Knowledge on Food Safety and Food-Handling Practices of Street Food Vendors in Ejisu-Juaben Municipality of Ghana

Street foods have become a major source of cooked food for most households and individuals in many developing countries including Ghana. However, the rising concern about food-borne illness has questioned the knowledge of the street food vendors to constitute safety practices for food handling. *is study assessed the knowledge of street food vendors on food safety and foodhandling practices in the Ejisu-Juaben Municipality of Ghana. *e study used a cross-sectional mixed approach involving 340 participants selected by simple random sampling. A structured questionnaire and an observational checklist were used to collect data and analyzed using STATA version 12. *e results indicated that 98.8% of the food vendors had good knowledge on food safety and handling. *e knowledge on food safety was associated with training (p value ≤0.011), license status (p value ≤0.002), marital status (p value <0.001), and religion (p value ≤0.038). Good food-handling practices were associated with training (p value ≤0. 001) and license (p value ≤0.002) and not their educational levels. *e study found training of food vendors as the most effective way to increase knowledge on food safety and enhance food-handling practices. *e study recommended for collaborations of municipal assemblies with other agencies to strengthen, sustain, and organize regular training programs for new entrants and existing food vendors as well as retraining of trainers to equip them adequately with knowledge and skills to enable them effectively facilitate training programs for food vendors.


Introduction
Street foods have now become a major source of food for most homes and individuals especially in developing countries [1]. It is consumed by about 2.5 billion people worldwide on daily basis [2]. is is because most people spend less time at their home due to busy work schedules and therefore depend on street foods [3]. Street foods are relatively inexpensive, easily accessible, and offer a variety of meals to consumers [4]. e street food industry is therefore growing at a very fast rate worldwide [5]. It has become a source of employment and income for individuals and homes. Increasing unemployment rates and poverty are also major factors that influence people to venture into street food business [6] because it requires minimal capital to set up [7].
According to the WHO [8], globally, one out of every ten persons contract food-borne illnesses. Over ninety-one million people including Africa acquire food-borne illnesses every year with resultant deaths of about one hundred and thirty seven thousand. In Ghana, one out of every 40 people is infected with a food-borne disease annually [9] and results in about sixty five thousand deaths [1]. It is also estimated that the government spends about US $ 69,000,000.00 on food-borne illnesses [4,9].
Street foods have been linked with numerous food-borne illnesses and food poisoning outbreaks [10,11]. is has led to a growing public health concern on food safety [12]. e activities of street food vendors are therefore regulated in many countries. In Ghana, the Food and Drugs Authority under the Ministry of Health ensures that food available for public consumption is safe. eir effort is complemented by the Ghana Standards Authority, the Ministry of Food and Agriculture, the Veterinary services, the Ghana Tourism Board, and others. e metropolitan, municipal, and district assemblies have also been mandated to enforce street food safety standards [13]. e Environmental Health Department of these assemblies ensures that food vendors are medically screened and certified and are also trained periodically on food hygiene and sanitation [4,9]. e World Health Organization has recommended five strategies to ensure food safety. ese include separating raw and cooked food, using safe water and raw materials, cooking thoroughly, keeping food at safe temperatures, and keeping clean. ese strategies have been adopted by several training programs for street food vendors especially in developing countries [14]. Despite all these efforts, there are, however, gaps in the operations of food safety regulatory institutions and the laws governing food safety, knowledge of food vendors on safety food practices, and the food-handling practices of food vendors [15]. is has led to substandard food safety practices by food vendors [11]. In view of these problems, this study aimed at assessing the knowledge on food safety and food-handling practices of street food vendors to ensure food safety. It also sought to determine the factors which can influence the knowledge on food safety and food-handling practices of food vendors in Ejisu-Juaben Municipality, Ghana.

