MEAT HYGIENE PRACTICES AMONG MEAT SELLERS IN DHARAN MUNICIPALITY OF EASTERN NEPAL Affiliation

* Corresponding Author Jamuna Bhattarai Lecturer, Community Health Nursing Nobel Medical College Teaching Hospital, Biratnagar Nepal Email: jgbhattarai@gmail.com ABSTRACT Introduc on Ea ng the meat derived from animals suffering from zoono c diseases or contaminated with meat borne bacteria cause infec on or intoxica on and grave danger to both the handler and consumer causing morbidity and mortality.


Objec ve
The study aims to assess the meat hygiene prac ces among meat sellers in Dharan City of Eastern Nepal.

Methodology
A descrip ve cross sec onal study was carried in all meat shops registered in Dharan from December 2013 to December 2014.A total of 125 meat shops, which were registered in Dharan Municipality, Dharan Mashu Baybasashi Prabadhi Sang and Dharan Mashu Baybasashi Sangh were enrolled.Checklist and semi structured interview schedule were used to assess the hygiene prac ces of meat shops.Data were analyzed by using descrip ve as well as inferen al sta s cs.

Results
This study revealed that prac ce of meat inspec on, antemortem and post-mortem examina on of animals/carcass were not seen and separate slaughterhouse was not made.Only few (19%) of the respondents had prac ce of washing hands before and a er touching of meat.Near about half (48.8%) of the meat sellers reported that they do not wear body protec ve material/device while selling, 43% of them had prac ce of selling meat of infec ous, emaciated and pregnant animals as well as with suckling offspring.None of them met all the criteria, whereas more than half met the criteria up to 50% set by meat act.Educa on, amount of selling and type of meat was significantly associated (p<0.001) with hygiene prac ces.

Conclusion
The study concludes that hygiene prac ces of all the meat shops in Dharan Municipality was not found to be sa sfactory.Most of the criteria set by authori es remained unmet.Only few meat shops were maintaining the scien fic handling and hygienic prac ces.Study revealed that educa on and type of meat were significantly associated with meat hygiene prac ce.Concerned authori es should be aware to improve the quality of meat hygiene prac ce.

INTRODUCTION
Food-borne pathogens are the leading cause of illness and death in developing countries, cos ng billions of dollars in medical care with social costs.Contaminated raw meat is one of the main sources of food-borne illnesses.The risk of the transmission of zoono c infec ons is also associated 1 with contaminated meat.
During the slaughtering opera ons performed in slaughter places with inadequate sanita on and unskilled staff, contamina on frequently occurs from dirt, unclean water, intes nal contents or from dirty knives, hands or clothing of 1 butcher.These factors all lead to infec on of meat, bacterial mul plica on and possible toxin produc on.Lack of basic facili es, cross-contamina on by insects, flies and numerous other unhygienic factors contribute to the danger of consumer 2 infec on.There is strong evidence that in many developing countries condi ons of slaughter houses and current meat handling prac ces contribute greatly to the spread of zoono c diseases.Similarly lack of ante-mortem, postmortem examina on cannot iden fy the diseased animals so that zoono c diseases transmits easily by handling raw 2 meat, blood and ea ng diseased meat.WHO es mates that cys cercosis affects some 50 million people worldwide and 1 in endemic areas, causes some 50000 deaths.
In Nepal, minimum hygienic standard defined by na onal and interna onal laws and regula ons is not followed during However, the magnitude of public health concern and significance of meat-borne diseases in developing countries is o en underes mated.The frequency, intensity and prevalence of such diseases has drama cally increased in 2 developing countries.The authori es of these countries are mostly aware of the bad situa on, in some cases they have tried for the moderniza on and development of slaughter houses and revised their meat-handling procedure.However, these plans usually apply in urban areas where as most of the slaughtering s ll occurs in rural areas where there is an urgent need for improvement in meet and slaughter 2 hygiene.For regula ng and managing the meat sector, Government of Nepal passed Slaughterhouse and Meat Inspec on Act (SMIA) in 1999.Since then, Department of Livestock Services (DLS) has made many efforts to implement the Act and manage the meat business in Kathmandu city and other large ci es.In spite of such efforts, consumers are compelled to eat poor quality and diseased meat, public are bound to live with the risk of various zoono c-meat borne diseases; and various cases of frauds 7 are evident from me to me.Lack of slaughter house, lack of proper infrastructure in the slaughtering places and meat shops, shortage of adequately trained personnel, improper slaughtering and handling of meat and the most importantly the lack of meat inspec on and examina on, have caused cumula ve effect on improper meat hygiene in Dharan Municipality.Meat products coming from such condi ons are o en deteriorated due to bacterial infec on or contamina on, which may cause food poisoning 8 or diseases in consumers.
Average meat consump on per person in Dharan is 13kg 5 compared to na onal 9 kg per person consump on.This shows high meat consump on by the people living in Dharan and also transporta on of meat (especially pork) from Dharan to other places is popular.The iden fica on of magnitude meat health prac ce problem is important for designing the preven ve program to address public health problem related to meat-borne diseases with medical and social costs related to it.
The study is therefore, focused to assess the hygienic condi on of the presently growing meat business of Dharan, par cularly meat hygiene prac ce at meat shop in Dharan Municipality.4) Terms and condi ons followed by seller (5) Personnel hygiene of meat seller.Structure of meat shop included, wall, roof, floor and basic structural facility according to act.Terms and condi ons included provisions, requirements and rules, for conduc ng the slaughtering and meat selling business according to SIMA.All the demographic variable were independent variable and meat hygiene prac ce was dependent variable.Tool was pretested among 14 meat sellers, and necessary modifica on was done.Content validity was done with 7 subject experts.Demographic informa on of the subjects was obtained first and then the slaughtering places and meat shop were observed and meat sellers were interviewed by the researcher herself.Privacy and confiden ality was maintained during study.All the subjects involved were more than 18 years old.Data was collected from December 2013 to December 2014.

