SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Mr.RAMESH.BANDAGAR

I YEAR M. Sc NURSING

COMMUNITY HEALTH NURSING

YEAR 2012-2013

TULZA BHAVANI COLLEGE OF NURSING

NO, 899/3, NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI,

BIJAPUR-586101.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

01

NAME OF THE CANDIDATE AND ADDRESS

Mr.RAMESH.BANDAGAR

I YEAR M.Sc. (NURSING),

TULZA BHAVANI COLLEGE OF

NURSING

02

NAME OF THE INSTITUTE

TULZA BHAVANI COLLEGE OF NURSING,

NO, 899/3, NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI, BIJAPUR-586101.

03

COURSE OF THE STUDY AND SUBJECT

I YEAR M.SC. (NURSING)

COMMUNITY HEALTH NURSING

04

DATE OF ADMISSION TO THE COURSE

05/06/2012

05

TITLE OF THE STUDY

“A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE REGARDING FOOD HYGIENE AMONG WOMEN IN SELECTED RURAL AREA AT BIJAPUR DISTRICT.”

6. BRIEF RESUME OF THE INTENDED WORK

6.1. INTRODUCTION

A good meal makes a man feel more charitable toward the whole world than any sermon.

-Arthur Pendenys

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain (as in “Good health” or “Healthy”). The World Health Organization (WHO) defined health in its broader sense in 1946 as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."1 

A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases.2

The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred toas the “Health triangle.” The WHO's 1986 Ottawa Charter for Health Promotion furthered that health is not just a state, but also "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." 3

Food surveillance is essential for the protection and maintenance of community health. Broadly it implies the monitoring of food safety/food hygiene. The WHO (155) has defined food safety/food hygiene as “All conditions and measures that are necessary during the production, processing, storage, distribution and preparation of food to ensure that it is safe, sound, and wholesome and fit for human consumption.” The declaration of Alma-Ata considered food safety as an essential component of primary health care. Food is a potential source of infection and is liable to contamination by microorganisms, at any point during its journey from the producer to the consumer. Food hygiene, in its widest sense, implies hygiene in the production, handling, distribution and serving of all types of food (157). The primary aim of food hygiene is to prevent food poisoning and other food-borne diseases.4

The word ‘Hygiene’ is derived from ‘Hygeia’ the Goddess of Health in Greek mythology. It is the science of health and embraces all factors which contribute to healthful living. Food hygiene is a broad term used to describe the preservation and preparation of foods in a manner that ensures the food is safe for human consumption. This process of kitchen safety includes proper storage of food items prior to use, maintaining a clean environment when preparing the food and making sure that all serving dishes are clean and free of bacteria that could lead to some type of contamination.5

Food borne illness usually arises from improper handling, preparation or food storage. Good hygiene practices before, during, and after food preparation can reduce the chances of contracting an illness. There is a consensus in the public health community that regular hand-washing is one of the most effective defenses against the spread of food borne illness. The action of monitoring food to ensure that it will not cause food borne illness is known as “Food safety”. Food borne disease can also be caused by a large variety of toxins that affect the environment. Food borne illness can also be caused by pesticides or medicines in food and naturally toxic substances such as poisonous mushrooms or reef fish.6

Consumer awareness of food safety and nutrition is a major issue in relation to healthy lifestyles and disease prevention. Improper consumer food management has been implicated in a large number of cases of food borne illnesses. To reduce the risk of food borne illness, consumers must be willing to change behaviors that are not consistent with safe food storage and preparation practices. Change in such behaviors is strongly related to consumer knowledge of proper food handling practices. At the same time there is public consciousness of the role of diet in contributing to the health status, but this awareness has not led to sufficient improvement of eating habits. What people buy and eat and the way they manage food depends not only on the individual but also on social, cultural, economic and environmental factors. Identifying an effective strategy to improve consumers’ behavior is a concern for politicians and health promoters.7

6.2. NEED FOR THE STUDY

“To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear” - Buddha

Need for the study means scientific method which refers to a body of technique for investigation phenomena, acquiring new knowledge or collecting and integrating previous knowledge to be termed scientific method of enquiry must be based on gathering empirical and measurable evidence subject to specific principles of reasoning.

Nurses working in the community as public health nurse along with other public health care personnel work towards health promotion, health maintenance, restoring health alleviating the sufferings.

