A Review On Food Safety And Food Hygiene Studies In Ghana

P.F. Ababio, P. Lovatt / Food Control 47 (2015) 92e97Table 1General food and water borne disease status in the country.AuthorYearCaseOpare et al.2010MOFA/World Bank2007Food and DrugsBoard e Ghana2008Ghana HealthService,Food and DrugsAuthority e Ghana20129000 Cholera cases with 250deaths recorded1 in every 40 Ghanaian experienceserious Food Borne Disease annually90,692 deaths related to food andpersonal hygiene with 297,104 casesreported at various outpatientdepartments of clinics and hospitals6000 cholera outbreaks with 69 deaths201377% of all traceable food borne diseasesresult from improper handling infood establishmentsfood safety. The Food and Drugs Authority (FDA) is the nationalregulatory body under the Ministry of Health with the responsibility of implementing food policies and ensuring the safetyand wholesomeness of food for consumers. FDA roles include foodmanufacturing and processing site inspections, licensing, productregistration and monitoring. They also provide good hygienepractices training for food handlers. The Ghana Standard Authoritydevelops and promotes international and locally acceptable standards for the industry. Other supporting agencies include theMinistry of Health, Ministry of Agriculture, Ghana Tourist Boardand the Environmental agency. The government of Ghana has alsogiven directives to the local authorities including metropolitanassemblies and their districts to actively control and monitor foodsafety practices of food vendors who are individuals or group ofpeople who sell ready to eat foods at readily accessible areasincluding caterers, nightclubs, beer bars, chop bars, cold stores,hotels and restaurant operators and bagged water processors. TheWater and Food Hygiene unit of the Environmental HealthDepartment of the districts is responsible for the health monitoringand certification of food vendors which is subject to renewal on ayearly basis. Food preparation traditionally in this country is awoman's place and this has reflected in most demographic reportsof workers in this field. Level of education (formal) which isconsidered to have direct positive effect on Good Hygiene Practicesis low among food handlers in Ghana (Ababio, Adi, & Commey,2012; Ackah et al., 2011; Tomlins, Johnson, Aseidu, Myhara, &Greenhalgh, 2002).World Health Organisation reports of high levels of Diarrhoealcases of which a higher percentage are due to food and water borneinfections (Table 1).According to the Ministry of Food and Agriculture and the WorldBank (2007), 1 in every 40 Ghanaian suffer serious food borneillness per year, 420,000 cases are reported with an annual deathrate of 65,000 which cost the government US 69,000,000.00annually. This report could be an under estimate as report rate islow and in the calculation of cost in developing countries only thecost borne by individuals through hospitalization and medication isconsidered whilst others in developed countries consider the costto employers, institutional bodies like laboratories, surveillance,disability cost and cost from other family members who take care ofthe sick member and premature mortality (Abelson, Forbes, & Hall,2006). According to FDA, the loss of productivity in Ghana in 2006due to food borne diseases was approximately 594,279 days(19,809 months) this could be huge in terms of cost to the state.Studies from the commercial food sector have dominated researchin the country with special focus on street foods although there arereported food poisoning cases on the media from institutional setups specifically schools. Saba and Gonzalez-Zorn (2012) reportedthat studies on microbiological food safety is on the decline and93highly centered in the capital city of the country. Although all foodhazards are detrimental to the health of consumers and requiremonitoring and control in the country, currently microbiologicalhazards in ready to eat foods and chemical hazards mostly pesticides from agricultural products including fresh vegetables andfruits have been highlighted (Amoah, Abaidoo, & Ntow, 2006;Bempah, Donkor, Agei, Buah-Kwofie, & Boateng, 2011; Feglo &Sakyi, 2012; Mensah, Yeboah-Manu, Owusu-Darko, & Ablordey,2002). There is minimal information on physical contaminants/hazards, food allergy and injuries caused by these. This could bedue to less awareness and or lack of public education of thesehazards. The FAO/WHO, 2005 regional report on food safety forAfrica recorded microbiological hazards as the most eminent riskfrom street foods but also reported the danger of high levels ofheavy metals including lead, cadmium, arsenic, mercury and copper and also pesticide residues from utensils, raw materials ortransport methods used. This work looks at food safety and hygienereports in Ghana.2. ApproachA desk top review of literature was carried out. Search wasconducted using mainly Google search engine with phrasesincluding ‘food safety in Ghana’, ‘food hygiene in Ghana’, ‘foodhygiene training Ghana’, and ‘list of food poisoning in Ghana’.Journals used included Food control, Internet Journal of Food Safety,Food and Nutrition Science, Food and Public Health, Food Scienceand Technology, Journal of Infection in developing countries,Journal of Urban Health and African Journal of Food AgricultureNutrition and Development. Professional sites included WorldHealth Organisation (WHO), Ghana Health Services and TEPHINETlibrary. Media sources were used for individual cases of foodpoisoning in homes, commercial and institutional set ups. Dataused ranged from 1999 to 2013.3. Report from media and scholarly research articles3.1. Food poisoning cases from homes, commercial and institutionalcateringFood poisoning occurs in individual homes, commercial andinstitutional catering in the country (Table 2). Commercial cateringincluding hotels, restaurants, finished products from retailers andfood vendors. Institutional catering includes schools, hospitals, daycare centers, prisons and industry staff kitchens. Restaurants andindividual food vendors were identified sources of food bornediseases. Schools stand out from the data to be another suspectedsource of food hygiene problems among Institutional catering services. Thus schools constitute a percentage of the food establishments which are reported to be responsible for 77% of all traceablefood borne diseases in the country (FDA, 2013). Consumers in theirhomes equally practice poor hygiene which brings about foodborne diseases. On the whole institutional catering stands out asthe unit with huge number of consumers at a time due tocommunal feeding and these include school children, sick andvulnerable people from hospitals who equally require great care interms of food safety.3.2. Research reports from food scientist in the country3.2.1. Food hygiene practicesHygiene practices among food handlers, mostly food vendorsand catering services have been reported to be below standard(Addo, Mensah, Bonsu, & Akyeh, 2007; Afoakwa, 2005; Feglo &Sakyi, 2012; Tomlins et al., 2002). Research covering the

94P.F. Ababio, P. Lovatt / Food Control 47 (2015) 92e97Table 2Selected food poisoning cases from the media and other online sources.SourceDateCitifm online2013Home/Private casesDaily guideGhana web2007201117 out of 28 farmers die of chemicalfood poisoning in northern region awhole family dies of food poisoningAnonJoy NewsDer et al.20102008;2010a,2010b,2009Outbreak of food poisoning at a ChildNaming Ceremony Anyaa Ghana- locallymade drinkGhana Health ServiceDaily Guide20072007Institutional kitchens/catering casesCommercial catering casesOver 40 students hospitalised in AdontenSecondary School. in Eastern Region over foodpoisoning. case under investigationOver 100 girls in Archbishop Porter GirlsHospitalised from food poisoning after eating indining hall.Pupils reject insect infested meals supplied inschool feeding programme1, 348 children suffered food poisoning amongschools in Madina, Accra from food served bycontracted caterer.Dozens of pupils from two schools hospitalisedfrom food poisoning from school mealsDozens suffer food poisoning inObuasi on Nov. 13th after eatingfried rice from a fast food jointand 30 are hospitalised.40 persons suffer foodpoisoning at a salad joint atKoforiduaCausative agent ClostridiumperfringensInformation sources and dates provided correspond with successive cases in the columns provided.hospitality industry has been around hotels, restaurants and streetfood vendors mostly in the capital city, Accra (Ackah et al., 2011;Addo et al., 2007; Donkor, Kayang, Quay, & Akyeh, 2009). Highlevels of total bacterial counts in street vendored food beyond theacceptable reference figures, 105 Colony Forming Units (CFU) g 1set by the Ghana Standards Authority for Ready to Eat Foods (RTE)have been reported by Mensah et al. (2002) and Feglo and Sakyi(2012) (Table 3).Bempah et al. (2011) reported on detectable levels of organochlorine pesticides in sampled fruit based drinks with an averageconcentration of 0.0019 mg l 1 which they alerted was 4 timesmuch higher than the EU's Maximum Residual Limits (MRL) forthe sum of pesticides permitted in positive samples. Amoah et al.