microbial quality and safety of cooked foods sold in urban schools in ghana: a review of food...

8/11/2019 Microbial Quality and Safety of Cooked Foods Sold in Urban Schools in Ghana: a review of food handling and heal

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Microbial Quality and safety of cooked foods sold in Urban Schools in

Ghana: a review of food handling and health implications

Keywords:

Microbial Quality, Hazard Analysis Critical Control Point (HACCP), Quality

Improvement (QI), Vended foods, Food Hygiene

ABSTRACT:

Foodborne diseases are major causes of illness, human suffering and

economic losses. It is therefore imperative to study, monitor and supervise food

handlers to ensure that they observe personal hygiene to avoid food contamination.

This study reviews microbial quality of ready-to-eat foods with focus on food safety,

food storage, basic Hazard Analysis Critical Control Point (HACCP) public perception

of foodborne diseases, knowledge of food safety and personal hygiene, good

hygienic practices, and some foodborne diseases. Others include the vulnerable group

of foodborne diseases, bacterial food-borne diseases, causes of foodborne diseases

and causal organisms, parasitic food-borne diseases. The objective of this study is to

determine the microbial quality of vended foods in urban school canteens in Ghana

This study determines the microbial levels of vended foods sold in schools and to

explore food borne diseases of vended food in relation to hygienic practices for

recommendation of measures that can be implemented to ensure microbial food

safety in the canteens of the schools in urban areas. This is a descriptive study and a

review of facts from the l iterature and from the website and described.

063-072| JRPH | 2013 | Vol 2 | No 1

This article is governed by the Creative Commons Attribution License (http://creativecommons.org/

licenses/by/2.0), which gives permission for unrestricted use, non-commercial, distribution andreproduction in all medium, provided the original work is properly cited.

www.jhealth.info

Journal of Research in

Public HealthAn International Scientific

Research Journal

Authors:Emmanuel Owusu1,

Reuben K. Esena2* ,

Ted Annang1,

Margaret Ottah Atkpo3.

Institution:1. University of Ghana ,Institute of Environmental andSanitation Studies, Legon-AccraGhana.

2. University of Ghana, Schoolof Public Health, P. O. Box LG

13 Legon-Accra Ghana.

3. Food Microbiology Division,CSIR- Food Research Institute,Accra, Ghana.

Corresponding author:

Reuben K. Esena.

Email:

Web Address:http://www.jhealth.info/documents/PH0016.pdf.

Dates:

Received: 22 Aug 2013 Accepted: 05 Sep 2013 Published: 28 Dec 2013

Article Citation:

Emmanuel Owusu, Reuben K. Esena,Ted Annang and Margaret Ottah Atkpo.

Microbial Quality and safety of cooked foods sold in Urban Schools in Ghana: a review

of food handling and health implicationsJournal of Research in Public Health (2013) 2(1): 063-072

An International Scientific Research Journal

Original Research

Journal of Research in Public ealth

Jour

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earch

inP

ublicHealth


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INTRODUCTION

Food intake as a basic human requirement

exposes humans to the risk of foodborne pathogens.

Ready-to-eat-foods [or vended food are foods prepared

and sold by vendors in public places for consumption-

without-further-processing (WHO, 1996), including

fresh fruits and vegetables sold outside market areas

(WHO, 2006). This practice of food sale is on the

increase in West Africa as a result of socioeconomic

changes, characterized by massive urbanization in recent

times. This has made ready-to-eat foods important in the

informal sector of many-developing countries. Such

foods are inexpensive, convenient and often affordable

by urban and rural poor. This entrepreneurial activityprovides income for a vast number of persons, especially

women; and provides the avenue for self-employment in

business development skills to assist a wide variety of

people (Taylor et al.,2000).

In contrast to the benefits they provide, ready-to-

eat foods are however potential sources of disease.

Depending on the type of food, the method of

preparation and the manner in which it is held before

consumption, the risk of bacterial contamination mayoccur (Muoz de Chvez et al., 2000).

High risk foods-such as meat, cooked rice, fish,

eggs, poultry, milk and similar foods must therefore be

handled hygienically to avoid the risk of being

contaminated with bacteria endotoxins and exotoxins.

The main type of pathogenic bacteria associated with

foodborne diseases include Salmonella spp, Clostridium

perfringens, Staphylococcus aureus, Listeria

monocytogenes, Campylobacter jejuni, Clostridium

botulinum,B. cereus, andEscherichia coli (Okolie et al.,

2012).

