Food safety knowledge, attitudes and practices of street food...

Accepted Manuscript

Food safety knowledge, attitudes and practices of street food vendors and consumersin Port-au-Prince, Haiti

S. Samapundo, R. Climat, R. Xhaferi, F. Devlieghere

PII: S0956-7135(14)00516-7

DOI: 10.1016/j.foodcont.2014.09.010

Reference: JFCO 4059

To appear in: Food Control

Received Date: 3 June 2014

Revised Date: 4 September 2014

Accepted Date: 9 September 2014

Please cite this article as: Samapundo S., Climat R., Xhaferi R. & Devlieghere F., Food safetyknowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti, FoodControl (2014), doi: 10.1016/j.foodcont.2014.09.010.

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http://dx.doi.org/10.1016/j.foodcont.2014.09.010

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Food safety knowledge, attitudes and practices of street food vendors and 1

consumers in Port-au-Prince, Haiti 2

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Samapundo, S.a*, Climat, R.a, Xhaferi, R.a, Devlieghere, F.a 4

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a Laboratory of Food Microbiology and Food Preservation, Department of Food Safety and 6

Food Quality, Faculty of Bioscience Engineering, Ghent University, Member of Food2Know, 7

Coupure Links 653, 9000 Gent, Belgium 8

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* Corresponding author. Simbarashe Samapundo - Tel.: ++ 32 9 264 9902. Fax: ++ 32 9 225 10

5510. E-mail: [email protected] 11

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Running title: Food safety knowledge, attitudes and practices in Haiti 14

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Abstract 25

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This study had the major objective of determining the food safety knowledge, attitudes and 27

practices of vendors and consumers of street food in Port-au-Prince, Haiti. Haiti currently has 28

no food safety legislation in place. 160 consumers and 80 vendors from four different 29

communes (Tabarre, Delmas, Pétion-ville and downtown Port-au-Prince) volunteered to 30

participate in the study. In general, consumers and vendors exhibited average food safety 31

knowledge and attitude levels. Gender, training, level of education and location did not have a 32

significant effect (p < 0.05) on the level of food safety knowledge of the consumers. Vendors 33

were determined to have higher levels of food safety knowledge than consumers, whilst 34

trained vendors had better food safety knowledge and attitudes compared to untrained 35

vendors. The majority of vendors and consumers were aware of the importance of washing 36

hands and proper cleaning with regards to the prevention of foodborne diseases. However, 37

some other aspects were of concern. Consumers and vendors did not know that Hepatitis A, 38

Salmonella spp. and Staphylococcus spp. are pathogens responsible of foodborne diseases. 39

They also had difficulties in identifying the groups at risk of foodborne diseases and most 40

were unaware of the importance of reheating food to fight against foodborne diseases. In the 41

observational part of the study, it was found that in 60% of the cases, flies and animals were 42

evident around the stall and 65% did not have access to potable water. The majority served 43

food with bare hands and did not wash their hands after handling money. Additionally, 70% 44

of the vendors did not chill pre-cooked food. The conditions in which street food vendors 45

operate in Port-au-Prince are largely unacceptable from a food safety point of view and an 46

effort should be made to provide them with adequate infrastructure including potable water, 47

toilets and waste disposal facilities. The results of this study should be used to generate part of 48

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the impetus towards the development of enforcement of appropriate food safety legislation in 49

Haiti. 50

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Keywords: food safety knowledge, street food, vendors, consumers, Haiti 52

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1 Introduction 74

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Street foods are defined as ready-to-eat (RTE) food and beverages prepared and/or sold by 76

vendors and handlers especially in streets and similar public places (FAO, 2013) for 77

immediate consumption or consumption at a later stage without further processing or 78

preparation. Street foods are largely appreciated for their flavours, convenience, low cost and 79

their cultural and social heritage links (Aluko, Ojeremi, Olakele, & Ajidagba, 2014; 80

Chukuezi, 2010; da Silva et al. 2014; Ekanem, 1998). Street foods represent a significant 81

portion of the diet of many inhabitants in many major cities (Ag Bendech, Tefft, Seki, & 82

Nicolo, 2013; FAO, 2010; Suneetha, Manjula, & Depur, 2011). An estimated 2.5 billion 83

people world-wide consume street food each day. In Latin America street food accounts for 84

up to 30% of urban household purchases (FAO, 2007). 85

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Many countries have experienced a change in their socio-economic status during the past few 87

decades. These changes have in part led to a significant growth in the popularity of street 88

foods (Chukuezi, 2010; Omemu & Aderoju, 2008). As urban populations are growing, 89

especially in developing countries, it is expected that the street-vended foods sector will 90

continue to expand. Although street vended foods are very common in third world and 91

developing countries such as Haiti, there is paucity in data and studies regarding the safety of 92

these foods. However, it has been recognized that the conditions under which street vendors 93

operate are often unacceptable for the purposes of preparing and selling of food (Aluko et al. 94

2014; da Silva et al. 2014; Hanashiro, Morita, Matté, Matté, & Torres, 2005; Muyanja, 95

Nayiga, Namugumya, & Nasinyama, 2011; Sharma & Mazumdar, 2014). Street food vendors 96

are very often poor, uneducated and show little concern towards the safe handling of foods 97

(Lues, Mpeli, Venter, & Theron, 2006; Mensah, Yeboah-Manu, Owusu-Darko, & Ablordey, 98

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2002; WHO, 1996). Consequently, some serious concerns do exist about the safety of street 99

food (FAO, 2013; Muinde & Kuria, 2005; Rheinländer et al. 2008). The concerns have been 100

realized as street-vended foods have dually been implicated in outbreaks of foodborne 101

illnesses all around the world (Aluko et al. 2014; Bryan et al. 1992; Dawson & Canet, 1991). 102

In 1988, 14 deaths were reported in Perek (Malaysia) because of foodborne diseases related to 103

street foods whilst 300 persons became ill in Hong Kong after consumption of street vended 104

foods (FAO, 1990). Associations have been established between the purchasing street food 105

and foodborne illness; in particular Salmonella infections (Vollard et al. 2004). By means of 106

Quantitative Microbial Risk Assessment (QMRA), Barker, Amoah, & Drechsel (2014) 107

recently demonstrated that significant interventions are required to protect the health and 108

safety of street food consumers in Kumasi, Ghana. 109

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In different studies conducted to assess the food safety knowledge and attitudes of street food 111

vendors, it has been observed that street food vendors generally have poor levels of food 112

safety knowledge (FAO, 2013; Rane, 2011). Demographic characteristics such as age and 113

gender do not appear to play a role in food safety knowledge of street food vendors (Annor & 114

Baiden, 2011; Soares, Almeida, Cerqueira, Carvalho, & Nunes, 2012). Contrasting results 115

have been reported on the relationship between the level of educational of street food vendors 116

and their food safety knowledge. Soares et al. (2012) reported that a positive correlation 117

occurred between the educational level and food safety knowledge of vendors whilst Annor 118

and Baiden (2011) did not find any significant effect of educational level on the food safety 119

knowledge. Additionally, whilst some studies have found a significant correlation between the 120

level of food safety knowledge and the food safety attitude (Cuprasitrut, Srisorrachatr, & 121