(2006) reported that 78% of vegetables sampled from 3 majorcities across the country were chemically contaminated withchlorpyrifos residue exceeding the recommended level of0.05 mg kg 1. This chemical has an Acceptable Daily Intake (ADI)of 0.01 mg kg 1 (WHO, 1997) indicating possible high exposure.Hotels in the Capital region were reported to have improved hygiene practices after implementing Good Hygiene practices butwith the need for improvement in cleaning of food contact surface(Addo et al., 2007).3.2.2. Food handlers demographics and effectsAbabio and Adi (2012) and Ababio et al. (2012), Feglo and Sakyi(2012) and Tomlins et al. (2002) reported on low level of educationamong food handlers in Kumasi and Accra respectively. They alsoreported of limited numbers of food safety management systemsacross the country mostly among locally owned businesses. Thesewere mostly small and micro enterprises that lacked the capacity toimplement and maintain acceptable international standards. Theinternational food manufacturers and processors mostly had foodsafety management systems in place showing their commitment tolegislation and customer requirement. Rheinlander, Bakang, Takyi,Konradsen, and Samuelson (2008) reported of some level of foodsafety and hygiene awareness in Kumasi but added that foodhandling practices did not reflect knowledge. They reiterated thatboth consumers and food handlers used aesthetic qualitiesincluding appearance of environment, appearance of the vendor,others included consumer and vendor relationships, price andproximity as food hygiene and buying indicators neglecting goodhygiene practices like hand washing procedure and kitchencleanliness. There was a growing concern as food handlers in thecountry overlooked documentation and quality assurance part offood production. This could be happening due to the absence ofstipulated qualification for persons who prepare food for sale andthis affects the acceptable practices in food preparation. Whilst it ismandatory as a public health policy for food handlers to bescreened before preparing food for sale (Feglo & Sakyi, 2012), aresearch conducted by Ackah et al. (2011) showed that only 40% ofsampled food handlers for their study had health certificates andthere was absence of periodic screening in the capital city of thecountry. Ababio and Adi (2012) equally reported of higher levels ofscreening but lack of renewal in Kumasi of the Ashanti Region.3.3. Ready to eat (RTE) foods and processed foods with neededcontrolSelected foods for hazard analysis by researchers revealedvarying microbiological contamination levels (Addo et al. 2007;Feglo & Sakyi, 2012; Mensah et al., 2002; Tortoe, Johnson, OttahAtikpo & Tomlins, 2013). Food from hotels sampled in Accrashowed acceptable levels whiles street food from the same city haddetectable levels of enteric pathogens. Kenkey due to low pH wasreported to be a low risk food in terms of microbial load, wakye(cooked rice and beans mixed) had a similar report but both couldbe contaminated with lead above the acceptable levels of 0.2 mg/kgdue to usage of informally manufactured pots that could have leadlevels as high as 419 mg/kg (Tortoe et al., 2013) causing cumulativeharm. Fufu due to its method of preparation (Table 4) had Escherichia coli and detectable Staphylococcus aureus. Similar reports weremade on High Risk street foods in Kumasi. Food studied includedice kenkey, cocoa drinks, fufu, ready to eat red pepper sauce, saladand macaroni. All had plate count levels above the acceptable national standard of 5.0 log10 cfu/ml (Feglo & Sakyi, 2012). Entericbacterial were also isolated.Bempah et al. (2011) reported on the presence of monitoredpesticides in fruit-based drinks sampled to be above the maximumrequired limits which is a safety issue considering that children arethe target consumers in the country. The safety and quality of mealsfrom institutional catering units in the country have not beenreported.3.4. Some recommendations from research out putTraining of personnel in food safety and hygiene was highlyrecommended across board. Training is a fundamental requirementfor food safety management systems and it is a legal requirement

P.F. Ababio, P. Lovatt / Food Control 47 (2015) 92e9795Table 3Selected Food research articles and recommendations.AuthorsDateTitleFindings and recommendationJournalTortoe et al.2013Systematic Approach for theManagement and control offood safety for the street/informal food sector in GhanaFood and Public Health. 2013,3(1):59e67Ababio et al.2012Food Safety ManagementSystems their availability andmaintenance among foodindustries in GhanaFeglo and Sakyi2012Bacterial contamination ofstreet vending food in Kumasi,GhanaSaba and Gonzalez-Zorn2012Microbial food safety in Ghanameta-analysisBempah et al.2011Monitoring of OrganochlorinePesticide Residues in locallyproduced fruits-based softdrinks in GhanaAnnor, and Baiden,2011Evaluation of food hygieneknowledge attitude andpractices of food handlers infood businesses in Accra GhanaDonkor et al.2009Application of the WHO keys ofsafer food to improve foodhandling practices of foodvendors in poor resourcecommunity in GhanaJohnson et al.2008Rheinlander et al.2008A case study to develop anappropriate quality assurancesystem for two cassava-basedconvenience foods in GhanaKeeping up appearances:perceptions of street food safetyin urban Kumasi GhanaAddo et al.2007Food and its preparations inhotels in Accra, Ghana: Aconcern for food safetyMensah et al.2002Street foods in Accra, Ghana:how safe are they?Modules developed for RTE street foods in