Presonal Hygine Practice and Disease Awareness

A SURVEY BASED STUDY ON PERSONAL HYGIENE PRACTICE AND

DISEASE AWARENESS AMONG STUDENTS AND VENDORS AROUND

EAST WEST UNIVERSITY

A thesis report, submitted to the Department of Pharmacy, East West University, in

partial fulfillment of the requirements for the degree of Bachelor of Pharmacy

Submitted by:

Wahida Akther

ID: 2007-3-70-042

Department of Pharmacy

East West University

CERTIFICATE

This is to certify that the dissertation entitled

“A Survey Based Study on Personal Hygiene and Disease Awareness among Students and

Vendors around East West University” is a survey research work done by Wahida Akther

(2007-3-70-042) under the guidance of Dr. Sufia Islam, Associate Professor and Chairperson,

Department of Pharmacy, East West University, Aftab Nagar, Dhaka. No part of the thesis has

been submitted for any other degree. I also certify that all the sources of information availed of

this connection is duly acknowledged.

____________________________

Dr. Sufia Islam Ph.D (Supervisor)

Chairperson and Associate Professor



Aftab Nagar, Dhaka, Bangladesh

____________________________

Farhana Rizwan (Co-investigator)

Senior Lecturer




____________________________

Nishat Nasrin (Co-investigator)

Senior Lecturer




ACKNOWLEDGMENT

First, all praise and glory are to Allah for all the bounties granted to me and only with His

guidance and help this achievement has become possible.

I would like to express my profound gratitude and deep respect to my supervisor and respected

chairperson, Dr. Sufia Islam, Associate Professor and Chairperson, Department of Pharmacy,

East West University, Aftab Nagar, Dhaka for her constant supervision, intense support and

constructive criticism during the thesis work. Her timely advice and encouragement have made it

possible for me to accomplish the task as per schedule. It is my great pleasure and privilege to

acknowledge my deepest regards and gratitude to my supervisor for her inspiration.

I am thankful to my honorable teachers and co-investigators, Ms. Farhana Rizwan, Senior

lecturer, Department of Pharmacy, East West University and Nishat Nasrin, Senior lecturer,

Department of Pharmacy, East West University and for their kind support during the survey

work and after the survey Work.

I wish to thank my fellow researchers namely, Shamima Nasrin and Rejawana Akther for their

endless cooperation and whole hearted inspiration throughout the period of the research work.

I express my sincere thankfulness to my family members for guiding me all through my life,

including that for my research project.

Dedicated

To

My Loving Parents

ABSTRACT

Purpose: The present research was a comprehensive study that was conducted to identify the

personal hygiene practice and disease awareness among students and vendors around East West

University.

Methods: This was a survey based study where students and street vendors of different genders,

locations, and occupations were taken as volunteers. A questionnaire was made to complete this

survey. Information was collected by taking interview of the participants over a period of four

months. Data was analyzed using Microsoft Excel 2010 and SPSS 17.0.

Results: 21.8% students were smokers and 78.2% students did not smoke. 91.6 % students,

participated in this study, had the concern that some infections. 36.44% students have suffered

from Fever. 49.8% student agreed that they had been affected by diseases after taking street-

vended foods. 52.3% street vendors never took any vaccination. 79% street vendors have

recently suffered diseases. All vendors have suffered from RTI.

Conclusion: The results of the study clearly indicate that street-vended foods are available

beside East West University are not safe for meal avoiding street vended may be one of the best

health decisions to prevent food borne diseases. To raise public awareness about their health and

to make this process easy a weekly program can be held on “hygiene practice and disease

awareness” for street vendors and students. And can be organized by social workers and

government.

Keywords: Food, water, disease, awareness, safety, waste, hazard, street.

Table of Contents

Serial No. Topics Page No.

Chapter 1 Introduction 1-33

1.1 Concept of Hygiene 1-2

1.2 Importance of Personal Hygiene 2-3

1.2.1 Health Implications 2

1.2.2 Considerations 3

1.2.3 Attractiveness 3

1.2.4 Professional Life 3

1.3 Benefits of the Personal Hygiene 4-5

1.3.1 Good Health 4

1.3.2 Healthy Personal Relationships 4

1.3.3 Healthy Professional Relationships 5

1.4 Applications of Personal Hygiene Practices 5-13

1.4.1 Personal Hygiene in the daily life of a person 5-6

1.4.2 Kitchen Hygiene 7

1.4.3 Respiratory Hygiene 7

1.4.4 Food Hygiene at Home 7-8

1.4.5 Household water treatment and safe storage 8-9

1. 4.6 Laundry hygiene 9-11

1.4.7 Medical hygiene at home 11-12

1.4.8 Personal hygiene for employers and workers 12-13

1.5 Water borne diseases 13-15

1.6 Food borne diseases and involved organisms 15-18

1.7 Street-vended Foods 19-20

1.8 Hazard Analysis of street-vended foods 20-30

1.8.1 Vending Location: Food Handling and Waste Disposal 20-23

1.8.1.1 Food Handling 22

1.8.1.2 Waste Disposal 22-23

1.8.2 Quality of Raw Materials: Water and Other Materials 23-25

1.8.2.1 Water 23-24

1.8.2.2 Other Raw Materials 24-25

1.8.3 Utensils and Equipment: Chemical and Microbial

Contaminants

25-26

1.8.3.1 Chemical Contaminants 26

1.8.3.2 Microbial Contaminants 26

1.8.4 Food Preparation: Storage and Reheating 26-28

1.8.4.1 Storage 27

1.8.4.2 Reheating 28

1.8.5 Personal Hygiene of the Vendors or Food Handlers 28-29

1.8.6 Control Measures and Initiatives to Improve Street Food

Vending

29-30

1.9 Disease Awareness and Food Safety 30-33

Chapter 2 Methodology 34-38

2.1 Objective of the Study 34

2.2 Rationale of the Study 34-35

2.3 Significance of the Study 35

2.4 Type of study 35

2.5 Place of study 35-36

2.6 Study population 36

2.7 Inclusion criteria of the cases 36

2.8 Exclusion criteria of the cases 36

2.9 Study period 36

2.10 Ethical considerations 37

2.11 Research approach 37

2.12 Data collection method 37

2.13 Data Analysis 37

2.14 Questionnaire 38

3.1 Smoking habits of the Students 39

3.2 Vaccination status of the Students 40

3.3 Students’ awareness about Vaccination 41

3.4 Students suffered from diseases recently 42

3.5 Types of diseases students suffered from 43-44

3.7 Vendors knowledge about street-vended food borne

diseases

Chapter 3 Results 39-50

3.6 Students’ disease status after taking Street-vended food 44-45

45-46

3.8 Vaccination status of the vendors 46-47

3.9 Vendors’ knowledge of vaccination 47-48

3.10 Vendors suffered from disease recently 48-49

3.11 Types of diseases Vendors suffered from 49-50

Chapter 4 Discussions 51-52

Chapter 5 Conclusion 53

Chapter 6 Reference 54-61

Chapter 7 Appendix 62-76

List of Tables

Table no. Title of the table Page no.

Table 1.4.1 Personal Hygiene in the daily life of a person 5-6

Table 1.5.1 Pathogens in Water-related Diseases 13-14

Table 1.5.2 Water-related Health risks from chemicals 15

Table 3.1 Smoking habits of the students 39

Table 3.2 Vaccination status of the Students 40

Table 3.3 Students’ awareness about Vaccination 41

Table 3.4 Students suffered from diseases recently 42

Table 3.5 Types of diseases students suffered from 43

Table 3.6 Students’ disease status after taking Street-vended food 45

Table 3.7 Vendors knowledge about street-vended food borne diseases 46

Table 3.8 Vaccination status of the vendors 47

Table 3.9 Vendors’ knowledge of vaccination 48

Table 3.10 Vendors suffered from disease recently 49

Table 3.11 Types of diseases Vendors suffered from 50

List of Figures

Figure no. Title of the figure Page no.

Figure 1.4.1 Procedure of Hand Wash 6

Figure 1.4.6 Laundry Hygiene 10

Figure 3.1 Smoking habits of the students 39

Figure 3.2 Vaccination status of the Students 40

Figure 3.3 Students’ awareness about Vaccination 41

Figure 3.4 Students suffered from diseases recently 42

Figure 3.5 Types of diseases students suffered from 44

Figure 3.6 Students’ disease status after taking Street-vended food 45

Figure 3.7 Vendors knowledge about street-vended food borne diseases 46

Figure 3.8 Vaccination status of the vendors 47

Figure 3.9 Vendors’ knowledge of vaccination 48

Figure 3.10 Vendors suffered from disease recently 49

Figure 3.11 Types of diseases Vendors suffered from 51

Chapter: 1

Introduction

Personal Hygiene Practice and Disease Awareness EWU

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1. INTRODUCTION

Personal hygiene is the basic concept of cleaning, grooming and caring for our bodies. It is an

important part of our daily lives at home (Gomes, et al. 1999). Hygiene refers to the set of

practices perceived by a community to be associated with the preservation of health and healthy

living. In modern medical sciences there is a set of standards of hygiene recommended for

different situations. Regular hygienic practices are considered as good habits by a society while

the neglect of hygiene is considered filthy, disrespectful or nasty. According to the statement of

World Health Organization (WHO) ―Hygiene refers to conditions and practices that help to

maintain health and prevent the spread of diseases. Medical hygiene therefore includes a specific

set of practices associated with this preservation of health, for example environmental cleaning,

sterilization of equipment, hand hygiene, water and sanitation and safe disposal of medical

waste‖(WHO, 2012).

