Food safety profile of street food vending units in Chennai, Tamil Nadu: A cross-sectional study

Operational definitions

“Street vended foods/street foods” are defined as foods and beverages prepared and/or sold by vendors In streets and other public places for immediate consumption at a later time without further processing or preparation. It includes fresh fruits and vegetables which are sold outside authorized market areas for immediate consumption.^[6]

Food handler: any person who handles food regardless of whether he actually prepares or serves it.^[6]

Statistical analysis:

The data was entered in Microsoft Office Excel 2007 and statistical analysis was performed using Statistical Package for Social Sciences version 23. Categorical data was expressed as frequencies and percentages. Continuous variables were summarised as mean and standard deviation (SD). Chi square test and student t-test were used for statistical analysis of categorical and continuous variables respectively. A P-value of 0.05 was considered significant.

Sociodemographic characteristics

Two hundred street-food units participated in the study. Sixty two percent respondents were aged between 26 to 45 years. Similar predominance of age group 25 to 45 years (63%) was reported by Thakur et al in their study among street-food vendors in Delhi.^[9] The similar age distribution among Indian studies reflect the importance of street-food sector as source of livelihood for the most productive age group. Males constituted 71% of our study population. The gender distribution varies from similar studies by Isara et al and Muyanja et al.^[10,11] One fourth of our participants (26.5%) had never had formal education. Thakur et al and Donkor et al have reported similar trend from Delhi and Ghana respectively.^[9,12] This distribution has implications on the greater need to create awareness among street food handlers. Since these units are usually run by individuals or by families, educational status of respondents plays an important role in ensuring food safety measures.

Professional characteristics of respondents

More than half respondents of our study were employed as cooks, while rest were employed as helpers, waiters or sellers. This reflects the fact that most units are run by one or two persons who do multi-tasking. None of the participants in our study had any formal training or approved licence. Our findings contrast that reported by Okojie et al in Nigeria, where 28.7% of the respondents employed in street-food sector had undergone food safety training.^[13] Thakur et al and Mudey et al have also reported that none of the food establishments in their studies had been registered or have valid licence.^[9,14] Only 4.2% participants had undergone food handlers training in a similar study in Northwest Ethiopia.^[15] A slightly higher proportion was reported by Zain et al in Malaysia, though more than 50% had no formal training or valid licence.^[16] But Zain et al had included all types of food establishments and food stalls accounted for only 53.8%. Such comparable distribution among above studies highlights the informal nature of most food establishments in developing countries.

Food business characteristics

In our study 34.5% of food stalls sold fried food items followed by fruits and vegetables (23%) and meat and fish (21%). Thakur et al also reports that majority of establishments studied, supplied fried food items followed by meat-based snacks.^[9] This differs from the distribution In Dhaka by Khairuzzaman et al, where fruits and vegetable-based food stalls were preponderant.^[12] Most units supplied more than one type of foods in all the above studies.

In our study, less than 50% of street-food units had fixed stalls. Khalruzzaman et al reported a different picture from Bangladesh where majority were fixed stalls.^[17] Only 11% of the establishments was registered and 8.5% of the food handlers had access to social security. The findings resemble those reported by Mudey et al in Wardha and Thakur et al in Delhi.^[9,14] The comparable findings reveal gross underrepresentation of street-food units and need for regulatory measures.

In our study, 38% units operated full-time and 28% units, cooked-on-site. In Thakur et al's study in Delhi, 95% units operated full-time and almost twice the number of units, cooked-on-site revealing a well established street-food sector.^[9]

Knowledge about foodborne diseases among food handlers

In our study only 73% participants had ever heard about foodborne diseases. The overall knowledge on foodborne diseases was less compared to similar studies in Malaysia and Northwest Ethiopia.^[15,16] Among those who were aware about foodborne diseases, one-fourth had no idea about mode of transmission (26.5%). Though 95% respondents thought foodborne diseases are preventable, only 71% were aware about preventive measures. Fifteen percent of respondents opined that raw and cooked foods could be stored together. All respondents had adequate awareness on etiology and symptoms of foodborne diseases. The participants had limited idea on direct causes of foodborne diseases which varies greatly from the findings reported by Donkor et al where 98.4% had knowledge on pathogens and faeco-oral transmissions.^[12] Tessema et al in Northwest Ethiopia, also reported that 88.9% respondents were aware about foodborne diseases, albeit only 32.4% had good knowledge.^[13] In Zain et al's study knowledge regarding modes of transmission and preventive measures was higher compared to etiology and symptoms.^[16] This varying pattern of responses could be due to diversity of study units in the above studies.