Accra.Microbiological survey showed that some street foodsare intrinsically safer than others thus requiringsystems of control. Intensified training of street foodvendors and consumers created awareness of therelationship between contaminated food and fooddisease.International food safety management systems weresparingly in use in the country especially among locallyowned businesses. It was recommended that there isthe need for awareness creation and manpowerdevelopment with improved surveillance andlegislative backing.Most ready to eat food are contaminated with entericbacteria and other pathogens at higher levels thanacceptable.Food vendors needed to be trained on food hygieneMicrobiological food contamination in Ghana wasalarming. There was a downward trend in research inmicrobiological food safety and a concerted effort in thisarea was needed in Ghana to help curb the incidence ofpreventable food-borne disease.Most of the fruit-based soft drinks sampled containedresidues of the monitored pesticides above the EU MRLlevel in drinking water. There was the need for changesin processing to ensure food safety especially forchildrenMicrobial counts of all food sampled were generallyhigh and food handler's hygiene knowledge wasinadequate and knowledge was not reflected in theirpractices. Food managers were advised to developtactics to motivate staff to practice food hygieneFood vendors acquired knowledge after training wasput into practice. Lack of food safety equipment was amajor hindrance to behavioral change among vendors.It was recommended that workshops on food safety andhygiene should be organized for vendors to help themput acquired knowledge into practiceFood safety management based on the HACCPprinciples is applicable to food processing industry inGhana and HACCP Plan was contingent on addressingsome of the constraints facing the industry.Both consumers and vendors in Kumasi used aestheticsappearance of food and stand, appearance of vendor,interpersonal trust and price and proximity as mainfood selection criteria. Food handlers over all hygienepractices were not sufficiently safe to ensurebiomedically safe food. It was recommended thatpractices such as good hand hygiene and cleanliness ofkitchen should be emphasized during trainingFood served in sampled hotels had satisfactory resultsalthough most locally produced juices werecontaminated with coliforms. Stringent measures toinsure safety and good hygiene in the preparation ofjuices was recommended.Out of 511 menu items selected 69.7% werecontaminated with mesophilic bacteria. Salads,macaroni, fufu and omo tuo and red pepper hadunacceptable levels of contamination. Humanpathogens including Salmonella were isolated from lightsoup. Street foods could be sources of enteropathogenand street vendors required education in hygienetraining.for persons in supervisory position to have the requisite knowledgeon the product and process of their operations whiles those underthem are given the necessary training to ensure food safety (FoodSafety Act 1990 UK, PNDCL 305B 1992 Ghana). The Codex Alimentarius Commission's Good Hygiene Practices Basic Text recommends all governments to ensure that food handlers receive thenecessary training to equip them for their work (FAO/WHO, 2009).Food Science and Technology.Featured article Nov. tjournal.org/node/add/articleJournal of medical andBiomedical Sciences(2012)1(1):1e8Journal of Infection inDeveloping Countries(2012);6(12):828e835Internet Journal of Food Safety.Vol. 13 2011p 315e320Food and Nutrition Sciences,2011, 2, 830e836International Journal ofEnvironment Research andPublic Health. Vol 6(11) Nov.2009Internet Journal of Food Safety,Vol. 10. 2008 p 81e84Journal of Urban Health. 2008Nov. 85(6):952e64African Journal of Food,Agriculture Nutrition andDevelopment Vol 7 No 5. 2007Bulletin of World HealthOrganisation. 2002:80(7): 546e54Training is one of the requirements that is seriously neglected bythe food industry in the country as reported by Ababio et al. (2012).Absence of Prerequisite measures and lack of documentation ofavailable ones causes lack of standardization. Hazard Analysis andCritical Control Point (HACCP), a food safety tool upon which allother food safety assurance systems are built is rarely known and orused and Johnson, Tomlins, Oduro-Yeboah, Tortoe, and Quayson

