DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING FOOD BORNE DISEASES AND FOOD HYGIENE AMONG THE
MOTHERS OF UNDERFIVE CHILDREN IN SELECTED RURAL AREA
M.SC (N) DEGREE EXAMINATION
BRANCH – IV COMMUNITY HEALTH NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
A Dissertation submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032
In partial fulfillment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2019
DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING FOOD BORNE DISEASES AND FOOD HYGIENE AMONG THE MOTHERS OF UNDERFIVE
CHILDREN IN SELECTED RURAL AREA
Examination : M.Sc., (Nursing) Degree Examination Examination month and year : October 2019
Branch & Course : IV – COMMUNITY HEALTH NURSING
Register No : 301726157
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
Sd: _________________ Sd: _________________
Internal Examiner External Examiner
Date: Date:
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,
CHENNAI – 600 032
CERTIFICATE
This is to certify that this dissertation titled, “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FOOD BORNE DISEASES AND FOOD HYGIENE AMONG THE MOTHERS OF UNDERFIVE CHILDREN IN SELECTED RURAL AREA”, is a bonafide work done by M.VIDHUBALA PRISKILLAL, M.Sc.,(Nursing) II year Student, College of Nursing, Madras Medical College, Chennai - 03, submitted to The Tamil Nadu Dr.M.G.R. Medical University, Chennai in partial fulfillment of the requirement for the award of the degree of Master of Science in Nursing Branch – IV, Community Health Nursing under our guidance and supervision during academic year 2017 – 2019.
Mrs.A.Thahira Begum, M.Sc.,(N), MBA., M.Phil., Principal
College of Nursing, Madras Medical College, Chennai -03
Dr. R.Jayanthi, MD, FRCP., (Glasg) Dean
Madras Medical College Chennai - 03
DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING FOOD BORNE DISEASES AND FOOD HYGIENE AMONG THE MOTHERS OF UNDERFIVE
CHILDREN IN SELECTED RURAL AREA
Approved by the Dissertation Committee on 24.07.2018CLINICAL SPECIALITY GUIDE
Selvi.B.Lingeswari, M.Sc(N)., MBA., M.Phil., _____________
Reader in Community Health Nursing, College of Nursing,
Madras Medical College, Chennai -03.
HEAD OF THE DEPARTMENT
Mrs.A.Thahira Begum, M.Sc(N)., MBA., M.Phil., _____________
Principal,
College of Nursing,
Madras Medical College, Chennai-03.
DEAN
Dr.R.Jayanthi, MD., F.R.C.P. (Glasg)., ___________
Dean,
Madras Medical College, Chennai-03.
A Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI
In partial fulfillment of the requirement for award of the degree
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
ACKNOWLEDGEMENT
“ I Can do all things through Christ who strengthens me”
- Bible First and foremost my gratitude goes to GOD LORD ALMIGHTY for his abundant blessings and sustaining me in all my endeavour, giving me an ample resilience, exhortation and patronage to complete this research work, so that today I can stand proudly with my head held high.
I am highly indebted to express my deep sense of gratitude to DR.R.Jayanthi, MD., FRCS(GLASG)., Dean, Madras medical college, Chennai-03, for granting me permission to conduct the study in this prestigious institution.
My special words of thanks should also goes to Institutional Ethics Committee, of Madras Medical College, Chennai -03, for giving me an approval to conduct this study
It is my proud privilege to express my sincere thanks and whole hearted gratitude to Mrs.A.Thahira Begum M.Sc(N)., MBA., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai -03.
Who shower her blessings in my tough time. She always views young people not as empty bottles to be filled, but candles to be lit. She tugs, pushes and leads me to the next plateau. I bow my head for respect her treasured guidance, motivating talk, moral support, and patience that has moulded me to conquer the spirit of knowledge for sculpturing my manuscript into thesis. My respect turns into reverence.
I express my sincere thanks and deep sense of gratitude goes to Dr.R.Shankar Shanmugam M.Sc(N)., MBA., Ph.D., Reader and HOD in Nursing Research, College of Nursing, Madras Medical College,
Chennai -03, for the perfect direction, valuable guidance, constructive criticism, positive appreciation and brainstorming ideas. His own zeal for perfection, passion, unflinching courage and conviction inspired me to laid a strong foundation on research. The investigator feels that words would not be sufficient enough to express his gratefulness which led to the successful completion of the research study.
I am grateful to Selvi.B.Lingeswari, M.Sc(N)., MBA., M.Phil., Reader and HOD of community health Nursing department, college of Nursing, Madras Medical college, Chennai -03, for her keen interest, affection and care shown towards me during my research tenure. Her interest and involvement in my research and concern for my welfare have greatly motivated me .
I express my whole hearted gratitude and immense thanks to Mrs.N.Sathyanarayani M.Sc(N)., Former Lecturer, Mrs.T.Ramani Bai M.Sc(N)., Reader, dept of community health Nursing, Mrs.R.Sumathy M.Sc(N)., Reader, College of Nursing, Madras Medical College, Chennai -03, for their guidance, encouragement, moral support and en - lighting ideas, generous care in completing this study.
I deem it a great privilege to express my sincere gratitude and deep sense of indebtedness to Dr.G.Mala M.Sc(N)., Ph.D., Mr.K.Kannan M.Sc(N)., and Mrs.P.Tamilselvi M.Sc(N)., for their valuable guidance and kind cooperation. I thank for their patience, constant interest, and continuous support through out this study.
With utmost respect I wish to thank Dr.Joy Patricia Pushparani MD., Professor Institute of Community Medicine, Madras Medical College, Chennai -03, for her valuable guidance and encouragement in making this study a grand success.
My earnest and genuine gratitude goes to Mrs.L.Shanthi, M.Sc(N)., former head of the department, community health nursing, college of nursing, Chennai -03, for her valuable guidance, patience, constant encouragement which enabled me to accomplish this study.
I extend my special thanks to all the Readers, Lecturers and Faculty members of college of Nursing, Madras Medical College, Chennai -03, for their support and assistance given in all possible manners to complete this study .
It is my pleasure to express my heartfelt gratitude to Dr.Palani, M.B.B.S., DPH., Director General of Health Services, Chengalpet, for permitting me to conduct the study in the rural area under the ambit of Medavakkam Upgraded Primary Health Centre, Kanchipuram District, Tamil Nadu.
