Microbial Quality and Safety of Cooked Foods Sold in Urban Schools in Ghana: A Review of Food Handling and Health Implications Ghana A Review of Food Handling and Health Implications
Foodborne diseases are major causes of illness, human suffering and economic losses. It is therefore imperative to study, monitor and supervise food handlers to ensure that they observe personal hygiene to avoid food contamination. This study reviews microbial quality of ready-to-eat foods with focus on food safety, food storage, basic Hazard Analysis Critical Control Point (HACCP) public perception of foodborne diseases, knowledge of food safety and personal hygiene, good hygienic practices, and some foodborne diseases. Others include the vulnerable group of foodborne diseases, bacterial food-borne diseases, causes of foodborne diseases and causal organisms, parasitic food-borne diseases. The objective of this study is to determine the microbial quality of vended foods in urban school canteens in Ghana This study determines the microbial levels of vended foods sold in schools and to explore food borne diseases of vended food in relation to hygienic practices for recommendation of measures that can be implemented to ensure microbial food safety in the canteens of the schools in urban areas. This is a descriptive study and a review of facts from the literature and from the website and described.
Article Citation:
Emmanuel Owusu, Reuben K. Esena, Ted Annang and Margaret Ottah Atkpo.
Microbial Quality and safety of cooked foods sold in Urban Schools in Ghana: a review of food handling and health implications
Journal of Research in Public Health (2013) 2(1): 063-072.
Full Text:http://jhealth.info/documents/PH0016.pdf
Original Title
Microbial Quality and Safety of Cooked Foods Sold in Urban Schools in Ghana: a review of food handling and health implications Ghana a Review of Food Handling and Health Implications
Foodborne diseases are major causes of illness, human suffering and economic losses. It is therefore imperative to study, monitor and supervise food handlers to ensure that they observe personal hygiene to avoid food contamination. This study reviews microbial quality of ready-to-eat foods with focus on food safety, food storage, basic Hazard Analysis Critical Control Point (HACCP) public perception of foodborne diseases, knowledge of food safety and personal hygiene, good hygienic practices, and some foodborne diseases. Others include the vulnerable group of foodborne diseases, bacterial food-borne diseases, causes of foodborne diseases and causal organisms, parasitic food-borne diseases. The objective of this study is to determine the microbial quality of vended foods in urban school canteens in Ghana This study determines the microbial levels of vended foods sold in schools and to explore food borne diseases of vended food in relation to hygienic practices for recommendation of measures that can be implemented to ensure microbial food safety in the canteens of the schools in urban areas. This is a descriptive study and a review of facts from the literature and from the website and described.
Article Citation:
Emmanuel Owusu, Reuben K. Esena, Ted Annang and Margaret Ottah Atkpo.
Microbial Quality and safety of cooked foods sold in Urban Schools in Ghana: a review of food handling and health implications
Journal of Research in Public Health (2013) 2(1): 063-072.
Full Text:http://jhealth.info/documents/PH0016.pdf
Microbial Quality and Safety of Cooked Foods Sold in Urban Schools in Ghana: A Review of Food Handling and Health Implications Ghana A Review of Food Handling and Health Implications
Foodborne diseases are major causes of illness, human suffering and economic losses. It is therefore imperative to study, monitor and supervise food handlers to ensure that they observe personal hygiene to avoid food contamination. This study reviews microbial quality of ready-to-eat foods with focus on food safety, food storage, basic Hazard Analysis Critical Control Point (HACCP) public perception of foodborne diseases, knowledge of food safety and personal hygiene, good hygienic practices, and some foodborne diseases. Others include the vulnerable group of foodborne diseases, bacterial food-borne diseases, causes of foodborne diseases and causal organisms, parasitic food-borne diseases. The objective of this study is to determine the microbial quality of vended foods in urban school canteens in Ghana This study determines the microbial levels of vended foods sold in schools and to explore food borne diseases of vended food in relation to hygienic practices for recommendation of measures that can be implemented to ensure microbial food safety in the canteens of the schools in urban areas. This is a descriptive study and a review of facts from the literature and from the website and described.
Article Citation:
Emmanuel Owusu, Reuben K. Esena, Ted Annang and Margaret Ottah Atkpo.
