EatSafe: Evidence and Action Towards Safe, Nutritious Food Global Review of Consumer and Vendor Perspectives on Food Safety September 2020 This EatSafe report presents evidence that will help engage and empower consumers and market actors to better obtain safe nutritious food. It will be used to design and test consumer-centered food safety interventions in informal markets through the EatSafe program. Recommended Citation: GAIN. Global review of "Consumer and Vendor Perspectives on Food Safety." A USAID EatSafe Report. Acknowledgements for Part 1: This review was undertaken, and the report written, by Sarah Bauerle Bass, PhD, MPH; Jesse Brajuha, MPH; Paul D’Avanzo, MS; Patrick Kelly, MPH – Temple University College of Public Health, with useful feedback provided by Caroline Smith DeWaal; Eva Monterrosa, PhD; Stella Nordhagen, PhD; Elisabetta Lambertini, PhD. Acknowledgments for Part 2: This review was undertaken, and the report written, by Navneet Mittal and Fiona Wallace with feedback provided by Stella Nordhagen and Elisabetta Lambertini. Agreement Number: 7200AA19CA00010/ Project Year 1 output Project Start Date and End Date: July 31, 2019 to July 30, 2024 USAID Technical Office: Bureau for Food Security (BFS)/Office of Market and Partnership Innovations (MPI) Agreement Officer Representative (AOR): Lourdes Martinez Romero Submission Date: 30 September 2020 For additional information, please contact: Bonnie McClafferty, EatSafe Project Director Global Alliance for Improved Nutrition (GAIN) 1701 Rhode Island Ave NW Washington, D.C. 20026 Email: bmcclafferty@gainhealth.org Caroline Smith DeWaal, EatSafe Deputy Director Global Alliance for Improved Nutrition (GAIN) 1701 Rhode Island Ave NW Washington, D.C. 20026 Email: cdewaal@gainhealth.org This document is produced by the Global Alliance for Improved Nutrition (GAIN) and made possible by the generous support of the American people through the support of the U.S. Agency for International Development (USAID). Its contents are the sole responsibility of the Global Alliance for Improved Nutrition (GAIN) and do not necessarily reflect the views of USAID or the U.S. Government. TABLE OF CONTENTS OVERVIEW…………………………………………………………………………………………………………………………………………7 PART 1: The Consumer ....................................................................................................................... 9 1. BACKGROUND ........................................................................................................................ 11 2. METHODOLOGY ..................................................................................................................... 12 2.1 Research Questions ......................................................................................................... 12 2.2 Data Sources and Search Strategy ..................................................................................... 13 2.3 Citation management ....................................................................................................... 13 2.4 Eligibility Criteria .............................................................................................................. 13 2.5 Title and Abstract Relevance Screening – Levels 1 and 2 ..................................................... 14 2.6 Data Characterization and Synthesis ................................................................................. 15 2.7 Limitations ....................................................................................................................... 15 3. STUDY CHARACTERISTICS ......................................................................................................... 16 3.1 General Characteristics of Cross-sectional Studies .............................................................. 17 3.2 Data Collection Methods, Target Populations, and Theory ................................................. 19 3.3 Study Objectives and Focus ............................................................................................... 21 4. SYNTHESIS OF EVIDENCE ............................................................................................................ 29 4.1 Food safety concerns and attitudes ................................................................................... 30 4.2 Risk perception ................................................................................................................. 31 4.3 Consumer purchasing behavior ......................................................................................... 31 5. CONCLUSIONS ............................................................................................................................ 32 3 Part II: The Vendor ............................................................................................................................. 34 1. BACKGROUND ........................................................................................................................ 36 2. 2. METHODOLOGY ................................................................................................................. 37 2.1. Objectives of the Review .................................................................................................. 37 2.2. Geographic Focus............................................................................................................. 38 2.3. Definitions and Protocol ................................................................................................... 38 2.4. Eligibility Criteria ............................................................................................................. 39 2.5. Search Strategy ............................................................................................................... 40 2.6. Selection Strategy ............................................................................................................ 41 2.7. Data Charting Process ...................................................................................................... 41 2.8 Limitations ....................................................................................................................... 42 3. STUDY CHARACTERISTICS ......................................................................................................... 43 3.1 Selection of Sources of Evidence ................................................................................... 43 3.2. Population and Locations Studied..................................................................................... 44 3.3. Design and Methods ....................................................................................................... 46 4. SYNTHESIS OF EVIDENCE ............................................................................................................ 49 4.1 Vendor Knowledge, Attitudes, and Practices ................................................................ 49 4.1.1 Vendor knowledge ...................................................................................................... 49 4.1.2. Vendor Attitudes ......................................................................................................... 50 4.1.3. Vendor Practices.......................................................................................................... 52 4.2. Demographic Differences and Gaps in Practices ................................................................ 54 4.5 Summary of Findings ........................................................................................................ 59 5. CONCLUSIONS ................................................................................................................................. 62 REFERENCES FOR OVERVIEW AND PART I: THE CONSUMER .............................................................. 65 REFERENCES FOR PART II: THE VENDOR ............................................................................................. 75 4 APPENDICES ...................................................................................................................................... 83 APPENDIX I: Consumer Study Full Search Strategy with Search Terms by Database .................. 83 APPENDIX II: Consumer Cross-Sectional Survey Studies Summary ............................................ 92 Appendix III: Consumer Qualitative Studies Table .................................................................. 142 APPENDIX IV: Consumer Cross-sectional Mixed-Methods Studies Table .................................. 153 APPENDIX V: Consumer Studies by Type and Country ............................................................ 174 APPENDIX VI: List of Consumer Studies by Study Objective and Focus .................................... 175 APPENDIX VII: Studies including Consumers and Vendors ...................................................... 182 Appendix VIII: Vendor Studies Summary Table ...................................................................... 185 LIST OF TABLES – CONSUMER & VENDOR Table 1. General Characteristics of Consumer Food Safety Perspectives ............................................ 18 Table 2. Study Objective and Focus by Category ................................................................................. 24 Table 1. Inclusion and Exclusion Criteria for the Scoping Review ........................................................ 39 Table 2. Indirect Markers of Food Safety Used in the Study ................................................................ 55 Table 3. Challenges Encountered by Food Vendors ............................................................................. 57 LIST OF FIGURES – CONSUMER & VENDOR Figure 1. Inclusion Flow Chart ............................................................................................................. 17 Figure 2. Study Objectives for Survey Studies ...................................................................................... 22 Figure 3. Study Objectives fr Qualitative Studies ................................................................................. 23 Figure 4. Study for Mixed-Methods Studies ........................................................................................ 23 Figure 5. Summary of Search Process (Vendor Figure 1) ..................................................................... 44 5 ACRONYMS Below is a list of all acronyms and abbreviations used in the report. Codex Codex Alimentarius FAO Food and Agriculture Organization FGD Focus Group Discussions GAIN Global Alliance for Improved Nutrition GPS Global positioning system IFPRI International Food Policy Research Institute ILRI International Livestock Research Institute KAP Knowledge, Attitude and Practice KABB Knowledge, Attitudes, Beliefs, Behaviors LMICs Low- and Middle-Income Countries PPE Personal protective equipment SPS Sanitary and Phytosanitary measures WHO World Health Organization WTO World Trade Organization WB World Bank 6 OVERVIEW Unsafe food causes 600 million cases of foodborne related illness and 420,000 deaths a year worldwide, one third of which are among children under the age of 5.(1) The World Health Organization (WHO) estimates that every year, one in every 10 people will fall ill due to foodborne illness.(1) Unsafe food containing pathogens, chemical hazards (e.g., pesticides, radiological residue), or physical agents such as plastics can cause more than 200 different diseases.(2) Foodborne disease can include both acute and long-term effects. Foodborne disease is also has closely linked with nutrition, as many of the most nutritious foods such as vegetables and meat can be highly susceptible to contamination. Worldwide, 92% of foodborne illnesses and 55% of deaths are due to diarrheal diseases, most often caused by food contaminated with norovirus, pathogenic E. coli, and Salmonella.(3) An estimated 33 million years of healthy life (DALYs - Disability Adjusted Life Years) are lost every year due to foodborne disease, mostly occurring in low- and middle-income countries, where regulation of food production processes and food handling are less restrictive and consumers and food handlers have less access to water and adequate food storage.(3) The economic consequences of foodborne disease for these countries are also significant. The World Bank estimates approximately $110 billion US dollars are lost in productivity and medical expenses each year (4), At the individual level, this translates to an inability to care for oneself and one’s family, perpetuating cycles of poverty. It also impacts the greater society, including national economies, trade, tourism, and sustainable development. Prevention of foodborne illness is a shared responsibility across the food chain, including both consumers and food vendors. At the local level in lower-income countries, food safety practices of local stakeholders (such as farmers, vendors, and consumers) may have a large impact on reducing the burden of foodborne disease. This is particularly true in settings where regulations may not be enforced due to lack of knowledge or government resource constraints. Central to the approach of EatSafe is that the interaction between consumers and vendors offers a leverage point for significantly improving food safety in informal markets in lower-income countries by empowering consumers to demand safe food, and vendors to deliver it. This makes it essential to understand how both food vendors and consumers conceptualize food safety, their attitudes and beliefs about the risk of foodborne illness and how to prevent it, and how this knowledge and these beliefs are reflected in their practices. It is also essential to better understand how consumers and food vendors interact in order to develop effective, targeted interventions to improve food safety. To meet these goals, EatSafe commissioned two scoping reviews, one on consumer perceptions of food safety (Part 1) and one on vendor perceptions of food safety (Part 2). We present them here as two separate sections within this document, though some differences in scope and methods are unique to each. 7 • The consumer review identified a total of 131 studies: 84 cross-sectional surveys, 22 qualitative, and 25 mixed-methods studies. The majority of studies assessed consumer food safety knowledge, attitudes, beliefs, behaviors, and/or risk perceptions, used general adult audiences, and occurred in Asia. Several research methodologies were found to have been used, including respondent and investigator driven surveys, in- depth individual interviews, focus groups, and direct observation. Most did not have a specific commodity focus. The consumer review covered a shorter time period than the vendor review (5 years vs. 20 years). • The vendor review identified 84 relevant studies, most of them conducted in or after 2015 and concentrated in urban and peri-urban Africa (especially East Africa), followed by South-East Asia. Most studies used a cross-sectional design with mixed methods, with a typical sample size of less than 50 individuals. The majority of the food vendors studied were women and were either illiterate or had attended/completed primary education. Common food value chains studied were dairy, meat (including bushmeat), and fruits and vegetables. Very few studies examined more than one type of commodity or value chain. While the vendor review focused only on low- and middle-income countries, the consumer review did not use this restriction. • Importantly, 15 of the 131 studies uncovered in the consumer review, and about 20 of the 84 studies uncovered in the vendor review, included both consumers and vendors or other food chain actors in the study population. Such studies tend to focus on examining consumer trust in food purchased from vendors, consumers’ perceptions of vendors’ food safety practices, and/or comparing consumers’ and vendors’ views on food safety. Several gaps to address in future research emerged from each review. These included a need for evidence from a greater range of geographies (notably, South Asia and Latin/South America), more integrated work examining both vendors and consumers, and more work examining gender and social dynamics as related to food safety. There is also a need for more research examining the meaning of “food safety” as a concept or value among vendors and consumers, and for studies that increase our understanding of the relative importance of food safety concerns (among other criteria and concerns driving food choices) for both consumers and vendors. The consumer review also highlighted a need for more theory-based examinations of individual and social behavior, while the vendor review noted a gap in understanding vendors’ sources of information on food safety (and their trust therein). This Global Review contains Part 1 on the Consumer and Part 2 on the Vendor. Each part has its own Table of Contents, References and Appendices. 8 EatSafe - Evidence and Action Towards Safe, Nutritious Food PART 1: The Consumer 9 SUMMARY Prevention of foodborne illness is a shared responsibility across the food chain, including both consumers and food vendors. This review covers how consumers conceptualize food safety and food safety behavior, their beliefs about their risk of foodborne illness, and how they interact with and perceive food vendors, all of which are key to developing effective and targeted interventions that will improve food safety behavior as well as expand access to safe food in informal markets. This section of the global review presents a rigorous scoping review of consumers perceptions related to food safety. It synthesizes evidence from cross-sectional studies (qualitative, mixed-methods, and survey studies) carried out globally over the past 5 years. The studies are categorized and analyzed by geography, target group, study objective and focus to understand how consumers conceive of food safety, how it might differ by group or region and how these perceptions are connected to their behavior and perception of risk. A total of 131 studies was reviewed - 84 cross-sectional surveys, 22 qualitative, and 25 mixed- methods. The majority of studies focus on general adult audiences, and most studies were carried out in Asia. Several research methods have been used, including respondent and investigator driven surveys, in-depth individual interviews, focus groups, and direct observation. We found 22 studies on consumers and vendors interactions and perceptions of food safety, including consumer experiences and trust in the food purchased from street vendors or markets. Some of these studies sought to characterize the extent to which food safety was a relevant decision criterion. In general, however, most of the studies examined food handling and hygiene behaviors with a focus on the practice of food safety (i.e., ‘what is food safety’) rather than how consumer perceive the consequences of unsafe food. In the last five years, this review shows that the research has primarily conceptualized food safety practices, with less research on the gains or losses that consumer experience because of safe or unsafe foods, respectively. The emotions or emotional experiences related to unsafe food were explored only in a few of these cross-sectional studies. There is some evidence to suggest that consumers are making trade-offs between food safety criteria, price, and convenience. 10 1. BACKGROUND Food quality and safety are universal consumer concerns and consumer knowledge, attitudes, and behaviors impact food safety throughout the food system. (12) Food safety is impacted by the places where consumers buy and prepare foods. A large portion of consumers in low- and middle-income countries primarily purchase food in informal outdoor “wet” markets, and from street vendors, where food is generally not subject to oversight and food is not inspected to meet quality and safety standards.(11) While food from such markets does not necessarily pose a higher risk than food from ‘formal’ supermarkets, there is room for significant food safety improvements in informal markets Most consumers have knowledge of the quality and safety of the foods they eat (6) and studies indicate that consumers use sensory cues to assess quality and freshness when buying foods (7) and will chose products they perceive as safe even if they cost more.(8) Once purchased consumers need an understanding of food safety practices to properly prepare and cook foods, including proper handwashing, preparing food to reduce cross-contamination, and cooking and storing foods at the correct temperature.(9, 10) Consumers can influence other actors in the food chain who are responsible for ensuring food safety at the stage of the supply chain they control or influence. Consumers can be “agents of change” by elevating their demands for food safety, including through their interactions with food handlers and food suppliers. Consumers and food vendors may work together or build upon each other’s efforts, to foster a culture of food safety. In this context, understanding how food safety is perceived and valued across the food supply chain, in particular how attitudes, beliefs, and information motivate the behaviors and choices of consumers and food vendors is key to develop effective food safety interventions both inside and outside the home. The purpose of this scoping review is to examine cross-sectional studies – quantitative surveys, qualitative studies, and mixed-method studies – that have occurred in the past 5 years (2015- 2020) to understand the current knowledge, attitudes, beliefs, and perceptions of food safety among consumers to inform future EatSafe interventions at informal markets where many vulnerable consumers buy their food. Our analysis includes a categorization by study, theoretical underpinning, method, and geography to elucidate potential differences. We discuss how these findings might be used to identify research gaps, advance the conceptualization of food safety, and create a food safety culture where consumers are able to demand that other food chain actors deliver safe foods. EatSafe will examine the important role consumers play in identifying safety issues and demanding improved safety in markets and vending stalls. But many countries may not have regulatory standards or the ability to ensure food safety at informal markets, including through certification and food safety training to individual vendors. While the trend to certify specific products as being hazard-free (169) may play a role in consumer choice, some studies noted that having certification of products may lead to higher prices,(170, 146) negating the perceived benefit to consumers. 2. METHODOLOGY Scoping reviews are a way to synthesize research evidence by documenting the volume, nature and characteristics of the primary research that has been done in a field of interest.(13, 14) Scoping reviews share some of the same processes as systematic reviews, including a rigorous and transparent search method, but the purpose of a scoping review is to provide a wider lens for analysis of the literature, such as identifying themes and knowledge gaps, rather than presenting empirical evidence of a smaller number of studies.(15) The methodology for this consumer part of the review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines (16) and we then applied the framework outlined by Arksey and O’Malley.(14) This framework outlines five key phases for a scoping review: identifying the research questions, identifying relevant studies, selecting studies for review, charting the data, and collating, summarizing and reporting the results. 2.1 Research Questions The review of food safety cross-sectional studies was guided by the following questions: 1. What do current cross-sectional and descriptive studies indicate are consumer knowledge, attitudes, beliefs, and behaviors (KABB) of food safety and how can findings inform interventions that address food safety for both consumers and food vendors? 2. What studies have included both consumers and street or food market vendors to better describe how food safety is conceptualized among these actors? 3. What theories have been used to describe consumer attitudes, beliefs, and perceptions of food safety? 12 2.2 Data Sources and Search Strategy To identify relevant studies, the review team worked with a medical librarian to develop detailed search strategies for each database. The search queries were tailored to the specific requirements of each database. The initial search was done June 16, 2020 in seven electronic databases: PubMed (National Library of Medicine), Embase (Elsevier), Web of Science (Clarivate Analytics), Cochrane Central (Wiley), CINAHL (EbscoHost), GreenFile (EbscoHost), and Clinicaltrials.gov using a combination of keywords and subject headings where appropriate. These databases were selected to cover a broad range of disciplines, understanding that food safety is a topic studied in the empirical and the social sciences. Handsearching was also performed by other members of the review team by examining review articles, looking at references used in articles as a way of spot-checking for consistency, and reviewing findings from the grey literature. The search was limited to the English language and to publications since 2015. This was to ensure research was relevant to the present understanding of the current research trends in consumer food safety. The full search details are provided in Appendix I. An EatSafe review, Publicly available food safety information: Grey Literature resources for consumers and practitioners, with a focus on Nigeria, looked at 36 organizational or governmental websites. It was conducted to identify any other potential studies to include in the scoping review. Cross-sectional and descriptive research articles deemed to be peer reviewed were pulled and became a hand-sorted reference. 2.3 Citation management All citations were first uploaded to Endnote X.7, and duplicates were removed. Remaining citations were then imported into the web-based systematic review software DistillerSR (Evidence Partners Incorporated, Ottawa, ON) for subsequent title and abstract review. 2.4 Eligibility Criteria Studies were eligible for inclusion in the scoping review if they had a consumer focus (vs. only food handlers, such as workers or vendors), had a food safety focus (vs. studies asking consumers about their knowledge of nutrition), and were a cross-sectional survey, qualitative study (using interviews, focus groups or observation), or mixed-method study (i.e. using both quantitative and qualitative methods) with the aim of understanding consumer food safety knowledge, attitudes, and perceptions, as well as consumer or vendor behavior. We included studies on other food chain actors (e.g. vendors) if consumers were included as a target audience. We also reviewed 13 the abstracts of intervention studies, but these are not reviewed here: they were instead reviewed separately1. Only studies that included primary empirical data were included. Papers that described the development of a survey measurement, psychometrically tested a measurement tool or were reviews articles were not included, as they did not have outcomes related to answering the research questions. However, references in these studies were used to identify additional studies that may not have been captured in our search. Any relevant study found via this ‘snowballing’ search had to also comply with the search criteria (published since 2015 and available in English) and eligibility criteria (e.g., a cross-sectional study with a consumer and food safety focus). 2.5 Title and Abstract Relevance Screening – Levels 1 and 2 For the Level 1 screening, citations were screened by title and abstract by two independent reviewers for the first 1,500 entries. They were not masked by author or journal name. Titles for which an abstract or author was not available were included for subsequent review. If a tiebreaker was needed, a third reviewer was called in to make a determination. To determine inter-rater reliability (a statistical measurement of agreement between two or more coders), a Kappa statistic was run. Once a Kappa of at least 0.80 was found between two reviewers,(17) we went to a “one reviewer to include, two reviewers to exclude” review (i.e., both reviewers had to agree to exclude a study, but only one was needed to decide to include a study). As recommended by Levac et al., (18) reviewers met regularly to resolve conflicts and discuss the selection process. This process was repeated for full-text article screening and article selection. For level-two screening, included citations were carefully reviewed for applicability, eligibility criteria (e.g., consumer food safety focus, year of publication), and duplicates. Citations that did not provide an abstract or author were looked at in detail to see if they met eligibility criteria. A review of journals was also done to ensure that no citation was from a predatory journal or publisher by checking against the List of Predatory Journals (19) and assessing whether the journal is a member of the Committee on Publication Ethics (COPE) (20) or the Open Access Scholarly Publishers Association.(21) 1Global Alliance for Improved Nutrition. 2020. Consumer-facing interventions to improve food safety perceptions and practices in low- and middle-income countries: a review. A USAID EatSafe Project Report. 14 2.6 Data Characterization and Synthesis Once a final list of citations was created, all full text articles were pulled. If a full text was not available through institutional holdings or through inter-library loans, attempts were made to reach out to authors or the journal for assistance. A data extraction form was then used to categorize each study by the following information: author/title/journal/year of publication, theory(ies) used, summary of study, study design, results, location, and sample description for cross-sectional surveys (Appendix II), for qualitative studies (Appendix III), and one for mixed- methods studies (Appendix IV). These forms were reviewed by the research team, and slight modifications were made after the first ten studies were reviewed and summarized. Any study found to not fit eligibility criteria at this level was flagged and the study team reviewed for inclusion. Excluded studies were either added to the exclusion number or moved to the companion review examining interventions (i.e., if the study was not cross-sectional study but instead tested an intervention meant to change knowledge, attitudes or behaviors). Once these summary tables were complete, analysis to characterize the studies and answer the research questions was completed. This included looking at each study by region where it occurred, target group, theoretical underpinning, study objective, and focus. Descriptive statistics were calculated to summarize the data, including frequencies and percentages to depict nominal data; these statistics were then analyzed by outcome to characterize the overall findings. 2.7 Limitations This scoping review has some limitations. First, only articles available in English were included. Some interventions published in other languages may have enriched the review (particularly those in Spanish, in the case of Latin/South America). Additionally, some potentially relevant articles may have been missed by the search; this was mitigated as much as possible by a comprehensive search strategy, working with a medical librarian, and a search that encompassed seven databases, a grey literature search, and a hand citation search to spot-check results. As the review focused on food safety, it did not include other fields that could be relevant to designing consumer-facing food safety interventions, such as hygiene, water and sanitation, or other aspects of public health as well as broader food features relevant to consumer preferences. Finally, the review only encompasses studies published within the past five years, to capture new trends in food safety research. This also limits the results, although other scoping reviews of earlier studies have been conducted and report on those findings. (172) Most of the studies were atheoretical and simply cataloged knowledge and behaviors of the populations under study. The few studies that did use theory to drive understanding of food 15 safety KABB may provide a better context to understand how and why risk perception occurs. The Freivogel and Visschers study,(47) for example, used the theory to model intention to perform safe food handling behaviors by assessing risk perception of getting foodborne illness, positive outcome expectancy (that performing the behavior would prevent that illness), and self- efficacy in being about to perform the behavior. Ruby et al. (87) showed that in Malaysia, subjective norms (in this case the familial expectation of safety) and perceived behavioral control were significant predictors of intention of food safety behavior in the home. Theory-based studies can better explain the context in which KABB exists and the connections among knowledge, attitudes, beliefs, behaviors. EatSafe surveys and research on interventions should seek not only to describe food safety perceptions or practices, but also examine the linkages among knowledge, beliefs (including social norms), attitudes, emotions, gains/losses, and intention. 3. STUDY CHARACTERISTICS The initial search resulted in 21,397 studies (149 from grey literature sources); 3,221 duplicate studies were found and omitted, leaving 18,176 references eligible to screen. After relevance screening, 322 studies met the eligibility criteria based on title and abstract. Level-two review eliminated 149 studies based on duplicates not identified previously, not being peer-reviewed, or being out of date range, leaving 173 citations. An additional 50 were hand-added from reference and grey literature searches, for a final sample of 223 citations. This included 84 cross- sectional surveys, 22 qualitative studies, 25 mixed-methods studies, and 92 interventions; in this paper the interventions are excluded, so the analysis focuses on 131 cross-sectional studies. The flow of articles is presented in the PRISMA diagram in Figure 1. 16 Figure 1. Inclusion Flow Chart 3.1 General Characteristics of Cross-sectional Studies Of the 131 cross sectional studies (84 surveys (22-105), 22 qualitative (106-127), 25 mixed methods (128-152)), 58% have been published in the past three years (Appendix II-IV). For all types of studies, they have been more likely to occur in Asia, with a total of 54 studies. This represents 41.2% of all studies (45.2% of survey studies, 36.4% of qualitative studies, and 32% of mixed methods studies); for comparison, approximately 60% of the global population lives in Asia. Africa, Europe, and North America jointly represent another 46.5% of the total (n=61). Three studies (2.3% of total) have covered more than one continent. Overall, 49 different countries are represented in these studies, 20 of which are in Asia. Countries with the most studies include the United States (11), China (10), South Africa (8), and Vietnam (7) (Appendix V). Using the World Bank characterization of Gross National Income per capita to categorize countries by income (5) 38.2% of the studies have been conducted in High Income countries, in North America, Europe, and Australia. Only 3.8% have occurred in Low-Income countries, where the public may be more exposed to and at risk of foodborne illnesses. A total of 56.5% have 17 occurred in Middle Income countries, with 37.4% in Upper Middle-Income countries and 19.1% in Lower Middle-Income countries (See Table 1). Table 1. General Characteristics of Consumer Food Safety Perspectives Characteristic Surveys Qualitative Mixed- Total (n=84) (n=22) Methods (n=131) (n=25) Publication year 2015 14 (16.7%) 4 (18.2%) 4 (16.0%) 22 (16.8%) 2016 7 (8.3%) 6 (27.3%) 7 (28.0%) 20 (15.3%) 2017 8 (9.5%) 5 (22.7%) 3 (12.0%) 16 (12.2%) 2018 22 (26.2%) 1 (4.5%) 3 (12.0%) 26 (19.8%) 2019 24 (28.6%) 5 (22.7%) 6 (24.0%) 35 (26.7%) 2020 9 (10.7%) 1 (4.5%) 2 (8.0%) 12 (9.2%) Continent (n=84) (n=22) (n=25) (n=131) Africa 11 (13.1%) 2 (9.1%) 8 (32.0%) 21 (16.0%) Asia 38 (45.2%) 8 (36.4%) 8 (32.0%) 54 (41.2%) Australia 3 (3.6%) 2 (9.1%) - 5 (3.8%) Europe 14 (16.7%) 5 (22.7%) 2 (8.0%) 21 (16.0%) North America 12 (14.3%) 2 (9.1%) 5 (20.0%) 19(14.5%) South America 4 (4.8%) 3 (13.6%) 1 (4.0%) 8 (6.2%) Multi Continent 2 (2.4%) - 1 (4.0%) 3 (2.3%) Income (n=84) (n=22) (n=25) (n=131) High 32 (38.1%) 9 (40.9%) 9 (36.0%) 50 (38.2%) Middle Upper Middle 38 (45.2%) 7 (31.8%) 4 (16.0%) 49 (37.4%) Lower Middle 11 (13.1%) 5 (22.8%) 9 (36.0%) 25 (19.1%) Low 2 (2.4%) - 3 (12.0%) 5 (3.8%) Multi-income 1 (1.2%) 1 (4.5%) - 2 (1.5%) Data Collection Methods* (n=85) (n=28) (n=62) (n=174) Self-Administered Survey 47 (55.3%) - 18 (29.0%) 65 (37.4%) Interviewer Admin. 24 (28.2%) - 8 (12.9%) 32 (18.4%) Survey/Inventory Online Survey 14 (16.5%) - - 14 (8.0%) Structured/semi- - 13 (46.4%) 14 (22.6%) 27 (15.5%) structured/in-depth interview Structured/Semi-structured - 11 (39.3%) 13 (21.0%) 23 (13.2%) focus group Observational - 4 (14.3%) 9 (14.5%) 13 (7.5%) 18 Study Population* (n=95) (n=27) (n=34) (n=156) General adult consumers 47 (49.5%) 16 (59.3%) 16 (47.1%) 79 (50.6%) Older Adults 3 (3.2%) - 1 (2.9%) 4 (2.6%) Parents/Heads of household 4 (4.2%) 3 (11.1%) 1 (2.9%) 8 (5.1%) Primary/Secondary School 8 (8.4%) - 2 (5.9%) 10 (6.4%) aged Children/Adolescents College/University and 12 (12.6%) - 1 (2.9%) 13 (8.3%) Professional Students Food producers/ 7 (7.4%) 3 (11.1%) 5 (14.7%) 15 (9.6%) Preparers/Handlers1 Experts/Academics/Officials 1 (1.1%) 2 (7.4%) 1 (2.9%) 4 (2.6%) Mothers/Female heads of 6 (6.3%) 1 (3.7%) 3 (8.8%) 10 (6.5%) household Women (general, excluding 3 (3.2%) 2 (7.4%) 1 (2.9%) 6 (3.8%) mothers/heads of household) Adult patients with health 3 (3.2%) - 1 (2.9%) 4 (2.6%) issues (e.g., HIV, Cancer, Salmonella infection) Other populations2 1 (1.1%) - 2 (5.9%) 3 (1.9%) Theory* (n=86) (n=23) (n=25) (n=134) None noted 77 (89.5%) 18 (78.3%) 20 (80.0%) 115 (85.8%) Theory of Planned 6 (7.0%) 1 (4.3%) 1 (4.0%) 8 (6.0%) Behavior/Theory of Reasoned Action Health Belief Model - - 1 (4.0%) 1 (.8%) Grounded Theory - 2 (8.7%) - 2 (1.4%) Other Theory3 3 (3.5%) 2 (8.7%) 3 (12.0%) 8 (6.0%) * Categories are not mutually exclusive so total numbers are larger than number of studies 1. Studies including food producers, preparers, and handlers were only included if they also had consumers as a target group. 2. Other populations include: Caregivers of cancer patients, Native Americans 3. Other theories include: Health Action Process Approach (HAPA), Information Integration Theory, Protection Motivation Theory, Social Practice Theory, Ecological Systems Theory, Precede-Proceed model, Theory of Social Representation 3.2 Data Collection Methods, Target Populations, and Theory Data collection methods varied by study type. Cross-sectional survey studies used three modes: 1. self-administered surveys, where the respondent was given a survey and they completed it; 2. interviewer-administered surveys, where the researcher read the survey to the respondent and marked their answers either on paper or on a computer or hand-held device (either in person or over the phone); and, 3. online surveys, where the respondent completed the survey online. Over half (55.3%) of the 84 survey studies used self-administered survey collection methods, while 28.2% were interviewer-administered and 16.5% were done online. 19 Qualitative studies also used three data methods: in-depth interviews; focus groups, in which a group of people come together and are guided in a discussion about the topic; and observation of purchasing or food preparation behavior. In-depth interviews were the most used method, representing 46.4% of the total, followed by focus groups with 39.3% of the total. Observation was used in 14.3% of the studies. Finally, mixed-methods studies used a variety of methods, usually pairing surveys (41.9% of mixed-methods studies) with either interviews (22.6%) or focus groups (21%). Some mixed-method studies used observation (14.5%) of either individual behavior at home or street vendor behavior along with surveys of consumers. The cross-sectional studies reviewed present data from a variety of populations, although general adult consumers (79 studies, 50.6% of total) were the most represented group in each study category. This represents 47 survey studies, 16 qualitative studies and 16 mixed-methods studies. Other populations include mothers/female heads of households or parents/heads of households (18 studies; 11.6% of total), food preparers or handlers (15 studies; 9.6% of total. These studies were only included if they also included consumers in their target group), college/university students (13 studies; 8.3% of total), and primary/secondary school children (10 studies; 6.4% of total). The rest all represent less than 5% of the total. Women are specifically targeted in an additional six studies (3.8%), outside of their role as mothers or heads of household (See Table 1). Across geographies, there is a preference for certain audiences. In Africa, target audiences include general adults (4 survey studies, 2 qualitative studies, 4 mixed methods studies) and mothers or female heads of households (6 survey studies, 2 mixed-methods studies). Asia has more studies with general adults (23 surveys, 5 qualitative studies, 5 mixed-methods) and students, either primary/secondary school or university (11 surveys, 1 mixed-methods). Studies done in Asia are also most likely to include food producers/preparers/handlers along with consumers (3 surveys, 2 qualitative, 2 mixed methods). Europe, North America and South American studies focus mainly on general adults (Appendix V). Of relevance to EatSafe, reviewers found 22 studies that specifically connect consumers to vendors or other food chain actors by exploring food safety within the context of street foods or foods purchased in open or wet markets. These studies highlight a range of issues from food retailing locations (supermarket or wet market), who is selling the food (and their knowledge or practices) and whether they are ‘trusted’ sellers, to the role of media and information that creates misinformation among consumers and vendors alike. Only 14.2% of the studies indicated a theoretical underpinning for the research. Cross-sectional survey studies were least likely to be theory based (only 10.5%), compared to 21.7% of qualitative studies and 20% of mixed-methods studies. Of those that did note a theory base, the most 20 common theory used was the Theory of Planned Behavior/Theory of Reasoned Action (8.5%).(153) In these studies, the constructs of perceived behavioral control, behavioral intention and subjective norms were used to guide survey or interview/focus group questions. These studies include understanding psychosocial determinants of safe food handling,(47, 73, 87) the ways people feel about street food and its effect on behavioral intentions,(50) beliefs about specific food products,(122, 139) and intentions to store food properly.(98) Other theories represented included the use of Grounded Theory (a systematic methodology to construct theory through qualitative research) (154) in two qualitative studies,(110,126) and, in one mixed- methods study, the Health Belief Model,(151) which assesses the perceived severity and susceptibility of health threats to understand behavioral intention.(155) Two theories used in mixed-methods studies, Social Practice Theory (156) and Social-Ecological Systems Theory,(157) are aimed at understanding behavior in the context of societal or social settings and included observational components.(138, 152) 3.3 Study Objectives and Focus Reviewers identified five general categories of study objectives (See Figures 2-4 and Appendix V). Studies investigating general risk perceptions associated with food safety, often related to specific types of foods, such as milk or seafood, or perceived risk of getting a foodborne illness. Risk perception or perception of food safety is assessed in 16 survey studies (19%), 11 qualitative studies (50%), and two mixed-methods studies (8.3%). Studies of general food safety knowledge/attitudes/beliefs/behaviors (KABB). KABB studies assess actual levels of knowledge, types of attitudes, or behavior in a population. General food safety KABB in adult consumers include 20 surveys (23.8%), two qualitative studies (9.1%), and one mixed-methods study (4%). Other KABB studies have focused on sub-populations of consumers, including students (both primary/secondary and university students), older adults, and special populations (See Figure 2-4). Another important objective as part of our gender analysis was to assess KABB in mothers or caretakers of children and households, which was studied in eight survey studies (9.4%), two qualitative studies (9.1%), and six mixed-methods studies (25%) (See Figure 2-4). Studies that assess food safety information sources (i.e. how people use labels or use of/recall of food safety information). Information sources as they relate to food safety and trust of food sources are the objective for seven survey studies (8.2%), three qualitative studies (13.6%), and 21 two mixed-methods studies (8.3%). These studies asses use of food labels, influence of written or Internet-based information, or media campaign information recall. (See Figures 2-4). Studies that primarily assess consumer KABB as it relates to street vendors, markets or restaurants. These studies are differentiated from the risk perception and KABB categories by their focus specifically on vending or purchasing of food or street food. There are 10 survey studies (11.8%), 2 qualitative studies (9.1%), and 10 mixed methods studies (41.7%) with this focus (See Figure 2-4). Studies that include expert opinions on food safety for consumers. There are 2 qualitative studies (9.1%) with this focus (See Figure 3). Risk Perceptions 8% 19% KABB (adults) 12% KABB (children) KABB (university) 10% KABB (elderly) KABB (special pops) 2% 24% KABB (mothers/caretakers) 2% Consumer/Vendors 16% 7% Food Safety Information Figure 2. Study Objectives for Survey Studies KABB: knowledge, attitudes, beliefs, behaviors. Legend matches the pie chart if pie chart is read clockwise beginning at 12 o’clock. ‘Special pops’ is short form of special populations. Numbers in figures are rounded to the nearest integer. 22 9% Risk Perceptions 14% KABB (adults) KABB (mothers/caretakers) 50% 9% Consumer/Vendors Food Safety Information 9% Experts 9% Figure 3. Study Objectives for Qualitative Studies KABB: knowledge, attitudes, beliefs, behaviors. Legend matches the pie chart if pie chart is read clockwise beginning at 12 o’clock. Numbers in figures are rounded to the nearest integer. 4% 4% 8% 4% 8% Risk Perceptions 8% KABB (adults) KABB (children) KABB (mothers/caretakers) 24% Consumer/Vendors 40% Food Safety Information KABB (elderly) KABB (university) Figure 4. Study for Mixed-Methods Studies KABB: knowledge, attitudes, beliefs, behaviors. Legend matches the pie chart if pie chart is read clockwise beginning at 12 o’clock. Numbers in figures are rounded to the nearest integer. 23 Though reviewers identified five general categories of study objectives, the focus of the identified studies examined were much more varied (See Table 2). Table 2. Study Objective and Focus by Category SURVEYS (n=84) Study Objective Study Focus Risk perceptions or perceptions of • Perceptions of Fura and nunu food products in Nigeria food safety (16 studies, 19.0%) • Perceptions of the safety of seafood consumption • Food safety cues used when purchasing food • Perceptions of safety of online food products • Perceived risk and control of food safety • Perceptions of the safety of milk • Perceptions of safety of food additives and contaminants • Perceptions of risk of getting Campylobacter, Salmonella, Toxoplasmosis • Perceived qualities important to assess food quality and safety • Perceptions of safety of food additives and contaminants and traits of food safety • Perceived safety of rice and vegetables • Perceived safety of fresh fruits and vegetables • Perceptions of food quality and relationship to safety • Perceived safety of slaughtering and handling of goats • Risk perception and risk avoidance of foodborne disease • Risk perception of foodborne disease General Food Safety KABB – General • Chicken prep and raw chicken labels Adults (20 studies; 23.8%) • Shopping and storage behavior and knowledge • Awareness of food safety and factors deemed important • Factors related to food handling behaviors • Food safety KABB and self-perception of salmonella exposure • Poultry handling, purchasing of minorities • Purchasing behavior related to food safety • Personal hygiene in refugee camp • Raw chicken handling and knowledge • Raw chicken handling and knowledge • General food safety KABB • Food safety behaviors • General food safety KABB • General food safety KABB • General food safety KABB at home • General food safety KABB at home 24 • Food safety KABB around poultry purchasing, transport • General food safety knowledge and behavior • Food poisoning knowledge and food preparation • Knowledge of foodborne risks during pregnancy General Food Safety KABB - • Knowledge and food hygiene practice, secondary Children/Adolescents/Teens (6 schools studies; 7.1%) • General food safety KABB • General food safety KABB • General food safety KABB in high school students • General food safety KABB in males • General food safety KABB General Food Safety KABB - • General knowledge of foodborne illness and University Students or Young Adults transmission; behavior (13 studies; 15.5%) • Eating behavior, food safety knowledge, behavior • General food safety KABB • Handwashing frequency • General food safety KABB • Knowledge of food safety • General food safety KABB • Food safety knowledge in nutrition majors • Food storage knowledge • General food safety KABB in young women • General food safety KABB in young consumers • General food safety KABB in vet students • General food safety KABB General Food Safety KABB - Older • Food safety KABB with ready to eat food products Adults (2 studies; 2.4%) • Food safety intentions and beliefs about food storage General Food Safety KABB - Special • Food safety KABB Cancer patients on chemo Populations (2 studies; 2.4% • Food safety risk perception, attitudes, behaviors in cancer patients General Food Safety KABB - • Knowledge of food storage and handling; personal Mothers/Caregivers (8 studies; 9.5%) hygiene and food poisoning risks • Food safety knowledge and attitudes • Food safety practices at home • Food handling practices in parents • Hand washing practices • Hand washing practices • Knowledge and practices related to disease and cooking • General food safety KABB Influence of Food Safety Information • Perceptions of food labels and packing; relationship to Sources (7 studies; 8.3%) beliefs about food safety • Perceived food safety and customer loyalty • Relationship between sources of information on food safety perceptions • Sources of information and food safety handling at tailgates 25 • Information sources on food safety and relationship to demographics • KABB related to influence of media campaign • Food safety evaluation and association with Internet use Consumer Food Safety KABB in • Food safety knowledge, microbial hazard awareness Connection to Street related to using vendors Vendors/Markets/Restaurants (10 • Food safety perceptions and preferences of street food studies; 11.9%) • Risk perception and knowledge food handlers and consumers in restaurants • Perceptions of street food safety • Tourist perceptions of food safety in ports • Food safety KABB in consumers, street vendors • Perceptions of informal food markets and factors that influence purchasing and food safety • Customer KABB about food facilities • Customer and vendor food safety KABB • Chicken customer, farmer and vendor knowledge about avian flu virus and food safety QUALITATIVE STUDIES (n=22) Study Objective Study Focus Risk perceptions or perceptions of • Definitions of food safety and perceptions of food safety (11 studies; 50%) mold/fungus infestations • Consumer perceptions of risk of purchasing and consuming bivalve meat • Perceptions of meat safety • Perceptions of trust in food sources • Perceptions of health risks related to kitchens • Perceptions of mistrust in food and strategies used to identify and cope • KABB of consumers on what “healthy eating” means • Perceptions of safety of local beef • Food risk perceptions in food purchasers • Food incident scenarios and consumer opinion on risk and response • Perceptions of grain safety General Food Safety KABB – General • Understanding of food borne diseases and self- Adults (2 studies; 9.1%) involvement in food chain • Domestic kitchen interpretation through diaries to assess food safety KABB General Food Safety KABB - • Behaviors and knowledge of prevention of cross Mothers/Caregivers (2 studies; 9.1%) contamination in home kitchens • Caregiver hygiene practices Influence of Food Safety Information • Perceptions of trust for food safety and purchasing Sources (3 studies; 13.6%) decisions in women; influence of certification and food labels 26 • Perceptions of good food governance and trust of food safety information from government • Use of information sources to make purchasing decisions about food safety and trust of the food system Consumer Food Safety KABB in • Barriers to health literacy and knowledge in customers Connection to Street and street vendors Vendors/Markets/Restaurants (2 • Feelings related to presence of flies in fish market in studies; 9.1%) consumers and traders Expert Opinion on Food Safety for • Develop food safety hygiene checklist with consumer Consumers (2 studies; 9.1%) input • Areas of food safety education important to learn in school MIXED-METHODS (n=25) Study Objective Study Focus Risk perceptions or perceptions of • Perceptions of safety of mangoes food safety (2 studies; 8.0%) • Perceptions of European products and food safety/food fraud General Food Safety KABB – General • Knowledge of risk of using personal electronic devices in Adults (1 study; 4%) kitchen and behavior General Food Safety KABB - • General food safety KABB among male school students Children/Adolescents/Teens (2 • Hand washing in students and observation of available studies; 8.0%) facilities in schools General Food Safety KABB - • Food safety knowledge, eating habits and beliefs about University Students or Young Adults microbiological risk in vet, ag and university students (1 study; 4.0%) General Food Safety KABB - Older • Home kitchen safety and KABB in home-bound adults Adults (1 study; 4.0%) General Food Safety KABB - • Behaviors in home related to food safety Mothers/Caregivers (6 studies; 24%) • Behaviors of female caregivers in home related to food safety • Caregiver input on a food safety questionnaire to assess home behavior • Household hygiene and food safety • Food safety preparation and child feeding practices • Food safety KABB of food preparer in Native American families Influence of Food Safety Information • Food related information sources in people on Sources (2 studies; 8.0%) chemotherapy • Eye tracking of attention and impressions from website use on milk safety Consumer Food Safety KABB in • Safety perceptions and practices in pork food chain Connection to Street actors, including consumers Vendors/Markets/Restaurants (10 • Perceptions of food quality and safety of food in markets studies; 40.0%) – consumers and market vendors 27 • KABB of food safety of street food in those attending Carnival and vendors • Consumer food safety and nutrition knowledge; government officials and food vendors perceptions of certification • Perceptions of food safety of vegetable in traditional markets • Perceptions of safe food handling practices in grocery stores • Perceptions to assess consumer trust of vegetables and stakeholder assessment of food chain production • Consumer perceptions of safety of “fast food” in Ghana • Food safety perceptions of consumer and street food vendors; observation of vendors • Food retailing and association with food safety, food choice and behavior The risk perception studies assessed a wide range of perceptions on different food safety practices (111) and food categories, such as fruits and vegetables (74, 77, 129) and meat or seafood. (31, 85, 110, 111, 122) General food safety KABB studies examined consumers’ formal knowledge and general food safety behaviors. This was the case for adults, as well as the sub-populations (i.e. mothers/caretakers, children etc.). Several studies look at KABB related to food safety for specific food items, for example purchasing, handling, and cooking poultry (23, 55, 61, 62, 93). Information sources studies look at specific sources of information accessed by the study population (i.e. the Internet) and the relationship that information has to food safety KABB, risk perception or purchasing behavior.(51, 52, 75, 103, 124, 150). Information sources studies have also examined labeling and food packaging and its associations with consumer beliefs (32) or purchasing decisions. (109) Reviewers included in the information source category two studies on governance of the food chain and its influence on consumer perceptions about food safety or the integrity of the food supply chain. (112,125) Consumers and vendors KABB studies. 