Knowledge, practices and related factors of food hygiene among street food vendors in vientiane capital, laos

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH KHAMPHOU CHANTHAPANY H P KNOWLEDGE, PRACTICES AND RELATED FACTORS OF FOOD HYGIENE AMONG STREET FOOD VENDORS U IN VIENTIANE CAPITAL, LAOS H MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 Hanoi, 2019 ii MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH KHAMPHOU CHANTHAPANY H P KNOWLEDGE, PRACTICES AND RELATED FACTORS OF FOOD HYGIENE AMONG STREET FOOD VENDORS IN VIENTIANE CAPITAL, LAOS U MASTER THESIS MASTER OF PUBLIC HEALTH H CODE: 8720701 Assoc Prof La Ngoc Quang, PhD Hanoi, 2019 Dr Sengchanh Konnavong iii ACKNOWLEDGEMENTS This independent study would not have been possible without the help and support of many people First of all, I would like to give praise and thanks to the Lord Buddha who made it possible for me to come to the end of this program I am very thankful to the Ministry of Health of the Lao People‘s Democratic Republic (Lao PDR) and to the European Union (EU) for funding my studies at the both the University of Health Sciences (Laos) and the Hanoi University of Public Health (Vietnam) The Department of Public Health, Vientiane Capital is also gratefully acknowledged for allowing me to study at both the universities, which are among H P the best institutions of higher learning in Laos and Vietnam I wish to express my gratitude to my supervisors, Prof La Ngoc Quang and Dr Sengchanh Kounnavong, who took time to read and make the necessary criticisms, suggestions and comments in the course of my writing this thesis Special thanks go to my research assistants and study participants, without U whom it would have been difficult to obtain data I also want to thank the members of staff in the Food and Drug Section of the Department of Public Health, Vientiane Capital for their help with data collection for my study This study could not have H been completed without their generous assistance I am grateful to all the lecturers, teachers and staff of the Hanoi University of Public Health (Vietnam) and the University of Health Sciences (Laos) for their continuous assistance and helpful advice I would like to thank my classmates for their kindness throughout our Masters‘ program Finally, I would like to thank my family for their love, understanding, support and encouragement during the period of my studies at the two universities iv CONTENTS ACKNOWLEDGEMENTS iii LIST OF TABLES viii ABBREVIATIONS xi ABSTRACT xii INTRODUCTION .1 OBJECTIVES .3 Chapter .4 LITERATURE REVIEW H P 1.1 Definition 1.1.1 Knowledge of street food vendors 1.1.2 Practice of street food vendors .4 1.1.3 Food hygiene 1.2 Translating food safety (general food hygiene) knowledge into practice U 1.3 Standard of food hygiene practices 1.4 Food hygiene strategies 1.5 Food vendors‘ hygiene .8 H 1.6 Environmental hygiene .8 1.7 Hazard Analysis of Critical Control Point (HACCP) and food safety 11 1.8 Regulatory on food hygiene of street food vendors .13 1.9 Food policy .14 1.10 Studies on knowledge and practices of street food vendors 15 1.11 Some factors related to food hygiene 16 1.12 Some studies on knowledge and practice of food hygiene 18 1.13 Conceptual framework 19 Chapter 22 RESEARCH METHODOLOGY 22 2.1 Study setting and duration 22 2.1.1 Study setting 22 v 2.1.2 Study duration .22 2.2 Study design 22 2.3 Study population 22 2.3.1 Inclusion and exclusion criteria in study 22 2.3.2 Sample size 23 2.3.3 Sampling selection method 23 2.4 Variables measured .24 2.4.1 Independent variables .24 2.4.2 Dependent variables .24 2.5 Measures and assessment criteria 25 H P 2.5.1 Measures 25 2.5.2 Assessment criteria 25 2.5.3 Definitions of operational terms .27 2.6 Data collection methods .28 2.6.1 Interview and observation methods 28 U 2.6.1.1 Interviews with street food vendors to collect data on knowledge 28 2.6.1.2 Observation to collect data on practices related to food hygiene 29 2.7 Testing tools for collecting information 29 2.8 Data analysis process 29 2.9 Data analysis methods 30 2.10 H Ethical considerations 30 2.11 Limitations and bias and how to minimize this bias 30 2.11.1 Limitations of the study 30 2.11.2 Errors 31 2.11.3 Ensuring reliability 31 Chapter 33 RESULTS 33 3.1 Factors related to hygiene practices 33 3.1.1 Socio-demographic characteristics 