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CHAPTER V
PERSONAL HYGIENIC PRACTICES AND HAND WASHING PRACTICES OF
CONSUMERS AND ITS CAUSE AND EFFECT IN FOOD SAFETY
Food contamination creates an enormous social and economic burden on
communities and their health systems. Every year about 325,000 people are hospitalized
with diagnosis of food poisoning, and 5,000 die. Improper cooking and cross
contamination may not be perceived as major food safety threats in the Indian context
because certain food safety measures are traditionally practised by the people perhaps
even without the knowledge of the scientific rationale behind them. Balkumar Marthi,
(1999)1 in his study, pointed out that Indian social and cultural practices have
traditionally been based on religion. Food is generally treated as sacred, and it is,
therefore, not surprising that all our ancient scriptures and religious texts foster great
attention and care to the subject of food preparation, storage and handling and clean food
habits among people.
A large percentage of illnesses however resulted from improper food handling
practices in the home. The role of the home as a point of origin for food borne illness has
prompted studies to evaluate aspects of contamination and improper handling of food in
the home. Proper hand washing is important to everyone, including low-income families
who often have limited resources for medical treatment. The role of hands in the
transmission of disease is well-established and effective hand washing and hand drying is
considered to be an important control measure in preventing the transmission of food-
borne diseases. Snelling et al., (1991)2 concluded that poor hand washing practices
inevitably lead to retention of bacterial and viral pathogens on the hands, which are
obtained from handling raw produce or from toilet activities.
98
HAND WASHING PRACTICES – FACTOR ANALYSIS
Poor personal hygiene, including inadequate handwashing among the food
handlers is a common practice that contributes to food borne illnesses (FDA, 2004)3. In
Table 5.1, factor analysis has been used to analyze the handwashing practices of the
respondents.
Table 5.1 Factors influencing hand washing practices
Total Variance Explained
Com
pone
nt
Initial Eigenvalues Extraction Sums of Squared
Loadings
Rotation Sums of Squared
Loadings
Total % of
Varia
nce
Cumula
tive %
Total % of
Varian
ce
Cumul
ative %
Total % of
Varian
ce
Cumul
ative
%
1 4.285 42.84
6
42.846 4.285 42.846 42.846 3.265 32.646 32.646
2 2.114 21.14
4
63.989 2.114 21.144 63.989 3.134 31.343 63.989
3 .932 9.316 73.306
4 .790 7.901 81.207
5 .690 6.905 88.111
6 .493 4.933 93.045
7 .238 2.378 95.422
8 .183 1.834 97.256
9 .147 1.467 98.723
10 .128 1.277 100.000
Extraction Method: Principal Component Analysis.
Rotated Component Matrix
a
Hand Washing Practices Component
1 2
Before consuming food with soap .874 -.112
After consuming food with soap .864 -.065
Before cooking food with soap .844 -.227
After cooking food with soap .838 -.214
After using toilet with soap .490 -.051
After cooking without soap -.174 .851
Before consuming without soap -.139 .842
Before cooking without soap -.171 .833
After consuming without soap -.137 .821
After using toilet without soap -.029 .464
99
Factor I ‘Hand washing practices with soap’:
Before consuming food .874
After consuming food .864
Before cooking food .844
After cooking food .838
After using toilet .490
Factor II ‘Hand washing practices without soap’:
After cooking .851
Before consuming .842
Before cooking .833
After consuming .821
After using toilet .464
To test the validity of the instrument, KMO test was conducted. The Kaiser-
Major-olkin measure of sampling adequacy in a statistic tool indicates the proportion of
variance in the variables that might be caused by various factors; high values (close to
1.0) generally indicate that a factor analysis is useful with the data. If the value is less
than 0.70, the results of the factor analysis are probably not useful. Here, the KMO value
for the instrument is 0.769, which is accepted as a good value. The Barlett test showed a
significant level and hence the instrument was accepted. Principal component analysis
was the method of extraction. Varimax was the rotation method. As per the Kaiser
Criterion, three factors in the initial solution have values greater than 1. Together, they
account for almost 63.989 (63%) of the variability in the original variables. Table 5.1
shows the Eigen values of the factors. Using the above rotated component value; the
100
variables are classified into two factors, namely, hand washing practices with soap and
hand washing practices without soap.
1. Hand washing practices with soap is the name given to the first set of factors and
are identified through factor analysis.
All these variables had a factor loading of more than 0.4. All these items have
one commonality. Lack of awareness about hand washing practices leads to various
health issues, including food borne illness.
In addition to this, hand washing with soap before consuming food is considered
as the most important factor in safe hand washing practices. Washing hands after
consuming food is considered as the second important factor. It is followed by washing
hands before and after cooking. Further, hand washing with soap after using toilet is
considered as an important hand washing practices. To maintain good health, hand
washing is very important. Hence, it is essential to follow good hand washing practices
to lead a healthy life.
2. Hand washing practices without soap:
Hand washing practices include washing hands after cooking without soap, before
consuming food without soap, before cooking without soap, after consuming food
without soap and after using toilet without soap. It is a set of practices designed to have
an impact on safe cooking in effective manner. Hand washing after cooking is
considered as an important factor in maintaining good health. It is followed by washing
hands before consuming and cooking food without soap. Washing hands after
consuming food is also observed as an important factor. Further, washing hands after
101
visiting toilet without soap is also considered as a crucial factor. Hence, it is concluded
that hand washing practices are very essential to avoid unnecessary health issues.