28 Reviewers identified 22 studies that investigate consumer and vendor or other food chain actor KABB related to food safety (Appendix VII). Of these, five studies include consumers only and focus on their perceptions of street food or market vendors, and 15 studies include both consumers and vendors as the study Consumers Views on Government population. Of the 22 studies, five have Certification occurred in Vietnam, (76, 88, 133, 146, 152) three in South Africa,(28, 67, 138) two in Three studies specifically looked at governmental Brazil,(29, 39) and two in China.(65, 104). certification or trust and the relationship to beliefs There were three studies in Asia (India, about food safety.(138, 146, 152) For example, Bangladesh, Myanmar),(50, 116, 134) three Wertheim-Heck et al. (152) looked at food retailing in Africa (Zambia, Nairobi, Ghana),(121, and its association with perceived food safety, food 140, 147) three in North American (United choice and behavior in Vietnam. They found that there were more informal “wet” markets than States) and three in the Caribbean (Haiti, supermarkets and while the variety of fresh fruits Barbados,),(56, 137, 142, 149). These and vegetables was similar, wet markets lacked studies either survey consumers about visual food safety claims and certificates. Despite their experiences and trust of food this, consumers still preferred to shop at informal purchased from street vendors or markets. markets,(28, 29, 50, 56, 67) or survey both consumers and vendors about food safety.(39, 65, 76, 88, 104) Qualitative and mixed-methods studies add personal experiences by looking at barriers to health information and knowledge of food safety among both customers and vendors (116, 121), or combine surveys with in-depth interviews or observations to understand the relationship between consumer trust and food safety knowledge, with vendor or food chain actors’ behavior (133, 134, 137, 140, 147, 149). Gaps in knowledge were found not only among consumers but also among vendors. For example, Haque et al.’s (116) qualitative study linking food safety knowledge to social determinants (such as societal mores, laws, skills) found that there were significant gaps in food safety knowledge and behavior that could be related to health literacy skills, despite the presence of a vendor training program in Bangladesh. 4. SYNTHESIS OF EVIDENCE This review of 131 cross-sectional survey, qualitative, and mixed-methods studies related to consumer food safety showed that the majority assess consumer KABB and risk perceptions about food safety through the study of adult audiences. Research methodologies included surveys, in-depth interviews, focus groups, and direct observation. It should be noted that in most of the studies, food safety as a concept is assumed, meaning that studies are assessing concrete knowledge about food safety, safe food storage, personal hygiene 29 behaviors, and foodborne illness. Survey studies either use validated surveys or have developed their own scales to measure self-reported knowledge or compliance with food safety behaviors (e.g., questions about the specific temperature to safely store food or the correct way to wash hands). Qualitative and mixed methods studies were similar in this respect, often using qualitative interviews or focus groups to understand how people think about concrete behaviors such as handwashing or food storage. This is seen in studies across the globe, suggesting that researchers assume that consumers conceive food safety as a salient construct, not as a dimension of food “healthiness.” The reviewers identify three areas of relevant findings to help characterize the type of consumer- driven interventions that may be better suited for informal markets. These include: • Food safety concerns and attitudes • Risk perception • Consumer behavior (purchasing) 4.1 Food safety concerns and attitudes Public Health Concerns. Seven common public health concerns, with the majority occurring in LMICs, were identified in a systematic review of 81 studies on public health risks related to food safety issues in food markets. (159) These seven concerns included: • Microbial contamination • Chemical contamination • Food adulteration • Misuse of food additives • Mislabeling • Genetically modified foods • Outdated foods Addressing such concerns can be challenging in LMICs where regulatory oversight may be weaker (11) and food sellers tend to be informal players, (160) making compliance with food hygiene and safety regulations weaker. (161) Socio-demographic differences. Though the majority of the studies reviewed showed that the consumer populations studied have knowledge about food safety, it seems to be associated to a number of socio-demographic characteristics including education level, age and gender, with women consistently showing higher knowledge then men. A study by Odeyemi et al. (79) done in seven LMICs showed that those in Asia and the upper middle income category (Iran, Jordan, Malaysia, Pakistan) had better food safety knowledge than those in Africa and the low middle income category (Ghana, Cameroon, Nigeria). However, interventions that simply attempt to increase knowledge may not increase preventive behavior. A survey study by Sanlier and Baser 30 (89) with women in Turkey found that positive attitudes about food safety was an important mediator between food safety knowledge and actual behavior. Attitudes, which are evaluative dispositions of objects or events, are important constructs that include thoughts (what we know and believe), emotions, and behavioral intentions. (153, 171) Attitude strength is associated with topical relevancy (often called ‘top of mind’) and the considerations consumers give to food safety as a decision-criterion (171). Knowledge of consumers vs. vendors. Many of the studies that assessed both consumers’ and vendors’ food safety KABB showed that consumers had more knowledge than vendors (see Samapundo et al. (88)). Various studies noted that consumer use visual clues, such as appearance of a food stall, presence of flies, smell, and vendor hygiene, to decide where to buy food.(34, 65, 68,77) That food vendors do not exceed consumers in their knowledge of food safety may be a function of its place in the economic hierarchy. Often, food vending, especially mobile or street vending, is a subsistence business,(168) and those operating those businesses often lack training in food safety.(169) Regulation of street vending is an important mechanism to increase food safety practices of vendors.(138) Only two studies,(137, 152) however, assessed the presence of a training certificate or a symbol of regulatory compliance as a factor in consumers food decisions. 4.2 Risk perception Risk threshold is personal and knowledge as an influencer varies. Risk perception research has shown that consumers perceive hazards and risk based not only on overall knowledge but on how they prioritize that risk in their everyday lives. That perception might be heightened if the person feels they do not have control or if they do not trust those providing the information(162), as illustrated in studies by Chiu and Yu (109), Devany et al. (112) and Tonkin et al. (124). Often risk is conceptualized at an emotional level (163) and decisions are made using heuristics or short cuts that are influenced by psychological or cultural factors.(164,165) Of the studies reviewed here, potential risks associated with consumption of unsafe food were not seen to be the most important factors in consumer decision making .(166, 167) It is not clear from the studies reviewed here if the risks and consequences of consumption of unsafe food had been communicated to consumers in a way to influence their purchases. 4.3 Consumer purchasing behavior Perceived risk does not necessarily translate to purchasing. It is not clear whether and how food safety concerns affect purchasing behavior. Omari and Frempong’s study (147) in Ghana, for example, noted that consumers were aware of and worried about the public health risks in “fast food” products, but these products were often more economical and easier to get. This theme is repeated in Ng et al.’s (146) study in Vietnam, Downs et al.’s (134) study in Myanmar, Marumo 31 and Mabuza’s (67) study in South Africa, and Gupta et al.’s (50) study in India. Consumers in all these studies had correct perception of food-related health risks but noted their preference for convenience and price offered by street vendors or wet markets. This trade-off among food safety, convenience, and price warrants further exploration. 5. CONCLUSIONS This scoping review examined cross-sectional studies, survey, qualitative, and mixed-method research, on consumers’ perceptions and behavior related to food safety over the last five years. In the studies reviewed here, we distinguished between consumer risk perceptions, which are personal beliefs and attitudes on safety of food, from KABB, which capture the formal food safety knowledge, attitudes, and practices. Most of KABB studies have focused on food handling and hygiene behaviors with a focus on practices related to food safety rather than examining how consumers perceive the consequences of unsafe food. Thus, in the last five years, the research has primarily conceptualized food safety practices but there is less research on the perceived gains or losses that consumers experience because of safe or unsafe foods or practices. The emotions or emotional experiences related to unsafe food were explored in only a few of these cross-sectional studies. From those risk perception studies that assessed food safety consequences, gains/benefits, and losses as experienced by the consumer, there is some evidence to suggest that consumers make trade-offs between food safety criteria, price, and convenience. Research is also lacking on how consumers communicate food safety needs to market actors (vendors or food safety regulators) or whether interventions that empower consumers to voice these benefits or losses have yielded demonstrable changes in vendor practices. This is an important area for future study. 32 Recommendations for Intervention Design and Future Studies under EatSafe EatSafe aims to generate the evidence and knowledge on leveraging the potential for increased consumer demand for safe food to substantially improve the safety of nutritious foods in informal market settings. Central to EatSafe’s work is understanding and potentially shaping the motivations, attitudes, beliefs, and practices of consumers and food vendors. While EatSafe will undertake novel primary research on consumer and vendor motivations and practices, it is essential to ensure that this work is informed by and builds on what has already been done— both in terms of methods used and results obtained. As EatSafe designs consumer-based interventions for food safety and nutrition the following lessons emerging from this review. In the literature since 2015, food safety appears to be conceptualized as a set of practices and is less often conceptualized as perceptions of risk. Risk perception would appear to be more aligned with examining consumers’ motives, their gains or losses, and consequences associated with unsafe foods. Examining the risk perception literature found in this review will be relevant to designing and testing messaging strategies used in intervention design. • Consumers in LMICs appear to be making trade-offs between food safety, price, and convenience. EatSafe will need to consider to what extent food safety creates consumer segments and if it limits consumer access to safe foods through higher prices or time costs. Thus, some further lines of inquiry or hypothesis that need to be explored in the next phase of EatSafe are: o Do immediate considerations of convenience and price outweigh the costs of unsafe food, the effects of which may or may not occur in the future? o Will consumers voice their desire for safer food if they feel that their choices are limited due to limited purchasing power? o Both consumer attitudes and emotional experiences may be highly relevant to engaging consumers on food safety. Consumer understanding of food safety consequences, gains/benefits, and losses from unsafe food may assist in understanding the trade-offs between food safety criteria, price, and convenience. • EatSafe will need to gather socio-demographic evidence to test knowledge as one of several drivers of consumer behavior vis a vis food safety 33 EatSafe - Eviden ce and Action Towards Safe, Nutritious Food Part II: The Vendor 34 SUMMARY Vendors’ willingness, motivation, and ability to ensure safe food is partly shaped by their knowledge, attitudes, and practices (KAP); understanding vendor perspectives is thus important when designing interventions to improve food safety. This is particularly relevant in LMICs, where most consumers purchase food from vendors in informal markets, where poor infrastructure, lack of regulatory oversight, and hot ambient temperatures, among other factors, can increase food safety risks. This section of the review summarizes existing research on the perspectives and practices vis- à-vis food safety of vendors of food commodities in LMICs. Through a robust search, relevant studies examining vendor food safety KAP in informal markets across all food value chains were identified. Over 17,000 titles were screened, from which 84 relevant studies were identified. The relatively small number of studies indicates a large research gap on food safety among market vendors in LMICs. Of the shortlisted studies, most of them were of medium quality, conducted in or after 2015, and concentrated in urban and peri-urban Africa (especially East Africa), followed by South-East Asia. Most studies used a cross-sectional design with mixed methods (e.g., quantitative and qualitative analysis of vendors’ KAP through interviews and observations), with a typical sample size of less than 50 individuals. The majority of the food vendors studied were women (except in predominantly Muslim countries like Bangladesh, where men were dominant) and were either illiterate or had attended/completed primary education. Common food value chains studied were dairy, meat (including bushmeat), and fruits and vegetables. Very few studies examined more than one type of commodity or value chain. Food vendors’ knowledge typically ranged from none to little, which was also evident from poor observed food handling and storage practices and operating in unsafe and unhygienic conditions. Poor compliance with existing food safety policies, laws, and regulations was evident in some cases; this was primarily due to either limited awareness of existing laws and regulations or limited knowledge of how to implement them. Vendor attitudes towards food safety were generally assessed as positive (i.e., vendors expressed willingness to receive food safety information or act to make food safer). No significant gaps were found between food safety knowledge and actual practices. Knowledge, attitudes, and practices, and gaps between food safety knowledge and actual practices, was not found to vary with the vendor’s age, gender, type of product sold, or geography. Vendors encountered challenges to implementing food safety practices at the vendor level (e.g., limited education, knowledge, or training on food safety), market level (e.g., inadequate infrastructure), and government level (e.g., stringent laws and regulations). Local government 35 staff were identified as key enabling actors, interacting with food market vendors to foster better food safety practices. However, it was noted that even when these actors tried to support food vendors, their initiatives posed additional challenges to food vendors. Initiatives mentioned to help increase food safety in informal markets included training food vendors on both handling practices and legal requirements; development of market infrastructure, laboratory facilities, and vendor-friendly food safety regulations; enhancing compliance with existing laws and regulations; involving market authorities; forming cooperatives among value chain actors; and advocacy. 1. BACKGROUND Food vendors are among the most important members of the food system in LMICs (1). They play a critical role in food safety, especially in open-air informal “wet” markets, where the risk of food contamination is thought to be high. It is hypothesized that consumer-driven demand can be a critical driver of increased supply of safe foods in LMICs. However, the specifics of how much food safety concerns dictate consumer demands, particularly in the informal markets of the poorest countries, and how vendors might change food safety practices to meet these demands, is not well characterized across LMICs. Consumer demands likely vary by product and by country, as does consumer risk tolerance and knowledge of food safety issues. Vendors’ priorities, and how much they value food safety as a consumer “selling feature,” are largely unclear. While food safety certifications connected to foods sold by vendors in informal markets (e.g., certification of chicks bought by poultry farmers) have been launched in some countries, adoption has been slow (2). It is also not well known how vendors’ knowledge, attitudes, and beliefs can drive their personal behaviors related to food safety, or how these behaviors might jeopardize or foster improved food safety. A recent EatSafe scoping review of past studies on these questions in Nigeria found that most studies concluded that vendors’ knowledge of food safety was generally good but that self- reported practices were worse, and that observed food safety practices were generally poor (3). This review also stressed that there was a need for future investigations into wet markets, a greater focus on the practices of vendors of fruits and vegetables, and more focus on understanding vendors’ motivations, beliefs, and values placed on food safety, especially as they differ by cultural context and country. Food purchase and consumption are driven by social and cultural elements, which can impact the food hygiene and handling practices of vendors. Diets also vary widely between countries, and by culture and religion. Food safety issues may also disproportionally affect women, due to their generally higher level of risk through exposure. Food safety hazards and practices will thus not necessarily be the same across countries, cultures, or genders; nevertheless, there will likely be commonalities and trends in past studies that can inform future work. Research on vendor knowledge, attitudes, beliefs, and practices in LMICs, however, appears to be both vast and fragmented; to our knowledge, 36 there has not been a previous scoping review investigating this topic specifically for market- based food vendors across multiple LMICs. The aim of this review is to build on the work done in Nigeria by GAIN (2020) (3) and examine existing research on vendors’ knowledge, attitudes, and practices across LMICs, particularly those in Africa and Southeast Asia. This review will add to the existing literature on the subject, helping to fill useful gaps. As part of the EatSafe project, it will serve as a reference on current practices and inform elements of the research methodology and eventual intervention design. 2. 2. METHODOLOGY The method used is a scoping review, which allows for the assessment of emerging evidence, as a first step in research development. Scoping reviews provide an overview of a broad topic, in response to a more general question or questions, and through a broad exploration of the related literature. The exploration of the knowledge, attitudes, and practices of small-scale food vendors in LMICs is a subject that lends itself to this type of investigation, given its breadth and the diversity of potential research that could be carried out on the subject. 2.1. Objectives of the Review This scoping review examines past research on vendor perceptions of food safety in LMICs. Specific questions that the review aimed to answer include: 1. What are the food safety knowledge, attitudes, and practices (KAP) of small-scale food market vendors selling food ingredients to consumers for home preparation in LMICs? 2. What is the gap/difference between knowledge on food safety and actual practice? 3. Does the gap/difference between knowledge and attitude on food safety and actual practice vary with gender, type of product sold, and geography? 4. What are the markers (i.e., criteria for assessing food safety, direct or indirect) used to assess food safety among food market vendors?2 5. What challenges (related to knowledge, attitude, and practices) are encountered by these small-scale food market vendors while implementing food safety measures? 2 It was originally planned to also assess the markers used for food safety by the vendors themselves, but insufficient information was found to answer this question in depth. 37 6. How have key enabling environment actors (e.g., local government; market or consumer associations) interacted with food market vendors to foster food safety practices or create a culture of food safety? 2.2. Geographic Focus The scoping review covered all LMICs, as per the World Bank Global Index LMIC List 2020 (4). This includes the following countries: Low-Income countries: Afghanistan, Benin, Burkina Faso, Burundi, Central African Republic, Chad, Democratic Republic of Congo, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Haiti, Liberia, Madagascar, Malawi, Mali, Mozambique, Nepal, Niger, North Korea, Rwanda, Sierra Leone, Somalia, South Sudan, Syria, Tajikistan, Tanzania, Togo, Uganda, and Yemen. Lower-Middle Income countries: Algeria, Angola, Bangladesh, Benin, Bhutan, Bolivia, Cameroon, Cambodia Comoros, Congo, Côte d'Ivoire, Cabo Verde, Djibouti, El Salvador, Egypt Arab Rep, Eswatini, Gaza, Ghana Honduras, India, Kenya, Kiribati, Kyrgyz Republic, Lao PDR, Lesotho, Mauritania, Moldova, Mongolia, Morocco, Federated States of Micronesia, Myanmar, Nepal, Nicaragua, Pakistan, Papua New Guinea, Philippines, São Tomé and Principe, Senegal, Solomon Islands, Sri Lanka, Tanzania, Timor-Leste, Tunisia, Ukraine, Uzbekistan, Vanuatu Vietnam, West Bank, Zambia, and Zimbabwe. Nigeria would be included in the list of ‘lower-middle income countries.’ However, this review explicitly excluded Nigeria, as the subject of vendor (and consumer) food safety perceptions in Nigeria was already covered in another EatSafe review (3), and it would be inefficient to duplicate that work. 2.3. Definitions and Protocol There were several key definitions that guided the search for studies and the determination of their relevance for inclusion. Vendor was defined as a person selling food (in the form of raw ingredients, as opposed to ready-to-eat foods) directly to consumers in a wet market, open air market, shop/kiosk, or other informal setting, such as a farmstead; some studies referred to these people as “retailers” or “sellers,” but here “vendor” is used as a blanket term. Market was defined as a wet market (i.e., a market where fresh meat/fish and/or produce is sold), open-air market, or similar informal setting for selling food. These markets sometimes had a permanent site and/or structure from which individual vendors could operate, and sometimes did not. This specific focus, which excluded outlets like street vendors of ready-to-eat foods and supermarkets, was chosen to align to the focus of the EatSafe project. 38 Food safety knowledge covered the respondents’ factual understanding of different food safety aspects, such as personal hygiene, cross-contamination, causes and symptoms of foodborne diseases, and time/temperature control, etc. Attitude reflected positions, opinions, beliefs, and ways of being (e.g., agreement or disagreement with the importance of various food safety practices related to aspects like handwashing, cross contamination, food handling, storage). Practices referred to the observable (though perhaps self-reported) actions of vendors on aspects such as personal hygiene, handwashing practices, food handling and storage practices, and treatment of food waste. A detailed scoping review protocol was developed before the review was initiated, and the review followed this protocol as planned. The protocol was not registered on any external registry since it did not aim to assess the effectiveness or efficacy of any particular intervention. 2.4. Eligibility Criteria The scoping review used the inclusion and exclusion criteria outlined in Table 1, below. Table 3. Inclusion and Exclusion Criteria for the Scoping Review Inclusion criteria Exclusion criteria Publication Year: 2000 to 2020 Publication Language: English Publication types: Published in a journal or on the Excluded publication types: Blogs, website of certain global institutions and newspaper articles and magazines, thesis organizations. publications, book chapters publications covering all food groups (such as cereals, legumes, fruits, vegetables, fats and oils, milk, meat, poultry, eggs, fish, sugar) Excluded target groups: Included target groups: food market vendors Restaurants/hotels; vendors preparing and selling food ingredients for home preparation in selling ready-to-eat foods (i.e., street informal markets (e.g. wet markets, open-air foods) unless they also sold ingredients; markets); butchers (if they were in or near an people involved in food production, open-air market); small-scale dairy farmers, as it is harvest, storage, and transport (before the common in developing countries for these farmers food reaches the market); consumers; to sell milk directly to consumers (however, these supermarkets. farmers were only included if there was evidence in the study that this occurred); mixed shops that sell some ready-to-eat together with ingredients. Excluded topics: studies on packaged goods; studies which only looked at microbiological elements, and did not 39 Included topics: vendor KAP; vendor views on the include any data on knowledge, attitudes, enabling environment (regulations and policies, i.e. or practices of vendors; studies from what is working and what can work better). Nigeria, as they had been previously reviewed. 2.5. Search Strategy A structured search was undertaken in July and August 2020 using the following databases: Pubmed, Ovid Medline, and Google Scholar, accessed through the library services of Ryerson University, Canada or London School of Tropical Medicine and Hygiene, United Kingdom. Websites of the FAO, International Food Policy Research Center (IFPRI), International Livestock Research Institute (ILRI), WHO, World Trade Organization (WTO), and World Bank (WB) were also searched for relevant literature. Publications from international food safety conferences were also evaluated if they came up in the search. References cited in the good- quality papers identified in the searches (with quality determined as detailed later in this section) were also reviewed to identify additional relevant papers. Finally, Google Scholar was used to identify any subsequent papers citing the shortlisted papers/reports. A set of predetermined search items were used to identify studies of relevance for answering all the research questions. This approach was similar to approach used by GAIN (2020) (3) and included the following search terms: Pub Med Search string: ((Food Safety[MeSH Terms]) OR (Foodborn*, or Food-born*, or Microb*, or Fertiliz*, or Herbic*, or Rodentic*, or Antimicrob*, or Enterovir*, or Histamin*, or Erysipelothr*, or Flie*, or Fly*, or Rodent*, or Bird*, or Fomite*, or Spoil*, or Contamina*, or Hygien*, or Coli*, or Salmonella*, or Noro*, or Campylobact*, or Monocytogen*, or Enterobact*, or Burnet*, or Brucel*, or Shig*, or Aflatox*, or Mold*, or Adulter*, or Lister*, or Lyster*, or Acrylami*, or Hazard*, or Pestic*, or Worm* or Virus* or Bacteri* or Cleanli*or Protoz* or Faec*, or Fec*, or Parasit*, or Helminth*, or *Toxi*, or Cronobact*, or Taeni*, or Tremat*, or Echino*, or Fasciolo*, or Heterophy*, or Metagoni*, or Starch*, or Protein*, or Pathogen*, or Zoono*, Nocardio* or Metal*, or Lead*, or Arsen*, or Mercur*, or Cadmi*, or Bovin*)) AND (Consum*, or Produc*, or Sell*, or Vendor*, or Market, or Shop*, or Men*, or Female*, or Adolesc*, or Gender* or Market* or Knowl* or Awaren* or Attitud* or Belief* or Opion* or Pract* or Priori* or Expect*) AND (LMIC))) Ovid Medline Search: “food safety” “vendor” AND LMIC Google Scholar Search: “food safety” “vendor” AND LMIC The initial search used the term ‘LMIC’ (in acronym form), as specified above. The term “developing country” was also used as a search term instead of LMIC in all databases. Finally, 40 all PubMed, Ovid Medline, and Google Scholar searches were repeated with “LMIC” being replaced with each country name listed in the “Geographic Focus” section, above (e.g., “food safety” “vendor” and “India”). The first 100 titles (sorted by relevance in Google Scholar and PubMed) were reviewed for each country search and for the overall “LMIC” and “developing country” searches. The search approach used for institutional websites was adapted slightly to each website, both based on the organization’s focus and on the functionality of its search engine. The search terms were as follows: • FAO food safety site - search term: LMIC • IFPRI - search terms: “food safety” LMIC • WHO - search terms: “food safety” [MeSH] + LMIC • World Bank - search terms: “food safety” LMIC • ILRI - search terms: “food safety” For institutional websites, the first 100 titles (sorted by relevance) were reviewed for the FAO, IFPRI, and WHO. No relevance-sorting option was possible on the World Bank and ILRI websites, so the first 100 titles were screened without sorting for relevance. 2.6. Selection Strategy The following data sources and types of evidence were included in this scoping review: quantitative and/or qualitative observational research, interventions, and reports and expert opinions from reputed international organizations containing new empirical evidence. For all publications identified via the search, the title was reviewed for relevance. If it passed the title-screening stage, the abstract (or summary) was reviewed for relevance and compliance with the inclusion criteria. For publications that passed the abstract-screening stage, the full- text publication was reviewed and either accepted or rejected, based on the eligibility criteria. 2.7. Data Charting Process For those studies meeting the inclusion criteria, relevant information was extracted into a review template (Appendix VIII), which included the data items defined below. Single data entry was used to populate this template. Due to time constraints, no contact was made with authors of the publications to obtain more information. Data was sought for the following items: • Publication information (lead author, title, source (i.e., journal, organization), year published) • Geographic focus area (country, state, or city) 41 • Study methodology (including study design, sampling methods, aspects assessed, laboratory data if available, sample size, and qualitative and quantitative data collection methods) • Results o Vendor profile (as reported) o Customer profile (if included) o Enabling actors and actions • Conclusions and recommendations • Assessment of study quality • Full reference for the study and any relevant links (e.g., website, DOI) • Any additional comments “Study Quality” was assessed according to completeness of information for answering the study questions and was categorized as Good, Medium, or Poor, based on the following criteria: • Good: Evaluated >50 vendors, used random sampling, provided detailed information on vendor demographics, and has at least one of knowledge, attitude, and/or practices. • Medium: Evaluated >10 vendors, using purposive sampling. Paper provided some information on vendor demographics, knowledge, attitude, and/or practices. • Poor: Evaluated <10 vendors, no information on sampling, or provides no information on vendor demographics but some information on vendor knowledge, attitude, and practices. 2.8 Limitations This scoping review has a number of limitations. First, although the reviewers methodically searched for results country by country, only the first 100 references for each search were reviewed for relevance. This meant that results for certain countries with more extensive research, such as India, may not have been sufficiently scrutinized. Second, this review only focused on LMICs, which excluded research done in upper-middle-income countries such as South Africa, Malaysia, or Thailand, where vendors may have a lot in common with vendors from some of the LMICs. Third, only papers written in English were reviewed, which may account for the limited studies found in non-English speaking countries (e.g., in Latin America). It would be worthwhile to do searches in other languages, such as French and Spanish. Fourth, data included in book chapters and PhD and master’s theses were considered out of scope but may have contained useful information. Indeed, several theses were identified from Indian universities, which could help fill the apparent evidence gap on this topic for this populous country. Fifth, there was limited review of the reference lists of shortlisted publications, which could have yielded additional relevant studies. Sixth, publications involving multiple countries, although few, were not included. Finally, due to the 42 focus of the EatSafe project and the need to narrow scope, the review focused only on sellers of commodities in markets; this omitted street vendors of ready-to-eat foods, on which considerable research has been done and who might face similar constraints to improving food safety. 3. STUDY CHARACTERISTICS 3.1 Selection of Sources of Evidence As summarized in Figure 1, the various search strategies, applied for all the included LMICs, yielded a total of 333,357 hits. Of these, the first 100 titles (sorted by relevance) for each search were screened; if fewer than 100 were identified in the search, then all titles were screened. This resulted in 17,483 titles being screened. Of these 17,483 titles, a total of 981 papers were selected for abstract screening based on the relevance of the title. Of the 981 available abstracts, a total of 135 publications were identified for full-text screening. The main reasons studies were excluded at the abstract-screening stage were: no focus on vendors’ knowledge, attitudes, or practices related to food safety; no focus on LMICs; only examining vendors prepring ready-to-eat street foods (which were out of scope) and not raw foods; or only examining food safety through a microbiological lens. Publications for which no full-text version was available were also excluded. Of the 135 full-text articles screened, 51 were excluded. Reasons for exclusion and numbers excluded for each reason are specified in Figure 1, below. 43 333,357 original records identified through database searching 16,50215,568 records 17,483 titles screened excluded 4 additional 850Approx. 843 documents relevant titles excluded Approx. 981 abstracts and identified documents screened through reference lists 51 studies excluded and citations Reasons: 135 full-text studies assessed • No vendor KAP included - 19 for eligibility • Only microbiology examined - 5 • Only street food focus - 6 • Only consumer focus - 7 • Only governance/inspector focus - 4 • Ineligible market channel - 3 84 studies included in synthesis • No full text available - 2 • Policy/review papers - 5 • Duplicates - 3 Note: some studies were excluded for more than one reason. Figure 5. Summary of Search Process (Vendor Figure 1) The review of reference lists of some of the 80 included studies uncovered an additional four relevant titles. This was not an exhaustive search and done for only some studies. The total number of studies included in the final review is thus 84. All 84 studies included are summarized in Appendix VIII. The next sections summarize the main results of the review, providing summaries of the overall research trends as well as showcasing particularly interesting examples, illustrative of either main tendencies in the research or interesting exceptions to those tendencies. 3.2. Population and Locations Studied Sample size Five studies reported no information on sample size. Of the 79 studies that did, 23 studies had a sample size of less than 50 individuals (i.e., vendors, butchers, farmers); 13 studies had a sample size from 50-99, 16 studies a sample size of 100-199, four studies a sample size of 200-299, 12 studies a sample size from 300-499, and eight studies had a sample size of 500 or higher. Four studies evaluated food safety experts and/or policy makers, with an average sample size of ~20. 44 Types of respondents The majority of the studies’ respondents were solely vendors (49 studies), followed by producers who also sold to consumers (including dairy/poultry farmers, butchers, herdsmen, and livestock owners; 28 studies). Some studies also included the following as respondents (often in addition to vendors/producers): collectors, transporters, and traders (8 studies); public officers (policy makers, officers in charge of licensing, city council officers, livestock production officers, public health officers, veterinary officers, police officers, inspectors; 5 studies); consumers (4 studies); private-sector personnel (market chairpersons (1 study), retail management board (1 study), industry players (1 study)); and civil-society organizations, and academics (1 study). Five studies focused on markets themselves (e.g. live bird markets), as opposed to individual human subjects. Respondents’ Gender Of 84 studies, 42 reported on the gender of the vendor(s). Of the 42 studies reporting gender, women represented the majority of respondents in most studies (26; 61.9%). Men represented the majority of vendors in 14 studies (30.9%), and two studies (4.8%) had a fairly equal split of male and female vendors. There did not appear to be regional differences in this trend between Africa and Asia. Respondents’ Age and Ethnicity Only 30 of 84 studies reported the age of the vendors/individuals studied. In the majority of these studies (26 studies), the vendors were adults (i.e., between 18-60 years). The majority of the studies (69 of 84) did not provide any information on the ethnicity of the vendor. Of the 16 studies that did report the vendors’ ethnicities, most (10 studies) found that the majority of the vendors were from ethnic castes and tribes; of those reporting on religion, four studies noted that the majority of the vendors were Muslim and two studies noted that the majority of the vendors were Hindu. Respondents’ Economic Status Seventy-seven of 84 studies did not report any information on the economic status (e.g., average monthly income) of the vendor. Of the studies that did report on the economic status of the vendor, the typical average monthly income was around USD $100. It will be crucial to understand vendors’ financial barriers to the adoption of improved food safety measures. Some useful examples of examining such topics include Kumar et al (2017) in Nepal (5), which sought to better understand how financial incentives to improve food safety practices motivated milk vendors, and Samaan et al (2012) in Indonesian market vendors (6). Respondents’ Education Of the 34 studies that reported on education of the vendor, 17 studies found that the majority of the vendors were illiterate; in 11 studies, most vendors had attended and/or completed primary education and in six studies, most vendors had attended and/or completed secondary school. 45 Location and type of market Sixty-three studies reported the vendors’ area of operation (urban and/or rural). Of these, 31 studies (49.2%) were in urban areas and seven studies (11.1%) were in peri-urban areas; 17 studies (27.0%) were in both urban and rural areas, while eight studies (12.7%) were only in rural areas. Due to the inclusion criteria, it is unsurprising that the majority of the studies evaluated vendors operating in open-air/informal food markets (50 of 77 studies), but some studies also considered food safety at more fixed market sites, kiosks/small shops, and farms and butcheries where food was sold directly to consumers. Value chain The majority of the studies (73 of 84) looked at vendors in specific value chains (i.e., commodity categories). Most vendors assessed were operating in the dairy value chain (19 studies), followed by fruits and vegetables (17 studies), meat (16 studies), poultry (12 studies, including one study from Ethiopia that focused on eggs), and fish (5 studies). Few vendors assessed were operating in cereal or nuts value chains (2 studies each). The majority of titles and abstracts reviewed that related to studies of cereals and nuts were monitoring for aflatoxins or similar and did not include any demographic or KAP details on vendors; as such, they were not eligible for inclusion. 3.3. Design and Methods Study quality Using the “Study Quality” criteria defined above, 53 of the 84 studies (63.1%) were rated as medium quality, 18 (21.4%) were of good quality, and 13 (15.5%) were rated as poor-quality studies. A rating of “poor” does not necessarily mean that the paper poorly answered its own research questions, however, as the assessment of quality used here focused on the objectives of the present review, which were not necessarily the same as the focus of the individual papers. Some exceptions to the study quality criteria were made because of the very wide variety and types of studies identified, as not every study fell neatly into the predefined study quality categories. When determining this, a greater weight was given to random sampling, providing information on vendor demographics, and completeness of information on knowledge, attitudes, and/or practices. Study Design The majority (77 studies, 95.1%) used a cross-sectional design; among this group, multiple different methods were used: quantitative assessment of contamination via sampling (of the food, water, vendor, equipment, or environment) followed by laboratory analyses3; surveys with closed-ended questionnaires and/or an observation checklist; and qualitative approaches using interviews with open-ended questions, informal discussions, less structured observations, and/or focus group discussions. 3 Such studies were included in the review only when accompanied by information on vendor KAP. 46 Sampling technique Of the 84 studies included, 81 studies mentioned their sampling methodology, of which 35 studies used random sampling, 31 studies used purposive sampling, nine studies used convenience sampling, one study used snowball sampling, and five studies used a combination of various sampling techniques. Study methodology Of the 84 studies identified, 44 (52.4%) included laboratory assessments of either the food sold, the sale environment, or the vendor. The assessments were done for either bacteria, viruses, parasites, or chemical hazards such as aflatoxins. Seventy-six of the 84 studies included other quantitative assessments (i.e., surveys using closed-ended questionnaires and/or observation checklists). Fifty-three of the 84 studies included qualitative assessments (interviews using open-ended questions, observations, and/or focus group discussions). Twenty-one of 84 studies used all three types of methods (i.e., laboratory assessments, other quantitative assessments, and qualitative assessments) to obtain a 3600 view of food safety- related factors. For example, one interesting study from the Philippines (7) studied the vendors themselves as a hazard and included stool sampling to assess parasitic load. The study showed that vendors and slaughterhouse workers were actually prime agents for the fecal-oral transmission of intestinal parasitic infections to consumers, and overall prevalence of parasitic infection was high, at 90% of the study population. Metrics and Measures Standardized questionnaires and observation checklists that had been customized for the local context were used in majority of the studies. Surveys and interviews were typically done face to face, in markets using questionnaires and/or observation checklists, which were completed on paper in majority of the studies. Some studies combined questionnaires and/or observation checklists to provide a “food safety score.” Khanal & Poudel (2017) (8), in a study of Nepalese butchers, prepared a semi-structured closed-ended questionnaire and observational checklist based on standard guidelines from Codex and FAO. Results were then coded and scored, and butchers were rated as having adequate, fair, or poor hygiene knowledge and practices based on the scores. Kumar et al (2017) in Nepal used an observational checklist to gather data to create a “food safety index,” which then allowed the researchers to classify different farmers as low, medium, or high adopters of food safety measures (5). This further allowed the researchers to calculate the cost of adopting these measures for the farmer/vendor. Dang-Xuan et al (2019), examined risk factors associated with Salmonella in smallholder pig value chains in Vietnam using observational checklists to assess hygiene practices at both the farm and vendor level, allowing investigators to identify areas in which improvements could be made (9). 47 There were several examples of different ways in which technology can be used to facilitate food safety research in LMICs. For example, a study evaluating prevalence and risk factors in the chicken meat value chain of Nairobi, Kenya used an electronic questionnaire, collected on tablets using Open Data Kit software. Separate farmer and vendor questionnaires were developed, covering the following themes: farm or vendor’s environment and characteristics; management practices; biosecurity, health, or sanitary practices; and sourcing and selling of chickens/chicken products. Sites and samples were identified by scanning unique barcodes (10). Global positioning systems (GPS) were also used in some studies, for example, Kirino et al (2016) conducted a survey of informal milk vendors in Nairobi, Kenya and evaluated prevalence of aflatoxin in marketed milk (11). The geographical locations (GPS coordinates) of all the eligible retail outlets were recorded using GPS units. A distribution map was derived by marking the location of each visited vendor and used to visually analyze the spatial distribution of aflatoxin contamination. Survey location was also recorded using GPS units and linked to each questionnaire using a unique identification number. Advanced communication technology was also used in the study by Ahmed et al (2019) in informal settlements in Nairobi, Kenya (12). The study used participatory geographical information system tools, including food mapping using mobile apps and high-resolution community aerial views obtained via balloons to capture and contextualize local knowledge. The community mappers collected data on 660 vendors from 18 villages and situated that data on multi-layered geographic summaries of each settlement. The resulting data on hazardous areas in relation to food spaces and infrastructure provision allowed local communities to prioritize areas for regular cleanup activities and assisted with advocacy to improve the cleanliness of these places in cooperation with local authorities. The multiple visual representations of foodscapes thus helped to make local food vendors, and the risks they face, more visible (12). Interventions. The review identified very few studies that reported on any type of intervention to improve food safety practices.4 Samaan et al (2012) implemented a suite of measures to improve food safety in Indonesia. Interventions included training sessions, participatory consultations, and education sessions, as well as infrastructure changes accompanied by financial incentives. These interventions facilitated behavior change and the adoption of hygienic practices by market stakeholders (6). Alonso et al (2018) investigated a training program that had been launched a few years prior (2006-2008) to see if trained practices were upheld (13). The study reported on the Kenyan Training and Certification (TC) scheme, which was an approach to professionalizing the informal dairy sector as a way of supporting smallholder market access, safeguarding the supply of affordable nutritious food to the poor, and improving milk safety. It was designed as a mechanism to progressively upgrade the milk handling and hygiene practices of those operating in the informal dairy sector and help support their livelihoods and legitimization in the eyes of authorities. Traders who engaged in the TC scheme received training on milk quality and hygiene and business 4 There were some interventions reported in theses, as well as some on street food vendors of ready-to-eat meals, both of which were out of the scope of this review. 48 skills, and in return received a certificate that facilitated access to a dairy license. Vendors valued the training not just for the food safety content but also for other elements of the program, such as business skills and learning traditional methods for value addition (e.g., making fermented milk, yoghurt, or cheese). It also reported that the timing and duration of the training were factors that greatly affected the ability of traders to attend. Traders suggested that the trainings should be modular, provided regularly, and at hours that do not conflict with business hours. Timing was also seen as the most important constraint on women's attendance, given that women face not only business-related time constraints but also household responsibilities (13) Across the studies uncovered in the review, certification programs were more common in meat value chains, but this did not seem to ensure better butchering or meat handling practices, as evidenced by Seesio et al (2009) in Lesotho (14). 4. SYNTHESIS OF EVIDENCE 4.1 Vendor Knowledge, Attitudes, and Practices The 84 studies of vendor perspectives used a wide range of different indicators and metrics, making it quite difficult to quantitatively summarize results across all studies and infeasible to attempt a meta-analysis. As such, we describe main trends in results as well as particularly interesting insights or aberrant results. 4.1.1 Vendor knowledge Knowledge of food safety was reported in 45 of 84 studies (53.5%). This was usually assessed through quantitative (close-ended questionnaires, 41 studies) or qualitative (face-to-face interviews with open-ended questions or focus group discussions, 28 studies) methods, or a combination of quantitative and qualitative approaches (24 studies). The results were analyzed in different ways, including merely summarizing the questionnaire responses and creating rankings or scores. In the majority of the studies that reported knowledge (36 of 45, 80%), the average level of food safety knowledge of the vendors ranged from “no knowledge” to “low/poor/limited/some/little” (with the exact wording/threshold used varying by study). Only nine of 45 included studies (20%) reported vendors having “adequate” food safety knowledge. As an example, one study that evaluated the pork value chain in Vietnam used workshops to investigate the potential role of “nudging” on food safety behaviors and reported generally good food safety knowledge among vendors. However, it was not clear if the participants had been selected to participate because of higher food safety knowledge and/or if the vendors had previously had food safety training. Interestingly, many vendors in that study reported obtaining food safety information via Facebook, even though they viewed it as an unreliable source of information (15). A study from Indonesia trained poultry handlers 49 and sellers using WHO guidelines to reduce the spread of Avian flu; improvements to vendors’ knowledge were reported after the intervention (6). Where assessed, vendors’ knowledge was generally not found to differ with age, gender, type of product sold, or geography (i.e., urban v. rural) meaning there was not one particular country or area that stood out as having vendors who were very knowledgeable or observing high food safety standards. Where studied, vendor knowledge was often found to differ by educational status, with poorly educated vendors generally having poorer food safety and hygiene knowledge. Some gender differences related to food safety trainings were also reported. One study in Kenya, for example, reported that almost half of men (42%) had received at least one food safety training, compared to a quarter of the women (26%) (13). 4.1.2. Vendor Attitudes No information on vendors’ attitudes towards food safety was reported in 66 of 84 publications. This is a significant research gap and is worth further investigation. Of the 18 studies that reported data on vendors’ attitudes towards food safety, the majority (12 of 18 studies) reported a generally positive/good vendor attitude towards food safety (i.e., vendors expressed a willingness to receive more information on food safety or to comply with best practices). Only six studies reported a negative/poor vendor attitude towards food safety (e.g., vendors were not willing to receive information on food safety). Attitude was assessed using direct and indirect approaches. For example, Tegegne & Phyo (2017) classified food safety attitudes as good or poor based on a set of questions, both factual and opinion-based questions (e.g., agreement with statements on whether regular training could improve meat safety and hygiene practices, or if safe meat handling to avoid contamination and diseases is part of meat handler job responsibilities) (16). Vendors had to answer questions with “agree”, “disagree”, or “don’t know.” The response was then coded as right or wrong, and a score was assigned accordingly. Food-handlers who answered 14 or more questions correctly were assessed as having “good” attitudes, whereas respondents who answered 13 or fewer questions correctly were assessed as having a “poor” attitude. Lindhal et al (2015) examined attitudes in a study focused on brucellosis among dairy farmers/vendors in Tajikistan (17). Attitudes were assessed based on willingness to receive more information on the disease and belief that family members were at risk. Of the 65 (of 279) respondents who had heard of brucellosis, only eleven believed some of their family members were at risk of contracting brucellosis, and every one of those considered the person in the household who was working most with the cows to be exposed to the highest risk. Musita et al (2019), in a study of potato vendors in Kenya, assessed vendor attitudes towards food safety by asking questions on food safety practices; poor vendor attitude towards food safety was reported based on the discrepancies between knowledge and 50 practices (e.g., even if vendors knew green potatoes were unsafe, they would sell them anyway) (18). As these examples indicate, “attitude” assessments are often hard to distinguish from assessments of “knowledge” or “practice.” Some studies also reported on linkages between food safety attitudes and cultural or consumer beliefs. Sanhoun et al (2020) (19) evaluated milk hygiene practices among both farmers and vendors in Cote d’Ivoire, and noted that for farmers from the Fulani ethnic group, there were common beliefs that “if milk was heated, cows’ udders dry up and animals die” and that “raw milk brings more strength to milk farmers, vendors and consumers.” Amenu et al (2019) found similar reluctance to pasteurize and/or boil milk among pastoral populations in Ethiopia because of the misconception that nutrients in the milk are destroyed when milk is boiled and “boiled milk is dead” (20). Majalija et al (2020) in Uganda reported that consumers preferred raw milk, as they believed that they had been drinking milk since they were children and it had not caused them any harm (21). There were also reports on deep- rooted traditions of eating raw meat and raw eggs in Ethiopia, for perceived medicinal values (22),(23). Similar beliefs were reported among consumers in Benin, where consumption of bush meat was seen to be healthy (24). These studies indicate that there are often strong cultural beliefs and traditions around certain foods, and that these cultural beliefs will have to be taken into consideration when implementing measures to support better food safety among vendors. A study by Prinsen et al (2020) examined, through an emic approach, the food safety perspectives and viewpoints of butchers and cooked meat-sellers in Tanzania (25). It investigated meat sellers’ meanings, sense of purpose, and their scope for undertaking actions to ensure food safety. This study examined the concept of agency—that is, recognition of people’s own ability to resolve problems, to shape social events in particular ways, and to monitor and reflect upon their own and others’ actions. The results reported some differences in attitude between urban and rural butchers. Both depended on veterinary inspections and inspection stamps to guarantee food safety, rather than their own hygiene practices (compared to restaurant owners, who relied more on their own practices). However, butchers in rural areas were more confident that future foodborne illness outbreaks would decrease than were butchers in urban centers, and generally were very positive towards food safety. The authors suggest this may be due to shorter supply chains for meat in rural areas (25). Finally, a study by Alonso et al (2018) explored some of vendors’ motivations for engagement in the dairy value chain, indicating how economic incentives and motivations can steer food safety-related decisions (13). Farmer/vendors reported that informal-sector (unpasteurized) dairy business was “profitable”: there is a ready market and high demand, and it provides a daily income with higher margins than pasteurized milk. The informal nature of the sector also gave value chain actors more flexibility in their operations, allowing for more negotiation with producers compared to formal processors. Entering the dairy business was easy (having 51 cows makes selling milk an obvious business), demand was high, and producers could sell not only directly to consumers but also to traders who would then distribute milk to several shops. The study also reported that for women, the informal dairy sector allows them to start and grow a small, investment-free business. Women reported that a dairy business was more compatible with household and family demands, compared to other businesses (13). Thus, vendors saw many advantages to producing and selling unpasteurized dairy, despite potential food safety hazards. 