‘assessment of awareness and hygienic practices among...

‘Assessment of awareness and hygienic practices among

poultry butchers in Patna city, Bihar’

Dr. Rajesh Kumar

Dissertation submitted in partial fulfillment of the requirement

for the award of the degree of

Master of Public Health.

Achutha Menon Centre for Health Science Studies (AMCHSS) Sree Chitra Tirunal Institute for Medical Sciences and

Technology (SCTIMST) Thiruvananthapuram, Kerala

India October 2006

1

Acknowledgement I express my heartfelt gratitude to Dr. Biju Soman, Assistant Professor, AMCHSS, SCTIMST,

for guiding me without which this study would not have reached this shape. I am also indebted to

Dr T K Sundari Ravindran, Honorary Professor, AMCHSS, SCTIMST and Dr Manju Nair,

AMCHSS, SCTIMST for providing valuable advice during the framing of my study. I sincerely

thank Dr. P. Sankara Sarma, Additional Professor, AMCHSS, SCTIMST, for providing statistical

advice. I am very grateful to Dr. K R Thankappan, Head of Department, AMCHSS, for his

support and guidance during my time in AMCHSS. I wish to express my deep gratitude to Dr

Raman kutty, Dr Mala Ramanathan and Dr Varatharanjan for their advice and help. I also thank

other staff at AMCHSS, especially Mr. Sunder Jayasingh, Assistant Registrar of AMCHSS for

the kind support. I express my sincere thanks to the members of the Technical Advisory

committee and the Institutional Ethics Committee for their valuable inputs.

I also express my sincere gratitude to the poultry butchers of Patna city for their

cooperation in this venture. I am very thankful to Dr Dhramendra Kumar, for providing

accommodation and all moral support during my data collection. I am also obliged to all my

colleagues for all their contributions and encouragement.

And, finally I thank God almighty and my parents for helping me to complete the project

despite many personal difficulties.

2

DECLARATION

I hereby declare that this dissertation work titled ‘Assessment of awareness and

hygienic practices among poultry butchers in Patna city, Bihar ’ is an original work of

mine and it has not been submitted to any other institution or University.

Thiruvananthapuram Dr. Rajesh Kumar

Kerala

October 2006.

3

Certificate

I hereby certify that the work embodied in this dissertation entitled ‘Assessment of

awareness and hygienic practices among poultry butchers in Patna city, Bihar’ is a

bonafide record of original research work undertaken by Dr Rajesh Kumar, in partial

fulfillment of the requirement for the award of the “Master of Public Health” degree

under my guidance and supervision.

Guide: Dr Biju Soman Assistant Professor, Achutha Menon Center for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences & Technology Thiruvananthapuram – 695011, Kerala, India. October 2006

