INTRODUCTION
PROBLEM STATEMENTS
The agricultural revolution significantly increased food production and improved the health of laborers, which is essential for human capital However, food safety issues pose a serious threat to sustainable development and national security in developing countries Recent outbreaks of food-related diseases have shifted global focus from merely increasing food quantity to prioritizing food safety.
The use of pesticides, chemical fertilizers, and feedstuff enhances agricultural productivity, but their overuse and misuse can compromise food quality Additionally, preservation methods, processing techniques, and the use of food additives can further reduce food safety According to the World Health Organization (2015), key contributors to food-borne diseases include bacteria, viruses, parasites, chemicals, and toxins, with children, pregnant women, and the elderly being the most vulnerable populations affected by food-borne illnesses.
The advancement of transportation and international trade has transformed food safety into a global concern rather than a localized issue Notable incidents, such as the Chinese milk scandal and the New Zealand milk crisis, have resulted in significant losses for manufacturers and have adversely affected consumer health worldwide.
1 World Health Organization (WHO) and Food and Agriculture Organization (FAO) defined:
“Food safety is the assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use” (WHO and FAO, 2009, p 6).
Figure 1.1: The number of food-borne cases annually (WHO, 2015)
Food-borne diseases (FBD) are a global concern, with developing regions like South East Asia and Africa experiencing the highest incidence of cases, while developed areas such as Europe and America report significantly fewer occurrences Interestingly, despite facing challenges related to food sources and safety controls, African countries have recorded fewer food-borne illness cases compared to South East Asia This discrepancy may be attributed to the abundance of diverse, nutritious foods and the tropical climate in South East Asia, which create favorable conditions for bacteria and other food safety risks to thrive, ultimately impacting human health.
According to the World Health Organization (WHO, 2015), food-borne diseases affect nearly 10% of the global population annually, leading to approximately 420,000 deaths, with one-third of these fatalities being children Diarrheal diseases stand out as the most prevalent illnesses associated with food-borne diseases.
Africa unsafe food, accounted for half of global burden of FBD and made 550 million people falling ill (including 220 million children), cause 230,000 deaths (96,000 children’s)
Figure 1.2: The number of death caused by FBD annually (WHO, 2015)
The trend in food-borne disease (FBD) deaths mirrors the rise in food-borne cases, with South East Asia and Africa reporting the highest mortality rates, while Europe and America experience the lowest Notably, Africa has fewer deaths than South East Asia, likely due to greater international medical support in Africa compared to Asia Additionally, differences in the physical resilience of the local populations in these regions contribute significantly to this disparity.
The FBD caused the burden about 33 million DALYs 2 Diarrheal diseases agents were the largest contributors, accounted for 18 million DALYs, 54% of total All three
Disability-adjusted life years (DALYs) serve as a crucial health metric that quantifies the overall burden of disease This measure combines two key components: years of life lost due to premature death (YLL) and years lived with disability (YLD) resulting from various health conditions By integrating these elements, DALYs provide a comprehensive view of the impact of diseases on both mortality and quality of life.
Africa figures 1.1, 1.2, 1.3 both indicated that South East Asian and African region’s food safety issue is severe and these areas suffered an enormous burden from FBD
Despite having fewer deaths from foodborne diseases (FBD) than Asia, Africa bears a burden nearly double that of Southeast Asia and significantly higher than other regions The combined burden in Europe, the Western Pacific, and the Americas is roughly equal to that of Southeast Asia, yet only half of Africa's burden These statistics highlight the disparities in healthcare access and food safety regulations across regions, directly affecting population health outcomes.
According to the World Health Organization (WHO, 2015), the burden of disease is measured in terms of Disability-Adjusted Life Years (DALYs), where one DALY represents one year of healthy life lost This metric highlights the varying degrees of severity of health issues, with time serving as a common measure for both death and disability.
Vietnam is classified by the World Health Organization (WHO) as part of the Western Pacific region, where food-borne illness rates are considered moderate on a global scale This region encompasses a diverse range of countries, from developed nations like Australia, Japan, and South Korea to developing countries such as Cambodia, the Philippines, and Vietnam, leading to significant disparities in health statistics Detailed information regarding Vietnam's specific situation is presented in Chapter 4.
Food-borne diseases (FBD) pose significant challenges not only for developing countries but also for developed nations like the USA In 2014, the Centers for Disease Control and Prevention (CDC) reported 864 food-borne disease outbreaks in the USA, resulting in 13,246 illnesses, 712 hospitalizations, and 21 deaths, alongside 21 food recalls A majority of these food poisoning cases, accounting for 65%, occurred in restaurants, while 12% took place in private homes Bacterial infections were the leading cause, contributing to 22% of total cases These statistics highlight that even countries with advanced healthcare systems face substantial struggles with food safety.
CDC also predicted that food safety issue would continue emerge in the future due to:
- Changes in our food production and supply, including more imported foods
- Changes in the environment leading to food contamination
- Better detection of multistate outbreaks
- New and emerging bacteria, toxins, and antibiotic resistance
- Changes in consumer preferences and habits
- Changes in the tests that diagnose foodborne illness.
In today's interconnected world, food-borne diseases have emerged as a global concern that transcends national boundaries, exacerbated by rising immigration and increased trade exchanges Addressing this issue requires a collective effort, as it affects the health and safety of populations worldwide.
RESEARCH OBJECTIVES AND RESEARCH QUESTIONS
The diverse food market in Vietnam provides convenience for households, leading most Vietnamese families to prepare and enjoy at least one home-cooked meal daily This cooking behavior is influenced by various factors, including socio-economic status, individual characteristics, and living conditions Additionally, the tradition of cooking in Vietnamese communities has been passed down through generations, deeply rooted in Asian customs and agricultural culture This cultural heritage significantly shapes household cooking practices, encompassing knowledge of food processing, preservation, and kitchen techniques.
Research conducted in Thua Thien Hue province (Duong, 2013) and Ho Chi Minh City (Nguyen, 2010) reveals a significant correlation between individuals' knowledge and attitudes towards food safety and their practices in food factories, restaurants, and households The "10 Golden Principles in Food Processing" (MOH, 2005) outline essential food safety behaviors that are crucial for ensuring the safety of food products.
- Clean, tidy kitchen and the cooker surface
- Using waste basket with cover
- Use clean water to handle food
- Use clean tool to prepare and divide food
- Not use forbidden food additives or out of date food
- Washing hand before cooking and after toileting
- Not smoke, spit out or nail polished while cooking
The golden principles have been widely applied in various research studies in Vietnam, serving as the foundation for the findings of this thesis However, many of these studies primarily focus on medical perspectives, often neglecting socio-economic factors and individual characteristics Consequently, the impact of these elements on food safety behaviors has not been thoroughly evaluated.
The research findings highlight the existing food safety issues within the community but fail to analyze the various factors influencing these problems Additionally, the participants did not engage in the annual survey, leading to a lack of discussion regarding the effects of government policies and initiatives on food safety.
This thesis aims to identify and assess the factors influencing food safety behavior, as well as to predict the likelihood of food-borne diseases among individuals Key factors include socio-economic status, knowledge of food safety, personal perceptions, and sources of information By understanding these personal determinants, the government can formulate effective strategies to modify behaviors, reduce risky practices, and ultimately minimize the incidence of food-borne diseases and their associated public health burdens.
To analyze food safety behavior and health outcomes of household primary cook
- To determine the relationship between knowledge, perception of consumer and their food safety practice at household kitchen
- To evaluate the impact of individual food safety practice to their food-borne disease probability
(1) Do food safety knowledge and perception have impact on individual food safety practice?
(2) How food safety practice affect to individual food-borne poisoning risk?
SCOPE OF RESEARCH
The thesis utilized data from a 2013 survey on Individual Food Poisoning and the Knowledge, Attitude, and Practice of households in Ho Chi Minh City Conducted across 24 districts from March to April 2013, the survey targeted primary cooks in households, with local medical staff serving as data collectors.
The annual survey features a diverse range of participants each year, including householders in 2010 and 2013, and restaurant workers from 2012 to 2016 Furthermore, the specific respondents within each category vary annually, with the most recent household data available from 2013, which is not linked to the 2010 survey As a result, it is not possible to create a panel data set for comprehensive analysis.
This research focuses on the behavior and incidence of acute food poisoning within the Ho Chi Minh City community from March to April 2013, aiming to assess the impact of various factors The study employs descriptive statistics alongside econometric methods, including factor analysis, multivariate probit, and propensity score matching, to analyze the data effectively.
THESIS STRUCTURE
Due to the available of the data, thesis is composed as the structure below:
Chapter 1 introduces the research problem, highlighting the significance and scope of the study It provides an overview of foodborne diseases (FBD) and their global impact, while also outlining the objectives and structure of the thesis.
Chapter 2: Literature Review examines the definitions of key concepts and summarizes previous research on the factors and models that form the foundation for developing an analytical framework This framework is essential for analyzing the impact of each component effectively.
Chapter 3: Research Methodology outlines the framework and econometric tools utilized in this study It details the sources of data and the methods employed for data collection, along with a comprehensive description of the variables involved.
Chapter 4: Research Results presents a comprehensive analysis of the collected data, highlighting key findings and comparing them with existing results This chapter also includes descriptive statistics for the variables under study, providing a clear overview of the research outcomes.