I am grateful to Block Medical Officer and Other Medical Officers in upgraded primary health centre in Medavakkam for giving me permission to conduct the study in Kalaignar Nagar rural area under the ambit of Medavakkam upgraded primary health centre, kanchipuram district.
I owe my special thanks to Dr.A.Vengatesan, M.Sc (Stat)., Ph.D., Retired Deputy Director of Medical Education (statistics), Directorate of Medical Education, Chennai, for his untiring valuable guidance and kind cooperation in the successful completion of statistical analysis and compilation of this research study.
I gratefully acknowledge the experts, Mrs.Shobana Gangadharan, M.Sc(N)., Ph.D., Asst Professor, Department of community health Nursing, Apollo college of Nursing, Vanagaram, Chennai -95, and Mrs.S. Kanchana M.Sc.,(N), Asst Professor, Madha
College of Nursing, Kundrathur, Chennai -95, for their valuable provoking suggestions constructive judgement while validating the tool.
It’s my fortune to gratefully acknowledge Dr.C.Arul Theresa, Ph.D., Asst.Professor, Dept of English, Govt.Arts&Science college, Veerapandi, Theni (Dt), and Dr.P.Umadevi, Ph.D., Asst.Professor, Dept of Tamil, Govt. Arts &Science college, Veerapandi, Theni (Dt), for editing the tool & content in English and Tamil.
I extend my thanks to Mr.Ravi, M.A., M.L.I.Sc., Librarian, College of Nursing Madras Medical College, Chennai-03 for his cooperation and assistance in getting books and journals for this study and also to the librarians of the Tamil Nadu, Dr.MGR Medical University, Chennai, for their co-operation in collecting the related literature for this study.
I owe my great sense of gratitude to Mr.Jas Ahamed Aslam, Shajee Computers and Mr.Ramesh, B.A., MSM Xerox for their enthusiastic help and sincere effort in typing the manuscript with valuable computer skills and also bringing this study into a printed form.
I extend my heartfelt gratitude to the entire mothers who were participated in my study, for their co-operation during the data collection .
Finally I acknowledge the people who mean a lot to me, my wonderful parents Mr.J.Masilamani & Mrs.M.Victoria my lovable brother Mr.M.Vinnarasan, my caring sisters Vimali Isac, Vino Jayakumar, Viji Gopi and their kids Lokesh, Imayan, Jenifer, and Gifta Ida, for showering faith in me and giving me liberty to choose what I desired. What Iam today is all because of these special people. I salute you all, for the selfless love, prayer, support, care and
encouraging words that certainly acted as a paddle and propelled me to have a smooth sail in my academics, Thank you for being my best support.
My heart felt regard goes to my father in law Mr.S.Sathyaseelan
& my mother in law Mrs.S.Susaimary, my sister in law Mrs.S.Jasline Presilda and her family for their love and moral support.
This journey would not have been possible without the meticulous support of my beloved husband Mr.Jose Moses Antony and my lovable kids Sharon Jovia and Riya Jovila who are the pride and joy of my life, for their continued and unfailing love, support and understanding.
Thank you for encouraging me in all my pursuits and inspiring me to follow my dreams. I consider myself the luckiest in the world to have such a lovely and caring family, standing beside me with their love and unconditional support.
I am greatly indebted to my ever loving sister Mrs.G.A.Velvezhi, my friends Mrs.D.Madhurima and Mrs.N.Charulatha, all my classmates, my department friends and other friends who helped me during the course of my study.
Finally, I extend my special thanks and gratitude to one and all those who have been directly and indirectly helped me to complete the thesis in grand success as well as express my apology that I could not mention personally one by one
THANKS TO ALL
TABLE OF CONTENTS
CHAPTER CONTENT PAGE
NO
I INTRODUCTION 1
1.1 Need for the study 8
1.2. Statement of the problem 14
1.3. Objectives of the study 14
1.4. Operational definitions 14
1.5. Hypothesis 15
1.6. Assumptions 16
1.7. Delimitation 16
1.8. Conceptual framework 16
II REVIEW OF LITERATURE 20
III METHODOLOGY 41
3.1. Research approach 41
3.2. Research design 41
3.3. Setting of the study 42
3.4. Duration of the study 42
3.5 Study population 42
3.6. Sample 43
3.7. Sample size 43
3.8. Sampling technique 43
3.9. Research variables 43
3.10. Development and description of the tool 44
3.11. Score interpretation 45
CHAPTER CONTENT PAGE NO
3.12. Content validity 46
3.13. Ethical consideration 46
3.14. Reliability of the tool 47
3.15. Pilot study 47
3.16. Data collection procedure 48
3.17. Data analysis 49
IV DATA ANALYSIS AND INTERPRETATION 52
V DISCUSSION 77
VI SUMMARY, IMPLICATION,
RECOMMENDATION, LIMITATION AND CONCLUSION
85 6.1. Summary and findings of the study 86
6.2. Implications of the study 88
6.3. Recommendations for the further study 91
6.4. Limitations 91
6.5. Conclusion 92
REFERENCES APPENDICES
LIST OF TABLES
TABLE
NO TITLE
3.1 Intervention protocol
4.1 Distribution of demographic variables of the study participants
4.2 Distribution of demographic variables of the study participants
4.3 Description of pre-test knowledge level of the study participants
4.4 Description of post-test knowledge level of the study participants
4.5 (A) Comparison of pre-test and post-test knowledge level
4.5 (B) Comparison of domain wise pre-test and post-test knowledge score
4.6 Effectiveness of structured teaching programme and generalization of knowledge gain score
4.7 Association of post-test knowledge with selected demographic variables of mothers
LIST OF FIGURES
FIG NO TITLE
1.1 PERI Model of public health
1.2 Conceptual framework based on Rosenstock’s Becker and Maiman’s health belief model
2.2 Schematic representation of the research methodology 4.1 Age distribution of mothers
4.2 Educational status of the mothers 4.3 Occupational status of the mothers 4.4 Educational status of the husband 4.5 Occupational status of the husband 4.6 Monthly family income
4.7 Religion
4.8 Number of under five children 4.9 Dietary pattern
4.10 Water facility in the home 4.11 Toilet facility
4.12 Drainage system
4.13 Pre-test level of knowledge score 4.14 Post-test level of knowledge score
4.15 (A) Comparison of pre-test and post-test level of knowledge score
4.15 (B) Comparison of domain wise pre-test and post-test knowledge score
4.16
Box plot compares the mothers knowledge score before and after the administration of structured teaching programme
4.17 Association between post-test level of knowledge score and age of mothers
4.18 Association between post-test knowledge score and educational status of mothers
4.19 Association between post-test knowledge score and monthly family income
4.20 Association between post-test knowledge score and number of under five children in the family
APPENDICES
S.NO CONTENT
1 Certificate of approval from Institutional Ethics Committee 2 Permission letter from DDHS, Chengalpet for conducting
study
3 Certificate of content validity
4 Information to participants and Informed consent-English and Tamil
5 Certificate of English editing 6 Certificate of Tamil editing
