Faculty of Bioscience Engineering

Academic year 2012-2013

Microbial safety aspects of street foods in Haiti

RUTH CLIMAT

Promoter: Prof. dr. ir. Frank Devlieghere

Co-promoter: Dr. Simbarashe Samapundo

Master’s dissertation submitted in partial fulfillment of the requirements for the degree of Master of Science in Nutrition and Rural Development

Main subject: Human nutrition Major: Public health

Copyright

“The author and the promoter give permission to put this Master’s Dissertation to disposal for consultation and copy parts of it for personal use. Any other use falls under the limitations of copyright regulations, in particular to explicitly mention the source when citing parts of this Master’s dissertation”.

Ghent University, 22th May 2013

_____________________ __________________________

Ruth Climat Dr. Simbarashe Samapundo

_____________________________

Prof. dr. ir. Frank Devlieghere

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Acknowledgments

I would like to acknowledge my supervisor Dr. Simbarashe Samapundo for his valuable support,

contribution and assistance all the way in the preparation of that master dissertation. My thanks

also go to my promoter Prof. dr. ir. Frank Devlieghere for giving me that great opportunity to

work in the lab and to analyze my samples. Appreciation is also due to a wonderful lady Mrs.

Ramize Xhaferi1 without whom the realization of the microbiology analysis wouldn’t be

possible.

My gratitude also goes to all my fellow students specially Gwao Omari Gwao whom in one

manner or another have given me their time and encouragements throughout the realization of

my work.

In addition, I would like to think the Human Nutrition and rural development staff: Mrs. ir.

Anne-Marie Remaut-De Winter and Mrs. Marian Mareen2 for being always there for

suggestions, advice and encouragements.

I would also like to express my sincere gratitude to VLIR-UOS for their generous financial

support of this master.

I would also like to thank all the street vendors who kindly gave me their approbation to carry on

the observation for the realization of this Master Dissertation.

Finally, I would like to thank my Family and my God who have never let me down in anything.

1 Laboratory assistant Flanders' Food Department of Food Safety and Food Quality 2 MSc. Nutrition and Rural Development    

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Table of Content

1.  INTRODUCTION ......................................................................................................................................... ‐ 1 ‐ 

1.1.  JUSTIFICATION OF THE STUDY ........................................................................................................................... ‐ 1 ‐ 

1.2.  MAJOR OBJECTIVES OF THE STUDY .................................................................................................................... ‐ 2 ‐ 

2.  LITERATURE REVIEW ................................................................................................................................. ‐ 3 ‐ 

2.1.  INTRODUCTION ............................................................................................................................................. ‐ 3 ‐ 

2.2.  FOOD SAFETY KNOWLEDGE AND ATTITUDES ........................................................................................................ ‐ 3 ‐ 

2.3.  FOOD HANDLING AND PRACTICES ...................................................................................................................... ‐ 6 ‐ 

2.4.  OVERVIEW OF STREET‐VENDED FOODS ............................................................................................................... ‐ 7 ‐ 

2.5.  MICROBIAL QUALITY OF STREET FOODS .............................................................................................................. ‐ 9 ‐ 

2.6.  CONCLUSION .............................................................................................................................................. ‐ 11 ‐ 

3.  MATERIALS AND METHODS ..................................................................................................................... ‐ 13 ‐ 

3.1.  MATERIALS ................................................................................................................................................ ‐ 13 ‐ 

3.1.1.  Food safety knowledge and attitude questionnaire ..................................................................... ‐ 13 ‐ 

3.1.2.  Food handling observation checklist ............................................................................................ ‐ 14 ‐ 

3.1.3.  Food samples ................................................................................................................................ ‐ 14 ‐ 

3.2.  METHODOLOGY .......................................................................................................................................... ‐ 15 ‐ 

3.2.1.  Food safety knowledge and attitude questionnaire ..................................................................... ‐ 15 ‐ 

3.2.2.  Food practices observation check list ........................................................................................... ‐ 15 ‐ 

3.2.3.  Food samples collection and analysis ........................................................................................... ‐ 16 ‐ 

3.2.4.  Partial Confirmation techniques for pathogens ........................................................................... ‐ 17 ‐ 

3.3.  DATA ENTRY AND DOCUMENTATION ............................................................................................................... ‐ 18 ‐ 

3.4.  STATISTICAL ANALYSIS .................................................................................................................................. ‐ 19 ‐ 

4.  RESULTS AND DISCUSSION ...................................................................................................................... ‐ 21 ‐ 

4.1.  FOOD SAFETY KNOWLEDGE AND ATTITUDE RESULTS ............................................................................................ ‐ 21 ‐ 

4.2.  OBSERVED FOOD HANDLING HABITS .................................................................................................................... 37 

4.3.  MICROBIAL ANALYSIS RESULTS ........................................................................................................................... 42 

4.3.1.  Description of street foods evaluated in this study ........................................................................... 42 

4.3.2.  Range of pH and water activity of the street foods ........................................................................... 44 

4.3.3.  Microbiological quality of Haitian street foods ................................................................................. 47 

5.  CONCLUSIONS ............................................................................................................................................. 53 

REFERENCES ......................................................................................................................................................... 54 

ANNEXES ............................................................................................................................................................... 1 

ANNEX 1: STUDY LOCATION .......................................................................................................................................... 1 

ANNEX 2:  FOOD SAFETY KNOWLEDGE AND ATTITUDE QUESTIONNAIRE .................................................................... 2 

ANNEX 3: FOOD SAFETY OBSERVATION CHECKLIST ...................................................................................................... 4 

ANNEX 4: CONSENT FORM ............................................................................................................................................ 7 

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Abstract

Street foods are an integral part of the society in the developing world and in Haiti as such. However, questions marks remain on their safety especially microbiologically. In Haiti, there are no specific regulations of the street food business and no study has been done yet to evaluate their quality. This study was a survey to assess the microbial quality of Haitian street foods in the metropolitan area of Port-au-Prince. It contained three main aspects. The first part focused on assessing the food safety knowledge and attitudes of vendors and consumers of street foods, the second part assessed the food handling practices of the street vendors in Port-au-Prince, whilst the last part analysed the microbial quality of the food sold in the streets. Materials and methods: consumers, street food vendors, stalls and samples of street foods were selected randomly in four different areas in the metropolitan area of Port-au-Prince with the criteria based on voluntary participation and recruitment in the most frequented places (crossroads, close to school, markets, and parks). A Questionnaire and a checklist were used to collect the data from July to August 2012. In total, 160 consumers and 80 vendors participated in the study; 20 stalls were observed and 77 food samples were collected. Results: Of the 160 consumers, who participated in the study, 62.5% were male and 88.7% did not have any training in food safety while 88.7% of the vendors were women, the majority (78.7%) did not have any food safety training and 67.5% did not have a middle school education. In general consumers and vendors exhibited average food safety knowledge and attitude although they had a better food safety attitude compare to knowledge. No statistical difference was found on the basis of gender, training, level of education and location for consumers ‘food safety knowledge. However, for vendors, their scores were higher compared to consumers and trained vendors also demonstrated better food safety knowledge and attitude compare to untrained vendors. A surprizing finding was that consumers with primary education showed better food safety attitude than those who went to high school and university. It was observed as well that consumers from the districts of Delmas and Port-au-Prince had a higher score compared to the district of Pétion-ville. Consumers and vendors did not know that hepatitis A, Salmonella spp. and Staphylococcus spp. are pathogens responsible of foodborne diseases. They also had some difficulties in identifying the groups at risk of foodborne diseases and most importantly they were not aware of the importance of reheating food to fight against foodborne diseases. On the other hand the majority of vendors and consumers were aware of the importance of hand washing and proper cleaning in prevention of foodborne diseases. In the observational part of the study, it was found that most of the stalls consisted of parasol or a table set in the middle of the street. In 85% of the cases the food was prepared on site. In 60% of the cases, flies and animals were evident around the stall and 65% did not have access to potable water. The majority served the food with bare hands and did not wash their hands after touching money. 70% of the vendors did not keep pre-cooked food at an appropriate temperature. The microbial analysis of the food samples that were collected revealed that anaerobes and acid lactic bacteria were present in 53% of the samples. 62% were contaminated with aerobes bacteria. 12.5%, 7.3% and 7% of the samples had total aerobic,

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anaerobic and lactic acid bacteria counts above the acceptable limit (107CFU/g), respectively. Presumptive B. cereus group spp. were identified in 13% (10) of the samples, however, the presence of B. cereus was confirmed in only one sample. The other ones consisted of Bacillus pumilus and Bacillus megaterium. Only one of the 9 selected presumptive S. aureus isolates (11.1%) was identified as S. aureus. The presence of Listeria monocytogenes was not confirmed in the samples evaluated. E. coli was confirmed in two samples and none of the presumptive positive Salmonella isolates was confirmed as Salmonella spp. In conclusion, although the majority of consumers and vendors exhibited average food safety knowledge and attitude, only few of them had a score higher than 75% which means food safety knowledge and attitude still need to be addressed in the country. The conditions in which street vendors operated in Port-au-Prince are precarious with no access to potable water and toilet facilities and an effort should be made to improve their conditions. Although foodborne pathogens were confirmed in only a few samples, the high count of total aerobes, anaerobes and acid lactic acid bacteria observed in the samples correlate to the low hygienic conditions in which the food is prepared.

Key words

Street foods, attitude, knowledge, handling, practice, food safety, consumer, vendor, microbial analysis, observation

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Listoftables

Table 3-1 Selective media for microbial analysis .................................................................................. - 17 - 

Table 4-1 Demographic characteristics of street food consumers in Haiti ............................................ - 21 - 

Table 4-2 Demographic characteristics of vendors ................................................................................ - 22 - 

Table 4-3 Consumer food safety knowledge .............................................................................................. 26 

Table 4-4 Vendor food safety knowledge score ........................................................................................ 27 

Table 4-5 Consumer food safety attitudes score ........................................................................................ 27 

Table 4-6 Vendor food safety attitudes ....................................................................................................... 29 

Table 4-7 Assessment of consumers' food safety knowledge ..................................................................... 33 

Table 4-8 Assessment of vendors' food safety knowledge ......................................................................... 34 

Table 4-9 Assessment of consumers' food safety attitude .......................................................................... 35 

Table 4-10 Assessment of vendors' food safety attitude ............................................................................. 36 

Table 4-11 Demographic characteristics of stall' vendors .......................................................................... 37 

Table 4-12 Food safety observation checklist ............................................................................................. 40 

Table 4-13 Summary of the street foods evaluated in this thesis ................................................................ 42 

Table 4-14 Overview of cooking methods, handling and possible sources of contamination of collected

food ............................................................................................................................................................. 43 

Table 4-15 pH and water activity (aw) of the street foods evaluated in this thesis...................................... 45 

Table 4-16 General microbial quality of Haitian street foods ..................................................................... 45 

Table 4-17 Microbial quality of different groups of Haitian street foods ................................................... 46 

Table 4-18 Confirmed microorganisms in positive plates ....................................................................... 48 

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Acronymsandabbreviations

CDC Center for Disease Control

CFU Colony Forming Units

EFSA European Food Safety Authority

FAO Food and Agriculture Organization

FBD

Food Borne Disease

ICMSF International Commission on Microbiological Specifications for Foods

IHSI Institut Haïtien de Statistique et d’Informatique

MRS Man, Rogosa and Sharpe agar

MSA Mannitol Salt Agar

MSPP Ministère de la Santé Publique et de la Population

MYP Mannitol egg Yolk Polymyxin agar

PAHO Pan American Health Organization

PCA Plate Count Agar

PPS Physiological Peptone Saline solution

RTE Ready To Eat food

TSA Tryptone Salt agar

USA United States of America

USDA United States Department of Agriculture

VRBA Violet Red Bile Agar

WHO World Health Organization

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1. Introduction

Foodborne diseases (FBDs) comprise a large group of illnesses that are caused by the ingestion

of contaminated food (WHO, 2013). The infectious agents range from a multitude of

microorganisms to some chemical hazards.

It has been shown that Street-vended foods have been implicated in outbreaks of foodborne

illnesses all around the world (Dawson and Canet, 1991; Bryan et al., 1992b; CNN, 1999). In

1988, 14 deaths were reported in Malaysia because of foodborne diseases related to street foods,

same year 300 persons became ill in Hong Kong after consumption of street vended foods; in

1981 a cholera epidemic in Pune, India was linked to consumption of street vended juice; In

1987 in Singapore, an outbreak of cholera has been also attributed to street foods (FAO, 1990).

According to Rane (2011), the poor knowledge and improper food handling of street vendors in

basic food safety measures and poor knowledge and awareness among consumers on the

potential hazards associated with certain foods could explain the health and safety issues that

street foods may pose (Rane, 2011).

1.1. Justification of the study

Foodborne diseases represent a major concern in developing countries and Haiti is no exception.

Infectious intestinal diseases represent the third leading cause of death in Haiti (PAHO, 2007).

