This document provides an overview of food hygiene, including definitions, concepts, and the public health importance. It discusses foodborne diseases, chemical contamination, adulteration, misbranding, and food spoilage. Existing food hygiene practices in Ethiopia are examined through several studies that found high rates of pathogens among food handlers and food establishments. Methods for food hygiene surveillance include laboratory tests, expert inspections, and programs like HACCP and GEMS. HACCP is explained in detail as a system to identify and control hazards through critical control points, monitoring, record keeping, and verification.

1. Food Hygiene
1
May, 2023

2. Learning outcomes
Definition and concept of foodhygiene
Public Health Importance of food hygiene
Tools to monitor and evaluate foodhygiene
Investigation of foodborne outbreak
Food hygiene Interventions inEthiopia
2

3. Definitions, concepts
3
Part 1

4. Definitions
Food:
• is any solid or liquid, when
eaten and absorbed by the
body, produce energy,
promote the growth and
repair of tissue; promotes
resistance against
diseases or maintains and
regulates these processes
4

5. Food
hygiene:
• means all conditions and
measures necessary for
ensuring the safety,
wholesomeness, and fitness
for consumption of food at all
its stages from its production,
processing, storage,
distribution, preservation, and
service (WHO/FAO).
5

6. Who is food handler
Food production
Food Transportation
Food Preparation
Food Distribution
Handling of equipments/utensils
Storage of food
6

7. Kinds of food
1. 1. Perishable foods: eggs, meat,
fish, vegetables; milk; creamy cake
2. Semi-perishable: bread, fruits
1.3. Non perishable: dry foods; canned
foods
7

8. Public Health Importance of food
8
Part II

9. Public Health significance of food
1
• Food borne diseases: Infection, intoxication
2
• Chemical poisoning
3
• Adulteration and misbranding
4
• Food spoilage
9

10. • is defined as a
disease usually either
infectious or toxic in
nature, caused by
agents that enter the
body through the
ingestion of food
“food
borne
disease
10
A. Food borne diseases

11. Food borne illnesses have significant impact
world wide including developed nation like US.
The Center for Disease Control and Prevention
(CDC) estimates
In the US , 76 million cases, more than 300,000
hospitalization and 5000 deaths in a year.
In addition 400 – 500 out breaks are reported in
the US.
Germany: 2011 Escherichia coli O104:H4
foodborne outbreak , 3,785 cases and 45 deaths
Ethiopia: 2008 Epidemic dropsy in AddisAbaba
Food adulteration , 143 cases and 9 deaths
11

12. Classification of food borne diseases
(causative agent)
 are diseases whose etiologic
agents are viable pathogenic
organisms ingested with foods
and that can establish infection
 d i s e a s e s arising from the ingestion
of toxins released by
microorganisms, intoxications from
poisonous plants or toxic animal
tissues: or due to consumption of
food contaminated by chemical
poisons
Food borne
infections
Food borne
poisonings/
intoxications
12

13. Food
Borne
diseases
Food bore
infection
Bacteria: typhoid fever
Virus: Viral hepatitis
Fungus: Aspergillus
Parasite: Tinea, Amebiasis
Food borne
poisoning/in
toxification
Chemical: pesticide and insecticide
Natural toxins: Neurolaterism , ergotism
Bacterial toxins: Botulism
Fungal toxins: Aflatoxin, Mycotoxin
Figure : classification of food borne diseases
13

14. Factors of food borne diseases
perishable food
1. Raw foods
• flies, rats, contaminated
water and equipment's
2. The environment
• skin lesions, spitting,
coughing
3. Food handlers
• ex. anthrax
1.4. From sick animals
14

