was carried out because L. monocytogenes is catalase positive. Gram staining was also carried
out and tumbling motility was assessed microscopically. Β-hemolysis activity of Listeria on
blood agar (TSA + 5% horse blood) was also checked.
3.3.
Data entry and documentation
The data obtained from the questionnaires and the checklists observation was entered into Epi
InfoTM 7. Data entry was double checked in order to avoid possible data entry mistakes. The
data set was then labeled and after realization of the first part of analysis, the data was exported
- 18 -
to Microsoft Excel (version 2010) where a compute score for positive answers was calculated
and expressed in percentage. The modified data set was then exported from Excel to Spotfire S+
8_2 for further analysis.
The data obtained from the microbiological analysis was entered directly to Microsoft Excel
2010 and the data set was exported afterwards to Spotfire S+ 8_2 for further analysis.
3.4.
Statistical analysis
Prior to analysis, the age and score parameters were split into different categories. For
descriptive analysis cut-off points of 25, 35, 45, 55 and 60 years were used for age. Because of
the small sample size when using five different age groups and abnormality of the samples, a
different cut-off point of 30 years (one group ≤ 30 years and the second group > 30 years) was
used for comparisons between age groups. For score range, cut-off points of 50 and 75 were
used. Descriptive analysis was first done to calculate means, standard deviation, maxima and
minima for age, and score according to age, education, location, sex and training using Spotfire
S+ 8_2. Frequency tables were generated using both Epi InfoTM 7 and Spotfire S+ 8_2 for each
parameter. Comparison of the scores obtained between sex, age groups, trained and not trained,
location and status was performed as follows. Two sample t-Test was used for comparison of 2samples data sets such as those for sex, training status and age groups (when comparison was
made between groups). Comparison of more than two groups was done by ANOVA fixed effect
through Spotfire S+ 8_2. Normality was checked by the use of QQ plot or KolmogorovSmirnov Test. Equal variances was also assessed by the used of modified Levene test. Normality
of residuals was also checked by using QQ plot or Kolmogorov-Smirnov Test. For samples that
were not normally distributed and with a sample size less than 30, analysis was done by the nonparametric Wilcoxon rank-sum test for two samples such as sex, training etc. and Kruskal-Wallis
rank sum test for more than two categories such as location and educational levels. P-values less
than 0.05 were considered as indicating a statistically significant difference between the
parameters being assessed.
For the microbiological and chemical (pH and aw) analysis of food samples, descriptive analysis
was also performed by calculating the means, standard deviation, maxima and minima for each
- 19 -
parameter, linear correlation with water activity and pH was also assessed. A coefficient of
correlation close to +1/-1 was considered as showing a strong positive or negative correlation.
Comparison of means with different types of products was also carried out using Spotfire S+
8_2.
- 20 -
4.
Resultsanddiscussion
4.1.
Food safety knowledge and attitude results
Although many studies have focused on the food safety knowledge of food handlers in general
and to a lesser extent on street food vendors, very few have investigated the food safety
knowledge of street food consumers. The few studies found in literature were generally focused
on consumers alone and the design of these studies was different from that used in this master
thesis. This study (thesis) is therefore a premiere in that it has assessed at the same time the food
safety knowledge of vendors and consumers of street foods.
The demographic characteristics of the 160 consumers who participated in this study are shown
in Table 4-1.
Table 4-1 Demographic characteristics of street food consumers in Haiti
Characteristics
Sex
Female
Male
Age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
Total
Number
Percentage
60
100
37.5 %
62.5%
74
49
23
6
5
3
46.2%
30.6%
14.4%
3.8%
3.1%
1.9%
13
25
69
53
8.2%
15.6%
43.1%
33.1%
18
142
11.3%
88.7%
40
40
40
40
160
25%
25%
25%
25%
100
Mean ± SD
Range
29.6±11.3
15-74
60 (37.5%) were female and 100 (62.5%) were male. The mean age of the participants was 29.6
(standard deviation = ± 11.3 years), and ages ranged from 15 to 74 years. 91% of the consumers
were between 15 and 45 years of age. With regards to the level of education attained, almost a
- 21 -
quarter (24%) of the consumers did not have a middle school education. The majority (76%)
were either still in high school or university or had completed either high school and/or
university. In addition, the majority of the consumers who participated in this study (88.7 %) did
not have any food safety training (Table 4-1).
The demographic characteristics of the 80 vendors who participated in this study are shown in
Table 4-2.
Table 4-2 Demographic characteristics of vendors
Characteristics
Sex
Female
Male
Age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
TOTAL
Numbers
Percentage
71
9
88.7%
11.3%
25
22
18
9
4
2
31.3%
27.5%
22.5%
11.2%
5%
2.5%
18
36
21
5
22.5%
45%
26.2%
6.3%
17
63
21.3%
78.7%
20
20
20
20
80
25%
25%
25%
25%
100%
Mean ± SD
Range
34.4±11.9
16-66
The results of this study have revealed that the street food business in Port-au-Prince is
dominated by women (88.7%). The same findings have been observed in other studies conducted
- 22 -
in Brazil, South Africa, Bangkok, Nigeria and the Phillipines (Hanashiro et al., 2005; Martin,
2006, Cuprasitrut et al., 2011; Soares et al., 2012, Omemu and Aderoju, 2008, Azanza et al.,
2000). These findings might be advantageous as it has been found in a study conducted in the
United States that women demonstrate safer food preparation techniques (Klontz et al., 1995).
However, it has to be noted that the women assessed in the study in the US had at least a high
school education which differs from our study since two thirds (67.5%) of the vendors did not
have a middle school education . Nevertheless the educational background of the vendors in
Haiti is quite similar to those in India, Ghana, Nigeria, Kenya and Sudan (Mensah et al., 2002;
Donkor et al., 2009; Muinde and Kuria, 2005; Omemu and Aderoju, 2008; Choudhury et al.,
2011; Abdalla et al., 2009). The mean age of the vendors was 34.4 years (standard deviation = ±
11.9 years) and ages ranged between 16 and 66 years. The majority (78.7%) did not have any
food safety training. Other studies have reported even lower levels of trained street food vendors
(Chukuezi, 2010; Omemu et al., 2008).
The results of the survey to determine the food safety knowledge of the consumers are shown in
Table 4-3. The consumers’ had a mean food safety knowledge score of 56 correct answers,
indicating that they generally had an average knowledge of food safety. This could partly be a
result of the extensive radio and TV campaign on foodborne diseases launched in the country
since the occurrence of cholera in November 2011. However, we need to point out that 59
(36.9%) of the 160 consumers had a score less than 50, whilst only 8 (5%) of the consumers
scored more than 75. Therefore, although the consumers in general have an average knowledge
of food safety, this later still remains an issue to be addressed in the country. No statistical
difference was found between the food safety knowledge’s of customers on the basis of gender
(male vs. female) (p = 0.38), age (p = 0.09), food safety training (or lack thereof) (p = 0.43),
level of education (p = 0.32) and location in Port-au-Prince (p = 0.06). Other studies have
indicated that there was an increase of food safety knowledge with age and practices and that
females obtained higher score compare to males (Bruhn and Schutz, 1998).
The results of the survey to determine the food safety knowledge of the vendors is shown in
Table 4-4. The vendors had a higher mean food safety knowledge score of 60. The difference in
food safety knowledge between the vendors and consumers was significant (p = 0.008, α = 0.05).
The individual scores ranged from 16 to 77. 22 (27.5%) of the vendors who participated in the
- 23 -
study had a score less than 50; 47 (58.8 %) had a score between 50 and 75 and 11 (13.8%) had a
score higher than 75. Amongst the studies that have used the same scoring methods, the mean
knowledge score of the vendors in Haiti was found to be higher than that of food handlers from
other countries such as Turkey (Bas et al., 2006) and Thailand (Cuprasitrut et al., 2011).
However, it has also been determined that street vendors in South Africa (Makhone, 2006) and
the Philippines (Azanza et al., 2000) exhibited a good level of food safety knowledge. No
statistical difference was found between the food safety knowledge’s of the vendors on the basis
of gender (p = 0.092), age (p = 0.75), educational level attained (p = 0.61) and location (p =
0.10). The same findings have also been observed in previous studies (Annor and Baiden, 2011;
Ansari-Lari et al., 2010). However, it was determined that food vendors who had received
training in food safety demonstrated better food safety knowledge than untrained vendors (p =
0.018, α 0.05).Though , it is difficult to ascertain if these results are a matter of chance because
none of the vendors could provide a certificate or an official document of the training received.