- Chapter 5: Conclusion and policy implications This chapter concludes the research finding, provides implication, further suggestion as well as the research limitations
LITERATURE REVIEW
FOOD SAFETY AND FOOD-BORNE DISEASES
Food-borne diseases (FBD) are illnesses transmitted through ingested food, caused by enteric pathogens, parasites, chemical contaminants, and biotoxins (WHO, 2007) There are two main approaches to estimating the burden of food-borne diseases: the etiologic agent approach, which starts with exposure levels of food-borne agents, and the syndromic approach, which begins with disease outcomes like gastroenteritis A thorough assessment of the burden of food-borne diseases necessitates integrating both methodologies.
In 2015, the World Health Organization reported approximately 600 million cases of food-borne illnesses and 420,000 related deaths, with children under five years old accounting for 40% of the disease burden However, the data utilized in this thesis was gathered through participant interviews via a questionnaire, without any food testing involved Consequently, the diagnosis of food-borne diseases relied on the respondents' self-assessments, along with evaluations made by medical professionals based on individual symptom descriptions.
Food safety is defined by the Vietnam Ministry of Health (2010) as the assurance that food will not harm human health or life This definition, while less specific than that of the World Health Organization, encompasses the entire process of food production, including growing, harvesting, preserving, and processing, rather than just the preparation and consumption stages Given the comprehensive nature of this definition and its relevance to the Vietnamese population, this thesis adopts it as the foundational concept of food safety.
THE HEALTH BELIEF MODEL
The Health Belief Model (HBM), rooted in psychological and behavioral theories from Maiman and Becker (1974), focuses on how individuals make decisions under uncertainty by evaluating the "value-expectancy" of potential outcomes When applied to health, this model posits that individuals critically assess the importance of illness prevention and health improvement, leading them to believe that their actions can prevent disease and enhance their well-being This belief is influenced by their perceptions of susceptibility to illness, the seriousness of diseases, and the likelihood of becoming ill due to their behaviors Key components of the HBM, as outlined by Glanz et al (2008), further elaborate on these concepts.
Table 2.1: The concepts of Health Belief Model
Perceived susceptibility Belief about the chances of experiencing a risk or getting a condition or disease
Define population(s) at risk, risk levels
Personalize risk based on a person’s characteristics or behavior
Make perceived susceptibility more consistent with individual’s actual risk
Perceived severity Belief about how serious a condition and its sequelae are
Specify consequences of risks and conditions
Perceived benefits Belief in efficacy of the advised action to reduce risk or seriousness of impact
Define action to take: how, where, when; clarify the positive effects to be expected
Perceived barriers Belief about the tangible and psychological costs of the advised action
Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance
Cues to action Strategies to activate
Provide how-to information, promote awareness, use appropriate reminder systems
Self-efficacy Confidence in one’s ability to take action
Provide training and guidance in performing recommended action Use progressive goal setting
Give verbal reinforcement Demonstrate desired behaviors
The components interact with various individual characteristics and are categorized into three groups: modifying factors, individual beliefs, and actions The relationships, components, and effects of each group are illustrated in the accompanying figure.
Figure 2.1: Health Belief Model Components and Linkages (Glanz et al, 2008)
Numerous studies have utilized the Health Belief Model (HBM) to examine food safety behaviors across various groups, including restaurant workers (Cho et al., 2010), primary food preparers in families with young children (Lum, 2013; Meysenburg et al., 2013), and older adults (Hanson and Benedict, 2002) These studies demonstrate that the components of HBM interact with one another and significantly influence individual behaviors, particularly highlighting the strong impact of food safety knowledge on perceptions of food safety.
EMPIRICAL REVIEWS ON DRIVERS OF FOOD SAFETY PRACTICES
Participants with a college degree or higher demonstrated superior food safety knowledge and behavior compared to those with lower educational attainment (Meysenburg et al., 2013) The research team employed the Health Belief Model and utilized a mixed-method analysis, which included scripted interviews and group discussions, to evaluate a sample of 72 participants.
Modifying factors Individual Beliefs Action
Perceived susceptibility to and severity of disease
Unusan (2005) found that higher education levels positively influence confidence in food safety practices, leading to reduced risk behaviors compared to those with lower education However, the study revealed no correlation between socio-economic status and individual food safety practices The research was conducted on Turkish households and utilized MANOVA for data analysis.
Unusan's research highlights the significant influence of gender and education level on food safety knowledge, as women, who are often the primary food preparers in households, tend to be more educated and attentive to information Supporting this, studies by Byrd-Bredbenner et al (2007) and Mullan et al (2014) also reveal that older individuals generally possess greater food knowledge Furthermore, research by Jevsnik et al (2006) indicates that women are more likely to take responsibility for food safety than men These findings were confirmed through participant analysis using ANOVA, underscoring the relationship between demographic factors and food safety awareness.
A study conducted by Langiano et al (2012) found that married individuals exhibited healthier eating habits compared to their single counterparts Additionally, the research indicated that as family size increased, the primary cook's food practices became more accurate and conscientious.
Food preparers primarily acquire their knowledge of food processes from family members and relatives (Meysenburg et al., 2013) Research has shown that families serve as crucial resources for food safety knowledge, significantly influencing individual behaviors (Kwon et al., 2008; Trepka et al., 2006) Kwon's study, which involved participants from the Special Supplemental Nutrition Program for Women, Infants, and Children, utilized a questionnaire to assess food knowledge and behavior, analyzing the results through ANOVA The findings revealed that individuals with strong food knowledge tend to engage in appropriate food practices.
(T H Vo et al, 2015) These authors group investigated in the canteens’ and restaurant’s workers by using logistic regression model to get this finding
Research by Cho et al (2010) indicates that the food safety knowledge of participants does not significantly affect their food practices This study, which focused on restaurant workers using multiple regression and maximum likelihood estimation, aligns with findings from Roberts et al (2008), which demonstrate that even after training and education in food safety, food workers exhibit only minimal changes in behavior These results support the notion that knowledge alone has a limited impact on influencing individual behavior change in food safety practices.
Individuals with high self-efficacy believe they can effectively prevent health threats and foodborne diseases (FBD) when managing food themselves (Meysenburg et al., 2013) However, this confidence diminishes when food is prepared by others Furthermore, those who have experienced foodborne illnesses or have inadvertently caused illness in family members due to improper food handling tend to feel less confident in their food preparation abilities.
Numerous studies reveal inconsistent findings regarding food safety perception and behavior According to Nesbitt et al (2013), many consumers believe that food contamination occurs prior to reaching their kitchens, with a significant number attributing their foodborne illnesses to meals prepared outside the home Conversely, Unusan (2007) found that consumers often do not recognize food poisoning as a serious health concern, viewing it as a commonplace issue This misunderstanding contributes to a lack of motivation to modify food safety practices or to prioritize food safety concerns.
Jevsnik et al (2006) discovered that household cooks favored products from farmers over those from industrial factories, believing that farmer-produced food was safer However, consumers expressed that they did not feel responsible for food safety, attributing that responsibility to food handlers—such as farmers, food factories, retailers, and caterers—as well as the government Additionally, research by Byrd-Bredbenner et al (2007) revealed that individuals under 30 often overestimated their ability to handle food safely, despite evidence to the contrary.
A study by T H Vo et al (2015) established a link between food safety knowledge and individual attitudes towards food safety issues, although the connection between attitude and food practices was found to be insignificant Similarly, Cho et al (2010) discovered that individuals with strong food safety knowledge are more likely to recognize the severity and likelihood of food poisoning Additionally, consumers with accurate food knowledge face fewer challenges in handling food safely However, the research did not identify a direct influence of knowledge on perceptions of foodborne disease (FBD) prevention or safe food practices Instead, it highlighted that individuals who understand the benefits of avoiding food poisoning are more likely to engage in safe food handling behaviors consistently.
Hanson and Benedict (2002) found that awareness of foodborne disease (FBD) severity can enhance individual behaviors, although the link between perceived FBD hazards and food safety practices is weak Their findings were derived using nonparametric statistics, specifically Spearman rank correlation coefficients.
A study by Cho et al (2010) highlighted a significant correlation between cues and individual food safety practices According to Lum (2010), individuals who have previously experienced foodborne diseases (FBD) are more inclined to adopt safe food handling practices However, Lum also noted that experiencing illness symptoms does not consistently result in improved food safety behaviors.
A similar result from Hanson and Benedict (2002) showed that the cue, content of
The study revealed that males experience a lesser impact from education compared to females, while older individuals are more significantly influenced by educational factors Additionally, the effect of education varies based on an individual's frequency of food handling.
A study by Byrd-Bredbenner et al (2013) found that food label messages regarding risky food practices positively influenced individual behaviors The research revealed that consumers across different age groups were concerned about food safety knowledge, but their level of concern was heightened when information was tailored specifically to their demographic.
Mullan et al (2014) highlighted that past behaviors and habits significantly predict current actions Habits develop through the repeated performance of behaviors within consistent contexts or in response to specific cues A lack of prompts or cues to action may lead individuals to neglect food safety practices in their homes.
RESEARCH METHODOLOGY
ANALYTIC FRAMEWORK
The study applied the Health Belief Model (HBM) framework to assess food safety behaviors, considering key components evaluated through specific variables Modifying factors included individual and demographic characteristics of participants and their families, while knowledge centered solely on food safety issues Additionally, individual beliefs were measured by attitudes and awareness regarding food safety Furthermore, participants' actions were assessed through various food safety practices, with information sources serving as cues for these behaviors.
