Food safety is an essential public health issue for all countries. Foodborne diseases due to microbial pathogens, biotoxins and chemical contaminants in food represent serious threats to health of thousands of millions of people (FAO and WHO, 2008). In Turkey, 84,340 and 77,515 cases of foodborne diseases were identified in 1999 and 2000, respectively (WHO, 2004b). The proportion of cases arising from food preparation practices in the home may be especially under-represented in outbreak statistics, due to many factors (Day, 2001) because the opportunities for cross-contamination in the domestic kitchen are vast. It can be either direct (i.e., direct contact with potential sources, such as raw food, pets) or indirect (i.e., transfer of pathogens from a source via a vehicle to another food) (Jay et al., 1999a). Inappropriate temperature, such as inadequate refrigeration and inadequate cooking, reheating or hot holding, was involved in 44% of the outbreaks investigated. Inadequate handling was reported in 14% of the investigated outbreaks, mostly resulting from cross contamination, inadequate processing, insufficient hygiene and reusing leftovers (WHO, 2004a).
Food safety programmes are increasingly focusing on a farm-to-table approach as an effective means of reducing foodborne hazards (FAO and WHO, 2008). The food chain-from those who produce it to those who prepare it -has a significant role in the effort to reduce the risk associated with foodborne pathogens (Redmond and Griffith, 2003). Before public education and training programs can be planned and printed materials developed, food professionals must learn what consumers know about home food safety and home preparation practices (Williamson et al., 1992). The aim of this research was to identify the methods used for food storage and preparation in the Turkish household and to determine the domestic knowledge on food hygiene and food safety.
MATERIALS AND METHODS
The research region is the provincial center of Ankara (The capital city of Turkey). The sample of the research was composed of 250 married women who were registered in Public Education centers affiliated to the Ministry of Education in five of the fifteen central districts in the provincial center of Ankara. The research data were collected through a questionnaire and face to face interviews. The questionnaire form was prepared by making use of the previous studies conducted in this field (Jay et al., 1999a; Anderson et al., 2004; Badrie et al., 2006). In a pilot study, the questionnaire was administered to 30 consumers, resulting in minor modifications in the question wording. The revised questionnaire was divided into two sections: 1. The demographic section, 2. Items related to food safety practices.
The data were analyzed using the Statistical Package for Social Sciences (SPSS) software. Frequencies, averages and standard deviations were calculated. In the statistical evaluation of the data, the Chi-square (X2) test was used and in the cases when the Chi-square test conditions were not met, the G statistics was applied.
RESULTS AND DISCUSSION
Sampling characteristics: Of the 250 women participating in the study,
44.8% were between 30-39 years old, 24.8% were 40-49, 19.6% were 20-29 and 10.8%
were 50 and above. The respondents educational levels were as follows:
33.2% of respondents were high school graduates, 29.2% were primary school graduates,
19.6% were university graduates and 18.0% were secondary school graduates. When
the women responding to the survey were evaluated according to their occupational
status, it was found that 80.4% of them were housewives, 12.8% of them were
retired, 5.6% of them were state civil servants, 0.8% of them were working freelance
and 0.4% of them were workers.
The behaviour of women regarding the food safety
Raw meat purchase, transportation and storage: Raw meat is a possible source
of pathogenic bacteria that have a potential to cause a foodborne illness (Jay
et al., 1999a). Table 1 shows information on at what
stage of shopping women buy meat and the duration of their getting back home
after the purchase.
The majority of the respondents, 43.6%, claimed to purchase meat at the end of shopping, while 23.6% purchased meat at the beginning of shopping. Jay et al. (1999a) found that 15% of respondents buy their meat at the start of their shopping trip, 18.6% in the middle and 58.3% at the end. In another study conducted by Ozcelik (2007), it was revealed that the rate of those buying meat at the end of the shopping were 47.2%. These findings have parallels with the findings of our research. People who buy raw meat at the start of the shopping expose meat to unrefrigerated conditions for the maximum possible time after purchase. The potential for temperature abuse would be reduced if they purchased meat at the end of the shopping (Jay et al., 1999a).
