A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE, AND

PRACTICE REGARDING FOOD HYGIENE

AMONG STREET VENDORS IN

URBAN AREAS OF BIDAR.

By

G.JAYAPRADA

Synopsis submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Banglore.

In partial fulfillment of the requirements for the degree of

M.Sc Nursing in Community Health Nursing

Under the guidance of

MRS.VANITHA KULKARNI

Community Health Nursing,

Akkamahadevi College of Nursing, Bidar, Karnataka State,

2010 – 2011.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

G.JAYAPRADA1ST YEAR M. Sc NURSING AKKAMAHADEVI COLLEGE OF NURSING,BIDAR, KARNATAKA STATE

2 NAME OF THE INSTITUTION AKKAMAHADEVI COLLEGE OF NURSING,BIDAR, KARNATAKA STATE

3 COURSE OF THE STUDY AND SUBJECT 1st year M.Sc NURSING( Community Health Nursing)

4 DATE OF ADMISSION OF COURSE May 10 – 2010

5 TITLE OF THE STUDY

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE, AND PRACTICE REGARDING FOOD HYGIENE AMONG STREET VENDORS IN URBAN AREAS OF BIDAR.

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INDEX

SL.NO CONTENT PAGE NO.

6.

Brief resume of the intended work 6.1 Need for the study 6.2 Review of Literature6.3 Statement of the Problem 6.4 Objectives6.5 Hypothesis6.6 Operational definitions6.7 assumptions6.8 Delimitations6.9 Projected out come

4 – 78 – 12

13131414151515

7.

Materials and methods7.1. Sources of data7.1.1 Research design7.1.2 Setting 7.1.3 Population7.2 Method of data collection7.2.1 Sampling Procedure7.2.2 Sample Size7.2.3 Inclusion Criteria7.2.4 Exclusion Criteria7.2.5 Variables 7.2.6 Tools for the study7.2.7 Data collection method7.2.8 Data analysis and interpretation7.3 Does the study requires any 7.4 Has the ethical clearance obtained from your institution

161616161616171717171818181919

8. Bibliography 20 – 21

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BRIEF RESUME OF THE INTENDED WORK

6.1 Need for the study:

“We are what we eat"

Food is any substance or materials eaten or drunk to provide nutritional support

for the body or for pleasure. It usually consists of plant or animal origin, that contains

essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals, and is

ingested and assimilated by an organism to produce energy, stimulate growth, and

maintain life. Through centuries food has been recognized as important for human beings

in health and diseases. The history of man has been to a large extend struggle to obtain

food. the purposes of food are to promote growth, to supply force and heat, and to

furnish material to repair the waste which is constantly taking place in the body. Every

breath, every thought, every motion, wears out some portion of the delicate and

wonderful house in which we live1.

The word ‘Hygiene’ is derived from ‘Hygeia’ the Goddess of Health in Greek

mythology. It is the science of health and embraces all factors which contribute to

healthful living. Food hygiene is a broad term used to describe the preservation and

preparation of foods in a manner that ensures the food is safe for human consumption.

This process of kitchen safety includes proper storage of food items prior to use,

maintaining a clean environment when preparing the food, and making sure that all

serving dishes are clean and free of bacteria that could lead to some type of

contamination2.

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Food safety is a scientific discipline describing handling, preparation, and storage of

food in ways that prevent food borne illness. This includes a number of routines that

should be followed to avoid potentially severe health hazards. Food can

transmit disease from person to person as well as serve as a growth medium

for bacteria that can cause food poisoning. Food sanitation rests directly upon the state

of personal hygiene and the habit of personal working in the food establishments. Proper

handling of foods, use of clean utensils and dishes together with emphasis upon the

necessity for good personal hygiene are of great importance in street food industry3.

Food borne diseases remain responsible for high levels of morbidity and mortality in

the general population, but particularly for at-risk groups, such as infants and young,

children, the elderly and the immunocompromised. In order to reduce the incidence and

economic consequences of foodborne diseases, the WHO Department of Food Safety and

Zoonoses (FOS) has been assisting the States to establish and strengthen their

programme for assuring the safety of food from production to final consumption. In this

regard, WHO offers a unique capacity, through its commitment to health, to work

collaboratively with government, industry and consumers, to strengthen and better focus

national food safety efforts4.