Malai, 2011) others have not reported no correlation between the two (Omemu & Aderoju, 122

2008). 123

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To date, the food knowledge safety, attitudes and practices of food handlers (including street 125

food vendors) in several countries has been reported in several studies i.e. in Turkey (Bas, 126

Ersun, & Divan, 2006), Bangkok, Thailand (Cuprasitrut et al. 2011), Shijiazhuang City, China 127

(Liu, Zhang, & Zhang, 2014), and Santos City, Brazil (da Cunha, Stedefeldt, & de Rosso, 128

2014). The food knowledge safety and attitudes of consumers have been reported to a lesser 129

extent. Unlike the countries evaluated in studies performed to date, Haiti presents a peculiar 130

and unique case in that it has no food safety legislation. Grandesso et al. (2014) recently 131

evaluated the risk factors for cholera transmission in Haiti during inter-peak periods. They 132

determined that eating street foods and washing disease with untreated water were significant 133

risk factors. Grandesso et al. (2014) also determined that (insufficient) essential hygiene 134

practices are an important issue to tackle in Haiti. The major objective of this study was to 135

establish the levels of food safety knowledge, attitudes and practices of the vendors and 136

consumers of street food in Haiti. The results of this study could potentially provide part of 137

the impetus for development and enforcement of legislation regulating the quality and safety 138

of street foods in Haiti. 139

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2 Materials and methods 149

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The study was conducted in the capital city of Haiti, Port-au-Prince from July 2012 to 151

September 2012. Four communes - Tabarre, Delmas, Pétion-ville and downtown Port-au-152

Prince - were selected for the survey. 80 street vendors, 160 consumers and 20 street food 153

vending stalls were involved in the survey. The numbers of street vendors, consumers and 154

vending stalls were evenly distributed between the four communes. Structured written 155

questionnaires were used to assess the food safety knowledge and attitudes of the consumers 156

and vendors whereas a check list was used to evaluate the food handling practices of the street 157

vendors. 158

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2.1.1 Food safety knowledge and attitude questionnaire 160

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The questionnaire used to assess the food safety knowledge and attitudes of the street food 162

vendors and consumers was adopted from Angelillo, Viggiani, Greco, and Rito (2001), 163

Bolton, Meally, Blair, Mcdowell, and Cowan (2008) and Ansari-Lari, Soodbakhsh, and 164

Lakzadeh (2010). These can be seen in Tables 7 to 10. The questionnaire was first translated 165

to French and a pilot test was conducted using twenty people in Tabarre, one of the selected 166

communes. Based on the comments of the respondents, very slight changes were made before 167

adoption of the final version. The questionnaire was organized into three main sections i) 168

demographic information ii) food safety knowledge and iii) food safety attitudes. It was filled 169

in either by the participants themselves or by the researcher for illiterate participants. 170

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The demographic section contained information regarding gender, age, educational level and 172

training in food safety. The food safety knowledge section was designed to assess the 173

awareness of the vendors and consumers to food poisoning pathogens, food and personal 174

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hygiene, high risk groups, proper cleaning etc. This section contained 18 questions with 3 175

possible answers – ‘yes’, ‘no’ and ‘do not know’. Each correct answer considered as one point 176

whilst no marks were awarded for incorrect answers or when the respondent indicated that 177

they did not know the answer. The score was then converted to 100 on a basis of maximum 178

possible score of 18 points. A score less than 50 (9 points) was considered as indicating poor 179

food safety knowledge. Scores between 50 to 75 were considered as indicating average 180

(adequate) food safety knowledge, whilst scores >75% were considered as indicating good 181

food safety knowledge. The food safety attitude section was designed to determine the 182

understanding of consumers and vendors about various food safety aspects. This section 183

contained 16 questions with three possible answers as described above. The scoring system 184

described above was also used for evaluation of the food safety attitudes. 185

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For selection of the consumers, the researcher frequented markets, schools, parks and highly 187

frequented streets and areas in each of the four communes. All persons from 15 years and 188

older were randomly approached and asked to voluntarily participate in the study. The 189

purpose of the study was fully elaborated to the potential participants after which they were 190

asked to sign an informed ethical consent form before they completed the questionnaire. The 191

study was stopped in each commune when 40 consumers had completed the questionnaire, 192

giving a total of 160 respondents. Vendors operating around markets, schools, bus stations, 193

highly frequented streets and areas in each commune were randomly approached and asked to 194

voluntarily participate in the study. As with the customers the purpose of the study was fully 195

elaborated to the potential participants after which they were asked to sign an informed ethical 196

consent form before they completed the questionnaire. The study was stopped in each 197

commune when 20 vendors had completed the questionnaire, giving a total of 80 respondents. 198

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2.1.2 Food handling observation checklist 200

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A checklist was used to assess the food safety practices of street foods vendors. The checklist 202

(see Table 12) was a combination of different checklists used in previous studies by Chukuezi 203

(2010) and Muinde and Kuria (2005). Demographic data such as age, sex, location, 204

educational level and food safety training were also registered. The checklist contained five 205

main sections i) information on facilities ii) the environment around the stall iii) personal 206

hygiene iv) food storage facilities at vending site and v) the maintenance and cleaning of 207

utensils. Absence or presence of each component of the checklist was recorded. 208

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The selection of participants for this part of the study was based on the same methodology as 210

for the selection of vendors for the food safety and attitude questionnaire. The objectives of 211

the study were first explained to the vendor. When the vendor volunteered to participate an 212

informed consent form based on ethical norms describing all the different components of the 213

study was provided and signed by each participant prior to the observation. 20 vending stalls 214

(five per commune) were observed. 215

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2.2 Data entry and statistical analysis 217

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The data obtained from the questionnaires and the observation checklists were labelled in Epi 219

Info 7 (CDC, US) after which it was exported to Microsoft Excel version 2013 (Microsoft, 220

Redmond, WA, U.S.A.) where the scores were computed. The data set was then exported 221

from Excel to Spotfire S+ 8_2 (TIBCO Spotfire, Boston, MA, US) for further statistical 222

analysis. Prior to analysis, the age and score parameters were split into different categories. 223

For descriptive analysis of the age, cut-off points of 25, 35, 45, 55 and 60 years were used. 224

Comparisons between different age groups were, however, limited to two groups - ≤ 30 years 225

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and > 30 years – due to the small sample size. For comparisons of the scores, cut-off points of 226

<50, 50-75, and >75 were used. 227

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Descriptive analysis (computation of the means, standard deviation, and range of the age, and 229

scores according to age, education, location, sex and training) was performed in Spotfire S+ 230

8_2. Comparison of the scores on the basis of gender, age, food safety training and location 231

was performed as follows. Two sample t-Tests were used for comparison of 2-sample data 232

sets such as those for gender, food safety training status and age. Comparison of more than 233

two groups was done by means of fixed effects ANOVA in Spotfire S+ 8_2. Normality was 234

checked by the use of QQ plots and the Kolmogorov-Smirnov Test. Equality of variances was 235

assessed by used of the modified Levene test whilst the normality of residuals was checked by 236

means of QQ plots and the Kolmogorov-Smirnov Test. For samples that were not normally 237

distributed and with a sample size less than 30, analysis was done by the non-parametric 238