4.1.3. Vendor Practices 76 of 84 studies (90.4%) reported vendor food safety practices. The assessment of practices was based on laboratory analysis combined with either self-reporting and/or observations (43 studies), self-reported and observed practices (17 studies), only self-reported practices (15 studies), or only observed practices (one study). The majority of the vendors evaluated were found to have inadequate and/or poor food safety practices. The practices considered were quite varied across the 76 studies but did share some common traits, such as poor vendor hygiene, unsafe food handling practices, unhygienic selling environments, and poor storage conditions. Examples of each are given in Box 1. Overall, the studies illuminated many different examples of poor food safety practices among vendors. For example, vendors generally were found to be treating sick animals with veterinary drugs obtained over the counter without advice from veterinary officers (36). Animal husbandry was also poor, with vendors keeping a variety of different species in close proximity to each other (45), (47). This was especially common in poultry and bushmeat markets (36), (45). In many of the studies, mixing of different species of birds and other animals (in markets, or pens too close to other species) was commonly observed, increasing the risk of zoonotic diseases (45), (63). Similar practices were observed in some of the studied bush meat markets (30)5,(64). Vendors were also adulterating some foods by various means, such as smoking containers used for milk storage and transport (26), (65), adulterating milk with water (66), selling milk and meat from animals that had just been treated with antimicrobials (26), or using formalin and hydrogen peroxide in milk to minimize spoilage (48). There were also some examples of deliberate deception (e.g., mixing fresh or inspected meat with old or uninspected) (25). In a study of milk trading in Mali, it was found that due to unsafe handling practices among vendors, pasteurized milk actually ended up becoming re-contaminated with bacteria, so much so that it ended up with higher bacterial counts than the raw milk on sale (28). This study shows how poor handling practices can derail the food safety initiatives brought in to 5 Much of the research in this area was aimed at discouraging the spread of Avian Influenza or Swine Fever, understanding the potential for zoonotic disease transmission in supply chains, or reducing the spread of antimicrobial resistance. 52 fix an issue. Use of contaminated water to wash or freshen produce was also found in a few studies (40), although sometimes the vendors did not have access to clean water (67). Box 1: Examples of Practices Examined in the Studies Poor vendor hygiene: untrimmed fingernails (26) (27); limited handwashing (usually assessed with reference to key moments recommended for handwashing, such as after toilet use, handling money, or slaughter) (28), (29), (30),(31); drying hands with dirty cloths after washing (9); no hand disinfectant used (29), (32); washing hands with unsafe water (33); limited use of existing sanitation facilities (34); no health certificates or invalid health certificates (35); handling food with bare hands (34); rare use of personal protective equipment (PPE, e.g., for handling meat) or infrequently washing PPE (36),(37); working while ill (38), (39); having dirty clothes (35), wearing jewelry on hands, ears, and other body parts(33),(35), (37). Unsafe food or livestock handling practices: Fruits and vegetables not being washed frequently or washed and splashed with poor-quality water with minimum or no use of disinfectant (40), (41), (68); a common balance used weighing different kinds of fruits (42); unclean utensils and/or equipment used for food handling (35), (43), (44); using the same equipment for handling different types of meat (35); no sorting of foods (e.g., fresh versus stale, sick animal versus healthy animal) (45); no screening for diseases before sale (of meat) (46); inappropriate use of veterinary drugs (36); keeping different species in close proximity (45); (47); adulterating foods (26), (48); and deliberate deception (25). Unhygienic selling/market environment: No/limited separation of foods/sick animals (e.g., different meats sold next to one another, wild animals traded with domestic animals (49) (50); no/limited market fencing (in a poultry market); limited market disinfection (51); selling uncovered food in markets, with no packaging (52); selling near garbage, toilets etc. (52); selling food exposed to flies and dust (34), (53) ; having food displayed on the floor (44), (68); selling food in unsafe packaging material (e.g. permeable, old newspaper, dirty bags) (36), (54), (55); using no dedicated vehicle for food transport (18) and poor tracing of supply (56). Poor storage conditions: Unclean and/or inappropriate plastic containers used to store food at ambient temperature and/or wet conditions (19), (57), (58), (59), (60), (61); use of plastic sacks (42); storing food on the floor (55); no isolation pen or quarantine for sick animals (26), (36); housing lactating animals in enclosures full of manure (26). Food waste management is crucial for food safety, but food waste management practices were only reported in 23.8% of studies (20 of 84), and often only in passing. Many studies reported poor waste disposal practices, such as irregular disposal of waste by market and/or other authorities and unsafe disposal of meat off-cuts and entrails (14), (40), (68). In one study, vendors complained that the authorities did not take waste away (50). Flies were also cited as being present in markets (34), (40), (69). Infrastructure needed for proper food waste management, such as sewage and water systems, was often lacking. Indeed, lack of refrigeration, or lack of electricity to run refrigeration, was also a major challenge that vendors in several of the studied informal markets faced (28), (63), (70), (71). Addressing this will be a barrier for successful implementation of future food safety interventions. 53 4.2. Demographic Differences and Gaps in Practices Where assessed, vendors’ practice was generally not found to differ with age, gender, type of product sold, or geography (i.e., urban v. rural). However, there were some exceptions. For example, a study assessing the predictors of risk factors for spread of avian influenza viruses by poultry handlers in live bird markets in Uganda (63) reported some variations among handlers. Handlers of different sexes had different rates for non-recommended practices like confining larger numbers (more than 20) of birds in a single cage and selling other livestock species alongside poultry (both of which were more common among women) or sharing poultry equipment (which was more common among men). The practice of selling other livestock species alongside poultry was found to vary substantially among respondents of the different age groups, with only 41.4% (167/403) of the adults compared to 61.9% (13/21) of the adolescents doing so.6 Considering education, a significant association between the education level of vendors and the parasitic contamination rate of the produce they were selling (indicating their food safety practices) was reported in a study in Ethiopia (72). The most in-depth exploration of gender issues as relates to food safety among vendors comes from Kenya (13). This study of Kenyan milk vendors reported that women faced some unique challenges in terms of ability to transport milk safely. Female study participants reported that women were less likely to own motorbikes or know how to ride a bicycle. Similarly, requirements for using metal cans for milk transportation posed specific challenges for women, as women considered the metal cans too big and heavy for them. Also, given that most household responsibilities fell disproportionately on women, they had less available time to travel to farms to source milk. These limitations on their mobility forced them to rely on middlemen or farmers to bring the milk to them. Men's higher mobility, in contrast, meant that they could source their milk directly from the farmer, getting a better deal and reaping higher profits. Women also reported that, compared to men, they were more likely to be cheated by the suppliers, such as by being given less milk than paid for or given milk of lower quality. Also, middlemen were reported to be more likely to accept the blame for such misconduct when in front of male buyers rather than female buyers (13). However, female participants were the only ones able to articulate the links between clean milk and health and the only ones reporting to find satisfaction in having met customers’ needs by providing good- quality milk for mothers and children. This confirms the existence of potentially important gendered aspects to food safety, even if these did not emerge from most of the studies. The studies show there is no clear gap between food safety knowledge and actual practices; knowledge was generally found to be poor, while practices were generally also found to be poor. A gap between food safety knowledge and actual practices within a given population, however, could be assessed in 40 of 84 studies. No significant differences between food safety knowledge and actual practice were reported in 38 of these 40 studies, again primarily 6 No information was reported on whether any of these relationships were statistically significant. 54 because both knowledge was low and practices were poor, whereas two studies reported differences between food safety knowledge and actual practice. One of these studies was from Lesotho (14), where the majority of vendors/butchers were trained in meat hygiene by the staff of the National Directorate of Veterinary Public Health and were aware of meat inspections and why they were carried out. However, observations of informal slaughter indicated that personal hygiene, the hygiene of the environment during slaughter, and the dressing of carcasses were deficient. Except for four commercial butcheries linked to supermarkets, slaughterers did not wear protective clothing or wash their hands, as toilet facilities were inadequate and even where water-based sewage systems were available, no handwashing basins were seen. Another study from Uganda (21) reported that most of the milk vendors and operators of mobile milk vendor centers within the milk supply chain studied were aware of the dangers of transporting milk in non-food-grade containers, particularly those made of plastic. Further, 75% were aware of the regulations and requirements for proper transportation of milk using metallic cans. However, this regulation was generally ignored, and poor handling and transportation practices, including collecting milk in plastic cans, were reported. No significant differences in the gap between knowledge, attitude, and actual practices were reported related to age, gender, type of product sold, or geography, largely because few studies assessed differences between knowledge, attitude, and actual practices as related to gender, age, value chains and geographies. 4.3. Markers used to assess, measure and/or describe food safety Assessment of vendors’ food safety practices was primarily done using indirect markers, as noted in Table 2. Some of these were common across all value chains, and some were specific to a particular value chain. Table 4. Indirect Markers of Food Safety Used in the Study Food Safety Metrics Food Safety Metrics (specific value chains) (all value chains) Meat, Fish, and Poultry Milk Cereals Personal: Personal: Food: Food: • Personal hygiene • Use of personal • Cleaning the udder of • Sorting (e.g., wearing clean protective equipment the cow • Drying clothes, taking a • Straining milk with a • Sieving shower before Food: cheesecloth work, hand • Disinfection of markets • Using preservation washing) • Fencing and gates for methods like • Stopping their live bird markets smoking, boiling or activities if • Checking quality of fish addition of formalin suffering from before buying (from and hydrogen diarrhea or typhoid other traders) by peroxide to minimize fever examining the general spoilage 55 appearance, color, • Refrigeration Food: odor, stomach fullness, • Testing the quality of • Washing food and thickness of back milk when receiving products before muscles or sourcing it using display • Isolation pens for sick lactometer • Visual inspections animals (e.g., removing • Separate chopping meat impacted by boards (or tables) and lead shot prior to knives for cutting of sale) meat and organs • Cleaning vending • Isolated area used for places and the slaughter of live equipment during birds activities or at the • Using ice to keep fish end of the day at a consistent • Using plastic temperature storage containers • Vaccination • Separating various • Not allow a buyer to food types come within 1 meter of • Displaying produce the products at least 1 m above • Screening pigs for the ground using African Swine Fever mats and not before sale exposing the • Freezing slaughtered product to sunlight birds • Managing waste in separate rubbish bins Market Infrastructure: Permanent market structure, source of electricity, access to running water, concrete floor 4.4. Challenges Faced by Vendors & Enabling Environment Factors The small-scale food market vendors covered in the studies found in this review encounter a number of challenges while implementing food safety measures. Forty-five of 84 studies reported specific challenges, as summarized in Table 3. 56 Table 5. Challenges Encountered by Food Vendors Vendor level Market level Government level • Inadequate food • No permanent • Stringent, complex, and unclear safety knowledge access to clean food safety standards, and multiple and training and potable and costly licenses and procedures • Lack of clarity on the water for obtaining them, which are not type of test needed • Other widely known to obtain a medical infrastructure • Regulations are fragmented or do certificate challenges (e.g., not align with the reality of • Low awareness of lack of toilets, informal markets or gender roles relevant policies and electricity, or cold (e.g., adherence to requirements standards storage; space for using metal cans for milk • Financial constraints constraints; no transport poses a specific (e.g., high cost and waste disposal challenge for women, as women frequency of facilities; no or consider metal cans too big and obtaining medical non-permanent heavy for them to carry) certificates, high buildings; lack of • No specific standards in some cost of food safety investment in areas (e.g., the addition of binders trainings and waste to feed; regulations for hygiene, certification management; zoning, or workflow for live bird programs, food limited markets), no licensing system for safety equipment processing informal markets (e.g., aluminum facilities; poor • Weak governance and cans, cold chain) roads) enforcement of standards (e.g., being unaffordable • Unfair lack of consistent food safety for most small-scale competition with monitoring, only ad hoc vendors) untrained engagement of food safety • Gender traders, and institutions (often in response to a discrimination (e.g., thereby reduced problem), inadequate inspections, results of [Alonso et incentives for limited government oversight, or al 2018]) (19) vendors to erratic application of existing laws • Weak vendor implement food and regulations) organizations and safety practices • Weak relationship or limited lack of an effective • Harassment, rapport between food safety forum at which corruption, and authorities and food vendors due vendors could make unfair decisions to minimal delivery of services their views heard by government (e.g., one vendor studied stated officers that “inspection officers take • Lack of samples but do not give feedback”) awareness of • Government officials lack food safety issues credibility as reliable sources of among information in many countries consumers • Lack of laboratories that can measure contaminants in food • Inadequacy of funds for infrastructure improvements and regulatory enforcement 57 Considering the enabling environment, 50 of the 84 studies (59.5%) referred to potential enabling environment factors that could influence food safety, either positive or negative. For example, certain enabling environment actors, such as local government staff, were noted as having interacted with food market vendors to foster optimal food safety practices and create a culture of food safety. Some national governments do have comprehensive food safety policies (e.g., the Kenya National Food Safety Policy 2013), aligned food safety standards for some value chains (e.g., milk safety standards for East Africa), or detailed and prescriptive precautionary measures laid out for some value chain actors (e.g., butchers) (25). While these are positive measures, and some studies noted there were improvements (73), more remains to be done to facilitate food safety in LMICs (74), (75). Government (national, regional, and municipal) and other duty-bearers (such as market management) were often negatively mentioned for not providing the tools to facilitate better food safety in the following ways: • Not establishing a proper code of food safety practice (34) • Not developing comprehensive food safety laws or laboratories (70) • Limited attention to the improvement of hygienic practices or to providing basic infrastructure necessary for food safety (e.g., clean water, electricity) (12), (45), (76) • Lack of an overarching coordination mechanism or agency to coordinate matters of food safety and food loss (75) • Inadequate extension services and inadequate food safety training and awareness-raising for vendors on existing policies, standards, laws, and regulations (27), (77) • Poor enforcement of existing standards and policies (13) • Developing overly bureaucratic and confusing regulations (13), (48), (78) • Not developing master plans for allocating specific areas within markets to specific value chain activities, such as poultry separation in live bird markets (47) • Not regulating veterinary fees, which caused them to be expensive (2) • Charging high fees for certification and licensing programs (2), (13) • Not supporting vendors livelihoods (79) Poor compliance with existing food safety policies and regulations was widely reported, either due to limited awareness of existing laws and regulations or limited ability to implement them. Some studies reported a general lack of trust of government officials (15), (80). Regulatory burden was also an issue. For example, in one study from Nepal (5), smallholder milk farmers complied with only 64% of regulations, on average, as after that point profitability started to be affected; in a business with small margins, this compliance load was found to be prohibitive. Alonso et al, (13), in a study of the dairy sector in Kenya, noted that regulations can also have a negative impact by creating unfair competition among vendors. The informal dairy sector includes different types of businesses, with different levels of legal 58 compliance. Licensed milk bars and corner-shops co-exist with unlicensed shops and street and mobile vendors, creating unfair competition. Licensed dairy businesses had higher running costs due to the need to adhere to regulatory standards (e.g., rent of adequate premises, cold chain services, utilities, licenses, and taxes) than did unlicensed traders. The study reported that unlicensed traders were more susceptible to harassment by authorities and might see their equipment and milk confiscated; they were also better able to escape the notice of inspection teams, as they operate outside of office hours or are mobile and can easily slip away when inspection teams appear in an area. On the other hand, licensed traders registered with authorities are subject to continued inspections and are at higher risk of facing consequences for noncompliance with requirements. Overall, regulatory activities seemed to have limited impact on the unlicensed traders. The study reported that traders generally did not oppose the existence and enforcement of regulations but wanted to see regulations applied fairly to all vendors (13). This highlights the importance of putting in place context- sensitive and equitable regulation and enforcement structures. 4.5 Summary of Findings The studies included in this scoping review used a wide range of methodologies to assess vendors perceptions and practices related to food safety. The studies that specifically investigated vendor KAP in relation to food safety were few (11 of 84) and predominately used a combination of qualitative methods, such as in-depth interviews and focus group discussions, as well as quantitative methods, such as surveys and observation checklist (9 studies). Generally speaking, this scoping review found that a combination of qualitative and quantitative methodologies was much more effective for collecting data on vendor perceptions than only one of the methodologies alone. An ideal approach might thus be a study that combined qualitative interviews with microbiological sampling and vendor observations by a third party, perhaps used before and after an intervention as an evaluation. Considering results, in general, many studies covered in the review examined knowledge, and they generally found that food safety knowledge levels were low. Very few vendors reported having any formal food safety training, and very few food training intervention studies were reported. Vendors generally had low education levels, and many were illiterate, which makes designing education and training programs challenging. Practices are also well characterized in the literature. Almost every study included in this review reported on food safety practices of vendors, either through observations or self- reports (e.g., questionnaire surveys). Generally, vendors’ food safety practices were poor and show an overall lack of vendor food hygiene across all value chains (e.g., poor general cleanliness; limited washing of hands, utensils, and/or fruits and vegetables). Indeed, inadequate washing emerges as the most common and most potentially “fixable” practice to improve food hygiene among vendors in LMICs. This lack of general hygiene occurs for many 59 reasons, primarily lack of access to clean water at the market and lack of knowledge about disease transmission (38) (81). These underlying causes will thus need to be addressed in order to improve hygiene. In contrast, few studies investigated beliefs, attitudes, or motivations in depth. In terms of motivations, one of the obvious motivators emerging from the review was income/livelihoods, which are likely particularly important for women, who have fewer options for employment other than food vending (as reflected in the high proportion of women vendors found in this review, 69%). However, little research examined this issue in depth. Regarding the enabling environment for food safety, the results of the review suggest that governments need to be pragmatic when writing regulations to ensure they will actually be achievable in the field and not pose an undue regulatory burden. Copying regulations from other countries is often impractical, although there is no harm in looking to other countries for guidance(5), (32). Finally, in reviewing the 84 studies, not one mentioned sharing results with the participants, which is necessary for enabling them to act on the findings. Future research should aim to remedy this by disseminating results among the studied vendor population. Many evidence gaps were evident from this review. First, there is a dearth of research on food market vendors’ perceptions in some LMICs. Most studies identified in this review took place in Sub-Saharan Africa, particularly East Africa. Limited evidence on vendors’ perceptions of food safety was available for Asian countries, with research being concentrated in only a few countries (Vietnam, Lao PDR, and Indonesia). Similar evidence gaps were found for LMICs in the Middle East (Syria, Yemen, West Bank and Gaza), South Pacific (Micronesia, Kiribati, Solomon Islands, Papua New Guinea, Timore Leste, Vananatu), and Central and South America (Bolivia, Nicaragua, El Salvador, Honduras). This does not imply that food safety issues are not important in these countries, or that food safety practices there are particularly better or worse; instead, the lack of research (outside of that on street food vendors) shows the topic to be an area ripe for future investigation. There is a surprising lack of studies on this topic from India and Pakistan; the majority of studies from these countries identified through searches focused on street food vendors, which were not included in this review. Only one relevant paper was identified for India, which looked at milk farmers/ vendors and had a primarily economic focus, examining cost of compliance with food safety measures in Bihar state (38). Similarly, only one study was found from Tajikistan (also examining dairy) (23), with no studies found from Uzbekistan, Kyrgyzstan, or Afghanistan. Food safety attitudes or food safety “cultures” within markets. is not well documented. For example, no information on vendors’ attitudes towards food safety was provided in 66 of 84 publications (78.5%). Where information on attitudes was included, definitions of “attitudes” 60 and how they differed from “knowledge” or “practice” were often unclear. Most studies examined practices without probing to understand the “why” behind the observed practices. Investigating food safety attitudes of vendors is an area for future research, as “positive attitude” can be crucial for the success or failure of future food safety interventions (82). New research techniques using best practices from the fields of behavior change science would be novel and welcome contributions to the limited research in this area. Similarly, few studies investigated cultural beliefs in depth; instead, content on beliefs typically emerged as an artifact of the investigation, and generally appeared in a side comment from a participant (19) (26). There are often, however, strong traditions around certain practices, such as eating high-risk foods like raw meat or eggs, or bush meat. These cultural beliefs may be a barrier (or motivator) to implementing food safety measures, and more research to better understand them is warranted. A very large number of studies identified in the initial searches were not included in the review, as they only assessed the microbiological quality of food samples without evaluating the associated ‘human’ factors driving the results, such as vendor KAP. Some did however do a cursory look at practices, and those that did at least try and collect some data are included for reference in the Annex I such as (44), (83). This indicates a lost opportunity for more integrated research. While many studies suggested that more training on food safety is needed, research on the effectiveness of current training programs in LMIC market contexts is scarce. No randomized control trials or other rigorous studies were found evaluating improvements in KAP among LMIC market vendors receiving training, providing limited information on the most effective ways to reach this disparate group. Moreover, only 11 out of the 84 studies (14.3%) reported on all three elements examined here: knowledge, attitudes, and practices. In most of these cases, attitude was interpreted via answers to questionnaires, rather than probing them deeply (6), (5), (7), (22), (18), (19), (26), (26), (35), (50), (84). Most of these studies focused on how knowledge linked to practices, with attitudes given only cursory treatment. As stated previously, more studies focusing on attitudes, an important element of behavior change, are needed, as knowledge alone rarely translates into improved practices. Understanding and leveraging motivations behind behavior change (one element of “attitude”) can lead to improved attitudes; for example, in some countries, vendor reputation works like a “brand” to drive increased business (e.g., in Vietnam (15)). No study was found, however, that explicitly looked at how vendors’ perceptions of customers’ motivations incentivize them to improve food safety, indicating another important research gap. Very few studies evaluated interactions between vendors and consumers. This review also identified few studies that investigated the sources of food vendors’ food safety information. A few studies, such as Lindhal et al (2015) in Tajikistan (17), did report on vendors’ preferred methods to receive information, but this is likely to vary by country, market type, education level of the vendor, and other factors. For example, another study 61 (15), in Vietnam, reported that vendors received most of their information from Facebook but that vendors did not believe it was a credible source of information. Altogether, there is not enough research on food safety information sources to be able to advise on potentially effective ways to communicate food safety messages, marking another area for future research. Limited research is available that examines interactions between vendors and government officials. In many studies, government agents were not seen as a credible source of information by vendors (15). In other cases, vendors perceived high costs of compliance with regulations, as was found in Kumar et al (2020) in India and Nepal (12), (5), indicating a need for reassessment of regulations with the perspective of small food businesses and vendors in mind. Government agents also reported that they often did not feel confident in their food safety knowledge (85). Training government agents alongside vendors may lead to common understanding of food safety knowledge and build a common understanding of hygiene requirements and policies. Finally, research using a “gender lens” to examine food safety KAP is limited and needs more attention. Few studies reported on differences in food safety KAP between the sexes or the motivations or reasons for these differences. Challenges faced by the different genders in ensuring safe food is in an important area to research, to ensure that interventions are equitable. 5. CONCLUSIONS This review of perceptions of food safety among market food vendors in LMICs identified few studies, despite screening over 17,000 titles, with research completely lacking for the majority of LMICs. Of those studies that were identified, only 11 reported on all of knowledge, attitudes, and practices of vendors, and even fewer reported on interventions to improve KAP. Informal markets of LMICs are incredibly important sources of food and livelihoods for lower-income, often vulnerable people, yet they appear to be subject to little regulatory oversight and are often strained by poor infrastructure, such as clean water and sanitation facilities, inconsistent electricity, and poor waste management as well as gender-related barriers. Food safety interventions that seek to improve the knowledge, attitude, and practices of vendors will need to address these barriers. Based on the results of this scoping review, we can make certain recommendations for future research and programing (see box, next page). First, training of vendors must be culturally appropriate and should offer some skills that can help their business’s profitability. It may be necessary to also train up-chain actors (e.g., farmers) in certain value chains (e.g., milk), as products may be contaminated before reaching the vendor and many farmers also act directly as vendors. Second, it is important to develop market infrastructure such as improved electricity, water and sanitation facilities, veterinary services, and cold storage. Similarly, 62 financing facilities should be created to help vendors buy equipment, such as coolers and milk pasteurization equipment, which vendors report to be prohibitively expensive. From a research perspective, it will be important to address the evidence gaps described above, including differences in perspectives between genders and to better understand vendors’ beliefs and attitudes. This would also include exploring how vendor reputation can be used as an incentive for behavior change and how market authorities can be engaged to better facilitate behavior change and bring about improved food safety practices. 63 Recommendations for the Design of Future Studies and Interventions within EatSafe EatSafe aims to generate evidence and knowledge on leveraging the potential for increased consumer demand for safe food to substantially improve the safety of nutritious foods in informal market settings. Central to EatSafe’s work is understanding (and potentially shaping) the motivations, attitudes, beliefs, and practices of consumers and food vendors. While EatSafe will undertake novel primary research on consumer and vendor motivations and practices, it is essential to ensure that this work is informed by and builds on what has already been done—both in terms of methods used and results obtained. Based on the results of this review, we recommend EatSafe consider the following in the design of its methods and interventions going forward: • Based on research elsewhere, it can be expected that vendor knowledge on food safety in EatSafe target markets will be low. Interventions should thus aim to raise this if sufficient vendor knowledge is needed for intervention success. • Literacy and education levels of food vendors tend to be limited and it is expected that vendor formal training and knowledge on food safety in EatSafe target markets will be low. EatSafe interventions will need to take this into account. • Food safety and hygiene practices of food vendors in EatSafe countries can also be expected to be generally poor. This is likely at least partly due to infrastructure-related constraints, which will need to be addressed to improve food safety in a long-term, sustainable way. • The topic of attitudes, beliefs, and motivations, and cultural determinants that shape of them, has been under-covered in prior research on food vendors and food safety in LMICs; this topic should be considered within EatSafe in developing interventions. • Understanding where vendors source food safety information should be evaluated for each market in which EatSafe works. Preferred methods to receive information are likely to vary by country, market type, and education level of the vendor. • Research that jointly examines consumer and vendor perceptions, and research that examines sources of information on food safety and trust in them, will also be particularly valuable in identifying relevant and culturally appropriate interventions and to fill gaps in existing knowledge. • Gender issues related to food safety also remain under-studied and deserve attention within EatSafe. • Qualitative methodologies have been found to generally be more effective for collecting useful data on vendor perceptions and should thus be included within EatSafe research. • EatSafe should aim to disseminate its results among the studied vendor population in order to foster community engagement and provide information that vendors may be able to use to improve their food safety practices. 64 REFERENCES FOR OVERVIEW AND PART I: THE CONSUMER 1. World Health Organization. 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Available from: http://www.fao.org/3/a-ar437e.pdf APPENDICES APPENDIX I: Consumer Study Full Search Strategy with Search Terms by Database PubMed (NLM) Consumer*[tiab] AND ((behavior*[tiab] OR behaviour*[tiab] OR intervention*[tiab] OR "Health Literacy"[Mesh] OR “health literac*”[tiab] OR educat*[tiab] OR attitud*[tiab] OR "Perception"[Mesh] OR "Attitude"[Mesh] OR "Attitude to Health"[Mesh] OR "Behavior"[Mesh] OR "Behavior and Behavior Mechanisms"[Mesh] OR "Risk Reduction Behavior"[Mesh] OR choice*[tiab] OR select*[tiab] OR decision*[tiab] OR factor*[tiab] OR judgement*[tiab] OR “decision mak*”[tiab] OR preferenc*[tiab] OR belief*[tiab] OR practic*[tiab] OR guidanc*[tiab] OR guideline*[tiab] OR perception*[tiab] OR awareness*[tiab] OR knowledg*[tiab] OR teach*[tiab] OR "Teaching"[Mesh] OR campaign*[tiab] OR media*[tiab] OR program*[tiab] OR radio*[tiab] OR TV[tiab] OR "Television"[Mesh] OR "Mass Media"[Mesh] OR televis*[tiab] OR "mass media*"[tiab] OR instruct*[tiab] OR celebrit*[tiab] OR ad[tiab] OR “targeting messag*”[tiab] OR “target messag*”[tiab] OR advertis*[tiab] OR video*[tiab] OR billboard*[tiab] OR “Motivation”[MeSH] OR motivation*[tiab] OR information*[tiab] OR inform*[tiab] OR prevent*[tiab] OR "Primary Prevention"[Mesh] OR “Health Behavior”[MeSH] OR “Choice Behavior”[MeSH] OR risk factor*[tiab] OR “Risk Factors”[MeSH] OR risk*[tiab] OR “risk perception*”[tiab] OR “cognitive bias*”[tiab] OR bias*[tiab] OR “Bias”[MeSH]) OR (“Consumer Behavior”[MeSH] OR “Consumer product safety”[MeSH] OR “Health knowledge, Attitudes, Practice”[MeSH] OR “consumer food safet*”[tiab]))) AND ((Food*[tiab] OR nutritio*[tiab] OR diet*[tiab] OR meal*[tiab] OR fruit*[tiab] OR vegetabl*[tiab] OR meat*[tiab] OR "Seafood"[Mesh] OR "Red Meat"[Mesh] OR "Meat"[Mesh] OR “red meat*”[tiab] OR cook*[tiab] OR “Cooking”[MeSH] OR poultr*[tiab] OR "Poultry"[Mesh] OR "Poultry Diseases"[Mesh] OR seafood*[tiab] OR fish*[tiab] OR "Raw Foods"[Mesh] OR “raw food*”[tiab] OR “raw meat*”[tiab] OR uncook*[tiab] OR “under cook*”[tiab]) AND ((safe*[tiab] OR hygien*[tiab] OR "Hand Hygiene"[Mesh] OR “hand hygien*”[tiab] OR clean*[tiab] OR hand wash*[tiab] OR mask*[tiab] OR glov*[tiab] OR wash*[tiab] OR “Hygiene”[MeSH] OR control*[tiab] OR qualit*[tiab] OR safety precaution*[tiab] OR safety procedur*[tiab] preperat*[tiab] OR manag*[tiab] OR disinfect*[tiab] OR sanitiz*[tiab] OR sanitis*[tiab] OR handl*[tiab] OR choice*[tiab] OR decision*[tiab] OR purchas*[tiab] OR consum*[tiab] OR eat[tiab] OR eating[tiab] OR eats[tiab] OR digest*[tiab] OR diseas*[tiab] OR “Decision Making”[MeSH] OR thermometer*[tiab] OR temperatur*[tiab] OR contamin*[tiab] OR cross contaminat*[tiab] OR spoil*[tiab] OR handl*[tiab])) OR (((food borne*[tiab] OR foodborne*[tiab] OR “Foodborne Diseases”[MeSH] OR “Food Contamination”[MeSH] OR “Food Handling”[MeSH] OR “Food safety”[MeSH] OR foodbook*[tiab] OR “food borne illness*”[tiab] OR “foodborne diseas*”[tiab] OR 83 “foodborne illness*”[tiab] OR “food borne diseas*”[tiab] OR virus*[tiab] OR bacteria*[tiab] OR “Food Microbiology”[MeSH] OR food microbiolog*[tiab] OR cross contaminat*[tiab] OR FBD[tiab]))))) AND (wet market*[tiab] OR street vendor*[tiab] OR restaurant*[tiab] OR “Restaurants”[MeSH] OR market*[tiab] OR home*[tiab] OR canteen*[tiab] OR school*[tiab] OR residenc*[tiab] OR hall*[tiab] OR bar*[tiab] OR kitchen*[tiab] OR food truck*[tiab] OR food cart*[tiab] OR commerc*[tiab] OR “Commerce”[MeSH] OR “Food Chain”[MeSH] OR food chain*[tiab] OR fast food*[tiab] OR consumer*[tiab]) AND ((((“semi structur*”[tiab] OR semistructur*[tiab] OR unstructur*[tiab] OR informal*[tiab] OR “in depth*”[tiab] OR indepth*[tiab] OR “face to face*”[tiab] OR structure*[tiab] OR guide*[tiab] OR guide*[tiab]) AND (interview*[tiab] OR discussion*[tiab] OR questionnaire*[tiab])) OR (“focus group*”[tiab] OR qualitative*[tiab] OR ethnograph*[tiab] OR fieldwork*[tiab] OR “field work*”[tiab] OR “key informant*”[tiab])) OR (((“interviews as topic”[Mesh] OR “focus groups”[Mesh] OR “narration”[Mesh] OR “qualitative research”[Mesh] OR "personal narratives as topic"[Mesh] OR “Cross-Sectional Studies”[Mesh] OR “cross sectional*”[tiab] OR “Prevalence”[mesh] OR prevalenc*[tiab] OR “transversal stud*”[tiab])))) OR ((((((food*[tw] OR "Food"[Mesh] OR pork*[tw] OR "Pork Meat"[Mesh] OR "swine"[mesh] OR poultr*[tw] OR "Poultry Diseases"[Mesh] OR "Poultry"[Mesh] OR "Poultry Products"[Mesh] OR seafood*[tw] OR "Seafood"[Mesh] OR meat*[tw] OR "meat"[mesh] OR "Meat Products"[Mesh] OR "Meat-Packing Industry"[Mesh] OR "red meat*"[tw] OR "Red Meat"[Mesh]))) AND (((nutritio*[tiab] OR diet*[tiab] OR food*[tiab] OR cook*[tiab] OR "cooking"[mesh] OR prepar*[tiab] OR consum*[tiab] OR "consumer behavior"[mesh]) AND (safe*[tiab] OR "Safety"[Mesh] OR hygien*[tiab] OR "Hygiene"[Mesh] OR consumer*[tiab])) AND (“Foodborne Diseases”[MeSH] OR “Food Contamination”[MeSH] OR “Food Handling”[MeSH] OR “Food safety”[MeSH] OR "hand wash*"[tiab] OR soap*[tiab] OR thermometer*[tiab] OR foodbook*[tiab] OR “food borne illness*”[tiab] OR “foodborne diseas*”[tiab] OR “foodborne illness*”[tiab] OR “food borne diseas*”[tiab] OR virus*[tiab] OR bacteria*[tiab] OR "cross contaminat*"[tiab] OR FBD[tiab] OR "hand disinfection"[mesh] OR "hand disinfect*"[tiab] OR "hygiene"[mesh] OR "hand hygiene"[mesh] OR "hand hygien*"[tiab]))) AND ((((health*[tw] OR communit*[tiab] OR school*[tiab] OR market*[tiab] OR "wet market*"[tiab] OR informat*[tiab] OR vendor*[tiab] OR street*[tiab] OR cart*[tiab] OR truck*[tiab] OR campus*[tiab] OR colleg*[tiab] OR universit*[tiab] OR rural*[tiab]))) AND ((safety* AND method*)) OR educat*[tiab] OR /education OR "health education"[mesh] OR "Health Promotion"[Mesh] OR learn*[tiab] OR teach*[tiab] OR campaign*[tiab] OR "mass media*"[tiab] OR media*[tiab] OR intervent*[tiab] OR inform*[tiab] OR "Consumer Health Information"[Mesh] OR "health behavior"[mesh] OR "health behavior*"[tiab] OR intention*[tiab] OR "intention"[mesh] OR "decision making"[mesh] OR decision*[tiab] OR behav*[tiab] OR communicat*[tiab] OR "risk reduction behavior"[mesh] OR "Risk benefit communicat*"[tiab] OR risk*[tiab] OR "risk factors"[mesh] OR bias*[tiab] OR "bias"[mesh] OR access*[tiab] OR aware*[tiab]) AND (english[Filter])))))) Year 2000 date limit 84 Embase (Elsevier) ((consumer*:ti,ab OR 'consumer'/exp) AND (behavior*:ti,ab OR behaviour*:ti,ab OR intervention*:ti,ab OR 'health literacy'/exp OR 'health literacy' OR 'health literac*':ti,ab OR educat*:ti,ab OR attitud*:ti,ab OR 'perception'/exp OR 'perception' OR 'attitude'/exp OR 'attitude' OR 'attitude to health' OR 'behavior'/exp OR 'behavior' OR 'behavior mechanisms'/exp OR 'behavior mechanisms' OR 'risk reduction'/exp OR 'risk reduction' OR 'risk reduction behavior women'/exp OR 'risk reduction behavior women' OR 'risk reduction behavior men'/exp OR 'risk reduction behavior men' OR choice*:ti,ab OR select*:ti,ab OR decision*:ti,ab OR factor*:ti,ab OR judgement*:ti,ab OR 'decision making'/exp OR 'decision making' OR 'decision mak*':ti,ab OR preferenc*:ti,ab OR belief*:ti,ab OR practic*:ti,ab OR guidanc*:ti,ab OR guideline*:ti,ab OR perception*:ti,ab OR awareness*:ti,ab OR 'awareness'/exp OR 'awareness' OR 'knowledge'/exp OR 'knowledge' OR 'advocacy group'/exp OR 'advocacy group' OR 'advocacy group*':ti,ab OR knowledg*:ti,ab OR campaign*:ti,ab OR media*:ti,ab OR program*:ti,ab OR radio*:ti,ab OR tv:ti,ab OR 'television'/exp OR 'television' OR teach*:ti,ab OR instruct*:ti,ab OR celebrit*:ti,ab OR ad:ti,ab OR 'advertising'/exp OR 'advertising' OR 'targeting messag*':ti,ab OR 'target messag*':ti,ab OR advertis*:ti,ab OR video*:ti,ab OR billboard*:ti,ab OR 'motivation'/exp OR 'motivation' OR motivation*:ti,ab OR information*:ti,ab OR 'information'/exp OR 'information' OR inform*:ti,ab OR prevent*:ti,ab OR 'prevention'/exp OR 'prevention' OR 'health behavior'/exp OR 'health behavior' OR 'risk factor*':ti,ab OR 'risk factor'/exp OR 'risk factor' OR risk*:ti,ab OR 'risk perception*':ti,ab OR 'risk perception'/exp OR 'risk perception' OR 'cognitive bias*':ti,ab OR 'cognitive bias'/exp OR 'cognitive bias' OR bias*:ti,ab) OR 'consumer attitude'/exp OR 'product safety'/exp OR 'attitude to health'/exp OR 'consumer food safet*':ti,ab OR 'food safety'/exp OR ((consumer* NEAR/3 behav*):ti,ab)) AND (((food*:ti,ab OR 'food'/exp OR nutritio*:ti,ab OR 'nutrition'/exp OR diet*:ti,ab OR 'diet'/exp OR 'meal'/exp OR meal*:ti,ab OR 'fruit'/exp OR 'vegetable'/exp OR fruit*:ti,ab OR vegetabl*:ti,ab OR meat*:ti,ab OR 'meat'/exp OR 'sea food'/exp OR 'red meat'/exp OR 'red meat*' OR cook*:ti,ab OR 'cooking'/exp OR poultr*:ti,ab OR 'poultry'/exp OR 'poultry product*':ti,ab OR 'poultry diseases'/exp OR 'bird disease'/exp OR 'bird diseas*':ti,ab OR seafood*:ti,ab OR 'sea food':ti,ab OR fish*:ti,ab OR 'fish'/exp OR 'raw food'/exp OR 'raw food*':ti,ab OR 'raw meat*':ti,ab OR 'raw meat'/exp OR uncook*:ti,ab OR 'under cook*':ti,ab) AND ((((safe*:ti,ab OR 'safety'/exp OR hygien*:ti,ab OR 'hygiene'/exp OR 'hand washing'/exp OR 'hand hygien*':ti,ab OR 'hand wash*':ti,ab OR clean*:ti,ab OR 'cleaning'/exp OR hand) AND wash*:ti,ab OR mask*:ti,ab OR 'mask'/exp OR glov*:ti,ab OR 'glove'/exp OR wash*:ti,ab OR control*:ti,ab OR qualit*:ti,ab OR 'quality control'/exp OR safety) AND precaution*:ti,ab OR safety) AND procedur*:ti,ab OR eat*:ti,ab OR 'eating'/exp OR digest*:ti,ab OR diseas*:ti,ab OR thermometer*:ti,ab OR temperatur*:ti,ab OR 'diseases'/exp OR contamin*:ti,ab OR preperat*:ti,ab OR manag*:ti,ab OR disinfect*:ti,ab OR 'disinfectant agent'/exp OR 'disinfection'/exp OR sanitiz*:ti,ab OR sanitis*:ti,ab OR 'hand saniti*':ti,ab OR choice*:ti,ab OR decision*:ti,ab OR 'hand sanitizer'/exp OR purchas*:ti,ab OR 'purchasing'/exp OR consum*:ti,ab) OR food) AND borne*:ti,ab OR foodborne*:ti,ab OR 'food poisoning'/exp OR 'food contamination'/exp OR 'cross contamination'/exp OR 'food handling'/exp OR 'food handler'/exp OR 'food handl*':ti,ab OR 'food safety'/exp OR 'food spoil*':ti,ab OR foodbook*:ti,ab OR 'food borne illness*':ti,ab OR 'foodborne diseas*':ti,ab OR 'foodborne illness*':ti,ab OR 'food borne diseas*':ti,ab OR virus*:ti,ab OR bacteria*:ti,ab OR 'virus'/exp OR 'bacterium'/exp OR 'virus infection'/exp OR 'food control'/exp OR 'food microbiolog*':ti,ab OR 85 fbd:ti,ab OR ((food* NEAR/3 safet*):ti,ab)) AND ('wet market*':ti,ab OR 'street vendor*':ti,ab OR 'vendors'/exp OR restaurant*:ti,ab OR 'restaurant'/exp OR market*:ti,ab OR home*:ti,ab OR canteen*:ti,ab OR 'canteen'/exp OR 'residence'/exp OR school*:ti,ab OR residenc*:ti,ab OR hall*:ti,ab OR bar:ti,ab OR bars*:ti,ab OR kitchen*:ti,ab OR 'kitchen'/exp OR ((food* NEAR/3 truck*):ti,ab) OR ((food* NEAR/3 cart*):ti,ab) OR commerc*:ti,ab OR 'commercial phenomena'/exp OR 'food chain'/exp OR ((food* NEAR/3 chain*):ti,ab) OR ((fast* NEAR/3 chain*):ti,ab) OR 'fast food'/exp OR 'consumer'/exp OR consumer*:ti,ab OR ((wet* NEAR/3 market*):ti,ab) OR ((wet* NEAR/3 vendor*):ti,ab)) AND (('semi structur*':ti,ab OR semistructur*:ti,ab OR 'unstructured interview'/exp OR 'semi structured interview'/exp OR unstructur*:ti,ab OR informal*:ti,ab OR 'in depth*':ti,ab OR indepth*:ti,ab OR 'in depth interview'/exp OR 'face to face*':ti,ab OR 'face to face interview'/exp OR structure*:ti,ab OR guide*:ti,ab) AND (interview*:ti,ab OR discussion*:ti,ab OR 'interview'/exp OR 'discussion group'/exp OR questionnaire*:ti,ab OR 'questionnaire'/exp) OR 'focus group*':ti,ab OR qualitative*:ti,ab OR ethnograph*:ti,ab OR fieldwork*:ti,ab OR 'field work*':ti,ab OR 'key informant*':ti,ab OR 'focus group'/exp OR 'qualitative research'/exp OR 'ethnographic research'/exp OR 'ethnography'/exp OR 'field work'/exp OR 'verbal communication'/exp OR 'literature'/exp OR 'cross-sectional study'/exp OR 'prevalence'/exp OR 'cross sectional*':ti,ab OR prevalenc*:ti,ab OR 'transversal stud*':ti,ab OR ((structur* NEAR/3 interview*):ti,ab)) AND [english]/lim AND [2000-2020]/py Cochrane Central (Wiley) consumer:ti,ab,kw AND (behavior*:ti,ab,kw OR behaviour*:ti,ab,kw OR intervention*:ti,ab,kw OR "health literac*":ti,ab,kw OR educat*:ti,ab,kw OR attitud*:ti,ab,kw OR choice*:ti,ab,kw OR select*:ti,ab,kw OR decision*:ti,ab,kw OR factor*:ti,ab,kw OR judgement*:ti,ab,kw OR "decision mak*":ti,ab,kw OR preferenc*:ti,ab,kw OR belief*:ti,ab,kw OR practic*:ti,ab,kw OR guidanc*:ti,ab,kw OR guideline*:ti,ab,kw OR perception*:ti,ab,kw OR awareness*,ti,ab,kw OR knowledg*:ti,ab,kw OR campaign*:ti,ab,kw OR media*:ti,ab,kw OR program*:ti,ab,kw OR radio*:ti,ab,kw OR TV:ti,ab,kw OR televis*:ti,ab,kw OR “mass media*”:ti,ab,kw OR instruction*:ti,ab,kw OR celebrit*:ti,ab,kw OR ad:ti,ab,kw OR "targeting messag*":ti,ab,kw OR "target messag*":ti,ab,kw OR advertis*:ti,ab,kw OR video*:ti,ab,kw OR billboard*:ti,ab,kw OR motivation*:ti,ab,kw OR information*:ti,ab,kw OR inform*:ti,ab,kw OR prevent*:ti,ab,kw OR "risk factor*":ti,ab,kw OR risk*:ti,ab,kw OR "risk perception*":ti,ab,kw OR "cognitive bias*":ti,ab,kw OR bias*:ti,ab,kw) OR "consumer food #1 safet*":ti,ab,kw food*:ti,ab,kw OR nutritio*:ti,ab,kw OR diet*:ti,ab,kw OR meal*:ti,ab,kw OR fruit*:ti,ab,kw OR vegetabl*:ti,ab,kw OR meat*:ti,ab,kw OR "red meat*":ti,ab,kw OR cook*:ti,ab,kw OR poultr*:ti,ab,kw OR seafood*:ti,ab,kw OR fish*:ti,ab,kw OR "raw #2 food*":ti,ab,kw OR "raw meat*":ti,ab,kw OR uncook*:ti,ab,kw OR "under cook*":ti,ab,kw safe*:ti,ab,kw OR hygien*:ti,ab,kw OR "hand hygien*":ti,ab,kw OR clean*:ti,ab,kw OR "hand wash*":ti,ab,kw OR mask*:ti,ab,kw OR glov*:ti,ab,kw OR wash*:ti,ab,kw OR control*:ti,ab,kw OR qualit*:ti,ab,kw OR "safety precaution*":ti,ab,kw OR "safety #3 procedur*":ti,ab,kw OR eats:ti,ab,kw OR digest*:ti,ab,kw OR diseas*:ti,ab,kw OR 86 thermometer*:ti,ab,kw OR temperatur*:ti,ab,kw OR contamin*:ti,ab,kw OR "cross contaminat*":ti,ab,kw OR spoil*:ti,ab,kw OR handl*:ti,ab,kw OR preperat*:ti,ab,kw OR manag*:ti,ab,kw OR disinfect*:ti,ab,kw OR santiz*:ti,ab,kw OR sanitis*:ti,ab,kw OR choice*:ti,ab,kw OR decision*:ti,ab,kw OR purchas*:ti,ab,kw OR consum*:ti,ab,kw OR eat:ti,ab,kw OR eating:ti,ab,kw “food borne*”:ti,ab,kw OR foodborne*:ti,ab,kw OR foodbook*:ti,ab,kw OR "food borne illness*":ti,ab,kw OR "foodborne diseas*":ti,ab,kw OR virus*:ti,ab,kw OR bacteria*:ti,ab,kw OR "food microbiolog*":ti,ab,kw OR "cross contaminat*":ti,ab,kw OR #4 FBD:ti,ab,kw #5 #2 AND #3 #6 #4 OR #5 #7 #1 AND #6 "wet market*":ti,ab,kw OR "street vendor*":ti,ab,kw OR restaurant*:ti,ab,kw OR market*:ti,ab,kw OR home*:ti,ab,kw OR canteen*:ti,ab,kw OR school*:ti,ab,kw OR residenc*:ti,ab,kw OR hall*:ti,ab,kw OR bar*:ti,ab,kw OR kitchen*:ti,ab,kw OR "food truck*":ti,ab,kw OR "food cart*":ti,ab,kw OR commerc*:ti,ab,kw OR "food #8 chain*":ti,ab,kw OR "fast food*":ti,ab,kw OR consumer*:ti,ab,kw "semi structur*":ti,ab,kw OR semistructur*:ti,ab,kw OR unstructur*:ti,ab,kw OR informal*:ti,ab,kw OR "in depth*":ti,ab,kw OR indepth*:ti,ab,kw OR "face to #9 face*":ti,ab,kw OR structure*:ti,ab,kw OR guide*:ti,ab,kw OR guide*:ti,ab,kw #10 #7 AND #8 AND #9 with Publication Year from 2000 to 2020, in Trials CINAHL (EBSCOHost) TI ( (Consumer* AND (behavior* OR behaviour* OR intervention* OR "health literac*" OR educat* OR attitud* OR choice* OR select* OR decision* OR factor* OR judgement* OR "decision mak*" OR preferenc* OR belief* OR practic* OR guidanc* OR guideline* OR perception* OR "awareness* OR knowledg*" OR campaign* OR media* OR program* OR radio* OR TV OR instruction* OR celebrit* OR "targeting messag*" OR "target messag*" OR advertis* OR video* OR billboard* OR motivation* OR information* OR inform* OR prevent* OR risk factor* OR risk* OR "risk perception*" OR "cognitive bias*" OR bias*)) ) OR AB ( (Consumer* AND (behavior* OR behaviour* OR intervention* OR "health literac*" OR educat* OR attitud* OR choice* OR select* OR decision* OR factor* OR judgement* OR "decision mak*" OR preferenc* OR belief* OR practic* OR guidanc* OR guideline* OR perception* OR "awareness* OR knowledg*" OR campaign* OR media* OR program* OR radio* OR TV OR instruction* OR celebrit* OR "targeting messag*" OR "target messag*" S1 OR advertis* OR video* OR billboard* OR motivation* OR information* OR inform* OR 87 prevent* OR risk factor* OR risk* OR "risk perception*" OR "cognitive bias*" OR bias*)) ) TI ( ("consumer food safet*" AND (food* OR nutritio* OR diet* OR meal* OR fruit* OR vegetabl* OR meat* OR "red meat*" OR cook* OR poultr* OR seafood* OR fish* OR "raw food*" OR "raw meat*" OR uncook* OR "under cook*")) ) OR AB ( ("consumer food safet*" AND (food* OR nutritio* OR diet* OR meal* OR fruit* OR vegetabl* OR meat* OR "red meat*" OR cook* OR poultr* OR seafood* OR fish* OR "raw food*" OR "raw meat*" OR uncook* OR "under cook*" OR (MH "Consumer Attitudes") OR (MH "Attitude+") OR (MH "Behavior+") OR (MH "Perception+") OR (MH "Motivation+") OR (MH "Risk S2 Factors+") OR (MH "Consumer product safety+") OR (MH "Health knowledge"))) ) S3 S1 OR S2 TI ( ((((safe* OR hygien* OR "hand hygien*" OR clean* OR hand wash*) AND (mask* OR glov* OR wash* OR (MH "Handwashing") OR (MH "Hygiene") OR control* OR qualit* OR thermometer* OR temperatur* OR contamin* OR spoil* OR handl* OR preperat* OR manag* OR disinfect* OR sanit* OR eat*) OR ("food borne*" OR foodborne* OR foodbook* OR "food borne illness"* OR "foodborne diseas*" OR virus* OR bacteria* OR S4 "food microbiolog*" OR "cross contaminat*" OR FBD)))) ) OR AB ( ((((safe* OR hygien* OR "hand hygien*" OR clean* OR hand wash*) AND (mask* OR glov* OR wash* OR control* OR qualit* OR thermometer* OR temperatur* OR contamin* OR spoil* OR handl* OR preperat* OR manag* OR disinfect* OR sanit* OR eat*) OR ("food borne*" OR foodborne* OR foodbook* OR "food borne illness"* OR "foodborne diseas*" OR virus* OR bacteria* OR "food microbiolog*" OR "cross contaminat*" OR (MH "Food Contamination+") OR (MH S4 (Cont’d) "Food Handling+") OR (MH "Food safety+") OR FBD)))) ) TI ( ((“wet market*” OR “street vendor*” OR restaurant* OR market* OR home* OR canteen* OR school* OR residenc* OR hall* OR bars* OR kitchen* OR “food truck*” OR “food cart*” OR commerc* OR Commerce OR food chain* OR fast food* OR consumer*) ) ) OR AB ( ((“wet market*” OR “street vendor*” OR restaurant* OR market* OR home* OR canteen* OR school* OR residenc* OR hall* OR bars* OR kitchen* OR “food truck*” OR “food cart*” OR commerc* OR Commerce OR food chain* OR fast food* OR S5 consumer* OR (DE "CONVENIENCE foods") OR (DE "FAST food restaurants") ) ) ) TI ( ((("semi structur*" OR semistructur* OR unstructur* OR informal* OR "in depth*" OR indepth* OR "face to face*" OR structure* OR guide*) AND (interview* OR discussion* OR questionnaire*)) OR (("focus group*" OR qualitative* OR ethnograph* OR fieldwork* OR "field work*" OR "key informant*" OR "cross sectional*" OR prevalenc* OR "transversal stud*"))) ) OR AB ( ((("semi structur*" OR semistructur* OR unstructur* OR informal* OR "in depth*" OR indepth* OR "face to face*" OR structure* OR guide*) AND (interview* OR discussion* OR questionnaire*)) OR (("focus group*" OR qualitative* OR ethnograph* OR fieldwork* OR "field work*" OR "key informant*" OR "cross sectional*" S6 OR prevalenc* OR "transversal stud*"))) ) S7 S3 AND S4 AND S5 AND S6 Year 2000, English Language limit 88 GreenFile (EBSCOHost) TI ( (Consumer* AND (behavior* OR behaviour* OR intervention* OR "health literac*" OR educat* OR attitud* OR choice* OR select* OR decision* OR factor* OR judgement* OR "decision mak*" OR preferenc* OR belief* OR practic* OR guidanc* OR guideline* OR perception* OR "awareness* OR knowledg*" OR campaign* OR media* OR program* OR radio* OR TV OR instruction* OR celebrit* OR "targeting messag*" OR "target messag*" OR advertis* OR video* OR billboard* OR motivation* OR information* OR inform* OR prevent* OR risk factor* OR risk* OR "risk perception*" OR "cognitive bias*" OR bias*)) ) OR AB ( (Consumer* AND (behavior* OR behaviour* OR intervention* OR "health literac*" OR educat* OR attitud* OR choice* OR select* OR decision* OR factor* OR judgement* OR "decision mak*" OR preferenc* OR belief* OR practic* OR guidanc* OR guideline* OR perception* OR "awareness* OR knowledg*" OR campaign* OR media* OR program* OR radio* OR TV OR instruction* OR celebrit* OR "targeting messag*" OR "target messag*" OR advertis* OR video* OR billboard* OR motivation* OR information* OR inform* OR S1 prevent* OR risk factor* OR risk* OR "risk perception*" OR "cognitive bias*" OR bias*)) ) TI ( ("consumer food safet*" AND (food* OR nutritio* OR diet* OR meal* OR fruit* OR vegetabl* OR meat* OR "red meat*" OR cook* OR poultr* OR seafood* OR fish* OR "raw food*" OR "raw meat*" OR uncook* OR "under cook*")) ) OR AB ( ("consumer food safet*" AND (food* OR nutritio* OR diet* OR meal* OR fruit* OR vegetabl* OR meat* OR S2 "red meat*" OR cook* OR poultr* OR seafood* OR fish* OR "raw food*" OR "raw meat*" S2 (Cont’d) OR uncook* OR "under cook*")) OR (DE "FOOD storage" OR DE "FOOD supply"))) ) S3 S1 OR S2 TI ( ((((safe* OR hygien* OR "hand hygien*" OR clean* OR hand wash*) AND (mask* OR glov* OR wash* OR DE "PUBLIC health" OR DE "BIOSURVEILLANCE" OR DE "DISEASE eradication" OR DE "ENVIRONMENTAL health" OR DE "EPIDEMIOLOGY" OR DE "FOOD inspection" OR DE "HEALTH risk assessment" OR DE "HOUSING & health" OR DE "RURAL health" OR DE "SANITARY districts" OR DE "SANITARY engineering" OR DE "URBAN health" OR DE "WORLD health" OR control* OR qualit* OR thermometer* OR temperatur* OR contamin* OR spoil* OR handl* OR preperat* OR manag* OR disinfect* OR sanit* OR eat* OR DE "FOOD consumption") OR ("food borne*" OR foodborne* OR foodbook* OR "food borne illness"* OR "foodborne diseas*" OR virus* OR bacteria* OR "food microbiolog*" OR "cross contaminat*" OR FBD)))) ) OR AB ( ((((safe* OR hygien* OR "hand hygien*" OR clean* OR hand wash*) AND (mask* OR glov* OR wash* OR control* OR qualit* OR thermometer* OR temperatur* OR contamin* OR spoil* OR handl* OR preperat* OR manag* OR disinfect* OR sanit* OR eat*) OR ("food borne*" OR foodborne* OR foodbook* OR "food borne illness"* OR "foodborne diseas*" OR virus* OR bacteria* OR "food microbiolog*" OR "cross contaminat*" OR DE "FOOD contamination" OR DE "CONTAMINATION of edible fish" OR DE "CONTAMINATION of potatoes" OR DE "DAIRY product contamination" OR DE "FEED additive residues" OR DE "FOOD of animal origin -- Contamination" OR DE "FRUIT contamination" OR DE "FUNGICIDE residues in food" OR DE "MEAT contamination" OR DE "OYSTER contamination" OR DE "PESTICIDE residues in food" OR DE "RADIOACTIVE contamination of food" OR DE "SEAFOOD contamination" OR S4 DE "SHELLFISH contamination" OR DE "VEGETABLE contamination" OR (DE "FOOD 89 handling") OR (DE "FOOD safety") OR FBD)))) ) TI ( ((“wet market*” OR “street vendor*” OR restaurant* OR market* OR home* OR canteen* OR school* OR residenc* OR hall* OR bars* OR kitchen* OR “food truck*” OR “food cart*” OR commerc* OR Commerce OR food chain* OR fast food* OR consumer*) ) ) OR AB ( ((“wet market*” OR “street vendor*” OR restaurant* OR market* OR home* OR canteen* OR school* OR residenc* OR hall* OR bars* OR kitchen* OR “food truck*” OR “food cart*” OR commerc* OR Commerce OR food chain* OR fast food* OR S5 consumer* OR (MH "Restaurants") OR (MH “Fast Foods”) ) ) ) TI ( ((("semi structur*" OR semistructur* OR unstructur* OR informal* OR "in depth*" OR indepth* OR "face to face*" OR structure* OR guide*) AND (interview* OR discussion* OR questionnaire*)) OR (("focus group*" OR qualitative* OR ethnograph* OR fieldwork* OR "field work*" OR "key informant*" OR "cross sectional*" OR prevalenc* OR "transversal stud*"))) ) OR AB ( ((("semi structur*" OR semistructur* OR unstructur* OR informal* OR "in depth*" OR indepth* OR "face to face*" OR structure* OR guide*) AND (interview* OR discussion* OR questionnaire*)) OR (("focus group*" OR qualitative* OR ethnograph* OR fieldwork* OR "field work*" OR "key informant*" OR "cross sectional*" OR prevalenc* OR "transversal stud*" OR (MH "Interview Guides+") OR (MH "Questionnaires+") OR (MH “Surveys+”) OR (MH "focus groups") OR (MH "Narratives+") OR (MH "Qualitative Studies+") OR (MH "Cross Sectional S6 Studies") OR (MH "Prevalence")))) ) S7 S3 AND S4 AND S5 AND S6 Year 2000, English Language limit Web of Science (Clarivate Analytics) TS=(Consumer* AND (behavior* OR behaviour* OR intervention* OR "health literac*" OR educat* OR attitud* OR choice* OR select* OR decision* OR factor* OR judgement* OR "decision mak*" OR preferenc* OR belief* OR practic* OR guidanc* OR guideline* OR perception* OR "awareness* OR knowledg*" OR campaign* OR media* OR program* OR radio* OR TV OR instruction* OR celebrit* OR "targeting messag*" OR "target messag*" OR advertis* OR video* OR billboard* OR motivation* OR information* OR inform* OR #1 prevent* OR risk factor* OR risk* OR "risk perception*" OR "cognitive bias*" OR bias*)) TS=("consumer food safet*" AND (food* OR nutritio* OR diet* OR meal* OR fruit* OR vegetabl* OR meat* OR "red meat*" OR cook* OR poultr* OR seafood* OR fish* OR "raw #2 food*" OR "raw meat*" OR uncook* OR "under cook*")) #3 #2 OR #1 TS=((((safe* OR hygien* OR "hand hygien*" OR clean* OR hand wash*) AND (mask* OR glov* OR wash* OR control* OR qualit* OR thermometer* OR temperatur* OR contamin* #4 OR spoil* OR handl* OR preperat* OR manag* OR disinfect* OR sanit* OR eat*) OR ("food 90 borne*" OR foodborne* OR foodbook* OR "food borne illness"* OR "foodborne diseas*" OR virus* OR bacteria* OR "food microbiolog*" OR "cross contaminat*" OR FBD)))) TS=((“wet market*” OR “street vendor*” OR restaurant* OR market* OR home* OR canteen* OR school* OR residenc* OR hall* OR bars* OR kitchen* OR “food truck*” OR “food cart*” OR commerc* OR Commerce OR food chain* OR fast food* OR consumer*) #5 ) TS=((("semi structur*" OR semistructur* OR unstructur* OR informal* OR "in depth*" OR indepth* OR "face to face*" OR structure* OR guide*) AND (interview* OR discussion* OR questionnaire*)) OR (("focus group*" OR qualitative* OR ethnograph* OR fieldwork* OR "field work*" OR "key informant*" OR "cross sectional*" OR prevalenc* OR #6 "transversal stud*"))) #7 (#6 AND #5 AND #4 AND #3) AND LANGUAGE: (English) Year 2000, English Language limit Clinicaltrials.gov food OR meat OR seafood OR poultry) AND (market OR home OR restaurant OR vendor) AND (handling OR washing OR sanitize OR "hand washing" OR safety) | Completed Studies 91 APPENDIX II: Consumer Cross-Sectional Survey Studies Summary Author(s), Title, Theory Summary Study Design Results Location Sample Journal, Year Alimi, B. A., None Primary data Cross- Safety and health were primary motivators for Nigeria N=205 Oyeyinka, A. T., collected sectional WTP, with income being the only significant consumers Olohungbebe, L. through survey demographic variable that influenced WTP in O.. Socio- structured regression analysis. Safety perception, income economic questionnaires and education were all found to be correlated characteristics was used to with WTP and willingness of assess safety consumers to pay perception and for the safety of willingness to fura de nunu in pay premium Ilorin, Nigeria. (WTP) for fura Quality Assurance and nunu food and Safety of products. Crops & Foods. 