chapter v personal hygienic practices and hand...

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CHAPTER V

PERSONAL HYGIENIC PRACTICES AND HAND WASHING PRACTICES OF

CONSUMERS AND ITS CAUSE AND EFFECT IN FOOD SAFETY

Food contamination creates an enormous social and economic burden on

communities and their health systems. Every year about 325,000 people are hospitalized

with diagnosis of food poisoning, and 5,000 die. Improper cooking and cross

contamination may not be perceived as major food safety threats in the Indian context

because certain food safety measures are traditionally practised by the people perhaps

even without the knowledge of the scientific rationale behind them. Balkumar Marthi,

(1999)1 in his study, pointed out that Indian social and cultural practices have

traditionally been based on religion. Food is generally treated as sacred, and it is,

therefore, not surprising that all our ancient scriptures and religious texts foster great

attention and care to the subject of food preparation, storage and handling and clean food

habits among people.

A large percentage of illnesses however resulted from improper food handling

practices in the home. The role of the home as a point of origin for food borne illness has

prompted studies to evaluate aspects of contamination and improper handling of food in

the home. Proper hand washing is important to everyone, including low-income families

who often have limited resources for medical treatment. The role of hands in the

transmission of disease is well-established and effective hand washing and hand drying is

considered to be an important control measure in preventing the transmission of food-

borne diseases. Snelling et al., (1991)2 concluded that poor hand washing practices

inevitably lead to retention of bacterial and viral pathogens on the hands, which are

obtained from handling raw produce or from toilet activities.

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HAND WASHING PRACTICES – FACTOR ANALYSIS

Poor personal hygiene, including inadequate handwashing among the food

handlers is a common practice that contributes to food borne illnesses (FDA, 2004)3. In

Table 5.1, factor analysis has been used to analyze the handwashing practices of the

respondents.

Table 5.1 Factors influencing hand washing practices

Total Variance Explained

Com

pone

nt

Initial Eigenvalues Extraction Sums of Squared

Loadings

Rotation Sums of Squared

Loadings

Total % of

Varia

nce

Cumula

tive %

Total % of

Varian

ce

Cumul

ative %

Total % of

Varian

ce

Cumul

ative

%

1 4.285 42.84

6

42.846 4.285 42.846 42.846 3.265 32.646 32.646

2 2.114 21.14

4

63.989 2.114 21.144 63.989 3.134 31.343 63.989

3 .932 9.316 73.306

4 .790 7.901 81.207

5 .690 6.905 88.111

6 .493 4.933 93.045

7 .238 2.378 95.422

8 .183 1.834 97.256

9 .147 1.467 98.723

10 .128 1.277 100.000

Extraction Method: Principal Component Analysis.

Rotated Component Matrix

a

Hand Washing Practices Component

1 2

Before consuming food with soap .874 -.112

After consuming food with soap .864 -.065

Before cooking food with soap .844 -.227

After cooking food with soap .838 -.214

After using toilet with soap .490 -.051

After cooking without soap -.174 .851

Before consuming without soap -.139 .842

Before cooking without soap -.171 .833

After consuming without soap -.137 .821

After using toilet without soap -.029 .464

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Factor I ‘Hand washing practices with soap’:

Before consuming food .874

After consuming food .864

Before cooking food .844

After cooking food .838

After using toilet .490

Factor II ‘Hand washing practices without soap’:

After cooking .851

Before consuming .842

Before cooking .833

After consuming .821

After using toilet .464

To test the validity of the instrument, KMO test was conducted. The Kaiser-

Major-olkin measure of sampling adequacy in a statistic tool indicates the proportion of

variance in the variables that might be caused by various factors; high values (close to

1.0) generally indicate that a factor analysis is useful with the data. If the value is less

than 0.70, the results of the factor analysis are probably not useful. Here, the KMO value

for the instrument is 0.769, which is accepted as a good value. The Barlett test showed a

significant level and hence the instrument was accepted. Principal component analysis

was the method of extraction. Varimax was the rotation method. As per the Kaiser

Criterion, three factors in the initial solution have values greater than 1. Together, they

account for almost 63.989 (63%) of the variability in the original variables. Table 5.1

shows the Eigen values of the factors. Using the above rotated component value; the

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variables are classified into two factors, namely, hand washing practices with soap and

hand washing practices without soap.

1. Hand washing practices with soap is the name given to the first set of factors and

are identified through factor analysis.

All these variables had a factor loading of more than 0.4. All these items have

one commonality. Lack of awareness about hand washing practices leads to various

health issues, including food borne illness.

In addition to this, hand washing with soap before consuming food is considered

as the most important factor in safe hand washing practices. Washing hands after

consuming food is considered as the second important factor. It is followed by washing

hands before and after cooking. Further, hand washing with soap after using toilet is

considered as an important hand washing practices. To maintain good health, hand

washing is very important. Hence, it is essential to follow good hand washing practices

to lead a healthy life.

2. Hand washing practices without soap:

Hand washing practices include washing hands after cooking without soap, before

consuming food without soap, before cooking without soap, after consuming food

without soap and after using toilet without soap. It is a set of practices designed to have

an impact on safe cooking in effective manner. Hand washing after cooking is

considered as an important factor in maintaining good health. It is followed by washing

hands before consuming and cooking food without soap. Washing hands after

consuming food is also observed as an important factor. Further, washing hands after

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visiting toilet without soap is also considered as a crucial factor. Hence, it is concluded

that hand washing practices are very essential to avoid unnecessary health issues.

HAND WASHING PRACTICES AFTER USING TOILET

Hand washing is a hygienic activity that can interrupt the transmission of

diarrhoea causing pathogens. A correct handwashing method is an effective way to

prevent the spread of communicable diseases. It helps in reducing infectious diseases

(Ejemot et al., 2008)4. F test has been used to find out the relationship of hand washing

practice after using toilet and food borne diseases.

Table 5.2 Hand washing practices after using toilet and its impact on food borne

diseases

Null Hypothesis: Hand washing after using toilet has no impact on food borne diseases.

