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Food safety, sanitation and hygiene practices among street food vendors in Pokhara, Kaski

Introduction: Street foods are unique and convenient urban food supply, but meanwhile it lacks food hygiene and safety posing a major public health risk. Thus, the study aimed to identify the food safety, sanitation and hygiene practices of street food vendors. Methods: The study was cross-sectional including seventy vending sites which were selected conveniently and conducted in May-June, 2019. A structured interview schedule and observation checklist was used as a data collection tool. Results: The mean age of the respondents was 38.06 (±10.417) years with more than half (61.4%) being females. The majority (77.1%) had formal education, 37.1% earned more than 40,000 per month and 86% had not taken any food hygiene training. Eighty percent of the respondents had fixed stalls with 82.9% selling freshly cooked food and 75% preparing it in the marketplace. About 84% of the respondents revealed diarrhea as the most prevalent disease caused by poor food hygiene. Very few (27%) had their health check-up regularly and 68.6% prepared food when they were ill. Almost half of the respondents heated food before serving, 58% washed dishes with tap water, 98.6% washed raw food before preparation and all of them washed cooking dishes daily. About half (48.6%) of the respondents re-used oil while cooking and 77.1% had a refrigeration facility. The practice of food vending was found to be good (>50) in 54.3% and sanitation was good (>50%) in 60%. Conclusions: Although the overall sanitary conditions of the vending sites were good, still there is need for improvement in most of the aspects of the sanitary condition.


INTRODUCTION
The trend of street food vending is increasing worldwide due to fast urbanization and alarmingly increasing hasty lifestyles. 1 The street foods have unique flavours, and also offers business opportunities for developing entrepreneurs. 2 Despite its benefit, food safety is a major concern as these foods are generally prepared and sold under unhygienic conditions 3 and food-borne illnesses contribute to millions of illnesses and thousands of deaths annually. 4 The majority of the food vendors had no previous training in food safety 5 and most of them do their business haphazardly with poor knowledge and practice. 5,6 They do not give due to preference to cover their food items, no spoon was used to serve the food and without the use of head covering and apron. 7 In the context of Nepal, the market for street foods is booming and limited studies have been carried out regarding food safety and hygiene through its great impact on the health of the public. And hence, the researcher aimed to identify food safety and hygiene practices among street vendors in Pokhara to generate evidence for concerned authorities to establish appropriate public health intervention and legal regulation. Food safety, sanitation and hygiene practices METHODS A descriptive cross-sectional study design was conducted among seventy registered vending units of Pokhara Metropolitan City, Gandaki Province, Nepal which were selected conveniently. Seven wards were selected purposively and ten vending units from each ward were taken conveniently. Only the few numbers of vending sites were systematically documented and registered, and this study excluded non-registered vending sites and hence the sample was limited to 70, ten registered vending sites from each ward. The information was collected from the food vendor who was directly involved in preparing the food from each vending unit. The period of data collection extended from May 2019 to June 2019.
The structured interview schedule was used to collect the data on the background characteristics of the respondent and general information regarding vending sites. An observational checklist was used for further exploration of food sanitation and hygiene practices which was modified from the "WHO essential requirement for the safety of street-vended foods". The area was observed while vending unit served for one customer that took about a half-hour to 2 hours. Data entry and analysis was carried out simultaneously with data collection. Pre-testing of the instrument was done in 10% of the sample and necessary modification was made accordingly.
Data entry and analysis was done using SPSS version 20.0 and descriptive analysis was done. Altogether 15 items were assessed for the vending practices. A total of "1" marks was given for correct practice and "0" for wrong practice. The total score was obtained by summing up the marks gained from each item which was then converted to 100%. The practice scoring ≤50% was considered as poor practice and a score >50% was marked as good practice. For sanitary conditions, eight parameters were assessed. A total of a "1" mark was given for correct sanitation and a "0" mark was given for the absence of correct sanitation. The total score was taken as 100% which was then categorized as ≤ 50% having poor sanitation and >50% for having good sanitation taking reference of the study by Okojie and Isha .8 The ethical approval was taken from the Ethical Review Board of Nepal Health Research Council (Ref. no 3052). The permission to conduct the study was obtained from Pokhara Metropolitan City.