4

Table of Contents

Content Page Number

Acknowledgements 1

Declaration 2

Certificate 3

Table of Contents 4

List of abbreviations 6

Abstract 7

Chapter 1 Introduction 8

1.1 Background 8

1.2 Objectives 10

Chapter 2 Review of Literature

2.1 Importance of meat in diet 11

2.2 Indian dietary habit about meat 11

2.3 Health hazards associated with meat production and consumption 12

2.4 Relevance of hygiene in meat production 14

2.5 Meat hygiene control 15

2.6 Slaughtering methods 18

2.7 Role of butchers, slaughtering methods and butcher shops in

maintaining healthy meat 20

2.8 Knowledge and awareness of butchers towards the hygiene 22

2.9 Importance of clean premises 22

5

Chapter 3 Methodology 23

3.1 Sample type 23

3.2 Study setting 23

3.3 Study population 23

3.4 Sample size 23

3.5 Sample selection procedure 23

3.6 Data collection techniques 24

3.7 Data analysis 26

Chapter 4 Results 27

4.1 Infrastructure details 27

4.2 Butchers’ details 29

4.3 Observation of hygienic practices 33

4.4. Hygienic score 36

Chapter 5 Discussion and Conclusion 42

5.1 Hygienic practices and Infrastructure 43

5.2 Hygienic practices during slaughtering 43

5.3 Unhealthy habits of butchers 44

5.4 Hygienic awareness of butchers 45

5.5 Overall hygienic score 47

References 50

Appendices

Appendix 1 Informed consent for interview 57

Appendix 2 Interview schedule 58

Appendix 3 Observation checklist 60

6

List of abbreviations

CNN - Cable News Network

IBN - International Business Network

POPs - Persistent Organic pollutants

PFA - Prevention of Food Adulteration

AGMARK - Agriculture Grading and Marketing

FPO - Fruit Products Order

APEDA - Agriculture and Processed Food Export Development Agency

FAO - Food and Agriculture Organization

WHO - World Health Organization

EIC - Export Inspection Council of India

MFPO - Meat Food Product Order

BIS - Bureau of Indian Standards

ISI - Indian Standards Institution

ISO - International Organization for Standardization

HACCP - Hazard Analysis and Critical Control Point

WTO - World Trade Organization

GIT - Gastro Intestinal Tract

SPSS - Statistical Package for the Social Sciences

7

ABSTRACT Background: Butchering centres are potential source of many zoonotic ailments including bird flu. Poultry meat consumption is rapidly increasing in India. This study assesses the hygienic practices at poultry butcher shops and its various modifiable correlates.

Objectives: To assess hygienic practices and hygienic awareness of poultry butchers in Patna city, Bihar.

Methodology: It was a descriptive cross sectional study. Two slaughtering centers were randomly selected from each of the 57 wards of Patna city. A checklist was used to assess infrastructure adequacy and slaughtering processes were observed by a qualified veterinary doctor to assess the practice and a questionnaire was used to study the awareness level of butchers. Practices were compared with standard stipulations of Codex Alimentarius Commission and Export Inspection Council of India guidelines.

Results: Of the total 113 facilities studied, majority (62.8 %) had limited infrastructural facilities and only one fifth (19.5%) had a valid license for slaughtering. Potable water, the most crucial commodity to ensure hygiene, was inadequate in most (73.5%) of the facilities. In none of the facilities a competent person inspected and certified the meat. Most (67%) the workers were without formal education and none had undergone any sort of job training. The awareness level of the workers on hygienic practices and about health hazards of butchering were dismally poor. Majority of them were having unhealthy habits and practices. The mean overall hygienic score was 17 (range 9, 33) out of the expected 69. Infrastructural facilities, water availability, having valid license and hygienic perception of the butchers were found to have statistically significant association with overall hygienic score. Workload, as measured by the number of chickens slaughtered per day, had a positive correlation with hygienic practices. (Spearman's rank correlation – 0.44, P= 0.000). Conclusion: Hygienic practices at the poultry butcheries in Patna (and probably in other Indian cities) were dismally poor. Ensuring adequate amounts of water, compulsory licensing and job training for the butchers are the dare needs of today. People’s preference to hygienic facilities, as revealed in the study, should be taken as a positive note.

8

Chapter 1

Introduction

1.1 Background

The poultry industry is growing worldwide faster with an annual growth rate of

5%1. During 2003, India accounted for 2.4% of the world meat production2 and this trend

is increasing. In India, poultry meat production ranks second to bovine meat production.

Poultry meat production in India is growing much faster annually at the rate of 11.1%3

whereas bovine meat is growing at 1.1%4. This growth of production directly reflects an

increase in its consumption in similar rates as shown in table no.1.

Table no. 1 Meat production and consumption of world and India (2000-2004)

Meat production (in 1000 tones) Meat consumption (in 1000 tones)

Chicken meat5 Bovine meat6 Chicken meat7 Bovine meat8

2000 1080.0 2857.9 1079.8 2569.8 2001 1250.0 2885.0 1250.0 2641.2 2002 1400.0 2912.3 1399.1 2613.3 2003 1600.0 2939.6 1595.0 2592.8 2004 1650.0 2966.3 1643.5 2686.5

With this much increased growth in meat production and consumption, hygiene aspects

become a major area of concern. This is very pertinent as more and more people in India

are turning into non-vegetarians as evident in the Hindu-CNN-IBN national survey9.