Due to the limitation of the secondary data, the components from HBM measured in several variables:
- Modifying factors: age, gender, residential location, occupation, education level, number of family’s member and the knowledge about food safety issue
- Individual belief: the awareness about the food safety problem, risky group and reason of food poisoning; attitude about food selection and processing; food source chosen
- Individual behavior: hygiene, process, preserve practice
- Cues to action: the food safety information source
The relatives and interactions of those components illustrated in the figure below:
ECONOMETRIC MODELS
The thesis utilizes the multivariate probit model (MVP) to analyze the impact of independent variables on various food safety behavior groups The study focuses on three key aspects of food safety: kitchen hygiene practices, food processing and preservation practices, and individual hygiene practices By employing the MVP with three equations, the research aims to provide comprehensive insights into these behaviors.
+ TV, newspaper + Local food safety communicator
Perceived susceptibility to and severity of disease
- Attention about food safety problem
Individual beliefs influence dependent variables, as described by Cappellari and Jenkins (2003) in their trivariate probit model The model is represented by the equation y im ∗ = β m X im + ϵ im for m = 1, 2, 3, where yim equals 1 if yim* is greater than 0, and 0 otherwise The error terms ϵ im for m = 1 to 3 are distributed as multivariate normal with a mean of zero and a variance-covariance matrix V, which has 1s on the leading diagonal and correlations ρjk = ρkj in the off-diagonal elements.
The log-likelihood function for the sample of N independent observation is given by:
Where ωi is an optional weight for observation i=1,…, N, and ϕ3 is the trivariate standard normal distribution with arguments ài and Ω, where
𝜇 𝑖 = (𝐾 𝑖1 𝛽 1 ′ 𝑋 𝑖1 , 𝐾 𝑖2 𝛽 2 ′ 𝑋 𝑖2 , 𝐾 𝑖3 𝛽 3 ′ 𝑋 𝑖3 ) With Kik=2yik – 1, for each I, k = 1,…,3 Matrix Ω has constituent elements Ωjk, where: Ωij = 2 for j =1,…,3 Ω21 = Ω12 = Ki1Ki2ρ21 Ω31 = Ω13 = Ki3Ki1ρ31 Ω32 = Ω23 = Ki3Ki2ρ32
The probability of every outcome is given by:
The study examines nine food safety practices categorized into three behavior groups: "kprac" for kitchen hygiene practices, "pprac" for processing and preservation practices, and "iprac" for individual hygiene practices Each practice is assigned a binary value of 1 for correct execution and 0 for incorrect execution, with the thesis defining correct practice as all behaviors within a group being accurate The behaviors are based on the "10 golden principles in food processing," with specific practices like maintaining a clean kitchen and separating cooked and raw foods further divided into four distinct behaviors for easier evaluation.
- “sex” is the dummy variable indicate the sexuality of participant, 0 for male and
1 for female The expected regression coefficient of this variable is predicted insignificant, due to the fact that most of the responders were females;
The variable "loc" serves as a dummy variable representing the location of respondents, with a value of 0 assigned to suburban participants from 12 districts, including Binh Tan, Binh Chanh, Thu Duc, Go Vap, and others, while a value of 1 is designated for urban participants from another set of 12 districts.
The analysis indicates that urban participants in areas such as Phu Nhuan, Tan Binh, Tan Phu, and Binh Thanh are expected to exhibit a higher probability of precise behavior compared to their suburban counterparts This is reflected in the anticipated positive regression coefficient for this variable.
The variables "age," "exp," and "f_member" represent the age in years, food expenditure in hundred thousand VND, and the number of family members, respectively It is anticipated that the regression coefficients for these variables will yield positive values To achieve a normal distribution for these variables, the thesis employs the natural logarithm of age (lnage) and expenditure (lnexp) for coefficient estimation.
The article categorizes respondents based on their job roles, such as office clerks, retirees, householders, physical laborers, and farmers, alongside their education levels, which range from below primary to university To simplify analysis and enhance interpretability, the study transforms the education variable into years of schooling and consolidates job categories into three groups: householders, common laborers, and others.
The "know" variable assesses participants' food safety knowledge, derived from a questionnaire based on WHO guidelines This knowledge is categorized into two groups: safe food selection and food processing and preservation Participants' scores, reflecting their understanding, are calculated using the difficulty index method outlined by Collen (2006, pp 98-100).
𝑁 , where: ρ: difficulty index nc: the number of right answer
N: the total number of responders
The study utilized a questionnaire to assess participants' perceptions of food safety issues, focusing on four key areas: susceptibility to and severity of foodborne diseases (FBD), benefits, barriers, and self-efficacy Despite data limitations, factor analysis was employed to identify perception factors from three of these groups, excluding the perception of benefits.
The study categorizes "cue" as the variable representing the sources of food safety information for respondents, including TV, radio, newspapers, local medical staff, and food documentaries To analyze this data, the thesis employs dummy variables for each cue: TV, radio, news, local staff, and food documentaries A detailed description of all the variables utilized in the model is provided in the table below.
Sex Gender of participant 0 for male, 1 for female
Location Residential place 0 for suburb, 1 for urban
Age The age of participant Years old
Expenditure Amount of money for food consumption Hundred thousand VND Family member Number of family member Person
Education Education level The number of schooling years
Job Occupation of participant Category variable: common labor, householder, other
Knowledge Food safety knowledge Food safety knowledge point Perception Awareness about food safety issue 3 point Likert’s scale
Cue to action Food safety information source Category variable: TV, radio, newspaper, local medical staff, food documentary
Multicollinearity occurs when explanatory variables in a regression model exhibit a linear relationship There are two types: perfect multicollinearity and imperfect multicollinearity In cases of perfect multicollinearity, the regression coefficients of the dependent variables become indeterminate, leading to infinite standard errors Conversely, imperfect multicollinearity results in determinate regression coefficients, but with large standard errors relative to the coefficients, indicating that these coefficients cannot be estimated with high precision or accuracy (Gujarati, 2004).
Research by Cho et al (2010) and T H Vo et al (2015) explored the relationship between knowledge and perceptions of food safety, utilizing a Likert scale to measure perceptions This approach indicates trends rather than the magnitude of perception's influence on behavior The study, which included over 1,000 observations, mitigated the effects of multicollinearity in the regression model Additionally, the thesis employed both the reduced form and the original form of the MVP to estimate the regression coefficients effectively.
3.2.3 Propensity Score Matching (PSM) Method
Chow and Mullan (2009) emphasize that past behaviors significantly influence food safety practices, recommending cues to help individuals adopt these behaviors as habits to improve cooking practices Additionally, Jevsnik et al (2007) highlight that consumers often lack awareness of their responsibilities within the food safety chain, which contributes to the prevention of foodborne diseases (Byrd-Bredbenner et al.).
2007) Due to these reason, the consumers could hardly change their behavior in a short time period after suffering food poisoning
Individuals often rely on rationality when they understand the cause-effect relationship between proper behavior and health benefits (Mari et al., 2008) However, it can be challenging for household cooks to identify practices that contribute to foodborne diseases (FBD) Moreover, the food poisoning data only accounted for health statements over a two-week period, leading this paper to assume that food poisoning incidents did not influence individual behavior Consequently, the study employs the Propensity Score Matching (PSM) method to estimate the probability of food poisoning based on individual behavior.
Khandker et al (2009) explain that Propensity Score Matching (PSM) creates a statistical comparison group by modeling the likelihood of treatment participation based on observed characteristics This method matches participants with nonparticipants according to their propensity scores To analyze the impact of food practices on the risk of food poisoning, this thesis employed PSM through a systematic four-step process.
- Step 1: establish the logit regression model with the dependent variable receive value as “0” if the participant had not suffer FBD within 2 week at the survey time, and
“1” otherwise The explanatory variables are individual food safety behaviors
- Step 2: using the probit regression model to predict the FBD possibilities of each responder in the survey data
- Step 3: remove all observations with too high or too low prediction among the sample
- Step 4: compare the food safety practices between 2 groups “suffer FBD” or
“non suffer FBD” in order to evaluate the impact of behavior to FBD probability of individual
The relative of continuous variables would check by the t-test while the bivariate variables’ tests by the Chi-square test.
DATA
In 2013, a comprehensive investigation was conducted in Ho Chi Minh City, focusing on individual food poisoning cases and assessing the Knowledge, Attitude, and Practice (KAP) regarding food safety among local households The findings from these surveys provide valuable insights into the food safety landscape in the city, highlighting critical areas for improvement and public awareness.
- Data source: Safety Hygiene Food Branch of Ho Chi Minh city
- Data description: the data had two parts:
+ Part 1 is the investigation in individual food poisoning and the relevant symptoms, included: individual characteristic, demographic information, food poisoning statement and clinical symptoms
+ Part 2 is the KAP survey of primary cook of household, included: individual characteristic, food safety knowledge, food safety attitude and examining the food safety practicing of primary cook
- Size of samples: 1,174 households and 4,593 individual participate in the survey The households were chosen by Probability Proportional to Size sampling technique (PPS):
In a study conducted across Ho Chi Minh City, researchers randomly selected 30 wards from a total of 319 Within each ward, surveyors began by interviewing the first household, followed by 39 additional households on the right side The survey utilized four questionnaires focusing on acute food poisoning, food knowledge, attitudes towards food, and food practice evaluation While the food practice checklist was assessed by the surveyor, the other questionnaires were completed by the respondents Local medical staff responsible for food safety in each selected ward carried out the research.