The results of the survey to determine the food safety attitude of the consumers are shown in
Table 4-5. The consumers had a mean food safety attitude score of 68, which indicated that they
(in general) had an average understanding of food safety knowledge. The range of scores was
between 18 and 93. With regards to distribution of the scores, it can be seen in Table 4-5 that the
majority (145, = 90.6%) had a food safety attitude scores greater than 50. Almost a quarter
(24.4%) could be considered as having a very good food safety attitude as they had scores
greater than 75. The food safety attitudes of the consumers were generally higher than their food
safety knowledge (p = 0). No statistical difference was found between the food safety attitudes of
the customers on the basis of gender (p = 0.94), training (p = 0.14) and age (p = 0.07). However,
statistically significant differences occurred between the food safety attitudes of consumers on
the basis of their educational levels (p = 0.004). Consumers who only went to primary school
had a higher score than those who went to high school and university. This was a very surprising
finding since one would expect that education to a higher level would have a positive effect on
food safety attitude. Even though the same findings have also been observed for food safety
knowledge in a study conducted in the US (Altekruse et al., 1999) many other studies reported
no effect of education on knowledge and attitude (Annor and Baiden, 2011; Rheinländer et al.,
2008). In the context of this study, this might be explained by the fact that in the Haitian culture,
cooking and household tasks are usually left for people who are less educated. Haitians with a
- 24 -
high education level and high incomes usually hire maids for cooking and cleaning. This also
could be a result of chance as even though the researcher made it clear to the participants that
they should choose “do not know” for questions that they did not know the answers, participants
with lower education levels are more likely to have taken a guess than educated people who
would have a better understanding of the potential consequences of guessing on the outcomes of
the study. They consequently were expected to be more honest in their answers. A significant
difference was also observed between the food safety attitudes of consumers on the basis of their
location in Port-au-Prince (p = 0.0006). It was observed that consumers from Delmas and Portau-Prince had a higher score than consumers from Pétion-ville which could also be linked to the
previous findings since people from Pétion-ville in general have a higher level of income
compare to the other districts.
The results of the survey to determine the food safety attitudes of the vendors are shown in Table
4-6. The mean food safety attitude score of the vendors was 73. The scores ranged from 25 to 93.
Four (5%) of the vendors had a score less than 50; whilst 95% had a score of at least 50. Even a
greater proportion of the vendors (43%), compared to consumers (24.4%), had scores greater
than 75, which as mentioned earlier indicates good food safety attitudes. The vendors
demonstrated significantly better food safety attitudes compared to knowledge (p = 0) and to
consumers (p = 0.0028, α = 0.05). No statistical difference was found on the basis of gender (p =
0.27), level of education (p = 0.43), location (p = 0.12) and age (p = 0.61). However, it was
determined that food vendors who had received training in food safety had a better attitude
towards food safety than untrained vendors (p = 0.01). Some studies have reported that trained
handlers have a higher food safety attitude compared to untrained food handlers (McIntyre et al.,
2013) while others reported that no significant differences occur between the two (Bas et al.,
2006)
- 25 -
Table 4-3 Consumer food safety knowledge
Number (% of correct answers)
Characteristics
Sex
Female
Male
Age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
Score range
50-75
<50
>75
Mean± SD
Range
25
34
(16)
(21)
33
60
(21)
(38)
2
6
(1.30)
(3.8)
55±13
56±12
22-94
27-83
36
13
5
0
2
3
(23)
(8.1)
(3.1)
0
(1.3)
(1.9)
36
31
18
6
2
0
(23)
(19)
(11)
(3.8)
(1.3)
(0)
2
5
0
0
1
0
(1.3)
(3.1)
(0.0)
(0.0)
(0.6)
(0.0)
53±12
59±13
56±7
64±3
61±13
40±11
22-83
28-94
38-66
61-66
50-77
27-50
6
6
(3.8)
(3.8)
7
17
(4.4)
(11)
0
2
(0.0)
(1.3)
55±12
58±11
27-72
38-77
29
18
(18)
(11)
38
31
(24)
(19)
2
4
(1.3)
(2.5)
54±11
57±13
27-83
22-94
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
7
52
(4.4)
(33)
10
83
(6.3)
(52)
1
7
(0.6)
(4.4)
54±8
55±12
38-77
22-94
11
18
10
20
(6.9)
(11)
(6.3)
(13)
28
21
26
18
(18)
(13)
(16)
(11)
1
1
4
2
(0.6)
(0.6)
(2.5)
(1.3)
57±10
52±13
0.59±11
53±11
27-77
22-83
27-94
33-83
TOTAL
59
(36.9%)
93
(58.1%)
8
(5%)
56±12
22-94
26
Table 4-4 Vendor food safety knowledge score
Number (% of correct answers)
Characteristics
Sex
Female
Male
Age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
TOTAL
<50
Score range
50-75
>75
Mean± SD
Range
19
3
(23.8)
(3.8)
42
5
(52.5)
(6.3)
10
1
(12.5)
(1.3)
60±13
60±13
16-77
44-77
10
4
5
2
1
0
(12.5)
(5)
(6.3)
(2.5)
(1.3)
(0)
13
15
11
4
3
1
(16.3)
(18.8)
(13.8)
(5)
(3.8)
(1.3)
2
3
2
3
0
1
(2.5)
(3.8)
(2.5)
(3.8)
(0)
(1.3)
57±10
61±15
59±12
64±12
59±8
72±7
38-78
16-77
33-77
50-77
50-66
66-77
3
13
5
1
(3.8)
(16.3)
(6.3)
(1.3)
15
16
14
2
(18.8)
(20)
(17.5)
(2.5)
0
7
2
2
(0)
(8.8)
(2.5)
(2.5)
58±12
59±13
62±10
65±12
16-72
33-77
44-77
50-77
3
19
(3.8)
(23.8)
9
38
(11.3)
(47.5)
5
6
(6.3)
(7.5)
66±13
58±11
38-77
16-77
7
6
3
6
(8.8)
(7.5)
(3.8)
(7.5)
12
14
12
9
(15)
(17.5)
(15)
(11.3)
1
0
5
5
(1.3)
(0)
(6.3)
(6.3)
58±11
57±12
66±10
60±14
38-77
16-72
50-77
33-77
22
(27.5)%
47
(58.8%)
11
(13.8%)
60±12
16-77
27
Table 4-5 Consumer food safety attitudes score
Number(% of correct answers)
Characteristics
Sex
Female
Male
age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
TOTAL
<50
Score range
50-75
>75
Mean± SD
Range
6
9
(4)
(6)
40
66
(25)
(41)
14
25
(9)
(16)
69±11
69±14
44-94
18-94
10
3
2
0
0
0
(6)
(2)
(1)
(0)
(0)
(0)
49
31
16
4
3
3
(31)
(19)
(10)
(3)
(2)
(2)
15
15
5
2
2
0
(9)
(9)
(3)
(1)
(1)
(0)
66±14
69±14
70±12
72±10
76±9
71±7
19-93
19-94
44-94
56-81
62-88
62-75
7
0
1
7
(4)
(0)
(1)
(4)
51
10
11
34
(32)
(6)
(7)
(21)
11
3
13
12
75±9
76±11
67±13
66±14
62-94
43-94
18-87
18-94
1
14
(1)
(9)
11
95
(7)
(59)
6
33
(7)
(2)
(8)
(8)
0
(4)
(21)
73±11
68±13
44-87
18-94
2
7
3
3
(1)
(4)
(2)
(2)
24
29
22
31
(15)
(18)
(14)
(19)
14
4
15
6
(9)
(3)
(9)
(4)
73±12
62±16
72±12
67±10
37-94
18-87
43-94
43-81
15
(9.4%) 106
(66.2%)
39
(24.4%)
68±13
18-93
28
Table 4-6 Vendor food safety attitudes score
Number ( % of correct answers)
Characteristics
Sex
Female
Male
age (years)
15-25
26-35
36-45
46-55
56-60
>60
Education
Illiterate
Primary school complete or not
High school complete or not
University complete or not
Food safety training
Yes
No
Location
Port-au-Prince
Pétion-ville
Delmas
Tabarre
TOTAL
Score range
50-75
<50
>75
Mean± SD
Range
4
0
(5)
(0)
38
4
(47.5)
(5)
29
5
(36.3)
(6)
73±11
78±9
25-93
62-94
1
1
1
1
0
0
(1)
(1)
(1)
(1)
(0)
(0)
13
13
10
3
3
0
(16)
(16)
(13)
(4)
(4)
(0)
11
8
7
5
1
2
(14)
(10)
(9)
(6)
(1)
(3)
74±9
70±15
75±10
77±11
71±8
87
50-87
25-93
50-87
50-94
62-81
87
0
1
3
0
(0)
(1)
(4)
(0)
9
9
21
3
(11)
(11)
(26)
(4)
11
8
13
2
(14)
(10)
(16)
(3)
72±15
72±12
77±8
77±3
25-87
50-93
56-87
75-81
0
4
(0)
(5)
5
37
(6)
(46)
11
23
(14)
(29)
80±7
72±12
62-94
25-94
2
2
0
0
(3)
(3)
(0)
(0)
9
13
10
10
(11)
(16)
(13)
(13)
9
5
10
10
(11)
(6)
(13)
(13)
74±13
68±14
76±.8
76±9
50-94
25-87
56-87
62-94
4
(5%)
42
(53%)
34
(43%)
73±11
25-93
29
Tables 4-7 and 4-8 show the tallied responses of the customers and vendors, respectively to each
question in the questionnaire about their food safety knowledge. The results show that the
majority of the consumers did not know that hepatitis A virus (88.8% of the respondents),
Salmonella (89.38%) and Staphylococcus aureus (91.9%) are pathogens that are responsible for
foodborne diseases and Almost half (44.4%) of the consumers failed to discern the groups at risk
of foodborne diseases. The same findings were reported by Woodburn and Raab (1997). 74.4%
knew that bloody diarrhea can be transmitted by food whilst 77.5% recognized that AIDS cannot
be transmitted by food. On the other hand, 86.3% knew that it is necessary to take leave from
work during cases of infectious skin diseases and 88.1% knew that microbes can be found in the
skin, mouth and nose of healthy handlers. 57.5% of consumers did not know that abortion could
be induced by foodborne diseases. 61.9 % of them believed wrongly that washing utensils with
detergents leave them free of contamination. 55% did not know that eating and drinking in the
work place increased the risk of food contamination. A considerable proportion of consumers
were aware of the critical role of hand washing (93.8 %) and proper cleaning of utensils (71.9%)
in the prevention of foodborne diseases. However, only 61.9% knew that the use of gloves is
important in reducing risk of contamination. 74.4% of the consumers knew that a swollen can
might contain microorganisms. 30% of the customers incorrectly thought that the reheating of
foods can contribute to food contamination whilst only 60% were able to answer correctly the
question about whether the preparation of foods in advance can reduce the contamination of
foods.