33 3.1.2 Personal information 35 vi 3.1.3 Social or environmental and other factors 36 3.1.4 Access to food information 37 3.2 Knowledge of street food vendors on food hygiene .38 3.2.1 General knowledge 38 3.2.2 Knowledge of food processing, preservation, distribution, preparation and transportation 40 3.2.3 Knowledge about causes of food contamination 41 3.2.4 Knowledge about hygiene and food hygiene measures 42 3.2.5 Knowledge about law on food 43 3.2.6 Knowledge of reporting and handling food in food poisoning situations 44 H P 3.2.7 Distribution of knowledge levels .44 3.3 Practices on food hygiene .46 3.3.1 Practice of personal hygiene and environmental sanitation .46 3.3.2 Distribution of personal hygiene and environmental sanitation scores 47 3.3.3 Practices of pre-processing, processing and preservation 48 U 3.3.4 Distribution of pre-processing, processing and preservation scores 48 3.4 Determinants of the associated factors .49 3.4.1 Relationship between socio-demographic characteristics and practice of H personal hygiene and environmental sanitation 49 3.4.2 Relationship between personal information factors and practice of personal hygiene and environmental sanitation 51 3.4.3 Relationship between social environmental and other factors and practice of personal hygiene and environmental sanitation .52 3.4.4 Relationship between accessibility of food information and practice of personal hygiene and environmental sanitation 53 3.4.5 Relationship between knowledge groups and practice of personal hygiene and environmental sanitation 54 3.5.1 Relationship between the socio-demographic characteristics and practice of pre-processing, processing and preservation 55 vii 3.5.2 Relationship between personal information and practices of preprocessing, processing and preservation .57 3.5.3 Relationship between social environmental and other factors and practice of pre-processing, processing and preservation 58 3.5.4 Relationship between accessibility of food information and practice of pre-processing, processing and preservation 60 3.5.5 Relationship between groups of knowledge and practice of preprocessing, processing and preservation 61 3.6 Multivariate analysis of factors associated with practices of personal hygiene and environmental sanitation 62 H P 3.7 Multivariate analysis of factors associated with practices of pre-processing, processing and preservation 63 Chapter 65 DISCUSSION 65 4.1 General information of study subjects 65 U 4.2 Factors related to practices on hygiene 65 4.3 Street food vendors‘ knowledge .68 4.4 Street food vendors‘ practice of hygiene 69 H CONCLUSION 71 RECOMMENDATIONS 72 REFERENCES 73 Annex 1: Questionnaires 80 Annex 2: Questionnaires 87 Annex 3: Concepts/Definitions of the terms .89 Annex 4: Informed consent form 103 Annex 5: Ethical Clearance .104 Annex 6: Vendor/ Participant Information Sheet 105 Annex 7: List of data collection team members .108 Annex 8: Schedule of thesis writing .109 Annex 9: Curriculum Vitae .111 viii LIST OF TABLES Table 2.1: Number of outlets to be recruited for the study … 24 Table 3.1: Frequency and percentage of socio-demographic characteristic……….34 Table 3.2: Frequency and percentage of personal information…………………….35 Table 3.3: Frequency and percentage of social environmental and other factors….36 Table 3.4: Frequency and percentage of access to food information………………37 Table 3.5: General knowledge on food hygiene…………………… 38 Table 3.6: Frequency and percentage of knowledge about food processing, preservation, distribution, preparation and transportation…………………………40 Table 3.7: Frequency and percentage of knowledge about causes of food H P contamination………………………………………………………………………41 Table 3.8: Frequency and percentage of knowledge about hygiene and food hygiene measures…………………………….