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Journal of Nursing

Women’s knowledge regarding preventive measures of Food Poisoning in Khartoum, Sudan

Waled Amen Mohammed Ahmed [email protected]


Background


Food poisoning is caused by the ingestion of food containing exotoxins. Outbreaks are still a problem in many countries. Food poisoning is a very common ailment that everyone suffers from at some stage in their life. It is an unfortunate fact that each year a large number of people throughout the world become ill and sometimes die because of illnesses or diseases spread by contaminated food. Both staphylococcal food poisoning and botulism are examples of toxication resulting from the ingestion of food containing exotoxins. In recent years a number of comprehensive reviews on staphylococcal food poisoning and on the staphylococcal enterotoxins have been published and indicated high spread of the disease. Food poisoning, more properly referred to as a food-borne illness, is the result of ingestion of food (or water) contaminated with pathogenic microbes, toxic chemicals or toxins produced by microbes [1].

For the past decade, the most reliable estimates were 76 million annual foodborne illnesses, 325,000 hospitalizations, and 5,000 deaths [2]. Unfortunately, the prevalence of food poisoning is most likely much higher, as many people become ill without ever seeing a doctor. In fact, health officials estimate that for every case of salmonella, three dozen go unreported. Moreover, this particular outbreak was especially unsettling because it involved prepackaged food - food consumers assumed to be safe. Health experts suggest these simple guidelines to reduce the risk of getting or spreading the infection: wash hands thoroughly after visiting the rest room and before preparing food; make sure food preparation surfaces are clean; avoid drinking untreated water; and cook shellfish thoroughly before eating. And people who experience nausea, vomiting or diarrhea should not attend school or work and should not handle food for others while ill [3]. Food poisoning has an impact on human welfare. The World Health Organization reported it as one of the main cause for morbidity and mortality in developing countries [4].

Food contaminated with bacteria may not look or smell spoiled. Consumption of food contaminated with these bacteria may cause food poisoning, a foodborne illness. Food poisoning can occur due to variety of reasons but most cases are due to poor hygienic practices by those who handle the food. Sometimes, undercooked or improperly cooked food can also lead to food poisoning. The known causes of food poisoning can be divided into two categories Infectious agents and toxic agents Infectious agents include viruses, bacteria, and parasites. Toxic agents include poisonous mushrooms, improperly prepared exotic foods (such as barracuda - ciguatera toxin), or pesticides on fruits and vegetables. Food usually becomes contaminated from poor sanitation or preparation. Food handlers who do not wash their hands after using the bathroom or have infections themselves often cause contamination. Improperly packaged food stored at the wrong temperature also promotes contamination [5].

Usually, food poisoning is mild but there can be instances under which the situation might become serious. The resistance to food poisoning is also dependent on the person’s immune system. There are cases wherein different people who have consumed the same contaminated food have shown very different reactions. Many a times, food poisoning is caused when a person is traveling to a different place and is not able to take sufficient care of their food habits. Most cases of food poisoning are actually intoxications, caused by bacterial toxins, either ingested pre-formed or produced by the micro-organisms in the gastrointestinal (GI) tract. In young children, the elderly and people with weakened immune systems, food poisoning may cause serious and sometimes deadly infections. In otherwise healthy people, food poisoning may cause short-term symptoms such as high fever, severe headache, vomiting, nausea, abdominal pain and diarrhea. Long-term complications may include severe arthritis [6].

However the food poisoning is very contagious diseases it has many prevention measure which could be applied. The prevention measures include food hygiene, personal hygiene and washing vegetable and fruits. Bacteria cannot be seen, smelled, or tasted, and they may be on any food. WHO identifies foodborne disease outbreaks and incidents, including those arising from natural, accidental and deliberate contamination of food; as major global public health threats in the 21st Century. These threats require urgent action. All Member States should establish basic systems to prevent or deter deliberate contamination of their food supplies and, if attacked, to respond rapidly to minimize the health, economic and other effects of such contamination [7].

This study, therefore, aims at assessing mothers’ knowledge about preventive measures of food poisoning in Alemtidad area. The information gathered is expected to help plan and implement a comprehensive package for preventing food poisoning. 

Justification Food poisoning is considered one of the main problems in Khartoum state, since there are 34 cases reported in 2010 from hospital admissions [8].

Food poisoning can affect one person or a group of people who all ate the same contaminated food. It more commonly occurs after eating at picnics, school cafeterias, large social functions, or restaurants [9].