In comparison to consumers, almost all vendors did not know that hepatitis A (96.3%)
Salmonella (100%) and Staphylococcus (98.75%) were foodborne pathogens. In agreement with
this finding, vendors from Iran and Brazil also failed to identify these foodborne pathogens
(Ansari-Lari et al., 2010; Soares et al., 2012). However, 93.8% of the vendors knew that bloody
diarrhea can be transmitted through food. Compared to the consumers (77.5%), a slightly lower
proportion of the vendors (68.75 %) knew that AIDS could not be transmitted by food even
though there is an on-going HIV prevention campaign in Haiti. This means that more efforts
should be done to reinforce the campaign. 88.8 % also knew that it is necessary to take leave
from work during infectious disease of the skin. 92.5% of the vendors knew that microbes could
be found in the skin, nose and mouth of healthy handlers. In similarity to the results observed for
the consumers (42.5%), 41.3 % of the vendors did not know that abortion could be induced by
30
foodborne diseases. 67.5% wrongly believed that washing utensils with detergent would leave
them free of contamination. More than a half (55%) of the vendors did not know that eating and
drinking while preparing food can lead to contamination. Most of the vendors were aware of the
importance of washing hands (95%), proper cleaning (82.5%) and the use of gloves (72.5%) in
the prevention of foodborne diseases. Although in other studies vendors were not able to identify
the group at risk of foodborne diseases (Ansari-Lari et al., 2010), the majority (72.5%) of the
participants in Haiti were able to identify children, pregnant women and elderly as being more at
risk of foodborne diseases. 76.3% of the vendors correctly responded that a swollen can is a
possible host of microorganisms. Slightly more vendors than consumers knew that reheating
could be used to prevent the occurrence of foodborne diseases (63.8 %) and that the preparation
of food in advance could lead to food poisoning (78.8 %).
Tables 4-9 and 4-10 show the tallied responses of the customers and vendors, respectively to
each question in the questionnaire about the food safety attitudes. Regarding food safety attitude
of the consumers, the study found that the majority of consumers answered correctly one third of
the questions (questions 1, 2, 3, 4, 7, 8, 9, 10, 11 and 13) with correct responses ranging between
70 to 96.3 %. However most of them wrongly believed that a well-cooked food is free of
contamination (62.5%) and that the ideal place to store raw meat was the bottom shelf of the
refrigerator (48.8%). Most of consumers incorrectly thought that eggs should be washed as soon
as possible after purchase (88.8%) and that the best way to thaw a chicken was not in a bowl of
cold water (60%). In a study conducted by Bruhn and Schutz (1998) it was also observed that
46%, of the consumers defrost food on a counter top and 10% defrost in warm water. 35%
agreed (wrongly) that defrosted foods can be refrozen and only half of them (51.3%) were able
to identify wearing masks as an important practice to reduce the risk of food contamination.
As observed for the consumers, it can be seen in Table 4-10 that the majority of the vendors also
correctly answered approximately one third of the questions (questions 1, 2, 3, 4, 7, 8, 9, 10, 11,
13 and 14) used to assess their food safety attitudes. The range of correct responses (77.5-100%).
was similar to those of the consumers. The vendors had the same difficulties in answering the
same questions that the consumers also could not answer. The lowest percentage of correct
answers (22.5%) was observed for the question concerning whether or not well-cooked food is
free of contamination. As in other studies conducted in Ghana and South Africa, a high
31
percentage of the street food vendors (84.4%) who participated in this study were aware of the
importance of separating cooked and raw foods in order to prevent foodborne diseases (Donkor
et al., 2009, Lues et al., 2006). It has been found in our study that the majority of consumers and
vendors did not know that thawing should not be done at the ambient temperature. This should
be taken into consideration since inappropriate thawing of meat and poultry can lead to growth
of harmful and spoilage bacteria (USDA, 2006).
32
Table 4-7 Assessment of consumers' food safety knowledge
Response N (%)
Statement
Right
1. Abortion in pregnant women can be induced by food-borne disease.
68 (42.50)
38 (23.7)
54 (33.7)
2. Bloody diarrhea can be transmitted by food
119 (74.4)
24 (15)
17 (10.6)
3. Swollen cans can contain microorganisms
119 (74.4)
15 (9.4)
26 (16.2)
4. During infectious disease of the skin, it is necessary to take leave from work.
138 (86.2)
14 (8.7)
8 (5)
5. Eating and drinking in the work place increase the risk of food contamination
72 (45)
73 (45.6)
15 (9.4)
6. Hepatitis A virus is among the food-borne pathogens
18 (11.2)
11 (6.9)
131 (81.9)
7. Microbes are in the skin, nose and mouth of healthy handlers
141 (88.1)
9 (5.6)
10 (6.2)
8. Salmonella is among the food-borne pathogens
17 (10.6)
3 (1.9)
140 (87.5)
9. Staphylococcus is among the food-borne pathogens
13 (8.1)
12 (7.5)
135 (84.4)
10. Typhoid fever can be transmitted by food
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)
60 (37.5)
11 (6.9)
14. Children, healthy adults, pregnant women and older individuals are at equal risk for food 89 (55.6)
Wrong
Do not know
poisoning
15. Food prepared in advance reduces the risk of food contamination
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)
33
Table 4-8 Assessment of vendors' food safety knowledge
Response N (%)
Statement
Right
Wrong
Do not know
1. Abortion in pregnant women can be induce by foodborne disease
47 (58.7)
15 (18.7)
18 (22.5)
2. Bloody diarrhea can be transmitted by food
75 (93.7)
1(1.2)
4(5)
3. Can swollen cans contain microorganisms
61 (76.2)
11(13.7)
8 (10)
