INTRODUCTION
PROBLEM STATEMENTS
The agricultural revolution significantly increased food production and improved the health of laborers, which is essential for human capital development However, issues related to food safety pose a serious threat to sustainable development and national security in developing countries Recent outbreaks of food-related diseases have shifted the focus of many nations from merely increasing food quantity to ensuring food safety.
The use of pesticides, chemical fertilizers, and feedstuff enhances agricultural productivity, but their overuse and misuse can compromise food quality Additionally, food preservation methods, processing techniques, and the use of additives can further diminish food safety According to the World Health Organization (2015), the primary contributors to food-borne diseases include bacteria, viruses, parasites, chemicals, and toxins Vulnerable populations such as children, pregnant women, and the elderly are particularly at risk for food-borne illnesses.
Due to the development of transportation and international trade, food safety issue is not only the problem of any countries but also a global problem For examples:
Chinese milk scandal, New Zealand material milk crisis caused an enormous loss for the manufacturer and impinge on other countries as well as consumer’s health
1 World Health Organization (WHO) and Food and Agriculture Organization (FAO) defined:
“Food safety is the assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use” (WHO and FAO, 2009, p 6).
Figure 1.1: The number of food-borne cases annually (WHO, 2015)
Food-borne diseases (FBD) are a global concern, with developing regions like South East Asia and Africa experiencing the highest incidence of cases, while developed areas such as Europe and America report significantly fewer instances Interestingly, despite challenges in food availability and safety controls, African countries have lower rates of food-borne illnesses compared to South East Asia This discrepancy may be attributed to the diverse availability of nutritious food and the tropical climate in South East Asia, which create optimal conditions for bacteria and other food safety risks to thrive, ultimately impacting human health.
WHO (2015) estimated that every year food-borne disease cause almost 10% global populations to fall ill and responsible for 420,000 deaths (one third are children)
Among all FBD, diarrheal diseases are the most common illnesses resulting from
Africa unsafe food, accounted for half of global burden of FBD and made 550 million people falling ill (including 220 million children), cause 230,000 deaths (96,000 children’s)
Figure 1.2: The number of death caused by FBD annually (WHO, 2015)
The trend in food-borne disease (FBD) deaths mirrors the rise in food-borne illness cases, with Southeast Asia and Africa reporting the highest mortality rates, while Europe and America experience the lowest Notably, Africa has fewer FBD deaths compared to Southeast Asia, possibly due to greater international medical support in Africa and differences in the physical resilience of the local populations in these regions.
The FBD caused the burden about 33 million DALYs 2 Diarrheal diseases agents were the largest contributors, accounted for 18 million DALYs, 54% of total All three
Disability-adjusted life years (DALYs) are a crucial health metric that quantifies the overall burden of disease by combining the years of life lost due to premature death (YLL) with the years lived with disability (YLD) This comprehensive measure helps to highlight health gaps and the impact of various diseases and conditions on populations.
Africa figures 1.1, 1.2, 1.3 both indicated that South East Asian and African region’s food safety issue is severe and these areas suffered an enormous burden from FBD
Despite having fewer death cases than Asia, Africa faces a burden of foodborne diseases (FBD) that is nearly double that of Southeast Asia and significantly higher than other regions The total burden in Europe, the Western Pacific, and the Americas is comparable to that of Southeast Asia but only half of Africa's burden These statistics highlight the disparities in healthcare facilities and food safety policies across regions, significantly impacting population health outcomes.
According to the World Health Organization (WHO, 2015), the burden of disease is measured by Disability-Adjusted Life Years (DALYs), which represent the time lost due to death and disability Each DALY corresponds to one year of healthy life lost, highlighting the varying degrees of severity associated with health issues.
Vietnam is classified by the World Health Organization (WHO) as part of the Western Pacific region, which has a moderate level of food-borne illnesses globally This region encompasses a diverse range of countries, including developed nations like Australia, Japan, and South Korea, alongside developing countries such as Cambodia, the Philippines, and Vietnam, leading to significant variations in health outcomes Detailed information regarding Vietnam's situation can be found in Chapter 4.
Despite the significant impact of food-borne diseases (FBD) on developing countries, developed nations also face challenges related to food-borne illnesses In 2014, the Centers for Disease Control and Prevention (CDC) reported 864 food-borne disease outbreaks in the USA, leading to 13,246 illnesses, 712 hospitalizations, and 21 deaths, along with 21 food recalls The majority of food poisoning cases, accounting for 65% (485 cases), occurred in restaurants, while private homes contributed to 12% (86 cases) Bacteria were identified as the leading cause of food-borne illness, representing 22% of total cases with 149 confirmed and suspected instances These statistics highlight that even countries with advanced healthcare systems continue to grapple with the issue of food poisoning.
CDC also predicted that food safety issue would continue emerge in the future due to:
- Changes in our food production and supply, including more imported foods
- Changes in the environment leading to food contamination
- Better detection of multistate outbreaks
- New and emerging bacteria, toxins, and antibiotic resistance
- Changes in consumer preferences and habits
- Changes in the tests that diagnose foodborne illness.
The rise in immigration and trade, alongside globalization, has highlighted that food-borne diseases are not confined to any one nation; rather, they represent a significant challenge for the modern world.
RESEARCH OBJECTIVES AND RESEARCH QUESTIONS
The diverse food market in Vietnam provides convenience for households, leading most Vietnamese families to prepare and consume at least one meal at home daily This cooking habit is influenced by various factors, including socio-economic status, individual characteristics, and living conditions Additionally, the tradition of cooking within Vietnamese communities has been passed down through generations, deeply rooted in Asian customs and agricultural culture This cultural heritage significantly shapes household cooking behaviors, encompassing knowledge of food processing, preservation techniques, and kitchen practices.
Research conducted in Thua Thien Hue province (Duong, 2013) and Ho Chi Minh City (Nguyen, 2010) highlights the significant relationship between knowledge and attitudes towards food safety and the actual food safety practices observed in food factories, restaurants, and households The "10 Golden Principles in Food Processing" (MOH, 2005) outline essential food safety behaviors that individuals should adopt to ensure safe food handling and preparation.
- Clean, tidy kitchen and the cooker surface
- Using waste basket with cover
- Use clean water to handle food
- Use clean tool to prepare and divide food
- Not use forbidden food additives or out of date food
- Washing hand before cooking and after toileting
- Not smoke, spit out or nail polished while cooking
This thesis highlights that while the golden principles have been widely applied in various research studies in Vietnam, most of these studies have primarily focused on a medical perspective Consequently, they often overlook the socio-economic factors and individual characteristics that could significantly influence food safety behaviors As a result, the impact of these elements on food safety practices remains inadequately assessed.
The research findings only reflect the current state of food safety issues in the community, lacking a comprehensive analysis of multiple factors that could confirm their impact Additionally, the participants did not engage in the annual survey, resulting in the omission of the effects of government policies and activities from the study.
This thesis aims to identify and assess the factors influencing food safety behavior, including socio-economic status, knowledge of food safety, individual perceptions, and information sources By understanding these personal determinants, the government can formulate effective strategies to modify behaviors, reduce risky practices, and ultimately minimize the incidence of food-borne diseases and their associated public health burden.
To analyze food safety behavior and health outcomes of household primary cook
- To determine the relationship between knowledge, perception of consumer and their food safety practice at household kitchen
- To evaluate the impact of individual food safety practice to their food-borne disease probability
(1) Do food safety knowledge and perception have impact on individual food safety practice?
(2) How food safety practice affect to individual food-borne poisoning risk?
SCOPE OF RESEARCH
The thesis utilized data from a 2013 survey on Individual Food Poisoning and the Knowledge, Attitude, and Practice of households in Ho Chi Minh City Conducted across 24 districts from March to April 2013, the survey targeted primary cooks in households, with local medical staff acting as data collectors.
The annual survey features a diverse range of participants each year, including householders in 2010 and 2013, and restaurant workers from 2012 to 2016 Furthermore, the specific respondents within the same category change annually, resulting in the most recent household data being from 2013, which is not comparable to the 2010 survey Consequently, this variability prevents the creation of a panel data set for comprehensive analysis.
This research focuses on the behavior and incidence of acute food poisoning in the Ho Chi Minh City community from March to April 2013, aiming to assess the influencing factors The study employs descriptive statistics and utilizes econometric methods, including factor analysis, multivariate probit, and propensity score matching, to analyze the data effectively.
THESIS STRUCTURE
Due to the available of the data, thesis is composed as the structure below:
Chapter 1 introduces the research problem, highlighting the significance and scope of the study It provides an overview of foodborne diseases (FBD) and their global impact, while outlining the objectives and structure of the thesis.
Chapter 2: Literature Review examines the definitions of key concepts and summarizes previous research on the factors and models that inform the development of the analytical framework This framework serves as the foundation for analyzing the impact of each component within the study.
Chapter 3: Research Methodology outlines the framework and econometric tools employed in this study It details the data sources and collection methods utilized, along with a comprehensive description of the variables involved in the research.
Chapter 4 presents a detailed analysis of the research findings, comparing the results with existing studies This section includes a comprehensive overview of the descriptive statistics for the variables examined, providing insights into the data collected.