Hand washing

practices Diseases N X s F value P value

After using

toilet with

soap

Vomiting 190 4.17 1.472

2.744 .042*

Fever 139 3.72 1.646

Diarrhoea 343 3.84 1.555

Unsettled

stomach

134 3.93 1.632

After using

toilet

without soap

Vomiting 190 2.88 1.851

.872 .455*

Fever 139 3.11 1.780

Diarrhoea 343 3.04 1.752

Unsettled

stomach

134 3.19 1.841

*Significant at 5% level

Table 5.2 shows the relationship between hand washing after using toilet and

food borne diseases. As per the rejection of null hypothesis, there is a significant

relationship between the hand washing after using toilet with soap and food borne

diseases of the respondents. This analysis indicates that after visiting toilet, the hand

should be washed with soap to avoid food borne diseases. In another variable as per the

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acceptance of null hypothesis, there is no significant relationship between hand washing

without soap after using toilet and food borne diseases. This analysis concludes that

washing hands with soap after using toilet reduces food borne diseases and washing

hands without soap after using toilet create food borne diseases among the respondents.

EDUCATION AND HAND WASHING PRACTICES

The Centre for Disease Control and Prevention (2007)5 reported that improper

hand washing practices cause a health care associated infection that accounted for 1.7

million infections and 99,000 associated deaths each year in American hospitals alone.

In Table 5.3, the educational qualifications of the respondents are related to their hand

washing practices before and after using toilet.

Table 5.3 Influence of education and hand washing practices after using toilet

Null Hypothesis: The education of the respondents does not influence their hand

washing practices after using toilet.

N X s F value P value

After using toilet

with soap

Illiterate 129 3.47 1.737

17.088 .000* School Level 508 3.84 1.614

College Level 169 4.47 1.080

After using toilet

without soap


.944 .389* School Level 508 3.01 1.792



This analysis shows the relationship between the education of the respondents and

the hand washing practices with or without soap after visiting toilet. As per the rejection

of null hypothesis, there is a significant relationship between the hand washing practices

after using toilet and education of the respondents. In another variable, as per the

acceptance of null hypothesis, there is no significant relationship between the education

of the respondents and hand washing practices after using toilet. The mean score of

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college level education of respondents is greater than the school level and illiterate

respondents. Hence, the education of the respondents has no impact in the hand washing

practices of using soap after visiting toilet. But education influences the practice of

washing hands without soap after using the toilet.

OCCUPATION AND HAND WASHING PRACTICES

Hygienic practices normally include hand washing, proper methods of washing

utensils, separation of utensils for raw and cooked food and the location where the food is

prepared (Kumiko et al., 2009)6. In Table 5.4, the occupation of the respondents is related

to their handwashing practices after using toilet. F-test has been used to find out its

relationship.

Table 5.4 Influence of occupation on hand washing after using toilet

Null Hypothesis: Occupation does not influence hand washing practices of the

respondents after using toilet.


After using toilet

with soap

Housewife 464 3.89 1.591

4.480 .004* Employed 138 4.14 1.431

Daily Wages 142 3.58 1.677

Unemployed 62 4.31 1.301

After using toilet

without soap

Housewife 464 3.13 1.807

3.359 .018* Employed 138 2.72 1.784

Daily Wages 142 3.23 1.764



This table describes the relationship between the respondents’ occupation and

washing of hands after using toilet. As per the rejection of null hypothesis, there is a

significant relationship between washing hands after using toilet and occupation of the

respondents. It is concluded that the hand washing practice after using toilet is influenced

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by the occupation of the respondents. The respondents hand washing practices differ

according to their different occupations.

HANDLING OF PET ANIMALS

Lin et al., (2003)7 stated that the Centre for Disease Control and Prevention

(CDCP) reported that hand washing is one of the most important hygienic procedures in

preventing the transmission of infectious diseases. It is the first line of defence against

infectious disease, including respiratory infectious and gastrointestinal disorders. In Table

5.5, food borne diseases are related to the handling of pet animals and burns in hands

among the food handlers. F test has been used to find out the relationship.

Table 5.5 Handling pet animals and its impact on food borne diseases

Null Hypothesis: Handling of pet animals and burns in hands has no impact on

food borne diseases.


Do not handle pets while

preparing food

Vomiting 190 4.27 1.048

1.353 .256*

Fever 139 4.01 1.216

Diarrhoea 343 4.14 1.123

Unsettled

stomach

134 4.13 1.370

Burns leads to food borne

diseases while cooking

Vomiting 190 3.41 1.357

3.091 .026*

Fever 139 3.15 1.541

Diarrhoea 343 3.28 1.468

Unsettled

stomach

134 2.93 1.488


This study shows the relationship between handling pet animals and burns in

hands. As per the acceptance of null hypothesis, there is no relationship between

handling pets while preparing food and food borne diseases. This shows that there is no

impact in food borne diseases even though respondents handle pets. In another variable,

as per the rejection of null hypothesis, there is a significant relationship between burns

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leads to food borne diseases while cooking and food borne diseases. There is an impact

on food borne diseases when there are burns in hands while preparing food. Hence,

burns in hands have an impact on food borne diseases.

FOOD BORNE DISEASES

Unsafe drinking water, along with poor sanitation and hygiene are among the

main contributors to an estimated 4 billion cases of diarrhoeal disease annually, causing

more than 1.5 million deaths, mostly among children under 5 years of age (WHO 2005)8.

In Table 5.6, correlation has been used to find out the relationship between purchasing

contaminated food materials, practicing bad personal hygiene, cooking food at improper

temperature and using unsafe drinking water.

Table 5.6 Correlation - Food borne diseases

Purchasing

contaminated

food

materials

Practicing

bad

personal

hygiene

Cooking

food at

improper

temperature

Unsafe

drinking

water

Purchasing

contaminated

food materials

Pearson

Correlation

1 .655**

.534**

.531**

P value .000 .000 .000

Respondents 806 806 806

Practicing bad

personal

hygiene

Pearson

Correlation

1 .601**

.571**

P value .000 .000

Respondents 806 806

Cooking food

at improper

temperature

Pearson

Correlation

1 .577**

P value .000

Respondents 806

Unsafe

drinking water

Pearson

Correlation

1

P value

Respondents

**. Correlation is significant at the 0.01 level (2-tailed).

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This table explains the correlation of four significant factors in unsafe food

practices: purchasing contaminated food materials, practising bad personal hygiene,

cooking food at improper temperature and using unsafe drinking water. The correlation

is 0.655, which is positive and it shows that the practising of bad personal hygiene is

moderately correlated with purchasing contaminated food materials. The correlation is

significant at 1% level. The results of the correlation is high (0.655) between the

purchasing contaminated food materials and practicing bad personal hygiene. It is

followed by the correlation between cooking food at improper temperature and practising

bad personal hygiene (0.601). Hence, it is concluded that a higher correlation exists

between purchasing contaminated food materials and practising bad personal hygiene.