4. During infectious disease of the skin, it is necessary to take leave from work.
71 (88.7)
7 (8.7)
2 (2.5)
5. Eating and drinking in the work place increase the risk of food contamination
36 (45)
37 (46.2)
7 (8.7)
6. Hepatitis A virus is among the food-borne pathogens
3 (3.7)
1 (1.2)
76 (95)
7. Microbes are in the skin, nose and mouth of healthy handlers
74 (92.5)
3 (3.7)
3 (3.7)
8. Salmonella is among the food-borne pathogens
0 (0)
1 (1.2)
79 (98.7)
9. Staphylococcus is among the food-borne pathogens
1 (1.2)
0 (0)
79 (98.7)
10. Typhoid fever can be transmitted by food
48 (60)
17 (21.2)
15 (18.7)
11. Using gloves while handling food reduces the risk of food contamination
58 (72.5)
19 (23.7)
3 (3.7)
12. Washing hands before work reduces the risk of food contamination
76 (95)
3 (3.7)
1 (1.2)
13. AIDS can be transmitted by food
55 (68.7)
16 (20)
9 (11.2 )
14. Children, healthy adults, pregnant women and older individuals are at equal risk for food 58 (72.5)
poisoning
15. Food prepared in advance reduces the risk of food contamination
63 (78.7)
15 (18.7)
7 (8.7)
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 (63.7)
21 (26.2)
8 (10)
18. Washing utensils with detergent leaves them free of contamination
26 (32.5)
53 (66.2)
1 (1.2)
34
Table 4-9 Assessment of consumers' food safety attitude
Response N (%)
Statement
Right
Wrong
Do not know
1. Proper hand hygiene can prevent food-borne diseases
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)
16 (10)
19 (11.9)
3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk 125 (78.1)
of food contamination
4. The health status of workers should be evaluated before employment
149 (93.1)
5 (3.1)
6 (3.7)
5. The best way to thaw a chicken is in a bowl of cold water
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)
30 (18.7)
14 (8.7)
13. Can a closed can/jar of cleaning product be stored together with closed cans and jars of food 116 (72.5)
products
14. Defrosted foods can be refrozen
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)
35
Table 4-10 Assessment of vendors' food safety attitude
Response N (%)
Statement
Right
Wrong
1. Proper hand hygiene can prevent food-borne diseases
75(93.75)
5(6.25)
Do not
know
0(0.00)
2. Raw and cooked foods should be stored separately to reduce the risk of food contamination.
66(82.50)
14(17.50)
0(0.00)
3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk of 71(88.75)
food contamination
4. The health status of workers should be evaluated before employment
76(95.00)
4(5.00)
5(6.25)
1(1.25)
3(3.75)
5. The best way to thaw a chicken is in a bowl of cold water
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)
9. Dish towels can be a source of food contamination
78(97.50)
2(2.5)
0(0.00)
10. Knives and cutting boards should be properly sanitized to prevent cross contamination
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 62(77.50)
products
14. Defrosted foods can be refrozen
69(86.25)
15(18.75)
3(3.75)
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)
16. Eggs must be washed after purchase as soon as possible
8(10)
71(88.75)
1(1.25)
36
4.2.
Observed food handling habits
The demographic characteristics of the vendors manning the 20 street food vending stalls that
were observed in this study are shown in Table 4-11. 18 (90%) of the stalls were manned by a
woman. The mean age of the vendors manning the stalls that were observed was 42.4 years. The
ages ranged from 28 to 68 years. The level of education was very low as 15 (75%) of the
participants had not attended secondary school, none of them had gone to university and 70% did
not have any food safety training.
Table 4-11 Demographic characteristics of stalls' vendors
Characteristics
Number
Percentage
Male
2
10%
Female
18
90%
Mean ± SD*
Range
42.4±10.3
28-68
Sex
Age(years)
<30
4
30-50
12
51-60
3
>60
1
Education
Illiterate
2
10%
Primary school
13
65
Secondary school
5
25%
Yes
6
30%
No
14
70%
Delmas
5
25%
Port-au-Prince
5
25%
Pétion-ville
5
25%
Tabarre
5
25%
TOTAL
20
100%
Food safety training
Location
*SD = standard deviation
37
Table 4-12 presents the characteristics of the observed stalls. 45% of the stalls observed
consisted of an informal canopy (mostly a parasol) and 35% consisted simply of a table set in the
street. As observed in this study other studies have also reported that street vending stalls are
most often made of tables and canopies (Chukuezi, 2010). Contrary to our study where 85% of
the food was prepared on site, only 10% and 14% of the food was prepared on site in South
Africa and Mauritius, respectively (Lues et al., 2006; Subratty et al., 2004). 65% of the stalls did
not have access to potable water and 80% did not have adequate hand washing and waste
disposal facilities. These findings were similar to the ones observed by Muyanja et al. (2011),
Muinde and Kuria (2005), and Badrie et al. (2004) in studies carried out in Uganda, Kenya and
Trinidad, respectively. Because of the lack of adequate waste disposal facilities, street vendors
have a tendency to dispose of their garbage in the street. This in turn attracts more flies and
insects which are potential vectors of pathogens. Animals or pests/flies were indeed evident
around the stall in 60% of the cases, which was also the case in Uganda, Kenya and Trinidad
(Muyanja et al., 2011; Muinde and Kuria, 2005; Badrie et al., 2004). 85% of the stalls were not
protected from the sun, dust and wind. The same findings have been observed by Muyanja et al.
(2011); Abdalla et al. (2009); Chukuezi, (2010); Muinde and Kuria, (2005) in Uganda, Sudan,
Nigeria and Kenya, respectively. With regards to the cleanliness of the environment around the
vending stalls, Muinde and Kuria (2005) observed a higher percentage of stalls with unclean
environments (85%) compared to our study where in 75% of cases the environment around the
stall was clean i.e. far from rubbish, waste water, toilet facilities, open drains and animals.
Only 45% of the vendors washed their hands in clean potable water each time before handling,
preparing and serving food. All of the vendors said that they washed their hands each time after
visiting the toilet. However, this was not confirmed in this study as the researcher could not
follow the vendor in the toilet. This finding is therefore highly questionable. It has been observed
in some studies that the washing of hands after visiting the toilet was not evident for street
vendors because of the non-existence of public toilets in many developing countries and if they
do exist, most of the time they have no hand washing facilities, no paper and running water
(Bryan et al., 1988). In a study conducted in Abeokuta (Nigeria), it was found that vendors
relieved themselves on dunghills and in bushes and used sheets of paper to clean up after
defecation without washing their hands (Idowu and Rowland, 2006). Although all the stalls
operators wore clean and presentable clothes, only 8 (40%) actually wore an apron while
38
handling, preparing and serving food. Other studies have also observed that a low percentage of
vendors use aprons and gloves while handling, preparing and serving food (Chukuezi, 2010;
Subratty et al., 2004; Lues et al., 2006; Muinde and Kuria, 2005).
In agreement to the
observations that have been made in other countries such as Kenya (Muinde and Kuria, 2005)
and Nigeria (Chukuezi, 2010; Omemu and Aderoju, 2008), 80 % of the vendors in Haiti handled
food with bare hands, handled money while serving the food and only 6.3% washed their hands
thereafter. These findings are a concern since the hands are vectors for pathogens such as S.
aureus. Consequently, it is advised that food handlers should avoid handling food with bare
hands and handling money at the same time (Anon, 1999). Additionally, according to the WHO,
food should be preferably handled with clean tongs, forks, spoons or disposable gloves
(FAO/WHO, 1999). The hair of 65 % of the vendors was covered, whilst 18 (90%) had clean and
short nails. This percentage is higher compared to other studies performed in Mauritius (Subratty
et al., 2004) Kenya (Muinde and Kuria, 2005) and Ghana (Mensah et al., 2002). However, it has
to be noted that the use of hair covers might not be primarily for food safety reasons since in
Haiti most of women vendors traditionally cover their hair irrespective of what they are selling
or doing. In 55% of the cases a clean cloth was used to remove dirt and dust. 8 (20%) of the
operators wore jewellery and only 2 of these 8 operators adequately covered the jewellery. None
of the operators smoke during the handling and serving of food. In 20% of the cases, the same
knives and boards were used to prepare raw and cooked food.
In all cases the ingredients were stored in sealed containers whilst raw, partially cooked and
cooked food products were kept separate (100%). In 70% of the cases previously cooked food
products were not kept cool. The same observations have been reported by Muinde and Kuria
(2005) and Badrie et al. (2004) in Kenya and Trinidad, respectively. This is an important finding
as it has been shown that inadequate cooling is among the key factors that contribute to the
occurrence of food poisoning outbreaks (Roberts, 1982; WHO, 1989). In almost half of the cases
(45%), the utensils were not covered whilst 95% of the vendors cleaned the utensils every time
after use in cold and soapy water. This practice of washing the dishes seems to be common in
other countries as well (Azanza et al., 2000; Van Kampen et al., 1998; Lues et al., 2006).