15. A famous example of an infectious disease carrier
was “Typhoid Mary”Mallon, who worked as a cook
in New York City during the early 1900s and was
alleged to be a typhoid carrier. Several cases of
typhoid fever were traced to households where she
was employed. Typhoid fever, caused by Salmonella
bacteria (S. typhi), is a systemic infection associated
with a 10% to 20% case fatality rate when untreated.
After the first cases of typhoid were associated with
her, Mallon was quarantined for three years on
Brother Island in New York City and then released
with the provision that she no longer work as a
cook. However, after she continued
working as a cook and was linked to additional
typhoid outbreaks, she again was confined to
Brother Island until
Mary.”
she died in 1938. “Typhoid
15

16. A
A C
C I
IP
P H
H
1.Contamination in the crop field
Accidental poisoning
From cooking metal containers
Unauthorized use of additives
Use of uncleaned sacks or containers used for
chemical storage
Migration of metals from metal containers to food in
acidic condition
B. chemical contamination
16
Ways of chemical contamination

17. 17
Common adulterations are:
Milk
Butter
Coffee
oil , etc…..
C. Adulteration and misbranding

18. Adultration of “ Jeso”Etv Sept, 2020
18

19. A
A C
C I
IP
P H
H
Non-
microbial
spoilage
Microbiol
ogical
spoilage
less moisture during Storage
• Aging of the egg makes
white thinner and watery.
#Microorganisms penetrate
and contaminate, shells,
pores, shell membrane and
to reach the egg white or the
yolk.
D. Food spoilage
19
Example: Egg

20. Food hygiene practice
(Existing country situation)
20
Part III

21. Knife Zeru, Abera Kumie. The Sanitary Conditions of Food Establishments
in Mekelle Town, Tigray, North Ethiopia. Ethiopian J. Health Dev 2010;
21(1):3-11.
• n=420; 20% subjected for plates/dish bact analysis
• Aerobic Mesophilic Bacteria (viable bacteria),
Escherichia Coli, Staphylococcus aureus as well as
total and fecal coliforms were isolated.
• Aerobic mesophilic bacteria were grown in 69(78.4%)
of the swabbed utensils with an average of 53 colonies
per utensil,
• 39(44.3%) of the swabbed utensils were found above
the acceptable level of aerobic mesophilic bacteria
(>100 colonies/utensil).
21

22. Nigusse D, Kumie A. Food hygiene practice and prevalence of
intestinal parasites among food handlers working in Mekele
University student’s Cafeteria, Mekele, Jan 2016
• n = 229
• Prevalence: 49.4% (n=113)
• About 75% of E Histolitica, 14% G Lamblia
Determinants
• Use of soap for handwashing
• Washing hands after toilet
• Medical check up provision
• History of deworming
22

23.  Dejen Gezehegn, Mebrahtu Abay, Desalegn Tetemke, Hiwet Zelalem,
Hafte Teklay, Zeray Baraki, and Girmay Medhin. Prevalence and
factors associated with intestinal parasites among food handlers of
food and drinking establishments in Ethiopia, Gezehegn et al. BMC
Public Health (2017) 17:819
 Five species of Intestinal Parasites (IPs) were
identified.
 The overall prevalence was was 14.5%, 95% CI
(11.3, 18.0). at least one intestinal parasite
 low medical check up(every 9th month)
 The Food handlers who received safety. Are a risk
factor for prevalence of intestinal parasites
23

24. Food Hygiene: surveillance
24
Part IV

25. A
A C
C I
IP
P H
H
Food hygiene surveillance
• “Produce and Test” quality
assurance(Traditional method)
 S a n i t a r y methods:sanI
tary inspection
• Environmental -epidemiological
studies
 HACCP
 G l o b a l networking: GEMS (global
environmental monitoring systems)
Methods:
Lab methods
Expert based
Holistic
based
International
networking
25

26. I. Lab methods
26
Examples
a) for cured Meat
A). Mesophillic aerobic bacteria.
B) Salmonella organisms
B) For fish products Enumeration of :-
 Mesophilic aerobic bacteria
 Feacal coli form.
 Staphylococcus aurous.
 Detection of salmonella.
 Vibrohaemolyticus

