Presonal Hygine Practice and Disease Awareness

A SURVEY BASED STUDY ON PERSONAL HYGIENE PRACTICE AND
DISEASE AWARENESS AMONG STUDENTS AND VENDORS AROUND

EAST WEST UNIVERSITY
A thesis report, submitted to the Department of Pharmacy, East West University, in

partial fulfillment of the requirements for the degree of Bachelor of Pharmacy
Submitted by:
Wahida Akther
ID: 2007-3-70-042
Department of Pharmacy
East West University
CERTIFICATE
This is to certify that the dissertation entitled
A Survey Based Study on Personal Hygiene and Disease Awareness among Students and
Vendors around East West University is a survey research work done by Wahida Akther
(2007-3-70-042) under the guidance of Dr. Sufia Islam, Associate Professor and Chairperson,
Department of Pharmacy, East West University, Aftab Nagar, Dhaka. No part of the thesis has
been submitted for any other degree. I also certify that all the sources of information availed of
this connection is duly acknowledged.
____________________________
____________________________
Farhana Rizwan (Co-investigator)

Senior Lecturer
Aftab Nagar, Dhaka, Bangladesh
Dr. Sufia Islam Ph.D (Supervisor)

Chairperson and Associate Professor
____________________________
Nishat Nasrin (Co-investigator)
Senior Lecturer
ACKNOWLEDGMENT
First, all praise and glory are to Allah for all the bounties granted to me and only with His
guidance and help this achievement has become possible.
I would like to express my profound gratitude and deep respect to my supervisor and respected
chairperson, Dr. Sufia Islam, Associate Professor and Chairperson, Department of Pharmacy,
East West University, Aftab Nagar, Dhaka for her constant supervision, intense support and
constructive criticism during the thesis work. Her timely advice and encouragement have made it
possible for me to accomplish the task as per schedule. It is my great pleasure and privilege to
acknowledge my deepest regards and gratitude to my supervisor for her inspiration.
I am thankful to my honorable teachers and co-investigators, Ms. Farhana Rizwan, Senior
lecturer, Department of Pharmacy, East West University and Nishat Nasrin, Senior lecturer,
Department of Pharmacy, East West University and for their kind support during the survey
work and after the survey Work.
I wish to thank my fellow researchers namely, Shamima Nasrin and Rejawana Akther for their
endless cooperation and whole hearted inspiration throughout the period of the research work.
I express my sincere thankfulness to my family members for guiding me all through my life,
including that for my research project.
Dedicated
To
My Loving Parents
ABSTRACT
Purpose: The present research was a comprehensive study that was conducted to identify the
personal hygiene practice and disease awareness among students and vendors around East West
University.
Methods: This was a survey based study where students and street vendors of different genders,
locations, and occupations were taken as volunteers. A questionnaire was made to complete this
survey. Information was collected by taking interview of the participants over a period of four
months. Data was analyzed using Microsoft Excel 2010 and SPSS 17.0.
Results: 21.8% students were smokers and 78.2% students did not smoke. 91.6 % students,
participated in this study, had the concern that some infections. 36.44% students have suffered
from Fever. 49.8% student agreed that they had been affected by diseases after taking streetvended foods. 52.3% street vendors never took any vaccination. 79% street vendors have
recently suffered diseases. All vendors have suffered from RTI.
Conclusion: The results of the study clearly indicate that street-vended foods are available
beside East West University are not safe for meal avoiding street vended may be one of the best
health decisions to prevent food borne diseases. To raise public awareness about their health and
to make this process easy a weekly program can be held on hygiene practice and disease
awareness for street vendors and students. And can be organized by social workers and
government.
Keywords: Food, water, disease, awareness, safety, waste, hazard, street.
Table of Contents
Serial No.
Topics
Chapter 1
Introduction
1-33
1.1
Concept of Hygiene
1-2
1.2
Importance of Personal Hygiene
2-3
1.2.1
Health Implications
1.2.2
Considerations
1.2.3
Attractiveness
1.2.4
Professional Life
1.3
Benefits of the Personal Hygiene
1.3.1
Good Health
1.3.2
Healthy Personal Relationships
1.3.3
Healthy Professional Relationships
1.4
Applications of Personal Hygiene Practices
5-13
1.4.1
Personal Hygiene in the daily life of a person
5-6
1.4.2
Kitchen Hygiene
1.4.3
Respiratory Hygiene
1.4.4
Food Hygiene at Home
7-8
1.4.5
Household water treatment and safe storage
8-9
1. 4.6
Laundry hygiene
9-11
1.4.7
Medical hygiene at home
11-12
1.4.8
Personal hygiene for employers and workers
12-13
1.5
Water borne diseases
13-15
Page No.
4-5
1.6
Food borne diseases and involved organisms
15-18
1.7
Street-vended Foods
19-20
1.8
Hazard Analysis of street-vended foods
20-30
1.8.1
Vending Location: Food Handling and Waste Disposal
20-23
1.8.1.1
Food Handling
22
1.8.1.2
Waste Disposal
22-23
1.8.2
Quality of Raw Materials: Water and Other Materials
23-25
1.8.2.1
Water
23-24
1.8.2.2
Other Raw Materials
24-25
1.8.3
Utensils and Equipment: Chemical and Microbial
25-26
Contaminants
1.8.3.1
Chemical Contaminants
26
1.8.3.2
Microbial Contaminants
26
1.8.4
Food Preparation: Storage and Reheating
1.8.4.1
Storage
27
1.8.4.2
Reheating
28
1.8.5
Personal Hygiene of the Vendors or Food Handlers
28-29
1.8.6
Control Measures and Initiatives to Improve Street Food
29-30
26-28
Vending
1.9
Disease Awareness and Food Safety
30-33
Chapter 2
Methodology
34-38
2.1
Objective of the Study
34
2.2
Rationale of the Study
34-35
2.3
Significance of the Study
35
2.4
Type of study
35
2.5
Place of study
35-36
2.6
Study population
36
2.7
Inclusion criteria of the cases
36
2.8
Exclusion criteria of the cases
36
2.9
Study period
36
2.10
Ethical considerations
37
2.11
Research approach
37
2.12
Data collection method
37
2.13
Data Analysis
37
2.14
Questionnaire
38
Chapter 3
Results
3.1
Smoking habits of the Students
39
3.2
Vaccination status of the Students
40
3.3
Students awareness about Vaccination
41
3.4
Students suffered from diseases recently
42
3.5
Types of diseases students suffered from
43-44
3.6
Students disease status after taking Street-vended food
44-45
3.7
Vendors knowledge about street-vended food borne
45-46
39-50
diseases
3.8
Vaccination status of the vendors
46-47
3.9
Vendors knowledge of vaccination
47-48
3.10
Vendors suffered from disease recently
48-49
3.11
Types of diseases Vendors suffered from
49-50
Chapter 4
Discussions
51-52
Chapter 5
Conclusion
53
Chapter 6
Reference
54-61
Chapter 7
Appendix
62-76
List of Tables
Table no.
Title of the table
Page no.
Table 1.4.1
Personal Hygiene in the daily life of a person
5-6
Table 1.5.1
Pathogens in Water-related Diseases
13-14
Table 1.5.2
Water-related Health risks from chemicals
15
Table 3.1
Smoking habits of the students
39
Table 3.2
40
Table 3.3
41
Table 3.4
42
Table 3.5
43
Table 3.6
45
Table 3.7
Vendors knowledge about street-vended food borne diseases
46
Table 3.8
47
Table 3.9
48
Table 3.10
49
Table 3.11
50
List of Figures
Figure no.
Title of the figure
Page no.
Figure 1.4.1
Procedure of Hand Wash
Figure 1.4.6
Laundry Hygiene
10
Figure 3.1
Smoking habits of the students
39
Figure 3.2
40
Figure 3.3
41
Figure 3.4
42
Figure 3.5
44
Figure 3.6
45
Figure 3.7
Vendors knowledge about street-vended food borne diseases
46
Figure 3.8
47
Figure 3.9
48
Figure 3.10
49
Figure 3.11
51
Chapter: 1
Introduction
Personal Hygiene Practice and Disease Awareness EWU
1. INTRODUCTION
Personal hygiene is the basic concept of cleaning, grooming and caring for our bodies. It is an
important part of our daily lives at home (Gomes, et al. 1999). Hygiene refers to the set of
practices perceived by a community to be associated with the preservation of health and healthy
living. In modern medical sciences there is a set of standards of hygiene recommended for
different situations. Regular hygienic practices are considered as good habits by a society while
the neglect of hygiene is considered filthy, disrespectful or nasty. According to the statement of
World Health Organization (WHO) Hygiene refers to conditions and practices that help to
maintain health and prevent the spread of diseases. Medical hygiene therefore includes a specific
set of practices associated with this preservation of health, for example environmental cleaning,
sterilization of equipment, hand hygiene, water and sanitation and safe disposal of medical
waste(WHO, 2012).
1.1 CONCEPT OF HYGIENE