TIME TAKEN TO WASH HANDS

Mitakakis et al., (2004)9 stated that 70.3% of the respondents were poor in

handling food preparation, 46.6% do not wash their hands properly, 41.7% mishandled

raw food, and 70.1% mishandled cooked food. This concludes that the risk of diseases

through home-cooked food was high due to poor food handling practices.

Table 5.7 Time duration to wash hands and its impact on food borne diseases

Null Hypothesis: Time duration to wash hands is not associated with food borne

diseases.

Value df P value

Pearson Chi-Square 21.220a 9 .012*

Likelihood Ratio 21.633 9 .010

Linear-by-Linear Association 2.190 1 .139

N of Valid Cases 806


This table shows the association between time taken to wash hands and food

borne diseases. As per the rejection of null hypothesis, there is a significant relationship

between the food borne diseases and the time taken to wash hands. The time taken to

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wash hands has an impact on food borne diseases. The less time taken to wash hands is a

cause for food borne diseases.

EDUCATION AND TIME TAKEN TO WASH HANDS

Most of the consumers lack knowledge of proper hand washing practices.

Keeping hands clean through improved hygienic methods is one of the most important

steps to avoid getting sick and spreading germs to others (CDCP, 2010)10

. Education

plays an important role in hand washing practices. The education levels among the

respondents are categorized into three, namely, illiterate, school level and college level.

Table 5.8, explains the respondents’ education and their time taken to wash hands.

Table 5.8 Influence of education on time taken to wash hands

Null Hypothesis: Education of respondents is not associated with the time taken to wash

hands.

Value df P value



Linear-by-Linear Association .685 1 .408



It is evident from the above table, that as per the acceptance of null

hypothesis, there is no significant association between the education of respondents and

the time taken to wash hands. It is inferred that the time taken to wash hands does not

depend on the educational levels of the respondents. The scientific hand washing practice

of 20 seconds is not followed by the educated respondents.

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OCCUPATION AND TIME TAKEN TO WASH HANDS

A hygienic hand wash for food handling purposes could be defined as one

requiring warm water, soap or detergent and a scrubbing or rubbing action for at least 20

seconds (Jay et al., 1999b)11

. In Table 5.9, the occupations of the respondents are related

to the time taken to wash hands.

Table 5.9 Influence of occupation on time taken to wash hands

Null Hypothesis: There is no significant association between respondents’ occupation and

the time taken to wash hands.

Value df P value



Linear-by-Linear Association .205 1 .650



Chi-Square test has been used to analyse the relationship between the time taken

to wash hands and the occupations of respondents. As per the acceptance of null

hypothesis, there is no significant difference between occupation of respondents and time

taken to wash hands. The respondents’ time taken to wash hands is not influenced by

their occupation. The time taken to wash hands is not same in different levels of

occupation.

HAND WASHING PRACTICES AFTER VISITING TOILET

Curtis and Cairn Cross (2003)12

in their study have explained that hand washing is

considered to be the primary control measure for disease transmission during food

preparation and as one of the most effective ways to reduce the risk of diarrhoea. In Table

5.10, different age groups of respondents are related to the washing of hands after using

toilet with or without soap.

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Table 5.10 Impact of age on hand washing practices and after visiting toilet

Null Hypothesis: Age of the respondents does not cause any change in the hand washing

practices after using toilet with or without soap.


After using toilet

with soap

Below 25 126 4.10 1.474

6.599 .000*

25-30 113 4.11 1.391

31-36 128 4.21 1.373

37-42 134 3.99 1.519

43-47 86 4.08 1.528

Above 47 219 3.41 1.757

After using toilet

without soap

Below 25 126 2.74 1.781

2.115 .062*

25-30 113 3.38 1.734

31-36 128 3.19 1.817

37-42 134 2.83 1.829

43-47 86 3.10 1.796

Above 47 219 3.06 1.778


This table shows the relationship between the age of the respondents and the hand

washing practices with or without soap after using toilet. As per the rejection of null

hypothesis in the first case, there is a significant relationship between the age of the

respondents and hand washing practices with soap after using toilet. The different ages

of the respondents influence the hand washing practices with soap after visiting toilets.

In the next case, as per the accepatance of null hypothesis, there is no relationship

between the different age group of respondents and washing hands without soap after

using toilet. The age of the respondents does not influence the practice of hand washing

without soap after using toilet.

CONSUMING FOOD AND TIME TAKEN TO WASH HANDS

The safe practice of washing hands with soap and water before preparation of

food makes food poisoning less likely to occur (Altekruse et al., 1995)13

. The time taken

to wash hands is related to the hand washing practice of before and after consuming food

with soap. F-test has been used to find out its association.

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Table 5.11 Time taken to wash hands before and after consuming food

Null Hypothesis: Time taken to wash hands is not related with the hand washing with

soap before and after food.


Before

consuming with

soap

1- 5 seconds 477 2.66 1.707

6.095 .000* 6- 10 seconds 241 3.08 1.693

11- 15 seconds 40 3.50 1.569

16- 20 seconds 48 2.48 1.637

After consuming

with soap

1- 5 seconds 477 2.63 1.673

5.972 .001* 6- 10 seconds 241 3.03 1.724

11- 15 seconds 40 3.50 1.485

16- 20 seconds 48 2.50 1.650


One way analysis of variance has been used to know the relationship between the

time taken to wash hands and hand washing practices with soap before and after

consuming food. As per the rejection of null hypothesis, there is a significant difference

between the time taken to wash hands and hand washing practices with soap before and

after consuming food. The respondents’ time taken to wash hands is influenced by hand

washing with soap before and after consuming. It is concluded that the time taken to

wash hands and handwashing with soap before and after consuming food have effects

and reduces food borne diseases.

