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Indian Journal of Community Medicine

An Evaluation of Health Status of Food Handlers of Eating Establishments in Various Educational and Health Institutions in Amritsar City

Author(s): V. Mohan, U. Mohan*, Lakshman Dass**, Manohar Lal***

Vol. 26, No. 2 (2001-04 - 2001-06)

Deptt. of Community Medicine, D.M.C. & Hospital, Ludhiana *Deptt. of Microbiology, D.M.C. & Hospital, Ludhiana **PHC Lopoke, Amritsar ***Deptt. of Community Medicine, G.G.S. Medical College, Faridkot


Research question: What is the health status of food handlers working in the eating establishments of educational and health institutions in Amritsar city?

Objective: To assess the health status of food handlers.

Study design: Cross-sectional.

Participants: All food handlers working in all the messes and kitchens of educational and health institutions in Amritsar city.

Method: Interview, physical examination and lab investigations.

Results: Most of the food handlers (45.7%) were in 20-29 years of age group with 61.7% as literate. 62% of them showed evidence of some disease or deficiency while 14% of them had intestinal parasitic infestations. Periodic health examination of food handlers must be done.

Keywords :Food handlers, Eating establishments, Health status


Food is a basic human need for survival. Through centuries, food has been recognized as an important need for humans in health and disease. It is one of the basic requirements of man as also of all living beings. Every activity of man is aimed at procurement of food and it is only after having met with this requirement that he thinks of other less important requirements.

India is basically an agricultural country. Industrialization and urbanization along with the tremendous growth in the population have promoted people to migrate from their rural homes to the urban areas in search of employment and a better way to life which has forced them to the necessity to have their meals at any place that offers food at a price they can afford. There has been a growing demand for eating places and as a result, a large number of eating establishments have mushroomed all over the cities which are manned by different categories of workers.

The health of people depends, to a large extent, on the food they eat. But food is frequently subjected to contamination by a variety of micro-organisms resulting into human illness and has a direct extensive and important bearing on public health. These contaminations may occur at any point during the journey of food from the producer to the consumer. The chances of food getting contaminated depend largely on the health status of the food handlers, their personal hygiene, their knowledge of food hygiene and above all, the proper application of that knowledge.

A food handler is any person who handles food, regardless whether he actually prepares or serves it. Unhealthy food handlers are potentially dangerous to the health of consumers and the danger is magnified many folds if they are employed in educational and health institutions. They can transmit a number of food-borne diseases like diarrhoea, dysentery, cholera, typhoid and paratyphoid fevers, viral hepatitis, protozoal cysts, ova of helminths, tuberculosis, staphylococcal and streptococcal infections, salmonellosis and many other through their hands. Food handlers are the most important sources for the transfer of the microorganisms to the food from their skin, nose, bowel and also from the contaminated food prepared and served by them.

Besides unhealthy food handlers, disease carriers handling the food also play an equally important role in transmitting these diseases and impose a great threat to the health of the public. Certainly, there are many other modes also by which the food borne diseases are transmitted. These include preparation of food in the untensils infected by handling or washing in the contaminated water or flies alighting on food after feeding on exposed infected faeces or during storage of food by insects, rodents etc. The role of food handlers in the transmission of food borne diseases comes atop.

Material and Methods:

All the food handlers (according to the lists procured from the heads of all the institutions) working in the messes and kitchens of all the educational and health institutions attached to hostels in Amritsar city were assessed for the evaluation of their health status. A total of 3 visits were paid to each of these institutions which were planned with the consent of their heads. The very purpose of these visits was explained both to the food handlers as well as to the heads of the institutions. The food handlers who could not be contacted during these 3 visits were excluded from this study. Due care was given that these visits did not disturb the routine activities of the establishments.

The food handlers were interviewed according to the proforma which was evolved and pre-tested for the purpose of the study. Information regarding age, sex, residential address, religion, marital status, income, educational status, occupation and certain personal habits like smoking, alcoholism etc. was obtained during the interview. Relevant history regarding present/past illness if any was obtained. General physical and systemic examinations were carried out. Haemoglobin estimation (Sahli's method) and stool examination (Direct smear method and salt concentration method) of all food handlers was done. Sputum examination for AFB (Ziehl-Neelsen method) was carried out in cases where relevant history was available.

Data thus collected were compiled, analysed and valid conclusions drawn.

Parameters taken for the assessment of health status were as under:

Morbidity: If any.

Nutritional status: According to the standard weight for height. Good: More than 90% of the standard weight. Fair: 81 to 90% of the standard weight. Moderate: 71 to 80% of standard weight. Poor: Less than 70% of the standard weight. (Jellife, 1966)1

Anaemia:Haemoglobin less than 13 gm% by Sahil's method.(WHO, 1966)2

Intestinal parasitic infestations:Presence of ova/cysts of protozoa/helminths in stools.

Observations and Discussion: Various observations made during the study were as under:

Table I: Messes/Kitchens of educational and health institutions surveyed during study.