Hygiene generally refers to the set of practices associated with the preservation of health and
healthy living. The focus is mainly on personal hygiene that looks at cleanliness of the hair,
body, hands, fingers, feet and clothing, and menstrual hygiene (Encyclopedia of Public Health,
2008).Improvements in personal knowledge, skill and practice that modify an individuals
behavior towards healthy practice are the focus of hygiene promotion. Safe hygiene practice
includes a broad range of healthy behaviors, such as hand washing before eating and after
cleaning a childs bottom, and safe feces disposal (Encyclopedia of Public Health, 2008). In
medicine and everyday life settings, hygiene practices are employed as preventative measures to
reduce the incidence and spreading of disease. In the manufacture of food, pharmaceutical,

cosmetic and other products, good hygiene is a key part of quality assurance i.e. ensuring that the
product complies with microbial specifications appropriate to its use. In general, hygiene mostly
means practices that prevent spread of disease-causing organisms. Since cleaning processes (i.e.
hand washing) remove infectious microbes as well as dirt and soil, they are often the means to
achieve hygiene. Hygiene is also the name of a branch of science that deals with the promotion
and preservation of health, also called hygienic. When we carry out hygiene education and
promotion the aim is to transfer knowledge and understanding of hygiene and associated health
risks in order to help people change their behavior to use better hygiene practices (Encyclopedia
of Public Health, 2008).
1.2 IMPORTANCE OF PERSONAL HYGIENE

The simple acts of brushing our teeth, showering, shampooing, using deodorant and brushing our
hair all add up to good hygiene practices. While these acts are simple and should be a part of
everyone's daily routine, some overlook taking care of their hygiene needs, putting themselves at
risk of illness, infection, poor dental health and social avoidance (Busvine, 1980).
1.2.1 Health Implications

Allowing ourselves to skip any good hygienic practices for more than a day puts us at increased
risk of illness. If we visit the bathroom and do not wash our hands with soap and water
afterward, then start preparing food, we potentially expose others to preventable illnesses. If we
skip showers and we have a cut that gets dirty, we run the risk of infection. Cultivating good
personal hygiene, showering and washing our hands frequently can help reduce the incidence of
illness (Busvine, 1980).
1.2.2 Considerations
Neglecting daily cleanliness practices leads to the accumulation of bacteria and sweat in various
areas of our body. When our feet sweat, this moisture combines with the bacteria on the soles of
our feet and between our toes. We often notice the result in objectionable foot odor. Washing our
feet, including between our toes, with antibacterial soap helps kill bacteria and reduce odor. We
should use antibacterial soaps to wash our body daily. As with our feet, perspiration mixes with
bacteria in our groin area and under our arms, causing body odor (Oosterom, 1998).
1.2.3 Attractiveness
Showering, brushing our teeth, shampooing and using deodorant every day help increase our
personal attractiveness quotient. When we are clean and we smell clean other people find it
easier to be close to us. When we take care of our hygiene needs every day, we find it easier to
think well of ourselves. We feel good physically, which helps us view ourselves in a positive
light (Oosterom, 1998).
1.2.4 Professional Life

The employee who goes to work without shampooing his hair, showering or brushing his teeth
presents a poor self-image. When his co-workers have to be in the same cubicle or office with
him, they may rush through the business they have to take care of in order to escape any odor
and return to fresher air. If the employee continues to neglect his personal hygiene and begins to
develop infections or poor dental health, his attendance at work suffers (Oosterom, 1998).
1.3 THE BENEFITS OF PERSONAL HYGIENE

Poor hygiene spreads illness. It also affects interpersonal relationships, social interactions and
job or school performance. Good hygiene, on the other hand, makes we come off as a capable
person with self-worth. This is but one of its many benefits (Esrey, et al. 1990).
1.3.1 Good Health

Every time we touch a surface, sneeze, prepare food, change a diaper, handle our pet or use the
bathroom, we pick up potentially harmful organisms. Simple acts such as regular bathing and
hand washing can stop us from transmitting cold, flu and infections caused by viruses and
bacteria on our skin. When we do not wash regularly, not only can we harbor and spread these
bacteria and viruses, but we are more likely to contract the illnesses they cause. If someone has
skin irritation or a wound, then poor hygiene will likely lead to infection. Proper hygiene also
helps to maintain healthy skin pH and skin strength. Our skin is a barrier from disease and good
hygiene helps our skin more effectively provide that protection (Esrey, et al. 1990).
1.3.2 Healthy Personal Relationships

Poor hygiene deters people from getting to know us. If people find our body odor or unkempt,
unclean appearance offensive, they are likely to pass judgments on our personality and our
ability to care for ourselves on a basic level. This can dissuade those forming friendships and
meaningful bonds with us. People generally avoid smells and situations they find unpleasant.
Maintaining good personal hygiene will benefit our social life in that it will remove this barrier
to interaction and connection (Esrey, et al. 1990).
1.3.3 Healthy Professional Relationships

Appearances broadcast more than just how we look to the world. For example, when I present to
a job interview well-dressed, displaying good hygiene, I look like a capable professional, able to
handle myself with care and respect. If I appear with poor hygiene, even if I am the most
qualified candidate, it may send the message that I am sloppy, I do not care about my
performance and I do not value and respect myself. If our hygiene declines in school or the
workplace, it can lead people to question our abilities and even our mental and physical health.
At the very least, good hygiene in the workplace or school environment avoids creating
unnecessary distractions to those around us (Esrey, et al. 1990).
1.4 APPLICATIONS OF PERSONAL HYGIENE

PRACTICES
1.4.1 Personal Hygiene in the daily life of a person
1.4.1 Personal Hygiene in the daily life of a person
Hair Care
Washing Hair
Cutting Hair
Dental Care
Going to Denist
Brushing Teeth
Flossing Teeth
Physical Care
Cleanliness of Body
Shaving
Washing Face

Trimming Nails
Washing Hands
Before Meals
After Restroom Use
Before Preparing Food
After Preparing Food
Figure 1.4.1: Procedure of Hand Wash
1.4.2 Kitchen Hygiene

In household and institutional practice, hygiene is mainly dedicated to the control of microorganisms in the inner environment. Household cleaning plays an important role in establishing
and maintaining an adequate level of hygiene. In cleaning research therefore substantial attention
is paid to the interrelation between cleaning and removal of micro-organisms. In general a worse
soil removal appears to lead to a lower level of hygiene. In the past decades technical measures
to reduce the environmental impact have affected household and institutional cleaning processes.
In several ways this has degraded the level of cleaning and indirectly the level of hygiene. In the
future more environmental measures that may affect the level of hygiene are to be expected.
Scientists and professionals dealing with hygiene should be aware of these phenomena and
should search for cleaning processes that are fit for use, sustainable and that do not endanger the
level of hygiene (Terpstra, 1998).
1.4.3 Respiratory hygiene

Correct respiratory and hand hygiene when coughing and sneezing reduces the spread of germs
particularly during the cold and flu season.
Carry tissues and use them to catch coughs and sneezes
Dispose of tissues as soon as possible
Clean your hands by hand washing or using an alcohol hand sanitize (Rook, et al. 2003).
1.4.4 Food hygiene at home

Food hygiene is concerned with the hygiene practices that prevent food poisoning. The five key
principles of food hygiene, according to WHO are (Chan, M., 2012):

Prevent contaminating food with pathogens spreading from people, pets, and
pests.
Separate raw and cooked foods to prevent contaminating the cooked foods.
Cook foods for the appropriate length of time and at the appropriate temperature
to kill pathogens.
Store food at the proper temperature.
Use safe water and raw materials.
1.4.5 Household water treatment and safe storage

Household water treatment and safe storage ensure drinking water is safe for consumption.
Drinking water quality remains a significant problem, not only in developing countries(World
Health Organization. 2007) but also in developed countries(Nath, Bloomfield, and Jones,
2006). Even in the European region it is estimated that 120 million people do not have access to
safe drinking water (Clasen and Haller, 2008). Point-of-use water quality interventions can
reduce diarrheal disease in communities where water quality is poor or in emergency situations
where there is a breakdown in water supply. Since water can become contaminated during
storage at home (e.g. by contact with contaminated hands or using dirty storage vessels), safe
storage of water in the home is also important. Methods for treatment of drinking water include
(World Health Organization, 2002):
a. Chemical disinfection using chlorine or iodine
b. Boiling
c. Filtration using ceramic filters.

d. Solar disinfection - Solar disinfection is an effective method, especially when no
chemical disinfectants are available.
e. UV irradiation - community or household UV systems may be batch or flow-though. The
lamps can be suspended above the water channel or submerged in the water flow.
f. Combined flocculation/disinfection systems available as sachets of powder that act by
coagulating and flocculating sediments in water followed by release of chlorine.
g. Multi barrier methods Some systems use two or more of the above treatments in
combination or in succession to optimize efficacy.
1.4.6 Laundry hygiene

Laundry hygiene pertains to the practices that prevent or minimize disease and the spreading of
disease via soiled clothing and household linens such as towels. Items most likely to be
contaminated with pathogens are those that come into direct contact with the body, e.g.,
underwear, personal towels, facecloths, nappies. Micro-organisms can also be transferred
between contaminated and uncontaminated items of clothing and linen during laundering. Of
concern are the new community strains of MRSA. Experience in the USA suggests that these
strains are transmissible within families, but also in community settings such as prisons, schools
and sport teams. Skin-to-skin contact (including un-abraded skin) and indirect contact with
contaminated objects such as towels, sheets and sports equipment seem to represent the mode of
transmission (Bloomfield, et al. 2006).
Figure 1.4.6: Laundry Hygiene
10