…………………………………………… 42 Table 3.9: Frequency and proportion of knowledge about the law of food hygiene and safety………………………………………………………………………….43 U Table 3.10: Frequency and percentage of knowledge reporting and handling food in case of food poisoning 44 Table 3.11: Distribution of frequency and percentage of knowledge group………45 H Table 3.12: Frequency and percentage of personal hygiene and environmental sanitation…………………………………………………… 46 Table 3.13: Frequency and percentage of personal hygiene and environmental sanitation…………………………………………………… 47 Table 3.14: Frequency and percentage of practices of pre-processing, processing and preservation……………………………………………… 48 Table 3.15: Frequency and percentage of pre-processing, processing and preservation…………………………………………………………… 48 Table 3.16: Bivariate analysis of socio-demographic factors associated and practice of personal hygiene and environmental sanitation…………… 49 ix Table 3.17: Bivariate analysis of personal information factors to practice of personal hygiene and environmental sanitation………………………… .51 Table 3.18: Bivariate analysis of social environmental factor and other factors and practice of personal hygiene and environmental sanitation………………… 52 Table 3.19: Bivariate analysis of accessibility of food information and practice of personal hygiene and environmental sanitation……………… 53 Table 3.20: Bivariate analysis of knowledge group and practice of personal hygiene and environmental sanitation…………………………………….……………… 54 Table 3.21: Bivariate analysis of socio-demographic characteristic and practice of pre-processing, processing and preservation………………… .55 H P Table 3.22: Bivariate analysis of personal information factors and practice of preprocessing, processing and preservation………………………………………… 57 Table 3.23: Bivariate analysis of social environmental and other factors and practice of pre-processing, processing and preservation……………….………………… 58 Table 3.24: Bivariate analysis of accessibility of food hygiene and practice of pre- U processing, processing and preservation………………………………………… 60 Table 3.25: Bivariate analysis of knowledge group and practice of pre-processing, processing and preservation……………………………………………………… 61 H Table 3.26: A multivariate logistic regression analysis……………………………62 Table 3.27: A multivariate logistic regression analysis ………………………… 63 x LIST OF FIGURES Figure 1.1: Conceptual framework of knowledge, practices and related factors of hygiene among street food vendors in Vientiane Capital 20 Figure 3.1: Sample sizes in four urban districts of Vientiane Capital 32 H P H U 110 Writing of thesis Final thesis submission Edited version submission Writing of manuscript Revision of thesis Submission of manuscript H P H U 111 Annex 9: Curriculum Vitae Family name: Chanthapany Insert Picture First name: Khamphou Date and place of birth: 19/12/1969 Address: Saphangmor village, Saysetha district Vientiane Capital H P Country: Lao PDR Nationality: Laotian Telephone: +856 20 55420464 U E-mail: chkhamphou@yahoo.com H Professional experience Education, training and courses Technical Staff, Food and Drug Section, Department of Public Health, from 1987 until now Bachelor of Pharmacy, 1996 112 HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: KNOWLEDGE, PRACTICE AND ITS RELATED FACTOR ON FOOD HYGIENE AMONG STREET FOOD VENDERS IN VIENTIANE CAPITAL, LAOS Thesis code: (Written on the right corner of thesis cover page) H P June 17th, 2019 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation):Yes Thesis topic: Research summary: - Summary of research results need to provide clear evidence, meeting the two objectives, particularly factors related to K and P For example: what are exact relationships between training on food hygiene and K and P?, etc OR and P values should be presented, not only percentages - Conclusions should be more concise and based on the study results No need to discuss in the conclusions - Recommendations must be based on the results, conclusions What is differences between Education programme and Training on food hygiene? Introduction: U H More information about Street Food Vendors‘ K and P of food hygiene in the Laos should be provided to have clear problem statement Research Objectives: Objectives are clear Literature review: In summary: literature review should be revised, considering the followings: Key concept and definition K and P: what are K and P (details contents of K, P), based on Laos MOH and WHO 113 Studies on K and P of food hygiene knowledge and practice: provide information of K, P of food hygiene knowledge and practice and related factors to practice What are really K and P of food hygiene knowledge and practice have been assessed in the previous studies? How they have been assessed? And What are related factors to practice? These information are basis for development of conceptual framework Section 1.3 ― Some measures against food poisoning‖ but