39
Table 4-12 Food safety observation checklist
Observation N (%)
Facilities
Kind of material the stall structure Were the food is prepared consist of:
Zinc/iron
Canopy
Container
Wooden table
Other
The food is prepared
At home
On site
Is vending stall protected from sun
Animals or pests flies etc. evident around the vending stall
The vending stall maintained in a clean condition
There is access to potable water at the site or close to the site
There are adequate hand washing facilities available
There are adequate waste water or food disposal facilities available
Environment around the stall
The environment around the stall is clean: far from rubbish, waste water, toilet facilities, open
drains and animals
The operator washes their hands in clean water each time before the handling, preparation and
serving of food
The operator washes their hands each time after visiting the toilet
The operators clothes are clean and presentable
The operator uses an apron when handling, preparing and serving of food
The operator handles food with bare hands
The operator has clean and short nails
The hair of the operator is covered when handling preparing and serving of food
The operator handles money while serving food
If yes Are hands washed after handling money before handling food again
Dirt or dust is removed by:
No
Yes
0
0
0
0
0
(0%)
((0%)
(0%)
(0%)
(0%)
2
9
1
7
1
(10%)
(45%)
(5%)
(35%)
(5%)
0
0
17
8
5
13
16
16
(0%)
(0%)
(85%)
(40%)
(25%)
(65%)
(80%)
(80%)
3
17
3
12
15
7
4
4
(15%)
(85%)
(15%)
(60%)
(75%)
(35%)
(20%)
(20%)
5
(25%)
15
(75%)
11
(55%)
9
(45%)
0
0
12
4
2
7
4
15
(0%)
(0%)
(60%)
(20%)
(10%)
(35%)
(20%)
(93.75%)
20
20
8
16
18
13
16
1
(100%)
(100%)
(40%)
(80%)
(90%)
(65%)
(80%)
(6.2%)
40
Apron
Bared hands
Dirty cloth
Clean cloth
Does the operator wear jewellery
If yes is the jewellery adequately covered
Does vendor smoke during the handling preparation of food
Does the operator use the same utensil knives and boards to prepare raw and cooked food
Food storage
Food is stored/displayed:
In sealed container
Are raw partially cooked and cooked food products kept separate
Are previously cooked foods kept cool i.e. ice box or refrigerated
Utensils
Are utensils covered
Are utensils cleaned adequately every time after use
Utensils are cleaned with:
Cold and soapy water
0
0
0
0
16
3
20
16
(0%)
(0%)
(0%)
(0%)
(80%)
(75%)
(100%)
(80%)
2
1
6
11
4
1
0
4
(10%)
(5%)
(30%)
(55%)
(20%)
(25%)
(0%)
(20%)
0
0
0
14
(0%)
(0%)
(0%)
(70%)
3
12
20
6
(15%)
(60%)
(100%)
(30%)
9
1
(45%)
(5%)
11
19
(55%)
(95%)
0
(0%)
20
(100%)
41
4.3.
Microbiological quality of Haitian street foods
4.3.1.
Description of street foods evaluated in this study
Table 4-13 gives an overview of the different types of street foods which were evaluated in this
study. A total of 77 food samples were collected. The most sampled street food was Fritay3
(37.7% of all samples collected). The traditional Haitian main dish4 represented the second most
sampled street food (36.4% of all samples collected). The rest of the street foods sampled were
paté5 (10%), boiled eggs (3.9%), hotdogs (3.9%), fruit juice (3.9%) and spaghetti (3.9%).
Table 4-13 Summary of the street foods evaluated in this thesis
Type of food
Eggs
Fritay
Hotdogs
Juice
Major dish
Paté
Spaghetti
TOTAL
Numbers
3
29
3
3
28
8
3
77
Percentage
3.9%
37.7%
3.9%
3.9%
36.4%
10.4%
3.9%
100%
With the exception of fruit juice, most of the street foods sampled in this study undergo a
substantial heat treatment during cooking. However, the post-cooking handling practices raise
some concerns. As can be seen in Table 4-14, in most of the cases the food was handled with
bare hands after cooking. The food was also served in polyethylene bags which were stored
uncovered in the stall. In addition, the vendors often blew into the bags to open them. It has been
shown that pathogens can invade the interior surfaces of the polyethylene bags during packaging
because of poor handling (Barro et al., 2007). Therefore, the common potential sources of
contamination of street food comprised of the food vendors’ hands, the utensils used to serve the
food and in cases where the dish was made of raw vegetables, the hygienic quality of the water
used to wash them.
3
Mixture of fried plantains, sweet potatoes, malanga, meat and some fermented vegetables (pickles) Made of boiled rice or maize associated with some beans (puree), salads and meat (chicken or pork or beef) 5
Fried wheat flour dough 4
42
Table 4-14 Overview of cooking methods, handling and possible sources of contamination of collected food
Type of
food
Eggs
Fritay
Hotdogs
Juice
Major dish
Paté
Spaghettis
Description
Eggs containing fermented sauce
with tabasco and salt
Slices of plantains, Akra6, sweet
potatoes, meat (mostly pork),
fermented or fresh vegetables, Paté
Chicken or beef meat with ketchup
or mayonnaise or mustard
Artificial juice
Compose of one staple food (rice or
maize)
cooked
together
or
separately with beans (red or black)
served with some salads or
vegetables and meat (chicken or
beef or pork)
Made of dough (wheat flour) which
is fried and may or may not contain
inside some vegetables, meat, eggs
or fish.
Spaghettis
with
ketchup
or
mayonnaise
Cooking methods
Boiling
Frying
Frying or grilling
No cooking
Boiling (rice, maize,
beans), raw salads
meat can be boiled or
fried
Handling after cooking
Sources of contamination
removal of the shell by bare hands
Served in a polyethylene bag
Served with bare hands or with a
fork in a polyethylene bag or paper
bag.
Served with bare hands in a
polyethylene bag
Hand tied polyethylene Bag
Hands, utensils and bags
Served with a spoon in
plates or normal plates
Hands, utensils, water and
bags
Hands, equipment, utensils
and bags
Hands, water, utensils and
bags
foam Hands, utensils, water, raw
vegetables
Frying
Served with a fork or with bare Hands, utensils, vegetables
hands in a polyethylene or paper and bags
bag
Boiling
Served with a fork in disposable Hands, utensils and plates
or non-disposable plates
6
Mashed malanga ( root ) with spices 43
The presence of vegetables and meat in the collected foods makes them at risk of contamination
by lactic acid bacteria such as Lactobacillus, Streptococcus, etc. However, such kinds of bacteria
are spoilage microorganisms and are therefore not implicated in foodborne diseases. The
presence of meat and meat products, poultry and eggs make them at risk of contamination by S.
aureus while the presence of pasta and rice makes them at risk of contamination by Bacillus
cereus (EU 2073, 2005). The presence of pork and poultry in the foods makes them at risk of
contamination by some Salmonella spp. and to a lesser extent the presence of salads in the major
dishes makes them at risk of contamination by Listeria monocytogenes (EU 2073, 2005).
According to the PAHO, fried foods prepared with sausages and other meat products are
considered as high risk food groups because they are most of the time stored at room temperature
(PAHO, 1992). According to WHO/PAHO, street foods are the most at risk of contamination
when they are of an animal origin, have high protein content, high moisture content, a relatively
high pH and a large number of ingredients (PAHO, 1992). (Table 4-14 and 4-15)
4.3.2.
Range of pH and water activity of the street foods
Tables 4-15 presents the pH and water activity values of the street foods evaluated in this study.
70% of the collected foods had a pH which was lower than 6; 26% had a pH between 6 and 8
and 3.9% had a pH > 8. The pH values ranged between 3.56 and 8.64. The product with the
lower pH was the fruit juice (range 3.6-4.4), whilst that with the highest pH was the eggs (mean:
8.2; range: 7.9-8.6). The Fritay had a large pH range; some were acidic while others were more
alkaline (range: 4.7-8.1). This could be explained by the fact that this type of food consists of
different components as mentioned earlier. Most of the samples (95.5%) had a water activity
higher than 0.90 while only 4.6% of them had a water activity lower than 0.90. The highest water
activity (0.99) was found for the juice which is quite understandable. The lowest water activity
was found among the patés and Fritay which are made of fried and consequently dry food
components. (Table 4-14 and 4-15)
Although the optimal pH for growth of most microorganisms is around 7, the pH values of most
of the foods that were collected was suitable for the growth of the most common microorganisms
implicated in foodborne diseases such as for instance S. aureus which grows at a pH of 4.5 to 9.3
(Uyttendaele, 2012).