Food is essential for nourishment and sustenance of life. But many times, the food that we eat to stay healthy can make us sick. It might be due to the presence of microorganisms, due to improper food handling right from the farm to the table. Food safety is a scientific discipline describing the handling, preparation, and storage of food in ways that prevent food borne illness. This includes a number of routines that should be followed to avoid potentially severe health hazards. Food safety is an increasingly important public health issue as food-borne diseases take a major toll on health. Food safety encompasses actions aimed at ensuring that all food is as safe as possible. Food safety policies and actions need to cover the entire food chain, from production to consumption.8

The Centers for Disease Control and Prevention (CDC) estimates that 48 million food borne illness cases occur in the United States every year.  At least 128,000 Americans are hospitalized and 3,000 die after eating contaminated food.  While most food borne illness cases go unreported to health departments, and are thus of unknown origin, the CDC estimates that 9.4 million of the illnesses are caused by 31 known food borne pathogens, and that 90% of all illnesses due to known pathogens are caused by seven pathogens: Salmonella, norovirus, Campylobacter, Toxoplasma, E. coli, Listeria and Clostridium perfringens. According to 2010 estimation, norovirus is the most common of the known pathogens, responsible for 5.4 million illnesses and 149 deaths each year.  Salmonella is now estimated to cause more than a million illnesses and 378 deaths annually.  E. coli toxins are estimated to cause 176,000 illnesses and 20 fatalities a year.  Campylobacter is estimated to cause 845,024 illnesses and 76 deaths.  Listeria is one of the most lethal pathogens, estimated to cause 1,591 illnesses and 255 deaths.9

Food borne illnesses are a widespread public health problem globally. Developing countries bear the brunt of the problem due to the presence of a wide range of food-borne diseases. In India an estimated 4, 00,000 children below five years age die each year due to diarrhoea. Several millions more suffer from multiple episodes of diarrhoea and still others fall ill on account of hepatitis A, enteric fever, etc. caused by poor hygiene and unsafe drinking water.10

A study was conducted in Europe, North America, Australia, and New Zealand on consumer food handling in the home. The studies indicate that a substantial proportion of food borne disease is attributable to improper food preparation practices in consumers' homes. Surveys (questionnaires and interviews) were used in 75% of the reviewed studies. One consumer food safety study examined the relationship between pathogenic microbial contamination from raw chicken and observed food-handling behaviors, and the results of this study indicated extensive Campylobacter cross-contamination during food preparation sessions. Limited information about consumers' attitudes and intentions with regard to safe food-handling behaviors has been obtained, although a substantial amount of information about consumer knowledge and self-reported practices is available. Observation studies suggest that substantial numbers of consumers frequently implement unsafe food-handling practices. Knowledge, attitudes, intentions, and self-reported practices did not correspond to observed behaviors. The study was concluded that observational studies provide a more realistic indication of the food hygiene actions actually used in domestic food preparation. This study was recommended that there is need for the development and implementation of food safety education strategies to improve specific food safety behaviors among the food handlers.11

During the research work researcher found that lack of knowledge and practices regarding hygienic preparation among the women living in rural community of Bijapur district. The occurrence of the food borne diseases and out breaks serious danger if the hygiene is not maintained properly. In the rural areas mainly focusing in to the people those who are consuming in the houses it is mainly due to the lack of knowledge about the food hygiene among those who are preparing food. This study is attempted to assess perceptions and practices of women regarding food hygiene. Hence the researcher felt, that there is a strong need to study the hygienic practices, handling and safe storage of food among the women.

6.3. REVIEW OF LITERATURE

The review of literature in a research report is a summary of current knowledge about a particular problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study. An extensive review of literature relevant to the research study topic was done to gain information and insight and to build the foundation of the study. The literature reviewed for the present study is organized and presented below.

A pilot study was conducted by an application of the theory of planned behavior--a randomized controlled food safety intervention for young adults, in school of Psychology, The University of Sydney, Australia. Approximately 48 million Americans are affected by food borne illness each year. In this study young adult participants (N = 45) were randomly allocated to intervention. Food safety observations and Theory of Planned Behavior (TPB) measures were taken at baseline and at 4-week follow-up. Within and between group differences on target variables were considered and regression analyses were conducted to determine the relationship between condition, behavior and the TPB intention constructs; attitude, subjective norm, perceived behavioral control (PBC). TPB variables at baseline predicted observed food safety behaviors. At follow-up, the intervention led to significant increases in PBC (p = .024) and observed behaviors (p = .001) compared to both control conditions. Furthermore, correlations were found between observed and self-reported behaviors (p = .008). The study was concluded that pilot intervention supports the utility of the TPB as a method of improving food safety behavior. Thus the study was recommended that further research should be conducted to increase effectiveness of translating TPB variables to food safety behaviors.12