not food hygiene This section needs much revision Subjects and research methods: Some suggestions for revision: - Section 2.2: Study design should be analytical but not descriptive cross-sectional study - Section 2.3: should be ―study subject‖, nots ―study sample‖ - Measurement, evaluation criteria should be explain clearly, e.g basis for measurement of K and P (based on what Agreement, Law, etc,.) - Section 2.5, 2.7 and 2.10 should be combined or made consistent: It is not clear: wrong answer gets point, but don‘t know/not sure answer gets 1? For negative questions, wrong answer gets 2, correct gets 1? - Basis for ―Good‖ or ―Poor‖ knowledge/practice What are cut off points (which points‖ and give references - What ―the good practice considered when the mean score above the total mean,…‖????? (section 2.5.2, p35) H P Research results: U H Structure of result chapter should be revised, followings the two objectives: o Knowledge on food hygiene, o Practice on food hygiene, and o Relate factors for food hygiene practice What is good/poor knowledge/practice? - In all tables, just number and % of ―yes‖ or ―no‖, but nut ―mean‖ as presented in Method chapter - Analytical statistics not cover all related factors presented in the conceptual framework Summary under each table should be shortened, not repeated all information in a table Discussion: 114 Discussion chapter is too short and not clear More discussion, including comparison this study results with others (references), explain results, etc, but not repeat study results Factors related to practice should include all four groups as presented in the conceptual framework 10 Conclusion: too long! - Conclusions must be clear and concise, providing with evidences from study results (present conclusions are very general and lack of evidences) - Conclusion must be meet the two study objectives (review the study objectives) - Factors related conclusion should be added - No more discussion, reference in conclusion H P 11 Recommendations - Rewrite accordingly to revised conclusion section - Recommendation must be based on the study results and provide clear and specific information about: what, who, how and when,… 12 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): U [ x ] Approval with some conditions - This thesis needs an intensive revision - English should be edited H Reviewer Ha Van Nhu 115 H P H U 116 H P H U 117 H P H U 118 H P H U 119 MINISTRY OF HEALTH FORM HANOI UNIVERSITY OF PUBLIC HEALTH MINUTES OF EXPLANATION AFTER INDEPENDENT ASSESSMENT ROUND Thesis title ―Knowledge, practices and its related factors on food hygiene among street food vendors in Vientiane capital, Laos‖ ………………………………………………………………………………………………… H P Student’s explanations detail Comments (Clearly state how, which part, page that student edits if students disagree, reasons should be indicated Orientation and specialized codes …………………… U Thesis topic ………………………… Abstract H -Summary of research results need to provide clear evidence, meeting the two objectives, particularly factors related to K and P For example: what are exact relationships between training on food hygiene and K and P?, etc -in summary of research result: I added some information to result and improved conclusion such as assessment of knowledge, practices and related factors on food hygiene (p X, IX) -Conclusions are not clear and no conclusion of K and P is provided - I added more information in summary, definition and a little bit information of food situation in Laos Summery need to be review, definition of key word and some situation on Laos Introduction More information about K and P of food hygiene - For the introduction, I have adapted all in the world and in Laos should be provided to part by filling new contents to suit the 120 have clear problem statement Introduction for knowledge and practice evaluation (p12) VTE need to put in Geography of food hygiene -I added more information of Lao and food vendors in Lao VTE Conceptual framework please put the main sentences of the figure and the key main sentences why draft it Objectives …………………… Review of Literature/Theoretical framework -Section 1.1 and 1.2 could be combined as they are about ―key concepts and definitions‖ H P -Key concepts and definitions: references for all key concepts, definitions presented must be provided There is no source of reference for all ―definition of terms‖ in section 1.1 and ―key definition‖ in section 1.2 -All references must be quoted from original sources E.g ―food hygiene‖ concept (p.5) is quoted from Jenpanich 2015, not form the WHO U -Section 1.3: only one reference (Out, 2014) is provided This is one of key sections of the thesis, therefor, what are included in ―food hygiene knowledge and practice?