Wilcoxon rank-sum test for two sample data sets such as those for gender, food safety training 239

status etc. and Kruskal-Wallis rank sum test was used for data sets with more than two 240

categories such as location (commune) and educational level. Statistical differences were 241

based on an α = 0.05. 242

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3 Results and discussion 251

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3.1 Demographic characteristics 253

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The demographic characteristics of the 160 consumers who participated in this study are 255

shown in Table 1. 60 (37.5%) were female and 100 (62.5%) were male. The mean age of the 256

participants was 29.6 ± 11.3 years, and ages ranged from 15 to 74 years. 91% of the 257

consumers were between 15 and 45 years of age. With regards to the level of education 258

attained, almost a quarter (24%) of the consumers did not have a secondary school education. 259

The majority (76%) were either still in high school or university or had completed either high 260

school and/or university. In addition, the majority of the consumers who participated in this 261

study (88.7 %) did not have any food safety training. 262

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The demographic characteristics of the 80 vendors who participated in this study are shown in 264

Table 2. The large majority of the street food vendors who participated in the study were 265

women (88.7%). This reflected our personal observation that the street food stalls were 266

manned by women. The same findings have been observed in other studies conducted in 267

Brazil (Hanashiro et al. 2005, Soares et al. 2012), South Africa (Martins, 2006), Thailand 268

(Cuprasitrut et al. 2011), Nigeria (Omemu & Aderoju, 2008) and the Philippines (Azanza, 269

Gatchalian, & Ortega, 2000). The educational background of the street food vendors in Haiti 270

is quite similar to those reported for vendors in India (Choudhury, Mahanta, Goswami, 271

Mazumder, & Pegoo, 2011), Ghana (Donkor, Kayang, Quaye, & Akyeh, 2009; Mensah et al. 272

2002), Nigeria (Omemu & Aderoju, 2008), Kenya (Muinde & Kuria, 2005) and Sudan 273

(Abdalla, Suliman, & Bakhiet, 2009). The mean age of the vendors was 34.4 ± 11.9 years and 274

the ages ranged between 16 and 66 years. The majority (78.7%) of the vendors did not have 275

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any food safety training. Other studies have reported even lower levels of trained street food 276

vendors including those in Nigeria (Chukuezi, 2010) and Ghana (Omemu & Aderoju, 2008). 277

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3.2 Food safety knowledge of consumers and vendors of street food 279

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The results of the survey to determine the food safety knowledge of the consumers are shown 281

in Table 3. The consumers had a mean food safety knowledge score of 56, indicating that they 282

generally had an average knowledge of food safety. However, 36.9% (59/160) of the 283

consumers had an inadequate level of food safety knowledge (scores <50), whilst only 5% 284

(8/160) of the consumers had a good level of food safety knowledge (scores >75). Therefore, 285

although the consumers in general have an average knowledge of food safety, quite a large 286

have an inadequate level of food safety knowledge. No statistical difference (α = 0.05) was 287

found between the food safety knowledge’s of customers on the basis of gender (p = 0.38), 288

age (p = 0.09), food safety training (or lack thereof) (p = 0.43), level of education (p = 0.32) 289

and location in Port-au-Prince (p = 0.06). In contrast to our findings other studies have 290

indicated that an increase of food safety knowledge occurs with age and that women have 291

higher levels of food safety knowledge compared to men (Bruhn & Schutz, 1998). 292

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The results of the survey to determine the food safety knowledge of the vendors is shown in 294

Table 4. The vendors had a significantly higher mean food safety knowledge (score of 60) 295

than the consumers (p = 0.008). The individual scores of the vendors ranged from 16 to 77. 296

27.5% (22/80) of the vendors who participated in the study had an inadequate level of food 297

safety knowledge (score <50) whilst 58.8 % (47) had an average food safety knowledge level 298

(scores >50 and <75. 13.8% (11/80) had a good level of food safety knowledge (scores >75). 299

Amongst the studies that have used the same scoring methods, the mean food safety 300

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knowledge score of the street food vendors in Haiti was found to be higher than that of food 301

handlers from Turkey (Bas et al. 2006) and Thailand (Cuprasitrut et al. 2011). It has also been 302

determined that street vendors in South Africa (Lues, Mpeli, Venter, & Theron, 2006) and the 303

Philippines (Azanza et al. 2000) have a good level of food safety knowledge. No statistical 304

difference (α = 0.05) was found between the food safety knowledge’s of the vendors on the 305

basis of gender (p = 0.092), age (p = 0.75), educational level attained (p = 0.61) and location 306

in Port-au-Prince (p = 0.10). The same findings have also been observed in Accra, Ghana 307

(Annor & Baiden, 2011) and Fars, Iran (Ansari-Lari et al. 2010). However, it was determined 308

in this study that food vendors who had received some training in food safety had a 309

significantly higher level ((p = 0.018) of food safety knowledge than untrained vendors. This 310

finding has to be viewed with caution as none of the vendors could provide a proof (i.e. a 311

certificate or an official document) of the food safety training they had received. 312

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3.3 Food safety attitudes of consumers and vendors of street food 314

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The results of the survey to determine the food safety attitude of the consumers are shown in 316

Table 5. The consumers had a mean food safety attitude score of 68, which indicated that they 317

generally had an average understanding of food safety. The range of scores was between 18 318

and 93. With regards to distribution of the scores, it can be seen in Table 5 that 90.6% 319

(145/160) of the consumers had at least an average food safety attitude (scores >50). Almost a 320

quarter (24.4%) had a very good food safety attitude as they had scores >75. The food safety 321

attitudes of the consumers were significantly higher than their food safety knowledge (p = 0). 322

No statistical difference was found between the food safety attitudes of the customers on the 323

basis of gender (p = 0.94), training (p = 0.14) and age (p = 0.07). However, statistically 324

significant differences (α = 0.05) occurred between the food safety attitudes of consumers on 325

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the basis of their educational level (p = 0.004). Consumers who only went to primary school 326

were determined to have higher scores than those who went to high (secondary) school and 327

university. This was a very surprising finding as one would expect that education to a higher 328

level would have a positive effect on food safety attitude. In agreement to our results the same 329

findings have also been observed for food safety knowledge in a multi-state study conducted 330

in the US (Altekruse, Yang, Timbo, & Angulo, 1999). However, in difference, the educational 331

level has been determined to have no bearing on the food safety knowledge and attitudes of 332

consumers in Ghana (Annor & Baiden, 2011; Rheinländer et al. 2008). In the context of this 333

study, the higher food safety attitudes of the less educated consumers might be explained by 334

the fact that cooking and household tasks in Haiti are usually reserved for people who are less 335

educated. A significant difference was also observed between the food safety attitudes of 336

consumers on the basis of their location in Port-au-Prince (p = 0.0006). It was observed that 337

consumers from Delmas and down-town Port-au-Prince had higher scores than consumers 338

from Pétion-ville. The inhabitants of Pétion-ville generally have a higher level of income 339

compared to the other communes investigated in the study, which (as discussed above) would 340

partly explain their lower food safety attitudes. 341

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The results of the survey to determine the food safety attitudes of the vendors are shown in 343