HAND WASHING PRACTICES AFTER USING TOILET
Hand washing is a hygienic activity that can interrupt the transmission of
diarrhoea causing pathogens. A correct handwashing method is an effective way to
prevent the spread of communicable diseases. It helps in reducing infectious diseases
(Ejemot et al., 2008)4. F test has been used to find out the relationship of hand washing
practice after using toilet and food borne diseases.
Table 5.2 Hand washing practices after using toilet and its impact on food borne
diseases
Null Hypothesis: Hand washing after using toilet has no impact on food borne diseases.
Hand washing
practices Diseases N X s F value P value
After using
toilet with
soap
Vomiting 190 4.17 1.472
2.744 .042*
Fever 139 3.72 1.646
Diarrhoea 343 3.84 1.555
Unsettled
stomach
134 3.93 1.632
After using
toilet
without soap
Vomiting 190 2.88 1.851
.872 .455*
Fever 139 3.11 1.780
Diarrhoea 343 3.04 1.752
Unsettled
stomach
134 3.19 1.841
*Significant at 5% level
Table 5.2 shows the relationship between hand washing after using toilet and
food borne diseases. As per the rejection of null hypothesis, there is a significant
relationship between the hand washing after using toilet with soap and food borne
diseases of the respondents. This analysis indicates that after visiting toilet, the hand
should be washed with soap to avoid food borne diseases. In another variable as per the
102
acceptance of null hypothesis, there is no significant relationship between hand washing
without soap after using toilet and food borne diseases. This analysis concludes that
washing hands with soap after using toilet reduces food borne diseases and washing
hands without soap after using toilet create food borne diseases among the respondents.
EDUCATION AND HAND WASHING PRACTICES
The Centre for Disease Control and Prevention (2007)5 reported that improper
hand washing practices cause a health care associated infection that accounted for 1.7
million infections and 99,000 associated deaths each year in American hospitals alone.
In Table 5.3, the educational qualifications of the respondents are related to their hand
washing practices before and after using toilet.
Table 5.3 Influence of education and hand washing practices after using toilet
Null Hypothesis: The education of the respondents does not influence their hand
washing practices after using toilet.
N X s F value P value
After using toilet
with soap
Illiterate 129 3.47 1.737
17.088 .000* School Level 508 3.84 1.614
College Level 169 4.47 1.080
After using toilet
without soap
Illiterate 129 3.24 1.815
.944 .389* School Level 508 3.01 1.792
College Level 169 2.99 1.789
*Significant at 5% level
This analysis shows the relationship between the education of the respondents and
the hand washing practices with or without soap after visiting toilet. As per the rejection
of null hypothesis, there is a significant relationship between the hand washing practices
after using toilet and education of the respondents. In another variable, as per the
acceptance of null hypothesis, there is no significant relationship between the education
of the respondents and hand washing practices after using toilet. The mean score of
103
college level education of respondents is greater than the school level and illiterate
respondents. Hence, the education of the respondents has no impact in the hand washing
practices of using soap after visiting toilet. But education influences the practice of
washing hands without soap after using the toilet.
OCCUPATION AND HAND WASHING PRACTICES
Hygienic practices normally include hand washing, proper methods of washing
utensils, separation of utensils for raw and cooked food and the location where the food is
prepared (Kumiko et al., 2009)6. In Table 5.4, the occupation of the respondents is related
to their handwashing practices after using toilet. F-test has been used to find out its
relationship.
Table 5.4 Influence of occupation on hand washing after using toilet
Null Hypothesis: Occupation does not influence hand washing practices of the
respondents after using toilet.
N X s F value P value
After using toilet
with soap
Housewife 464 3.89 1.591
4.480 .004* Employed 138 4.14 1.431
Daily Wages 142 3.58 1.677
Unemployed 62 4.31 1.301
After using toilet
without soap
Housewife 464 3.13 1.807
3.359 .018* Employed 138 2.72 1.784
Daily Wages 142 3.23 1.764
Unemployed 62 2.66 1.698
*Significant at 5% level
This table describes the relationship between the respondents’ occupation and
washing of hands after using toilet. As per the rejection of null hypothesis, there is a
significant relationship between washing hands after using toilet and occupation of the
respondents. It is concluded that the hand washing practice after using toilet is influenced
104
by the occupation of the respondents. The respondents hand washing practices differ
according to their different occupations.
HANDLING OF PET ANIMALS
Lin et al., (2003)7 stated that the Centre for Disease Control and Prevention
(CDCP) reported that hand washing is one of the most important hygienic procedures in
preventing the transmission of infectious diseases. It is the first line of defence against
infectious disease, including respiratory infectious and gastrointestinal disorders. In Table
5.5, food borne diseases are related to the handling of pet animals and burns in hands
among the food handlers. F test has been used to find out the relationship.
Table 5.5 Handling pet animals and its impact on food borne diseases
Null Hypothesis: Handling of pet animals and burns in hands has no impact on
food borne diseases.
N X s F value P value
Do not handle pets while
preparing food
Vomiting 190 4.27 1.048
1.353 .256*
Fever 139 4.01 1.216
Diarrhoea 343 4.14 1.123
Unsettled
stomach
134 4.13 1.370
Burns leads to food borne
diseases while cooking
Vomiting 190 3.41 1.357
3.091 .026*
Fever 139 3.15 1.541
Diarrhoea 343 3.28 1.468
Unsettled
stomach
134 2.93 1.488
*Significant at 5% level
This study shows the relationship between handling pet animals and burns in
hands. As per the acceptance of null hypothesis, there is no relationship between
handling pets while preparing food and food borne diseases. This shows that there is no
impact in food borne diseases even though respondents handle pets. In another variable,
as per the rejection of null hypothesis, there is a significant relationship between burns
105
leads to food borne diseases while cooking and food borne diseases. There is an impact
on food borne diseases when there are burns in hands while preparing food. Hence,
burns in hands have an impact on food borne diseases.