2016 Allan, P. D., None A cross-sectional Cross- Overall, participants scored high on topics Wellington N=401 adults Palmer, C., Chan, survey of sectional such as thoroughly cooking raw chicken (99%). , F., Lyons, R., consumer survey Participants also felt it was “essential” for New Nicholson, O., knowledge of labels to contain information such as the Zealand Rose, M., Hales, safe chicken correct handling of chicken (70%). When S., Baker, M. G. preparation and choosing between test labels, most chose a Food safety expectations for brightly colored label (71%), with the labelling of content and “current” label chosen the least often (<1%). chicken to design of raw Out of 45 current labels examined in the prevent chicken labels in study, the average content score was 1.7 out 92 campylobacterios New Zealand. of 5, and the average display score was 1.8 out is: Consumer Current labels on of 5. expectations and raw chicken current practices. products were BMC Public also examined. Health. 2018 Al-Sheyab, N. A., None A cross-sectional Cross- Very few participants knew about the cause of Jordon N=1,390 female Obaidat, M. M., survey of female sectional toxoplasmosis, its potential presence in cat undergraduate Bani Salman, A. undergraduate survey feces, contaminated water and undercooked university E., Lafi, S. Q. university meats, or its association with miscarriage students Toxoplasmosis- students in and/or sterility in women. Also, they indicated Related Jordon, which poor practices when handling and eating raw knowledge and covered the and undercooked meat and herbs. preventive topics of general practices among knowledge, risk undergraduate factors, female students symptoms and in Jordan. Journal timing of of Food infection, Protection. 2015. prevention knowledge, and preventative behaviors related to toxoplasmosis. Alsayeqh, A. F. None A cross-sectional Cross- Results indicated a risk for foodborne disease Riyadh, N=785 women Foodborne survey of women sectional through improper food handling Saudi disease risk from Riyadh, survey temperatures (45.28%), inadequate cooking Arabia factors among Saudi Arabia (35.47%), cross-contamination (32.23%), and women in Riyadh, covering topics unsafe food sources (22.39%). Additionally, 93 Saudi Arabia. including food those who claimed to have food safety Food Control. shopping, food knowledge were not supported by their 2015. storage, reported behaviors. Alsayeqh, A. F. cleaning, cooking Foodborne and disease risk consumption factors among behavior, women in Riyadh, and knowledge Saudi Arabia. of foodborne Food Control. diseases. 2015. (Cont’d) Aluh, D. O., None A cross-sectional Cross- Both the mean percentage knowledge score Kogi State, N=259 Nworie, K. M., study using self- sectional (75.79%) and the mean practice score Nigeria. secondary Aluh, F. O.. Food administered survey (82.48%) were high. There was also one noted school students safety knowledge questionnaires demographical impact, with knowledge and self-reported that were given scores being lower in students whose mothers practices among to secondary had low education. adolescents in school students rural secondary in Nigeria to schools in Nigeria. review their Int J Adolesc Med knowledge and Health. 2019. practice of food hygiene. Alzoubi, H. M., None A cross-sectional Cross- The mean times participants reported eating Jordan N=1,161 Abu-Helalah, M. study using a sectional at a restaurant was around 3.69 times a week. university A., Al-Zu’bi, A. Y., questionnaire survey The biggest thing they took into consideration students Al-Ma’aitah, O. given to when eating at a restaurant was hygiene Z., Dalbah, T. A., university (82.7%). Around half believed restaurant Alshraideh, H. A., students in workers always/often wear gloves (51.5%), Aqel, A. A. Food Jordan, and half also reported experiencing at least 94 safety perception evaluating their one symptom of food poisoning after eating and practices eating behavior, out (53.7%). Eighty-two and a half percent of among university food safety those with symptoms were confirmed by a students in knowledge and doctor that the symptom was due to food Jordan. Journal of food safety poisoning, but few reported it to authorities Pure and Applied practice, focused (4.1%). Microbiology. on eating at 2015. restaurants. Asiegbu, C. V., None A cross-sectional Cross- The majority of consumers were black males Johannesb N=402 adults Lebelo, S. L., survey of street sectional younger than 35, who were unmarried, urg Tabit, F. T. The vendor survey literate, and in the lower income group. The municipalit food safety consumers, highest reasons for buying from street y, South knowledge and administered via vendors included affordability, availability and Africa microbial hazards face-to-face convenience. awareness of interviews, Sixty percent of participants indicated they consumers of around safety were aware of the possibility of becoming sick ready-to-eat knowledge and/or because of street-vendor food but street-vended based on were not deterred from buying and eating it in food. Food microbial hazard the future. Over 70% had not heard of the Control. 2016. awareness. names of many of the most common forms of bacteria related to food borne illness. Auad, L. I., Risk- Cross-sectional Cross- Consumers (30%) indicated that taste was the Brazil N=133 food Ginani, V. C., benefit study to discern sectional most important factor in choosing a food truck Leandro, E. S., consumer Brazilian food survey truck. Poor vehicle hygiene was the most consumers Stedefeldt, E., decision truck consumers’ commonly indicated factor for not selecting a Nunes, A. C. S., making profiles, choices, food truck (30%). Factors that were deemed Nakano, E. Y., model preferences and important when eating at a food struck were Zandonadi, R. food safety food hygiene (78%) and vendors’ personal P.. Brazilian food perceptions hygiene (80%). Importance in food safety truck consumers’ hygiene differed significantly by age and 95 profile, choices, presence of children. Younger participants preferences, and and those without children had the highest food safety food safety importance perception scores. importance perception. Nutri ents. 2019 Ayaz, W. O., None A cross-sectional Cross- Mothers generally had adequate knowledge Saudi N=979 mothers Priyadarshini, A., survey study of sectional of personal hygiene (passing rate 83.8%) and Arabia Jaiswal, A. K. mothers in Saudi survey food poisoning (passing rate 78.5%) with Food safety Arabia, assessing moderate knowledge of food storage (passing knowledge and knowledge of rate 64.9%) and kitchen facility usage and practices among food storage and maintenance (passing rate 66.5%). Saudi mothers. handling, kitchen Participants had poor knowledge of food Foods. 2018. facility usage and handling (passing rate 30.4%). Knowledge and maintenance, practice improved with level of education. personal hygiene, and food poisoning. Baptista, R. C., None Online cross- Cross- The survey revealed a relatively high level of Brazil N=962 seafood Rodrigues, H., sectional study sectional knowledge and practices around hygiene consumers Sant'Ana, A. S.. assessing survey related to seafood preparation, but a lack of Consumption, consumers’ safe practices related to cooking time and knowledge, and frequency of storage temperature. Respondents showed a food safety seafood low level of knowledge about risks related to practices of consumption, seafood consumption. Those between the Brazilian seafood safety practices ages of 23-59, those with high income, higher consumers. Food associated with education levels, and families with no children Res Int. 2020 seafood were more likely to have meals in restaurants handling, and compared with other groups. Higher income perception of individuals are more likely to consume 96 risks associated seafood regularly. Males presented a higher with seafood. risk than females in regard to food safety practices and knowledge. Individuals 23-59 were less likely to believe that they would get sick from consumption of raw seafood compared to older generations. Bou-Mitri, C., None A cross- Cross- Participants indicated that packaging should Lebanon N=547 adults Abdessater, M., sectional, sectional “protect the food” (54.9%) and be safe (52%). Zgheib, H., Akiki, interviewer- survey At point-of-purchase, consideration of Z.. Food administered expiration date (46.1%) was higher than that packaging design survey study of of price (21.6%). The packaging chosen as the and consumer consumers at a most important, healthiest, and most perception of the grocery store in frequently bought was vacuum packed product quality, Lebanon, followed by tinned for cheeses, and glass safety, covering the bottles for juice. Those who valued safety as healthiness and impact of the the most important part of packaging reference. Nutriti packaging design preferred transparent packaging. Most felt on & Food on consumers’ nutrition and health claims on packaging were Science. 2020. perception of the some of the most important informative cues food quality, (87%) and were willing to pay more for better safety, packaging (73.1%). healthiness and their preference to buy. Bouranta, N., Developed Interview Cross- Consumers’ perceived food safety partially Greece N=836 adults Psomas, E., original administered sectional mediates the effect of a company’s service Vouzas, F. The conceptual cross-sectional survey recovery and customer loyalty. There was a effect of service framework survey assessing significant positive relationship between a recovery on the impact of company’s service recovery and consumers’ customer loyalty: consumers’ perceived food safety. Service recovery had a 97 The role of perceived food direct and positive effect on consumer loyalty. perceived food safety and a The relationship between customers’ safety. company’s perceived food safety and customer loyalty International service recovery was more pronounced among individuals who Journal of Quality and customer are married and who have children. and Service loyalty. Sciences. 2019. Chamhuri, N., None A cross-sectional Cross- The cue most associated with quality was Klang N=544 adults Batt, P. J. survey study of sectional freshness. Others included price, cleanliness, Valley Consumer consumers at a survey and Halal. Analysis identified food safety as region, perceptions of shopping mall in the most important construct in consumers’ Malaysia. food quality in Malaysia. evaluation of quality for meat, fruits and Malaysia. British Focused on vegetables. Food Journal. quality cues used 2015. by consumers when purchasing fresh meat, fruits, and vegetables. Cheng, Y., Zhang, None Cross-sectional Cross- Overall knowledge was high (42% of all Beijing, N=4,220 Y., Ma, J., Zhan, survey of sectional respondents had ‘high’ knowledge). China Students S.. Food safety secondary school survey Knowledge of food safety was significantly knowledge, students in associated with demographic characteristics attitude and self- Beijing assessing including region, school type and residence reported practice knowledge, type, as well as alcohol and tobacco use. of secondary attitudes and Attitudes related to food safety varied with school students in practices related 17% regarding Chinas’ food safety as ‘good’ Beijing, China: A to food safety. and 53.6% regarding it as ‘worrying’. Ninety- cross-sectional five percent worried about food safety of food from small restaurants and street food 98 study. PLoS peddlers despite 69.4% saying the ‘often’ or ONE. 2017 occasionally purchased food from these sources. Courtney, S. M., None A cross-sectional Cross- Average knowledge score was 56%. Some Ontario, N=485 Majowicz, S. E., study of sectional knowledge results were increased in students Canada undergraduate Dubin, J. A. Food undergraduate survey who reported currently handling food while students safety knowledge students in working or volunteering. Around 70% of of undergraduate Ontario, Canada. students knew the correct way to wash hands, students at a A survey was with the majority of wrong answers choosing Canadian used to assess hand sanitizer. Hand washing knowledge was university: Results food-related lower in students who worked/volunteered in of an online factors such as hospitals. Results were generally higher in survey. BMC cooking students in the Faculty of Science, who were Public Health. frequency, prior older, and who cooked more frequently. 2016. education or experience with food handling/prepar ation, and knowledge of food handling/prepar ation. Dagne, H., Raju, None A community- Cross- Good food safety practices were found in Debarq N=423 mothers R. P., Andualem, based, cross- sectional 49.6% of participants. Food safety practice Town, Z., Hagos, T., sectional study survey was associated with education, food safety Ethiopia Addis, K. Food of mothers who knowledge and attitudes towards food safety safety practice are food- and its associated handlers in factors among 99 mothers in Debarq Town, debarq town, Ethiopia Northwest Ethiopia: Community- based cross- sectional study. BioMed Research International. 201 9. 2019 Dang, A. K., Tran, None A cross- Cross- A majority (81.3%) reported using the internet Hanoi, N=1,736 B. X., Nguyen, C. sectional, sectional, to search for food products. Participants Vietnam consumers T., Le, H. T., Do, H. interviewer- survey identified convenience (69.1%) and price T., Nguyen, H. D., administered (59.3%) as factors influencing internet use. Nguyen, L. H., survey study Only 37.7% believed information on food Nguyen, T. H., assessing safety provided online. Most consumers were Mai, H. T., Tran, consumer concerned about food labels containing T. D., Ngo, C., Vu, behavior, expiration dates (51%) and brand (22.2%). T. T. M., Latkin, C. concerns and Participants who were female, highly A., Zhang, M. W. preferences influenced by online relationships, and had B., Ho, R. C. M.. regarding online difficulty doing activities of daily living were Consumer food products most likely to look for food products online. preference and attitude regarding online food products in Hanoi, Vietnam. International Journal of 100 Environmental Research and Public Health. 2018. de Andrade, M. None A cross-sectional Cross- Consumers demonstrated optimism bias in Brazil N=64 food L., Rodrigues, R. study using a sectional their comparison of their perception of food handlers R., validated survey borne disease (FBD) risk attributed to N=265 Antongiovanni, checklist and themselves and to peers. A direct effect of this consumers N., da Cunha, D. structured optimism bias on FBD risk was observed in in T.. Knowledge questionnaire to multivariate analysis, suggesting that bias may and risk evaluate the lead to greater risk of FBD. perceptions of knowledge, risk foodborne perception and disease by optimistic bias of consumers and food handlers food handlers at and consumers restaurants with in restaurants. different food safety profiles. Food Res Int. 2019 Demircan, V., None An interviewer- Cross- A majority of participants had heard of the Isparta, N=384 Celik Ates, H., administered sectional, concept of food safety (57.8%) though a Turkey consumers Sarica, D., survey of survey greater majority (86.2%) were unaware of Cavdar, N. families in quality control and food security systems. The Determination of Isparta, Turkey factor rated most important by consumers consumers’ assessing when purchasing food was “hygiene at the consciousness consumers’ place where the purchased products are level on food awareness of produced”. safety: Case of food safety. Isparta, 101 Turkey. Scientific Papers-Series Management Economic Engineering in Agriculture and Rural Development. 20 18 Dickie, R., Social A cross-sectional Cross- Handwashing was higher in female students. Scotland N=255 Rasmussen, S., Norms survey study of sectional Most students believed they washed their university Cain, R., Williams, Theory university survey hands more than their peers, and perception students L., MacKay, W. students in of peer handwashing was associated with The effects of Scotland, participant behavior. perceived social assessing norms on handwashing handwashing frequency and behaviour in perceptions of students. Psychol peer Health Med. handwashing 2018. Esfarjani, F., None A cross-sectional Cross- A majority (56%) of households reported food Tehran, N=630 women Hosseini, H., study of sectional security. Mild (29%) moderate (12%) and Iran Khaksar, R., women’s survey severe (3%) food insecurity was found in the Roustaee, R., household food remainder of households. Pertaining to food Alikhanian, H., safety practices safety practices: 37% of households had Khalafi, M., and food desirable food safety practices, 33% had Khaneghah, A. insecurity in acceptable and 29.5% had weak according to M., Mohammadi- Tehran, Iran the Home Food Safety Practice Questionnaire Nasrabadi, F.. using a tri- (HFSQ). In structural equation modeling, food 102 Home Food sectional insecurity was strongly and inversely Safety Practice questionnaire associated with food safety practices. and Household administered Food Insecurity: A face-to-face with Structural trained Equation interviewers Modeling Approach. Iranian Journal of Public Health. 2019 Evans, E. W., None A cross-sectional Cross- A majority (79%) reported positive attitudes Cardiff, N=100 older Redmond, E. C.. study using a sectional towards refrigeration, though 84% were Wales adults Older Adult self-completed, survey unaware of the 5°C recommended Consumer computer- temperature and 65% self-reported never Knowledge, assisted personal checking temperature. Seventy-five percent Attitudes, and interview reported using use-by dates to indicate safety Self-Reported (CAPI)of older and 62% reported always checking dates. Storage Practices adult consumers’ Sixty-seven percent reported beliefs that is of Ready-to-Eat knowledge, was safe to consume food past use-by dates. Food Products attitudes and Eighty-four percent reported consuming RTE and Risks self-reported foods past the recommended 2 days post Associated with practices opening. Listeriosis. J Food regarding ready- Prot. 2016 to-eat (RTE) food products in the UK Evans, E. W., None A cross-sectional Cross- Participants reported awareness of food United N=121 patients Redmond, E. C. study of patients sectional safety practices, but the reported behaviors Kingdom receiving Food Safety receiving survey indicated unsafe practices around chemotherapy Knowledge and chemotherapy 103 Self-Reported and their temperature control, handwashing, safe N=51 family Food-Handling caregivers in the cooking, and adherence to use-by dates. caregivers of Practices in United Kingdom. patients Cancer Used a self- receiving Treatment. Oncol administered chemotherapy Nurs Forum. questionnaire to 2018. assess food safety knowledge and self-reported food handling behaviors. Evans, E. W., None Online cross- Cross- Participants perceived themselves as having South N=100 adults Redmond, E. C. sectional study sectional lower food safety risks than other people, and Wales, over 60 Older adult of adults in south survey as having greater levels of personal control United consumers' Wales to and responsibility. Low levels of risk were Kingdom attitudes and determine correlated with high levels of control. Those perceptions of perceived risk, over eighty years old perceived higher levels risk, control, and control, and of risk and lower levels of control and responsibility for responsibility responsibility. Overall, older adult consumers food safety in the associated with expressed perceptions of invulnerability, domestic kitchen. food safety optimistic bias, and the illusion of control J Food Prot. 2019. regarding food safety. Fagnani, R., None A cross-sectional Cross- The majority (98%) reported purchasing dairy Brazil N=468 dairy Eleodoro, J. I., online study sectional products from supermarkets. Roughly half of consuming Zanon, E. utilizing an survey respondents were aware or illegal milk and internet users O.. Milk-borne online survey of dairy products, and 54% of those reported infections milk consumers consuming them (81% fresh cheese, 32% awareness and in Brazil ripened cheese, 24% fluid milk.) The majority the health status assessing their (90%) were aware of the risks associated with 104 of consumers: An health status and consuming illegal milk or dairy. Of those who on-line awareness of were aware that zoonotic diseases can be survey. Internatio milk-borne spread by milk, 44.9% were able to correctly nal Dairy infections identify a pathogen carried in milk. In Journal. 2019. regression analysis, knowledge of milk-borne disease was inversely associated with experiences of abdominal pain. Freivogel, C., Health An online cross- Cross- In hierarchical regression analysis, positive Switzerlan N=665 food Visschers, V. H. Action sectional sectional outcome expectancy and self-efficacy d preparers M.. Understandin Process examination of survey significantly predicted safe food handling g the underlying Approach psychosocial behaviors. The intention to adopt safe food psychosocial (HAPA), factors related to handling behaviors was most significantly determinants of Theory of consumers’ safe associated with risk perception, positive safe food Planned food handling outcome expectancy, and most significantly, handling among Behavior behaviors self-efficacy. In mediation analysis, coping, consumers to (TPB) utilizing a self- planning, and action control partially mitigate the reporting mediated the intention-behavior relationship transmission risk questionnaire. regarding safe food handling. Negative of antimicrobial- experiences with antimicrobial resistance resistant demonstrated a small but significant effect on bacteria. Inter J adopting safe food handling behaviors, while Environ Res Public negative experiences with food poisoning did Health. 2020 not. Godínez-Oviedo, None A cross-sectional Cross- The food groups of fruits and vegetables were Central N=1,199 adults A., Sampedro online survey sectional the most consumed and were the most region of Parra, F., study of adults survey related to perception of Salmonella exposure. Mexico Machuca living in the Refrigeration was the most common method Vergara, J. J., central region of of food storage (42.2% to 90.8%). Most Gutiérrez Mexico. consumers reported always washing their González, P., Assessed food hands before preparing food (86.4%), but 105 Hernández consumptions some reported using the same cutting board Iturriaga, M. Food habits of the five (16.9%) and knife (13.0%) on more than one Consumer food groups, product without cleaning. Those with the Behavior and food handling highest risk from food handling practices were Salmonella practices, and men, people aged 20 to 24, and people aged Exposure Self- self-perception 60 to 64. Perception of exposure to Perception in the of Salmonella Salmonella was associated with education Central Region of exposure. level and current gastrointestinal disease. Mexico. J Food Sci. 2019. Green, E. J., None A cross-sectional Cross- Participant’s food was most often prepared at United N=786 Knechtges, P. L. study of sectional on-campus dining facilities. Most (72%) felt States undergraduate Food safety undergraduate survey they were “unlikely” or “very unlikely” to be at college students knowledge and college students risk for foodborne disease. The mean food practices of young in the United safety knowledge score was 43%. adults. J Environ States, using an Health. 2015. online survey. Assessed food safety knowledge and perception of risk for foodborne illness, as part of a required health course. Gupta, V., Theory of A cross-sectional Cross- Risk and benefit perception of consumers are Delhi, India N=586 Khanna, K., Planned study using a sectional interrelated and responsible for their changes consumers Gupta, R. K.. A Behavior location survey in attitudes towards the street foods. In study on the (TPB) intercept exploratory factor analysis, a six-factor 106 street food approach of the solution with four risk factors and two benefit dimensions and risk and benefit factors was found that explained 70.05% of its effects on perceptions of the total variance. In structural equation consumer street food modeling, perceived risks and benefits attitude and consumers. explained 35.1% of the variance in attitude; behavioural perceived risks, benefits and attitudes intentions. Touris explained 49.4% of the variance in behavioral m Review. 2018 intention. Han, G., Liu, Y. None A cross-sectional Cross- Information sources had a high impact on risk China N=4,068 adults Does information study using a sectional perception. A higher perception of risk was (National pattern affect risk face-to-face survey associated with younger people, those in survey) perception of survey of adults urban areas, those without cohabitation food safety? A in China, experience, and those who use social media. national survey in assessing the Older residence and those who rely on face- China. Int J relationship to-face communication had the lowest Environ Res Public between perception of risk. Health. 2018. perceptions of food safety, primary information sources, and demographics. Hanson, J. A., None A cross-sectional Cross- Perceived severity of illness was associated Southern N=128 adults Hughes, S. M., study of adults at sectional with safer sanitation behaviors and weakly United Liu, P. Use of a tailgate event, survey associated with exposure to safe food States Health Belief using a face-to- handling media cues, but was not associated Model variables face with safe food handling educational cues. to examine self- questionnaire Around half of participants reported never or reported food assessing the seldom seeing information about foodborne handling relationship illness or ways to handle food in newspapers, 107 behaviors in a between Health magazines or store displays, and also never or sample of U.S. Belief Model seldom read the “safe handling instructions” adults attending a variables and on raw meat packages. tailgate event. J self-reported Food Prot. 2015. food handling behaviors, perceived threat of foodborne illness, and food handling cues to action. Hartmann, C., None Cross-sectional Cross Experts differed from consumers and Switzerlan N=422 Hubner, P., mailed survey, sectional producers in assigning a higher priority to d (41 experts, Siegrist, M. A risk assessing survey listeria in foods and hygiene control in 138 producers, perception gap? individuals’ restaurants. Producers and consumers 243 consumers) Comparing perception of assigned higher risk to products used to treat expert, producer risk associated plants, such as pesticides and herbicides, as and consumer with a wide well as GMO traces in food and animal feed. prioritization of variety of items, Application of nano-silica in food was ranked food hazard mostly related to higher by producers and consumers than by controls. 2018. food. experts. Consumers’ and producers’ rankings were highly correlated with one another, while the rankings of experts were significantly different from consumers and producers. Henke, K. A., None A cross-sectional Cross- Sixty-eight percent of respondents had heard Germany N=1,008 Alter, T., Doherr, study with online sectional of Campylobacter, 20.2% had heard but did consumers M. G., Merle, R. panel of survey not know how to prevent it, while 11.5% knew Comparison of consumer how to prevent it. Of those who had heard of consumer knowledge of Campylobacter, 52.5% knew it was 108 knowledge about Campylobacter, transmissible through meat. Knowledge and Campylobacter, Salmonella and age were positively associated. Consumer Salmonella and Toxoplasma, knowledge on Salmonella and Toxoplasma Toxoplasma and through use of were superior to that of Campylobacter with their an online panel the consumer being most informed about transmissibility of consumers. Salmonella. via meat: results of a consumer study in Germany. BMC Public Health. 2020 Henley, S. C., None A cross sectional Cross- African Americans were more likely to Philadelphi N=428 Stein, S. E., phone study of sectional perceive raw pork as a risk for bacteria caused a, PA consumers Quinlan, J. poultry-handling survey illness (88.2%) compared to Caucasians Characterization practices, and (76.9%) Asians (74.5%). Hispanics (45.1%) had of raw egg and other handling a significantly higher risk perception for tofu. poultry handling and purchasing Asian consumers were less likely to perceive practices among practices, of risk for raw chicken (59%). African Americans minority minority reported preparing pork at lower rates than consumers consumers Asians and Caucasians. Asian and Hispanic Identification of utilizing a respondents reported lower rates of unique culturally ownership of meat thermometers relative to practices. British themed survey African Americans and Caucasians. Caucasians Food developed from were less likely than respondents of other Journal. 2015. focus groups. races/ethnicities to purchase live poultry. This trend was also observed for purchasing eggs at room temperature. 109 Hull-Jackson, C., Theory of A descriptive, Cross- Both sets of respondents at the GAIA and BCT Barbados N=398 tourists Adesiyun, A. A. planned cross-sectional sectional had positive food safety perceptions (75.8% (240/158, GAIA, Visitor behavior, survey study of survey and 99.4% respectively), and a low frequency BCT). Perceptions of informatio tourists and their of foodborne illness (6% and 0.6%). Food Safety and n perceptions of Differences between the two samples Sociodemographi integration food safety in emerged: Among the GAIA sample, 82.3% c Determinants in theory, Barbados were influenced by vendor hygiene practices Barbados, West protection administered at while 66.5% surveyed at BCT were not. Indies. J Food motivation two ports: Ethnicity was significantly associated with Prot. 2018 theory Grantly Adams perceptions in both groups. Age was also a International significant predictor of risk perception in Airport (GAIA), among GAIA participants with older age and Bridgetown predicting greater risk perception. Among BCT Cruise Terminal participants, education was the only (BCT). significant predictor of concerns about hazards with greater education predicting greater concern. Iqbal, M., None A cross-sectional Cross- Though not significant, bachelor’s degree Indonesia N=482 nutrition Choiriyah, N. A., study using a sectional students demonstrated higher knowledge students Setyorini, I. Y.. random survey than associate degree students. Out of 10 Evaluating clustering items, the only two items answered correctly nutrition sample assessing by a majority of all students were the safe students' Indonesian cooking temperature, and safe food storage knowledge of nutrition temperature. food safety in students’ Indonesia: Multi- knowledge of strata comparison food safety by review. Annals of education strata Nutrition and (associate degree, 110 Metabolism. 201 bachelor’s 9 degree, and a second bachelor’s degree group) Ishwar, S., None A cross-section Cross- The majority (96%) were aware that milk can India N=100 Dudeja, P., study utilizing a sectional be adulterated. Awareness of adulteration of consumers Shankar, P., community- survey other foods ranged from roughly 20-50%. The Swain, S., based sample of most common indicator used to assess quality Mukherji, S.. residents of an when purchasing groceries was checking the 'Jago Grahak urban slum. seal, followed by the expiration date. None of Jago': A cross- the respondents reported checking either the sectional study to Food Safety Standards Authority of India assess awareness (FSSAI) logo or Agmark logo. 43% had about food reported purchasing adulterated food at least adulteration in an once in the past six months. urban slum. Med J Armed Forces India. 2018 Issa, M., None A cross-sectional Cross- Lower rates of diarrheal illness were Jerusalem N=96 adults McHenry, M., study of adults sectional associated with having water piped into the Issa, A. A., living in the survey home (62%), proper hand washing and Blackwood, R. A. Kulandia refugee adequate soap availability (58%), Access to safe camp in consideration of vendor cleanliness (51.3%), water and Jerusalem. Used having access to healthcare professionals personal hygiene an anonymous (15.6%), and higher income, higher level of practices in the survey to assess general education and higher level of health Kulandia refugee safe water and hygiene education. camp (Jerusalem). personal hygiene practices. 111 Infect Dis Rep. 2015. Kang, H. J., Lee, None A cross-sectional Cross- Respondents reported a desirable shopping Seoul, N=417 Parents M. W., Hwang, I. study of the safe sectional order that prioritized selecting perishable South of elementary K., Kim, J. W.. food handling survey items such as milk, meat, and fish last. Korea school children Development of practices of Regarding safe food handling practices, only Safe Food Korean parents 48% reported using soap during handwashing. Handling of school-aged Despite knowing the risks of contamination, Guidelines for children and an 58% reported using the same cutting board Korean evaluation of and knife for raw and cooked food. The largest Consumers. J food handling proportion (37.4%) reported using the Food Prot. 2015. guideline leaflet refrigerator to thaw food. Regarding leftovers, 47.2% said they keep soup in the refrigerator after boiling, while 32.1% said they keep it at room temperature after boiling. The safe food handling leaflet was piloted to a subsample of 50 parents. Evaluations were largely positive with a large majority saying the leaflet was easy to understand (94%) useful (94%). Katiyo W, de None Online survey Cross- More than half (55%) incorrectly handle raw South N=863 South Knock HL, Coorey assessed sectional chicken when purchasing and 44% incorrectly Africa African R, Buys EM. consumers’: self- survey thaw frozen raw chicken. Roughly one third consumers Assessment of reported (31%) do not correctly handwash before and safety risks practices when after (36%) handling raw chicken. Most associated with handling raw participants had moderate or poor (72%) handling chicken chicken from knowledge levels about factors impacting as based on retail to the chicken meat safety and most (62%) reported practices and home, moderate or poor safety practices. Consumers knowledge of a knowledge of ≥ 40 years old had greater knowledge and group of South factors affecting 112 African the safety of raw followed more safety practices than those ≤ consumers. Food chicken, 40 years old. Control. 2019 concerns about safety risks linked to handling chicken meat in and out of the home, and sociodemograph ic characteristics. Kosa, K. M., None Cross-sectional Cross- The majority of consumers who prepared raw United N=1,504 adult Cates, S. C., survey sectional poultry reported washing their hands after States grocery Bradley, S., administered survey handling the raw product (90%), separating shoppers Chambers, E. th, online nationally raw poultry in plastic bags before putting it in Godwin, S.. among adult their shopping cart (76.3%), and washing or Consumer- grocery swapping out dishes used to prepare raw reported handling shoppers, poultry (97.1%). Sixty-two percent of of raw poultry assessing food consumers reported owning a food products at safety practices thermometer and of those, 73.2% reported home: results when handling using it the last time they cooked a turkey, and from a national raw poultry at 56.7% when cooking whole chickens. The survey. J Food home. majority of consumers safely store raw Prot. 2015. poultry (70.6-94.4%) and cook poultry per 78:180-6 USDA cold storage guidelines (90.5-92.8%). Based on the findings, education to improve consumer handling practices for raw poultry is needed. Low, W. Y., Jani, None Online survey Cross- Moderate food safety knowledge scores were Kuala N=1,178 R., Halim, H. A., assessed sectional reported. Students were most knowledgeable Lampur, tertiary Alias, A. A., Moy, demographics, survey about personal food hygiene and least Malaysia students (n= 113 F. M.. food safety knowledgeable about symptoms of 496 art Determinants of knowledge, food foodborne diseases. Older students (≥30 years students, n=440 food hygiene safety attitudes old) were significantly more knowledgeable science knowledge and food on causes of foodborne diseases. Females students, n=242 among youths: A practices. The were more knowledgeable than males. technical cross-sectional results reported Science students reported the highest students) online study. food safety knowledge. Gender, level of study, field of Food Control. knowledge study and father’s education level are 2016. exclusively. significant predictors on overall knowledge of Areas for food hygiene. Food safety education is knowledge recommended. improvement were identified, and recommendatio ns about future educational programs are provided. Luo, X., Luo, L., None Cross-sectional Cross- Education students scored the highest on food Chongqing, N=3454 college Liu, H., Xiao, Y., survey assessing sectional safety attitudes and practices. More than 70% China students Yu, X., Hou, X., food safety survey were concerned or very concerned about Zeng, H., Zhang, knowledge, pesticide residues in vegetables and 80% of F., Zhang, Y., attitudes, and students were willing to improve their Zhao, Y.. Needs practices among knowledge of food safety and to change their survey of food students from inappropriate food safety practices. safety nursing, intervention education and through we- medical colleges. media: A cross- 114 sectional survey among junior educational and Medical University students in Chongqing, China. Annals of Nutrition and Metabolism. 2019. Ma L, Chen H, Yan None The study A cross- On average consumers were appropriately Handan, N= 100 street H, Wu L, Zhang explored food sectional knowledgeable about food safety. In general, China vendors W. Food safety safety survey and younger consumers were more N= 240 knowledge, knowledge and checklist for knowledgeable than older consumers. Food consumers attitudes, and attitudes of food vendors, however, had on average lower food N=90 streeet behavior of street vendors and handling safety knowledge scores than consumers. vending stalls food vendors and consumers of behaviors Food vendors who had a university education consumers in street food as had significantly greater food knowledge Handan, a third- well as the food scores. Greater income and education level tier city in handling were associated with greater food safety China. BMC Public practices. attitudes. Vendors practiced personal Health. 2019. protective behaviors such at not wearing jewelry, but barely half separated raw food from cooked food and only 1/3 used soap when washing dishes. Majowicz, S. E., None Self- Cross- Of students who reported handling food for a Ontario, N=2860 high Diplock, K. J., administered sectional job, less than half (45.1%) had ever taken a Canada school students Leatherdale, S. T., cross-sectional survey course in food preparation or handling and for Bredin, C. T., survey assessing those who were not currently handling food 115 Rebellato, S., food safety related to their work, it was even lower Hammond, D., knowledge, (32.5%). Knowledge was low related to food Jones-Bitton, A., attitudes and refrigeration, kitchen cleaning, hand washing, Dubin, J. A.. Food self-reported and cooking temperature. A majority (56.1%) safety knowledge, practices. reported always washing hands with soap and attitudes and self- warm running water before preparing or reported handling food, or after working with raw meat practices among or chicken (76.7%). Ontario high school students. Can J Public Health. 2016. Marumo O, None This study aimed Cross- Food quality and safety and convenience and Mahikeng N=230 Mabuza ML. to understand sectional bargaining opportunities were the Local households Determinants of perceptions of survey preeminent principal components of informal Municipalit (head of urban consumers' informal vegetable market engagement. Households y, North household participation in vegetable were more dependent on informal markets if West participated) informal markets and the they had more family members who were Province vegetable factors that unemployed or had no income. The older the South markets: influence head of household, the stronger the Africa Evidence from decisions about preference for informal vegetable markets. Mahikeng, North whether or not Having fewer household members who West province, to shop from received primary education was related to South Africa, and formal or increased preference for formal vegetable implications for informal markets. More wealth was associated with a policy. South vegetable stronger preference for formal markets. African Journal of markets. Economic and Management Sciences. 2018. 116 Mascarello G., None Cross sectional Cross A probit model that accounted for Italy N=1000 Pinto, A., Parise, survey collected sectional demographic and perception related factors consumers N., Crovato, S., through survey as explanatory variables used to identify main Ravarotto, L. The computer factors that influence vegetable market perception of assisted preferences. Key factors are discussed. It is food quality. telephone also determined that informal vegetable Profiling Italian interviewing markets are a key component of urban consumers. assessing the markets for multifaceted reasons. Thus, policy Appetite, 2015. qualities that changes are needed to ensure the safety of Italian the food sold in these markets. Four clusters consumers of consumers were identified but only two consider were numerically substantial, so only those important when were used to conduct analysis. The two assessing food groups were defined as: cluster 1 (those who quality. assess the quality of a food product mainly according to criteria associated with the organoleptic sphere, 76.2%), cluster 2 (those whose selection criteria are mainly related to the food’s place and methods of production, 20.4%). Cluster 1 consisted of mostly employed individuals, where Cluster 2 consisted mostly of retirees. Cluster 2 also consisted of more students, though there were not a large number of students in the study overall. Those living in the North West were more likely to fall into Cluster 1, whereas those living in the North East were more numerous in Cluster 2. No significant difference was found in terms of gender, age, and education. Cluster 2 had more individuals 117 showing poor level of food safety knowledge. Approximately 1/3 of consumers in Cluster 1 shop for food every day, whereas ¼ of consumers in Cluster 2 shop for food every day. Maughan, C., None This survey study Cross- Consumers think of hormones, pesticide and Canakkale N=166 Chambers, E. Iv, of consumers in sectional fertilizer residue and genetically modified Province in Godwin, S., Canakkale found survey organisms similarly and that they all pose a Turkey Chambers, D., that people threat to food safety. Consumers view Cates, S., Koppel, believe fruits and physical attributes of food similarly but see K.. Food Handling vegetables are quality, freshness, and traceability of foods as Behaviors tainted with unique. Observed in hormones, Consumers When pesticides, Cooking Poultry fertilizers and and Eggs. J Food may be Prot. genetically modified. Milazzo, A., Giles, None Cross-sectional Cross- Socioeconomic status was not significantly South N=183 L. C., Zhang, Y., survey sectional associate with unsafe food and personal Australia individuals who Koehler, A. P., administered survey hygiene practices or knowledge. Twenty-five had cases of Hiller, J. E., Bi, P.. online, hard percent reported unsafe personal and food Salmonella or Factors copy, or through hygiene practices and 25% had poor Campylobacter Influencing telephone knowledge about high-risk foods for infection Knowledge, Food interview foodborne infection. Forty-four percent of Safety Practices assessing food participants consumed high-risk foods on a and Food safety warm day. Approximately half of respondents Preferences knowledge and did not know what the correct refrigerator During Warm practices and temperature is, and women were twice as Weather of their relationship likely to know the correct setting. 118 Salmonella and with Campylobacter socioeconomic Cases in South position. Australia. Foodborne Pathog Dis. 2017. Mirzaei, A., None Cross-sectional Cross- Adolescents who graduated from high school, Ilam City, N=380 males Nourmoradi, H., survey assessing sectional with more educated parents, with employed Iran aged 13-19 Zavareh, M. S. A., food safety survey parents, and in a good economic situation had Jalilian, M., knowledge and higher levels of knowledge about food Mansourian, M., practices. hygiene. However, high levels of food safety Mazloomi, S., practice were only found in adolescents with Mokhtari, N., household mothers and in adolescents with a Mokhtari, F.. good family economic status. Food Safety Knowledge and Practices of Male Adolescents in West of Iran. Open Access Maced J Med Sci. 2018. Muhammad I, None Cross-sectional Cross- A majority of the food safety questions were Indonesia N=482 students Choiriyah NA, survey using a sectional answered incorrectly. Topics most often Yunita SI. cluster sampling survey answered incorrectly included safe storage Evaluating method to assess practices, safe food consumption principles, nutrition food safety food-borne disease principles, handling food students’ knowledge of at risk of food-borne disease-causing knowledge of students who microbes, subjects at risk of food-borne food safety in major in disease, safe food processing, preparation, 119 Indonesia: Multi- nutrition and and contamination prevention of animal strata comparison have completed sourced foods. There were no significant review. Pakistan a course on food differences found within the sample. Journal of safety using a Nutrition. 2018. biodata and food safety survey. Mullan, B., Allom, Theory of Online cross- Cross- Rates of safe food-handling behaviors were Australia N=170 college V., Sainsbury, K., Planned sectional survey sectional relatively high (77-90%). There was a strong students who Monds, L. A.. Behavior assessing food- survey correlation between Theory of Planned regularly handle Examining the handling Behavior variables and all four behaviors as and cook food predictive utility behaviors: well as habits. It appeared that moral norm of an extended cooking, hand was an important predictor of intention to theory of planned washing, keeping engage in each of the four behaviors. behaviour model food at the Similarly, habit strength was an important in the context of correct predictor of each of the behaviors and specific individual temperature, moderated the relationship between safe food- avoiding unsafe intention and behavior for the behavior of handling. foods avoiding unsafe food. Appetite. 2015. My, N, Rutsaert none Cross-sectional Cross- Participants were considerably unfamiliar Can Tho N=500 P, Van Loo EJ, survey on urban sectional with food quality certifications. Consumers and Ho Chi consumers Verbeke W. consumers’ survey unfamiliar with food quality certification had Minh, Consumers' familiarity with lower awareness of sustainability, food safety, Vietnam familiarity with food quality good agricultural practices, and organic food and attitudes certifications as compared to those with knowledge of food towards food and food choice quality certification. Perceived importance of quality decision making environmental outcomes of food choice and certifications for as it concerns food safety was associated with attitudes rice and health, food towards rice and vegetables. Perceived vegetables in safety, and eco- importance of health eating was positively 120 Vietnam. Food friendliness associated with attitudes about high quality Control. 2017. specifically rice but not vegetables. about rice and vegetables. Nan X, Verrill L, None The authors Cross- Consumers mostly obtained food safety United N=4,568 Kim J. Mapping sought to sectional information from the TV and radio; the States consumers sources of food understand survey internet was an uncommon source. However, safety where U.S. younger people were more likely to use new information for consumers media. Females and those with more U.S. Consumers: obtain education used a greater variety of Findings from a information information sources. Asian Americans were national about food more likely to use internet sources and survey. Health safety and how Hispanics were more likely to use Commun. 2017 these interpersonal sources. African Americans information turned to social media, the Internet, and TV sources are for information sources. Using social media related to and friends for information about food safety sociodemograph was associated with less perceived ic characteristics susceptibility to food borne illness compared and food safety to newspaper, healthcare providers, risk perceptions government websites, cooking classes, and on the 2010 FDA teachers. Food Safety Survey. Nguyen ATL, Tran None Cross-sectional Cross- Most respondents had good knowledge of Hanoi, N=1740 BX, Le HT, Le XTT, survey through sectional handling of raw and cooked food and the Vietnam customers Do KN, Do HT, Vu face-to-face survey proper environment practices when GT, Nguyen LH, interviews to processing food. However, only a third Latkin CA, Ho understand the understood the correct environmental CSH, Ho RCM. knowledge, requirements to maintain food safety. When 121 Customers' attitudes, and determining where to eat, consumers Knowledge, practices of reportedly mostly considering perceived Attitude, and consumers with hygiene and safety of the food as the most Practices towards regard to the important consideration. Only a modest Food Hygiene and practices of food portion of participants disclosed reporting Safety Standards facilities. unhygienic food practices to agencies of Handlers in potentially because of a belief that making Food Facilities in such reports would be a waste of time. People Hanoi, who worked white collar jobs were more Vietnam. Internat knowledgeable about food handler practices ional Journal of than those working lower class jobs. While Environmental participants were fairly knowledgeable about Research and food handling, there were clear knowledge Public gaps about the environmental requirements Health. 2018. to safely prepare food. Niyaz, O. C., None Survey with Cross- Consumers believed that fresh fruits and Canakkale, N=166 Demirbas, consumers in 7 sectional vegetables include hormones, pesticides, Turkey N.. Food Safety districts in survey fertilizer remains and GMOs that are harmful Perceptions of Canakkale, and make food less safe. Fresh Fruits and Turkey to Vegetables determine Consumers. Journ perceptions of al of Tekirdag food safety of Agriculture fresh fruits and Faculty-Tekirdag vegetables using Ziraat Fakultesi social Dergisi. 2018. determinants of health and multi- dimensional scaling analysis. 122 Obande D, Young None Survey to Cross- Participants had good knowledge of general Canada N=93 students I. Safe food understand food sectional safe food storage. White participants scored refrigeration storage survey the highest on knowledge scores of safe food knowledge, knowledge and storage. Those born outside of Canada had attitudes, and safe more positive attitudes toward food safety practices of refrigeration than Canadians. Overall, participants had university practices of inadequate knowledge about appropriate students. British college students refrigeration temperatures and poor practices Food living in about checking the temperatures of Journal. 