The question, How long is the duration between your purchase of meat and your getting back home? was answered as less than 30 min by 40.0% of the participants (Table 1). In this study by Jay et al. (1999a), the same question was answered at the following rates: 53.3%, less than 30 min; 30.3%, 30 min; 10.6%, 45 min and 5.8%, 1 h. These findings are similar to ours. In this study by Mahon et al. (2006), the majority of respondents (97%) generally returned home within 2 h of their food shopping and put groceries away immediately, hence reducing the risk of temperature increases in chilled/frozen products.
Seventy three point two percent of the women stated that they stored the meat they purchased in the freezer; 22.0% in the meat storage section of the refrigerator; and 4.8% in the top shelf of the refrigerator (Table 1). In this study by Mahon et al. (2006), half of the sample stored their meat in the fridge, 43% stored it in the freezer and the remaining respondents were not sure of their general practice. In this study by Jay et al. (1999a), 47.2% respondents stored meat in the meat compartment of their refrigerator and 21.4% stored in the top shelf.
Meat thawing practices: When food is stored by way of freezing, bacteria are not destroyed but their growth can be prevented. Although thawing frozen meat slowly on the kitchen counter is a usual practice, it is hazardous. For a safe thawing, to protect other foods from dripping, the bottom shelf of the fridge or a microwave oven can be used, the frozen meat can be thawn under running water after covering it with a protective cover, or cook it directly (Hernandez, 1998; Brown, 2000). Thirty nine point six percent of the women thaw meat on the kitchen counter, which is a wrong practice. The rate of those who do so is the lowest among the university graduates (28.6%).
It was determined by Jay et al. (1999a), Badrie et al. (2006) and Ozcelik (2007) that respectively 40.1%, 41.6% and 48.4% of the respondents thawed meat on the kitchen counter. These results are similar to our findings. Another question was whether they froze unused thawed meat again or not?. To this question, 91.6% of the women replied by saying they did not, which is a true practice. As per the educational status, it is seen that the university graduates never freeze the thawed meat again (Table 2).
Cooling and reheating leftovers: Leaving the cooked food at room temperature causes the growth of bacteria such as Clostridium perfiringens and Staphylococcus aureus (Leon and De Waal, 2004). Table 3 shows how women cool cooked food and store the leftovers.
Within the general sampling, it was found that the majority of the women (81.6%) left cooked food to cool in the room temperature. According to different studies, the rates of those who cooled cooked food at room temperature are as follows: in the study of Williamson et al. (1992) 29.0% of the respondents; in the study of Worsfold and Griffith (1997) 58.0% of the consumers; in the study of Jay et al. (1999a), 84.5% of the respondents; and according to Badrie et al. (2006) 58.0% of the respondents.
As these results also indicate, it is a common practice to store food in the fridge after cooling it in the room temperature. Our study also reveals that the majority of the participating women leave their food at the temperature range that provides a suitable environment for microorganisms to reproduce.
Although disposing of the leftovers is the appropriate thing to do with respect
to avoiding food poisoning, considering economic losses, instead of disposing
them, they can be stored in closed containers to be used within 24 h but they
should never be added into newly cooked food (Bas and Saglam, 1997).
time of womens purchasing meat, the duration of their getting back
home and storage place (%)
In this study, 49.2% of the women stated that they kept the leftovers in smaller
containers. The examination of the table as per educational status shows that
the rate of those who kept the remaining food in the container in which the
food was cooked is the highest among the university graduates (22.5%) and the
rate of those who kept the remaining food in a few small containers is the highest
among the middle school graduates (53.3%). The rate of those who also gave this
answer is 54.6% in the study of Ozcelik (2007) conducted in Ankara and 87.1%
in the study of Unusan (2007) conducted among housewives in Konya.
Refrigerator temperature: Microorganisms and enzymes are effective at a certain temperature. Thus, it is possible to keep food fresh by keeping it at cool temperatures. It is important that the temperature of the fridge is kept at 1-5oC. This temperature does not kill the bacteria but controls their production (Tayfur, 2002). Table 4 provides the opinions of the women about what the fridge temperature should be.
Nearly half of the women participating in the research (47.6%) stated that they did not know what the refrigerator temperature should be and 36.4% replied that it should be 1-5oC. The highest rate of those who replied this item correctly is among the university graduates with 55.1% (p<0.01). Jay et al. (1999a) determined that 26.3% of the respondents knew that the fridge temperature should be 1-5oC but 67.7% did not know the answer. Badrie et al. (2006) determined in their study that 65.3% of the participants did not know what the fridge temperature should be. These results indicate that in general the fridge temperature is not known.