Typhoid fever is responsible for 2.8% of deaths in children aged 5–9 years, 8.9% in the 10–14

age group, 3.2% in the 15–19 age group, and 1.5% in the 20–49 age group (MSPP, 2007). In

addition, in November 2010, Haiti has endured a cholera epidemic and since then the disease

became endemic in the country.

Street foods contribute significantly to the diet of many people in the developing world (FAO,

2007). Although there were no specific studies that have been performed in Haiti, there are no

reasons not to assume that the scenario is different. Despite the high prevalence of diarrheal

diseases, Haiti has no specific laws or regulations for the quality of street foods. The lack of

regulations could also be conversely seen as a reason why the prevalence of diarrheal diseases is

high in Haiti. The Ministry of Agriculture has a laboratory which is used for the purposes of

diagnosis of animal diseases, zoonosis; determination of environmental pollutants and quality of

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food control. However, it has been observed major weaknesses in the legislation and regulations

of the system (FAO, 2002). As a result the microbial quality of street vended foods in Haiti is

still unknown and until now no study has been done to evaluate their safety.

The study reported in this thesis was conducted in order to provide relevant information that

could be used to generate policy and actions by the Haitian government regarding food safety. In

order to do so, according to the World Health Organization (WHO, 2000), it is crucial to gain

more information on the attitudes, knowledge and practices of the food handlers. The study has

addressed this need in part by investigating the food safety knowledge and attitudes of vendors

and consumers of street foods in Port-au-Prince, the capital city of Haiti. The food handling and

hygiene practices of the vendors were also evaluated. In addition, an assessment of the

microbiological quality of the foods sold in the streets was carried out.

1.2. Major objectives of the study

The main objective of the study was to use qualitative and quantitative methodology approach in order to

assess the microbiological safety aspect of foods sold in the streets of Port-au-Prince. The specific

objectives were:

• Evaluation of consumers’ food safety knowledge and attitude,

• Evaluation of vendors’ food safety knowledge and attitude,

• Observation of food preparation in order to see if the preparation methods respect the standard

requirements,

• Evaluation of the microbiological quality of the foods sold in the streets.

Achieving these objectives would enable two hypotheses to be tested:

• Foods sold in the streets are assumed to be microbiologically unsafe,

• The consumers and vendors of street food have poor hygiene practices and limited food safety

knowledge

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2. Literaturereview

2.1. Introduction

It is estimated that 48 million cases of foodborne diseases occur each year in the United States of

America (USA) alone, resulting in 128,000 hospitalizations and 3,000 deaths (CDC, 2013). In

Europe a total of 5,262 foodborne diseases outbreaks were reported in 2011, causing 43,473

human cases, 4,695 hospitalizations and 25 deaths (EFSA, 2012).

Unfortunately, in most of the developing countries, data regarding foodborne illnesses remain

scarce (WHO, 2007). However, according to the World Health Organization (WHO), diarrheal

diseases were the third leading cause of death in low income countries resulting in 1.8 million

deaths around the world in 2005 alone (WHO, 2013). In general most of the cases result from

the consumption of contaminated food and water (WHO, 2013).

Although street vended foods are very common in developing countries, there is a paucity in data

and studies regarding the incidence of foodborne diseases related to these foods. However, it has

been recognized that the conditions under which street vendors operate are often unacceptable

for the purposes of preparing and selling of food (Bryan et al., 1988; Mosupye and Holy, 2000).

Street food vendors are very often poor, uneducated and show little concern towards the safe

handling of foods, and food safety knowledge and practice (WHO, 1996). Consequently, some

serious concerns do exist about the safety of street food (FAO, 2013).

This chapter presents a review of the studies that have been performed to evaluate food safety

knowledge, attitudes and food handling practices of street food vendors. In addition, the review

incorporated the results of the studies that have reported the microbial quality of street foods and

their potential role in causing foodborne diseases.

2.2. Food safety knowledge and attitudes

In 2000, WHO has recognized food safety as an essential public health function. Food safety has

been defined by Henson and Traill (1993) as the inverse of food risk—“the probability of not

suffering some hazard from consuming a specific food”. If one is not aware of the origin and

severity of foodborne diseases, it’s clear that they will be less motivated to change. it’s therefore

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necessary to believe that someone can get sick by some bad food handling attitudes and by

changing the behaviour, one can prevent illnesses (Schafer et al., 1993). Consequently, food

safety knowledge is important in prevention of foodborne illnesses although gain of knowledge

doesn’t necessarily lead to change in behaviour. That’s why attitude is also very important

(Henson and Traill, 1993).

Knowledge is defined as “a complex process of remembering, relating, or judging an idea or

abstract phenomenon (cognitive abilities)” (Gotsch et al., 2012). On the other hand attitude is

defined “as a state of mind, feelings, or beliefs about a particular matter (affective abilities)

(Gotsch et al., 2012). In other words attitude is the mental state in which someone is ready and

motivated to move to action. Attitude is shaped by knowledge, which itself is a product of

exposure to sources of information and personal willing in obtaining information (McIntosh et

al., 1994). Knowledge, attitude and practice can also be shaped by habits and other perceptions

that result from social, cultural, and economic influences (Rozin and Fallon, 1980).In a nation-

wide study conducted in the UK in 1993 (FDF-IEHO, 1993), it was observed that 45% of

consumers were discouraged from eating some types of food because they knew the possible risk

of food poisoning.

Many studies have been done to assess food safety knowledge and attitude of street food

vendors; in comparison to developed countries, very few studies have been conducted in the

third world countries on the consumer’s food safety knowledge and attitudes in general and no

studies could be found regarding street food consumers. Although it was observed that an

unknown proportion of foodborne diseases could be prevented by actions taken by the

consumers themselves (Medeiros et al., 2001).

According the food agriculture organization (FAO), when selecting a street food

vendor,consumers attach importance to hygiene; however they are often unaware of the health

hazards associated with street vended foods (FAO, 2013). Many people do not know the basic

rules of food hygiene (Sockett, 1995). It has been shown in available literature that attitudes and

knowledge of consumers in general differ according to their demographic and socio-economic

(e.g. gender, age, sex and educational level) background (Wilcock et al., 2004). According to

Altekruse et al. (1999), men were more likely to report risky attitudes than women and the

prevalence of risky behavior also increased with increasing socioeconomic status. McIntrye et al.

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(2013) reported contradicting findings. In their study it was observed that food handlers with

college and university education had a higher score in food safety knowledge compare to those

with incomplete or completed high-school education, trained workers scored significantly higher

also than untrained workers (McIntrye et al., 2013). Another study conducted in Belgium

indicated as well that male consumers attached more importance to safety compared to female

(Verbeke and Viaene, 1999). Unklesbay et al. (1998) in a study conducted in the US found that

students enrolled in a type of program that included food safety information had higher food

safety knowledge compare to others. Change in lifestyle has been also shown to have an

influence on consumer’s attitudes toward safe handling of food. In a nation-wide postal survey

conducted in the US, it has been shown that consumers had poor knowledge on the organisms

responsible for food poisoning, which type of foods were associated with these microorganisms,

the need of avoidance of cross contamination and the importance of proper cooking (Williamson

et al., 1992). Woodburn and Raab (1997) also reported that respondents could not identify which

groups of people were particularly at risk of food poisoning and what a foodborne illness was.

There is more interest of consumers in convenience and saving time than in proper food handling

and preparation (American Meat Institute, 1996) and consumers often use their senses in their

descriptions of safe food, and feel that food that looks or smells bad should not be eaten (Seward,

2003).

In different studies conducted on food safety knowledge and attitudes of street food vendors, it

was observed that in general street food vendors have poor food safety knowledge (PAHO, 1992;

FAO, 2013; WHO, 1996, Rane, 2009). Demographic characteristics such as age and gender

don’t seem to play a role in food safety knowledge of vendors (Soares et al., 2012; Annor and

Baiden, 2011). Regarding the role of educational level and food safety knowledge, the results are

quite different. Soares et al. (2012) reported that there was a positive link between educational

levels and food safety knowledge of vendors while Annor and Baiden (2011) didn’t find any

significant difference. In some studies, it was found that there was a significant relation between

knowledge and attitude (Cuprasitrut et al., 2011) while others found no difference (Omemu and

Aderoju, 2008).

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2.3. Food handling and practices

Three main factors play a role in the occurrence of food poisoning with regard to food handlers:

knowledge, attitude and practice (Sharif and Al-Malki, 2009). Food handlers are defined as

‘persons who prepare food and those who sell it, if they are different persons” (WHO, 1989).

According to the WHO, food handling is a key factor during production, processing, storage and

preparation in order to ensure food safety (WHO, 1989). Although knowledge and attitude are

important, there is a gap between food safety knowledge and self-reported practices (Woodburn

and Raab, 1997). Woodburn and Raab (1997) found during a telephone survey that 20% of

respondents reported unsafe practices in their food preparation even though they had a high

awareness of foodborne illnesses. Altekruse et al. (1996) found that 86% of respondents knew

that hand washing reduced the risk of food poisoning, however only 66% washed their hands

after handling raw meat or poultry.

In an attempt to determine the risk factors for foodborne diseases it has been found that most of

the outbreaks resulted from improper food handling practices (Ehiri and Morris, 1996).

According to different studies, it has been estimated that a considerable number of illnesses are

caused by improper food handling practices in the domestic kitchen (Flint et al., 2005). In

another study conducted in the US, it was determined that improper food handling practices

contributed to approximately (Howes et al., 1996). It has been observed that most of street

vendors have poor food handling practices and expose the food to dangerous conditions such as

cross contamination (Ekanem, 1998).

Different food handling problems by handlers have been identified: unsafe sources, inadequate

cooking or heating, improper cooling, long interval between preparation and eating, poor

hygiene or handlers colonized by pathogens (Bryan, 1988). Several foodborne diseases

outbreaks have been determined to be a result of poor food handling practices, such as the cross

contamination between raw and cooked products, temperature abuse, and poor personal hygiene

of food handlers i.e. failure to wash hands after using the toilet (Todd et al., 2007). In a study

conducted by Bryan (1988), it has been observed that the same knife without being clean was

used to cut raw meat and poultry as well as gravy and salad.

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Food handlers can contaminate food either passively or actively. The biological hazards may be

introduced from a sick handler, from organisms on the food handlers skin or faeces, from their

respiratory tract or by cross contamination after handling raw materials (WHO, 1989). Physical

hazards may also be introduced by food handlers wearing jewelry, bandages or by careless food

handling practices (WHO, 1989). The microorganisms are transferred from the faeces, nose and

skin mostly by the hands of the food handlers (WHO, 1989).

It has been determined that Salmonella, non typhi Salmonella, Campylobacter and E. coli can

survive on finger tips and other surfaces for different days (Pethers and Gilbert, 1971), from

which they can contaminate food. Sometimes they were able to survive even after washing;

supporting the fact that food handling can lead to contamination of street vended foods (ICMSF,

1998).

2.4. Overview of street-vended foods

Street foods are defined by the Food and Agriculture Organization (FAO) as ready-to-eat (RTE)

food and beverages prepared and or sold by vendors and handlers especially in streets and other

similar places for immediate consumption or consumption at a later stage without further

processing or preparation (FAO, 1989). Street foods represent a significant portion of the diet of

many inhabitants in many major cities (Suneetha et al., 2011). An estimated 2.5 billion people

world-wide consume street food each day. In Latin America street food accounts for up to 30%

of urban household purchases (FAO, 2007).

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

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

(WHO, 1996). As urbanization and population are growing, especially in developing countries, it

is expected that the street-vended foods sector, which is mainly but not exclusively an urban

phenomenon, will continue to expand (WHO, 1996). There are several benefits of street-vended

foods: i) this sector provides a regular source of income for millions of people specially women

and contributes to local and national growth ii) street foods represent a source of inexpensive,

convenient and often nutritious food for urban and rural poor iii) street foods also provide an

opportunity to develop business skills with low capital investment while giving a chance for self-

employment at the same time (WHO, 1996).

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Beside the fact that they may pose a problem of pollution by waste accumulation and traffic

congestion in the city, the major concern about street foods is related to their safeness. They

remain a potential cause of serious food poisoning outbreaks in many countries all over the

world, especially via microbiological hazards (WHO, 1996). In support of this, it has been

determined that 691 food poisoning cases and 49 deaths from 1983 to 1992 in Shandong (China)

were caused by street foods (Lianghui et al., 1993).

Street foods are considered to be a major public health risk due to the fact that the operations

tend to lack basic infrastructure and services, difficulties in monitoring and law enforcement,

difficulty in controlling due to not only the large numbers of street food vending operations but

also because of their diversity, mobility and temporary nature (Ghosh et al., 2007).