Table 6. The mean food safety attitude score of the vendors was 73 and the scores ranged 344

from 25 to 93. Only four (5%) of the vendors had an inadequate food safety attitude (scores 345

<50); whilst 95% had at least an average food safety attitude (scores of ≥50). Even a greater 346

proportion of the vendors (43%) had good food safety attitudes, compared to consumers 347

(24.4%). Statistically, the vendors had significantly better food safety attitudes than food 348

safety knowledge (p = 0) and better food safety attitudes than those of the consumers (p = 349

0.0028). No statistical difference was found in the food safety attitudes of the vendors on the 350

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basis of gender (p = 0.27), level of education (p = 0.43), location (p = 0.12) and age (p = 351

0.61). However, it was determined that food vendors who had received training in food safety 352

had a significantly greater food safety attitudes than untrained vendors (p = 0.01). Some 353

studies have also reported that trained food handlers have higher food safety attitudes 354

compared to untrained food handlers (McIntyre, Vallaster, Wilcott, Henderson, & Kosatsky, 355

2013) while others have reported that no significant differences occur between the two (Bas et 356

al. 2006) 357

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Tables 7 and 8 show the tallied responses of the customers and vendors, respectively, to the 359

food safety knowledge questionnaire. These tables provide greater insight into the areas where 360

the food safety knowledge is strongest and weakest. The results show that the majority of the 361

consumers did not know that hepatitis A virus (88.8%), Salmonella spp. (89.4%) and 362

Staphylococcus aureus (91.9%) are pathogens that are responsible for foodborne diseases and 363

Almost half (44.4%, 77/160) of the consumers failed to identify the demographic groups at 364

greatest risk of foodborne diseases. 53.1% (99/160) of the consumers wrongly believed that 365

washing utensils with detergents leaves them free of contamination, whilst 8.7% did not 366

know. On the positive side 74.4% (119/160) of the consumers knew that bloody diarrhoea can 367

be transmitted by food whilst 77.5% (124/160) recognized that AIDS cannot be transmitted 368

by food. 86.2% (138/160) knew that it is necessary to take leave from work during cases of 369

infectious skin diseases and 88.1% (141/160) knew that microorganisms can be found in the 370

skin, mouth and nose of healthy handlers. The majority of the consumers were also aware of 371

the critical role of washing hands (93.8%) and proper cleaning of utensils (71.9%) with 372

regards to the prevention of foodborne diseases. However, only 61.9% (99/160) knew that the 373

use of gloves is important in reducing the risk of contamination. 374

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In comparison to the consumers, almost all vendors did not know that hepatitis A (96.3%) 376

Salmonella (100%) and Staphylococcus aureus (98.8%) were foodborne pathogens. In 377

agreement with this finding, vendors in Brazil (Soares et al. 2012) also failed to identify these 378

foodborne pathogens. However, almost all of the vendors (75/80; 93.8%) knew that bloody 379

diarrhoea can be transmitted through food. Compared to the consumers, a slightly lower 380

proportion of the vendors (68.75 %) knew that AIDS could not be transmitted by food. 88.8 % 381

of the vendors also knew that it is necessary to take leave from work during infectious disease 382

of the skin. 92.5% (74/80) of the vendors knew that microbes could be found in the skin, nose 383

and mouth of healthy handlers. In similarity to the results observed for the consumers, 41.3% 384

of the vendors did not know that abortion could be induced by foodborne diseases. 67.5% 385

wrongly believed that washing utensils with detergent would leave them free of 386

contamination. Most of the vendors were aware of the importance of washing hands (95%), 387

proper cleaning (82.5%) and the use of gloves (72.5%) in the prevention of foodborne 388

diseases. The majority (72.5%) of the vendors in Port-au-Prince were able to identify 389

children, pregnant women and elderly as being at equal risk of foodborne diseases. The 390

majority of the vendors (76.3%) correctly noted that a swollen can is a possible host of 391

microorganisms. Slightly more vendors than consumers knew that the reheating of food could 392

be used to prevent the occurrence of foodborne diseases (63.8 % vs. 58.7) and that the 393

preparation of food in advance could lead to food poisoning (78.8% vs. 60%). 394

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Tables 9 and 10 show the tallied responses of the customers and vendors, respectively, to food 396

safety attitudes questionnaire. As mentioned above for food safety knowledge, these tables 397

provide greater insight into the areas where the food safety attitudes are strongest and 398

weakest. More than half of the customers (62.5%) wrongly believed that a well-cooked food 399

is free of contamination and that the ideal place to store raw meat was the bottom shelf of the 400

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refrigerator (48.8%). Most of consumers thought that eggs should be washed as soon as 401

possible after purchase (88.8%) whilst 60% thought that chicken should not be thawed in a 402

bowl of cold water. 35% of the customers incorrectly agreed thought that defrosted foods can 403

be refrozen and only half of them (51.3%) were able to identify wearing masks as an 404

important practice to reduce the risk of food contamination. The results observed in this study 405

point out the need to emphasize the importance of cold temperatures to retard growth of 406

microorganisms particularly refrigerating during defrosting. The vendors generally had the 407

same difficulties in answering the same questions that the consumers answered poorly. The 408

lowest percentage of correct answers (22.5%) was observed for the question concerning 409

whether or not well-cooked food is free of contamination. In agreement with the findings of 410

other studies conducted in Ghana (Donkor et al. 2009) and South Africa (Lues et al. 2006), a 411

high percentage of the street food vendors (84.4%) who participated in this study were aware 412

of the importance of separating cooked and raw foods in order to prevent foodborne diseases. 413

414

3.4 Observed food handling habits 415

416

The demographic characteristics of the vendors manning the 20 street food vending stalls that 417

were observed in this study are shown in Table 11. 18 (90%) of the stalls were manned by a 418

woman. The mean age of the vendors manning the stalls that were observed was 42.4 ± 10.3 419

years. The ages ranged from 28 to 68 years. The level of education was very low as 15 (75%) 420

of the participants had not attended high (secondary) school and none of them had gone to 421

university. In addition, 14 (70%) of them did not have any food safety training. 422

423

Table 12 shows the characteristics of the observed stalls. 45% (9/20) of the stalls observed 424

consisted of a canopy (in most cases a parasol) and 35% (7/20) consisted simply of a table set 425

alongside the street. As observed in this study other studies have also reported that street 426

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vending stalls are most often made of tables and canopies (Chukuezi, 2010). Contrary to our 427

study where 85% of the food was prepared on site, only 10% and 14% of the food was 428

prepared on site in South Africa (Lues et al. 2006) and Mauritius (Subratty et al. 2004), 429

respectively. 65% (13/20) of the stalls did not have access to potable water and 80% (16/20) 430

did not have adequate hand washing and waste disposal facilities. These findings were similar 431

to the ones observed by Muyanja et al. (2011), Muinde and Kuria (2005), and Badrie, Joseph, 432

and Chen (2004) in studies carried out in Uganda, Kenya and Trinidad, respectively. Because 433

of the lack of adequate waste disposal facilities, street vendors have a tendency to dispose of 434

their waste in the street. This in turn attracts flies and insects which are potential vectors of 435

pathogens. Animals, flies and insects were indeed evident around the stall in 60% (12/20) of 436

the cases, which was also the case in studies conducted in Uganda (Muyanja et al. 2011), 437