27. C) For fresh fruits and vegetables
 Tests for lactic acid forming bacteria
 Tests for salted tolerant cocci.
 Tests for yeasts and molds.
 Tests for mesophilic heat tolerant spores.
 Test for anaerobic producing H2S.
 Tests for anaerobic not producing H2S.
 Tests for cold tolerated micro- organisms
30

28. Conceived in 1972, UN Conference on Human Environment;
Formally organized in 1974.
Data collected since 1976;
Number of participating countries in 1990 were 39. Most from
developed ones.
19 Chemicals are under surveillance: Chlorinated Pesticides
(DDT, endosulfan, endrin, , Heptachlor); heavy metals (Cd, Hg,
tin); organophosphorous (daizinon, fenitrathion, malathion,
parathion, methyl parathion) 32
II. GEMS in food safety evaluation

29. III. Food Hazard Analysis Critical
Control Points (HACCP)
Definition:
 i t is a system by which food
processing and service
industries and establishments
ensure the safety and quality of
consumable food products.
29

30. Was developed during 1960’s: NASA
Primarily was used for “space food
services”
FDA approved HACCP use for food
industries
Production of safe food (food industry
then pharmaceuticals, cosmetics, mass
caterings)
30

31. • Looks from raw to finished
product
Holistic:
• risk assessment, risk mgmt,
epifindings, etc
Science-
based
 I n v o l v e s partnership
between stakeholder and
Gov’t
Needs
collaboration
31

32.  H e l p s companies compete
m
o
r
eeffectively in a market
Reduces barriers to international
trade
Requires
certification:
 s e a f o o d industry, juice industry
,
meat and poultry industry, small
business (mass catering, etc)
Applicable
to:
• A tool for effective government
oversight
T
ool
32

33. Elements of HACCP
Keep suitable records
Identify hazards, assess risks
Determine critical control point
Specify criteria to ensure control
Establish Monitoring system
Take correction action monitoring indicates criteria are not met
Verify that the system is working as planned
33

34. • Define Hazard, severity, risk
• Any physical, chemical, or biological property that
causes food unsafe
• an operation, practice, procedure, process, stage,
or a step in the system or operation
Identify hazards,
assess risks
Determine critical
control point
• Maximum or minimum value
• It can be time, To, chemical or biological values;
addition, restriction or deletion of procedures
Specify criteria to
ensure control
• evaluate if the hazard is under control through systematic
lab analysis, data recording, statistical analysis, surveillance
• reprocessing, disposing,
 C h e c k i n g the system is working according the HACCP
P
l
a
n
Verification: can be made internally and by externalbody
Documentation of HACCP plan, type of hazards, CCP,
critical limits, handling of process deviations, actionstaken
Establish
Monitoring system
Take correction
action monitoring
Verify that the
system is working
Keep suitable
records
34

35. 1.Conduct hazard analysis: hazard identification,
its severity, and risk assessment
i. Definition of hazard(What is the hazard?)
 It is unacceptable contamination, growth, or survival of
microbes in food that may affect food safety and quality;
 The presence of biological, chemical, or physical agent that
is reasonably likely to cause illness or injury in the absence
of its control
 Any physical, chemical, or biological property that causes
food unsafe
39

36. It is unacceptable production or persistence
in foods or in products of substances such
as toxins, enzymes, toxic chemicals or
products microbial metabolism;
Generally: Hazard is unacceptable
procedures, process, practice, policies,
presence of agents (microbe, chemical,
physical)
40

37. ii) Severity is the magnitude of the hazard or the
seriousness of the consequences that a hazard
may result; (Duration, magnitude, impact of illness
or injury; long-term and short-term exposure)
iii) Risk is an estimate of the probability of a
hazard occurring;
• Hazard analysis is the process collecting and
evaluating information on hazards associated
with the food under consideration to decide
which are significant and must be addressed in
the HACCP plan;
• It is used to identify hazards related to the
use of food
41