FOOD BORNE DISEASES
Unsafe drinking water, along with poor sanitation and hygiene are among the
main contributors to an estimated 4 billion cases of diarrhoeal disease annually, causing
more than 1.5 million deaths, mostly among children under 5 years of age (WHO 2005)8.
In Table 5.6, correlation has been used to find out the relationship between purchasing
contaminated food materials, practicing bad personal hygiene, cooking food at improper
temperature and using unsafe drinking water.
Table 5.6 Correlation - Food borne diseases
Purchasing
contaminated
food
materials
Practicing
bad
personal
hygiene
Cooking
food at
improper
temperature
Unsafe
drinking
water
Purchasing
contaminated
food materials
Pearson
Correlation
1 .655**
.534**
.531**
P value .000 .000 .000
Respondents 806 806 806
Practicing bad
personal
hygiene
Pearson
Correlation
1 .601**
.571**
P value .000 .000
Respondents 806 806
Cooking food
at improper
temperature
Pearson
Correlation
1 .577**
P value .000
Respondents 806
Unsafe
drinking water
Pearson
Correlation
1
P value
Respondents
**. Correlation is significant at the 0.01 level (2-tailed).
106
This table explains the correlation of four significant factors in unsafe food
practices: purchasing contaminated food materials, practising bad personal hygiene,
cooking food at improper temperature and using unsafe drinking water. The correlation
is 0.655, which is positive and it shows that the practising of bad personal hygiene is
moderately correlated with purchasing contaminated food materials. The correlation is
significant at 1% level. The results of the correlation is high (0.655) between the
purchasing contaminated food materials and practicing bad personal hygiene. It is
followed by the correlation between cooking food at improper temperature and practising
bad personal hygiene (0.601). Hence, it is concluded that a higher correlation exists
between purchasing contaminated food materials and practising bad personal hygiene.
TIME TAKEN TO WASH HANDS
Mitakakis et al., (2004)9 stated that 70.3% of the respondents were poor in
handling food preparation, 46.6% do not wash their hands properly, 41.7% mishandled
raw food, and 70.1% mishandled cooked food. This concludes that the risk of diseases
through home-cooked food was high due to poor food handling practices.
Table 5.7 Time duration to wash hands and its impact on food borne diseases
Null Hypothesis: Time duration to wash hands is not associated with food borne
diseases.
Value df P value
Pearson Chi-Square 21.220a 9 .012*
Likelihood Ratio 21.633 9 .010
Linear-by-Linear Association 2.190 1 .139
N of Valid Cases 806
*Significant at 5% level
This table shows the association between time taken to wash hands and food
borne diseases. As per the rejection of null hypothesis, there is a significant relationship
between the food borne diseases and the time taken to wash hands. The time taken to
107
wash hands has an impact on food borne diseases. The less time taken to wash hands is a
cause for food borne diseases.
EDUCATION AND TIME TAKEN TO WASH HANDS
Most of the consumers lack knowledge of proper hand washing practices.
Keeping hands clean through improved hygienic methods is one of the most important
steps to avoid getting sick and spreading germs to others (CDCP, 2010)10
. Education
plays an important role in hand washing practices. The education levels among the
respondents are categorized into three, namely, illiterate, school level and college level.
Table 5.8, explains the respondents’ education and their time taken to wash hands.
Table 5.8 Influence of education on time taken to wash hands
Null Hypothesis: Education of respondents is not associated with the time taken to wash
hands.
Value df P value
Pearson Chi-Square 8.367a 6 .212*
Likelihood Ratio 9.221 6 .162
Linear-by-Linear Association .685 1 .408
N of Valid Cases 806
*Significant at 5% level
It is evident from the above table, that as per the acceptance of null
hypothesis, there is no significant association between the education of respondents and
the time taken to wash hands. It is inferred that the time taken to wash hands does not
depend on the educational levels of the respondents. The scientific hand washing practice
of 20 seconds is not followed by the educated respondents.
108
OCCUPATION AND TIME TAKEN TO WASH HANDS
A hygienic hand wash for food handling purposes could be defined as one
requiring warm water, soap or detergent and a scrubbing or rubbing action for at least 20
seconds (Jay et al., 1999b)11
. In Table 5.9, the occupations of the respondents are related
to the time taken to wash hands.
Table 5.9 Influence of occupation on time taken to wash hands
Null Hypothesis: There is no significant association between respondents’ occupation and
the time taken to wash hands.
Value df P value
Pearson Chi-Square 11.923a 9 .218*
Likelihood Ratio 12.732 9 .175
Linear-by-Linear Association .205 1 .650
N of Valid Cases 806
*Significant at 5% level
Chi-Square test has been used to analyse the relationship between the time taken
to wash hands and the occupations of respondents. As per the acceptance of null
hypothesis, there is no significant difference between occupation of respondents and time
taken to wash hands. The respondents’ time taken to wash hands is not influenced by
their occupation. The time taken to wash hands is not same in different levels of
occupation.
HAND WASHING PRACTICES AFTER VISITING TOILET
Curtis and Cairn Cross (2003)12
in their study have explained that hand washing is
considered to be the primary control measure for disease transmission during food
preparation and as one of the most effective ways to reduce the risk of diarrhoea. In Table
5.10, different age groups of respondents are related to the washing of hands after using
toilet with or without soap.