96P.F. Ababio, P. Lovatt / Food Control 47 (2015) 92e97Table 4Reported Ready to eat (RTE) food types and style of preparation locally.Food typeIngredientsHow preparedHow servedKenkeyCorn doughWaakyeRice and beansMostly hot and intact in local packaging(corn husk/plantain leaves)With ladles or hands of food handlerFufuCassava with plantain, yam or cocoyamCocoa drinksRed pepper sauceCocoa powder and sugarPepper, onion, salt and tomatoSaladLeaves, fresh vegetablesMacaroniIce KenkeyWheat flourMixture of milled kenkey, milk powder and sugarFresh fruit juiceIndividual or mixed fresh fruit, water and sugarSemi cooked corn dough shaped in corn husk/plantain leaves and boiledRice added to pre boiled beans/cowpea andboiled until softBoiling and pounding in wooden mortar withpestle while turning with handsMixture of cocoa powder and water; no boilingGrinding in public disc attrition mills or locallymade clay grinders (asanka). No boilingWashed with water and cut into desired shapesand sizes with knives or hand. No boilingBoiledMilled kenkey mixed with water, milk andsugar. No boilingWashed, peeled and milled with added waterand sugar(2008) referred to its use as contingent in addressing food safetyconstraints in the country. Rheinlander et al. (2008) reported of theneed to include good hand hygiene and cleanliness of kitchen facilities and environment in training programmes as consumerscurrent risk avoidance strategy of looking at appearance of food,food stands and trustworthiness of food vendors were not enoughto protect them from food borne diseases.Feglo and Sakyi (2012)in their work on Salmonella carrier statusof food vendors in Kumasi, Ghana, supported the idea that indeveloping countries where money and time required to improveexisting environmental standards might demand longer waitingperiods, the most efficient way to improve on the hygiene activitiesof food handlers will be through education and regular surveillance. Food handlers in the region were concluded to be of significant risk in the spread of enteric fever.One of the characteristics of a growing economy is longer foodsupply chains to satisfy the demands of emerging affluent consumers locally and to access external market with locally producedraw materials and processed foods. This brings in foreign exchangeaiding rural development but also calls for quality and safe producewhich is achievable only through the strengthening of laws, institutions and infrastructure.According to Ministry of Food and Agriculture (MoFA)/WorldBank's 2007 report, sectors that currently have international standards include the cocoa, fisheries and vegetable subsectors thusprimary producers in the food chain who are in exporting business.They also called for restructuring and streamlining of the legislativeand institutional frame work in the country to bring about efficiencies and increased national and international competiveness inthe private sector.3.5. Gaps in researchi. The study on kitchen staff hygiene practices, food hygieneknowledge, food microbiological quality and safety of institutional meals including schools and hospitals.ii. Research on food safety in the other regions apart from thecapital region.iii. Other forms of food hazards including food allergens andsufferers in the population in addition to microbiology withdecision on effective control measures for food processingand handling.iv. Food poisoning and other forms of food borne diseases, thecausative organisms and vehicles of transmission studies andcontrol in the country.v. Food safety interventions in the food industry in Ghana.Served by hand into bowlsPackaged into polythene bags by handServed with spoonServed with spoon or handServed with spoon or handPacked into polythene bags by handPoured into cups or bottles by hand3.6. Possible support and interventions for Ghana- the UK exampleThe food industry is only as strong as its weakest link in the foodchain (Taylor, 2001). The food industry in every nation whetherdeveloped or not stand to loose if all stages in the food chain are notmotivated and strengthened to use food safety approaches. Thebenefits of reducing hazards in food include reduced morbidity,mortality and demands on healthcare services, a reduction in absences from education or loss of productivity at work and increasedconsumer confidence in food safety (Food Standards Agency, 2011).The United Kingdom's efforts listed below could strengthen thefood services and manufacturing sectors to become competitivewhiles ensuring consumer safety.i. Continuous sensitization programmes for food handlers andconsumers along the food chain of their roles on compliancewith food safety requirements.ii. Good Hygiene Practices which are mostly called Prerequisitemeasures to be available and enforced as the basic requirement for food industries and vendors. These include theestablishment of the following; process and facility design toacceptable standards, personal hygiene of food handlerswhich include effective hand washing, use of protectiveclothing, reporting and proper handling of infectious diseases including diarrhoea and vomiting, absence of jewelry/self adornment during preparation and service etc, cleaningprocedures for both equipment

catering and other forms of food hazards. The media currently serves as the main source for reporting of food borne diseases. Food establishments and other sources contributing to food borne diseases included . Food Control 47 (2015) 92e97. food safety. The Food and Drugs Authority (FDA)