Cases of food poisoning have increased fivefold over the past 15 years despite attempts to improve regulation, according to a report published by the Parliamentary Office of Science and Technology in England. The report says that the increase in food poisoning has occurred despite increasing regulation of food production and the absence of precautions in the food chain. It finds no simple, single answer to this anomaly but suggests that changes in urban sources are likely to be one of the most important factors [10].

Preventive measures such as improper personal hygiene, washing vegetable and fruit are effective in minimizing the prevalence of the problem. The evidence indicates effectiveness of increasing awareness of public in decreasing the disease transmission.

Objective



To assess the level of mothers’ knowledge about preventive measures of food poisoning.

Methods and materials

Study Design:


This is a descriptive cross-sectional community based study. It was conducted in Alemtidad area.

Study Area:

This study was conducted in Alemtidad area. Alemtedad area localize in the center of Khartoum city surrounded by Almahaly market from the south, Aldeim area from the north, Alshapy market from the west and Mohamed Najeeb Street from the east. It is divided into 12 blokes

Study duration:

The study started in September, 2012 and ended by the December, 2012

Study population:

The populations of this research study consist of all women in Alemtidad area. This study targeted all women who are living in Alemtidad area at the time of study. The target populations in (Block 5 and 8) at Alemtidad area are all ladies in reproductive age; they are 384 women.

Inclusion and exclusion criteria



Inclusion criteria:

All women are included in this study. The participation in the study is after agreement.

Exclusion criteria:

It includes women are not resident in study area, who reject to participate in the study, or who have disabilities or handicaps.

Variables

Age of women
Level of education
Source of information
Level of knowledge
Occupation
Storage of food
Level of knowledge about personal hygiene as preventive measures of food poisoning
Level of knowledge about wash vegetable as preventive measures of food poisoning
Level of knowledge about cooking meals as preventive measures of food poisoning
Sampling and sample size:
Sampling technique:
The sampling technique used was simple random sampling method; from Alemtidad area from which any household was registered then listed then using simple random sampling technique used to select 88 women.
Sample size:
n^0=(z^2 pq)/d^2
Where, n^0= factorial sample size, p=estimated proportion (0.1), q=(0.9), z =(1.96), and d=standard error for the estimated proportions of food poisoning (0.05). The n^(0 )was calculated to be 138.
Then n; sample size was calculated by n=n^0/(1+ n^0/N) ; while N=384
A sample size of 88 women was calculated as sample size in this study. 88 women were included.
Data collection
Technique of data collection
The researcher contacted the local health office to get there permission and collaboration as well, then he explained to them the objective of the study. House to house collection of the information according to the questionnaire took permission from the mothers and asked for their help in order to facilitate the visit of mother house by house in each selected blocks.
Tools of data collection
A pre-coded, pretested, designed structured questionnaire prepared by researcher under guidance of the supervisor was used to collect the data.
Data management and analysis
The collected data has been cleaned at the data collection field, organized into a master sheet, and then entered into the computer, using the software Statistical Package for Social Science (SPSS) version 20, in order to be analyzed according to the objectives. Both dependent and independent variables have been displayed as frequency tables, charts and graphs; then Chi-square test (cross-tabulation) and model logistic regression had been performed to test the significance of relationship between categorical variables, where only values equal to or less than 0.05 are considered as significant. The results had been presented with P-value and confidence intervals. The results have been discussed and compared with expected figures and rates through previous, national and regional studies. Interpretation of these results is done to lead to a constructive conclusion and recommendations.

Discussion:


Recently, food poisoning became one of the common prevailing problems in Sudan. The prevention of food poisoning is human attitude and behaviour which is better than cure. Mothers in the home are more contact to food preparation and cooking, they have to be aware about the diseases could be transmitted through food and the methods to prevent the transmission.

This study is unique in matter that food poisoning is neglected in developing countries; it also will provide a base for coming further studies.

This study conducted among mother in Alemtidad area to assess the level of knowledge regarding preventive measure of food poisoning. This study targeted the mothers using a descriptive cross-sectional approach using random sampling method. Tool of data collection is he pre-coded design structured questionnaire.

The study conducted among mothers in Alemtidad area; their age ranged between 19 and 90 years with the mean age 38 ± 11 years. From those mothers 79% live in unhealthy house, having good level of economic status and having acceptable educational level comparing to national and regional standards.

The study aims to assess the level of mothers’ knowledge regarding preventive measures of food poisoning. It was found that; most women are knowledgeable about the hand washing as preventive measure of food poisoning and less knowledgeable about washing vegetables as preventive measure of food poisoning and few numbers of mothers knowledgeable about appropriate cooking as preventive measure of food poisoning.