- Chapter 5: Conclusion and policy implications This chapter concludes the research finding, provides implication, further suggestion as well as the research limitations
LITERATURE REVIEW
FOOD SAFETY AND FOOD-BORNE DISEASES
Food-borne diseases (FBD) are illnesses transmitted through ingested food, caused by enteric pathogens, parasites, chemical contaminants, and biotoxins (WHO, 2007) Estimating the burden of FBD can be approached in two ways: the etiologic agent approach, which starts with exposure levels of food-borne agents, and the syndromic approach, which begins with disease outcomes like gastroenteritis A thorough assessment of the disease burden necessitates a combination of both methodologies.
In 2015, the World Health Organization reported approximately 600 million cases of food-borne illnesses and 420,000 related deaths, with 40% of the burden affecting children under five years old The thesis data was gathered through participant interviews using a questionnaire, without any food testing involved Consequently, the diagnosis of food-borne diseases relied on the participants' self-assessments and the evaluations made by medical professionals based on individual symptom descriptions.
Food safety is defined as the assurance that food will not harm human health or life, according to the Vietnam Ministry of Health (2010) While this definition may not be as specific as that of the World Health Organization (WHO), it encompasses the entire process of food production, including growing, harvesting, preserving, and processing, rather than focusing solely on preparation and consumption Given the comprehensive nature of this definition and the increasing awareness of food safety regulations among the Vietnamese population, this thesis adopts it as the foundational concept of food safety.
THE HEALTH BELIEF MODEL
The Health Belief Model (HBM), originally developed from psychological theories on decision-making under uncertainty (Maiman and Becker, 1974), posits that individuals evaluate the "value-expectancy" of potential outcomes when making health-related decisions In the context of health, the model suggests that individuals prioritize illness prevention and health improvement, believing that their actions can effectively prevent disease and enhance their well-being This belief is influenced by their perceptions of susceptibility to illness, the seriousness of the disease, and the likelihood of becoming ill as a result of their behavior Key components of the HBM, as outlined by Glanz et al (2008), further elaborate on these foundational concepts.
Table 2.1: The concepts of Health Belief Model
Perceived susceptibility Belief about the chances of experiencing a risk or getting a condition or disease
Define population(s) at risk, risk levels
Personalize risk based on a person’s characteristics or behavior
Make perceived susceptibility more consistent with individual’s actual risk
Perceived severity Belief about how serious a condition and its sequelae are
Specify consequences of risks and conditions
Perceived benefits Belief in efficacy of the advised action to reduce risk or seriousness of impact
Define action to take: how, where, when; clarify the positive effects to be expected
Perceived barriers Belief about the tangible and psychological costs of the advised action
Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance
Cues to action Strategies to activate
Provide how-to information, promote awareness, use appropriate reminder systems
Self-efficacy Confidence in one’s ability to take action
Provide training and guidance in performing recommended action
The various components interact with individual characteristics and are categorized into three groups: modifying factors, individual beliefs, and actions The relationships and impacts of these groups are illustrated in the figure below.
Figure 2.1: Health Belief Model Components and Linkages (Glanz et al, 2008)
Numerous studies have applied the Health Belief Model (HBM) to examine food safety behaviors among various groups, including restaurant workers (Cho et al., 2010), primary food preparers in families with young children (Lum, 2013; Meysenburg et al., 2013), and older adults (Hanson and Benedict, 2002) These studies demonstrate that the components of HBM interact with one another and significantly influence individual behaviors, particularly highlighting that food safety knowledge has a profound impact on perceptions of food safety.
EMPIRICAL REVIEWS ON DRIVERS OF FOOD SAFETY PRACTICES
Participants with a college degree or higher demonstrated superior food safety knowledge and behaviors compared to those with lower educational attainment (Meysenburg et al., 2013) The research team employed the Health Belief Model alongside mixed-method analysis, examining a sample of 72 participants through scripted interviews and group discussions.
Modifying factors Individual Beliefs Action
Age Gender Ethnicity Personality Socioeconomics Knowledge
Perceived susceptibility to and severity of disease
Unusan (2005) found that higher education levels positively influence confidence in food safety practices, with individuals in higher education groups exhibiting less risky behaviors compared to those with lower education levels However, the study revealed no correlation between socio-economic status and individual food safety practices The research analyzed data collected from Turkish households using MANOVAs.
Unusan's research highlights the influence of gender and education level on food safety knowledge, revealing that women, who often take on the role of primary food preparers in households, tend to possess greater awareness, particularly those with higher education Supporting this, Byrd-Bredbenner et al (2007) and Mullan et al (2014) found similar trends in their reviews of food safety studies, noting that age also plays a role, with older individuals generally scoring higher in food knowledge Furthermore, women are shown to take greater responsibility for food safety than men, as indicated by Jevsnik et al (2006), with these findings substantiated through ANOVA analysis of participant responses.
A study conducted by Langiano et al (2012) revealed that married individuals exhibited healthier eating habits compared to their single counterparts Additionally, the research indicated that as family size increased, the primary cook demonstrated more accurate food practices.
Food preparers primarily acquire their knowledge of food processing from family members and relatives (Meysenburg et al., 2013) Additionally, research has shown that families serve as a crucial resource for food safety knowledge, significantly influencing individual behaviors (Kwon et al., 2008).
Kwon (2006) conducted a study on participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, utilizing a questionnaire to assess food knowledge and behavior The results, analyzed using ANOVA, revealed that respondents with strong food knowledge demonstrated more accurate food practices.
(T H Vo et al, 2015) These authors group investigated in the canteens’ and restaurant’s workers by using logistic regression model to get this finding
Research by Cho et al (2010) indicates that participants' food safety knowledge does not significantly affect their food practices, particularly among restaurant workers analyzed through multiple regression and maximum likelihood estimation Furthermore, Roberts et al (2008) demonstrate that even after training and education in food safety, food workers exhibit only minimal changes in behavior These findings support the notion that knowledge has a limited influence on individual behavior change in the context of food safety.
Individuals with high self-efficacy believe they can effectively prevent health threats and foodborne diseases (FBD) when they are in control of food handling (Meysenburg et al., 2013) However, this confidence diminishes when food is prepared by others Furthermore, those who have experienced foodborne illness or have unintentionally caused illness in family members due to improper food handling tend to have lower confidence in their food preparation skills.
Many studies have shown mixed results on food safety perception and behavior
Research by Nesbitt et al (2013) revealed that many consumers believe food contamination occurs before it reaches their kitchens, with a significant number attributing foodborne illnesses to food prepared outside the home Conversely, Unusan's study (2007) showed that consumers often do not perceive food poisoning or foodborne diseases as serious health concerns, viewing them instead as commonplace issues This misunderstanding contributes to a lack of attention to food safety practices and a reluctance to modify food safety behaviors.
Jevsnik et al (2006) discovered that household cooks preferred products from farmers over those from industrial factories, believing that farmer-produced food is safer However, consumers felt that food safety was the responsibility of food handlers—such as farmers, food factories, retailers, and caterers—as well as the government Additionally, research by Byrd-Bredbenner et al (2007) revealed that individuals under 30 often overestimated their ability to handle food safely, despite evidence to the contrary.
A study by T H Vo et al (2015) demonstrated a significant correlation between food safety knowledge and individual attitudes towards food safety issues, although the link between attitude and food practices was found to be insignificant Additionally, research by Cho et al (2010) indicated that individuals with strong food safety knowledge are more likely to recognize the severity and likelihood of food poisoning Furthermore, consumers with accurate food safety knowledge typically encounter fewer barriers and challenges when it comes to safely handling food.
This study did not establish a direct link between knowledge and the perception of foodborne disease (FBD) prevention or safe food practices However, it revealed that individuals who recognized the benefits of avoiding food poisoning were more likely to engage in safe food handling behaviors consistently and effectively.
Hanson and Benedict (2002) found that a strong awareness of foodborne disease (FBD) severity can enhance individual behaviors related to food safety, although the link between the perception of FBD hazards and actual food safety practices was found to be weak Their findings were determined using nonparametric statistics, specifically Spearman rank correlation coefficients.
A study by Cho et al (2010) revealed a strong link between cues and individual food safety practices Individuals who have previously experienced foodborne diseases (FBD) are more inclined to adopt safe food handling behaviors, according to Lum (2010) However, Lum also noted that experiencing illness symptoms does not consistently result in improved food safety practices.
A similar result from Hanson and Benedict (2002) showed that the cue, content of
The study revealed that males are less influenced by education compared to females, while older individuals experience a stronger impact from educational attainment Additionally, the effect of education varies based on an individual's frequency of food handling.
RESEARCH METHODOLOGY
ANALYTIC FRAMEWORK
Consulting from other relating research, thesis implemented the HBM framework with the components evaluated through specific variables for food safety behaviors
Factors influencing food safety perceptions include individual and demographic characteristics of participants and their families, with a specific focus on food safety issues Additionally, individual beliefs are assessed through attitudes and awareness regarding food safety Furthermore, actions related to food safety are evaluated based on various practices, while information sources serve as cues for these behaviors.
Due to the limitation of the secondary data, the components from HBM measured in several variables:
- Modifying factors: age, gender, residential location, occupation, education level, number of family’s member and the knowledge about food safety issue
- Individual belief: the awareness about the food safety problem, risky group and reason of food poisoning; attitude about food selection and processing; food source chosen
- Individual behavior: hygiene, process, preserve practice
- Cues to action: the food safety information source The relatives and interactions of those components illustrated in the figure below:
ECONOMETRIC MODELS
This study utilizes the multivariate probit model (MVP) to analyze the impact of independent variables on various food safety behavior groups The research focuses on three key aspects of food safety: kitchen hygiene practices, food processing and preservation practices, and individual hygiene practices By employing the MVP with three equations, the paper aims to provide comprehensive insights into these behaviors.