Study Setting.
Ejisu-Juaben municipality is in the Ashanti Region of Ghana. It is found within Latitudes 1°15′ north and 1°45′ north of the equator and longitude 6°15′ west and 7°00 west of the Greenwich Meridian. As at 2010, the municipal has a population size of 143,762 in ninety-one communities and about three thousand (3000) registered street food vendors [16]. e majority of the households (61.8%) depends on borehole water for domestic activities. Open dumping is the mechanism for disposing solid wastes by the majority (65%) of the residents, while 43.4%, 34.9%, and 10.2%, respectively, disposed liquid waste unto the streets, compounds, and gutters [16]. Most households (48.8%) depend on public toilet facilities which are inadequate and poorly maintained, and therefore waste management is an area of major concern to the municipality [17].
e study was conducted in the two most urbanized communities (Ejisu and Juaben) where activities of street food vendors are higher.

Study Design and Approach.
e study adopted a crosssectional design and utilized a mixed approach to assess the knowledge and food safety practices of food vendors. is method was used to objectively quantify knowledge on food safety and also observe food-handling practices among participants.

Study Population.
e target population consisted of all food vendors in the municipality. Stationary street food vendors in Ejisu and Juaben communities constituted our sampling frame. e stationary food vendors have a permanent location and are therefore easily tracked and monitored. erefore, all stationary street food vendors within the sampling frame were given equal chance of being part of the study. Mobile food vendors (hawkers) within the sampling frame were excluded from the study.
eir mobile nature could have made tracing for clarification of responses and observation of their practices challenging.

Sampling and Sample
Size. Study participants were obtained using a simple random sampling method. All stationary food vendors within the sampling frame were given an equal chance of selecting a "YES" or a "NO" from a ballot box. ose who picked "YES" were enrolled into the study. Other vendors unwilling to participate in the study were, however, excluded.

Formula
n � Z 2 (p q)/d 2 [18] n � the required sample size Z � Z score at 95% confidence level with a standard value of 1.96

Data Collection Techniques and Tools.
A structured questionnaire and an observational checklist were used to collect data for the study. ese instruments were developed by the researchers based on the [19] essential requirements for street food vendors. e questionnaire was used for collecting data on the sociodemographic characteristics and knowledge on food safety among participants. In assessing knowledge, a mark was awarded for every correct answer and zero point for incorrect answers or unanswered questions. e total marks were expressed as a percentage. A score more than or equal to 50% was graded as good, and scores less than 50% was graded as poor.
An observational checklist was also used to compile information on food-handling practices of the participants during serving. ese practices were also scored and graded. A mark was awarded for every standard practice and zero for every unhygienic practice. e total marks in each section was expressed as a percentage and graded in the same way as the knowledge score. A nonparticipant observation was adopted by researchers.

Validity and Reliability.
To ensure validity, the data collection tools were subjected to the approval of the Committee of Human Research, Publication and Ethics of Kwame Nkrumah University of Science and Technology, for content validity. Pretesting of the questionnaires and the observation checklist was done among 30 street food vendors in the Bosomtwe district using the local language (Asante Twi) since most food vendors cannot read and understand English well. e pretest was conducted by the principal researcher (first author) supported by the other coauthors.
is enabled the researchers to fine-tune the questions and the checklist, making them clearer and more comprehensible to ensure reliability.

Limitations of the Study.
Researchers' direct observation of food vendors could have influenced food safety practices of respondents however creating a Hawthorne effect. Participants recalling information such as how long they have been operating and their most recent participation in a training program creates room for recall bias. Again, because there were no records to verify responses of participants, researchers assumed that participants' responses to these questions were accurate. Also, no causal conclusions were made from associations between variables since this was a cross-sectional study. ese limitations were managed by not notifying food vendors before observation starts even though consent was sought on previous days before observation on a different day. Participants were also allowed a good time to try to recall previous information to minimize recall bias. e researchers also took time to explain the questions accurately in the local language to the participants so that participants can provide accurate answers as possible.

Data Analysis Method. Data were entered into
Microsoft Excel 2013 edition and imported to STATA version 12 for analysis. Data were analyzed using descriptive and inferential statistics. Frequency distribution tables and histogram were used to descriptively analyze the data. Pearson chi-square and p values were also used to test for associations between variables. e knowledge of the food vendors on food safety was the independent variable, while the food safety practices of the food vendors were dependent.