To participate in the survey, households needed to meet specific criteria: all members must have resided at the same location for a minimum of six months prior to the investigation Each household had to consent to participate, with members sharing the same address, having at least one meal together, and engaging in similar household responsibilities If a household was unapproachable after three attempts, it would be replaced by another.
Participants in the survey were individuals without mental illness, deafness, or speech impairments Children included in the survey were at least 6 months old, as infants primarily consume breast milk Responses from children under 10 years old were verified by their mothers or primary caregivers.
+ The symptoms to diagnose food poisoning case: after having meal, the patient had the stomach-intestine symptoms (colic, vomit, diarrhea…), nerve symptoms
Food poisoning symptoms, such as a stiffened tongue, illusions, delirium, and convulsions, vary depending on the pathogen involved A case is only classified as food poisoning if individuals experienced symptoms after consuming a meal prepared at home A household is deemed to have suffered food poisoning when the primary cook or any family member exhibits symptoms following a home-cooked meal.
This thesis integrates two data components to assess the relationship between knowledge and perceptions of food safety and individual behaviors It also estimates how these food safety behaviors influence the likelihood of food poisoning among individuals.
RESEARCH RESULTS
FOOD SAFETY PROBLEMS IN VIETNAM
According to the World Health Organization (2016), food-borne diseases in Vietnam impose an estimated burden of around 1 billion USD annually, accounting for 2% of the country's GDP This figure encompasses costs related to lost work time, decreased productivity due to illness, and associated market losses Additionally, statistics from the Vietnam Food Administration (VFA) indicate that between 2007 and 2015, there were 150 reported cases of food-borne illnesses.
Vietnam experiences approximately 250 mass food poisoning outbreaks annually, affecting over 5,000 individuals each year Despite the implementation of the National Strategy on Food Safety since 2006 and the validated strategy for 2011-2020, the incidence of food poisoning cases remains consistently around 5,000 per year.
The stagnation in food safety regulations can be attributed to the inefficiency of legacy institutions Although the Law of Food Safety was enacted in 2011, accompanying regulatory documents remain inadequate, leaving the Food Safety Department without the necessary authority to enforce standards This gap results in insufficient information and guidance for both manufacturers and consumers regarding food safety practices Additionally, the complex network of food safety administration, involving multiple ministries and departments, further complicates the situation The tropical climate and ongoing climate change exacerbate the risk of foodborne illnesses, while the diverse nature of Vietnamese cuisine combined with limited consumer knowledge increases the likelihood of foodborne disease outbreaks Despite a stable incidence of food poisoning, the mortality rate has only gradually declined, with a significant portion attributed to natural toxins (Nguyen, 2016).
Figure 4.2: The number of food poisoning outbreaks and death in Vietnam
Between 2012 and 2016, Ho Chi Minh City experienced a decline in food poisoning incidents, recording a total of 20 cases with no fatalities Of these incidents, 19 were attributed to bacterial sources, while one case had an unidentified cause.
Figure 4.3: The number of food poisoning cases in HCM city (FSBDH, 2016)
Food poisoning cases in Vietnam, particularly in Ho Chi Minh City, are underreported due to insufficient government and research focus on this issue, leading to a lack of educational programs on safe household food preparation and cooking Most government resources are allocated to managing manufacturers and merchandising A 2013 survey revealed an individual food poisoning rate of 2.18%, indicating a significant risk of food-borne diseases within the population.
4.1.2 Problems with household’s cooking behavior
The Vietnamese government's insufficient focus on household food safety has led to poor practices among primary cooks A 2010 investigation by the Safety Hygiene Food Branch of Ho Chi Minh City revealed concerning statistics regarding food safety standards in the region.
54.3% of consumers in Ho Chi Minh city behave accurately in cooking The figures for Lao Cai province and Dong Thap Province are 67.7% and 76%, respectively (Nguyen,
Researchers emphasize the need for specific education programs for household cooks to enhance their food safety behaviors However, most communication and education strategies tend to prioritize food producers and workers instead While food poisoning incidents in households may appear less severe than those in schools and factories, the reality is that urban consumers often eat out due to time constraints, frequenting company canteens, schools, and various food establishments As a result, the significance of household cooking practices is often overlooked, leading to minimal governmental efforts to improve these practices.
DESCRIPTIVE STATISTICS
The data includes 1,174 households primary cooks with the characteristics listed in Table 4.1 and Table 4.2
Table 4.1: Demographic characteristics of participants (category variables) Demographic characteristics Number of participants (n) %
Data indicates that 93.02% of primary cooks in households are female, while 69.78% of respondents identify as householders Aside from common labor and householders, other occupations are negligible Consequently, the regression analysis categorizes occupations into three distinct groups: householders, common labor, and others.
The education levels of participants varied across the education system, with the majority holding Junior and High School diplomas The sampling method resulted in a nearly equal distribution of respondents from urban (53.53%) and suburban (46.47%) areas Television emerged as the primary source of information for households, utilized by 87.31% of respondents, followed by newspapers as the second most popular source Conversely, only 24.19% of participants reported receiving food safety information from local medical staff Additionally, the incidence of food poisoning in households was recorded at 5.11%, compared to 2.18% for individuals, highlighting that multiple food poisoning cases can occur within a single household.
In contrast, the descriptive statistic of continuous variables is show on the table below:
Table 4.2: Demographic characteristics of participants (continuous variables)
Variables Mean SD Min Max
The average age of the primary cook in Ho Chi Minh City is 47 years, highlighting that food preparation is predominantly the responsibility of middle-aged women, consistent with traditional Vietnamese family structures Households in the city average just over four members, aligning with government population policies On average, families spend nearly 100,000 VND daily on food, and the primary cooks possess a basic understanding of food safety, reflected in an average knowledge score of 9.46 out of 14.04 However, due to differences in the evaluation methods used in the 2010 survey, it is not possible to directly compare results from the two periods.
The Health Belief Model identifies five latent variables: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy However, this thesis evaluated only four components due to insufficient data: perceived susceptibility (3 questions), perceived benefits (3 questions), perceived barriers (1 question), and perceived self-efficacy (11 questions) The correlation coefficients ranged from -0.0004 to 0.8587, indicating relationships among these items Additionally, the Kaiser-Meyer-Olkin (KMO) value of 0.947 suggests a strong correlation, while the determinant of the correlation coefficient matrix is non-zero (p-value < 0.01), and Bartlett’s test also confirms significant results (p-value < 0.01) These findings indicate that the data is suitable for factor analysis.
The Cronbach alpha’s value of all components and the factor analysis result (after rotation) were showed in the table below
- Attention about food safety problem
Hygiene hand before touching food
Hygiene hand after touching food
Eating food right after processing
Among 18 factors (Appendix 2), there are three factors which Eigen value were more than one, accounted for a cumulative 66% of variance Therefore, the thesis showed all 3 factors and using only factor 1 (accounted for 50% of variance) as the indicator of perception value for the multivariate regression In summarize, the perception value varied from -3.01 to 2.36 with the average at 1 This figure implied the majority of participant perceived the threat of food safety issue
A recent survey revealed that individual hygiene practices were the most commonly observed behaviors among participants, with an accuracy rate of 81.48% Notably, hand washing emerged as the most accurately practiced behavior, with an impressive 97.77% compliance However, the processing and preservation of food showed the lowest adherence, with only 78.34% of participants practicing these behaviors correctly Additionally, the practice of not smoking, spitting, or using nail polish while cooking was reported by 81.68% of respondents.
A significant number of respondents demonstrated adherence to food safety practices; however, the percentage of individuals exhibiting perfect behavior remains notably lower across all groups This finding reflects an increase compared to the 2010 survey, which reported a compliance rate of 54.3%, whereas the current figure stands at 61.87% Despite the 2010 evaluation not being conducted by medical professionals, the improvement in individual food safety practices is still meaningful Detailed results can be found in the table below.
Behavior (n68) Responder with right behavior
- Separate cooking tool for cooked and uncooked material
- Separate in preserving with enough facilities
- Use clean tool to prepare, divide food
- Not use forbidden food additives or out of date food
- Wash hand before cooking or after toileting
- Not smoke, spit out, nail polished while cooking
Figure 4.4: The nonparametric relationship between food safety practice and
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Foo d s af et y K no w dle dg e v alu e
Figure 4.4 demonstrates the relationship between participants' practice evaluations and their perceived value and knowledge scores The data indicates that responders exhibiting appropriate behaviors within each practice group reported higher values in perception and food safety knowledge compared to others, despite the explanatory variables falling within a similar range The subsequent regression analysis will further elucidate these relationships.
RESULTS FROM MULTIVARIATE PROBIT MODELS
The Health Belief Model suggests that behaviors are influenced by perceived value and cues to action, while modifying factors such as individual characteristics and food safety knowledge indirectly affect these behaviors Consequently, this thesis employs both a reduced form of the multivariate probit model, focusing on perceived value and cues to action as independent variables, and the original form of the multivariate probit model, which includes all independent variables.