The global incidence of food borne disease is difficult to estimate, but it has

been reported that in 2005 alone 1.8 million people died from diarrhoeal diseases. A great

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proportion of these cases can be attributed to contamination of food and drinking water.

Additionally, diarrhea is a major cause of malnutrition in infants and young children.

According to the centers for disease control & prevention (CDC) food born disease cause

an estimated 76 million illness,325000 hospitalization & 5200 deaths in US each

year .Not only are the symptoms uncomfortable,food born illness can lead to secondary

long term illness. For eg: there are some strains of E.coli that can cause kidney failure in

young children, while salmonella can lead to reactive arthritis &8 serious infections. For

pregnant women the listeria bacteria can cause meningitis & still births5.

Food borne illness is a major public health problem in the United States and globally.

Both the developed and developing countries suffer the consequences of food borne

illness, but to varying degrees. Recent U.S. estimates indicate that some 76 million

illnesses and 5,000 deaths are attributed annually to food borne illness. Among all

illnesses attributed to food borne causes, 30% are caused by bacteria, 3% by parasites,

and 67% by viruses6.

The incidence of food borne illness in developing countries is less well-understood than

in the U.S. Estimates issued by the World Health Organization (WHO)3 that diarrheal

disease caused by the consumption of contaminated food or water is the third leading

cause of death in the developing countries. Estimates for 1998 indicate that 2.2 million

deaths are attributable to diarrheal disease, of which 1.8 million occur in children less

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than 5 y of age. Overall, it is estimated that 1.5 billion cases of diarrheal disease occur

annually in children under 5 years of age (WHO1999)7.

The term "street food" refers to a wide variety of ready-to eat foods and beverages sold

and sometimes prepared, in public places. Street food may be consumed where it was

purchased or can be taken away and eaten elsewhere8.

The street food industry has an important role in the cities and towns of many developing

countries in meeting the food demands of the urban dwellers. It feeds millions of people

daily with a wide variety of foods that are relatively cheap and easily accessible. The

street food industry offers a significant amount of employment, often to people with little

education and training. Street food vendors are often unlicensed, untrained in food

hygiene and sanitation and work under crude unsanitary conditions. They are mainly

those who are unsuccessful or unable to get regular jobs. At present street vendors are

trained as irritants to urban planning and organization9.

It is observed that the street food vendors have poor practices regarding food hygiene.

Here the health education can play an important role to change their attitude and enhance

their practices.

According to studies done in Africa on street foods, their tremendous unlimited and

unregulated growth has placed a severe strain on city resources, such as water, sewage

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systems and interference with the city plans through congestion and littering adversely

affecting daily life. FAO further stipulates that street foods raise concern with respect to

their potential for serious food poisoning outbreaks due to improper use of additives, the

presence of adulterants and environmental contaminants and improper food handling

practices amongst street food vendors. Street food vendors are often unlicensed,

untrained in food hygiene and sanitation, and work under crude unsanitary conditions10.

6.2 Review of Literature

The reviewed literatures are presented under the following three main areas.

1. Knowledge of food handlers.

2. Practice of food handlers

3. Structured teaching programme on food hygiene.

1. Knowledge of food handlers.

A study on “Evaluate the food safety knowledge and practice of street food vendors.

Etbara city between March and April 2008. 50 samples were selected by random

sampling techniques, the written questionnaire used in this study is modified version of a

questionnaire from the U.S F.D.A (Food and drug administration). Findings of study

shows the respondents were 28% male 72% female, but 38% of them age 31-40 years and

28% of then were 21 – 30 years old, the educational level of 48% of respondents was

primary schools were as 42% were illiterate. Most of the surveyed people 64% were

married. The sanitary vendors represented 90% the most prevalent isolated bacteria from

cooked meals, bottled drink and fresh juice were E.coli, staphylococcus auerus and

streptococous bacilli. Health and personal hygiene practices of street vendors positively

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responded for prevention of food born diseases 94%, 96% were responded hand washing

is required and 98% were responded reason for hand washing after eating meals.