A descriptive cross-sectional study was conducted to assess the knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State, Nigeria. The study was carried out among 350 respondents by systematic sampling method and interviewed using a semi-structured questionnaire. An observational checklist was thereafter used to inspect their personal hygiene status. The study results shown that the mean age of the food handlers was 26.4 +/- 6.1 years, in this 228 (65.1%) were females while 34.9% were males. A majority (98%) of the respondents had formal education. Food handlers who had worked for longer years in the fast food restaurants had better practice of food hygiene and safety (p = 0.036). The level of education of respondents did not significantly influenced their practice of food hygiene and safety (p = 0.084). Although, 299 (85.4%) food handlers were generally clean, skin lesions was seen in 4 (7.3%) of them. The study was concluded that Knowledge was significantly influenced by previous training in food hygiene and safety. Thus the study was recommended that there is need for improvement through training and retraining of food handlers by the management of the restaurants and the local government authorities.13

A study was conducted on Food Safety Knowledge and Practices among Women Working in Alexandria University, Egypt. The study was conducted on 270 women working in six faculties and institutions of Alexandria University were assessed using a questionnaire including data on personal characteristics, previous attack of prominent food poisoning, and four parameters of food safety knowledge and practices. The study results shown that highest percentage of food poisoning cases (46.8%) was belonging to staff members and 39.7% were in the age group <10 years. Half of the cases resulted from eating outside home compared to 16.7% from eating at home. The mean score percentage of the total safety Knowledge of the sample was 67.4 compared to 72.0 for their safety practices. The highest Knowledge score was in personal hygiene (73.8) while the highest practice score was in cooking (77.5). The lowest Knowledge score was in food preparation (59.8) whereas the lowest practice was in purchasing and storage (62.7). The highest scores of the total food safety practices and their parameters were among clerks except in practicing safe purchasing and storage where the highest mean score was among staff members (66.5+/- 12.8) with significant differences among jobs except in practicing personal hygiene. The study was concluded that inadequate safety knowledge and practices among all job categories. Thus the study was recommended that inconsistencies between knowledge and practices emphasize the need for implementing repeated food safety education programs.14

A study was conducted on food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults. The study was included 153 young adults (mean age 20.74+/-1.30 s.d.) attending a major American university. Each prepared a meal under observation in a controlled laboratory setting, permitted researchers to observe their home kitchen and completed an online survey assessing food safety knowledge, behavior and psychosocial measures. Descriptive statistics were generated for participant’s self-reported food-handling behaviors, psychosocial characteristics, knowledge, food preparation observations and home kitchen observations. Participants engaged in less than half of the recommended safe food-handling practices evaluated and correctly answered only 2/3 of the food safety knowledge items. They reported positive food safety beliefs and high food safety self-efficacy. Self-reported compliance with cross-contamination prevention, disinfection procedures and knowledge of groups at greatest risk for FBD was the best measures for predicting compliance with established safe food-handling practices. The study was concluded that food safety education directed towards increasing awareness of FBD and knowledge of proper cross-contamination prevention procedures to help promote better compliance with actual safe food handling. Thus the study was recommended that further research is needed on food safety and food handling behaviors.15

A study was conducted on food safety knowledge and behaviors of women, infant, and children (WIC) program participants in the United States. A study was included with participants of the Special Supplemental Food Program for Women, Infants, and Children (WIC). A survey was conducted with 1,598 clients from 87 WIC agencies nationwide. In this study descriptive statistics, chi-square analyses, t tests, and analyses of variance were used for calculation. A majority of respondents received food safety information from WIC (78.7%), family (63.1%), and television (60.7%). Most respondents recognized the necessity for washing and sanitizing cutting boards and utensils (94.3%), but only 66.1% knew the correct ways to sanitize. Using a thermometer to ensure doneness of meat was least recognized (23.7%) and used by even fewer respondents (7.7%). The majority (77.4%) used color of meat and/or juices when checking the doneness of ground beef items. Over half of the respondents (58.4%) used acceptable thawing methods, but many thawed frozen meats on the counter (21.0%) or in a sink filled with water (20.6%). The study was concluded that significant differences in thawing methods, white respondents had higher knowledge scores than did Hispanics, and blacks had lower behavior scores than did individuals in the other racial and ethnic groups. Thus the study was suggested the need for food safety education for low-income consumers and different messages to be delivered to specific demographic groups.16