109
Table 5.10 Impact of age on hand washing practices and after visiting toilet
Null Hypothesis: Age of the respondents does not cause any change in the hand washing
practices after using toilet with or without soap.
N X s F value P value
After using toilet
with soap
Below 25 126 4.10 1.474
6.599 .000*
25-30 113 4.11 1.391
31-36 128 4.21 1.373
37-42 134 3.99 1.519
43-47 86 4.08 1.528
Above 47 219 3.41 1.757
After using toilet
without soap
Below 25 126 2.74 1.781
2.115 .062*
25-30 113 3.38 1.734
31-36 128 3.19 1.817
37-42 134 2.83 1.829
43-47 86 3.10 1.796
Above 47 219 3.06 1.778
*Significant at 5% level
This table shows the relationship between the age of the respondents and the hand
washing practices with or without soap after using toilet. As per the rejection of null
hypothesis in the first case, there is a significant relationship between the age of the
respondents and hand washing practices with soap after using toilet. The different ages
of the respondents influence the hand washing practices with soap after visiting toilets.
In the next case, as per the accepatance of null hypothesis, there is no relationship
between the different age group of respondents and washing hands without soap after
using toilet. The age of the respondents does not influence the practice of hand washing
without soap after using toilet.
CONSUMING FOOD AND TIME TAKEN TO WASH HANDS
The safe practice of washing hands with soap and water before preparation of
food makes food poisoning less likely to occur (Altekruse et al., 1995)13
. The time taken
to wash hands is related to the hand washing practice of before and after consuming food
with soap. F-test has been used to find out its association.
110
Table 5.11 Time taken to wash hands before and after consuming food
Null Hypothesis: Time taken to wash hands is not related with the hand washing with
soap before and after food.
N X s F value P value
Before
consuming with
soap
1- 5 seconds 477 2.66 1.707
6.095 .000* 6- 10 seconds 241 3.08 1.693
11- 15 seconds 40 3.50 1.569
16- 20 seconds 48 2.48 1.637
After consuming
with soap
1- 5 seconds 477 2.63 1.673
5.972 .001* 6- 10 seconds 241 3.03 1.724
11- 15 seconds 40 3.50 1.485
16- 20 seconds 48 2.50 1.650
*Significant at 5% level
One way analysis of variance has been used to know the relationship between the
time taken to wash hands and hand washing practices with soap before and after
consuming food. As per the rejection of null hypothesis, there is a significant difference
between the time taken to wash hands and hand washing practices with soap before and
after consuming food. The respondents’ time taken to wash hands is influenced by hand
washing with soap before and after consuming. It is concluded that the time taken to
wash hands and handwashing with soap before and after consuming food have effects
and reduces food borne diseases.
VISITING TOILETS AND TIME TAKEN TO WASH HANDS
Personal hygienic practices play an important role in preventing the spread and
contact of diseases. The most important aspects of personal hygiene include good toilet
practices and personal hygienic practices like bathing and proper hand washing (PHPPD,
2010)14
. In Table 5.12, F test has been used to find out the relationship between the time
taken to wash hands with or without soap after using toilet.
111
Table 5.12 Time taken to wash hands after visiting toilet with or without soap
Null Hypothesis: Time taken to wash hands with or without soap is not related with after
visiting toilet.
N X s F value P value
After using toilet
with soap
1- 5 seconds 477 3.80 1.647
2.967 .031* 6- 10 seconds 241 4.14 1.404
11- 15 seconds 40 4.10 1.297
16- 20 seconds 48 3.73 1.685
After using toilet
without soap
1- 5 seconds 477 3.05 1.798
.489 .690* 6- 10 seconds 241 3.07 1.818
11- 15 seconds 40 3.15 1.594
16- 20 seconds 48 2.75 1.839
*Significant at 5% level
The time taken to washing hands with or without soap after visiting toilet has
been analysed with the help of ANOVA. As per the P value, and the rejection of null
hypothesis, there is a relationship between time taken to wash hands with soap and after
visiting toilet. It is followed by the acceptance of null hypothesis: without soap after
using toilet. Hence, there is no relationship between the time taken to wash hands without
soap after using toilet. It is concluded that the hand washing practices of washing hands
without soap after using toilet does not cause any change in the time taken to wash hands.
They give equal importance to hand washing practices of washing hands with soap after
using toilet.
EDUCATION AND HANDLING OF PET ANIMALS
The education of the respondents plays an important role in the hand washing
practices of the respondents. Education level of the respondents is categorized into three
categories, namely illiterate, school level and college level. F-test has been used to find
out the association between education and respondents’ hand washing practices. Hands
should be washed thoroughly with soap and water after touching pets or coming in
112
contact with them or the area where they live. It is very important to wash hands after
touching a pet and before preparing, serving, eating or drinking (CDCP, 2012)15
.
Table 5.13 Education and handling of pet animals
Null Hypothesis: Education of the respondents have no impact on hand washing practices
after touching pet animals.
N X s F value P value
Illiterate 129 3.85 1.225
6.208 .002* School Level 508 4.17 1.168
College Level 169 4.33 1.083
Total 806 4.15 1.168
*Significant at 5% level
This table describes the relationship between respondents’ education and washing
of hands after touching pet animals. As per the rejection of null hypothesis, there is a
significant relationship between washing hands after touching pet animals and the
education of the respondents. It is concluded that hand washing practices after touching
pet animals is influenced by the education of respondents. So hand washing practices
after touching pet animals change according to the education of the respondents.
HANDLING OF PET ANIMALS AND DISTRICTS
Hand washing is the most effective way to prevent the spread of infections. Good
hand washing techniques include using of adequate quantity of soap and running water.