VISITING TOILETS AND TIME TAKEN TO WASH HANDS

Personal hygienic practices play an important role in preventing the spread and

contact of diseases. The most important aspects of personal hygiene include good toilet

practices and personal hygienic practices like bathing and proper hand washing (PHPPD,

2010)14

. In Table 5.12, F test has been used to find out the relationship between the time

taken to wash hands with or without soap after using toilet.

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Table 5.12 Time taken to wash hands after visiting toilet with or without soap

Null Hypothesis: Time taken to wash hands with or without soap is not related with after

visiting toilet.


After using toilet

with soap

1- 5 seconds 477 3.80 1.647

2.967 .031* 6- 10 seconds 241 4.14 1.404

11- 15 seconds 40 4.10 1.297

16- 20 seconds 48 3.73 1.685

After using toilet

without soap

1- 5 seconds 477 3.05 1.798

.489 .690* 6- 10 seconds 241 3.07 1.818

11- 15 seconds 40 3.15 1.594

16- 20 seconds 48 2.75 1.839


The time taken to washing hands with or without soap after visiting toilet has

been analysed with the help of ANOVA. As per the P value, and the rejection of null

hypothesis, there is a relationship between time taken to wash hands with soap and after

visiting toilet. It is followed by the acceptance of null hypothesis: without soap after

using toilet. Hence, there is no relationship between the time taken to wash hands without

soap after using toilet. It is concluded that the hand washing practices of washing hands

without soap after using toilet does not cause any change in the time taken to wash hands.

They give equal importance to hand washing practices of washing hands with soap after

using toilet.

EDUCATION AND HANDLING OF PET ANIMALS

The education of the respondents plays an important role in the hand washing

practices of the respondents. Education level of the respondents is categorized into three

categories, namely illiterate, school level and college level. F-test has been used to find

out the association between education and respondents’ hand washing practices. Hands

should be washed thoroughly with soap and water after touching pets or coming in

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contact with them or the area where they live. It is very important to wash hands after

touching a pet and before preparing, serving, eating or drinking (CDCP, 2012)15

.

Table 5.13 Education and handling of pet animals

Null Hypothesis: Education of the respondents have no impact on hand washing practices

after touching pet animals.



6.208 .002* School Level 508 4.17 1.168


Total 806 4.15 1.168


This table describes the relationship between respondents’ education and washing

of hands after touching pet animals. As per the rejection of null hypothesis, there is a

significant relationship between washing hands after touching pet animals and the

education of the respondents. It is concluded that hand washing practices after touching

pet animals is influenced by the education of respondents. So hand washing practices

after touching pet animals change according to the education of the respondents.

HANDLING OF PET ANIMALS AND DISTRICTS

Hand washing is the most effective way to prevent the spread of infections. Good

hand washing techniques include using of adequate quantity of soap and running water.

Ensuring that food handlers wash the hands thoroughly after handling pets and raw meat

is the need of the hour (Peru, 2010)16

.

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Table 5.14 Handling of pet animals during food preparation in different districts

Null Hypothesis: District is not related to handling of pet animal while preparing food.


Thoothukudi 243 4.37 1.025

5.544 .001*

Kanyakumari 285 4.13 1.313

Virudhunagar 157 3.89 1.163

Madurai 121 4.10 1.003

Total 806 4.15 1.168


This table shows the relationship between respondents’ district and handling of

pet animals while preparing food. As per the rejection of null hypothesis, there is a

significant relationship between handling of pet animals while preparing food and the

district of the respondents. It is concluded that handling of pet animals while preparing

food is influenced by the district of the respondents. It differs from district to district.

INFLUENCE OF EDUCATION IN USING BARE HANDS TO SERVE FOOD

Many food borne diseases and pathogenic microorganisms are spread by

contaminated hands. If pathogens from human faeces enter a person’s mouth, they will

cause diarrhoea. School going children are exposed to greater risks of diarrhoeal disease

by consuming contaminated water and food (Dasgupta, 2005)17

.

Table 5.15 Influence of education in using bare hands to serve food

Null Hypothesis: Education of the respondents is not related to using bare hands to serve

food.



.951 .387* School Level 508 4.08 1.123


Total 806 4.06 1.129


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This table analyses the relationship between using bare hands to serve food and its

relationship with the education of the respondents. As per the acceptance of null

hypothesis, there is no significant relationship between the education of respondents and

using bare hands to serve food. It is concluded that the education of the respondents does

not influence in using bare hands to serve food. Using bare hands to serve food does not

vary with the different levels of education. The low level and high level educated

respondents have same attitude towards serving food with bare hands.

Fig. 5.2 Influence of education in using bare hands to serve food

OCCUPATION AND USING BARE HANDS TO SERVE FOOD

Fawzi and Shama (2009)18

in their study concluded that food safety at the

household level is well accepted and so an understanding of the status of food handling

knowledge and practices is needed. Many working women concentrate on their jobs, and

hence give less importance to safe food handling practices at home. They do not follow

hygienic hand washing practices. They are unaware that these unhygienic practices at

home kitchen leads to food borne diseases. In Table 5.16, the occupation of the

respondents is related to the use of bare hands to serve food.

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Table 5.16 Influence of occupation in using bare hands to serve food

Null Hypothesis: Occupation of the respondents is not associated with the use of bare

hands to serve food.


Housewife 464 4.06 1.152

.694 .556*

Employed 138 4.12 1.040

Daily Wages 142 4.05 1.107


Total 806 4.06 1.129


One way analysis of variance has been used to know the relationship between

using bare hands to serve food and the occupation of respondents. As per the acceptance

of null hypothesis, there is no significant difference between the occupation of

respondents and using bare hands to serve food. The different occupations are not related

with using bare hands to serve food. The occupation of the respondent is not a cause for

serving food with bare hands.

EDUCATION AND COOKING WITH BURNS IN HANDS

Guzewich and Ross, (1999)19

, in their study, analysed the different factors causing

food borne diseases. Finally, they concluded that the food handlers and poor hand

washing practices could be implicated as the source of food borne disease outbreaks. In

Table 5.17, the educational qualifications of the respondents are related to the possibility

that lead to food borne diseases.

Table 5.17 Relationship between different levels of education and cooking with

burns in hands

Null Hypothesis: There is no significant association between respondents’ education and

burns leads to food borne diseases.



