|Year : 2014 | Volume
| Issue : 1 | Page : 10-15
Assessment of the food hygiene practices of food handlers in the Federal Capital Territory of Nigeria
Chigozie O Ifeadike1, Okechukwu C Ironkwe2, Prosper O. U. Adogu1, Chinomnso C Nnebue3
1 Department of Community Medicine, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
2 IO Chuks Atlas Health Care Services Ltd, Abuja, Nigeria
3 Department of Community Medicine; HIV Care, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
|Date of Web Publication||7-Apr-2014|
Chinomnso C Nnebue
Department of HIV Care, Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra
Background: The principle of food hygiene implies that there should be minimal handling of food items. Food handlers are thus expected to observe proper hygiene and sanitation methods as the chances of food contamination largely depend on their health status and hygiene practices. Objective: This study assessed the food hygiene practices of food handlers and made recommendations for improved food safety measures within food establishments in the Federal Capital Territory. Materials and Methods: The study design was cross-sectional descriptive. A multistage sampling technique was employed to select 168 food handlers of various types. Data was collected using a mix of quantitative methods (structured interviewer-administered questionnaires and observation checklist). Data were analyzed using the statistical package for social sciences version 14. Results: Four categories of food handlers were identified in 45 food establishments. Seventy-one (42.3%) of the subjects are males, whereas 97 (57.7%) are females. Most of them, 122 (72.7%), had secondary education and above, whereas 46 (27.3%) had primary education and below. One hundred and fifty (89.3%) of them wash their hands after the use of toilets, whereas only 44 (26.7%) change their hand gloves at work. One hundred and twenty (71.4%) of them undergo regular medical checkup, whereas 53 (31.5%) are isolated from workplace when ill. A few of them, 51 (30.4%) use sanitizers/disinfectants at workplace, whereas 38 (22.6%) check food temperature with thermometer. Also, 103 (61.3%) use ideal waste disposal methods at workplace (P < 0.01). Conclusion: Establishments should train staff regularly on basic personal hygienic techniques, self care and good house-keeping practices.
Keywords: Food hygiene, food handlers, Federal Capital Territory
|How to cite this article:|
Ifeadike CO, Ironkwe OC, Adogu PO, Nnebue CC. Assessment of the food hygiene practices of food handlers in the Federal Capital Territory of Nigeria. Trop J Med Res 2014;17:10-5
|How to cite this URL:|
Ifeadike CO, Ironkwe OC, Adogu PO, Nnebue CC. Assessment of the food hygiene practices of food handlers in the Federal Capital Territory of Nigeria. Trop J Med Res [serial online] 2014 [cited 2019 Mar 20];17:10-5. Available from: http://www.tjmrjournal.org/text.asp?2014/17/1/10/130175
| Introduction|| |
According to e-How, a food handler is a person with any job that requires him/her to handle unpackaged foods or beverages and be involved in preparing, manufacturing, serving, inspecting, or even packaging of food and beverage items.  All food handlers are required to use proper hygiene and sanitation methods when working with food.
Food hygiene is the set of basic principles employed in the systematic control of the environmental conditions during production, packagng, delivery/transportation, storage, processing, preparation, selling and serving of food in such a manner as to ensure that food is safe to consume and is of good keeping quality.  However, food itself can pose a health threat, a problem that is serious in developing countries due to difficulties in securing optimal hygienic food handling practices. The public health objective of food hygiene and safety is the prevention of illness attributable to consumption of food. This is because of adequate supply of safe, wholesome and healthy food are essential for the health and well-being of humans. 
Okojie et al.,  in an assessment of food hygiene practices among food handlers in a Nigerian university campus reported that the knowledge and practice of food hygiene and safety was poor. Only 30.4% of respondents had pre-employment medical examination, whereas 48% had received any form of health education on food hygiene and safety.  Isara and colleagues reported good knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State.  But the study showed that knowledge and practice were influenced by previous training (P = 0.002), whereas food handlers who had worked for longer years in food restaurants had better practices of food hygiene and safety (P = 0.036). The level of education did not significantly influence practice. 
The consumption of contaminated or unsafe foods may result in illness, also referred to as foodborne disease. , Foodborne diseases remain a major public health problem across the globe. Even in developed countries, an estimated one-third of the population are affected by microbiological foodborne diseases each year.  Kaferstein and Abdussalam reported that up to 10% of the population of industrialized countries might suffer annually from foodborne diseases.  An estimated 70% of cases of diarrheal diseases are associated with the consumption of contaminated food. , Statistics show that every year, there are estimated 76 million foodborne illness in the United States (26,000 cases for 100,000 inhabitants) and 2 million in the United Kingdom (3,400 cases for 100,000 inhabitants).  Diarrheal diseases, mostly caused by foodborne or waterborne microbial pathogens, remain the leading causes of illness and deaths in these countries, killing an estimated 1.9 million people annually worldwide. Yet, it is expected that a large number of illnesses remain under-reported as only the most serious cases are usually investigated. In most developing countries, reliable statistics on foodborne diseases are not available due to poor or non-existent reporting systems. 
