International Journal of Community Medicine and Public Health

Mukherjee S et al. Int J Community Med Public Health. 2018 Mar;5(3):1206-1211

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20180786
Original Research Article

Knowledge, attitude and practice of food hygiene among street food

vendors near a tertiary care hospital in Kolkata, India
Saswati Mukherjee1*, Tushar Kanti Mandal1, Abhishek De1, Raghunath Misra1, Amitabha Pal2

1
Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West
Bengal, India
2
Department of General Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India

Received: 19 January 2018

Accepted: 10 February 2018

*Correspondence:
Dr. Saswati Mukherjee,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Health care set ups in Indian cities are being catered by a number of street food vendors on whom the
patients, visitors, doctors, medical students and staff depend. Thus, ensuring proper food hygiene among them is of
uttermost importance. The purpose of the study was to determine knowledge, attitude and practice of food hygiene
among them and various factors that influence it.
Methods: A cross sectional study was conducted on 106 street food vendors surrounding a tertiary care hospital in
Kolkata. A predesigned pretested schedule was used to collect information on socio-demographic profile, knowledge
and attitude on food hygiene through interviews and practice was observed. Statistical analysis was done using
Pearson’s Chi-squared test.
Results: The mean age of food vendors was 37.74±10.70 years and majority were familiar with the terms “food
hygiene” and “food borne illness”. The median score of attitude on food hygiene was 9.5 and significant (p<0.05)
association was found with age, gender and education. Less than one third of street food vendors had acceptable
practice and significant (p<0.05) association was found with education, marital status and type of food vendor.
Conclusions: The street food vendors were aware of food hygiene and had favourable attitude towards it, but it
wasn’t translated in their hygiene practice. This study can help to identify the factors that influence food hygiene
practice and incorporate them in food hygiene training.

Keywords: Attitude, Food hygiene, Knowledge, Medical college, Practice, Street food vendors

INTRODUCTION foods are also a potential source of food borne illness,

thus they pose a major health problem.2 WHO has
Street foods are one of the most saleable things which are highlighted the challenges associated with food safety
relatively cheap and readily available to a large number under the slogan “From farm to plate, make food safe”
of people. They are described as “wide range of ready to and has also emphasized on various ways to make food
eat food, beverages, which are sold on street and public safer.3
places”.1
It is often recognised that lack of food hygiene among
They are appreciated for their flavour, easy availability street food vendors lead to food borne illness. Vendors
and reasonable price. One very important aspect related being poor and uneducated, they lack proper
to the street food is its necessity for maintaining the understanding of food hygiene. Their poor knowledge
nutritional status of a large section of population. Street and poor food safety practices make street foods

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perceived as a major public health risk.4 A study Study tool

conducted by Kalua observed that knowledge positively
influences attitude formation that is translated into Predesigned, pretested schedule was used.
practice.5
Study technique
Kolkata is a metropolitan city where a large number of
people from government and private institutions, offices Data collection was done by face-to-face interviewing &
and even hospitals depend on street foods. In hospital, by using observational checklists.
these food vendors are catering a large number of
patients, visitors, medical students, doctors and hospital Study procedure
staffs. To avoid any major outbreak among them, a high
standard of hygiene and practice must be ensured. Hence, Data collection was started after obtaining permission
their knowledge, attitude and food hygiene practices are from Institutional Ethics Committee (IEC) and after
essential to understand. written consent from the study subjects. Information
pertaining to socio demographic profile, knowledge and
In India, very few studies have been conducted on street attitude were obtained by predesigned, pre tested
food vendors regarding food hygiene and hence there is schedule and practice of food hygiene was observed.
dearth of knowledge regarding it. This study was
undertaken to determine the knowledge, attitude and Scoring
practice of food hygiene among street food vendors and
their association with various socio demographic factors. Attitude towards food hygiene was assessed using 6- item
questionnaire, where the responses were given the
METHODS following weight age: Agree- 2 score, don’t know- 1
score, Disagree- 0 score. As per the responses, total score
Study type and design was computed. Attitude score more than median score
(excluding the median) was defined as favourable
Observational, Cross sectional descriptive study. attitude, with score less than median score (including the
median) was unfavourable attitude. For scoring of
Study period practice, positive response (Yes) was given 1 score,
negative response (No) was given 0 score. As per the
15th Nov 2017 to 15th Jan 2018 responses, total score was computed. Acceptable practice
was defined as practice score more than median score
Study setting (excluding the median itself) and Unacceptable practice
was defined as practice score less than median score
The study was conducted in the streets immediately (including the median itself).
adjoining IPGME&R and SSKM Hospital, Kolkata as
shown in Figure 1. Data analysis

Study population The data were compiled in MS Excel and statistical

analysis was done by descriptive and inferential statistics
Street food vendors in the area adjoining IPGME&R and using SPSS Version 20.
SSKM Hospital, Kolkata.