In a survey conducted by the WHO (WHO, 1993), almost all countries have reported a large

variety of street foods, types of preparation, facilities and infrastructure. Some keys findings of

the survey were:

i. In 74% of countries street-vended foods were a significant part of the urban food supply,

ii. Diverse type of foods such as meat, fish, fruits, cereals, frozen products and beverages

were sold in the street,

iii. There were different methods of preparation varying from foods without any preparation

(65%), ready-to-eat food (97%) and food cooked on site (82%),

iv. Vending facilities were also different, going from mobile carts to fixed stalls and food

centers,

v. There were limited infrastructures development with restricted access to potable water

(47%), toilets (15%), refrigeration (43%) and washing and waste disposal facilities,

vi. The majority of the countries reported contamination of food (coming from raw food,

infected handlers and inadequately cleaned equipment),

vii. Time and temperature abuse were the major factors contributing to foodborne disease;

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viii. Most countries reported that there was insufficient inspection of the personnel,

insufficient application of the HACCP concept and noted that registration, training and medical

examinations were not part of the management strategies of street vended foods.

One of the biggest problems which play a role in the contamination of street vended foods is the

water supply. The local water supply may not have an acceptable quality, may be in insufficient

quantities for drinking, washing, cleaning and other operations. Stationary stalls as well as

ambulatory vendors may not have direct access to water supply. There is also a need to take into

account that there is in general a scarcity of water in developing countries and tap water is not

always available. Many vendors re-use water that has been already used to clean and wash their

utensils (WHO, 1999).

Beside water, the places where the food is prepared are often not clean and are often located

close to potential sources of contamination such as waste, toilets etc. In 70 to 90 % of the cases,

insects, animals and liquid waste have been observed in area were street-vended foods were

being prepared (FAO, 1988). Most of the foods are not protected against insects, dust etc. which

may harbor foodborne pathogens (Rane, 2011). It was observed that street foods were not

covered appropriately and the safe storage temperature was difficult to maintain (Bryan et al.,

1988; Ekanem, 1998). The surfaces where the food is prepared sometimes have remains of food

prepared earlier which can become sources of cross contamination. Leftovers after spending the

entire day exposed in the sun are usually stored overnight at unacceptably high temperatures and

are reheated the day after before being sold (WHO, 1989). It has been observed also that the

same knives are often used during food preparation without any cleaning between uses (Mensah

et al., 2002). The food is sometimes prepared long before its consumption; stored at ambient

temperature, and undergo inadequate cooling and reheating processes leading to contamination

of the food (WHO, 1989).In addition, as mentioned earlier street food vendors are most often

uneducated and have poor knowledge and awareness regarding food safety.

2.5. Microbial quality of street foods

Potential hazards vary from natural and environmental contaminant to chemicals from the

agriculture field, veterinary drugs growth hormones, food packaging, physical foreign bodies etc.

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However, microbiological hazards are considered as a greater challenge to food safety because

harmful microorganisms can either proliferate in the food or in the human body once ingested

(Tent, 1999). As mentioned earlier, insufficient knowledge, poor practices and operation in

unsanitary environments are considered as the major risk factors leading to the production of

microbiologically unsafe street foods.

According to the Centers for Disease Control and prevention (CDC) 31 pathogens are known to

cause foodborne illnesses (CDC, 2013). Among the pathogens found in street vended food

Bacillus cereus, Clostridium perfringens, Salmonella and Staphylococcus aureus are the most

common ones (Bryan et al., 1988,; Mosupye and Holy, 2000; Umoh and Odaba, 1999).

In Several studies carried out in Brazil, foodborne pathogens and high microbial counts have

been found in different street foods in the country (Hanashiro et al., 2005). In Sao Paulo city (

Brazil), more spefically, Approximately 35% of the street food samples were inappropriate for

consumption and in 12.5%, 2.5% and 22.5% of street food samples, B. cereus, S. aureus and E.

coli were present respectively (Hanashiro et al., 2005). In another study conducted in

Johannesburg, B. cereus was the most prevalent bacteria detected in 23 (17%) out of 132 street

food samples (Mosupye, et al., 2000). In the same study, C. perfringens was detected in one raw

chicken sample, S. aureus in two raw beef and two stew samples of street vended foods

(Mosupye et al., 2000).

In some Latin American cities, the frequency of fecal contamination in street foods ranged from

9.4% to as high as 56.7% above the considered standard (Almeida et al., 1996).The most

implicated type of food (87.5%) regards to coliforms in a study in Latin America contained meat

or fish (Almeida et al., 1996). In another study carried out on street foods in Zaria, 26.3 % and

15% of the samples were contaminated with B. cereus and S. aureus respectively (Umoh and

Odoba, 1999). It has been observed in Ghana that a large proportion of street food dishes are

contaminated with unacceptable levels of bacteria (Mensah, et al., 2002). In a study carried out

on street foods in 13 towns, 41% of the samples did not meet the bacteriological criteria and

4.5% to 70.2% were contaminated with E.coli while 0.4% to 3% and 1.9% to 10.1% were

contaminated with B. cereus and S. aureus respectively (Garin et al., 2002) .In another study

conducted in Johannesburg, B. cereus was detected in 17% of the street food samples while S.

- 11 -

aureus was present in 3% of the samples (Mosupye and Holy, 2000). In Bangkok, out of the 92

street food samples collected, 14(15.2%) had an unacceptable total bacteria count and 38(41.3%)

an unacceptable total coliform count (Cuprasitrut et al., 2011).

Pathogens present in street vended foods come from different sources and practices. Improper

food handling can lead to transfer of pathogens such as Salmonella, E.coli and S. aureus from

human body and environment into foods (Rane, 2011). Improper waste disposal have been

associated with transmission of enteric pathogens like Salmonella, Shigella and E.coli.

Contaminated water has been associated with pathogens such as E. coli, fecal streptococci,

Salmonella and Vibrio cholera while vegetables and spices are associated with introduction of

spore formers like Bacilli and Clostridium and pathogens like L. monocytogenes, Shigella,

Salmonella etc (Rane, 2011). Improper storage temperature and reheating of food have been

associated with production of heat stable toxins produced by pathogens like C. perfringens and

B. cereus (Rane, 2011). A study performed in the Dominican Republic showed that the aerobic

mesophilic colony counts exceeded 8 logs CFU/g in beans collected from a vendor after being

left overnight at ambient temperature (Bryan et al., 1988). In another study carried out in the

Pakistan, aerobic mesophilic counts greater than 7 log CFU/g were observed in leftover beef and

rice collected from a vendor at a bus station (Bryan et al., 1992 b). It has been also reported in

these studies that the average food holding temperatures were ranged from 26⁰ C to 50⁰ C which

is ideal for the rapid growth of bacteria (Bryan et al., 1988, 1992 b). Utensils and equipment may

also lead to microbial cross contamination of food with S. aureus, E. coli and Shigella due to

contaminated water, dish cloth and handlers (WHO, 1996).

2.6. Conclusion

Because street vended foods are of great importance in the community, governments should consider their

official recognition. But in order to do so they should develop guidelines or regulations for this specific

food service sector. Many governments consider a Code of Hygienic Practice as an essential tool in this

regard. The code needs to focus on hygienic handling from preparation to sale of the food and should take

into account the principles of the Codex document (WHO, 1996). Preparation and processing should be

adequate to eliminate or reduce hazards to an acceptable level, prevent growth of pathogens, production

of toxic chemicals and the introduction of physical hazards; and to ensure that foods are not

recontaminated (WHO,1996). Because biological, chemical and physical hazards may be

- 12 -

introduced to the vending operation and may persist through preparation and processing, raw

materials are therefore important to the safety of street-vended food (FAO, 1996). Several

scientific studies suggested that if good communication strategies are to be developed they

should take into account not only technical risk assessments such as those reporting microbial

content and their level but also consumers and vendors risk perception of food safety and

contamination (Altekruse et al., 1999). Therefore it’s important to educate people on the

importance of food safety issues from the general public to stakeholders and regulatory

authorities (Wilcock et al., 2004).

- 13 -

3. Materialsandmethods

3.1. Materials

This study is a cross sectional study based on primary data. The survey was conducted in the

capital city of Haiti, Port-au-Prince from July 2012 to September 2012. Four (4) popular districts

were selected for the survey - Tabarre, Delmas, Pétion-ville and downtown Port-au-Prince (see

Annex 1). 80 street vendors, 160 consumers and 20 food street vending stalls were involved in

the survey with 20, 40 and 5 street vendors, consumers and vending stalls respectively from each

commune. A structured written questionnaire was used to assess the food safety knowledge and

attitudes of the consumers and vendors whereas a check list was used for evaluation of the food

handling practices of the street vendors. During this period, 77 food samples were also collected

in the four communes on three different days. Upon collection, the samples were immediately

stored in a cooler box for a maximum of six hours after which they were kept frozen until their

microbial quality was evaluated at the Laboratory of Food Microbiology and Food Preservation

of Ghent University.

3.1.1. Food safety knowledge and attitude questionnaire

The questionnaire that was used was adopted from Angelillo, et al. (2001), Bolton et al. (2008)

and Ansari-Lari et al. (2010). The same questionnaire was also used in a previous study made in

the municipal schools of Camaçari, Bahia in the northeast of Brazil (Soares et. al., 2012). The

questionnaire was first translated to French and a pilot test was conducted using 20 people in one

of the selected commune, Tabarre. Based on the comments of the respondents, slight changes

were made before adoption of the final version for the study. The questionnaire was organized

into the following three (3) main sections i) demographic information ii) food safety knowledge

and iii) food safety attitudes. It was filled in either by the participants themselves or by the

researcher for participants with limited education.

The demographic section contained information regarding gender, location, age, educational

level and training in food safety.

The knowledge section was designed to evaluate the food safety knowledge of vendors and

consumers of food poisoning pathogens, hygiene, high risk groups and proper cleaning. This

- 14 -

section contained 18 questions with 3 possible answers “yes”, “no” and “do not know”. For

evaluation a score between 0 and 18 was used with a correct answer considered as one point

while an incorrect answer or a “do not know” answer was regarded as zero points. The score was

then converted to its equivalent on a basis of 18 = 100. A score less than 50 was considered as

poor knowledge, 50 to 75 was considered as median (adequate food safety knowledge) and more

than 75 was considered as having a good level of food safety knowledge.

The food safety attitude section was designed to determine the understanding of consumers and

vendors about food safety. This section contained 16 questions with three possible answers as

described above. The same procedure used for evaluation in the knowledge section has been

applied. (See Annex 2)

3.1.2. Food handling observation checklist

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

was a combination of different checklists used in previous studies (Chukuezi, 2010; Dirks, 2010;

Muinde and Kuria, 2005). Demographic data such as age, sex, location, educational level and

food safety training were registered. The checklist contained five main components i)

information on facilities (source of potable running water versus stored water in containers,

availability of toilets, adequate washing facilities) ii) the environment around the stall (presence

of flies, animals, and litter) iii) personal hygiene - whether or not head gear and aprons were

worn iv) food storage (cool/refrigeration storage at vending site and v) utensils (the use of soap

and clean water). Absence (no) or presence (yes) of each component has been recorded and a

frequency table for all components has been computed and used for description of food handling

practices by vendors (see Annex 3).

3.1.3. Food samples

Food samples were collected from the different communes selected for the study. The types of

food collected consisted mostly of spaghettis, boiled eggs, paté (wheat dough with meat and

vegetables inside), fried plantains, fried pork meat (griot), deep fried malanga (akra), fried or

grilled hotdogs, fried salami and more conventional dishes such as rice with beans (black, red

etc.) or peas, maize with beans, meat (chicken, pork and beef) with sauce and vegetables or

- 15 -

salads. 77 food samples of approximately 100 g were collected with 12, 23,17and 24 samples

coming from downtown Port-au-Prince, Delmas, Pétion-ville and Tabarre respectively. The

samples were analyzed in the Laboratory of Food microbiology and Food Preservation of Ghent

University (Gent, Belgium). The following general microbial parameters were analyzed i) total

anaerobes ii) total aerobes and iii) coliforms. The presence of the following five pathogens was

also assessed: Listeria monocytogenes, Escherichia coli, Bacillus cereus spp., Salmonella spp.,

and Staphylococcus aureus.

3.2. Methodology

3.2.1. Food safety knowledge and attitude questionnaire

For selection of consumers, the researcher stood at the cross sections of highly frequented areas

in each district selected. All persons passing from 15 years and older were asked to voluntary

participate. Places around markets, schools, parks and highly frequented streets were considered.

The places of investigation were Pétion-ville (center), downtown Port-au-Prince (city center),

Delmas (center) and Tabarre (center). In total 160 consumers participated in the study with 40

from each selected commune.

For selection of the vendors, places around markets, schools, bus station, highly frequented

streets and places with an agglomeration of vendors were considered. The researcher has

randomly selected the first vendor and to select the next one, the researcher has spun a bottle and

walked in the direction pointed by the bottle until the nearest vendor. Same process has been

repeated over and over. The vendors were asked to voluntary answer the questions. The places of

investigation were Pétion-ville (center), downtown Port-au-Prince (city center), Delmas (center)

and Tabarre (center). A total of 80 vendors participated in the study comprising 20 vendors from

each selected commune.

