The Cambridge advanced learners dictionary defines ethnic minority as "a national or racial group living in a country or area which contains a larger group of people of a different race or nationality". According to Schratz et al. 2010, ethnic minority groups are often excluded and marginalized thus making them particularly vulnerable to certain diseases caused by micro-organisms. The UK Office of National Statistics (ONS) in 2011 estimated that about 11.3 ethnic minorities currently live in the UK (ONS 2011) with about 2.1% living in Wales (Public Health Wales 2012). Previous researches in the UK have shown that ethnic minorities have higher rates of diseases such as diabetes (Memon eta l. 2002), coronary heart diseases,( Mental health foundation 2012) and mental illnesses (Chaturvedi, 2003). However, there is dearth of information about the burden of food borne illnesses and consequently, food safety knowledge and practices in this category of people below par, as only few studies have been conducted in that area. Available reports from the US suggest that food borne illnesses are higher among Blacks, Hispanic, and Asian population than the Caucusian population (Alexander 2012).
This study therefore aims to assess the knowledge, risk perception and self reported practices among multicultural ethnic minority young adults residing in Cardiff, UK.
FOOD BORNE DISEASE.
The manner in which people in these homes prepare their local meal (including those for sale to the public) have been identified to be below UK food safety standards, the resultant effect of this is an increase in food borne illnesses and infections in the city. Estimate show the prevalence of food borne illnesses amongst those from multi-cultural backgrounds as a result of the lack of food safety knowledge in the UK is on the increase, a recent study carried out by the public health department of wales (2009), confirmed salmonella infection from food prepared with raw beef had increased phenomenally. According to McCarthy, et al., (2007), although the public is increasingly concerned about food-related risks, the rise in food poisoning cases suggests that people still make decisions of food consumption, food storage and food preparation that are less ideal from a health and safety perspective. Food, although vital to human existence, also has the capacity to transmit disease from one human to another by serving as a growth medium for bacteria which can cause diseases (Fiore 2004). Diseases which occur as a result of the intake of contaminated food are referred to as food borne diseases.
Food borne diseases as defined by the World Health Organization (WHO, 2007) are "diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food." A disease caused by consuming contaminated food or drink. Myriad microbes and toxic substances can contaminate foods. There are about 250 known food borne illnesses (FSA, 2011), the majority are infectious and are caused by bacteria, viruses, and parasites. Some other food borne diseases may be caused by poisonous toxins or chemicals contaminating the food and entering the body through the gastrointestinal tract and often causing symptoms which may likely be nausea, vomiting, abdominal cramps and diarrhea. Many microbes can spread in more than one way, so it may not be immediately evident that a disease is food borne. There have been many occurrences of food borne diseases worldwide, many of which have been difficult to estimate. However, about 1.8 million deaths from diarrhea diseases was reported in 2005 alone, out of many other food borne illnesses (WHO, 2007), which the world health organization suggests that a great proportion of these cases can be attributed to contamination of food and drinking water. Food borne illnesses, when they occur usually affect a large proportion of individuals in a society, leading to the outbreak of disease (WHO 2007), these outbreaks has thus been defined as "the occurrence of two or more cases of a similar food borne disease resulting from the ingestion of a common food" (WHO 2008).
In the United States of America (USA), the record of food borne diseases outbreak is about 76 million each year, of which about 5000 individuals die as a result and about 325,000 are hospitalized (WHO, 2007). Some examples of food borne diseases outbreaks include the outbreak of salmonellosis which occurred in the USA in 1994 as a result of contaminated ice cream affecting up to 224,000 individuals (WHO 2007). Also, a hepatitis A outbreak was reported in China in 1998 which was as a result of the consumption of contaminated clams, affecting about 30,000 individuals. Th echolera outbreak in Haitii in 2010 is another classical example of a food borne disease, investigations by the united nations reveales that the cholera most likely started in a united nations military base but ended up causing an epidermic which affected six hundred thousand people (600,000) and killing about a thousand others. Closer home here in the United Kingdom, 137 outbreaks were reported between 2008 and 2010 (HPA, 2012).
