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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 154-159

A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures among urban households


Department of Community Medicine, J. N. Medical College, KAHER, Belagavi, Karnataka, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. Shilpa Reddy Ganta
Department of Community Medicine, J. N. Medical College, KAHER, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_277_18

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  Abstract 


OBJECTIVE: The objective of this study was to assess knowledge, attitude, and practices of food safety measures among urban households of Belagavi using the World Health Organization (WHO) “Five keys for food safety.”
MATERIALS AND METHODOLOGY: A community-based cross-sectional study was conducted from January 1, 2017, to December 31, 2017 among 400 women aged above 18 years who were involved in food preparation at urban households in the field practice area of Ashok Nagar, Belagavi, Karnataka, India. Data were collected using pretested and predesigned questionnaire based on the WHO five keys for food safety. Households were selected based on systematic random sampling. Statistical analysis was done by percentages, mean and standard deviation, and ANOVA using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Cor.
RESULTS: The mean age of the participants was 37.96 ± 14.9 years, and the mean scores of knowledge, attitude, and practice regarding food safety were 7.1 ± 1.47 out of total score of 11, 15.45 ± 1.65 out of total score of 18, and 30.18 ± 4.21 out of total score of 40, respectively. The mean knowledge score was found to be lower in the age group of >35 years (P < 0.05, F = 5.7415) and socioeconomic status Classes III, IV, and V (P < 0.05, F = 1.828), and these differences were found to be statistically significant.
CONCLUSION: Knowledge and attitude scores regarding food safety were good, but food safety practice scores were lower. Among the WHO five keys for food safety, knowledge, attitude, and practices regarding “cook thoroughly” and “keep food at safe temperature” were observed to be lower.

Keywords: Attitude, five keys for food safety, knowledge, practice, urban households


How to cite this article:
Ganta SR, Kadeangadi DM. A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures among urban households. Indian J Health Sci Biomed Res 2019;12:154-9

How to cite this URL:
Ganta SR, Kadeangadi DM. A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures among urban households. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Aug 24];12:154-9. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/154/259636




  Introduction Top


According to the World Health Organization (WHO) (2015), globally, an estimate of 600 million people – almost one in ten people fall ill after eating contaminated food.[1] In India, foodborne illness is often unreported or unrecognized. Foodborne illness is a major public health problem both in developed and developing countries hindering the socioeconomic development of a nation by burdening health-care system. Food safety promotes healthier and longer lives and helps in reducing health-care burden.

Food handlers play an important role in making food safe for consumption, especially at all levels of household from purchase to food consumption. The factors which can lead to food contamination are improper maintenance of hygiene such as the practice of handwashing, not keeping utensils and kitchen surface clean, inadequate cooking, and improper storage.[2] It is important to make sure that food handlers at households are maintaining certain standards for food safety.

To strengthen food safety systems in all countries, the WHO stated the theme for “World Health Day” for the year 2015 as “From farm to plate, make food safe.” The WHO “Five keys for safer food” were used for promotion of the WHO theme.

The core messages of the “Five Keys to Safer Food” are:

  1. Keep clean
  2. Separate raw and cooked
  3. Cook thoroughly
  4. Keep food at safe temperatures and
  5. Use safe water and raw materials.[3]


Proper application of these “Five keys for Food safety” helps in combating foodborne illness. There is a need for understanding the extent of knowledge and level of practices followed by food handlers at household level during storage of raw food, food preparation, and consumption as it plays an important role in the prevention of foodborne illness. Hence, the present study was undertaken with an objective to assess the knowledge, attitude, and practices about food safety among urban households based on the WHO five keys for food safety.


  Materials and Methodology Top


A community-based cross-sectional study was conducted among urban households of Urban Health Centre, Ashok Nagar, Belagavi city in Karnataka which is an urban field practice area of the Department of Community Medicine, JNMC, KAHER. The study was conducted for a period of 1 year from January 1, 2017, to December 31, 2017.

The sample size was calculated using the formula n = 4pq/d2, assuming the prevalence (p) of knowledge about food safety among households as 50% with allowable error taken as 5% as 400 for urban households. The households were selected using systematic random sampling by calculating sampling interval, and every fourth household was selected in the study. Ethical clearance was obtained from the Institutional Ethics Committee for Human Subjects Research of the medical college dated October 17, 2016 vide under letter (MDC/DOME/5).