Two processes are considered suitable for hygienic cleaning of clothing and linen (Beumer, et
al. 2008):
Washing or laundering at 60 C (140 F) or above
Washing or laundering at 30 C (86 F) - 40 C (104 F) using a bleach-based product:

This produces decontamination of fabrics by a combination of physical removal and
chemical inactivation. However, some types of fungi and viruses that are harder to
inactivate, may not be removed.
Washing at temperatures of 40 C (104 F) or below with a non-bleach product is considered to

carry a risk of inadequate decontamination (Bloomfield and Cookson, et al. 2006).
1.4.7 Medical hygiene at home

Medical hygiene pertains to the hygiene practices that prevents or minimizes disease and the
spreading of disease in relation to administering medical care to those who are infected or who
are more at risk of infection in the home. Across the world, governments are increasingly under
pressure to fund the level of healthcare that people expect. Care of increasing numbers of
patients in the community, including at home is one answer, but can be fatally undermined by
inadequate infection control in the home. Increasingly, all of these at-risk groups are cared for at
home by a career who may be a household member who thus requires a good knowledge of
hygiene. People with reduced immunity to infection, who are looked after at home, make up an
increasing proportion of the population (currently up to 20%). The largest proportion is the
elderly who have co-morbidities, which reduce their immunity to infection. It also includes the
very young, patients discharged from hospital, taking immune-suppressive drugs or using
11

invasive systems, etc. For patients discharged from hospital, or being treated at home special
medical hygiene procedures may need to be performed for them e.g. catheter or dressing
replacement, which puts them at higher risk of infection. Antiseptics may be applied to cuts,
wounds abrasions of the skin to prevent the entry of harmful bacteria that can cause sepsis. Dayto-day hygiene practices, other than special medical hygiene procedures are no different for those
at increased risk of infection than for other family members. The difference is that, if hygiene
practices are not correctly carried out, the risk of infection is much greater (Bloomfield, et al.
2009).
1.4.8 Personal hygiene for employers and workers

Personal hygiene is not only about combed shiny hair and brushed teeth; it is important for
worker health and safety in the workplace. Workers who pay attention to personal hygiene can
prevent the spread of germs and disease, reduce their exposures to chemicals and contaminants,
and avoid developing skin allergies, skin conditions, and chemical sensitivities (Gomes, et al.
1999).
The first principle of good hygiene is to avoid an exposure by forming a barrier over the skin
with personal protective equipment (PPE) such as gloves, coveralls, and boots. It is important to
check the PPE often for excessive contamination, wear, tears, cuts, or pinholes. Workers should
clean, decontaminate or replace protective equipment frequently to make sure it does not collect
or absorb irritants. If protective equipment becomes too soiled during the job, the worker should
stop and replace it with clean equipment (Gomes, et al. 1999).
12

Workers should periodically wash their hands before the entrance and after leaving their
workstation. In some jobs, regular hand washing is required by law. Workers should wash their
hands before, during, and after preparing food and before they take breaks at work to eat, drink
or smoke. To control the spread of germs that can cause the flu or common cold, workers should
wash their hands whenever they cough, sneeze, or blow their noses, and whenever they are
around someone that is sick (Gomes, et al. 1999).
Hand washing involves more than a quick rinse under a faucet. To wash hands properly, workers
should first wet them under the faucet and then use liquid or bar soap. Hands should be held out
of the water until all skin surfaces are scrubbed and lathered for at least twenty seconds. Workers
can then rinse with clean water and dry their hands with a disposable towel. To wash hands with
a hand sanitizer, workers should apply the appropriate amount of sanitizer into the palm of the
hand, and then rub hands together until they are dry, being careful to cover all surfaces of the
hands. For some job activities, hand sanitizers are not an acceptable means of hand cleaning.
Showering and face-washing after work is also a good idea. Proper personal hygiene and hand
protection can help keep workers productive and on the job. Be safely clean with good hygiene
(Gomes, et al. 1999).
1.5 WATERBORNE DISEASES

Table 1.5.1: Pathogens in Water-related Diseases (World Health Organization. 2004;
World Health Organization, 2011)
Diseases
Pathogen
Campylobacteriosis
Campylobacter jejuni,
13

C. coli
Diarrhea
Escherichia coli,
Entamoeba histolytica
Dysentery
Salmonella dysenteriae,
S. flexneri,
S. boydii
andS. sonnei
Typhoid fever
Salmonella typhi,
S. paratyphi,
S. enteritidis,
S. typhimurium
Amoebic dysentery
Entamoeba histolytica,
Giardia duodenalis,
Toxoplasma gondii
Cholera
Vibrio cholerae
Helminthes diseases
nematodes (roundworm), trematodes

(Flukes) and cestodes (tapeworms).
Legionellosis
Legionella pneumophila
Cryptosporidiosis
Cryptosporidium parvum
Giardiasis
Giardia intestinalis
Cyanotoxicity
Cyanobacteria
Dientamoebiasis (travelers diarrhea)
Dientamoeba fragilis
14

Table 1.5.2: Water-related Health risks from chemicals (World Health Organization. 2004;
World Health Organization, 2011).
Health risks from chemicals
Chemicals
Fluorosis
Fluorides
Arsenicosis
Arsenic
hypophosphatemia
Cadmium
Anosmia (lose sense of smell)
Cadmium
Hyperchloremia
Cadmium
Neurodegenerative diseases
Aluminium
Fanconi syndrome (disease of the proximal Lead

renal tubules)
Nephropathy
Lead
1.6 FOODBORNE DISEASES AND INVOLVED

ORGANISMS
Table 1.7: The most common foodborne diseases (CDC, 2007) are:
Diseases
Botulism
Symptoms
Causes
Treatment
Double vision and Clostridium botulinum
Botulism
drooping eyelids
Immune
Slurred speech
Globulin
Dry
mouth
and
15
Intravenous-
Campylobacteriosis
difficulty
Human (BIG-IV
swallowing
or BabyBIG).
Weak muscles
Diarrhea
(often Campylobacter jejuni,
Erythromycin,
tetracycline.
bloody)
C. fetus,
Abdominal
cramping and pain
Nausea
and C. coli
and
vomiting
E. coli Infection
Fever
Tiredness
Abdominal pain
Pathogenic Escherichia Carbapenem
Diarrhea
coli
Fever
Loss of appetite
Headache,
Muscle pain
Abdominal
cramping
Infectious Hepatitis
Fatigue
Jaundice
Hepatitis A
16
There
is
no
Fatigue
specific
Abdominal pain
treatment
for
Nausea
hepatitis
A.
vomiting
Sufferers
are
Diarrhea
advised to rest,
Fever
avoid
fatty
Loss of appetite
foods
and
Dark urine
alcohol, eat a
and
well-balanced
diet, and stay
hydrated
Norovirus Infection
Salmonellosis
Nausea
Abdominal cramps
specific
Vomiting
treatment
Diarrhea
Noroviruses.
Headache
Fatigue
Fever
Muscle aches
Nausea,
Vomiting,
Noroviruses
Salmonella enterica,
There
is
no
for
The FDA has

published
S. bongori
Abdominal cramps,
17
guidelines
to
Bloody
diarrhea
help reduce the
with mucus,
chance of food-
Headache,
borne
Fatigue
salmonellosis.
Rose spots
Food must be
cooked to 68
72C
(145
160F).
Shigellosis
(sudden) Shigella dysenteriae
Acute
Antimicrobial
abdominal pain or
therapy
cramping
usually
Acute (sudden) fever
recommended
Blood,
for treatment of
mucus,
or
pus in stool
shigellosis
Crampy rectal pain
(Dutta, 2003).
(tenesmus)
Nausea
and
vomiting
Watery diarrhea
18
is
1.7 STREET VENDED FOODS

Street vended foods are defined as foods and beverages prepared and/or sold by vendors in
streets and other public places for immediate consumption or consumption at a later time without
further processing or preparation (FAO, 1989). This definition includes fresh fruits and
vegetables which are sold outside authorized market areas for immediate consumption. Because
of socioeconomic changes in many countries, this sector has experienced significant growth
during the past few decades. Urbanization and population growth, especially in developing
countries, are expected to continue into the next century and street-vended foods, which are
largely but not exclusively an urban phenomenon, will expand accordingly. While street-vended
foods are appreciated for their unique flavors as well as their convenience, they are also often
essential for maintaining the nutritional status of the population (Ekanem, 1998). Street food
vending assures food security for low-income urban populations and provides a livelihood for a
large number of workers who would otherwise be unable to establish a business for want of
capital. Street food vending also offers business opportunities for developing entrepreneurs
(Bhowmik, 2005). In contrast to these potential benefits, it is also recognized that street-food
vendors are often poor and uneducated and lack appreciation for safe food handling.
Consequently, street foods are perceived to be a major public health risk. If a community is to
have the full benefits of street-vended foods with minimal risk of foodborne disease, government
intervention is required to ensure that the standard of safety for such foods is the best attainable
in the context of the prevailing local situation (Ghosh, 2007). A general lack of factual
knowledge about the epidemiological significance of many street vended foods, poor knowledge
of street vendors in basic food safety measures and inadequate public awareness of hazards
posed by certain foods has severely hampered the deployment of a precise scientific approach to
19

this very serious issue of public health and safety (Rane, 2011). The epidemiological studies to
suggest that street foods contribute to a significant number of food poisonings are inadequate,
due to paucity of data deficiencies in knowledge about important parameters in the food chain
and host pathogen interactions; however, there have been several documented cases of food
poisoning outbreaks due to street foods. Street foods were responsible for 691 food poisoning
outbreaks and 49 deaths from 1983 to 1992 in Shangdong Province, China (Lianghui,
1993).Foodborne bacterial pathogens commonly detected in street vended foods are Bacillus
cereus, Clostridium perfringens, Staphylococcus aureus and Salmonella spp.(Bryan, 1992).
People who patronize street food, have been reported to suffer from food borne diseases like
diarrhea, cholera, typhoid fever and food poisoning (Desenclos, 1991).This study was
undertaken to develop an understanding of the microbiological problems associated with street
vended foods with particular reference to sources of risk and to identify the behavior and
practices that may be hazardous and microbial risk assessment was used as tool for the purpose
(Abdussalam, 1993).
1.8 HAZARD ANALYSIS OF STREET VENDED FOODS