Most of the slaughter houses of Bihar are in the unorganized sector. According to

official figures only 53,000 bullocks, 30,000 buffaloes, 25,000 sheep, 574000 goats and

2000 other animals had been slaughtered in recognized slaughter houses of Bihar during

9

year 1999 - 200010. There is no specific data available on number of poultry slaughtered.

Perhaps most of the poultry meat is supplied by slab slaughterers, the unauthorized ones,

having inadequate facilities which are usually located on the sides of roads and streets.

These shops might be a source of meat-borne diseases and food poisoning among the

population as they hardly adhere to any hygienic practices. Ideally butchers should have

a good understanding on meat hygiene and basic infrastructural facilities should be made

available to them. Then only one can expect the butchers to practice hygienic ways of

slaughtering. This study is an attempt to explore the gaps in hygienic awareness and

infrastructural amenities of poultry slaughterers in Bihar.

10

1.2 Objectives

1. To assess hygienic practices among the poultry butchers in Patna city, Bihar.

2. To find out the awareness about occupational hazards and hygienic practices

among the poultry butchers in Patna city, Bihar.

11

Chapter 2

Review of literature

2. 1. Importance of meat in diet

Meat is an important component of diet as it is a rich source of proteins. It

consists of some amino acids closely matched to that of human beings and significant

amounts of Vitamin B12. They are excellent sources of minerals and micronutrients such

as iron, copper, zinc and manganese. Chicken meat, if taken without skin, has extra

advantage of being less in fat content (5%) which is almost similar to that of lean meat of

large animals. Moreover, chicken flesh has less saturated fatty acids (33% of the total)

and more poly-unsaturated fatty acid (14%) than lean meat which has 45% saturated and

4% unsaturated fat respectively11.

2.2 Indian dietary habit about meat

Meat is held in high regard by most communities in India. Serving meat at meals

is considered a sign of prestige and it is included as a main item in food when any menu

is planned. According to Hindu-CNN-IBN state of the national survey in year 2006,

majority (60%) of Indians are non-vegetarians. Only about 55% of Brahmins were

vegetarian while among Muslims and Christians they were 3% and 8% respectively.

Vegetarian people were least prevalent in coastal states such as Kerala (2%), Bengal

(3%), Andhra Pradesh (4%), Orissa (8%), and Tamil Nadu (8%) whereas they were more

in landlocked states such as Rajasthan (63%), Haryana (62%), Uttar Pradesh (33%),

Madhya Pradesh (35%), Gujarat (45%) and Punjab (48%).9 Changing over to poultry

12

meat has become a fashion in India among the non-vegetarians. Indians conventionally

consume properly cooked and many often over-cooked meat.

2.3 Health hazards associated with meat production and consumption

Meat has been identified as a major source of food-borne diseases in man.

Moreover butchers12 and meat handlers are at risk of various health hazards due to

inadequate facilities and unhygienic practices. Zoonotic diseases constitute almost 70%

of the emerging diseases, which are a major public health problem all over the world.13

Butchers who have regular contact with birds, meat and its products are more prone to

contract and transmit zoonotic diseases. Confirmation of bird flu in a Thai poultry

butcher in 200414 proves this beyond doubt. Meat consumers are susceptible to meat-

borne food poisoning. Proper cooking alone may not be sufficient to safeguard them from

food poisoning as the exo-toxins produced by some pathogens such as Clostridium or

Staphylococcus can withstand even heating.15. So, proper meat inspection that would

ensure hygiene in poultry slaughtering and handling of meat is very important. There are

numerous reports of food poisoning occurring due to the consumption of contaminated

poultry meat. In 2003, 8271 cases of laboratory confirmed salmonella infection were

reported in Austria and the cause was stated to be infected chicken meat.16 The outbreaks

of salmonellosis among the Norwegian, Swedish and Finnish travelers returning from

Greece during 2001-03, were identified to be associated with consumption of

contaminated chicken meat.17 Slaughtering occupation may also be associated with some

occupational diseases such as lung cancer, warts18, dermatitis19 and many zoonotic

diseases among butchers. A cohort study among meat workers in New Zealand done in