Kenya (Muinde & Kuria, 2005) and Trinidad (Badrie et al. 2004). 85% (17/20) of the stalls 438

were not protected from the sun, dust and wind. These findings are in agreement with the 439

observations that have been made in Uganda (Muyanja et al. 2011), Sudan (Abdalla et al. 440

2009), Nigeria (Chukuezi, 2010) and Kenya (Muinde & Kuria, 2005). 75% (15/20) of the 441

stalls had a clean environment i.e. far from rubbish, waste water, toilet facilities and open 442

drains. In contrast Muinde and Kuria (2005) reported that only 15% of street food stalls in 443

Kenya were clean. 444

445

Only 45% (9/20) of the vendors were observed to wash their hands in clean potable water 446

each time before handling, preparing and serving food. Although all of the vendors said that 447

they washed their hands each time after visiting the toilet this was not confirmed as the 448

researcher did not follow the vendors into the toilets. This finding is therefore highly 449

questionable. Moreover, it has been observed in some studies that the washing of hands after 450

visiting the toilet by street food vendors is not always as a result of the lack of public toilets in 451

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many developing countries (Bryan, 1988). When they do exist, most of the time they have no 452

hand washing facilities, no running water and paper (Bryan, 1988). In a study conducted in 453

Abeokuta (Nigeria), it was found that vendors relieved themselves on dunghills and in bushes 454

and used sheets of paper to clean up after defecation without washing their hands (Idowu & 455

Rowland, 2006). Although all the vendors who participated in this part of the study were 456

observed to be wearing clean and presentable clothes, only 40% (8/20) actually wore an apron 457

while handling, preparing and serving food. Other studies in various developing countries 458

have also observed that a low percentage of street food vendors use aprons and gloves while 459

handling, preparing and serving food (Chukuezi, 2010; Subratty, Beeharry, & Chan, 2004; 460

Lues et al. 2006; Muinde & Kuria, 2005). 461

462

In agreement to the observations that have been made in Kenya (Muinde & Kuria, 2005) and 463

Nigeria (Chukuezi, 2010; Omemu & Aderoju, 2008), 80 % (16/20) of the vendors in Haiti 464

handled food with bare hands and handled money while serving the food. Only 6.3% (1/16) 465

washed their hands thereafter. These findings are a concern as hands are vectors for pathogens 466

such as S. aureus. It has already been advised by E.C. (1997) that food handlers should avoid 467

handling food with bare hands and handling money at the same time. Additionally, according 468

to the WHO, food should be preferably handled with clean tongs, forks, spoons or disposable 469

gloves (FAO/WHO, 1999). The hair of 65% (13/20) of the vendors was covered, whilst 90% 470

(18/20) had clean and short nails. However, it has to be noted that the use of hair covers by 471

the street food vendors in Haiti might not be primarily for food safety reasons. Most of for 472

traditional reasons women usually cover their hair irrespective of what they are doing. In 55% 473

(11/20) of the cases a clean cloth was used to remove dirt and dust. 20% (4/20) of the 474

operators wore jewellery and only 2 (25%) of these 8 operators covered the jewellery 475

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adequately. None of the vendors smoked during the handling and serving of food. In 20% 476

(4/20) of the cases, the same knives and boards were used to prepare raw and cooked food. 477

478

The ingredients were stored in sealed containers, whilst raw, partially cooked and cooked 479

food products were kept separate at all 20 stalls evaluated. In 70% (14/20) of the cases 480

previously cooked food products were not kept cool. The same observations have been 481

reported by Muinde and Kuria (2005) in Kenya and Badrie et al. (2004) in Trinidad. This is an 482

important finding as it has been shown that inadequate cooling is one of the key factors that 483

contribute to the occurrence of food poisoning outbreaks (Roberts, 1982; WHO, 1989). In 484

almost half of the stalls (9/20), the utensils were not covered whilst 95% (19/20) of the 485

vendors cleaned the utensils every time after use in soapy cold water. This practice of 486

washing the dishes seems to be common in other countries as well such as the Philippines 487

(Azanza et al. 2000), Indonesia (Van Kampen, Gross, Schultnik, & Usfar, 1998) and South 488

Africa (Lues et al. 2006). 489

490

491

492

493

494

495

496

497

498

499

500

501

502

503

504

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4 Conclusions 505

506

This study had the major objective of determining the food safety knowledge, attitudes and 507

practices of street food consumers and vendors in Haiti. The study was the first of its nature 508

that has been done in Haiti. 509

510

Some findings of concern were consumers and vendors did not know that Hepatitis A, 511

Salmonella spp. and Staphylococcus spp. are pathogens responsible of foodborne diseases. 512

They also had difficulties in identifying the groups at risk of foodborne diseases and most 513

were unaware of the importance of reheating food to fight against foodborne diseases. In the 514

observational part of the study, it was found that in 60% of the cases, flies and animals were 515

evident around the stall and 65% did not have access to potable water. The majority served 516

food with bare hands and did not wash their hands after handling money. Additionally, 70% 517

of the vendors did not keep pre-cooked food at an appropriate temperature. The conditions in 518

which street food vendors operate in Port-au-Prince are mostly unacceptable from a food 519

safety point of view and an effort should be made to improve their conditions by development 520

of appropriate infrastructure i.e. potable water, toilets and waste disposal facilities. The 521

majority of the vendors did not have any food safety training. Therefore there is an urgent 522

need to organize formal training in food hygiene and food safety. 523

524

Importantly, Haiti currently has no food safety legislation and some of the findings obtained 525

in this study are a result of the status quo. These results should therefore provide part of the 526

impetus for such legislation to be developed for regulation of this sector and the food industry 527

in general. Due to the limits of the research mentioned above, one should be careful in 528

generalizing the results of the study and there is a need for more studies in the street food 529

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sector and perhaps it might also be interesting to extend that study to other cities and towns in 530

Haiti. 531

532

533

534

535

536

537

538

539

540

541

542

543

544

545

546

547

548

549

550

551

552

553

554

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5 Acknowledgement 555

556

The authors are very grateful to co-author Dr. Ruth Climat for her invaluable contribution to 557

the study by conducting the interviews, questionnaires and observation study in Port-au-558

Prince, Haiti. 559

560

561

562

563

564

565

566

567

568

569

570

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TABLES Samapundo et al. 1

2

Table 1. Demographic characteristics of street food consumers in Port-au-Prince, Haiti 3

4

Characteristics Number (%) Mean ± standard deviation Range Sex Female 60 (37.5%) Male 100 (62.5%) Age (years) 15-25 74 (46.2%) 29.6 ± 11.3 15 - 74 26-35 49 (30.6%) 36-45 23 (14.4%) 46-55 6 (3.8%) 56-60 5 (3.1%) >60 3 (1.9%) Education Illiterate 13 (8.2%) Primary school 25 (15.6%) High school 69 (43.1%) University 53 (33.1%) Food safety training Yes 18 (11.3%) No 142 (88.7%) Location Port-au-Prince 40 (25%) Pétion-ville 40 (25%) Delmas 40 (25%) Tabarre 40 (25%) Total 160 *stdev = standard deviation 5