44
It is well known that water activity plays also an important role in growth of microorganism. It
has been shown in literature that Gram negative bacteria needed a minimum aw of 0.95 whilst
Gram positive require a aw of at least 0.91 for growing (Samapundo, 2012). According to this
observation, 95.5 % of the collected samples had a water activity adequate for growth. (Table 415)
Table 4-15 pH and water activity (aw) of the street foods evaluated in this thesis
Type of food
Eggs
pH
8.2 ± 0.4*
(7.9 - 8.6)**
aw
0.97 ± 0.005
(0.97 - 0.98)
Fritay
5.8±0.71
(4.7-8.11)
0.94±0.02
(0.85-0.98)
Hotdogs
5.9±0.5
(5.5-6.5)
0.95±0.01
(0.94-0.97)
Juice
3.8±0.5
(3.6-4.4)
0.98±0.005
(0.98-0.99)
Major dish
5.9±0.3
(4.8-6.9)
0.96±0.009
(0.94-0.98)
Paté
5.9±0.7
(4.8-6.9)
0.94±0.02
(0.89-0.97)
0.97±0.01
(0.95-0.98)
Spaghettis
5.7±0.3
(5.5-6)
*mean ± standard deviation, **range
Table 4-16 General microbial quality of Haitian street foods
Bacteria
Lactic acid bacteria
Total anaerobes
Total aerobes
B. cereus
S. aureus
L. monocytogenes
Salmonella spp.
E. coli
Observation
41
41
48
10
20
29
3
4
Percentage
53%
53%
62%
13%
26%
38%
4%
5%
Mean ± SD
7
3.68±1.65
3.72±1.58
4.21±1.65
4.57±1.82
3.17±1.26
3.48±1.31
2.79±0.2
2.9±1.01
Range
1.70-7.41
1.30-7.48
2-8.54
2-7.32
2-7.81
2-6.66
2.6-3
2.6-4.36
7
Log CFU/g or ml 45
Table 4-17 Microbial quality of different groups of Haitian street foods
Food
type
Total
aerobes8
Total
anaerobes9
Lactic acid
bacteria10
Bacillus
Spp.11
Staphylococci12
Salmonella
spp. 13
E. coli14
Listeria
spp.15
Total
coliforms16
Fritay
4.6±1.817
4.2±1.7
4.1±1.9
5.6±1.5
3.28±1.5
2.8±0.2
3.2±0.98
3.8±1.4
3.9±2.3
2-8.518
1.3-7.48
1.7-7.4
4.5-7.3
2-7.81
2.6-3
2.7-4.4
2-6.7
2.3-5.6
3.5±0.6
0
2.5±1.1
0
3.2±1.2
0
0
3.7±0.9
0
3.1-4.1
0
1.7-3.3
0
2.3-4.1
2.7
2±0.8
2.6
0
0
2.7
1.5-2.6
2.6
0
0
3.6±1.6
3.5±1.6
3.3±1.5
2
3.65
2-5.3
1.9-5.1
1.9-4.9
2
3.65
4±1.9
3±1.3
3.3±1.2
4.4±1.9
2.9±1.02
2-8.2
1.5-5.3
1.9-5.3
2-7.3
2-4.03
3.9±0.7
3.8±0.4
3.2±1.1
5.12
2.5±0.33
3.4-5.2
3.3-4.2
1.8-4.8
5.12
2.3-2.8
3.6
0
0
0
0
0
3.6
0
0
0
0
0
Eggs
Hotdogs
Spaghetti
Major
dish
Pate
Juice
8
PCA, 9 PCAA, 10 MRS, 11 MYP
12
MSA
13
Salmonella rapid
14
rapid E.coli
3-4.3
0
0
0
0
0
0
2.3±0.3
0
2-2.6
0
0
15
Aloa
16
2
3.4±1.4
2
2.3-5.95
0
2.9±0.44
2
2.6-3.2
2
0
0
0
0
0
0
VRBA
17
Mean ± SD
0
18
Range
46
4.3.3.
Microbiological quality of Haitian street foods
General microbiological quality
Table 4-16 and 4-17 present the results obtained from the microbiological analyses performed.
Anaerobes and lactic acid bacteria were found in 53% of the samples. Mean counts (log CFU/g
or ml) of total anaerobes and lactic acid bacteria were 3.72 (± 1.58) and 3.68 (± 1.65),
respectively, with the values ranging between 1.30 - 7.48 and 1.70 - 7.41, respectively. The total
aerobic counts were slightly higher (62% of the samples were contaminated with aerobes). The
mean count was 4.21 (± 1.65) log CFU/g and the values ranged between 2 and 8.54 log CFU/g.
In conclusion, respectively 12.50%, 7.31% and 7% of the samples had total aerobic, anaerobic
and lactic acid bacteria counts above the acceptable limit i.e. 107CFU/g (Uyttendaele et al.,
2010). No significant difference was found between the contamination levels of the different
type of street foods evaluated (lactic acid bacteria count, p = 0.53; total aerobic counts, p = 0.68;
total anaerobic counts, p = 0.17). In addition, no strong linear correlation was found between
these counts and pH (lactic acid bacteria count, r8 = -0.18; total aerobic counts, r = -0.04; total
anaerobic counts, r = -0.09) or water activity of the food products (lactic acid bacteria count, r = 0.10; total aerobic counts, r = 0.03; total anaerobic counts, r = 0.04).
Presence and levels of pathogenic bacteria in Haitian street foods
As mentioned in the methodology, selected colonies from plates with presumptive positive
pathogens were further tested to confirm the presence of these pathogens. Table 4-18 presents
the results of the confirmation.
Presumptive B. cereus group spp. was identified in 13% (10) of the samples. The mean counts of
presumptive B. cereus group spp. was 4.57 ± 1.82 log CFU/g and the values ranged between 2
and 7.32 log CFU/g on the products were they occurred. Of concern was the observation that
most of the products (70%) contaminated with presumptive B. cereus spp., were contaminated at
levels higher than 104 CFU/g, which is the level at which B. cereus spp. are known to be capable
of causing illness (NSW Food Authority, 2009). No difference was found between the
contamination levels of the different types of food contaminated by presumptive B. cereus spp.
(p = 0.45). From seven colonies of presumptive B. cereus spp. selected for confirmation from
8
r: correlation coefficient 47
products with counts above the acceptable limit, (one each from seven different food samples), 4
(57%) were confirmed as Bacillus spp. However, B. cereus itself was only found in one sample.
The sample consisted of paté which is made of wheat flour with chicken and some vegetables
inside. Bacillus pumilus was identified in two samples (major dish made of rice and beans) and
Bacillus megaterium in one sample of fried sweet potatoes. Although focus is mainly on B.
cereus, from a food safety point of view, food poisoning by other Bacillus spp. has been reported
(Rowan et al., 2003; From et al., 2006). For example, B. pumilus has been identified as the only
contaminant in some cases of food poisoning where no foodborne pathogens could be detected
(Kramer and Gilbert, 1989; Suominen et al., 2001). The mechanism of pathogenicity seems to be
linked to the production of complex lipoproteins toxins known as pumilacidins which are
produced at the highest quantity at 15⁰C (From et al., 2007).
Table 4-18
Confirmed microorganisms in positive plates
Description
Food component
Microorganisms
Major dish
Major dish
Fritay
Paté
spaghetti
Egg
Fritay
Fritay
Fritay
Rice+ red beans + vegetables
Rice+ black beans +chicken
Fried sweet potatoes
Wheat flour dough+ chicken+ vegetables
Spaghetti, ketchup
Eggs, tabasco
fried plantains+ Akra+ vegetables
Plantains
Plantains, chicken, sweet potatoes
Major dish
Rice, black beans
Bacillus pumilus 93.4%a
Bacillus pumilus 99.8%
Bacillus megaterium 92%
Bacillus cereus 50%
S. sciuri 91%
S. aureus 97.8%
S. epidermidis 89.5%
S. lugdunensis 66%
S.lentus 99.9%
E. coli
E. coli
Log
CFU
7.32b
4.11
4.50
5.12
3.65
4.10
3.34
3.41
3.74
2.60
2
a % correlation, b: Log CFU/g of presumptive species in the food sample 26% of the samples were presumptively positive for S. aureus. The mean log CFU/g was 3.17
(±1.26). The range of contamination was between 2 and 7.81 log CFU/g. 15% of these values
were above 104 CFU/g which is considered as a potential hazardous level in ready to eat food
products (NSW Food Authority, 2009). No difference was found among the type of foods (p =
0.69). No strong correlation was found either with pH and water activity. Of 9 colonies of
presumptive S. aureus (one each from nine different food samples) selected for confirmation,
only one isolate (11.1%) was identified as S. aureus. The sample from which this isolate came
48
from consisted of boiled eggs. The presence of S. aureus in this product could be probably
explained by the fact that the shell of the boiled eggs is removed by bare hands which might have
been contaminated. The other presumptive S. aureus were identified as Staphylococcus sciuri,
Staphylococcus epidermidis, Staphylococcus lugdunensis and Staphylococcus lentus. Although
these species are not frequently associated with foodborne diseases, S. sciuri is considered as an
important human pathogen and is responsible of cases of endocarditis, peritonitis, septic shock,
urinary tract and wound infections and pelvic inflammatory disease (Gan et al., 2007).