13

1988-2000, had shown many cases of cancer20. Health hazards due to chicken meat

production and consumption can be viewed in the following sub-topics.21

2.3.1 Bacterial diseases - These might be divided in two parts - primary diseases of

poultry that can be transmitted to human being and exogenous infections acquired during

processing of meat. Among the first group, common bacterial diseases of poultry having

potential health hazards are salmonellosis, staphylococcal infection, clostridial diseases,

coliform infections, fowl typhoid, paratyphoid infection, Arizona infection, fowl cholera,

tuberculosis, chronic respiratory disease, “air sacs disease”, listeriosis, and

campylobacteriosis. Listeriosis manifests in human being in the form of fever, headache,

nausea and vomiting22. Salmonella, Campylobacter, E. coli and Staphylococcus causes

diarrhoea in human beings23. In the second category, major exogenous organisms, which

might lead to infections and intoxications, are Staphylococcus, E. coli, Salmonella,

Clostridium and others.

2.3.2. Viral and chlamydial diseases - Avian influenza (bird flu), Newcastle disease,

infectious bronchitis, laryngo-tracheitis, fowl pox, avian leucosis complex, lymphoid

leucosis, Marek's disease, eastern equine encephalitis and ornithosis are major viral and

chlamydial zoonotic diseases of poultry. Eastern equine encephalitis mostly affects

persons under the age of 15 or over 50 years of age24. The dreaded bird flu which is at

present considered to be in the third stage of pandemic falls under this category.25

2.3.3. Protozoan diseases – Histomoniasis, coccidiosis and Cryptosporidium are major

protozoan diseases that get transmitted from poultry to human. In immuno-compromised

people, Cryptosporidium can cause severe, persistent diarrhoea and weight loss. The risk

of infection to humans due to coccidia is extremely low as it is host specific.23

14

2.3.4 Fungal diseases – Cryptococcosis, aspergillosis, candidiosis, and histoplasmosis

are common fungal diseases transmitted from poultry to humans. Histoplamosis primarily

causes pulmonary symptoms in human beings.24 Cryptococcosis is manifested as

meningitis or meningo-encephalitis in human beings.24

2.3.5 Miscellaneous diseases – Skin bruising, fracture of bones, physical contamination

by biological residues, faecal material, paints, the dirty scalding-tank-water, heavy

metals, and antibiotic residues in chicken are other concerns that negatively affect the

health of poultry meat. Bruising is important as it has been revealed in a study that

bruised tissue might carry bacteria such as Staphylococci.26 A study in 2002 in US food

supply had revealed that most of the food category including poultry meat had persistent

organic pollutants (POPs) residues.27.

2.4 Relevance of hygiene in meat production

E coli, Salmonella, Campylobacter, Staphylococcus, and Listeria are likely to

contaminate poultry products and are often associated with food (meat) borne illnesses.

In the absence of hygiene, these hazards might lead to serious consequences. This was

evident in the recent outbreak of bird flu.14 Thus, it is essential to maintain hygiene to

ensure safe meat production. Studies clearly indicate that hygiene is important for

wholesome poultry meat production. It is imperative to maintain hygiene at each step

from the hatcheries to meat consumption at the dinning table. This was illustrated in a

study from Belgium in 2003 in which the many routes of Campylobacter contamination

of poultry-meat from hatcheries to slaughterhouses were demonstrated.28 In 2001,

research showed that 62% (38 of 61) of the raw broiler pieces bought from retail stores

15

were positive for L. monocytogenes.29 In 1999, another Belgium study observed that

poultry meat samples were contaminated with Salmonella, C. jejuni and C. coli, and L.

monocytogenes.30

2.5 Meat hygiene control –

In India, quality control for food products is carried out by various regulatory

mechanisms such as the Prevention of Food Adulteration Acts (PFA) of various States,,

Agriculture Grading and Marketing (AGMARK) agency, Fruit Products Order (FPO),

Agriculture and Processed Food Export Development Agency (APEDA) 31 etc.

In bringing in policy advocacy in the area of meat hygiene in India, the following

organizations have a lead role.