7 Tool for Data collection - English and Tamil
8 Lesson plan for structured teaching programme - English and Tamil
9 Flash cards – Tamil 10 Photographs
LIST OF ABBREVIATIONS
ABBREVIATION EXPANSION
WHO World Health Organization
CDC Centers for Disease Control and Prevention
NIN National Institute of Nutrition
IDSP Integrated Disease Surveillance Programme
ADD Acute Diarrhoeal Diseases
FERG Food borne Diseases Epidemiology Reference Group
FSSAI Food safety and Standard Authority of India
FAO Food and Agricultural Organization
FBD Food Borne Diseases
US United States
CI Class Interval
DF Degree of Freedom
SD Standard Deviation
P Significance
H Hypothesis
STP Structured Teaching Programme
ABSTRACT
Food borne diseases encompass a wide spectrum of illness and remains one of the growing public health problem in developing and developed countries, causing a rise in social and economic burden globally. Children are disproportionately affected by food borne illnesses. Approximately half of the reported food borne illnesses occur in children, with the majority of these cases occurring in children under 5 years of age. These diseases can lead to short and long term health consequences and sometimes can result in death. Food handlers have been found to play a prominent role in the transmission of food borne diseases because of their poor knowledge of safe food handling. Food hygiene encompasses all conditions and measures necessary to ensure safety and suitability of food at all stages of the chain of food production. At household levels, women from the majority of group to handle the kitchen and they are the primary care givers of under five children in our society. Adopting basic hygienic measures while preparing food is vital to minimize food borne infections and outbreaks in the community.
TITLE
A study to assess the effectiveness of structured teaching programme on knowledge regarding food borne diseases and food hygiene among the mothers of under five children in selected rural area . OBJECTIVES OF THE STUDY
The study was conducted 1. to assess the pre -test level of knowledge of mothers of under five children regar ding food borne diseases and food hygiene, 2. to evaluate the effectiveness of structured teaching programme on knowledge regarding food borne diseases and
food hygiene among the mothers of under five children, 3. to compare the pre-test and post-test knowledge scores of mothers 4. to find out the association between the post-test knowledge scores regarding food borne diseases and food hygiene with selected demographic variables .
METHODOLOGY
This study was conducted at Kalaignar Nagar, Medavakkam rural area, Kanchipuram district, Tamil Nadu with 60 samples in quantitative research approach, pre-experimental one group pre-test post-test design was adopted. Prior conducting the study, necessary permission was obtained from Institutional Ethics Committee. Sample selection was done by convenient sampling technique. Mothers of under five children were informed about the study details and informed consent was obtained from each participants. Mothers not willing to participate were excluded from the study. The study period was from February 2019 to march 2019. Pre-existing knowledge was assessed by using structured questionnaires prepared by the investigator and validated by the medical and nursing experts. Questionnaire was prepared by adopting the five key principle on food hygiene by WHO. Components of hygienic measures like food handling and hand washing were covered in this questionnaire. After the pre-test, structured teaching programme was given regarding food borne diseases and food hygiene among the mothers of under five children using flash cards. After 7 days post-test was conducted by using the same tool. Data was entered in MS Excel and analyzed using statistical software SPSS Version 17.0.
STUDY RESULTS
The result of the present study shows that, after structured teaching programme, out of 60 study participants, none of the mothers are having inadequate level of knowledge score, 26.7% of the mothers are having moderate knowledge score and 73.3% of the mothers are
having adequate level of knowledge score. On an average, in post-test after structured teaching programme, the mothers of under-five children have gained 34.50% knowledge score than pre-test score. The result interestingly revealed that there is a statistically significant association found between demographic variables such as age, mother’s education, monthly family income, number of under five children, with knowledge of mothers at the p<0.05 level of significance.
CONCLUSION
Food hygiene is a key component to reduce the burden of childhood morbidity and mortality due to food borne diseases. but knowledge on food borne diseases and food hygiene is low among the mothers of under five children. The present study shows that there is an effectiveness of structured teaching programme on food borne diseas es and food hygiene and also highlights the need to spread importance of proper and regular food hygienic measures through health education programmes and general awareness campaigns that intend not only to enhance knowledge but also promote mothers to pra ctice food hygienic measures strictly and further strengthen their awareness level. Safe food handling leads to healthy food and diseases free life which in turn will have a significant impact on the society, to minimize food borne illnesses and outbreaks in the community.
CHAPTER-I INTRODUCTION
“ Laughter is brightest where food is best ”
– Irish proverb
Food is an important basic necessity and it is a substance that supplies nutrients and energy for growth and development of humans.Good food is essential for good health and it is one of the greatest pleasures in life. Food is also rich in nutrients required by micro organisms and may be exposed to contamination by major sources like water, air, dust, sewage, insects, rodents, utensils, food handlers, preparation techniques as well as eating habits. The fact remains that they all have direct influence on health. Hence it is pertinent to keep food free from contamination. The food is the medicine when it is balanced and at the same time it is the vehicle of disease transmiss ion, if it is liable to contaminate with harmful microbes such as bacteria, viruses, parasites or chemicals / toxins at any moment during its journey from the producer to the consumer.
Food borne disease has become one of the most widespread public health problem in the world today. Globally, billions of people are at risk of food-borne diseases and millions fall ill every year. Many also die as a result of consuming unsafe food. Food borne diseases are defined as infections which are toxic in nature, caused by harmful agents that enter the body through the ingestion of contaminated food and water. Food borne diseases are increasing throughout the world because of urbanization, industrialization, tourism, and also due to mass catering services. Particularly children under the age of five years are at high risk with 1,25,000 deaths every year due to food borne diseases.
