Background: Due to consumption of unhygienic and unsafe food, foodborne diseases are a major public health concern causing a significant morbidity and mortality rate globally. In our time, street foods are thriving in many towns of Ethiopia including urban areas in Shashemane. It becomes common to see street vendors around schools, hospitals, bus stations where numerous people are congested. Since street vended food is operated under poor sanitary conditions near the street, it can be contaminated with many pathogens that can expose consumers to various foodborne diseases. These situations require an evaluation of safety and hygiene of street foods being served in urban areas in order to prevent them from developing into health risks among consumers.

Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.

Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using EpiData 3.1 and finally, it was analyzed using SPSS VERSION 20.

Results: The magnitude of good food handling practice among street food vendors and food handlers in food establishments in this study is 27.5% - 49.2% of food handlers had good Knowledge of food handling practice. Average monthly income > 1500 Ethiopian Birr; Primary school level of education; good Knowledge of Food handling and Receiving Food handling training are independent predictors of Good food handling practice.

Conclusion: Good food handling practice among street food vendors and food handlers in food establishments in this study is very low; monthly income > 1500 Ethiopian Birr; Primary school level of education; good Knowledge of Food handling and Receiving Food handling training are independent predictors of Good food handling practice

Abbreviations

AOR: Adjusted Odds Ratio; COR: Crude Odds Ratio; EU: European Commission; FAO: Food and Agricultural Organization; FBDs: Food Borne Diseases; FERG: Foodborne Epidemiology Reference Group; SFVs: Street Food Vendors; SVFs: Street Vended Foods; WHO: World Health Organization

Introduction

In both developed and developing world, foodborne diseases are a public health concern. Billions of people are at risk and millions fall ill every year; thousands die as a result of consuming unsafe food [1-3]. However, the extent of health problem is not the same; it varies among regions and within sub regions [4]. The global burden of FBDs/foodborne diseases is considerable, and affects individuals of all ages, particularly children < 5 years of age and persons living in low-income regions of the world [1].

Using unsafe water for cleaning and processing of food, poor food-production processes and food-handling, absence of adequate food storage infrastructure and inadequate or poorly enforced regulatory standards aggravate the burden of FBDs [1,5,6]. This may be the characteristics of environmental conditions of street food vendors in low-income countries like Ethiopia [1,7,8].

As reported in the scientific literature during the years of 2006 and 2007, 3 out of 10 people in the world suffered from Foodborne Diseases/FBDs [9-13]. Even though this figure is reduced to 10% since 2010 [5,11], it is still a critical public health problem of our globe.

Research forms the backbone for addressing food safety and hygiene practices on the reduction of foodborne diseases [1]. WHO and EU recommend the community measures (such as food safety, food hygiene and water safety) to be reassessed in the light of scientific knowledge which is therefore crucial in addressing foodborne prevention [1,9-11]. Hence, looking into the presence of knowledge gap on food hygiene and safety practices among street food vendors are a prime footstep for proper planning and performing requisite interventions in low income regions and sub-regions like Ethiopia.

Moreover, in urban areas of Ethiopia like Shashemane, dining out in street shops is common among numerous consumers [14]. However, to the best of our awareness, no study has been undertaken on the level of food hygiene and safety among street food vendors particularly in Shashemane. In the absence of such data, planning successful intervention methods for improving food hygiene and safety among food handlers is impossible. This may limit the preventive strategies of food-borne diseases to improve public health status in the zones. Therefore, this study aimed to investigate the hygiene practices of street food vendors and safety of street foods in Shashemane, West Arsi Zone, Oromia, Ethiopia.

Methods

Study area and period

This study was conducted in Shashemene town located at 250 km from Addis Ababa in South of Oromia region. Shashemene town is the capital city of West Arsi zone; located in Oromia national regional state.

Study design and period

A cross-sectional study design was used and this study was conducted from December 28, 2019 to January 27, 2020.

Source population

All food handlers working in street food vendors in the Gedeo zone were used as source of population.

Study population

The study subjects are those food handlers who were selected or the study using random sampling techniques

Sample size determination and sampling technique

Due to the nature of the issue convenient sampling technique was used to take data from 120 street food venders.

Inclusion criteria

All street food vendors, who gave their consents, in the town, were included in this study. Food handlers who were working in street food vendors during the study period were included.

Exclusion criteria

Street food vendors who were absent on data of data collection were excluded.

Data collection tools and procedure

A structured questionnaire composed of socio-demographic factors, food safety knowledge, working environment characteristics and food hygiene practices were employed to collect the data via face to face interview and observation. The questionnaire was designed from standardized food and drink establishments’ inspection checklist by reviewing different literatures. To maintain its consistency, the questionnaire was originally prepared in English, then translated to local language, and finally retranslated back to English.

Public health and environmental health professionals were recruited as data collectors and field supervisors. One day training regarding the objective of the study, interview and inspection techniques, and confidentiality of information was given to data collectors and supervisors.

The questionnaire was pre-tested on 5% of the total sample out of the study area. To maintain the quality of data, the investigators and supervisors carried out regular supervision, spot-checking, and reviewing the completeness of the questionnaire on daily basis.

Data handling and analysis

The data entry was done using EpiData version 3.1; data analysis were done using the SPSS VERSION 20. Level of significance was set at 95% confidence interval. Descriptive analysis was done. Pearson correlation was used to test relationships of variables within the study areas. Results were summarized and presented by tables.

Operational definitions

The level of food hygiene practice was determined by using 17 food hygiene practice questions complemented with direct observation based on Derso, et al. [7,14]. The food hygiene practice was computed with a maximum score of seventeen. By considering the mean score as twelve, 12; the food hygiene practice of food handlers was categorized as poor if their score was below twelve, otherwise good practice if their score was greater or equal to twelve.