Researcher felt that routine medical examination of food handlers must be carried out by

medical personal towards regulating safe street food handling preparation and vending11.

A study on evaluation of F.H know attitude and practices of F.H in food business in

turkey in the year 2004. information uptaine from the sample with the help of structured

interview method. A total no.of samples were participated in study 764 food handlers

9.6% were involved in distributing on wrap food routinely and use protective gloves

during their working activity. A majority of participants (47.8%) had not taken basic

food safely education the mean safety food knowledge score was 43.4± 6.3%. study

shows that food handlers are having lack of knowledge regarding basi food hygiene12.

A study on food safety knowledge and practices of street food vendors in Khartoom city

between March and May 2008. Sample size was 50, information obtained from the

samples by structured questionnaire, questionnaire was prepared on health and personal

hygiene knowledge of vendors and food hygiene and knowledge of food born diseases.

Results shows that respondents were 50% males and 50% were females, respectively

38% in 21 – 30% of age group and 8 was ≤ 20 of age only 44% respondents had non

formal education while 46% had al least primary school education. 50% of street food

vendors are married while 44% were singled. 66% of vendors surveyed were stationary

34% were mobile. Only 52% respondents had health certificate to indicate that they had

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carried out annual medical checkup while 48% could not present their health certificate.

Few 4% of the vendors acquired their knowledge by formal training while majority of

them acquired through observation, about 73% of vendors had no knowledge need to

wash hands after handling money, very few 14% vendors were aware of that it is

necessary to wash their hand even when hand kerchief was used for sneezing, less than

46% of respondents felt that use of soap is always not necessary for hand washing, but

86% said that use of clean water when washing their hand. It shows that street vendors

had lack of knowledge and the practice regarding food hygiene and food born diseases13.

2. Practice of food handlers

A study on food safety and hygienic practices at street food vendors in owerri, Ngira.

Data collection was down with help of structured interviews, semi structured

questionnaires as well as through observations. A descriptive survey design was used.

Results shows that 23.81% of the vendors prepared food in on hygienic conditions,

42.86% did not use aprons, 47.62% handled food with bare hands and 52.38% wore no

hair coverings while 61-90% handled money while serving food. 19.05% wore jewellery

while serving foods and 28.57% blew air into polythene bag before use. 9.52% of the

vendors stored food for serving openly in the stalls while 23.81% stored then in the wheel

barrows. 42.86% had left overs for serving the next day with poor storage facilities.

47.62% of the vendors washed their utensils with dirty water which is recycled and used

severally in 28.57% despite the fact that only 9.52% of them complained of water

shortages. There researcher recommends that there is need for health education of those

vendors in order to ensure food safety for the consumers14.

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A study on Hygiene and sanitary practices of vendors of street foods in Nairobia,

KENYA. The accessible population was all street food vendors from Dandora and

Kayole estates. Data collection was done by using in depth interview schedule and

observational checklist. Data was analyzed using both descriptive and inferential

statistics. It is used to present the findings and also used to test the relationship between

the variables (demographic variables) Results shows that 35% of vendors of belongs to

20-25% 60% were males while 40% were females. Slightly over half of vendors (57.5%)

were married. 62% of vendors were primary education and below, 36.3% had secondary

education while only 1.3% had college education. Most 61% vendors acquired cooking

principles by observation 33.3% were taught by parents while 6.3% gained by trial and

error. Based on observation about 85% of vendors prepared their foods in unhygienic

conditions given that garbage and dirty waste were consciously close to the stalls, about

92.5% did not have garbage receptacles, hence they dispose their waste just near the

stalls. 92% of vendors through waste water just beside the stalls making the environment

surrounding the eaters quite fitting. Hence there is a significant P value > 0.5 indicating

that here was no relation between education and state of environment15.

A study on “Hygienic practices by vendors of the street food “doubles” and public

perception of vending practices in Trinidad”. A structured questionnaire was

administered to 120 street vendors and 115 public members in Trinidad, West Indies.