1.1 CONCEPT OF HYGIENE

Hygiene generally refers to the set of practices associated with the preservation of health and

healthy living. The focus is mainly on personal hygiene that looks at cleanliness of the hair,

body, hands, fingers, feet and clothing, and menstrual hygiene (Encyclopedia of Public Health,

2008).Improvements in personal knowledge, skill and practice that modify an individual‘s

behavior towards healthy practice are the focus of hygiene promotion. Safe hygiene practice

includes a broad range of healthy behaviors, such as hand washing before eating and after

cleaning a child‘s bottom, and safe feces disposal (Encyclopedia of Public Health, 2008). In

medicine and everyday life settings, hygiene practices are employed as preventative measures to

reduce the incidence and spreading of disease. In the manufacture of food, pharmaceutical,


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cosmetic and other products, good hygiene is a key part of quality assurance i.e. ensuring that the

product complies with microbial specifications appropriate to its use. In general, hygiene mostly

means practices that prevent spread of disease-causing organisms. Since cleaning processes (i.e.

hand washing) remove infectious microbes as well as dirt and soil, they are often the means to

achieve hygiene. Hygiene is also the name of a branch of science that deals with the promotion

and preservation of health, also called hygienic. When we carry out hygiene education and

promotion the aim is to transfer knowledge and understanding of hygiene and associated health

risks in order to help people change their behavior to use better hygiene practices (Encyclopedia

of Public Health, 2008).

1.2 IMPORTANCE OF PERSONAL HYGIENE

The simple acts of brushing our teeth, showering, shampooing, using deodorant and brushing our

hair all add up to good hygiene practices. While these acts are simple and should be a part of

everyone's daily routine, some overlook taking care of their hygiene needs, putting themselves at

risk of illness, infection, poor dental health and social avoidance (Busvine, 1980).

1.2.1 Health Implications

Allowing ourselves to skip any good hygienic practices for more than a day puts us at increased

risk of illness. If we visit the bathroom and do not wash our hands with soap and water

afterward, then start preparing food, we potentially expose others to preventable illnesses. If we

skip showers and we have a cut that gets dirty, we run the risk of infection. Cultivating good

personal hygiene, showering and washing our hands frequently can help reduce the incidence of

illness (Busvine, 1980).


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1.2.2 Considerations

Neglecting daily cleanliness practices leads to the accumulation of bacteria and sweat in various

areas of our body. When our feet sweat, this moisture combines with the bacteria on the soles of

our feet and between our toes. We often notice the result in objectionable foot odor. Washing our

feet, including between our toes, with antibacterial soap helps kill bacteria and reduce odor. We

should use antibacterial soaps to wash our body daily. As with our feet, perspiration mixes with

bacteria in our groin area and under our arms, causing body odor (Oosterom, 1998).

1.2.3 Attractiveness

Showering, brushing our teeth, shampooing and using deodorant every day help increase our

personal attractiveness quotient. When we are clean and we smell clean other people find it

easier to be close to us. When we take care of our hygiene needs every day, we find it easier to

think well of ourselves. We feel good physically, which helps us view ourselves in a positive

light (Oosterom, 1998).

1.2.4 Professional Life

The employee who goes to work without shampooing his hair, showering or brushing his teeth

presents a poor self-image. When his co-workers have to be in the same cubicle or office with

him, they may rush through the business they have to take care of in order to escape any odor

and return to fresher air. If the employee continues to neglect his personal hygiene and begins to

develop infections or poor dental health, his attendance at work suffers (Oosterom, 1998).


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1.3 THE BENEFITS OF PERSONAL HYGIENE

Poor hygiene spreads illness. It also affects interpersonal relationships, social interactions and

job or school performance. Good hygiene, on the other hand, makes we come off as a capable

person with self-worth. This is but one of its many benefits (Esrey, et al. 1990).

1.3.1 Good Health

Every time we touch a surface, sneeze, prepare food, change a diaper, handle our pet or use the

bathroom, we pick up potentially harmful organisms. Simple acts such as regular bathing and

hand washing can stop us from transmitting cold, flu and infections caused by viruses and

bacteria on our skin. When we do not wash regularly, not only can we harbor and spread these

bacteria and viruses, but we are more likely to contract the illnesses they cause. If someone has

skin irritation or a wound, then poor hygiene will likely lead to infection. Proper hygiene also

helps to maintain healthy skin pH and skin strength. Our skin is a barrier from disease and good

hygiene helps our skin more effectively provide that protection (Esrey, et al. 1990).

1.3.2 Healthy Personal Relationships

Poor hygiene deters people from getting to know us. If people find our body odor or unkempt,

unclean appearance offensive, they are likely to pass judgments on our personality and our

ability to care for ourselves on a basic level. This can dissuade those forming friendships and

meaningful bonds with us. People generally avoid smells and situations they find unpleasant.

Maintaining good personal hygiene will benefit our social life in that it will remove this barrier

to interaction and connection (Esrey, et al. 1990).


5

1.3.3 Healthy Professional Relationships

Appearances broadcast more than just how we look to the world. For example, when I present to

a job interview well-dressed, displaying good hygiene, I look like a capable professional, able to

handle myself with care and respect. If I appear with poor hygiene, even if I am the most

qualified candidate, it may send the message that I am sloppy, I do not care about my

performance and I do not value and respect myself. If our hygiene declines in school or the

workplace, it can lead people to question our abilities and even our mental and physical health.

At the very least, good hygiene in the workplace or school environment avoids creating

unnecessary distractions to those around us (Esrey, et al. 1990).

1.4 APPLICATIONS OF PERSONAL HYGIENE

PRACTICES

1.4.1 Personal Hygiene in the daily life of a person

1.4.1 Personal Hygiene in the daily life of a person

Hair Care Washing Hair

Cutting Hair

Dental Care Going to Denist

Brushing Teeth

Flossing Teeth

Physical Care Cleanliness of Body

Shaving

Washing Face


6

Trimming Nails

Washing Hands Before Meals

After Restroom Use

Before Preparing Food

After Preparing Food

Figure 1.4.1: Procedure of Hand Wash


7

1.4.2 Kitchen Hygiene

In household and institutional practice, hygiene is mainly dedicated to the control of micro-

organisms in the inner environment. Household cleaning plays an important role in establishing

and maintaining an adequate level of hygiene. In cleaning research therefore substantial attention

is paid to the interrelation between cleaning and removal of micro-organisms. In general a worse

soil removal appears to lead to a lower level of hygiene. In the past decades technical measures

to reduce the environmental impact have affected household and institutional cleaning processes.

In several ways this has degraded the level of cleaning and indirectly the level of hygiene. In the

future more environmental measures that may affect the level of hygiene are to be expected.

Scientists and professionals dealing with hygiene should be aware of these phenomena and

should search for cleaning processes that are fit for use, sustainable and that do not endanger the

level of hygiene (Terpstra, 1998).

1.4.3 Respiratory hygiene

Correct respiratory and hand hygiene when coughing and sneezing reduces the spread of germs

particularly during the cold and flu season.

Carry tissues and use them to catch coughs and sneezes

Dispose of tissues as soon as possible

Clean your hands by hand washing or using an alcohol hand sanitize (Rook, et al. 2003).

1.4.4 Food hygiene at home

Food hygiene is concerned with the hygiene practices that prevent food poisoning. The five key

principles of food hygiene, according to WHO are (Chan, M., 2012):

http://en.wikipedia.org/wiki/WHO


8

Prevent contaminating food with pathogens spreading from people, pets, and

pests.

Separate raw and cooked foods to prevent contaminating the cooked foods.

Cook foods for the appropriate length of time and at the appropriate temperature

to kill pathogens.

Store food at the proper temperature.

Use safe water and raw materials.

1.4.5 Household water treatment and safe storage

Household water treatment and safe storage ensure drinking water is safe for consumption.

Drinking water quality remains a significant problem, not only in developing countries(World

Health Organization. 2007) but also in developed countries(Nath, Bloomfield, and Jones,

2006). Even in the European region it is estimated that 120 million people do not have access to

safe drinking water (Clasen and Haller, 2008). Point-of-use water quality interventions can

reduce diarrheal disease in communities where water quality is poor or in emergency situations

where there is a breakdown in water supply. Since water can become contaminated during

storage at home (e.g. by contact with contaminated hands or using dirty storage vessels), safe

storage of water in the home is also important. Methods for treatment of drinking water include

(World Health Organization, 2002):

a. Chemical disinfection using chlorine or iodine

b. Boiling

c. Filtration using ceramic filters.

http://en.wikipedia.org/wiki/Pathogens


9

d. Solar disinfection - Solar disinfection is an effective method, especially when no

chemical disinfectants are available.

e. UV irradiation - community or household UV systems may be batch or flow-though. The

lamps can be suspended above the water channel or submerged in the water flow.

f. Combined flocculation/disinfection systems – available as sachets of powder that act by

coagulating and flocculating sediments in water followed by release of chlorine.

g. Multi barrier methods – Some systems use two or more of the above treatments in

combination or in succession to optimize efficacy.