Data were collected from women aged above 18 years and were mainly involved in food preparation regularly at urban households and who were permanent residents (residing in the area at least since the preceding year) in the study area. Cooks who were employed for food preparation and were not a family member of household and the households which were locked during three consecutive visits were excluded from the study. Data were collected through personal interview after taking written informed consent using predesigned and pretested WHO questionnaire on “Five Keys for Food safety.” Sociodemographic details and knowledge, attitude, and practices of food safety were obtained from the participants.

The WHO questionnaire was used to collect information of KAP of food safety.[3] In the knowledge section, there were 11 items to assess regarding food safety. Response to each item was taken as “True” or “False.” One mark each was given for each correct answer and zero mark was given for each wrong answer with a maximum score of 11.

There were nine items to assess the respondents' attitude toward food safety. Each item was assessed using agree, disagree, and not sure, and marks given for each response were two, one, and zero, respectively, with a maximum score of 18.

Similarly, 10 items were included to assess the respondents' food safety practices. Each item was assessed using always, most times, sometimes, not often, and never with coding of 4, 3, 2, 1, and 0, respectively, with a maximum score of 40.

The data collected using the questionnaire were coded and entered into Microsoft Excel sheet. Descriptive analysis was carried out by mean and standard deviation, frequency, and percentages. ANOVA with least significant difference test was used to test the association of sociodemographic profile with knowledge, attitude, and practices regarding food safety.


  Results Top


Among the 400 urban households, the sociodemographic characteristics of the study participants showed that 51% of the participants were in the age group of 25–45 years with the mean age of 37.96 ± 14.9 years. About 52.5% of the participants belonged to the Muslim community. Majority of the participants were married (88.8%). Most of the participants were literates (99.2%), of which 52.3% were having secondary level of education, followed by 25.8% completed graduation. By occupation, majority of the women were homemakers (84%), followed by women in other types of occupation such as teacher, tailor, and shopkeeper (8.8%). More than half of the households (62%) belonged to socioeconomic status Classes III and IV according to the modified BG Prasad classification. Most of the participants were from nuclear (58.5%) families [Table 1].
Table 1: Distribution of study participants according to the sociodemographic details (n=400)

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Almost all (100%) the participants knew that the hands must be washed before handling food. About 98.2% of participants knew that raw food should be stored separately from cooked food, while only 42.7% of participants knew that the same cutting board cannot be used for raw and cooked food; 44.5% of participants knew that cooked food needs to be thoroughly reheated; 79.5% of participants knew that cooked food should be served hot; and only 22.5% of participants knew that safe water cannot be identified by the way it looks [Table 2].
Table 2: Distribution of study participants according to the knowledge on the World Health Organization Five keys for food safety (n=400)

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Sixty-one percent of participants agreed that soups and stews must be boiled to ensure food safety. About 77.8% of participants agreed that thawing food in a cool place is safe, and 42.5% of participants agreed that it is unsafe to leave cooked food out of the refrigerator for more than 2 hours [Table 3].
Table 3: Distribution of participants according to the attitude toward the World Health Organization Five keys for food safety (n=400)

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Majority (91.8%) of the participants always washed hands before or during food preparation. Forty-six percent of participants always reheated cooked food until it is piping hot; 25.5% of participants never practiced thawing of frozen food in the refrigerator or other cool place; and 41% of participants never practiced storage of leftover cooked food in a cool place within 2 hours [Table 4].
Table 4: Distribution of participants according to the practice of the World Health Organization Five keys for food safety (n=400)

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Out of the total score of 11, the mean knowledge score for the participants was 7.1 ± 1.47. Out of the total score of 18, the mean attitude score for the participants was 15.45 ± 1.65. Out of the total score of 40, the mean practice score for the participants was 30.18 ± 4.21. Among the WHO “Five keys for food safety,” the mean knowledge scores were good for the first key – keep clean was 1.77 ± 0.42 and second key – separate raw and cooked food was 1.41 ± 0.52 [Table 5].
Table 5: Distribution of study participants according to knowledge regarding the World Health Organization Five keys for food safety

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The mean knowledge score was lower among the age group more than 35 years (6.71 ± 1.64) compared to younger age group (7.64 ± 1.07), and these differences were found to be statistically significant (P < 0.001). The mean knowledge scores were higher among the participants who belonged to socioeconomic Class I (7.7 ± 1.37) compared to those who belonged to Class V (6.62 ± 1.53). Moreover, these differences were found to be statistically significant (P = 0.002). The mean practice scores were higher among the participants who belonged to socioeconomic Class I (31.62 ± 3.53) compared to those who belonged to Class V (28.56 ± 2.80), and these differences were found to be statistically significant (P < 0.001).