Diarrhoea remains the second leading cause of mortality and morbidity among under five children. Worldwide, diarrhoeal diseases are
responsible for more than half of the global burden of food borne diseases causing 550 million people to fall ill and 2,30,000 deaths every year. Children are at particular risk of food borne diarrhoeal diseases with 220 million falling ill and 96,000 dying every year. Diarrhoea is often caused by eating raw or under-cooked meat, eggs, and dairy products contaminated by microorganisms. There are many different microorganisms including bacteria, viruses, and parasites that can cause food borne illness. Eight pathogens are known that cause the vast majority of illnesses, hospitalizations and deaths. Norovirus, Salmonella, Clostridium perfringens, Campylobacter, Staphylococcus aureus, Toxoplasma gondii, Listeria monocytogenes and E.coli. Among these Norovirus, Salmonella, Clostridium perfringens, Campylobacter and Staphylococcus aureus are the top five pathogens that contribute to domestic food borne illnesses resulting in death. The common infections which likely to transmit through the ingestion of contaminated foods are Diarrhoea, Dysentery, Viral hepatitis, Enterocollitis, Typhoid and Paratyphoid fever, etc. Symptoms associated with food borne illness usually depend on the microorganism causing the disease but often include abdominal cramps, vomiting, nausea, fever, diarrhoea, and dehydration. Microorganisms are more common than physical and chemical hazard, accounting for 90% of food borne illnesses. There are many ways in which a microorganism can contaminate food, such as coughing and sneezing by an infected individual, under cooked food and inadequate hand washing. For bacteria to cause a food borne illness, it has to multiply to large numbers under certain conditions such as food, acidity, temperature, time, oxygen and moisture. Viruses and parasites require a host to live and multiply. Viruses do not grow on food: Food serves as a vehicle for viruses and a virus can remain infectious and cause food borne illness if the contaminated food is consumed.
Typically the fecal-oral route is the mode of transmission of viruses. As viruses are not destroyed by normal cooking temperatures, it is
extremely important to practice good personal hygiene. Food handlers suffering with any of the illness strictly not allowed to prepare and handle the food as they are highly transmitting the food borne diseases.
Food borne illness can affect anyone who eats contaminated food.
Handling and preparing the food in a hygienic manner is very important to prevent and avoid food borne diseases. Food hygiene is a broad term used to describe the practices needed to safeguard the quality of food from production to consumption. This is sometime referred to as “Farm to fork ’’or “Farm to plate’’, because it includes every stage in the process from growing on the farm, through storage and distribution, to finally eating the food. It also includes the collection and disposal of food wastes. Throughout this chain of events there are many points where, directly or indirectly, knowingly or unknowingly, unwanted chemicals and microorganisms may contaminate food. Food hygiene is vital for creating and maintaining hygienic and healthy conditions for the production and consumption of the food that we eat.
The term “food hygiene” refers particularly to the practices that prevent microbial contamination of food at all points along the chain from farm to table. Food safety is a closely related but broader concept which means food is free from all possible contaminants and hazards. In practice both terms may be used interchangeably. Utensils, dishes and Proper handling of foods, play a crucial role in food hygiene. Food hygiene also extends in keeping the preparation area clean and relatively germ free. Mixing bowls, Spoons, Pairing knives and any other tools used in the kitchen should be washed thoroughly before us e. Kitchen surfaces and cutting boards should also be cleaned and sterilized time to time. One of the important aspects of food hygiene is cleaning of serving dishes before taking the food to the table but many people do not address this, often the dishes are removed from the cupboard and not washed properly before use. While the dishes are likely to be relatively
clean, a quick rinse with hot water and a small amount of dish washing liquid prevent bacteria from transferring from the dish to the food.
Preventing cross contamination is also an important aspect of food hygiene. Cross contamination can occur when cooking and preparation utensils are used with more than one type of food at a time and unclean material come and contact with clean material. For example, if the knife used to debone a raw chicken is used to chop vegetables for a salad, there is a good chance that contamination will occur and possibly lead to food poisoning.
The five key principle of food hygiene, according to WHO are,
Prevent contaminating food with pathogens spreading from people, pets, and pests.
Separate raw and cooked foods.
Cook foods for the appropriate length of time and at the appropriate temperatures to kill pathogens.
Store food at proper temperature.
Do use safe water and raw materials.
India is being a country with diverse socioeconomic background, wide agricultural practices, various storage processes and habits, dynamic climatic conditions with change in eating habits and life style practices which need special attention towards food hygiene. At household levels, women from the majority of group to handle the kitchen. Educating these mothers about personal hygiene, steps in hand washing, food handling techniques, utensils & dish washing, insects and rodent control are the best ways of promoting the food hygiene and it will helps to prevent the food borne diseases to all the age group in a community especially children below five years of age. Hence the
of under five children towards food borne diseases and food hygiene and to educate them in all aspects.
BACKGROUND OF THE STUDY
“ You don’t need a silver fork to eat good food ”
- Paul Prudhomme
Food borne diseases are of great importance since, it leads to multiple health problems resulting in illness, malnutrition, mortality, and economic loss. The data comes from the World Health Organization (WHO) Food Borne Disease Epidemiology Reference Group (FERG) in 2015. Researchers found the number of FBD cases is expected to rise from 100 million in 2011 to 150-177 million in 2030.This means that by 2030, one out of nine people on average fall sick, up from one out of 12 in 2011.
According to a report by World Health Organization, the magnitude of food borne diseases caused by contaminated food and water significantly contributed to a myriad of health problems. Centre for Disease Control and Prevention further added that poor hygiene practices, inadequate cooking, improper holding temperatures, use of contaminated equipment and poor personal hygiene contributed significantly to the spread of Food borne diseases.