- Food expenditure, Number of family’s member
+ TV, newspaper + Local food safety communicator
Perceived susceptibility to and severity of disease
- Attention about food safety problem
Individual beliefs significantly influence dependent variables, as outlined by Cappellari and Jenkins (2003) in their trivariate probit model The model is represented as \( y_{im}^* = \beta_m X_{im} + \epsilon_{im} \) for \( m = 1, 2, 3 \), where \( y_{im} = 1 \) if \( y_{im}^* > 0 \) and \( y_{im} = 0 \) otherwise The error terms \( \epsilon_{im} \) are distributed as multivariate normal, each with a mean of zero and a variance-covariance matrix \( V \) This matrix \( V \) features values of 1 along the leading diagonal and correlations \( \rho_{jk} = \rho_{kj} \) as off-diagonal elements.
The log-likelihood function for the sample of N independent observation is given by:
Where ωi is an optional weight for observation i=1,…, N, and ϕ3 is the trivariate standard normal distribution with arguments ài and Ω, where
𝜇 𝑖 = (𝐾 𝑖1 𝛽 1 ′ 𝑋 𝑖1 , 𝐾 𝑖2 𝛽 2 ′ 𝑋 𝑖2 , 𝐾 𝑖3 𝛽 3 ′ 𝑋 𝑖3 ) With Kik=2yik – 1, for each I, k = 1,…,3 Matrix Ω has constituent elements Ωjk, where: Ωij = 2 for j =1,…,3 Ω21 = Ω12 = Ki1Ki2ρ21 Ω31 = Ω13 = Ki3Ki1ρ31 Ω32 = Ω23 = Ki3Ki2ρ32
The probability of every outcome is given by:
The dependent variable in this study encompasses nine food safety practices categorized into three behavior groups: hygiene kitchen practices (kprac), process and preserve practices (pprac), and hygiene individual practices (iprac) Each practice is assigned a binary value of 1 for correct implementation and 0 for incorrect implementation, with the thesis defining correct practice as having all behaviors within a group executed accurately The behaviors are based on the "10 golden principles in food processing," with specific attention to "clean, tidy kitchen and cooker surface" and "proper separation of cooked and raw food," which are further divided into four distinct behaviors to facilitate easier evaluation by interviewers.
- “sex” is the dummy variable indicate the sexuality of participant, 0 for male and
1 for female The expected regression coefficient of this variable is predicted insignificant, due to the fact that most of the responders were females;
The variable "loc" serves as a dummy indicator for the responder's location, where a value of 0 represents suburban participants from 12 districts, including Binh Tan, Binh Chanh, Thu Duc, Go Vap, and others, while a value of 1 designates urban participants from another set of 12 districts.
The expected regression coefficient indicates that urban participants in areas such as Phu Nhuan, Tan Binh, Tan Phu, and Binh Thanh are more likely to exhibit precise behavior compared to their suburban counterparts.
In this study, the variables "age," "exp," and "f_member" represent the age in years, food expenditure in hundred thousand VND, and the number of family members, respectively The anticipated regression coefficients for these variables are expected to be positive To achieve a normal distribution for the analysis, the thesis employs the natural logarithm of age (lnage) and expenditure (lnexp) to estimate the coefficients effectively.
In this study, the variables "job" and "edu" categorize respondents by their professions, such as office clerk, retiree, homemaker, physical laborer, and farmer, as well as their education levels, including primary, junior high, high school, college/university, and below primary To simplify the analysis and enhance interpretability, the research utilizes transformed variables that represent education in terms of schooling years and consolidates job categories into three groups: householders (hholder), common laborers (com_labor), and others.
The variable "know" reflects the food safety knowledge of participants, assessed through a questionnaire aligned with WHO guidelines This knowledge is categorized into two groups: safety food selection and food processing and preservation Participants' scores, derived from survey responses, are calculated using the difficulty index method (Collen, 2006, pp 98-100).
𝑁 , where: ρ: difficulty index nc: the number of right answer
N: the total number of responders
The study utilized the "per" indicator to assess participants' perceptions of food safety issues through a questionnaire This evaluation focused on four key areas: perceptions of susceptibility to and severity of foodborne diseases (FBD), perceptions of barriers, and perceptions of self-efficacy Although data limitations were present, the thesis employed Factor Analysis to identify perception factors from three of the four groups, excluding perceptions related to benefits.
The study categorizes "cue" as the variable indicating the sources of food safety information for respondents, including TV, radio, newspapers, local medical staff, and food documentaries To analyze this data, the thesis employs dummy variables representing these cues: TV, radio, news, local staff, and food documentaries A comprehensive description of all variables utilized in the model is provided in the accompanying table.
Sex Gender of participant 0 for male, 1 for female
Location Residential place 0 for suburb, 1 for urban
Age The age of participant Years old
Expenditure Amount of money for food consumption Hundred thousand VND Family member Number of family member Person
Education Education level The number of schooling years
Job Occupation of participant Category variable: common labor, householder, other
Understanding food safety is crucial, as it encompasses essential knowledge that influences consumer behavior Awareness of food safety issues can be effectively measured using a 3-point Likert scale, which helps gauge public perception Additionally, various sources serve as cues to action regarding food safety information, including television, radio, newspapers, local medical staff, and food documentaries, each playing a vital role in educating the community.
Multicollinearity occurs when explanatory variables in a regression model exhibit a linear relationship There are two types: perfect multicollinearity and imperfect multicollinearity In cases of perfect multicollinearity, the regression coefficients of the dependent variables become indeterminate, leading to infinite standard errors Conversely, with imperfect multicollinearity, while the regression coefficients are determinate, they tend to have large standard errors relative to the coefficients, resulting in reduced precision and accuracy in estimation (Gujarati, 2004).
Research by Cho et al (2010) and T H Vo et al (2015) examined the relationship between knowledge and perceptions of food safety The study utilized a Likert scale to measure perception, indicating that the coefficient reflects trends rather than the magnitude of perception's influence on behavior This approach, combined with a substantial sample size of over 1,000 observations, mitigated the effects of multicollinearity in the regression model Additionally, the thesis employed both the reduced and original forms of the MVP to estimate the regression coefficients.
3.2.3 Propensity Score Matching (PSM) Method
Chow and Mullan (2009) emphasize that past behavior is a crucial predictor of food safety practices, recommending cues to help individuals adopt these behaviors as habits to improve primary cooking actions Additionally, Jevsnik et al (2007) highlight that consumers often lack awareness of their responsibilities within the food safety chain, which contributes to the prevention of foodborne diseases (FBD) as noted by Byrd-Bredbenner et al.
2007) Due to these reason, the consumers could hardly change their behavior in a short time period after suffering food poisoning
Individuals often rely on rationality when they understand the cause-and-effect relationship between proper behavior and health benefits (Mari et al., 2008) However, it can be challenging for household cooks to identify incorrect practices that lead to foodborne diseases (FBD) Additionally, the data on food poisoning only accounted for health statements over a two-week period, leading this paper to assume that the food poisoning incidents did not influence individual behavior Consequently, individual behavior is utilized to estimate the probability of food poisoning using the Propensity Score Matching (PSM) method.
DATA
The study utilized data from a 2013 investigation on individual food poisoning cases in Ho Chi Minh City, alongside insights from the Knowledge, Attitude, and Practice (KAP) survey regarding food safety among households in the same city.
- Data source: Safety Hygiene Food Branch of Ho Chi Minh city
- Data description: the data had two parts:
+ Part 1 is the investigation in individual food poisoning and the relevant symptoms, included: individual characteristic, demographic information, food poisoning statement and clinical symptoms
+ Part 2 is the KAP survey of primary cook of household, included: individual characteristic, food safety knowledge, food safety attitude and examining the food safety practicing of primary cook
- Size of samples: 1,174 households and 4,593 individual participate in the survey The households were chosen by Probability Proportional to Size sampling technique (PPS):
In a study conducted across 319 wards in Ho Chi Minh City, researchers randomly selected 30 wards for investigation Each ward's surveyor began by randomly selecting the first household and subsequently interviewed the next 39 households on the right side The survey included four questionnaires focusing on acute food poisoning, food knowledge, attitudes towards food, and food practice evaluation While the food practice checklist was assessed by the surveyor, the other questionnaires were completed by the respondents Local medical staff responsible for food safety in each selected ward carried out the research.
To be eligible for the survey, households had to meet specific criteria, including that all members had resided at the same location for a minimum of six months prior to the investigation Participation required the household's consent, with members sharing the same address, having at least one meal together, and engaging in similar household responsibilities If a household was unapproachable after three attempts, it would be replaced by another household.
Participants in the survey did not have any mental illnesses, deafness, or speech impairments Children included in the survey were at least 6 months old, as infants primarily consume breast milk Responses from children under the age of 10 were verified by their mothers or primary caregivers.
Food poisoning symptoms can manifest after a meal, including gastrointestinal issues like colic, vomiting, and diarrhea, as well as neurological symptoms such as a stiff tongue, hallucinations, reduced vision, delirium, and convulsions, depending on the pathogen involved A case of food poisoning is confirmed only if the affected individuals consumed the meal at home prior to the onset of symptoms A household is considered to have experienced food poisoning when either the primary cook or any family member exhibits symptoms after eating a meal prepared at home.