38. 42

39. 2. Determination of CCP
Identify a critical control point(CCP) is an
operation, practice, procedure, process,
stage, or a step in the system or operation
or food process in which control exercise
can be made to eliminate or prevent or
minimize the hazard.
(Examples: receiving raw food, food
storage, cooking, chilling, cleaning, personal
hygiene, presence of fly etc)
43

40. Engineering and sanitary inspection is the
main tool to identify and monitor CCP
temperature, time, physical dimensions,
humidity, moisture level, water activity (aw),
pH, acidity, salt concentration, available
chlorine, viscosity, preservatives, or sensory
information such as aroma and visual
appearance
44

41. 3. Establish Criteria or critical limit (s) for each
CCP
Maximum or minimum value to which a physical,
biological, or chemical hazard must be controlled
to prevent, eliminate, or reduce to an acceptable
level;
Measures, specifications, and procedures that
indicates the CCPis under control.
It can be time, temperature, chemical or biological
values; addition, restriction or deletion of
procedures; etc.
Lower and upper boundaries of food safety
45

42. Example: Patty CCP
46

43. 4. Establish a system or procedures of
Monitoring and Evaluation of each
criteria and CCP to evaluate if the hazard
is under control through systematic lab
analysis, data recording, statistical
analysis, surveillance, etc.,
5 Establish corrective actions to be taken
when monitoring shows that CCP has not
been met:[reprocessing, disposing, etc]
47

44. 6. Verify that HACCP system is working
effectively:
 (Validating, auditing HACCP if safe food is
ensured) [Establish verification procedures]
 Checking the system is working according the
HACCP Plan
 Checking standards, regulations, or
specifications that could meet the objectives of
HACCP in Preventing; Eliminating; Reducing
hazards to acceptable limits;
 Verification: can be made internally and by
external body
48

45. 7.Establish effective record-keeping and
documentation procedures
Documentation of HACCP plan, type of
hazards, CCP, critical limits, verification
activities, handling of process deviations,
actions taken
49

46. HACCP approval
Bearing certification is needed by Gov’t
delegated body
ISO 2200 standard specifying requirements
incorporating elements of all 7 HACCP
principles
Ensures Food quality management system
51

47. HACCP Example
Restaurants/Hotels
1.Hazard: Contamination of food by
micro organisms from the food
handlers
2.CCP: -The hair-The eyes, ears.
nose and the skin;
52

48. 3. Criteria:
i. Hairs should be short ( if possible ) and should be
clean-Workers should always wear hair covers (
caps )
ii. Should never be touched with the hands while
handling food
iii. Should always be with out visible discharge
iv.Avoid sneezing and coughing directly on to the
food;
v. No finger rings and ear ornaments;
vi. Fingernails short
53

49. 4. Monitoring:
a)Check whether the workers have worn
their caps every day before work begins
b)Ask employers and workers to identify
themselves during sicknesses and make
inspections for the general conditions of
workers every day before work begins
c)Make surprise inspections;
54

50. 5. Action:
i. Prevent workers without hair caps from
working
ii. Provide workers with adequate number of
hair caps
iii. Provide health education every week
iv. Prohibit sick food handlers
v. Ask sick food handlers to bear evidences
for being treated
55

51. 6. Verification:- verify or check food handlers by
inspectors weather they apply or not the whole
requirements.
7. Record keeping:- Documentation type of
hazards,, actions taken, etc….
56

52. Food borne outbreak
57
Part V

53. INVESTIGATION OF FOOD BORN OUTBREAK
To determine the cause of the outbreak.
To find food and food products responsible for outbreak.
To identify and locate the source and the causative agent.
To determine how the food staff become contaminated, and how the growth of toxicogenic or infectious
organisms involved.
To take steps to limit and arrest further spread.
To educate responsible individuals in the prevention of similar occurrence.
Information collected during the investigation can be used to prevent subsequent out breaks
58
1. OBJECTIVE

54. 2. PROCEDURES.
1.Take rapid action whenever illness is
reported.
2.Visit and make a complete inspection of
the places where the suspected meals or
beverages were consumed.
3.Interview as many persons as possible
who partook of the suspected food.
4.Prepare a questionnaire suitable for the
outbreak to be completed for each person.
54

