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Chronic and Acute illnesses caused by Food Poisoning

INTRODUCTION AND LITTERATURE REVIEW

Unsafe food causes many acute and life-long diseases, ranging from diarrhoeal diseases to various forms of cancer (WHO, 2010). According to the WHO about 2.2 million people are killed every year by food borne and water born diarrhoeal diseases among which 1.9 million of them are children. Food borne illnesses are defined as diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food (WHO,2007).It has been reported that each year about 30% of the population of industrialized countries is affected by food borne diseases. The presence of wide range of food borne diseases and the high prevalence of diarrhoeal diseases in many developing countries suggests major underlying food safety problems.

During the past year we have witness different outbreaks related to food poisoning throughout the world. Studies carried out have shown that in 1988, an outbreak of hepatitis A, resulting from the consumption of contaminated clams, affected some 300,000 individuals in China (WHO, 2007). In 1994, outbreak of salmonellosis due to contaminated ice cream occurred in the USA, affecting an estimated 224,000 persons (WHO, 2007). In 1997, an outbreak of cholera related to water contamination occurred in Kenya and Mozambique, resulting in 130 and 14 deaths respectively (Afr Health, 1997). According to available statistics it is estimated that during the year 2009 there were 718 cases of food poisoning in Mauritius. (Ministry of health, 2010)

Various studies have been carried out and the presence of Salmonella, E. coli, L. monocytogenes, Staphylococcus spp., and histamine levels were noted. The comparison of the microbial quality of ground beef and ground beef patties from internet and local retail markets, it showed that the samples contained Salmonella, Listeria spp. and L. monocytogenes. (Pao S, Ettinger MR. 2009).Prevalence of E. coli and Salmonella spp, in street-vended food of open markets (tinguis) and general hygienic and trading practices in Mexico City, it showed that street-vended food pose a health risk as 43% of sample contained E.coli, 5% Salmonella and 80% of the stalls were Salmonella positive. (Epidemiol Infect. 2004). Another bacterium namely Staphylococcus was isolated from a sample in a relatively large proportion according to the study on bacteriological analysis of fresh produce in Norway, the result shows that the presence of pathogenic bacteria represents a risk to food born disease. (Int J Fod Microdiol. 2002). In another study carried out as the prevalence of food borne microorganisms in retail foods in Thailand, of the 200 samples tested 61% were Salmonella positive, 15.5 % Camphylobacter spp. Positive, 15 % C. jejuni positive, 21 % Arcobacter positive. (Foodborne Pathog Dis. 2007). In Alberta, Canada, a total of 36 markets were sample and the vegetables were analyzed for Salmonella, E. coli and Campylobacter. 8.2% of sample contained E. coli. (J Food Prot. 2009). A study was conducted to outline the prevalence of Salmonella species in various raw meat samples of a local market in Kathmandu and it revealed an unsatisfactory condition in the local meat market with 14.5% chicken sample, 13.5% buffalo sample and 3.3% goat sample to be contaminated with Salmonella and also that more than 805 were contaminated with coliform. (Ann N Y Acad Sci 2006)

Mauritius is a small tropical island situated in the southwest Indian Ocean. It has a population of 1,277,853 as at end 2009 (Ministry of Health 2009). The Ministry of Local Government and Rodrigues is the parent ministry of the five Municipalities, four District Councils and 124 Village Councils. Apart from their own revenue the local authorities benefits from grants from the parent ministry so as to provide adequate amenities and services to the residents. One of these includes the provision of market in villages and towns. Mahebourg village falls under the jurisdiction o f the Grand-port/Savanne District Council with a population of 15,753 inhabitants (Ministry of Health 2009).

AIM

To assess the level of hygienic practices among food handlers dealing with fleshy foods and vegetables in the Mahebourg market.

OBJECTIVES

To assess the hygienic level of Mahebourg market.

To study the knowledge, aptitude and practice of hygiene among food handlers.

To study the opinion of consumers related to hygienic practices of food handlers.

Structure,layout and administration of Mahebourg market

Structure and layout plan of Mahebourg market

To get market plan layout from the GPSDC

Administration of the Mahebourg market (organigram):-

Principal health inspector, 01

Senior health inspector, 01

Health inspector and Assistant health inspectors, 02

Figure1 shows the hierarchy of the management of Mahebourg Market.