This study integrates two data components to assess the relationship between knowledge and perceptions of food safety and individual behaviors It also estimates how these food safety behaviors influence the likelihood of food poisoning among individuals.
RESEARCH RESULTS
FOOD SAFETY PROBLEMS IN VIETNAM
According to the World Health Organization (2016), the economic burden of food-borne diseases in Vietnam is estimated at approximately 1 billion USD annually, accounting for 2% of the country's GDP This figure encompasses costs associated with lost work time, reduced productivity due to illness, and related market losses Additionally, statistics from the Vietnam Food Administration (VFA) indicate that between 2007 and 2015, there were 150 reported cases of food-borne illnesses.
Vietnam experiences approximately 250 mass food poisoning outbreaks each year, affecting over 5,000 individuals annually Despite the implementation of the National Strategy on Food Safety since 2006 and the validated strategy for 2011-2020, the incidence of food poisoning cases in the country remains consistently around 5,000 per year.
The stagnation in food safety regulation can be attributed to the inefficiencies of legacy institutions Although the Food Safety Law was enacted in 2011, accompanying regulatory documents remain inadequate, leaving the Food Safety Department ill-equipped to manage the situation Consequently, both manufacturers and consumers lack essential information and guidance for implementing food safety practices The complex network of Food Safety Administration, involving multiple ministries and departments, further complicates matters Additionally, Vietnam's tropical climate and ongoing climate change contribute to increased risks of foodborne illnesses The diverse nature of Vietnamese cuisine, coupled with limited consumer knowledge, heightens the potential for foodborne disease outbreaks While the incidence of food poisoning remains stable, the rate of fatalities has only gradually decreased, with a significant portion attributed to natural toxins (Nguyen, 2016).
Figure 4.2: The number of food poisoning outbreaks and death in Vietnam
Between 2012 and 2016, Ho Chi Minh City experienced a decline in food poisoning incidents, recording a total of 20 cases without any fatalities Of these incidents, 19 were attributed to bacterial contamination, while one case had an unidentified cause.
Figure 4.3: The number of food poisoning cases in HCM city (FSBDH, 2016)
Food poisoning cases in Vietnam, particularly in Ho Chi Minh City, are underreported due to insufficient attention from the government and researchers Consequently, there are limited educational programs focused on proper household food preparation and cooking practices Most government resources are primarily allocated towards regulating manufacturers and merchandising, leaving a gap in addressing food safety at the household level.
However, the finding from the survey in 2013 show that the individual food poisoning ratio is 2.18% That figure implies the high possibility of population with food-borne diseases
4.1.2 Problems with household’s cooking behavior
The Vietnamese government's insufficient focus on household food safety has led to poor practices among primary cooks A 2010 investigation by the Safety Hygiene Food Branch of Ho Chi Minh City revealed significant concerns regarding food safety standards in domestic kitchens.
54.3% of consumers in Ho Chi Minh city behave accurately in cooking The figures for Lao Cai province and Dong Thap Province are 67.7% and 76%, respectively (Nguyen,
While researchers emphasize the need for specific education programs for household cooks to enhance their practices, most communication and education strategies primarily target food producers and workers Additionally, the risk of food poisoning in households is perceived as less critical compared to incidents in schools and factories Due to the pressures of work and transportation in urban areas, consumers often eat outside their homes at company canteens, schools, or food shops Consequently, the influence of household cooking behavior is often overlooked, leading to minimal governmental efforts to improve these practices.
DESCRIPTIVE STATISTICS
The data includes 1,174 households primary cooks with the characteristics listed in Table 4.1 and Table 4.2
Table 4.1: Demographic characteristics of participants (category variables) Demographic characteristics Number of participants (n) %
Data indicates that 93.02% of primary cooks in households are female, while 69.78% of respondents identify as householders Other occupations, aside from common labor and householder, are negligible Consequently, the regression analysis categorizes occupations into three distinct groups: householder, common labor, and others.
The education levels of participants varied, with Junior and High school being the most common among responders The sampling method resulted in a nearly equal distribution between urban (53.53%) and suburban (46.47%) respondents Television emerged as the primary source of information for households (87.31%), followed by newspapers, while only 24.19% of responders relied on local medical staff for food safety information Additionally, the food poisoning rate within households was recorded at 5.11%, compared to 2.18% for individuals, indicating that multiple food poisoning cases can occur within a single household.
In contrast, the descriptive statistic of continuous variables is show on the table below:
Table 4.2: Demographic characteristics of participants (continuous variables)
Variables Mean SD Min Max
The primary cook in Vietnamese households, primarily middle-aged women, has an average age of 47, reflecting traditional family roles In Ho Chi Minh City, households average just over four members, aligning with government population policies On average, families spend nearly 100,000 VND daily on food, while the primary cooks possess basic food safety knowledge, scoring an average of 9.46 out of 14.04 However, the 2010 survey's evaluation method, based on the percentage of correct answers, prevents direct comparison of results across the two periods.
The Health Belief Model identifies five latent variables: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy However, this thesis evaluated only four components due to data limitations: perceived susceptibility (3 questions), perceived benefits (3 questions), perceived barriers (1 question), and perceived self-efficacy (11 questions) The correlation coefficients ranged from -0.0004 to 0.8587, indicating relationships among these variables Additionally, the Kaiser-Meyer-Olkin (KMO) value of 0.947 suggests a strong correlation between the items The determinant of the correlation coefficients matrix was not equal to 0 (p-value < 0.01), and Barrett’s test confirmed similar results (p-value < 0.01), demonstrating that the data is suitable for factor analysis.
The Cronbach alpha’s value of all components and the factor analysis result (after rotation) were showed in the table below
- Attention about food safety problem
- Hygiene in food processing Separate cooking tool
Hygiene hand before touching food Hygiene hand after touching food Use clean water
- Hygiene in food preserving Wash ingredient
Eating food right after processing Heating food after 2 hours
Among 18 factors (Appendix 2), there are three factors which Eigen value were more than one, accounted for a cumulative 66% of variance Therefore, the thesis showed all 3 factors and using only factor 1 (accounted for 50% of variance) as the indicator of perception value for the multivariate regression In summarize, the perception value varied from -3.01 to 2.36 with the average at 1 This figure implied the majority of participant perceived the threat of food safety issue
A recent survey revealed that individual hygiene practices were reported as the most accurate behavior among three groups, achieving a compliance rate of 81.48% Notably, hand washing emerged as the behavior most consistently practiced correctly, with an impressive 97.77% adherence among respondents Conversely, the processing and preservation of food exhibited the lowest compliance, with only 78.34% of participants practicing these behaviors correctly Additionally, the practice of not smoking, spitting, or having polished nails while cooking was reported at a rate of 81.68%.
In general, a large proportion of responders practiced precisely in food safety practice, but the rate of people with 100% of right behavior is significant lower than each group
This figure is a bit higher than the result of the 2010 survey (61.87% versus 54.3%)
The 2010 survey revealed that even though the evaluation of practice was not conducted by medical staff, the enhancement in individual food safety practices holds significant importance The specific results are detailed in the table below.
Behavior (n68) Responder with right behavior
- Separate cooking tool for cooked and uncooked material
- Separate in preserving with enough facilities
- Use clean tool to prepare, divide food
- Not use forbidden food additives or out of date food
- Wash hand before cooking or after toileting
- Not smoke, spit out, nail polished while cooking
Figure 4.4: The nonparametric relationship between food safety practice and
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Figure 4.4 demonstrates the relationship between participants' practice evaluations and their perceived value and knowledge scores The data indicates that responders exhibiting appropriate behaviors in each practice group reported higher levels of perception and food safety knowledge compared to others, despite the explanatory variables showing similar ranges The subsequent regression analysis will further elucidate these relationships.
RESULTS FROM MULTIVARIATE PROBIT MODELS
The Health Belief Model suggests that behaviors are significantly influenced by perceived value and cues to action, while modifying factors such as individual characteristics and food safety knowledge indirectly affect these behaviors This thesis employs both a reduced form of the multivariate probit model, focusing on perception value and cues to action as independent variables, and the original multivariate probit model, which includes all independent variables.
Table 4.5: MVP regression reduced form Variable Coefficient p-value Coefficient p-value Coefficient p-value
The table presents the coefficients, standard errors, and p-values from the reduced form of the multivariate probit analysis All estimated coefficients for the three pairs are positive and statistically significant, with point estimates of 0.57 for the relationship between Hygiene kitchen practice and Process/preserve practice, 0.46 for Hygiene individual practice and Hygiene kitchen practice, and 0.48 for Hygiene kitchen practice and Process/preserve practice.
The positive correlation coefficients indicate that a primary food preparer's likelihood of effectively engaging in a specific set of behaviors increases if they are already proficient in at least one of the other two behavior groups.
The correlation coefficients of perception value are positive and highly significant for all three behaviors (hygiene kitchen practice: 0.191, process/preserve practice:
0.561, hygiene individual practice: 0.316) This result implies that the perception cause positive effect on food practice behavior
Radio news significantly influences kitchen hygiene and food preservation practices, with positive correlations of 0.367 and 0.511, respectively Participants who listen to radio news are more likely to maintain a cleaner kitchen and better food preservation habits Conversely, food documentaries and advice from local medical staff negatively impact food preparers, leading to poorer hygiene practices and food preservation Regression analysis indicates that those who engage with food documentaries or receive safety information from local medical personnel tend to exhibit worse practices in kitchen hygiene and food preservation The other factors analyzed show no significant effects.