‖ should be provided They are basis for developing the contents of food hygiene knowledge and practice presented in the Conceptual framework These contents (food hygiene knowledge and practice) should be based on official documents of Laos MOH/relevant organization (or form the WHO) H -Section 1.6 ―measures to handle food poisoning‖ should be ―Measurement/Assessment of food hygiene knowledge and practice‖ because this study is about ―food hygiene knowledge and practice‖, but not only ―Handling food poisoning‖ This section will include information (from references) on how food hygiene knowledge and practice have been assessed -Section 1.12: it is not appropriate to separate studies on food hygiene knowledge from food -Regarding literature review, I've modified and changed the new number completely because I've filled some new contents and cut out some of it: I added new contents to section 1.1 (1.1.2) to be knowledge on food hygiene of street food vendors; section (1.1.2) to be food hygiene practices of street food vendors and section 1.2 into sociodemographic characteristic (p 15,16,17) - I edited reference from WHO into Jenpanich 2015 (p.21) -I combined together in old section 1.1 and 1.2 and edited references in section 1.1 , 1.2 -In section 1.3, I added a new contents to be proper with knowledge and practices of food hygiene (p.23,24,25) -Section 1.6, I changed all measure to handle food poisoning to be assessment of knowledge and practices on food hygiene, but I moved it to chapter methodology in section 2.5 (p.35) -Section 1.12, I changed to be section 1.5, for some studies was done by researchers, I combined together between knowledge and practices of food hygiene (p 28) 121 hygiene practice, because knowledge and practice are mixed in the section 1.12.1 (studies on K) It will be clearer and better if this section provides what are the contents of K and P of food hygiene and how they are assessed (method) by referenced researchers -Factors related to food hygiene practices, I added some contents in section 1.2 such as socio demographic characteristic (p25) -Factors related to food hygiene and practice should be reviewed to provide basis for developing conceptual framework -In literature review, I have added some information, edited and improve several points to be appropriated In summary: literature review should be revised, considering the followings: In literature review I added added some information, edited and improve several points to be appropriated, so that I developed new references 1.Key concept and definition I improve almost of literature review 2.K and P: what are K and P (details contents of K, P), based on Laos MOH or WHO Studies on K and P of food hygiene knowledge and practice: provide information of K, P of food hygiene knowledge and practice and related factors What are really K and P of food hygiene knowledge and practice have been assessed in the previous studies? How they have been assessed? And what are related factors? U -There are many references in citation is not available in references list -Put the point literature in the right format H Objects and research methods ……………… Study results H P -Section 3.4, Table 3.6 should be divided in tables accordingly to present in the conceptual framework What is ―DK‖? -Section 3.4, Table 3.6 I divided to be six parts of knowledge with six table: General knowledge on food hygiene Knowledge of processing, preserving… Knowledge about cause of contamination knowledge of hygiene and hygiene measures knowledge about law on food hygiene 122 knowledge of reporting and handling food (p.47-57) -Section 3.6.2: no ―Poor‖ and ―Good‖ practices are presented? These need to be added -section 3.6.2, I added poor and good practice in table 3.20 (p.59) and I edited each tables to be shortened; I changed correct, reach, failing, wrong to be Yes and No -Table 3.11 and 3.12 ―What is hygiene?