Hygiene control and inspection

Hygiene is a very important aspect in the management of any market. Provision are made in the market rules and regulations to allow the managing authority to remove any product that may be potentially harmful to the consumers and to declare null and void any contract in cases of recurrent violation of hygiene standards. Health Inspectors posters at Mahebourg Market are responsible to carry out daily inspections about hygiene as mentioned in some sections of the Market Regulations.

1.3. Hygienic facilities

1.3.1. Cleaning

The cleaning activity is being carried out by a cleaning company namely “Hyper Cleaning Ltd” and a checklist is being filled daily by Health Inspectors posted at Mahebourg Market.

1.3.2. Supply of water

There is an adequate supply of potable water in the market to be used by everyone, the Grand-port/Savanne District Council has installed an electric water pump so as to make provision for a continuous water supply and a plastic tank so as to prevent water contamination and act as a reservoir in case of water shortage. As per the food act of 1998, there are four concrete wash basin into the market and separate stainless wash basins for each occupier of each fleshy food section.

1.3.3. Ventilations

The ventilation system is vital in the regulation of humidity, where required, to ensure the safety and fitness of food. Ventilations systems should be designed and constructed ‘so that air does not flow from contaminated areas to clean areas and, where necessary, they can be adequately maintained and cleaned’ (Abdussalam & Kaferstein, 1994).

1.3.4. Waste collection and disposal

Waste collection and disposal is contract out to a private firm, collection and disposal is being made on every working days.

1.3.5. Control of flies, pests and rodent

As per the Food Act 19998 all the doors in fleshy food sections should be fitted with self closing devise so as to prevent dogs and other stay animals entering these sections, other openings must be fitted with fly proof so as to prevent entering of flies, insects.

1.3.6. Sanitation

According to Marriott (1997) sanitation ‘means creating and maintaining hygienic and healthful conditions’. It contribute in reducing contamination of food by microorganisms that cause food borne illness and food spoilage, it is therefore more than just cleanliness. Sanitary principles are devised by the manager or the government; for example, it applies to cleaning methods and waste disposal (Marriot, 1997).

1.4. Market Regulations – Local Government Act

The Local Government Act represents a guideline to the local authority for the management of respective markets through the market regulations.

1.5. Hygiene and food handlers

1.5.1. Hygiene

Hygiene is defined as healthy habits including bathing, keeping the mouth clean, frequent washing hands, keep fingernails clean and well trimmed, do not smoke, sneeze, cough, spit where food is being handle, do not attend duty when ill. It is thus one of the most effective ways we have to protect ourselves and others from illness (Victorian Government Department of Human Services, Melbourne, Victoria, Australia).

Food Hygiene is defined as ‘all the conditions and measures that are necessary during production, processing, storage, distribution and preparation of food to ensure that it is safe, sound and fit for human consumption (WHO).

1.5.2. Foodhandlers

The Food Safety Standards define a food handler as ‘anyone who works in a food production and who either handles food or surfaces that are likely to make contact with the food such as cutlery, plates and bowls.’ This may include preparing, cooking and serving, packing or displaying food.

1.5.3. Personal Hygiene for Food Handlers

Some microorganisms like E. coli and staphylococcus spp. Forms part of our natural flora and are present on our skin, hair, noses and in our mouths and bowels. Such microorganism can be harmless to the carrier by harmful to other host and are easily spread to food by direct contact with the food, therefore good personal hygiene is of high importance.

1.5.4. Training and Education

Frequent training courses on food hygiene are part of an on-going program structured by the Ministry of Health. It aimed at providing adequate advice and technical support to food handlers on proper food and personal hygiene practices.

1.5.5. Medical Check-up

Any food handler who suffered from or suffering from any of the following symptoms: sickness/diarrhea/changes to bowel habits; flu like symptoms; has knowingly been in contact with anyone suffering from typhoid; paratyphoid or cholera, must undergo medical check-up before starting to work.

1.6. Food safety

Food safety is the shielding food from the threat of contamination which may be caused by harmful bacteria, poisons and alien objects and also minimizing the risk of multiplication of harmful bacteria to such an extent that it may result in food poisoning or early spoilage.

1.6.1. Sources of Food Contamination

Food can get contaminated at various stages in its production. These contaminants can be physical, chemical or biological (Fraiser & Westhoff, 1978).

1.6.1.1. Physical hazards

Physical hazards are foreign particles, like glass or metal.

1.6.1.2. Chemical Hazards

Chemical hazards include substances such as cleaning solutions and sanitizers.

