Risk Factors Associated with Hygienic Practices Among Food Handlers in Dubai

Al Suwaidi A.¹, Hussein H.^{2, *}, Al Faisal W.², El Sawaf E.³, Wasfy A.⁴

¹Preventive Medicine Department, Ministry of Health, Dubai, UAE

²School and Educational Institutions Health Unit, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE

³Health Centers Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE

⁴Statistics and Research Department, Ministry of Health, Dubai, UAE

Abstract

Background: Food handlers have a major role in the prevention of food poisoning during food production and distribution. Food handlers are defined as employees who are employed directly in the production and preparation of foodstuffs, including those in the manufacturing, catering and retail industries as well as those who are undertaking maintenance or repairing of equipment in food handling areas, whether permanent staff, workers on contract or visitors to food handling areas. Objectives: To study hygienic practices and factors associated with Food handling among Dubai food handlers. Methodology: A cross sectional study was carried out. The study was conducted in Dubai Municipality clinic which is the only authorized place for issuing medical fitness card for food handlers in Dubai. The study included food handlers attending the clinic for issuing medical fitness card. An appropriate sample size was calculated according to the sample equation obtained by using computer program Epi Info Version 6.04. The study sample was 425 food handlers with 100% response rate. Results: Significantly lower personal hygienic score was observed among females versus males (66.76 + 8.77 and 72.38 + 6.78 respectively) and house maid in contrast to cooks and kitchen helpers (65.31 + 7.90 and 75.04 + 5.51 respectively). General hygienic score was found to be significantly lower among secondary educated (87.07 + 6.78) compared to university educated (88.07 + 9.58), among house maid (84.60 + 5.00) in contrast to backers and confectioners (89.87% + 4.85) and among the 1500-<2000 AED income category (85.30 + 10.61) in contrast to the <1000 AED category (88.85 + 5.53). Hygienic practices related to cooking showed significant difference only with income with maximum mean score obtained for the 1500-<2000 AED income category (91.75 + 6.15) and minimum mean score for the <1000 AED category (89.35 + 7.08). Conclusions: The most significant factor was found to be occupation. Those more likely to have fair to bad hygienic score were those working in restaurants or housemaid (at least 3 times more likely relative to bakers and confectioners).

Keywords

Risk Factors, Hygienic Practice, Food Handlers, Dubai

Received:June 8, 2015
Accepted: June 10, 2015
Published online: August 2, 2015

@ 2015 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/

1. Introduction

Food handlers have a major role in the prevention of food poisoning during food production and distribution phases. Food handlers are defined as employees who are employed directly in the production and preparation of foodstuffs, including those in the manufacturing, catering and retail industries as well as those who are undertaking maintenance or repairing of equipment in food handling areas, whether permanent staff, workers on contract or visitors to food handling areas.

Food handling involves all aspects of treating and storing food from receipt of raw materials to the delivery of the final prepared product.⁽¹⁾ Food handlers may cause food borne diseases by cross-contaminating the raw and processed foodstuffs as well as cooking and storing food under inappropriate conditions and using contaminated equipment. They can be symptomatic carriers of food poisoning organisms.⁽²⁾ Therefore, food safety is a major concern of the food industry and a key public health issue at international, national and local levels.⁽³⁾