Most vendors are male (61.7%), had been vending for 5 years (81.7%) and received

primary level of education (72.5%). Preparation of doubles was mainly by family

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(84.2%) in the morning of vending (81.7%). Vendors were appropriately dressed

(99.2%), used forks/spoons (100%) and tongs (81.7%) for serving. At vending sites,

containers with faucets supplied water (85.7%) and toilets were not close (97.5%). Most

respondents (86.1%) consumed doubles. Some (30.6%) felt ill from eating doubles, but

only 2.7% reported to a medical doctor/health authority. Significant associations were

found for vending practices and sanitation of vending environment16.

3. Structured teaching programme on food hygiene.

A study on “A study about the impact of nutrition education and awareness of food safety

among women self help group members: Data was collected from 150 respondents by

random sampling method. A structured questionnaire was used to obtain the data. The

respondents were divided into control (75) as well as experimental group (75), Food

safely education were imparted to experimental groups. The results of the study shows

there is lack of awareness amongst the self help groups women involving in food

processing trade. So educational materials need to emphasize safe food handling

practices17.

A study on effect of structured teaching programme on knowledge and practices

related to hand washing technique among food handlers. The study was conducted in the

mess of Christian Medical College and Hospital, Ludhiana (Punjab). The main findings

of the study were Pretest mean knowledge scores were found to be 43.7% and post test

mean knowledge score was 83.1% and that of mean hand washing practice score, found

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49.3% in pretest and 92% in post test. There was no significant relationship found

between knowledge and practices with the variables like age, education, experience etc.

The above findings indicate that food handlers had poor knowledge and hand washing

practices, and structured teaching had been significantly effective increasing their

knowledge and practice scores. She concluded her studies with the recommendation, that

is, to have inservice training to the food handlers, which should be given regularly and

reinforced in working area18.

6.3 Statement of the problem

A study to evaluate the effectiveness of structured teaching programme on knowledge

and practice regarding food hygiene among street vendors in urban areas of Bidar.

6.4 Objectives of the study

The objectives of the study are:

1. To assess the existing knowledge level of street vendors regarding food hygiene.

2. To evaluate the prevailing practices of street vendors regarding food hygiene.

3. To determine the effectiveness of planned teaching programme on food hygiene.

4. To find out the association between the pre test score with the selective

demographic variables.

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6.5 Hypothesis

H1: The mean post test knowledge and practice scores of street vendors on food hygiene

will be significantly higher than the mean pre test knowledge and practice scores after the

structured teaching programme at 0.05 level of significance.

6.6 Operational Definitions

Assess

It refers to assessment of knowledge level of street venders regarding food hygiene.

Knowledge:

It refers to information and skills gained through experience or education. In this study,

it refers to the street vendor’s knowledge on food hygiene as is evident from knowledge

questionnaire.

Practice:

It refers to the way of doing something usually or regularly. In this study practice refers

to the practice of street vendors with regard to food hygiene.

Structured Teaching programme

It refers to systematically developed instructions designed to provide information to

street vendors on food hygiene.

Street vendors:

Street food vendor is defined as anybody selling ready-to-eat foods or drinks in streets

and public places within the area of study.

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Food Hygiene

It implies hygiene in production handling, distribution and serving of all types of food.

6.7 Assumptions

Assumptions underlying the study are:

1. Street vendors will have some knowledge regarding food hygiene

2. Street vendors will have a potential to learn more about food hygiene

3. Street vendors will be willing to express their knowledge, and practice regarding

food hygiene

4. Group teaching will provide opportunity for active learning among the

participants.

5. The knowledge gained will modify the practices of the street vendors in their

work.

6.8 Delimitations

1. The study is delimited to street vendors residing in the selected areas of Bidar.

2. The street vendors who are willing to participate during data collection.

3. Assessment of knowledge and practice is limited to the written responses.

6.9 Projected outcome

The findings of this study will help the street vendors to gain adequate knowledge and

practice on food hygiene. The teaching programme will help the health care providers to

understand the existing level of knowledge and practice on food hygiene among the street

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vendors in urban areas of Bangalore. The findings will help to develop appropriate

material to improve the knowledge and practices regarding food hygiene.

