Www.icddrb.org Hygiene in restaurants and among street food vendors in Bangladesh 1 Md. Fosiul Alam Nizame Assistant Scientist WASH Research Group, icddr,b.

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Hygiene in restaurants and among street food vendors in Bangladesh

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Md. Fosiul Alam NizameAssistant Scientist

WASH Research Group, icddr,[email protected]

Water and Health ConferenceChapel Hill, North Carolina

October 29, 2015

Background•Food and waterborne diseases are major causes of illness

and death in less developed countries1

•Poor personal and environmental hygiene contribute significantly to food contamination2

•Outbreaks of food borne disease have been linked to poor hygiene in restaurants and eating food from street vendors3,4

• Availability of water and soap at handwashing place can have an impact on hygiene practices5

Ref. 1. WHO 2002, 2. Mathee, A. et al 1996, 3. Todd et al 2008, 4. Vollaard et al 2004, 5. Luby et al 2009.

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•Bangladesh Ministry of Health and Family Welfare (MOHFW) have major responsibility to ensure safe food by doing inspection of food processing and selling6

•Food hygiene indicators such as practices, facilities and perceptions are not available for street food vendors and restaurants

•Nationally representative indicator data can be used to advocate for intervention programs and used to measure progress of the planned National Hygiene Promotion Strategy7

Ref. 6. Laws and regulation of foods and food additives, Bangladesh country report. 7. National Hygiene promotion Strategy for Water Supply and Sanitation Sector in Bangladesh 2012.

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Objectives•To obtain nationally representative data on hygiene

practices, facilities, barriers and perceptions among street food vendors and restaurants

•To use data for advocacy, hygiene intervention development and planning

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● = Rural Clusters

● = Urban Clusters

Study area and period

Data collection period: January to October 2013

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Study population• Restaurants:

- Manager

- Cook

- Service staff

• Street food vendors

Sell food in a street/public location without having a permanently built structure but a temporary static structure or mobile stall

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A low-middle class restaurant

A street food vendor

50 Rural Clusters100 clusters

(probability proportion to size of population)Survey:

3 restaurants,Total 300Survey:

6 street food vendors,Total 600

50 Urban Clusters

Sampling

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Data collection methods•Structured observation (90 Minutes)

[300 cooks + 300 service staff + 600 vendors]

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•Spot check [300 restaurants + 600 vendors]

•Structured interview [300 cooks + 300 service staff + 600 vendors]

• In-depth interview [service staff/cooks and street food vendors (N=64)]

Hygiene facilities and practices. Perceptionsregarding hand/food hygiene and relatedbarriers, and their thoughts on customer’ssatisfaction

9Kept food inside kitchen Stored water inside restaurant

Cutting vegetables inside kitchen A street food vendor preparing/serving food

Indicators Restaurant Street food vendor

Male manager/Owner 99% 97%

Male cook 81% -

Male service staff 98% -

Median age of manager 40 Years 35 Years

No formal education: manager 13% 52%

Median hours open each day 16 8

Characteristics of businesses

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Water Water and soap 0

20

40

60

80

100

4233

%

Handwashing agents available

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In restaurants food preparation area

Water Water and soap

9991

32

11

Restaurant Street food vendors

In handwashing location for customers

Spot check

Service staff

Restaurant handwashing with soap reported versus observed

12

Before serving

Before food preparation

Before mashing/mixing

After cutting fish/meat/vegetables

0 20 40 60 80 100

57

15

8

8

1

4

1

7

ObservedReported

%

Total HW opportunities observed =2656

Restaurant handwashing with soap reported versus observed

13

%

Total HW opportunities observed =716

Before serving

Before food preparation

Before mashing/mixing

After cutting fish/meat/vegetables

0 10 20 30 40 50 60 70 80 90 100

17

74

14

38

4

3

0

8

ObservedReported

Cook

%

Street food vendor handwashing with soap reported versus observed

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Before food preparation

Before serving

Before mashing/mixing

After cutting fish/meat/vegetables

0 20 40 60 80 100

29

8

5

2

0

0

0

0

ObservedReported

Total HW opportunities observed =8491

Toilet within premises (restaurants)

15

No facilities

Improved toilets

Unimproved toilets

0 20 40 60 80 100

82

12

6

Reported N=300

(%)

%

How do street food vendors access toilet facilities?