No. of
No. of food
No. of food
Educational 20 181 162
Health 4 55 52
Total 24 236 214

Table I reveals that out of 236 enlisted food handlers, 214 could be examined.

Table II: Distribution of food handlers according to age.

Age group (years) (n=214) Cumulative
No. (%)
10-19 56 (26.16) 56 26.16
20-29 98 (45.74) 154 71.90
30-39 30 (14.01) 184 85.91
40-49 15 (7.09) 199 93.00
50-59 10 (4.67) 209 97.67
>60 5 (2.33) 214 100.00

Table II reveals that maximum number (71.90%) of food handlers were below 30 years of age and only 2.33% were in the age group of 60 years and above.

Gupta and Ketkar (1981)3 from Nagpur in their study on food handlers observed that 22.3% of them were below 25 years of age. In the similar study by Chitnis (1982)4 from Pune, it was found that 73.87% of food handlers were below 30 years of age.

Table III: Distribution of food handlers according to their socio-demographic profile.

Parameter (n=214) No. (%)
Male 206 (96.26)
Female 08 (03.74)
Cook 106 (49.54)
Waiter 54 (25.24)
Dish washer 31 (14.46)
Helper 23 (10.76)
Residential locality
Rural 146 (68.22)
Urban 38 (17.62)
Slum 30 (14.16)
Education status
Illiterate 82 (38.31)
Just literate 10 (04.67)
Primary 68 (31.77)
Middle 26 (12.14)
Matric 22 (10.28)
Above matric 06 (02.83)

Table III reveals that a vast majority (96.2%) of food handlers were males. Maximum number (49.54%) were cooks and majority (68.22%) of food handlers were from rural areas while 30(14.16%) were from the slums. 82(38.31%) food handlers were illiterate.

In a study by Chitnis (1982)4 there was no female food handler, while in another study by Gupta and Ketkar (1981)3 from Nagpur, 28.9% were females.

The lower literacy rate in the present study may be due to the fact that majority of food handlers in educational and health institutions were from states like Himachal Pradesh and Uttar Pradesh where the literacy rates are relatively lower.

Table IV: Distribution of food handlers according to habits and addictions.

Habits and addictions No. (%)
Smokers 115 (53.74)
consuming alcohol 52 (24.30)
Chewing tobacco 24 (11.20)
Betal chewing 23 (10.74)
Mixed/double habits 70 (31.72)
No addiction 52 (24.30)

Table IV reveals that 115(53.74%) were smokers, 52(24.30%) consumed alcohol daily, 24(11.2%) were in the habit of chewing tabacco and 23(10.74%) habituated to betal chewing. Some of the food handlers were habituated to more than one habit. Double habituation (31.72%) was mostly found in the case of smokers also being alcoholics. 52(24.30%) of the food handlers were free from any of the common addictions. Thus the common habits were those of smoking and drinking.

Gupta and Ketkar (1981)3 in their study reported that 50% of the food handlers were habituated to pan chewing and 40.1% to chewing tabacco. This could be due to the fact that their subjects of study were from Nagpur.

Table V: Illnesses/injuries suffered by the study population in previous three months.

Illness/injury No. (%)
Diarrhoea/dysentary 15 (7.09)
Cough, cold/sore throat 5 (2.34)
Febrile illness 4 (1.86)
Hypertension 4 (1.86)
Injuries 4 (1.86)
Conjunctivitis 3 (1.40)
Pain abdomen 2 (0.9)
Old case of tuberculosis 2 (0.93)
Burns 2 (0.93)
Osteoarthritis 1 (0.46)
Diabetes mellitus with hypertension 1 (0.46)
Total 43 (20.91)

Table V reveals that 43(20.91%) of food handlers gave the history of some illness during the past 3 months. The morbidity suffered has been depicted in the table in order of magnitude. The past history was restricted to 3 months to facilitate better recall. Chitnis (1982)4 observed that 25.33% of food handlers suffered one or the other illness in the past 6 months.

Table VI: Distribution of food handlers according to the current morbidity.

Morbid condition No. (%)
Apparently healthy 82 (38.32)
Anaemia 39 (18.22)
Intestinal parasites 28 (13.08)
Poor nutritional status 17 (7.94)
Caries teeth 12 (5.60)
Trachoma 06 (2.80)
Injuries on skin and face 05 (2.34)
Acute respiratory infections 03 (1.40)
Scabies 02 (0.94)
Ringworm 02 (0.93)
Boils and fruncles 02 (0.93)
Burns 02 (0.93)
Diarrhoea/dysentary 02 (0.93)
Hypertension 02 (0.93)
Diabetes mellitus 02 (0.93)
Tuberculosis 02 (0.93)
Chronic SOM 02 (0.93)
Fever 02 (0.93)

Table VI reveals that out of total 214 food handlers, 82(38.32%) were apparently healthy and 132(61.68%) were suffering from one or more morbid conditions. Anaemia was found in maximum i.e. 39(18.22%), followed by parasitic infestations in 28(13.08%). The current morbidity profile of food handlers has been depicted in the table in order of magnitude.