Ensuring that food handlers wash the hands thoroughly after handling pets and raw meat
is the need of the hour (Peru, 2010)16
.
113
Table 5.14 Handling of pet animals during food preparation in different districts
Null Hypothesis: District is not related to handling of pet animal while preparing food.
N X s F value P value
Thoothukudi 243 4.37 1.025
5.544 .001*
Kanyakumari 285 4.13 1.313
Virudhunagar 157 3.89 1.163
Madurai 121 4.10 1.003
Total 806 4.15 1.168
*Significant at 5% level
This table shows the relationship between respondents’ district and handling of
pet animals while preparing food. As per the rejection of null hypothesis, there is a
significant relationship between handling of pet animals while preparing food and the
district of the respondents. It is concluded that handling of pet animals while preparing
food is influenced by the district of the respondents. It differs from district to district.
INFLUENCE OF EDUCATION IN USING BARE HANDS TO SERVE FOOD
Many food borne diseases and pathogenic microorganisms are spread by
contaminated hands. If pathogens from human faeces enter a person’s mouth, they will
cause diarrhoea. School going children are exposed to greater risks of diarrhoeal disease
by consuming contaminated water and food (Dasgupta, 2005)17
.
Table 5.15 Influence of education in using bare hands to serve food
Null Hypothesis: Education of the respondents is not related to using bare hands to serve
food.
N X s F value P value
Illiterate 129 3.93 1.160
.951 .387* School Level 508 4.08 1.123
College Level 169 4.08 1.126
Total 806 4.06 1.129
*Significant at 5% level
114
This table analyses the relationship between using bare hands to serve food and its
relationship with the education of the respondents. As per the acceptance of null
hypothesis, there is no significant relationship between the education of respondents and
using bare hands to serve food. It is concluded that the education of the respondents does
not influence in using bare hands to serve food. Using bare hands to serve food does not
vary with the different levels of education. The low level and high level educated
respondents have same attitude towards serving food with bare hands.
Fig. 5.2 Influence of education in using bare hands to serve food
OCCUPATION AND USING BARE HANDS TO SERVE FOOD
Fawzi and Shama (2009)18
in their study concluded that food safety at the
household level is well accepted and so an understanding of the status of food handling
knowledge and practices is needed. Many working women concentrate on their jobs, and
hence give less importance to safe food handling practices at home. They do not follow
hygienic hand washing practices. They are unaware that these unhygienic practices at
home kitchen leads to food borne diseases. In Table 5.16, the occupation of the
respondents is related to the use of bare hands to serve food.
115
Table 5.16 Influence of occupation in using bare hands to serve food
Null Hypothesis: Occupation of the respondents is not associated with the use of bare
hands to serve food.
N X s F value P value
Housewife 464 4.06 1.152
.694 .556*
Employed 138 4.12 1.040
Daily Wages 142 4.05 1.107
Unemployed 62 3.87 1.208
Total 806 4.06 1.129
*Significant at 5% level
One way analysis of variance has been used to know the relationship between
using bare hands to serve food and the occupation of respondents. As per the acceptance
of null hypothesis, there is no significant difference between the occupation of
respondents and using bare hands to serve food. The different occupations are not related
with using bare hands to serve food. The occupation of the respondent is not a cause for
serving food with bare hands.
EDUCATION AND COOKING WITH BURNS IN HANDS
Guzewich and Ross, (1999)19
, in their study, analysed the different factors causing
food borne diseases. Finally, they concluded that the food handlers and poor hand
washing practices could be implicated as the source of food borne disease outbreaks. In
Table 5.17, the educational qualifications of the respondents are related to the possibility
that lead to food borne diseases.
Table 5.17 Relationship between different levels of education and cooking with
burns in hands
Null Hypothesis: There is no significant association between respondents’ education and
burns leads to food borne diseases.
N X s F value P value
Illiterate 129 3.33 1.491
2.002 .136* School Level 508 3.27 1.462
College Level 169 3.04 1.443 *Significant at 5% level
116
One way analysis of variance has been used to know the relationship between
cooking with burns in hands and food borne diseases and the education of respondents.
As per the acceptance of null hypothesis, there is no significant difference between
education of respondents and the burns in the hands leading to food borne diseases. The
respondents’ cooking with burns in hands leads to food borne diseases is not related with
their education. Education of the respondents is not a crucial factor to determine the
cooking food with burns in hands.
OCCUPATION AND COOKING WITH BURNS IN HANDS
The food borne transmission of known pathogens caused 6.5 million illnesses and
upto 9,000 deaths each year (Bennett et al., 1987)20
. In 1989, Todd used a combination of
methods, including extrapolation from Canadian surveillance data, to arrive at an
estimate of 12.5 million food borne illnesses and 522 related deaths each year (Todd
1989)21
. In Table 5.18, the concept that burns leads to food borne diseases while cooking
is analysed. One way analysis of variance has been used to find out the relationship.
Table 5.18 Occupation and burns in hands leads to food borne diseases while
cooking
Null Hypothesis: The occupation of respondents has no impact on burns leading to
food borne diseases while cooking.
N X s F value P value
Housewife 464 3.31 1.460
5.419 .001* Employed 138 2.83 1.489
Daily Wages 142 3.45 1.427
Unemployed 62 3.05 1.372
*Significant at 5% level
An attempt has been made to understand the association between respondents’
occupation and their burns in hands leading to food borne diseases while cooking. As per
the rejection of null hypothesis, there is a significant association between occupation and
burns in hands leading to food borne diseases while cooking. This concluded that the
117
burns in hands cause food borne diseases while cooking differs with the different
occupations of the respondents.