The link between reliance on street food

consumption and prevalence of gastrointestinal

infections has been established (Mensah, 2002). Street

food has also been implicated with environmental

contaminants such as chemicals, traces of pesticides and

heavy metals (Tomlin, 2002). Poor food handling

practices is known to result in up to 97 per cent of food

borne illnesses in establishments and the home (Howes

et al.,1996).

Food safety

Food safety has been defined as the conditions

and measures that are necessary during the production,

processing, storage, distribution and preparation of food

to ensure that it is safe, sound, wholesome and fit for

human consumption (WHO, 1984). Food safety is thus

the condition which ensures that food will not cause

harm to the consumer when prepared and/or eaten

according to their intended use. It is crucial to critically

handle,preparation,and storage of food to prevent foodborne illness. Ready-to-eat foods are a critical issue

because of the unhygienic conditions, under which some

are prepared and sold (Rheinlnder et al.,2008).

The Ghanaian community has experienced an

upsurge in the operation of ready-to-eat-foods and there

are an estimated 60,000 food vendors in the capital alone

(Afele, 2006; Ayeh-Kumi el al., 2009). It is therefore

imperative to ensure food safety at all times in all the

ready-to-eat food establishments. The aim is to protectthe huge number of consumers who may be infected with

foodborne pathogens at a time. Abdus-salam (1993) is of

the view that ready-to eat-foods could pose significant

public health problems because most food handlers lack

knowledge on safe food handling. This is compounded

by the difficulty in controlling and supervising them,

their large numbers and inadequate resources.

It is therefore important to ensure that food

handlers observe good personal hygiene to avoid

contamination or transmission of foodborne pathogens to

consumers who patronize their food unknowingly. In

line with this, WHO (1989) noted that a key vehicle for

micro-organisms transfer is from faeces, nose, skin and

other parts of the body into food. So hand washing is

important. A similar study by Pether and Gilbert (1971)

noted that bacteria such as Salmonella typhi and

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Escherichia colican survive for varying periods on the

fingers and other parts of the body.

Food handlers must therefore be screened by the

appropriate regulatory body to ensure that they are

always in good health and hygienic conduct before they

sell to the public. In Ghana, one way to ensure food

safety of ready-to-eat food is by issuing periodic health

certificate to food vendors. This is confirmed by a study

by Musa and Akande (2002) who noted that in the

developing countries, the common approach to

regulating vended food is through medical examination

of food vendors.

METHODS

This is a descriptive review from a wide array

of literature from health records [Ministry of Health],

Ghana Health Service (GHS), Food and Drugs

Authority [Ghana] and from International Journals and

from the website. All these were analyzed and

described.

Ethical Principle

There was the need for Ethical approval. This

was obtained from Ethics Committee of the GhanaHealth Service, the University of Ghana School Of

Public Health and from the Municipal Director of Health

Services.

Food Handling

In Ghana, it is a requirement for food handlers to

go through medical screening for infectious diseases

before they are granted certificate of fitness to sell their

cooked foods. Further the Metropolitan, municipal and

district environmental health officers periodically

conduct screening exercises and vendors are expected

to carry out complete physical and medical examination

and obtain health certificates issued by the authorized

health centers. This practice is consistent with what

prevails in other developing countries. In some

developing countries, public health code requires food

handlers to undergo medical examination before they are

employed in food establishments. But these regulatory

measures are ineffective because it is an expensive

exercise for the impoverished food handlers and does not

prevent infection after the examination (WHO, 1996).

Despite this notion, Ngozi and Onyenekwe (2003) assert

that many developing nations place premium on food

handlers undergoing medical examination to ensure

detection, treatment and subsequent reduction in

transmission of foodborne pathogens.

According to WHO (2006), there are five

principles of food hygiene that can be implemented to

ensure food safety. These are prevention of

contaminated food from spreading, separation of raw and

cooked food to avoid cross-contamination, cooking food

thoroughly at the right temperature, storage of food at the

proper temperature and the usage of safe water and raw

material for food preparation. Failure to observe these

principles in food preparation exposes consumers to

pathogens and toxins that cause foodborne illnesses. One

of the means to ensure that ready-to-eat foods are

without pathogens and chemicals is the application of the

principles of Hazard Analysis Critical Control Point

(HACCP). The HACCP system seeks to identifyhazards associated with any stage of food processing and

determines the operations where control procedures are

necessary to guarantee food safety (http://

w h q l i b d o c . w h o . i n t /

publications/1992/9241544333_eng.pdf).