55. 5. If the patient to be visited are hospitalized or being
treated obtain information from the responsible physician.
6. Obtain specimens of stool and or vomits of ill persons.
7. Secure a copy of food menu of the day if available.
8. Inquire methods of preparation of each meal.
9. Inquire source of food, visit the area.
10. Observe and determine the health status of food
service employer.
55

56. 11. Collect the necessary samples of
food suspected to be the cause.
12. Arrange for the laboratory
examination of food samples and
other samples taken from the
patients.
NB: The sooner an out break is notified the
greater the chance of isolating the germs
responsible for the outbreak
56

57. 3. ANALYSIS OF THE DATA.
Organization and collect data obtained
from the ill and well persons
who have partook on the suspected
meal, who attended a common event
or who ate the suspected food.
The groups affected, identified groups,
common sources, vehicles as well as
the need for further investigation
should be classified and decided.
57

58. Plot an epidemic curve.
An epidemic curve is a graph that
depicts distribution of the time of onset
of the initial symptoms of all cases that
are associated with diseases out break.
Helps to estimate the incubator period
and investigate the common source
and site.
58

59. 59
Determine sign and symptoms.
Frequency of symptoms of 14 sick
people is given below.
symptoms Number of cases %
Diarrhea 13 93
Abdominal Paine 8 57
Head ache 8 57
Nausea 7 50
Fever 7 50
Vomiting 1 7
Chills 1 7

60. Determine sign and symptoms
This information assists in
determining whether the outbreak
was caused by agents that produce
enteric, neurological or generalized
illness.
Calculate incubation period and
determine the range and median of
the incubation period.
60

61. It is the number of new cases of that disease
that has been reported during a specified
interval with respect to the size of the
population being studied.
IR = No of new cases X 100,000.
Population at risk
determine the responsible or suspected meal.
66
Calculate the incidence rate

62. When the approximate time of exposure for
groups who shared common meals is
obvious, calculating the attack rate among
people who ate the meal can be used.
The formula is the number of persons who
become ill divided by the people who ate the
meal multiplied by 100.
Do the same calculation for the people who
did not eat that meal.
67

63. The suspected meal will be the one having
the highest score of attack rate for those
who ate the meal and the lowest for those
who did not eat the meal.
The following food specific rate is given in
table and will help to identify the
suspected meal.
68

64. 69
Food
item
involved
No of people who ate the
suspected food.
No of people who did not eat
the suspected food.
ill Not ill total %
AR
ill Not ill total %
AR
Chicken 97 36 133 73 2 23 25 8
Peas 77 28 105 73 22 31 53 46
Pumpkin 22 14 36 61 77 45 122 63
Coffee 89 39 98 60 40 20 60 67
milk 12 6 18 67 87 53 140 62

65. 70
Food
item
involved
No of people who ate the
suspected food.
No of people who did not eat
the suspected food.
ill Not ill total %
AR
ill Not ill total %
AR
Diff
Chicken 97 36 133 73 2 23 25 8 +65
Peas 77 28 105 73 22 31 53 46 +27
Pumpkin 22 14 36 61 77 45 122 63 -2
Coffee 89 39 98 60 40 20 60 67 -7
milk 12 6 18 67 87 53 140 62 +5

66. CALCULATE THE FOOD PREFERENCE
In situations when common
meals wear not eaten by
the ill persons or when
investigating a diseases
that have a long incubation
period, food preference
attack rate tables may help
to identify a food vehicle.
71

67. ♣ To determine groups affected which may
suggest a likely vehicle, classify both ill
and well persons in to applicable groups
i.e. Age, sex, religion, affiliation,
occupation, economical status, etc….
♣ Make statistical tests of significance so as
to confirm your hypothesis.
74