3.2.2. Food practices observation check list

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

the selection of vendors for the food safety and attitude questionnaire. The aim of the study was

first explained to the vendor or the responsible of the stall or the food shop. An informed consent

form based on ethical norms describing all the different components of the study was provided

- 16 -

and signed by each participant prior to the observation (see Annex 4). Due to limited time in

which the study had to be completed, 20 food shops (5 per commune) were observed.

3.2.3. Food samples collection and analysis

The same methodology used for selection of vendors for the food safety questionnaire was used

for the collection of food samples. The food was collected over 3 days. The food was bought and

packaged in either a plastic or paper bag or in a foam plate. From the purchased food, 100g were

transposed to a sterile stomacher bag using a spoon previously sterilized by flaming (immerse in

ethanol and flame). The sterile bag was then labelled (date of sample collection, place of

collection and sample number) and placed in an ice cooler. All samples were kept on ice during

transportation for approximately five hours from the place of purchase to the storage room where

they were placed in a freezer at -10 ⁰ C until the day of examination.

The samples were then transported frozen to the Laboratory of Food Microbiology and Food

Preservation of Ghent University where they were stored again in a freezer at -18⁰ C.

One day prior to analysis, the food samples were removed from the freezer and placed in a

refrigerator at 4⁰ C in order to thaw. The next day, ca. 20 ± 1-g amount of each sample was

aseptically taken from the original bag (with ca. ~ 100g), using a sterile spoon. The food was

then placed in a stomacher bag, decimally diluted with physiological peptone saline solution

(PPS, 0.1% peptone and 0.85% NaCl) and thereafter homogenized for 1 min in a stomacher

(Stomacher, Lab blender model Tekmar 80, Seward) in a 1/10 ml of buffer solution (0.1%

peptone and 0.85% NaCl) for 1 min. Serial decimal dilutions in PPS were then prepared up to -6

(1/106) dilution. For enumeration of the total anaerobic and lactic acid bacteria counts the

decimal dilutions of samples were pour plated in plate count agar (PCA, Oxoid, Hampshire, UK)

and de Man Rogosa Sharpe agar (MRS agar, Oxoid, Hampshire, UK). Enumeration of the total

aerobes and all the pathogens groups evaluated was done by spread plating the decimal dilutions.

Table 3-1 shows the microbiological media, plating method, incubation temperature and

durations used for all the microbial parameters investigated. In addition, the pH and water

activity of each sample was measured using a SevenEasy pH meter (Mettler Toledo, GmbH,

Schwerzenbach, Switzerland) and a Novasina Labmaster respectively. For solid products the

- 17 -

counted plate colony counts were reported as either CFU/g and converted to log10 CFU/g, or

CFU/ml or log10 CFU/ml for liquid products. The calculation method used was as followed:

X= (A*V)/ I

Where X = Colony Forming Units (CFU) per g or ml of products,

A = Numbers of colonies,

V = Reciprocal of dilution factor and

I = Inoculum volume (ml)

Table 3-1 Selective media for microbial analysis

Parameters Media Incubation temp. &

time

General microbial quality

Total aerobic counts Plate count agar (spread plate) 30°C for up to 48 hours Total anaerobic counts Plate count agar (pour plate + over-layer) Lactic acid bacteria MRS agar (pour plate + over-layer) 22°C, up to 48 hours Pathogens

Escherichia coli Rapid E. coli agar (spread plate) 37°C, 24-48 hours Staphylococcus aureus Mannitol salt agar (spread plate) 37°C, 24-48 hours Bacillus cereus spp. Mannitol egg yolk polymyxin agar (spread

plate) 30°C, 24-48 hours

Salmonella spp. Rapid salmonella agar (spread plate) 37°C, 24 hours Total coliforms Violet red bile agar (pour plate + over-

layer) 37°C, 24hours

Listeria monocytogenes Aloa enriched agar(spread plates) 30°C, up to 48 hours

3.2.4. Partial confirmation techniques for pathogens

The plates on which the pathogens were enumerated were first examined for typical colonies of

the target pathogens on the basis of the morphological features described by the manufacturer of

the media used. These were then considered as presumptive, Bacillus cereus spp., presumptive

- 18 -

Salmonella spp. etc. The plates used for the enumeration were then kept until more (partial)

confirmation tests were carried out. These are described below.

For Bacillus cereus spp. two separated colonies aseptically were picked from each MYP plate

used for enumeration of presumptive Bacillus cereus spp. of a particular sample. These were

resuscitated overnight in 5 ml of BHI broth at 37°C. A serial dilution was prepared in PPS and

plated out on tryptone soy agar (TSA, Oxoid, Hampshire, UK). Isolated colonies were then

picked from these plates and an API 50 CHB/E kit (Biomerieux, Durham NC, USA) was used

for identification of the presumptive Bacillus cereus spp. This kit is used for the identification of

Bacillus spp. and related genera. Positive plates were reported with percentage of identification.

For identification of the presumptive Staphylococcus aureus isolates a similar approach as for

Bacillus cereus spp. was used for resuscitation of the colonies. Finally an API Staph kit

(Biomerieux, Durham NC, USA) was used for identification of the genera Staphylococcus.

Positive plates were reported with percentage of identification.

For identification of the presumptive Escherichia coli isolates, the first step was also similar to

the one used for presumptive Bacillus cereus spp. A Chrome ID E. coli kit (Biomerieux, Durham

NC, USA) was used for confirmation. The number of positive plates was counted.

For the presumptive Salmonella spp., the same approach was used for resuscitation after which

the ID Chrome Salmonella agar (Biomerieux, Durham NC, USA) was used for confirmation.

The number of positive plates was counted.

For the presumptive Listeria monocytogenes isolates, two colonies were resuscitated in 5 ml of

BHI as described above. Then a catalase test using a 3% solution of hydrogen peroxide (H2O2)

was carried out because L. monocytogenes is catalase positive. Gram staining was also carried

out and tumbling motility was assessed microscopically. Β-hemolysis activity of Listeria on

blood agar (TSA + 5% horse blood) was also checked.

3.3. Data entry and documentation

The data obtained from the questionnaires and the checklists observation was entered into Epi

InfoTM 7. Data entry was double checked in order to avoid possible data entry mistakes. The

data set was then labeled and after realization of the first part of analysis, the data was exported

- 19 -

to Microsoft Excel (version 2010) where a compute score for positive answers was calculated

and expressed in percentage. The modified data set was then exported from Excel to Spotfire S+

8_2 for further analysis.

The data obtained from the microbiological analysis was entered directly to Microsoft Excel

2010 and the data set was exported afterwards to Spotfire S+ 8_2 for further analysis.

3.4. Statistical analysis

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

descriptive analysis cut-off points of 25, 35, 45, 55 and 60 years were used for age. Because of

the small sample size when using five different age groups and abnormality of the samples, a

different cut-off point of 30 years (one group ≤ 30 years and the second group > 30 years) was

used for comparisons between age groups. For score range, cut-off points of 50 and 75 were

used. Descriptive analysis was first done to calculate means, standard deviation, maxima and

minima for age, and score according to age, education, location, sex and training using Spotfire

S+ 8_2. Frequency tables were generated using both Epi InfoTM 7 and Spotfire S+ 8_2 for each

parameter. Comparison of the scores obtained between sex, age groups, trained and not trained,

location and status was performed as follows. Two sample t-Test was used for comparison of 2-

samples data sets such as those for sex, training status and age groups (when comparison was

made between groups). Comparison of more than two groups was done by ANOVA fixed effect

through Spotfire S+ 8_2. Normality was checked by the use of QQ plot or Kolmogorov-

Smirnov Test. Equal variances was also assessed by the used of modified Levene test. Normality

of residuals was also checked by using QQ plot or Kolmogorov-Smirnov Test. For samples that

were not normally distributed and with a sample size less than 30, analysis was done by the non-

parametric Wilcoxon rank-sum test for two samples such as sex, training etc. and Kruskal-Wallis

rank sum test for more than two categories such as location and educational levels. P-values less

than 0.05 were considered as indicating a statistically significant difference between the

parameters being assessed.

For the microbiological and chemical (pH and aw) analysis of food samples, descriptive analysis

was also performed by calculating the means, standard deviation, maxima and minima for each

- 20 -

parameter, linear correlation with water activity and pH was also assessed. A coefficient of

correlation close to +1/-1 was considered as showing a strong positive or negative correlation.

Comparison of means with different types of products was also carried out using Spotfire S+

8_2.

- 21 -

4. Resultsanddiscussion

4.1. Food safety knowledge and attitude results

Although many studies have focused on the food safety knowledge of food handlers in general

and to a lesser extent on street food vendors, very few have investigated the food safety

knowledge of street food consumers. The few studies found in literature were generally focused

on consumers alone and the design of these studies was different from that used in this master

thesis. This study (thesis) is therefore a premiere in that it has assessed at the same time the food

safety knowledge of vendors and consumers of street foods.

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

in Table 4-1.

Table 4-1 Demographic characteristics of street food consumers in Haiti

Characteristics Number Percentage Mean ± SD 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 complete or not 25 15.6% High school complete or not 69 43.1% University complete or not 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 160 100

60 (37.5%) were female and 100 (62.5%) were male. The mean age of the participants was 29.6

(standard deviation = ± 11.3 years), and ages ranged from 15 to 74 years. 91% of the consumers

were between 15 and 45 years of age. With regards to the level of education attained, almost a

- 22 -

quarter (24%) of the consumers did not have a middle school education. The majority (76%)

were either still in high school or university or had completed either high school and/or

university. In addition, the majority of the consumers who participated in this study (88.7 %) did

not have any food safety training (Table 4-1).

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

Table 4-2.

Table 4-2 Demographic characteristics of vendors

Characteristics Numbers Percentage Mean ± SD 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 complete or not 36 45%

High school complete or not 21 26.2%

University complete or not 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 80 100%

The results of this study have revealed that the street food business in Port-au-Prince is

dominated by women (88.7%). The same findings have been observed in other studies conducted

- 23 -

in Brazil, South Africa, Bangkok, Nigeria and the Phillipines (Hanashiro et al., 2005; Martin,

2006, Cuprasitrut et al., 2011; Soares et al., 2012, Omemu and Aderoju, 2008, Azanza et al.,

2000). These findings might be advantageous as it has been found in a study conducted in the

United States that women demonstrate safer food preparation techniques (Klontz et al., 1995).

However, it has to be noted that the women assessed in the study in the US had at least a high

school education which differs from our study since two thirds (67.5%) of the vendors did not

have a middle school education . Nevertheless the educational background of the vendors in

Haiti is quite similar to those in India, Ghana, Nigeria, Kenya and Sudan (Mensah et al., 2002;

Donkor et al., 2009; Muinde and Kuria, 2005; Omemu and Aderoju, 2008; Choudhury et al.,

2011; Abdalla et al., 2009). The mean age of the vendors was 34.4 years (standard deviation = ±

11.9 years) and ages ranged between 16 and 66 years. The majority (78.7%) did not have any

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

(Chukuezi, 2010; Omemu et al., 2008).

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

Table 4-3. The consumers’ had a mean food safety knowledge score of 56 correct answers,

indicating that they generally had an average knowledge of food safety. This could partly be a

result of the extensive radio and TV campaign on foodborne diseases launched in the country

since the occurrence of cholera in November 2011. However, we need to point out that 59

(36.9%) of the 160 consumers had a score less than 50, whilst only 8 (5%) of the consumers

scored more than 75. Therefore, although the consumers in general have an average knowledge

of food safety, this later still remains an issue to be addressed in the country. No statistical

difference was found between the food safety knowledge’s of customers on the basis of gender

(male vs. female) (p = 0.38), age (p = 0.09), food safety training (or lack thereof) (p = 0.43),

level of education (p = 0.32) and location in Port-au-Prince (p = 0.06). Other studies have

indicated that there was an increase of food safety knowledge with age and practices and that

females obtained higher score compare to males (Bruhn and Schutz, 1998).

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

Table 4-4. The vendors had a higher mean food safety knowledge score of 60. The difference in

food safety knowledge between the vendors and consumers was significant (p = 0.008, α = 0.05).

The individual scores ranged from 16 to 77. 22 (27.5%) of the vendors who participated in the

- 24 -

study had a score less than 50; 47 (58.8 %) had a score between 50 and 75 and 11 (13.8%) had a

score higher than 75. Amongst the studies that have used the same scoring methods, the mean

knowledge score of the vendors in Haiti was found to be higher than that of food handlers from

other countries such as Turkey (Bas et al., 2006) and Thailand (Cuprasitrut et al., 2011).

However, it has also been determined that street vendors in South Africa (Makhone, 2006) and

the Philippines (Azanza et al., 2000) exhibited a good level of food safety knowledge. No

statistical difference was found between the food safety knowledge’s of the vendors on the basis

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

0.10). The same findings have also been observed in previous studies (Annor and Baiden, 2011;

Ansari-Lari et al., 2010). However, it was determined that food vendors who had received

training in food safety demonstrated better food safety knowledge than untrained vendors (p =

0.018, α 0.05).Though , it is difficult to ascertain if these results are a matter of chance because

none of the vendors could provide a certificate or an official document of the training received.