Even in industrialized countries, it is estimated that up to 30% of the population may be affected by food borne illness (WHO, 2012). Contaminated foods are not necessarily meals from restaurants, pub places or eateries alone, they can also be self prepared. In the United Kingdom, it is estimated that about 1 million people suffer from food borne diseases annually among which 20,000 receive hospital treatment and 500 ends up in fatalities (Foods Standards Agency 2011). In addition to the disease burden, the economic burden of disease is also high, costing the UK about £2 billion pounds each year (Society for General Microbiology, 2012).
SOME COMMON CAUSES OF FOOD BORNE DISEASES
Causes of food borne diseases include pathogenic bacteria, moulds (mostly found on stale foods and not properly preserved meals), protozoa, parasites (Larson 2006) and viruses. Bacteria are naturally present in our environment and can be on food items from the time they are purchased but the pathogenic ones are responsible for food borne illnesses (USDA, 2011). Bacteria grow rapidly between 400F -1400 F (Fahrenheit); therefore, food should be kept at an appropriate temperature to prevent bacterial growth (USDA 2011). Examples of common bacterial food borne micro organisms include Salmonella which causes salmonellosis. Prior to 2010, Salmonella was the leading cause of food borne diseases in the UK, but it was overtaken by Campylobacter, and it currently contribute about 13% to the food borne diseases burden in the UK (SGM, 2012). The types of foods associated with salmonellosis are eggs, poultry foods and other types of meat, raw milk and chocolate (WHO, 2007). Between 1992 and 2010, a total number of 1,175 Salmonella outbreaks was reported in England and Wales to the Health Protection Agency.
Campylobacter jejuni is a bacterium which causes campylobacteriosis, an illness characterised by abdominal cramps, fever and diarrhoea ( SGM, 2012). In 2010, it became the leading cause of food borne illnesses in the UK responsible for about 30% of reported cases (FSA, 2012). It is however unclear whether the increase in campylobacter food borne diseases is due to a true increase in incidence or due to an increase in reporting or the two combined (Food Standards Agency (FSA, 2011). Foods like raw milk, undercooked or raw poultry food and drinking water can be sources of this food borne disease. Escherichia coli O157 is another common bacterial cause of food borne illnesses though less common than the two previously discussed. It constitutes about 2-3% of food borne illness in the UK (SGM, 2012) and some of its symptoms include abdominal cramps and intestinal bleeding. Foods most likely to be contaminated by E Coli include raw meat, raw milk and salads. Other important pathogenic bacteria causing food borne illnesses include Listeria monocytogenes which constitutes about 2-3% of food borne illnesses in the UK and is responsible for the highest number of food related deaths, Clostridium perfringens, Bacillus cereus and Staphylococcus aureus (FSA, 2011).
Viruses account for about 30% of food borne illnesses (SGM 2012). About 200,000 cases of food borne illnesses occurring in England and Wales annually are caused by noroviruses (FSA, 2011), other examples of viruses causing food borne illnesses include hepatitis A virus (HAV) which causes hepatitis A (Fiore, 2004), rotaviruses and enteroviruses (Cunha, 2012). Parasites unlike the above bacteria and viruses , hardly cause food poisoning, however, they are only passed through contaminated water which causes mild symptoms which can be long lasting, examples are, Giardia which causes mild diarrhae, Cryptosporidium which causes mild diarrhea also, and Toxoplasma causing headache, eye pain and blurred vision. (Cunha 2012).
Food borne outbreaks reported to the Health Protection Agency, England and Wales, 1992 - 2010 (by pathogen)
Year
Salmonella spp.
Viruses
Campylobacter spp.
E Coli O157
L. monocytogenes
1992
142
12
4
4
0
1993
133
27
6
6
0
1994
104
40
8
3
0
1995
104
30
4
6
0
1996
102
17
6
8
0
1997
128
21
8
6
0
1998
65
16
13
7
0
1999
49
13
8
9
1
2000
39
22
10
9
0
2001
42
11
3
5
0
2002
36
15
11
2
0
2003
47
9
3
1
3
2004
37
7
4
3
1
2005
34
11
7
4
0
2006
29
7
0
5
0
2007
27
5
3
3
0
2008
21
1
4
3
1
2009
28
18
13
7
1
2010
8
10
18
2
2
Total
1175
292
133
93
9
Source: HPA 2012
The above table shows the key food borne disease pathogens monitored by the Food Standards Agency as part of its strategy to reduce food borne disease England and in Wales.