Microbial Quality and safety of cooked foods sold in Urban Schools in Ghana: a review of food handling and health implications
Journal of Research in Public Health (2013) 2(1): 063-072.
Full Text:http://jhealth.info/documents/PH0016.pdf
Microbial Quality and safety of cooked foods sold in Urban Schools in
Ghana: a review of food handling and health implications
Keywords: Microbial Quality, Hazard Analysis Critical Control Point (HACCP), Quality Improvement (QI), Vended foods, Food Hygiene ABSTRACT:
Foodborne diseases are major causes of illness, human suffering and economic losses. It is therefore imperative to study, monitor and supervise food handlers to ensure that they observe personal hygiene to avoid food contamination. This study reviews microbial quality of ready-to-eat foods with focus on food safety, food storage, basic Hazard Analysis Critical Control Point (HACCP) public perception of foodborne diseases, knowledge of food safety and personal hygiene, good hygienic practices, and some foodborne diseases. Others include the vulnerable group of foodborne diseases, bacterial food-borne diseases, causes of foodborne diseases and causal organisms, parasitic food-borne diseases. The objective of this study is to determine the microbial quality of vended foods in urban school canteens in Ghana This study determines the microbial levels of vended foods sold in schools and to explore food borne diseases of vended food in relation to hygienic practices for recommendation of measures that can be implemented to ensure microbial food safety in the canteens of the schools in urban areas. This is a descriptive study and a review of facts from the literature and from the website and described. 063-072| JRPH | 2013 | Vol 2 | No 1 This article is governed by the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/2.0), which gives permission for unrestricted use, non-commercial, distribution and reproduction in all medium, provided the original work is properly cited. www.jhealth.info Journal of Research in Public Health An International Scientific Research Journal Authors: Emmanuel Owusu 1 , Reuben K. Esena 2* ,
Ted Annang 1 , Margaret Ottah Atkpo 3 .
Institution: 1. University of Ghana , Institute of Environmental and Sanitation Studies, Legon-Accra Ghana.
2. University of Ghana, School of Public Health, P. O. Box LG 13 Legon-Accra Ghana.
3. Food Microbiology Division, CSIR- Food Research Institute, Accra, Ghana.
Corresponding author: Reuben K. Esena.
Email:
Web Address: http://www.jhealth.info/ documents/PH0016.pdf.
Dates: Received: 22 Aug 2013 Accepted: 05 Sep 2013 Published: 28 Dec 2013 Article Citation: Emmanuel Owusu, Reuben K. Esena,
Ted Annang and Margaret Ottah Atkpo.
Microbial Quality and safety of cooked foods sold in Urban Schools in Ghana: a review of food handling and health implications Journal of Research in Public Health (2013) 2(1): 063-072 An International Scientific Research Journal Original Research Journal of Research in Public Health J o u r n a l
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R e s e a r c h
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P u b l i c
H e a l t h
INTRODUCTION Food intake as a basic human requirement exposes humans to the risk of foodborne pathogens. Ready-to-eat-foods [or vended food are foods prepared and sold by vendors in public places for consumption- without-further-processing (WHO, 1996), including fresh fruits and vegetables sold outside market areas (WHO, 2006). This practice of food sale is on the increase in West Africa as a result of socioeconomic changes, characterized by massive urbanization in recent times. This has made ready-to-eat foods important in the informal sector of many-developing countries. Such foods are inexpensive, convenient and often affordable by urban and rural poor. This entrepreneurial activity provides income for a vast number of persons, especially women; and provides the avenue for self-employment in business development skills to assist a wide variety of people (Taylor et al., 2000). In contrast to the benefits they provide, ready-to- eat foods are however potential sources of disease. Depending on the type of food, the method of preparation and the manner in which it is held before consumption, the risk of bacterial contamination may occur (Muoz de Chvez et al., 2000). High risk foods-such as meat, cooked rice, fish, eggs, poultry, milk and similar foods must therefore be handled hygienically to avoid the risk of being contaminated with bacteria endotoxins and exotoxins. The main type of pathogenic bacteria associated with foodborne diseases include Salmonella spp, Clostridium perfringens, Staphylococcus aureus, Listeria monocytogenes, Campylobacter jejuni, Clostridium botulinum, B. cereus, and Escherichia coli (Okolie et al., 2012). The link between reliance on street food consumption and prevalence of gastrointestinal infections has been established (Mensah, 2002). Street food has also been implicated with environmental contaminants such as chemicals, traces of pesticides and heavy metals (Tomlin, 2002). Poor food handling practices is known to result