Table 4.6: MVP regression original form
Variable Coefficient p-value Coefficient p-value Coefficient p-value
Hygiene individual practice Food safety knowledge
- Local staff (*) -0.160 0.194 -0.611 0.000 -0.378 0.002 ρkp ρik ρip
The regression analysis revealed that knowledge of food safety significantly influences participants' behaviors across all three groups, while other factors had varying impacts Notably, living in an urban area negatively affects food processing and preservation practices (p-value < 0.05), indicating that urban residents tend to process and preserve food less accurately than those in suburban areas Additionally, the number of family members correlates with kitchen hygiene practices, suggesting that larger households maintain cleaner kitchens Other variables did not demonstrate any statistically significant effects The table below illustrates the marginal effects from the multivariate probit regression.
Table 4.7: Marginal effect after MVP regression
Variable ME p-value ME p-value ME p-value
Hygiene individual practice Food safety knowledge
- Common labor (*) 0.017 0.722 0.015 0.722 0.016 0.722 Logarithm of Age 0.038 0.400 0.035 0.400 0.035 0.400 Logarithm of Food expenditure
Notes: (*) dummy variables, ME: marginal effect
The marginal effect of each variable reveals the specific impact of various factors on the independent variable For example, an increase of 1 point in a participant's knowledge score raises the likelihood of proper food safety behavior by 1.9% for kitchen hygiene practices and 1.7% for both process/preservation and individual practices A similar trend is observed with the number of family members, where enhanced perception also boosts the probability of accurate practices across all three categories Additionally, individuals who seek food safety information from the radio exhibit a 10% improvement in kitchen hygiene practices and a 9.1% increase in other behaviors compared to those who do not.
(process/preserve practice and individual practice)
Local medical staff advice can reduce the likelihood of proper individual practices by 37.8% Additionally, food safety information from documentaries negatively impacts hygiene kitchen practices by 9.9% and process/preservation practices by 8.9%.
To assess the reliability of the regression outcomes, the thesis employed a Poisson model to accurately predict the frequency of behaviors practiced by participants, assuming uniform effects on food poisoning The independent variables mirrored those used in the multivariate probit model, while the dependent variable represented the count of correct behaviors performed by participants, with a maximum of 12 The regression results are detailed in the table below.
Variable Coefficient p-value ME p-value
The Poisson regression analysis, like the MVP regression, reveals a significant relationship between behavior and factors such as food safety knowledge, perceived value, location, and various cues to action, including radio, food documents, and local medical staff However, unlike the MVP regression findings, the Poisson regression indicates that the number of family members does not influence the precise behavior of the primary cook in the household.
RESULTS FROM PROPENSITY SCORE MATCHING MODEL
In a survey of 4,593 participants, 98 suspected cases of food poisoning were reported across 79 households Notably, 60 of these cases exhibited symptoms following the consumption of home-prepared meals.
In the MVP model, all variables serve as explanatory factors in the estimated probit regression To enhance the understanding of foodborne disease (FBD) symptoms, the thesis introduces an independent variable, coded as food_place, representing the location of food purchases This variable is assigned a value of “0” for food bought at regulated markets or supermarkets and “1” for purchases made at unregulated spontaneous markets It is anticipated that this variable will demonstrate a negative correlation with food poisoning incidents Additionally, the expenditure variable has been excluded to maintain the balancing property The dependent variable in the probit regression is the incidence of food poisoning, where households that experienced food poisoning are coded as “1” and those that did not are coded as “0.”
The coefficients in the regression result are not implied the same meaning as other regression above due to the huge different in the two values of the dependant variable
(60 versus 1115) The table below shows the result of the probit model:
However, after estimating the propensity score and choosing the control group by radius matching (caliper is 0.0001), there are only 33 observations in treated group and
In a study involving a control group of 96 participants, the expenditure variable was found to unbalance the probit regression; however, its impact was assessed without affecting the results of the Propensity Score Matching (PSM) method The mean differences in continuous variables between individuals who experienced foodborne diseases (FBD) and those who did not were evaluated using a t-test, yielding the results outlined below.
Table 4.10: Differences of continuous variables
(Not suffered FBD – Suffered FBD) p-value
At the 5% significance level, the analysis reveals that the only notable differences between respondents who suffered from poisoning and those who did not are in their food expenditure and years of schooling Specifically, individuals who experienced poisoning spent approximately 21,000 VND more on food and had more years of education compared to their counterparts Additionally, while there is a distinction in the accuracy of behaviors between the two groups, this difference is only significant at the 10% level, with non-sufferers demonstrating more precise practices than those who suffered from poisoning.
On the other hand, the correlations between the binary variables and the FBD variable tested by the Pearson’s Chi square test:
Table 4.11: Correlations between binary variables and FBD
Variable Pearson’s Chi square value p-value
The analysis revealed that only the location of residence significantly affects the likelihood of experiencing foodborne diseases (FBD), with a p-value of less than 0.05 In contrast, other factors examined did not demonstrate a meaningful relationship, indicating minimal differences between individuals who suffered from FBD and those who did not.
DISCUSSION AND IMPLIED POLICY
POLICY IMPLICATION
To address the shortcomings in food safety, the government must enhance the knowledge of medical staff and develop institutions dedicated solely to food safety Improving communication channels is essential, focusing on providing detailed information about food processing rather than just warnings about food issues on national TV Radio has proven to be an effective medium for disseminating food safety information, particularly in mountainous provinces where radio signals are more accessible than television The increase in food safety knowledge from 2010 to 2013 indicates a growing public interest in this issue, which the government can leverage to educate the population and encourage greater involvement in food safety initiatives, such as utilizing freelancers or communicators for outreach.
The study indicates that there is no direct correlation between purchasing behaviors and the risk of foodborne diseases (FBD), highlighting the need for better control over food sources and restaurant quality to mitigate hazards Additionally, school education programs should incorporate practical life skills related to food safety, while public communication strategies should focus more on consumer awareness rather than solely targeting manufacturers or restaurant staff Furthermore, food quality from supermarkets and organized markets may not necessarily exceed that of local markets, despite higher costs, prompting the government to establish specific standards and quality assurance institutions for these outlets Lastly, environmental factors, particularly water quality, require regular monitoring and improvement, as the significant lack of clean water in Ho Chi Minh City poses a serious threat to public health.
LIMITATION AND IMPLICATIONS FOR FURTHER RESEARCH
The FBD survey relies on participants' self-reports rather than medical doctors' assessments, which may lead to inaccuracies in the findings Additionally, the data lacks comprehensive information from an economic perspective, particularly regarding perception To better understand the factors influencing FBD probability and the impact of living environments and food resources, further research is essential.
Furthermore, the FBD expose not only with food poisoning but also with chronic diseases such as cancer though it is complicated to impute the pathogen to food
Therefore, more researches need to implement to this field to find more evidences
The thesis highlights the significance of the living environment as a crucial factor influencing foodborne diseases (FBD) It emphasizes the need for more substantial evidence to clarify this concept, particularly regarding the quality of water used for edible purposes, as water sources differ significantly between urban and suburban areas.
This research faces limitations in its measurement methods for various variables, as many were assessed differently compared to similar studies, potentially hindering effective comparisons with other results Additionally, the perceived value derived from a questionnaire lacks sufficient questions and methods to ensure respondents accurately express their true perceptions.
The correlation matrix of perception’s factors
The data presents a series of correlation coefficients among various variables labeled from a1new to a18new Notably, a1new shows a perfect correlation of 1.0000 with all subsequent variables, indicating a strong linear relationship Variables a2new through a14new exhibit high correlations, with a14new reaching 0.6567 with a12new, showcasing significant interdependencies The lower correlations observed in a15new and a18new suggest weaker relationships within the dataset Overall, the analysis highlights varying degrees of correlation, emphasizing the interconnectedness of the variables in question.
