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Indian Journal of Community Medicine

A Study of Carrier State of S. Typhi, Intestinal Parasites & Personal Hygiene amongst Food Handlers in Amritsar City

Author(s): U. Mohan1, V. Mohan2, K. Raj3

Vol. 31, No. 2 (2006-04 - 2006-06)

Abstract:

Research Ouestion: What is the carrier state of S. typhi, intestinal parasites & personal hygiene status of food handlers in various educational institutions in Amritsar city. Obiective: (1) To identify S. typhi carriers & treat them. (2) To detect prevalence of intestinal parasites among them, (3) To study personal hygiene measures observed by food handlers. Study design: Cross-sectional. Participants: Food-handlers of hostels attached to health and educational institutions of Amritsar city. Sample Size: 214 food handlers enlisted in all health & educational institutions of Amritsar City. Study Variables: Laboratory examination of Stool, Urine, Nail-washing & Blood samples, Vi agglutination reaction, complete physical examination & Medical check-up. Statistical Analysis: Percentages. Results: 12.9% food handlers were suffering from intestinal parasitic infestation, out of which 42.81% were contributed by Entamoeba histolytica. Only one person (0.47%) was found to have S. typhi in stool sample while 28(13%) were Vi Reactors by agglutination test. The main deficiencies in personal hygiene were poorly kept nails, dirty working clothes, lack of foot-wear, irregular bathing & not brushing teeth. Conclusions: Incidence of carrier state of salmonella among food handlers was found to be 0.47% although Vi agglutination positivity rate was 13%. The personal hygiene habits among these food handlers was not found to be proper.

Key words: Food handlers, Salmonella carriers, Intestinal Parasites, Personal hygiene.

Introduction:

Food borne diseases continue to be a major public health problem in the developed & developing worlds alike. Current statistics for food-borne illness in various industrialized countries show that up to 60% of cases may be caused by poor food handling techniques, and by contaminated food served in food service establishments. No valid data are available for most developing countries, but there is reason to believe that they have similar problems. A major risk of food contamination lies with the food handlers. Dangerous organisms present in or on, the food handler's body can multiply to an infective dose, given the right conditions, and come into contact with food, or surfaces used to prepare food.1

Since food handlers in bigger eating establishments cater to larger number of people, they are epidemiologically more important than domestic food handlers in spreading of foodborne diseases. In view of above the present study was undertaken in health & educational institutions in Amritsar city with the objectives to identify salmonella carriers if any among the food handlers & to treat them, to detect the prevalence of intestinal parasites among them, and to study the personal hygienic measures observed by the food handlers.

Material & Methods

All the health and educational institutions with hostel facility were included in the study. In these institutions all the food handlers were studied except those who could not be contacted. After explaining the purpose of this study to the Heads of the institutions as well as to food handlers, the food handlers were contacted. Identification data was collected from them according to a pre-tested proforma evolved for the purpose of this study. After filling the proforma, the food handlers were subjected to a general physical examination & complete medical check-up. Stool, urine, nailwashing & blood samples were collected for laboratory examination. Selenite F broth was used as an enrichment medium for the isolation of various Salmonella species from fecal & nail washing specimens & urine. An arbitrary 10 point scale was devised for classifying the level of personal hygiene of food handlers. The scale includes hygiene & sanitation component about wearing clothes, use of gloves, cutting of hairs, washing of hands, cutting of nails, use of towels, bathing frequency, brushing of teeth & use of footwear. They were classified as good ≥7 score, satisfactory 4-6 score & poor ≤ 3 score.

Results

A total of 24 messes with 236 enlisted food handlers were visited. Out of these 214 could be examined. Out of these 28 (12.9%) food handlers were suffering from intestinal parasitic infestation. Out of 28, 12 (42.81%) were contributed by Entamoeba histolytica, followed by 8 (28.6%) cases of Ascaris lumbricoides. Evidence of Giardia lamblia infestation was found in 5 (17.8%), T. solium in 2 (7:2%) and Strongyloidosis in 1 (3.6%) of food handlers. Of 214 cases, only one person (0.47%) was found to have S. typhi in the stool sample. S. typhi could not be isolated from the urine & nail washings as any of the cases while 28 (13%) were found to be Vi reactors by the agglutination test.