2.002 .136* School Level 508 3.27 1.462

College Level 169 3.04 1.443 *Significant at 5% level

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One way analysis of variance has been used to know the relationship between

cooking with burns in hands and food borne diseases and the education of respondents.

As per the acceptance of null hypothesis, there is no significant difference between

education of respondents and the burns in the hands leading to food borne diseases. The

respondents’ cooking with burns in hands leads to food borne diseases is not related with

their education. Education of the respondents is not a crucial factor to determine the

cooking food with burns in hands.

OCCUPATION AND COOKING WITH BURNS IN HANDS

The food borne transmission of known pathogens caused 6.5 million illnesses and

upto 9,000 deaths each year (Bennett et al., 1987)20

. In 1989, Todd used a combination of

methods, including extrapolation from Canadian surveillance data, to arrive at an

estimate of 12.5 million food borne illnesses and 522 related deaths each year (Todd

1989)21

. In Table 5.18, the concept that burns leads to food borne diseases while cooking

is analysed. One way analysis of variance has been used to find out the relationship.

Table 5.18 Occupation and burns in hands leads to food borne diseases while

cooking

Null Hypothesis: The occupation of respondents has no impact on burns leading to

food borne diseases while cooking.


Housewife 464 3.31 1.460

5.419 .001* Employed 138 2.83 1.489

Daily Wages 142 3.45 1.427



An attempt has been made to understand the association between respondents’

occupation and their burns in hands leading to food borne diseases while cooking. As per

the rejection of null hypothesis, there is a significant association between occupation and

burns in hands leading to food borne diseases while cooking. This concluded that the

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burns in hands cause food borne diseases while cooking differs with the different

occupations of the respondents.

BURNS IN HANDS AND AWARENESS OF FOOD BORNE DISEASES

Handwashing is one of the basics of good hand hygiene. Hand hygiene is

regarded as the most important element in infection control activities (Purva Mathur,

2011)22

. In Table 5.19, t test has been used to find out the relationship between the burns

leading to food borne diseases while cooking and awareness of food borne diseases.

Table 5.19 Cooking with burns and awareness of food borne diseases

Null Hypothesis: Burns leading to food borne diseases while cooking is not associated

with the awareness of food borne diseases.

Awareness of Food

borne Diseases N X s t value P value

Burns leads to

food borne

diseases while

cooking

Awareness of food

borne diseases

705 3.24 1.496

.385 .700* Unawareness of

food borne diseases

101 3.18 1.228


This table shows the relationship between burns in hands leading to food borne

diseases while cooking and the awareness of food borne diseases. As per the acceptance

of null hypothesis, there is no significant association of cooking with burns in hands

leading to food borne diseases and the awareness of food borne diseases. Hence, it is

infered that awareness of food borne diseases is not influenced by cooking with burns in

hands leading to food borne diseases.

WASHING HANDS WITH SOAP AFTER HANDLING MEAT/FISH

One small case control study of infectious mortality risk with retrospective data

on reported hand washing was located. It showed a reduction in overall mortality

associated with reported hand washing with soap, but not in diarrhoea mortality (Hoque

118

et al., 1999)23

. In Table 5.20, the education level of the respondents is associated with

washing hands with soap after handling meat/fish.

Table 5.20 Influence of education in washing hands with soap after handling

meat/fish

Null Hypothesis: Respondents’ education is not associated with washing of hands with

soap after handling meat/fish.



2.086 .125* School Level 508 4.29 1.239


Total 806 4.27 1.233


This table reveals the relationship between the education of the respondents and

washing of hands with soap after handling meat/fish. As per the acceptance of null

hypothesis, there is no relationship between the education of the respondents and washing

hands with soap after handling meat/fish. Hence, it is concluded that the low and high

levels education of respondents do not cause any change in washing hands with soap after

handling meat/fish. They look upon washing hands equally with soap after handling

meat/fish irrespective of their education.

Occupation and washing hands after handling meat/fish

For more than a century, handwashing has been recognized as an essential

component in the prevention of the spread of microbial infection (Fendler et al., 1998)24

.

Proper handwashing practices help to reduce the spread of bacteria and viruses that cause

other illnesses. Handwashing practice is an indispensible technique to prevent food

borne diseases. In Table 5.21, handwashing with soap after handling meat/fish among

the respondents is analysed. F test has been used to relate the occupation and the


119

Table 5.21 Influence of occupation in washinng hands after handling meat/fish

Null Hypothesis: The different occupations of respondents do not influence



Housewife 464 4.28 1.241

.215 .886*

Employed 138 4.21 1.276

Daily Wages 142 4.26 1.213


Total 806 4.27 1.233


This table shows the relationship between the occupation of the respondents and

washing hands with soap after handling meat/fish. As per the acceptance of null

hypothesis, the respondents’ occupations do not cause any change in washing hands with

soap. This analysis concludes that the respondents’ occupations do not influence

washing hands with soap after handling meat/fish. Washing hands with soap after

handling meat/fish is equally followed by the respondents irrespective of their

occupation.

INFLUENCE OF INCOME IN WASHING HANDS AFTER HANDLING

MEAT/FISH

Hand washing is vital in preventing contamination of food by food handlers.

Harmful bacteria present in the hands of food handlers can be removed by proper hand

washing techniques. Regular hand washing should be practised before handling raw food

(Food safety Authority of Ireland, 2012)25

. In Table 5.22, F test has been used to find out

the association between income and the hand washing practices of respondents after

handling meat/fish.

120

Table 5.22 Influence of income in washing hands after handling meat/fish

Null Hypothesis: The different levels of income do not cause any change in washing

hands after handling meat/fish.


Below Rs. 5000 172 4.26 1.249

2.742 .044*

Rs. 5001 - Rs.15000 84 4.02 1.326

Rs. 15001- Rs. 25000 15 4.80 .561

Above Rs. 25000 9 4.89 .333

Total 280 4.24 1.242


Table 5.22 analyses the association of income of the respondents with hand

washing practices after handling meat/fish. As per the rejection of null hypothesis, there

is a relationship between washing hands after handling meat/fish and the different levels

of income. This analysis concludes that the different levels of income cause changes in

the hand washing attitudes of the respondents after handling meat/fish. The low and high

income groups’ of the respondent vary in hand washing practices after handling

meat/fish.

