How effective is good domestic kitchen hygiene at reducing diarrhoeal disease in developed countries? A systematic review and reanalysis of the UK IID study

Current knowledge, attitude and behaviour of hand and food hygiene in a developed residential community of Singapore: a cross-sectional survey

Background

Diarrhoea incidence has been increasing progressively over the past years in developed countries, including Singapore, despite the accessibility and availability to clean water, well-established sanitation infrastructures and regular hygiene promotion. The aim of this study is to determine the current knowledge, attitude and behaviour of hand and food hygiene, and the potential risk factors of diarrhoea in a residential community of Singapore.

Methods

A cross-sectional study was conducted within a residential area in the west of Singapore from June to August 2013. A total of 1,156 household units were randomly sampled and invited to participate in an interviewer-assisted survey using standardised questionnaires. Descriptive, univariate and multivariate analyses were performed using descriptive statistics, Fisher’s Exact test and multivariate logistic regression modelling, respectively. R program was used for all statistical analysis. All tests were conducted at 5 % level of significance with 95 % confidence intervals (CI) reported where applicable.

Results

A total of 240 units (20.8 %) consented and responded to the survey invitation. About 77 % of the expected knowledge and attitude were observed in at least 80 % of the participants, compared to only about 31 % of the expected behaviours and practises. Being single [adjusted odds ratio (AOR) = 2.29; 95 % CI = 1.16-4.48], having flu in the past six month (AOR = 3.24; 95 % CI = 1.74-6.06), preferred self-medication (AOR = 2.07; 95 % CI = 1.06–4.12) were risk factors of diarrhoea. Washing hands with water before attending to children or sick persons (AOR = 0.30; 95 % CI = 0.11–0.82), washing hands with water (AOR = 0.16; 95 % CI = 0.05–0.45) and water with soap (AOR = 0.29; 95 % CI = 0.12–0.72) after attending to children or sick persons, and hand washing between 30 s to a minute (AOR = 0.44; 95 % CI = 0.20-0.90) were protective factors against diarrhoea.

Conclusions

Good knowledge and attitude of the participants did not positively translate into high compliance and motivation to perform good hygiene practices. This observation may have resulted in a significant extent on the increasing diarrhoea incidences. Current interventions may be improved with more active community partnership among the residents, schools and the relevant social organizations, to raise awareness on the importance of compliance to good hygiene practices, and the risk factors of diarrhoea. A large case–control study would be required to validate these findings in future.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1910-3) contains supplementary material, which is available to authorized users.

Behavioural factors associated with diarrhea among adults over 18 years of age in Beijing, China

BACKGROUND

To date, a large proportion of people still suffer from diarrhea diseases. In addition to the burden of diarrhea, there are substantial social and economic costs caused by the high incidence of diarrheal diseases. Therefore, the purpose of this study was to explore the self-reported prevalence of diarrhea and associated risk factors of diarrhea among adults in Beijing, China.

METHODS

A multistage, stratified study based on cross-sectional data was performed using randomized and systematic sampling, recruiting 12,936 adults over 18 years of age in Beijing. All adults were requested to complete a questionnaire, including information such as demographic characteristics, incidence of diarrhea, and behaviors related to the diarrhea.

RESULTS

The self-reported prevalence of diarrhea was 17.5% during the last year prior to the survey. Six behavioral factors were significantly associated with diarrhea in our study including: (1) washing hands before meals and after defecation (Adjusted Odds Ratio (AOR) 0.707, 95% CI 0.597 ~ 0.837), (2) washing hands with soap and running water (AOR 0.872, 95% CI 0.786 ~ 0.967), (3) consuming raw seafood (AOR 1.285, 95% CI 1.138 ~ 1.450), (4) using the same chopping block and knife when processing raw and cooked food (AOR 1.375, 95% CI 1.225 ~ 1.542), (5) using the same chopsticks to handle raw and cooked food (AOR1.149, 95% CI 1.041 ~ 1.268), and (6) regularly participating in physical exercise (AOR 0.719, 95% CI 0.651 ~ 0.793).

CONCLUSION

Good health habits, good eating habits, and regular exercise can prevent the episodes of diarrhea, and thus decrease the potential for disease occurrence.

Risk scoring for setting priorities in a monitoring of antimicrobial resistance in meat and meat products

Meat and meat products can be contaminated with different species of bacteria resistant to various antimicrobials. The human health risk of a type of meat or meat product carry by emerging antimicrobial resistance depends on (i) the prevalence of contamination with resistant bacteria, (ii) the human health consequences of an infection with a specific bacterium resistant to a specific antimicrobial and (iii) the consumption volume of a specific product. The objective of this study was to compare the risk for consumers arising from their exposure to antibiotic resistant bacteria from meat of four different types (chicken, pork, beef and veal), distributed in four different product categories (fresh meat, frozen meat, dried raw meat products and heat-treated meat products). A semi-quantitative risk assessment model, evaluating each food chain step, was built in order to get an estimated score for the prevalence of Campylobacter spp., Enterococcus spp. and Escherichia coli in each product category. To assess human health impact, nine combinations of bacterial species and antimicrobial agents were considered based on a published risk profile. The combination of the prevalence at retail, the human health impact and the amount of meat or product consumed, provided the relative proportion of total risk attributed to each category of product, resulting in a high, medium or low human health risk. According to the results of the model, chicken (mostly fresh and frozen meat) contributed 6.7% of the overall risk in the highest category and pork (mostly fresh meat and dried raw meat products) contributed 4.0%. The contribution of beef and veal was of 0.4% and 0.1% respectively. The results were tested and discussed for single parameter changes of the model. This risk assessment was a useful tool for targeting antimicrobial resistance monitoring to those meat product categories where the expected risk for public health was greater.