Microbial risks in domestic food preparation and handling.
Food borne diseases can result at any point in time between the farm and the dinning table, in order to prevent the occurrence, the producer, processor, transporter and consumer will all have to play vital roles (Bramley, 2000). Consequently, as much as it can affect quite a large number of individuals in a country who consume food from the same source, it can also be found at homes of individual who personally prepare their meals. There is therefore a need to focus on the possibilities of food borne diseases occurring in the home as numerous microbiological studies have shown immense presence of pathogenic bacteria in food prepared at home and consumed at home ( Lasasso et al. 2012). Food borne disease cases attributable to foods consumed in private homes are three times more frequent than those arising from foods consumed in public establishments (Sanlier, 2008). According to Kennedy (2011), the most common sources of food borne diseases outbreak in England and Wales were inappropriate storage, inadequate cooking and cross contamination most especially in individual homes.
It was further expressed that in the report presented to the European food safety authority, the most common setting for food borne disease outbreak was that of the private household, since an estimated 85% of cumsumers in the UK are known to cook their own food at home at least once a day. Griffith (1994) conducted surveys which showed that, family outbreaks of food poisoning are quite important and that domestic knowledge and practices relating to the prevention of food borne diseases and illnesses maybe inadequate, at such focus should be on consumer's house hold hygiene. In addition, Redmond (2003) stated that a large amount of food borne illnesses reported in Europe, North America, Australia, and New Zealand are as a result of unsafe food preparation practices by consumers at home which has called for an international concern about consumer food safety and domestic food-handling practices. To corroborate the above, Jevsnik et al. (2008) in a study of Slovenian consumers' food safety knowledge and practices during purchase, transportation and storage of food, as well as food handling practices at home, found that most consumers wash their hands in the kitchen, while fewer people wash in the bathroom, also that less than 50% dry their hands with kitchen cloth intended for drying hands, while others make use of cloths intended for cleaning dishes to dry their hands.
Proper hygiene practices in the home will likely prevent the proliferation of food borne diseases. On the other hand, unsafe food hygiene practices results in cross contamination, as it has been found that pathogens spread via cross contamination in domestic kitchens e. g. from dish clothes, knives, sinks e. t. c (Kennedy et al. 2011). Medeiros et al. (2001) corroborates the study of Kenedy and his group, stating that the five major control factors for pathogens include "personal hygiene, adequate cooking, avoiding cross-contamination, keeping food at safe temperatures, and avoiding foods from unsafe sources". It was further expressed that pathogens as a result of poor personal hygiene have more records.
Foods that are potentially contaminated with pathogens causing food borne illness are constantly brought, prepared, handled and consumed at home. Even when foods brought into the home is not contaminated, by virtue of improper handling method, preparation and storage methods, that kind of meal can attract pathogens within the home, therefore, need for proper home hygiene, proper preparation process and proper food storage techniques. According to WHO (2012), there are five key principles of food hygiene and they are;
Prevent contaminating food with pathogens spreading from people, pets, and pests.
Separate raw and cooked foods to prevent contaminating the cooked foods.
Cook foods for the appropriate length of time and at the appropriate temperature to kill pathogens.
Store food at the proper temperature.
Do use safe water to cook
Food home hygiene includes proper hand washing before handling food, and even during food preparation, washing hands after using the toilet, good sanitization environment e. t.c. The reason for this is because most pathogens causing the food borne diseases are found on surfaces of kitchen utensil, or carried on our hands and can easily be transferred into food, thereby causing food borne illness.
There is also need to always separate raw foods from cooked foods, and separate kitchen utensils should be used in handling them. Most raw foods especially poultry foods carry micro organisms that are transferrable to other foods. The way food is prepared at home is also vital, raw foods are to be cooked thoroughly in order to kill the micro organisms they may carry. Foods like soups and stews should be at a boiling point of 700C and for meat and poultry food, it is more ideal to make use of thermometer. Asides the issue of personal hygiene and proper preparation in the home, in order to reduce the risk of food borne diseases, there is need to address the issue of proper food storage in the home. The appearance of some common pathogens on food could be as a result of food storage techniques which are not ideal. Most meals have the normal temperature at which they are best preserved. For example cooked food should not be left at the room temperature for a period over two hours; perishable foods and cooked foods refrigerated at a temperature below 50C; food should not be stored for too long in the refrigerator, and frozen food must not be thawed at room temperature. All these are simple food safety advises which when implemented can go a long way in reducing the cases of food borne diseases from homes.