Study protocol was approved by Ins tu onal Ethical Review
Commi ee of B. P. Koirala Ins tute of Health Science (BPKIHS), Dharan Nepal, which is an authorized ins tu on of Nepal Health Research Council Nepal.A er taking permission from BPKIHS, Dharan Municipality Office, Veterinary Office, local meat organiza ons data collec on was started.The subjects were explained regarding the objec ves of the study and informed verbal consent was obtained from each subject before data collec on.Confiden ality of the data was maintained and assurance of data for not disclosing was provided prior to study.

Data Processing and Analysis
The data was entered into Microso Excel 2007 and analyzed in SPSS 17.0.Mean and standard devia on were calculated.In three domains, scoring was given to each characteris c as 1 for correct prac ce and 0 for wrong prac ce.Which prac ce was correct and which was wrong was determined according to Slaughterhouse and Meat Inspec on Regula on Act 2001 A.D. (2057 B.S.).A er that, percentage score of each domain and total domain was calculated.Full marks of domain characteris cs were taken as 100, according to this obtaining less than 25 percent was classified as poor, 25-50 percent as fair, 50-75 percent as average.Those shops which were obtaining 75-100 percent were classified as good hygiene prac ce.Inferen al sta s cs were applied to find out associa on between socio-demographic variables with percentage hygiene score of different domain of meat hygiene prac ce.Socio-demographic variables were categorical and score on hygiene status were not normally distributed therefore non-parametric Mann-Whitney test and Kruskal Wallis test were used to show the associa on between selected independent variables (age, educa on, type of meat, amount of selling, income and training regarding meat hygiene) with the percentage score of 3 domains of meat hygiene.Probability of significance was set at 5% level of significance.

Table 2: Distribu on of Meat Seller on the Basis of Training (n=125)
It was observed that only 30.4% of meat seller had taken training on meat hygiene or hygienic slaughtering and selling technique.

Table 3: Terms and Condi ons followed by Meat Seller (n=125)
Prac ce of using colour, medicine, and chemical in meat, prac ce of periodic medical examina on of staff and prac ce of meat inspec on by meat inspector was not found, almost all meat sellers had not the prac ce of spraying, sinking meat in water or covering the meat with wet cloth.Nearly half (47.2%) of the weighing tools were untouched with other goods or ground.Some (17.6%) of the meat sellers cover chop board while not in use.In less than half (45.6%) of the shop intes ne, abdomen, head, legs, blood were kept separate from meat, similarly some (23.5%) the meat seller involved or allowed worker with purulent wounds and infec ous disease to work with meat.More than half (56.8%) had prac ce of selling meat of animals free from infec on, emacia on, pregnant and suckling offspring.