PCA result
Factor18 0.11946 0.0066 1.0000 Factor17 0.14848 0.02902 0.0082 0.9934 Factor16 0.18985 0.04138 0.0105 0.9851 Factor15 0.22501 0.03515 0.0125 0.9746 Factor14 0.24595 0.02094 0.0137 0.9621 Factor13 0.27260 0.02665 0.0151 0.9484 Factor12 0.33196 0.05936 0.0184 0.9333 Factor11 0.35120 0.01924 0.0195 0.9148 Factor10 0.38457 0.03337 0.0214 0.8953 Factor9 0.42785 0.04328 0.0238 0.8739 Factor8 0.49646 0.06861 0.0276 0.8502 Factor7 0.53475 0.03829 0.0297 0.8226 Factor6 0.63879 0.10405 0.0355 0.7929 Factor5 0.77367 0.13488 0.0430 0.7574 Factor4 0.92689 0.15322 0.0515 0.7144 Factor3 1.10618 0.17929 0.0615 0.6629 Factor2 1.61396 0.50777 0.0897 0.6015 Factor1 9.21238 7.59842 0.5118 0.5118 Factor Eigenvalue Difference Proportion Cumulative
MVP regression (reduced form)
chi2(3) = 233.196 Prob > chi2 = 0.0000 Likelihood ratio test of rho21 = rho31 = rho32 = 0: rho32 4790893 0463972 10.33 0.000 3831738 564783 rho31 4570518 0457674 9.99 0.000 3628716 5419888 rho21 5779966 0398654 14.50 0.000 4945877 650856 /atrho32 5218016 0602191 8.67 0.000 4037743 6398289 /atrho31 4935782 0578527 8.53 0.000 3801891 6069673 /atrho21 659449 0598651 11.02 0.000 5421155 7767824 _cons 1.115008 131358 8.49 0.000 8575512 1.372465 loc_staff -.2856251 1125314 -2.54 0.011 -.5061825 -.0650677 doc -.2218455 1445481 -1.53 0.125 -.5051546 0614635 news -.1736675 0932207 -1.86 0.062 -.3563769 0090418 radio 1360822 106534 1.28 0.201 -.0727206 344885 tv -.0526691 1323381 -0.40 0.691 -.3120469 2067088 perc_f1 3153075 0457522 6.89 0.000 2256348 4049802 indi
_cons 8597885 1280854 6.71 0.000 6087457 1.110831 loc_staff -.3910883 1129624 -3.46 0.001 -.6124905 -.1696861 doc 0380902 1532165 0.25 0.804 -.2622086 3383889 news -.1393973 0918987 -1.52 0.129 -.3195155 040721 radio 5054202 1102772 4.58 0.000 2892808 7215597 tv 01221 1287667 0.09 0.924 -.2401682 2645881 perc_f1 5595797 0538308 10.40 0.000 4540732 6650862 proc
_cons 8138421 1249069 6.52 0.000 5690291 1.058655 loc_staff -.041626 1137304 -0.37 0.714 -.2645335 1812815 doc -.3644403 1437517 -2.54 0.011 -.6461885 -.082692 news 0023601 0902982 0.03 0.979 -.1746211 1793413 radio 3546625 1059468 3.35 0.001 1470106 5623144 tv -.0520822 1268091 -0.41 0.681 -.3006235 1964591 perc_f1 1903142 0435442 4.37 0.000 1049691 2756593 kitc
Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -1518.5305 Prob > chi2 = 0.0000 Wald chi2(18) = 178.29Multivariate probit (MSL, # draws = 5) Number of obs = 1168
MVP regression (original form)
/atrho32 5116009 0619345 8.26 0.000 3902115 6329902 /atrho31 4838027 060206 8.04 0.000 3658011 6018044 /atrho21 7554267 0655425 11.53 0.000 6269657 8838876 _cons -.043319 1.424135 -0.03 0.976 -2.834573 2.747935 loc_dum -.1004265 0978174 -1.03 0.305 -.292145 0912921 loc_staff -.3780484 1210943 -3.12 0.002 -.6153888 -.140708 doc -.2109011 1503647 -1.40 0.161 -.5056104 0838083 news -.2908288 1000615 -2.91 0.004 -.4869457 -.0947119 radio 1352087 1093668 1.24 0.216 -.0791462 3495636 tv -.119521 136583 -0.88 0.382 -.3872188 1481768 perc_f1 2590135 0495196 5.23 0.000 1619568 3560702 lnexp 0184813 1028084 0.18 0.857 -.1830195 2199822 lnage 0848241 1683457 0.50 0.614 -.2451273 4147756 job_new2 -.1420892 1721359 -0.83 0.409 -.4794695 195291 job_new1 -.1077489 1512042 -0.71 0.476 -.4041037 188606 edu_new 0176512 0135823 1.30 0.194 -.0089696 044272 sex 1051301 1846875 0.57 0.569 -.2568508 467111 f_mem 0219332 0236432 0.93 0.354 -.0244066 068273 know2 0663949 0219701 3.02 0.003 0233343 1094554 indi
_cons -1.336828 1.416824 -0.94 0.345 -4.113753 1.440096 loc_dum 7533018 1046908 7.20 0.000 5481116 9584921 loc_staff -.6107935 1252602 -4.88 0.000 -.856299 -.3652881 doc -.2434742 1594121 -1.53 0.127 -.5559162 0689678 news -.1172928 1002116 -1.17 0.242 -.3137039 0791183 radio 3673403 1156295 3.18 0.001 1407106 5939699 tv -.0984783 1385747 -0.71 0.477 -.3700797 1731231 perc_f1 4491142 0566682 7.93 0.000 3380466 5601818 lnexp -.0402706 1018324 -0.40 0.693 -.2398585 1593172 lnage 2859399 1696803 1.69 0.092 -.0466273 6185071 job_new2 -.1626987 1753452 -0.93 0.353 -.506369 1809716 job_new1 044128 1540247 0.29 0.774 -.2577549 3460109 edu_new 0365416 0138528 2.64 0.008 0093906 0636926 sex 0971573 1934886 0.50 0.616 -.2820734 476388 f_mem 0366151 0231059 1.58 0.113 -.0086717 0819019 know2 1033148 0223409 4.62 0.000 0595275 1471022 proc
_cons -.2533119 1.378816 -0.18 0.854 -2.955741 2.449118 loc_dum -.0398895 0942509 -0.42 0.672 -.2246178 1448388 loc_staff -.1597777 1228875 -1.30 0.194 -.4006328 0810774 doc -.3515957 1503444 -2.34 0.019 -.6462652 -.0569261 news -.0582825 0965137 -0.60 0.546 -.247446 130881 radio 3581531 1099266 3.26 0.001 142701 5736053 tv -.1535407 1309093 -1.17 0.241 -.4101183 1030368 perc_f1 1364628 046897 2.91 0.004 0445464 2283792 lnexp -.0294486 099663 -0.30 0.768 -.2247844 1658872 lnage 1361739 16177 0.84 0.400 -.1808894 4532373 job_new2 0605255 1698464 0.36 0.722 -.2723673 3934182 job_new1 -.1238851 1469004 -0.84 0.399 -.4118047 1640344 edu_new 0189987 0132713 1.43 0.152 -.0070125 04501 sex 021229 1788945 0.12 0.906 -.3293977 3718557 f_mem 0672752 0240019 2.80 0.005 0202324 114318 know2 0666814 0209181 3.19 0.001 0256827 1076801 kitc
Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -1433.2637 Prob > chi2 = 0.0000 Wald chi2(45) = 273.03Multivariate probit (MSL, # draws = 5) Number of obs = 1147
Poisson regression
_cons 2.258058 2828686 7.98 0.000 1.703646 2.81247 loc_staff -.0411455 0249034 -1.65 0.098 -.0899552 0076643 doc -.0341781 0305385 -1.12 0.263 -.0940326 0256763 news -.0023822 0203121 -0.12 0.907 -.0421931 0374287 radio 0403983 0212309 1.90 0.057 -.0012136 0820101 tv 0051544 0277787 0.19 0.853 -.0492909 0595996 perc_f1 0449872 009692 4.64 0.000 0259911 0639833 loc_dum 0327238 019411 1.69 0.092 -.005321 0707687 lnexp -.0051244 0205234 -0.25 0.803 -.0453495 0351006 lnage 015889 0337333 0.47 0.638 -.0502271 0820051 job_4 -.0224146 0341957 -0.66 0.512 -.089437 0446078 job_5 -.0173529 0296353 -0.59 0.558 -.0754371 0407313 edu 0097375 0097973 0.99 0.320 -.0094648 0289399 sex 0126925 0364342 0.35 0.728 -.0587172 0841023 f_mem 00365 0045554 0.80 0.423 -.0052784 0125783 know2 0098917 004481 2.21 0.027 0011092 0186742 count Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -2627.7535 Pseudo R2 = 0.0100 Prob > chi2 = 0.0000
LR chi2(15) = 53.01Poisson regression Number of obs = 1143
Questionaire form
BẢNG CÂU HỎI KIẾN THỨC VỀ VSATTP NGƯỜI DÂN
I ĐẶC ĐIỂM ĐỐI TƯỢNG KHẢO SÁT A1) Họ và tên người được phỏng vấn:
A4) Tuổi người được phỏng vấn: ………
A5) Trình độ học vấn: Không Cấp 1 Cấp 2 Cấp 3 Đại học Khác
1 Cán bộ 1 [ ] Lao động phổ thông 4 [ ]
A7) Số người có trong hộ: …………
A8) Số tiền đi chợ trung bình 1 ngày : đ_/ người ăn (*) A9) Anh chị là người nấu ăn : Chính phụ trong gia đình
II KIẾN THỨC VỀ VSATTP: (4 Câu) B1) Anh chị có thường để ý đến vấn đề VSATTP không ? Có Không B2) Anh chị có được thông tin về VSATTP từ :
TV Đài PT Báo chí Sách vở CBYT Khác
B3) Theo anh chị tại sao bị ngộ độc thực phẩm?
- Thực phẩm nhiễm hóa chất
- Thực phẩm không vệ sinh , bị nhiễm vi sinh vật
B4) Theo anh chị, làm thế nào để phòng ngừa ngộ độc thực phẩm cho gia đình :
Mua những loại thực phẩm đã được chế biến an toàn
Rửa rau và thực phẩm kỹ
Nấu nướng thức ăn kỹ
Tránh đụng chạm giữa thực phẩm sống và chín
3 Sử dụng/Ăn uống sau khi nấu: Ăn ngay thức ăn vừa được nấu chín
Hâm nóng thức ăn trước khi ăn
4 Ngoài việc giữ vệ sinh thực phẩm, anh chị còn chú ý giữ vệ sinh cho những việc gì khác nữa:
Giữ vệ sinh nhà bếp
Bảo quản kỹ thức ăn đã nấu
Không để thực phẩm bị côn trùng , súc vật gặm nhấm
III LỰA CHỌN THỰC PHẨM (7 Câu) C1) Anh chị thường đi chợ nào ? vì sao ?