Kitchen cleaning: Cleaning is the process of removing the visible dirt in the environment. As bacteria remain alive and reproduce fast in dirty environment, dirt is a critical danger for hygiene. When the kitchen utensils and tools and work surfaces are not clean, foods can be contaminated with pathogens. Therefore, to maintain food hygiene, kitchen utensils and tools as well as work surfaces should be effectively cleaned (Cigerim and Beyhan, 1994). The respondents were asked 2 questions on this topic. The first question was how many times a day they cleaned the kitchen counter. The majority (83.2%) replied that they cleaned it after every use. The highest rate for this answer is among the university graduates. Similar findings were obtained in the study of Ozcelik (2007) while Jay et al. (1999a) found that 30.4% of the respondents cleaned the kitchen counter once a day. The second question asked the respondents how they cleaned the counter and 73.6% replied that they used lukewarm water with detergent and a piece of cloth. The way women clean the kitchen counter differs by their educational status (p<0.01). A physical action such as wiping and a surface active element such as soap or detergent are needed to remove microbial contaminations completely from surfaces. The existence of antimicrobial elements in a cleaning material can assist to reduce microbial contamination (Jay et al., 1999a). Although the rate is lower than our study, study of Jay et al. (1999a) also established that the majority of the participants (42.4%) clean the kitchen counter by using lukewarm water with detergent and cloth. The rate of those who use spray cleaners is 14.4%. Badrie et al. (2006) reported that the majority of the participants (43.7%) cleaned the kitchen counter using hot water + detergent and bleaching agent and 32.0% used hot water and detergent.
Hand washing for food preparation: Hands, which carry microorganisms
to the foods, are the risk factor in food contamination (Bas and Saglam, 1997).
Washing hands effectively is the prerequisite of successful food preparation
(Jay et al., 1999b).
method of thawing frozen meat and refreezing (%)
women cool cooked food and store the leftovers (%)
opinions of the women about the fridge temperature (%)
According to the Fight BAC! Recommendations, hands should be washed in hot
soapy water before preparing food and after using bathroom, changing diapers,
and handling pets. For best results, consumers should use warm water to moisten
their hands and then apply soap and rub their hands together for 20 sec before
rinsing thoroughly (Anderson et al., 2004). The participating women were
asked the question: how important is it for you to wash the hands before and
after preparing food?. Eighty-nine point two percent of the respondents replied
that it was very important to wash their hands. When asked if the respondents
washed their hands prior to preparing food, 98.8% claimed they did so, 1.2%
said sometimes. Only 43.2% claimed that they used hot water and soap to wash
their hands. In this study by Mahon et al. (2006), over three quarters
claimed that they washed their hands with warm water and soap, 85% of the respondents
washed their hands prior to preparing food, and 91% of them washed their hands
after handling mince. In this study by Jay et al. (1999a), too, 81.6%
of the respondents stated that washing hands is very important for them. The
results of this study have parallels with our research findings.
Way of cleaning hands after touching raw meat, chicken and fish: Fresh
meat is an ideal environment for the growth of bacteria. The nutrient elements
that it contains (carbohydrates, proteins, etc.), its water activity and its
pH degree are very suitable for the growth of bacteria. The gastro-intestinal
systems and the skins of healthy animals include a great deal of microorganisms,
the most frequent of which are bacteria such as Escherichia coli, Salmonella
spp. and Camphylobacter spp. (Bas, 2004). To avoid the contamination
of this bacteria existing on the surface of the meat to other foodstuff, hands
should be thoroughly washed after touching raw food (Cigerim and Beyhan, 1994).
frequency and method of cleaning the kitchen counter (%)
|*Combined with the statistical operation
opinions of women about washing hands and how they wash their hands (%)
The question how do you clean your hands after touching raw meat, chicken and
fish? was answered by stating that they did so using soap and hot water by 76.4%
of the women in the research. The ratio of those who wash their hands in this
way increase with education level and this is also statistically significant
In the study of Jay et al. (1999a), it was determined that 55.8% of the participants washed their hands with hot water and soap after touching raw food; the ratio was 78.3% (Badrie et al., 2006). The results of these studies and ours are similar.