2020. residence halls. refrigerators were observed. Students also incorrectly associated smell with determining whether food was safe to eat. Odeyemi OA, None Survey assessed Cross- Generally, participants from Asian countries Iran, N=453 (n=265 Sani NA, Obadina the food safety sectional had greater food safety knowledge than Jordan, from Africa, AO, Saba CKS, knowledge, survey participants from African countries. Malaysia, n=188 from Bamidele FA, attitudes, and Cameroonian participants had the least food Pakistan, Asia) Abughoush M, practices of safety knowledge compared to Ghanaian and Ghana, Asghar A, consumers from Nigerian participants. Likewise, Iranian Cameroon, Dongmo FFD, developing participants had the lowest food safety Nigeria Macer D, countries in knowledge compared to Malaysian and Aberoumand A. Africa and Asia Pakistani participants. Many participants were Food safety were compared. unaware of the relationship between food knowledge, borne illness and leaving food at room attitudes and temperature. practices among consumers in developing countries: An international 123 survey. Food Res Int. 2019 Opara, P., Alex- None Cross-sectional Cross- Handwashing with soap and water (HWWS) by Port N= 154 mothers Hart, B. & Okar, T. study used to sectional mothers in Port Harcourt is weak due to Harcourt, (ages 20 to 44) Hand-washing collect data on survey varying factors like educational status, lack of Nigeria, Practices hand-washing sanitation infrastructures, perceived West Africa Amongst Mothers practices motivation, and hand-hygiene practices in of Under-5 amongst public places. Generally, 64 (41.6%) mothers Children in Port mothers of regularly washed their hands with soapy Harcourt, Nigeria. children under 5 water in a container, 30 (19.5%) used soap Paediatrics and after defecation and running water, and 60 (38.9%) used only International or cleaning an water, either running or in a container. 82 Child Health. infant's (53.2%) and 70 (45.5%) reported always 2017. perineum to washing their hands before preparing their prevent infant's food and before feeding their infants. childhood With hand-hygiene practices in public places mortality caused after cleaning a child's perineal area, 30.5% by diarrhea and (n=47) of mothers choose to clean their hands Pneumonia in with baby wipes, 27.9% (n=43) wash with Port Harcourt, water carried along for child's use, and 17.5% Nigeria. (n=27) wait to clean their hands at home. However, mothers' fear of being judged or embarrassed about poor handwashing practices may have slightly skewed the results. Paden, H., Hatsu, None Self- Cross- Food safety risk perception, food safety United N= 288 patients L., Kane, K., administered sectional attitudes, and food safety behaviors were not States Lustberg, M., cross-sectional survey contingent on cancer type. The majority of the Grenade, C., survey with sampled population (70.2%) understood the Bhatt, A., Pardo, cancer patients dangers of foodborne pathogens. However, 124 D. D., Beery, A., receiving 49.4% were oblivious of their higher & Ilic, S. treatment form susceptibility due to their weak immune Assessment of three cancer system. Approximately 87.4% expressed Food Safety clinics in optimism about sanitation practices. Food Knowledge and Columbus, Ohio, safety knowledge scores were overall low Behaviors of USA to assess among cancer patients; the average score was Cancer Patients their food safety 74.77 ± 12.24% (average ± standard Receiving behaviors, deviation). Many participants (46.3%) Treatment. attitudes, risk engaged in high-risk behaviors such as Nutrients. 2019. perceptions, and consuming fruits and vegetables after food acquisition removing damaged parts, and 84.9% did not behaviors. cook alone. Pang, J., Chua, S. None Interviewer- Cross- The results indicated good knowledge and Singapore N= 240 W. J. L., & Hsu, L. assisted cross- sectional attitude towards hand washing and food residential units Current sectional study survey hygiene among the residents with the consented and Knowledge, among the majority of the sampled population (92.5%) & 18 rejected Attitude and residents of a reporting washing their hands multiple times participation Behaviour of residential area in a day. Seventy-one percent reported out of 1,156 Hand and Food in Singapore to washing their hands with soap, and 6.3% used units invited Hygiene in A determine the alcohol-based disinfectants four or more Developed current times in a day. Similarly, 96.3 % agreed that Residential knowledge, washing hands with soap effectively reduces Community of attitude and the spread of diseases. However, 87.9% stated Singapore: A behaviors of they only wash their hands when their hands Cross- Sectional hand and food are physically dirty. Only 75% of participants Survey. BMC hygiene, as well reported completing all eight steps to proper Public Health. as to establish handwashing. Everyone reported washing 2015. the potential risk their raw food properly before cooking, and factors of 94.2% check the expiration date on the food diarrhea in an 125 area where clean packaging before purchasing or cooking the water and soap food. are easily available and affordable. Petrescu DC, None The authors Cross- Consumers were most focused on food Belgium N=797 (n=441 Vermier I, aimed to sectional quality. Attributes such as appearance, and Belgians, n=356 Petrescu-Mag understand survey freshness of food, and taste were most Romania Romanians) RM. Consumer social, commonly cited as how people appraised understanding of environmental, their food. The emphasis on food quality was food quality, and qualitative related to health and concerns about healthiness, and food ques that environmental protection. environmental that impact impact: A cross- purchasing food. national Belgian and perspective. Inter Romanian national Journal consumers most of Environmental commonly cite Research and quality of food as Public something of Health. 2020 great importance when making decisions about food. Phillips, R. M., None Cross-sectional Cross- Nearly all households had soap available and South N=600 female Vujcic, J., Boscoe, survey of female sectional reported water was available “always” or Sudan heads of A., Handzel, T., heads of survey “sometimes”. Exposure to handwashing households Aninyasi, M., households promotion was reported by 85% of Cookson, S. T., assessing respondents. Rinsing hands with water alone 126 Blanton, C., L, S. handwashing was more commonly observed (80%) verses Blum, Ram, P. K.. knowledge, handwashing with soap and water (7%) before Soap is not access, and eating and before cooking (72.3% vs 23%). enough: behaviors as well After using the toilet, 46% were observed handwashing as observations washing hands with soap while 38% rinsed practices and of handwashing with water. knowledge in behaviors. refugee camps, Maban County, South Sudan. Confl Health. 2015. Qekwana, D. N., None Cross-sectional Cross- A high proportion (62.64%) did not wear Tshwane, N=105 McCrindle, C. M. survey of sectional protective clothing during slaughter. South individuals E., Oguttu, J. W., individuals survey Slaughtering was mainly conducted by males Africa involved in the Grace, D.. involved in the (99%). Forty-four percent or practitioners only slaughter of Assessment of the slaughter of changed their clothing that they wore during goats (as a occupational goats to assess slaughtering when they got home. Up to spectator or health and food the occupational seven people may be involved in the participant) safety risks health and food slaughter. In 77.5% of cases, the health status associated with risks associated of the person performing the slaughter was the traditional with the not known. Meat inspection was not practiced slaughter and practice. by any of the respondents. Throughout the consumption of slaughter process, the same knife was used by goats in gauteng, individuals (84.3%) and the knife was only South Africa. Inter cleaned when soiled (84.7%). Fifty-two J Environ percent processed the carcass and cooked the Research Public meat immediately. The majority (80%) Health. 2017. consumed the meat within 30 minutes of cooking. 127 Ruby GE, Abidin None The knowledge Cross- Consumers had good food safety knowledge Sibu, N=623 Ufuz Lihan S, of food safety sectional as well as personal hygienic practices like Sarawak, consumers Jambari NN, Radu among survey handwashing. They also identified the link Malaysia S. A cross consumers who between foods that are at high risk of causing sectional study on handle food food borne illness and cross-contamination. food safety safety at home Although, participants often did not correctly knowledge was assessed. identify correct temperatures to safely store among adult food. A majority of participants correctly consumers. Food identified symptoms of food borne illness. A Control. 2019. regression found that being female and having advanced education predicted higher food safety knowledge scores. Compared to participants over the age of 50, participants between 30-39 were the more knowledgeable. Similarly, families with 3 or more children were considered to have good knowledge about food safety as were those who reportedly preparing food in the home daily. Ruby GE, Abidin Theory of Structural Cross- Constructs of the Theory of Planned Behavior Sibu, N=623 Ufuz Lihan S, Planned equation sectional that were included consisted of attitude, Sarawak, consumers Jambari NN, Radu Behavior modeling was survey subjective norm, perceived behavioral Malaysia S. Predicting used to predict control. Findings suggest that subjective norm intention on safe the intention of was the strongest predictor of intention to food handling consumers safely handle food whereas attitude about among adult towards safe and knowledge of food safety were the consumers: A food handling at weakest factors that determined food safety. cross sectional home. Models that account for demographic study in Sibu variation are warranted and could possibly district, explain examined relationships. The theory 128 Malaysia. Food accounted for roughly 34% of the variance in Control. 2019(b). the positive influence of attitude, subjective norm, and perceived behavioral control as it concerns intention to safely handle food in the home. The largest influence on attention was subjective norm (i.e., familial expectation of safety). Perceived behavioral control was also a significant predictor of intention, thus it is recommended that interventions that focus on the ease of health protective behaviors that can reduce food borne illness are developed. Knowledge was also positively associated with attitudes towards food safety, despite attitude only accounting for a modest portion of the variance of intention to safely handle food. Samapundo S, None The authors Cross- Consumers had greater food safety Bing N=160 (n=120 Thanh TNC, aimed to sectional knowledge than vendors although nearly one Thanh, Thu consumers, Xhaferi R, understand the survey fifth of consumers had poor food safety Duc, n=40 street Devlieghere F. food safety knowledge scores (comparable to 90% of District 3, food vendors) Food safety knowledge, vendors who had poor food safety District 8, knowledge, attitudes, and knowledge). Among consumers, youth was in Ho Chi attitudes and practices of associated with greater food safety Minh City, practices of street street food knowledge as was greater educational level. Vietnam food vendors and vendors and Again, among vendors, educational level was consumers in Ho consumers. associated with food safety knowledge with Chi Minh city, lower levels of education being associated Vietnam. Food with lower levels of food safety knowledge. Control. 2016. The large majority of vendors received no food safety training. This was reflected by the 129 unsanitary working conditions in which food Samapundo S, was prepared. Generally, consumers were Thanh TNC, knowledgeable about food safety practices. Xhaferi R, However, food vendors were not, and this Devlieghere F. reflected in the problematic observations Food safety regarding food handling practices and knowledge, unhygienic facilities. Food safety training for attitudes and food vendors is greatly needed. practices of street food vendors and consumers in Ho Chi Minh city, Vietnam. Food Control. 2016. (Cont’d) Sanlier, N., Baser, Theory of Cross-sectional Cross- The study aimed to reveal the mediating role Ankara, N=1,219 young F. The Behavior interview sectional of attitude between knowledge and behavior. Turkey women (ages Relationship Change administered survey Correlations among food safety knowledge, 20-25) Among Food survey of young attitude, and behavior were all statistically Safety women (20-25 significant. The paths from knowledge to Knowledge, years old) in attitude and from attitude to behavior were Attitude, and Ankara, Turkey both strong, which was in line with the Behavior of Young assessing food author’s hypothesis. The implication is that Turkish Women. J safety encouraging food safety attitude by increasing Am Coll Nutr. knowledge, knowledge might be an appropriate target for 2020 attitude, and behavior change. behavior. Sanlier, N., None Self- Cross- Male subjects had higher street food Turkey N=847 high Sezgin, A. C., administered sectional preference scores (86.3 +/- 6.1) than females school and Sahin, G., survey of survey (80.3 +/- 12.2). University students (86.2 +/- 130 Yassibas, E.. A students 7.5) preferred consuming street foods more university study about the assessing street than high school students (77.4 +/- 12.1). students young consumers' food There was a statistically significant negative consumption preferences. correlation between street food consumption behaviors of and education level as well as age. Although street foods. Cien young consumers knew that street food was Saude Colet. easily contaminated, that vendors do not pay 2018. attention to hygiene, that street foods are raw or not cooked well, they prefer this food for its cheapness, satisfaction, taste, variety, fast service, and because it is consumed by most people. Senkham, K., None Cross-sectional Cross- Overall, respondents had “high level of Bankok, N=430 adults Hongsranagon, survey to assess sectional knowledge” (70.8%), “neutral attitude” Thailand P., Havanond, P.. the knowledge, survey (58.4%), and “fair practice” (71.2%) toward Knowledge, attitude and the campaign. Almost all respondents (98.8%) attitude, and practice towards knew that diarrhea is caused by eating practice towards the campaign unclean food or contaminated water. Most the campaign "eat “Eat hot food, knew that eating cooked food can help hot food, use use serving prevent food and water borne diseases serving spoon, spoon, and (96.3%). Occupation and income per month and always wash always wash were associated significantly with knowledge your hands" your hands” toward the campaign. Education, occupation among food and income were associated significantly with consumers in attitude toward the campaign. Age, Chulalongkorn education, occupation and income were University significantly associated with practices canteens, following the campaign. There was a Bangkok, significant association between knowledge an attitude, attitude and practice, while no 131 Thailand. J Health significant association between knowledge Research. 2015. and practice. Sithole, M. I., None Interview Cross- The study revealed that more men were Eastern N=361 heads of Bekker, J. L., administered sectional responsible for meat purchasing compared to Cape households. Mukaratirwa, S.. survey of heads survey women. The majority of study participants Province, Consumer of households in identified pork as an important part of their South knowledge and Eastern Cape diet (73.1%). Over half (54.2%) agreed that Africa practices to pork Province, South pork infected with T. soium cysts could be safety in two Africa, assessing harmful et 57.3% were unable to identify T. Taenia solium consumer solium cysts in pork when slaughtered at cysticercosis knowledge and home. The majority (69.5%) trusted the pork endemic districts practices related they purchased from butcheries, very few in Eastern Cape to disease (less than 10%) were aware of legal Province of South (Taenia solium), requirements in regard to food preparation, Africa. BMC Infect storage, and slaughter, and disease control. While most Dis. 2020. cooking safety consumers (88.7%) kept pork in the related to pork refrigerator, only 11.3% used a freezer to consumption. store pork. Approximately 80% of participants preferred well-cooked pork, mostly due to the belief that cooking kills germs (43.6%). Sternisa, M., Grounded Interview- Cross- The majority of respondents were women Slovenia N=560 Mozina, S. S., Theory administered sectional (66.1%) and overall, women were more aware consumers in Levstek, S., survey of survey of the health risks associated with improper grocery stores. Kukec, A., Slovenian poultry meat handling than men. Raspor, P., consumers, Respondents with lower educational Jevsnik, M.. Food assessing attainment and seniors were less aware of safety knowledge, knowledge, risks associated with improper poultry self-reported awareness of the handling. The majority of respondents (90.9%) practices and microbiological check poultry meat for freshness but 44% do attitude of risk, and self- not pay attention to the origin of the poultry 132 poultry meat reported meat. Respondents generally had good handling among practices in knowledge about proper food handling, cross- Slovenian poultry handling contamination, the importance of cooking to consumers. during purchase, prevent disease. Large majority (84.2%) British Food transport, and showed sufficient knowledge of the heat Journal. 2018. preparation in treatment of poultry. Almost half agreed that the home. the follow instructions for poultry meat preparation if they are included. Only 57.8 % stated that poultry meat in retail can be contaminated with harmful microorganisms. Questions regarding Campylobacter had a low response rate, indicating insufficient knowledge. The majority (95.9%) were unaware of poultry meat contamination with Campylobacter. Stratev, D., None Online survey of Cross- Generally, food safety knowledge, practices, Bulgaria N=100 Odeyemi, O. A., veterinary sectional and attitudes were high, though some undergraduate Pavlov, A., students to survey practices were lower than was desirable such veterinary Kyuchukova, R., assess food as 44.4% of participants dishing out food with medicine Fatehi, F., safety unprotected hands, 22.2% washing eggs students Bamidele, F. A.. knowledge, before cooking or frying them, 54.4% storing Food safety attitudes and raw chicken separately from other food. Food knowledge and practices. safety knowledge was positively influenced by hygiene practices years of study, but no differences were seen among veterinary based upon age or gender. medicine students at Trakia University, Bulgaria. J Infect 133 Public Health. 2017. Suth, M., None Interview- Cross- Age, gender, and income were found to play a Hungary N=1003 Mikulka, P., Izso, administered sectional significant role in assessments of the Hungarian T., Kasza, G. survey of survey importance of food safety. Older adults and consumers Possibilities of pedestrians in 11 women tended to place greater importance targeting in food locations in on food safety. Individuals with higher income chain safety risk Hungary to perceived changes in general food safety in communication. assess the country more favorably. Four clusters Acta Alimentaria. consumers’ risk were established based upon distribution of 2018. perception and the data: Disinterested youngsters (more risk avoidance in likely to be male (57.7%), youngest group, order for more underperformed in basic knowledge, efficient, overperformed in advance knowledge, not targeted risk regularly informed about food safety issues, communication. internet users), Conscious elders (mostly female (58.7%), older group with lowest education and income level, gather information on food safety for the household but lowest level of knowledge, fond of cooking, television watchers), Food adepts (high food safety knowledge, low shopping and household awareness, mostly men (57.5%), large percentage (30%) between the ages of 30-39, highly educated with high income levels, internet users), Soul of the family (high basic knowledge, low complex knowledge, conscious behavior in shopping and household, majority female (62%), and 134 most between 40-50 years old, heterogeneous education levels) Syahira, B. Z, None Self- Cross- While the majority knew that they should Selangor, N=610 Huda, B. B, Mohd adiministered sectional inspect food before eating it and wash hands Malaysia secondary Rafee. Factors survey assessing survey after coughing and sneezing, only 29.6% school students associated with food safety responded correctly to the statement that level of food knowledge and washing hands under only running water is safety knowledge practices. able to remove bacteria and only 42.4% knew among form four that it is not enough for food handlers to clean students in Hulu their hands with a cloth prior to handling food. Langat District, The majority (74.4%) did not know that Selangor. chilling or freezing food does not eliminate International germs. Overall knowledge ranged widely and Journal of Public was highest among Malays (compared to Health & Clinical other ethnicities), individuals with higher Sciences. 2019. education, children of food workers, and individuals who had experienced food poisoning. Tabrizi, J. S., None Interview Cross- Overall percentage mean score for knowledge Iran N=1,500 Iranian Nikniaz, L., administered sectional and self-reported practices was 77.66 and consumers Sadeghi- survey of survey 70.77 percent, respectively, which were Bazargani, H., Iranians to assess considered good. The majority of consumers Farahbakhsh, M., food safety were aware of food safety rules, but there Nikniaz, Z. knowledge and were many gaps in their knowledge and Determinants of practices as well practices that could lead to food-borne the food safety as the illnesses. Age and education were not found knowledge and association to play a significant role in food knowledge practice among between food and practice scores. Women had significantly Iranian safety better scores than men, married individuals consumers A knowledge and had significantly better scores than single 135 population-based practices with individuals, and people living in urban settings study from socio- had significantly better food knowledge and northwest of Iran. demographic practice scores than those in rural settings. British Food characteristics Journal. 2017. Thaivalappil, A., Theory of Online survey of Cross- Knowledge and safe food handling behavior Canada N=78 older Papadopoulos, Planned independent sectional outcomes were not reported in this study. The adults (60+) A., Young, I.. Behavior living older survey study found that all TPB antecedents were who live Intentions to adults (60+) who predictors of behavioral intentions except independently adopt safe food prepared food attitudes, which was only a significant and cook storage practices regularly and predictor of intentions to safely thaw meats. regularly. in older adults an who were living Respondents had similar attitudes towards application of the in Canada to storing leftovers and thawing meat safely in theory of planned assess food the refrigerator. They had similar subjective behaviour. British safety norms related to storing leftovers for an Food Journal. knowledge, TPB adequate amount of time. Some TPB 2019. components constructs were significantly different (attitudes, between two behaviors. Participants exerted subjective greater behavioral control over storing norms, leftovers compared to thawing meats. They perceived had significantly different intentions to behavioral perform safe storage of leftovers compared to control and thawing meats. Gender and past safe leftover behavioral storage behavior both predicted intentions to intention) and store leftovers within recommended self-reported guidelines. Women were more likely to have habitual stronger intentions to store leftovers than behaviors. men. 136 Tomaszewska, None Cross-sectional Cross- In regard to food poisoning knowledge, Polish Poland & N=600 M., Trafialek, J., survey of sectional consumers provided significantly better Thailand consumers (300 Suebpongsang, randomly survey responses than Thai consumers on seven from Poland, P., Kolanowski, selected questions and Thai consumers provided 300 from W.. Food hygiene individuals in significantly better responses to three Thailand) knowledge and public spaces to questions. Overall scores were slightly higher practice of assess food for Polish consumers. In Poland, women consumers in poisoning showed significantly greater knowledge than Poland and in knowledge, and men whereas in Thailand the difference was Thailand - A self-reported not significant. In Thailand, younger survey. Food hygienic food consumers were more likely to answer Control. 2018. preparation knowledge questions correctly whereas in practices in the Poland, older consumers had higher home. knowledge scores. In Poland those with higher education scored better on knowledge, but in Thailand there was no significant difference based on education. In both countries, women scored better with respect to food hygiene practice than men. While in both countries knowledge was influenced by food hygiene practices, there was a greater degree of correlation between Thai consumers’ knowledge and their food hygiene practices. Traversa, A., None Online survey Cross- The majority of users were aware of the Italy N=191 Bianchi, D. M., assessing sectional outbreak associated with frozen berries and IZSalimenTO Astegiano, S., consumer’s survey precautionary treatment to prevent hepatitis (Experimental Barbaro, A., knowledge of the A. Less than half recognized pesto as the food Zooprophylactic Bona, M. C., main foodborne matrix involved in botulism outbreaks though Institute of Baioni, E., agents and the majority were familiar with the bacterium Peidmont, Rubinetti, F., dietary regimen responsible for botulism and the main foods Liguria and Valle 137 Aliberti, E., during associated with infections. About half of d’Aosta) Palazzo, C., pregnancy. consumers identified honey as a risk to website users. Gallina, S., infants, ¾ knew of the risk of Salmonella Decastelli, L.. associated with raw eggs, and about ¾ Consumers' believed that vegetables and fruits washed Perception and with sodium bicarbonate is able to inactivate Knowledge of Toxoplasma. Only a small portion of people Food Safety: knew of the cheeses that are considered to be Results of a risk for pregnant women. Questionnaires Accessible on IZSalimenTO Website. Ital J Food Saf. 2015. Tutu, B. O., None Cross-sectional Cross- Aside from age and grade level, there were no Ghana N=1343 Hushie, C., survey of sectional significant differences observed among students (ages Asante, R., students to survey various demographic characteristics in regard 7-21) Egyakwa- assess food to knowledge and safety practices. Food Amusah, J. A.. safety safety knowledge was seen as inadequate Food safety knowledge and (mean score: 64.1%) while food practice knowledge and food safety scores (mean score: 80.4%) was seen as self-reported practices. appropriate. The majority (70%) report practices among washing hands before eating while food school children in storage practices were seen as poor. There the Ga West was a significant positive relationship Municipality in between food safety knowledge and Ghana. Food practices. The majority (68.3%) of students Control. 2020. look for cleanliness and (59.4%) neatness when assessing which food vendors to purchase from. 138 Wang, S. S., Shan, None Interview- Cross- Knowledge of pathogens among respondents China N=834 adult L. J., Wang, X. L., administered sectional varied widely but even for those who knew of consumers Wu, L. H.. survey assessing survey two or more foodborne pathogens, Consumer's risk consumers’ risk knowledge was superficial. Sixty-eight percent perception of perception and of respondents always washed cutting boards foodborne behaviors after cutting meat and more than half stated diseases and high- regarding that they always separate raw and cooked risk food safety foodborne food during storage and handling. Sixty practices in diseases. percent of respondents had eaten domestic undercooked meat or seafood. Gender, age, kitchens. marital status and education were not International associated with perceived risk, but family Food and income was positively associated with Agribusiness perceived risk. Management Review. 2019. Zhang, J. P., Cai, None Using data from Cross There was a significant association between China N=9536 Z. Y., Cheng, M. the Chinese sectional internet use and food safety evaluation (Food W., Zhang, H. R., Social Survey survey safety evaluation: “How do you evaluate food Zhang, H., Zhu, Z. (2013-2015), this safety in the current society?”) whereby K.. Association of study assesses greater internet use led to lower food safety Internet Use with the association evaluation. Individuals with a college Attitudes Toward between education as well as individuals below a senior Food Safety in Internet use and high school level, women, and urban residents China: A Cross- individuals’ food were significantly more concerned about food Sectional Study. safety safety. Inter J Environ evaluations. Research Public Health. 2019. 139 Zhou, X., Zhang, None Interview- Cross- The average knowledge, attitudes and Eastern N=274 Y., Shen, C., Liu, administered sectional practices (KAP) scores of chicken farmers China (95 chicken A., Wang, Y., Yu, survey used to survey were higher than that of chicken vendors. farmers, 104 Q., Guo, F., assess Females and older people had significantly chicken Clements, A. C. knowledge, lower overall KAP scores than males and vendors, and 75 A., Smith, C., attitudes, and younger people, though women had better market Edwards, J., practices on practice scores than men. Respondents with consumers) Huang, B., Soares avian influenza secondary education had lower attitude Magalhães, R. J.. (AI) virus among scores toward AI compared with those with Knowledge, chicken farmers, primary school and below. It is suggested that attitudes, and chicken vendors further analysis is necessary and that practices and consumers. interventions aimed at improving food safety associated with should target all stakeholders involved. avian influenza along the live chicken market chains in Eastern China: A cross- sectional survey in Shanghai, Anhui, and Jiangsu. Transbound Emerg Dis. 2019. Zyoud, S., None Interview- Cross- Significant modest positive correlations were Palestine N=412 parents Shalabi, J., Imran, administered sectional found between respondents’ knowledge and (92.7% K., Ayaseh, L., survey survey attitude scores regarding food poisoning, mothers) Radwany, N., conducted with knowledge and practice scores regarding food Salameh, R., parents in poisoning, and attitude and practice scores Sa'dalden, Z., primary regarding food poisoning. Respondents with a 140 Sharif, L., healthcare higher education level and who live in a city Sweileh, W., centers to assess were the only factors significantly associated Awang, R., Al- food safety with higher knowledge scores. Attitude Jabi, S.. knowledge, improved as educational level increased and Knowledge, attitudes, and income level increased. Those of female attitude and practices. gender and employed were statistically practices among significantly associated with higher parents regarding satisfactory hygienic practices in relation to food poisoning: a the prevention of food poisoning. cross-sectional study from Palestine. BMC Public Health. 2019. 141 Appendix III: Consumer Qualitative Studies Table Author(s), Title, Theory Summary Study Design Results Location Sample Journal, Year Araújo, J. A. M., None Themes derived Moderator-guided focus Focus groups were used to Brazil N=28 participants Esmerino, E. A., from four focus group study generate 28 items separated in six N=4 focus groups Alvarenga, V. O., groups blocks: water supply; hygiene; Cappato, L. P., Hora, conducted with health and training; waste control; I. C., Silva, M. C., academics and pest control; packaging and Freitas, M. Q., professionals traceability; and hygiene of Pimentel, T. C., within food facilities and equipment Walter, E. H. M., safety and Sant'Ana, A. S., security were Cruz, A. used to develop G.. Development of a checklist for a Checklist for good hygiene Assessing Good practices (GHP) Hygiene Practices of Fresh-Cut Fruits and Vegetables Using Focus Group Interviews. Foodbor ne Pathog Dis. 2018 Behrens, J. H., Theory of Social A qualitative Guided in-depth Interviewees reported concern Brazil N=66 interview Vedovato, G. M., Representation study using interviews conducted about hygiene and good practices with consumers Cervato-Mancuso, guided in-depth with semi-structured with a focus on hazards of a A. M., Bastos, D. H. interviews to questionnaires. chemical or biological nature. M.. Social assess Some consumers expressed representations of perceptions of greater concern with access to safety in food safety, food resulting from economic services. Food knowledge of constraint. Generally, consumers 142 Research food borne expressed a passive role in the International. 2015 diseases and food production chain. self- involvement in the food production chain Chavez, J. Y. A., None A qualitative Qualitative focus groups Problems related to food safety Nepal N=7 focus groups Ghosh, S., Rogers, B. study utilizing separated by gender and crop storage emerged in focus N=73 participants L., Shively, G., Baral, semi-structured groups. The main problems noted (40/33, K., Webb, P.. “Molds focus groups to were pests and disease, overuse of women/men) attack rice-but we determine pesticides, unpredictable weather, don't know what to definitions of lack of agricultural inputs (seeds), do”. A Qualitative food safety and lack of adequate knowledge of study of farming community farming techniques, and problems families' perceptions perceptions of with infrastructure (irrigation, of food safety in mold/fungus storage, etc.). Strategies to Banke, Nepal. FASEB infestations improve food safety emerged as Journal. 2016 among farmers. well: ensuring crop safety from pre-harvest to storage, safeguarding/cleaning crops before consumption, and properly processing moldy crops through sun drying, disposal or producing alcohol. Chiu, Y. C., Yu, S. H. Risk/Benefit A qualitative Semi-structured in-depth Thematic analysis revealed that Taiwan N=39 women Everyday strategies Analysis Model study utilizing interviews and field notes women perceive collusion for handling food in-depth between government and business safety concerns: a interviews to as a primary cause of food safety qualitative study of discern scandals. Despite this mistrust, distrust, strategies for women also indicated a reliance on contradictions, and handling food food labels and certification when helplessness among safety concerns making food purchasing decisions. 143 Taiwanese women. Health Risk & Society. 2019 Crovato, S., Grounded theory An exploratory Qualitative, in-depth, The most frequently mentioned Italy N=4 focus group Mascarello, G., qualitative focus interviewer guided focus factors were reason for preparing N=42 participants Marcolin, S., Pinto, group study to groups bivalves at home; where bivalves A., Ravarotto, discern are purchased; elements guiding L.. From purchase to consumer when consumer purchase of consumption of perceptions of bivalves; bivalve preparation, bivalve molluscs: A risk and cooking and storage; risks qualitative study on practices associated with consuming raw consumers' surrounding bivalves; and consumer categories practices and risk purchasing and who are most at risk. Practices perceptions. Food consuming mentioned with the greatest Control. 2019. bivalve meat at frequency were: storing/washing home. bivalves in salty water; preparing them immediately; keeping for at most one day refrigerated, covered with a damp cloth; and eliminating any that do not open after cooking. Dastile, L. S., None A qualitative Qualitative semi- Hygiene at the place of purchase of South N=43 focus Francis, J., analysis of semi- structured focus group meat and freshness of meat Africa groups Muchenje, V.. structured guided by a closed and emerged as the primary concerns. N=251 Consumers' Social questionnaire- open-ended Significant concern about the participants Representations of assisted focus questionnaire. safety of meat was also expressed. Meat Safety in Two group assessing Relatively low concern about food Selected consumers’ borne disease was noted, however Restaurants of social the importance of hand washing Raymond Mhlaba representations during meat preparation and Municipality in the of meat safety hygiene during meat processing Eastern Cape, South were important to consumers. 144 Africa. Sustainability . 2017 Devaney, L. Good None A qualitative Qualitative focus groups Participants expressed a need for Republic N=8 focus groups governance? study of using a flexible topic food safety responsibility to be of Ireland N=49 Consumers Perceptions of perceptions of guide conducted with a distributed across a range of accountability, good food non-probability sample actors. A significant degree of transparency and governance uncertainty regarding the food risk effectiveness in Irish utilizing natural governing structures was food risk focus groups expressed. This was interpreted as governance. Food a general lack of accountability and Policy. 2016. 62:1-10 transparency on behalf of the food risk governance. Diplock, K. J., Jones- None 19 in-depth Qualitative in-depth The interviewed experts identified Ontario N=19 Bitton, A., interviews were interviews with experts. four educational areas that need to Canada Leatherdale, S. T., conducted with be addressed including: how to Rebellato, S., food safety safely handle food, how to keep Hammond, D., educators to themselves and kitchens clean, Majowicz, S. E.. identify the information about illness causing Food Safety areas of food microorganisms and specific tips Education Needs of safety education about keeping food out of the High-School that are danger zone. Students: Leftovers, important for Lunches, and high school Microwaves. J students to School Health. 2019. learn. Dolgopolova, I., None Eight focus Focus groups Participants from both countries Russia and N=59 Teuber, R., Bruschi, groups with shared in distrust related to health Germany V.. Consumers' Russians and benefits of products as well as perceptions of Germans about marketing material about functional foods: functional foods products. Soviet history likely trust and food- were conducted influences the Russian distrust of neophobia in a and formal institutions whereas cross-cultural comparisons 145 context. Internation between German distrust stems from food al Journal of countries were scandals and specific institutions. Consumer made. Findings Studies. 2015. suggest that both Russian and Germans are distrustful of their sources of food, but the source of the distrust differs by cultural nuances. Elsey, H., None A tri-part Semi-structured Various health issues were Kathmand N=21 women Manandah, S., Sah, qualitative study interviews, observation, identified by the women related to u, Nepal interviewed D., Khanal, S., was conducted and participatory respiratory and gastrointestinal N=69 workshop MacGuire, F., King, with Napalese workshops health as well as burns and other participants R., Wallace, H., women to injuries. Stress was highlighted as a Baral, S. C.. Public understand their threat to wellness. Social capital health risks in urban perceptions of was identified as a protective slums: Findings of health risks as it factor. the qualitative related to 'healthy kitchens kitchens. healthy cities' study Women were in Kathmandu, well aware of Nepal. PLoS the many risks at ONE. 2016. varying eco- social levels and identified health protective factors as well. Findings can inform 146 intervention development. Haque, I. T., Kohda, None Qualitative Structured Four key social determinants of Khulna N= 40 vendors Y. Understanding methods questionnaires, health were identified including City, the impact of social included interviews, and focus social and political environment, Banglades N= 20 customers determinants of interviews, and group discussions physical and working environment, h health in street food focus group lower socio-economic status, and safety: a qualitative discussions to education. A conceptual model study in Bangladesh. assess barriers situated these determinants within International Journal to health a model to improve health in the of Health Promotion information and street food vendor sector. and Education. 2020 adequate knowledge across street food vendors who did and did not participate in a street food safety intervention and well as costumers to develop a model of understanding the role of social determinants of health in food safety. Hosseini, H., None Twelve focus Focus groups Eight themes emerged: Iran N=96 Khaksar, R., groups found sanitization of hands is important Esfarjani, F., that among for personal hygiene, low Mohammadi, F., Iranian knowledge about boiling times for 147 Roustaee, R., households raw milk and canned foods, low Alikhanian, H.. there was knowledge about temperature Home food safety confidence in storage and distribution of food in knowledge and strategies to refrigerators, keeping unwashed practices among prevent cross food in refrigerators, defrosting Iranian: A qualitative contamination, frozen meat at room temperature, study. Clinical but this did not separation of sanitized cutting Nutrition. 2015. equate to board for vegetables and raw protective meat, incorrectly disinfecting behaviors. Areas vegetables and improperly for education reheating food. were identified. Kendall, H., None Seven focus Focus groups Key themes were that food fraud Beijing, N=42 Kuznesof, S., Dean, groups were threatened the safety of food, Guangzho M., Chan, M. Y., conducted to there are barriers to obtaining u, and Clark, B., Home, R., understand how authentic and safe food, there Chengdu Stolz, H., Zhong, Q. Chinese exist consequences for the China D., Liu, C. H., consumers consumer of fraudulent food, and Brereton, P., viewed food that there are several risk relieving Frewer, L.. Chinese fraud in order to strategies people engage in consumer's better because of the lack of control attitudes, understand people have over their food perceptions and implications of authenticity. behavioural food policy. responses towards food fraud. Food Control. 2019 Nizame, F. A., Integrated Qualitative Semi-structured Almost none of the participants Banglades N=55 Leontsini, E., Luby, Behavioral methods were observations; video washed hands with soap and few h (n=24 female S. P., Nuruzzaman, Model for Water, used to assess observations; in-depth with water during food caregivers, M., Parveen, S., Sanitation and hygiene interviews; focus group preparation event. Though half n=29 male heads Winch, P. J., Ram, P. practices during discussions. reported the importance of of households) 148 K., Unicomb, L.. Hygiene (IBM- food washing hands, they tended to Hygiene Practices WASH) preparation of only recognize the importance if During Food caregivers hands were visibly dirty, and they Preparation in Rural within rural saw their hands as being washed in Bangladesh: Bangladeshi water when they were washing Opportunities to villages. utensils. Some expressed that lack Improve the Impact of time, or cost of soap, as barriers of Handwashing to washing hands. Water sources Interventions. Am J were generally located away from Trop Med Hyg. 2016. food preparation areas. Passos, J. A., de Phenomenology In depth Qualitative interviews; The meaning of healthy eating is Bahia, N=7 consumers Freitas, M. D. S., interviews were participant observation something that interviewees Brazil Santos, L. A. D., conducted with revisit daily and related to their life Soares, M. D.. consumers who experiences. Disease, aging, media Meanings attributed frequently reports, and learning new to healthy eating by visited the information from health care consumers of a targeted street professionals influenced shifts in street market. market to gather perceptions of healthy and safe Revista De Nutricao- information foods. Generally, healthy foods Brazilian Journal of about their were represented by fruits and Nutrition. 2017. thoughts and vegetables, by practices behaviors considered hygienic, and by related to sensations such as pleasure and healthy eating satiation provided by eating. and food safety. Songe, M. M., None Semi-structured Semi-structured All consumers said they would Zambia N=30 consumers Hang'ombe, B. M., interviews with interviews prefer to buy fish from a trader (20 in Lusaka, 10 Knight-Jones, T. J., randomly that employed an intervention in Mongu) Grace, D.. selected traders such as the use of chlorinated Antimicrobial and consumers water to disinfect the fish stalls, N=20 traders Resistant assessing their which could help to reduce the Enteropathogenic feelings related number of flies. Four consumers in Escherichia coli and to the presence Mongu said that the presence of 149 Salmonella spp. in of large no flies would be suspicious, as Houseflies Infesting numbers of flies perhaps an indication that the fish Fish in Food Markets at fish stalls. had been treated with harmful in Zambia. Int J chemicals. All traders complained Environ Res Public that flies shorten the shelf-life of Health. 2016. their fish and give the impression of an unhygienic product. Many asked for help in getting rid of flies and there were mixed feelings about nets. Some liked the idea as a deterrent from flies getting to their fish, but others thought they could be a turn off to customers. Telligman, A. L., Theory of Interviews using Structured Interviews Beef safety was not a top-of-mind Alabama, N=275 beef Worosz, M. R., Planned closed and concern for a majority of USA consumers Bratcher, C. L.. A Behavior/Reason open-ended participants. Customers believed qualitative study of ed Action questions local beef was safer because they Southern U.S. assessing food have greater knowledge about the consumers' top of safety beliefs product, and it does not involve as the mind beliefs about local beef. much shipping. Consumers believe about the safety of that locally processed meat comes local beef. Appetite. from smaller operations which is 2017. more likely to meet U.S. regulatory standards. Tiozzo, B., Mari, S., None Focus groups Focus Groups Quality was linked to freshness and Italy N=45 consumers Ruzza, M., Crovato, assessing food local origin. Most participants S., Ravarotto, L.. risk perceptions identified fresh foods (fruits, N=4 focus groups Consumers' of people who vegetables, meat, fish), eggs, and perceptions of food were food contaminated with chemicals risks: A snapshot of responsible for as risky. Consumers expressed the Italian Triveneto buying food for concern about expired, area. Appetite. 2017. their family. deteriorated or poorly preserved food. Interviewees expressed a 150 preference for Italian foods. Participants gave little attention to organic verses genetically modified food and opinions were varied. People preferred smaller shops or to buy directly from small producers. Large-size fish, farm animals, and fish slices are generally avoided as they are considered the most dangerous. Choice of food largely depended on the amount of time they had at their disposal: having less time meant more frozen foods, for example. Consumers were skeptical of the hygiene of canteens/cafeterias. Television was the most frequently used source of food safety information, followed by magazines. Tonkin, E., Coveney, Adaptive Theory Semi-structured In-depth semi-structured Participants defined quality in Austrailia N=24 consumers J., Meyer, S. B., in-depth interviews terms of risk, better quality Wilson, A. M., interviews products being lower risk. Parents Webb, T.. Managing gathering were the most risk averse. Some uncertainty about information consumers focus on a specific risk food risks - about like a food allergy but are Consumer use of consumers’ otherwise not as concerned with food labelling. main themes of food risk. Participants were Appetite. 2016. shopping generally little concerned with considerations, issues of food spoilage, having use of labelling, confidence in the food system comparison of managing them. Food labelling was labelled and seen as a symbol of the food 151 unlabelled system having managed traditional products, and risks and a tool for consumers to trust in the food manage perceived risk. system. Tonkin, E., Wilson, None Food incident Qualitative public Public opinion was consistent with Austrailia N=15 Austratilian A. M., Coveney, J., scenarios were deliberation study the best practice model for food adults Meyer, S. B., presented to system actors to use in the event of Henderson, J., participants and a food incident and to assist in McCullum, D., discussion and rebuilding trust of consumers. Webb, T., Ward, P. debate ensued, Some suggestions made for food R.. Consumers in order to actors to maintain consumer trust respond to a model assess the after an incident include: openness for (re)building strategies that and transparency, providing consumer trust in participants statements from local health the food system. suggest food governing bodies, testing, having Food Control. 2019. actors use to independent oversight, and address the providing information to issue. consumers. Wills, W. J., Meah, Grounded Theory Multiple Kitchen tour and mapping Household kitchens were used for England N=20 households A., Dickinson, A. M., qualitative exercise; photography a range of non-food related Short, F.. 'I don't methods were and photo-elicitation; activities and food work extends think I ever had food implemented to observation and video- beyond the boundaries of the poisoning'. A investigate and observation; informal kitchen. The youngest children, practice-based interpret interviews; diaries and oldest adults and pets, all had approach to domestic scrapbooks. agency in the kitchen. Households understanding kitchen derived logics and principles about foodborne disease practices to food safety in terms of rules of that originates in the provide insight thumb about “how things are home. Appetite. about how the done” including using senses and 2015. domestic setting experiential knowledge when might influence judging whether food is safe to eat. food safety. 152 Zhu, H. Y., Jackson, None Semi-structured Semi-structured Consumers expressed worry about China N=142 P., Wang, W. T.. interviews interviews the production and processing consumers Consumer, anxieties assessing safety of food grains. Anxiety is about food grain consumer amplified by social media reports safety in China. Food anxiety related of food scandals, polluted Control. 2017. to food grain ecological environments, food- safety. related chronic disease and cancer, concerns about food system governance and lack of knowledge and ability to identify grain quality. Consumers feel better when identifying grain quality themselves, choosing foreign grains and paying close attention to reports about unsafe food. APPENDIX IV: Consumer Cross-sectional Mixed-Methods Studies Table Author(s), Title, Theory Summary Study Design Results Location Sample Journal, Year Almansour, M., Quant: A self-administered An Food hygiene knowledge was higher N=377 students Sami, W., Al- survey was used to assess observational, among high school compared to (same sample used Rashedy, O. S., knowledge, attitudes and cross-sectional primary students. Attitudes towards in observation) Knowledge Alsaab, R. S., self-reported practices study utilizing a food hygiene were primary school Attitudes Alfayez, A. S., Qual: Direct observation was stratified students compared to intermediate. and Saudi Almarri, N. R.. additionally used to assess random sample Among all students, 88.4% responded Practices Arabia Knowledge, practices of male hands should be washed before eating, (KAP) attitude, and primary, 89% washed hands after eating raw Model practice (KAP) of intermediate meat, 82.7% washed their hands with food hygiene and high school soap after eating, 88.9% said the among schools’ students 153 students' in expiration date should be checked Majmaah city, before purchasing food. Saudi Arabia. J Pak Med Assoc. 2016 Quant: A three section Mixed methods Hierarchical cluster analysis was N=450 Consumers questionnaire designed to with focus conducted using questionnaire assess (1) consumption groups responses and three clusters emerged: preferences (2) buying informing the (1) Mango Lovers (2) Value Seekers (3) preferences (3) mango development Safety Conscious. Mango Lovers Badar, H., attribute preferences of a consumer (34.45%) were motivated exclusively Ariyawardana, A., questionnaire by attributes of the mangos Collins, R.. themselves and not price or safety Capturing attributes. Value seekers (44.44%) Consumer were notable in that they were more Preferences for concerned about the certification Value Chain status of mangos relative to other Improvements in None Pakistan clusters. They also purchased mangos the Mango Industry in greater quantity. Safety Conscious of (21.11%) differed in that they had Pakistan. Internatio higher mean score on health and safety nal Food and items relative to another cluster. They Agribusiness were lighter consumers overall and Management preferred traditional retailors as they Review. 2015. source for mangos Qual: Five focus groups N=5 focus groups conducted with consumers to (Focus group N not Focus group results are not discussed. explore consumer value reported in text) attributes of mango Bigson, K., Quant: A questionnaire was A descriptive, It was observed that the majority of N=600 students Essuman, E. K., used to assess hygiene cross-sectional students did not wash hands with soap N=60 teachers Lotse, C. W.. Food None practices and water source study and running water. Most schools under Ghana N=60 kitchen staff Hygiene Practices combining observation did not have hand washing (same sample used at the Ghana School observational facilities. Hygienic conditions under in observation) 154 Feeding Qual: Observation and data, which food was prepared was reported Programme in Wa unstructured interviews for unstructured as good or fair according to students. and Cape Coast used to assess hygiene interviews and The personal hygiene practices of Cities. J Environ practices and facilities questionnaires kitchen staff were observed to be Public Health. 2020 using a random generally good. More than 50% of sample of pupils had some complaint regarding students, meals served in school (partially teachers and cooked, presence of foreign material, kitchen staff unappealing color, etc. ) Quant: Surveys, Checklists A mixed- Food prepared for immediate N=30 households and microbio assays were methods cross- consumption was found to pose for checklist used to assess risks sectional, minimal health risk. Certain poor observations, Chidziwisano, K., associated with poor hygiene observational hygiene practices were associated with N=80 households Tilley, E., Malolo, practices study with increased risk (non-use of soap, for structured R., Kumwenda, S., microbio assays improper storage temperature). observations, Musaya, J., Morse, Utensils were not found to be a N=323 for T.. Risk Factors primary source of contamination. questionnaire Associated with None Check list and structured observation Malawi N=20 for microbio Feeding Children revealed similar results: that sampling under 2 Years in handwashing did not occur during Rural Malawi-A Qual: Structured critical times, i.e. during food Formative Study. observations were used for preparation. Int J Environ Res additional assessment of Public Health. 