16

Nearby market/mosque

Nearby residential houses

Nearby school/college/hospital

Do not defecate during business hours

No facility/bush/field---open defecation

0 20 40 60 80 100

45

30

15

9

1

Reported N=600

(%)

%

0

20

40

60

80

100

50

71

55

14

0

Restaurants

Food vendors

Spot check%

Almost all (99%) of the water sources used by restaurants and food vendors were improved.

Drinking water treatment and storage

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Running water Dipped utensils into bucket of reused

water

Poured water on the utensils

0

20

40

60

80

100

4540

15

0

44

8

Restaurants

Food vendors

%

Observation of cleaning utensils

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Food items kept in a covered and clean pot/container for sale:    

Restaurants: 3 – 25% of foods were kept covered

Food vendors: 5 – 42 % of foodswere kept covered

Food hygiene (spot check)

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Respondents’ thoughts on customer satisfaction

FactorsRestaurant Food vendors

N=32(%)

N=32(%)

Tasty food 63 78

Clean utensils 44 28

Well-mannered behavior 34 25

Different variety of food 44 16

Fresh food (Not stale/preserved food) 19 16

Cheap food 28 3

Covering food with lid 0 16

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Nobody can make foods as tasty as me. That’s why customers don’t buy foods from other vendors if I am present over there” (A mixed puffed rice seller of a rural area)

•Most (80%) respondents reported that during food preparation and serving they do not touch dirty things

•14% of respondents equated contact with water to handwashing

•All respondents believed that tube well water is germ free

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Perception of contamination and handwashing

Barriers to washing hands with soap•Carrying soap and water is not

possible (vendors)

•High volume of customers and fast-paced work

•Soap is costly

•Lack of awareness and negligence

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“I always move from one place to another, so carrying water and soap is a hassle for me, therefore I can’t wash hands with soap while I am selling food on the street” (A street food vendor from a rural area)

A street food vendor

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“We can’t wash hands with soap as we have to serve customers so frequently. If we can’t serve quickly then customers get angry. Customers should have patience on this issue” (A restaurant service staff from an urban area)

“We people are poor. Sometimes soap is available in my restaurant and sometimes not. When there is no soap we wash our hands with water only”(A restaurant manager from an urban area)

Conclusion• Restaurant staff and street food vendors in Bangladesh do

not usually wash their hands with soap during food handling

- Limited facilities contributes to a lack of hand and food hygiene

- Impractical for street food vendors to carry and store water

- Cost of soap is also a barrier

• Equated handwashing with hands contacting water

• Respondents perceived that customers are satisfied if they get tasty food

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Considerations for an intervention•Messages should stress that only

hand dipping into water is not adequate to remove contaminants

•Encourage using inexpensive alternative; soapy water

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A handwashing station with a soapy water bottle

•Promote the marketing of hygienic food to attract and retain happy customers

• Involve customers in the interventions, they can demand hygienic food

Next step and future research

• Share study findings with government inspectors

• Explore what motivates customers to purchase from or avoid restaurants and food vendors

- how important hygiene is? what hygiene measures they would like to see?

• Develop and pilot:

- an intervention that has a customer and business profit focus to improve hygiene practices by restaurants and food vendors

- a hand sanitizer acceptability and feasibility intervention to improve hygiene practices by street food vendors

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Icddr,b team:Leanne UnicombAmal K HalderMahbub-Ul AlamFosiul A NizameStatisticianField Team

- Senior/Research Officers - Field Research Assistants

Technical partners:• PSU, Government of

Bangladesh• WaterAid

Buffalo University:• Pavani K Ram• Wit Wichaidit

Stanford University:• Stephen P Luby • Lily Horng

Collaborators

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• Study participants

• Diana DiazGranados

Study team

Acknowledgements

www.icddrb.org

icddr,b thanks its Core Donors

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