Regarding to food safety knowledge, ten questions were used to determine the food handler’s knowledge about food safety [7]. Finally, by considering the mean score as 6, the food handlers’ knowledge was categorized as poor if their score was less than six, otherwise good knowledge if they score greater than or equal to six.

Ethical consideration

Ethical approval and clearance was obtained from Paradize Valley College, Shashemene, Ethiopia. Verbal consent was obtained from owners/managers and study subjects. Interview was carried out only with full consent of the person being interviewed. Each respondent was assured that the information provided by her/him are kept confidential and used only for the purpose of this research.

Result

Socio-Demographic Characteristics of the study participants

The great majority of food handlers in street food shops (90.8%; 109/120) were women. About 31% (38/120) of the study participants just attended up to Primary school. The mean age of street food vendors was 27 ± 6.3 years, respectively (Table 1).

Environmental hygiene parameters of the study participants

83% of Food vendors had unclean Surrounding Environment on Observation. The majority of Food shops/vending sites have washing basin (80%) (Table 2).

Observed food handling/vending practices of Participants

Only 10% of the Street food handlers among participants had hair covering. Greater than half of food vending sites (86.7%) had foods in uncovered container (Table 3).

Factors associated with food handling practice

In bivariate logistic regression analyses; socio demographic and economic characteristics such as Educational Status of the study participant; having the level of education of Primary school [Crude Odds Ratio/COR = 4.63, 95% Confidence Interval/ CI (2.14 - 10.01)] having the level of education of secondary school and above [COR = 0.11, 95% CI (0.08 - 0.58)], and Average monthly income (having monthly income > 1500 ETB) were found to be associated with food handling practice [COR = 1.6, 95% CI (1.08 - 7.82). p < 0.05. Moreover; knowledge of food handling [COR = 7.4, 95% CI (4.8 - 8.53) and Food handling training [(COR = 23, 95% CI (19.38 - 26.59) were the other factors found to be associated at bivariate level.

In multivariable logistic regression analyses level, the odds of good food handling practice in those who are at primary school is three times higher compared with those who are unable to read and write [(Adjusted odds ratio/AOR = 3, 95 CI = (1.36 - 7.67)]. Regarding average monthly income food handlers who earn greater than 1500 Ethiopian Birr per month were two times more likely to have good food handling practice as compared to those who earn less than 800. [AOR = 2.2, 95% CI = (1.9 - 5.87)]. The odds of good food handling practice in those who had good knowledge of food handling was three times more compared with those who has poor knowledge of food handling; [AOR = 3, 95% CI = (1.87 - 9.36)]. Moreover, the odds of good food handling practice in those whose received food handling training was four times higher; [AOR = 4.5, 95% CI = (2.56 - 9.26)] (Table 4).

Discussion

We conducted a community-based cross-sectional study among street food vendors and food handlers in food establishments in Shashemane, town, Ethiopia. Our main findings showed that; only 27.5% had good food handling practice and almost half (49.2%) had good Knowledge of food handling practice. Average monthly income (having monthly income > 1500 Ethiopian birr); having primary school level of education; good knowledge of food handling and receiving food handling training are independent predictors of food handling practice.

Our findings showed low level of good food hygiene and safety practices (27.5%) than previous studies conducted in other Ethiopian towns, i.e. (49.0%) of food handlers had good food handling practice in a facility-based cross-sectional study conducted in Gondar city [15]. In addition 72% and 49.6% of food handlers had good food handling practice in study conducted at Desse and Debark town, Ethiopia respectively [7,16]. These variations might be due to the difference in socioeconomic characteristics of the study population, variation in training, and the provision of food hygiene/safety materials and education from government bodies.

The odds of good food handling practice in those having primary school level of education was three times more compared with those who are unable to read and write; Cross-sectional studies in Amhara region, Northwest Ethiopia, Dangila town [6] and Bahir Dar town [7] also showed that educational status is an independent predictor of good food handling practice. This could be due to the marvellous multipurpose impact of education that improves our daily practice, as body hygiene is thought in schools across Ethiopia.

The odds of good food handling practice in those who had good knowledge of food handling is three times more compared with those who has poor knowledge of food handling; Studies conducted on knowledge attitude and practice about food safety in Hanoi, Veitnam [17] and in Taif, Saudi Arabia [18] suggested that efforts to prevent foodborne illnesses in food facilities require sufficient knowledge on hygiene and safety standards from both food processors and customers. Although good Knowledge is not a guarantee for good practice, it is one of the key enabling factors to have a better food handling practice.

The odds of good food handling practice in those whose received Food handling training was four times higher; A cross-sectional study conducted on factors associated with food safety practices among food handlers in Gonder town reveled similar finding [15]. Training is one of the best interventions to improve human practice as it significantly increase knowledge which is a key factor to improve practice.

Average monthly income of food handlers who earn greater than 1500 ETB per month per two times more likely to have good food handling practice as compared to those who earn less than 800 ETB; This could be due to the fact that ;those who have better economic status can buy all the necessary materials for keeping food hygiene.

Conclusions

The magnitude of good food handling practice among street food vendors and food handlers in food establishments in this study was 27.5% - 49.2% of food handlers had good Knowledge of food handling practice. Average monthly income > 1500 ETB; having Primary school level of education; good knowledge of food handling and receiving food handling training were independent predictors of good food handling practice.

Recommendations

Based on the findings of this study the following recommendations are forwarded:

Shashemane town health office should support and facilitate inspection, education and intensive trainings to food handlers.

Health facilities should support with provision of necessary materials to keep environmental hygiene

Health extension worker should work hard on teaching food handlers to increase awareness.

Finally, we recommend for further community based Interventional/follow up study.

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