in up to 97 per cent of food borne illnesses in establishments and the home (Howes et al., 1996). Food safety Food safety has been defined as the conditions and measures that are necessary during the production, processing, storage, distribution and preparation of food to ensure that it is safe, sound, wholesome and fit for human consumption (WHO, 1984). Food safety is thus the condition which ensures that food will not cause harm to the consumer when prepared and/or eaten according to their intended use. It is crucial to critically handle, preparation, and storage of food to prevent food borne illness. Ready-to-eat foods are a critical issue because of the unhygienic conditions, under which some are prepared and sold (Rheinlnder et al., 2008). The Ghanaian community has experienced an upsurge in the operation of ready-to-eat-foods and there are an estimated 60,000 food vendors in the capital alone (Afele, 2006; Ayeh-Kumi el al., 2009). It is therefore imperative to ensure food safety at all times in all the ready-to-eat food establishments. The aim is to protect the huge number of consumers who may be infected with foodborne pathogens at a time. Abdus-salam (1993) is of the view that ready-to eat-foods could pose significant public health problems because most food handlers lack knowledge on safe food handling. This is compounded by the difficulty in controlling and supervising them, their large numbers and inadequate resources. It is therefore important to ensure that food handlers observe good personal hygiene to avoid contamination or transmission of foodborne pathogens to consumers who patronize their food unknowingly. In line with this, WHO (1989) noted that a key vehicle for micro-organisms transfer is from faeces, nose, skin and other parts of the body into food. So hand washing is important. A similar study by Pether and Gilbert (1971) noted that bacteria such as Salmonella typhi and Esena et al.,2013 064 Journal of Research in Public Health (2013) 2(1): 063-072 Escherichia coli can survive for varying periods on the fingers and other parts of the body. Food handlers must therefore be screened by the appropriate regulatory body to ensure that they are always in good health and hygienic conduct before they sell to the public. In Ghana, one way to ensure food safety of ready-to-eat food is by issuing periodic health certificate to food vendors. This is confirmed by a study by Musa and Akande (2002) who noted that in the developing countries, the common approach to regulating vended food is through medical examination of food vendors.
METHODS This is a descriptive review from a wide array of literature from health records [Ministry of Health], Ghana Health Service (GHS), Food and Drugs Authority [Ghana] and from International Journals and from the website. All these were analyzed and described. Ethical Principle There was the need for Ethical approval. This was obtained from Ethics Committee of the Ghana Health Service, the University of Ghana School Of Public Health and from the Municipal Director of Health Services. Food Handling In Ghana, it is a requirement for food handlers to go through medical screening for infectious diseases before they are granted certificate of fitness to sell their cooked foods. Further the Metropolitan, municipal and district environmental health officers periodically conduct screening exercises and vendors are expected to carry out complete physical and medical examination and obtain health certificates issued by the authorized health centers. This practice is consistent with what prevails in other developing countries. In some developing countries, public health code requires food handlers to undergo medical examination before they are employed in food establishments. But these regulatory measures are ineffective because it is an expensive exercise for the impoverished food handlers and does not prevent infection after the examination (WHO, 1996). Despite this notion, Ngozi and Onyenekwe (2003) assert that many developing nations place premium on food handlers undergoing medical examination to ensure detection, treatment and subsequent reduction in transmission of foodborne pathogens. According to WHO (2006), there are five principles of food hygiene that can be implemented to ensure food safety. These are prevention of contaminated food from spreading, separation of raw and cooked food to avoid cross-contamination, cooking food thoroughly at the right temperature, storage of food at the proper temperature and the usage of safe water and raw material for food preparation. Failure to observe these principles in food preparation exposes consumers to pathogens and toxins that cause foodborne illnesses. One of the means to ensure that ready-to-eat foods are without pathogens and chemicals is the application of the principles of Hazard Analysis Critical Control Point (HACCP). The HACCP system seeks to identify hazards associated with any stage of food processing and determines the operations where control procedures are necessary to guarantee food safety (http:// w h q l i b d o c . w h o . i n t / publications/1992/9241544333_eng.pdf). Bryan (1992) indicated that four factors should be taken into account when choosing a place to conduct HACPP. These include the food property, food operation, volume of food prepared and susceptibility of consumer. Food property factor relates to the process of foods prepared and served in an establishment, the characteristics of the food (such as pH, water activity) and its ability to support the rapid growth of infectious microorganisms. The food operations factor analyses the process that the foods usually undergo that exposes them to contamination. This process might not destroy Esena et al.,2013 Journal of Research in Public Health (2013) 2(1): 063-072 065