Codex Alimentarius Commission32

Export Inspection Council of India (EIC) was set up by the Government of India under

Section 3 of the Export (Quality Control & Inspection) Act, 1963 as an apex body to

ensure sound development of export trade through quality control and pre-shipment

- The Codex Alimentarius Commission was created

in 1963 by FAO and WHO to develop food standards, guidelines and related texts such as

codes of practice under the Joint FAO/WHO Food Standards Programme. The major

aims of this initiative are, to protect health of the consumers, to ensure fair trade practices

in the food trade, and to promote coordination of all other food standards initiatives of

international, governmental and non-governmental organizations. In India Ministry of

Health and Family Welfare under Government of India is the nodal agency to implement

this.

16

inspection.33 The Act empowers the Central Government to notify various commodities

and their minimum standards for exports and to set up suitable machinery for inspection

and quality control. Generally international standards or standards of the importing

countries are adopted as EIC guidelines. Poultry Meat & Poultry Meat Products were

brought under compulsory quality control and pre-shipment inspection under the

provisions of the Export (Quality Control and Inspection) Act, 1963.

Meat Food Product Order (MFPO)34 1973 - promulgated under the Essential

Commodities Act, 1955 stipulates sanitary and other requirements for the preparation of

meat and maximum acceptable limits of heavy metals, preservatives, insecticides, other

residues in meat and related food products. This order was being implemented by

Ministry of Rural Development in the Ministry of Rural Area & Employment. As per the

recent amendment to the Allocation of Business, Ministry of Agriculture (Dept. of

Agriculture & Cooperation) would now be the nodal agency to implement this order.

Bureau of Indian Standards (BIS)35 – The BIS is the National Standards Body of India

which is the supreme authority in all matters concerning Standardization, Certification

and Quality. Bureau of Indian Standards Act 1986 was inacted on 1st April 1987 and it

had taken over staff assets, liabilities and functions of erstwhile Indian Standards

Institution (ISI) Government of India had envisaged that the establishment of BIS would

create an environment for quality-culture and consciousness with greater participation of

consumers in the formulation and implementation of National Standards in the country.

Under BIS there is provision of Food Safety Management Systems Certification (ISO

22000:2005) in order to maintain food safety.

17

Hazard Analysis and Critical Control Point (HACCP) is a process control system

designed internationally to identify and prevent microbial and other hazards in food

production. It includes steps designed to prevent problems before they occur and to

correct deviations as soon as they are detected.36 Pillsbury Company working along with

NASA and US army laboratories at Natick had developed a system to ensure the safety of

food for astronauts. This was based on the fact that if something has the potential to go

wrong at any stage in an operation, it would definitely go wrong at some stage unless one

deploys effective control mechanisms. This system was later expanded and became

HACCP, a part of Codex guidelines under World Trade Organisation (WTO). In India,

HACCP guidelines are implemented through Prevention of Food Adulteration (PFA) act,

1954.37 HACCP acts as a watchdog for meat hygiene. It is a welcome trend that efforts

are being made to implement HACCP in organized sector of the food industry. There is a

dare need to implement HACCP in unorganized sector also as 70-80% of meat food is

being produced and processed in the unorganized sector in India.31

HACCP mainly identified following major risk factors.38

Improper holding temperatures

Preparing food ahead of planned schedule

Poor personal hygiene

Inadequate cooking

Inadequate cleaning and disinfecting of equipments

Cross contamination

Use of left over

Contaminated raw material

18

Public health Acts mainly try to ensure the bare minimum facilities that should be

followed by the people engaged in poultry slaughtering for selling purposes. University

of Minnesota has put forward some guidelines for the hygienic requirements of

household level slaughtering.30

2.6 Slaughtering methods 39, 21 –

2.6.1 Selecting birds for slaughter – Healthy, clean and well-fleshed birds are the

prerequisites for getting wholesome poultry meat. Ideally birds should not be fed for 24

hours prior to slaughter, only water can be given. This is to prevent contamination of

meat with the feed and ingested material in the digestive tract while slaughtering and

evisceration of the bird. Under University of Minnesota guidelines for household level

slaughtering of poultry this duration of fasting is only 6-8 hours. .