BURNS IN HANDS AND AWARENESS OF FOOD BORNE DISEASES
Handwashing is one of the basics of good hand hygiene. Hand hygiene is
regarded as the most important element in infection control activities (Purva Mathur,
2011)22
. In Table 5.19, t test has been used to find out the relationship between the burns
leading to food borne diseases while cooking and awareness of food borne diseases.
Table 5.19 Cooking with burns and awareness of food borne diseases
Null Hypothesis: Burns leading to food borne diseases while cooking is not associated
with the awareness of food borne diseases.
Awareness of Food
borne Diseases N X s t value P value
Burns leads to
food borne
diseases while
cooking
Awareness of food
borne diseases
705 3.24 1.496
.385 .700* Unawareness of
food borne diseases
101 3.18 1.228
*Significant at 5% level
This table shows the relationship between burns in hands leading to food borne
diseases while cooking and the awareness of food borne diseases. As per the acceptance
of null hypothesis, there is no significant association of cooking with burns in hands
leading to food borne diseases and the awareness of food borne diseases. Hence, it is
infered that awareness of food borne diseases is not influenced by cooking with burns in
hands leading to food borne diseases.
WASHING HANDS WITH SOAP AFTER HANDLING MEAT/FISH
One small case control study of infectious mortality risk with retrospective data
on reported hand washing was located. It showed a reduction in overall mortality
associated with reported hand washing with soap, but not in diarrhoea mortality (Hoque
118
et al., 1999)23
. In Table 5.20, the education level of the respondents is associated with
washing hands with soap after handling meat/fish.
Table 5.20 Influence of education in washing hands with soap after handling
meat/fish
Null Hypothesis: Respondents’ education is not associated with washing of hands with
soap after handling meat/fish.
N X s F value P value
Illiterate 129 4.08 1.272
2.086 .125* School Level 508 4.29 1.239
College Level 169 4.36 1.178
Total 806 4.27 1.233
*Significant at 5% level
This table reveals the relationship between the education of the respondents and
washing of hands with soap after handling meat/fish. As per the acceptance of null
hypothesis, there is no relationship between the education of the respondents and washing
hands with soap after handling meat/fish. Hence, it is concluded that the low and high
levels education of respondents do not cause any change in washing hands with soap after
handling meat/fish. They look upon washing hands equally with soap after handling
meat/fish irrespective of their education.
Occupation and washing hands after handling meat/fish
For more than a century, handwashing has been recognized as an essential
component in the prevention of the spread of microbial infection (Fendler et al., 1998)24
.
Proper handwashing practices help to reduce the spread of bacteria and viruses that cause
other illnesses. Handwashing practice is an indispensible technique to prevent food
borne diseases. In Table 5.21, handwashing with soap after handling meat/fish among
the respondents is analysed. F test has been used to relate the occupation and the
washing hands with soap after handling meat/fish.
119
Table 5.21 Influence of occupation in washinng hands after handling meat/fish
Null Hypothesis: The different occupations of respondents do not influence
washing hands with soap after handling meat/fish.
N X s F value P value
Housewife 464 4.28 1.241
.215 .886*
Employed 138 4.21 1.276
Daily Wages 142 4.26 1.213
Unemployed 62 4.35 1.147
Total 806 4.27 1.233
*Significant at 5% level
This table shows the relationship between the occupation of the respondents and
washing hands with soap after handling meat/fish. As per the acceptance of null
hypothesis, the respondents’ occupations do not cause any change in washing hands with
soap. This analysis concludes that the respondents’ occupations do not influence
washing hands with soap after handling meat/fish. Washing hands with soap after
handling meat/fish is equally followed by the respondents irrespective of their
occupation.
INFLUENCE OF INCOME IN WASHING HANDS AFTER HANDLING
MEAT/FISH
Hand washing is vital in preventing contamination of food by food handlers.
Harmful bacteria present in the hands of food handlers can be removed by proper hand
washing techniques. Regular hand washing should be practised before handling raw food
(Food safety Authority of Ireland, 2012)25
. In Table 5.22, F test has been used to find out
the association between income and the hand washing practices of respondents after
handling meat/fish.
120
Table 5.22 Influence of income in washing hands after handling meat/fish
Null Hypothesis: The different levels of income do not cause any change in washing
hands after handling meat/fish.
N X s F value P value
Below Rs. 5000 172 4.26 1.249
2.742 .044*
Rs. 5001 - Rs.15000 84 4.02 1.326
Rs. 15001- Rs. 25000 15 4.80 .561
Above Rs. 25000 9 4.89 .333
Total 280 4.24 1.242
*Significant at 5% level
Table 5.22 analyses the association of income of the respondents with hand
washing practices after handling meat/fish. As per the rejection of null hypothesis, there
is a relationship between washing hands after handling meat/fish and the different levels
of income. This analysis concludes that the different levels of income cause changes in
the hand washing attitudes of the respondents after handling meat/fish. The low and high
income groups’ of the respondent vary in hand washing practices after handling
meat/fish.
AGE AND WASHING VEGETABLES
Davila et al., (2009)26
in his study analysed the reasons for diarrhoeal illness
among mothers, infants and children and found that there are lack of food safety practices
like washing hands before preparing meals and infant formula, washing hands after
changing diaper for children, washing hands after handling raw and cooked food. In
general mothers reported less frequent in hand washing and had lower food safety
practices. In Table 5.23, the age groups of the respondents are related to washing
vegetables before cooking.