contaminants and therefore contamination could increase. The volume of food prepared risk factor assesses the tendency of large volumes of the same food prepared for people in advance that creates hazards when not stored in conditions that prevents bacteria growth. In that the risks increase with the time of holding. The susceptibility of the consumer risk factor assesses those people more prone to disease than the general population such as the hospital patients, infants or the elderly (Bryan, 1992). HACCP as a measure of ensuring food safety has many merits compared to the other traditional ways of ensuring food safety. It is a proactive approach that anticipates problems before they occur, provides rapid control mechanisms, easy to monitor and can be used to predict potential hazards (Bryan, 1992). It identifies critical food safety risk factors that could serve as a basis for training and education of street food vendors as well as consumers. Furthermore, it emphasizes monitoring of critical control points in food operation and serve as inexpensive food safety assurance compared to chemical and microbiological methods of analysis. Some basic HACCP food safety approaches on food handling The principle of HACCP as food safety measure is relevant right from the farm land to when the food is on the table for consumption. To ensure food safety, raw materials should be obtained from known and reliable sources and not from clandestine dealers. Raw materials are very relevant to the safety of street-vended foods since they can introduce biological, chemical and physical hazards that may persist through preparation and processing of ready-to-eat foods. To protect against food hazards, materials to be consumed in their raw state, should be transported and stored separately from other raw materials and non-food items. Raw foods (e.g., raw meat and poultry) are often contaminated at source with salmonellae, Campylobacter jejuni, Clostridium perfringens, Yersinia enterocolitica, Listeria monocytogenes, or Staphylococcus aureus (Bryan, 1992). Water as a raw material is critical in ready-to-eat foods preparations which when contaminated can transmit foodborne illnesses when used for drinking, washing of foods, incorporated in the food as an ingredient and either used in the processing of the food or for washing equipment, utensils and hands. Angulo et al., (1997) intimated that water is a well-known vehicle for enteropathogens such as E. coli, Salmonella spp. and Campylobacter spp., amongst others. In this connection, a study to determine the bacteriological quality of the water used by some food vendors in schools has shown frequent contamination with Coliform and feacal Coliform (Chakravarty and Canet, 1996). Dawson and Canet (1991) observed that acute shortage of clean potable water compels many vendors to re-use the water, especially for cleaning utensils and used dishes. Preparing and processing of ready- to-eat foods Food preparation and processing are critical steps prior to their sale and consumption and is important in determining the safety of food. One key principle in preparing and processing food is to avoid direct and indirect contact between raw and cooked or prepared foods which will be consumed without further heating (WHO, 1996). Raw foods (e.g. salads and peeled or cut fruit) should be prepared with special attention to cleanliness. Grains (e.g. rice, pulses, and beans), vegetables and some fruits (especially if they are to be consumed raw) should be washed sufficiently with safe water to reduce contamination to an acceptable level (ht t p: / / www. who. i nt / foodsafet y/ publ i cat i ons/ fs_management/en/streetvend.pdf). Furthermore, the preparation of food 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). Esena et al.,2013 066 Journal of Research in Public Health (2013) 2(1): 063-072 Food storage It is known that most foodborne diseases cases are caused by the inappropriate handling in kitchens and restaurants of contaminated food (including improper storage, undercooking, or cross contamination) (Blaser, 2004). It has been reported that diarrhoeal cases can be reduced by 39% via household water treatment and safe storage (Fewtrell et al., 2005). Similarly, Mitakakis et al., (2004) in a study identified food-handling and storage practices in the home as major risk factors for gastroenteritis. Longer holding time of certain high risk foods create favorable conditions