‖ -Summary under each table should be shortened, not repeated all information in a table -Terminology used in tables must be consistence (reach, failing or wrong, correct (table 3.9 and 3.10) (table 3.6) or no, yes (table 3.11, etc)) It mean that ―hygiene practice‖ -What are No and Yes? H P -Table 3.11 and 3.12 are not clear What is ―Hygiene‖? it is ―Food hygiene practice‖ perhaps???; what are ―no‖ and ―yes‖? They are ―Poor‖ and ―Good‖ practice??? - The author needs check data presented in table 3.11 and 3.12 to ensure they are correct For example, data on knowledge presented in Table 3.11 are different from that in Table 3.7 U -Some table need to be rewrite the result especially the table of multiple logistic regression and check the value of 95% CI you mentioned about statistical significant H -Please check on table 3.12, p.57 and interpret the result Not duplicate for each table and present the data based on the objective like: knowledge level in The ―No‖ mean that, the respondents answer ―No‖ (n=122) and the ―Yes‖ mean that the respondents answer ―Yes‖ (n=75) (For example in the table 3.11, 3.12) -Aged ―14-39 year‖ No=59; Yes=40 ―40-60 year‖ No=62; Yes=35 Sump up: No=59+62=121 =(n=121) Yes=40+35=75= (n=75) - In some result, I rewrote and edited it -And reinterprets of result -The result, I have edited the contents in each tables - For multivariate, I revised and separated between group of hygiene practices where was relationship with independent -I have edited -each component good and bad -Influent factor: p 60-61:Explain more for multivariate analysis with model that used and explain p 63 -Objective need to clear compare with outcome Discuss Discussion chapter is too short and not clear More discussion, including comparison this study results with others (references), explains results, etc, but -For discussion, I improved of discussion and I followed by comment, such as General information of study subjects, Knowledge of food hygiene, Practice of 123 not repeat study results food hygiene and Factors related to knowledge and practices Structure of Discussion Chapter should be revised as follows: -For discussion, I improved of discussion and I followed by comment, such as General information of study subjects, Knowledge of food hygiene, Practice of food hygiene and Factors related to knowledge and practices and added new references General information of study subjects Knowledge of food hygiene Practice of food hygiene Factors related to K and P (this can be combined with section and accordingly) -Regarding discussion, I revised and improved the contents related to factors -Check the references and citation list - Reliability and validity for measurement need to put in discussion part, no need to discuss for Demo, but discuss by group of related factors subheading H P Practice of food vendor Conclusions -Conclusions must be clear and concise, providing with evidences from study results (present conclusions are very general and lack of evidences) U -Conclusion must be meet the two study objectives (review the study objectives) -The first paragraphs and section 5.1 should be deleted H -Factors related conclusion should be added -Conclusion, I improved and edited as General information of study subject, Street food vendors‘ knowledge on food hygiene, Practice on food hygiene and Socio-demographic characteristics and related factors on food hygiene -I changed almost of conclusion No more discussion, reference in conclusion - Conclusion move to result It is too long and bases on the objectives Recommendations -Rewrite accordingly to revised conclusion section -Recommendation must be based on the study results and provide clear and specific information about: what, who, how and when,… References As also recommendation, I edited and developed it 124 ……………………… Questionnaire ……………………………… Other comments …………………………………… Notes: - Use lines to separate each comments and explanations Comments and equivalent explanations stay at the same row Explanations should be written by following thesis structure (if any) Day 16 Month 8, 2019 Student H P (Sign and full name) 1st supervisor (Sign and full name) Prof La Ngoc Quang 2nd supervisor (Sign and full name) U Supporting lecture (if any) (Sign and full name) H Examiners’ comments (if any): ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Day month year On behalf of the committee (Sign and full name) Nguyen Thanh Huong