121
Table 5.23 Influence of age in washing vegetables before cooking
Null Hypothesis: Age does not influence washing vegetables before cooking.
N X s F value P value
Below 25 126 4.74 .761
1.004 .414*
25-30 113 4.77 .668
31-36 128 4.73 .684
37-42 134 4.80 .487
43-47 86 4.72 .730
Above 47 219 4.64 .761
*Significant at 5% level
This table shows the relationship between the age of the respondents and their
practice of washing vegetables before cooking. As per the acceptance of null hypothesis,
there is no relationship between the age of the respondents and their washing of
vegetables before cooking. This analysis concludes that the hygienic practice of washing
vegetables before cooking is not related with the age of the respondents.
EDUCATION AND WASHING VEGETABLES BEFORE COOKING
Hands are one of the main ways through which germs spread. So it is important
to wash hands thoroughly with soap and warm water before cooking, after touching the
bin, after cooking, after toilet and after touching raw food (FSA, 2010)27
. In Table 5.24,
the education level of the respondents is compared with washing vegetables before
cooking.
Table 5.24 Influence of education in washing vegetables before cooking
Null Hypothesis: Education of the respondents does not influence washing
vegetables before cooking.
N X s F value P value
Illiterate 129 4.59 .835
3.144 .044* School Level 508 4.76 .635
College Level 169 4.72 .733
*Significant at 5% level
122
This table illustrates the relationship between the education of the respondents
and their practice of washing vegetables before preparing food. As per the rejection of
null hypothesis, there is a significant relationship between the education of the
respondents and the washing of vegetables before preparation of food. It is concluded that
the level of education influences the practice of washing vegetables before preparation of
food. The respondents with high level education take more care in washing vegetables
than the low level educated consumers.
OCCUPATION AND WASHING VEGETABLES
Worsfold and Griffith (1997)28
reported poor food handling practices after
observing 108 consumers during all stages of food preparation: purchase, preparation,
cooking and storage of four recipes. Such bad practices may lead to the great danger of
cross-contamination and subsequent food poisoning. It has been estimated that 66% of
consumers do not wash their hands before work, 41% do not wash vegetables, and 60%
use a single board for all cutting tasks.
Table 5.25 Influence of occupation in washing vegetables before cooking
Null Hypothesis: Washing vegetables before cooking food does not vary with the
respondents’ occupation.
N X s F value P value
Housewife 464 4.73 .651
.795 .497* Employed 138 4.68 .783
Daily Wages 142 4.68 .802
Unemployed 62 4.82 .497
*Significant at 5% level
This table shows the relationship between respondents’ occupation and washing
of vegetables before preparation of food. As per the acceptance of null hypothesis, there
is no significant difference among the respondents in different occupations and their
123
washing of vegetables before cooking. It is concluded that the washing of vegetables
before preparation of food is not based on the respondents’ occupation. The same
processes are followed by the respondents in different occupations.
IMPACT OF DRYING HANDS AND DIFFERENT OCCUPATION
Harmful substance is transmitted by ingesting contaminated food or drink, by
direct person-to person contact, or from contaminated hands. Human hands usually
harbor microorganisms both as part of person’s normal microbial flora as well as
transient microbes acquired from the environment (Lindberg et al., 2004)29
. In Table
5.26, the occupation level has been compared with the respondents’ drying of hands.
F test has been used to find out the relationship.
Table 5.26 Impact of drying hands and different occupation
Null Hypothesis: Awareness about drying hands with paper towel or cloth does not
vary with the occupation of the respondents.
N X s F value P value
Housewife 464 3.66 1.318
.797 .496*
Employed 138 3.80 1.289
Daily Wages 142 3.81 1.266
Unemployed 62 3.79 1.203
Total 806 3.72 1.295
*Significant at 5% level
Table 5.26 shows the relationship between the awareness of drying hands and the
different occupation levels of the respondents. This one way analysis concludes that the
different occupation of the respondents and their awareness towards drying hands is the
same. As per the acceptance of null hypothesis, there is no significant relationship
between respondents’ occupation and their awareness in drying hands. The respondents
have awareness to dry hands with towards irrespective of their occupation.
124
EDUCATION AND DRYING HANDS WITH PAPER TOWEL/CLOTH
Strina et al. (2002)30
revealed that the prevalence of diarrhoea among children in
mainly unhygienic behaviour recorded was 2.2 times higher than among children in the
mainly poor hygienic group. The home and school environments were of particular
concern for the transmission of infections among young children. Unfortunately, most
schools in developing countries do not provide appropriate hand washing facilities.
Where these facilities are available, they may be poorly located, have insufficient hand
washing materials, be inaccessible, or be improperly used. Effective hand washing
(including drying) is important in infection control.
Table 5.27 Relationship in education and drying hands with paper towel/cloth
Null Hypothesis: Drying hands with paper towel/cloth does not vary with the different
education levels of the respondents.
N X s F value P value
Illiterate 129 3.64 1.298
1.172 .310* School Level 508 3.70 1.305
College Level 169 3.85 1.261
Total 806 3.72 1.295
*Significant at 5% level
The education of respondents and their practice of drying hands with paper
towel/cloth is analysed with the help of ANOVA. As per the P value, the null hypothesis
is accepted regarding the drying of hands with paper towel/cloth. Hence, there is no
relationship between the education of the respondents and their practice in drying hands
with paper towel/cloth. This analysis indicates that respondents in low and high levels
education do not show any difference in drying hands. They give equal response to dry
hands with paper towel/cloth.