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

Table 4-5. The consumers had a mean food safety attitude score of 68, which indicated that they

(in general) had an average understanding of food safety knowledge. The range of scores was

between 18 and 93. With regards to distribution of the scores, it can be seen in Table 4-5 that the

majority (145, = 90.6%) had a food safety attitude scores greater than 50. Almost a quarter

(24.4%) could be considered as having a very good food safety attitude as they had scores

greater than 75. The food safety attitudes of the consumers were generally higher than their food

safety knowledge (p = 0). No statistical difference was found between the food safety attitudes of

the customers on the basis of gender (p = 0.94), training (p = 0.14) and age (p = 0.07). However,

statistically significant differences occurred between the food safety attitudes of consumers on

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

had a higher score than those who went to high school and university. This was a very surprising

finding since one would expect that education to a higher level would have a positive effect on

food safety attitude. Even though the same findings have also been observed for food safety

knowledge in a study conducted in the US (Altekruse et al., 1999) many other studies reported

no effect of education on knowledge and attitude (Annor and Baiden, 2011; Rheinländer et al.,

2008). In the context of this study, this might be explained by the fact that in the Haitian culture,

cooking and household tasks are usually left for people who are less educated. Haitians with a

- 25 -

high education level and high incomes usually hire maids for cooking and cleaning. This also

could be a result of chance as even though the researcher made it clear to the participants that

they should choose “do not know” for questions that they did not know the answers, participants

with lower education levels are more likely to have taken a guess than educated people who

would have a better understanding of the potential consequences of guessing on the outcomes of

the study. They consequently were expected to be more honest in their answers. A significant

difference was also observed between the food safety attitudes of consumers on the basis of their

location in Port-au-Prince (p = 0.0006). It was observed that consumers from Delmas and Port-

au-Prince had a higher score than consumers from Pétion-ville which could also be linked to the

previous findings since people from Pétion-ville in general have a higher level of income

compare to the other districts.

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

4-6. The mean food safety attitude score of the vendors was 73. The scores ranged from 25 to 93.

Four (5%) of the vendors had a score less than 50; whilst 95% had a score of at least 50. Even a

greater proportion of the vendors (43%), compared to consumers (24.4%), had scores greater

than 75, which as mentioned earlier indicates good food safety attitudes. The vendors

demonstrated significantly better food safety attitudes compared to knowledge (p = 0) and to

consumers (p = 0.0028, α = 0.05). No statistical difference was found on the basis of gender (p =

0.27), level of education (p = 0.43), location (p = 0.12) and age (p = 0.61). However, it was

determined that food vendors who had received training in food safety had a better attitude

towards food safety than untrained vendors (p = 0.01). Some studies have reported that trained

handlers have a higher food safety attitude compared to untrained food handlers (McIntyre et al.,

2013) while others reported that no significant differences occur between the two (Bas et al.,

2006)

26

Table 4-3 Consumer food safety knowledge

Number (% of correct answers)

Score range

Characteristics <50 50-75 >75 Mean± SD Range

Sex

Female 25 (16) 33 (21) 2 (1.30) 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 (0.0) 56±7 38-66

46-55 0 0 6 (3.8) 0 (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 (0.0) 40±11 27-50

Education

Illiterate 6 (3.8) 7 (4.4) 0 (0.0) 55±12 27-72

Primary school complete or not 6 (3.8) 17 (11) 2 (1.3) 58±11 38-77

High school complete or not 29 (18) 38 (24) 2 (1.3) 54±11 27-83

University complete or not 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 (1.3) 53±11 33-83

TOTAL 59 (36.9%) 93 (58.1%) 8 (5%) 56±12 22-94

27

Table 4-4 Vendor food safety knowledge score

Number (% of correct answers)

Score range

Characteristics <50 50-75 >75 Mean± SD Range

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 complete or not 13 (16.3) 16 (20) 7 (8.8) 59±13 33-77

High school complete or not 5 (6.3) 14 (17.5) 2 (2.5) 62±10 44-77

University complete or not 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 16-77

28

Table 4-5 Consumer food safety attitudes score

Number(% of correct answers)

Score range

Characteristics <50 50-75 >75 Mean± SD Range

Sex

Female 6 (4) 40 (25) 14 (9) 69±11 44-94

Male 9 (6) 66 (41) 25 (16) 69±14 18-94

age (years)

15-25 10 (6) 49 (31) 15 (9) 66±14 19-93

26-35 3 (2) 31 (19) 15 (9) 69±14 19-94

36-45 2 (1) 16 (10) 5 (3) 70±12 44-94

46-55 0 (0) 4 (3) 2 (1) 72±10 56-81

56-60 0 (0) 3 (2) 2 (1) 76±9 62-88

>60 0 (0) 3 (2) 0 (0) 71±7 62-75

Education

Illiterate 7 (4) 51 (32) 11 (7) 75±9 62-94

Primary school complete or not 0 (0) 10 (6) 3 (2) 76±11 43-94

High school complete or not 1 (1) 11 (7) 13 (8) 67±13 18-87

University complete or not 7 (4) 34 (21) 12 (8) 66±14 18-94

Food safety training 0

Yes 1 (1) 11 (7) 6 (4) 73±11 44-87

No 14 (9) 95 (59) 33 (21) 68±13 18-94

Location

Port-au-Prince 2 (1) 24 (15) 14 (9) 73±12 37-94

Pétion-ville 7 (4) 29 (18) 4 (3) 62±16 18-87

Delmas 3 (2) 22 (14) 15 (9) 72±12 43-94

Tabarre 3 (2) 31 (19) 6 (4) 67±10 43-81

TOTAL 15 (9.4%) 106 (66.2%) 39 (24.4%) 68±13 18-93

29

Table 4-6 Vendor food safety attitudes score

Number ( % of correct answers)

Score range

Characteristics <50 50-75 >75 Mean± SD Range

Sex

Female 4 (5) 38 (47.5) 29 (36.3) 73±11 25-93

Male 0 (0) 4 (5) 5 (6) 78±9 62-94

age (years)

15-25 1 (1) 13 (16) 11 (14) 74±9 50-87

26-35 1 (1) 13 (16) 8 (10) 70±15 25-93

36-45 1 (1) 10 (13) 7 (9) 75±10 50-87

46-55 1 (1) 3 (4) 5 (6) 77±11 50-94

56-60 0 (0) 3 (4) 1 (1) 71±8 62-81

>60 0 (0) 0 (0) 2 (3) 87 87

Education

Illiterate 0 (0) 9 (11) 11 (14) 72±15 25-87

Primary school complete or not 1 (1) 9 (11) 8 (10) 72±12 50-93

High school complete or not 3 (4) 21 (26) 13 (16) 77±8 56-87

University complete or not 0 (0) 3 (4) 2 (3) 77±3 75-81

Food safety training

Yes 0 (0) 5 (6) 11 (14) 80±7 62-94

No 4 (5) 37 (46) 23 (29) 72±12 25-94

Location

Port-au-Prince 2 (3) 9 (11) 9 (11) 74±13 50-94

Pétion-ville 2 (3) 13 (16) 5 (6) 68±14 25-87

Delmas 0 (0) 10 (13) 10 (13) 76±.8 56-87

Tabarre 0 (0) 10 (13) 10 (13) 76±9 62-94

TOTAL 4 (5%) 42 (53%) 34 (43%) 73±11 25-93

30

Tables 4-7 and 4-8 show the tallied responses of the customers and vendors, respectively to each

question in the questionnaire about their food safety knowledge. The results show that the

majority of the consumers did not know that hepatitis A virus (88.8% of the respondents),

Salmonella (89.38%) and Staphylococcus aureus (91.9%) are pathogens that are responsible for

foodborne diseases and Almost half (44.4%) of the consumers failed to discern the groups at risk

of foodborne diseases. The same findings were reported by Woodburn and Raab (1997). 74.4%

knew that bloody diarrhea can be transmitted by food whilst 77.5% recognized that AIDS cannot

be transmitted by food. On the other hand, 86.3% knew that it is necessary to take leave from

work during cases of infectious skin diseases and 88.1% knew that microbes can be found in the

skin, mouth and nose of healthy handlers. 57.5% of consumers did not know that abortion could

be induced by foodborne diseases. 61.9 % of them believed wrongly that washing utensils with

detergents leave them free of contamination. 55% did not know that eating and drinking in the

work place increased the risk of food contamination. A considerable proportion of consumers

were aware of the critical role of hand washing (93.8 %) and proper cleaning of utensils (71.9%)

in the prevention of foodborne diseases. However, only 61.9% knew that the use of gloves is

important in reducing risk of contamination. 74.4% of the consumers knew that a swollen can

might contain microorganisms. 30% of the customers incorrectly thought that the reheating of

foods can contribute to food contamination whilst only 60% were able to answer correctly the

question about whether the preparation of foods in advance can reduce the contamination of

foods.

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

Salmonella (100%) and Staphylococcus (98.75%) were foodborne pathogens. In agreement with

this finding, vendors from Iran and Brazil also failed to identify these foodborne pathogens

(Ansari-Lari et al., 2010; Soares et al., 2012). However, 93.8% of the vendors knew that bloody

diarrhea can be transmitted through food. Compared to the consumers (77.5%), a slightly lower

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

though there is an on-going HIV prevention campaign in Haiti. This means that more efforts

should be done to reinforce the campaign. 88.8 % also knew that it is necessary to take leave

from work during infectious disease of the skin. 92.5% of the vendors knew that microbes could

be found in the skin, nose and mouth of healthy handlers. In similarity to the results observed for

the consumers (42.5%), 41.3 % of the vendors did not know that abortion could be induced by

31

foodborne diseases. 67.5% wrongly believed that washing utensils with detergent would leave

them free of contamination. More than a half (55%) of the vendors did not know that eating and

drinking while preparing food can lead to contamination. Most of the vendors were aware of the

importance of washing hands (95%), proper cleaning (82.5%) and the use of gloves (72.5%) in

the prevention of foodborne diseases. Although in other studies vendors were not able to identify

the group at risk of foodborne diseases (Ansari-Lari et al., 2010), the majority (72.5%) of the

participants in Haiti were able to identify children, pregnant women and elderly as being more at

risk of foodborne diseases. 76.3% of the vendors correctly responded that a swollen can is a

possible host of microorganisms. Slightly more vendors than consumers knew that reheating

could be used to prevent the occurrence of foodborne diseases (63.8 %) and that the preparation

of food in advance could lead to food poisoning (78.8 %).

Tables 4-9 and 4-10 show the tallied responses of the customers and vendors, respectively to

each question in the questionnaire about the food safety attitudes. Regarding food safety attitude

of the consumers, the study found that the majority of consumers answered correctly one third of

the questions (questions 1, 2, 3, 4, 7, 8, 9, 10, 11 and 13) with correct responses ranging between

70 to 96.3 %. However most of them wrongly believed that a well-cooked food is free of

contamination (62.5%) and that the ideal place to store raw meat was the bottom shelf of the

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

as possible after purchase (88.8%) and that the best way to thaw a chicken was not in a bowl of

cold water (60%). In a study conducted by Bruhn and Schutz (1998) it was also observed that

46%, of the consumers defrost food on a counter top and 10% defrost in warm water. 35%

agreed (wrongly) that defrosted foods can be refrozen and only half of them (51.3%) were able

to identify wearing masks as an important practice to reduce the risk of food contamination.

As observed for the consumers, it can be seen in Table 4-10 that the majority of the vendors also

correctly answered approximately one third of the questions (questions 1, 2, 3, 4, 7, 8, 9, 10, 11,

13 and 14) used to assess their food safety attitudes. The range of correct responses (77.5-100%).

was similar to those of the consumers. The vendors had the same difficulties in answering the

same questions that the consumers also could not answer. The lowest percentage of correct

answers (22.5%) was observed for the question concerning whether or not well-cooked food is

free of contamination. As in other studies conducted in Ghana and South Africa, a high

32

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

importance of separating cooked and raw foods in order to prevent foodborne diseases (Donkor

et al., 2009, Lues et al., 2006). It has been found in our study that the majority of consumers and

vendors did not know that thawing should not be done at the ambient temperature. This should

be taken into consideration since inappropriate thawing of meat and poultry can lead to growth

of harmful and spoilage bacteria (USDA, 2006).

33

Table 4-7 Assessment of consumers' food safety knowledge

Response N (%)

Statement Right Wrong Do not know

1. Abortion in pregnant women can be induced by food-borne disease. 68 (42.50) 38 (23.7) 54 (33.7)

2. Bloody diarrhea 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 among the 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)

34

Table 4-8 Assessment of vendors' food safety knowledge

Response N (%)

Statement Right Wrong Do not know

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

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

3. Can swollen cans contain microorganisms 61 (76.2) 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 food-borne 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 food-borne pathogens 0 (0) 1 (1.2) 79 (98.7)

9. Staphylococcus is among the food-borne 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 (63.7) 21 (26.2) 8 (10)

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

35

Table 4-9 Assessment of consumers' food safety attitude

Response N (%)

Statement Right Wrong Do not know

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)

36

Table 4-10 Assessment of vendors' food safety attitude

Response N (%)

Statement Right Wrong Do not know

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)

37

4.2. Observed food handling habits

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

were observed in this study are shown in Table 4-11. 18 (90%) of the stalls were manned by a

woman. The mean age of the vendors manning the stalls that were observed was 42.4 years. The

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

participants had not attended secondary school, none of them had gone to university and 70% did

not have any food safety training.