The WHO has identified five factors that contribute to these illnesses: improper cooking procedures, temperature abuse during storage, lack of hygiene and sanitation by food handlers, cross-contamination between raw and fresh ready-to-eat foods, and acquiring food from unsafe sources.⁽⁴⁾ Four of five of these practices are related directly to food service food handler behavior (acquiring foods from unsafe sources is the exception). Food borne diseases result from factors such as staff with unclean hands, low-level hygiene knowledge, wrong temperature applications, storage temperature of cold-stored foods and low level knowledge of acceptable freezer temperatures, food pathogens and similar issues⁽⁵⁾ Moreover, poor information on hand hygiene is also known to result in food borne diseases for instance, when staff prepare salad without washing his/her hands after going to the toilet or after touching raw meat.⁽⁶⁾ Inappropriate working conditions, low-level personnel hygiene and improper equipment used by food handlers may cause food poisoning.⁽⁷⁾ Improvements in the field of food hygiene may reduce the risk of food-borne diseases.⁽⁸⁾ A number of studies indicated that although training may bring about an increased knowledge of food safety it does not always result in a positive change in food handling behavior.^(7,9) Traces of the foods served by catering firms were found in nearly 22% of the food borne diseases in England, in 45% of the food borne diseases in the USA and in 50% of the food-borne diseases in Ireland. ⁽¹⁰⁾ Intestinal parasitic infection is one of the most important food borne diseases .The studies that have been carried out on intestinal parasitic infections among different food handler groups in the Middle East and North Africa, showed a wide range of variation in prevalence rates. The highest rate was reported among Nigerian food handler (97%),⁽¹¹⁾ while a prevalence of 28.7%,12.4% and 29.4% were reported successively from Lebanon, Yemen and Sudan.^(12,13,14) In one study in Iran "as an Asian countries" , the rate of intestinal parasites among food handlers was found to be 29 %.⁽¹⁵⁾

The Gulf countries have experienced a rapid socio-economic development in recent years. The improved standards of living have led to a large influx of expatriate workers from developing countries where parasitic infections can be expected among them. ⁽¹⁶⁾ The expatriate laborers, largely coming from India, Pakistan, Sri Lanka, Indonesia, Philippines and Bangladesh, could be expected to have been infected with various types of parasites where intestinal parasites are major health problems in these countries.⁽¹⁷⁾ In UAE, a study done in Emirate of Al-Ain 1993 showed that the prevalence of parasitic infections among food handlers was 23.1%.⁽¹⁸⁾ Another studies conducted in Saudi Arabia, showed that the prevalence rates were 32.2%, 46.5% and 31.4%. Successively in Riyadh, Abha and AlKhobar.^{(16, 19, 20)} In Qatar, a study was done on patterns of infection with intestinal parasites among food handlers and housemaids where it revealed that the prevalence of infections was 33.9 %. ⁽²¹⁾ This study is one of the very few or may be the unique study in Dubai to tackle hygienic practices among food handlers.

2. Objectives

To study Factors associated with Food handling and hygienic practice among Dubai food handlers.

3. Methodology

A cross sectional study was carried out. The study was conducted in Dubai city, the second largest city in U. A. E. Study was carried out in Dubai Municipality clinic which is the only authorized place for issuing medical fitness card for food handlers in Dubai. The study included food handlers attending Dubai municipality clinic for issuing medical fitness card. An appropriate sample size was calculated according to the sample equation obtained by using computer program Epi Info Version 6.04. the minimum sample size required was 420 food handlers. The study sample was 425 food handlers with 100% response rate. A systematic random sample procedure was carried out. Considering that filling the questionnaire was taking about 20-30 minutes, every 10th person was involved to select nearly 10 food handlers a day until accomplishment of the required sample size. A systematic random sample procedure was carried out. Considering that filling the questionnaire was taking about 20-30 minutes, every 10th person was involved to select nearly 10 food handlers a day until accomplishment of the required sample size. The data was collected through face-to-face interviews (Appendix, II) using structured questionnaire after Tonder Izanne et al., (2) and WHO. (11)The questionnaire was reviewed by community medicine consultants to review the face and content validity. Reliability of the questionnaire using cronbach's alpha with Guttmann split half reliability coefficient was carried out.

4. Results

When hygienic practices were compared among socio-demographic data (tables 1-7), significant differences were observed by sex, education, occupation and monthly income. Significantly lower personal hygienic score was observed among females versus males (66.76 + 8.77 and 72.38 + 6.78 respectively) and house maid in contrast to cooks and kitchen helpers (65.31 + 7.90 and 75.04 + 5.51 respectively). General hygienic score was found to be significantly lower among secondary educated (87.07 + 6.78) compared to university educated (88.07 + 9.58), among house maid (84.60 + 5.00) in contrast to backers and confectioners (89.87% + 4.85) and among the 1500-<2000 AED income category (85.30 + 10.61) in contrast to the <1000 AED category (88.85 + 5.53). Hygienic practices related to cooking showed significant difference only with income with maximum mean score obtained for the 1500-<2000 AED income category (91.75 + 6.15) and minimum mean score for the <1000 AED category (89.35 + 7.08).

