Socio-demographic characteristics of respondents
There were a total of 38 (100%) respondents of which 9 (23.7%) were males while 29 (76.3%) were females. Majority 17 (44.7%) were within the age bracket 18-25 years, followed by 12 (31.6%) aged 26-35 years while 5 (13.2%) and 4 (10.5%) were aged 45 years above and 36-45 years respectively. A greater proportion 27 (71.1%) had tertiary education, 7 (18.4%) had secondary education, while 2 (5.3%) independently had primary and no formal education respectively.
Result of pre-intervention phase from observational check-list
Assessment of premises and food handlers in identified eateries before intervention
1. Environmental assessment
- Dry floors (no wet floors): All the eateries identified were found guilty of wet floor both at point of serving and food preparation point.
- Storage of raw food items free from rodents and arthropods: here again, all the assessed eateries were found wanting.
- Storage of prepared/processed meals: A good practice was observed across the eateries.
- Environment where food is served: all the eateries were again found not to meet standard.
2. Food handler’s assessment
- Use of apron, face mask and chef caps: A total of 15 (39.5%) were found using their apron, out of which only 3 (7.9%) were consistent in using it while 12 (31.6%) were not consistent; there was observable 14 (36.8%) usage of chef caps, out of which 8 (21.1%) were consistent in usage while 6 (15.8%) were not consistent but there was no observable use of facemasks (Figure-1). That is none of the eateries were consistent in the use of these PPEs.
- Assessment of health status and routine health checks by food handlers. Food handlers provided certificates showing their being fit and they undergo routine health checks at least annually.
Determinants of non-use or adherence to effective and consistent use of PPEs based on questionnaire and KII guide
Out of the 38 respondents interviewed on why they do not like using the PPEs provided, 23 (60.0%) reported the PPE burden. Respondents reported that it comes with discomfort and difficulty in breathing freely especially using the facemask. Apart from discomfort as a major sub-theme for why people are not using the PPEs, 30% reported that the PPEs cannot go round all the staff, therefore, only those who manage to see one uses it. This presents insufficiency as another sub-theme.
“I don’t like to use it oh. It makes me feel uncomfortable but now that you have told me why I must use it, I will try to always use it” (28 years old female key informant).
“I only use when I remember even though I never saw the need to always use the chef cap especially the facemask” (Male Key Informant aged 31).
“I would have loved to use it but the facemasks, chef caps and the apron are limited in number compared to the number of us working here” (A female key informant aged 24).
Result of intervention phase
Based on the results and findings of the study, an intervention was carried out to address the problems and challenges encountered by the eateries and food handlers to solve them. The following intervention activities were carried out in all the eateries used for the study:
- Health education on maintaining clean premises for food storage, preparation and handling; consistency in the use of facemasks, aprons and chef caps; and the need for routine health checks for all staff working in the eateries.
- Distribution of free facemasks, aprons and chef caps to all the eateries used in the study.
The managers of all the eateries were delighted on the intervention and the show of concern for presenting such items to them and educating them on the need to maintain a clean environment for food handling and ensuring staff are medically fit to handle customers’ meals.
“I must confess, I like what I’m seeing. I can’t remember when last such an intervention took place in this community” (One of the managers aged 41).
“I have tried my best in providing the aprons but I will try to keep it up from these ones your team have given us” (One of the managers aged 39)
“I have really learnt a lot from this health education piece and I belief even other participant have gained more insight the same way I did” (Male participant aged 36)
Result of Evaluation (post-intervention) Phase
Assessment of premises and food handlers in identified eateries three months after intervention
1. Environmental assessment
- Dry floors (no wet floors): There was an observable compliance to maintenance of dry floors by avoiding wet floors at storage rooms and kitchens including service rooms/halls.
- Storage of raw food items free from rodents and arthropods: at the time of evaluation, there was no observable trace of rodents of cockroaches or other food contaminating organisms.
- Storage of prepared/processed meals: the practice was better than how we met it. That is to say, the good practice was improved upon.
- Environment where food is served: the standard was better than how the research team left it.
2. Food handlers’ assessment
- Use of apron, face mask and chef caps: A total of 37 (97.4%) were found using their apron, out of which only 35 (92.1%) were consistent in using it while 2 (5.3%) were not consistent; there was observable 28 (73.7%) usage of chef caps, out of which 26 (68.4%) were consistent in usage while 2 (5.3%) were not consistent; 33 (86.8%) were found to use facemasks, out of which 19 (50.0%) were consistent in usage while 14 (36.8%%) were not consistent in the use of facemasks. That is, 36.8% wear it under the chin, and 5 (13.2%) still feel uncomfortable using it (Figure-1).
- Assessment of health status and routine health checks by food handlers. Food handlers provided certificates showing their being fit and they undergo routine health checks at least annually. That is, results were the same as compared to results presented at the pre-intervention phase.