38% of the samples were presumptively positive for Listeria monocytogenes. The mean count
was 3.48 (±1.31) log CFU/g. The values range between 2 and 6.66 log CFU/g. These values
were above the acceptable limit which is absence in 25g/102CFU/g of ready to eat products able
or unable to support the growth of Listeria monocytogenes (NSW Food Authority, 2009). No
difference was found between the different type of foods (p = 0.46) and there was no strong
correlation with pH and water activity. All the 15 samples of presumptive L. monocytogenes spp.
selected for confirmation were determined to be Streptococcus viridicans which is not known as
a foodborne pathogen.
Only 4% and 5% of the samples were presumptively positive for Salmonella spp. and E. coli,
respectively. The mean count were 2.79 (± 0.2) and 2.91 (± 1.01) log CFU/g for Salmonella and
E. coli, respectively. The values ranged between 2.6 and 3 for Salmonella spp. and 2.6 and 4.36
for E. coli. The values for both microorganisms were above the acceptable limit which is absence
in 25g of ready to eat food (NSW Food Authority, 2009). Presumptive Salmonella spp. was
found only in Fritay, whilst one presumptive E. coli were also found in Fritay. No difference was
found between the contamination levels of the different types of food and there was no strong
correlation found with pH and water activity. Of the four colonies of presumptive E. coli (one
each from four different food samples) selected for confirmation, two (50%) were confirmed as
E. coli. These originated from samples of Fritay and Haitian main dish. Salmonella was not
confirmed in any of the selected presumptive plates. (Table 4-18)
Some key findings in the assessment of the microbial quality of street vended food in Port-auPrince were the high numbers of anaerobes, aerobes and lactic acid bacteria. The same findings
have been observed in other studies described below. This might suggest that the hygienic
quality of the street food is very poor. However, the number of samples contaminated with
49
pathogens was low. B. cereus and S. aureus were confirmed in only one sample each, whereas E.
coli was confirmed in two samples. These findings are surprising as the conditions in which the
street vendors operated were precarious as described above and also as different studies carried
on around the world have reported the contamination of street vended foods by various
pathogens. For instance in the Dominican Republic (which neighbours Haiti), E. coli (in water,
milk, and cheese samples), B. cereus (in bean and rice samples) and C. perfringens (in meat,
chicken and bean samples) were identified in street vended foods (Bryan et al., 1988). However,
they all occurred at numbers less than 103/g and no information could be found on whether they
were presumptive positive or confirmed microorganisms. In a study on street foods in South
Africa, S. aureus ranged between 102 and 103 CFU/g on beef, 103 CFU/g on chicken, ≤ 103
CFU/g in gravy and no Listeria spp. was isolated but no specific test was done to confirm the
identity of these pathogens (Lues et al., 2006). In Ghana, mesophilic bacteria were identified in
356 food samples (69.7%); and confirmed B. cereus, S. aureus and Enterobacteriaceae were
found in 28 (5.5%), 163 (31.9%), and 172 (33.7%) street food samples, respectively, although
the microbial quality of most foods was within acceptable limits (Mensah et al., 2002). In
Bangkok (Thailand), 14 samples (15.2%) and 38 samples (41.3%) of ready-to-eat food were
contaminated with bacteria in general and coliforms, respectively (Cuprasitrut et al., 2011). In
Lome (Togo) median total aerobic bacteria and total coliform counts of 3.2 x 106 and 1.9 x 104
CFU/g were found in samples of salads. Sixteen samples (23.2%) were contaminated by
confirmed S. aureus at levels between 10 and 200 CFU/g (Adjrah et al., 2013). In Brazil, fecal
coliforms were detected in 22 samples (55%) (>3 MPN/g), 50% were above acceptable limits,
confirmed B. cereus, S. aureus and E. coli were present in 12.5%, 2.5% and 22.5% of street food
samples, respectively. B. cereus counts ranged from 1.4 x103 up to 1.7 x104 CFU/g of food
sample (Hanashiro et al., 2005). In Johannesburg, 22% of 51 street food samples were
contaminated with presumptive positive B. cereus, however, the counts were all below 1 log
CFU/g and it was found to be the most prevalent pathogen in all samples collected; presumptive
positive S. aureus was isolated in two chicken stew samples (16/66, 24%) and no E. coli were
detected (Mosupye et al., 2000). In Sudan, confirmed E. coli, S. aureus and Bacillus spp. were
identified in street food samples and the viable counts in cooked vegetables, bottled drink and
juice were 4.6, 3.7 and 4.1 log10 CFU/ml, respectively (Abdalla et al., 2009). In Trinidad and
50
Tobago, a study carried on street vended hamburgers revealed that even though pathogens were
present, the microbial risk was 0 i.e. was within the acceptable limits (Badrie et al., 2004).
Difference between the results of our microbiological analysis and those of previous studies in
other countries could be that the type of collected food was totally different from the ones in
other studies. It is important to notice also that in many studies, only presumptive positive
pathogens were reported and no further confirmation tests were carried out. Contrary to other
studies as well, the majority of the food evaluated in this study was prepared on site which could
have reduced the overall risk of contamination by pathogens.
The study presents some considerable limits:
i.
Because of the lack of available data on the number of street food vendors in Haiti and
also because of a limited amount of time and resources, the sample size was not
calculated but was arbitrary defined. This could be a source of bias in the study since we
do not know how representative our participants really were,
ii.
The selection of the studied communes was also designed arbitrary and some areas,
specifically the slums, were excluded from the study due to accessibility issues. Since
hygienic conditions in slums are usually very poor their inclusion could have most likely
impacted on the results of our study,
iii.
The same observation regarding the sample size can also be extended to the number of
food samples collected and evaluated in this study. 77 samples were arbitrary collected
and transported to Belgium for analysis since the samples could not be analysed in Haiti.
This posed some serious constraints for collecting more samples,
iv.
In the study, priority was given to places around schools for selection of consumers,
which could partly explain why there was a high educational level compared to the reality
of the country.
v.
In addition, we need to be very careful in interpreting the microbial results since a high
count of presumptive positive pathogens was found in several samples. It has to be
emphasized that only one isolate per plate with colonies of a presumed pathogen was
randomly selected and used for the confirmation. This significantly reduced the chances
that the presumed pathogen was actually selected for confirmation. Ideally, more (five to
51
ten) colonies should have been confirmed. However, more colonies have been selected
for further analysis and these results will be published in a separate paper soon. This will
give us a more valuable insight on the real contamination of the street food marketed in
Haiti by pathogens.
We need also to mention that some critical aspects have not been approached in our study and
consequently are highly recommended:
i) Because of the inaccessibility to potable water, it would be interesting to also evaluate the
microbial quality of the water used to wash the dishes by the street vendors,
ii) It would also be interesting to take swab samples of the preparation boards and hands of food
handlers since it was observed that the hygienic quality of the collected foods was very low,
iii) An investigation of the acquisition of raw materials and outcomes of leftovers might be also
relevant since there was a limited capacity of cooling by the street vendors,
iv) The presence of some other foodborne pathogens such as Norovirus, Campylobacter,
Clostridium perfringens and Vibrio cholera has not been assessed in this study, it could also
interesting to test these pathogens.
52
5.
Conclusions
This study had the major objective of determining the food safety knowledge, attitude and
practice of street food consumers and vendors in Haiti. To a lesser extent, it also had the
objective of assessing the microbial quality of street vended food in Port-au-Prince. According to
the WHO, these factors play an important role in order to address correctly food safety issues
(WHO, 2000). The study was the first of its nature that has been done in Haiti.