In 27 the lowest serum dilution used was 1:10. Out of these 28, 27 were false positive i.e. Salmonella could not be isolated in stool culture of these. In the food handler who yielded growth of S. typhi from his stool sample, Vi-Reaction showed 1:20 serum dilution. The main deficiencies in personal hygiene were poorly kept nails improper working clothes, lack of footwear, irregular bathing & not brushing teeth.

Discussion

Gupta & Ketkar2 found the overall prevalence of intestinal parasites infestation to be 69.7% & reported that Entamoeba histolytica was the commonest parasite followed by round worm & Giardia. Chitnis3 had also found that the overall prevalence of intestinal parasites was 44.53% - the maximum being E. histolytica followed by roundworms. The findings of the present study are similar with E. histolytica found to be the commonest parasite.

Typhoid continues to be a global problem. Even in nonendemic/ developed areas imported cases continue to cause problems. As estimated by Paras, in 1980, there are about 12.5 million cases of typhoid in the world (excluding China), an incidence of 365 cases per 10,000 population. 3-5% of patients with typhoid fever become life long carriers4. However in the present study only one (0.47%) was found to have S. typhi in the stool sample while none of the samples of urine or nail washing tested positive. The carrier rate of 0.47% comparable with the studies of Bok-Kenhauser (1964) & Aggarwal et al (1985)5,6. Though 28 cases had tested positive on the Vi agglutination test, all but one turned out be to be positive. Hence isolation of the organism from the stool is a more sensitive method of detection of carriers. This has also been recommended by other workers5,7. The personal hygiene of the present study population appears to be better as compared to the findings of Gupta & Ketkar & Chitnis2,3. Gupta & Ketkar found 56.6% food handlers with dirty & untrimmed nails, dirty & unkempt hair & dirty clothes with habits like spitting indiscriminately. Chitnis reported 26.13% food handlers with poor personal hygiene and 28.8.% with good personal hygiene. This higher level of personal hygiene can be attributed to ready access to sanitary facilities and stringent supervisory control.

Conclusions

Out of 28 Vi-Reactors by agglutination test only 1 showed S. typhi in stool sample culture. It can thus be concluded from the present study that incidence of carrier state of Salmonella among food handlers was 0.47%, although Vi agglutination positivity rate was 13%. Therefore, it can be reaffirmed that culture examination is the only reliable & definitive method for the detection of carrier state of Salmonella though it is tedious & expensive.

The poor hygiene of these food handlers & the prevalence of various, disease conditions among them could adversely affect the health of the inmates of their respective institutions. Therefore, the need for pre-placement & periodic medical examination of food handlers can not be overemphasized, in order to protect the health of patients & students.

References

  1. Jacob M. Safe Food Handling- A Training Guide for Managers of Food Service Establishments. WHO Monograph Series 1989; 1-78.
  2. Gupta S Ketkar YA. Health & Hygiene status of food handlers. Indian Medical Gazette 1981;15(8):295-298.
  3. Chitnis UKB. An Evaluation of Health Status of Workers in Eating Establishments in Pune Cantonment. Medical Journal Armed Forces Medical College 1986; 2: 34-35.
  4. Lanta CF, Levine MM, Ristori, C. Vi Serology in the detection of chronic S. typhi carriers in an endemic area. Lancet 1983; II: 441-443.
  5. Bokkenheuser V. Detection of Typhoid Carriers. American Journal Public Health 1964; 54 (3): 477-485.
  6. Aggarwal P, Singh M, Basu RN. Detection of enteric carriers of S. typhi & other enteropathogens amongst food handlers,Indian Journal Medial Microbiology 1985; 3 (1): 29-32.
  7. Manson-B. Manson's Tropical Diseases 18th Edition. ELBS Publication, London: 380-390.

1. Deptt. of Microbiology
2. Deptt. of Community Medicine, DMC&H, Ludhiana.
3. Deptt. of Microbiology, Govt. Medical College, Amritsar.
Received 3-1-2001

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