Inclusion criteria

Inclusion criteria were those who were directly dealing

with food preparations; agreed to participate in the study.

No exclusion criteria were applied.

Sample size and sampling design

Purposive sampling was done.

The area adjoining IPGME&R and SSKM Hospital was

surveyed for enumeration of all street food vendors.
Among 125 vendors, 106 consented to participate in the
study, so final sample size was 106. The response rate Figure 1: Depicting the location of the study area
was 84.8%. adjoining the hospital.

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RESULTS Respondents’ knowledge of food hygiene

Socio demographic profile Among 106 street food vendors, majority 94 (88.7%)
were familiar with the term food hygiene, with 88 (83%)
Mean age of the food vendors was 37.74±10.709 years, knew lack of food hygiene can cause food borne illness.
with mean age for male vendor was 37.59±11.067 years
and for female vendor was 38.35±9.235 years. Majority (72.72%) of them knew “loose motion”,
followed by vomiting (67.04%) as symptoms of food
Most of them (53.77%) belonged to the group of 20 to 40 borne illness. About 30.68% of food vendors thought
years of age, with 3.77% was of less than 19 years of age typhoid as food borne illness followed by cholera
and only 2.83% of the food vendors were more than 60 (20.45%). However, misconceptions still remain, for
years of age. instance, 14.77% and 9.09% thought dengue and malaria
to be a food borne illnesses respectively as shown in
Majority (81.13%) of them were male, with 78.30% Table 2.
belonged to Hindu religion. Nearly one-third (33.96%)
had completed middle school, followed by primary Table 2: Distribution of street food vendors by their
school (26.42%) and 14.15% never visited any school. knowledge about food borne illness (n=88)*.
Most of them (80.19%) were married.
No (%)
Around 61.32% of street food vendors were serving fast Symptoms of food borne illness (n=88)
food. Others were selling fruit juice (16.04%), meals
1. Loose motion 64 (72.72)
(15.09%) and tea (7.55%).
2. Vomiting 59 (67.04)
Mean years of experience of street food vendors was 3. Pain abdomen 33 (37.5)
13.37±8.06 years, with 77.36% had more than 5 years of Type of food- borne illness (n=88)
experience as depicted by Table 1. 1. Typhoid 27 (30.68)
2. Cholera 18 (20.45)
Table 1: Distribution of street food vendors by 3. Malaria 8 (9.09)
different socio demographic characteristics (n=106). 4. Dengue 13 (14.77)

Socio demographic characteristics No (%) Respondents’ attitude towards food hygiene

Age
≤19 4 (3.77) Majority (84.90%) of street food vendors agreed that
20 - 40 57 (53.77) proper hand washing reduces food contamination. About
41 - 60 42 (39.63) 71.69% agreed that raw food should be washed properly
>60 3 (2.83) and 62.26% supported that well cooked food is less
Gender contaminated. A higher proportion of vendors (73.58%)
Male 86 (81.13) thought food safety was a part of their work, though less
Female 20 (18.87) than half of them agreed that they may be a source of
Religion food borne illness. The median score of attitude was 9.5,
Hindu 83 (78.30) with 89.62% having favourable attitude. There was a
Muslim 23 (21.70) significant association between attitude and socio
demographic characteristics like age, gender and
Education
education (p<0.05) (Table 3 and 5).
Illiterate 15 (14.15)
Primary 28 (26.42)
Respondents’ practice towards food hygiene
Middle 36 (33.96)
Secondary 19 (17.92) Majority (73.58%) of street food vendors washed hands
Higher secondary and above 8 (7.55) after using toilet, while only 14.5% washed their hands
Marital status while dealing with food and money. Nearly half of them
Married 85 (80.19) separated utensils for raw materials and kept area free of
Single 21 (19.81) stray animals. Very few (11.32%) covered their head
Years of working experience during handling of food. Certain aspects of food hygiene
≤5 years 24 (22.64) practice like covering of food, cleaning of food storage
>5 years 82 (77.36) and checking of expiry of products before use were found
Type of food vendor in less than one third of vendors. There was a significant
Fast food 65 (61.32) association between practice and socio demographic
Meals 16 (15.09) characteristics like education, marital status and type of
Tea 8 (7.55) food vendor (p<0.05) (Table 4 and 5).
Fruit juice 17 (16.04)

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Table 3: Distribution of street food vendors according to their attitude on food hygiene (n=106).

Agree Disagree Don’t know

Statement
No (%) No (%) No (%)
Well cooked food is less contaminated 66 (62.26) 23 (21.71) 17 (16.03)
Proper hand washing before eating, while cooking, handling of
90 (84.90) 6 (5.67) 10 (9.43)
food & money and after using toilet reduces food contamination
Raw food should be washed properly 76 (71.69) 23 (21.70) 7 (6.61)
Raw and cooked food should be stored separately 44 (41.50) 33 (31.13) 29 (27.37)
Food handler may be a source of food borne illness 51 (48.11) 26 (24.53) 29 (27.36)
Safe food handling is an important part of my work 78 (73.58) 16 (15.09) 12 (11.33)

Table 4: Distribution of street food vendors according to their practice on food hygiene (n=106).