2.6.2 Stunning – Generally electric method of stunning is preferred wherein the head of

birds is either brought in contact with a 500V electrified metal slope or with 150 V

electrically charged water bath. Stunning is not permitted in Muslim religion.40

2.6.3 Cutting and bleeding – After stunning, the anterior part of bird’s throat, just below

the lower jaw, is cut open severing both the large jugular veins to allow free flow of

blood. This stab/ cut should not open the esophagus or trachea which might result in

contamination of meat. Slaughtered bird should be kept upside down at least for 90

seconds, so that at least 50% of the blood is drained out. Putting the birds upside down in

bleeding cones or hooking the birds upside down on their legs on clothsline would ensure

complete drainage of blood. In the halal method of slaughtering adopted by Muslim’s, the

19

birds are simply bled without stunting by cutting directly across the exposed throat at the

base of the skull.40

2.6.4 Scalding – Scalding involves submerging the carcass in hot water to relax the

muscles holding the feathers.Ideally it should be done in continuously running warm

water. Younger birds can be scalded at 125° - 130° F for 30 to 75 seconds but for older

birds it may need higher temperatures of about 140° F for 30 to 75 seconds.

2.6.5 De-feathering – Removal of feathers from the dead birds could be done

mechanically or manually. De-feathering machines are used to do it in large scale

slaughtering centers. In smaller settings, usually the butcher himself plucks the feathers

manually. Hand plucking is the usual pattern in household level slaughtering as well.

2.6.6 Singeing - Young birds may not need singeing. Generally, it is done with a bottle

gas torch or an open flame. It is done to remove pin feathers from carcass.

2.6.7 Neck slitting and foot removal – Afterwards neck and head should be removed

without breaking of bone by using a twisting motion to cut through the joint. Then skin

should be loosened from the neck and crop and trachea. Removal of gullet (what is it?

Explain) is the next step. Feet are removed by cutting through the shank joint without

breaking the bones.

2.6.8 Evisceration – Safe removal of the viscera and related tissue of the carcass (dead

bird) is called evisceration. The body cavity of the bird is cut open with an incision from

the hind end with a cut around the vent to form a ‘J’shaped incision. Vent (the excretory

opening), surrounding oil glands and some adjacent tissue are removed together, taking

care not to contaminate the meat with bird’s faeces. Likewise with intestine and other

viscera are removed carefully. One should not cut open the intestine which can cause

20

contamination of the meat. Other viscera should be removed by stretching the abdominal

opening. After separation of the viscera from the carcass, the edible parts of the viscera,

the giblets (the gizzard, liver and heart) should be salvaged separately. Gallbladder

should be separated from the liver without rupturing it. Gizzard should be split open,

discard the contents, thoroughly washed under a stream of water and its inner lining

peeled off by inserting the thumbnail under the lining at the edge of the cut surface. It is

washed again before putting it back along with the edible parts. Lungs are removed from

the carcass by inserting the hand in the body cavity. The whole process is done

mechanically in large-scale slaughter settings.

2.6.9 Cutting meat – After evisceration, the carcass is again washed thoroughly and

place on cleaned slab and cut into pieces according to the requirements.

2.7 Role of butchers, slaughtering methods and butcher shops in maintaining meat

hygiene

Many studies clearly state the importance of butchers in maintaining meat

hygiene. Heavy microbial contamination (salmonella and campylobacter bacteria) were

detected in the surrounding premises and in the meat produced from some of the halal

butchering centres in London. Aprons worn by those butchers also were found to be

heavily contaminated.42 The findings of yet another study done in 2003 in London had

emphasized the importance of environmental hygiene in butcher’s settings in avoiding

microbial contamination in large and medium scale facilities.42 A study done in Hajj,

Saudi Arabia, had cautioned that butchers from the Indian Sub–Continent work barefoot

and they often hold the knife in their mouth while working, an easy way for cross

21

contamination. This can lead to cross contamination of the meat products and often

adversely affect the butchers’ health.43 There are many newspaper reports that in Punjab