1.6.1.3. Microbial Hazards

Biological hazards include bacteria, viruses and parasites. Microorganism grows best in foods that are high in protein or carbohydrates such as meat, poultry, seafood, milk, rice and eggs. There exist different ways of microbiological food contamination, among which are faecal-oral route, normal bacteria flora ‘some organisms form part of our normal flora of the human being, for example, Staphylococcus aureus and can infect consumers’(Ward, 2000) and cross contamination.

1.6.1.4. Common food poisoning illnesses

Table 1. Shows the characteristics of some bacteria responsible for food-borne diseases, their incubation period, the symptoms and sources (Marriot 1997).

Clostridium perfingens

Foods implicated

Poultry and meat products, especially stews, gravies and pies.

Main Symptoms

Abdominal pain, diarrhea and nausea.

Onset of Illness

8 to 12 hours, (usually 10 to 12 hours).

Source

The microorganism is found in excreta of human, animals, soil.

It can grow in anaerobic conditions and can survives ordinary cooking.

Salmonella spp.

Foods implicated

Chicken, pigs and birds products.

Main Symptoms

High fever ( typhoid and paratyphoid fever), at times diarrhea and at times constipation

Onset of Illness

10 to 14 days

Source

These are transmitted by oral-fecal route, food get contaminated by feaces of infected person/animal

The toxin produced by the species can survive ordinary cooking.

Staphylococcus spp.

Foods implicated

Meat, eggs and fish products.

Main Symptoms

Abdominal pain, severe vomiting, diarrhea, abdominal cramps.

Onset of Illness

1 to 6 hours (usually 2 to 4 hours).

Source

Infected sores, nasal secretions and skin .The toxin that causes illness can survive ordinary cooking.

Campylobacter spp.

Foods implicated

Contaminated meat and meat products, especially poultry.

Contaminated water, and raw milk.

Main Symptoms

Diarrhea, abdominal pain, fever, nausea, and vomiting.

Onset of Illness

1 to 10 days (usually 3 to 5 days).

Source

Campylobacter bacteria are normally found in excreta of man and domestic animals such as poultry.

It may be contagious to other human beings.

Escherichia coli

Foods implicated

Contaminated meat and meat products, water and raw milk.

Main Symptoms

Diarrhea, vomiting, abdominal cramps and fever

Onset of Illness

10 hours to 9 days ( usually 3 – 5 days)

Source

These are transmitted by oral-fecal route, food get contaminated by feaces of infected person

Clostridium botulinum

Foods implicated

Canned meat, fish and vegetables

Main Symptoms

Difficulty in movements, swallowing of food and respiration

Onset of Illness

If left untreated death may result in 72 hours

Source

Main source is improperly canned food

Vibrio cholerea

Foods implicated

Contaminated food e.g water

Main Symptoms

Profuse diarrhea and vomiting

Onset of Illness

The disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days if not treated.

Source

A person may get cholera by drinking contaminated water or food, in brackish rivers and coastal waters.

1.7. Beef, Goat, Venison, Poultry and Fish

The Food Act 1998, food regulation state that meat offered for sale shall be the edible part of:-

‘a healthy slaughter animal slaughtered in an abattoir and includes the edible offal of the animal’.

‘a healthy animal shot or otherwise killed as game’.

Market regulations GN 9.. of 1997 :-

The section 29 of the market regulation GN .. of 1997 up to the section 46 of the same regulation (see appendix) cover different aspects such as slaughtering of animals, introduction into the market, exposed for sales, game meat, fish exposed for sales, carcasses with part of skin and tail, washing of hands and tripe, offal, gutting of fish and storage of unsold fleshy food items.

1.7.1. Meat

All living animals are brought to the Mauritius Meat Authority slaughterhouse, ‘where they are examined by the official veterinary and when an animal is declared healthy it can undergo the slaughter process’ (Catsberg & Kempen-Van Dommellen, 1990).

Before delivery a certificate is issued and it indicates:-

‘the name of the owner of the animal’

‘the market at which the meat is intended to be sold’

‘the number and weight of the carcasses or part of carcasses, the quantity of sausages, black pudding and other preparations intended to be introduced in the market’ (Market Regulations, 1997).

1.7.2. Exposure and display of fresh meat

According to the food regulations fresh meat on sale should be exposed in a chilling cabinet at a temperature of 1°C and 8°C. The chilling cabinet has to be maintained in a clean and hygienic condition. The butcher has to indicate that the meat on sale is chilled or frozen (Food Act 1998).