6

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9

10

11

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13

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15

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Table 2. Demographic characteristics of street food vendors in Port-au-Prince, Haiti 17

Characteristics Numbers Mean ± standard deviation Range

Sex Female 71 (88.7%) Male 9 (11.3%) Age (years) 15-25 25 (31.3%) 34.4±11.9 16-66 26-35 22 (27.5%) 36-45 18 (22.5%) 46-55 9 (11.2%) 56-60 4 (5%) >60 2 (2.5%) Education Illiterate 18 (22.5%) Primary school 36 (45%) High school 21 (26.2%) University 5 (6.3%) Food safety training Yes 17 (21.3%) No 63 (78.7%) Location Port-au-Prince 20 (25%) Pétion-ville 20 (25%) Delmas 20 (25%) Tabarre 20 (25%) TOTAL 80

18

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Table 3. Effect of gender, age, education level, food safety training and location on the food safety knowledge of consumers 19

20

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22

23

24

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26

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29

30

31

32

33

34

35

*stdev = standard deviation 36

Characteristics Number of respondents (%)

Mean score ± stdev* Range <50 50-75 >75

Sex Female 25 (16) 33 (21) 2 (1.3) 55 ± 13 22 - 94 Male 34 (21) 60 (38) 6 (3.8) 56 ± 12 27 - 83 Age (years) 15-25 36 (23) 36 (23) 2 (1.3) 53 ± 12 22 - 83 26-35 13 (8.1) 31 (19) 5 (3.1) 59 ± 13 28 - 94 36-45 5 (3.1) 18 (11) 0 (0) 56 ± 7 38 - 66 46-55 0 (0) 6 (3.8) 0 (0) 64 ± 3 61 - 66 56-60 2 (1.3) 2 (1.3) 1 (0.6) 61 ± 13 50 - 77 >60 3 (1.9) 0 (0) 0 (0) 40 ± 11 27 - 50 Education Illiterate 6 (3.8) 7 (4.4) 0 (0) 55 ± 12 27 - 72 Primary school 6 (3.8) 17 (11) 2 (1.3) 58 ± 11 38 - 77 High school 29 (18) 38 (24) 2 (1.3) 54 ± 11 27 - 83 University 18 (11) 31 (19) 4 (2.5) 57 ± 13 22 - 94 Food safety training

Yes 7 (4.4) 10 (6.3) 1 (0.6) 54 ± 8 38 - 77 No 52 (33) 83 (52) 7 (4.4) 55 ± 12 22 - 94 Location Port-au-Prince 11 (6.9) 28 (18) 1 (0.6) 57 ± 10 27 - 77 Pétion-ville 18 (11) 21 (13) 1 (0.6) 52 ± 13 22 - 83 Delmas 10 (6.3) 26 (16) 4 (2.5) 0.59 ± 11 27 - 94 Tabarre 20 (13) 18 (11) 2 (0.3) 53 ± 11 33 - 83 TOTAL 59 (36.9) 93 (58.1) 8 (5) 56 ± 12 22 - 94

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Table 4. Effect of gender, age, education level, food safety training and location on the food safety knowledge of street food vendors 37

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48

49

50

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52

53




Sex Female 19 (23.8) 42 (52.5) 10 (12.5) 60 ± 13 16 - 77 Male 3 (3.8) 5 (6.3) 1 (1.3) 60 ± 13 44 - 77 Age (years) 15-25 10 (12.5) 13 (16.3) 2 (2.5) 57 ± 10 38 - 78 26-35 4 (5) 15 (18.8) 3 (3.8) 61 ± 15 16 - 77 36-45 5 (6.3) 11 (13.8) 2 (2.5) 59 ± 12 33 - 77 46-55 2 (2.5) 4 (5) 3 (3.8) 64 ± 12 50 - 77 56-60 1 (1.3) 3 (3.8) 0 (0) 59 ± 8 50 - 66 >60 0 (0) 1 (1.3) 1 (1.3) 72 ± 7 66 - 77 Education Illiterate 3 (3.8) 15 (18.8) 0 (0) 58 ± 12 16 - 72 Primary school 13 (16.3) 16 (20) 7 (8.8) 59 ± 13 33 - 77 High school 5 (6.3) 14 (17.5) 2 (2.5) 62 ± 10 44 - 77 University 1 (1.3) 2 (2.5) 2 (2.5) 65 ± 12 50 - 77 Food safety training

Yes 3 (3.8) 9 (11.3) 5 (6.3) 66 ± 13 38 - 77 No 19 (23.8) 38 (47.5) 6 (7.5) 58 ± 11 16 - 77 Location Port-au-Prince 7 (8.8) 12 (15) 1 (1.3) 58 ± 11 38 - 77 Pétion-ville 6 (7.5) 14 (17.5) 0 (0) 57 ± 12 16 - 72 Delmas 3 (3.8) 12 (15) 5 (6.3) 66 ± 10 50 - 77 Tabarre 6 (7.5) 9 (11.3) 5 (6.3) 60 ± 14 33 - 77 TOTAL 22 (27.5%) 47 (58.8) 11 (13.8) 60 ± 12 16 - 78

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Table 5. Effect of gender, age, education level, food safety training and location on the food safety attitudes of street food consumers 55

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58

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Sex Female 6 (3.8) 40 (25) 14 (8.8) 69 ± 11 44 - 94 Male 9 (5.6) 66 (41.3) 25 (15.6) 69 ± 14 18 - 94 Age (years) 15-25 10 (6.3) 49 (30.6) 15 (9.4) 66 ± 14 19 - 93 26-35 3 (1.9) 31 (19.4) 15 (9.4) 69 ± 14 19 - 94 36-45 2 (1.3) 16 (10) 5 (3.1) 70 ± 12 44 - 94 46-55 0 (0) 4 (2.5) 2 (1.3) 72 ± 10 56 - 81 56-60 0 (0) 3 (1.9) 2 (1.3) 76 ± 9 62 - 88 >60 0 (0) 3 (1.9) 0 (0) 71 ± 7 62 - 75 Education Illiterate 7 (4.4) 51 (31.9) 11 (6.9) 75 ± 9 62 - 94 Primary school 0 (0) 10 (6.3) 3 (1.9) 76 ± 11 43 - 94 High school 1 (0.1) 11 (6.9) 13 (8.1) 67 ± 13 18 - 87 University 7 (4.4) 34 (21.3) 12 (7.5) 66 ± 14 18 - 94 Food safety training Yes 1 (0.1) 11 (6.9) 6 (3.8) 73 ± 11 44 - 87 No 14 (8.8) 95 (59.4) 33 (20.6) 68 ± 13 18 - 94 Location Port-au-Prince 2 (1.3) 24 (15) 14 (8.8) 73 ± 12 37 - 94 Pétion-ville 7 (4.4) 29 (18.1) 4 (2.5) 62 ± 16 18 - 87 Delmas 3 (1.9) 22 (13.8) 15 (9.4) 72 ± 12 43 - 94 Tabarre 3 (1.9) 31 (19.4) 6 (3.8) 67 ± 10 43 - 81 TOTAL 15 (9.4) 106 (66.3) 39 (24.4) 68 ± 13 18 - 93