Table 4.5: MVP regression reduced form Variable Coefficient p-value Coefficient p-value Coefficient p-value
The table presents the coefficients, standard errors, and p-values from the reduced form of a multivariate probit analysis All three pairs of estimated coefficients are positive and significant, with values of 0.57 for the relationship between Hygiene kitchen practice and Process/preserve practice, 0.46 for Hygiene individual practice and Hygiene kitchen practice, and 0.48 for Hygiene kitchen practice and Process/preserve practice These positive correlation coefficients indicate that a primary food preparer's likelihood of engaging in a specific set of behaviors increases when they demonstrate proficiency in at least one of the other two behavior groups.
The correlation coefficients indicate a strong positive relationship between perception value and food practice behaviors, with significant values for hygiene kitchen practices (0.191), process/preserve practices (0.561), and hygiene individual practices (0.316) These findings suggest that individuals' perceptions have a beneficial impact on their food-related behaviors.
Radio news significantly influences hygiene kitchen practices and food preservation, with positive correlations of 0.367 and 0.511, respectively Participants who listen to radio news tend to maintain cleaner kitchens and better food preservation practices Conversely, food documentaries and advice from local medical staff negatively impact food preparers, leading to poorer hygiene practices and food preservation Regression analysis indicates that those who engage with food documentaries or receive safety information from local medical staff exhibit worse hygiene and preservation behaviors Other factors assessed show no significant effect.
Table 4.6: MVP regression original form
Variable Coefficient p-value Coefficient p-value Coefficient p-value
Hygiene individual practice Food safety knowledge
- Local staff (*) -0.160 0.194 -0.611 0.000 -0.378 0.002 ρkp ρik ρip
The regression analysis revealed consistent relationships among the variables in the reduced form, indicating that knowledge of food safety significantly influences participants' behaviors across all three groups Notably, living in urban areas negatively affects food processing and preservation practices (p-value < 0.05), suggesting that urban residents are less meticulous in these tasks compared to those in suburban areas Additionally, the size of the household impacts kitchen hygiene practices, with cleaner kitchens observed in larger households However, the other variables analyzed did not demonstrate any statistically significant effects The marginal effects of the multivariate probit regression are summarized in the table below.
Table 4.7: Marginal effect after MVP regression
Variable ME p-value ME p-value ME p-value
Hygiene individual practice Food safety knowledge
- Common labor (*) 0.017 0.722 0.015 0.722 0.016 0.722 Logarithm of Age 0.038 0.400 0.035 0.400 0.035 0.400 Logarithm of Food expenditure
Notes: (*) dummy variables, ME: marginal effect
The marginal effect of each variable reveals the specific impact of various factors on the independent variable For example, a one-point increase in knowledge score correlates with a 1.9% rise in the likelihood of proper food safety behavior related to kitchen hygiene, and a 1.7% increase in adherence to process, preservation, and individual practices This pattern is similarly observed with family size; as perceptions improve, the likelihood of accurate practices across all three categories also rises Additionally, individuals who receive food safety information via radio demonstrate significantly better behaviors—approximately 10% improvement in kitchen hygiene practices and 9.1% in process, preservation, and individual practices—compared to those who do not.
Local medical staff recommendations can reduce the likelihood of proper individual practices by 37.8% Additionally, food safety information from documentaries negatively impacts hygiene kitchen practices by 9.9% and process/preservation practices by 8.9%.
To validate the regression results, the thesis employed a Poisson model to accurately predict the number of behaviors practiced by participants, assuming uniform effects on food poisoning This model utilized the same independent variables as the multivariate probit model, with the dependent variable representing the count of correct behaviors performed by participants, capped at a maximum of 12 The regression outcomes are detailed in the table below.
Variable Coefficient p-value ME p-value
The Poisson regression analysis, like the MVP regression, demonstrates a significant relationship between behavior and factors such as food safety knowledge, perceived value, location, and various cues to action, including radio, food documents, and local medical staff However, unlike the MVP regression, the Poisson regression reveals that the number of family members does not influence the precise behavior of the primary cook in the household.
RESULTS FROM PROPENSITY SCORE MATCHING MODEL
A survey of 4,593 participants revealed 98 suspected cases of food poisoning across 79 households Notably, 60 of these cases reported symptoms occurring after consuming home-prepared meals.
In the MVP model, all variables serve as explanatory factors in the estimated probit regression, with the addition of the independent variable "food_place," which indicates the location where food was purchased This variable is coded as "0" for food bought at regulated markets or supermarkets and "1" for purchases made at unregulated spontaneous markets, aiming to demonstrate a negative correlation with food poisoning incidents The expenditure variable has been excluded to maintain the balancing property, while the dependent variable represents households that have experienced food poisoning, coded as "1" for those affected and "0" for those unaffected It is important to note that the coefficients derived from this regression differ significantly in interpretation compared to previous models due to the substantial disparity in the values of the dependent variable.
(60 versus 1115) The table below shows the result of the probit model:
However, after estimating the propensity score and choosing the control group by radius matching (caliper is 0.0001), there are only 33 observations in treated group and
In a study involving a control group of 96 participants, the expenditure variable was found to create an imbalance in the probit regression analysis Despite this, the impact of the expenditure variable was evaluated through testing, which did not influence the results of the Propensity Score Matching (PSM) method Additionally, the mean differences of continuous variables between individuals who experienced foodborne diseases (FBD) and those who did not were assessed using a t-test, yielding significant results.
Table 4.10: Differences of continuous variables
(Not suffered FBD – Suffered FBD) p-value
At the 5% significance level, the analysis reveals that the only significant differences between respondents who suffered from poisoning and those who did not are related to their food expenditure and years of schooling Specifically, the poisoned group spent nearly 21,000 VND more on food and had more years of education Additionally, there is a notable difference in the precision of behaviors between the two groups, with non-sufferers exhibiting more accurate practices; however, this distinction is only significant at the 10% level.
On the other hand, the correlations between the binary variables and the FBD variable tested by the Pearson’s Chi square test:
Table 4.11: Correlations between binary variables and FBD
Variable Pearson’s Chi square value p-value
The analysis revealed that the living environment significantly influences the likelihood of experiencing foodborne disease (FBD), with a p-value of less than 0.05 In contrast, other factors examined did not demonstrate a substantial correlation, indicating minimal differences between individuals affected by FBD and those who were not.
DISCUSSION AND IMPLIED POLICY
POLICY IMPLICATION
To address the shortcomings in food safety management, the government must enhance the knowledge of medical staff and develop institutions dedicated solely to food safety oversight Strengthening communication channels is essential, particularly by increasing the quantity and quality of food safety information shared, focusing on proper food handling rather than just warning messages on national TV Radio has proven to be an effective medium for disseminating food safety information, especially in mountainous and remote areas where radio signals are more accessible than television The improvement in food safety knowledge from 2010 to 2013 indicates a growing public interest in food safety issues The government should leverage this trend to educate the population and encourage their participation in food safety initiatives, potentially utilizing freelancers or community communicators to facilitate this outreach.
The study indicates that there is no direct correlation between consumer behaviors and the locations where food is purchased in relation to foodborne diseases (FBD) To mitigate hazards, it is essential to ensure the quality of food resources and restaurants is well-regulated Additionally, school education programs should incorporate practical life skills, while public food safety communication should target consumers more than manufacturers or restaurant staff Furthermore, food from supermarkets or organized markets may not necessarily be of higher quality than that from informal markets, despite higher costs; thus, the government should establish specific standards and quality control institutions for these markets Lastly, environmental factors, particularly water quality, require regular monitoring and improvement, especially given that a significant portion of Ho Chi Minh City's population lacks access to clean water, which poses risks to individual health outcomes.
LIMITATION AND IMPLICATIONS FOR FURTHER RESEARCH
The FBD survey relies on participants’ self-reports rather than medical doctors' assessments, which may lead to inaccuracies in the findings Furthermore, the data primarily reflects a medical perspective and lacks sufficient economic variables, particularly regarding perception To better understand the factors influencing the probability of FBD and the impact of living environments and food resources, additional research is necessary.
Foodborne diseases (FBD) are linked not only to food poisoning but also to chronic illnesses like cancer, making it challenging to directly attribute pathogens to specific food sources Consequently, further research is essential to uncover more evidence in this area.
The thesis highlights that the living environment significantly influences foodborne diseases (FBD), necessitating further evidence to clarify this relationship In particular, the quality of water used for edible purposes is crucial, as water sources differ between urban and suburban areas.
This research faces challenges in its measurement methods, as many variables differ from those used in similar studies, potentially leading to less reliable comparisons Furthermore, the perception value was assessed through a questionnaire that lacked sufficient questions and effective techniques to encourage respondents to reveal their true feelings.
The correlation matrix of perception’s factors
The data presents a series of numerical values associated with various categories labeled from a1new to a18new, showcasing their respective correlations Notably, a1new exhibits a perfect correlation of 1.0000 with itself, while a2new also shows a strong correlation of 0.7716 with a1new The values for a14new and a13new indicate high correlations of 0.5619 and 0.6492, respectively, suggesting significant relationships among these categories Additionally, the values for a10new and a9new reflect correlations of 0.6304 and 0.6621, indicating a moderate level of association Overall, the dataset highlights varying degrees of correlation across the different categories, emphasizing the interconnectedness within the dataset.