Furthermore, the level of the mothers’ knowledge about preventive measure of food poisoning was investigated. The relationships of mother knowledge to other factor were not statistically significant. Furthermore this study shows that; level of mothers’ knowledge is not in a relation with housing Condition.

It supposed that more educated mothers are more knowledgeable, but the findings of this study showed that there is no statically significant different between educated mothers and illiterate mothers, since p-value less than 0.05. The findings from this study are in contrast to the finding from Indian study which showed that; the mothers’ education is predictor for food poisoning mothers; knowledge. A survey was conducted to investigate knowledge, attitudes and related behavior on food-borne diseases and food-handling practices among consumers in one region of Italy.

This opposite finding from Italy study about the educational level of mothers is not a factor influencing the level of mothers’ knowledge about food poisoning.

The mothers in Alemtidad aware about the four diseases transmitted by food; 87.8% of mothers mentioned diarrhea, 84.4% mentioned food related cholera, 90.0% mentioned food related food poisoning, and 88.9%% mentioned food related dysentery. This finding is contradicting to the findings from a study conducted in Italy to investigate the consumers’ knowledge, attitude and related behaviour concerning foodborne diseases and food-handling practices. The Italy study showed that only 11.1% correctly indicated six related different food vehicles; education level was a predictor of this knowledge which is on contrast to this study since the educational level of mothers is not a factor influencing the level of mothers’ knowledge about food poisoning.

Although there have been scarcity in studies on mothers’ knowledge about food poisoning, the present study is unique in several ways. First, the topic is touching many population and all age groups. Second is the importance and effectiveness of preventive measures in our daily life. Third, this research identifies key determinants of mothers’ knowledge, rather than simply documenting what mothers should do. The findings have implications for increasing mothers’ awareness and then the practices in their house surroundings.
Conclusion
This is a descriptive, cross sectional community-based study, it was conducted in Alemtidad area during period extended from September, 2012 and ended by the December, 2012, to assess the mothers’ knowledge regarding preventive measures of food poisoning. It involved 88 mothers chosen by simple randomization sampling. The data were collected by using interview questionnaire, and then was analyzed using suitable tests of SPSS version 20.

From the results of this study, the researcher concludes that; mothers' knowledge about prevention for food poisoning in their daily life practices is satisfactory about hand washing, washing vegetables, and appropriate cooking as preventive measures for food poisoning.

Mothers' education level, economic status, and house type are with no significant relation with level of mothers’ knowledge about food poisoning.

Recommendations



The researcher recommends:

  • Health education for mothers about prevention of food poisoning should be held in their communities by Community Health Nurses.
  • Community Health Nurses should take a more active role and should set their priorities for providing health advices towards common home prevailing problems.
  • Raising mothers and school children about preventive measures for food poisoning.
  • Spreading awareness about checking food labels and reporting to the health authorities in case of food poisoning also the need of the hour.
  • Further studies to be conducted with different design, different location, different approach such as qualitative and interventional studies.

    Authors’ contributions



  • The main author, Esra Hassan, BSc. Nursing. She is the main investigator and responsible for the data collection and analysis and intervention programme.
  • Waled Amen Mohammed Ahmed, Ph.D., He is supervisor of this study.
    Acknowledgment
  • We would like to express the sincerest gratitude, indebtedness and appreciation to UMST President, Academic Secretary for giving me this great opportunity of researching.
  • To the Professor Awatif Ahmed Osman, Dean of Nursing Faculty
  • Last, but not least, I express My grateful thanks extend to the all mothers who participated in this study for their cooperation that made this study possible.

    References



    1. GILBERT RJ: Staphylococcal food poisoning and botulism. Postgraduate Medical Journal 1974, 50:603-611.
    2. Bottemiller H: New Estimates Lower Incidence of Food Poisoning. Food Safety News 2010.
    3. World Health: Food poisoning; a more common affliction than we think. 2009.
    4. Olea A, Díaz J, Fuentes R, Vaquero A, García M: Foodborne disease outbreaks surveillance in Chile. Unbound MEDLINE 2012, 29
    5. Cunha JP, FACOEP D: food poisoning. Emedicine health 2012.
    6. Blouw M, Embil JM: Taking a Bite out of Food Poisoning. The Canadian Journal of CME 2005.
    7. WHO: Food Safety Issues; Guidance for Establishing and Strengthening Prevention and Response Systems. Geneva: Department of Food Safety,; 2012.
    8. Health-Sudan FMo: Sudan Household Health Survey. Khartoum; 2010.
    9. Food poisoning
    10. Mayor S: Regulation has not reduced food poisoning in Britain. BMJ 1997, 315.

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