Demographic Data of Participants.
e study comprised 340 street food vendors participating in the study (100% response rate). e mean age of the participants was 35.47 ± 10.39 years. eir ages ranged from 15 to 62 years, and the majority of them (82.6%) were between 20 and 49 years, as shown in Table 1. ose below 20 years and above 49 years represented 6.8% and 10.6% of the total participants, respectively. Most of the food vendors (91%) were females. More than half of the participants (53.2%) had attained junior high school education. Sixty nine (20.3%) had completed senior high school and only seven (2.1%) had attained tertiary education. ose who had attained primary education and those without any formal education constituted 8.8% and 15.6% of the total participants, respectively, as indicated in Table 1. Also, 85.88% of the participants were Christians, while the remaining 14.12% were Muslims. On marital status, 55.59% and 32.35% of the participants were, respectively, married and single. Others including those separated, divorce, cohabitation, and widow constituted 4.41%, 1.47%, 2.65%, and 3.53%, respectively. 52.06% (177) of the participants had 0-4 years of working experience as food vendors, while only 3.24% (11) had 30-34 years of experience as indicated in Table 1. Also, 210 (61.76%) had been trained by the district on food safety, while the remaining were never trained. However, 83.24% were having license for operation at the time of the study. And among these, only 25.09% had their licenses at the work place at the study time. e majority of the participants (66.82%) work all day from morning to evening, while an insignificant 0.88% of them operate only in the afternoon.

Knowledge of Food Vendors on Food Safety.
e mean food safety knowledge score of food vendors in the study was 78.35 ± 9.33% and graded as good. e level of knowledge of the majority (98.8%) of the participants was good, while only 1.2% had poor knowledge on food safety. e distribution of the food safety knowledge scores of the participants is presented in Figure 1.

Food-Handling Practices of Participants.
e mean foodhandling score of food vendors during serving was 70.41 ± 19.34% (Table 3). is score was graded as good. e majority of the food vendors (85.2%) practiced good food handling during serving. Also, out of 340 food vendors, the majority of the food vendors (91.1%) served food hot, 84.1% protected their food from flies, and 89.1% did not allow customers to make contact with food being served (see Table 3). e majority of the food vendors (56.4%) did not handle food with their bare hands. It was observed that about 7 out of every 10 food vendors used the same hand to serve and collect money. Most food vendors used either plates (or bowls) or plain rubber for serving food (92.8% and 96.8%, respectively), while few vendors used disposable bowls (takeaway bowls) or newspaper for serving food (7.1% and 2.9%, respectively) (see Table 3).

Discussion
e greater proportion of females who were street food vendors in this study reflects the sociocultural role of women in food preparation and serving in Ghana. Similar findings have been reported in Benin City, Nigeria [20], Ethiopia [21], and Uganda [6]. In countries such as Haiti [22] and Kenya [23], it was reported that street food vendors were predominantly males.
e average age of the food vendors was 35 years, and this is consistent with the mean age of street food vendors in Ghana [5]. However, Tessema et al. [21] reported a younger mean age (22.4 years) in Ethiopia. is discrepancy could be attributed to the desire of most Ghanaian youth to find better occupation, as being a street food vendor is seen as a least respected occupation among many Ghanaians. It is usually engaged as a temporal occupation or when there is no better alternative, hence waiting for longer periods before engaging as food vendors. Chukuezi [24] also reported a much older mean age (41.2 years) in Nigeria.
e study also showed that many of the food vendors have at least attained basic level of education, predominantly at the junior high school (JHS) level and many others at senior high school (SHS) level. Even though a good number of them (15.59%) had no formal education, the findings reflected the increasing level of education of the Ghanaian population coupled with relatively low formal jobs for the teaming youth. e level of education of food vendors in Ghana may go higher in subsequent years due to the provision of free education up to SHS level by the government. Previously, studies by Apanga et al. [25] and Amaami et al. [1] reported low levels of education among street food vendors in Northern Ghana and Accra, respectively. However, Odonkor et al. [26] reported predominance of senior high-level education among street food vendors in Accra metropolis. is could be due to the fact that most educated individuals in Ghana like other developing countries seek jobs in the capital city where they are more likely to gain lucrative employment even in the informal sector (which includes the street food industry).
Education and training are major strategies for imparting knowledge and skills. From this study, the food safety knowledge of food vendors was good though the level of education of most of them was low below the tertiary level. eir knowledge was associated with training but not their education level. ese findings reflect that of Samapundo et al. [22] in Haiti. Temeche et al. [27] on the other hand found no association between knowledge on food safety and education level or training in Ethiopia. However, anh [28], found an association between food safety knowledge of food vendors in Vietnam and their level of education and training. e findings show the relevance of the Ghana food safety policy direction which seeks to empower street food vendors on food safety through training. It also calls for the need to ensure the participation of food vendors in decision-making (policy formulation). e study showed that though most of the food vendors do not attain tertiary education, their knowledge on food safety is good and should therefore not be sidelined.