Table 4: Meat Displaying and Shop Cleaning Prac ce (n =125)
Table 4 majority (20.8%) of meat sellers used to display meat on Cabinet (net/glass) with table, similar percentage also display on plas c carpet on wooden cement slab.While selling (19%) of the meat sellers used to keep meat in refrigerator and marble/ le slab.Half (51.2%) of the meat seller cleaned the shop two mes a day whereas one third (29.6%) cleaned one me.Regarding type of chemical and detergent used to clean the sales counter, majority (64.8%) of meat seller used detergent and water, followed by water only (13.6%), and sheet of packing box change (11.2%).For cleaning the wall and floor more than half (53.6%) of meat seller only swept followed by 15.2% of them used water only and 11.2% used phenyl water and surf water / kerosene.

Table 5: Personal Hygiene of Meat Sellers (n =125)
Regarding personnel hygiene of meat sellers, more than half (60%) of meat sellers wore finger ring, watches and bracelets; similarly, they had no prac ce of wearing working clothes at all.Almost all (96%) had prac ce of cleaning, disinfec on of hand/tools/clothes a er contact with highly contaminated subjects and more than half (57.4%) used soap water for cleaning followed by water only (38.4%).Regarding hand washing prac ce, nearly two third (67.2%) washed their hands a er finishing work, followed by before and a er touching of meat (19.2%).Almost half (48.8%) of meat seller don't wear body protec ve material/device during selling of meat, 39.2% used cloth apron and 12% of sellers used plas c apron only.Almost all (92.8%) had no prac ce to cover the wounds by water ght bandages however all meat sellers had prac ce of washing their hands with soap and water a er going toilet.

Table 6: Percentage Distribu on of Meat Hygiene Prac ce at Meat Shop(n =125)
Table 6 presents meat hygiene prac ce in different domains.In structural status of meat shop, 52.8% had fair prac ce but very few (5.6%) maintained good prac ce.Almost half (48.8%) of them had fair prac ce terms and condi on for meat handling.In personnel hygiene domain, 83.2% of the meat seller had fair hygiene but no one maintained good prac ce.
Overall meat hygiene status of meat shop was not good.More than half (58%) of the meat shop had fair and only 15% had average level of hygiene prac ce.Birat Journal of Health Sciences Type of meat was highly significant with structure of meat shop (p=<0.001).There was significant associa on between educa on level of the meat seller with personnel hygiene (p=<0.001).Mean hygiene score of personal hygiene domain was found to be increased according to the level of educa on.The study also found that the type of meat sold (p=<0.001) and amount of meat sold per day (p=<0.004)was significantly associated with terms and condi ons followed by meat seller.Table 7 shows that there was significant associa on between terms and condi on (p=<0.002)and personnel hygiene (p=<0.029)with profit of meat seller.Similarly mean score of the hygiene was found high where profit earned was more than Rs.31000.