1.7.3. Quality characteristics of fresh meat

Meat and poultry are perishable foods and they are ideal food for microorganisms that cause discoloration, spoilage and food borne illness (Marriot, 1997).

The shelf-life of fresh meat depends upon preservation and adequate storage methods. Inappropriate storing of fresh meat ‘can lead to deterioration in quality and even spoilage’ (Catsberg & Kempen-Van Dommellen, 1990).

1.7.4. Poultry

The poultry meat industry ‘has been and remains one of the most successful growth industries in agriculture in the world’ (Bremner & MacJohnson, 1996). In Mauritius it is mainly the flesh of chicken which is offered for sales as compared to other countries where poultry meat ‘can be turkeys, domestic ducks, tame geese, tame pigeon tame guinea fowl and tame quails’ (Catsberg & Kempen-Van Dommellen, 1990).

Poultry is a ‘significant reservoir of bacterial food-borne pathogens’ such as Salmonella, Campylobacter and has also been in many cases ‘the cause of human food poisoning outbreaks’. Inadequate storing of flesh poultry meat will cause ‘microbial spoilage and the shelf-life is also decreased’ (Bremner & MacJohnson, 1996).

1.7.5. Spoilage of poultry

Poultry meat is nutrient rich. The growth of certain types of bacteria renders spoilage of chicken inevitable. Psychotropic bacteria have the ability to grow under chilled conditions, grows faster when the temperature is raised to an optimum of 25°C (Bremner & MacJohnson, 1996).

1.7.6. Fish

The best way to check freshness is by the smell, color, appearance, taste, and the texture of cooked flesh. Sensory evaluation is smelling and visual check for quality. (Fox etal; 1995)

1.7.7. Spoilage of Fish

In fresh fish, there are 2 spoilage factors to consider, these are the enzymes and the bacteria.

Enzymes help to break down food particles into simpler forms and function even after death. Unfortunately, in terms of food quality once the fish die, anabolic and catabolic processes are not controlled. Enzymes activities increases when fish is kept at a temperature between -1.5°C and -5°C, compared to that at 0°C. This occurs because some cell membranes that separate enzymes and the substances are destroyed during the freezing process. (FAO, 1994)

Bacteria are another cause of fish spoilage that is more dangerous. They are present in high numbers in the gut of living fish, and also on the gills and skins. Bacteria are present on any living fish and feed on the substances of fish and continue to do so even after death. The waste products of bacteria are particularly foul smelling compounds such as ammonia and hydrogen sulfide. (FAO, 1994)

2. METHODOLOGY

Survey

To study the hygienic practices at the Mahebourg Market, three different types of questionnaires were designed. They aim at:-

Assessing the hygienic level of Mahebourg Market.

Study the knowledge, aptitude and practices of the food handlers.

Assessment of hygienic level of food handlers from consumers.

Personal Observation

It consists of two parts, the first on aimed at the general environment and structure of the building and the second part aimed at the personal hygiene of the food handlers. Personal observation was carried out on different days and time.

Food handlers

This questionnaire was designed so as to assess the knowledge, aptitude and practice of the food handlers. The survey was carried out on several days namely Monday, Thursday and Friday of each week for a whole month. These days were choosen regarding the activity of the markets, Monday and Friday are fair days and Thursday it’s the day of meat delivery from the Mauritius Meat Authority.

Customer

This questionnaire targeted the appreciation of the level of hygienic practices of the food handlers from the consumers. The questions were set in a way to facilitate answering from the consumer. As for the food handlers’ questionnaire survey this one also was carried out on the same day as the latter.

Method of Analysis

The analysis of results was carried out for each category of questionnaire as soon as the survey was done. Compilations of data were done Microsoft Office Excel 2003 and for simple compilation all answer was represented by a numerical value hence the setting up of a key on Microsoft Office Word as shown in Appendix … to Appendix …. Spss17.0 statistical package was used for all descriptive or interactive analysis.

3. RESULT ANALYSIS

3.1. Personal observation questionnaire.

The personal observation questionnaire was designed to gather information about different aspects such as the general environment of the market, facilities provided, personal and hygienic practices of food handlers. The markets management has taken care that no garbage is left over in the markets premises thus collection and disposal of refuse is done on same day. All the bins are made up of rusty irons sheets and are deprived of covers. On several occasions the presence of strays dogs, cats and birds were found roaming and flying inside the markets premises. According to the observation made 69.8% of the food handlers exposed fruits and vegetables for sales on aloe fibre placed on iron sheets with wooden cradle over the concretes tables, 2.3% exposed their fleshy food directly on the tables, 18.6 % on tiles and hooks and 9.3% uses both tiles and chilled cabinets.