  Discussion Top


Based on the literature search, there were very few studies conducted on knowledge, attitude, and practices of WHO “Five keys for food safety,” especially among women at household level in Indian setting. It is difficult to compare the results of previous studies with the present study due to the difference in study participants (food handlers at restaurants, mess of different campuses, street vendors, etc.,), different sociocultural patterns in cooking practices existing in India, and different criteria used in defining knowledge, attitude, and practices of food handling.

In the present study, almost all the participants (100%) knew that the hands should be washed before handling food, which was similar to a study conducted in the year 2015 on 85 food handlers working in canteens of Malaysia (100%).[4] In a study conducted on 274 food handlers at food courts in Putrajaya, Malaysia, in the year 2013, 100% of the respondents knew that improper storage of food can cause health hazards which were similar to the present study (98.5%).[5] In the present study, only 44% of participants knew that cooked food needs to be thoroughly reheated whereas in a study conducted on 32 Anganwadi workers in Mandya in Karnataka state, 81.3% knew about it.[6] In a study conducted on 72 primary food preparers of families in the United States, only 11.3% knew that the best way to check that chicken has cooked thoroughly is by looking whether juices are clear which was lower than our study (42.3%).[7] In the present study, 55.3% of participants had correct knowledge that cooked meat cannot be left at room temperature overnight, which was lower than a study conducted on Anganwadi workers in Mandya in Karnataka state (90.1%).[6] In the present study, 48% of the participants knew that refrigerating food slows bacterial growth, which was similar to a study conducted on food handlers in Slovenia (63.4%).[8] In a study conducted on 200 food handlers in military hospitals of Jordan, 96% of the participants knew that fruits and vegetables must be washed which was similar to our study (100%).[9]

In the present study, majority of the participants (98.5%) agreed that frequent handwashing during food preparation is worth, which was similar to a study conducted on 200 residential units in Singapore (97.9%).[10] In the present study, 76.3% of the participants agreed that the use of different knives and cutting board for raw and cooked food is useful, which was similar to a study conducted on 200 residential units in Singapore (75.4%).[10] In the present study, majority of 98.3% agreed that it is important to check and throw food beyond expiry date, which was similar to a study conducted on 200 residential units in Singapore (97.1%).[10]

In a study conducted on women at households of Kalaburgi, Karnataka, and India, mean knowledge score of food safety was 8.65 ± 1.25 out of the total score of 11, mean attitude score was 16.03 ± 1.75 out of the total score of 19, and mean practice score was 30.87 ± 4.24 out of total score of 38, which was almost similar to the present study, in which mean knowledge score was 7.1 ± 1.47 out of the total score of 11, mean attitude score was 15.45 ± 1.65 out of the total score of 18, and the mean practice score was 30.18 ± 4.21 out of the total score of 40.[11]

The present study was one of the first kinds of study conducted on knowledge, attitude, and practices about food safety among food handlers at urban household level in Indian setting using the WHO “five keys for food safety.” A standard questionnaire on the WHO five keys for food safety was used from the WHO food safety manual as data collection tool. Limitation of our study was that food safety practices were self-reported by the participants. The investigator did not directly observe the practices about food safety. Hence, the chances of recall bias might be observed. An interventional study with the present knowledge, attitude, and practices of food safety measures after health education and demonstration would have been better, but lack of time and resources were the reasons for KAP study.


  Conclusion Top


Knowledge and attitude regarding food safety were good, whereas the mean scores for food safety practices were lower. Among the WHO “Five keys for food safety,” knowledge, attitude, and practices regarding “cook thoroughly” and “keep food at safe temperature” were observed to be lower. Younger age group (<35 years) and higher socioeconomic status were associated with better knowledge, attitude, and practices about food safety. Health education through health programs such as National Nutrition Week and Intensified Diarrhea Control Fortnight focus on the WHO five keys for food safety.