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Table 6. Effect of gender, age, education level, food safety training and location on the food safety attitudes of street food vendors 73

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Sex Female 4 (5) 38 (47.5) 29 (36.3) 73 ± 11 25 - 93 Male 0 (0) 4 (5) 5 (6.3) 78 ± 9 62 - 94 Age (years) 15-25 1 (1.25) 13 (16.3) 11 (13.8) 74 ± 9 50 - 87 26-35 1 (1.25) 13 (16.3) 8 (10) 70 ± 15 25 - 93 36-45 1 (1.25) 10 (12.5) 7 (8.8) 75 ± 10 50 - 87 46-55 1 (1.25) 3 (3.8) 5 (6.3) 77 ± 11 50 - 94 56-60 0 (0) 3 (3.8) 1 (1.25) 71 ± 8 62 - 81 >60 0 (0) 0 (0) 2 (2.5) 87 87 Education Illiterate 0 9 (11.3) 11 (13.8) 72 ± 15 25 - 87 Primary school 1 (1.25) 9 (11.3) 8 (10) 72 ± 12 50 - 93 High school 3 (3.8) 21 (26.3) 13 (16.3) 77 ± 8 56 - 87 University 0 (0) 3 (3.8) 2 (2.5) 77 ± 3 75 - 81 Food safety training Yes 0 (0) 5 (6.3) 11 (13.8%) 80 ± 7 62 - 94 No 4 (5) 37 (46.3) 23 (28.8) 72 ± 12 25 - 94 Location Port-au-Prince 2 (2.5) 9 (11.3) 9 (11.3) 74 ± 13 50 - 94 Pétion-ville 2 (2.5) 13 (16.3) 5 (6.3) 68 ± 14 25 - 87 Delmas 0 (0) 10 (12.5) 10 (12.5) 76 ± 8 56 - 87 Tabarre 0 (0) 10 (12.5) 10 (12.5) 76 ± 9 62 - 94 TOTAL 4 (5%) 42 (52.5%) 34 (42.5%) 73 ± 11 25 - 93

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Table 7. Assessment of the food safety knowledge of street food consumers 92

Question Number of responses (%)

Correct Wrong Do not know

1. Abortion in pregnant women can be induced by food-borne disease. 68 (42.5) 38 (23.7) 54 (33.7)

2. Bloody diarrhoea can be transmitted by food 119 (74.4) 24 (15) 17 (10.6)

3. Swollen cans can contain microorganisms 119 (74.4) 15 (9.4) 26 (16.2)

4. During infectious disease of the skin, it is necessary to take leave from work. 138 (86.2) 14 (8.7) 8 (5)

5. Eating and drinking in the work place increase the risk of food contamination 72 (45) 73 (45.6) 15 (9.4)

6. Hepatitis A virus is a food-borne pathogens 18 (11.2) 11 (6.9) 131 (81.9)

7. Microbes are in the skin, nose and mouth of healthy handlers 141 (88.1) 9 (5.6) 10 (6.2)

8. Salmonella is among the food-borne pathogens 17 (10.6) 3 (1.9) 140 (87.5)

9. Staphylococcus is among the food-borne pathogens 13 (8.1) 12 (7.5) 135 (84.4)

10. Typhoid fever can be transmitted by food 75 (46.9) 47 (29.4) 38 (23.7)

11. Using gloves while handling food reduces the risk of food contamination 99 (61.9) 49 (30.6) 12 (7.5)

12. Washing hands before work reduces the risk of food contamination 150 (93.7) 9 (5.6) 1 (0.6)

13. AIDS can be transmitted by food 124 (77.5) 18 (11.2) 18 (11.2)

14. Children, healthy adults, pregnant women and older individuals are at equal risk for food

poisoning

89 (55.6) 60 (37.5) 11 (6.9)

15. Food prepared in advance reduces the risk of food contamination 96 (60) 51 (31.9) 13 (8.1)

16. Proper cleaning and sanitization of utensils increase the risk of food contamination. 115 (71.9) 41 (25.6) 4 (2.5)

17. Reheating cooked foods can contribute to food contamination 94 (58.7) 48 (30) 18 (11.2)

18. Washing utensils with detergent leaves them free of contamination 61 (38.1) 85 (53.1) 14 (8.7)

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Table 8. Assessment of the food safety knowledge of street food vendors 95



1. Abortion in pregnant women can be induce by foodborne disease 47 (58.7) 15 (18.7) 18 (22.5)

2. Bloody diarrhoea can be transmitted by food 75 (93.7) 1(1.2) 4(5)

3. Can swollen cans contain microorganisms 61 (76.3) 11(13.7) 8 (10)

4. During infectious disease of the skin, it is necessary to take leave from work. 71 (88.7) 7 (8.7) 2 (2.5)

5. Eating and drinking in the work place increase the risk of food contamination 36 (45) 37 (46.2) 7 (8.7)

6. Hepatitis A virus is among the foodborne pathogens 3 (3.7) 1 (1.2) 76 (95)

7. Microbes are in the skin, nose and mouth of healthy handlers 74 (92.5) 3 (3.7) 3 (3.7)

8. Salmonella is among the foodborne pathogens 0 (0) 1 (1.2) 79 (98.7)

9. Staphylococcus aureus is among the foodborne pathogens 1 (1.2) 0 (0) 79 (98.7)

10. Typhoid fever can be transmitted by food 48 (60) 17 (21.2) 15 (18.7)

11. Using gloves while handling food reduces the risk of food contamination 58 (72.5) 19 (23.7) 3 (3.7)

12. Washing hands before work reduces the risk of food contamination 76 (95) 3 (3.7) 1 (1.2)

13. AIDS can be transmitted by food 55 (68.7) 16 (20) 9 (11.2 )

14. Children, healthy adults, pregnant women and older individuals are at equal risk for food

poisoning

58 (72.5) 15 (18.7) 7 (8.7)

15. Food prepared in advance reduces the risk of food contamination 63 (78.7) 11 (13.7) 6 (7.5)

16. Proper cleaning and sanitization of utensils increase the risk of food contamination. 66 (82.5) 14 (17.5) 0 (0)

17. Reheating cooked foods can contribute to food contamination 51 (63.8) 21 (26.2) 8 (10)

18. Washing utensils with detergent leaves them free of contamination 26 (32.5) 53 (66.2) 1 (1.2)

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Table 9. Assessment of food safety attitudes of street food consumers



1. Proper hand hygiene can prevent food-borne diseases 132 (82.5) 25 (15.6) 3 (1.9)

2. Raw and cooked foods should be stored separately to reduce the risk of food contamination. 135 (84.4) 21 (13.1) 4 (2.5)

3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk

of food contamination

125 (78.1) 16 (10) 19 (11.9)