Figure2 represents the mode of exposure of food items.

The flooring was not always kept clean, it was observed that 25.6% was cleaned, 16.3 % was muddy, 39.5% was slippery and 18.6 % was muddy and sliperry.

Figure3 represents the percentage of flooring being cleaned, muddy, slippery or both.

No cracks was observed in neither the vegetables section nor the fleshy food section

As per the Food Act four concrete wash basins were put at the disposition of the vegetables sellers for general usage and individual stainless steels wash basins for each occupier of the fleshy food section. 69.2% of the occupiers of the fleshy food section use wooden base for chopping and 30.8% use plastic chopping board for cutting purposes.

All the doors are equipped with self closing device but none of them are in working order. As per the Food Act all openings are fitted with flies proofing but 100% are partly damaged allowing entrance of flies.

In the vegetables section only 50% of the food handlers wears their apron and in the fleshy food section 76.9% of the food handlers having worn an apron were dirty and the remaining 23.1% does not wear any apron.

The hands and hair can be a source of contamination and may lead to food poisoning. In the vegetables section only 23.3% were using caps and 100% were not using gloves, in the fleshy food section 76.9% were not using their caps and 53.8% were not using gloves. Only 37.2% were well shaved and 39.5% were not well shaved, it is to be noted that this question does not apply to 23.3 % as they are of female sex.

Figure4 represents the percentage of food handlers being well shaved

During the survey it was noted that only 2.3% used to wash their hands prior to serving of consumers and 97.7 % does not wash their hands, 74.4 % and 25.6% used cold tap water and cold tap water with detergents/disinfectant respectively for cleaning of their utensils.

Figure5 represents the percentage of food handler using of cold tap water and clod tap water with detergents/disinfectants for cleaning purpose.

At the end of the survey the level of hygienic practices of the food handlers was evaluated and 14.0 % had a good hygienic practice, 39.5% were satisfactory and 46.5 % had poor hygienic practices.

Figure6 represents the level of hygienic practices.

3.2. Interview of food handlers questionnaire.

The interview of the food handler questionnaire was designed to assess the knowledge, aptitude and practice of the food handler and also to determine if they are operating accordingly to the Food Act regulations.The questionnaire was administrated to 45.5 % males and 54.5 % females with and age range from 26 to 60 years. 74.5 % sells fruits and vegetables whereas the remaining 9.1 %, 1.8%,9.1%, and 5.5% sells beef, fish, poultry and goat/venison/pigs respectively, among which 89.1% operate on a daily basis, 9.1 % works only once a week and 1.8 % three days a week.

Figure7 represents the percentage of different food items offered for sales.

100% of the interviewed food handlers states that they do poses a food handler certificate and that they are aware of good hygienic practices and also that they have followed a training session from the ministry of health in relation to personal and food hygiene. Even after having followed the said training, 16.4% sates that they usually smoke while being at work. 89.9% of the food handlers interview stated that they usually wash their hands after having smoked, eaten or gone to the toilet prior to handling of food stuffs, while the remaining 10.1% says that they does not follow the same principle. Concerning washing of their utensils 56.4% replied that they does it for at least twice a day, 41.8% says that the does it for more than two times and 1.8% stated that they wash it after each use.

Figure8 represents the frequency at which they wash their utensils.

When the food handlers were asked about their opinion on attending work while being injured or sick, 76.4% and 100% replied that they do not attend duty while suffering from any lesion or sickness respectively.85.5% of the food handlers import food everyday into the market so as to provide fresh food at all times during the week and 14.5% import food only once a week. According to the food handlers only 34.5% succeed in selling all their food and the remaining 65.5% cannot afford to sell all the food on the same day. 74.5% stated that the unsold food is kept covered with cloth or plastics after each working day whereas 25.5% stored the remaining in refrigerator, they, 100%, also added that the stored food is re-offer for sales on the next working day.

Figure9 represents the ways by which unsold food items are stored.

According to the Food Act Regulations, it is the sole responsibility of the food handler to keep the food the premises where food is being handle clean,76.4% says that they do not sue any insecticidal sprays/ sanitizer or any other chemical cleaning solution for killing insects or disinfection process while 23.6% agrees making use of such products.

Figure10 represents the use of chemicals for cleaning or disinfection purpose.