AGE AND WASHING VEGETABLES

Davila et al., (2009)26

in his study analysed the reasons for diarrhoeal illness

among mothers, infants and children and found that there are lack of food safety practices

like washing hands before preparing meals and infant formula, washing hands after

changing diaper for children, washing hands after handling raw and cooked food. In

general mothers reported less frequent in hand washing and had lower food safety

practices. In Table 5.23, the age groups of the respondents are related to washing

vegetables before cooking.

121

Table 5.23 Influence of age in washing vegetables before cooking

Null Hypothesis: Age does not influence washing vegetables before cooking.


Below 25 126 4.74 .761

1.004 .414*

25-30 113 4.77 .668

31-36 128 4.73 .684

37-42 134 4.80 .487

43-47 86 4.72 .730

Above 47 219 4.64 .761


This table shows the relationship between the age of the respondents and their

practice of washing vegetables before cooking. As per the acceptance of null hypothesis,

there is no relationship between the age of the respondents and their washing of

vegetables before cooking. This analysis concludes that the hygienic practice of washing

vegetables before cooking is not related with the age of the respondents.

EDUCATION AND WASHING VEGETABLES BEFORE COOKING

Hands are one of the main ways through which germs spread. So it is important

to wash hands thoroughly with soap and warm water before cooking, after touching the

bin, after cooking, after toilet and after touching raw food (FSA, 2010)27

. In Table 5.24,

the education level of the respondents is compared with washing vegetables before

cooking.

Table 5.24 Influence of education in washing vegetables before cooking

Null Hypothesis: Education of the respondents does not influence washing

vegetables before cooking.


Illiterate 129 4.59 .835

3.144 .044* School Level 508 4.76 .635

College Level 169 4.72 .733


122

This table illustrates the relationship between the education of the respondents

and their practice of washing vegetables before preparing food. As per the rejection of

null hypothesis, there is a significant relationship between the education of the

respondents and the washing of vegetables before preparation of food. It is concluded that

the level of education influences the practice of washing vegetables before preparation of

food. The respondents with high level education take more care in washing vegetables

than the low level educated consumers.

OCCUPATION AND WASHING VEGETABLES

Worsfold and Griffith (1997)28

reported poor food handling practices after

observing 108 consumers during all stages of food preparation: purchase, preparation,

cooking and storage of four recipes. Such bad practices may lead to the great danger of

cross-contamination and subsequent food poisoning. It has been estimated that 66% of

consumers do not wash their hands before work, 41% do not wash vegetables, and 60%

use a single board for all cutting tasks.

Table 5.25 Influence of occupation in washing vegetables before cooking

Null Hypothesis: Washing vegetables before cooking food does not vary with the

respondents’ occupation.


Housewife 464 4.73 .651

.795 .497* Employed 138 4.68 .783

Daily Wages 142 4.68 .802

Unemployed 62 4.82 .497


This table shows the relationship between respondents’ occupation and washing

of vegetables before preparation of food. As per the acceptance of null hypothesis, there

is no significant difference among the respondents in different occupations and their

123

washing of vegetables before cooking. It is concluded that the washing of vegetables

before preparation of food is not based on the respondents’ occupation. The same

processes are followed by the respondents in different occupations.

IMPACT OF DRYING HANDS AND DIFFERENT OCCUPATION

Harmful substance is transmitted by ingesting contaminated food or drink, by

direct person-to person contact, or from contaminated hands. Human hands usually

harbor microorganisms both as part of person’s normal microbial flora as well as

transient microbes acquired from the environment (Lindberg et al., 2004)29

. In Table

5.26, the occupation level has been compared with the respondents’ drying of hands.

F test has been used to find out the relationship.

Table 5.26 Impact of drying hands and different occupation

Null Hypothesis: Awareness about drying hands with paper towel or cloth does not

vary with the occupation of the respondents.


Housewife 464 3.66 1.318

.797 .496*

Employed 138 3.80 1.289

Daily Wages 142 3.81 1.266


Total 806 3.72 1.295


Table 5.26 shows the relationship between the awareness of drying hands and the

different occupation levels of the respondents. This one way analysis concludes that the

different occupation of the respondents and their awareness towards drying hands is the

same. As per the acceptance of null hypothesis, there is no significant relationship

between respondents’ occupation and their awareness in drying hands. The respondents

have awareness to dry hands with towards irrespective of their occupation.

124

EDUCATION AND DRYING HANDS WITH PAPER TOWEL/CLOTH

Strina et al. (2002)30

revealed that the prevalence of diarrhoea among children in

mainly unhygienic behaviour recorded was 2.2 times higher than among children in the

mainly poor hygienic group. The home and school environments were of particular

concern for the transmission of infections among young children. Unfortunately, most

schools in developing countries do not provide appropriate hand washing facilities.

Where these facilities are available, they may be poorly located, have insufficient hand

washing materials, be inaccessible, or be improperly used. Effective hand washing

(including drying) is important in infection control.

Table 5.27 Relationship in education and drying hands with paper towel/cloth

Null Hypothesis: Drying hands with paper towel/cloth does not vary with the different

education levels of the respondents.



1.172 .310* School Level 508 3.70 1.305


Total 806 3.72 1.295


The education of respondents and their practice of drying hands with paper

towel/cloth is analysed with the help of ANOVA. As per the P value, the null hypothesis

is accepted regarding the drying of hands with paper towel/cloth. Hence, there is no

relationship between the education of the respondents and their practice in drying hands

with paper towel/cloth. This analysis indicates that respondents in low and high levels

education do not show any difference in drying hands. They give equal response to dry

hands with paper towel/cloth.

125

INCOME AND DRYING HANDS

Tambekar et al. (2009)31

studied the effect of hand washing in preventing the

enteric infections among students. Redmond and Griffith (2003)32

documented the ability

of the various stages of hand washing to decrease skin-surface microbial counts. Table

5.28, explains the drying of hands with paper towel/cloth and income. It is analysed by

using F test.

Table 5.28 Income and its impact on drying hands with paper towel/cloth

Null Hypothesis: Income of the respondents does not influence drying hands with

paper towel/cloth.