1.4.6 Laundry hygiene

Laundry hygiene pertains to the practices that prevent or minimize disease and the spreading of

disease via soiled clothing and household linens such as towels. Items most likely to be

contaminated with pathogens are those that come into direct contact with the body, e.g.,

underwear, personal towels, facecloths, nappies. Micro-organisms can also be transferred

between contaminated and uncontaminated items of clothing and linen during laundering. Of

concern are the new ―community‖ strains of MRSA. Experience in the USA suggests that these

strains are transmissible within families, but also in community settings such as prisons, schools

and sport teams. Skin-to-skin contact (including un-abraded skin) and indirect contact with

contaminated objects such as towels, sheets and sports equipment seem to represent the mode of

transmission (Bloomfield, et al. 2006).


10

Figure 1.4.6: Laundry Hygiene


11

Two processes are considered suitable for hygienic cleaning of clothing and linen (Beumer, et

al. 2008):

Washing or laundering at 60 °C (140 °F) or above

Washing or laundering at 30 °C (86 °F) - 40 °C (104 °F) using a bleach-based product:

This produces decontamination of fabrics by a combination of physical removal and

chemical inactivation. However, some types of fungi and viruses that are harder to

inactivate, may not be removed.

Washing at temperatures of 40 °C (104 °F) or below with a non-bleach product is considered to

carry a risk of inadequate decontamination (Bloomfield and Cookson, et al. 2006).

1.4.7 Medical hygiene at home

Medical hygiene pertains to the hygiene practices that prevents or minimizes disease and the

spreading of disease in relation to administering medical care to those who are infected or who

are more at risk of infection in the home. Across the world, governments are increasingly under

pressure to fund the level of healthcare that people expect. Care of increasing numbers of

patients in the community, including at home is one answer, but can be fatally undermined by

inadequate infection control in the home. Increasingly, all of these at-risk groups are cared for at

home by a career who may be a household member who thus requires a good knowledge of

hygiene. People with reduced immunity to infection, who are looked after at home, make up an

increasing proportion of the population (currently up to 20%). The largest proportion is the

elderly who have co-morbidities, which reduce their immunity to infection. It also includes the

very young, patients discharged from hospital, taking immune-suppressive drugs or using


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invasive systems, etc. For patients discharged from hospital, or being treated at home special

medical hygiene procedures may need to be performed for them e.g. catheter or dressing

replacement, which puts them at higher risk of infection. Antiseptics may be applied to cuts,

wounds abrasions of the skin to prevent the entry of harmful bacteria that can cause sepsis. Day-

to-day hygiene practices, other than special medical hygiene procedures are no different for those

at increased risk of infection than for other family members. The difference is that, if hygiene

practices are not correctly carried out, the risk of infection is much greater (Bloomfield, et al.

2009).

1.4.8 Personal hygiene for employers and workers

Personal hygiene is not only about combed shiny hair and brushed teeth; it is important for

worker health and safety in the workplace. Workers who pay attention to personal hygiene can

prevent the spread of germs and disease, reduce their exposures to chemicals and contaminants,

and avoid developing skin allergies, skin conditions, and chemical sensitivities (Gomes, et al.

1999).

The first principle of good hygiene is to avoid an exposure by forming a barrier over the skin

with personal protective equipment (PPE) such as gloves, coveralls, and boots. It is important to

check the PPE often for excessive contamination, wear, tears, cuts, or pinholes. Workers should

clean, decontaminate or replace protective equipment frequently to make sure it does not collect

or absorb irritants. If protective equipment becomes too soiled during the job, the worker should

stop and replace it with clean equipment (Gomes, et al. 1999).


13

Workers should periodically wash their hands before the entrance and after leaving their

workstation. In some jobs, regular hand washing is required by law. Workers should wash their

hands before, during, and after preparing food and before they take breaks at work to eat, drink

or smoke. To control the spread of germs that can cause the flu or common cold, workers should

wash their hands whenever they cough, sneeze, or blow their noses, and whenever they are

around someone that is sick (Gomes, et al. 1999).

Hand washing involves more than a quick rinse under a faucet. To wash hands properly, workers

should first wet them under the faucet and then use liquid or bar soap. Hands should be held out

of the water until all skin surfaces are scrubbed and lathered for at least twenty seconds. Workers

can then rinse with clean water and dry their hands with a disposable towel. To wash hands with

a hand sanitizer, workers should apply the appropriate amount of sanitizer into the palm of the

hand, and then rub hands together until they are dry, being careful to cover all surfaces of the

hands. For some job activities, hand sanitizers are not an acceptable means of hand cleaning.

Showering and face-washing after work is also a good idea. Proper personal hygiene and hand

protection can help keep workers productive and on the job. Be safely clean with good hygiene

(Gomes, et al. 1999).

1.5 WATERBORNE DISEASES

Table 1.5.1: Pathogens in Water-related Diseases (World Health Organization. 2004;

World Health Organization, 2011)

Diseases Pathogen

Campylobacteriosis Campylobacter jejuni,


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C. coli

Diarrhea Escherichia coli,

Entamoeba histolytica

Dysentery Salmonella dysenteriae,

S. flexneri,

S. boydii

andS. sonnei

Typhoid fever Salmonella typhi,

S. paratyphi,

S. enteritidis,

S. typhimurium

Amoebic dysentery Entamoeba histolytica,

Giardia duodenalis,

Toxoplasma gondii

Cholera Vibrio cholerae

Helminthes diseases nematodes (roundworm), trematodes

(Flukes) and cestodes (tapeworms).

Legionellosis Legionella pneumophila

Cryptosporidiosis Cryptosporidium parvum

Giardiasis Giardia intestinalis

Cyanotoxicity Cyanobacteria

Dientamoebiasis (travelers‘ diarrhea) Dientamoeba fragilis


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Table 1.5.2: Water-related Health risks from chemicals (World Health Organization. 2004;

World Health Organization, 2011).

Health risks from chemicals Chemicals

Fluorosis Fluorides

Arsenicosis Arsenic

hypophosphatemia Cadmium

Anosmia (lose sense of smell) Cadmium

Hyperchloremia Cadmium

Neurodegenerative diseases Aluminium

Fanconi syndrome (disease of the proximal

renal tubules)

Lead

Nephropathy Lead

1.6 FOODBORNE DISEASES AND INVOLVED

ORGANISMS

Table 1.7: The most common foodborne diseases (CDC, 2007) are:

Diseases Symptoms Causes Treatment

Botulism Double vision and

drooping eyelids

Slurred speech

Dry mouth and

Clostridium botulinum Botulism

Immune

Globulin

Intravenous-


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difficulty

swallowing

Weak muscles

Human (BIG-IV

or BabyBIG).

Campylobacteriosis Diarrhea (often

bloody)

Abdominal

cramping and pain

Nausea and

vomiting

Fever

Tiredness

Campylobacter jejuni,

C. fetus,

and C. coli

Erythromycin,

tetracycline.

E. coli Infection Abdominal pain

Diarrhea

Fever

Loss of appetite

Headache,

Muscle pain

Abdominal

cramping

Fatigue

Pathogenic Escherichia

coli

Carbapenem

Infectious Hepatitis Jaundice Hepatitis A There is no


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Fatigue

Abdominal pain

Nausea and

vomiting

Diarrhea

Fever

Loss of appetite

Dark urine

specific

treatment for

hepatitis A.

Sufferers are

advised to rest,

avoid fatty

foods and

alcohol, eat a

well-balanced

diet, and stay

hydrated

Norovirus Infection Nausea

Abdominal cramps

Vomiting

Diarrhea

Headache

Fatigue

Fever

Muscle aches

Noroviruses There is no

specific

treatment for

Noroviruses.

Salmonellosis Nausea,

Vomiting,

Abdominal cramps,

Salmonella enterica,

S. bongori

The FDA has

published

guidelines to


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Bloody diarrhea

with mucus,

Headache,

Fatigue

Rose spots

help reduce the

chance of food-

borne

salmonellosis.

Food must be

cooked to 68–

72°C (145–

160°F).

Shigellosis Acute (sudden)

abdominal pain or

cramping

Acute (sudden) fever

Blood, mucus, or

pus in stool

Crampy rectal pain

(tenesmus)

Nausea and

vomiting

Watery diarrhea

Shigella dysenteriae Antimicrobial

therapy is

usually

recommended

for treatment of

shigellosis

(Dutta, 2003).