When they were asked if they knew what is food poisoning, 100% replied YES and they also agrees that unhygienic practices may lead to food contamination and food poisoning.

3.3. Feedback questionnaire from consumers.

The questionnaire for the consumer was designed in order to know the opinion of the consumer s visiting the market. Mahebourg market is the central market in the district of Grand-port which attracts people from all localities. The participants consisted of 45 % males and 55 % females and were mainly from Mahebourg/Beau Vallon 45.3% and the remaining 54.7% were from different localities as illustrated below. Most of the consumers, 63.7%, visit the market at least once a week.

Figure11 represents the percentage of visitors from different localities.

Among which 27.0% buys only vegetables, 5.0% buys only fleshy foods and 68.0% buys both fleshy food and vegetables. They were asked if they are satisfied with the food freshness and 66.3% states that they are satisfied, 29.0% were neither satisfied nor dissatisfied and 4.7% were not satisfied.

As per the Food Act all meat shall be exposed in chilled cabinets, only 4.0% confirmed that fleshy food is being exposed for sales in chilled cabinets. Food offered for sales in open air like on tables, hooks are liable to potential contamination from the surrounding environments.

Figure12 represents the mode of exposure of fleshy food

When they were asked if they have ever found any dogs, cats, birds or rodents inside the market premises, 100% says YES.

Not every person visiting a market has knowledge about good hygienic practices, only 87.3% of the participant had this knowledge. 100% replied that only a few food handlers do wear an apron or gloves while working. When they were told to evaluate the hygienic level of the food handlers 44.3% said 25% satisfied, 52.7% said 50% satisfied and 3.0% said 75% satisfied.

Figure13 represents the evaluation of the level of hygienic practices of food handlers by consumers.

As for good hygienic practices not all participants have an adequate knowledge about food poisoning, 87.7 % said Yes and 12.3% said NO. Among these 82.7% stated that they never suffered from any food poisoning whereas 1.3%, 8.3% and 7.7% suffered from vomiting, diarrhoea and all food poisoning symptoms respectively.

Figure14 represents the percentage of consumer having suffered from a symptom of food poisoning.

Concerning improving and maintaining hygienic practices in the market the consumer was ask to choose among the ministry of health (denoted as the sanitary authority), the local authority and the market management. 17.7% opted for the ministry of health, 5.3% the market management and 77.0% said that it is the responsibility of all of them and out of those interviewed 6.0% were neither satisfied nor dissatisfied with their work while 43.7% were not satisfied at all.

Figure15 represents the percentage satisfaction of performance of duty by different enforcing bodies.

4. DISCUSSION

Food Safety (Chapter 1, section 1.6) is a basic requirement of food quality which can be considered as a complex characteristic of food that determines its value or acceptability to consumers. However, food can transmit diseases from one person to another as well as serve as a growth medium for bacteria that can cause food poisoning. It is a common, yet distressing and sometimes life-threatening problem for people throughout the world depending on the type of infection one can have. Unhygienic practices among food handlers and poor hygienic conditions in which they trade are responsible for most cases of food borne diseases. Food handlers have been widely recognized as a source of infection during several food borne outbreaks.

In the study carried out at Mahebourg Market, most of the Food handlers were found to have a low literacy level and they therefore venture into food business, as it one of the best job option for an income generation .The majority of the food handlers were found to be females as serving is regarded to be females domain. According to them, they all possess a medical certificate but it is possible that they do not have one yet or their medical certificate have been expired and not renewed yet. It is also not surprising that many of the food handlers did not understand the importance of medical examination in terms of spread and prevention of food borne diseases. They were medically examined only because it is a legal requirement and pay no attention to its significance.

Consumers, regardless of their literacy level, frequented Mahebourg market at least once a week. They come from different localities as described in figure 11. There are two fair days Monday and Friday and people seize the opportunity to buy fresh vegetables at an affordable price as on these days there are competition of prices among the vegetable sellers.

In general the food handlers appeared to have a positive attitude towards hygienic practices (Chapter 3) .Although most of them were of opinion that Personal Hygiene and Food Hygiene were important to run their business, it was evident that these were not put into practice and the drive to generate an income was more important. It was obvious that despite having got a training session on hygiene, they still lack its principles and application.

Fresh vegetables are made available everyday, fresh beef are brought for sale only once a week on Thursdays whereas poultry and fish are sold on a daily basis. Food handlers at the Goat and pork sections operate 3 days a week. However, when their items remain unsold at the end of the day, they are exposed for sale the next working day or the following weeks for items sold weekly such as beef. This type of practice encourages the sales of thawed out fleshy food items.