Advances in Public Health
Food-handling practices of food vendors during serving in this study were good. It was not associated with knowledge on food safety or level of education. It was however associated with training. is finding emphasizes the importance of training on influencing food-handling practices of food vendors. In places where proper handwashing with soap is rarely practiced before handling food, as found in Kenya by [29] where only 15% of the participants were washing their hands with soap before food handling, it becomes worrying when a significant proportion of participants in this study (73.24% and 43.53%) used the same hand to handle money and food and with bare hands, respectively. Similar observation has been reported by Muyanja et al. [6] in Kampala and Jinja. is may increase the risk of food crosscontamination since money and bare hands have been found to harbor microorganisms [30]. Also, as indicated in the findings, 15.88% and 8.88% of the food vendors, respectively, exposed their foods to flies and serve cold foods. is poses serious health risk to consumers of such foods as they can easily be contaminated with germs and/or harbor different kind of disease-causing microorganisms. Plain rubber (polythene) may pose long-term health risk to individuals especially when used to serve hot and oily foods. erefore, the discovery of majority of participants serving hot foods on plain rubber in this study calls for more research in this area of food safety, regular training of food vendors, and revised food safety-handling policies.

Conclusion
With women of an average age of 35 years dominating street food vending in the Ejisu-Juaben municipality in Ghana, their food safety knowledge and food-handling practices were generally good even though they had low level of education. e training programs organized by the municipal assembly for food vendors are of significant relevance to enhancing food vendors' knowledge on food safety and food-handling practices. ough encouraging, specific gaps in food-handling practices were discovered in this study and therefore calls for urgent action and further studies.
is study has revealed various gaps and clearly presented unsafety food-handling practices which are either overlooked or out of ignorance on the side of food vendors.
is informs the municipal assemblies to revisit and intensify their training programs to include important but neglected food-handling practices.
e study therefore recommended that municipal assemblies should collaborate with international, governmental, and other nongovernmental organizations interested in street food safety to ensure effective implementation of food safety policies and organize more training programs. e municipal assemblies should make effort to secure regular funding and human resources support from these collaborations to strengthen and sustain the training programs by organizing regular training programs based on evidence from research. ese collaborations can also be in the area of research to improve practices related to food safety.
Collaboration with media houses within a municipality to help advertise upcoming food safety training programs to promote patronage by food vendors is also relevant. Environmental health officers should also be equipped adequately with knowledge and skills through retraining to enable them to effectively facilitate training programs for food vendors. Information, education, and communication materials on food safety should also be readily available and easily accessible to food vendors.

Data Availability
e data used to support the findings of this study are available from the corresponding author upon request.

Ethical Approval
Ethical approval was obtained from the Committee of Human Research, Publication and Ethics of Kwame Nkrumah University of Science and Technology (reference number: CHRPE/AP/491/17). Ethical issues such as voluntariness, confidentiality, and anonymity stated on the consent forms were strictly complied with.

Consent
Informed consent was verbally obtained from every participant before the study. e researchers briefed the participants about the purpose and relevance of the study.

Conflicts of Interest
All authors declared no conflicts of interest.