From the initial contamination of raw foods with pathogenic bacteria to subsequent
contamination by vendors during preparation (Bryan, 1992), the factors that should be
considered for the analyzing the hazards due to street foods are many (Table 1).
1.8.1 Vending Location: Food Handling and Waste Disposal

The conditions under which some street vendors operate are reported to be unsuitable for the
preparation and selling of food (Bryan, 1981). The food is prepared either at home or at stalls,
20

which are located on the street side and are made up of wood, polythene bags, tin, etc. The place
of preparation is not always clean, well lit and not far from source of contamination. Preparation
surfaces used by some vendors have remains of foods prepared earlier that can promote cross
contamination. Most of these foods are not covered and are exposed to flies and dust, which may
harbor foodborne pathogens. In 7090% of the cases, presence of animals, insects and liquid
wastes in food preparation areas have been reported (FAO, 1988). The two major sources from
where the contaminants can enter the preparation area are: Improper food handling and waste
disposal.
Table 1.8: Source and type of hazard and the microbial risk involved (Rane, 2011):
SL.
Source
Hazard
Risk involved
Vendor
Improper food handling
Transfer of pathogens like Salmonella and
No.
1
location
E. coli, S. aureus from human body and

environment into foods
Improper waste disposal
Transmission of enteric pathogens like

Salmonella, Shigella and E. coli via vectors.
Raw materials
Water
Passage of pathogens like E. coli, fecal

streptococci,
Salmonella
and
Vibrio
cholera.
Vegetables and spices
Introduction spore formers like Bacilli and

Clostridium
and
pathogens
like
L.
monocytogenes, Shigella, Salmonella, etc.

3
Utensils and
equipment
Chemical contaminants
Leaching of chemical leading to poisoning
Microbial contaminants
Cross
contamination
of
food
with
Staphylococcus aureus, E. coli and Shigella
21

due to contaminated water, dish cloth,
handler
4
Storage and
Improper storage
Likelihood of heat stable toxins produced by
reheating
temperature and
pathogens like C. perfringens and B. cereus
reheating of food
5
Personal
Biological hazards
Introduction of Staphylococcus, Salmonella
hygiene of
and Shigella via carriers
vendors
1.8.1.1 Food Handling

Unsanitary handling of street foods by the some of the vendor has been commonly found to be
the source of contamination (Dawson, 1991). The vendors can be carriers of pathogens like
Escherichia coli, Salmonella, Shigella, Campylobacter and S. aureus who eventually transfer
these food borne hazards to the consumers. The hands of the food handlers are the most
important vehicle for the transfer of organisms from faeces, nose, and skin to the food (WHO,
1989). The finding that Salmonella, non-typhi salmonellae, Campylobacter and E. coli can
survive on finger tips and other surfaces for varying periods of time (Pethers, 1971) and in some
cases even after washing, supports the reports of contamination of street vended food with
toxigenic S. aureus, the major being suppurative lesions of human beings and the environment
(Mohapatra, 2002).
1.8.1.2 Waste Disposal

Few vendors congregate in overcrowded areas where there are high numbers of potential
customers, which usually provide limited access to basic sanitary facilities. Hence, the
contamination of street foods is often linked to the waste generated by food processing, that is
usually dumped near the vending site. The lack of facilities for liquid drainage and wastewater
22

and garbage disposal encourages wastes to be thrown into nearby streets and gutters. Such areas
act as habitats for rodents, breeding points for flies and media for growth of microorganisms. A
study done (Muinde, 2005) in Africa revealed that 85% of the vendors prepared foods like fish,
fruit salads, roasted maize and chips in unhygienic conditions, given that garbage and dirty waste
were conspicuously close to the stalls. In these areas large amounts of garbage accumulates
which provide harborage for insects and animal pests that are linked to enteric disease
transmission (Shigella, Salmonella and E. coli) (El-Sherbeeny, 1985).
1.8.2 Quality of Raw Materials: Water and Other Material

The quality of raw materials used in the preparation of street foods is very important as their
contamination can persist through preparation and or cooking (Rane, 2011).
1.8.2.1 Water
Water is a critical raw material in many street-vended operations. Contaminated water can create
a public health risk when it is used for drinking, washing of foods, incorporated in the food as an
ingredient and used in the processing of food or used for washing equipment, utensils and hands.
It is a well-known vehicle for enter pathogens such as E. coli, Salmonella spp. and
Campylobacter spp. amongst others (Angulo, 1997). Studies carried out in different regions of
Asia, Africa and South America has frequently pointed the unavailability of potable water for
various activities at the vending site as a major concern. Due to the shortage of clean potable
water, many vendors tend to reuse the water, especially for cleaning utensils and used dishes
(Dawson, 1991).
23

Studies done to find out the bacteriological quality of the water used by some street vendors have
revealed frequent contamination with coliforms and fecal coli forms (Chakravarty, 1996).
When the street foods in Trinidad and Tobago were analyzed, it was reported found that 35% of
foods were contaminated by E. coli while 57.5% of water used by vendors were contaminated by
coliforms (Mankee, 2003). These reports were similar to the findings that the stored water used
by consumers and vendors, at the vending site, showed heavy bacteriological contamination of
faecal origin (Dawson, 1991). Such heavily contaminated water is a primary source of diarrheal
diseases to the street food consumers. When water samples from storage tanks used by some
vendors were checked at different localities in Pune, India, it was revealed that 29.6% of the
water samples were not conforming to the WHO standards of portability and had coliform counts
of more than 16/100 ml, while fecal coliform counts were more than 16/100 ml in 15.5% of
water samples, 4.5% of samples were positive for E. coli and 2.7% for enteropathogenic E. coli
(Bhat, 2000). Similarly, pathogens like Salmonella and Shigella have been detected in the water
used by vendors for dishwashing (Barro, 2006).
1.8.2.2 Other Raw Materials

Besides water, other raw materials are also important to the safety of the street vended foods
because of the biological, chemical and physical hazards that they might introduce. In order to
keep prices down, some vendors purchase cheap or adulterated ingredients containing
unpermitted chemical additives from unauthorized suppliers which may further increase the risks
associated with the food so prepared. Raw meat, poultry and vegetables are commonly
contaminated with large numbers of bacteria, including potential foodborne pathogens such as B.
cereus, C. perfringens, C. jejuni, E. coli, L. monocytogenes, Salmonella and S. aureus
(Hutabarat, 1994). Spices are known to harbor a large number of microorganisms which
24

include members of the genus Bacillus, anaerobic spore formers, enterococci, and members of
Enterobacteriaceae, a variety of yeast and mold and pathogens like coagulase positive
staphylococci. Contamination of foods by spices which act as spore carriers has been reported to
lead to food spoilage and can even lead to food poisoning (Powers,1976).Spore formers in spices
may lead to food spoilage, when they survive the cooking process and multiply under favorable
conditions (Beuchat, 1980).
In a study (Chakravarty, 1996) done in Calcutta, samples that were suspected of adulteration
were analyzed and in 30 of the 50 samples, unauthorized food additives were detected. Similarly,
pathogens like B. cereus, S. aureus, C. perfringens, V. metschnikovii and E. coli were reported
(Mosupye, 1999) in raw chicken, salad and gravy raw materials. These organisms were probably
present in these foods either prior to purchase by vendors or may have been introduced by cross
contamination during food handling or during preparation.
1.8.3 Utensils and Equipment: Chemical and Microbial Contaminants

Use of proper utensils for cooking and storage of prepared food is often critical to the safety of
street vended foods. Poor quality of material coupled with improper practices may lead to toxin
formation, pathogen growth or recontamination. The design, construction and maintenance of
equipment and utensils is very important to food safety, as their poor maintenance may lead to
the inability to effectively clean and sanitize surfaces. This may then result in the build-up of
residues of food, facilitating microbial growth, leading to an increased likelihood of
contamination. The appropriate use of equipment is also important to prevent the cross
contamination from raw materials (Kaul, 1988).
25
1.8.3.1 Chemical Contaminants