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1.7 STREET VENDED FOODS

Street vended foods are defined as foods and beverages prepared and/or sold by vendors in

streets and other public places for immediate consumption or consumption at a later time without

further processing or preparation (FAO, 1989). This definition includes fresh fruits and

vegetables which are sold outside authorized market areas for immediate consumption. Because

of socioeconomic changes in many countries, this sector has experienced significant growth

during the past few decades. Urbanization and population growth, especially in developing

countries, are expected to continue into the next century and street-vended foods, which are

largely but not exclusively an urban phenomenon, will expand accordingly. While street-vended

foods are appreciated for their unique flavors as well as their convenience, they are also often

essential for maintaining the nutritional status of the population (Ekanem, 1998). Street food

vending assures food security for low-income urban populations and provides a livelihood for a

large number of workers who would otherwise be unable to establish a business for want of

capital. Street food vending also offers business opportunities for developing entrepreneurs

(Bhowmik, 2005). In contrast to these potential benefits, it is also recognized that street-food

vendors are often poor and uneducated and lack appreciation for safe food handling.

Consequently, street foods are perceived to be a major public health risk. If a community is to

have the full benefits of street-vended foods with minimal risk of foodborne disease, government

intervention is required to ensure that the standard of safety for such foods is the best attainable

in the context of the prevailing local situation (Ghosh, 2007). A general lack of factual

knowledge about the epidemiological significance of many street vended foods, poor knowledge

of street vendors in basic food safety measures and inadequate public awareness of hazards

posed by certain foods has severely hampered the deployment of a precise scientific approach to


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this very serious issue of public health and safety (Rane, 2011). The epidemiological studies to

suggest that street foods contribute to a significant number of food poisonings are inadequate,

due to paucity of data deficiencies in knowledge about important parameters in the food chain

and host pathogen interactions; however, there have been several documented cases of food

poisoning outbreaks due to street foods. Street foods were responsible for 691 food poisoning

outbreaks and 49 deaths from 1983 to 1992 in Shangdong Province, China (Lianghui,

1993).Foodborne bacterial pathogens commonly detected in street vended foods are Bacillus

cereus, Clostridium perfringens, Staphylococcus aureus and Salmonella spp.(Bryan, 1992).

People who patronize street food, have been reported to suffer from food borne diseases like

diarrhea, cholera, typhoid fever and food poisoning (Desenclos, 1991).This study was

undertaken to develop an understanding of the microbiological problems associated with street

vended foods with particular reference to sources of risk and to identify the behavior and

practices that may be hazardous and microbial risk assessment was used as tool for the purpose

(Abdussalam, 1993).

1.8 HAZARD ANALYSIS OF STREET VENDED FOODS

From the initial contamination of raw foods with pathogenic bacteria to subsequent

contamination by vendors during preparation (Bryan, 1992), the factors that should be

considered for the analyzing the hazards due to street foods are many (Table 1).

1.8.1 Vending Location: Food Handling and Waste Disposal

The conditions under which some street vendors operate are reported to be unsuitable for the

preparation and selling of food (Bryan, 1981). The food is prepared either at home or at stalls,


21

which are located on the street side and are made up of wood, polythene bags, tin, etc. The place

of preparation is not always clean, well lit and not far from source of contamination. Preparation

surfaces used by some vendors have remains of foods prepared earlier that can promote cross

contamination. Most of these foods are not covered and are exposed to flies and dust, which may

harbor foodborne pathogens. In 70–90% of the cases, presence of animals, insects and liquid

wastes in food preparation areas have been reported (FAO, 1988). The two major sources from

where the contaminants can enter the preparation area are: Improper food handling and waste

disposal.

Table 1.8: Source and type of hazard and the microbial risk involved (Rane, 2011):

SL.

No.

Source Hazard Risk involved

1

Vendor

location

Improper food handling Transfer of pathogens like Salmonella and

E. coli, S. aureus from human body and

environment into foods

Improper waste disposal Transmission of enteric pathogens like

Salmonella, Shigella and E. coli via vectors.

2 Raw materials Water Passage of pathogens like E. coli, fecal

streptococci, Salmonella and Vibrio

cholera.

Vegetables and spices Introduction spore formers like Bacilli and

Clostridium and pathogens like L.

monocytogenes, Shigella, Salmonella, etc.

3 Utensils and

equipment

Chemical contaminants Leaching of chemical leading to poisoning

Microbial contaminants Cross contamination of food with

Staphylococcus aureus, E. coli and Shigella


22

due to contaminated water, dish cloth,

handler

4 Storage and

reheating

Improper storage

temperature and

reheating of food

Likelihood of heat stable toxins produced by

pathogens like C. perfringens and B. cereus

5 Personal

hygiene of

vendors

Biological hazards Introduction of Staphylococcus, Salmonella

and Shigella via carriers

1.8.1.1 Food Handling

Unsanitary handling of street foods by the some of the vendor has been commonly found to be

the source of contamination (Dawson, 1991). The vendors can be carriers of pathogens like

Escherichia coli, Salmonella, Shigella, Campylobacter and S. aureus who eventually transfer

these food borne hazards to the consumers. The hands of the food handlers are the most

important vehicle for the transfer of organisms from faeces, nose, and skin to the food (WHO,

1989). The finding that Salmonella, non-typhi salmonellae, Campylobacter and E. coli can

survive on finger tips and other surfaces for varying periods of time (Pethers, 1971) and in some

cases even after washing, supports the reports of contamination of street vended food with

toxigenic S. aureus, the major being suppurative lesions of human beings and the environment

(Mohapatra, 2002).

1.8.1.2 Waste Disposal

Few vendors congregate in overcrowded areas where there are high numbers of potential

customers, which usually provide limited access to basic sanitary facilities. Hence, the

contamination of street foods is often linked to the waste generated by food processing, that is

usually dumped near the vending site. The lack of facilities for liquid drainage and wastewater


23

and garbage disposal encourages wastes to be thrown into nearby streets and gutters. Such areas

act as habitats for rodents, breeding points for flies and media for growth of microorganisms. A

study done (Muinde, 2005) in Africa revealed that 85% of the vendors prepared foods like fish,

fruit salads, roasted maize and chips in unhygienic conditions, given that garbage and dirty waste

were conspicuously close to the stalls. In these areas large amounts of garbage accumulates

which provide harborage for insects and animal pests that are linked to enteric disease

transmission (Shigella, Salmonella and E. coli) (El-Sherbeeny, 1985).

1.8.2 Quality of Raw Materials: Water and Other Material

The quality of raw materials used in the preparation of street foods is very important as their

contamination can persist through preparation and or cooking (Rane, 2011).

1.8.2.1 Water

Water is a critical raw material in many street-vended operations. Contaminated water can create

a public health risk when it is used for drinking, washing of foods, incorporated in the food as an

ingredient and used in the processing of food or used for washing equipment, utensils and hands.

It is a well-known vehicle for enter pathogens such as E. coli, Salmonella spp. and

Campylobacter spp. amongst others (Angulo, 1997). Studies carried out in different regions of

Asia, Africa and South America has frequently pointed the unavailability of potable water for

various activities at the vending site as a major concern. Due to the shortage of clean potable

water, many vendors tend to reuse the water, especially for cleaning utensils and used dishes

(Dawson, 1991).


24

Studies done to find out the bacteriological quality of the water used by some street vendors have

revealed frequent contamination with coliforms and fecal coli forms (Chakravarty, 1996).

When the street foods in Trinidad and Tobago were analyzed, it was reported found that 35% of

foods were contaminated by E. coli while 57.5% of water used by vendors were contaminated by

coliforms (Mankee, 2003). These reports were similar to the findings that the stored water used

by consumers and vendors, at the vending site, showed heavy bacteriological contamination of

faecal origin (Dawson, 1991). Such heavily contaminated water is a primary source of diarrheal

diseases to the street food consumers. When water samples from storage tanks used by some

vendors were checked at different localities in Pune, India, it was revealed that 29.6% of the

water samples were not conforming to the WHO standards of portability and had coliform counts

of more than 16/100 ml, while fecal coliform counts were more than 16/100 ml in 15.5% of

water samples, 4.5% of samples were positive for E. coli and 2.7% for enteropathogenic E. coli

(Bhat, 2000). Similarly, pathogens like Salmonella and Shigella have been detected in the water

used by vendors for dishwashing (Barro, 2006).

1.8.2.2 Other Raw Materials

Besides water, other raw materials are also important to the safety of the street vended foods

because of the biological, chemical and physical hazards that they might introduce. In order to

keep prices down, some vendors purchase cheap or adulterated ingredients containing

unpermitted chemical additives from unauthorized suppliers which may further increase the risks

associated with the food so prepared. Raw meat, poultry and vegetables are commonly

contaminated with large numbers of bacteria, including potential foodborne pathogens such as B.

cereus, C. perfringens, C. jejuni, E. coli, L. monocytogenes, Salmonella and S. aureus

(Hutabarat, 1994). Spices are known to harbor a large number of microorganisms which


25

include members of the genus Bacillus, anaerobic spore formers, enterococci, and members of

Enterobacteriaceae, a variety of yeast and mold and pathogens like coagulase positive

staphylococci. Contamination of foods by spices which act as spore carriers has been reported to

lead to food spoilage and can even lead to food poisoning (Powers,1976).Spore formers in spices

may lead to food spoilage, when they survive the cooking process and multiply under favorable

conditions (Beuchat, 1980).