As mentioned earlier, Medeiros et al. (2001) put foward the five major control factors for pathogens, which include:
personal hygiene,
adequate cooking,
avoiding cross-contamination,
keeping food at safe temperatures,
and avoiding foods from unsafe sources.
A study to evaluate food safety knowledge of consumers in Ireland and establish the level of bacterial contamination shows the effect of basic food hygiene knowledge on hygienic practice and identified the need for educating consumers in specific areas that has to do with their personal hygiene which includes hand washing and drying techniques (Kennedy et al.l 2005). Furthermore, in their survey, consumers who scored better in terms of basic food safety knowledge had reduced incidence of food-associated illnesses. Also, lack of good hygiene practices results into cross contamination as it has been found tha pathogens spread via cross contamination in the domestic kitchen. E. g from dish clothes, knives, sinks e. t. c (Kennedy et al., 2005a; Kusumaningrum et al., 2003; Gorman et al., 2002; Hilton and Austin, 2000; Boer and Hahne, 1990 cited in Kennedy et all 2011). According to Griffith (1994), surveys have shown family outbreaks of food poisoning are quite important and that domestic knowledge and practices relating to the prevention of food borne diseases and illnesses maybe inadequate, at such focus should not be removed from consumer's house hold hygiene.
Redmond (2003) stated clearly that "epidemiological data from Europe, North America, Australia, and New Zealand indicate that a substantial proportion of food borne disease is attributable to improper food preparation practices in consumers' homes." And this to him has called for an International concern about consumer food safety and domestic food-handling practices. Jevsnik et al.l (2008) in his study of the Slovenian consumers' food safety knowledge and practices during purchase, transportation and storage of food, as well as food handling practices at home discovered that most consumers was their hands in the kitchen ,while lesser persons wash in the bathroom, also that less than 50% dry their hands with kitchen cloth intended for drying hands, others make use of cloths intended for cleaning dishes to dry their hands. He therefore, concluded that effective hand washing and drying techniques was not properly practiced by a significant proportion of people during food preparation.
Food Safety at Home
As a result of the huge health and financial burden constituted by food borne illnesses, it became expedient for consumers negative practices to be altered and knowledge of food safety practices be promoted in every way especially among consumers necessitating the adoption of a resolution in 2000 by the World Health Organization to recognize food safety as an essential part of public health (WHO, 2000). Food safety is defined as a highly significant and important scientific discipline that deals with the handling, preparation, and storage of food in ways that prevents food borne illnesses (Sanlier, 2008). It was expressed to be the assurance that food will not cause harm to the consumer when it is prepared or eaten according to its intended use (Larson, 2006)
Knowledge, attitudes, self reported practices and risk perspectives of consumers in the prevention of food borne diseases
The problem facing the safety of food has to do with consumer's practice, knowledge of food safety and their risk perspective (Jacob 2010). The risk perception of consumers will determine their safe food practice behaviour. Therefore, in order to ensure food safety, it becomes paramount for consumers to be concerned about all conditions and measures that are necessary to ensure the safety and suitability of food at all stages of the food chain" (Larson 2006). Food becomes unsafe due to some factors like biological hazard which has been discussed earlier, physical hazards, and chemical hazards. Both biological hazards and physical hazards can partly be controlled if good personal and environmental hygiene can be maintained. The knowledge and practices of consumers at home seem not to be sufficient. For example in a study to evaluate food safety knowledge of consumers in Ireland and establish the level of bacterial contamination, the effect of basic food hygiene knowledge on hygienic practice was shown and the need for educating consumers in specific areas that has to do with their personal hygiene which includes hand washing and drying techniques was identified (Kennedy et al. 2005). Furthermore, in this survey, consumers who scored better in terms of basic food safety knowledge had reduced incidence of food-associated illnesses. A study by (Jevsnik et al. 2008) shows gaps in food safety knowledge and practices of consumers that occur from shopping to eating.