As some containers will leach hazardous chemicals like copper, lead and cadmium into food, use
of equipment and utensils incompatible with the food being handled, should be avoided. This has
been observed particularly with acidic food and beverages (Ohiokpehai, 2003).
1.8.3.2 Microbial Contaminants

The serving utensils used at the vending site are often contaminated with Micrococcus spp. and
Staphylococcus spp. which may have originated from the vendors hands when they touched the
food preparation areas, dishcloths, or the water during dish washing or hand washing which
indicates cross contamination between dishwater, food preparation surfaces, and the food itself
(Cardinale, 2005). It is reported that bacteria from dirty dish washing water and other sources
adhere to the utensil surface and can constitute a risk during the food vending process.
Microbiological analysis of utensils surface and knives have shown the presence of Salmonella
and Shigella (Barro, 2006). It is also reported that during the preparation of food, the raw
material is cut and chopped using the same knife without in between cleaning and such knives
are often invaded by flies (Mensah, 2002).
1.8.4 Food Preparation: Storage and Reheating

An important issue influencing food contamination and contributing to further increase in
contamination is food storage temperature. The preparation of food long before its consumption,
storage at ambient temperature, inadequate cooling and reheating, contaminated processed food,
and undercooking are identified as the key factors that contribute to food poisoning outbreaks
(WHO, 1989).
26
1.8.4.1 Storage
Holding foods at high ambient temperatures for long periods of time have been reported to be a
major contributor to the occurrence of food poisoning outbreaks (Adesiyun, 1996). Foods are
often held for several hours after cooking and this includes overnight holding at ambient
temperatures, until sold, and thus can harbor high microbial populations (Saddik, 1985).
Besides, some of the foods are held in the pans in which they are cooked, until sold or reheated,
which results in longer holding time, hence creating favorable conditions for the growth of
foodborne pathogens. In such foods, the counts of Escherichia coli, Staphylococcus aureus,
Bacillus cereus and Clostridium perfringens are reported to be high (Bryan, 1995).B. cereus was
isolated from 42 (26.3%) samples of fried fish, two, soup, boiled rice and moinmoin suggesting
that their spores survived the cooking process (Omemu, 2008). The presence of this bacterium
coupled with the storage of these foods at ambient temperatures for several hours under high
temperature and high relative humidity showed that the product could be hazardous. B. cereus
has been responsible for outbreaks of foodborne illness because it produces heat stable (emetic)
and heat sensitive (diarrheal) toxins when foods are held under conducive conditions for several
hours (Mensah, 2002).
Kaul and Agarwal (Kaul, 1988)reported high microbial count in fruit chat sold by a street vendor
in Chandigarh, India where the counts ranged between 106 and 108 cfu/g, and a further increase
in count by 13 log cycles was observed after 16 and 24 h of storage at room temperature. A
number of pathogens, such as E. coli, Salmonella typhimurium, Salmonella gallinarum, Shigella
dysentriae, Pseudomonas fluorescens and Klebsiella pneumoniae were also found to be present
in these samples.
27
1.8.4.2 Reheating
Timetemperature exposures during reheating need to be sufficiently high or long to inactivate
large quantities of infectious microorganisms that could develop during the lengthy holding
process. Some food vendors often partially or fully cook some products ahead of time, store
them and then reheat them when requested by customers (Omemu, 2008). However, this
reheating is often inadequate to destroy bacteria that may be present as this would allow the
foodborne pathogens that germinate from spores which survived cooking or that contaminate the
food after cooking, to survive and proliferate.
1.8.5 Personal Hygiene of the Vendors or Food Handlers

According to WHO (WHO, 1989), food handling personnel play an important role in ensuring
food safety throughout the chain of food production, processing, storage and preparation.
Mishandling and disregard of hygienic measures on the part of the food vendors may enable
pathogens to come into contact with food and in some cases to survive and multiply in sufficient
numbers to cause illness in the consumer.
Some food handlers may introduce biological hazards by cross contamination after handling raw
materials when they suffer from specific diseases (Ohiokpehai, 2003) and physical hazards by
careless food handling practices. Most of the vendors pack the food in polythene bags for their
customers. When packing these foods, they blow air into the polythene bags to open them, in this
process a number of pathogens can be passed on to the consumer.
28

A study in Santa Fe de Bogota, Colombia revealed that over 30% of a group of food handlers
examined
were
carriers
of
pathogenic
microorganism
including
Salmonella
typhi,
Staphylococcus aureus, Salmonella enteritidis, and Shigella (Buchanan, 1998).
1.8.6 Control Measures and Initiatives to Improve Street Food Vending

A logical step towards reducing the risks of food borne illness from street foods would be
controlling the steps in food preparation and sale that may contribute to the contamination,
growth and survival of the microbes responsible for food borne illness. The efforts made should
focus on (a) educating the food handlers (b) improving the environmental conditions under
which the trade is carried out (c) providing essential services to the vendors to ensure safety of
their commodities (World Health Organization, 1996).
To enable official recognition and control of the street food industry as an integral part of the
food supply, appropriate regulations should be prepared, and incorporated into existing food
regulations. FAO has implemented and supported several projects which aimed at improving
various aspects of the street food sector in countries like Bolivia, Colombia, Ecuador, India,
Zaire, etc.
Malaysia, Philippines and India are the three countries which have regulations for protecting
street vendors. Malaysia is the only country where licensed street vendors are provided facilities
for conducting their trade. An initiative has been taken in Africa, where a coalition between local
and national authorities, explored the food laws associated with street vending and developed
strategies that could be used to control identified food hazards. Another policy was framed in
Durban, Africa, where the street vendors were allocated specific areas to operate, issued
29

certificate of acceptability and were also given training on essential food hygiene practices. The
scheme to upgrade hygiene and quality of street food has also been undertaken by the Ministry of
Food Processing Industries, India. Under the proposed programme, 10,000 street food vendors
will be identified, and the majority of stake-holders will be upgraded in terms of quality and
hygiene and efforts would be made to make it mandatory for the vendors to register with the
local authorities (Holy, 2006).
1.9 DISEASES AWARENESS AND FOOD SAFETY

Basic hand washing and skin care can prevent work exposures and disease. Good washing and
scrubbing with water and soap helps to remove germs, contaminants, and chemicals. It can also
prevent exposure by ingestion and cross-contamination of the surfaces and objects we touch
Hand washing is important before and after using the restroom and before or after certain
activities (Gomes, et al. 1999).
To prevent getting foodborne diseases (CDC, 2007) everyone should:
Follow strict hygienic steps when canning foods at home
Refrigerate oils containing garlic or herbs
Keep baked potatoes wrapped in aluminum foil either hot until served or refrigerated
Consider boiling home-canned food before eating it to kill any bacteria lurking in the
food (CDC, 2007).
Wash hands before preparing food
Wash hands immediately after handling raw poultry or other meat
30
Wash thoroughly with soap and hot water all food preparation surfaces and utensils that
have come in contact with raw meat
Cook poultry products to an internal temperature of 170F for breast meat and 180F for
thigh meat
Not drink unpasteurized milk
Not drink un-chlorinated water that isnt boiled
Wash hands after handling pet feces or visiting petting zoos (Altekruse, 1999).
Parched grains, dry bakery products, sufficiently sugared, salted or acidulated foods, and many
fermented items have a much lower disease-producing potential than certain foods which readily
support bacterial growth. Similarly, foods thoroughly fried or cooked and consumed while hot
are inherently safer than pre-cooked foods especially when the latter are held at ambient
temperatures (15-40C) for more than four to five hours. Highly colored foods and beverages are
more likely to have unauthorized additives than others. Fruits in their structural covers and many
foods which are industrially processed and pre-packed are generally safe even when exposed for
sale on streets. Consequently, consideration of the varying potential of different food items to
cause disease can be used in classifying local street foods for application of appropriate
intervention measures (World Health Organization, 1996).
Many countries currently license street food vendors, however a significant proportion of
vendors commonly remain unlicensed. While unlicensed vendors operate outside the law,
authorities often lack the resources to prevent their operation. Furthermore, consumers pay little
attention to whether a vendor is licensed or not, as licensing rarely relates to the quality and
safety of the food served. Registering or licensing vendors has many advantages for authorities.
31