PCA result
Factor Eigenvalue Difference Proportion Cumulative
MVP regression (reduced form)
Likelihood ratio test of rho21 = rho31 = rho32 = 0: rho32 4790893 0463972 10.33 0.000 3831738 564783 rho31 4570518 0457674 9.99 0.000 3628716 5419888 rho21 5779966 0398654 14.50 0.000 4945877 650856 /atrho32 5218016 0602191 8.67 0.000 4037743 6398289 /atrho31 4935782 0578527 8.53 0.000 3801891 6069673 /atrho21 659449 0598651 11.02 0.000 5421155 7767824 _cons 1.115008 131358 8.49 0.000 8575512 1.372465 loc_staff -.2856251 1125314 -2.54 0.011 -.5061825 -.0650677 doc -.2218455 1445481 -1.53 0.125 -.5051546 0614635 news -.1736675 0932207 -1.86 0.062 -.3563769 0090418 radio 1360822 106534 1.28 0.201 -.0727206 344885 tv -.0526691 1323381 -0.40 0.691 -.3120469 2067088 perc_f1 3153075 0457522 6.89 0.000 2256348 4049802 indi
_cons 8597885 1280854 6.71 0.000 6087457 1.110831 loc_staff -.3910883 1129624 -3.46 0.001 -.6124905 -.1696861 doc 0380902 1532165 0.25 0.804 -.2622086 3383889 news -.1393973 0918987 -1.52 0.129 -.3195155 040721 radio 5054202 1102772 4.58 0.000 2892808 7215597 tv 01221 1287667 0.09 0.924 -.2401682 2645881 perc_f1 5595797 0538308 10.40 0.000 4540732 6650862 proc
_cons 8138421 1249069 6.52 0.000 5690291 1.058655 loc_staff -.041626 1137304 -0.37 0.714 -.2645335 1812815 doc -.3644403 1437517 -2.54 0.011 -.6461885 -.082692 news 0023601 0902982 0.03 0.979 -.1746211 1793413 radio 3546625 1059468 3.35 0.001 1470106 5623144 tv -.0520822 1268091 -0.41 0.681 -.3006235 1964591 perc_f1 1903142 0435442 4.37 0.000 1049691 2756593 kitc
Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -1518.5305 Prob > chi2 = 0.0000 Wald chi2(18) = 178.29Multivariate probit (MSL, # draws = 5) Number of obs = 1168
MVP regression (original form)
/atrho32 5116009 0619345 8.26 0.000 3902115 6329902 /atrho31 4838027 060206 8.04 0.000 3658011 6018044 /atrho21 7554267 0655425 11.53 0.000 6269657 8838876 _cons -.043319 1.424135 -0.03 0.976 -2.834573 2.747935 loc_dum -.1004265 0978174 -1.03 0.305 -.292145 0912921 loc_staff -.3780484 1210943 -3.12 0.002 -.6153888 -.140708 doc -.2109011 1503647 -1.40 0.161 -.5056104 0838083 news -.2908288 1000615 -2.91 0.004 -.4869457 -.0947119 radio 1352087 1093668 1.24 0.216 -.0791462 3495636 tv -.119521 136583 -0.88 0.382 -.3872188 1481768 perc_f1 2590135 0495196 5.23 0.000 1619568 3560702 lnexp 0184813 1028084 0.18 0.857 -.1830195 2199822 lnage 0848241 1683457 0.50 0.614 -.2451273 4147756 job_new2 -.1420892 1721359 -0.83 0.409 -.4794695 195291 job_new1 -.1077489 1512042 -0.71 0.476 -.4041037 188606 edu_new 0176512 0135823 1.30 0.194 -.0089696 044272 sex 1051301 1846875 0.57 0.569 -.2568508 467111 f_mem 0219332 0236432 0.93 0.354 -.0244066 068273 know2 0663949 0219701 3.02 0.003 0233343 1094554 indi
_cons -1.336828 1.416824 -0.94 0.345 -4.113753 1.440096 loc_dum 7533018 1046908 7.20 0.000 5481116 9584921 loc_staff -.6107935 1252602 -4.88 0.000 -.856299 -.3652881 doc -.2434742 1594121 -1.53 0.127 -.5559162 0689678 news -.1172928 1002116 -1.17 0.242 -.3137039 0791183 radio 3673403 1156295 3.18 0.001 1407106 5939699 tv -.0984783 1385747 -0.71 0.477 -.3700797 1731231 perc_f1 4491142 0566682 7.93 0.000 3380466 5601818 lnexp -.0402706 1018324 -0.40 0.693 -.2398585 1593172 lnage 2859399 1696803 1.69 0.092 -.0466273 6185071 job_new2 -.1626987 1753452 -0.93 0.353 -.506369 1809716 job_new1 044128 1540247 0.29 0.774 -.2577549 3460109 edu_new 0365416 0138528 2.64 0.008 0093906 0636926 sex 0971573 1934886 0.50 0.616 -.2820734 476388 f_mem 0366151 0231059 1.58 0.113 -.0086717 0819019 know2 1033148 0223409 4.62 0.000 0595275 1471022 proc
_cons -.2533119 1.378816 -0.18 0.854 -2.955741 2.449118 loc_dum -.0398895 0942509 -0.42 0.672 -.2246178 1448388 loc_staff -.1597777 1228875 -1.30 0.194 -.4006328 0810774 doc -.3515957 1503444 -2.34 0.019 -.6462652 -.0569261 news -.0582825 0965137 -0.60 0.546 -.247446 130881 radio 3581531 1099266 3.26 0.001 142701 5736053 tv -.1535407 1309093 -1.17 0.241 -.4101183 1030368 perc_f1 1364628 046897 2.91 0.004 0445464 2283792 lnexp -.0294486 099663 -0.30 0.768 -.2247844 1658872 lnage 1361739 16177 0.84 0.400 -.1808894 4532373 job_new2 0605255 1698464 0.36 0.722 -.2723673 3934182 job_new1 -.1238851 1469004 -0.84 0.399 -.4118047 1640344 edu_new 0189987 0132713 1.43 0.152 -.0070125 04501 sex 021229 1788945 0.12 0.906 -.3293977 3718557 f_mem 0672752 0240019 2.80 0.005 0202324 114318 know2 0666814 0209181 3.19 0.001 0256827 1076801 kitc
Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -1433.2637 Prob > chi2 = 0.0000 Wald chi2(45) = 273.03Multivariate probit (MSL, # draws = 5) Number of obs = 1147
Poisson regression
_cons 2.258058 2828686 7.98 0.000 1.703646 2.81247 loc_staff -.0411455 0249034 -1.65 0.098 -.0899552 0076643 doc -.0341781 0305385 -1.12 0.263 -.0940326 0256763 news -.0023822 0203121 -0.12 0.907 -.0421931 0374287 radio 0403983 0212309 1.90 0.057 -.0012136 0820101 tv 0051544 0277787 0.19 0.853 -.0492909 0595996 perc_f1 0449872 009692 4.64 0.000 0259911 0639833 loc_dum 0327238 019411 1.69 0.092 -.005321 0707687 lnexp -.0051244 0205234 -0.25 0.803 -.0453495 0351006 lnage 015889 0337333 0.47 0.638 -.0502271 0820051 job_4 -.0224146 0341957 -0.66 0.512 -.089437 0446078 job_5 -.0173529 0296353 -0.59 0.558 -.0754371 0407313 edu 0097375 0097973 0.99 0.320 -.0094648 0289399 sex 0126925 0364342 0.35 0.728 -.0587172 0841023 f_mem 00365 0045554 0.80 0.423 -.0052784 0125783 know2 0098917 004481 2.21 0.027 0011092 0186742 count Coef Std Err z P>|z| [95% Conf Interval]
Log likelihood = -2627.7535 Pseudo R2 = 0.0100 Prob > chi2 = 0.0000
LR chi2(15) = 53.01Poisson regression Number of obs = 1143
Questionaire form
BẢNG CÂU HỎI KIẾN THỨC VỀ VSATTP NGƯỜI DÂN
I ĐẶC ĐIỂM ĐỐI TƯỢNG KHẢO SÁT
A1) Họ và tên người được phỏng vấn:
A2) Địa chỉ: A3) Giới 1 Nam 2 Nữ
A4) Tuổi người được phỏng vấn: ………
A5) Trình độ học vấn: Không Cấp 1 Cấp 2 Cấp 3 Đại học Khác
1 Cán bộ 1 [ ] Lao động phổ thông 4 [ ]
A7) Số người có trong hộ: …………
A8) Số tiền đi chợ trung bình 1 ngày : đ_/ người ăn (*)
A9) Anh chị là người nấu ăn : Chính phụ trong gia đình
II KIẾN THỨC VỀ VSATTP: (4 Câu)
B1) Anh chị có thường để ý đến vấn đề VSATTP không ? Có Không B2) Anh chị có được thông tin về VSATTP từ :
TV Đài PT Báo chí Sách vở CBYT Khác
B3) Theo anh chị tại sao bị ngộ độc thực phẩm?