Transmission of intestinal parasites and entero-pathogenic bacteria is affected directly or indirectly through objects contaminated with feces. These include food, water, nails, and fingers, indicating the importance of feco-oral human-to-human transmission.  Accordingly, food handlers with poor personal hygiene working in food-serving establishments could be potential sources of infections of many intestinal helminths, protozoa, and enteropathogenic bacteria.  Food-handlers who harbor and excrete intestinal parasites and enteropathogenic bacteria may contaminate foods from their feces via their fingers, then to food, and finally to healthy individuals.  Compared to other parts of the hand, the area beneath fingernails harbors the most micro-organisms and is most difficult to clean.  Biological contaminants largely bacteria, viruses, and parasites constitute the major cause of food-borne diseases. In developing countries, such contaminants are responsible for a wide range of diseases, including cholera, campylobacteriosis, E. coli gastroenteritis, Salmonellosis More Details, shigellosis, typhoid and paratyphoid fevers, Brucellosis More Details, amoebiasis, and poliomyelitis. 
Various factors such as the general sanitary standards of the house, the proper use of sanitary facilities like latrines, hand-washing lavatories, refuse management systems, and dishwashing facilities affect food safety in food establishments. Food handling, preparation, and service practices are other important factors in determining the safety of food. Conditions of cooking utensils, food storage systems (time and temperature), as well as food handlers' knowledge and practices similarly affect food safety directly or indirectly. ,,
Food hygiene rests directly on the state of personal hygiene and habits of the personnel working in the establishments.  In developing countries such as Nigeria, the normal atmospheric temperature is ideal for the multiplication of micro-organisms which cause food poisoning.  Sometimes the food may look attractive and may be normal in smell and taste, and yet cause acute illness almost immediately after consumption or after a period of time due to toxins produced by bacteria. Globally foodborne illness affects an estimated 30% of individuals annually.  Meals prepared outside the home have been implicated in up to 70% of traced outbreaks. And with urbanization, industrialization and development, people tend to increasingly patronize public food vendors. Thus proper handling of foods, utensils and dishes together with emphasis on the necessity for good personal hygiene are all of great importance. This study assessed the food hygiene practices of food handlers in the Federal Capital Territory (FCT) and made appropriate recommendations for the improvement of food safety and sanitary conditions within food establishments in the FCT.
| Materials and Methods|| |
Abuja is Nigeria's FCT. It was created in 1976, covers an area of 800 km 2 and has a population of about 1.4 million.  The FCT is subdivided into 6 area councils.
The study design was descriptive cross sectional. A sample size of 168 was calculated based on the assumption of 5% expected margins of error and 95% confidence interval using the formulae for calculating sample size for descriptive studies in population >10,000, n = z2pq/d2 . 
where, n = calculated sample size, z = standard normal deviate at 95%, Confidence Interval = 1.96, P = percentage of food handlers with acceptable food hygiene practice (50%),  q = the complementary probability of P which is (1 − p) that is, percentage of food handlers without acceptable food hygiene practice (50%), d = precision level 5% = 0.05.
A multistage sampling technique was used and this included the following stages: First, out of the six council areas in Abuja, two (Abuja municipal and Kuje) council areas were selected by a simple random sampling method. Secondly, a comprehensive list of existing catering establishments was obtained from the Department of Public/Occupational Health, Federal Capital Development Authority (FCDA), Abuja. This list was then stratified by the type of service they provide into the following strata: Restaurant 16, bar 8, butcher shop 12, juice vendor 9, totaling 45 food establishments. The main purpose of stratification was to avoid over or under-representation of certain types of establishments. A proportional sample size was then determined for each stratum, and selection performed using a table of random numbers to obtain a sample size of 168 from an estimated population size of 285. Four categories of food handlers were identified, which include: Production staff, cooks, butchers, and waiters. Participants were selected from the list of work groups mentioned above and included all the staff that prepare and serve food.