It enables authorities to identify persons employed in such enterprises and the types of food sold,
to raise revenue and to provide an opportunity to give food handlers training in food safety.
Licensing, however, currently provides few advantages to vendors. To facilitate licensing,
authorities should centralize licensing requirements, make the issuance of a license dependent
upon food safety knowledge and a commitment to produce safe food and use the opportunity to
train handlers regarding critical control points, control measures, monitoring procedures and
corrective actions. Certificates might be awarded to trained food handlers. Renewal of licenses
should also be simplified, particularly for those implementing proper control measures during
food preparation (World Health Organization, 1996).
In establishing a plan of action to improve the safety of street-vended food, many authorities
have also identified the need to improve design and construction of vending carts, stalls and
markets. The application of technology to improve design and construction has focused on the
provision of water, handling liquid and solid waste and sanitation facilities. Some technological
advances will improve food safety. The provision of a safe water supply must innately reduce the
risk of waterborne diseases. Design and construction that reduces the likelihood of cross
contamination between raw and cooked food will reduce the risk of microbiological hazards.
Other advances, however, have not directly impacted on food safety but rather on aesthetics and
environmental management (World Health Organization, 1996).
Viewed from a general perspective, most foodborne hazards may be prevented by thorough
cooking, hot holding, rapid cooling, and cold storage, avoidance of cross-contamination or
combinations of these. However, street-vended foods and their preparation and handling vary
enormously among countries, reflecting the unique characteristics of the societies, and even
32

within countries the variations in street-vended foods are often considerable. Consequently,
training and education programs should be based on the food safety hazards presented by the
local street food situation. Health authorities may consider government recognition of private
schools and their curricula. Consequently, government would be able to set the training standard
without intensive involvement in the training itself (World Health Organization, 1996).
Health authorities must utilize a diversity of educational approaches including mass media,
national seminars and community health education. To encourage consumer selection based
upon the safety of the food, consumers must first be made aware of the benefits of street-vended
food, their association with foodborne disease and what are safe and unsafe food-handling
practices. Children are a group of con summers at particular risk in relation to most foodborne
diseases. Consequently, children should be awarded special consideration by health authorities in
their efforts to improve the safety of street-vended food through consumer education.
Approaches to improve the education of parents and children regarding food safety may be
integrated into general and health education. Attendance of parents and children at health clinics
offers the opportunity for integration of health and education regarding the safety of streetvended food. In particular, such clinics provide the opportunity to discuss the safety of streetvended weaning food. Similarly, incorporation of food safety messages into school curricula and
school social elements provide opportunities for increasing awareness of children regarding food
safety (World Health Organization, 1996).
33
Chapter: 2
Methodology
2. METHODOLOGY
2.1 Objective of the Study
The study was conducted to evaluate the food safety knowledge and practices of street food
vendors around the East West University (EWU) from 10th April 2012 to 14th August 2012. The
objectives of the study were firstly to determine the health risks associated with street food
vending, secondly to determine the knowledge of street food vendors regarding their personal
hygiene practice during food preparing, serving & disease awareness.
1. The specific objectives of the study: The results of the study will be helpful for better
understanding the dangers of the consumption of street food. The findings of the study
will be useful in taking the necessary measures for the bringing of awareness to the EWU
community and to the food vendors themselves.
2. Street foods comprise a wide array of products ranging from small snacks to full meals,
therefore the assessment of the contribution of street foods to the diet needs to also take
into account the niche, which street foods fill, in the individual diet.
2.2 Rationale of the Study

Street foods have been reported to be contaminated with pathogens and have also been
implicated in food-borne epidemics. Foodborne diseases can cause severe and/or long lasting
damage to health, including acute, watery and bloody diarrhoeas leading to severe dehydration
or dysentry. Street-food vendors are often poor and uneducated and lack appreciation for safe
food handling. The data from East West University medical center showed that a lot of students
suffer from food borne diseases. This may be due to consumption of the street-vended foods.
34

This study will be conducted to determine the presence of pathogenic microorganisms in the
street- vended foods, beverages and water causing the foodborne diseases in the area around East
West University. The findings of the study will be helpful to take some necessary interventions
for bringing awareness to the EWU community and the food vendor themelves. Thus, the
occurrence of the diseases will be reduced. The findings of this research will give us a platform
to conduct a study throughout Bangladesh which will ultimately provide us a total picture of the
quality of the street vended food.
2.3 Significance of the Study

Food borne diseases can cause severe and/or long lasting damage to health. It has been shown
that the EWU community suffer from different types of diseaes which may be related to the
street foods. It is important to find out the causative organisms reponsible for the diseases.This
study will be carried out to find out the current situation of food borne diseases in the EWU community.
All the possible information about the pathogens responsible for food borne diseases in the EWU
community will be helpful for better understanding of the danger of the food borne diseases.
2.4 Type of study

It was attempted to find out knowledge, attitude and practices about personal hygiene among
East West University students. In addition to this, the study examined for other risk factors of
poor personal hygiene practices.
2.5 Place of study

The study was conducted in East West University. The university is largest private university of
Dhaka city. It was established in 1996, situated in Aftab Nagar, Dhaka 1219. This institute
35

comprise of many department. A good number of teacher and lab specialists and other
supporting staffs are providing their best for their students.
2.6 Study population:

The street food vendors (n=151) around the EWU was interviewed by using mostly structured
questions to know their hygiene practice, food safety training, understanding regarding the
incidences of food borne diseases, food processing practice either before or during preparation
and consumption etc. The students (n=225) of EWU was interviewed to know their health
safety, awareness about the food safety and socio cultural status etc.
2.7 Inclusion criteria of the cases

EWU students of all age and street food vendors around the EWU community were participated
in the study.
2.8 Exclusion criteria of the cases

1. Students who disagreed.
2. Street food vendors other than EWU community.
2.9 Study period

To complete the study in time a work schedule was prepared depending on different task of the
study. From April 2012 to August 2012, four months was used to collect data. Subsequent
months spent on report writing and submission of report.
36
2.10 Ethical Consideration

Consent was taken from the students and the street food vendors fulfilling the eligibility criteria
and agreeing to participate as indicated by signing on an informed consent form. The
confidentiality of the information was maintained.
2.11 Research approach

After getting the approval of the research proposal from the honorable faculty members for data
collection, research work was approached by collecting information from different pharmacy
department students and who were agreed to give the information.
2.12 Data collection method

After explaining the purpose of the study to the students randomly they were interviewed by
asking question in English and used thoroughly pre-tested questionnaires. The questionnaire
contained general information and socio-economic status, personal hygiene practices and
awareness and diseases awareness.
2.13 Data analysis

After collecting all data, data were analyzed with SPSS 17.0. Then we analyze the all data by
different strategies based on our target of study. The results were presented in tabulated from as
well as figures and drawings.
37
2.14 Questionnaire (mostly structured)

Two guidelines will be developed to interview the street food vendors and students of EWU.
Guidelines for the students consist of
Identification of students age.
Street food consumption practice
Socio-economic factors.
Caring practice of students by the family member.
Disease controls of the students who has already suffered from foodborne
diseases.
Perception on causes and consequences of health safety.
Questionnaire for the street food vendors consist of
Hygiene practice
Hand washing practice
Source of water used for cleaning the utensils
Understanding the health safety etc.
The perception about food safety
Perception about the food quality
Perception on personal hygiene and sanitation.
38
Chapter: 3
Results
3. RESULTS
3.1 Smoking habits of the Students
No. of Students
Percentage (%)
Smoker
49
21.8%
Non-smoker
176
78.2%

78.2%
100.00%
90.00%
Percentage%
80.00%
70.00%
60.00%
50.00%
40.00%
21.8%
30.00%
20.00%
10.00%
0.00%
Smoker
Non-smoker
Figure 3.1: Smoking habits of the students
From the data analysis it was found that 21.8% students were smokers and 78.2% students did
not smoke.
39
3.2 Vaccination status of the Students

Vaccination status of the
No. of students
Percentage (%)
Yes
189
84%
No
36
16%
Students

84%
100.00%
90.00%
Percentage
80.00%
70.00%
60.00%
50.00%
40.00%
16%
30.00%
20.00%
10.00%
0.00%
Yes
No
Figure 3.2: Vaccination status of the Students
84% students had taken vaccine and 16% did not take any kind of vaccination.
40
3.3 Students awareness about Vaccination

Students awareness about
No. of Students
Percentage (%)
Yes
206
91.6%
No
19
8.4%
Vaccination

91.6%
100.00%
90.00%
Percentage
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
8.4%
20.00%
10.00%
0.00%
Yes
No
Figure 3.3: Students awareness about Vaccination
91.6 % students, participated in this study, had the concern that some infections can be avoided
by taking vaccine at proper time.
41
3.4 Students suffered from diseases recently

Students suffered from
No. of Students
Percentage (%)
Yes
122
54%
No
103
46%
diseases recently
No
46%
Yes
54%
Figure 3.4: Students suffered from diseases recently
54% students had been suffered from diseases recently. The remaining 46% did not face any
physical problem recently.
42
3.5 Types of diseases students suffered from

Types infection or disease
No. of Students
Percentage (%)
Fever
82
36.44%
Cough/Cold
59
26.22%
Diarrhea/dysentery
35
15.56%
Vomiting/Stomachache
22
9.78%
Pneumonia
2.67%
Ear Infection
1.78%
Skin Problem
12
5.33%
RTI
0.44%
Others
12
5.33%
40.00%
36.44 %
35.00%
30.00%
26.22%
Percentage
25.00%
20.00%
15.00%
15.56%
9.78%
10.00%
5.33%
2.67% 1.78%
5.00%
0.00%
Diseases
Figure 3.5: Types of diseases students suffered from
43
5.33%
0.44%

36.44% students have suffered from Fever, 26.22% students suffered from Cough/Cold, 15.56%
suffered from Diarrhea/Dysentery, 9.78% suffered from Vomiting/Stomachache, 2.67% suffered
from Pneumonia, 1.78% suffered from Ear infection, 5.33% suffered from Skin problem, 0.44%
suffered from RTI and 5.33% suffered from other miscellaneous diseases. Percentage of fever
and cough diseases were high due to seasonal flus mainly caused by viruses. These viruses
mainly contagious and infectious and they can be carried via both water and food. Percentage of
Diarrhea/Dysentery is also high and these are mainly cause by water or food borne bacteria. This
can be reduced through making the habit of maintaining personal hygiene.
3.6 Students disease status after taking Street-vended food