Bryan (1992) indicated that four factors should

be taken into account when choosing a place to conduct

HACPP. These include the food property, food

operation, volume of food prepared and susceptibility of

consumer. Food property factor relates to the process of

foods prepared and served in an establishment, the

characteristics of the food (such as pH, water activity)

and its ability to support the rapid growth of infectious

microorganisms. The food operations factor analyses the

process that the foods usually undergo that exposes them

to contamination. This process might not destroy

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Journal of Research in Public Health (2013) 2(1): 063-072 065


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contaminants and therefore contamination could

increase. The volume of food prepared risk factor

assesses the tendency of large volumes of the same food

prepared for people in advance that creates hazards when

not stored in conditions that prevents bacteria growth. In

that the risks increase with the time of holding. The

susceptibility of the consumer risk factor assesses those

people more prone to disease than the general population

such as the hospital patients, infants or the elderly

(Bryan, 1992).

HACCP as a measure of ensuring food safety has

many merits compared to the other traditional ways of

ensuring food safety. It is a proactive approach that

anticipates problems before they occur, provides rapidcontrol mechanisms, easy to monitor and can be used to

predict potential hazards (Bryan, 1992). It identifies

critical food safety risk factors that could serve as a basis

for training and education of street food vendors as well

as consumers. Furthermore, it emphasizes monitoring of

critical control points in food operation and serve as

inexpensive food safety assurance compared to chemical

and microbiological methods of analysis.

Some basic HACCP food safety approaches on foodhandling

The principle of HACCP as food safety measure

is relevant right from the farm land to when the food is

on the table for consumption. To ensure food safety, raw

materials should be obtained from known and reliable

sources and not from clandestine dealers. Raw materials

are very relevant to the safety of street-vended foods

since they can introduce biological, chemical and

physical hazards that may persist through preparation

and processing of ready-to-eat foods. To protect against

food hazards, materials to be consumed in their raw state,

should be transported and stored separately from other

raw materials and non-food items. Raw foods (e.g., raw

meat and poultry) are often contaminated at source with

salmonellae, Campylobacter jejuni, Clostridium

perfringens, Yersinia enterocoli tica, Listeria

monocytogenes, or Staphylococcus aureus (Bryan,

1992).

Water as a raw material is critical in ready-to-eat

foods preparations which when contaminated can

transmit foodborne illnesses when used for drinking,

washing of foods, incorporated in the food as an

ingredient and either used in the processing of the food

or for washing equipment, utensils and hands.

Angulo et al., (1997) intimated that water is a

well-known vehicle for enteropathogens such as E. coli,

Salmonella spp. and Campylobacter spp., amongst

others. In this connection, a study to determine the

bacteriological quality of the water used by some food

vendors in schools has shown frequent contaminationwith Coliform and feacal Coliform (Chakravarty and

Canet, 1996). Dawson and Canet (1991) observed that

acute shortage of clean potable water compels many

vendors to re-use the water, especially for cleaning

utensils and used dishes.

Preparing and processing of ready- to-eat foods

Food preparation and processing are critical steps

prior to their sale and consumption and is important in

determining the safety of food. One key principle inpreparing and processing food is to avoid direct and

indirect contact between raw and cooked or prepared

foods which will be consumed without further heating

(WHO, 1996). Raw foods (e.g. salads and peeled or cut

fruit) should be prepared with special attention to

cleanliness. Grains (e.g. rice, pulses, and beans),

vegetables and some fruits (especially if they are to be

consumed raw) should be washed sufficiently with safe

water to reduce contamination to an acceptable level

(ht tp : / /www.who. int / foodsafe ty/publ ica t ions /

fs_management/en/streetvend.pdf). Furthermore, the

preparation of food before its consumption, storage at

ambient temperature, inadequate cooling and reheating,

contaminated processed food, and undercooking are

identified as the key factors that contribute to food

poisoning outbreaks (WHO, 1989).