"Bar" includes establishment that serves alcoholic drinks: Beer, wine, liquor cocktails and pepper soup for consumption on the premises. " Restaurant" includes establishments that prepare and serve food, drink to customers. Meals are generally served and eaten on premises, but may also offer take-out and food delivery services. " Butcher/suya shop" includes establishments that slaughter animals, dress their flesh and sell their meat or any combination of these three tasks. They may prepare standard cuts of meat, poultry, fish and shellfish for sale in retail or wholesale to other food establishments. "Ice cream/fruit juice shop" includes establishments that prepare frozen dessert usually made from dairy products, such as milk and cream, and often combined with fruits or other ingredients and flavors.
Data was collected using a mix of quantitative methods (structured, pre-tested interviewer administered questionnaires and observation checklist). Data collected include: Socio-demographic characteristics of food handlers; physical infrastructure of premises; availability of water supply, toilet facility, refuse management and dish/hand washing facility. Five sanitarians were recruited and trained for 3 days on the purpose of the study, the format of the questionnaire and checklist, interviewing techniques, and data quality management, which was also ensured by regular supervision, spot checking and reviewing the completeness and consistency of questionnaire and checklist on a daily basis. Data were analyzed using the statistical package for social sciences (SPSS) version 14. The results were presented in tables for easy appreciation.
The researchers obtained Ethical clearance from the Ethics Committee of NAUTH, Nnewi.
| Results|| |
The socio-demographic characteristics of the food handlers are shown in [Table 1]. Of the four categories of food handlers identified, 71 (42.3%) of participants are males while 97 (57.7%) are females. While 87 (51.8%) of participants are married, 81 (47.6%) are single. As many as 122 (72.7%) of the subjects had secondary education and above, while 46 (27.3%) had primary education and below. Sixty-six (39.3%) of the respondents are semi-urban dwellers, while 62 (36.9%) and 60 (23.8%) reside in rural and urban centers, respectively.
[Table 2] shows the personal hygiene practices of the participants. One hundred and fifty (89.3%) of the subjects engaged in hand wash after the use of toilets, 83 (49.4%) use hand gloves, while 44 (26.2%) practice changing of hand gloves at work. Furthermore, 57 (33.9%) of subjects were observed with an open wound or cut while 94 (55.9%) make use of apron/head tie at work.
In [Table 3] which shows the medicare practices of the respondents, 120 (71.4%) of the subjects undergo regular medical checkup (medical check up includes: History taking and examination for signs and symptoms of medical conditions such as diarrhea, dysentery, typhoid, sore throat, which can lead to food poisoning, stool and urine analysis.), 53 (31.5%) are isolated from work place when ill, while 32 (19.0%) are provided with medication when ill.
[Table 4] depicts the workplace hygiene practices of the subjects in which 51 (30.4%) of them used sanitizers and disinfectants at workplace, also 51 (30.4%) of respondents observe proper hand washing with soap and water and 38 (22.6%) checked food temperature with thermometer. Furthermore, 103 (61.3%), of the participants make use of proper waste disposal methods in their workplace.
[Table 5] shows that only 54 (32.1%) of the food handlers had undergone regular food hygiene training/health education as opposed to 114 (67.9%) who had not.
|Table 5: Food handlers who attend regular training/receive health education on food hygiene |
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[Table 6] shows the observed work place practices of establishments. Sixteen (35.6%) had their facilities regularly inspected by sanitary officers (for adequacy of size, water supply, lighting, toilet facilities etc), 21 (46.7%) practiced meat inspection by the FCT public health department. There was good environmental hygiene in 27 (60.0%) of them. None of the food establishments practiced posting of food safety info sheets, notification of carriers or food handlers with communicable diseases to local authority, certification of medical fitness of workers.
|Table 6: Observation on ideal work place hygiene practices of establishments |
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| Discussion|| |
Poor and faulty food handling practices have been identified as the leading cause of the majority of foodborne diseases.  This study identified some poor hygiene practices exhibited at work. These include: Lack of provision of medication by establishment, non isolation from work environment when sick, irregular use of sanitizers and disinfectants, lack of change of hand gloves between ready-to-eat meal, irregular food hygiene training, non use of thermometer to check food temperature. This finding of our study is a strong indication of the poor health status and poor hygiene practices of food handlers/establishments in the FCT and agrees with the findings of Okojie and colleagues in Benin, who in an assessment of food hygiene among food handlers in a Nigerian university campus reported that the knowledge and practice of food hygiene and safety were poor.  It, however, differs from the findings of Isara et al.,  who reported good knowledge and practice of food hygiene and safety among food handlers in fast food restaurants in Benin City, Edo State.