Students disease status after taking No. of Students
Percentage (%)
Street-vended food
Yes
112
49.8%
No
76
33.8%
Do not know
37
16.4%
44
Students disease status after taking Streetvended food

100.00%
Percentage
90.00%
80.00%
49.8%
70.00%
60.00%
33.8%
50.00%
40.00%
16.4%
30.00%
20.00%
10.00%
0.00%
Yes
No
Do not know
Figure 3.6: Students disease status after taking Street-vended food
49.8% student agreed that they had been affected by diseases after taking street-vended foods.
3.7 Vendors knowledge about street-vended food borne diseases

Vendors knowledge about street- No. of Vendors
Percentage (%)
vended food borne diseases

Yes
69
46 %
No
82
54%
45
Vendors knowledge about street-vended food

borne diseases
Yes
46%
No
54%
Figure 3.7: Vendors knowledge about street-vended food borne diseases

54% vendors did not know about food borne diseases.
3.8 Vaccination status of the vendors

Vaccination status of the vendors No. of Vendors
Percentage (%)
Yes
72
47.7%
No
79
52.3%
46

100.00%
Precantage
80.00%
52.3%
47.7%
60.00%
40.00%
20.00%
0.00%
Yes
No
Figure 3.8: Vaccination status of the vendors

52.3% street vendors never took any vaccination. 47.7% had vaccination.
3.9 Vendors knowledge of vaccination

Vendors
knowledge
of No. of Vendors
Percentage (%)
vaccination
Yes
36
23.8%
No
115
76.2%
47

76.2%
100.00%
90.00%
Percentage
80.00%
70.00%
60.00%
50.00%
23.8%
40.00%
30.00%
20.00%
10.00%
0.00%
Yes
No
Figure 3.9: Vendors knowledge of vaccination

76.2% vendors did not have any kind of knowledge about vaccination.
3.10 Vendors suffered from disease recently

Vendors suffered from No. of Vendors
Percentage (%)
disease recently
Yes
120
79%
No
31
21%
48

No
21%
Yes
79%
Figure 3.10: Vendors suffered from disease recently

Only 21% street vendors did not have recent disease history. On the other hand 79% street
vendors have recent disease history.
3.11 Types of diseases Vendors suffered from

Types infection or disease
No. of Vendors
Percentage (%)
Fever
75
49.7%
Cough/Cold
63
41.7%
Diarrhea/Dysentery
54
35.8%
Vomiting/Stomachache
38
25.2%
Pneumonia
2.6%
49

Ear Infection
3.3%
Skin Problem
1.3%
RTI
151
100%
Others
3.3%
100%
100.00%
90.00%
Percentage
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
49.7%
41.7%
35.8%
25.2%
20.00%
2.6%
10.00%
3.3%
1.3%
3.3%
0.00%
Diseases
Figure 3.11: Types of diseases Vendors suffered from

All vendors have suffered from RTI. 49.7 % vendors have suffered from Fever, 41.7% vendors
suffered from Cough/Cold, 35.8% suffered from Diarrhea/Dysentery, 25.2% suffered from
Vomiting/Stomachache, 2.6% suffered from Pneumonia, 3.3% suffered from Ear infection, 1.3%
suffered from Skin problem and 3.3% suffered from other miscellaneous diseases.
50
Chapter: 4
Discussions
DISCUSSION
From the data analysis it was found that 21.8% students were smokers and 78.2% students did
not smoke. It is a positive site that most of students of East West University are non-smoker.
Tobacco leaf contains chemicals that are harmful to both smokers and nonsmokers. Breathing
even a little tobacco smoke can be harmful. Of the more than 7,000 chemicals in tobacco leaf, at
least 250 are known to be harmful, including hydrogen cyanide, carbon monoxide, and ammonia.
Smoking is a leading cause of cancer and death from cancer. It causes cancers of the lung,
esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as
acute myeloid leukemia (U.S. Department of Health and Human Services, 2010). 91.6 %
students, participated in this study, had the concern that some infections can be avoided by
taking vaccine at proper time. 36.44% students have suffered from Fever, 26.22% students
suffered from Cough/Cold, 15.56% suffered from Diarrhea/Dysentery, 9.78% suffered from
Vomiting/Stomachache. Percentage of fever and cough diseases were high due to seasonal flus
mainly caused by viruses. These viruses mainly contagious and infectious and they can be
carried via both water and food. Percentage of Diarrhea/Dysentery is also high and these are
mainly cause by water or food borne bacteria. This can be reduced through making the habit of
maintaining personal hygiene. 49.8% student agreed that they had been affected by diseases after
taking street-vended foods. So, It is cleared that street-vended foods are available beside East
West University are not safe for meal. 52.3% street vendors never took any vaccination. So, they
might suffer from serious infectious diseases and these diseases might spread in their ready-made
food and might contaminate them and ultimately might cause spread disease among the
customers who would buy food from those infected street foods. Only 21% street vendors did not
have recent disease history. On the other hand 79% street vendors have recent disease history.
51

Some of them might be still suffering from infectious diseases. It is important to make them
aware about their health and to make this process easy a weekly program can be held on
hygiene and disease awareness for street vendors. And can be organized by social workers and
government. All vendors have suffered from RTI. 49.7 % vendors have suffered from Fever,
41.7% vendors suffered from Cough/Cold, 35.8% suffered from Diarrhea/Dysentery, 25.2%
suffered from Vomiting/Stomachache, 2.6% suffered from Pneumonia, 3.3% suffered from Ear
infection, 1.3% suffered from Skin problem and 3.3% suffered from other miscellaneous
diseases. Percentage of fever and cough diseases were high due to seasonal flus mainly caused
by viruses. These viruses mainly contagious and infectious and they can be carried via both
water and food. Percentage of Diarrhea/Dysentery is also high and these are mainly cause by
water or food borne bacteria. This can be reduced through making the habit of maintaining
personal hygiene.
52
Chapter: 5
Conclusion
CONCLUSION
The result of this study confirms that there is highly significant association between personal
hygiene practices and keep the body healthy among them who maintain hygiene practices than
who does not maintain. Attention to personal hygiene will help a person look their best, feel their
best and can even help in avoiding disease. Failure to keep up a standard of hygiene can have
many implications. Not only is there an increased risk of getting an infection or illness, but there
are many social and psychological aspects that can be affected. The knowledge and practice of
personal hygiene are vital in all our everyday activities. This study is expected to provide
important information to better understand the importance of personal hygiene. Thus the result of
this study will contribute to students and vendors health by making awareness about the bad
effects of poor personal hygiene and reduce the risk associated with poor hygiene practices.
53
Chapter: 6
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61
Chapter 7
Appendix
Questionnaire:
Isolation and identification of the causative organisms on street vended food
samples collected from East West University area.
Annexure 1: Questionnaire for Vendors
Section 1: Identification of the vendors

Interview Date:
Starting time:
Hour
DDMM YY Y Y
Duration:
Vendors Name:
Location
Sex
Date of Birth
::
(1= Male, 2= Female)
:
dd
Present Age
mm
yyyy
:::
Dd
mm
yy
62
Minutes
Section 1: General information:
Q#
Questions
Categories
Q 1:
How old are you?
Age
Q 2:
Have you ever attended

School?
Yes..01
What is your Educational

Status?
Below class 5..01
Q 3:
Code
No.......................................02
Class 5-10...02
S.S.C ..03
H.S.C .04
Vocational Course .05
B.A/B.Com/B.S.S (Pass)06
B.Sc.(Hons.)...07
M.Sc...08
Others.09
Q 4:
What is your occupation?
Vending foods................... 01
Supplying foods to other vendors......... 02
Others.................................... 03
(Specify)
Q 5:
Q 6:
Is this your main

occupation?
Yes..01
No.......................................02
If this is not your main

occupation, what else do
you do?
______________________________
Section 2: Information about Socio-economic Status:
63
Q#
Questions
Categories
Code
Q 7:
What is your monthly

family income?
__ , __ __, __ __ __ /= Tk.
Q 8:
Where do you live in the

city? In -
a slum.01
beside street...02
near bazaar.03
beside railway04
near a river side.05
Others............................06
(Specify)
Q 9:
Source of Washing
/bathing water
Tap.............................................01
Tubewell............................................02
Pond......................................03
Ditch/Canal/Lake..............................04
River/Fountain..............................05
Rain water.............................06
Others............................07
(Specify)
Q 10:
Source of drinking water
Tap.............................................01
Tubewell............................................02
Pond......................................03
Ditch/Canal/Lake..............................04
River/Fountain..............................05
Rain water.............................06
Others............................07
64

(Specify)
65
Section 3: Personal hygiene practices:
Q#
Questions
Categories
Q 11:
Do you wash your hands

properly after coming from
toilet?
Yes..01
How do you wash your

hands after coming from
toilet?
Using water only..............................01
Q 12:
Code
No.......................................02
With soaps ........................................02