At the vegetable section, only concrete stalls are available by the local authority. Some sellers have modified their stalls on their own cost to facilitate the sale of their items. The vegetables are exposed for sale in an unhygienic condition. Some vegetables are placed on damp Aloe Fibre, wooven plastic bags which sometimes were found to be soiled, wet and muddy. This can promote the growth of fungus and other microorganisms, thus causing food contamination. Vegetables are also exposed on additional tables made of iron sheets with wooden crates which are found to be in a rusty and muddy state. Also stock of vegetables is placed in baskets on floors. The muddy and dirty state of the vegetable section is due to the fact that the food handlers there use to practice trimming/washing/deleafing/packing of fresh vegetables nearby their stalls, thus causing spillage of vegetables leaves, wastewater, and mud. Some vegetable sellers hardly wash their hands at regular intervals when serving such to consumers and therefore, some vegetables which are consumed in the raw state as salad are more prone to contamination which may lead to food poisoning by bacteria for example, E. coli and Staphylococcus aureus, Clostridium spp and Campylobacter spp.

From the statement of the vegetables sellers it is understand that the unsold vegetables are stored at their respective working place and are covered with a piece of plastic or cloth. Since there are additional tables at the vegetable section, sometimes the drains remain unclean and not disinfected, giving rise to odor nuisance. Hence, there is permanent accumulation of wastewater/silt/actively decaying sludge deposit. Rodent like rats and mice are known to be vector of disease such as plague. Unclean drains and accumulation of waste inside will lead to the proliferation of these rodents. These rodents when come into contact with unsold food will contaminate the food with urine and feaces and also transmit their disease on the food which may be eventually consumed by human beings.

The practice of trimming/washing/deleafing of vegetables leads to accumulation of refuse in bins placed in the vegetable section. Since these bins are not emptied regularly to the garbage room available at the Mahebourg Market, there are more attraction of flies, mosquitoes and rodents which are responsible for most of the bacterial and viral infection in human. Carting away is done daily in the early morning at Mahebourg Market. However, if this is not done on a day or the garbage rooms are not properly cleaned and disinfected, this give rise to odor and maggot nuisances.

According to Section 26(2) and 27 of the Market Regulations, stallholders have no right to erect any structure on his stall and shall not scatter or throw any leaves, peelings or other refuse in the market. Due to their low literacy level, they do not pay attention to the Market Regulations and concentrate only on their job and income.

The fleshy food section of Mahebourg Market include the Fish, Meat and poultry section which are build with the hygienic facilities such as lighting, ventilation, water supply, self-closing doors and waste disposal . However, defective fly proofs, uncovered bins, defective ceiling fans, cross-contamination, absence of chilling cabinet for displayed items and other factors contribute for the unhygienic state of the fleshy food section. There is no hot water fascility inside the fleshy food section. The use of hot water for cleaning of utensils, floors, walls and other amenities helps to get rid of fatty substances that may have stick to it and thus preventing the growth and multiplication of bacteria and microorganism. Water sink basins available are being used for hand washing and washing of fleshy food also. Sanitizers and paper towels are hardly put into practice. Food handlers complain about poor ventilation due to defective ceiling fans and therefore self-closing doors are kept open most of the time so as in their point of view will facilitates the air circulation inside the fleshy food section. The air coming inside from the outside environment is a source of contamination. The food handlers also believe that keeping the door open will enhance their business activities as an open door will attract more customers than a closed one. It has also been observed that most of the fly proofing are defective. Defective fly proofs and open doors invite mosquitoes, flies, pests, rodents, birds and stray dogs to the fleshy food section bringing along infectious diseases.