(India) animals are slaughtered openly in shops and private premises and sold to people

without observing hygienic practices nor certification from an veterinary doctor which is

against public health act stipulations.44 A review paper from Nepal in 2003 warns that

slaughtering places are frequently contaminated and meat products from such a place can

be a potential source of food poisoning and zoonotic diseases.45

Cross contamination is a dreaded danger at slaughterhouses and utmost care

should be taken to prevent this. Likewise, equipments and personnel working at

slaughterhouses can be important sources for the contamination of meat.46 A study in

1985 done at Nsukka (Nigeria) revealed the presence of various types of pathogenic

bacteria in slaughtering equipments like knife, table, etc and on the hands of the butchers

as well as in the meat displayed for sale.47 A report in 1999 attributes apron clothes worn

by the butchers to be the primary source of cross contamination in meat shops.41

Improper cleaning procedures and lack of disinfectants at slaughterhouses were reported

in UK during 2003.23 Another study from UK, cautions of the lack of proper hand

washing among butchers, that can leads to cross contamination.48 One report points out

that incorrect slaughtering procedure might result in contamination of poultry carcasses

with their own faeces, GIT content, or feathers. This was resulted in contamination of

meat with several bacteria such as E. coli, enterobacter, coliforms and salmonella,

campylobacter.49

22

2.8. Hygienic knowledge and awareness of butchers

Butcher’s knowledge and awareness about the hazards of improper butchering is

essential to safeguard their health as well as the health of the community. A study done

in Kerala (India), in 1999 revealed that butchers hardly know anything about scientific

and hygienic aspects of animal slaughtering.50 A Ghanian study highlighted the near total

absence of any sort of training given to butchers whose awareness levels are pretty

primitive.51

2.9. Importance of clean premises

Byproducts and wastes from the slaughterhouses should be properly disposed;

otherwise this can lead to environmental pollution and ecological imbalance.

Indiscriminate disposal of poultry wastes and its byproducts can contaminate the

environment and lead to the spread and sustenance of infection in the community.44 One

study from Nangal (Punjab) reports that many birds perished after consuming the

'leftover' of slaughtered animals which were dumped into the river Sutlej from a nearby

slaughterhouse.44 Indiscriminate spillage of abattoir by-products, effluents and solid

wastes could lead to recycling of infection in animals52, which may get into the human

cycle and cause disease in humans.

23

Chapter 3

Methodology

3.1 Study Type

This is a descriptive field based cross sectional study done in Patna city, Bihar.

3.2 Study setting

Patna city is located on the south bank of the River Ganges and has a population

of 1.3 million53 as per census of 2001. With an area of 42 sq km,54 its population density

is quite high at 1132 persons per square kilometer53 compared to whole India figure of

324 persons per square kilometer54. The overall literacy rate is only 62.9%.56 The

population comprises of people from diverse religious groups such as Hindu, Muslim,

Sikh and Christian. For administrative purpose the city has been divided into 57 wards.

3.3 Study Population

The study population comprised of butchers involved in poultry slaughtering

practice in Patna city during the study period, i.e. from 5th June 2006 to 30th July 2006.

In Patna city most of the slaughtering facilities were in the unorganized sector, and so no

reliable estimates of the number of the existing facilities was available.

3.4 Sample size

Two facilities from each of the 57 wards were selected in a random fashion. A

total of 114 facilities were intended to be studied but only 113 could be done as one of

the sampled facility refused to participate in the study. As per the stipulations of the

Institute Ethics Committee guidelines, the researcher had to leave out that facility. As this

particular facility was in the residential ward where there was not many other

slaughtering centres, this could not be substituted either.

24

3.5 Sample selection procedures

The researcher went to the major chowk (junction) of each of the 57 wards and

using the lottery method and selected one direction. The researcher then proceeded along

the road in that direction and selected the nearest slaughtering facility as the first facility

to be studied. The researcher then went back to the main chowk and proceeded along the

road leading to the opposite direction to the first one selected. The second facility was

selected as the nearest poultry slaughtering facility from the junction along this road

diagonally opposite to the first road. The researcher was successful in all but one instance

wherein the selected facility refused to participate in the study.