Table 4-11 Demographic characteristics of stalls' vendors

Characteristics Number Percentage Mean ± SD* Range

Sex

Male 2 10%

Female 18 90%

Age(years)

<30 4 42.4±10.3 28-68

30-50 12

51-60 3

>60 1

Education

Illiterate 2 10%

Primary school 13 65

Secondary school 5 25%

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%

*SD = standard deviation

38

Table 4-12 presents the characteristics of the observed stalls. 45% of the stalls observed

consisted of an informal canopy (mostly a parasol) and 35% consisted simply of a table set in the

street. As observed in this study other studies have also reported that street vending stalls are

most often made of tables and canopies (Chukuezi, 2010). Contrary to our study where 85% of

the food was prepared on site, only 10% and 14% of the food was prepared on site in South

Africa and Mauritius, respectively (Lues et al., 2006; Subratty et al., 2004). 65% of the stalls did

not have access to potable water and 80% did not have adequate hand washing and waste

disposal facilities. These findings were similar to the ones observed by Muyanja et al. (2011),

Muinde and Kuria (2005), and Badrie et al. (2004) in studies carried out in Uganda, Kenya and

Trinidad, respectively. Because of the lack of adequate waste disposal facilities, street vendors

have a tendency to dispose of their garbage in the street. This in turn attracts more flies and

insects which are potential vectors of pathogens. Animals or pests/flies were indeed evident

around the stall in 60% of the cases, which was also the case in Uganda, Kenya and Trinidad

(Muyanja et al., 2011; Muinde and Kuria, 2005; Badrie et al., 2004). 85% of the stalls were not

protected from the sun, dust and wind. The same findings have been observed by Muyanja et al.

(2011); Abdalla et al. (2009); Chukuezi, (2010); Muinde and Kuria, (2005) in Uganda, Sudan,

Nigeria and Kenya, respectively. With regards to the cleanliness of the environment around the

vending stalls, Muinde and Kuria (2005) observed a higher percentage of stalls with unclean

environments (85%) compared to our study where in 75% of cases the environment around the

stall was clean i.e. far from rubbish, waste water, toilet facilities, open drains and animals.

Only 45% of the vendors washed their hands in clean potable water each time before handling,

preparing and serving food. All of the vendors said that they washed their hands each time after

visiting the toilet. However, this was not confirmed in this study as the researcher could not

follow the vendor in the toilet. This finding is therefore highly questionable. It has been observed

in some studies that the washing of hands after visiting the toilet was not evident for street

vendors because of the non-existence of public toilets in many developing countries and if they

do exist, most of the time they have no hand washing facilities, no paper and running water

(Bryan et al., 1988). In a study conducted in Abeokuta (Nigeria), it was found that vendors

relieved themselves on dunghills and in bushes and used sheets of paper to clean up after

defecation without washing their hands (Idowu and Rowland, 2006). Although all the stalls

operators wore clean and presentable clothes, only 8 (40%) actually wore an apron while

39

handling, preparing and serving food. Other studies have also observed that a low percentage of

vendors use aprons and gloves while handling, preparing and serving food (Chukuezi, 2010;

Subratty et al., 2004; Lues et al., 2006; Muinde and Kuria, 2005). In agreement to the

observations that have been made in other countries such as Kenya (Muinde and Kuria, 2005)

and Nigeria (Chukuezi, 2010; Omemu and Aderoju, 2008), 80 % of the vendors in Haiti handled

food with bare hands, handled money while serving the food and only 6.3% washed their hands

thereafter. These findings are a concern since the hands are vectors for pathogens such as S.

aureus. Consequently, it is advised that food handlers should avoid handling food with bare

hands and handling money at the same time (Anon, 1999). Additionally, according to the WHO,

food should be preferably handled with clean tongs, forks, spoons or disposable gloves

(FAO/WHO, 1999). The hair of 65 % of the vendors was covered, whilst 18 (90%) had clean and

short nails. This percentage is higher compared to other studies performed in Mauritius (Subratty

et al., 2004) Kenya (Muinde and Kuria, 2005) and Ghana (Mensah et al., 2002). However, it has

to be noted that the use of hair covers might not be primarily for food safety reasons since in

Haiti most of women vendors traditionally cover their hair irrespective of what they are selling

or doing. In 55% of the cases a clean cloth was used to remove dirt and dust. 8 (20%) of the

operators wore jewellery and only 2 of these 8 operators adequately covered the jewellery. None

of the operators smoke during the handling and serving of food. In 20% of the cases, the same

knives and boards were used to prepare raw and cooked food.

In all cases the ingredients were stored in sealed containers whilst raw, partially cooked and

cooked food products were kept separate (100%). In 70% of the cases previously cooked food

products were not kept cool. The same observations have been reported by Muinde and Kuria

(2005) and Badrie et al. (2004) in Kenya and Trinidad, respectively. This is an important finding

as it has been shown that inadequate cooling is among the key factors that contribute to the

occurrence of food poisoning outbreaks (Roberts, 1982; WHO, 1989). In almost half of the cases

(45%), the utensils were not covered whilst 95% of the vendors cleaned the utensils every time

after use in cold and soapy water. This practice of washing the dishes seems to be common in

other countries as well (Azanza et al., 2000; Van Kampen et al., 1998; Lues et al., 2006).

40

Table 4-12 Food safety observation checklist

Observation N (%)

Facilities No Yes Kind of material the stall structure Were the food is prepared consist of: Zinc/iron 0 (0%) 2 (10%) Canopy 0 ((0%) 9 (45%) Container 0 (0%) 1 (5%) Wooden table 0 (0%) 7 (35%) Other 0 (0%) 1 (5%) The food is prepared At home 0 (0%) 3 (15%) On site 0 (0%) 17 (85%) Is vending stall protected from sun 17 (85%) 3 (15%) Animals or pests flies etc. evident around the vending stall 8 (40%) 12 (60%) The vending stall maintained in a clean condition 5 (25%) 15 (75%) There is access to potable water at the site or close to the site 13 (65%) 7 (35%) There are adequate hand washing facilities available 16 (80%) 4 (20%) There are adequate waste water or food disposal facilities available 16 (80%) 4 (20%) Environment around the stall The environment around the stall is clean: far from rubbish, waste water, toilet facilities, open drains and animals

5 (25%) 15 (75%)

The operator washes their hands in clean water each time before the handling, preparation and serving of food

11 (55%) 9 (45%)

The operator washes their hands each time after visiting the toilet 0 (0%) 20 (100%) The operators clothes are clean and presentable 0 (0%) 20 (100%) The operator uses an apron when handling, preparing and serving of food 12 (60%) 8 (40%) The operator handles food with bare hands 4 (20%) 16 (80%) The operator has clean and short nails 2 (10%) 18 (90%) The hair of the operator is covered when handling preparing and serving of food 7 (35%) 13 (65%) The operator handles money while serving food 4 (20%) 16 (80%) If yes Are hands washed after handling money before handling food again 15 (93.75%) 1 (6.2%) Dirt or dust is removed by:

41

Apron 0 (0%) 2 (10%) Bared hands 0 (0%) 1 (5%) Dirty cloth 0 (0%) 6 (30%) Clean cloth 0 (0%) 11 (55%) Does the operator wear jewellery 16 (80%) 4 (20%) If yes is the jewellery adequately covered 3 (75%) 1 (25%) Does vendor smoke during the handling preparation of food 20 (100%) 0 (0%) Does the operator use the same utensil knives and boards to prepare raw and cooked food 16 (80%) 4 (20%)

Food storage Food is stored/displayed: 0 (0%) 3 (15%) In sealed container 0 (0%) 12 (60%) Are raw partially cooked and cooked food products kept separate 0 (0%) 20 (100%) Are previously cooked foods kept cool i.e. ice box or refrigerated 14 (70%) 6 (30%) Utensils Are utensils covered 9 (45%) 11 (55%) Are utensils cleaned adequately every time after use 1 (5%) 19 (95%) Utensils are cleaned with: Cold and soapy water 0 (0%) 20 (100%)

42

4.3. Microbiological quality of Haitian street foods

4.3.1. Description of street foods evaluated in this study

Table 4-13 gives an overview of the different types of street foods which were evaluated in this

study. A total of 77 food samples were collected. The most sampled street food was Fritay3

(37.7% of all samples collected). The traditional Haitian main dish4 represented the second most

sampled street food (36.4% of all samples collected). The rest of the street foods sampled were

paté5 (10%), boiled eggs (3.9%), hotdogs (3.9%), fruit juice (3.9%) and spaghetti (3.9%).

Table 4-13 Summary of the street foods evaluated in this thesis

Type of food Numbers Percentage

Eggs 3 3.9% Fritay 29 37.7% Hotdogs 3 3.9% Juice 3 3.9% Major dish 28 36.4% Paté 8 10.4% Spaghetti 3 3.9%

TOTAL 77 100%

With the exception of fruit juice, most of the street foods sampled in this study undergo a

substantial heat treatment during cooking. However, the post-cooking handling practices raise

some concerns. As can be seen in Table 4-14, in most of the cases the food was handled with

bare hands after cooking. The food was also served in polyethylene bags which were stored

uncovered in the stall. In addition, the vendors often blew into the bags to open them. It has been

shown that pathogens can invade the interior surfaces of the polyethylene bags during packaging

because of poor handling (Barro et al., 2007). Therefore, the common potential sources of

contamination of street food comprised of the food vendors’ hands, the utensils used to serve the

food and in cases where the dish was made of raw vegetables, the hygienic quality of the water

used to wash them.

3 Mixture of fried plantains, sweet potatoes, malanga, meat and some fermented vegetables (pickles) 4 Made of boiled rice or maize associated with some beans (puree), salads and meat (chicken or pork or beef) 5Fried wheat flour dough 

43

Table 4-14 Overview of cooking methods, handling and possible sources of contamination of collected food

Type of food

Description Cooking methods Handling after cooking Sources of contamination

Eggs Eggs containing fermented sauce with tabasco and salt

Boiling removal of the shell by bare hands Served in a polyethylene bag

Hands, utensils and bags

Fritay Slices of plantains, Akra6, sweet potatoes, meat (mostly pork), fermented or fresh vegetables, Paté

Frying Served with bare hands or with a fork in a polyethylene bag or paper bag.

Hands, utensils, water and bags

Hotdogs Chicken or beef meat with ketchup or mayonnaise or mustard

Frying or grilling Served with bare hands in a polyethylene bag

Hands, equipment, utensils and bags

Juice Artificial juice No cooking Hand tied polyethylene Bag Hands, water, utensils and bags

Major dish Compose of one staple food (rice or maize) cooked together or separately with beans (red or black) served with some salads or vegetables and meat (chicken or beef or pork)

Boiling (rice, maize, beans), raw salads

meat can be boiled or fried

Served with a spoon in foam plates or normal plates

Hands, utensils, water, raw vegetables

Paté Made of dough (wheat flour) which is fried and may or may not contain inside some vegetables, meat, eggs or fish.

Frying Served with a fork or with bare hands in a polyethylene or paper bag

Hands, utensils, vegetables and bags

Spaghettis Spaghettis with ketchup or mayonnaise

Boiling Served with a fork in disposable or non-disposable plates

Hands, utensils and plates

6 Mashed malanga ( root ) with spices  

44

The presence of vegetables and meat in the collected foods makes them at risk of contamination

by lactic acid bacteria such as Lactobacillus, Streptococcus, etc. However, such kinds of bacteria

are spoilage microorganisms and are therefore not implicated in foodborne diseases. The

presence of meat and meat products, poultry and eggs make them at risk of contamination by S.

aureus while the presence of pasta and rice makes them at risk of contamination by Bacillus

cereus (EU 2073, 2005). The presence of pork and poultry in the foods makes them at risk of

contamination by some Salmonella spp. and to a lesser extent the presence of salads in the major

dishes makes them at risk of contamination by Listeria monocytogenes (EU 2073, 2005).

According to the PAHO, fried foods prepared with sausages and other meat products are

considered as high risk food groups because they are most of the time stored at room temperature

(PAHO, 1992). According to WHO/PAHO, street foods are the most at risk of contamination

when they are of an animal origin, have high protein content, high moisture content, a relatively

high pH and a large number of ingredients (PAHO, 1992). (Table 4-14 and 4-15)

4.3.2. Range of pH and water activity of the street foods

Tables 4-15 presents the pH and water activity values of the street foods evaluated in this study.