Thường xuyên Thỉnh thoảng Giá mắc Giá rẻ ATTP Tiện lợi (ghi rõ)
C2) Khi lựa chọn thực phẩm tươi sống, Anh chị dựa vào tiêu chuẩn nào là chính :
Màu Mùi Độ chắc Mắt Mang Da Mua người quen
C3) Khi lựa chọn rau quả tươi sống , Anh chị dựa vào tiêu chuẩn nào ?
Toàn vẹn (không bị trầy xướt , dập nát , gọt vỏ , xắt mỏng, )
C4) Khi chọn mua thực phẩm bao gói sẵn, đồ hộp, anh chị có đọc nhãn không? Có Không
C5) Nếu có , Anh chị thường xem nội dung gì trên nhãn ?
- Tên hàng hóa Tên cơ sở sản xuất
- Thành phần cấu tạo của sản phẩm Ngày sản xuất và hạn sử dụng
- Hướng dẫn bảo quản sử dụng Khối lượng
C6) Ngoài việc đọc nội dung nhãn , Anh chị còn để ý điều gì ?
- Bao bì còn nguyên vẹn, không bể, Hộp kim loại không bị phồng nắp, gĩ sét
- Nắp chai kín còn niêm phong, Khác
C7) Anh chị có sử dụng các loại phụ gia sau trong chế biến thức ăn cho gia đình
Có Không 1 lần/tuần Thỉnh thoảng
Bột nổi (làm bánh bông lan , làm mềm thịt )
Bột nổi nâu ( làm bánh mì, )
IV CHẾ BIẾN, SỬ DỤNG VÀ BẢO QUẢN THỨC ĂN (17 Câu):
E1) Mặt bếp nhà anh chị được xây dựng như thế nào và bếp sử dụng là loại gì?
- Gạch men Xi măng Gỗ Đất Bếp củi
- Bếp điện Bếp ga Bếp dầu Bếp than Khác
E2) Anh chị thường vệ sinh nhà bếp (mặt, vách bếp, bếp nấu) khi nào?
- Sau mỗi bữa nấu xong Cuối ngày/ lần
E3) Anh chị có mang tạp dề, găng tay khi nấu nướng không?
E4) Khi chế biến thức ăn, anh chị thường rửa tay lúc nào và rửa bằng gì?
Rửa nước sạch Rửa nước sạch với xà phòng
- Sau tiếp xúc với thực phẩm sống
E5) Nhà Anh chị có bao nhiêu cái thớt ? …… cái Có phân biệt sống, chín (*) Không E6) Anh chị có dùng khăn lau chén không? Có Không
Giặt khăn lau chén bát nên thực hiện mỗi ngày, vài ngày một lần, hoặc tuần/lần tùy thuộc vào mức độ sử dụng Để đảm bảo rau quả ăn sống được sạch và an toàn, anh chị có thể xử lý bằng cách rửa kỹ với nước sạch, ngâm trong dung dịch muối hoặc giấm, và cắt bỏ phần hư hỏng trước khi sử dụng.
Rửa nước nhiều lần Rửa thuốc tím
- Rửa nước thuốc Rửa nước muối Khác
E9) Gia đình anh chị thường bắt đầu ăn vào lúc nào, sau khi thức ăn đã nấu chín?
- Khi thức ăn còn nóng ấm
E10) Thức ăn để nguội (> 2 giờ) , trước khi ăn anh chị có hâm lại không? Có Không E11) Không hâm lại, vì sao? Mất công Thấy không sao Khác
E12) Có hâm lại như thế nào: Hâm nóng Nấu vừa sôi Nấu sôi kỹ > 2 phút Khác E13) Thức ăn thừa của bữa ăn thường để lại hay đổ bỏ
Luôn để lại Tùy món để lại Luôn bỏ đi Để lại dùng bằng cách nào? Để riêng, hâm lại Trộn với thức ăn mới, hâm lại
E14) Anh, chị thường giữ thức ăn sau khi nấu chín ( để 1 buổi ) như thế nào?
Thức ăn cho người lớn Thức ăn cho trẻ em ( ≤ 5 tuổi )
- Cho vào tủ đựng thức ăn
E15) Anh chị có trữ thực phẩm khô (bánh tráng, lạp xưởng, mực cá khô ) Có Không
E16) Bảo quản như thế nào?
Cất tủ riêng có lưới Cất tủ riêng không lưới Khác
Treo ( để trần ) Treo ( có bao bọc )
E17) Anh chị xử lý rác, thức ăn thừa trong nhà như thế nào?
- Bỏ vào giỏ rác, xô Khác
- Bỏ vào thùng rác có bao nylon có nắp đậy
- Bỏ bao nylon cột lại Điều tra viên :………
PHIẾU ĐIỀU TRA THÁI ĐỘ CỦA NGƯỜI TIÊU DÙNG VỀ NĐTP
Theo anh/chị những việc nào cần làm để phòng ngộ độc thực phẩm :
(Chọn “ * “ : kết thúc phỏng vấn)
A1 Lựa chọn thực phẩm tươi sạch A2 Sử dụng thực phẩm có nguồn gốc rõ ràng A3 Không ăn tái, tiết canh…
Để đảm bảo an toàn thực phẩm, hãy rửa sạch thực phẩm trước khi chế biến và ăn ngay sau khi nấu Thức ăn đã nấu chín cần được hâm lại hoặc bảo quản trong tủ lạnh nếu không sử dụng trong vòng 2 giờ Luôn che đậy và bảo quản cẩn thận thức ăn chín, đồng thời sử dụng dụng cụ chế biến riêng cho thực phẩm sống và chín Trước và sau khi tiếp xúc với thực phẩm, hãy rửa tay sạch sẽ bằng nước sạch Cuối cùng, đảm bảo rằng các dụng cụ chế biến luôn được giữ sạch sẽ.
A13 Giữ nơi chế biến nơi chế biến luôn khô ráo và sạch sẽ A14 Tìm hiểu thông tin về Vệ sinh an toàn thực phẩm
Theo anh/chị làm thế nào để người dân tích cực, mạnh dạn, phát hiện với các hành vi vi phạm về VSATTP?
Kết thúc phỏng vấn, xin chân thành cảm ơn anh/chị Điều tra viên
BẢNG QUAN SÁT THỰC HÀNH CỦA NGƯỜI DÂN PHÒNG CHỐNG NGỘ ĐỘC THỰC PHẨM
STT NỘI DUNG THỰC HÀNH ĐẠT KHÔNG ĐẠT
A Vệ sinh nơi chế biến
1 Nơi chế biến gọn, sạch, ngăn nắp
2 Giữ bề mặt chế biến, bếp luôn khô ráo, sạch sẽ
3 Có dụng cụ chứa chất thải kín, có nắp đậy
4 Nhà vệ sinh không mở cửa trực tiếp vào khu vực chế biến
B Vệ sinh trong chế biến và bảo quản
1 Đủ nước sạch để chế biến
2 Thức ăn chín được bảo quản trong tủ kín sạch hoặc có lồng bàn đậy
4 Dùng dụng cụ để gắp, phân chia thức ăn chín
5 Có tủ bảo quản dụng cụ ăn uống
6 Rửa rau qua 3 lần hoặc rửa trực tiếp dưới vòi nước sạch
7 Không sử dụng phụ gia thực phẩm ngoài danh mục, thực phẩm hết hạn dùng để chế biến thức ăn
1 Có rửa tay sạch trước khi vào chế biến, sau khi đi vệ sinh và trước khi ăn
2 Không đeo đồ trang sức, giữ móng tay ngắn, sạch sẽ, không sơn móng tay
Xin trân trọng cảm ơn! Điều tra viên
PHIẾU ĐIỀU TRA TRƯỜNG HỢP NGỘ ĐỘC THỰC PHẨM
CẤP TÍNH TRONG CỘNG ĐỒNG
Để phục vụ cho việc thống kê và đánh giá thực trạng ngộ độc thực phẩm cấp tính trong cộng đồng tại TP HCM, xin vui lòng cung cấp thông tin liên quan theo các nội dung dưới đây Mọi thông tin bạn cung cấp sẽ được bảo mật hoàn toàn.
Phần I: thông tin cá nhân
4 Trình độ học vấn: Dưới lớp 5 Lớp 5 – 11 12 trở lên
5 Thu nhập bình quân hàng tháng:………VNĐ
9 Số điện thoại liên lạc khi cần………
Phần II: thông tin lâm sàng
Trong vòng 2 tuần qua, bạn có gặp phải triệu chứng bất thường sau khi ăn uống không? Những triệu chứng này có thể bao gồm buồn nôn, nôn, đau bụng, hoặc tiêu chảy nhiều lần trong 24-48 giờ Nếu bạn cảm thấy bất kỳ khó chịu nào ở ruột hay dạ dày sau khi ăn, hãy cho biết Kết thúc phỏng vấn, chúng tôi sẽ chuyển sang điều tra kiến thức.