The main conclusion of our study is although consumers and vendors exhibit an average good
food safety knowledge and attitude; a considerable percentage had a very low score meaning that
there is still a need for food safety education. The actual food handling practices by street
vendors also raise some serious concerns. Since the majority of vendors did not have any food
safety training, there is a need to organize formal training in food safety for the street foods
vendors. There is also a need for the government to make more infrastructures available such as
potable water, toilets and waste disposal facilities as the lack of these structures was evident in
our study. The results observed in this study point out the need to emphasize the importance of
cold temperatures to retard growth of microorganisms particularly refrigerating during
defrosting. Since no data could be found on the numbers of street food vendors in the country,
there is a need for the institute of Haitian Institute of Statistics and Informatics (IHSI) which is
responsible for national surveys to generate more data in order for the government to have more
control and organization on this sector. Haiti currently has no food safety legislation. A project
of legislation has been introduced to the parliament in 2012 but it has not been adopted yet. This
would be necessary for regulation of the street food business and the food industry in general.
Due to the limits of the research mentioned above, one should be careful in generalizing the
results of the study and there is a need for more studies in the street food sector and perhaps it
might also be interesting to extend that study to other departments of the country.
53
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62
Annexes
Annex1:Studylocation
Source: google earth
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Annex2:Foodsafetyknowledgeandattitudequestionnaire
Sex: Male / Female
Education:
Illiterate
Age:
Elementary school
FOOD SAFETY KNOWLEDGE
Food safety training: Yes / No
High school
YES
Higher education
NO
DO NOT KNOW
Washing hands before work reduces the risk of
food contamination
Using gloves while handling food reduces the risk
of food contamination.
Proper cleaning and sanitization of utensils
increase the risk of food contamination.
Eating and drinking in the work place increase the
risk of food contamination.
Food prepared in advance reduces the risk of food
contamination.
Reheating cooked foods can contribute to food
contamination.
Washing utensils with detergent leaves them free
of contamination.
Children, healthy adults, pregnant women and
older individuals are at equal risk for food
poisoning.
Typhoid fever can be transmitted by food.
AIDS can be transmitted by food.
Bloody diarrhea can be transmitted by food.
Abortion in pregnant women can be induced by
food-borne disease.
Salmonella is among the food-borne pathogens.
Hepatitis A virus is among the food-borne
pathogens.
Staphylococcus is among the food-borne
pathogens.
Can swollen cans contain microorganisms
Microbes are in the skin, nose and mouth of
healthy handlers.
During infectious disease of the skin, it is
necessary to take leave from work.
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FOOD SAFETY ATTITUDES
Well-cooked foods are free of contamination.
Proper hand hygiene can prevent food-borne
diseases.
Can a closed can/jar of cleaning product be
stored together with closed cans and jars of food
products
Raw and cooked foods should be stored
separately to reduce the risk of food
contamination.
It is necessary to check the temperature of
refrigerators/freezers periodically to reduce the
risk of food contamination.
Defrosted foods can be refrozen.
The health status of workers should be evaluated
before employment.
The best way to thaw a chicken is in a bowl of
cold water.
Wearing masks is an important practice to reduce
the risk of food contamination.
Wearing gloves is an important practice to reduce
the risk of food contamination.
Wearing caps is an important practice to reduce
the risk of food contamination.
The ideal place to store raw meat in the
refrigerator is on the bottom shelf.
Eggs must be washed after purchase
Dish towels can be a source of food
contamination.
Knives and cutting boards should be properly
sanitized to prevent cross contamination.
Food handlers who have abrasions or cuts on
their hands should not touch foods without
gloves.
YES
NO
DO NOT KNOW
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Annex3:Foodsafetyobservationchecklist
Food safety observation checklist
Name vendor: …………………………………………………………….
Location: ………………………………………………………………….
Age: …………………
Sex: …………………
Education level: ……………………………………..
Food safety training: …………………..……………
1. Facilities
-
Indicate what kind of material the stall/structure were the food is prepared and sold is
made
Wooden
Canopy
Van
Wheelbarrow
Zinc/ iron
Container
-
Is food prepared on-site or at home?
-
Is vending stall protected from sun, dust and wind?
-
Are animals or pests (flies etc.) evident around the vending stall? Yes/No
-
Is the vending stall maintained in a clean condition? Yes/No
-
Is there access to potable water at the site or close to the site? Yes/No
-
Are adequate hand washing facilities available? Yes/No
-
Are adequate waste (water or food) disposal facilities available? Yes/No
Yes/No
o this is usually a closed (foot operated) bin
o access to community operated waste water and general waste disposal sites
2. Environment around the stall
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-
Is environment around the stall clean: far from rubbish, waste water, toilet facilities, open
drains and animals? Yes/No
3. Personal hygiene
-
Does the operator wash their hands in clean water each time before the handling,
preparation and serving of food? Yes/No
-
Does the operator wash their hands each time after visiting the toilet? Yes/No
-
Are the operators’ clothes clean and presentable? Yes/No
-
Does the operator use an apron when handling, preparation and serving of food? Yes/No
-
Does the operator handle food with bare hands? Yes/No
o If answer was NO, do they use disposable or reusable gloves?
o Are the gloves cleaned properly i.e.. in clean water (with or with soap) before the
handling, preparation and serving of food?
-
Does the operator have clean short nails? Yes/No
-
Is the hair of the operator covered when handling, preparation and serving of food?
Yes/No
-
Does the operator handle money while serving food? Yes/No
o Are hands washed after handling money before handling food again? Yes/No
-
Does the operator wear jewelry? Yes/No
o Is the jewelry adequately covered? Yes/No
-
Does the operator blow air into polythene bag before use? Yes/No
-
Is dirt or dust removed by means of an apron, dirty cloth or bare hands?
-
Is dirt or dust removed by blowing?
-
Does vendor smoke during the handling/ preparation of food? Yes/No
-
Does the operator use the same utensil (knives and boards) to prepare raw and cooked
food products or to cut raw vegetables and fresh meat and poultry? Yes/No
-
Please note down any unhygienic behavior you may notice by the operator while vending
food i.e.
o Blowing of nose into hands continuing to work without washing the hands
o Coughing into hands and continuing to work without washing the hands
A5
4. Food storage
-
Is food stored/displayed
o Openly in the stalls
o In a wheelbarrow
o In sealed (transparent or opaque) containers
-
Are raw, partially cooked and cooked food products kept separate? Yes/No
-
Are previously cooked foods kept cool (i.e. ice box) or refrigerated?
5. Utensils
-
Are utensils cleaned with
o Warm soapy water
o Cold soapy water
o Clean water with no soap
o Dirty water with no soap
-
Are utensils covered? Yes/No
-
Are utensils cleaned adequately every time after use? Yes/No
A6
Annex4:Consentform
VOLUNTEER AGREEMENT FORM
Title: Food safety knowledge of consumers and handlers of street food in Haiti
Principal Investigator: [Ruth Climat]
Address: Ghent University, Coupure Link, 9000 Gent, Tel: 09 264 9902
Email: [email protected]
General Information about Research
This study will investigate the food safety knowledge, attitudes and practices of street food vendors and
consumers of street food.
Possible Benefits, Risks and Discomforts
There are no direct benefits to be gained from this study immediately, neither are there any risks
associated with it. The only inconvenience might come from the time you will spend completing the
questionnaire. The data from this study will be used only for the purpose of the study. (Master Thesis)
Confidentiality
Your identity and your participation in this study will be treated strictly confidential. The information that
we obtain from you will not be shared with anybody, except the study investigators. Your identity
remains secret since your personal information will only be designated by a unique participant number.
Your name will not appear in any reports or publications resulting from this study. After the study is
completed, you may request information about the study results.
Voluntary Participation and Right to Leave the Research
You participate entirely voluntarily in this study. You have the right to refuse to participate in the study.
You also have the right to stop your participation in the study at any time, even after you have signed this
informed consent form. The withdrawal of your consent will not cause any disadvantage or loss of
advantages/privileges.
Contacts for Additional Information
Any questions or any further clarifications concerning the study can be directed to:
Contact of the promoter:
Prof. Frank Devlieghere/ Dr. Simba Samapundo
Laboratory of Food Microbiology and Food preservation
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Faculty of Bioscience Engineering
Ghent University
Coupure Links 653, 9000 Gent, Belgium
Tel: 00 32 9 264 9902, Fax: 00 32 9 225 5510
Email: [email protected]
Contact of local researcher
Ruth Climat
Tel: 37229627
Email: [email protected]
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (name of
research) has been read and explained to me. I have been given an opportunity to have any questions
about the research answered to my satisfaction. I agree to participate as a volunteer.
Date
Name of volunteer
If volunteers cannot read the form themselves, a witness must sign here:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were
answered and the volunteer has agreed to take part in the research.
Date
Name of Witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating
in this research have been explained to the above individual.
Date
Signature of Person Who Obtained Consent
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