Acknowledgment

The authors would like to thank Dr. Shivaswamy M.S, Professor, and (late) Mr. M.D. Mallapur, Biostatistician Department of Community Medicine, JNMC, KAHER, Belagavi, Principal JNMC, KAHER, Belagavi. Professor and HOD, Department of Community Medicine, JNMC, KAHER, Belagavi and all the study participants from households in the Urban field practice area of Ashok Nagar, Belagavi.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The World Health Organization. Food Safety, Fact Sheet N°399. World Health Organization; December, 2015. Available from: http://www.who.int/mediacentre/factsheets/fs399/en/. [Last accessed on 2016 Oct 22].  Back to cited text no. 1
    
2.
The World Health Organization, Regional Office for South-East Asia. World Health Day, Food Safety: What you should Know. World Health Organization; 7th April, 2015. Available from: http://www.searo.who.int/entity/world_health_day/2015/whd-what-you-should-know/en/. [Last accessed on 2016 Aug 15].  Back to cited text no. 2
    
3.
The World Health Organization, Department of Food Safety, Zoonosis and Foodborne Diseases, Five Keys to Safer Food Manual. World Health Organization; 2006. Available from: http://www.who.int/foodsafety/publications/5keysmanual/en/. [Last accessed on 2016 Jun 27].  Back to cited text no. 3
    
4.
Lee HK, Abdul Halim H, Thong KL, Chai LC. Assessment of food safety knowledge, attitude, self-reported practices and microbiological hand hygiene of food handlers. Int J Environ Res Public Health 2017;14:55. Available from: http://www.mdpi.com/1660-4601/14/1/55/htm. [Last accessed on 2018 Aug 26].  Back to cited text no. 4
    
5.
Son R, Mohhiddin O, Toh P, Chai L. Food court hygiene assessment and food safety knowledge, attitudes and practices of food handlers in Putrajaya. Int Food Res J 2015;22:1843-54. Available from: https://www.search.proquest.com/openview/9f99a87b18de1af10030f8bf53e55565/1?pq-origsite=gscholar and cbl=816390. [Last accessed on 2018 Aug 26].  Back to cited text no. 5
    
6.
Sheethal MP, Shashikantha SK. Knowledge, attitude and practice regarding food safety among the anganwadi workers in Mandya district. Int J Health Sci Res 2015;5:28-32. Available from: http://www.scopemed.org/fulltextpdf.php?mno=198383. [Last accessed on 2018 Aug 08].  Back to cited text no. 6
    
7.
Meysenburg R, Albrecht J, Litchfield R, Ritter-Gooder P. Food safety knowledge, practices and beliefs of primary food preparers in families with young children. A mixed methods study. Appetite 2014;73:121-31. Available from: https://www.sciencedirect.com/science/article/pii/S019566631300425X?via%3Dihub. [Last accessed on 2018 Oct 26].  Back to cited text no. 7
    
8.
Jevšnik M, Hlebec V, Raspor P. Food safety knowledge and practices among food handlers in Slovenia. Food Control 2008;19:1107-11. Available from: http://www.doi: 10.1016/j.foodcont. 2007.11.010. [Last accessed on 2018 Sep 05].  Back to cited text no. 8
    
9.
Sharif L, Obaidat MM, Al-Dalalah M. Food hygiene knowledge, attitudes and practices of the food handlers in the military hospitals. Food Nutr Sci 2013;4:245-51. Available from: https://www.researchgate.net/publication/276492346_Food_Hygiene_ Knowledge_Attitudes_and_Practices_of_the_Food_Handlers_in_the_Military_Hospitals. [Last. [Last accessed on 2018 Jul 25].  Back to cited text no. 9
    
10.
Pang J, Chua SW, Hsu L. Current knowledge, attitude and behaviour of hand and food hygiene in a developed residential community of Singapore: A cross-sectional survey. BMC Public Health 2015;15:577. Available from: https://www.bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015. [Last accessed on 2018 Aug 26].  Back to cited text no. 10
    
11.
Mendagudali RR, Akka KD, Swati IA, Shedole DT, Bendigeri NA. Knowledge, attitude, and practices of food safety among women of Khaza bazar, the urban field practice area of KBN Institute of Medical Sciences, Kalaburagi, Karnataka. Int J Med Sci Public Health 2016;5:516-20. Available from: http://www.scopemed.org/fulltextpdf.php?mno=206318. [Last accessed on 2018 Aug 10].  Back to cited text no. 11
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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