The study was conducted on food safety knowledge of consumers and the microbiological and temperature status of their refrigerators in Ireland. In this study food safety knowledge questionnaire applied to a representative sample of households (n = 1,020) throughout the island of Ireland found the gaps in consumer food safety knowledge. Analysis of swab samples (n = 900) recovered from the domestic refrigerators in these households showed average total viable counts of 7.1 log CFU/cm2 and average total coliform counts of 4.0 log CFU/cm2. Analysis of swab samples also detected the incidence of Staphylococcus aureus (41%), Escherichia coli (6%), Salmonella enterica (7%), Listeria monocytogenes (6%), and Yersinia enterocolitica (2%). Campylobacter jejuni and E. coli O157:H7 were not detected in domestic refrigerators. The temperature profiles of a subset of the sampled refrigerators (100) were monitored for 72 h, and 59% were found to operate, on average, at temperatures above the recommended 5 degrees C. Knowledge and temperature survey results varied considerably, but consumers who scored better in terms of basic food safety knowledge had reduced levels of bacterial contamination in their refrigerators and reported a reduced incidence of food-associated illnesses. Thus the study was recommended that further studies are needed on microbiological and temperature status of their refrigerators.17

The study was conducted on diarrhea prevention through food safety education in Department of Foods and Nutrition, Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India. Food safety education (FSE) was imparted in order to reduce the prevalence of diarrhea in children and improving the knowledge, attitude and practices of mothers regarding safe feeding practices. The study was conducted on mothers (n=200) of underprivileged children (6-24 months) through Anganwadi workers (AWW). The food safety education package incorporated three messages: washing hands with soap and water avoid feeding leftover food and keep surrounding area clean. These were imparted using lectures, slogans; posters, charts, flash cards, role-play, calendars and leaflets were also handed over to the mothers as education material. The results are shown that there was 52% reduction in the incidence of diarrhea. The environmental sanitation and personal hygiene scores of most of the households and mothers improved. Improvement in the practice of hand-washing and avoidance of feeding leftovers to children was seen. The study was concluded that AWW proved to be effective change agents and FSE was successful in bringing about a positive behavior modification in mothers. Thus the study was recommended that further food safety education campaign is needed to improve the knowledge and practices of mothers regarding safe feeding practices.18

A study was conducted on food safety knowledge, attitudes and behaviors among Puerto Rican caretakers living in Hartford, Connecticut. The study was included 10 in-depth household observations and a quantitative survey (n = 100) were conducted to understand food-handling techniques among caretakers of young children, followed by 2 focus groups (n = 12) to further characterize food safety knowledge, attitudes, and behaviors and the proper media channels for the delivery of food safety education. 97% of survey participants reported washing their hands with soap and water before preparing foods, only 1 of the 10 participants in the household observations actually did it. About 60% of the household participants washed the cutting boards with soap and water compared with 89% of survey participants who claimed to do it. In the survey, 5% reported to know the meaning of cross-contamination, and 71% (n = 80) to use the same cutting board for meats and vegetables. Overall, 96% of survey participants did not use a thermometer to check if meats were cooked properly and only 10% defrosted their meats in the refrigerator. Statistically significant relationships (p < 0.05) were found between speaking English and knowing the meaning of cross-contamination and how to use a meat thermometer. The study was concluded that household food safety education is needed to minimize the risk of exposure to food borne pathogens. Thus the study was recommended that further food safety education is needed to improve food safety knowledge, attitude and practices.19

A descriptive study was carried out to determine food safety practices among food Vendors in secondary schools in Ilorin. In this study pre-tested questionnaire and observational checklist were administered to 185 respondents recruited using inclusion and exclusion criteria, in this 182 (98.4%) of the subjects were females and only 6 (3%) were teenagers and 102 (56.8%) had no formal education while 72 (39%) had received training on food hygiene. Pre-employment medical examination practice was high 141(76%) but periodic medical examination was low 30(16%). So 61 (33%) and 72 (39%) respondents were prepared food well in advance and reheat food before sale respectively. The major unhygienic practices observed among the food vendors were poor care of used utensils 100(54%), use of previously used water for washing and cleaning, lack of covering apron among the vendors 128(69%) and lack of wash hand basin for immediate cleaning 61(33%). Only 85(46%) of the respondents used soap and water to clean their utensils while the rest 100(54%) used unhygienic methods to clean their utensils. It was observed that respondents who used soap and water for cleaning, vended food at locations that were relatively closer to water source, compared to other vendors who used other methods to clean their utensils. This is also statistically significant. Unkempt fingernails, skin lesions and poor food protection from flies were some of the food contaminating risk factors observed in the study. The study was recommended that the need exists for food vendors and other food handlers to be trained on basic principles of safe food handling.20