In a study (Chakravarty, 1996) done in Calcutta, samples that were suspected of adulteration

were analyzed and in 30 of the 50 samples, unauthorized food additives were detected. Similarly,

pathogens like B. cereus, S. aureus, C. perfringens, V. metschnikovii and E. coli were reported

(Mosupye, 1999) in raw chicken, salad and gravy raw materials. These organisms were probably

present in these foods either prior to purchase by vendors or may have been introduced by cross

contamination during food handling or during preparation.

1.8.3 Utensils and Equipment: Chemical and Microbial Contaminants

Use of proper utensils for cooking and storage of prepared food is often critical to the safety of

street vended foods. Poor quality of material coupled with improper practices may lead to toxin

formation, pathogen growth or recontamination. The design, construction and maintenance of

equipment and utensils is very important to food safety, as their poor maintenance may lead to

the inability to effectively clean and sanitize surfaces. This may then result in the build-up of

residues of food, facilitating microbial growth, leading to an increased likelihood of

contamination. The appropriate use of equipment is also important to prevent the cross

contamination from raw materials (Kaul, 1988).


26

1.8.3.1 Chemical Contaminants

As some containers will leach hazardous chemicals like copper, lead and cadmium into food, use

of equipment and utensils incompatible with the food being handled, should be avoided. This has

been observed particularly with acidic food and beverages (Ohiokpehai, 2003).

1.8.3.2 Microbial Contaminants

The serving utensils used at the vending site are often contaminated with Micrococcus spp. and

Staphylococcus spp. which may have originated from the vendors hands when they touched the

food preparation areas, dishcloths, or the water during dish washing or hand washing which

indicates cross contamination between dishwater, food preparation surfaces, and the food itself

(Cardinale, 2005). It is reported that bacteria from dirty dish washing water and other sources

adhere to the utensil surface and can constitute a risk during the food vending process.

Microbiological analysis of utensils surface and knives have shown the presence of Salmonella

and Shigella (Barro, 2006). It is also reported that during the preparation of food, the raw

material is cut and chopped using the same knife without in between cleaning and such knives

are often invaded by flies (Mensah, 2002).

1.8.4 Food Preparation: Storage and Reheating

An important issue influencing food contamination and contributing to further increase in

contamination is food storage temperature. The preparation of food long before its consumption,

storage at ambient temperature, inadequate cooling and reheating, contaminated processed food,

and undercooking are identified as the key factors that contribute to food poisoning outbreaks

(WHO, 1989).


27

1.8.4.1 Storage

Holding foods at high ambient temperatures for long periods of time have been reported to be a

major contributor to the occurrence of food poisoning outbreaks (Adesiyun, 1996). Foods are

often held for several hours after cooking and this includes overnight holding at ambient

temperatures, until sold, and thus can harbor high microbial populations (Saddik, 1985).

Besides, some of the foods are held in the pans in which they are cooked, until sold or reheated,

which results in longer holding time, hence creating favorable conditions for the growth of

foodborne pathogens. In such foods, the counts of Escherichia coli, Staphylococcus aureus,

Bacillus cereus and Clostridium perfringens are reported to be high (Bryan, 1995).B. cereus was

isolated from 42 (26.3%) samples of fried fish, two, soup, boiled rice and moinmoin suggesting

that their spores survived the cooking process (Omemu, 2008). The presence of this bacterium

coupled with the storage of these foods at ambient temperatures for several hours under high

temperature and high relative humidity showed that the product could be hazardous. B. cereus

has been responsible for outbreaks of foodborne illness because it produces heat stable (emetic)

and heat sensitive (diarrheal) toxins when foods are held under conducive conditions for several

hours (Mensah, 2002).

Kaul and Agarwal (Kaul, 1988)reported high microbial count in fruit chat sold by a street vendor

in Chandigarh, India where the counts ranged between 106 and 108 cfu/g, and a further increase

in count by 1–3 log cycles was observed after 16 and 24 h of storage at room temperature. A

number of pathogens, such as E. coli, Salmonella typhimurium, Salmonella gallinarum, Shigella

dysentriae, Pseudomonas fluorescens and Klebsiella pneumoniae were also found to be present

in these samples.


28

1.8.4.2 Reheating

Time–temperature exposures during reheating need to be sufficiently high or long to inactivate

large quantities of infectious microorganisms that could develop during the lengthy holding

process. Some food vendors often partially or fully cook some products ahead of time, store

them and then reheat them when requested by customers (Omemu, 2008). However, this

reheating is often inadequate to destroy bacteria that may be present as this would allow the

foodborne pathogens that germinate from spores which survived cooking or that contaminate the

food after cooking, to survive and proliferate.

1.8.5 Personal Hygiene of the Vendors or Food Handlers

According to WHO (WHO, 1989), food handling personnel play an important role in ensuring

food safety throughout the chain of food production, processing, storage and preparation.

Mishandling and disregard of hygienic measures on the part of the food vendors may enable

pathogens to come into contact with food and in some cases to survive and multiply in sufficient

numbers to cause illness in the consumer.

Some food handlers may introduce biological hazards by cross contamination after handling raw

materials when they suffer from specific diseases (Ohiokpehai, 2003) and physical hazards by

careless food handling practices. Most of the vendors pack the food in polythene bags for their

customers. When packing these foods, they blow air into the polythene bags to open them, in this

process a number of pathogens can be passed on to the consumer.


29

A study in Santa Fe de Bogota, Colombia revealed that over 30% of a group of food handlers

examined were carriers of pathogenic microorganism including Salmonella typhi,

Staphylococcus aureus, Salmonella enteritidis, and Shigella (Buchanan, 1998).

1.8.6 Control Measures and Initiatives to Improve Street Food Vending

A logical step towards reducing the risks of food borne illness from street foods would be

controlling the steps in food preparation and sale that may contribute to the contamination,

growth and survival of the microbes responsible for food borne illness. The efforts made should

focus on (a) educating the food handlers (b) improving the environmental conditions under

which the trade is carried out (c) providing essential services to the vendors to ensure safety of

their commodities (World Health Organization, 1996).

To enable official recognition and control of the street food industry as an integral part of the

food supply, appropriate regulations should be prepared, and incorporated into existing food

regulations. FAO has implemented and supported several projects which aimed at improving

various aspects of the street food sector in countries like Bolivia, Colombia, Ecuador, India,

Zaire, etc.

Malaysia, Philippines and India are the three countries which have regulations for protecting

street vendors. Malaysia is the only country where licensed street vendors are provided facilities

for conducting their trade. An initiative has been taken in Africa, where a coalition between local

and national authorities, explored the food laws associated with street vending and developed

strategies that could be used to control identified food hazards. Another policy was framed in

Durban, Africa, where the street vendors were allocated specific areas to operate, issued


30

certificate of acceptability and were also given training on essential food hygiene practices. The

scheme to upgrade hygiene and quality of street food has also been undertaken by the Ministry of

Food Processing Industries, India. Under the proposed programme, 10,000 street food vendors

will be identified, and the majority of stake-holders will be upgraded in terms of quality and

hygiene and efforts would be made to make it mandatory for the vendors to register with the

local authorities (Holy, 2006).

1.9 DISEASES AWARENESS AND FOOD SAFETY

Basic hand washing and skin care can prevent work exposures and disease. Good washing and

scrubbing with water and soap helps to remove germs, contaminants, and chemicals. It can also

prevent exposure by ingestion and cross-contamination of the surfaces and objects we touch

Hand washing is important before and after using the restroom and before or after certain

activities (Gomes, et al. 1999).

To prevent getting foodborne diseases (CDC, 2007) everyone should:

Follow strict hygienic steps when canning foods at home

Refrigerate oils containing garlic or herbs

Keep baked potatoes wrapped in aluminum foil either hot until served or refrigerated

Consider boiling home-canned food before eating it to kill any bacteria lurking in the

food (CDC, 2007).

Wash hands before preparing food

Wash hands immediately after handling raw poultry or other meat


31

Wash thoroughly with soap and hot water all food preparation surfaces and utensils that

have come in contact with raw meat

Cook poultry products to an internal temperature of 170ºF for breast meat and 180ºF for

thigh meat

Not drink unpasteurized milk

Not drink un-chlorinated water that isn‘t boiled

Wash hands after handling pet feces or visiting petting zoos (Altekruse, 1999).

Parched grains, dry bakery products, sufficiently sugared, salted or acidulated foods, and many

fermented items have a much lower disease-producing potential than certain foods which readily

support bacterial growth. Similarly, foods thoroughly fried or cooked and consumed while hot

are inherently safer than pre-cooked foods especially when the latter are held at ambient

temperatures (15-40°C) for more than four to five hours. Highly colored foods and beverages are

more likely to have unauthorized additives than others. Fruits in their structural covers and many

foods which are industrially processed and pre-packed are generally safe even when exposed for

sale on streets. Consequently, consideration of the varying potential of different food items to

cause disease can be used in classifying local street foods for application of appropriate

intervention measures (World Health Organization, 1996).

