Knowledge about kitchen hygiene and associated factors in caregivers in a peri-urban area of Lima

Introduction

Poor food storage and handling as well as poor kitchen hygiene contribute to a large number of foodborne diseases (FDs).¹ Up to 87% of food poisoning incidents originate at home due to improper food handling.^2,3 FDs are a threat to public health in this century due to the role of the household in the transmission and acquisition of foodborne diseases. The most frequent causes are diarrheal pathogens,⁴ on contaminated surfaces such as kitchen towels⁵ and chopping boards in the kitchen⁶ as they can harbour a large number of coliforms. The most affected are children under 60 months old.⁷ In the event of the child having diarrhea mothers tend to offer less food and the nutrients needed for growth decrease, and can result in malnutrition and make them more prone to illnesses,⁸ infections, and inadequate development.⁹

In many countries, hygiene and infant feeding processes become a highly vulnerable activities due to poor handling of the food,^10,11 and affect 13.2% of children aged 6 to 60 months. Research in a peri-urban area of Lima reported that 21.8% of the children who required hospitalization were referred for diarrhoea.¹²

Despite education efforts, consumers develop unsafe food storage and handling behaviors, contaminating sponges, cloths and kitchen towels, making them reservoirs and vectors of bacteria in the kitchen and contaminating other surfaces.¹³ Peru has a food sanitary regulation, published by the Dirección General de Salud Ambiental DIGESA,¹⁴ which regulates the products for sale and publishes a consumer defense code. The Health Ministry, Ministerio de Salud MINSA has published manuals on good food handling practices, aimed at restaurants, sale stores, but there are none designed and written for mothers in the home.

Mothers play an important role in the prevention and control of Foodborne illness with regard to hygiene measures, including production, storage, food handling and hygienic practices.¹⁵ Unwashed hands, fecal contamination, microbial load in water, flies, parasites, the presence of animals in the kitchen, poorly washed containers, and an unhygienic environment contaminate food.¹⁶ Studies of mothers in the rural jungle and highlands of Peru reported that only 20% of them washed their hands before touching food and only 6% of those who did wash their hands used soap.¹⁷ In other countries mothers who were observed to practice optimal cleaning of foods have been associated with better health and less disease in the children.¹⁸

There is information showing that the economic and demographic aspects (e.g., rural living, poor access to water) are associated with mothers’ knowledge with regard to kitchen hygiene. In this study we proposed to establish whether the mothers’ sociodemographic characteristics were related to good knowledge about food management in the home or not, in a population of mothers in a peri-urban area of Lima. The results can be an opportunity to understand this group of mothers and their role in food management, since most of them are the mainly responsible for the preparation of meals for their families.

Methods

We conducted a cross-sectional observational study. The study was carried out in a peri-urban area in Lima, Peru in the human settlements of San Pablo and Huáscar V (SJL).

Research execution

We visited the mothers' clubs and comedores populares (community kitchens) in Huáscar V and San Pablo, in San Juan de Lurigancho (a large relative poor “shanty town” communities in the outskirts of Lima city, to ask permission from the people in charge of these organizations and to inform them about the activities that were going to be carried out. This included approaching the mothers during the morning shift, very close to lunchtime. Only in Huascar V, the sample was completed interviewing mothers at the health facility where mothers take their children for health checks, doctor appointments and vaccinations. Two local field workers assisted with the face-to-face interviews. Prior to starting the questionnaire (as described in Table 1), the informed consent process was conducted. Detailed information about the study was provided to each potential participant, who was given the opportunity to ask questions and clarify doubts. After that, if they agreed to participate, they proceeded to sign the informed consent form. The questionnaires were completed in almost two months between April and May, 2018. Mothers were interviewed at the comedores (local community kitchens) or, if necessary, at home.

Results

A total of 250 caregivers were interviewed: 91.2% (114) of them were mothers living in the Huascar V and 95.2% (119) were from San Pablo community. Fifty-four percent of the caregivers were between 21 and 30 years old. The highest education level achieved in Huascar V and San Pablo was secondary school (68.8% (86) and 72.0% (90), respectively). In Huascar V and San Pablo, the majority of the mother were living with a partner (68.0%(85) and 70.4%(88), respectively), and were housewives (82.4%(104) and 78.4%(98), respectively), had houses built of brick 68.0% (85) and cement 68.8%(86), had a bare floor 70.4%(88) and earth floor 69,6%(87) respectively), did not have drinking water (88.0%(110) and 88.8%(111), respectively), no gas stove (96.8%(121) and 96.0%(120), respectively), refrigerator (48.8%(61) and 51.2%(64), respectively), radio and TV set (79.2%(99) and 84.8%(106), respectively), and no microwave oven (82.4%(103) and 84.8%(106), respectively) respectively, see Table 2.