Others......................................03
(Specify)
Q 13:
Q 14:
Do you wash your hands

properly before preparing
foods?
Yes..01
Which water do you use for

cleaning utensils?
Tap.............................................01
No.......................................02
Tubewell............................................02
Pond......................................03
Ditch/Canal/Lake..............................04
River/Fountain..............................05
Others............................06
(Specify)
Q 15:
Where from you get/fetch

water while vending foods
in the street?
From home.01
From road side tap.02
From nearby tubewell....03
Others.04
(Specify)
Q 16:
Where do you store/keep

water while vending?
In open pots01
In closed container.02
66

Others03
(Specify)
Q 17:
How do you wash your

hands before you start
preparing foods?
Using water only..............................01

With soaps ........................................02
Others......................................03
(Specify)
Q 18:
Do you vend stale foods?
Yes..01
No.......................................02
Q 19:
Q 20:
Do you process/prepare
foods at home?
If not, the where do you
process/prepare foods?
Yes..01
No.......................................02
In the van01
In the street-side shop.02
Others......................................03
(Specify)
Q 21:
Q 22:
Q 23:
Q 24:
Q 25:
Do you cut your nail per

week?
Yes..01
Do you maintain hygiene

during the time you cook
food?
Yes..01
Do you properly clean

utensils or pots before
cooking food on them?
Yes..01
Do you properly clean

utensils or pots after
cooking food on them?
Yes..01
Do you keep the food open?
Yes..01
No.......................................02
No.......................................02
No.......................................02
No.......................................02
No.......................................02
Q 26:
Do you remove flies right
Yes..01
67

away when you see them
roaming over your food?
No.......................................02
Section 4: Disease Awareness:
Q#
Questions
Categories
Q 27:
Do you know that streetvended food may be a source

for the spread of (infectious)
diseases?
Yes..01
Did you take vaccine ever?
Yes..01
Q 28:
No.......................................02
No.......................................02
Q 29:
Q 30:
Q 31:
Do you know that some

infections can be avoided by
taking vaccine at proper
time?
Yes..01
Did you suffer from any

infectious or other diseases
recently?
Yes..01
Which type of
infection/disease?
Fever...................................................01
No.......................................02
No.......................................02
Cough/Cold........................................02
Diarrhoea/dysentery.......................03
Vomiting/Stomachache......................04
Pneumonia..................................05
Ear Infection.......................................06
Skin problem......................................07
RTI......................................08
Others.........................................09
(Specify)
68
Code
69
Annexure 2: Questionnaire for Students
Section 1: Identification of the students

Interview Date:
Starting time:
Hour
DDMM YY Y Y
Duration:
Minutes
Name:
Institute:
Sex
Department:
Semester:
(1= Male, 2= Female)
Date of Birth
::
:
dd
Present Age
mm
yyyy
:::
Dd
mm
yy
Section 1: General information and socio-economic status:
Q#
Questions
Categories
Code
Q 1:
Who is the earning

member of your family?
Father..01
Mother.02
Both.03
Others..............................04
(Specify)
Q 2:
What is his/her/their
occupation?
Govt. Service..01
Private Job..02
70

Business..03
Others.........................................04
(Specify)
Q 3:
What is your monthly
__ , __ __, __ __ __ /= Tk.
family income?
Q 4:
How many brothers/sisters

do you have in total?
Specify number in the box
Q 5:
Why have you admitted in

a Private University?
To avoid session jam..01

Others.........................................02
(Specify)
Q 6:
How much money do you
Less than 2000....01
get from your parent(s) per

month?
(For students on selfaccommodation coming
Tk 2000-3000.....02
Tk 3000-5000.....03
More than 5000..04
from other districts)

Others.05
(Specify)
Q 7:
What is the amount of your
Less than 500..01
pocket money that you

from your parent(s)?
(For students residing with
their parents in Dhaka)
Tk 500-1000.......02
Tk 1000-3000.....03
Tk 3000-5000.....04
More than 5000..05
Others.06
(Specify)
Q 8:
Where do you live in the

city?
Near university...01
At a moderate distant.02
71

Far away 03
Others............................04
(Specify)
Q 9:
Source of Washing
/bathing water
Tap.............................................01
Tubewell............................................02
Pond......................................03
Ditch/Canal/Lake..............................04
River/Fountain..............................05
Rain water.............................06
Others............................07
(Specify)
Q 10:
Source of drinking water
Tap.............................................01
Tubewell............................................02
Pond......................................03
Ditch/Canal/Lake..............................04
River/Fountain..............................05
Rain water.............................06
Others............................07
(Specify)
72
Section 2: Personal hygiene practices and awareness:
Q#
Questions
Q 11:
Do you know the standard process of

washing hands?
Q 12:
Q 13:
Do you wash your hands properly after

coming from toilet?
How do you wash your hands after
coming from toilet?
Categories
Yes..01
No.......................................02
Yes..01
No.......................................02
Using water only................................01
With soaps ..........................................02
Others........................................03
(Specify)
Q 14:
Q 15:
Do you wash your hands properly

before eating foods?
Yes..01
How do you wash your hands before

you start taking foods?
Using water only..............................01
No.......................................02
With soaps ........................................02

Others......................................03
(Specify)
Q 16:
Do you take street-vended foods?
Yes..01
No.......................................02
Q 17:
Q 18:
Q 19:
Do you know that the food may be

contaminated with germs if not properly
cooked or stored?
Yes..01
Do you know that street-vended food

may be a source for the spread of
(infectious) diseases?
Yes..01
Why do you take foods from street side?
They are cheap.......................................01
No.......................................02
No.......................................02
Very tasty/mouth watering.....................02
73
Code

Easily available......................03
Others ........................04
Specify
Q 20:
Why dont you take foods from a good

restaurant?
Cant afford....01
It is too far away.....02
Dont know.03
Others ........................04
Specify
Q 21
Which street food do you like most?
Chotpoti..01
Fuchka02
Shingara..03
Tehari..04
Others..05
Specify
74
Section 3: Disease Awareness:
Q#
Questions
Categories
Q 21:
Do you smoke?
Yes..01
No.......................................02
Q 22:
Did you take vaccine ever?
Yes..01
No.......................................02
Q 23:
Q 24:
Do you know that some

infections can be avoided by
taking vaccine at proper
time?
Yes..01
Did you suffer from any

infectious or other diseases in
last 3 months?
Yes..01
How long?
Q 25:
Which type of
infection/disease?
No.......................................02
No.......................................02
.
Fever...................................................01
Cough/Cold........................................02
Diarrhoea/dysentery.......................03
Vomiting/Stomachache......................04
Pneumonia..................................05
Ear Infection.......................................06
Skin problem......................................07
RTI......................................08
Others.........................................09
(Specify)
75
Code

Q 26:
Did you ever become sick

after taking street-vended
food?
Yes..01
No.......................................02
Dont know.03
76

Presonal Hygine Practice and Disease Awareness

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Presonal Hygine Practice and Disease Awareness

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A SURVEY BASED STUDY ON PERSONAL HYGIENE PRACTICE AND

DISEASE AWARENESS AMONG STUDENTS AND VENDORS AROUND

A thesis report, submitted to the Department of Pharmacy, East West University, in

Farhana Rizwan (Co-investigator)

Dr. Sufia Islam Ph.D (Supervisor)

Keywords: Food, water, disease, awareness, safety, waste, hazard, street.

Importance of Personal Hygiene

Benefits of the Personal Hygiene

Healthy Personal Relationships

Healthy Professional Relationships

Applications of Personal Hygiene Practices

Personal Hygiene in the daily life of a person

Food Hygiene at Home

Household water treatment and safe storage

Medical hygiene at home

Personal hygiene for employers and workers

Water borne diseases

Food borne diseases and involved organisms

Hazard Analysis of street-vended foods

Vending Location: Food Handling and Waste Disposal

Quality of Raw Materials: Water and Other Materials

Other Raw Materials

Utensils and Equipment: Chemical and Microbial

Food Preparation: Storage and Reheating

Personal Hygiene of the Vendors or Food Handlers

Control Measures and Initiatives to Improve Street Food

Disease Awareness and Food Safety

Objective of the Study

Rationale of the Study

Significance of the Study

Inclusion criteria of the cases

Exclusion criteria of the cases

Data collection method

Smoking habits of the Students

Vaccination status of the Students

Students awareness about Vaccination

Students suffered from diseases recently

Types of diseases students suffered from

Students disease status after taking Street-vended food

Vendors knowledge about street-vended food borne

Vaccination status of the vendors

Vendors knowledge of vaccination

Vendors suffered from disease recently

Types of diseases Vendors suffered from

Title of the table

Personal Hygiene in the daily life of a person

Pathogens in Water-related Diseases

Water-related Health risks from chemicals

Smoking habits of the students

Vaccination status of the Students

Students awareness about Vaccination

Students suffered from diseases recently

Types of diseases students suffered from

Students disease status after taking Street-vended food

Vendors knowledge about street-vended food borne diseases

Vaccination status of the vendors

Vendors knowledge of vaccination

Vendors suffered from disease recently

Types of diseases Vendors suffered from

Title of the figure

Procedure of Hand Wash

Smoking habits of the students

Vaccination status of the Students

Students awareness about Vaccination