Below Rs. 5000 172 3.78 1.296

.136 .939*

Rs. 5001 - Rs.15000 84 3.82 1.243

Rs. 15001- Rs. 25000 15 4.00 1.309

Above Rs. 25000 9 3.78 1.302

Total 280 3.81 1.275


This table demonstrates the relationship between income of the respondents and

their practice of drying the hands with paper towel/cloth. As per the acceptance of null

hypothesis, there is no significant relationship between the income of the respondents and

drying hands with paper towel/cloth. It is concluded that the monthly income does not

influence the practice of drying hands with paper towel/cloth. The respondents dry hands

with paper towel/cloth irrespective of their income.

FOOD BORNE DISEASES AND DRYING HANDS WITH PAPER

TOWEL/CLOTH

Hand washing is one of the range of hygiene promotion interventions that can

interrupt the transmission of diarrhoea-causing pathogens (Ejemot et al., 2008)33

. Hence

126

the purpose of this study is to identify bacterial enteric pathogens associated with hands

and to arrive at reduction of danger after hand washing to reduce diarrhoea disease linked

to poor hand hygiene. In Table 5.29, F test has been used to find out the relationship

between drying hands with paper towel/cloth and food borne diseases.

Table 5.29 Drying hands with paper towel/cloth and its impact on food borne

diseases

Null Hypothesis: Drying hand with paper towel/cloth is not related with food borne

diseases.


Vomiting 190 3.65 1.237

.680 .564*

Fever 139 3.67 1.188

Diarrhoea 343 3.80 1.337

Unsettled stomach 134 3.69 1.372

Total 806 3.72 1.295


Table 5.29 shows the mean value of drying hands and its impact on food borne

diseases. As per the acceptance of null hypothesis, there is no significant relationship

between the practice of drying hands with paper towel/cloth and food borne diseases.

This analysis concludes that drying hand with paper towel/cloth is not related to food

borne diseases among the respondents.

WASHING HANDS WITH SOAP

Improper food handling practices include, inadequate cooking, inadequate cooling

and storage of foods, cross-contamination of raw and cooked foods, inadequate personal

hygiene such as hand washing, and consumption of raw, undercooked, or unsafe foods

(CAST, 1994)34

. In Table 5.30, washing hands with soap after handling meat/fish and

food borne diseases is analysed. F test has been used to find out its association.

127

Table 5.30 Washing hands with soap after handling meat/fish

Null Hypothesis: Washing hands with soap after handling meat/fish is not related

with food borne diseases.


Vomiting 190 4.27 1.288

2.467 .061*

Fever 139 4.06 1.267

Diarrhoea 343 4.38 1.102

Unsettled stomach 134 4.20 1.408

Total 806 4.27 1.233


The association between washing hands with soap after handling meat/fish and

food borne diseases is analysed with the help of F test. As per the acceptance of null

hypothesis there is no association between the food borne diseases and washing hands

with soap after handling meat/fish. The respondents wash hands with soap after handling

meat/fish and this has no impact on food borne diseases.

AWARENESS OF FOOD BORNE DISEASES AND WASHING HANDS

Food borne diseases remain a major public health problem across the globe. The

problem is more severe in developing countries due to lack of personal hygiene and food

safety measures. As much as 70% of diarrhoeal diseases in developing countries are

believed to be of food borne origin (WHO 2010)35

. In Table 5.31, washing hands with or

without soap before and after consuming food and the awareness of food borne diseases

are associated and analysed.

128

Table 5.31 Awareness of food borne diseases and washing hands

Null Hypothesis: Awareness of food borne diseases does not cause any change in

washing hands with or without soap before and after consuming food.

Awareness of Food

Borne Diseases N X s t value P value

Before consuming

without soap

Awareness of food

borne diseases

705 3.37 1.768

.119 .905* Unawareness of food

borne diseases

101 3.35 1.682

After consuming

without soap

Awareness of food

borne diseases

705 3.39 1.748

.273 .785* Unawareness of food

borne diseases

101 3.34 1.716

Before consuming

with soap

Awareness of food

borne diseases

705 2.85 1.715

1.337 .182* Unawareness of food

borne diseases

101 2.60 1.656

After consuming

with soap

Awareness of food

borne diseases

705 2.85 1.694

2.930 .003* Unawareness of food

borne diseases

101 2.33 1.632


The awareness of food borne diseases and its influence on washing hands with or

without soap before and after consuming food is analysed with the help of ANOVA.

As per the P value, the null hypothesis is accepted regarding hand washing practices.

Hence, there is no relationship between the awareness of food borne diseases and the

practice of washing hands with or without soap before and after consuming food. This

analysis indicates that awareness of food borne diseases does not cause any change in

washing hands with or without soap before and after consuming food. They wash hands

with or without soap before and after consuming food irrespective of their awareness.

Next in the another variable, as per the rejection of null hypothesis, there is a relationship

among the respondents in washing hands with soap after consuming food and their

awareness of food borne diseases.

129

REFERENCES

1. Balkumar Marthi, (1999). Food safety challenges in developing countries: the Indian

situation. Microbiology Section, Hindustan Lever Research Centre, Andheri (East),

Mumbai 400 099, India Food Control, Vol: 10, pp.243-245.

2. Snelling, A.M., Kerr, K.G., and Heritage, J., (1991). The survival of Listeria

monocytogenes on fingertips and factors affecting elimination of the organism by

handwashing and disinfection. Journal of Food Protection, Vol:54, pp.343–348.

3. Food and Drug Administration, (2004). FDA report on the occurrence of food borne illness

risk factors in selected institutional foodservice, restaurant, and retail food store facility types

(2004). College Park, MD: FDA/Center for Food Safety and Applied Nutrition, Office of

Compliance. Retrieved May 10, 2006, from http://www.cfsan .fda.gov/~dms/retrsk2.html

4. Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M., and Critchley, J.A., (2008). Hand

washing for preventing diarrhoea. Cochrane Database Syst. Rev., 23(1): Art. No. CD

004265.

5. Centre for Disease Control and Prevention, (2007). Guideline for Isolation

Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

http://www.cdc.gov /ncidod/dhqp/pdf/isolation2007.pd

6. Kumiko Takanashi, Yuko Chonan, Dao To Quyen, Nguyen Cong Khan, Krishna

C.Poudel and Masamine Jimba, (2009). Survey of Food-hygiene Practices at Home

and Childhood Diarrhoea in Hanoi, Vietnam. Health PopulNutr. 2009 October; Vol:

27(5), pp: 602–611.