125
INCOME AND DRYING HANDS
Tambekar et al. (2009)31
studied the effect of hand washing in preventing the
enteric infections among students. Redmond and Griffith (2003)32
documented the ability
of the various stages of hand washing to decrease skin-surface microbial counts. Table
5.28, explains the drying of hands with paper towel/cloth and income. It is analysed by
using F test.
Table 5.28 Income and its impact on drying hands with paper towel/cloth
Null Hypothesis: Income of the respondents does not influence drying hands with
paper towel/cloth.
N X s F value P value
Below Rs. 5000 172 3.78 1.296
.136 .939*
Rs. 5001 - Rs.15000 84 3.82 1.243
Rs. 15001- Rs. 25000 15 4.00 1.309
Above Rs. 25000 9 3.78 1.302
Total 280 3.81 1.275
*Significant at 5% level
This table demonstrates the relationship between income of the respondents and
their practice of drying the hands with paper towel/cloth. As per the acceptance of null
hypothesis, there is no significant relationship between the income of the respondents and
drying hands with paper towel/cloth. It is concluded that the monthly income does not
influence the practice of drying hands with paper towel/cloth. The respondents dry hands
with paper towel/cloth irrespective of their income.
FOOD BORNE DISEASES AND DRYING HANDS WITH PAPER
TOWEL/CLOTH
Hand washing is one of the range of hygiene promotion interventions that can
interrupt the transmission of diarrhoea-causing pathogens (Ejemot et al., 2008)33
. Hence
126
the purpose of this study is to identify bacterial enteric pathogens associated with hands
and to arrive at reduction of danger after hand washing to reduce diarrhoea disease linked
to poor hand hygiene. In Table 5.29, F test has been used to find out the relationship
between drying hands with paper towel/cloth and food borne diseases.
Table 5.29 Drying hands with paper towel/cloth and its impact on food borne
diseases
Null Hypothesis: Drying hand with paper towel/cloth is not related with food borne
diseases.
N X s F value P value
Vomiting 190 3.65 1.237
.680 .564*
Fever 139 3.67 1.188
Diarrhoea 343 3.80 1.337
Unsettled stomach 134 3.69 1.372
Total 806 3.72 1.295
*Significant at 5% level
Table 5.29 shows the mean value of drying hands and its impact on food borne
diseases. As per the acceptance of null hypothesis, there is no significant relationship
between the practice of drying hands with paper towel/cloth and food borne diseases.
This analysis concludes that drying hand with paper towel/cloth is not related to food
borne diseases among the respondents.
WASHING HANDS WITH SOAP
Improper food handling practices include, inadequate cooking, inadequate cooling
and storage of foods, cross-contamination of raw and cooked foods, inadequate personal
hygiene such as hand washing, and consumption of raw, undercooked, or unsafe foods
(CAST, 1994)34
. In Table 5.30, washing hands with soap after handling meat/fish and
food borne diseases is analysed. F test has been used to find out its association.
127
Table 5.30 Washing hands with soap after handling meat/fish
Null Hypothesis: Washing hands with soap after handling meat/fish is not related
with food borne diseases.
N X s F value P value
Vomiting 190 4.27 1.288
2.467 .061*
Fever 139 4.06 1.267
Diarrhoea 343 4.38 1.102
Unsettled stomach 134 4.20 1.408
Total 806 4.27 1.233
*Significant at 5% level
The association between washing hands with soap after handling meat/fish and
food borne diseases is analysed with the help of F test. As per the acceptance of null
hypothesis there is no association between the food borne diseases and washing hands
with soap after handling meat/fish. The respondents wash hands with soap after handling
meat/fish and this has no impact on food borne diseases.
AWARENESS OF FOOD BORNE DISEASES AND WASHING HANDS
Food borne diseases remain a major public health problem across the globe. The
problem is more severe in developing countries due to lack of personal hygiene and food
safety measures. As much as 70% of diarrhoeal diseases in developing countries are
believed to be of food borne origin (WHO 2010)35
. In Table 5.31, washing hands with or
without soap before and after consuming food and the awareness of food borne diseases
are associated and analysed.
128
Table 5.31 Awareness of food borne diseases and washing hands
Null Hypothesis: Awareness of food borne diseases does not cause any change in
washing hands with or without soap before and after consuming food.
Awareness of Food
Borne Diseases N X s t value P value
Before consuming
without soap
Awareness of food
borne diseases
705 3.37 1.768
.119 .905* Unawareness of food
borne diseases
101 3.35 1.682
After consuming
without soap
Awareness of food
borne diseases
705 3.39 1.748
.273 .785* Unawareness of food
borne diseases
101 3.34 1.716
Before consuming
with soap
Awareness of food
borne diseases
705 2.85 1.715
1.337 .182* Unawareness of food
borne diseases
101 2.60 1.656
After consuming
with soap
Awareness of food
borne diseases
705 2.85 1.694
2.930 .003* Unawareness of food
borne diseases
101 2.33 1.632
*Significant at 5% level
The awareness of food borne diseases and its influence on washing hands with or
without soap before and after consuming food is analysed with the help of ANOVA.
As per the P value, the null hypothesis is accepted regarding hand washing practices.
Hence, there is no relationship between the awareness of food borne diseases and the
practice of washing hands with or without soap before and after consuming food. This
analysis indicates that awareness of food borne diseases does not cause any change in
washing hands with or without soap before and after consuming food. They wash hands
with or without soap before and after consuming food irrespective of their awareness.
Next in the another variable, as per the rejection of null hypothesis, there is a relationship
among the respondents in washing hands with soap after consuming food and their
awareness of food borne diseases.
129
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