At the fish section, there is only one food handler operating. Fresh fish and other marine foods are brought for sale on a daily basis. These are exposed on plastic recipients placed on the stall available which is of concrete and tiles. No chilling cabinet is being used for sale display of fish. According to the Market Regulations, any fish intended to be cut for sale shall forthwith be gutted and cleaned (Section 38). However, since descaling and cleaning of fish activities taking place in the building itself, the floors, walls and stalls remain dirty with odor nuisance. The fish seller instead of placing a watertight vessel containing quick lime placed close to his stall to put any offal while cleaning and cutting of fish (Section 39 of the Market Regulations), he just disposed them directly in the bin. Such practices give rise to attraction of flies inside the fish section which will definitely leads to contamination of the fish. It has also been observed that the fish is kept outside in the ambient temperature throughout the whole day. With reference to section 1.7.7 spoilage of fish, it can be deduce that at the end of the day this fish is no longer safe for human consumption. The presence of a deep freeze in the fish section confirm that all the remaining unsold fish and other marine foods are kept in it so that these can be resold the next morning. As per Market Regulations, these fish shall be gutted and cleaned and that these shall be removed from such refrigerator as and when required for sale (Section 43) but at Mahebourg Market, it is not put into practice. The frozen unsold fish are exposed together with fresh one that is they are not exposed for sale in their frozen state and are not maintained in the temperature required. In this context, there is a high risk of cross-contamination and multiplication of bacteria which may cause food poisoning.

In the beef/goat/venison section, no chilled cabinet have been found for sale display of meat, tripe, feet hence attracting load of flies. They are exposed either on hooks or directly on the table itself. These hooks are made up of ordinary iron bars. Rusting of these hooks will contaminate the meat offered for sales with microorganism such as Clostridium spp. According to section 35 of the Market Regulations, fresh water shall be kept constantly at hand for the washing of feet , tripe and other articles sold by them as often as necessary to prevent offensive smell but this is not the case in the beef section. Wooden Chopping boards are being used for cutting purposes. Tiny pieces of flesh getting trapped into crevices on the wooden chopping board will lead to microbial multiplication. However, if these chopping boards are not well cleaned and disinfected the same day after working hours, there will be spreading of microorganisms which can cause infectious diseases.

Referring to figure 15, it is noted that part of the interviewed consumer admitted having suffered from food poisoning after having consumed food brought at the Mahebourg market. It can be assumed that Mahebourg market is the source of contamination that has lead to food poisoning. The fact that the food handlers of Mahebourg market does not always have a good attitude towards good hygienic practices such as omission to use gloves, caps, washing of hands, the mode of exposure of the fleshy food, use of inappropriate chemicals for cleaning leads to contamination of the food item exposed for sales. Most of consumers indicated that they are of opinion that the Sanitary Authority, the Market Management and the Local Authority are all responsible for improving and maintaining hygiene in market. Consumers are more concerned about food freshness and food safety but only a little portion of the population are aware of how to distinguish between safe and unsafe food. If there is no immediate remedial action to improve the hygienic practices at Mahebourg market, this can prove to be fatal in the future days.

5. CONCLUSION AND RECOMENDATION

The study explores the personal views of the consumers as well as the food handlers of Mahebourg Market. The Personal Observation Questionnaire for the selling area has revealed some shortcomings. Findings demonstrate that all the food handlers are aware of the food poisoning but they do not support to promote the enactment of safe food handling practices or evaluate its effectiveness. Food handlers are attributed to financial considerations being more of a priority than food safety as most food handlers and their families are totally reliant for their financial support in working at the market. It is therefore quite restrictive for them to put food safety considerations before their economic needs.

Due to the serious public and environmental concerns arising from this study, the lack of enforcement needs to be addressed as a matter of urgency. It is clear that marketplace cannot be avoided and that this sector should be supported as it contributes to employment and the general economy of the population. Therefore the findings of this research should be brought to the attention of the different organizations concerned.

The Grand Port Savanne District Council has the responsibility of monitoring sanitary standards at Mahebourg Market. This responsibility cannot be relegated because of the country’s economy and the shortage of Health Inspectorate.

The Grand Port Savanne District Council together with the Ministry of Local Government should work for the improvement of the current structures and the environment should be sought for in collaboration with the food handlers operating at Mahebourg Market. Crude structures should over a period of time be replaced with more permanent structures that make provision for proper ventilation, illumination, storage facilities, hand wash facilities, waste disposal and toilets.

Training in personal and food hygiene is essential for food handlers. Adequate training strategies and education should be established, implemented and maintained to improve the knowledge and resulting attitude and practices of food handlers and food consumers.

The Ministry of Health should be more involved in the management of markets. They will help to promote better hygienic practices such as use of proper detergents for cleaning, interdiction of using rusty iron sheets in vegetables section, banning of wooden chopping boards in favour of plastics ones, imposing of chilled cabinets, supply of hot water and better display of food items.

Proper and more effective flies, rodents, stray animals and birds control should be enforced by the Grand port/ Savanne District Council.

Posters, pamphlets, seminars on hygiene should be encouraged for its proper understanding and importance

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