Many countries currently license street food vendors, however a significant proportion of

vendors commonly remain unlicensed. While unlicensed vendors operate outside the law,

authorities often lack the resources to prevent their operation. Furthermore, consumers pay little

attention to whether a vendor is licensed or not, as licensing rarely relates to the quality and

safety of the food served. Registering or licensing vendors has many advantages for authorities.


32

It enables authorities to identify persons employed in such enterprises and the types of food sold,

to raise revenue and to provide an opportunity to give food handlers training in food safety.

Licensing, however, currently provides few advantages to vendors. To facilitate licensing,

authorities should centralize licensing requirements, make the issuance of a license dependent

upon food safety knowledge and a commitment to produce safe food and use the opportunity to

train handlers regarding critical control points, control measures, monitoring procedures and

corrective actions. Certificates might be awarded to trained food handlers. Renewal of licenses

should also be simplified, particularly for those implementing proper control measures during

food preparation (World Health Organization, 1996).

In establishing a plan of action to improve the safety of street-vended food, many authorities

have also identified the need to improve design and construction of vending carts, stalls and

markets. The application of technology to improve design and construction has focused on the

provision of water, handling liquid and solid waste and sanitation facilities. Some technological

advances will improve food safety. The provision of a safe water supply must innately reduce the

risk of waterborne diseases. Design and construction that reduces the likelihood of cross

contamination between raw and cooked food will reduce the risk of microbiological hazards.

Other advances, however, have not directly impacted on food safety but rather on aesthetics and

environmental management (World Health Organization, 1996).

Viewed from a general perspective, most foodborne hazards may be prevented by thorough

cooking, hot holding, rapid cooling, and cold storage, avoidance of cross-contamination or

combinations of these. However, street-vended foods and their preparation and handling vary

enormously among countries, reflecting the unique characteristics of the societies, and even


33

within countries the variations in street-vended foods are often considerable. Consequently,

training and education programs should be based on the food safety hazards presented by the

local street food situation. Health authorities may consider government recognition of private

schools and their curricula. Consequently, government would be able to set the training standard

without intensive involvement in the training itself (World Health Organization, 1996).

Health authorities must utilize a diversity of educational approaches including mass media,

national seminars and community health education. To encourage consumer selection based

upon the safety of the food, consumers must first be made aware of the benefits of street-vended

food, their association with foodborne disease and what are safe and unsafe food-handling

practices. Children are a group of con summers at particular risk in relation to most foodborne

diseases. Consequently, children should be awarded special consideration by health authorities in

their efforts to improve the safety of street-vended food through consumer education.

Approaches to improve the education of parents and children regarding food safety may be

integrated into general and health education. Attendance of parents and children at health clinics

offers the opportunity for integration of health and education regarding the safety of street-

vended food. In particular, such clinics provide the opportunity to discuss the safety of street-

vended weaning food. Similarly, incorporation of food safety messages into school curricula and

school social elements provide opportunities for increasing awareness of children regarding food

safety (World Health Organization, 1996).

Chapter: 2

Methodology


34

2. METHODOLOGY

2.1 Objective of the Study

The study was conducted to evaluate the food safety knowledge and practices of street food

vendors around the East West University (EWU) from 10th April 2012 to 14th August 2012. The

objectives of the study were firstly to determine the health risks associated with street food

vending, secondly to determine the knowledge of street food vendors regarding their personal

hygiene practice during food preparing, serving & disease awareness.

1. The specific objectives of the study: The results of the study will be helpful for better

understanding the dangers of the consumption of street food. The findings of the study

will be useful in taking the necessary measures for the bringing of awareness to the EWU

community and to the food vendors themselves.

2. Street foods comprise a wide array of products ranging from small snacks to full meals,

therefore the assessment of the contribution of street foods to the diet needs to also take

into account the niche, which street foods fill, in the individual diet.

2.2 Rationale of the Study

Street foods have been reported to be contaminated with pathogens and have also been

implicated in food-borne epidemics. Foodborne diseases can cause severe and/or long lasting

damage to health, including acute, watery and bloody diarrhoeas leading to severe dehydration

or dysentry. Street-food vendors are often poor and uneducated and lack appreciation for safe

food handling. The data from East West University medical center showed that a lot of students

suffer from food borne diseases. This may be due to consumption of the street-vended foods.


35

This study will be conducted to determine the presence of pathogenic microorganisms in the

street- vended foods, beverages and water causing the foodborne diseases in the area around East

West University. The findings of the study will be helpful to take some necessary interventions

for bringing awareness to the EWU community and the food vendor themelves. Thus, the

occurrence of the diseases will be reduced. The findings of this research will give us a platform

to conduct a study throughout Bangladesh which will ultimately provide us a total picture of the

quality of the street vended food.

2.3 Significance of the Study

Food borne diseases can cause severe and/or long lasting damage to health. It has been shown

that the EWU community suffer from different types of diseaes which may be related to the

street foods. It is important to find out the causative organisms reponsible for the diseases.This

study will be carried out to find out the current situation of food borne diseases in the EWU community.

All the possible information about the pathogens responsible for food borne diseases in the EWU

community will be helpful for better understanding of the danger of the food borne diseases.

2.4 Type of study

It was attempted to find out knowledge, attitude and practices about personal hygiene among

East West University students. In addition to this, the study examined for other risk factors of

poor personal hygiene practices.

2.5 Place of study

The study was conducted in East West University. The university is largest private university of

Dhaka city. It was established in 1996, situated in Aftab Nagar, Dhaka 1219. This institute


36

comprise of many department. A good number of teacher and lab specialists and other

supporting staffs are providing their best for their students.

2.6 Study population:

The street food vendors (n=151) around the EWU was interviewed by using mostly structured

questions to know their hygiene practice, food safety training, understanding regarding the

incidences of food borne diseases, food processing practice either before or during preparation

and consumption etc. The students (n=225) of EWU was interviewed to know their health

safety, awareness about the food safety and socio cultural status etc.

2.7 Inclusion criteria of the cases

EWU students of all age and street food vendors around the EWU community were participated

in the study.

2.8 Exclusion criteria of the cases

1. Students who disagreed.

2. Street food vendors other than EWU community.

2.9 Study period

To complete the study in time a work schedule was prepared depending on different task of the

study. From April 2012 to August 2012, four months was used to collect data. Subsequent

months spent on report writing and submission of report.


37

2.10 Ethical Consideration

Consent was taken from the students and the street food vendors fulfilling the eligibility criteria

and agreeing to participate as indicated by signing on an informed consent form. The

confidentiality of the information was maintained.

2.11 Research approach

After getting the approval of the research proposal from the honorable faculty members for data

collection, research work was approached by collecting information from different pharmacy

department students and who were agreed to give the information.

2.12 Data collection method

After explaining the purpose of the study to the students randomly they were interviewed by

asking question in English and used thoroughly pre-tested questionnaires. The questionnaire

contained general information and socio-economic status, personal hygiene practices and

awareness and diseases awareness.

2.13 Data analysis

After collecting all data, data were analyzed with SPSS 17.0. Then we analyze the all data by

different strategies based on our target of study. The results were presented in tabulated from as

well as figures and drawings.


38

2.14 Questionnaire (mostly structured)

Two guidelines will be developed to interview the street food vendors and students of EWU.

Guidelines for the students consist of-

Identification of students‘ age.

Street food consumption practice

Socio-economic factors.

Caring practice of students by the family member.

Disease controls of the students who has already suffered from foodborne

diseases.

Perception on causes and consequences of health safety.

Questionnaire for the street food vendors consist of-

Hygiene practice

Hand washing practice

Source of water used for cleaning the utensils

Understanding the health safety etc.

The perception about food safety

Perception about the food quality

Perception on personal hygiene and sanitation.

Chapter: 3

Results


39

3. RESULTS

3.1 Smoking habits of the Students

Smoking habits of the Students No. of Students Percentage (%)

Smoker 49 21.8%

Non-smoker 176 78.2%

Figure 3.1: Smoking habits of the students

From the data analysis it was found that 21.8% students were smokers and 78.2% students did

not smoke.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Smoker Non-smoker

21.8%

78.2%

Per

cen

tag

e%

Smoking habits of the Students


40

3.2 Vaccination status of the Students

Vaccination status of the

Students

No. of students Percentage (%)

Yes 189 84%

No 36 16%

Figure 3.2: Vaccination status of the Students

84% students had taken vaccine and 16% did not take any kind of vaccination.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Yes No

84%

16%

Per

cen

tag

e

Vaccination status of the Students


41

3.3 Students’ awareness about Vaccination

Students‘ awareness about

Vaccination

No. of Students Percentage (%)

Yes 206 91.6%

No 19 8.4%

Figure 3.3: Students’ awareness about Vaccination

91.6 % students, participated in this study, had the concern that some infections can be avoided

by taking vaccine at proper time.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Yes No

91.6%

8.4%

Per

cen

tag

e

Students’ awareness about Vaccination


42

3.4 Students suffered from diseases recently

Students suffered from

diseases recently


Yes 122 54%

No 103 46%

Figure 3.4: Students suffered from diseases recently

54% students had been suffered from diseases recently. The remaining 46% did not face any

physical problem recently.