- Thực phẩm nhiễm hóa chất
- Thực phẩm không vệ sinh , bị nhiễm vi sinh vật
B4) Theo anh chị, làm thế nào để phòng ngừa ngộ độc thực phẩm cho gia đình :
Mua những loại thực phẩm đã được chế biến an toàn
Rửa rau và thực phẩm kỹ
Nấu nướng thức ăn kỹ
Tránh đụng chạm giữa thực phẩm sống và chín
3 Sử dụng/Ăn uống sau khi nấu: Ăn ngay thức ăn vừa được nấu chín
Hâm nóng thức ăn trước khi ăn
4 Ngoài việc giữ vệ sinh thực phẩm, anh chị còn chú ý giữ vệ sinh cho những việc gì khác nữa:
Giữ vệ sinh nhà bếp
Bảo quản kỹ thức ăn đã nấu
Không để thực phẩm bị côn trùng , súc vật gặm nhấm
III LỰA CHỌN THỰC PHẨM (7 Câu)
C1) Anh chị thường đi chợ nào ? vì sao ?
Thường xuyên Thỉnh thoảng Giá mắc Giá rẻ ATTP Tiện lợi (ghi rõ)
C2) Khi lựa chọn thực phẩm tươi sống, Anh chị dựa vào tiêu chuẩn nào là chính :
Màu Mùi Độ chắc Mắt Mang Da Mua người quen
C3) Khi lựa chọn rau quả tươi sống , Anh chị dựa vào tiêu chuẩn nào ?
Toàn vẹn (không bị trầy xướt , dập nát , gọt vỏ , xắt mỏng, )
C4) Khi chọn mua thực phẩm bao gói sẵn, đồ hộp, anh chị có đọc nhãn không? Có Không
C5) Nếu có , Anh chị thường xem nội dung gì trên nhãn ?
- Tên hàng hóa Tên cơ sở sản xuất
- Thành phần cấu tạo của sản phẩm Ngày sản xuất và hạn sử dụng
- Hướng dẫn bảo quản sử dụng Khối lượng
C6) Ngoài việc đọc nội dung nhãn , Anh chị còn để ý điều gì ?
- Bao bì còn nguyên vẹn, không bể, Hộp kim loại không bị phồng nắp, gĩ sét
- Nắp chai kín còn niêm phong, Khác
C7) Anh chị có sử dụng các loại phụ gia sau trong chế biến thức ăn cho gia đình
Có Không 1 lần/tuần Thỉnh thoảng
Bột nổi (làm bánh bông lan , làm mềm thịt )
Bột nổi nâu ( làm bánh mì, )
IV CHẾ BIẾN, SỬ DỤNG VÀ BẢO QUẢN THỨC ĂN (17 Câu):
E1) Mặt bếp nhà anh chị được xây dựng như thế nào và bếp sử dụng là loại gì?
- Gạch men Xi măng Gỗ Đất Bếp củi
- Bếp điện Bếp ga Bếp dầu Bếp than
E2) Anh chị thường vệ sinh nhà bếp (mặt, vách bếp, bếp nấu) khi nào?
- Sau mỗi bữa nấu xong Cuối ngày/ lần
E3) Anh chị có mang tạp dề, găng tay khi nấu nướng không?
E4) Khi chế biến thức ăn, anh chị thường rửa tay lúc nào và rửa bằng gì?
Rửa nước sạch Rửa nước sạch với xà phòng
- Sau tiếp xúc với thực phẩm sống
E5) Nhà Anh chị có bao nhiêu cái thớt ? …… cái Có phân biệt sống, chín (*) Không
E6) Anh chị có dùng khăn lau chén không? Có Không
E7) Bao lâu giặt khăn lau chén bát một lần? mỗi ngày vài ngày tuần/lần Khác
E8) Anh chị xử lý rau quả (ăn sống) bằng cách nào để bảo đảm sạch và an toàn :
Rửa nước nhiều lần Rửa thuốc tím
- Rửa nước thuốc Rửa nước muối Khác
E9) Gia đình anh chị thường bắt đầu ăn vào lúc nào, sau khi thức ăn đã nấu chín?
- Khi thức ăn còn nóng ấm
E10) Thức ăn để nguội (> 2 giờ) , trước khi ăn anh chị có hâm lại không? Có Không E11) Không hâm lại, vì sao? Mất công Thấy không sao Khác
E12) Có hâm lại như thế nào: Hâm nóng Nấu vừa sôi Nấu sôi kỹ > 2 phút Khác E13) Thức ăn thừa của bữa ăn thường để lại hay đổ bỏ
Luôn để lại Tùy món để lại Luôn bỏ đi Để lại dùng bằng cách nào? Để riêng, hâm lại Trộn với thức ăn mới, hâm lại
E14) Anh, chị thường giữ thức ăn sau khi nấu chín ( để 1 buổi ) như thế nào?
Thức ăn cho người lớn Thức ăn cho trẻ em ( ≤ 5 tuổi )
- Cho vào tủ đựng thức ăn
E15) Anh chị có trữ thực phẩm khô (bánh tráng, lạp xưởng, mực cá khô ) Có Không
E16) Bảo quản như thế nào?
Cất tủ riêng có lưới Cất tủ riêng không lưới Khác
Treo ( để trần ) Treo ( có bao bọc )
E17) Anh chị xử lý rác, thức ăn thừa trong nhà như thế nào?
- Bỏ vào giỏ rác, xô Khác
- Bỏ vào thùng rác có bao nylon có nắp đậy
- Bỏ bao nylon cột lại Điều tra viên :………
PHIẾU ĐIỀU TRA THÁI ĐỘ CỦA NGƯỜI TIÊU DÙNG VỀ NĐTP
Theo anh/chị những việc nào cần làm để phòng ngộ độc thực phẩm :
(Chọn “ * “ : kết thúc phỏng vấn)
A1 Lựa chọn thực phẩm tươi sạch
A2 Sử dụng thực phẩm có nguồn gốc rõ ràng
A3 Không ăn tái, tiết canh…
A5 Ăn ngay thức ăn vừa chế biến xong
A6 Thức ăn nấu chín sau 2 giờ cần được hâm lại hay để vào tủ lạnh
A7 Che đậy, bảo quản cẩn thận thức ăn chín
A8 Có dụng cụ chế biến riêng cho thực phẩm chín và sống
A9 Rửa sạch tay trước khi chạm vào thực phẩm
A10 Rửa sạch tay sau khi chạm vào thực phẩm
A11 Sử dụng nước sạch để chế biến thực phẩm
A12 Giữ dụng cụ chế biến luôn sạch sẽ
A13 Giữ nơi chế biến nơi chế biến luôn khô ráo và sạch sẽ
A14 Tìm hiểu thông tin về Vệ sinh an toàn thực phẩm
Theo anh/chị làm thế nào để người dân tích cực, mạnh dạn, phát hiện với các hành vi vi phạm về VSATTP?
Kết thúc phỏng vấn, xin chân thành cảm ơn anh/chị Điều tra viên
BẢNG QUAN SÁT THỰC HÀNH CỦA NGƯỜI DÂN PHÒNG CHỐNG NGỘ ĐỘC THỰC PHẨM
STT NỘI DUNG THỰC HÀNH ĐẠT KHÔNG ĐẠT
A Vệ sinh nơi chế biến
1 Nơi chế biến gọn, sạch, ngăn nắp
2 Giữ bề mặt chế biến, bếp luôn khô ráo, sạch sẽ
3 Có dụng cụ chứa chất thải kín, có nắp đậy
4 Nhà vệ sinh không mở cửa trực tiếp vào khu vực chế biến
B Vệ sinh trong chế biến và bảo quản
1 Đủ nước sạch để chế biến
2 Thức ăn chín được bảo quản trong tủ kín sạch hoặc có lồng bàn đậy
4 Dùng dụng cụ để gắp, phân chia thức ăn chín
5 Có tủ bảo quản dụng cụ ăn uống
6 Rửa rau qua 3 lần hoặc rửa trực tiếp dưới vòi nước sạch
7 Không sử dụng phụ gia thực phẩm ngoài danh mục, thực phẩm hết hạn dùng để chế biến thức ăn
1 Có rửa tay sạch trước khi vào chế biến, sau khi đi vệ sinh và trước khi ăn
2 Không đeo đồ trang sức, giữ móng tay ngắn, sạch sẽ, không sơn móng tay
Xin trân trọng cảm ơn! Điều tra viên
PHIẾU ĐIỀU TRA TRƯỜNG HỢP NGỘ ĐỘC THỰC PHẨM
CẤP TÍNH TRONG CỘNG ĐỒNG
Để phục vụ cho việc thống kê và đánh giá tình hình ngộ độc thực phẩm cấp tính trong cộng đồng tại TP HCM, xin vui lòng cung cấp thông tin liên quan theo các nội dung dưới đây Tất cả thông tin mà quý vị cung cấp sẽ được bảo mật hoàn toàn.
Phần I: thông tin cá nhân
4 Trình độ học vấn: Dưới lớp 5 Lớp 5 – 11 12 trở lên
5 Thu nhập bình quân hàng tháng:………VNĐ
9 Số điện thoại liên lạc khi cần………
Phần II: thông tin lâm sàng
Trong vòng 2 tuần qua, nếu bạn gặp triệu chứng bất thường sau khi ăn uống như buồn nôn, nôn, đau bụng, tiêu chảy nhiều lần trong 24 - 48 giờ hoặc bất kỳ khó chịu nào ở ruột, dạ dày, hãy cho biết Có: 1, Không: 2 Kết thúc phỏng vấn, chuyển sang điều tra kiến thức.