Covering hair when preparing meals: Falling hair itself and the dandruff may cause foodstuff to be contaminated. As the head skin often contain pathogenic bacteria such as Staphylococcus aureus, this is an area for which precautions should be taken to avoid contamination (Bas, 2004). Covering the hair or wearing a bonnet will be useful. The table lists the answers given to the question do you cover your hair and do you use gloves and an apron when preparing a meal?.
Thirty-eight percent of the women always cover their hair while preparing food, while 35.6% never do so. As the educational level increases, the rate of women covering their hair falls (p<0.01). The state of womens using gloves and aprons while preparing meals was investigated. The majority of the women did not use gloves (81.6%) and aprons were sometimes used (38.8%). Womens using gloves (p<0.01) and aprons (p<0.01) vary according to their educational status.
Knowledge of cross-contamination: Cross-contamination happens when bacteria
in one food spread to another, often from a cutting board, knife, plate, spoon
or hands. For example, drippings from raw meat, poultry and seafood left on
a cutting board can transfer bacteria to vegetables which are to be sliced next
(Duyff, 2002). The women in the research were asked whether they knew the meaning
of cross contamination and 90.4% did not know the meaning. From an educational
status perspective, any of the elementary school graduates, 97.8% of the middle
school graduates, 88.0% of the high school graduates and 73.5% of the university
graduates did not have an idea on this topic. Regarding the knowledge on cross
contamination, the difference between educational levels is significant (p<0.01).
way women clean their hands after touching raw meat, fish and chicken
|*It does not consider in the statistical analysis
the hair and using gloves and aprons while preparing meals (%)
Twenty-four of the women stated that they had knowledge about cross contamination
and of these respondents, 25.0% defined it as contact of cooked food with raw
food, 29.2% defined it as using the knife etc that has already been used for
raw food for cooked food, and 45.8% defined it as contact of cooked food with
raw food + using the knife etc that has already been used for raw food for cooked
food + preparing food on contaminated surfaces.
When foodstuff is handled, raw and cooked food should be separated and separate cutting boards should be used for meat, chicken, fish and vegetables (Soner and Özgen 2002; Anonymous, 2003). Table 10 shows the state of participating womens using the knife and board they used for raw food for cooked food and data regarding the materials of the cutting tools they use.
As can be seen from the table, more than half of the women (53.6%) always and
24.4% sometimes use the same utensils and tools for raw and cooked food. The
rate of those who always use the same utensils and tools is the highest among
the elementary school graduates (65.8%). Whether the same materials are used
for raw and cooked food as per educational status is found to be significant
by the chi-square analysis (p<0.05). Worsfold and Griffith (1997) found that
the rate of the research participants who use the same cutting board for all
cutting processes is as high as 60.0% and this result is similar to our finding.
In this study by Mahon et al. (2006), 74% of the respondents washed chopping
board between the preparation of meat and vegetables. In this study by Altekruse
et al. (1999), 19.0% of the respondents used the cutting board that was
used for raw food for cooked food without washing it and 67.0% did so after
washing it. In Andress (1999) study, it was also determined that one fourth
of the participants did not wash the cutting board that they used for raw meat
or chicken before they used it again. Shiferaw et al. (2000) found out
that 93.0% of the respondents washed the cutting boards that came in touch with
raw foodstuff. In the study carried out by Badrie et al. (2006), 6.0%
stated that they wiped the cutting board used for raw food with a wet cloth
and 2.0% stated that they just rinsed it under water. Study of Williamson et
al. (1992) showed that only 54% of the respondents said they would wash
the knife and cutting board with soap and water, then chopped the vegetables;
whereas, 37% would only rinse the knife and cutting board and 5% would immediately
chop the vegetables using the same unwashed knife and board. In the general
sampling, it was determined that 36.0%, 33.6%, 22.8% and only 7.6% of the women
used wooden, plastic, wooden-plastic and glass cutting boards.
knowledge about cross contamination (%)
||The state of participating womens using the knife and
board they used for raw food for cooked food and data regarding the materials
of the cutting tools they use (%)
Conclusion: To conclude, it was determined that as the educational status
of women increased, positive practices were also increased. This proves the
importance of education.