Yes

54%

No

46%

Students suffered from diseases recently


43

3.5 Types of diseases students suffered from

Types infection or disease No. of Students Percentage (%)

Fever 82 36.44%

Cough/Cold 59 26.22%

Diarrhea/dysentery 35 15.56%

Vomiting/Stomachache 22 9.78%

Pneumonia 6 2.67%

Ear Infection 4 1.78%

Skin Problem 12 5.33%

RTI 1 0.44%

Others 12 5.33%

Figure 3.5: Types of diseases students suffered from

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00% 36.44 %

26.22%

15.56%

9.78%

2.67% 1.78%

5.33%

0.44%

5.33%

Per

cen

tag

e

Diseases


44

36.44% students have suffered from Fever, 26.22% students suffered from Cough/Cold, 15.56%

suffered from Diarrhea/Dysentery, 9.78% suffered from Vomiting/Stomachache, 2.67% suffered

from Pneumonia, 1.78% suffered from Ear infection, 5.33% suffered from Skin problem, 0.44%

suffered from RTI and 5.33% suffered from other miscellaneous diseases. Percentage of fever

and cough diseases were high due to seasonal flus mainly caused by viruses. These viruses

mainly contagious and infectious and they can be carried via both water and food. Percentage of

Diarrhea/Dysentery is also high and these are mainly cause by water or food borne bacteria. This

can be reduced through making the habit of maintaining personal hygiene.

3.6 Students’ disease status after taking Street-vended food

Students’ disease status after taking

Street-vended food


Yes 112 49.8%

No 76 33.8%

Do not know 37 16.4%


45

Figure 3.6: Students’ disease status after taking Street-vended food

49.8% student agreed that they had been affected by diseases after taking street-vended foods.

3.7 Vendors knowledge about street-vended food borne diseases

Vendors knowledge about street-

vended food borne diseases

No. of Vendors Percentage (%)

Yes 69 46 %

No 82 54%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Yes No Do not know

49.8%

33.8%

16.4%

Per

cen

tag

e Students’ disease status after taking Street-

vended food


46

Figure 3.7: Vendors knowledge about street-vended food borne diseases

54% vendors did not know about food borne diseases.

3.8 Vaccination status of the vendors

Vaccination status of the vendors No. of Vendors Percentage (%)

Yes 72 47.7%

No 79 52.3%

Yes

46% No

54%

Vendors knowledge about street-vended food

borne diseases


47

Figure 3.8: Vaccination status of the vendors

52.3% street vendors never took any vaccination. 47.7% had vaccination.

3.9 Vendors’ knowledge of vaccination

Vendors’ knowledge of

vaccination


Yes 36 23.8%

No 115 76.2%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Yes No

47.7% 52.3%

Pre

can

tag

e

Vaccination status of the vendors


48

Figure 3.9: Vendors’ knowledge of vaccination

76.2% vendors did not have any kind of knowledge about vaccination.

3.10 Vendors suffered from disease recently

Vendors suffered from

disease recently


Yes 120 79%

No 31 21%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Yes No

23.8%

76.2%

Per

cen

tag

e

Vendors’ knowledge of vaccination


49

Figure 3.10: Vendors suffered from disease recently

Only 21% street vendors did not have recent disease history. On the other hand 79% street

vendors have recent disease history.

3.11 Types of diseases Vendors suffered from

Types infection or disease No. of Vendors Percentage (%)

Fever 75 49.7%

Cough/Cold 63 41.7%

Diarrhea/Dysentery 54 35.8%

Vomiting/Stomachache 38 25.2%

Pneumonia 4 2.6%

Yes

79%

No

21%

Vendors suffered from disease recently


50

Ear Infection 3 3.3%

Skin Problem 2 1.3%

RTI 151 100%

Others 5 3.3%

Figure 3.11: Types of diseases Vendors suffered from

All vendors have suffered from RTI. 49.7 % vendors have suffered from Fever, 41.7% vendors

suffered from Cough/Cold, 35.8% suffered from Diarrhea/Dysentery, 25.2% suffered from

Vomiting/Stomachache, 2.6% suffered from Pneumonia, 3.3% suffered from Ear infection, 1.3%

suffered from Skin problem and 3.3% suffered from other miscellaneous diseases.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

49.7% 41.7%

35.8%

25.2%

2.6% 3.3% 1.3%

100%

3.3%

Per

cen

tage

Diseases

Chapter: 4

Discussions


51

DISCUSSION

From the data analysis it was found that 21.8% students were smokers and 78.2% students did

not smoke. It is a positive site that most of students of East West University are non-smoker.

Tobacco leaf contains chemicals that are harmful to both smokers and nonsmokers. Breathing

even a little tobacco smoke can be harmful. Of the more than 7,000 chemicals in tobacco leaf, at

least 250 are known to be harmful, including hydrogen cyanide, carbon monoxide, and ammonia.

Smoking is a leading cause of cancer and death from cancer. It causes cancers of the lung,

esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as

acute myeloid leukemia (U.S. Department of Health and Human Services, 2010). 91.6 %

students, participated in this study, had the concern that some infections can be avoided by

taking vaccine at proper time. 36.44% students have suffered from Fever, 26.22% students

suffered from Cough/Cold, 15.56% suffered from Diarrhea/Dysentery, 9.78% suffered from

Vomiting/Stomachache. Percentage of fever and cough diseases were high due to seasonal flus

mainly caused by viruses. These viruses mainly contagious and infectious and they can be

carried via both water and food. Percentage of Diarrhea/Dysentery is also high and these are

mainly cause by water or food borne bacteria. This can be reduced through making the habit of

maintaining personal hygiene. 49.8% student agreed that they had been affected by diseases after

taking street-vended foods. So, It is cleared that street-vended foods are available beside East

West University are not safe for meal. 52.3% street vendors never took any vaccination. So, they

might suffer from serious infectious diseases and these diseases might spread in their ready-made

food and might contaminate them and ultimately might cause spread disease among the

customers who would buy food from those infected street foods. Only 21% street vendors did not

have recent disease history. On the other hand 79% street vendors have recent disease history.


52

Some of them might be still suffering from infectious diseases. It is important to make them

aware about their health and to make this process easy a weekly program can be held on

―hygiene and disease awareness‖ for street vendors. And can be organized by social workers and

government. All vendors have suffered from RTI. 49.7 % vendors have suffered from Fever,

41.7% vendors suffered from Cough/Cold, 35.8% suffered from Diarrhea/Dysentery, 25.2%

suffered from Vomiting/Stomachache, 2.6% suffered from Pneumonia, 3.3% suffered from Ear

infection, 1.3% suffered from Skin problem and 3.3% suffered from other miscellaneous

diseases. Percentage of fever and cough diseases were high due to seasonal flus mainly caused

by viruses. These viruses mainly contagious and infectious and they can be carried via both

water and food. Percentage of Diarrhea/Dysentery is also high and these are mainly cause by

water or food borne bacteria. This can be reduced through making the habit of maintaining

personal hygiene.

Chapter: 5

Conclusion


53

CONCLUSION

The result of this study confirms that there is highly significant association between personal

hygiene practices and keep the body healthy among them who maintain hygiene practices than

who does not maintain. Attention to personal hygiene will help a person look their best, feel their

best and can even help in avoiding disease. Failure to keep up a standard of hygiene can have

many implications. Not only is there an increased risk of getting an infection or illness, but there

are many social and psychological aspects that can be affected. The knowledge and practice of

personal hygiene are vital in all our everyday activities. This study is expected to provide

important information to better understand the importance of personal hygiene. Thus the result of

this study will contribute to students‘ and vendors‘ health by making awareness about the bad

effects of poor personal hygiene and reduce the risk associated with poor hygiene practices.

Chapter: 6

Reference


54

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Chapter 7

Appendix


62

Questionnaire:

Isolation and identification of the causative organisms on street vended food

samples collected from East West University area.

Annexure 1: Questionnaire for Vendors

Section 1: Identification of the vendors

Interview Date:

D D M M Y Y Y Y

Starting time: Hour

Duration: Minutes

Vendor‘s Name:

Location :

Sex : (1= Male, 2= Female)

Date of Birth : : :

dd mm yyyy

Present Age : : :

Dd mm yy


63

Section 1: General information:

Q# Questions Categories Code

Q 1: How old are you? Age……………………………………

Q 2: Have you ever attended

School?

Yes……….…………………………….01

No…………….......................................02

Q 3: What is your Educational

Status?

Below class 5…………………………..01

Class 5-10……………………………...02

S.S.C …………………………………..03

H.S.C ………………………………….04

Vocational Course …………………….05

B.A/B.Com/B.S.S (Pass)………………06

B.Sc.(Hons.)…………………………...07

M.Sc…………………………………...08

Others………………………………….09

Q 4: What is your occupation? Vending foods...……………................ 01

Supplying foods to other vendors......... 02

Others………….................................... 03

(Specify)

Q 5: Is this your main

occupation?