2019 practices associated with risk for disease, followed by in- depth interviews Chidziwisano, K., None Quant: Cross-sectional study Mixed- Rates of washing utensils was higher in Masache, N=323 household Slekiene, J., of households with female methods cross- those with adequate water in the Ngowe/N with female Kumwenda, S., caregivers of children ages 6 sectional household. Keeping utensils elevated gabu and caregivers of Mosler, H. J., to 24 months living in rural survey and was higher in those with animals, dish Maseya, children aged 6 to Morse, T. Toward Malawi. Used a survey to observational racks, and who perceived that other Malawi 24 months. complementary assess “factor blocks”: Risk, study people in the village were also 155 food hygiene attitude, normative, ability, elevating their utensils. Hand washing practices among and self-regulation factors. was higher among those with higher child caregivers in literacy, with hand washing facilities, rural Malawi. Am J and with a higher perceived risk of Trop Med Hyg. diarrhea. It was also lower in those who 2019. felt the soap was expensive and that hand washing was time consuming. Qual: Observed three behaviors: Washing utensils with soap, keeping them in an elevated area, and washing hands at appropriate times Dang-Xuan, S., None Quant: Questionnaire Mixed- Slaughterhouse owners knew more Hung Yen N=3 Nguyen-Viet, H., assessing general information methods, cross about pig diseases affecting food safety Province, Slaughterhouse Meeyam, T., Fries, on pig procurement and sectional study and quality than pork sellers and Vietnam owners R., Nguyen-Thanh, slaughtering process. utilizing consumers. However, there were H., Pham-Duc, P., structured considerable misperceptions Lam, S., Grace, D., questionnaires, surrounding zoonotic and foodborne Unger, F.. Food observation disease among them. Safety Perceptions checklist, focus Qual: Focus groups assessing Workers frequently wore boots, but N=25 (10 and Practices group perception of pig diseases, not uniforms or aprons. According to slaughterhouse among Smallholder discussions, food safety, and food safety slaughterhouse workers, there are no workers; 15 pork Pork Value Chain and key practices. specific regulations or standard sellers. Actors in Hung Yen informant operating procedures in the Province, interviews slaughterhouse, but they operate with Vietnam. J Food informal rules, where they learn safe Prot. 2016. handling from more senior workers. Approximately half of the pork sellers transported the carcass or pork to be sold at pork shops by themselves via motorbike. None of the sellers stored 156 pork in cooled cabinets or covered the pork. Most sellers did not use gloves to handle the pork, but they always wore aprons. Sellers used cloths to wipe and clean meat, table or equipment but also used their bare hands to handle pork and equipment. Qual: Interviews assessing: All three public health officers N=24 (N=9 community member’s interviewed stated that their community perceptions of the responsibilities were for “cooked food” members; N=9 advantages and while raw meat was under the consumers; N=3 disadvantages of having veterinary authorities’ responsibilities. veterinary staff; slaughterhouses in the area; Veterinary staff mentioned a gap N=3 public health consumer’s criteria for between existing legislation and staff) selecting pork, perceptions on inspection practices for pork safety pork-bone diseases, and food surrounding transportation, safety; veterinary staff and slaughterhouses, markets, and raw public health staff meat handling and processing. perceptions of their Inspection legislation mainly applied to responsibilities, food safety big or medium slaughterhouses or management and markets, whereas small or private collaborations. butchers were not inspected frequently. Consumers assumed that less safe pork originates from sick or dead pigs and may have a bad smell or have a wet feel when touched. Most consumers knew of at least one pig disease affecting food safety. Community members emphasized some advantages of having slaughterhouses near their homes, such as providing jobs and providing fresh pork nearby. A disadvantage for 157 community members included noise, but all stated that they have become accustomed to the noises associated with the slaughterhouse. Some mentioned smell, water pollutions and the spread of animal diseases as disadvantages of living near a slaughterhouse. Quant.: A combination of Mixed methods Consumer surveys revealed a N=22 market market and consumer surveys with focus preference for fruits, vegetables and surveys assessing the types, quality group results red meat compared to processed snack N=400 Consumer and price of foods at markets; informing foods. Market surveys revealed that surveys Downs, S. M., as well as food preferences of survey fresh, minimally processed foods were Glass, S., Linn, K. K., consumers development available at all markets that were Fanzo, J.. The and study assessed. interface between Qual.: Semi-structured focus locale. Focus groups indicated that range of N=1 Focus group consumers and group to determine available food has increased over time, their food None preference, purchasing and while quality had decreased, Myanmar environment in consumption patterns, and particularly the physical appearance, Myanmar: an beliefs about how food organoleptic quality and taste. Health exploratory mixed- environs have changes was primarily associated with concept methods of food safety, though there was an study. Public Health overall lack of knowledge of what Nutrition. 2019 foods were healthy. Food safety was often associated with adulteration either through chemical preservatives or pesticides. 158 Esfarjani, F., PRECEDE Quant.: The HFSQ was Focus groups The resulting product of the methods is Iran N=96 focus group Hosseini, H., model reviewed by expert panel and and a panel a valid and reliable measure of home participants Mohammadi- then women completed the review board food safety among Iranian women. Nasrabadi, F., questionnaire. Statistical informed HFSQ N= 10 panel Abadi, A., testing demonstrates the development members Roustaee, R., HFSQ was sufficiently as well as cross- Alikhanian, H., developed. sectional N=320 survey Khalafi, M., Kiaee, survey testing participants M. F., Khaksar, R.. of the Development of a instrument. Home Food Safety Questionnaire Qual.: Focus groups with Based on the women and electronic data PRECEDE Model: base review informed the Targeting Iranian development of the Home Women. Journal of Food Safety Questionnaire food (HFSQ). protection. 2016. Evans, E. W., None Quant.: Food related Content Online food-related patient United N=15 patients and Redmond, E. C. An information resources were analysis of information resources failed to Kingdom caregivers assessment of food reviewed to assess the online patient highlight the increased risk of safety information inclusion of food safety information. foodborne infection and an emphasis provision for UK information for In-depth semi- on the importance of food safety for chemotherapy chemotherapy patients. structured patients during chemotherapy patients to reduce Qual.: Interviews were interviews treatment. N=45 food related the risk of conducted with patients and Many patients indicated awareness of information foodborne family caregivers to explore immunosuppression during treatment resources for infection. Public food-related experiences and thought they reported practicing chemotherapy Health. 2017. during chemotherapy caution to reduce the risk of patients treatment. communicable diseases by avoiding crowded spaces, food safety was 159 reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. Franklyn, S., None Quant.: Surveys assessed Cross-sectional More than half of Carnival goers Tobago, N=150 consumers Badrie, N. Vendor Carnival goers’ level of survey; purchased food at Carnival events West Hygienic Practices consumption and purchase of Observational (57.3%). Twenty-five percent Indies and Consumer street food, awareness of check-list; purchased from specific vendors and Perception of Food food safety, self-reported interviews 46% purchased from vendors who Safety during the foodborne illness. displayed food badges. Forty-three Carnival festival on percent of consumers indicated that the island of food was not purchased at Carnival Tobago, West events. Fifty-eight percent of Indies. consumers had seen or read food International safety articles in local newspapers Journal of during the Carnival season. Ninety-six Consumer Studies. percent were aware of the possible 2015. transmission of pathogens, and almost half reported being affected by foodborne illness throughout their lives (49.3%). Younger consumers were more aware of foodborne illness transmission. There were significant associations between education and awareness of hygiene practices and were more likely to report foodborne illness formally. Qual.: Observation of and The majority of vendors were N=50 vendors interviews with Carnival stationary (78%) and acquired more vendors to assess food safety than 5 years of experience (44%). The and hygienic practices. most common food sold was hot dogs. The majority displayed valid food badges (74%), appeared outwardly 160 clean (88%), used aprons (54%), hair Franklyn, S., covering (70%), and had clean Badrie, N. Vendor unpainted nails (98%). Most (78%) Hygienic Practices handled money while serving. Most and Consumer foods were appropriately displayed Perception of Food (92%), stored (86%), and covered Safety during the (90%). The majority of vendors failed to Carnival festival on clean utensils (68%), 48% were unable the island of to access any water, 76% had access to Tobago, West garbage bins, and 82% had access to Indies. nearby toilet facilities. Overall, 14% of International vendors’ overall environment appear Journal of to be visually very clean, 50% appeared Consumer Studies. to be fairly clean, and 36% appeared 2015. (Cont’d) poorly cleaned. Hill, J., McHiza, Z., Socio- (Phase 1) Quant.: Cross- Cross-sectional The results of this portion of the study South N=1047 consumers Puoane, T., Steyn, Ecological sectional survey assessing surveys were published elsewhere and not Africa N. P.. The Model vendors’ operations and food mentioned in this paper. N=831 food development of an items and consumers’ vendors evidence-based purchases and nutrition street food vending knowledge. model within a (Phase 2) Qual.: Interviews In-depth Participants gave the most attention to N=22 government socioecological and focus groups with staff Interviews & legislation, regulations and bylaws officials framework: A guide from the Western Cape Focus Groups which street food vendors should for African Department of Environmental adhere to in order to run a legally countries. PLoS Health and Department of compliant operation. Environmental One. 2019. Economic Development. health and hygiene were of concern to Questions pertained to officials. Consumer and vendor regulations, bylaws, and education were identified as the policies that relate to street greatest challenges affecting the street food vending, certification, food vending operations. business and hygiene 161 requirements, and support Hill, J., McHiza, Z., available for vendors. N=28 food vendors Puoane, T., Steyn, Focus groups All participants agreed to the (Four Focus N. P.. The (Phase 3): Data was relevance, acceptability, and feasibility Groups) development of an integrated from surveys, of including the components of the evidence-based focus groups, and interviews Street Food Vending Model, including street food vending into main themes and nutrition, hygiene, safety, business and model within a components which would operational aspects of street-food socioecological contribute to the vending. framework: A guide development of a street food for African vending model. Focus groups countries. PLoS were conducted among street One. 2019. (Cont’d) food vendors to assess the acceptability and practicalities of the proposed model. Kendall H, Theory of Mixed Guangzhou participants expressed Beijing, N= 850 survey Naughton P, Planned Quant.: A survey explored methods: greater hazard concerns. Food fraud Guangzho respondents Kuznesof S, Raley Behavior factors influencing intention Seven focus resulted in the development risk- u, (n=284 Beijing, M, Dean M, Clark to purchase infant formula, groups were relieving strategies and preference for Chengdu n=283 Guangzhou, B, Stolz H, Home R, scotch whisky, and olive oil conducted to internationally sourced food because China n=283 Chengdu) Chan MY, Zhong Q, from Europe. inform a of a lack of trust in Chinese food. Brereton P, Frewer quantitative LJ. Food fraud and survey with the perceived comparisons integrity of made between European food economically imports into China. developed tier PLoS One. 2018 1 cities (Beijing & Guangzhou) and economically 162 Qual.: Focus groups assessed developing tier Focus group findings: persistent link N = 7 focus groups, perceptions of food fraud 2 cities between food fraud and food safety n = 42 participants including risk to consumer, (Chengdu). with greatest risk concerns about long- trust of food source, and term cumulative impacts on health of Kendall H, strategies to ensure the youth. Consumers acknowledged that Naughton P, integrity of purchased food. cities with most vulnerable populations Kuznesof S, Raley Focus group findings receive the least regulatory attention M, Dean M, Clark informed the development of regarding food fraud and safety. B, Stolz H, Home R, a conceptual model that was Greater confidence was displayed for Chan MY, Zhong Q, tested via structural equation international rather than domestic Brereton P, Frewer modeling using quantitative supply chains. To cope with perceived LJ. Food fraud and survey data. Chinse risks, consumers developed risk the perceived consumers trusted relieving strategies such as seeking integrity of international food sources food from Europe. European food over domestic supply chains. imports into China. Targeted communication is PLoS One. 2018 needed to improve Chinese (Cont’d) trust in domestic food supply chain. Lagerkvist, C. J., None Quant: Survey to assess Survey Results do not appear to have been Nairobi N=40 consumers Okello, J. J., pre/post involvement in documented Karanja, N.. relation to food safety. Consumers' mental model of food safety for fresh Qual: Participants’ Photos taken Participants had positive and negative vegetables in photographs used to assess by participants connotations related to their thoughts Nairobi A field consumers’ mental models in related to food and feelings associated with food experiment using relationship to food safety of safety, safety. Negative thoughts include fear the Zaltman vegetables in traditional Interviews of death or illness from fruits or Metaphor markets in Nairobi. 1.5-2- vegetables because of lack of food Elicitation hour interviews with safety, as well as sadness associated Technique. British participants so that they with food that may not be safe to eat, Food Journal. 2015. could tell stories and thoughts of poverty arise from 163 thinking about food safety. Positive notions of happiness and independence were expressed as the feelings associated with the ability to buy safe vegetables. Many associated safe foods with the ability to work and provide for their family. Lando AM, Bazaco None Quant: Data were derived Data derived Findings suggest that participants are United Focus group N= MC, Chen Y. from the 2016 FDA Food from the 2016 generally aware of the threat PEDs States of n=73 participants Consumers' Use of Safety Survey and focus FDA Food pose in the kitchen, yet do not take America Survey N=4,169 Personal Electronic groups. Safety Survey proper precautions like handwashing Devices in the Cross-sectional to avoid contamination during food Kitchen. J Food survey. preparation. Interventions are needed Prot. 2018 to address this gap between knowledge and practice. Nearly half of those who prepared food used PEDs. Qual: Focus groups Eight focus Findings reveal that consumers groups were acknowledge their PEDs (especially also conducted. cellphones) are likely contaminated, yet do not report taking the appropriate precautions while cooking to protect themselves from contaminants on PEDs. Instead, consumers were more likely to wash their hands after touching cooking ingredients. Levine, K., Yavelak, None Quant: Cross-sectional Cross-sectional Respondents identified the United N=1,041 survey M., Luchansky, J. surveys survey and four appropriate risks associated with States participants B., Porto-Fett, A. C. focus groups photographic scenarios posed in the (focus S., Chapman, B.. used to better survey. However, there was a groups N= 39 focus group Consumer understand significant difference in risk conducted participants 164 Perceptions of the consumer perceptions between photographic in Safety of Ready-to- perceptions of scenarios of actual risky events California) Eat Foods in Retail safe food compared to photographic scenarios of Food Store handling events only perceived to be risky. Settings. J Food practices in Prot. 2017 consumer Qual: Focus groups with settings like Focus group findings confirmed this adults grocery stores. divide between reality of risk and consumer perception of risk. McWilliams, R. M., None Quant: Food inventories and A mixed Lack of food safety knowledge was Iowa, N=725 adults over Hallman, W. K., home kitchen safety audits method, cross- noted: 32% of seniors were unaware of New 60 years old. Senger-Mersich, were used to assess food sectional study, how long perishable food items could Jersey, A., Netterville, L., safety knowledge, behaviors, using direct be left unrefrigerated, and 35% were South Byrd-Bredbenner, environments, and in-home observation in unsure or unaware of how long cooked Carolina, C., Cuite, C. L., food supplies among home- combination meat, fish, eggs, etc. were safe to keep Arkansas, Sastri, N.. Food bound seniors with in the refrigerator. California, Safety Practices of Qual: Direct observation, quantitative Poor kitchen conditions contributed to USA Homebound face-to-face interviews were data collected lack of food safety including vision Seniors Receiving used to assess food safety through use of problems, inadequate Home-Delivered knowledge, behaviors, inventories, freezer/refrigerator temperatures, and Meals. Topics in environments, and in-home checklists cleanliness of kitchen appliances. Clinical Nutrition. food supplies among home- 2017. bound seniors. Mkhungo, M. C., Quant: An observational A mixed The majority (72%) were unaware of N=50 survey Oyedeji, A. B., study using data obtained method, cross- the temperature of their freezers. respondents Ijabadeniyi, O. A.. from structured face-to-face sectional study Improper thawing, packaging and Food safety interviews to assess combining improper handling were all observed as knowledge and knowledge and food safety questionnaire practices with high risk of cross South None microbiological practices combined with data with contamination with meat. Roughly 20% Africa hygiene of microbio sampling. microbio assays of respondents indicated checking households in expiration dates on meat before selected areas of purchase. The most commonly Kwa-Zulu Natal, reported methods for thawing meat 165 South Africa. Ital J was dipping it in tap water (40%) Food Saf. 2018 followed by leaving out on a kitchen surface (28%) Sampling: Microbio sampling Microbio assays revealed presence of N=2,500 samples of raw foods and contact pathogenic agents in both raw food (50 per household) surfaces were used to assess samples, contact surfaces, and utensils. Mumma, J. A. O., Qual/Quant: Structured A qualitative The main findings included observation N=28 mothers, and Cumming, O., observations and in-depth study utilizing of behaviors that are associated with N=29 nonmaternal Simiyu, S., interviews were used to both in-depth food contamination. Namely, hand caregivers Czerniewska, A., assess childcare, food interviews and feeding infants as well as storing food Aseyo, R. E., preparation and feeding direct for extended periods of time. Food Muganda, D. N., practices observation prepared by mothers in the morning Davis, E., Baker, K. was often fed to infants by other K., Dreibelbis, R.. caregiver later in the day after Infant Food reheating but was never observed None Kenya Hygiene and being reheated to boiling point. Childcare Practices in Context: Findings from an urban information settlement in Kenya. Am J Trop Med Hyg. 2020 Ng, H. M., Vu, H. None Quant.: Additional semi- A descriptive, Safe vegetables were found to N=250 surveys with Q., Liu, R., structured questionnaires cross-sectional encompass only 10-15% of produce in consumers Moritaka, M., were used to assess study modern retailers compared to Fukuda, S.. consumer trust and combining conventional vegetables. Low price Vietnam Challenges for the purchasing behavior relative primary data was revealed as a problem facing safe Development of to safe vegetables collected vegetable farmers. Confusion resulting Safe Vegetables in through in- from mixed messages about food Vietnam: An Insight depth poisoning incidents reported in mass 166 into the Supply interviews and media was implicated in creating Chains in Hanoi semi- distrust and worry about vegetable City. Journal of the structured safety. Faculty of questionnaires Agriculture Kyushu University. 2019. Qual.: Qualitative in-depth N=44 in-depth interviews were conducted interviews with with Vietnamese agricultural Survey results indicated that only 20% local government, stakeholders to assess “safe of consumers who know about safe managers, vegetable” production vegetables purchase them regularly. distributors, farmers and consumers Quant: A face-to-face, open Mixed methods Findings revealed that fast food N=419 fast food ended questionnaire was design with consumers were concerned with food consumer administered to fast food emergent safety hazards in the form of pesticide questionnaires patrons themes from residue on vegetables, excessive use of Omari, R., focus groups artificial flavoring, bacterial Frempong, G.. Qual: Three focus groups used to contaminants, contamination N=3 focus groups of Food safety were used to evaluate develop a transferring from plastics, and 12 participants concerns of fast- consumer opinions on food consumer unhygienic conditions where food is each None food consumers in safety issues. Themes were Ghana questionnaire sold and prepared. Concern was also urban subsequently used to develop administered expressed for specific diseases such as Ghana. Appetite. 2 an open-ended questionnaire to a non- cholera, typhoid, zoonotic influenzas 016 probability and typical food-borne diseases. Male sample of fast- respondents indicated more concern food about general food safety and younger consumers participants expressed greater concern about typhoid exposures. Ravarotto, L., None Quant.: Cross-sectional Cross-sectional One hundred, twenty-three students Italy N=123 university Crovato, S., survey assessing eating habits survey who had lived outside of their family students studying Mantovani, C., and perception of administered home for at least six months conducted agrarian and D'Este, F., Pinto, A., microbiological risk via face-to-face a survey. Most (97.6%) reported veterinary science Mascarello, G.. cooking at least three times per week 167 Reducing interviews and and a majority (75.4%) cooked every microbiological risk focus group day. Of students who shopped for in the kitchen: groceries, 75% always or often read the piloting consensus label when purchasing an item for the conference first time. Less consideration was given methodology as a to storage instructions than to best- communication before date and origin. On a scale from strategy. Journal of 1-10, the average judgement of the Risk Research. possibility of contracting a food borne 2016. infection was 4.5. The majority (67%) believed there was a higher probability of contracting foodborne infection from food served in a public eating place than from food prepared at Ravarotto, L., home. Crovato, S., Quant: Survey assessing Three conferences were held in which N=34 university Mantovani, C., satisfaction and usefulness of first students discussed and debated students D'Este, F., Pinto, A., food safety conference with one another about food safety. Mascarello, G.. among university students. They then interacted with experts Reducing based upon the previous conversation microbiological risk with their peers. The discussion in the kitchen: between students and experts led to piloting consensus the production of food safety conference guidelines. Two weeks after the methodology as a conference, students filled out an communication online questionnaire on satisfaction. strategy. Journal of Overall, students found the conference Risk Research. interesting (mean score=8.24/10), 2016. (Cont’d) Ninety-seven percent of students found the conference very or quite useful. Most (70.6%) found that the conversation with experts was the most engaging part of the conference. 168 Ravarotto, L., Qual.: Focus group assessing Generally, two specific practices were N=8 university Crovato, S., behavior in the kitchen and not considered to be a potential source students studying Mantovani, C., microbiological risk of risk for young people: thawing meat agrarian and D'Este, F., Pinto, A., associated with meat. and its storage after cooking. Checking veterinary science Mascarello, G.. times and temperatures during Reducing cooking was deemed to be a waste of microbiological risk time. in the kitchen: piloting consensus conference methodology as a communication strategy. Journal of Risk Research. 2016. (Cont’d) Samapundo, S., None Quant: Cross-sectional survey Mixed method Vendors had significantly higher food Haiti N=240 (N=160 Climat, R., Xhareri, assessing food safety study: cross- safety knowledge scores than consumers; N=80 R., Devlieghere, F. knowledge and attitudes of sectional consumers, but the majority of people vendors) Food safety street food vendors and survey; in both groups had average food safety knowledge, consumers. observational knowledge. Vendors who self-reported attitudes and checklist that they had received some training in practices of street food safety had a significantly higher food vendors and level of food safety knowledge and consumer in Port- attitudes than untrained vendors. au-Prince, Haiti. Consumers had average food safety Food Control. 2015. attitudes, and those with less education had higher scores than those with higher levels of education. There were significant differences based on location, with those in Delmas and Port-au-Prince having higher scores than consumers from Petion-ville. Ninety-five percent of vendors had at 169 Samapundo, S., least an average food safety attitude Climat, R., Xhareri, score and had significantly higher food R., Devlieghere, F. safety attitude scores compared with Food safety consumers. The majority of consumers knowledge, and vendors (89.4-100%) did not know attitudes and that Hepatitis A, Salmonella, and S. practices of street aureus were foodborne pathogens. food vendors and The majority of vendors and consumer in Port- consumers did not know the groups of au-Prince, Haiti. people who were most at risk of Food Control. 2015. foodborne diseases and the (Cont’d) importance of reheating food to fight against foodborne diseases. Qual: Food handling In the observational part of the study, N=20 street food observation checklist 60% of vendors had flies or animals vendors assessing food safety around their stall, 65% did not have practices of street food access to potable water. The majority vendors. served food with bare hands and did not wash their hands after handing money. Seventy percent of vendors did not keep pre-cooked food at an appropriate temperature. Sillence, E., Hardy. Staged Quant: Eye tracking of milk Mixed method Introductory text was seen to be a United N=33 consumers C., Medeiros, L. C., Model consumers capturing their study including significant feature of the homepage in Kingdom & LeJeune, J. T. Approach initial attention and first eye tracking of terms of setting out the message, Examining Trust impressions and trust scores milk consumers direction and tone of the website. Factors in Online associated with viewing along with Websites with higher negative first Food Risk different websites. focus groups impressions ratings had low overall Information: The and interviews trust scores. 170 Case of Qual: Participants first looked with milk Messages perceived as more United N=41 consumers Unpasteurized or at websites with different consumers. trustworthy are those presenting a Kingdom, ‘Raw’ Milk. milk safety messages. They balance of risks and benefits, United Appetite. 2016. completed a logbook for each information via a range of clearly States site. Afterwards they engaged accessible, vivid evidence formats, in a guided group discussion which express both the authorship or interview and two weeks credentials of the site and the personal later, a follow-up telephone and social relevance of the materials to interview. the reader. 171 Vlasin-Marty, K., Health Quant: Cross-sectional survey Convergent Participant demographics: Among the USA N = 102 (Native Ritter-Gooder, P., Belief with Native American parallel mixed sample participants (n=102) 55 (54%) American & Albrecht, J. A. Model consumers method design: were unemployed, 55 (54%) lived on consumers) Food Safety Food safety tribal land/reservation, 87 (86%) had a Participants Knowledge, knowledge secondary education. For some recruited via survey Attitudes, and survey questions there was a significant pilot test = 38 Behaviors of Native administered difference between those living on or Participants American Families prior to 8 focus off the reservation. The average score recruited via focus with Young groups on the knowledge survey was 62.2 %. group = 66 Children: A Mixed discussions 85 % (n=87) knew how to wash fresh Females = 83 Methods Study. using a focus fruits and vegetables. Seventy-seven Males = 19 Journal of Racial group script. percent knew how to correctly wash and Ethnic Health hands after changing a diaper. Twenty- Disparities. 2016. four percent knew how to clean kitchen counters before preparing food and 51% (n=52) knew how to properly wash their hands. Eighty-six percent knew the harmful effects of E. coli to children kidneys, and 89% knew raw eggs can cause food poisoning for vulnerable populations. The following four themes were Qual: Focus groups with male discovered in the focus groups: food and female Native American can make one sick, I am not in control consumers. when others handle food, I know how to safely prepare foods for my family, and I do not have time or best equipment for food safety. 172 Wertheim-Heck, S. Social Quant: Data derived from Multi-year Census surveys on food retailing Vietnam N = 1,426 C.O. & Raneri, J. E. Practice census and household cross- proved that there are more informal A Cross-disciplinary Theory practice surveys over two disciplinary markets (wet-markets and street retail 2017 Census: N = Mixed-Method years. nutrition and outlets) than supermarkets. Ninety 563 Approach to social practices percent of households still preferred to Understand How study to shop at informal markets. The 24-h 2017 Household Food Retail understand dietary recall showed no significant Practice Survey: N = Environment how food retail difference in dietary quality across the 400 Transformations environment different strata and diet quality was Influence Food transformation minimal. The quantitative knowledge 2017 Household Choice and Intake s (food and attitudes survey proved that Nutrition Survey: N Among the Urban supermarkets) consumers have a basic understanding = 347 Poor: Experiences influence food of nutritional concepts. Interviews from Vietnam. choice and indicated many consumers know the 2017 Sub-sample Appetite. 2019. intake among importance of consuming fresh and Repeat: n = 60 the urban poor safe vegetables. who rely 2018 Shopping heavily on Trips: N =14 traditional The variety of fresh fruits and fresh food vegetables was similar in both 2018 Multi- Qual: Shopping trip vending supermarkets and informal markets. generation observation and interviews. structures like However, supermarkets offered a Household Study: N markets and variety of processed foods and wet =14 street vendors. markets lacked visual food safety Balanced claims and certificates. Also, 2018 Multi- sequential convenience retail channels accounts generation quantitative- for 67% of all food outlets. Produce in household qualitative modern chain-stores offered 62% fresh interviews: N = 28 mixed-method vegetables and mom-and-pop stores design. offered only 2%. 173 APPENDIX V: Consumer Studies by Type and Country COUNTRY Surveys Qual Mixed Methods TOTAL ASIA Jordon 2 2 Saudi Arabia 2 1 3 Malaysia 5 5 China 7 2 1 10 Vietnam 4 3 7 Turkey 5 5 Iran 3 1 1 5 Indonesia 2 2 India 2 2 Israel 1 1 Korea 1 1 Singapore 1 1 Thailand 1 1 Palestine 1 1 Lebanon 1 1 Nepal 2 2 Taiwan 1 1 Bangladesh 2 2 Pakistan 1 1 Myanmar 1 1 AFRICA Nigeria 3 3 South Africa 5 1 2 8 Ethiopia 1 1 Sudan 1 1 Ghana 1 2 3 Zambia 1 1 Malawi 2 2 Nairobi 1 1 Kenya 1 1 EUROPE United Kingdom 3 1 1 5 Italy 2 2 1 5 Ireland 1 1 Russia/Germany 1 1 Germany 1 1 Greece 1 1 Scotland 1 1 Switzerland 2 2 Belgium/Romania 1 1 Slovenia 1 1 Bulgaria 1 1 Hungary 1 1 NORTH AMERICA Canada 4 1 5 United States 6 1 4 11 174 Mexico 1 1 Barbados 1 1 Haiti 1 1 SOUTH AMERICA Tobago, West Indies 1 1 Brazil 4 3 7 AUSTRALIA Australia 3 2 5 MULTI CONTINENT Asia/Africa 1 1 Europe/Asia 1 1 Europe/North America 1 1 APPENDIX VI: List of Consumer Studies by Study Objective and Focus SURVEYS (n=84) Study Objective Study Focus Citation Perceptions of food safety • Fura and nunu food products in 1. Alimi et al. 2016 17.9% Nigeria 2. Baptista et al. 2020 • Seafood consumption 3. Chamhuri et al. 2015 • Food safety cues used when 4. Dang et al. 2018 purchasing food 5. Fagnani et al. 2019 • Online food products 6. Hartmann et al. 2018 • Milk 7. Henke et al. 2020 • Food additives and 8. Mascarello et al. 2015 contaminants 9. Maughan et al. 20?? • Campylobacter, Salmonella, 10. My et al. 2017 Toxoplasmosis 11. Niyaz and Demirbas, • Qualities important to assess 2018 food quality 12. Petrescu et al. 2020 Food additives and 13. Qekwana et al 2017 • contaminants and traits of food 14. Suth et al., 2018’ safety 15. Wang et al. 2019 16. Evans and Redmond, • Food safety of rice and 2019 vegetables • Food safety of fresh fruits and vegetables • Perceptions of food quality and relationship to safety • Slaughtering of goats • Risk perception and risk avoidance of foodborne disease • Risk perception of foodborne disease General food safety KABB • Chicken prep and raw chicken 1. Allan et al. 2018 (adults) (23.8%) labels 2. Alsayeqh et al. 2015 • Shopping and storage behavior 3. Demircan et cl. 2018 and knowledge 4. Freivogel et al, 2020 175 • Awareness of food safety and 5. Godinez-Oviedo et al. factors deemed important 2019 • Factors related to food 6. Henley et al. 2015 handling behaviors 7. Ishwar et al. 2018 • Food safety KABB and self- 8. Issa et al. 2015 perception of salmonella 9. Katiyo et aol. 2019 exposure 10. Kosa et al. 2015 • Poultry handling, purchasing of 11. Milazzo et al. 2017 minorities 12. Mullan et al. 2015 • Purchasing behavior related to 13. Odeyemi et al. 2019 food safety 14. Pang et al. 2015 General food safety KABB • Personal hygiene in refugee 15. Ruby et al., 2019 (adults) (23.8%) (Cont’d) camp 16. Ruby et al. 2019(b) • Raw Chicken handling and 17. Sternisa et al. 2018 knowledge 18. Tabrizi et al. 2017 • Raw chicken handling and 19. Tomaszewska et al. knowledge 2018 Food safety KABB 20. Traversa et al. 2015 • • Food safety behaviors • Food safety KABB • Food safety KABB • Food safety KABB at home • Food safety KABB at home • Food safety KABB poultry purchasing, transport • Knowledge and behavior • Food poisoning knowledge and food preparation • Knowledge of foodborne risks during pregnancy General food safety KABB • Knowledge and food hygiene 1. Aluh et al. 2019 (children/adolescents/teens) practice, secondary schools 2. Cheng et al. 2017 7.1% • KABB food safety 3. Low et al. 2016 • KABB of food safety 4. Majowicz et al. 2016 • KABB food safety in high school 5. Mirzaei et al. 2018 students 6. Tutu et al. 2020 • Food safety KABB in males • Food safety KABB General food safety KABB • General knowledge of 1. Al-Sheyab et al. 2015 (university students or young foodborne illness and 2. Alzoubi et al. 2015 adults) 15.5% transmission; behavior 3. Courtney et al. 2016 • Eating behavior, food safety 4. Cain et al. 2018 knowledge, behavior 5. Green and Knechtges, • Food safety KABB 2015 • Handwashing frequency 6. Iqbal et al. 2019 • Food safety KABB 7. Luo et al. 2019 • Knowledge of food safety 8. Muhammad et al. 2018 • Food safety KABB 9. Obande and Young, 2020 • Food safety knowledge in 10. Sanlier and Baser, 2020 nutrition majors 11. Sanlier et al. 2018 176 • Food storage knowledge 12. Stratev et al., 2017 • Food safety KABB in young 13. Syahira et al. 2019 women • Food safety KABB in young consumers • Food safety KABB in vet students • Food safety KABB General food safety KABB • Food safety KABB with ready to 1. Evans and Redmond, (older adults) 2.4% eat food products 2016 • Food safety 2. Thaivalappil et al. 2019 General Food Safety KABB • Food safety KABB Cancer 1. Evans and Redmond, (special populations) 2.4% patients on chemo 2018 • Food safety risk perception, 2. Paden et al. 2019 attitudes, behaviors in cancer patients Consumer food safety KABB • Food safety knowledge, 1. Asiegbu et al. 2016 in connection to street microbial hazard awareness 2. Auad et la. 2019 vendors/markets/restaurants • Food safety perceptions and 3. de Andrade et al. 2019 11.9% preferences of street food 4. Gupta et a l. 2018 • Risk perception and knowledge 5. Hull-Jackson et al. 2018 food handlers and consumers 6. Ma et al. 2019 in restaurants 7. Marumo and Mabuza, • Perceptions of street food 2018 safety 8. Nguyen et al. 2018 • Tourist perceptions of food 9. Samapundo et al., 2016 safety in ports 10. Zhou et al. 2019 • Food safety KABB in consumers, street vendors • Perceptions of informal food markets and factors that influence purchasing and food safety • Customer KABB about food facilities • Customer and vendor KABB • Chicken customer, farmer and vendor knowledge about avian flu virus Mothers/Caregivers food • Knowledge of food storage and 1. Ayaz et al. 2018 safety KABB 9.5% handling; personal hygiene and 2. Dagne et al. 2019 food poisoning risks 3. Esfarjani et al. 2019 • Food safety knowledge and 4. Kang et al. 2015 attitudes 5. Opara et al. 2017 • Food safety practices at home 6. Phillips et la. 2015 • Food handling practices in 7. Sithole et al., 2020 parents 8. Zyoud et al. 2019 • Hand washing practices • Hand washing practices 177 • Knowledge and practice related to disease and cooking • Food safety KABB Food safety information • Perceptions of food labels and 1. Bou-Mitri et al. 2020 sources and perceptions packing; relationship to beliefs 2. Bouranta et al. 2019 8.3% about food safety 3. Han et al. 2018 • Perceived food safety and 4. Hanson et al. 2015 customer loyalty 5. Nan et al. 2017 • Relationship between sources 6. Senkham et al. 2015 of information on food safety 7. Zhang et al. 2019 perceptions • Sources of information and food safety handling at tailgates • Information sources on food safety and relationship to demographics • KABB to media campaign • Food safety evaluation and association with Internet use QUALITATIVE STUDIES (n=22) Study Objective Study Focus Citation Expert opinion on food • Develop food safety hygiene 1. Araujo et al. 2018 safety for consumers 9.1% checklist 2. Diplock et al. 2019 • Areas of food safety education important to learn in school General food safety KABB • Understanding of food borne 1. Behrens et al. 2015 (adults) 9.1% diseases and self-involvement 2. Wills et al. 2015 in food chain • Domestic kitchen interpretation through diaries to assess food safety KABB Perceptions of food safety • Definitions of food safety and 1. Chavez et al. 2016 50% perceptions of mold/fungus 2. Crovato et al. 2019 infestations 3. Dastile et al. 2017 • Consumer perceptions of risk of 4. Dolgopolva et al. 2015 purchasing and consuming 5. Elsey et al. 2016 bivalve meat 6. Kendall et al. 2019 • Perceptions of meat safety 7. Passos et al. 2017 • Perceptions of trust in food 8. Telligman et al. 2017 sources 9. Tiozzo et al. 2017 • Perceptions of health risks 10. Tonkin et al. 2019 related to kitchens 11. Zhu et al. 2017 • Perceptions of mistrust in food and strategies used to identify and cope • KABB of consumers of a street market on what “healthy eating” means 178 • Perceptions of safety of local beef • Food risk perceptions in food purchasers • Food incident scenarios and consumer opinion on risk and response • Perceptions of grain safety Food safety information • Perceptions of trust for food 1. Chiu and Yu, 2019 sources and perceptions safety and purchasing decisions 2. Devaney 2016 13.6% in women 3. Tonkin et al. 2016 • Perceptions of good food governance • Use of information sources to make purchasing decisions about food safety and trust of the food system Consumer food safety KABB • Barriers to health information 1. Haque et al. 2020 in connection to street and knowledge in customers 2. Songe et al. 2016 vendors/markets/restaurants and street vendors 9.1% • Feelings related to presence of flies in fish market in consumers and traders Mothers/Caregivers food • Behaviors and knowledge of 1. Hosseini et al. 2015 safety KABB 9.1% prevention of cross 2. Nizame et al. 2016 contamination in home kitchens • Caregiver hygiene practices MIXED-METHODS (n=25) Study Objective Study Focus Citation General food safety KABB • Personal electronic devices in 1. Lando et al. 2018 (adults) 4% kitchen General food safety KABB • Food safety KABB among male 1. Almansour et al. 2016 (children/adolescents/teens) school students 2. Bigson et al. 2020 8.0% • Hand washing in students and observation of available facilities in schools Perceptions of food safety • Consumers related to the 1. Badar et al. 2015 8.0% perception of safety of 2. Kendall et al. 2018 mangoes • Perceptions of European products and food safety/food fraud Mothers/Caregivers food • Behaviors in home related to 1. Chidziwisano et al. 2019 safety KABB 24% food safety 2. Chidziwisano et al. 2019 • Behaviors of female caregivers (b) in home related to food safety 3. Esfarjani et al. 2016 • Input on Food safety 4. Mkhungo et al. 2018 questionnaire to assess home 5. Mumma et al. 2020 behavior 6. Vlasin-Marty et al. 2016 179 • Household hygiene and food safety Mothers/Caregivers food • Food safety preparation and safety KABB 24% (Cont’d) child feeding practices • Food safety KABB of food preparer in Native American families Consumer food safety KABB • Safety perceptions and 1. Dang-Xuan et al. 2016 in connection to street practices in pork food chain 2. Downs et al. 2019 vendors/markets/restaurants actors, including consumers 3. Franklyn et al. 2015 40.0% • Perceptions of food quality and 4. Hill et al. 2019 safety of food in markets – 5. Lagerkvist et al. 2015 consumer and market 6. Levine et al. 2017 • KABB of food safety in those 7. Ng et al. 2019 attending Carnival and vendors 8. Omari and Frempong • Consumer food safety and 2016 nutrition knowledge, 9. Samapundo et al. 2015 government officials and food 10. Wertheim-Heck et al. vendors perceptions of 2019 certification etc. • Perceptions of food safety of vegetable in traditional markets. • Perceptions of safe food handling practices in grocery stores • Perceptions to assess consumer trust of vegetables and stakeholder assessment of food chain production • Consumer perceptions of safety of “fast food” in Ghana • Food safety perceptions of consumer and street food vendors; observation of vendors • Food retailing and association with food safety, food choice and behavior Food safety information • Food related information 1. Evans and Redmond, sources and perceptions sources in people on 2017 8.0% chemotherapy 2. Sillence et al. 2016 • Eye tracking of attention and impressions from website use on milk safety General food safety KABB • Home kitchen safety and KABB 1. McWilliams et al. 2017 (older adults) 4.0% in home-bound adults General food safety KABB • Perceptions of food safety, 1. Ravorotto et al. 2016 (university students or young eating habits and adults) 4.0% microbiological risk in vet, ag and university students 180 181 APPENDIX VII: Studies including Consumers and Vendors Citation Location Focus Results Surveys Asiegbu et South Africa Food safety knowledge, Use of street food – most males, less than 35. Used street food for affordability, availability and al. 2016 microbial hazard awareness convenience. 60% award of risk but not deterred. 70% did not know names of common food bacteria related to illness. Auad et la. Brazil Food safety perceptions and Choose street food for taste. Factors affecting choice of truck were food hygiene, vendor 2019 preferences of street food personal hygiene. Those who were younger and without children had highest food safety importance perception scores. de Andrade Brazil Risk perception and Both food handlers and consumers felt foodborne illness was less likely to occur to them et al. 2019 knowledge food handlers compared to their peers. 61.7% of food handlers and 59% of consumers got food safety and consumers in knowledge questions correct. restaurants Gupta et a l. India Perceptions of street food Perceived risk factors of hygiene of vendor/food and health/environment risks were most 2018 safety risks and benefits and important; benefits were convenience and value. Risks better drive intention and to lower risk behavior intention perception, vendors would need to provide food information through menu labeling and according to Theory of address hygiene. Planned Behavior Hull-Jackson Barbados Tourist perceptions of food Tourists generally has positive food perceptions of two major ports (airport and cruise terminal), et al. 2018 safety in ports although more respondents at the airport reported importance of vendor hygiene. Ma et al. China Food safety KABB in Consumers knowledgeable about food safety, but vendors had lower food safety knowledge 2019 consumers, street vendors scores than consumers. Only half of vendors indicated they separate raw food from cooked and only 33% used soap when washing dishes. Marumo South Africa Perceptions of informal Food quality, safety and convenience were main reasons for wanting to use informal vegetable and vegetable food markets and markets. More likely in households with more family members, and when head of household is Mabuza, factors that influence unemployed and has lower education level. 2018 purchasing and food safety Nguyen et Vietnam Customer KABB about food Most respondents had good knowledge of handling of raw and cooked food and proper al. 2018 facilities environment practices when processing food. Perceived hygiene and food safety were most important considerations when eating out. Most had never reported unhygienic food practices because of the belief that it was a waste of time. 182 Samapundo Vietnam Customer and vendor KABB Consumers had greater food safety knowledge than vendors (80% vs. 10%). Age and education et al., 2016 related to better knowledge. Vendors did not have food safety training and most places were unsanitary. Zhou et al. China Chicken customer, farmer Knowledge, attitudes and practice scores were higher for farmers than vendors. Female vendors 2019 and vendor knowledge and those who conducted slaughter was higher. Consumers who bought chicken at least once about avian flu virus a month had better risk awareness compared to those buying more frequently and female consumers were more knowledgeable than males. Qualitative Haque et al. Bangladesh Barriers to health Interviewed and did focus groups with vendors who had and had not had food safety training 2020 information and knowledge and consumers. Looked at KABB related to their social determinants. Findings show need to in customers and street address things like health literacy to address gaps in knowledge and understanding, despite vendors training. Songe et al. Zambia Feelings related to presence Consumers indicated they prefer to buy fish from trader that used chlorinated water to disinfect 2016 of flies in fish market in stalls, although some felt not having any flies would be suspicious, meaning fish had been consumers and traders treated with harmful chemicals. Traders said flies shorten the shelf-life of fish and give impression of it being unhygienic. Mixed-Methods Dang-Xuan Vietnam Safety perceptions and Slaughterhouse owners knew more about pig diseases and food safety than pork sellers and et al. 2016 practices in pork food chain consumers. Observation showed that workers did not wear uniforms or aprons and did not think actors, including consumers there were specific regulations or SOP. Pork transported via motorbike; sellers did not store in cooled cabinets or cover. Gap between existing legislation and practices. Downs et al. Myanmar Perceptions of food quality Health was associated with concept of food safety; perception that adulteration of food either 2019 and safety of food in through chemical preservatives or pesticides made food less safe. markets – consumer and market Franklyn et Tobago, KABB of food safety in those 57% indicated they had bought street food during carnival; 25% only from specific vendors they al. 2015 West Indies attending Carnival and “trusted” and 46% if they displayed a food “badge”. Observation of vendors indicated most vendors were outwardly clean and displayed and stored food appropriately. However most failed to clean utensils and almost half did not have access to running water. Hill et al. South Africa Consumer food safety and Consumers, governmental officials and vendors were included to develop a street food vending 2019 nutrition knowledge, model that would include regulations and bylaws to address hygiene and safety. government officials and 183 food vendors perceptions of certification etc. Lagerkvist Nairobi Perceptions of food safety Consumers were provided cameras to take pictures of things they associated with food safety, et al. 2015 of vegetable in traditional including foods and vendors. Positive emotions were associated with the ability to buy safe markets. vegetables and safe food was associated with the ability to work and provide for the family. Levine et al. United Perceptions of safe food Respondents identified appropriate risks from photographic scenarios, however there was a 2017 States handling practices in grocery significant different in risk perceptions between the scenarios and actual risky events when stores compared. There is a divide between reality of risk and consumer perception of risk. Ng et al. Vietnam Perceptions to assess Only 20% of consumers who knew about safe vegetables purchased them regularly, mostly 2019 consumer trust of because of cost. Vendors said price and confusion in messaging about safety in the media vegetables and stakeholder created distrust in consumers and worry about vegetable safety. assessment of food chain production Omari and Ghana Consumer perceptions of Consumers concerned about food safety hazards in “fast” food from pesticide residue, artificial Frempong safety of “fast food” in flavoring, bacterial contaminants and plastics, as well as hygiene where food is sold. 2016 Ghana Samapundo Haiti Food safety perceptions of Vendors had higher food safety knowledge than consumers and reported some training in food et al. 2015 consumer and street food safety. Consumers in larger urban centers had higher knowledge. However, neither knew that vendors; observation of Hepatitis A, Salmonella and S. aureus were foodborne pathogens. On observation, 60% of vendors vendors had flies or animals around the stall and 65% did not have access to potable water. Most served food with bare hands and did not wash hands after handling money. 70% did not keep pre-cooked food at appropriate temperature. Wertheim- Vietnam Food retailing and More informal markets than supermarkets, although variety of fresh fruits and vegetables were Heck et al. association with food safety, similar. Wet markets lacked visual food safety claims and certificates. 90% of consumers 2019 food choice and behavior preferred to shop at informal markets and most knew the importance of consuming fresh and safe vegetables. Summary of Geographies of consumer-vendor studies: Vietnam – 5 studies; South Africa – 3 studies; Brazil – 2 studies; China – 2 studies. Asia: India 1, Bangladesh 1, Myanmar 1; Africa: Zambia 1, Nairobi 1, Ghana 1; N America: US 1, Haiti 1, Barbados 1; S America: Tobago 184 Appendix VIII: Vendor Studies Summary Table Author(s), Title, Summary Study Design Results Location Sample size Journal, Year Ahmadi S, Maman S, Examined process from hunting to Cross sectional The findings, suggest that the hunting, Benin 8 bush meat Zoumenou R, consumption of bush meat, from sale, and consumption of bush meat sellers Massougbodji A, Cot the perspective of preventive killed by Pb-based ammunition are MGlorennec P and measures. Few sellers common and well-known in this Bodeau-Livinec F acknowledged removing the meat setting. As there is no safe level of Pb (2018 )Hunting, Sale, impacted by lead shot prior to sale. exposure in humans, serious attention and Consumption of of the public health authorities and Bushmeat Killed by researchers are required in this regard. Lead-Based Ammunition in Benin Int. J. Environ. Res. Public Health 2018, 15, 1140 185 Marc K, Philippe S, Examined microbiological quality of Cross sectional Producers and vendors were not Benin 42 fish sellers Eustache H, Boniface smoked T. trachurus sold to following good hygiene practices for Y, Sohounhloue consumers and a survey in 4 major the smoking, storage and sale of T. Dominique S, Abomey-Calavi township markets trachurus. Souaïbou F (2014) to assess the processing and selling Microbiological conditions for T. trachurus. Lack of Quality of Smoked hygienic practices for the smoking, Mackerel (Trachurus storage and sale of T. trachurus. All trachurus), Sold in fish were hot smoked without Abomey-Calavi gutting, drying or salting of the fish. Township Markets, About 95% of the producers Benin. Journal of reported using well water that had Microbiology not been tested for microbiological Research 2014, 4(5): quality. In general, the production 175-179 and sale of fish were done in environments that were not sanitary. Fish were most likely washed with compromised quality water, sold in the open air without packaging, sometimes near piles of garbage and toilets with a large presence of flies around the fish. Thus, 28% of vendors were in an unhealthy environment, 19% used uncleaned equipment, 21% of the vendors were not themselves clean, garbage was present close to 19% of the fish stalls, flies were present at 26% of the fish for sale, and toilets were only available to about 12% of vendors. All vendors were outside with fish left open with no 186 Akoachere JFTK, Examined bacteriological and Cross sectional The majority of the participants did Cameroon 60 vendors Tatsinkou BF and parasitological quality of salad not practice good hygiene thus Nkengfack JM (2018) vegetables, antimicrobial sensitivity increasing the chances of Bacterial and of bacterial isolates, and hygiene contamination. Transportation to the parasitic and preservation practices of market was under unhygienic and contaminants of vendors. Hygiene and vegetable uncontrolled temperature conditions. salad vegetables sold preservation practices of vendors Thus there is an urgent need to in markets in Fako were poor. Hand washing with soap sensitize vendors on good hygiene and Division, Cameroon was practiced by 23.3%. Washing of preservation of vegetables, and the and evaluation of vegetables was practiced by 35.0% public on proper washing and hygiene and amongst which 38.1% used stream sanitization of vegetables prior to handling practices of water. None of the vendors consumption. vendors. Akoachere transported vegetables to the et al. BMC Res Notes market or sold them under (2018) 11:100 controlled temperature conditions. Vegetables were placed on dirty bags during sale. Unsold vegetables were kept in the market (55.0%) or left in the backyard of their houses (45.0%). 187 Sanhoun AR, Traore´ General hygiene was poor. Milk was Cross sectional This study provided the first dairy Cote Producers 30, SG, Gboko KDT, not filtered by producers and production system assessment and D'Ivoire collectors 30 Kirioua J, Kurt F, collectors and was often stored in Sii/SBSEC prevalence determination and milk Otaru N, et al. (2020) inappropriate containers. Hand and for Northern Coˆte d’Ivoire, the main vendors 13 Traditional milk utensil washing was infrequent. A dairy producing area of Cote d’Ivoire. transformation small proportion of vendors heated The dairy production system featured schemes in Cote the milk to boiling temperatures. limited compliance with good d’Ivoire and their However, the heat-treated milk was manufacturing practice and had high impact on the still sold at ambient temperatures bacterial counts. It was a value chain prevalence of (31.5˚C) by the majority of vendors. study and as so much of the milk that Streptococcusbovis Only approximately 1/3 of vendors the vendors receive is poor quality it complex bacteria in sold their milk refrigerated. was worth while characterizing this as dairy products. PLoS Vendors kept the milk raw only on future interventions just targeting ONE 15(5): specific demand by customers. vendor won't likely make milk much e0233132 safer until this is fixed. 