68. 68
A. Epidemic dropsy: a case in Addis Ababa
Food adulteration
• May 2008- June 2008 due to the consumption
of adulterated food oils
• Casually related to products of Prickly poppy
(Argemone Mexicana, “Medafe” or
“Kosheshila”)
• Minimum concentration of 1% of Argemone oil
as an adulterant was necessary to produce
clinical features
• A total of 143 cases & 9 deaths

69. 69
Dropsy cont’d
• The differential diagnosis:
– hypoproteinaemic state, filariasis, venous
insufficiency, and Beri-Beri, hypothyroidism and
nephrotic syndrome
– impression of Viral hemorrhagic fever epidemic and
toxin poisoning as the cases reported as other family
members are attached
• It was after experts’ consultation epidemic dropsy was
suspected and lab test identified the chemical
• What interventions would you suggest: ???

70. Argemone Mexicana
• Seeds contain 22–36% of a pale yellow non-edible oil, called
argemone oil or katkar oil, which contains the toxic alkaloids
sanguinarine and dihydrosanguinarine.
• The seed oil is used to grease the cooking plate to bake the
injera in Ethiopia
• The seeds resemble the seeds of “Brassica nigra” (mustard)
• Local names: “kosheshila”, “dem astefita”, “Medafe”
70

71. 78
Argemona Ethiopia: Abine Germame, Zeway,
29 Oct 2009
It is considered as
“Arem”, “Kore” or
Grows with “Astenagir”
and “Nitisha”
“Ishoh”, “Yeset Milas”

72. 79
Seed

73. 80
Seed Argemona and
“Astenagir”, Zeway
area, 29 Oct 2009

74. 81
• 245 samples during the epidemics
• 83% had positive test
were examined
• Observed clinical symptoms and deaths among mice fed the oil
Source: EPHA 25th annual conference, 2016

75. Questions?
• Who is responsible for the 143 cases & 9
deaths
• Hierarchy in responsibilities??
• What would you have done if you were given
a chance to prevent the occurrence of similar
incidences?
82

76. Food Hygiene: interventions
76
Part VI

77. A
A C
C I
IP
P H
H
What must be done to improve the sanitary
(Legal framework)
1.Designing legal framework (proclamation, regulation,
guideline, codes practice, organizational aspect)
1.Popularizing the regulations
1.Enforcing the law: (in priority order)
1.Planning routine and regular food inspections
San and lab surveillance enforcing
2.Motivating experts(training, supportive)
2.Sustained support from policymakers
77

78. A C IP H
1
Licensing, approving, certification (construction, work procedures,
equipment's, etc)
2
• Sanitary education/training of owners, food handlers
3
• Sanitary inspections: pre-employment and periodical
4
• Food handler’s health provisions
5
• Lab investigation
• License suspension, establishment closing, permit revocation
6
7
8
• Providing citations: improvement/advice/information notice, prohibition
notice / order (adulteration, additives, unsafe) practices, packing, labeling,
advertisement)
• Penalties by Court: imprisonment, monetary fine
9
• M & Evaluating performance (Regular surveillance)
88
Food hygiene interventions/tools
A. General(traditionallegalactions:regulatory)

79. B. Owner’s perspective
1.Preferably trained in food safety
2. Food manger’s responsibility to ensure full compliance
3. Enforcing food regulations
4. Sensing, committing the subject of hygiene
5. Being aware on local regulations
6. Getting feed back from consumers
7. Alert for improvement
79

80. C. Consumersperspective
1.Consumers association
2.Public debates about the food
establishments
3.Reporting to the Authorities
unhygienic practices
4.Bringing the matter to the court
with out seeking other’s help
80

81. Enforcing mechanisms/ tools
Subjects of sanitary inspection
1.Pre-employment: Site location, sanitary facilities
•At preparation: raw food, cooking, washing, etc
Storage: temperature regimen, type of food
•Service: temperature; cleanliness of utensils, personal
hygiene
Distribution: transporting, temperature
Equipments: washing, cutlery, cookery
•Construction condition: wall, floor, roof, space lay-out,
etc
•Food handlers health and hygiene behavior
81

82. Any question
92