Epidemiological data demonstrates that food is an important factor in transmitting pathogens that cause diarrhoeal illness. Recent data from WHO indicates that globally food borne and waterborne diarrhoeal diseases kills an estimated 2 million people annually. Up to an estimated 70 percent of diarrhoeal episodes among young children could be due to pathogens transmitted through contaminated food. This is because the amount of bacteria in contaminated food, when it remains at ambient temperature for extended periods, is much higher than in
water. Food provides a medium for exponential growth. Contaminated weaning foods are potentially a major contributor in low-income settings. Around 72% of death associated with diarrhoea happen in the first two years of life and diarrhoea risk increases during the infant weaning period, with potentially long -lasting effects, as in many conditions and infants may be exposed to infective doses of food borne pathogens. Repeated episodes of diarrhoea in early life can have a long lasting and irreversible impact on an individual‟s nutritional status, by causing loss of appetite, malabsorption, increased nutrient loss and increased metabolism. A quarter (25%) of stunting can be attributed to five or more episodes of diarrhoea before the age of two. WHO recommends that infants be exclusively breastfed for the first six months of life, and that from six months up to two years or older, they should receive safe complementary food. In most countries, breast-fed children aged between 4 to 6 months are given complementary food (such as water, juice, solid and semi solid food) and are thus potentially exposed to food borne pathogens in early life.
World Health Organization (2015) reported that food borne illness outbreaks are reported frequently at national as well as international levels, underscoring the importance of food safety. The global burden of food borne diseases show almost 1 in 10 people fall ill every year from eating contaminated food and as a result 4,20,000 die especially children under 5 years of age are at particularly high risk, with 1,25,000 children dying from food borne diseases every year. It is also reported that the health of people in many countries is affected by consuming contaminated food products. The WHO South-East Asia Region has the second highest burden of food borne diseases per population after the African Region with more than 150 million cases and 1,75,000 deaths a year. Some 60 million children under the age of
five fall ill and 50,000 die from food borne diseases in the South-East Asia region every year.
The National Institute of Nutrition (NIN)(2016) in India reported that infants and children are affected most by food borne illnesses. In India alone about 4,00,000 children (<5 years) die every year due to diarrhoea. Many more suffer from Hepatitis A, enteric fever etc, caused by poor hygiene and unsafe food and drinking water. People all over the world get sick from the food they eat everyday. Millions of people become sick each year because of food borne diseases, many food borne illnesses arise from practices in home kitchen. Food handlers usually mothers play a major role in ensuring food safety for children.
Integrated Disease Surveillance Programme (IDSP)(2017) Indicated that food poisoning is one of the commonest outbreaks reported in 2017. According to their data 312 of the 1649 outbreaks reported in 2017 were due to Acute Diarrhoeal Diseases and 242 were due to food poisoning. The IDSP has interpreted that the incidence of ADD and food poisoning is high in places where food is cooked in bulk, such as canteens, hostels, and wedding venues. Outbreaks have increased from 50 in 2008 to 242 in 2017. Similarly ADD cases have increased from 228 in 2008 to 312 in 2017.
Food borne diseases in India extract an economic cost of about
$28 billion, or over three times the union health ministry‟s budget for 2017. The study by researchers at the International Livestock Research Institute (ILRI) in Kenya and the Wageningen University in the Netherlands has also predicted that the number of people in India who become ill from food borne diseases may rise from 100 million in 2010 to over 150 million by 2030.
Most cases of food borne illness are preventable, if food hygienic principles are followed from production to consumption. In order to
reduce the morbidity and mortality relating to FBD. Food and Agriculture Organization (FAO) and World Health Organization provides strict guidelines and regulations, for food processing, handling and consumption.
Inspite of many regulations and guidelines, the incidences of food borne illness still continue to prevail. According to a nation wide study conducted, the prevalence of food borne illness at the household level was 13.2 %. Data from the same study also showed that 40% of the food poisoning cases occurred due to home cooked food. The effect is much more in children who tend to be affected by the vicious cycle of diarrhoea and malnutrition. The home has been identified as an important location for acquiring food borne diseases, due to largely to specific food hygiene practices. 7% to 47% of all food borne infections are thought to originate in home, including high income settings. The high prevalence of food borne illness at home could be attributed to poor food hygiene and preparation. With this background, the present study is being conducted to assess the knowledge of food borne diseases and food hygiene among the mothers of under five children in accordance with five keys to safer food as formulated by WHO and also educate them about food hygienic measures.
1.1 NEED FOR THE STUDY
“ Save life with safe food ’’
Surveillance of food borne disease outbreaks are fairly well established in developed countries. Even then, only about 10% of actual cases in industrialized countries are recorded in official statistics . In case of developing countries like India it could be even less than 1%, such surveillance of food borne disease is poor and official statistics do not accord any special position to food. Food borne illness hits one in six Americans every year. The US Centers for Disease Control and
Prevention says, that 48 million people get sick due to one or another of 31 pathogens. About 128,000 people end up in the hospital while 3000 die annually. American Academy of Paediatrics and the Center for Food borne Illness (2014) reported many pathogens commonly transmitted through food have a disproportionate impact on children younger than five. Some die from these preventable illnesses, and many others suffer from life long health problems. More than 250 food borne illnesses identified, most of the infections caused by a known pathogen.
A variety of bacteria, viruses, and parasites, as well as harmful toxins and chemicals (5%), cause food borne illness. Norovirus is the most common pathogen to cause illness through food contamination (42%), followed by salmonella (30%). The global burden of infectious diarrhoea involves 3-5 billion cases and nearly 1.5 million deaths annually, mainly in young children due to diarrhoeal diseases caused by contaminated food and water, and 33 million healthy life-years are lost.
Hygiene is an essential part of healthy living, not just selecting the right food choices but also cooking & consuming it in a hygienic way is equally important in preventing the diseases, food borne diseases remains responsible for high levels of morbidity and mortality in the general population particularly for the vulnerable groups such as infants, young children, the elderly and the immuno compromised. Data from the World Health Organization (WHO) indicated that food borne and waterborne diarrhoeal diseases kills an estimated 2 million people annually (2015), evidence also suggests that food is equal to and maybe more important than water as a route of transmission of diarrhoea in developing countries. Worldwide food borne diseases are major health burden leading to high morbidity and mortality. The food borne diseases are increased more than twice compared to previous years (Center for Diseases Control, 2017).