70% of the collected foods had a pH which was lower than 6; 26% had a pH between 6 and 8

and 3.9% had a pH > 8. The pH values ranged between 3.56 and 8.64. The product with the

lower pH was the fruit juice (range 3.6-4.4), whilst that with the highest pH was the eggs (mean:

8.2; range: 7.9-8.6). The Fritay had a large pH range; some were acidic while others were more

alkaline (range: 4.7-8.1). This could be explained by the fact that this type of food consists of

different components as mentioned earlier. Most of the samples (95.5%) had a water activity

higher than 0.90 while only 4.6% of them had a water activity lower than 0.90. The highest water

activity (0.99) was found for the juice which is quite understandable. The lowest water activity

was found among the patés and Fritay which are made of fried and consequently dry food

components. (Table 4-14 and 4-15)

Although the optimal pH for growth of most microorganisms is around 7, the pH values of most

of the foods that were collected was suitable for the growth of the most common microorganisms

implicated in foodborne diseases such as for instance S. aureus which grows at a pH of 4.5 to 9.3

(Uyttendaele, 2012).

45

It is well known that water activity plays also an important role in growth of microorganism. It has been shown in literature that Gram negative bacteria needed a minimum aw of 0.95 whilst Gram positive require a aw of at least 0.91 for growing (Samapundo, 2012). According to this observation, 95.5 % of the collected samples had a water activity adequate for growth. (Table 4-15)

Table 4-15 pH and water activity (aw) of the street foods evaluated in this thesis

Type of food pH aw

Eggs 8.2 ± 0.4* (7.9 - 8.6)** 0.97 ± 0.005 (0.97 - 0.98)

Fritay 5.8±0.71 (4.7-8.11) 0.94±0.02 (0.85-0.98)

Hotdogs 5.9±0.5 (5.5-6.5) 0.95±0.01 (0.94-0.97)

Juice 3.8±0.5 (3.6-4.4) 0.98±0.005 (0.98-0.99)

Major dish 5.9±0.3 (4.8-6.9) 0.96±0.009 (0.94-0.98)

Paté 5.9±0.7 (4.8-6.9) 0.94±0.02 (0.89-0.97)

Spaghettis 5.7±0.3 (5.5-6) 0.97±0.01 (0.95-0.98)

*mean ± standard deviation, **range

Table 4-16 General microbial quality of Haitian street foods

7 Log CFU/g or ml  

Bacteria Observation Percentage Mean ± SD Range

Lactic acid bacteria 41 53% 3.68±1.657 1.70-7.41 Total anaerobes 41 53% 3.72±1.58 1.30-7.48 Total aerobes 48 62% 4.21±1.65 2-8.54

B. cereus 10 13% 4.57±1.82 2-7.32 S. aureus 20 26% 3.17±1.26 2-7.81

L. monocytogenes 29 38% 3.48±1.31 2-6.66 Salmonella spp. 3 4% 2.79±0.2 2.6-3

E. coli 4 5% 2.9±1.01 2.6-4.36

46

Table 4-17 Microbial quality of different groups of Haitian street foods

8 PCA, 9 PCAA, 10 MRS, 11 MYP 12 MSA 13 Salmonella rapid 14 rapid E.coli 15 Aloa 16 VRBA 17 Mean ± SD 18 Range

Food

type

Total

aerobes8

Total

anaerobes9

Lactic acid

bacteria10

Bacillus Spp.11

Staphylococci12 Salmonella

spp. 13

E. coli14 Listeria

spp.15

Total

coliforms16

Fritay 4.6±1.817 4.2±1.7 4.1±1.9 5.6±1.5 3.28±1.5 2.8±0.2 3.2±0.98 3.8±1.4 3.9±2.3

2-8.518 1.3-7.48 1.7-7.4 4.5-7.3 2-7.81 2.6-3 2.7-4.4 2-6.7 2.3-5.6

Eggs 3.5±0.6 0 2.5±1.1 0 3.2±1.2 0 0 3.7±0.9 0

3.1-4.1 0 1.7-3.3 0 2.3-4.1 3-4.3

Hotdogs 2.7 2±0.8 2.6 0 0 0 0 0 0

2.7 1.5-2.6 2.6 0 0

Spaghetti 3.6±1.6 3.5±1.6 3.3±1.5 2 3.65 0 0 2.3±0.3 0

2-5.3 1.9-5.1 1.9-4.9 2 3.65 2-2.6

Major

dish

4±1.9 3±1.3 3.3±1.2 4.4±1.9 2.9±1.02 0 2 3.4±1.4 0

2-8.2 1.5-5.3 1.9-5.3 2-7.3 2-4.03 2 2.3-5.95

Pate 3.9±0.7 3.8±0.4 3.2±1.1 5.12 2.5±0.33 0 0 2.9±0.44 2

3.4-5.2 3.3-4.2 1.8-4.8 5.12 2.3-2.8 2.6-3.2 2

Juice 3.6 0 0 0 0 0 0 0 0

3.6 0 0 0 0 0 0 0 0

47

4.3.3. Microbiological quality of Haitian street foods

General microbiological quality

Table 4-16 and 4-17 present the results obtained from the microbiological analyses performed.

Anaerobes and lactic acid bacteria were found in 53% of the samples. Mean counts (log CFU/g

or ml) of total anaerobes and lactic acid bacteria were 3.72 (± 1.58) and 3.68 (± 1.65),

respectively, with the values ranging between 1.30 - 7.48 and 1.70 - 7.41, respectively. The total

aerobic counts were slightly higher (62% of the samples were contaminated with aerobes). The

mean count was 4.21 (± 1.65) log CFU/g and the values ranged between 2 and 8.54 log CFU/g.

In conclusion, respectively 12.50%, 7.31% and 7% of the samples had total aerobic, anaerobic

and lactic acid bacteria counts above the acceptable limit i.e. 107CFU/g (Uyttendaele et al.,

2010). No significant difference was found between the contamination levels of the different

type of street foods evaluated (lactic acid bacteria count, p = 0.53; total aerobic counts, p = 0.68;

total anaerobic counts, p = 0.17). In addition, no strong linear correlation was found between

these counts and pH (lactic acid bacteria count, r8 = -0.18; total aerobic counts, r = -0.04; total

anaerobic counts, r = -0.09) or water activity of the food products (lactic acid bacteria count, r = -

0.10; total aerobic counts, r = 0.03; total anaerobic counts, r = 0.04).

Presence and levels of pathogenic bacteria in Haitian street foods

As mentioned in the methodology, selected colonies from plates with presumptive positive

pathogens were further tested to confirm the presence of these pathogens. Table 4-18 presents

the results of the confirmation.

Presumptive B. cereus group spp. was identified in 13% (10) of the samples. The mean counts of

presumptive B. cereus group spp. was 4.57 ± 1.82 log CFU/g and the values ranged between 2

and 7.32 log CFU/g on the products were they occurred. Of concern was the observation that

most of the products (70%) contaminated with presumptive B. cereus spp., were contaminated at

levels higher than 104 CFU/g, which is the level at which B. cereus spp. are known to be capable

of causing illness (NSW Food Authority, 2009). No difference was found between the

contamination levels of the different types of food contaminated by presumptive B. cereus spp.

(p = 0.45). From seven colonies of presumptive B. cereus spp. selected for confirmation from

8 r: correlation coefficient 

48

products with counts above the acceptable limit, (one each from seven different food samples), 4

(57%) were confirmed as Bacillus spp. However, B. cereus itself was only found in one sample.

The sample consisted of paté which is made of wheat flour with chicken and some vegetables

inside. Bacillus pumilus was identified in two samples (major dish made of rice and beans) and

Bacillus megaterium in one sample of fried sweet potatoes. Although focus is mainly on B.

cereus, from a food safety point of view, food poisoning by other Bacillus spp. has been reported

(Rowan et al., 2003; From et al., 2006). For example, B. pumilus has been identified as the only

contaminant in some cases of food poisoning where no foodborne pathogens could be detected

(Kramer and Gilbert, 1989; Suominen et al., 2001). The mechanism of pathogenicity seems to be

linked to the production of complex lipoproteins toxins known as pumilacidins which are

produced at the highest quantity at 15⁰C (From et al., 2007).

Table 4-18 Confirmed microorganisms in positive plates

Description Food component Microorganisms Log CFU

Major dish Rice+ red beans + vegetables Bacillus pumilus 93.4%a 7.32b Major dish Rice+ black beans +chicken Bacillus pumilus 99.8% 4.11 Fritay Fried sweet potatoes Bacillus megaterium 92% 4.50 Paté Wheat flour dough+ chicken+ vegetables Bacillus cereus 50% 5.12 spaghetti Spaghetti, ketchup S. sciuri 91% 3.65 Egg Eggs, tabasco S. aureus 97.8% 4.10 Fritay fried plantains+ Akra+ vegetables S. epidermidis 89.5% 3.34 Fritay Plantains S. lugdunensis 66% 3.41 Fritay

Plantains, chicken, sweet potatoes S.lentus 99.9% 3.74 E. coli 2.60

Major dish Rice, black beans E. coli 2  

a  % correlation,  b: Log CFU/g of presumptive species in the food sample 

26% of the samples were presumptively positive for S. aureus. The mean log CFU/g was 3.17

(±1.26). The range of contamination was between 2 and 7.81 log CFU/g. 15% of these values

were above 104 CFU/g which is considered as a potential hazardous level in ready to eat food

products (NSW Food Authority, 2009). No difference was found among the type of foods (p =

0.69). No strong correlation was found either with pH and water activity. Of 9 colonies of

presumptive S. aureus (one each from nine different food samples) selected for confirmation,

only one isolate (11.1%) was identified as S. aureus. The sample from which this isolate came

49

from consisted of boiled eggs. The presence of S. aureus in this product could be probably

explained by the fact that the shell of the boiled eggs is removed by bare hands which might have

been contaminated. The other presumptive S. aureus were identified as Staphylococcus sciuri,

Staphylococcus epidermidis, Staphylococcus lugdunensis and Staphylococcus lentus. Although

these species are not frequently associated with foodborne diseases, S. sciuri is considered as an

important human pathogen and is responsible of cases of endocarditis, peritonitis, septic shock,

urinary tract and wound infections and pelvic inflammatory disease (Gan et al., 2007).

38% of the samples were presumptively positive for Listeria monocytogenes. The mean count

was 3.48 (±1.31) log CFU/g. The values range between 2 and 6.66 log CFU/g. These values

were above the acceptable limit which is absence in 25g/102CFU/g of ready to eat products able

or unable to support the growth of Listeria monocytogenes (NSW Food Authority, 2009). No

difference was found between the different type of foods (p = 0.46) and there was no strong

correlation with pH and water activity. All the 15 samples of presumptive L. monocytogenes spp.

selected for confirmation were determined to be Streptococcus viridicans which is not known as

a foodborne pathogen.

Only 4% and 5% of the samples were presumptively positive for Salmonella spp. and E. coli,

respectively. The mean count were 2.79 (± 0.2) and 2.91 (± 1.01) log CFU/g for Salmonella and

E. coli, respectively. The values ranged between 2.6 and 3 for Salmonella spp. and 2.6 and 4.36

for E. coli. The values for both microorganisms were above the acceptable limit which is absence

in 25g of ready to eat food (NSW Food Authority, 2009). Presumptive Salmonella spp. was

found only in Fritay, whilst one presumptive E. coli were also found in Fritay. No difference was

found between the contamination levels of the different types of food and there was no strong

correlation found with pH and water activity. Of the four colonies of presumptive E. coli (one

each from four different food samples) selected for confirmation, two (50%) were confirmed as

E. coli. These originated from samples of Fritay and Haitian main dish. Salmonella was not

confirmed in any of the selected presumptive plates. (Table 4-18)

Some key findings in the assessment of the microbial quality of street vended food in Port-au-

Prince were the high numbers of anaerobes, aerobes and lactic acid bacteria. The same findings

have been observed in other studies described below. This might suggest that the hygienic

quality of the street food is very poor. However, the number of samples contaminated with

50

pathogens was low. B. cereus and S. aureus were confirmed in only one sample each, whereas E.

coli was confirmed in two samples. These findings are surprising as the conditions in which the

street vendors operated were precarious as described above and also as different studies carried

on around the world have reported the contamination of street vended foods by various

pathogens. For instance in the Dominican Republic (which neighbours Haiti), E. coli (in water,

milk, and cheese samples), B. cereus (in bean and rice samples) and C. perfringens (in meat,

chicken and bean samples) were identified in street vended foods (Bryan et al., 1988). However,

they all occurred at numbers less than 103/g and no information could be found on whether they

were presumptive positive or confirmed microorganisms. In a study on street foods in South

Africa, S. aureus ranged between 102 and 103 CFU/g on beef, 103 CFU/g on chicken, ≤ 103

CFU/g in gravy and no Listeria spp. was isolated but no specific test was done to confirm the

identity of these pathogens (Lues et al., 2006). In Ghana, mesophilic bacteria were identified in

356 food samples (69.7%); and confirmed B. cereus, S. aureus and Enterobacteriaceae were

found in 28 (5.5%), 163 (31.9%), and 172 (33.7%) street food samples, respectively, although

the microbial quality of most foods was within acceptable limits (Mensah et al., 2002). In

Bangkok (Thailand), 14 samples (15.2%) and 38 samples (41.3%) of ready-to-eat food were

contaminated with bacteria in general and coliforms, respectively (Cuprasitrut et al., 2011). In

Lome (Togo) median total aerobic bacteria and total coliform counts of 3.2 x 106 and 1.9 x 104

CFU/g were found in samples of salads. Sixteen samples (23.2%) were contaminated by

confirmed S. aureus at levels between 10 and 200 CFU/g (Adjrah et al., 2013). In Brazil, fecal

coliforms were detected in 22 samples (55%) (>3 MPN/g), 50% were above acceptable limits,

confirmed B. cereus, S. aureus and E. coli were present in 12.5%, 2.5% and 22.5% of street food

samples, respectively. B. cereus counts ranged from 1.4 x103 up to 1.7 x104 CFU/g of food

sample (Hanashiro et al., 2005). In Johannesburg, 22% of 51 street food samples were

contaminated with presumptive positive B. cereus, however, the counts were all below 1 log

CFU/g and it was found to be the most prevalent pathogen in all samples collected; presumptive

positive S. aureus was isolated in two chicken stew samples (16/66, 24%) and no E. coli were

detected (Mosupye et al., 2000). In Sudan, confirmed E. coli, S. aureus and Bacillus spp. were

identified in street food samples and the viable counts in cooked vegetables, bottled drink and

juice were 4.6, 3.7 and 4.1 log10 CFU/ml, respectively (Abdalla et al., 2009). In Trinidad and

51

Tobago, a study carried on street vended hamburgers revealed that even though pathogens were

present, the microbial risk was 0 i.e. was within the acceptable limits (Badrie et al., 2004).