188 Kabwang R, Kitwa Examined food safety risk factors Cross sectional Attitude, practices, and lack of food DRC 168 meat M,, Melin P,Daube associated with retail meat sales in safety knowledge in meat handling, Congo vendors G, De Mol P,and Lubumbashi, Congo D.R via improper slaughtering processes, poor Mukeng A. Kaut3Risk interviews and direct observations. environmental and personal hygiene, factors associated There was a poor practices toward inadequate storage of food and lack of with retail meat basic hygiene rules such as hand potable water were identified as major vendors in washing and body hygiene among risk factors which may contribute to Lubumbashi, meat vendors in Lubumbashi. Only various contamination of meat sold at Democratic Republic 32.7% of meat vendors washed retail outlets in Lubumbashi. Local of Congo African their hands after using toilet government, as well as regulatory Journal of Food facilities, 13.6% after the goat authorities, may support informal Science 13(11) pp. slaughter process and 0% after markets by recognizing them as a part 248-260, handling other products such as of the economy. However, they should money and live animals. Only 39% provide regulation and control to of vendors used clean water to ensure food safety of meat vended at clean their vending sites and, 53.3% a retail outlet, and thus reduce the risk their utensils. Besides, 29.7 and toward public health. Local 47% used wastewater to clean their administration should provide primary vending places and utensils, facilities such as adequate vending respectively. Some vendors (19.6%) places where minimal services are performed a dry cleaning of their provided like potable water, energy, vending places with brush; others tile-flooring outlets, coated walls and (26.1%) used cloth to wipe their waste management. Each point of utensils at the end of daily meat sale should be equipped with a activities. Concerning personal basic hygiene appliance containing a hygiene, 61.3% of vendors were refrigerator if possible, with aware of taking a shower before transparent displays to facilitate the they leave home to go for their customer's choice. Storage activities, and 88.7% wore clean warehouses in the market must be clothes. Thirty-nine per cent equipped with refrigerators or freezers (39.9%) were wearing hand jewels to ensure better storage of meats. and watch, and 74.4% were Local authorities should provide carrying their mobile phones. In the conventional goat's slaughterhouses 189 case of diseases, 24.4 and 30.4% and request minimal training in goat were willing to stop their activities slaughtering for those who are if they suffer respectively from involved in this practice. Furthermore, diarrhea or typhoid fever. None had the local government should raise a health certificate, and only 15.4% awareness of the threat of improper were interested in a voluntary practices in meat/food handling and screening of diseases. Gender and set up control measures to oversee type of activity did not reveal any meat vending activities in markets and difference in practices. In the streets. For instance, vendors must be market, meats were directly licensed before they practice their displayed on concrete stalls or business; and they should undergo wooden table, or directly on the medical screening for transmissible floor. Plastic, cardboard, old diseases. Meat vendors should be newspaper or other materials were aware of the role they play in the used as a tablecloth. There were no transmission of foodborne illnesses. scopes to avoid insect or dust Finally, an educational program and during the display. Vendors used food safety training should be knives, metal saw, axe and machete considered for persons dealing with to cut the meat into small pieces meat and street food. The cost/benefit weighing 50 to 120 g. All the of the educational program in good handling processes were achieved hygiene practice during meat/food with bare hands. Sometimes, meats handling is more economical than of different species, fish and dealing with consequences of vegetables were sold by a single foodborne diseases due to lack of vendor without a proper knowledge in food handling. separation. In the market, clean and unused polythene bags were used for packaging. There is no formal abattoir in Lubumbashi dedicated to goat slaughter. In general, goats were slaughtered in 190 Fasanmi OG, Ahmed, Biosecurity compliance level and Cross Sectional This study compared food safety Egypt 80 LBMs SSU, Oladele-Bukola risk factor assessments in 155 LBMs practices in Nigeria and Egypt. Only MO, El-Tahawye AS, was evaluated in Nigeria and Egypt Egypt stats are recorded in the Ahmed R. Elbestawy through the administration of a 68- spreadsheet, and the paper has AR,Fasina FO (2016) item biosecurity checklist, scored captured a lot of information on An evaluation of based on the modifications of practices. LBM operators play a critical biosecurity previous qualitative data, and role in the disruption of transmission compliance levels analyzed for degree of compliance. of H5N1 virus infection through and assessment of Claims of hand disinfection after improved biosecurity and participatory associated risk slaughter were significant risk epidemiology and multidisciplinary factors for highly factors while mandatory routine approach is needed. The use of pathogenic avian disinfection of markets, fencing and participatory epidemiology using influenza H5N1 gates for live bird market and hand multidisciplinary task team is highly infection of live-bird- washing after slaughter were recommended to enable the LBM markets, Nigeria and protective factors for and against operators adopt biosecurity measures. Egypt Acta Tropica the infection of Nigerian and Government legislation should include 16 4321–328 Egyptian LBMs with the HPAI H5N1 bottom-up approach and surveillance virus. Almost all the LBMs complied (active, passive and risk-based) and poorly with most of the variables in sero-monitoring should be a routine the checklist, but pathways to exercise at the LBMs. improved biosecurity in the LBMs existed. Policy and regulation- related biosecurity compliance were poor in all the LBMs in Egypt. Egypt (vs Nigeria) performed significantly better in compliance with control of presence of wild birds, control of presence of pests, less other non-avian animals traded in the market, less wild animals traded in the market, mandatory routine disinfections of the markets 191 Eltholth M, Fornace The aim of this study was to Cross sectional There are many potential sources for Egypt 100 Retailers K, Grace D ,Rushton characterize production, marketing contamination of farmed tilapia with J, Häsler B (2015) and consumption patterns of different pollutants along the Characterisation of farmed tilapia. More than 70% of production chain due to some current production, the retailers did not know if their practices, low level of marketing and fish supplier was licensed or not. A hygiene and lack of monitoring consumption high proportion (62%) check the systems at farms, transporting and patterns of farmed quality of fish before buying by retailing. However, there was high tilapia in the Nile examining the general appearance, awareness of hygiene and safety and Delta of Egypt / Food color, odor, stomach fullness and many good practices along the value Policy 51 131–143 thickness of back muscles. They chain, despite limited awareness of usually transport tilapia in plastic international standards. Public health boxes with ice (87%), without ice may be promoted by creating an (11%) or in water tanks with oxygen awareness of hygienic handling and supply for live fish (2%). Most healthy cooking of tilapia. retailers (79%) clean their crates and other storage equipment on a daily basis. However, only 9% used disinfectants. Most retailers (87%) sold fish directly to consumers. Interviewers’ observations for retailers showed that `50% of retailers had a permanent structure, a source of electricity, access to running water, a concrete floor, separate rubbish bins and clean cloths. More than 50% used plastic storage containers. 192 Abd-Elaleem R, Bakr Evaluation of butchers regarding Cross sectional There is an immediate need for health Egypt 50 butchers WMK, Hazzah WA, their bacterial hand contamination education of butchers about the Nasreldin O(2014) and hygienic practices. Evaluation proper hygienic practices they should Assessment of the of the hygienic practices of the 50 follow personal hygiene butchers revealed that daily hand and the wash was performed by 40 (80%) bacteriological butchers at the beginning of the quality of butchers’ day, where 15 (37.5%) out of those hands in some used soap andwater,16 (40%) used abattoirs in tap water only, while 9 (22%) used Alexandria, Egypt unclean basin water. Paper towels Food Control 41 147- were used by 16 (40%) butchers for 150 hand drying, while 11(27.5%) butchers dried their hands by their clothes and 13 (32.5%) butchers let their hands wet. Regarding protective clothes, 15 butchers (30%) put aprons while 8 butchers (16%) used gloves and gumboots, respectively. It was found that none of butchers cleaned aprons daily, while 12 (24%) butchers cleaned it once/week and 3 (6%) butchers cleaned it twice/week. By inspection of health certificates, out of 50 butchers, 23 (46%) had health certificates of which 9 (39.13%) were valid. 193 Gemeda BA, Amenu Knowledge, attitude, and practice Cross sectional The need for interventions to increase Ethiopia 379 K, Ulf Magnusson U, (KAP) of smallholder livestock knowledge among smallholder farmers smallholder Dohoo I, Hallenberg owners regarding antimicrobial use, to improve the way antimicrobials in livestock GS, Alemayehu G, residue, and resistance in three general and antibiotics in particular owners Desta H and Wieland agro-ecological zones and are used in these settings is confirmed. (households) B (2020) production systems in Ethiopia. In addition, professional involvement, Antimicrobial Use in Around 21.7% of the respondents supervision, and guidance can also Extensive had a tendency of keeping leftover lead to more efficient antimicrobial Smallholder antimicrobials at home, as they use by smallholder livestock owners. Livestock Farming might be useful in the future. Systems in Ethiopia: Regarding practices related to Knowledge, antimicrobial use large proportion Attitudes, and of the respondents reported that Practices of they commonly consumed milk and Livestock Keepers meat from animals that had just Front. Vet. Sci. 7: 55 been treated with antimicrobials, although they assumed it might not be good for human health. The majority of pastoralists reported this practice. Overall, the majority of the respondents (70%) administered antibiotics as advised, but 72.3% of pastoralists administered antibiotics by not following through the full treatment course: “until the animal cured,” “until package empty,” “as long as they can afford,” “one time treatment or continuously over extended period.” All pastoralists self- administered antibiotics to their animals without any laboratory 194 diagnosis. About 98% of pastoralists had good practice with regard to care of expired veterinary drugs, which they either disposed of by burying or returning to the vendor. Indeed, during data collection, 97% of the pastoralist households did not have any expired antimicrobial at hand. Half of the respondents (50%) reported to have an isolation pen for sick animals and 40% indicated that they would allow animals currently receiving treatment to immediately freely graze with other animals without quarantine. Only 9% of the respondents implemented proper practices regarding disposal of dead animals, either through burial or incineration. The majority (97.5%) of the pastoralists and 4% of respondents from each of the highland and lowland mixed crop production systems revealed consumption of dead animals 195 Getaneh Alemu G, Data on sociodemographic Cross sectional Public health sector should create Ethiopia 112 vendors Nega M, Alemu M characteristics of vendors and awareness among farmers, vendors (2020)Parasitic factors associated with and consumers about safe cultivation, Contamination of contamination of fruits and transportation, handling and Fruits and vegetables were collected using a consumption of fruits and vegetables. Vegetables Collected structured questionnaire. About Periodic screening of on-market fruits from Local Markets 200 g of fruit and vegetable and vegetables should be done. of Bahir Dar City, samples were processed for Northwest Ethiopia parasites. Fruits and vegetables Research and sold by vendors having untrimmed Reports in Tropical fingernails, displayed in a bucket Medicine 2020:11 with water and without washing 17–25 were at higher risk of parasitic contamination Alemu G, Mama M, A structured questionnaire was Cross sectional Local public health sector should Ethiopia 347 vegetable and Siraj M (2018) used to capture data about factors establish a system for continuous samples Bacterial associated with parasitic monitoring of contamination of contamination of contamination of vegetables in the vegetables sold at local markets. The vegetables sold in marketing phase. Selected public health sector Arba Minch Town, vegetables were purchased and should also advocate to the Southern Ethiopia. processed for examination of community not to consume vegetables BMC Res Notes 11: parasitic contamination. Vegetables without adequate washing or proper 775 were not washed before display cooking and were displayed on the floor, though these practices were not associated with the increased microbial load. 196 Sahile S, Legesse T, Examined bacteriological quality of Cross sectional Food producers, distributors and Ethiopia 45 vendors and Teshome Z fresh lettuce and tomato and vendors are responsible for ensuring (2019) handling practice of retailers. that their products meet all applicable Bacteriological Vendors pack and store the fruits in food safety requirements protecting Quality Assessment plastic sacks, in baskets usually fruit/vegetable displaying sites from of Fresh Lettuce and made from woven grasses, and in fecal contamination and containers Tomato from Local wooden crates. Almost none of the used for displaying, transportation and Markets of Gondar, respondents used plastic crates. storage facilities are kept clean and Ethiopia. Journal of Regarding the handling practices of dry. Academia and retailers the result of this study Industrial Research showed that all the respondents (JAIR) 8 (1) 1-10 (100%) have prolonged the shelf- life of unsold fruits and vegetables by moistening with water than using refrigeration. Vendors did not wash vegetables before sale or containers used for keeping vegetables. All retailers used a single common balance for weighing different kinds of fruits; this may result in cross contamination. They lacked sanitary practices and personal hygiene was not observed. The displaying area for fruits and vegetables were found to be Unhygienic. Feces of animals like donkeys and humans were observed just around the displaying sites. Swarms of flies were also common. 197 Abayneh M, Tesfaw Assess presence and antimicrobial Cross-sectional Strategies should be planned and Ethiopia 168 minced G, Woldemichael K, susceptibility patterns of ESBLs - implemented to improve the meat and Yohannis M and producing E. coli isolates from knowledge and practice of butchers swab samples Abdissa A(2019) minced meat and environmental about handling and processing of Assessment of swab samples at meat retailer meat. extended-spectrum shops. 80 swab samples taken from βlactamase (ESBLs) – butcher’s hand, knives, chopping producing board and protective clothing. Escherichia coli from Checklist was used to assess minced meat of hygienic status of butcher shops cattle and swab and practices meat handlers. Poor retailer shops in hygienic status of butcher shops Jimma town, and unhygienic practice of meat Southwest Ethiopia handlers were observed. Only BMC Infectious 36.4% of the floors were made of Diseases 19:897 concrete ceramic and only 33% of the floors were free of cracks. 81.8% of the butcher shops had ceiling however only 30.7% of them were properly finished and free of dusts. Only 8% butcher shops had insect and dust proof shelf for meat display and only 19.3% of them were having smooth and easily washable chopping board for cutting of meats. Only 34.1% of butcher shops used clean knives and clean meat hanger. Only 10.2% of them wore clean protective clothing during meat handling. None of the butchers had taken any 198 Amenu K, Wieland B, Assess the hygienic milk Cross Sectional It is important to promote hygienic Ethiopia 40 women Szonyi B and Grace D production, processing and handling practices of milk and closely (2019) Milk handling consumption practices, and engage with local communities to practices and behaviors of Borana pastoralists: improve their understanding of milk consumption milk handling practices, perceptions safety to facilitate change in practices. behavior among of quality and safety of milk, Educating pastoralists on good milk Borana pastoralists including perceived criteria for production practices should be given in southern Ethiopia. good milk, awareness of milk-borne priority. One of the ways to do this Journal of Health, diseases, and perception towards could be by strengthening the Population and milk boiling practices. Unhygienic integration of milk hygiene in research Nutrition 38:6 1-12 conditions in handling milk and milk and development programs as an products, smoking of milk entry point for behavioral change containers (which may help reduce towards the safe handling and microbial growth), there was no consumption of milk and milk attempt by the pastoralists to products. remove dirty matter from the udder before milking. Hand milking was used, and the persons milking the animals were observed not to wash their hands before milking or between milking of different animals in a herd. Lactating animals were housed in kraals full of manure. Borana pastoralists often use traditional containers for milking, storage, or transportation of milk. They had also started using other containers such as plastic jerry cans for milk transport or storage. Both traditional containers and plastic jerry cans are difficult to 199 Alemu G, Mama M, Examined level of bacterial Cross sectional Public health sector should work on Ethiopia 347 vendors Misker D and Haftu contamination and associated safe transportation, handling and D (2018) Parasitic factors among vegetables utilization of contamination prone contamination of marketed. Vegetables were not vegetables as well as continuous vegetables marketed washed before display and were screening of on-market vegetables. in Arba Minch town, displayed on the floor, though southern Ethiopia these practices were not associated BMC Infectious with the increased bacterial Diseases 19:410 contamination 200 Disassa N, Sibhat Examined hygienic practices during Cross sectional Most of the milk supplied to the Ethiopia 178 farmers BMengistu S, Muktar milking, handling, storage, consumer in the town was managed and 202 Y and Belina D transportation, duration of under poor hygienic conditions at vendors (2017) Prevalence transportation, and storage of the ambient temperatures with poor levels and Antimicrobial milk by the stakeholders and their of sanitation in plastic containers. Susceptibility Pattern knowledge regarding diseases Most of the stakeholders were of E. coli O157:H7 associated with milk, in order to managing the raw milk with limited Isolated from assess the associated risks. Well awareness and knowledge on milk Traditionally water used by vendors for cleaning contamination and on the public Marketed Raw Cow purposes and only water was used health impact of milk-borne Milk in and around for washing milk handling pathogens. The sources of E. coli in the Asosa Town, equipment's . Sanitary practices raw cow milk may be from Western Ethiopia were followed sometimes. Some contaminated udders, contaminated Veterinary Medicine vendors used plastic containers to water, poor sanitation practices, International store the milk which was contaminated containers, and milk Volume 2017, Article transported over 5 hours from the handlers themselves. Since the milk is ID 7581531 source of origin. managed at an ambient temperature, high microbial populations can be reached within short period of time. 201 Tegegne HA, Phyo Determined food safety knowledge, Cross-sectional Majority of the meat handlers were Ethiopia 91 meat HWW (2017) Food attitudes, and practices in abattoir illiterate (30.8%) and primary school handlers safety knowledge, and retail meat shops. The food- leaver (52.7%), and no one went attitude and handlers’ safety practices were through any food safety training practices of meat below acceptable level. It was except one meat inspector. Knowledge handler in abattoir found that almost no respondents of food borne pathogens was and retail meat (98.9%) maintained food safety extremely low. Though most of the shops of Jigjiga practices. 69.2% of respondents meat handler have basic Town, Ethiopia. J eat and drink and 65.9% smoke at understanding and good attitude PREV MED HYG; 58: their work place. Almost no (98.9%) about personal hygiene, hand washing E320-E327 meat handlers use gloves during and proper cleaning, they did not meat processing. Most of the translate into strict food hygiene respondents do not use aprons practices. Thus, there is need for (55%), hairnet or cap (62.6%) and continuous education and hands on mask (98.9%) while doing their training for meat handlers that can work. Concerning sanitizer use, enhance good safety practices through 79.1% respondents do not use any better understanding and positive sanitizer to wash utensils such as attitude. knives, hooks cutting boards and the floor surface as well. Most of the handlers (86.6%) did not wash hands after smoking, coughing, and sneezing. 202 Bekele F, Tefera T, Assessed level of parasitic Cross-sectional Effort should be made by the relevant Ethiopia 360 fruits and Biresaw G and contamination of fruits and bodies to reduce the rate of vegetable Yohannes T (2017) vegetables sold and associated contamination of products with samples and Parasitic factors. A pre-tested semi- medically important parasites by 196 vendors contamination of structured questionnaire was used educating the vendors and the raw vegetables and for collecting data on factors community fruits collected from associated with parasitic selected local contamination of fruits and markets in Arba vegetables such as: status of the Minch town, produces [washed before display or Southern not, freshly collected or stayed Ethiopia. . Infectious more than one day, source of water Diseases of Poverty used for washing, educational 6:19 1-7 status of the vendors]. Data on means of display and type of the market were recorded by simple observation. Majority (79.6%) of the products were not washed before display. The analysis revealed that 35%, 48.3%, and 28.6% of the produce washed by pipe water, well water, and river water was contaminated with at least one parasite species, respectively. 203 Kemal J, Sibhat B, Assessed levels and patterns of Cross sectional Salmonella contamination of eggs in Ethiopia 300 egg Menkir S, Beyene D antimicrobial resistance of Haramaya area was low, with an samples and (2016) Prevalence, Salmonella from chicken eggs and overall prevalence of 2.7%. However, 75 farmers assessment, and assess consumers’ raw egg people consumed raw and cracked (egg sellers) antimicrobial consumption and farmers’ handling eggs in the area, indicating a lack of and resistance patterns practices. The questionnaire awareness of zoonosis. The presence consumers of Salmonella administered to farmers and egg of Salmonella contamination in local from raw chicken consumers indicated that 28% of chicken eggs is of public health eggs in Haramaya, the respondents had a concern, as these are the most widely Ethiopia J Infect Dev preference for raw egg available and used egg types. Ctries 2016; consumption, while 72% disliked Therefore, the public should be made 10(11):1230-1235. eating raw eggs. The habit of aware of risks associated with washing eggs before consumption consumption of raw chicken eggs and was also investigated, and the raw eggs cracked during storage and results showed that 90.7% did not transportation. have the habit of washing eggs, and the other 9.3% had this habit only when the eggs become extensively dirty. Egg-keeping practices of respondents showed that 57.3% used open containers such as baskets, cartons, and trays, while 42.7% of the respondents kept eggs together with different cereal crops and coffee 204 Tadele Amentie, Negative vendor practices: Do not Cross sectional Milk handling practices performed Ethiopia 160 milk Mitiku Eshetu, stop milk handling while showing across the supply chain in the study producers, 54 Yoseph Mekasha and disease symptoms, exposed to risk area were unhygienic and therefore milk collectors Ameha Kebede factors while handling milk, use suggested the need for improving and (2016) Milk hands to remove physical hazards hygienic practices. There is an transporters, postharvest handling to remove from milk and do not interesting chart providing 152 vendors practices across the protect milk from being exposed to demographic differences between and 160 supply chain in coughing and sneezing. All traders consumer and vendors. Most of the consumers Eastern Ethiopia. use plastic containers for milk milk producers, informal collectors, Journal of Advanced handling, milk handling and informal traders were illiterate. Veterinary and equipment's were commonly Consumers were approx. 50% less Animal Research 3 washed (though just once) using likely to be illiterate and generally had (2), 112-126. warm water, and sand, however, in a higher level of education (primary most cases they were not properly and/or secondary). Neither consumers protected from risk factors after or milk producers/collectors/vendors washing. Some vendors use water had any kind of food safety training, from non-tap sources, though but consumers rated higher on general majority of them did not treat food safety practices than the other water before use for hygiene groups. purposes. Smoking milk equipment's was common, with minimum protection of milk containers and cups used for milk delivery. Positive vendor practices: Washes hands before starting milk handling, although only cold water was used for hand washing. 205 Tafesse F, Desse G, Assessed microbial quality and Cross sectional Majority of raw meats considered in Ethiopia 33 street Bacha K and safety of street vended raw meats. this study had high microbial load and vendors Alemayehu H(2014) A questionnaire was used to assess in some cases, even pathogens were Microbiological the profile of 33 street vendors. The isolated. Time/temperature abuse quality and safety of sanitary condition of the vending during vending on the street or cross street vended raw environment was poor. The contamination due to improper meat in Jijiga town samples were held in a handling of meat or inappropriate of Somali Regional temperature range of 17.5-27.5°C. vending practices or a combination of State, southeast The sanitary condition of the these factors might contribute to the Ethiopia. African vending environment was poor as it presence of high microbial counts. Journal of was dusty and full of remains of Furthermore, the absence of clean Microbiology slaughtered animals such as bones, potable water and receptacles, and Research. 8 (48) horn, head and other body parts. also the poor sanitary condition of the 3867-74 House flies were also very prevalent vending area revealed inadequacies throughout the vending area and concerning quality and safety of the even on the raw meats displayed meats analyzed in this study. Training for sale by street vendors. It was and inspections are important. also observed that the raw meats Moreover, provision of basic were displayed uncovered for more infrastructures and establishment of than 6 h for sale at ambient code of practice for the sector are also temperature on a table or a carton recommended. which would be used again and again. All food handlers have a basic task to maintain a high degree of personal cleanliness and observe hygienic and safe food handling practices. Only 67% of the vendors had relatively good personal hygiene with respect to cleanness of their cloths and visible body parts. None of raw meat street 206 Gaye M, Iyekowa O, Assessed potential exposure to Cross sectional The following recommendations were Gambia 498 of which Anthony A, Mendy biogenic amines from meat and provided : I) ban imported chicken 447 were M, Ntomchukwu CC, fish. Fish was dried out in the open which stays too long in storage, 2) vendors of Oyelakin O (2020) air, or salted or sold fresh, many educate on food handling practices fish, meat or Asessment of Levels store fish in salt water in scrap and 3) that The food authority of the yoghurt. of Exposure to refrigerators, which can promote country, Food Safety and Quality Biogenic Amines – A the creation of biogenic amines. Agency, establishes a fully equipped Gambia Case Study. Meat is delivered from the laboratory sophisticated enough to African Journal of slaughterhouse and kept for 3-4 conduct proper analysis of biogenic Chemical Education days, with refrigeration and cold amines and by default other hazards. 10 (1) 97-106 water to keep it fresh. vendors complained about erratic electricity. 207 Washabaugh JR, Examined bacterial contamination Cross sectional The potential for milk contamination Gambia 31 milk Olaniyan OF, Seckac of milk and hygienic practices. by pathogenic bacterial species, could vendors and A, Jengc M, Milking buckets were only cleaned have negative effects on consumer 12 herdsmen Bernstein RM (2019) by one herdsman and they did not health. First, there is a dearth of Milk hygiene and use soap to do so. Only 2 reported hygienic measures implemented at any consumption straining milk with a cheesecloth stage of the milk production chain, practices in the before providing to vendors, but with an absence of handwashing or Gambia. Food they did not wash the cheesecloth. regular sanitary measures in place. Control 98: 303–311 All vendors stored milk in plastic Additionally, over 90% of raw cow's buckets. 67% of vendors reported milk samples exceeded the acceptable washing containers, but 32% threshold for concentrations of EB in reported washing with water only. food products. The factors affecting Only three vendors reported milk bacterial quality in this region are refrigerating the milk. Observed dynamic and complex, it is important levels of handwashing was low. to that food quality and safety are evaluated from both a biological and cultural perspective when forming the basis of community-level intervention and management programs. 208 Resnick D, Examined key factors supporting or Cross sectional For the full sample of traders, and Ghana ~12 policy Sivasubramanian B preventing food traders from particularly for inside traders, simply makers and (2020) Negotiating following food safety measures paying taxes is associated with a 1200 informal the Social Contract in reduction in trust. However, across all traders Urban Africa five samples, paying the requisite fees Informal Food to authorities and being able to Traders in Ghanaian identify a benefit in return enhances Cities IFPRI trust in the relevant local government. Discussion Paper 01938 Oduro-Yeboah C, Assessed food safety knowledge Cluster Randomized Good sanitary practices and other Ghana 104 vendors Ackah NB, Akonor and practices of fresh coconut public health and food safety advocacy PT, Amponsah SK, vendors. Positive: Nearly 72% may be adopted to complement the Mboom FP (2020) intimated that they wash their knowledge of vendors. Food safety hands in between servings and knowledge and about 73% wash their paring knives practices among and scoops in between servings or fresh coconut after use. A few vendors had water vendors. Scientific stored in handy buckets or gallons African 8 e00392 at their vending sites. Negative: Polybags used to sell water and fresh coconut are kept together with the raw coconuts. Washing and sanitizing fruits not widely practiced, though nuts were washed with a solution of alum to maintain freshness, prevent discoloration and make them attractive. 209 Antwi-Agyei P, Examined knowledge and Cross sectional In order to reduce health risks, Ghana 80 market Peasey A, Biran A, awareness of wastewater use for interventions that could more directly vendors in Bruce J, Ensink J crop production, its related health impact benefits (especially economic central (2016) Risk risks, and adoption of health benefits) to salespersons and markets Perceptions of protective measures by market consumers of salad crops should be Wastewater Use for salespersons. Health indicators like promoted, rather than relying on Urban Agriculture in clean environment, and how well health promotion and awareness. Accra, Ghana. PLoS produce had been displayed were These interventions could include ONE 11 lower priority for consumers. credit scheme support, and also the (3): e0150603. Domestic consumers of produce award of safety certificates to vendors seemed satisfied with how produce who comply with prescribed risk was displayed, and the general reduction measures including good sanitation at vending sites. hygienic practices at markets. Interventions are likely to be successful if they are implemented in a participatory manner to involve government, at-risk groups and other major stakeholders. 210 Antwi-Agyei P, Microbial assessment of soil, water Cross sectional Use of untreated wastewater poses Ghana Three central Cairncross S, Peasey and vegetables. Market vendors significant risks for produce markets A, Price V, Bruce J, were observed on where and how contamination at the farm level, but its (Makola, Baker K, et al. (2015) they displayed, sold and stored role in influencing consumer risks at Agbobloshie A Farm to Fork Risk their produce, and any methods of markets remains unclear. Salad and Kaneshie) Assessment for the treating produce. In addition, produce was faecally contaminated at for sample Use of Wastewater general sanitation, including refuse, all entry points of the food chain, with collection in Agriculture in open drains, visible feces, street salad being the most (500) and Accra, Ghana. PLoS defecation areas as well as the contaminated. Key risk factors vendors ONE 10(11): presence of flies were observed. identified included farm soil (market) for e0142346. Although 68% of market vendors contamination, use of wastewater for observations reportedly washed their vegetables irrigation, poor food and and interviews (lettuce and carrots) before sales, environmental hygiene, produce observation of vendors 'washing storage time and temperature, and practices at markets showed that operating without a hygiene permit. washed water for produce was used without changing it for an average of 22 minutes, and the washed water was always dirty. At markets, at least 80% of produce were sold within 24 hours, but in some cases could be stored for 48 hours for lettuce, and 84 hours for cabbage before sale. Majority of the vendors had concreted vending sites, displayed produce >1m above the ground using mats, did not expose the product to sunlight, did not cover the product, stored produce >25 degree, stored for an average time of 10 hours before selling. 211 Amponsah-Doku F, Examined bacterial levels (E. coli Cross sectional Wastewater used as refreshing water Ghana 3 market sites Obiri-Danso K, and Enterococci) on market lettuce in markets could be the main including Abaidoo RC, Andoh leaves and refreshing water contributors to lettuce contamination vegetable LA, Drechsel P, and samples, assessed perception of and that education on use of effective sellers, 24 F.Kondrasen (2010) health risks by vegetable sellers at de-contamination or washing methods food vendors Bacterial market sites. Observed use of cane before selling and eating will contamination of baskets, dirty cover clothes and contribute to reducing the risk lettuce and fertilizer sacks as carrying and associated with the consumption of associated risk transporting receptacles for the such contaminated foods. factors at production lettuce and the storage of the sites, markets and produce under tables and on the street food market floor. restaurants in urban and peri-urban Kumasi, Ghana. Scientific Research and Essay. 5 (2), pp. 217-223, Zhang LX, Koroma F, Food hygiene practices were not Cross sectional Not reported Guinea 20 vendors Fofana ML, Barry AO, explicitly investigated in this paper Diallo S, Songbono as it had a food security focus. JL, Stokes-Walters R, Although vendors expressed Klemm RD, positive attitudes to food safety- Nordhagen S, and lack of infrastructure at the markets Winch PJ (2020) and poor waste disposal was a Food Security in hindrance to achieving good Artisanal Mining practices. Communities: An Exploration of Rural Markets in Northern 212 Kiambia S, Ononoa Reduced food safety practices e.g. Cross sectional Information on retail practices, Kenya ~15 Retailers JO, Kang’ethea E, selling raw milk to low income challenges encountered provide (including road Abogea GO, Murungi consumers due to lack of access to indications to decision-makers of side vendors, MK, Muinde P, pasteurization services and potential governance areas that could kiosks etc.) Akokob J, Momanyi consumers demanding low price, help improve efficiency and ~29 public K, Rushton J, Fèvre use of non-food grade plastic and food safety along the dairy value officers (Kenya EM, Alarcon P (2020) containers, some traders cleaning chain. Dairy Board Investigation of the the containers with hot water and officers in governance soap, using preservation methods charge of structure of the like addition of formalin and licensing, city Nairobi dairy value hydrogen peroxide to minimize council chain and its spoilage, adulterate milk through officers, influence on food addition of margarine, water, livestock safety. Preventive antibiotics and flour. production Veterinary Medicine officers (LPOs) 179 (2020) 1-15 and public 105009 health officers (PHOs)) 213 Birgen BJ, Njue LG, Most vendors operate under Cross sectional There is a need to regulate the Kenya 15 vendors, Kaindi DM, Ogutu unhygienic conditions. Microbial informal food processing and and swabs of FO, and Owade results revealed that raw portions marketing channels, besides trainings, the equipment JO(2020) of chicken had the highest infrastructural development, and code and work Determinants of contamination with all the four of practice and inspections which are surfaces and Microbial tested microorganisms. The recommended in order to enhance the chicken Contamination of predictors of E. coli contamination quality and safety standards of street- Street-Vended were the presence of pests and vended chicken products. Chicken Products flies, unclean vending place, Sold in Nairobi vending environment littered with County, Kenya. waste, washing of hands by the International Journal vendor, and lack of appropriate of Food Science. clothing among the vendors. Only Volume 2020, Article 33% of the vending places were ID 2746492, 8 pages sheltered while 60.0% of them were not clean. Lack of clean clothing (60%), lack of appropriate clothing for food preparation (47%), and long nails with visible dirt of some vendors increased chances of cross contamination 214 Kang’ethe EK, Examined food safety issues in dairy Cross sectional Build capacity of value chain actors on: Kenya 28 Industry Muriuki S, Karugia J, and horticulture. High - I) improvements in good agricultural players and Guthiga P and Kirui microbiological hazards due to poor practices at primary production, ii) Experts L(2019) Report on: hygiene practices and unsuitable hygienic handling practices and iii) Prioritization of Food conditions along the commodity regulators on enhanced enforcement Safety Issues in the value chains. of food safety standards. Dairy and Infrastructural (transportation and Horticulture Value cooling facilities) development to Chains, Kenya. ILRI, enhance speedy delivery to markets Nairobi with minimum cross contamination and spoilage. Kang’ethe EK, A questionnaire and literature Cross sectional Create an overarching agency to Kenya Questionnaires Muriuki S, Karugia J, review assessed institutional coordinate the food safety issues, administered Guthiga P and Kirui L arrangements, food legislations and develop food control laboratories to a team of (2019) Scoping Study policies, regulations and standards, (public and private) in rural areas, experts from Report on: National harmonization of national and increase awareness of parasitic CSOs, Food Safety international standards, codes of hazards and pesticide residues. academia and Architecture of the hygienic practice, food control public sector Horticulture Value laboratories, inspection, extension institutions Chain, Kenya. ILRI, and advisory, food safety at primary Nairobi production and processing, and food loss. Poor handling practices, poor grading, and failure to comply with specific limits were observed. 215 Musita CN, Okoth Potatoes take 1-3 days on the Cross sectional Potato consumers in Nairobi may be Kenya 100 potato MW, and Abong market 47% of potatoes are experiencing long term exposure to vendors from GO(2019) exposed to sunlight during Glycoalkalyoid toxins due to buying of 5 markets Postharvest Handling transport, potatoes are left out greening, bruised, or sprouting Practices and overnight. Some traders stored potatoes for home consumption or Perception of Potato potatoes for up to a month. More consuming of potato products such as Safety than half of the potatoes on the French fries from restaurants or among Potato market are exposed to unfavorable roadside vendors who use greening, Traders in Nairobi, temperature and light conditions as bruised, or sprouting potatoes sold to Kenya International seen through the direct exposure of them by the traders to make these Journal of Food the tubers to sunlight. Bruising and potato products. It is important that all Science Volume sprouting are some of the factors potato traders be continuously 2019, Article ID that contribute to increased levels sensitized and educated on the health 2342619 of glycoalkaloids in potatoes; hence effects of glycoalkaloids and proper potatoes that are sprouting or have postharvest handling of potatoes to been bruised should not be prevent continued consumer exposure consumed but only 2% of traders to these toxins. Farmers and threw away such potatoes. The transporters of the tubers to the remaining traders either sold market should also be included in the bruised or sprouting potatoes sensitization activities. In addition, the directly to consumers at a lower Nairobi County Government should price or sold them to restaurants or channel resources towards building other vendors of French fries. permanent stalls that have proper storage places with proper protection against the sun to prevent against direct exposure of potatoes to the sun. 216 Ahmed S, Haklay M Food vendors near waste dumping Cross sectional Food vendors need more food safety Kenya 660 vendors M, Tacoli C, Githiri G, sites inevitably their food are likely training to improve their hygiene Dávila JD, Allen A, to be exposed to poor practices and cover more ground Fèvre EM (2019) environmental conditions, Food towards strategic partnerships with Participatory sold by vendors on stalls located to the Nairobi County government mapping and food‐ main roads is likely to get soiled (formerly City Council) to organize centred justice in and exposed to contaminated frequent clean‐up exercises around informal settlements water and sludge from open drains disposal sites and sewerage lines, and in Nairobi, Kenya. and open sewage. Around a quarter to arrange community awareness Geo: Geography and of the 161 vendors surveyed in the campaigns to designate waste disposal Environment. 1-21 three settlements did not use sheds sites, improved water provision, e00077. to sell their produce. These vendors sanitation and lighting, as well as run additional daily risks to their communal storage and refrigeration health from exposure to heat from facilities. the scorching sun and to heavy rains. Without adequate storage facilities, the food they sell is more likely to suffer from spoilage. spend, Food vendors use water sparingly, which means food quality and food safety are often compromised as washing produce and cooking pans, and even personal hygiene, including hand‐ washing, involve the additional cost of water. 217 Alonsoa S, Muunda Most vendors used at least one way Cross sectional Initiatives aimed at engaging and Kenya ~16 (4 FGDs, E, Ahlberg S, of testing the quality of milk when improving practices of operators in the number of Blackmore E, Grace receiving or sourcing it. The most informal sector could deliver benefits participants D (2018) Beyond being a lactometer (device to in multiple aspects. People operating ranged from 5 food safety: Socio- measure the density of the milk and businesses in the informal sector are to 8 in the economic effects of detect water-adulterated milk). looking for opportunities to improve male groups training informal Most traders reported using at least their business, improve milk quality and from 3 to dairy one preservation method for the and safety and reduce spoilage. So a 7 in the female vendors in Kenya. milk they sell, most common training that supports traders to groups) + 67 Global Food Security method was boiling. Less than half achieve this should have buy-in from vendors 18: 86–92 kept their milk in a refrigerator, and informal operators and provide an none reported adding chemical entry point to work with informal substances such as antibiotics or markets. Trainings that teach good hydrogen peroxide. Most traders hygiene practices and help traders kept their milk in plastic containers. identify and demand good quality milk There were no gender differences can contribute to having safer and in these patterns. higher quality milk in the markets, although sustaining these effects in the long-term will require new approaches to training that reinforce knowledge overtime, and the creation of opportunities for operators to gradually upgrade their practices and facilities, for example through access to credit. Making women-specific adjustments to the trainings and capacity building in general would ensure that women are brought on board, contributing to equity and maximizing health and food security outcomes 218 Carron M, Chang Assessed prevalence of Cross sectional The open nature of both small-scale Kenya 171 farm YM, Momanyi K, Campylobacter spp. in Nairobi's broiler and indigenous chicken premises and Akoko J, Kiiru J, small-scale chicken farms and meat production practices with low 53 retailers Bettridge J, Chaloner retailers, and to identify potential biosecurity, hygiene and informal G, Rushton J, O’Brien risk factors associated with its transactions, likely plays a role in S, Williams N, Fèvre presence in those sites. Chicken compromising food security. While EM, Hasler B (2018) feces were collected using one pair gradual improvement of farm Campylobacter, a of boot socks per farm, and 3 raw biosecurity is recommended, risk zoonotic pathogen chicken meat samples were factors identified suggest that of global purchased per retailer for microbial consumer education and enforcement importance: analysis. A questionnaire-based of basic food safety principles at the Prevalence and risk survey on sanitary, sourcing and retailer end of the food continuum factors in the fast- selling practices was conducted at represent key targets for risk reduction evolving chicken each site for risk factor in informal settings. meat system of identification. Using display Nairobi, Kenya. PLoS material not easy to clean and Negl Trop Dis 12(8): selling defrosted meat was e0006658. associated with increased odds of bacterial contamination. 219 Kang’ethe EK, A detailed questionnaire sought Situation analysis The food control institutional Kenya 15 food safety Muriuki S, Karugia J, information on institutional architecture in Kenya is inadequate for experts in the Guthiga P and Kirui L architecture; policy environment; effective and efficient delivery of food dairy value (2018) Scoping Study hygiene practices; regulations and safety services. The many players chain Report on: National standards; harmonization with charged with the responsibility are Food Safety international standards; inspection; disjointed, uncoordinated and poorly Architecture of the extension and advisory services; governed. It is necessary to put Dairy Value Chain in food control laboratories; causes of mechanisms in place to enhance the Kenya. ILRI, Nairobi. food safety and food loss concerns; institutional and policy environment food safety at primary production for food safety. The institutions and processing; food loss reduction; charged with food safety mandates and the engagement of have legal mandates but lack an stakeholders across the board. The overarching coordination mechanism questionnaire was supplemented and a unified policy framework to with a desk review of literature. The guarantee effectiveness and efficiency food safety issues raised were in discharge of their mandates. The microbial and chemical hazards, sector is served by several food control which were mainly due to failure to laboratories (public and private) which observe hygienic handling are located in large urban centers. practices. Consequently, their services are not easily accessible to smallholder farmers who produce the bulk of the milk serving the domestic market and which may be a foodborne illness risk. 220 Brown LH, Alonso S, Examined awareness and Cross sectional Increase producers’ and vendors’ Kenya 96 dairy Lindahl J, Varnell H, compliance with dairy standards in awareness of regulations, offer them farmers and Hoffman V, and Kenya and investigate the practical training on how to comply, traders Grace D (2018) conditions of milk sold in Kenya by educate consumers on the importance Regulatory sampling dairy products across of milk safety through mass media Compliance in the informal and formal market traders campaigns and outreach by Kenyan Dairy Sector: in Nairobi County. Low compliance community health workers; routine Awareness and to regulations (~70% of those product sampling and strengthen Compliance among involved in selling milk were penalties for non-compliance. Farmers and unaware of at least some Vendors. IFPRI regulations is of concern). Milk PROJECT NOTE | (majority) was stored in plastic DECEMBER 2018 containers, milk was neither refrigerated nor cooled. 221 Nyokabi S, Birner R, Assessed knowledge of zoonoses Cross sectional Participation in livestock value chain Kenya 154 value Bett B, Isuyi L, Grace and adoption of biosecurity activities is dictated by gender. Men chain actors D, Güttler D & measures by livestock and milk participate more in livestock and meat (livestock Lindahl J (2017) value chain actors. Four categories value chain activities, while women traders, milk Informal value chain of biosecurity measures were participate more in the milk value traders, actors’ knowledge investigated: personal, chain activities. However, while few abattoir and perceptions environmental, food safety and men participated in the milk value workers and about zoonotic animal health. Animal blood sample chain, a small number of women were transporters), diseases and analysis for Brucella antibodies. meat traders, butchers or 119 (traders, biosecurity in Kenya Milk and Meat: Low levels of transporters. There was a gendered butchers and and the importance adherence to food safety dimension, evidenced by markedly slaughter for food safety and standards, low adoption and use of different participation in value chains house public health. Trop PPE. Traders did not refrigerate and lower adoption rates and workers) Anim Health Prod meat or milk overnight, despite the knowledge levels among female (2018) 50:509–518 risks of quick spoilage or actors. Cultural and religious practices deterioration of quality in the hot were shown to play an important role and humid study area. Unhygienic in exposure and transmission of handling of containers used for diseases, influencing perceptions and transporting milk and meat boxes, attitudes to risks and adoption of exposing them to dust, flies and biosecurity measures. other sources of contamination. No actors reported sterilizing their containers after or before use, and many reported washing them using soap/detergent powders and untreated water from irrigation canals Meat: Low adoption of biosecurity measures, never undergone mandatory medical checkups required for food handlers (only butchers and slaughterhouse 222 workers reported regularly receiving medical check-ups as a prerequisite for being granted a working certificate/permit). Female actors reported lower rates of annual medical examination and lower adoption rates of use of personal protective equipment’s (PPE), Untreated water was frequently used for cleaning and washing, and water was purchased from vendors who had sourced it from irrigation canals when slaughterhouse water tanks were empty. Meat was hung in the open, without protection from dust or flies. Butchers reported selling meat wrapped in old newspaper and/or wrapped in polythene first then an old newspaper. Animal health biosecurity measures observed by livestock traders included spraying livestock for vector control, isolating livestock at the market, inspecting livestock at the markets, quarantining livestock at the markets and reporting when livestock died at the market. When animals died, the actors reported that they burned the carcass, buried the carcass, reported livestock death immediately to vet and disposed the carcass in the 223 open (for scavengers to eat). Some reported that they used (consumed) the dead animal. Livestock traders reported treating sick animals with veterinary drugs obtained over-the-counter, often without advice from veterinary officers. Some traders and livestock keepers used medicine intended for humans to treat sick animals. In cases where the market committee (managerial group selected by traders) detected sick animals (through visible symptoms), animals were treated by a veterinary officer and the owner was advised to take them back home until the disease was gone. However, there was no strict enforcement of this directive, and therefore, best practices regarding treatment and isolation of sick animals were not observed by all actors. Milk: Traders stored milk in plastic containers. Milk was sold packaged in polythene paper or in recycled plastic bottles which were not properly cleaned or sterilized. Although some vendors kept milk in open containers, it was more commonly kept in closed 224 Ondieki GKOmbui Assessed compositional quality of Cross sectional There is need to Kenya 152 vendors and 207 JN, Obonyo M, milk, antimicrobial residues in milk, routinely test marketed farmers Gura Z, Githuku J, Factors associated with poor milk, intensify public Orinde AB, Gikunju compositional quality of marketed health education JK(2017) raw cow milk among farmers and regarding milking and Antimicrobial vendors. Farmers and vendors were good milk handling residues and using a herbal substance with a local practices, train farmers compositional name “mpingo” which they applied on strict adherence to quality of by smoking the inner side of wooden antimicrobial use and informally milk handling containers, to serve as withdrawal periods and marketed raw cow a milk preservative. impose stiffer penalties milk, Lamu West on those adulterating Sub-County, Kenya, milk. 2015. The Pan African Medical Journal 28 (Supp 1):5 Sverdik, A (2017) Conducted community-led mapping, Cross sectional In addition to holistic Kenya 1,670 vendors Promoting Food focus group discussions (FGDs), and upgrading initiatives, Security, Safe Food surveys of food vendors in informal food vendors may Trading, and settlements. benefit from greater Vendors’ recognition by food Livelihoods in security advocates, Informal informal worker Settlements: organizations, and Lessons from slum-dweller groups. If Nairobi. Urban Zoo vendors are Policy Brief. June incorporated into 2017 broader urban food- system strategies, 225 Kirino Y, Makita K, Assessed aflatoxin contamination Cross sectional It is important to Kenya 350 milk retailers Grace D and status in marketed raw milk and understand processes Lindahl J (2016) associated risk factors in peri-urban which can influence Survey of Informal Nairobi. Structured questionnaires aflatoxin concentration Milk Retailers in were filled in by face-to-face in milk along the value Nairobi, Kenya and interviews with all retailers. Small chain, and could orient Prevalence of portions of milk were purchased governmental Aflatoxin MI in from each respondent and tested for strategies to ensure Marketed Milk. aflatoxin. In the kiosks and grocery supply of safe milk. African Journal of stands, milk was stored at room Even though education Food Agriculture temperature in transparent plastic of the general public Nutrition and jugs of approximately three-to-four- has been impeded by Development 16:3 liter capacity and displayed in front limitations, such as 11022-11038 of the shops so that customers could funding and human recognize it on sale from outside. resources, basic The dairy shops, called “milk bars”, information about kept their milk in refrigerated tanks. aflatoxin and its risk The mobile vendors transported and factors should be sold their milk outdoors in metal or accumulated and plastic containers provided. Additionally, milk retailers may be a subset of the population particularly at risk. The milk consumption by retailers’ households in this study was above 900 ml per person per day, which corresponds to more than 300 liters per year and is 226 McCarron M, A standardized questionnaire was Cross sectional Education on Kenya 380 respondents, 51% Munyu P, Chenga administered to each type of actor. preventive activities, backyard farmers, 24% PY, Manga T, Questionnaires addressed frequency, biosecurity practices, middlemen and 25% Wanjohi C, Moena volume, and geography of trade, as and awareness of avian market traders A, Mounts A, Katz well as biosecurity practices. Of the influenza could be MA(2015) markets visited, only one had an targeted in key Understanding the isolated area used for the slaughter locations in order to poultry trade of live birds. maximize their network in Kenya: effectiveness Implications for in reaching important regional disease players in the poultry prevention and trade network. control, Preventive Education on Veterinary investigation, control, Medicine 120 321– containment and 327 reporting of poultry die-offs could be targeted in those same areas 227 Mutegi C, Wagacha Investigated peanut market Cross sectional Awareness creation at Kenya 1263 vendors M, Kimani J, Otieno characteristics and their association all levels of the peanut G, Wanyama R, Hell with levels of aflatoxin in peanuts. value chain, especially K, Christie ME Data were collected from vendors in for end consumers, in (2012) Incidence of various market outlets using a order to enhance the aflatoxin in peanuts structured questionnaire. Packaging understanding of the (Arachis hypogaea material significantly influenced the benefits of Linnaeus) from amount of aflatoxin in the product, purchasing/consuming markets in with the majority (68%) of peanut low risk products. Western, Nyanza samples that were stored in plastic Recommend regulatory and Nairobi jars having >10 mg/kg of aflatoxin. approaches and Provinces of Kenya Polyvinyl chloride (PVC) and education campaigns. and related market propylene bags were the most traits. Journal of common packaging materials for Stored Products different peanut products. However, Research 52 118- preference for packaging material 127 was dependent on the peanut product. Whereas shelled and podded raw nuts were commonly packaged in propylene bags, PVCwas the preferred material for roasted and fried peanuts, while peanut butter was commonly packaged in plastic jars. There was negligible packaging of peanuts in jute bags. Peanut vendors used five crop protection measures aimed at maintaining quality and managing pests. Sorting was the most common (58%) measure, while drying (20%) and sieving (16%) were also widely practiced. Almost a third of the vendors did not use any measures to 228 maintain quality and avoid pests. The floor of peanut storage structures in the three study regions was either made of mud (60%) or concrete (40%), while a negligible proportion was made from wooden material. The majority of the stores were dusty with no windows for ventilation. Sixteen percent of the structures were infested with insects, with Nairobi being the worst affected. One out of eight stores was characterized by poor lighting and a musty smell. Over 70% of all storage structures were poorly ventilated and dusty. Post-harvest handling practices were insufficient in controlling contamination and in some cases, have worsened contamination levels. 