4. The health status of workers should be evaluated before employment 149 (93.1) 5 (3.1) 6 (3.7)

5. The best way to thaw a chicken is in a bowl of cold water 64 (40) 73 (45.6) 23 (14.4)

6. Wearing masks is an important practice to reduce the risk of food contamination 82 (51.2) 58 (36.2) 20 (12.5)

7. Wearing gloves is an important practice to reduce the risk of food contamination 112 (70) 45 (28.1) 3 (1.9)

8. Wearing caps is an important practice to reduce the risk of food contamination 134 (83.7) 22 (13.7) 4 (2.5)

9. Dish towels can be a source of food contamination 154 (96.2) 4 (2.5) 2 (1.2)

10. Knives and cutting boards should be properly sanitized to prevent cross contamination 154 (96.2) 3 (1.9) 3 (1.9)

11. Food handlers who have abrasions or cuts on their hands should not touch foods without gloves 142 (88.7) 9 (5.6) 9 (5.6)

12. Well-cooked foods are free of contamination 60 (37.5) 97 (60.6) 3 (1.9)

13. Can a closed can/jar of cleaning product be stored together with closed cans and jars of food

products

116 (72.5) 30 (18.7) 14 (8.7)

14. Defrosted foods can be refrozen 104 (65) 40 (25) 16 (10)

15. The ideal place to store raw meat in the refrigerator is on the bottom shelf 82 (51.2) 69 (43.1) 9 (5.6)

16. Eggs must be washed after purchase as soon as possible 18 (11.2) 134 (83.7) 8 (5)

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Table 10. Assessment of food safety attitudes of street food vendors

Question

Number of responses (%)


1. Proper hand hygiene can prevent food-borne diseases 75(93.75) 5(6.25) 0(0.00)

2. Raw and cooked foods should be stored separately to reduce the risk of food contamination. 66(82.50) 14(17.50) 0(0.00)

3. It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk of food contamination

71(88.75) 4(5.00) 5(6.25)

4. The health status of workers should be evaluated before employment 76(95.00) 1(1.25) 3(3.75)

5. The best way to thaw a chicken is in a bowl of cold water 41(51.25) 34(42.50) 5(6.25)

6. Wearing masks is an important practice to reduce the risk of food contamination 46(57.50) 30(37.50) 4(5.00)

7. Wearing gloves is an important practice to reduce the risk of food contamination 67(83.75) 13(16.25) 0(0.00)

8. Wearing caps is an important practice to reduce the risk of food contamination 77(96.25) 3(3.75) 0(0.00)

9. Dish towels can be a source of food contamination 78(97.50) 2(2.5) 0(0.00)

10. Knives and cutting boards should be properly sanitized to prevent cross contamination 80(100) 0(0) 0(0.00)

11. Food handlers who have abrasions or cuts on their hands should not touch foods without gloves. 74(92.50) 6(7.5) 0(0.00)

12. Well-cooked foods are free of contamination 18(22.5) 60(75) 2(2.5)

13. Can a closed can/jar of cleaning product be stored together with closed cans and jars of food products

62(77.50) 15(18.75) 3(3.75)

14. Defrosted foods can be refrozen 69(86.25) 9(11.25) 2(2.50)

15. The ideal place to store raw meat in the refrigerator is on the bottom shelf 39(48.75) 38(47.50) 3(3.75)

16. Eggs must be washed after purchase as soon as possible 8(10) 71(88.75) 1(1.25)

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Table 11. Demographic characteristics of stall vendors who participated in the food practices observational study

Characteristics Number (%) Mean ± standard deviation Range

Sex

Male 2 (10%)

Female 18 (90%)

Age (years)

<30 4 (20%) 42.4 ± 10.3 28 - 68

30-50 12 (60%)

51-60 3 (15%)

>60 1 (5%)

Education

Illiterate 2 (10%)

Primary school 13 (65%)

Secondary school 5 (25%)

University 0 (0%)

Food safety training

Yes 6 (30%)

No 14 (70%)

Location

Delmas 5 (25%)

Port-au-Prince 5 (25%)

Pétion-ville 5 (25%)

Tabarre 5 (25%)

TOTAL 20 (100%)

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Table 12. Facilities and observed food safety practices of street food vendors

Observation checklist item Observation (%) Yes No

Facilities 1. What material is the structure made of were the food sold: Zinc/iron 2 (10) 0 (0) Canopy 9 (45) 0 (0) Container 1 (5) 0 (0) Wooden table 7 (35) 0 (0) 2. Where is the food prepared : At home 3 (15) (0) On site 17 (85) (0) 3. Is vending stall protected from sun 3 (15) 17 (85) Animals or pests flies etc. evident around the vending stall 12 (60) 8 (40) 4. Is the vending stall maintained in a clean condition 15 (75) 5 (25) 5. Is there access to potable water at the site or close to the site 7 (35) 13 (65) 6. Are there adequate hand washing facilities available 4 (20) 16 (80) 7. Are there adequate waste water or food disposal facilities available 4 (20) 16 (80) Environment around the stall 8. Is the environment around the stall clean i.e. far from rubbish, waste water, toilet facilities, open drains and

animals 15 (75) 5 (25)

Personal hygiene 9. Does the operator wash their hands in clean water each time before the handling, preparation and serving of

food 9 (45) 11 (55)

10. Does the operator wash their hands each time after visiting the toilet 20 (100) (0) 11. Are the operators clothes clean and presentable 20 (100) (0) 12. Does the operator use an apron when handling, preparing and serving of food 8 (40) 12 (60) 13. Does the operator handle food with bare hands 16 (80) 4 (20) 14. Are the nails of the operator clean and short 18 (90) 2 (10) 15. Is the hair of the operator covered when handling preparing and serving of food 13 (65) 7 (35) 16. Does the operator handle money while serving food 16 (80) 4 (20)

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If answer to Q14 is yes: are the hands washed after handling money before handling food again? 1 (6.3) 15 (93.8) 17. Is dirt or dust is removed by means of: An apron 2 (10%) (0) Bare (uncovered) hands 1 (5%) (0) Dirty cloth 6 (30%) (0) Clean cloth 11 (55%) (0) 18. Does the operator wear jewellery during the handling of food 4 (20) 16 (80) If answer to Q18 is yes: is the jewellery adequately covered 1 (25) 3 (75) 19. Does vendor smoke during the handling of food 0 (0) 20 (100) 20. Does the operator use the same utensil knives and boards to prepare raw and cooked food 4 (20) 16 (80) Food storage 21. Is the food stored/displayed in sealed containers 12 (60) (0) 22. Are raw, partially cooked and cooked food products kept separate 20 (100) (0) 23. Are previously cooked foods kept cool i.e. in an ice box or refrigerator 6 (30) 14 (70) Utensils 24. Are utensils covered 11 (55) 9 (45) 25. Are utensils cleaned adequately every time after use 19 (95) 1 (5) 26. Are the utensils cleaned with soapy water 20 (100) 0 (0)

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ACCEPTED MANUSCRIPTHIGHLIGHTS Samapundo et al. 1

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- Food safety knowledge, attitudes, and practices were evaluated in Port-au-Prince 3

- 160 consumers and 80 vendors from four different communes participated 4

- Consumers and vendors exhibited average food safety knowledge and attitude levels 5

- Vendors generally have higher levels of food safety knowledge than consumers 6

- Street food vendors in Port-au-Prince operate under largely unhygienic conditions 7

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