DISCUSSION
Although zoonoses and meat borne infec on is preventable, lack of awareness about zoonoses and meat borne infec on, poor SIMA implementa on have made it a major public health problem in developing countries.In this study most of the meat shop did not meet the structural requirement and minimum basic facili es according to Slaughterhouse and Meat Inspec on Regula on Act (SIMA) 2001 AD.The legal provisions against person who don't meet the criteria is to pay fine of five thousand (NPR) for the first me and ten thousand for every next me or one-month imprisonment, or both.But there was no evidence of such punishment 11 and not any of the shop meet all the criteria.Prac ce of ante-mortem and postmortem examina on of animals/ carcass was not found as well as separate slaughterhouse was not made but the butchers had felt need of slaughterhouse.Another study conducted by Joshi in Kir pur municipality found no pre and post mortem meat inspec on and slaughterhouse examina on by any 9 government authority.The study conducted in Dharan municipality in 2012 supported the present study that no ante-mortem inspec on of animals and post-mortem inspec on of carcass/meat and viscera were carried out.Similarly, 48.39 % of the butchers felt the necessity of 5 slaughterhouse.
This study shows butcher had no prac ce of periodic medical examina on of self as well as staffs, 43% butcher had prac ce of selling meat of infec ous, emacia on, pregnant animals and with suckling offspring.Prac ce of meat inspec on by meat inspector was not found, similarly almost two third of the meat seller are involved or allowed worker with purulent wounds and infec ous disease to work with meat.All these factors contribute to contaminate meat and may cause meat borne infec on and intoxica on.
Another study conducted previously in same se ng found that around 16 % of the butchers clean their shops 2-4 mes only in a week.Further 74.12 % of the shops used water for cleaning, 22.58 % used soap or detergent powder as sani zing agent.From the survey, 16.13 % of the shops this study.Another study showed that 14.6% of the aba oir workers did not wear aprons and they all handled food with 10 their bare hands.
In Dharan, almost all meat sellers (96%) had prac ce of cleaning, disinfec on of hand/tools/clothes a er contact with highly contaminated subjects and majori es (57.4%) of them used soap water for cleaning.Only 19.2% had prac ce of washing hands before and a er touching of meat.They also answered that more than half (67.2%) washed their hands a er finishing work only.During survey it was found that meat seller had prac ce of handling money, touching other objects, drinking fluids and ea ng dry foods as well as selling of meat without washing their hands so that meat handlers are probable sources of contamina on for microorganisms.Almost all (92.8%) had no prac ce to cover the wounds by water ght bandages so human blood, body fluid and microorganism easily transmits to the fresh meats.All meat sellers had prac ce of washing their hands with soap and water a er going toilet.
Study found that educa on was highly significant (p=<0.001)with slaughtering prac ce and personnel hygiene (p=<0.001) of the meat seller.Mean score of hygiene of all domain was found to be increased along with the level of educa on.Study conducted among pig meat seller in Chitwan also supports this study that the hygienic prac ces like sanita on of equipments' and regular washing of hands were 3 significantly associated (p=<0.05)with level of educa on.
There was significant associa on between type of meat and structure of meat shop (p=<0.001).Mean hygiene score of chicken and mu on was higher in all domains than pork and buff it may be due to size of animals which may affect slaughtering prac ces.Significant associa on (p=<0.002)was found between profit earned and terms, condi on followed by meat seller, it may be due to increase in income level automa cally changes in prac ce.
The study result conducted by Adhikari BM, support the unhygienic meat selling prac ce of Dharan.Buffalo meat of local market can be said to be heavily contaminated with spoilage and pathogenic organisms, due to unhygienic 5 slaughtering and handling condi ons.
Above all findings found that lack of ante-mortem postmortem examina on and poor handling prac ce of meat in Dharan.Although the impact of meat -borne diseases has been least detected because of thorough cooking, the nutrient loss in meat due to the contamina ng pathogens and microorganisms cannot be compensated.Also some diseases may eventually be passed on to staffs working in the slaughter-sites or meat shops and those involved in handling such meat.sector.Lack of poor Act implementa on by the responsible body was the example of current meat business of Dharan.
Local Meat organiza on are demanding well facilitated slaughterhouse and some support from government should be provided to manage the meat business before strict implementa on of act.So the responsible authori es meat sellers and public should jointly make effort to improve this sector.

3 the
meat produc on and marke ng chain.The zoono c pork tapeworm, Taenia solium, is becoming an increasing 4 problem in Nepal.In Dharan, survey of 31 meat shops showed that the hygiene condi on of meat sold was found 5 unsa sfactory.Hospital evidence shows that 5 Cys cercosis, 16 cases of Echinococcosis/Hyda dosis and 23 cases of Epilepsy were treated in B. P. Koirala Ins tute of Health 6 Sciences, Dharan in 2013.
This study is based on descrip ve cross sec onal study design.All the meat sellers who were registered either in Dharan Sub-Metropolitan city or local meat organiza on were enrolled in study sample.All together the registered 125 meat shops were found ac ve at present in Dharan Sub-Metropolitan city.Self-prepared checklist and semi-structured interview schedule was developed based on Slaughterhouse and Meat Inspec on Regula on Act (SIMA) 2001 A. D. (2057 B.S) which also meet the criteria of WHO Guidelines for sloughter house in developing countries.The instrument consisted of five sec ons: (1) Socio-Demographic Characteris cs (2) Ante-mortem and post-mortem examina on (3) Structure of meat shop (

Table 7 : Associa on of Socio-demographic Variables with domain of Meat Hygiene (n =125)
*Mann-Whitney test **Kruskal Wallis test ISSN: 2542-2758 (Print) 2542-2804 (Online) 5atmosphere was found dirty.About half (51.2%) of the meat seller cleaned the shop 2 mes a day, further 64.8% of the meat seller used soap or detergent powder as sani zing agent.This study showed prac ce was be er in the present study compared to previous study.This contradic on may be due to study sample.Previous study conducted among buff meat shop whereas in this study only 16% were buffalo meat seller.In general, more hygienic prac ces found in mu on and chicken slaughtering and selling place than buffalo slaughtering and selling.
Department of Livestock Services (DLS) have major responsibili es for the implementa on and enforcement of Animal Slaughterhouse & Meat Inspec on Act 1999 and Animal Slaughterhouse & Meat Inspec on Regula on 2001 as well as local municipali es are the first level of local governance, responsible for proper management of all the 11