Children are the main victims of food borne disease globally, almost one third (30%) of all deaths from food borne diseases are in children under the age of five years, despite the fact that they make up only 9% of the global population. This is among the findings of the World Health Organization‟s (WHO) estimates of the global burden of food borne diseases the most comprehensive report to date on the impact of contaminated food on health and well being. Food borne illness can be caused by ingestion of contaminated food and this contamination can occur at home if food is incorrectly handled or cooked. Understanding the food hygiene related knowledge and practice of food handlers both commercial and private is key to identifying ways to minimize the risk of food borne illness at food handler step of the Farm to fork. There are estimated 582 million cases of 22 different food borne endemic diseases responsible for more deaths. Salmonella typhi (35,000) and 40% people suffer from endemic diseases caused by contaminated food. While the burden of food borne diseases is a public health concern globally, the WHO African and South East Asia Regions have the highest incidence and highest death rates, including the children under the age of 5 years.
Keeping this in mind the need for increasing food safety and standards from the producer to the consumer. World Health Organization announced the theme for WORLD HEALTH DAY 2015 as “FARM TO PLATE, MAKE FOOD SAFE”. The Indian Government has its own governing body of Food Safety and Standards Authority of India (FSSAI), which also supervise food safety and provide regulatory standards for food production and consumption.
A study was Conducted to find out the epidemiology of food borne disease outbreaks from 2011 to 2016 in Shandong province, China. During 2011 to 2016, Shandong centre for disease control received reports of 1043 food borne disease outbreaks, resulting in 8078 illnesses, 2442 hospitalizations, and 17 deaths. These findings underline
the importance of targeted prevention measures for the specific settings and foods that are associated with the most outbreaks and illnesses.
A Cross sectional study was conducted in Kelambakkam village, Kanchipuram district, Tamil Nadu from November 2016 to 2017 with a sample size of 200 mothers to assess food safety awareness and food handling practices. A pretested structured questionnaire was used to collect the data. Among the 200 study participants 50.5% of the subjects have the knowledge regarding nutritive value getting diminished because of overcooking. Around 33% lack the knowledge of proper methods of washing vegetables. While 36% said consuming food not freshly prepared may lead to food poisoning and 23.5% have no idea about that. The study concluded that community awareness through systemic teaching regarding basic food hygiene is necessary to avoid many food borne infectious diseases in rural areas.
A descriptive cross sectional study was carried out among 495 mothers with children aged 6-59 months in a rural community of Southern Nigeria. Selection of participants was by multistage sampling technique. Tool for data collection was interviewer administered semi structured questionnaire which sought information on age, occupation, educational status of the mother, history of diarrhoea in the child and food hygiene practices of the mother. The prevalence of diarrhoea among the under five was 43.4%. The rate of diarrhoea was higher among children of mothers who prepared child‟s food on the floor (45.5%) than those who prepared it on the table (40.7%) and those who used only water for hand washing (48.2%) than those who used soap and water (40.3%). The rate of diarrhoea decreased with increasing orde r of the child‟s position in the family (p=0.19). There was an association between the prevalence of diarrhoea and mothers educational level (p=0.49) and occupation(p=0.10). The prevalence of diarrhoea was considerably high among the under fives. Mothers food hygiene habit
was associated with the development of diarrhoea among their under fives. Health education on diarrhoea and food hygiene practices need to be intensified at the community level to improve mothers food hygienic practices.
All the above studies shows the importance of food hygiene among the mothers of under five children to prevent food borne diseases. Safety is a major concern when it comes to feeding the infants and toddlers. Infants and young children tend to have weaker immune systems than adults, which makes food poisoning very dangerous for this age group with increased rates of infection and serious complications. Under five children are usually dependent on their parents especially on their mothers for their basic needs. A mother is a person who prepares food and feeds their children. Food borne diseases may occur in under five children because of her improper food handling and unhygienic food preparation techniques at home. Homes are the natural settings where the delivery of health education takes a primordial prevention of food borne diseases. Knowledge regarding food borne diseases and food hygiene among the mothers is very essential, and increasing their knowledge by health care professional is the foremost necessity for present scenario. So, the mothers need to be educated regarding the prevention of food borne diseases and the necessity of food hygiene. PERI model is a type of evidence based public model used in community health nursing that addresses health or social problems in a comprehensive way. It considers human factors, characteristics of the source of harm, and the environment, identifies causes and suggests possible interventions on epidemiologic surveillance, health promotion, disease prevention and access to and evaluation of services. It has its application in many disciplines such as health, education and welfare.
Fig.1.1 PERI Model of Public Health
Nurses play a vital role in promoting health among the community.
The nurse can guide, educate and influence mothers by certain nursing interventions in alleviating their problems and promote health and well being. We the nurses, need to be made aware to the rural mothers how to prevent these problems and learn how to combat them by taking precautionary measures as early as possible. “Children are the world‟s most valuable resource and its best hope for the future”. The health and welfare of under five children is solely in the hands of their mother. So the study on knowledge regarding food borne diseases and food hygiene for the mothers is vital to prevent food borne diseases among under five children. Hence, being a community health nurse, the researcher felt that there is a need to conduct a study among the mothers of under five children.
ETIOLOGY Lack of knowledge unhygienic&improper
food handling
RECOMMENDATIONS Education on key principles of handling food and food products
safely INTERVENTION
Structured Teaching Programme on Food Borne
diseases and food hygiene
PROBLEM (Food Borne Diseases)
1.2 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on knowledge regarding food borne diseases and food hygiene among the mothers of under five children in selected rural area”.
1.3 OBJECTIVES OF THE STUDY
To assess the pre-test level of knowledge of mothers of under five children regarding food borne diseases and food hygiene.
To evaluate the effectiveness of structured teaching programme on knowledge regarding food borne diseases and food hygiene among the mothers of under five children.
To compare the pre-test and post-test knowledge scores of mothers.
To find out the association between the post-test knowledge scores regarding food borne diseases and food hygiene with selected demographic variables .
1.4 OPERATIONAL DEFINITIONS
AssessIn this study, it refers to estimate the outcome of the structured teaching programme on knowledge of mothers regarding food borne diseases and food hygiene.
Effectiveness
In this study, it refers to determine the extent to which teaching program has achieved the desired effect and is measured in terms of significant gain in the post test knowledge.
Structured Teaching Programme
In this study, it refers to a systematically developed instructional programme using instructional aids, designed to provide information to mothers on food borne diseases and food hygiene.