6.4. STATEMENT OF PROBLEM:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE REGARDING FOOD HYGIENE AMONG WOMEN IN SELECTED RURAL COMMUNITY AT BIJAPUR DISTRICT”.

6.5. OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding food hygiene among women.

2. To develop the information booklet regarding food hygiene among the women.

3. To evaluate the effectiveness of planned teaching programme in terms of change in the level of knowledge regarding food hygiene among women.

4. To determine the association between pre test knowledge scores with selected socio demographic variables.

6.6. OPERATIONAL DEFINITIONS:

1. Evaluate: Refers to impact of self instructional module on knowledge of women regarding food hygiene as elicited by self administered knowledge questionnaire.

2. Effectiveness: It refers to the extent to which the planned teaching program has achieved the desired effect as measured by the subjects gain in knowledge scores.

3.Information booklet: In this study it refers to the educational tool prepared by the investigator to evaluate the knowledge regarding food hygiene.

4.Knowledge: It refers to information and skills gained through experience or education. In this study, it refers to the women knowledge on food hygiene as it is evident from knowledge questionnaire.

5.Food hygiene: It refers to the food hygiene means maintain the cleanliness in preparation, storage and the distribution and serving of all type of foods free from infection and infestation.

6. Women: It refers to the women those who are married, preparing, handling the food in the houses of selected rural areas.

7. Rural community: The place of residences fulfilling the criteria of the rural community.

6.7. HYPOTHESIS:

H1: There is no statistical significance between knowledge scores with selected socio demographic variables.

H2: There is a statistical significance between knowledge scores of with selected socio demographic variables.

6.8. ASSUMPTION:

1. Women have inadequate knowledge regarding food safety and food hygiene.

2. Information booklet is an effective method to improve knowledge regarding food safety and food hygiene.

6.9. DELIMITATION:

The study is delimited to the women present in rural area at Bijapur District.

7. MATERIAL AND METHODS 7.1 SOURCE OF DATA : Women in selected rural community

at Bijapur District.

7.2 METHODS OF DATA COLLECTION

7.2.1. Research Design : Pre-experimental One group pre test-post test research design. 7.2.2. Research approach : Research approach adopted in this study . is to evaluative approach. 7.2.3. Research Variables

Independent variables : Information booklet regarding the

food hygiene among the women.

Dependent variables : Knowledge level of the women regarding the food hygiene.

7.2.4. Setting : This study will be conducted in selected rural area of Bijapur District.

7.2.5. Population : The population of present study consists of women those who are preparing and handling the food in the family in selected rural community at Bijapur District.

7.2.6. Sample : Women those who are preparing and handling the food in the family in selected urban area at Bijapur District, who fulfill the inclusion criteria.

7.2.7. Sample size : The total sample of the study consists of 60 women. 7.2.8. Criteria for the sample selection Inclusion criteria: Women;

· Who are residing in the selected rural area at Bijapur District. · Who are able to understand Kannada · Who are willing to participate in the study.· Who are available during data collection.· Who are in the age group between 18-45 years.

Exclusion criteria: Women;

· Those who are not available during the study.

7.2.9. Sampling Technique : Non-probability, convenaient sampling Technique.

7.2.10. Tool for data collection : The tool consist of the following section,

Section A : It includes selected socio demographic variables. Section B : Structured knowledge questionnaire to assess the level of knowledge regarding food hygiene.

7.2.11. Method of data collection : On 1stday (pre-test) the women knowledge will be assessed by the investigator through structured knowledge questionnaire. On the same day information booklet will be distributed to women. On 8thday of the pre test, post test will be conducted regarding food safety and food hygiene with the same structured knowledge questionnaire to assess the knowledge regarding food hygiene among women residing in rural area at Bijapur District.