The present study shows that general morbidity rate in food handlers, (61.68%) was quite high. The high morbidity in food handlers could probably be due to poor environmental conditions, poor personal hygiene and low socio-economic status.

Chitnis (1985)4 who had reported 74.13% overall morbidity, found that parasitic infestation (44.53%) and anaemia (22.13%) were the most frequently seen morbid conditions. Gupta and Ketkar (1981)3 observed that 69.7% food handlers suffered from intestinal parasitic infestations and 32.09% were anaemic.

Table VII: Anaemia among food handlers in relation to their dietary habits.

Dietary habits No. (%) Anaemics Percentage
Vegetarian 67 (31.31) 22 32.83
Non-vegetarian 147 (68.69) 17 11.56
Total 214 (100.00) 39 18.2

*2=13.97; df=1; p<0.001.

Table VII depicts that out of 214 food handlers, 147(68.69%) were non-vegetarians and 67(31.31%) were vegetarians. Out of 147 non-vegetarians, 17(11.56%) were anaemic while out of 67 vegetarians, 22(32.83%) were anaemics. The association between the prevalence of anaemia and the dietary habits of the food handlers studied was highly significant (p<0.001).

Table VIII: Distribution of food handlers according to intestinal parasitic infestations.

Intestinal parasite (n=200) No. (%)
Entamoeba histolytica 12 (42.80)
Ascaris lumbricoides 08 (28.60)
Giardia lamblia 05 (17.80)
Taenia solium 02 (07.20)
Strongyloids 01 (03.60)
Total 28 (100.00)

Note - Only 200 food handlers were examined.

Table VIII depicts that out of 200 food handlers whose stools were examined, 28(14%) were found to be suffering from parasitic infestations. Entamoeba histolytica was found to be the commonest (42.80%) followed by Ascaris lumbricoides (28.6%).

Chitnis (1982)4 found a relatively higher (44.53%) overall prevalence. He also found that Entamoeba histolytica was the commonest worm infestation.

Table IX: Nutritional status of food handlers in relation to the literacy.

Literacy status Nutritional status by weight for height
Good Fair Moderate Poor Total
Illiterate 13 (15.85) 20 (24.39) 35 (42.68) 14 (17.08) 82 (100.0)
Literate 29 (21.96) 41 (31.06) 59 (44.59) 03 (2.29) 132 (100.0)
Total 42 (19.62) 61 (28.50) 94 (43.92) 17 (7.96) 214 (100.0)

Figures in parentheses show percentages; *2=3.31; df=2; p>0.05.

Table IX depicts a direct positive relationship of literacy with the nutritional status of food handlers. There was a progressive improvement in nutritional status with the increasing level of education. The association, however, was not found to be statistically significant (p>0.05). This was likely to be not directly due to education but due to other factors related to education, like those who were better educated were coming from families having a higher socio-economic status. It may be related with their health conscious attitude as compared to uneducated persons.

Table X: Nutritional status of food handlers in relation to the dietary habits.

Dietary habits Nutritional status by weight for height
Good Fair Moderate Poor Total
Vegetarian 7 (10.44) 17 (25.37) 37 (55.20) 06 (8.97) 67 (100.0)
Non-vegetarian 35 (23.80) 44 (29.93) 57 (43.92) 11 (7.50) 147 (100.0)
Total 42 (19.62) 61 (28.50) 94 (43.92) 17 (7.96) 214 (100.0)

Figures in parentheses show percentages; *2=5.92; df=2; p>0.05.

Table X depicts that nutritional status was generally found to be better among non-vegetarians as compared to the vegetarians. The association between dietary habits and nutritional status in the food handlers studied, however, was not significant (p>0.05).

Summary and Conclusions:

Most of the food handlers were young in age, mostly cooks (49.5%) and literate (61.7%). About 62% of them showed evidence of some disease or deficiency while 21% of them gave history of some illness in 3 months preceding the study. 14% of food handlers had intestinal parasitic infestations and 18% were anaemic.

So it is implicated that the periodic medical examination along with necessary treatment such as deworming should be done. On the job training in sanitation and food handling is necessary.


  1. Jellife DB. The assessment of the nutritional status of the community. WHO Monograph series No. 53. WHO, Geneva (Switzerland). (1966), 216.
  2. WHO. WHO nutritional anaemias report of a WHO scientific group. Technical Report Series 408, Geneva (1968).
  3. Gupta SC, Ketkar YA. Prevalence of intestinal parasites in food handlers. Ind Med Gaz, 1981; 15(8): 295-8.
  4. Chitnis UKB. An evaluation of health status of workers in eating establishments in Pune Cantonment (1982) Med Jour Armed Forces, 1986; 2: 34-5.
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