Practice observed Category

Environment aspect of food hygiene Yes (%)
1. Place free of fly nuisance or rodents 38 (35.84)
2. Place free of stray animals 61 (57.54)
3. Surrounding of stall kept clean 43 (40.56)
4. Garbage disposed in bin 52 (49.05)
Personal aspect of food hygiene
1. Hand washing before eating, while cooking, handling of food and money 15 (14.50)
2. Hand washing after using toilet 78 (73.58)
3.Finger nails are short, clean, without polish 46 (43.39)
4. Hair covered during food handling 12 (11.32)
5. Avoiding behaviour such as smoking, spitting, chewing, eating, coughing, sneezing over
45 (42.45)
unprotected food
Food safety aspect of food hygiene
1. Separation of utensils for handling raw materials 55 (51.88)
2. Cleaning of food storage before use 37 (34.90)
3. Covering of food 28 (26.41)
4. Checking of expiry of products 30 (28.30)

Table 5: Association of various socio demographic characteristics of street food vendors with attitude and practice
(n=106).

Socio demographic Favourable attitude Acceptable practice

n χ2, p χ2, p
characteristics No. (%) No. (%)
All 106
Age
≤ 19 4 3 (75) 9.053, 0.029* 1 (25) 0.080, 0.994
20 – 39 57 44 (100) 17 (29.82)
40 - 59 42 32 (72.72) 13 (30.95)
≥60 3 0 (0) 1 (33.33)
Gender
Male 86 80 (93.02) 5.667, 0.032* 25 (29.07) 0.271, 0.603
Female 20 15 (75) 7 (35)
Religion
Hindu 83 74 (89.15) 0.089, 1.000 28 (33.73) 2.283, 0.131
Muslim 23 21 (91.30) 4 (17.39)
Education
Illiterate 15 14 (93.33) 6.887, 0.032* 1 (6.67) 7.952, 0.019*
At least primary 83 76 (91.57) 26 (31.32)
At least higher
8 5 (62.5) 5 (62.5)
secondary and above

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Socio demographic Favourable attitude Acceptable practice

n χ2, p χ2, p
characteristics No. (%) No. (%)
Marital status
Married 85 42 (49.41) 0.059, 0.801 22 (25.88) 3.775, 0.05*
Single 21 11 (52.38) 10 (47.62)
Years of working experience
≤5 years 24 21 (87.5) 0.150, 0.709 8 (33.33) 0.146, 0.703
>5 years 82 74 (92.24) 24 (29.27)
Type of food vendor
Fast food 81 73 (90.12) 0.093, 0.761 19 (23.46) 7.385, 0.007*
Only beverages 25 22 (88) 13 (52)
*p<0.05 is considered as significant.

DISCUSSION some studies where more than half of the respondents

were having good practice.14,18-22
In this study, 106 street food vendors were interviewed;
about half of them belonged to 20-40 years of age group Significant association (p<0.05) between practice and
and the mean age was 37.74±10.709 years. More than socio demographic characteristics like education, marital
two-third of food vendors had completed schooling up to status and type of food vendor was found, suggesting
primary level and had working experience of more than 5 practice is not only dependent on knowledge and attitude
years. This was similar to findings of studies conducted but is also influenced by several other socio demographic
among food handlers in Slovenia, Nigeria and Malaysia factors.
while contrasting findings were seen in a Nigerian study
whose maximum respondents did not have any formal CONCLUSION
education.7-10 Majority of the food vendors were male and
married which is similar to findings in Malaysia and Good knowledge with favourable attitude doesn’t
India.11 necessarily mean good practice, which is shown by the
results. This study may thus, help to identify various
In our study, majority of street food vendors were factors that influence the outcome and may be considered
familiar with the term “food hygiene” and knew that lack while training of street food vendors.
of hygiene may cause food borne illness. Such awareness
is very crucial as they serve as vectors in the spread of ACKNOWLEDGEMENTS
food borne illnesses due to poor personal hygiene or
cross contamination.6 A similar response was obtained We would like to thank all the under graduate students of
from one study conducted in Ethiopia.12 Several studies IPGME&R, Kolkata for their help in conduct of the
conducted in different parts of the world (Ethiopia, study, and also the study participants for their
Malaysia, Iran) had shown that majority of street food cooperation.
vendors had poor knowledge of food hygiene.13-15
Funding: No funding sources
Reduction in incidences of food borne illness is strongly Conflict of interest: None declared
influenced by the attitudes of food handlers.17 In this Ethical approval: The study was approved by the
study, majority of food vendors had favourable attitude, Institutional Ethics Committee
with significant association (p<0.05) was found with
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