Table 1. Hygienic practices of food handlers by age.

Table 2. Hygienic practices of food handlers by sex.

Table 3. Hygienic practices of food handlers by nationality.

Table 4. Hygienic practices of food handlers by education.

Table 5. Hygienic practices of food handlers by occupation.

Table 8 illustrates results of stepwise logistic regression analysis of factors affecting hygienic practices. The most significant factor was found to be occupation. Those more likely to have fair to bad hygienic score were those working in restaurants or housemaid (at least 3 times more likely relative to bakers and confectioners).

Table 6. Hygienic practices of food handlers by duration of work.

Table 7. Hygienic practices of food handlers by monthly income.

Table 8. Hygienic practices of food handlers by training.

5. Discussions

The current study revealed no significant differences as regards age of the workers in association with hygienic practices. In HACCP study in Italy⁽²²⁾ it was found that the younger staff had significantly better knowledge and practices. In another study in china⁽²³⁾ it was found that male respondents, age less than 30 years, secondary education or above, five years or more of working experience, or who had previously attended a health training program within the last two years, generally performed better on the knowledge of food hygiene.

The study results reflected that those living in homes with one toilet had higher personal and general hygienic score compared to workers with two or more toilets. This may be explained by more care and worry practiced by those who had only one toilet as a compensatory act for the shortage in toilet facilities. In relation to training, it appears that those who were trained had significantly higher personal, general and cooking hygienic score than workers who were not trained. In agreement with our results, a recent study done in Nigeria⁽²⁴⁾ in Benin City, Edo State found that the majority (98%) of the respondents had formal education. There was good knowledge and practice of food hygiene and safety among the respondents. Knowledge was significantly influenced by previous training in food hygiene and safety. A study carried out by Chukwuocha, (2009),⁽²⁵⁾ in metropolis in south eastern Nigeria, found no significant difference in attitude and practice between trained and untrained food handlers. Another study conducted in Shiraz, Iran ⁽¹⁶⁾ revealed that there was a lack of knowledge due to lack of training among the catering staff about the critical temperatures of hot or cold ready-to-eat foods, acceptable refrigerator temperature ranges, and food-borne pathogens. Several studies ^(6,26) have demonstrated that although training may increase food safety knowledge, a positive change does not always subsequently occur in terms of food handling behavior.

It was found that those more likely to have parasitic infection were workers who came for renewing their health cards, males from India and South East of Asia in contrast to other nationalities, working as bakers or in restaurants in contrast to home maid category and those with income <1000 or 1500-2000 AED/month in contrast to 2000+ AED/month. Many studies done in Makkah during Hajj Season, ⁽²⁷⁾ Qatar (33.9%)⁽²¹⁾ and UAE⁽¹⁸⁾ showed a significant association between the nationality of the food handler and a positive stool specimen for parasites.

In Regards to home environmental factors, the study revealed that there was a significant association with parasitic infection. Those living in homes with one toilet had significantly higher risk of parasitic infection compared to workers in facilities with two or more toilets. Other environmental factors didn’t show significant association with parasitic infection. In contrast, Thailand study⁽²⁸⁾ showed of the total 20 analyzed factors, only three revealed significant correlations with intestinal parasitic infections which were low annual income, having inadequate toilets and eating undercooked food.

The poor hygiene practice might have been confounded by the fact that most food-handlers were individuals from the lower socioeconomic class with low level of education.

6. Conclusions

The most significant factor was found to be occupation. Those more likely to have fair to bad hygienic score were those working in restaurants or housemaid (at least 3 times more likely relative to bakers and confectioners). Developing food borne diseases surveillance and notification program and carrying out competent statistical analysis and addressing for the problem. Further studies are recommended.

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