Table 3 shows the percentage of questionnaire answers about knowledge of kitchen hygiene in Huáscar and San Pablo, where the mothers or caregivers were surveyed.

The caregivers from Huáscar responded affirmatively to the questions related to knowledge about cleanliness and storage in the kitchen (5, 6, 7, and 8) in a higher proportion than the caregivers in San Pablo.

Ninety-five percent of mothers agree that sponges used to wash utensils may be contaminated, and 90.8% state that cloths used to clean surfaces may also contain bacteria and microorganisms. 93.2% consider that the garbage bag can be open as long as the utensils are protected or covered. 99.6% of chopping boards can cause contamination to other products. 74% consider that glass is of high quality for storage; 87.6% consider that utensils would be clean with dishwashing detergent; 84.4% state that food consumption can cause illness in children; 60% consider that if the table where the child consumes food is contaminated, it will also contaminate the food; 62% of mothers or caregivers consider that diarrhea and discomfort in children can have their origin in the food.

In Table 4, we can see that the bivariate regression analysis did not identify any predictive capacity of any evaluated sociodemographic characteristic on the level of knowledge of kitchen hygiene.

However, we can observe that in the age group older than 30, there was a higher proportion of caregivers with good knowledge of kitchen hygiene compared to the group aged 30 years or younger.

In addition, when the caregiver's role was filled by the grandmother or another person, most of them did not have a good level of knowledge of kitchen hygiene.

Furthermore, when the caregiver had reached a secondary level of education, most of them showed a good level of knowledge about kitchen hygiene in contrast to the group with primary or higher education.

Discussion

In the investigated areas of SJL (San Pablo and Huáscar V), more than half are between 21 and 30 years of age. Their marital status is not married but living together in the majority. The surveyed mothers were mainly housewives and had a secondary education level. The vast majority of households lacked water and sewage services.

Although no significant associations were identified between the variables studied and the level of knowledge of kitchen hygiene, the mothers’ education and age in other studies were associated with knowledge of safe food handling and consumption in the home.²¹ In this regard, studies in Africa have shown that caregivers, especially the younger ones, drop out of education or even abandon it, thus affecting their future.²² Another study developed in communities in Peru showed an intervention for handwashing in child feeding, where 12% of children were identified and this was increased to 32%.²³

Years of school attendance could improve hygiene knowledge, as well as generating a larger social network in which mothers or caregivers interact. Likewise, having a radio in a large percentage of households can be a channel to increase mothers' knowledge and good practices and to obtain appropriate cooking behaviours, through hygiene educational programs. In other studies, mothers’ occupations (homemaker or work outside the home) was shown to be associated with more satisfactory hygienic practices in relation to food poisoning prevention.^19,24

The WHO and the Food and Agriculture Organization of the United Nations mention that unsafe food affects the most vulnerable groups, and to promote the improvement of food safety. They should be kept informed, foodborne disease can be prevented with optimal handling, some of the measures that we have assessed here in this study, are related to the cleanliness where food is prepared, including avoiding mixing raw and cooked food, the cooking of food should be complete, use of safe raw materials and use potable water.²⁵

Mother with lower socioeconomic status have been found more likely to experience food products with a high microbial count.²⁶ Our study presented the limitation of not including the microbial count. Studies such as Gil et al., 2014, have shown that this measure has been an accurate indicator to determine families’ household cleaning condition.²⁷

Likewise, demographic and socioeconomic factors may have contributed to unsafe food handling behaviours and microbial contamination risks during preparation.²⁸ Poor food handling has been evidenced among low-income consumers.²⁹

Hygiene education, improved treatment, storage and water connections are necessary.³⁰

This study was conducted in a peri-urban area of Lima; some of our limitations may be due to the fact that the entire study population had the same socioeconomic status. Through an evaluation that includes heterogeneous populations, we could obtain complementary results regarding the influence of other variables not examined in the present study, that could improve our understanding of kitchen hygiene knowledge. It is important to highlight that data collection through interviews and surveys is prone to the possibility that the information revealed by the participants may be incomplete or not entirely truthful, which could directly impact the validity of the results.

Conclusions

We could not identify a predictive capacity in regard to the level of knowledge of kitchen hygiene in the evaluated sociodemographic characteristics in this sample. Caregivers in these communities should receive more education on treatment, food storage and achieve better health outcomes. Governments are called upon to join the efforts to accelerate efforts to lead education campaigns.

Data availability