Esenaet al.,2013

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Food storage

It is known that most foodborne diseases cases

are caused by the inappropriate handling in kitchens and

restaurants of contaminated food (including improper

storage, undercooking, or cross contamination) (Blaser,

2004). It has been reported that diarrhoeal cases can be

reduced by 39% via household water treatment and safe

storage (Fewtrell et al., 2005). Similarly, Mitakakis

et al., (2004) in a study identified food-handling and

storage practices in the home as major risk factors for

gastroenteritis. Longer holding time of certain high risk

foods create favorable conditions for the growth of

foodborne pathogens that causes foodborne diseases.

Foods vendors most often prepare ready -to eat foods in

bulk and store them for several hours after cooking

including overnight holding at ambient temperatures,

until sold, and thus can harbor high microbial

populations (El-Sherbeeny et al., 1985, Bryan et al.,

1992 and Lianghui et al., 1993). Bryan (1995) observed

that in such foods, the counts of pathogens including

Escherichia coli, Staphylococcus aureus, Bacillus

cereus and Clostridium perfringens are bound to be

unacceptably high.Reheating

During reheating the time-temperature exposure

should be able to inactivate microorganisms and toxins

of concern. Omemu and Aderoju (2007) indicated in a

study that some food vendors often cook products ahead

of time, store them and then reheat them when requested

by customers. Their low knowledge of food hygiene

may require them to reheat food just to warm it and

improve on its palatability, rather than to destroy

pathogens. Bryan (1992) recommended that during

reheating the highest temperature attained at the

geometric centre of foods or the time-temperature

exposure of foods should be measured and recorded to

determine whether pathogens could survive the

temperature.

Knowledge of food handlers on food safety and

personal hygiene

The term food handler applies to persons who

prepare food and to those who sell it, if they are different

persons (WHO, 1996). Rheinlnder et al., (2008)

indicated that food safety is a major concern with ready-

to-eat foods as these foods are generally prepared and

sold under unhygienic conditions, with limited access to

safe water, sanitary services, or garbage disposal

facilities.

The importance of food handlers in the vending

of ready-to-eat foods cannot be overemphasized. They

have a prime role to play in food businesses, and thus

guarantee that meals served to their customers are

hygienic for consumption. It has been noted that the

examination of knowledge on food handling and health

problems on some food handlers proved that they did not

fully understand hazards, their risks and methods of

managing such hazards in the preparation and handling

of food (Amponsah et al.,2011).

WHO (1989) indicated that food handlers have

important role in ensuring food safety throughout the

chain of food production, processing, storage andpreparation. Any disregard and mishandling of hygienic

measures on the part of the food vendors may cause

pathogens to come into contact with food and multiply in

numbers of medical significance capable of causing

illness in the consumer. In Ghana, the use of a polythene

bag to package ready to- eat foods by food vendors is a

common phenomenon. In the course of packaging the

foods, food handlers blow air into the polythene bags to

open them and in the process a number of pathogens

could be passed on to the consumer. Mensah et al.,

(2002) are of the view that many food handlers introduce

biological and physical hazards through cross

contamination and mishandling of food.

Mensah et al., (2002) are of the view that the use

of bare hands to serve food increases the level of

contamination as entero-pathogens can survive on the

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hands for three hours or longer.

Pathogens can be harbored and transmitted on to

others by individuals who themselves are healthy. Such

carriers may have recently suffered an attack of food

poisoning and still be carriers of the organisms in their

body. In some in stances, carriers of food pathogens such

as Salmonella typhi and Bacillus cereusact as host over

a longer period of time having themselves acquired

immunity to organisms concerned. Such individuals

might end up transmitting organisms to other people

through food without being aware of it. It is thus

important that food handlers are educated on routes and

means through which pathogens invade the food they

prepare and sell to the public.Addo et al., ( 2007) intimated that food vendors

who sell ready to eat meals on the streets are important

factors who contribute significantly to food borne

related diseases as they have very little or no educational

background and hence have low understanding of food

safety issues (Mensah et al., 2002). Most often food

handlers are unaware of their role as a reservoir of

infection (Nichol and Salek, 2007). Improper handling

and sanitation practices lead to person-to-person, personto food and utensils to food cross contamination that

ultimately results in 27 % of reported outbreaks and

infection from food borne pathogens (WHO, 2002). The

transmission of pathogenic microorganisms by food

handlers is a problem in the food industry (Barza, 2004).