Knowledge
It refers to the information, ideas, or views about a subject which a person gets by experience or education. In this study, it refers to the mothers knowledge on food borne diseases and food hygiene.
Mothers
In this study, it refers to the women who are residing in Medavakkam, preparing and handling the food in the house for under five children.
Under five Children
It refers to the children between 0 to 5 years Food Borne Diseases
In this study, it refers to the diseases that are caused by the harmful agents that enter the body through the ingestion of contaminated food. It may be bacterial, viral, parasitic, toxic and other chemicals which tend to have acute ill effects on human health.
Food Hygiene
In this study food hygiene refers to, all conditions and measures that are necessary for purchasing, storing, handling, preparing, and serving of safe and wholesome food fit for under five children.
1.5 HYPOTHESIS
H1: There will be a significant difference between pre-test and post-test knowledge scores of mothers regarding food borne diseases and food hygiene.
H2: There will be a significant association between the post-test knowledge scores with selected demographic variables.
1.6 ASSUMPTIONS
1) Mothers will have some knowledge regarding food borne diseases and food hygiene.
2) Mothers will have potential to learn more about food borne diseases and food hygiene.
3) Mothers will be willing to express their knowledge, regarding food borne diseases and food hygiene.
4) Structured teaching will provide opportunity for active learning among the participants.
5) The knowledge gained will modify the practices of the mothers.
1.7 DELIMITATIONS
1) The study is delimited to mothers residing in the Medavakkam area.
2) The sample of study is about 60 mothers.
3) Period of study is 4 weeks.
4) Assessing the knowledge is limited to the written responses.
1.8 CONCEPTUAL FRAME WORK
Theoretical and conceptual frameworks play a several interrelated roles in science, and their overall purpose is to make research findings meaningful and generalizable (Polit and Hungler 2007). A conceptual framework or a model is made up of concepts which are mental images of the phenomenon. These concepts are linked together to express the relationship between them. The important purpose of conceptual framework is to communicate clearly the interrelationship of various concepts.
The frame work of the present study is adopted from the Health belief model-REVISED (ROSENSTOCK, STRETCHER & BECKER’S HEALTH BELIEF MODEL). This model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model suggests that people‟s beliefs about health problems, perceived benefits of action and barriers to action, and self efficacy explain engagement in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health promoting behavior.
Background
Perceptions
Action
BACKGROUND
In this study, it refers to age, education, occupation, family income religion, number of under-five children, dietary pattern, hygienic facilities available at home.
PERCEPTIONS
This component includes threat and expectations.
Threat involves perceived susceptibility and perceived ser iousness of the ill health condition. In this study, it refers to previous history of food borne illness like diarrhoea, typhoid and threat and perceptions about food borne illness due to unhygienic practices.
Expectations involves perceived benefits of action minus perceived barriers to action and perceived self efficacy to perform action. In this study, perceived benefits of action refers following hygienic practices during preparation, storage, serving, and feeding the children minus perceived barriers to action denotes inconvenience to follow good hygienic practices due to busy schedule in occupation and
inadequate hygienic facilities like hand washing, water facility and toilet facility and perceived self efficacy refers to the efficacy of mothers to do good food hygienic practices .
ACTION
It includes cues to action and behaviour to reduce threat based on expectations .
In this study, it refers to the awareness regarding food borne diseases and food hygiene through mass media, advice from family members, friends & relatives, during hospital visit may results in improvement of the knowledge of the mothers regarding food borne diseases and food hygiene which in turn promote practice of food hygienic measures while caring their children.
FIG. 1.2 CONCEPTUAL FRAMEWORK BASED ON ROSENSTOCK’S BECKER AND MAIMAN’S HEALTH BELIEF MODEL
CHAPTER-II
REVIEW OF LITERATURE
This chapter deals with review of literature related to knowledge on food borne diseases and food hygiene among the mothers of under five children.
2.1 CONSISTS OF LITERATURES RELATED TO MAJOR AREAS OF THE STUDY TITLE. IT COMPRISES OF THREE SECTIONS THEY ARE
SECTION A:2.1.1 Studies related to prevalence, causes and prevention of food borne diseases.
SECTION B:2.1.2 Studies related to knowledge of mothers regarding food borne diseases & food hygiene.
SECTION C:2.1.3 Studies related to the effectiveness of structured teaching programme on food borne diseases &
food hygiene.
SECTION A: 2.1.1 STUDIES RELATED TO
PREVALENCE,CAUSES AND PREVENTION OF FOODBORNE DISEASES
Joseph James whiteworth (2018) in his research article he has mentioned that more than 24,000 infections, 5600 hospitalizations and 120 deaths were reported last year in the US, according to food borne illness surveillance data. The 10 US sites of the food borne diseases active surveillance network (food net) monitor cases of laboratory transmitted through food. The most frequent causes of infection in 2017 were Salmonella and Campylobacter, which is consistent with previous years compared with 2014-2016, the incidence of infections with Campylobacter, Listeria,-0157 Shigatoxin producing E.coli, Yersinia and Cyclospora increased.
Khanya Z Bishala et al. (2018) Conducted a retrospective, observational, quantitative design study to determine the prevalence of food borne diseases in rural areas in the Eastern Cape, South Africa, by comparing data obtained from a cross sectional survey and clinic records. In the first phase of the study, a random sample of household heads (n=87) were interviewed to determine the prevalence of food borne diseases between 2012 and 2014. In the second phase, registers from clinics serving the villages were screened for food borne disease cases during the same time period. A total of 109 (27.3%) household members fell ill because of food borne diseases. They concluded that the prevalence of food borne diseases in rural villages in the Eastern Cape, South Africa, was reported as high but the records in clinic registers are low, indicating a gap in the health care system. Monitoring of these diseases needs to improve.
Abdul Samad et al. (2018) Conducted a study to examine the prevalence of deadly food contaminants like Salmonella spp, Listeria monocytogenes, Campylobacter jejuni and E.coli in various types of food items consumed locally in Quetta, Pakistan. The overall contamination of food samples with infectious agents was 48.37%.
Campylobacter jejuni was recorded much higher (28.99%) compared to other food borne pathogens. 5% tested food samples were found co infected with at least two pathogens. The results urge to adopt proper food hygiene practices to reduce the incidence of food borne diseases.