It is a known fact that chlorinated tap water kills Salmonella More Detailse,  yet many food handlers living in the city slums and shanty towns do not have access to potable pipe-borne water and so are at a high risk of infection, especially with enteric fever known to be endemic in places of low personal hygiene and environmental sanitation.  This study has also established that food handlers in the FCT constitute significant risk in the spread of enteric fever. It has also buttressed the role that food handlers play in disease transmission as several authors have reported. ,, However, given the time and money required to improve environmental sanitation, and increase the accessibility to potable water, the most rewarding option are regular food hygiene education and periodic screening of food handlers with a view to following up those found infected and getting them cured. According to Okojie and others, only about a third of respondents had premployment medical examination. 
Majority of the respondents in this study (89.3%) reported that they usually washed their hands before starting the preparation of food and after handling raw meat. A smaller number reported that they do not use hand wash detergent to wash their hands before starting the preparation food and after handling raw meat. In studies conducted by Altekruse et al.,  Yang et al., and Shiferaw et al., 87% to 92% of the respondents also indicated that they usually washed their hands before handling food, and 62% to 100% that they also usually washed their hands after handling raw meat or poultry. Effective hand washing therefore has been an essential control measure for prevention of pathogen Pathogen.
Any agent capable of causing disease. The term pathogen is usually restricted to living agents, which include viruses, rickettsia, bacteria, fungi, yeasts, protozoa, helminths, and certain insect larval stages transmission in food service establishments. Facilities for personnel should be adequate and all hand washing basins in toilet areas must be supplied with hot and cold water, and hand-cleaning preparations in dispensers and paper towels or air hand-dryers should be provided Codex Alimentarius.
A document entitled 'Recommended International Codes of Hygienic Practice for Fresh Meat, for Ante-Mortem and Post-Mortem Inspection of Slaughter Animals and for Processed Meat Products' pub. The potential for cross-contamination is reduced, however, when disposable paper towels are used. 
Less than one-third of these respondents indicated using soap and water for washing their hands before starting the preparation of food and or after handling raw poultry or meat. Furthermore, it is most probable that majority of the participants do not wash hands according to good hygienic practices. This may be connected with lack of potable water and standard hand wash facilities in establishments. Even when such facilities are available, most participants do not have basic understanding of standard hand washing procedures. Other notable violations include; nonprovision of thermometers for temperature control. It is important to note that further evaluation of the above mentioned factors is vital in food safety and how best to control these factors is of importance in improving the system.
The safety of food in the FCT was further challenged by the sanitary condition of some food outfits that participated in this study. The observations made include the fact that personnel with infections are not restricted from potentially hazardous work, inadequate provision of disinfectants/sanitary products including hand gloves, apron and head tie. Also, observed work place practices of establishments indicated that about one-third had their facilities regularly inspected by sanitary officers (for adequacy of size, water supply, lighting, toilet facilities). None of the food establishments practiced posting of food safety infosheets, notification of carriers or food handlers with communicable diseases to local authority, certification of medical fitness of the workers. The Centre for Disease Control and Prevention (CDC) has called for food safety communication to design methods and messages aimed at increasing food safety risks reduction practices from farm to fork.  The CDC advocated that posting food safety info sheets is a tested and an effective intervention tool that positively influence the food safety behavior of food handlers. 
This study showed that approximately one-third of respondents had regular training and health education on food hygiene and safety. This agrees with the finding by Okojie et al.,  where poor food hygiene practice was linked to the fact that barely half of the respondents had received any form of health education on food hygiene and safety. Isara et al., also concurred that knowledge and practice were influenced by previous training (P = 0.002). These findings emphasized the place of training and health education on good food hygiene practices among food handllers.
In a bid to maintain good health, the establishments should provide disposable rubber gloves, plasters and other measures for minor cuts for use as necessary to the personnel who have contact with food. Establishments should train and re-train staff on good hygienic practices with emphasis on the importance of good hygiene and ideal hand washing practices. The staffs should be made to appreciate the impact of poor personal cleanliness and unsanitary practices on food safety. Equally important, is the need to educate food handlers on the avoidance of unwholesome practice of scratching the head, placing finger in or about the mouth or nose and indiscriminate and uncovered sneezing. Finally, they should be encouraged to inculcate the habit of thorough and proper hand washing after using the toilet/bathroom, before and after eating.
The FCT public health departments should ensure the posting of food safety infosheets as advocated by the CDC as well as the notification of carriers or food handlers with communicable diseases by the establishments to local authority. The FCT public health departments in collaboration with public and private health facilities should enforce compliance of pre-placement and periodical medical examination of food handlers in the FCT and a certificate by a medical practitioner should be submitted, stating whether such person is fit to handle food or not.
Health inspectors/sanitary officers should work out modalities to ensure that persons with any foodborne infection are restricted and treated. Also, there should be periodic inspection of food premises by sanitary officers, to ensure compliance with minimum standards in terms of housekeeping, equipment and materials.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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