Difference between the results of our microbiological analysis and those of previous studies in

other countries could be that the type of collected food was totally different from the ones in

other studies. It is important to notice also that in many studies, only presumptive positive

pathogens were reported and no further confirmation tests were carried out. Contrary to other

studies as well, the majority of the food evaluated in this study was prepared on site which could

have reduced the overall risk of contamination by pathogens.

The study presents some considerable limits:

i. Because of the lack of available data on the number of street food vendors in Haiti and

also because of a limited amount of time and resources, the sample size was not

calculated but was arbitrary defined. This could be a source of bias in the study since we

do not know how representative our participants really were,

ii. The selection of the studied communes was also designed arbitrary and some areas,

specifically the slums, were excluded from the study due to accessibility issues. Since

hygienic conditions in slums are usually very poor their inclusion could have most likely

impacted on the results of our study,

iii. The same observation regarding the sample size can also be extended to the number of

food samples collected and evaluated in this study. 77 samples were arbitrary collected

and transported to Belgium for analysis since the samples could not be analysed in Haiti.

This posed some serious constraints for collecting more samples,

iv. In the study, priority was given to places around schools for selection of consumers,

which could partly explain why there was a high educational level compared to the reality

of the country.

v. In addition, we need to be very careful in interpreting the microbial results since a high

count of presumptive positive pathogens was found in several samples. It has to be

emphasized that only one isolate per plate with colonies of a presumed pathogen was

randomly selected and used for the confirmation. This significantly reduced the chances

that the presumed pathogen was actually selected for confirmation. Ideally, more (five to

52

ten) colonies should have been confirmed. However, more colonies have been selected

for further analysis and these results will be published in a separate paper soon. This will

give us a more valuable insight on the real contamination of the street food marketed in

Haiti by pathogens.

We need also to mention that some critical aspects have not been approached in our study and

consequently are highly recommended:

i) Because of the inaccessibility to potable water, it would be interesting to also evaluate the

microbial quality of the water used to wash the dishes by the street vendors,

ii) It would also be interesting to take swab samples of the preparation boards and hands of food

handlers since it was observed that the hygienic quality of the collected foods was very low,

iii) An investigation of the acquisition of raw materials and outcomes of leftovers might be also

relevant since there was a limited capacity of cooling by the street vendors,

iv) The presence of some other foodborne pathogens such as Norovirus, Campylobacter,

Clostridium perfringens and Vibrio cholera has not been assessed in this study, it could also

interesting to test these pathogens.

53

5. Conclusions

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

practice of street food consumers and vendors in Haiti. To a lesser extent, it also had the

objective of assessing the microbial quality of street vended food in Port-au-Prince. According to

the WHO, these factors play an important role in order to address correctly food safety issues

(WHO, 2000). The study was the first of its nature that has been done in Haiti.

The main conclusion of our study is although consumers and vendors exhibit an average good

food safety knowledge and attitude; a considerable percentage had a very low score meaning that

there is still a need for food safety education. The actual food handling practices by street

vendors also raise some serious concerns. Since the majority of vendors did not have any food

safety training, there is a need to organize formal training in food safety for the street foods

vendors. There is also a need for the government to make more infrastructures available such as

potable water, toilets and waste disposal facilities as the lack of these structures was evident in

our study. The results observed in this study point out the need to emphasize the importance of

cold temperatures to retard growth of microorganisms particularly refrigerating during

defrosting. Since no data could be found on the numbers of street food vendors in the country,

there is a need for the institute of Haitian Institute of Statistics and Informatics (IHSI) which is

responsible for national surveys to generate more data in order for the government to have more

control and organization on this sector. Haiti currently has no food safety legislation. A project

of legislation has been introduced to the parliament in 2012 but it has not been adopted yet. This

would be necessary for regulation of the street food business and the food industry in general.

Due to the limits of the research mentioned above, one should be careful in generalizing the

results of the study and there is a need for more studies in the street food sector and perhaps it

might also be interesting to extend that study to other departments of the country.

54

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Annexes

Annex1:Studylocation

Source: google earth

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Annex2:Foodsafetyknowledgeandattitudequestionnaire

Sex: Male / Female Age: Food safety training: Yes / No

Education: Illiterate Elementary school High school Higher education

FOOD SAFETY KNOWLEDGE YES NO DO NOT KNOW

Washing hands before work reduces the risk of food contamination

Using gloves while handling food reduces the risk of food contamination.

Proper cleaning and sanitization of utensils increase the risk of food contamination.

Eating and drinking in the work place increase the risk of food contamination.

Food prepared in advance reduces the risk of food contamination.

Reheating cooked foods can contribute to food contamination.

Washing utensils with detergent leaves them free of contamination.

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

Typhoid fever can be transmitted by food. AIDS can be transmitted by food. Bloody diarrhea can be transmitted by food. Abortion in pregnant women can be induced by food-borne disease.

Salmonella is among the food-borne pathogens. Hepatitis A virus is among the food-borne pathogens.

Staphylococcus is among the food-borne pathogens.

Can swollen cans contain microorganisms Microbes are in the skin, nose and mouth of healthy handlers.

During infectious disease of the skin, it is necessary to take leave from work.

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FOOD SAFETY ATTITUDES YES NO DO NOT KNOWWell-cooked foods are free of contamination. Proper hand hygiene can prevent food-borne diseases.

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

Raw and cooked foods should be stored separately to reduce the risk of food contamination.

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

Defrosted foods can be refrozen. The health status of workers should be evaluated before employment.

The best way to thaw a chicken is in a bowl of cold water.

Wearing masks is an important practice to reduce the risk of food contamination.

Wearing gloves is an important practice to reduce the risk of food contamination.

Wearing caps is an important practice to reduce the risk of food contamination.

The ideal place to store raw meat in the refrigerator is on the bottom shelf.

Eggs must be washed after purchase Dish towels can be a source of food contamination.

Knives and cutting boards should be properly sanitized to prevent cross contamination.

Food handlers who have abrasions or cuts on their hands should not touch foods without gloves.

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Annex3:Foodsafetyobservationchecklist

Food safety observation checklist

Name vendor: …………………………………………………………….

Location: ………………………………………………………………….

Age: …………………

Sex: …………………

Education level: ……………………………………..

Food safety training: …………………..……………

1. Facilities

- Indicate what kind of material the stall/structure were the food is prepared and sold is

made

Wooden Canopy Van Wheelbarrow Zinc/ iron Container

- Is food prepared on-site or at home?

- Is vending stall protected from sun, dust and wind? Yes/No

- Are animals or pests (flies etc.) evident around the vending stall? Yes/No

- Is the vending stall maintained in a clean condition? Yes/No

- Is there access to potable water at the site or close to the site? Yes/No

- Are adequate hand washing facilities available? Yes/No

- Are adequate waste (water or food) disposal facilities available? Yes/No

o this is usually a closed (foot operated) bin

o access to community operated waste water and general waste disposal sites

2. Environment around the stall

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- Is environment around the stall clean: far from rubbish, waste water, toilet facilities, open

drains and animals? Yes/No

3. Personal hygiene

- Does the operator wash their hands in clean water each time before the handling,

preparation and serving of food? Yes/No

- Does the operator wash their hands each time after visiting the toilet? Yes/No

- Are the operators’ clothes clean and presentable? Yes/No

- Does the operator use an apron when handling, preparation and serving of food? Yes/No

- Does the operator handle food with bare hands? Yes/No

o If answer was NO, do they use disposable or reusable gloves?

o Are the gloves cleaned properly i.e.. in clean water (with or with soap) before the

handling, preparation and serving of food?

- Does the operator have clean short nails? Yes/No

- Is the hair of the operator covered when handling, preparation and serving of food?

Yes/No

- Does the operator handle money while serving food? Yes/No

o Are hands washed after handling money before handling food again? Yes/No

- Does the operator wear jewelry? Yes/No

o Is the jewelry adequately covered? Yes/No

- Does the operator blow air into polythene bag before use? Yes/No

- Is dirt or dust removed by means of an apron, dirty cloth or bare hands?

- Is dirt or dust removed by blowing?

- Does vendor smoke during the handling/ preparation of food? Yes/No

- Does the operator use the same utensil (knives and boards) to prepare raw and cooked

food products or to cut raw vegetables and fresh meat and poultry? Yes/No

- Please note down any unhygienic behavior you may notice by the operator while vending

food i.e.

o Blowing of nose into hands continuing to work without washing the hands

o Coughing into hands and continuing to work without washing the hands

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4. Food storage

- Is food stored/displayed

o Openly in the stalls

o In a wheelbarrow

o In sealed (transparent or opaque) containers

- Are raw, partially cooked and cooked food products kept separate? Yes/No

- Are previously cooked foods kept cool (i.e. ice box) or refrigerated?

5. Utensils

- Are utensils cleaned with

o Warm soapy water

o Cold soapy water

o Clean water with no soap

o Dirty water with no soap

- Are utensils covered? Yes/No

- Are utensils cleaned adequately every time after use? Yes/No

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Annex4:Consentform

VOLUNTEER AGREEMENT FORM

Title: Food safety knowledge of consumers and handlers of street food in Haiti

Principal Investigator: [Ruth Climat]

Address: Ghent University, Coupure Link, 9000 Gent, Tel: 09 264 9902

Email: rclimat@yahoo.com

General Information about Research

This study will investigate the food safety knowledge, attitudes and practices of street food vendors and consumers of street food.

Possible Benefits, Risks and Discomforts

There are no direct benefits to be gained from this study immediately, neither are there any risks associated with it. The only inconvenience might come from the time you will spend completing the questionnaire. The data from this study will be used only for the purpose of the study. (Master Thesis)

Confidentiality

Your identity and your participation in this study will be treated strictly confidential. The information that we obtain from you will not be shared with anybody, except the study investigators. Your identity remains secret since your personal information will only be designated by a unique participant number. Your name will not appear in any reports or publications resulting from this study. After the study is completed, you may request information about the study results.

Voluntary Participation and Right to Leave the Research

You participate entirely voluntarily in this study. You have the right to refuse to participate in the study. You also have the right to stop your participation in the study at any time, even after you have signed this informed consent form. The withdrawal of your consent will not cause any disadvantage or loss of advantages/privileges.

Contacts for Additional Information

Any questions or any further clarifications concerning the study can be directed to:

Contact of the promoter:

Prof. Frank Devlieghere/ Dr. Simba Samapundo

Laboratory of Food Microbiology and Food preservation

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Faculty of Bioscience Engineering

Ghent University

Coupure Links 653, 9000 Gent, Belgium

Tel: 00 32 9 264 9902, Fax: 00 32 9 225 5510 Email: Simbarashe.samapundo@ugent.be

Contact of local researcher

Ruth Climat

Tel: 37229627

Email: rclimat@yahoo.com

VOLUNTEER AGREEMENT

The above document describing the benefits, risks and procedures for the research title (name of research) has been read and explained to me. I have been given an opportunity to have any questions about the research answered to my satisfaction. I agree to participate as a volunteer.

Date Name of volunteer

If volunteers cannot read the form themselves, a witness must sign here:

I was present while the benefits, risks and procedures were read to the volunteer. All questions were answered and the volunteer has agreed to take part in the research.

Date Name of Witness

I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above individual.

Date Signature of Person Who Obtained Consent

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