11 Triệu chứng bất thường xuất hiện vào thời điểm nào?
Từ 2- 4 giờ sau khi ăn
Trên 24 giờ sau khi ăn
12 Mô tả thực phẩm Anh/ chị đã sử dụng Được đun nóng trước khi phục vụ
Thức ăn đã nấu chín và nguội Được nấu và phục vụ ngay Được chia suất sẵn Được cung cấp bởi người bán thức ăn nhanh
Thức ăn được để qua đêm
Không biết, không xác định ………
Khi điều tra về bệnh nhân có liên quan đến NĐTP, điều quan trọng là khai thác tiền sử ăn uống Điều tra viên nên hỏi về các món ăn mà bệnh nhân đã tiêu thụ, bao gồm cả những món ăn cụ thể và ai là người đã ăn cùng bệnh nhân.
14 Anh/ chị xuất hiện những triệu chứng bất thường về đường tiêu hóa có liên quan đến ăn uống: có không không rõ thời khoảng xuất hiện
Sốt 1 2 9 ……… Đau nhức mình mẩy 1 2 9 ………
Những triệu chứng khác (Ghi rõ): ………
15 Chẩn đoán của bác sĩ là gì?
16.Chỉ định điều trị của bác sĩ trực tiếp điều trị của Anh/chị?
17 Anh/ chị có phải nhập viện vì bệnh này không? có: 1 (xuống 19) không: 2, 3 Khám, lấy thuốc rồi về
18 Nhập bệnh viện vào khoa/bệnh viện:
19 Anh/ chị có tự mua thuốc uống trước khi vào khám không? có: 1 không: 2
20 Có bất kỳ ai khác tham gia bữa ăn nghi ngờ bị triệu chứng giống Anh/ chị không? có: 1 không: 2,
22 Sau khi tham gia bữa ăn người đó có triệu chứng bất thường giống Anh/ chị không? có: 1 không: 2, Không biết: 3
23 Những người cùng ăn với Anh/ chị có đi bệnh viện không? có: 1 không: 2, Không biết: 3
24 Người đó có được điều trị giống anh chị không? có: 1 không: 2, Không biết: 3 Cuộc phỏng vấn hoàn tất, cám ơn anh chị đã hợp tác với chúng tôi.
1 Abbot, J M., Byrd-Bredbenner, C., Schaffner, D., Bruhn, C M., & Blalock, L
(2009) Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults European Journal of
2 Becker, M H., Maiman, L A., Kirscht, J P., Haefner, D P., & Drachman, R
H (1977) The Health Belief Model and prediction of dietary compliance: a field experiment Journal of Health and Social Behavior, 348-366
3 Byrd-Bredbenner, C., Maurer, J., Wheatley, V., Schaffner, D., Bruhn, C., & Blalock, L (2007) Food safety self-reported behaviors and cognitions of young adults: results of a national study Journal of Food Protection®, 70(8), 1917-1926
4 Byrd-Bredbenner, C., Berning, J., Martin-Biggers, J., & Quick, V (2013) Food safety in home kitchens: a synthesis of the literature International journal of environmental research and public health, 10(9), 4060-4085
5 Cappellari, L., & Jenkins, S P (2003) Multivariate probit regression using simulated maximum likelihood The Stata Journal, 3(3), 278-294
6 Centers for Disease Control and Prevention (2016) Surveillance for Foodborne Disease Outbreaks, United States, 2014, Annual Report US Department of Health and Human Services, CDC, 1- 14
7 Cho, S., Hertzman, J., Erdem, M., & Garriott, P (2010) Changing Food Safety Behavior Among Latino(a) Food Service Employees: The Food Safety Belief Model
International CHRIE Conference-Refereed Track July 30, 2010 Paper 22
8 Chow, S., & Mullan, B (2010) Predicting food hygiene An investigation of social factors and past behaviour in an extended model of the Health Action Process Approach Appetite, 54(1), 126-133
9 Di Iorio, C K (2006) Measurement in health behavior: Methods for research and evaluation (Vol 1) John Wiley & Sons
10 Glanz, K., Rimer, B K., & Viswanath, K (Eds.) (2008) Health behavior and health education: theory, research, and practice John Wiley & Sons
11 Gettings, M A., & Kiernan, N E (2001) Practices and perceptions of food safety among seniors who prepare meals at home Journal of Nutrition
12 Gujrarati, D N (2004) Basic Econometrics, 4 th Edition Tata McGraw Hill
13 Hanson, J A., & Benedict, J A (2002) Use of the Health Belief Model to examine older adults' food-handling behaviors Journal of Nutrition Education and
14 Havelaar, A H., Cawthorne, A., Angulo, F., Bellinger, D., Corrigan, T., Cravioto, A., & Lake, R (2013) WHO initiative to estimate the global burden of foodborne diseases The Lancet, 381, S59
15 Jevšnik, M., Hlebec, V., & Raspor, P (2008) Consumers’ awareness of food safety from shopping to eating Food control, 19(8), 737-745
16 Kennedy, J., Jackson, V., Cowan, C., Blair, I., McDowell, D., & Bolton, D
(2005) Consumer food safety knowledge: Segmentation of Irish home food preparers based on food safety knowledge and practice British Food Journal,107(7), 441-452
17 Kwon, J., Wilson, A N., Bednar, C., & Kennon, L (2008) Food safety knowledge and behaviors of Women, Infant, and Children (WIC) program participants in the United States Journal of Food Protection®, 71(8), 1651-1658
18 Khandker, S R., Koolwal, G B., & Samad, H A (2010) Handbook on impact evaluation: quantitative methods and practices World Bank Publications
19 Langiano, E., Ferrara, M., Lanni, L., Viscardi, V., Abbatecola, A M., & De Vito, E (2012) Food safety at home: knowledge and practices of consumers Journal of Public Health, 20(1), 47-57
20 Lum, A (2010) Food handling practices, knowledge and beliefs of families with young children based on the health belief model MS thesis University of
21 Mari, S., Tiozzo, B., Capozza, D., & Ravarotto, L (2012) Are you cooking your meat enough? The efficacy of the Theory of Planned Behavior in predicting a best practice to prevent salmonellosis Food research international,45(2), 1175-1183
22 McArthur, L H., Holbert, D., & Forsythe, W A (2006) Compliance with food safety recommendations among university undergraduates: Application of the Health Belief Model Family and Consumer Sciences Research Journal, 35(2), 160-170
23 Meysenburg, R., Albrecht, J A., Litchfield, R., & Ritter-Gooder, P K (2014) Food safety knowledge, practices and beliefs of primary food preparers in families with young children A mixed methods study Appetite, 73, 121-131
24 Mullan, B., Allom, V., Fayn, K., & Johnston, I (2014) Building habit strength:
A pilot intervention designed to improve food-safety behavior Food Research
25 Nesbitt, A., Thomas, M K., Marshall, B., Snedeker, K., Meleta, K., Watson, B.,
& Bienefeld, M (2014) Baseline for consumer food safety knowledge and behaviour in Canada Food Control, 38, 157-173
26 Nguyen, H L (2016) Reality of food poisoning caused by natural toxins in Viet Nam in 2010 - 2014 period Vietnam Journal of Preventive Medicine, XXVI(1),
27 Nguyen, T P., Tran, T T L (2016) Assessment of food safety practices of food consumers in Lao Cai and Dong Thap provinces in 2015 Vietnam Journal of Preventive Medicine, XXVI(5), 9-12
In 2014, a study conducted by Nguyen, V L examined the knowledge of food safety and hygiene among individuals preparing food in households within Cai Tac and Tan Hoa communes of Chau Thanh A district, Hau Giang province The findings, published in the Vietnam Journal of Preventive Medicine, highlight critical insights into local practices and awareness regarding food safety standards.
29 Roberts, K R., Barrett, B B., Howells, A D., Shanklin, C W., Pilling, V K., & Brannon, L A (2008) Food safety training and foodservice employees' knowledge and behavior Food protection trends, 28(4), 252-260
30 Safety Hygiene Food Branch of Ho Chi Minh city (2010) Assessment Knowledge, Attitude, Practice (KAP) in food safety of Ho Chi Minh city’s Household
In 2013, the Safety Hygiene Food Branch of Ho Chi Minh City conducted an assessment of individual food poisoning rates and evaluated the Knowledge, Attitude, and Practice (KAP) regarding food safety among households in the city The findings are detailed in a scientific report that highlights the importance of understanding food safety practices to mitigate foodborne illnesses in the community.
32 Safety Hygiene Food Branch of Ho Chi Minh city (2016) Reality of food safety management in Ho Chi Minh city Food safety management in industrial zone Conference Report
33 Trepka, M J., Murunga, V., Cherry, S., Huffman, F G., & Dixon, Z (2006) Food safety beliefs and barriers to safe food handling among WIC program clients, Miami, Florida Journal of nutrition education and behavior, 38(6), 371-377
34 Unusan, N (2007) Consumer food safety knowledge and practices in the home in Turkey Food Control, 18(1), 45-51
35 Vietnam Ministry of Health and Health Partnership group (2016) Joint Annual Health Review 2015: Strengthening primary health care at the grassroots towards universal health coverage Medical Publish House
36 Vo, T H., Le, N H., Le, A T N., Minh, N N T., & Nuorti, J P (2015) Knowledge, attitudes, practices and training needs of food-handlers in large canteens in Southern Vietnam Food Control, 57, 190-194
37 Wertheim-Heck, S C., Spaargaren, G., & Vellema, S (2014) Food safety in everyday life: Shopping for vegetables in a rural city in Vietnam Journal of Rural