7. Lin, C.M., Wu, F.M., Kim, H.K., Doyle, M.P., Michaels, B.S., and Williams, L.K.,

(2003). Comparison of hand washing techniques to remove Escherichi coli and

Caliciviruses under natural or artificial fingernails. J. Food Prot. Vol: 66(12), pp:

2296-2301.

8. WHO, (2005). Progress towards the Millennium Development Goals, 1990-2005.

(downloadedfromhttp://unstats/un.org/unsd/mi/goals_2005/goal_4.pdfon15November

2005).

9. Mitakakis, T.Z., Sinclari, M.I., Fairley, C.K., Lightbody, P.K., Leder, K., and Hellar,

M,E., (2004). Food safety in family homes in Melbourne. Australia Journal of Food

Protection, Vol: 67(4), pp. 818-822.

130

10. Centre for Disease Control and Prevention. (2010). http://www.cdc.gov/healthy

water/hygiene/hand/handwashing.html.

11. Jay, L.S., Comar, D., and Govenlock, L.D., (1999b). A national Australian food

safety telephone survey. Journal of Food Protection, Vol: 62(8), pp. 921–928.

12. Curtis, V., and Cairn Cross, S., (2003). Effect of washing hands with soap on

diarrhoea risk in the community: a systematic review. Lancet Infect Dis. Vol: 3 (3),

pp. 275 – 281.

13. Altekruse, S.F., Street, D.A., Fein, S.B., and Levy, A.S., (1995). Consumer

knowledge of food borne microbial hazards and food handling practices. Journal of

Food Protection, Vol: 59(3), pp. 287–294.

14. Personal Hygiene Practice to Prevent Disease (PHPPD), (2010). http://www.livestro

ng.com/ article/92288-personal-hygiene-practice-prevent-disease/

15. Centre for Disease Control and Prevention, (2012). http://www.cdc.gov/Features

/SalmonellaDryPetFood/index.html.

16. Peru, (2010). A Handwashing Behavior Change Journe August. Global Scaling Up

Hand washing Project.

17. Dasgupta, R., (2005). Prevention of diarrhoeal disease in migrant households in

Delhi. Population-Envis Centre, 2(3): 3-9.

18. Fawzi, M., and Shama, M.E., (2009). “Food Safety Knowledge and practices among

women working in Alexandria University, Egypt. Department of Nutrition, High

Institute of public Health, Alexandria University, Egypt. Journal Egypt Public Health

Association. Vol: 84, (1-2), pp: 95 – 117.

19. Guzewich, J.J., and Ross, M.P., (1999). White paper, section one: A literature review

pertaining to food borne disease outbreaks caused by food workers. 1978–1998.

20. Bennett, J., Holmberg, S., Rogers, M., Solomon, S., (1987). Infectious and parasitic

diseases. In: Amler, R., Dull, H., editors. Closing the gap: the burden of unnecessary

illness. New York: Oxford Univ Press; 1987: 102-14.

21. Todd, ECD. Preliminary estimates of costs of food borne disease in the United States.

J Food Protect 1989; Vol: 52, pp. 595-601.

131

22. Purva Mathur, (2011). Hand hygiene: Back to the basics of infection control. Indian J

Med Res. 2011 November; Vol: 134(5), pp. 611–620.

23. Hoque, B., Chakraborty, J., Chowdhury, J., (1999). Effects of environmental factors

on child survival in Bangladesh: a case control study. Public Health, Vol: 113, pp.

57–64.

24. Fendler, E. J., Dolan, M. J., and Williams, R. A., (1998). Handwashing and gloving

for food protection part I: Examination of the evidence. Dairy, Food and

Environmental Sanitation, 18, 814-823. Food worker handwashing practices: An

observational study. Journal of Food Protection, Vol. 69, pp. 2417-2423.

25. Food safety Authority of Ireland, (2012). FSAI Websites Users Survey. http://

www.fsai.ie/faqs/hand_washing.html.

26. Davila, E.P., Trepka, M.J., Newman, F.L., Huffman, F.G., and Dixon, Z., (2009).

“Diarrhoeal illness among Women, Infants and Children (WIC) Program Participate

in Miami, Florida International University, Stempel School of Public Health, Miami;

Vol: 41 (6), pp. 420-424.

27. Food Standards Agency. (2010). Advice for registered carers on domestic premises

operating as a food business. Available at: www.food.gov.uk.

28. Worsfold, D., and Griffith, C.J., (1997). Food safety behaviour in the home. British

Food Journal, Vol: 99, pp. 97–104.

29. Lindberg, E.I., Adlerberth, B., Hesselmar, R., Saalman, I., Strannegared, N., Aberg

A., and Wold, (2004). High rate of transfer of Staphylococcus aureus from parental

skin to infant gut flora. J. Clin. Microbial. Vol: 42, pp. 530-534.

30. Strina, A.S., Cairn Cross, M.L., Larrea, C.B., and Prado, M.S., (2002). Childhood

diarrhoea and observed hygiene behaviour in Salvodor, Brazil. Am. J. Epidemiol.,

157, pp. 1032-1038.

31. Tambekar, D.H., Shirsat, S.D., Kakde, S.R., and Ambekar, K.B., (2009). Hand

hygiene and health: An epidemiological study of students in Amravati. Afr. J. Infect.

Dis., Vol: 3(1), pp. 26-30.

32. Redmond, E.C., Griffith, C.J., (2003). Consumer food handling in the home: a review

of food safety study. J Food Prot.; Vol: 66, pp. 130–161.

132

33. Ejemot, R.I., Ehiri, J.E., Meremikwu, M.M., and Critchley, J.A., (2008). Hand

washing for preventing diarrhoea. Cochrane Database Syst. Rev., 23(1): Art. No. CD

004265.

34. CAST, (1994). Council for Agricultural Science and Technology. Food borne

pathogens: risks and consequences. Task Force Report No. 122, Washington, DC and

Ames, IA.

35. WHO, (2010). Food borne Disease: A focus for Health Education. 2000. Available

fromhttp://www.who.int/foodsafety/publications/capacity/fbd/en/index.html[last

accessed on 2010 Aug 2].

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