for the growth of foodborne pathogens that causes foodborne diseases. Foods vendors most often prepare ready -to eat foods in bulk and store them for several hours after cooking including overnight holding at ambient temperatures, until sold, and thus can harbor high microbial populations (El-Sherbeeny et al., 1985, Bryan et al., 1992 and Lianghui et al., 1993). Bryan (1995) observed that in such foods, the counts of pathogens including Escherichia coli, Staphylococcus aureus, Bacillus cereus and Clostridium perfringens are bound to be unacceptably high. Reheating During reheating the time-temperature exposure should be able to inactivate microorganisms and toxins of concern. Omemu and Aderoju (2007) indicated in a study that some food vendors often cook products ahead of time, store them and then reheat them when requested by customers. Their low knowledge of food hygiene may require them to reheat food just to warm it and improve on its palatability, rather than to destroy pathogens. Bryan (1992) recommended that during reheating the highest temperature attained at the geometric centre of foods or the time-temperature exposure of foods should be measured and recorded to determine whether pathogens could survive the temperature.
Knowledge of food handlers on food safety and personal hygiene The term food handler applies to persons who prepare food and to those who sell it, if they are different persons (WHO, 1996). Rheinlnder et al., (2008) indicated that food safety is a major concern with ready- to-eat foods as these foods are generally prepared and sold under unhygienic conditions, with limited access to safe water, sanitary services, or garbage disposal facilities. The importance of food handlers in the vending of ready-to-eat foods cannot be overemphasized. They have a prime role to play in food businesses, and thus guarantee that meals served to their customers are hygienic for consumption. It has been noted that the examination of knowledge on food handling and health problems on some food handlers proved that they did not fully understand hazards, their risks and methods of managing such hazards in the preparation and handling of food (Amponsah et al., 2011). WHO (1989) indicated that food handlers have important role in ensuring food safety throughout the chain of food production, processing, storage and preparation. Any disregard and mishandling of hygienic measures on the part of the food vendors may cause pathogens to come into contact with food and multiply in numbers of medical significance capable of causing illness in the consumer. In Ghana, the use of a polythene bag to package ready to- eat foods by food vendors is a common phenomenon. In the course of packaging the foods, food handlers blow air into the polythene bags to open them and in the process a number of pathogens could be passed on to the consumer. Mensah et al., (2002) are of the view that many food handlers introduce biological and physical hazards through cross contamination and mishandling of food. Mensah et al., (2002) are of the view that the use of bare hands to serve food increases the level of contamination as entero-pathogens can survive on the Esena et al.,2013 Journal of Research in Public Health (2013) 2(1): 063-072 067
hands for three hours or longer. Pathogens can be harbored and transmitted on to others by individuals who themselves are healthy. Such carriers may have recently suffered an attack of food poisoning and still be carriers of the organisms in their body. In some in stances, carriers of food pathogens such as Salmonella typhi and Bacillus cereus act as host over a longer period of time having themselves acquired immunity to organisms concerned. Such individuals might end up transmitting organisms to other people through food without being aware of it. It is thus important that food handlers are educated on routes and means through which pathogens invade the food they prepare and sell to the public. Addo et al., ( 2007) intimated that food vendors who sell ready to eat meals on the streets are important factors who contribute significantly to food borne related diseases as they have very little or no educational background and hence have low understanding of food safety issues (Mensah et al., 2002). Most often food handlers are unaware of their role as a reservoir of infection (Nichol and Salek, 2007). Improper handling and sanitation practices lead to person-to-person, person to food and utensils to food cross contamination that ultimately results in 27 % of reported outbreaks and infection from food borne pathogens (WHO, 2002). The transmission of pathogenic microorganisms by food handlers is a problem in the food industry (Barza, 2004). Food Hygiene Awareness among Food Handlers There is no gainsaying that food handlers have a major role in the prevention of food poisoning during food preparation and distribution. Walker et al., (2003) argued that food handlers usually cross-contaminate processed food stuff and are likely to under-cook and store foods properly. It is possible that in most cases, they contaminate processed food stuffs without