Yes……….…………………………….01

No…………….......................................02

Q 6: If this is not your main

occupation, what else do

you do?

______________________________

Section 2: Information about Socio-economic Status:


64


Q 7: What is your monthly

family income?

__ , __ __, __ __ __ /= Tk.

Q 8: Where do you live in the

city? In -

a slum………………………………….01

beside street…………………………...02

near bazaar…………………………….03

beside railway…………………………04

near a river side……………………….05

Others…………............................……06

(Specify)

Q 9: Source of Washing

/bathing water

Tap……….............................................01

Tubewell…............................................02

Pond……….....................................….03

Ditch/Canal/Lake…..............................04

River/Fountain….............................….05

Rain water……...........................……..06

Others…………............................……07

(Specify)

Q 10: Source of drinking water Tap……….............................................01

Tubewell…............................................02

Pond……….....................................….03

Ditch/Canal/Lake…..............................04

River/Fountain….............................….05

Rain water……...........................……..06

Others…………............................……07


65

(Specify)


66

Section 3: Personal hygiene practices:


Q 11: Do you wash your hands

properly after coming from

toilet?

Yes……….…………………………….01

No…………….......................................02

Q 12: How do you wash your

hands after coming from

toilet?

Using water only.............................….01

With soaps ........................................02

Others………......................................03

(Specify)

Q 13: Do you wash your hands

properly before preparing

foods?

Yes……….…………………………….01

No…………….......................................02

Q 14: Which water do you use for

cleaning utensils?

Tap……….............................................01

Tubewell…............................................02

Pond……….....................................….03

Ditch/Canal/Lake…..............................04

River/Fountain….............................….05

Others…………............................……06

(Specify)

Q 15: Where from you get/fetch

water while vending foods

in the street?

From home…………………………….01

From road side tap…………………….02

From nearby tubewell………………....03

Others…………………….……………04

(Specify)

Q 16: Where do you store/keep

water while vending?

In open pots……………………………01

In closed container…………………….02


67

Others…………………………………03

(Specify)

Q 17: How do you wash your

hands before you start

preparing foods?

Using water only.............................….01

With soaps ........................................02

Others………......................................03

(Specify)

Q 18: Do you vend stale foods? Yes……….…………………………….01

No…………….......................................02

Q 19: Do you process/prepare

foods at home?

Yes……….…………………………….01

No…………….......................................02

Q 20: If not, the where do you

process/prepare foods?

In the van………………………………01

In the street-side shop………………….02

Others………......................................03

(Specify)

Q 21: Do you cut your nail per

week?

Yes……….…………………………….01

No…………….......................................02

Q 22: Do you maintain hygiene

during the time you cook

food?

Yes……….…………………………….01

No…………….......................................02

Q 23: Do you properly clean

utensils or pots before

cooking food on them?

Yes……….…………………………….01

No…………….......................................02

Q 24: Do you properly clean

utensils or pots after

cooking food on them?

Yes……….…………………………….01

No…………….......................................02

Q 25: Do you keep the food open? Yes……….…………………………….01

No…………….......................................02

Q 26: Do you remove flies right Yes……….…………………………….01


68

away when you see them

roaming over your food?

No…………….......................................02

Section 4: Disease Awareness:


Q 27: Do you know that street-

vended food may be a source

for the spread of (infectious)

diseases?

Yes……….…………………………….01

No…………….......................................02

Q 28: Did you take vaccine ever?

Yes……….…………………………….01

No…………….......................................02

Q 29: Do you know that some

infections can be avoided by

taking vaccine at proper

time?

Yes……….…………………………….01

No…………….......................................02

Q 30: Did you suffer from any

infectious or other diseases

recently?

Yes……….…………………………….01

No…………….......................................02

Q 31: Which type of

infection/disease?

Fever…...................................................01

Cough/Cold…........................................02

Diarrhoea/dysentery…….......................03

Vomiting/Stomachache…......................04

Pneumonia………..................................05

Ear Infection….......................................06

Skin problem…......................................07

RTI…………......................................…08

Others……….........................................09

(Specify)


69


70

Annexure 2: Questionnaire for Students

Section 1: Identification of the students

Interview Date:

D D M M Y Y Y Y

Starting time: Hour

Duration: Minutes

Name:

Institute: Department: Semester:

Sex : (1= Male, 2= Female)

Date of Birth : : :

dd mm yyyy

Present Age : : :

Dd mm yy

Section 1: General information and socio-economic status:


Q 1: Who is the earning

member of your family?

Father…………………………………..01

Mother………………………………….02

Both…………………………………….03

Others…………............................….….04

(Specify)

Q 2: What is his/her/their

occupation?

Govt. Service….……………………….01

Private Job……………………………..02


71

Business………………………………..03

Others……….........................................04

(Specify)

Q 3: What is your monthly

family income?

__ , __ __, __ __ __ /= Tk.

Q 4: How many brothers/sisters

do you have in total?

Specify number in the box

Q 5: Why have you admitted in

a Private University?

To avoid session jam…………………..01

Others……….........................................02

(Specify)

Q 6: How much money do you

get from your parent(s) per

month?

(For students on self-

accommodation coming

from other districts)

Less than 2000..………………………..01

Tk 2000-3000....……………………….02

Tk 3000-5000..………………………...03

More than 5000………………………..04

Others 05 ………………………………….

(Specify)

Q 7: What is the amount of your

pocket money that you

from your parent(s)?

(For students residing with

their parents in Dhaka)

Less than 500…………………………..01

Tk 500-1000......……………………….02

Tk 1000-3000..………………………...03

Tk 3000-5000..………………………...04

More than 5000………………………..05

Others 06 ………………………………….

(Specify)

Q 8: Where do you live in the

city?

Near university………………………...01

At a moderate distant………………….02


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Far away ………………………………03

Others…………............................……04

(Specify)

Q 9: Source of Washing

/bathing water

Tap……….............................................01

Tubewell…............................................02

Pond……….....................................….03

Ditch/Canal/Lake…..............................04

River/Fountain….............................….05

Rain water……...........................……..06

Others…………............................……07

(Specify)

Q 10: Source of drinking water Tap……….............................................01

Tubewell…............................................02

Pond……….....................................….03

Ditch/Canal/Lake…..............................04

River/Fountain….............................….05

Rain water……...........................……..06

Others…………............................……07

(Specify)


73

Section 2: Personal hygiene practices and awareness:


Q 11: Do you know the standard process of

washing hands?

Yes……….…………………………….01

No…………….......................................02

Q 12: Do you wash your hands properly after

coming from toilet?

Yes……….…………………………….01

No…………….......................................02

Q 13: How do you wash your hands after

coming from toilet?

Using water only...............................….01

With soaps ..........................................02

Others………........................................03

(Specify)

Q 14: Do you wash your hands properly

before eating foods?

Yes……….…………………………….01

No…………….......................................02

Q 15: How do you wash your hands before

you start taking foods?

Using water only.............................….01

With soaps ........................................02

Others………......................................03

(Specify)

Q 16: Do you take street-vended foods? Yes……….…………………………….01

No…………….......................................02

Q 17: Do you know that the food may be

contaminated with germs if not properly

cooked or stored?

Yes……….…………………………….01

No…………….......................................02

Q 18: Do you know that street-vended food

may be a source for the spread of

(infectious) diseases?

Yes……….…………………………….01

No…………….......................................02

Q 19: Why do you take foods from street side? They are cheap.......................................01

Very tasty/mouth watering.....................02


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Easily available…………......................03

Others ………………..…......................04

Specify

Q 20: Why don‘t you take foods from a good

restaurant?

Can‘t afford...………………………….01

It is too far away..……………………...02

Don‘t know…………………………….03

Others ………………..…......................04

Specify

Q 21 Which street food do you like most? Chotpoti………………………………..01

Fuchka…………………………………02

Shingara………………………………..03

Tehari…………………………………..04

Others…………………………………..05

Specify


75

Section 3: Disease Awareness:


Q 21: Do you smoke? Yes……….…………………………….01

No…………….......................................02

Q 22: Did you take vaccine ever?

Yes……….…………………………….01

No…………….......................................02

Q 23: Do you know that some

infections can be avoided by

taking vaccine at proper

time?

Yes……….…………………………….01

No…………….......................................02

Q 24: Did you suffer from any

infectious or other diseases in

last 3 months?

How long?

Yes……….…………………………….01

No…………….......................................02

…………………………………………….

Q 25: Which type of

infection/disease?

Fever…...................................................01

Cough/Cold…........................................02

Diarrhoea/dysentery…….......................03

Vomiting/Stomachache…......................04

Pneumonia………..................................05

Ear Infection….......................................06

Skin problem…......................................07

RTI…………......................................…08

Others……….........................................09

(Specify)


76

Q 26: Did you ever become sick

after taking street-vended

food?

Yes……….…………………………….01

No…………….......................................02

Don‘t know…………………………….03

Documents

Presonal Hygine Practice and Disease Awareness