11 Triệu chứng bất thường xuất hiện vào thời điểm nào?
Từ 2- 4 giờ sau khi ăn
Trên 24 giờ sau khi ăn
12 Mô tả thực phẩm Anh/ chị đã sử dụng Được đun nóng trước khi phục vụ
Thức ăn đã nấu chín và nguội Được nấu và phục vụ ngay Được chia suất sẵn Được cung cấp bởi người bán thức ăn nhanh
Thức ăn được để qua đêm
Không biết, không xác định ………
Khai thác tiền sử ăn uống của bệnh nhân liên quan đến NĐTP là rất quan trọng Điều tra viên cần hỏi bệnh nhân về những món ăn đã tiêu thụ, cụ thể là họ đã ăn gì, ai là người cùng ăn với họ và thời điểm ăn uống Những thông tin này giúp xác định mối liên hệ giữa chế độ ăn uống và tình trạng sức khỏe của bệnh nhân.
14 Anh/ chị xuất hiện những triệu chứng bất thường về đường tiêu hóa có liên quan đến ăn uống: có không không rõ thời khoảng xuất hiện
Sốt 1 2 9 ……… Đau nhức mình mẩy 1 2 9 ………
Những triệu chứng khác (Ghi rõ): ………
15 Chẩn đoán của bác sĩ là gì?
16.Chỉ định điều trị của bác sĩ trực tiếp điều trị của Anh/chị?
17 Anh/ chị có phải nhập viện vì bệnh này không? có: 1 (xuống 19) không: 2, 3 Khám, lấy thuốc rồi về
18 Nhập bệnh viện vào khoa/bệnh viện:
19 Anh/ chị có tự mua thuốc uống trước khi vào khám không? có: 1 không: 2
20 Có bất kỳ ai khác tham gia bữa ăn nghi ngờ bị triệu chứng giống Anh/ chị không? có: 1 không: 2,
22 Sau khi tham gia bữa ăn người đó có triệu chứng bất thường giống Anh/ chị không? có: 1 không: 2, Không biết: 3
23 Những người cùng ăn với Anh/ chị có đi bệnh viện không? có: 1 không: 2, Không biết: 3
24 Người đó có được điều trị giống anh chị không? có: 1 không: 2, Không biết: 3 Cuộc phỏng vấn hoàn tất, cám ơn anh chị đã hợp tác với chúng tôi.
1 Abbot, J M., Byrd-Bredbenner, C., Schaffner, D., Bruhn, C M., & Blalock, L
(2009) Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults European Journal of
2 Becker, M H., Maiman, L A., Kirscht, J P., Haefner, D P., & Drachman, R
H (1977) The Health Belief Model and prediction of dietary compliance: a field experiment Journal of Health and Social Behavior, 348-366
3 Byrd-Bredbenner, C., Maurer, J., Wheatley, V., Schaffner, D., Bruhn, C., &
Blalock, L (2007) Food safety self-reported behaviors and cognitions of young adults: results of a national study Journal of Food Protection®, 70(8), 1917-1926
4 Byrd-Bredbenner, C., Berning, J., Martin-Biggers, J., & Quick, V (2013) Food safety in home kitchens: a synthesis of the literature International journal of environmental research and public health, 10(9), 4060-4085
5 Cappellari, L., & Jenkins, S P (2003) Multivariate probit regression using simulated maximum likelihood The Stata Journal, 3(3), 278-294
6 Centers for Disease Control and Prevention (2016) Surveillance for Foodborne Disease Outbreaks, United States, 2014, Annual Report US Department of Health and Human Services, CDC, 1- 14
7 Cho, S., Hertzman, J., Erdem, M., & Garriott, P (2010) Changing Food Safety Behavior Among Latino(a) Food Service Employees: The Food Safety Belief Model
International CHRIE Conference-Refereed Track July 30, 2010 Paper 22
8 Chow, S., & Mullan, B (2010) Predicting food hygiene An investigation of social factors and past behaviour in an extended model of the Health Action Process Approach Appetite, 54(1), 126-133
9 Di Iorio, C K (2006) Measurement in health behavior: Methods for research and evaluation (Vol 1) John Wiley & Sons
10 Glanz, K., Rimer, B K., & Viswanath, K (Eds.) (2008) Health behavior and health education: theory, research, and practice John Wiley & Sons
11 Gettings, M A., & Kiernan, N E (2001) Practices and perceptions of food safety among seniors who prepare meals at home Journal of Nutrition
12 Gujrarati, D N (2004) Basic Econometrics, 4 th Edition Tata McGraw Hill
13 Hanson, J A., & Benedict, J A (2002) Use of the Health Belief Model to examine older adults' food-handling behaviors Journal of Nutrition Education and
14 Havelaar, A H., Cawthorne, A., Angulo, F., Bellinger, D., Corrigan, T., Cravioto, A., & Lake, R (2013) WHO initiative to estimate the global burden of foodborne diseases The Lancet, 381, S59
15 Jevšnik, M., Hlebec, V., & Raspor, P (2008) Consumers’ awareness of food safety from shopping to eating Food control, 19(8), 737-745
16 Kennedy, J., Jackson, V., Cowan, C., Blair, I., McDowell, D., & Bolton, D
(2005) Consumer food safety knowledge: Segmentation of Irish home food preparers based on food safety knowledge and practice British Food Journal,107(7), 441-452
17 Kwon, J., Wilson, A N., Bednar, C., & Kennon, L (2008) Food safety knowledge and behaviors of Women, Infant, and Children (WIC) program participants in the United States Journal of Food Protection®, 71(8), 1651-1658
18 Khandker, S R., Koolwal, G B., & Samad, H A (2010) Handbook on impact evaluation: quantitative methods and practices World Bank Publications
19 Langiano, E., Ferrara, M., Lanni, L., Viscardi, V., Abbatecola, A M., & De Vito, E (2012) Food safety at home: knowledge and practices of consumers Journal of Public Health, 20(1), 47-57
20 Lum, A (2010) Food handling practices, knowledge and beliefs of families with young children based on the health belief model MS thesis University of
21 Mari, S., Tiozzo, B., Capozza, D., & Ravarotto, L (2012) Are you cooking your meat enough? The efficacy of the Theory of Planned Behavior in predicting a best practice to prevent salmonellosis Food research international,45(2), 1175-1183
22 McArthur, L H., Holbert, D., & Forsythe, W A (2006) Compliance with food safety recommendations among university undergraduates: Application of the Health Belief Model Family and Consumer Sciences Research Journal, 35(2), 160-170
23 Meysenburg, R., Albrecht, J A., Litchfield, R., & Ritter-Gooder, P K (2014)
Food safety knowledge, practices and beliefs of primary food preparers in families with young children A mixed methods study Appetite, 73, 121-131
24 Mullan, B., Allom, V., Fayn, K., & Johnston, I (2014) Building habit strength:
A pilot intervention designed to improve food-safety behavior Food Research
25 Nesbitt, A., Thomas, M K., Marshall, B., Snedeker, K., Meleta, K., Watson, B.,
& Bienefeld, M (2014) Baseline for consumer food safety knowledge and behaviour in Canada Food Control, 38, 157-173
26 Nguyen, H L (2016) Reality of food poisoning caused by natural toxins in Viet Nam in 2010 - 2014 period Vietnam Journal of Preventive Medicine, XXVI(1),
27 Nguyen, T P., Tran, T T L (2016) Assessment of food safety practices of food consumers in Lao Cai and Dong Thap provinces in 2015 Vietnam Journal of Preventive Medicine, XXVI(5), 9-12
In 2014, a study by Nguyen, V L focused on the knowledge of food safety and hygiene among individuals preparing food at home in Cai Tac and Tan Hoa communes, located in Chau Thanh A district, Hau Giang province The findings, published in the Vietnam Journal of Preventive Medicine, highlight essential insights into local practices and awareness regarding food safety measures.
29 Roberts, K R., Barrett, B B., Howells, A D., Shanklin, C W., Pilling, V K., &
Brannon, L A (2008) Food safety training and foodservice employees' knowledge and behavior Food protection trends, 28(4), 252-260
30 Safety Hygiene Food Branch of Ho Chi Minh city (2010) Assessment Knowledge, Attitude, Practice (KAP) in food safety of Ho Chi Minh city’s Household
In 2013, the Safety Hygiene Food Branch of Ho Chi Minh City conducted a study assessing the individual food poisoning ratio and the Knowledge, Attitude, and Practice (KAP) regarding food safety among households in the city This scientific report highlights critical insights into the food safety awareness and practices of residents, emphasizing the need for improved education and preventive measures to reduce foodborne illnesses.
32 Safety Hygiene Food Branch of Ho Chi Minh city (2016) Reality of food safety management in Ho Chi Minh city Food safety management in industrial zone Conference Report
33 Trepka, M J., Murunga, V., Cherry, S., Huffman, F G., & Dixon, Z (2006)
Food safety beliefs and barriers to safe food handling among WIC program clients, Miami, Florida Journal of nutrition education and behavior, 38(6), 371-377
34 Unusan, N (2007) Consumer food safety knowledge and practices in the home in Turkey Food Control, 18(1), 45-51
35 Vietnam Ministry of Health and Health Partnership group (2016) Joint Annual Health Review 2015: Strengthening primary health care at the grassroots towards universal health coverage Medical Publish House
36 Vo, T H., Le, N H., Le, A T N., Minh, N N T., & Nuorti, J P (2015)
Knowledge, attitudes, practices and training needs of food-handlers in large canteens in Southern Vietnam Food Control, 57, 190-194
37 Wertheim-Heck, S C., Spaargaren, G., & Vellema, S (2014) Food safety in everyday life: Shopping for vegetables in a rural city in Vietnam Journal of Rural