Awareness on foodborne diseases was significantly associated with age distribution and educational status of participants. Similar statistically significant relationship between educational status and knowledge was also reported by Zain et al.^[16] Awareness about foodborne diseases had a significant influence on mean score of personal habits and hygiene. Tessema et al have also reported significant association between knowledge about foodborne diseases and food handling practices in Northwest Ethiopia.^[15]

Environmental characteristics of street-food units

In our study, 65% of street-food units had clean neighbourhood and 59.5% had hand washing facilities. This differs from findings reported by Okojie et al in Nigeria where 90.5% of street-food units had clean premises and 70% had exclusive hand-washing facilities.^[13] Khairuzzaman et al in Bangladesh reported that only 22% of street food units had hand washing facilities.^[17]

In our study 80.5% and 61% of the food units had their own safe water source for cooking and washing purposes respectively. Although unsatisfactory, the figures are higher compared to that reported by Thakur et al in Delhi (7%) and Khairuzzaman et al in Bangladesh (22%).^[9,17]

About half of the street-food units studied had exclusive solid waste disposal facility which is marginally higher than that reported by Okojie et al (43.2%) and Khairuzzaman et al (47%) and 44% had liquid waste disposal facility.^[13,17] The proportion of study units which used closed lid bins for solid waste disposal (10.5%) was similar to that reported by Thakur et al (11%).^[9] While 10% of our study units practised open waste disposal, the proportion reported by Thakur et al was much higher (17%).^[9] In our study 59% units had fly and insect breeding in the premises which is much higher than that reported by Okojie et al (41.3%).^[13] Our study records suboptimal environmental hygiene standards in most study units. Donkor et al study from Ghana reports satisfactory environmental hygiene in more than three-fourths of units.^[12]

In our study, about one-fifth of street-food units had refrigeration facilities, whereas in the study by Khairuzzaman et al in Bangladesh, none of the units had refrigeration facilities.^[17]

More than 75% of our study units did not have access to sanitary toilets. Among the rest, 20% used public facilities. This disproportionate access to sanitary toilet facilities was similar to findings by Khairuzzaman et al in Bangladesh.^[17]

Personal habits and Personal hygiene of food handlers

In the present study, only 13% had undergone any routine medical examination in the past one year. In Zain et al study in Malaysia, 61.9% had undergone routine medical examinations and 59.6% were immunised with Typhoid vaccine.^[16] But Zain et al had included diverse food establishments. Hence the difference points to the state of disadvantage of street food sector.

The proportion of participants who adopted personal protective measures in our study was lower compared to that reported by Okojie et al.^[13] Only 35% of the participants wore aprons; 9% wore head cover, 74% wore jewellery while serving, 51% had clean, trimmed nails and 5.5% wore clean gloves while serving. Okojie et al in their study conducted among street food vendors in Nigeria, reveal improved personal hygiene practices, where 84.6% wore apron; 98.6% wore hair cover and more than 90% had trimmed nails and did not wear jewellery.^[13] In Thakur et al study from Delhi, a significant proportion had neat, trimmed nails.^[9] But other personal hygiene measures such as wearing apron, head cover and gloves, washing hands were practised by less than 5% of participants.^[9] These comparable trends related to inadequate personal hygiene practices among street food sector employees in India is an issue of great public health concern and point to a pressing need for regulatory measures. While more than 50% participants reported washing their hands before cooking, only 34.5% participants reported washing their hands with soap and water before cooking. An approximate 30% of study population accepted not washing their hands with soap and water after using rest rooms which is much higher than that reported by Donkor et al among vendorsin Ghana (86.6%).^[12]

The present study reveals significant association between age distribution and duration of employment with personal habits and hygiene score. Udgiri et al and Mudey et al has reported a statistically significant association between educational status and hygiene score.^[14,18] Participants with 5 to 15 years of experience had better personal hygiene scores and this relationship was statistically significant.

Work surface characteristics

In the present study, about three-fourths of food units stored ready-to-eat food in clean and covered containers. Only 66% units stored raw and cooked foods separately despite 84.9% respondents being aware of the need to store raw and cooked foods separately. This indicates that the existing knowledge had not transformed into right behaviour. Okojie et al reported that 94.4% of study units stored their foods in covered container.^[13] Donkor et al in their study reported that only 27% of the food stalls stored raw and cooked food separately at all times.^[12] An approximate 25% units in our study did not store their cooking and storing utensils clean and separate. More than 50% of the units used plastic containers and plates, the quality and disposal of which is an issue of great concern. Twenty percent units used metal containers which require thorough washing, an activity which is questionable under circumstances observed. Eco-friendly materials like paper plates and plantain leaves were used by 28% units, which was encouraging.

Our study was conducted among street-food units spread over 3 divisions and 15 zones of Chennai Corporation and hence could be representative of street-food sector in most urban areas of India. This is one of the few studies which explore safety profile of street-food sector in India and the first in Tamil Nadu. We have attempted a comprehensive appraisal of food safety with assessment of knowledge on foodborne diseases; individual hygiene practices and environmental safety characteristics. There are pronounced similarities with other Indian studies on street food sector, with regard to underrepresentation in aspects of registration and access to social security, inadequate knowledge on foodborne diseases, poor individual hygiene and environmental safety practices. The findings are comparable with those reported in Bangladesh and North West Ethiopia, emphasising the need for active and sustained measures to upgrade street-food sector in developing world.^[15,17] However Okojie et al report better food handling practices and environmental sanitation in Benin City, Nigeria.^[13] Donkor et al reports significant improvement in food handling practices, personal and environmental hygiene following a training programme on WHO keys for Safer food.^[12]

The study has few limitations. Physical examination and laboratory investigations to rule out infections and other diseases among participants and microbiological sampling of work surface would have added value to the study, but were not carried out due to logistic and financial constraints.

Considering the increasing contribution of street-food sector to accessible and affordable food, there is a necessity for coordinated efforts from all stakeholders including the Government, local administrative authorities, food unit owners, food handlers and general public. Organised training sessions for all categories of food handlers is the need of the hour. Training and educational sessions should be followed by mandatory refresher courses and regulatory measures.

Sources of support:

Nil