7.2.12. Plan for the data analysis : The collected data will be analyzed using descriptive and inferential statistics. Descriptive statistics : Frequency, Percentage, mean and standard deviation will be used.

Inferential statistics : paired “t” test to compare the pre and post

knowledge score of 0.01 level and chi- square test will be used.

7.3. DOES the study requires any investigation or intervention to be conducted on patient orother human or animals? : Yes There is an intervention as an information booklet and there is no active manipulation on the subject..

7.4. Has ethical clearance been obtained from your institution : Yes, Ethical clearance will be obtained from the institution to conduct the study.

8. LIST OF REFERENCE

1. “Health-Wikipedia” Nov, 2011, available on http://www.google.co.in, retrieved on 18/11’2012.

2. “Disease” Dec, 2012, available from http://www.wikipedia.com, retrieved on 1811/2012.

3. World Health Organization, “Health”2012, (online) available from http://www.who.int/topics/health/en/, retrieved on 22/11/2012.

4. Park K. Text book of Preventive and Social medicine. 19th edition. Banarsidas Bhanot publication Jabalpur, 2007: 490p.

5. Hoy.S (1995) chasing dirt; American pursuit of cleanliness, oxford university press, Newyork.

6. Food borne illnesses and hygienic practice of food, (online) available from http://en.wikipedia.org/wiki/Foodborne_illness, retrieved on: 8/11/2012

7. Food safety and nutrition : improving consumer behavior, available from http://www.sciencedirect.com/science/journal/09567135/26/2, retrieved on 8/11/2012

8. Nana O.B. Ackerson, Food safety- Food commodity, Codex alimentary; available from:

www.indian women’s health.com, retrieved on : 13/11/2012

9. Food safety and food borne illnesses, available from: www.foodbone illnesses.com/food poisoning, retrieved on: 16/11/2012

10. Sudershan R.V, Food safety related perceptions and practices of mothers – A case study.

11. Redmond EC, Griffith CJ. Consumer food handling in the home: a review of food safety studies in Europe, North America, Australia, and New Zealand , J Food Prot. 2003 Jan;66(1):130-61p.

12. Milton AC, Mullan BA, An application of the theory of planned behavior-a randomized controlled food safety pilot intervention for young adults, 2012 Mar;31(2):250-9p.

13. Isara AR, Isah EC, Knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State, Niger Postgrad Med J. 2009 Sep; 16(3):207-12p.

14. Fawzi M, Shama ME. Food Safety Knowledge and Practices among Women Working in Alexandria University, Egypt. J Egypt Public Health Assoc. 2009; 84(1-2):95-117p.

. 15. Abbot JM, Byrd-Bredbenner C, Schaffner D, Bruhn CM, Blalock L.Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults. Eur J Clin Nutr. 2009 Apr; 63(4):572-9p.

16. Kwon J, Wilson AN, Bednar C, Kennon L. Food safety knowledge and behaviors of women, infant and children (WIC) program participants in the United States. J Food Prot. 2008 Aug; 71(8):1651-8p.

15. Kennedy J, Jackson V, Blair IS, McDowell DA, Cowan C, Bolton DJ. Food safety knowledge of consumers and the microbiological and temperature status of their refrigerators. J Food Prot. 2005 Jul; 68(7):1421-30p.

16. Sheth M, Obrah M. Diarrhea prevention through food safety education. Indian journal of pediatrics. 2004 Oct; 71(10):879-82p.

19. Bermúdez-Millán A, Pérez-Escamilla R, Damio G, González A, Segura-Pérez S, Food safety knowledge, attitudes, and behaviors among Puerto Rican caretakers living in Hartford, Connecticut. J Food Prot. 2004 Mar; 67(3):512-6p.

20. Musa OI, Akande TM. Food hygiene practices of food vendors in secondary schools in Ilorin. Niger Post grad Med J. 2003 Sep; 10(3):192-6p

9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF11.1 GUIDE : MR.SATEESH SINDHE ASSOCIATE PROFESSORTULZA BHAVANI COLLEGE OF NURSING. NEAR HAZARAT JUNEEDI DARGA, BIJPUR 11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT : MR.SATEESH SINDHE ASSOCIATE PROFESSOR TULZA BHAVANI COLLEGE OF NURSING NEAR HAZARAT JUNEEDI DARGA, BIJPUR 11.6 SIGNATURE :

12. 12.1 REMARKS OF THE PRINCIPAL :

12.2 SIGNATURE

20