229 Lewis L, Onsongo Maize was wet at the time of Cross sectional Public health efforts to Kenya 65 markets and 243 M, Njapau H, purchase and storing under wet interrupt aflatoxin maize vendors Schurz-Rogers H, conditions exposure during an Luber G, Kieszak S, aflatoxicosis event Nyamongo J, must include both an Backer L, Dahiye assessment of aflatoxin AM, Misore A, contamination within DeCock K, Rubin C, the regional market and the Kenya distribution system and Aflatoxicosis replacement of Investigation Group contaminated market (2005) Aflatoxin products. Therefore to Contamination of effectively prevent Commercial Maize future outbreaks of Products during an aflatoxicosis, Outbreak of Acute establishment of long- Aflatoxicosis in term interventions such Eastern and Central as a comprehensive Kenya food safety program Environmental must be implemented. Health These interventions Perspectives: 113 must target both (12) 1763-7 market vendors and local farmers in order to prevent or minimize future aflatoxicosis outbreaks and reduce long-term exposure to aflatoxins 230 Seeiso TM and Assessed microbiological Cross sectional This study examined Lesotho 44 butchers (some also McCrindle (2009) contamination of meat, and lack of butchers and vendors) of formal and An investigation of meat hygiene inspection. slaughterers, not informal butcheries the quality of meat Observations of informal slaughter vendors per se, but as sold in Lesotho indicated that personal hygiene, the some butchers were JS.Afr.vet.Ass. hygiene of the environment during also vendors it was 80(4): 237–242 slaughter and the dressing of included. The study carcasses, were deficient. Except for found that despite the 4 commercial butcheries linked regulations, the lack of to supermarkets, slaughter men did formal abattoirs in not wear protective clothing or wash Lesotho, means that their hands, as ablution facilities Illegally slaughtered were inadequate and even where carcasses are not being waterborne sewage was available, inspected by trained no hand basins were seen personnel to ensure that the meat offered for sale to the general public is free of diseases and parasites. High microbiological counts found in the study confirm this. Since the closure of the abattoir in 2003 due to financial issues, steps should be taken to investigate cost- effective models or international donors, to make meat inspection a profitable reality. 231 Lazaro J, Kapute F, The aim of this study was to review Cross sectional Three key opportunities Malawi 45 vendors Rochelle, Holm RH national acts and policies and local were identified: (a) (2019)Food safety regulations focused on fresh fish sold Regulatory framework policies and at open‐air markets or by mobile including informal practices in public vendors and to further examine the markets and mobile spaces: The urban water, sanitation, and hygiene vendors; (b) Safe water, water, sanitation, environment that may impact food clean and functional and hygiene safety. Only three of the four toilets, and environment for markets had any water access for handwashing stations fresh fish sold from vendors. Of these, the two markets with soap at every individual vendors with piped water had safe water market; and (c) in Mzuzu, Malawi. whereas the Zolozolo Market was Foodborne disease Food Sci Nutr.7: using a shallow education for vendors. 2986–2994 well which had E. coli levels of 450 cfu/100 ml. All vendors stored water in a container for use throughout the day to sprinkle over the fish with their bare hands to keep them from drying out. Mobile vendors stored water in a 1‐ or 2‐L plastic bottle. Market‐based vendors stored it in a 5‐ to 20‐L metal or plastic bucket. Only two markets (Chibavi Market and Mzuzu Central Market) had working sanitation facilities (pour flush, urinal, or a room containing a flush toilet piped to a septic tank) for customers and vendors, and although both had a handwashing station with water, there was no soap present. One other market, Area 1B, had some sanitation infrastructure, but there 232 was a plumbing blockage at the time of data collection, rendering it nonoperational. Where there were sanitation facilities present, the vendors (8/10) generally reported using them, though this was contrary to our researcher observations of a mean of one person per hour using each sanitation facility. The sanitation facilities were designed for a higher level of use than was observed. The vendors used bicycles and public transport (local minibuses and taxis) to transport fish; in no case was a vehicle dedicated for food transport reported to be used. only three vendors (3/25), all operating at the Mzuzu Central Market, used ice and not necessarily enough to keep all fish at a consistent temperature. No vendors actually monitored the temperature; no thermometers were present or used by vendors. When using ice, vendors reported getting it from a shop within the market area; they did not make their own ice. For the mobile vendors, fish were not covered with block ice, a sunlight barrier, or a dust barrier. 233 Bonfoh B, Wasem Examined milk hygiene and Repeated The number of Mali 3 (one selling milk from A, Traoré AN, Fané contamination sources, including measures containers used in the a traditional farm, one A,Spillmann H, total microflora (TC, milk chain was the semi modern farm and Simbé CF, Enterobacteriaceae, S. aureus, and main source of one from a modern Alfaroukh IO, yeast/moulds). Poor hygiene was contamination. High farm, sampling repeated Nicolet J, Farah Z, observed both at the farm and at the ambient temperatures at three different time Zinsstag J (2003) vendor in terms of lack of coupled with general points). Microbiological handwashing and soap, using lack of refrigeration quality of cows milk unsanitary containers, unsanitary and poor standard of taken at different cloths, mixing milk between multiple hygiene means that the intervals from the containers, lack of refrigeration milk, which often udder to the selling facilities, and use of water from the contains a large point in Bamako well in Bamko which is often number of bacteria, (Mali) Food Control contaminated. In the modern system acidifies on its way to 14 495–500 the bacterial count was actually the market. This was higher, but the milk was boiled so it one of the few studies is assumed safer. however, due to found which had a the unsanitary filters and containers repeated measures it was subjected to it was design, even though recontaminated. the sample size was small. Recommendations are clean municipal water sources at markets, a broad microbiological assessment, the establishment of milk hygiene standard, and information to the producers and consumers about the 234 Nishimwe K, Assessed aflatoxin B1 (AFB1) in Cross sectional All vendors declared Rwanda 228 vendors Wanjuki I, maize, and associated vendor that they are unaware Karangwa C, perceptions. A questionnaire given of aflatoxins and their Darnell R, Harvey J to vendors was used to determine if consequences. These (2016) An initial gender and education level of findings reveal the characterization of vendors, origin of maize and need to both enforce aflatoxin B1 awareness of aflatoxins had any and update existing SPS contamination of significant effect on AFB1 level in relating aflatoxins in maize sold in the collected samples. Rwanda, and for principal retail education programs to markets of Kigali, raise awareness Rwanda. Food amongst stakeholders Control 73 574-580 and their capacity to reduce aflatoxin risk. 235 Stevens A, Kaboré Assessed Salmonella levels in beef, Cross sectional This study primarily Senegal 199 vendors from Y, Perrier-Gros- and vendor characteristics and assesed Salmonella various types of markets Claude practices. Very few vendors were occurrence, with JDMillemann Y, reported to have good personal limited details on Brisabois A, hygiene, none of the vendors in the vendor attitudes and Catteau M, Cavin itinerant markets wore protective practices. It found the JF, Dufour B (2006) equipment. Storage and transport following in the Prevalence and temperatures were not optimal, markets it surveyed 1) antibiotic- likely due to lack of refrigeration. a very high Salmonella resistance of prevalence in retail Salmonella isolated beef; 2) contamination from beef sampled at the slaughterhouse is from the amplified by poor slaughterhouse and hygiene practices and from retailers in secondary Dakar (Senegal) contamination from International resident flora; 3) a high Journal of Food rate of resistance to Microbiology 110: antibiotics but a low 178–186 rate of multiresistance; 5) the emergence of multi-resistant strain of Salmonella in retail beef. This is the very first data about meat contamination by Salmonella in the sub- saharian area. 236 Prinsen G, Assessed knowledge, attitudes and Cross sectional There is awareness of Tanzania 64 operators Benschop J, reported practices of operators of the inspection stamps Cleaveland S, butcheries and eateries with regards as a measure of food Crump JA, French to meat safety in an urban and in a safety. Local authorities NP, Hrynick TA, rural environment. Operators of enforcing policies in a Mariki B, Mmbaga butcheries relied more on official resource-poor context BT, Sharp JP, Swai inspections. Deliberate deception may explore the ES, Thomas KM, (mixing fresh or inspected meat with potential for more Zadoks RN, and old or uninspected) efficient or even Linda Waldman solicited inspections, by (2020) Meat Safety building on the finding in Tanzania’s Value that meat inspections Chain: Experiences, add commercial value, Explanations and particularly meat sold Expectations in in butcheries. Butcheries and Preoccupation of Eateries. Int. J. inspection with visible Environ. Res. Public abnormalities suggest a Health 17, 2833 1- lack of awareness 19 around invisible pathogens originating from healthy animals’ gastrointestinal tracts. Rural operators and urban operators may, quite possibly, respond differently to policy interventions because of their different expectations of the future. 237 Häsler B, Msalya G, The aim of this scoping study in Cross sectional Efforts to upgrading the Tanzania 156 producers and 157 Garzac M, Fornacec Tanzania was to identify dairy value chain in consumers K, Eltholth M, opportunities for nutritional and Tanzania should focus Kurwijila L , food safety benefits from cow milk. on a multi-intervention, Rushton J, Grace D Farmers reported that veterinary multi-sectorial Integrated food medicines were frequently given to approach to promote safety and nutrition cattle, and a majority did not discard food security and food assessments in the milk during or after treatment. Less safety simultaneously. dairy cattle value than half of the producers boiled chain in Tanzania. milk, although sale of fermented Global Food milk, made by spontaneous Security 18: 102– fermentation of raw milk, was 113 common. Cattle management was characterized by low levels of biosecurity, hygienic practices and disease control. Vaccination was used by less than the half of the producers. Almost all respondents hand milked their cows; 11% of respondents did so without cleaning the udder. Cattle was in contact with other animals, there were no footbaths present, no uniform or security shoes were worn by the workers, there was no separate designated area for the storage of milk, the floor in the dairy area was not clean, no training was available for the producers and there were no incentives or punishments for good and bad performance. 238 Nonga HE, Ngowi Assessed physicochemical Cross sectional The physicochemical Tanzania Not reported for HA, Mdegela RH, characteristics and microbial quality characteristics of food vendors Mutakyawa E, of raw milk, fruit juice and fish and vended in Morogoro Nyahinga GB, hygiene of food containers, Municipality were of William R, Mwadini personnel and the vending poor quality. The food MM (2015) Survey environment. Raw milk sold was had high bacterial of physicochemical adulterated with water, Raw fruit contaminations. This characteristics and juice was stored in dirty containers situation poses health microbial and sold under unhygienic risks to the public and contamination in environment. losses to food vendors selected food due to spoilage. locally vended in Stakeholders in food Morogoro value chain should be Municipality, educated on safe Tanzania BMC Res production and good Notes 8: 727 1-10 hygienic practices. Routine quality and safety assessment of locally vended food, inspection of selling premises and regular health checkup of the personnel involved in food vending industry should be instituted. 239 Majalija S, Assessed the milk handling practices, Cross sectional The raw milk Uganda 40 farmers, vendors Tumwine G, Kiguli the bacterial quality and the contaminated with J, Bugeza J, associated health concerns of raw antibiotic drug- Ssemadaali MA, milk along the informal milk value resistant bacterial Kazoora HB, chain. The quality of raw milk was pathogens is of public Muwanguzi EN, affected by poor hygienic, handling health concern. Thus, Nantima N and and transportation practices. Hand measures to improve Tuyiragize R (2020) milking was carried out mainly by the quality of milk need Pastoral men (92.5%), of whom only 7.5% to be designed for the community routinely washed hands before, 25% pastoral community in practices, microbial rarely or never washed hands while Nakasongola district. quality and 42.5% cleaned their hands on the associated health skin of cows. Most milkers (50%) risks of raw milk in used a rod referred to as enkoni to the milk value restrain the calf while milking. Milk chain of was collected from the farm mainly Nakasongola by M2Vs (80%) using motorcycles District, Uganda. (70%) and in plastic cans (75%). The Pastoralism: most frequently used milk adulterant Research, Policy was water (75%); others include flour and Practice 10:3 (cassava), herbs and chemicals. Scores of 11 practices affecting the quality of raw milk were ranked, of which 8 (73%) had scores of 3–5 that indicated poor quality of milk. Cleaning milkers’ hands on the skin of cows and poor hygiene of the milking environment were scored 5, while unhygienic mobile milk- collecting centers and dirty water used to wash milking utensils scored 240 Kirunda H, Examined the influence of socio- Cross sectional Several Uganda 39 live bird markets & Mugimba KK, Erima demographic characteristics of sociodemographic 424 poultry handlers B, Mimbe D, poultry handlers: age, sex, religion, characteristics of bird Byarugaba DK and educational background, level of handlers are predictors Wabwire-Mangen F income, location of residence and for risky practices. This (2014) Predictors region of operation on 20 potential information would be for Risk Factors for risk factors for introduction and very useful in Spread of Avian spread of Avian Influenza in Live Bird development of Influenza Viruses Markets. Never frequently washed strategies for by Poultry Handlers hands, never wore protective prevention and control in Live bird markets clothing, Never disinfected returned of AI disease outbreaks in Uganda. troughs, Shared equipment, Sold in the country. Zoonoses and other livestock species, Stored feed Public Health, in open containers, Feed/water 62:334–343 provided were dirty, Never cleaned troughs and cages, Cages were stacked, Never separated sick birds, Never separated birds by species, Never quarantined new birds, Never kept records, >20 birds in a cage, Allowed buyer <1 meter away. Sex of poultry handlers was not a significant predictor for the risky hygiene and management practices for introduction and spread of AI viruses in LBMs. Despite the absence of significant statistical relationships, there were some variations among handlers of different sex involved in confinement of larger numbers (more than 20) of birds in a single cage, selling of other livestock species alongside poultry and sharing 241 of poultry equipment. While up to 83.4% of the female bird handlers confined more than 20 birds in a single cage, only 57.1% of the male counterparts had this practice. Selling of other livestock species alongside poultry was more in female (57.1%) than male respondents (41.7%). Conversely, 34.6% of the male shared equipment compared to only 14.2% of the female bird handlers. There was no significant scientific correlation between age of poultry handlers and practices that could pose increased risk for introduction and spread of AI viruses in the study LBMs. Among the 20 study risky practices, only the practice of selling other livestock species alongside poultry exhibited substantial variation among respondents of the different age groups. Only 41.4% (167/403) of the adults compared to 61.9% (13/21) of the adolescents with the practice. 242 Siamupa C & Saasa The aims of the study were to Cross sectional Improving biosecurity; Zambia 15 traders (and Farmers, N & Phiri AM identify market value chain-related sensitizing farmers, district veterinary (2018) Contribution factors that were associated with traders, and all officers, veterinary of market value ASF outbreaks and assess why these stakeholders in the pig assistants, police chain to the control outbreaks are becoming frequent value chain on ASF officers, and veterinary of African swine despite control measures being put prevention and control; staff manning veterinary fever in Zambia in place. Only 50% of farmers had reinforcement of staff checkpoints, abattoir Trop Anim Health their animals screened for ASF at checkpoints; and and processing plant Prod 50: 177–185 before sale. Traders used different regulation of pig managers, meat modes of transport depending on its markets are some of inspectors, market availability in the area such as the ways in which chairpersons) bicycles, wheelbarrows, ox carts, and future outbreaks can be vehicles while at times they walked prevented. the pigs to the market. The traders Government should had no knowledge of whether pig create a favorable owners disinfected them or not. The business environment same transport was used to collect with incentives that pigs from more than one household attract private sector or from one farm to another. The investment in the pig purchased pigs were not tested for value chain. Enforcing ASF before movement though some regulations, ensuring farmers got movement permits from quality input supply, the police to show that the animals pork quality assurance, were not stolen but legally theirs. and standards are some of the critical roles that the government should do. Such market environments would provide better incentives and improve pig production 243 Bumbangi NF, Determined the levels of aflatoxins in Cross sectional A market vendor's Zambia No information given on Muma JB, Choongo raw peanuts sold in Lusaka district's awareness through the number of vendors K, Mukanga M, markets as well as identified factors education campaigns interviewed Velu MR, Veldman associated with increased on practices which F, Hatloy A, presence.Vendors used opened reduce the AF Mapatano MA permeable packaging, stored contamination in (2016) Occurrence peanuts after the daily selling under peanuts should be and factors the raised concrete surface or on the conducted. Further, a associated with selling shelves and stored raw human exposure aflatoxin peanut on the market for more than assessment to AFs contamination of 15 days. Although none of these through consumption raw peanuts from practices were associated with the of peanuts need to be Lusaka district's presence of aflatoxin in raw peanuts. carried out in order to markets, Zambia. determine the public Food Control 68: health impact caused 291-296 by AFs to the Zambian population. 244 Songe MM, Assessed fish vendors’ and Cross sectional Findings in this study Zambia 30 consumers and 40 Hang’ombe BM, consumers’ perception of flies that further justify the semi- vendors from two Knight-Jones TJD beset food markets in Zambia, and structured interviews markets and Grace D (2016) interest in interventions to reduce respondents’ concern Antimicrobial their numbers. Identified if flies carry over the poor sanitary Resistant important pathogenic bacteria on conditions and lack of Enteropathogenic their bodies, and subsequently if formal refuse collection Escherichia coli and these bacteria carry resistance genes facilities which would Salmonella spp. in to commonly used antibiotics, which serve as breeding Houseflies Infesting would indicate problems in grounds for disease- Fish in Food eradicating these pathogens. 20 causing organisms in Markets in Zambia consumers in Lusaka and 10 the markets. Also, flies Int. J. Environ. Res. consumers in Mongu said they would are a menace to fish Public Health, 14, prefer to buy fish from a trader that traders, Both fish 21 employed an intervention, such as traders and consumers the use of chlorinated water to would greatly disinfect the fish stalls, which could appreciate an help reduce the number of flies intervention, such as infesting the fish. However Four of the use of nets, against the ten consumers in Mongu (40%) flies at fish stalls as a pointed out that a complete absence practical way of of flies might mean that the trader addressing the had treated their fish with chemicals underlying causes of that reduce flies but could be compromised food harmful to humans and hence an safety. The conflicting absence of flies might be a deterrent. views of consumers that too many flies are a deterrent to purchase- but that no flies may also be a deterrent as it implies overuse of chemicals - 245 Knight-Jones TDJ, Assessed safety of smallholder fresh Cross sectional On-farm milk heating Zambia 9 farmers Hang’ombe MB, cow’s milk by observation and options should also be Songe MM, Sinkala sampling of milk along the value assessed. In this under- Y and Grace D chain from milking to point-of-sale developed setting, (2016) Microbial and storage. Milking was done by options for improving Contamination and hand into a plastic, wooden or metal milk safety are limited. Hygiene of Fresh container and then poured into a However, sustainable Cow’s Milk plastic (three farmers, 33%) or metal methods of milk Produced by (six farmers, 67%) container that pasteurization should Smallholders in could be sealed, mostly through a be investigated as a Western Zambia. muslin cloth or a sieve (8/9 farmers, microbial kill-step is Int. J. Environ. Res. 89%), which was always rinsed needed to mitigate Public Health 2016, between cows. Unlike plastic buckets upstream 13, 737 and containers, metal buckets and contamination. containers were designed for handling milk or food. Although contamination of the pooled herd milk with cattle hair was not seen, some visible dirt contamination was observed for 5/9 (56%) farms. Handwashing at milking was not done, though those who washed hands did not use soap and water was untreated surface water from the wetlands which was also used to rinse milking equipment. The milk was typically transported by bicycle in high ambient temperatures without refrigeration until reaching the point-of-sale (journey times of 30–120 min), where it was sold 246 Farhana Z, Assessed vendor food safety Cross sectional More oversight and Bangladesh 44 food vendors (mix of Sutradhar N, practices: handwashing, covering enforcement and waste street food (32) and fruit Mustafa T, Naser food from dust and flies, level of past disposal from and vegetable vendors MN (2020) Food formal training in food safety, use of 'management' is (12)), 54 consumers on a Safety and soap in cleaning hands/utensils, and needed. There is lack of university campus. Environmental environmental awareness. Also knowledge of food Awareness of investigated consumers attitudes to safety among food Street Food food safety. 86% of vendors handle vendors/handlers. Vendors of the foods with bare hands and 56.82 % Dhaka University vendors wash their hands in clean Campus, water each time before handling of Bangladesh. food. 54% of vendors covered their Bangladesh J. Zool. foods from dust. Most of the vendors 48(1): 171-178 (86.36%) do not cover their utensils. Fifty nine percent vendors clean used utensils with bucket water but without soap. All the food vendors use tap water for preparing food, cleaning utensils and as drinking water. 247 Moyen N, Ahmed Examined poultry vendor practices in Cross sectional Poultry types need to Bangladesh 849 poultry traders, no G, Gupta S, Tenzin relation to zoonotic infectious be discriminated in consumers T, Khan R, Khan T, disease. Vendors were asked about order to understand Debnath N, Yamage their trading practices in the week the way in which M, Pfeiffer DU and preceding the interview: number of poultry trading Fournie G (2017 ) poultry sold to other poultry traders networks are shaped, large-scale study of or consumers, number of poultry and the level of risk of a poultry trading bought, types and locations from disease spread that network in which poultry were sourced. these networks may Bangladesh: Informants were asked about their promote. Knowledge of implications for trading practices in the week the network structure control and preceding the interview: number of could be used to target surveillance of poultry sold to other poultry traders control and surveillance avian influenza or consumers, number of poultry interventions to a small viruses BMC bought, types and locations from number of LBMs Veterinary which poultry were sourced. Research (2018) 14:12 248 Khan MSI, Sayeed Assessed hygiene and sanitation Cross sectional The study provides Bangladesh 91 vendors - mostly A, Akter A, Md practices of vendors, such as socio-demographic street food but some Azharul Islam and handwashing, washing of utensils, status and safety natural food. Sharmin AkterFood storage practices, sources of water practices of street food safety and hygiene used in food preparation, and habits vendors in Barisal city practices of during illness. area. Vendors are not vendors during completely ignorant of chain of street food the basic food hygiene production in practices, but the Barisal city. Food following areas need Safety and Health. attention - like source 1 (1): 57-65. of drinking water, food preparation water, hand washing, reused leftover food, selling during sickness etc. Food-handling training and education, awareness programs, enforcement of government regulations and infrastructure may improve the safety for street foods. 249 Sayeed MA, Assessed avian influenza virus Cross sectional A majority of poultry Bangladesh 290 vendors, 40 markets Smallwood C, Imam presence, and potential risk of study stalls were retail stalls T, Mahmud R, spreading via poor hygiene practices. performing Hasan RB, Hasan Majority of stalls were cleaned 1x slaughtering of poultry M, Anwer SM, day (75%) but 54% only used water supplies by multiple Rashid MH, Hoque not detergent. 86% of markets had a vendors. The vendors MA (2017) supply of water. Not strictly food themselves frequently Assessment of safety, but hygiene practices are had basic levels of hygienic conditions relevant. education (Class I–IX) of live bird markets showing the ability to on avian influenza read Bengali text. Most in Chittagong stalls had unsanitary metro, Bangladesh conditions including Preventive mud floors, lack of Veterinary quarantined space for Medicine 142: 7–15 sick animals, contamination of residential wild birds, use of water only for cleaning, holding unsold birds overnight, and poor waste disposal. The prevalence of Avian influenza virusat LBM and stall level was 40% and 20. It is recommended to increase public awareness through education, supply 250 FAO. 2009. The objective of the study was to Cross sectional Not reported Cambodia 305 poultry meat and Assessment of characterize bird markets and eggs sellers, licensed and poultry markets develop a user-friendly database unlicensed. Most were and sellers in 25 with market characteristics to help licensed. Provinces and government institutions and other Cities of Cambodia. organizations concerned to manage Prepared by Khieu and support of the poultry sectors Borin, Pok Samkol and other subsectors. This is done in and Olaf Thieme. order to assess risks for spread of AHBL - Promoting Avian Flu (H5N1). None of the strategies for licensed sellers were producers, but prevention unlicensed sellers were often and control of producers. Only 7.5 percent sellers HPAI. Rome. separated their animals by species, especially chickens and ducks. Among poultry sellers, 47.1 percent freeze leftover slaughtered birds for the next day. People handling slaughtered poultry did not use or were not instructed to use masks and gloves for protection. These are the people most vulnerable to AI risk because they handle poultry from many sources, which could include sick animals. Consumers trust the inspection certification program for pigs and cattle, but this does not exist for poultry. 251 Kumar A, Ashok K. Assessed adoption of food safety Cross sectional This is a modelling India 684 dairy farmers, many Mishra, Sunil Saroj, measures such as handwashing by study on FSM and dairy marginal or landless, Vinay K. Sonkar, smallholder farmers. Investigated farmers, many of with approximately 1.5 Ganesh Thapa, current practices when it came to whom sell milk directly animals each Pramod K. Joshi milking such as udder, equipment to consumers. There (2020) Food safety and environmental cleaning are associations that measures and food practices. Only 27% of dairy farmers bear exploring but security of wash their hands before milking each must be not completely smallholder dairy dairy animal. Most households use thought of causal. farmers: Empirical normal water alone to wash their Governments, evidence from hands, and only 9.7% use soap, extension agencies, and Bihar, India. disinfectant, or both. About one‐ NGOs should promote Agribusiness 36: sixth of the dairy farmers dry their drivers of milk safety 363–384 hands before milking, a practice that measures, including is expected to reduce the livestock training and transmission of infection. Less than awareness of food 10% of the households dry the udder safety. Any incentives after washing, which reduces the and policy designs that probability of milk contamination increase herd size and and udder or teat infection improve housing (mastitis). In more than 43% of the conditions for animals cases, additives are used to facilitate (i.e., concrete flooring) milking—mostly oil or ghee. Such can positively influence additives are considered a source of the adoption of milk potential contamination and are not safety measures. recommended. Tools were washed only 44% of the time. 252 Samaan G, Assessed bird handling practices in Intervention- Combining Indonesia 34 poultry vendors Hendrawati F, relationship to avuan influenza H5N1 application of infrastructural changes (start) 29 poultry Taylor T, Pitona T, spread. Poultry vendors rejected face the WHO with behavior change vendors (end), 2 live bird Marmansari D, masks and goggles because they guidelines in interventions is critical markets Rahman R, Lokuge made them feel too hot when worn two markets to to guideline K, Kelly PM (2012) during poultry slaughter. The use of introduce implementation. Application of a plastic aprons increased after the infrastructure Participatory approach healthy food intervention. and behavior involving monthly markets guide to change using consultations and two Indonesian participatory educational sessions markets to reduce approaches. can facilitate the transmission of The adoption of safe food- “avian flu” Bull 10 control handling practices and World Health measures sanitation. Market Organ authorities assumed 2012;90:295–300 important leadership roles during the interventions and this helped shift attitudes towards regulation and market maintenance needs. There was significant ongoing monitoring by officials and researchers, and incentives were provided to the vendors by the government in terms of free energy. Involving stakeholders upfront was important. 253 Samaana G, Survey focused on documenting the Cross sectional Not reported Indonesia 37 bird vendors and 3 Gultomb A, Indriani poultry workflow steps, equipment market managers R, Lokugea K, Kelly used including personal protective PM (2011) Critical equipment, knowledge and attitudes control points for on avian influenza, and hygiene avian influenza A practices. Use of personal protective H5N1 in live bird equipment was limited with only 11 markets in low (29.7%) workers wearing boots and resource settings. 11 (29.7%) wearing aprons. Cages in Preventive each stall were overcrowded with Veterinary birds and they were placed in close Medicine 100 71– proximity to work surfaces. Study 78 teams observed feathers and feces transfer from inside the cage to work surfaces when birds flapped around inside cages. None of the workers reported using soap or detergents when cleaning work surfaces and only 7 (18.9%) used soap to clean knives and defeathering equipment. The majority of vendors (n = 32, 86.5%) reported cleaning chopping boards several times per day and the others cleaned the boards once at the end of trade (n = 5, 13.5%). One- third (n = 11, 29.7%) of vendors did not know or gave incorrect symptoms of AI infection in birds 254 Pruvot Assessed zoonotic disease and food Conceptual risk 100% of the Lao PDR 35 vendors, 182 MKhammavong K, safety risk of bush meat analysis model interviewed bush meat consumers Milavong P, consumption. Wildlife consumers composed of vendors were female. Philavong C, indicated a high risk (28.1%), low risk mixed Not much data was Reinharz D, Mayxay (22.5%), and no risk (16.9%) towards methods, collected on food M, Rattanavong S, consumption and handling of bush primarily safety practices of Horwood P, Dussart meat, while the majority (32.6%) did questionnaires, these vendors, but P, Douangngeun B, not know. Males had lower risk interviews and attitudes towards this Theppangna W, perception, and there was no observations type of trade, Fine AE, Olson SH, significant effect of education level of bush meat knowledge of potential Robinson M, on the perceived risk. When focusing vendors and zoonotic risks, and Newton P specifically on their knowledge of consumers. some demographics (2019)Toward a any disease transmitted from wildlife were collected. Law quantification of to humans, 36.3% of respondents enforcement and risks at the nexus of indicated that they were aware of regulators seem conservation and such risk, the level of education ineffective in enforcing health: The case of significantly increased this regulations. bush meat markets proportion. “bird flu” was the most in Lao PDR. Science frequently cited. Other health risks of the Total frequently cited included chemicals Environment 676: and formalin, related to rumors that 732–745 some wildlife vendors inject formalin into carcasses to keep them longer. Injuries from handling animals, and 5% of respondents indicated that people having high blood pressure should not consume wildlife. 255 Greatorex ZF, Olson Examined zoonotic disease risk in Observational The data on the volume Lao PDR Not reported SH, Singhalath S, wildlife markets. Handwashing was study and species of wildlife Silithammavong S, seldom observed, cleaning of tables and biosafety found in Khammavong K, was rarely seen. Butchering practices markets in Lao PDR Fine AE, Weisman were poor, and bush meat and other demonstrate that there W, Douangngeun B, meat kept in close proximity, are significant Theppangna W, increasing the risk of zoonotic opportunities in certain Keatts L, Gilbert M, disease transmission markets for wildlife, Karesh WB, Hansel and any zoonotic T, Zimick S, pathogens they carry, O’Rourke K, Joly to come into contact DO, Mazet JAK with humans. Food (2016)Wildlife hygiene and safety Trade and Human knowledge is low based Health in Lao PDR: on observed practices. An Assessment of Enforcement could be the Zoonotic stronger. Disease Risk in Markets. PLoS ONE 11(3): e0150666 256 Examined butchers' knowledge of Cross sectional Majority of butchers in Nepal 114 butchers Khanal G, and meat hygiene. A total of 54 (47.4%) Ratnanagar were Poudel S, (2017) respondents had a satisfactory level unaware of the hygiene Factors Associated of practice on meat hygiene aspects of meat with Meat Safety according to their scoring system. handling exposing them Knowledge and None of the respondents acquired an and the public to Practices Among adequate level of knowledge and threats of meat-borne Butchers of practice diseases. Having a side Ratnanagar job, poor education, Municipality, workload, and Chitwan, Nepal: A structure of shop were Cross-sectional the determinants of Study.Asia Pacific knowledge and practice Journal of Public levels in meat hygiene. Health 2017, Vol. These components 29(8) 683–691 must be taken into consideration while preparing the policy and plan for meat hygiene guidelines. Proper registration and licensing of the meat shops should be made mandatory by the municipal authority and only those who have undergone a proper training on meat hygiene should be permitted to work as butchers. 257 Kumar A, Thapa G, Assessed adoption of food safety Cross sectional The average cost of Nepal 809 smallholder farmers Roy D, Joshi PK practices as per Nepal code of compliance was (2017) Adoption of practice for dairy industry. Milk estimated to be Rs 1.99 food safety Hygiene and animal health practices per liter of milk. On measures on milk according to the dairy industry code average, farms adopted production in of practice. There are 42 metrics 64% of all FSM. The Nepal: Impact on measured. 64% of these were adoption of FSM smallholders’ farm- adopted. One concerning feature related to hygienic gate prices and was that farmers continued to sell milking and milk profitability. Food milk if animal was sick. storage was better than Policy 70: 13–26 those associated with adoption of those related to animal health. Having a larger family and a larger herd size also influenced adoption of FSM. Routine inspection and provision of information on FSM may be useful. 258 Paudel M, Acharya Assessed butchers' knowledge and Cross sectional There are significant Nepal 120 butchers in B and Adhikari M hygiene practices relevant to avian and widespread food Kathmandu (2013) Social influenza H5N1. Use of masks, safety gaps among determinants that gloves, apron and boots, hand theses butchers. lead to poor washing after touching raw meat, Stakeholders are knowledge about, presence of a hand washing facility, required to consider and inappropriate and cleaning of utensils were and target butchers in precautionary considered good practice. Other future prevention and practices towards, measures related to controlling AI preparedness avian influenza spread. These measures were programs. among butchers in scored, Respondents <25 years’ Kathmandu, Nepal and ‘butchers with Infectious Diseases primary education of poverty 2:10 'should be especially targeted with educational activities relating to AI 259 Vizon KCC, Battad Assessed vendors' knowledge and Cross- Green leafy vegetables, Philippines 9 vendors from 3 wet ZG, Castillo DSC awereness of contamination of sectional, particularly chinese markets. (2019) vegetables with food borne parasites repeated cabbage were heavily Contamination of including helminths and protozoa. measures infested with parasites. food-borne Cabbage and chinese cabbage were study design Limited knowledge and parasites from washed with tap water or awareness regarding green-leafy groundwater before display. The tap diseases caused by vegetables sold in water comes from the public water contaminated public markets of supply. Lettuce was not washed to vegetables were also San Jose City, keep the outer leaves from observed from the Nueva Ecija, deteriorating. Vegetables that fell to surveyed vendors. Philippines. J the ground were sometimes washed. Recommend increase in Parasite Dis (Oct- Only 1 of the nine vendors refrained public information and Dec 2019) from work if they were sick. monitoring on food 43(4):651–657 Handwashing was done with tap safety by local water. government units. 260 Lirio GAC, Labana Examined vendors' personal hygiene Cross sectional Intestinal parasites are Philippines 50 (food vendors - RV, Bernardo IRA, and intestinal parasites presence. endemic. 82 of the 91 included food vendors Bernarte RP, Most vendors washed their hands participants were and street food vendors- Dungca JZ, before meals, cut their nails infested, with men numbers not specified) Nissapatorn frequently, owned a private toilet, being more likely to be and 41 V(2018) Survey of Washed hands after toilet. The infected than women.. butchers/slaughterhouse Intestinal Parasites majority of participants ate raw and workers. Including unwashed fruits and vegetables, ate Associated Risk street foods and drinks. Most Factors Among participants did not eat raw meat, Food Vendors and and approximately 50% drank tap Slaughterhouse water. Despite this, 82 of the 91 Workers in Metro participants were infected with Manila, Philippines parasites. 4th International Research Conference on Higher Education, KnE Social Sciences, pages 493–505. 261 Assessed KAPs related to brucellosis. Cross sectional Knowledge of Tajikistan 441 farmers, 76 of which Lindahl E, Sattorov Households with a history of brucellosis is poor sold direct to consumer. N, Boqvist S, reported Brucellis infection among among the dairy Magnusson U humans, cattle, sheep or goats were farmers in the urban (2015) A Study of equally inclined to sell and consume and peri-urban area of Knowledge, unpasteurized dairy products as the capital city in Attitudes and those who had not had the infection Tajikistan. Several Practices Relating within the household or who had known high-risk to Brucellosis never heard of the disease. Showing behaviors were among Small-Scale that knowledge of the disease did common self-reported Dairy Farmers in an not always lead to good practices. 81 practices among the Urban and % would contact a veterinarian if an farmers. Such PeriUrban Area of animal was sick, and most used behaviors were Tajikistan. PLoS gloves if dealing with aborted tissue consumption of ONE material. unpasteurized dairy 10(2):e0117318. products and not wearing gloves when dealing with cows having an abortion or with aborted materials veterinarians appear to be enabling actors and credible sources of information. 262 Thinh NT, Grace D, Assessed food safety KAP of value Cross sectional There was Vietnam 542 informant Hung PV, Huyen chain actors. Many consumers lacked misperception of interviews that includes LTT, Hung NV, Sinh trust in actors along the value chain various value chain traditional, modern, DX, Nga NTD, and were the least trusting of all the actors regarding street food and canteen Luong NT, Huyen interviewed stakeholders. threats on human vendors. Details not NTT, Ngoc TTB, Consumers also raise major concerns health from chemical provided Phuc PD and Unger towards inappropriate use of hazards as opposed to F (2020)Food safety antibiotics and banned veterinary biological hazards. performance in key residues, high levels of microbial Most actors believe pork value chains in contamination, and spoiled products. that producers should Vietnam. ILRI However, these concerns are mainly be the most research brief 94 linked to chemical hazards. responsible for the May safety of pork. It is recommended to strengthen communications so actors focus on the most important risks, Tailor risk communication messages to make them relevant to the location of value chain actors and types of pork value chains, and Prioritize TV and local radio when disseminating food safety messages to consumers. 263 Hennessey M, Kima Investigated the use of nudges to Cross sectional Given that pork value Vietnam 132 questionnaires were S, Unger F, Nguyen- support food safety interventions in chain actors working completed with a variety Viet H, Dang-Xuan the pork value chain in Vietnam in around Hanoi and Hung of pork value chain S, Nguyen-Thib T, order to change value chain actors Yen Province were actors, reflecting a Häsler B (2020) food safety behaviors and reduce risk found to be particularly response rate of 80%. Exploring the of FBD esp. Salmonella. Authors state influenced by the Canteen workers were potential of using there is distrust in government potential of their the main group to be nudges to promote regulatory systems and poor reputation to act as an underrepresented food hygiene in the motivation amongst PVC actors cited incentive, consider (target sample size n = pork as reasons for the limited progress. their peers and 28, achieved sample n = value chain in veterinarians as 8). Vietnam Preventive trustworthy Veterinary messengers, and are Medicine 181 affected by the type of 105003 visual media used to display information, these nudge aspects should be given careful consideration in the design of future food safety interventions and research to assess their effectiveness. Money was another incentive that was highly motivating. 264 Dang-Xuan S, Assessed Salmonella prevalence Cross Presence of flies, and Vietnam 72 pig farms, 13 Nguyen-Vieta H, along the pork value chain and sectional, having a stall near a slaughterhouses, and Pham-Duc P, Unger control practices. Approximately half repeated drain were risk factors 217 pork shops F,Tran-Thia N, the shops were located in the area of measures for higher salmonella Grace D, Makita K the market for selling pork. Flies load. Salmonella was (2019) Risk factors were present on 53%of pork stalls. found throughout the associated with 40% of vendors had access to tap value chain. Salmonella spp. water at the shops. The shop was prevalence along next to sewerage or drain in 63% of smallholder pig cases. In 47% of cases the same cloth value chains in was used for wiping hands and Vietnam. wiping pork. various types of International surfaces were used for the counter Journal of Food and as cutting boards. Microbiology 290: 105–115 265 McCain AK, Vu PTT, This study monitored the prevalence Cross sectional Bacterial counts in Vietnam Not reported Tran TTM, Le MVV, of Salmonella, Listeria, E. coli and supermarkets was the Nguyen DH, total aerobic bacterial loads in meat same as open and Broadway PR, and poultry products. Researchers indoor markets. Guillen LM, investigated sampling timing and Observations such as Brashears MM, occurrence at different types of covered display use and Donaldson JR, markets. Physical barriers among use of PPE occurred at Schilling MW and meat products and consumers were different frequencies at Dinh TTN used only in Supermarkets and different times of day (2015)Influence of indoor markets. 33.3% of SM and IM and observed food Market Setting and vendors used covered display cases- safety practices may Time of Purchase but not at all time points. This change over the course on Bacterial Counts variation in meat display was of the day. The current and Prevalence of observed across various study, together with a Salmonella and supermarkets and indoor markets in previous report of Listeria in Pork in the current study. No Outdoor microbiological Vietnam. Agric. Market vendor covered pork during baseline of retail beef, Food Anal. sampling time. Gloves and hairnets emphasizes the need of Bacterial. 5: 166- were not worn by outdoor or indoor regulations, control of 182 market vendors, but sometimes hazards, and education worn by supermarket vendors at to improve the safety different time periods. Refrigeration of meat products in was present at supermarkets but not Vietnam indoor or outdoor markets. Bacterial counts on pork however were similar across all markets. 266 Tram NT and Assessed Cryptosporidium, Giardia, Cross sectional Current practices are Vietnam Only % are stated, but Dalsgaard A (2014) and E. coli risk from water used to spreading 200 splashing water Water used to splash vegetables by traders in microbiological risk at samples were collected moisten vegetables Hanoi. All traders recorded splashing the markets through from buckets used by is a source of vegetables with tap water obtained poor hygiene practices traders. So assume Escherichia coli and either from the market or from their and unsafe water. The around 200 traders. protozoan parasite private home. Most traders kept findings of protozoan contamination water in a bucket at their vegetable parasites in splashing at markets in stall for all day use. To keep water are a food Hanoi, Vietnam vegetables moistened, vegetables safety hazard. Urgent Journal of Water were mainly submerged in a bucket action is needed to and Health 12:4 (66.0%) or traders used the wetted educate traders and 896-900 vegetables to splash water on other the responsible vegetables (30.5%). On several authorities to improve occasions traders were observed to sanitary conditions at use their hands for scattering water markets in Hanoi and onto vegetables, either by pouring elsewhere in less water onto their hands using a developed countries, to plastic bottle with small holes in the improve food safety cap or by dipping the hands in a and protect public water bucket. No details were health. collected on hand washing. Traders washed the plastic buckets typically once a month without the use of soap (70.5%) and some traders never cleaned them (18.5%) 267 Wertheim-Heck Examined food safety as it relates to Cross sectional Food safety is a well- Vietnam Various cohorts SCO, Spaargaren G, shopping and food selection in wet recognized concern for interviewed: sales Vellema S (2014) markets; assessed what elements vegetables. Concern information: 8 wet Food safety in drive trust, or factors of largest about pesticides and market retailers 3 street everyday life: concern. Also investigated why fertilizer residues are vendors and a shop Shopping for consumers in Viet Tri do not much higher than manager. Retail vegetables in a embrace the supermarket microbiological risk structure- management rural city in modernization of the fresh-food factors vegetables. board of 4 wet markets Vietnam. Journal of system as an appropriate solution for Small scale producers were interviewed. 75 Rural Studies their apparent and serious food- are more trusted vendors- participated in 35:37-48 safety concerns, and how they because they are not the retail census to manage food safety concerns when 'mass produced'. Trust understand assortment shopping in wet markets. No direct in food safety is built on of vegetables. measure of food safety was carried vendor/consumer out in this paper, which reported on relationships and a number of interviews. Vendors vendor/farmer seem to pass the responsibility of relationships. Within 'safe' vegetables back to farmers. In the wet-market setting trying to regulate food safety, both providers and retailers rely on personal experience retailers and street- and expertise in supplier selection: “I vendors and can’t be sure whether suppliers consumers apply (mostly farmers) are honest or not, different repertoires for but I can only rely on their honesty.” generating trust in (Interview #18) Retailers tend to vegetables. prefer suppliers with whom they Certification programs maintain a longer-term relation and do not appear to be with whom they haven’t experienced working despite these any complaints from consumers on food safety pesticide food poisoning, stomachache, concerns. diarrhea and vomiting, thus far. Understanding why Consumers in Vietnam are highly traditional trust concerned about food safety and relations survive under 268 often relate it not to bacterial the increasing treats disease but to contamination by and anxieties chemicals. Given aforementioned generated by food- consumer’ tendency to relate safety scandals. experienced foodborne illnesses to Traditional regulators excessive agrochemical residues on appear to have little the vegetables they consumed, they ability to moderate will blame the retailer for selling some of these trust unsafe vegetables, even when concerns when it consumers’ own unhygienic food comes to food safety. handling practices might have induced the health problem. Two interviewed retailers reported to be confronted with consumer complaints. As a consequence, both stated to have become reluctant in sourcing vegetables from unknown suppliers even when insufficient supplies of regular suppliers would urge them to do so. 269 Merino A, Hoan Assessed practices in the fresh Observational Hygiene and sanitary Vietnam Not reported NV, Ayuda A, anchovy supply chain. Handlers use study- it’s a conditions of the Desarrollo I (2011) chilled sea water or salted water, value chain marketed fish can be Review of selected even if they are going to sell or report improved by providing (fish) marketing process in less than four hours. more training to chains and Fishers and collectors sort anchovy involved agents, arrangements” in by size when packing it into chilled development of cold Quang Nam and sea water in plastic drums of 20-25 storage facilities, and Thua Thien Hue kg capacity. Hygiene and sanitary better sharing of Provinces. Regional conditions for preserving and information. Fisheries handling fresh anchovy could be Livelihoods improved but this is not a priority for Programme for the anchovy value chain, as there is South and no loss of fish quality or value Southeast Asia because of handling. Trade is rapid (GCP/RAS/237/SPA) and anchovies are processed or sold Field Project to final consumers on the day they Document are caught. The lack of cold storage 2011/VIE/3. facilities forces fishers to trade quickly. Fishers lose negotiation capacity, but not quality. 270 Ifft J, Otte J, The objective of this work, and the Cross sectional Not reported Vietnam 66 commune traders, 88 Roland-Holst D, and larger project from which it wholesale traders, 200 Zilberman D (2008) originates, is to improve live bird market traders Poultry Market understanding about how markets Institutions and can act as catalysts for rural poverty Livelihoods: alleviation. Food safety was not the Evidence from focus of the survey- but as this study Vietnam. Rural captured data on vendor Development demographics, it was included. Research Slaughterhouse facilities exist in the Consortium markets with discreet operators. A Research Report RR few slaughterhouse operators also Nr. 08-02 was a vendor. 2/3 of the live bird vendors only sell live chickens. They do not sell slaughtered chickens. The companion consumer survey indicated that household buyers at all income levels are very discerning about poultry and poultry products. They exhibit distinct preferences for fresh meat from local varieties, and are willing to pay substantial premia for this. In response to these demand-side forces, vendors devote 59% of their inventory to local bird types, 32% to industrial chicken, and 9% to crossbred birds. No details were provided about food safety expectations but it can be implied it is expected and high due to prices commanded. 271