being aware that they are doing so. Continuous training and education thus become very important if food handlers are to handle food in a hygienic and safe manner. Thus the best preventive measure lies in educating the food handler on good personal hygiene and food safety. Marth (1985) however observed that the food handlers are usually young, itinerant and inexperienced people who hardly stay on the job for a year and hence it becomes extremely difficult to find and educate them while actively working. In relation to this Walker et al., (2003) thus asserted that there is high probability that the absence of continuous training and reinforcement is to be blamed for lack of food hygiene knowledge concerning a number of important aspects in safe food production. A lot of studies have confirmed the rather low level of knowledge of food handlers on hygienic and microbial safety of ready-to-eat foods (Walker et al., 2003). Inadequate hygienic knowledge and lack of understanding of the basic principles of food hygiene is thus a major bottleneck to the implementation of good hygienic practices in the handling of ready-to-eat foods in our schools and other public places. In this connection, Ehiri and Morris, (1996) are of the view that there is the need to conscientiously prevail upon and motivate food handlers to put to practice their knowledge in food hygiene. In contrast to the assertion made by Walker et al., (2003) and Bryan (1988), is the view that in addition to ignorance, reluctance by food handlers to apply the acquired knowledge also contributes in no small measure to food poisoning by food handlers. Connected to this, Angelillo et al., (2000), further indicated that a study conducted in Italy depicted that although food handlers had positive attitude towards food safety, it has not supported their practices in food handling. There seem therefore to be no correlation between good knowledge in food handling and the actual practice in food processing among food handlers. It is abundantly clear therefore that apart from knowledge, there might be other factors that bring about attitudinal change in safe food handling practices. Taylor (2000) identified these factors to include socio-economic status, Esena et al.,2013 068 Journal of Research in Public Health (2013) 2(1): 063-072 educational level and literacy and itinerant nature of most food handlers. Appropriate hygienic aspects of vending operations as a major source of concern may not be readily available. Toilets and adequate washing facilities are rarely available. Hand washing and washing of utensils and dishes is often done in buckets or bowls. Disinfection is not usually carried out, and insects and rodents may be attracted to sites where there is no organized sewerage disposal. It has also been observed that food is not adequately protected from flies; and refrigeration is not usually available (Mensah et al., 2002). Some Food borne diseases Foodborne diseases are either infectious or toxic in nature. The toxins usually enter the human body through consumption of food. Foodborne illness on the other hand is sickness that results from eating contaminated food laden with pathogenic microorganisms, chemical or physical agents. The victims normally experience one or more symptoms such as nausea, vomiting, diarrhea, dehydration, abdominal pain, headache, and fever (McSwane et al., 2002). Foodborne diseases are a serious health hazard and an important cause of morbidity and mortality in developing countries. It is an undisputable fact that most cases go unreported and scientific investigations are rarely conducted in most developing countries (Anuradha et al., 1999). WHO (2002) observed that food and waterborne diseases are the leading causes of illness and death in under-developed countries, killing almost 1.8 million people annually, most of whom are children. Inappropriate handling practices by humans in unhygienic behaviour could lead to food borne diseases and poisoning (Adams and Moss, 2003); and foodborne illness costs lives and money. The effect is that, millions of people fall sick each year as thousands die after eating con-taminated or mishandled foods. Children, the elderly and people with weakened immune systems are especially vulnerable to foodborne illness.
CONCLUSION AND RECOMMENDATION Studies across Africa have shown the extent to which health hazards are posed to children by foods sold on streets; and it is known that such foods contribute significantly to morbidity and even mortality among children (Canet and NDiaye, 1996). For the fact that food vendors operate in insanitary environments that could cause transmission of pathogens into food and subsequent outbreak of foodborne diseases, it is important that monitoring of foods sold in the various places are conducted by the regulatory authorities (e.g. municipal environmental and sanitation directorate) as quality checks. Furthermore, there should be policies to regulate and ensure that school canteens are strategically located and not close to filth such as dumping sites and toilets.
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