Background characteristics of the respondents
Of all the respondents, the mean age was found to be 38.06 (±10.417) years with more than half being females (61.4 %). The majority (77.1%) had formal education. Most of them (90%) were doing vending as a full-time job. Thirtyseven per cent had been engaged in food vending for more than five years. More than three quarters (85.7%) had not taken any training regarding food hygiene and sanitation (Table 1).

If yes, training by
Cook training by hotels 10 14.3  Table 2 portrays that around four fifth of the respondents had fixed stalls (80%) and was selling freshly cooked food (83%). Three fourth of the vendors prepared it in the market place and 38% prepared them in the morning.

Observed vending and food handling practices and sanitary condition of the vending sites
Approximately 66% covered their food, 70% vending sites were exposed to flies, and 72.9% grilled semi-prepared food. Almost 79% wore jewellery which preparing food, 45.7 % had long nails, 10% had cut on their skin, only 5.7% and 10% wore a head covering and apron respectively. The majority (65.7%) wore clean clothes, 14.3% blew air in cellophane/ plastic bags, 74.3% served food with bare hands whereas 20% used spoons and only 1.4% use gloves. Almost half (51.4%) concurrently served food and received money and 12.9% picked nose while preparing food. (Table 4) Most of the vending units (91.4%) had dustbin however only 24.3% had waste disposing sites nearby. About 65.7% had the facility of tap water to clean dishes, 24.3 % had the facility of the towel and 61.4% had soap to wash hands. Sixty percent had cockroaches/rats present in the vending site and 11.4% with water collectors do not clean the collector after each use (Table 5).

DISCUSSION
In this study, about 83% of street food vendors sell freshly cooked food and most of them (75%) prepare it in the marketplace. About 38% of foods are prepared in the morning. Likewise, the study conducted by Oluwasen and Musa et al 9 revealed 33% of vendors prepare food in advance. Also, the study done in India found that 62.5% prepare their food in the market place and less than half prepare food in the morning and during the sale. 8  The present study found that 65.7% covered their food which is in contrast with other studies which showed approximately 95% covering of food 8,10 whereas other studies revealed 39% to 55% covering of food. 7,13,14 In this study almost 79% wear jewellery while preparing food while in contrast Hill et al 14 found 21.6% use of jewellery and only 8.8% use of jewellery was identified in the study of Okojie et al. 8 The present study showed 45.7 % of respondents have long nails, 10% have cut on their skin, 5.7% and 10% wear head covering and apron respectively.
Regarding unmanaged nails findings, other studies showed almost similar findings ranging from 15% to 53% 11, 13, 14 and 18.9% have undressed skin lesion 9 and 27.3% have cut on their hand. 8 The apron use ranges from 23% to 85% in different studies 8,9,11,12 whereas hair covering was in between 15% to 99%. 7,9,12,13 Seventy vending sites were exposed to flies in this study while the study of Musa  The study design is cross-sectional has its inherent set of limitations. Sanitation and hygiene levels were recorded based on an observation checklist. The same level of hygiene doesn't need to be maintained at all times as when the interviewer visited the food vendor. There was no component of follow-up in the study. In this study, we looked at only a few numbers of hygiene and sanitation practices. Those vendors who were not registered did not have a chance to participate in the study.

CONCLUSIONS
Overall, the sanitary conditions of the vending sites were Original Research Article Food safety, sanitation and hygiene practices good. But the major areas which put major hazards to health are poor hand washing practice, no regular health checkup, re-use of oil, poor use of personal protective equipment and presence of flies and other vectors like cockroaches and rats in the vending sites which needs due attention.
This study recommends that every vendor, helper, or food handler should undergo basic training in food hygiene and sanitation; establishment of a code of practices for street food business. There should be provision of basic water and waste management facilities, and constant supervision by the respective authority.
In major cities of Nepal, there are large numbers of local eateries and there is no systematic documentation of the number of street food vendors and their hygiene practices. Thus, this study can be used to generate the evidence to establish appropriate public health intervention and legal regulation for street food vending practices.