Kumarasamy Hemalatha et al. (2018) Conducted a cross sectional study involving 150 adult females who were residing in rural field practice areas of a tertiary care teaching hospital to assess the practices towards prevention of food borne diseases among females in rural area of Trichy, India. Practices of safe food handling were assessed using an interviewer administered questionnaire Out of 150 females 147 (98%) were aware of the importance of washing hands before cooking.
Sixty four (42.7%) females had a habit of washing the vegetables with water twice before cooking. 102 (68%) females consumed stored food after reheating and 48 (32%) females consumed without heating. Though 70% were aware of food adulteration. None of the participants have lodged complaint against adulteration. Through this study they found that most of the females practiced proper hand washing before cooking and proper storage of the leftover food. The proportion of females who followed adequate cleaning of non vegetarian food items and vegetables were found to be inadequate.
Chef Gaurav Khurana (2016) Conducted an exploratory research study to assess the clinically borne illness disease in food hygiene. The study concluded that food industry as reported by researches has more room for improvement. Good hygiene principles need to be regulated and enforced. The media currently serve as the main sources for reporting of food borne illness, food Establishment and other sources contributing to food borne illness including restaurants, food vendors, food joints, schools and individual homes. Limited use of pre requisites measures and food safety management system was identified.
Recommendations on regulating on general hygienic principle , implementation of (HACCP) to strengthen the food sector .
Jeannie Sneed et al.(2015) Conducted a study to determine the impact of external safe food handling cues. Participants (n=123) were randomly assigned to a control group or to one of two experimental groups. Experimental groups were given a defined educational intervention: then all three groups videotaped preparing a meal with raw chicken or ground beef and a ready to eat fruit salad. About 90% of salads were contaminated and 24% were highly contaminated, although levels were lower for the food safety messages group. Hand washing scores were lower for the control group than for the other groups. Cloth towels were the most contaminated contact surface and towels were
frequently handled by participants. Cell phone use was observed in the kitchen and should be studied as a source of cross contamination. An educational intervention had a small impact on some measures, but most participants in all groups used procedures that resulted in cross contamination.
Abd-elaleem et al. (2014) done a study on food handlers and food borne diseases. The study concluded that poor hygiene state of surfaces such as hands, kitchen slabs, utensils and food equipment plays a major role in cross contamination which often leads to diseases outbreaks .
Sudershan Rao Vemula et al. (2012) Conducted a quantitative study on food borne diseases with 90 mothers having children below <5 years. It was attempted to assess perceptions and practices of mothers on food safety. Data collected with using a knowledge, attitudes, beliefs and practices questionnaire showed that over 90 % wash hands before feeding children, eating, serving or cooking food, but usage of soap is very limited. Over 60 % store leftover cooked foods at room temperature as a majority (82%) do not own refrigerators, they identified a total of 37 outbreaks involving 3485 persons who have been affected due to food poisoning have been reported in India. Although the common forms of food borne diseases are those due to bacterial contaminatio n of foods, however, higher numbers of deaths have been observed due to chemical contaminants in foods.
Gauci and Gauci (2012) In their study they stated that food borne illnesses cause a significant burden of diseases globally. Majority of the confined cases of food borne illness in Malta are caused by salmonellosis. Investigation by the diseases surveillance unit revealed that most of the notified cases of infectious intestinal diseases are most likely to be due poor food safety practice at home.
Kennady et al. (2011) Conducted a study to determine the potential for the spread of bacteria from raw meat and poultry during home food preparation to the surrounding kitchen environment, hands and prepared food due to unsafe handling practices. The results of the study showed that transfer of bacteria around the kitchen environment and on to prepared meals are predicted by a lack of thoroughly washing contaminated hands, knives and chopping boards both during and after meal preparation.
Zaglool et al. (2011) In their study they identified that intestinal parasites and protozoa infections are among the most common food borne infections world wide. It is estimated that some 3.5 billion people are affected, and that 450 million are ill as a result of these infection s, the majority being children
Avitaa Usfer et al. (2010) In their research article they stated that unsafe drinking water and improper food handling practices lead to diarrhoea which is the second leading cause of child mortality world wide. Each year more than 1.5 million children under the age of 5 die of acute diarrhoea, which translates 18% of deaths of children under the age of five. In their study they stated that seventy percent of all cases of diarrhoea in children may be attributed to food contamination. The incidences of diarrhoea have increased after the introduction of complementary food due to under unhygienic preparation of weaning food especially in children aged 6 to 24 months.
Osagbemi et al. (2010) In their study they revealed that the number of reported cases of food poisoning has been increasing in recent years and many of the outbreaks can be traced to contamination caused by poor hygiene among people and also they suggested that the annual incidence of food poisoning outbreaks continues to present a great challenge to environmental health of management and a threat to
the health of people globally. There is a low level of awareness concern in food poisoning or the potential dangers that lurk side by side with some food nutrients.
Patil et al. (2010) In their study they indicated that the epidemiological surveillance summaries of food borne diseases clearly stated that consumer behaviour such as ingestion of raw/under cooked foods and poor hygienic practices are important contributors to outbreaks of food borne diseases.
P.Vasickova et al. (2010) In his review article he has mentioned that viruses cause many diseases in plants, animals, and humans. They are strict intra cellular parasites with cellular specificity. Viral particles can be transmitted by different routes such as contaminated food and water. People usually get infected orally, after ingestion of products contaminated during processing or subsequent handling or preparation and this review article is focused on the most severe food borne viruses specific for humans of the following genera; Norovirus, Entrovirus, Hepato virus, Astrovirus, and some others.
SECTION B:2.1.2 STUDIES RELATED TO KNOWLEDGE OF MOTHERS REGARDING FOOD BORNE DISEASES & FOOD HYGIENE
Sa’ed Zyoud et al. (2019) Conducted a cross sectional study to assess the knowledge attitude and practices among parents regarding food poisoning in primary health centre in Nablus district from may to July 2015. Data were collected using structured questionnaire interviews with parents to collect information on food safety knowledge attitudes and practices and socio demographic characteristics. Four hundred and twelve parents were interviewed, 92.7% were mothers. Significant modest positive correlations were found between respondents knowledge and attitude scores regarding food poisoning (r=0.24, p<0.001), knowledge and practice scores regarding food poisoning (r=0.30,