7. MATERIALS AND METHODS

7.1. Source of Data

Data will be collected from the urban area population of Bidar.

7.1.1 Research design

Research design adopted for the present study is pre-experimental, one group pre

test- post test design.

K1 P1 X K2 P2

7.1.2 Setting of the study

Setting of the study will be the selected urban areas of Bidar.

7.1.3 Population

People who are residing in urban areas of Bidar

7.2 Method of data collection

7.2.1 Sampling procedure

Sampling procedure used in this study is Simple random sampling

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7.2.2 Sample size

The proposed sample size of the study is 60 Street Vendors

7.2.3. Inclusion criteria

1. Who are residing in Bangalore urban area.

2. Who are able to understand and speak Kannada

7.2.4. Exclusion criteria

1. Who can not read and write Kannada

2. Those who are not willing to participate in the study

7.2.5 Variables

Independent variables:

The independent variable is the condition manipulated by the researcher. In this study

the independent variable is the effectiveness of structured teaching programme on food

hygiene.

Dependent Variables:

The dependent variable is the condition that appears or disappears as a result of an

independent variable.

The dependent variables in this study are knowledge, and practice of street vendors

regarding food hygiene.

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7.2.6 Tool for the study

Tool for data collection in the study is

1. Base line proforma. It includes five items on demographic variables such as age,

religion, education, income ,and family type

2. Structured questionnaire. It consists of twenty knowledge items and twenty

practice items. (Multiple choise type). Each item had one or more correct

responses. A score of one was assign to each correct response and zero was assign

to each wrong answer. The total score of questioner was 40. those who scored 30

were consider as having adequate knowledge and practice skills, and 30 and

below 30 were consider as having inadequate knowledge and practice skills.

7.2.7 Data for collection

The data will be collected from the prescribed time period from the selected

population residing in urban areas of Bidar. Permission will be obtained from higher

authorities. Purpose of the study will be explained to the respondents. Pre test will be

conducted using baseline proforma and structured questionnaire. Subsequently planned

teaching programme will be given on the day. On the seventh day post test will be

conducted to evaluate the effectiveness of structured teaching programme in terms of

improving knowledge and practice skills in food hygiene.

7.2.8 Data analysis and interpretation

In this study descriptive and inferential statistics will be used.

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Knowledge and practice will be completed using frequency and percentage distribution.

Effectiveness is assessed using “t” test.

Association will be assessed using chi-square test.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF

SO PLEASE DESCRIBE BRIEFLY

Yes, the study will conducted on urban population of Bangalore.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM POPULATION?

Yes, informed consent will be obtained from the subjects, privacy, confidentiality and

anonymity will be guarded, scientific objectivity of the study will be maintained with

honesty and impartiality.

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3. Satin, M, Food Alert the ultimate source for food safety facts on file. Sep – 2008.

4. WWW.Google.com/Food born diseases.

5. “Herald of Health” Family magazine for vibrant living Aug 2008.

6. WWW. Google.com/Food born illness.

7. WWW.who int/Food born diseases

8. WWW.Google.com/street food.

9. FAO, street foods, FAO, Rome 1997, 1 – 14.

10. African journal of food agriculture mutiriton and development (AJFAND) volume

.5, 2005.

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14. Comfort O.Chukuez studies in sociology of science, vol – 1, 2010, PP 50 – 57

15. Onesmus Kilongu muinde, African journal of food agriculture nutrition and

development, vol – 5, 2005

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16. Chandra Benny – Ollivierra, “Hygeienic practices by vendors of the street food

doubles and the public perception of these practices, 18 January 2007.

17. B.Gowri, Dr.K.P.Vasantha devi, “A study about the impact of nutrition education

and awareness of food safety among self help group members.

18. M.S.Sunitha Christian Medical College and hospital, “A study on effect of

structured teaching programme on knowledge and practices related to hand

washing techniques among food handlers’ 2004.

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