Food Hygiene Awareness among Food Handlers

There is no gainsaying that food handlers have a

major role in the prevention of food poisoning during

food preparation and distribution. Walker et al.,(2003)

argued that food handlers usually cross-contaminate

processed food stuff and are likely to under-cook and

store foods properly. It is possible that in most cases,

they contaminate processed food stuffs without being

aware that they are doing so. Continuous training and

education thus become very important if food handlers

are to handle food in a hygienic and safe manner. Thus

the best preventive measure lies in educating the food

handler on good personal hygiene and food safety. Marth

(1985) however observed that the food handlers are

usually young, itinerant and inexperienced people who

hardly stay on the job for a year and hence it becomes

extremely difficult to find and educate them while

actively working. In relation to this Walker et al., (2003)

thus asserted that there is high probability that the

absence of continuous training and reinforcement is to be

blamed for lack of food hygiene knowledge concerning a

number of important aspects in safe food production. A

lot of studies have confirmed the rather low level of

knowledge of food handlers on hygienic and microbial

safety of ready-to-eat foods (Walker et al., 2003).Inadequate hygienic knowledge and lack of

understanding of the basic principles of food hygiene is

thus a major bottleneck to the implementation of good

hygienic practices in the handling of ready-to-eat foods

in our schools and other public places. In this connection,

Ehiri and Morris, (1996) are of the view that there is the

need to conscientiously prevail upon and motivate food

handlers to put to practice their knowledge in food

hygiene.In contrast to the assertion made by Walker

et al., (2003) and Bryan (1988), is the view that in

addition to ignorance, reluctance by food handlers to

apply the acquired knowledge also contributes in no

small measure to food poisoning by food handlers.

Connected to this, Angelillo et al., (2000), further

indicated that a study conducted in Italy depicted that

although food handlers had positive attitude towards

food safety, it has not supported their practices in food

handling. There seem therefore to be no correlation

between good knowledge in food handling and the actual

practice in food processing among food handlers. It is

abundantly clear therefore that apart from knowledge,

there might be other factors that bring about attitudinal

change in safe food handling practices. Taylor (2000)

identified these factors to include socio-economic status,

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educational level and literacy and itinerant nature of

most food handlers.

Appropriate hygienic aspects of vending

operations as a major source of concern may not be

readily available. Toilets and adequate washing facilities

are rarely available. Hand washing and washing of

utensils and dishes is often done in buckets or bowls.

Disinfection is not usually carried out, and insects and

rodents may be attracted to sites where there is no

organized sewerage disposal. It has also been observed

that food is not adequately protected from flies; and

refrigeration is not usually available (Mensah et al.,

2002).

Some Food borne diseases

Foodborne diseases are either infectious or toxic

in nature. The toxins usually enter the human body

through consumption of food. Foodborne illness on the

other hand is sickness that results from eating

contaminated food laden with pathogenic

microorganisms, chemical or physical agents. The

victims normally experience one or more symptoms such

as nausea, vomiting, diarrhea, dehydration, abdominal

pain, headache, and fever (McSwane et al., 2002).Foodborne diseases are a serious health hazard and an

important cause of morbidity and mortality in developing

countries. It is an undisputable fact that most cases go

unreported and scientific investigations are rarely

conducted in most developing countries (Anuradha et al.,

1999). WHO (2002) observed that food and waterborne

diseases are the leading causes of illness and death in

under-developed countries, killing almost 1.8 million

people annually, most of whom are children.

Inappropriate handling practices by humans in

unhygienic behaviour could lead to food borne diseases

and poisoning (Adams and Moss, 2003); and foodborne

illness costs lives and money. The effect is that, millions

of people fall sick each year as thousands die after eating

contaminated or mishandled foods. Children, the

elderly and people with weakened immune systems are

especially vulnerable to foodborne illness.

CONCLUSION AND RECOMMENDATION

Studies across Africa have shown the extent to

which health hazards are posed to children by foods sold

on streets; and it is known that such foods contribute

significantly to morbidity and even mortality among

children (Canet and NDiaye, 1996). For the fact that

food vendors operate in insanitary environments that

could cause transmission of pathogens into food and

subsequent outbreak of foodborne diseases, it is

important that monitoring of foods sold in the various

places are conducted by the regulatory authorities (e.g.

municipal environmental and sanitation directorate) as

quality checks. Furthermore, there should be policies to

regulate and ensure that school canteens are strategically

located and not close to filth such as dumping sites and

toilets.

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