3.6 Data collection techniques

Each of the selected facility was studied in three ways. Firstly, the infrastructures

of the facilities were analyzed using a checklist prepared combining standard guidelines

Codex Alimentarius Commission of Food and Agriculture Organization (FAO)57 and

Export Inspection Council of India (EIC)58. As a second step, the researcher, who is a

qualified veterinary surgeon, observed the butchering practice at the centre for a period of

one hour or till five birds were fully slaughtered, whichever was longer. Afterwards, the

main butcher at the facility was interviewed using a structured questionnaire to assess

his/her awareness with regards to the hygienic aspects of poultry slaughtering. The three

research tools as listed below were used to study the hygienic aspects of poultry

slaughtering in this study.

1. Checklist to assess adequacy of infrastructure/facilities

2. Observation checklist to assess the practice

3. Questionnaire to assess the butchers’ awareness level

25

Each one of the tool is discussed in detail in the following sessions.

3.6.1 Checklist to assess adequacy of Infrastructure/Facilities - During the pilot phase,

it became evident that there were no large-scale poultry slaughtering facility in Patna city

and all the available ones are with limited facilities. Therefore, for the purpose of this

study, slaughtering facilities were categorized into the following three groups based on

their type of construction, absence of construction itself such as open facilities (there is

no permanent physical structure), small facilities (with limited facilities and a single

person doing all the jobs) and medium facilities (with minimum facilities and one more

person to help the butcher in his work). More detailed analysis of the facilities were done

by observing the cleanliness of the facilities, cleanliness of the slaughtering slab,

presence of slope in the floor for ease of washing, presence of drainage facilities,

availability of adequate quantity of running water, presence of adequate lighting,

cleanliness of lairage (cage), presence of stray animals or insects in large amount in and

around the facilities, etc. The availability of detergent, disinfectant, soap, license from

health authorities, etc., were also assessed.

3.6.2 Observation checklist to assess the practice - The slaughtering practice was

assessed by observing the facility in action for duration of one hour or until they finish

slaughtering five birds, which ever is longer. The aspects studied were the following; use

of clean and healthy birds, cleaning and disinfecting knife, slab and floor before each

slaughtering to avoid cross contamination, method of killing birds, complete draining of

blood from the carcass, washing of the carcass before and after evisceration, whether

feathers or stomach contents come in contact with flesh, whether flesh touches the

ground, whether slaughtered meat get in touch with live/raw birds or their contents, etc.

26

Other aspects studied included washing of hands by the butchers in between work,

spitting or use of tobacco products while at work, counting currency in between,

improper wiping of hands in between (by using feathers of slaughtered birds etc).

3.6.3 Questionnaire to assess butchers’ awareness level - This is started with gathering

of baseline information about the butchers. Information on Age, sex, educational status,

years of work experience, whether they owned the shop or not, whether they indulged in

any other job other than this, etc. were collected. The butchers’ awareness with regards to

the diseases transmitted via butchering or eating of poultry meat, occupational hazards of

butchers, importance of hygienic aspects of butchers etc. were verified. A full set of study

tools used in this research are appended at the end (Appendix no.1)

3.7 Data analysis

First the infrastructural details of the slaughter centers were explored. Thereafter,

the age, educational status, years of experience and other individual characteristics of the

butchers were studied. After that, the hygienic practices of the butchers as realized by

way of observation were studied. Butchers’ awareness with regard to hygienic practices

of butchering was studied next. The findings were compared with the guidelines issued

by Codex Alimentarius Commission and Export Inspection Council of India (EIC) to

assess how far poultry slaughtering centres in Patna observe these guidelines. Cross

tabulations were done (bi-variate analysis) to elicit meaningful associations, if any,

between hygienic practices of slaughtering and infrastructural facilities or individual

characteristics and awareness level of butchers. Statistical analysis has done with SPSS

version 14.0. Findings were compared with similar studies done earlier for drawing up

meaningful inferences.

27

Chapter 4

Results

4.1 Infrastructure details

4.1.1 Location and structure

Most of the structures were located in market areas. (Table. 2)

Table 2. Location and structure of slaughtering centers

Total number 113 Number (%) Location of shop

In market area 106 (93.8) In residential area 7 (6.2) Structure of shop Open facilities 35 (31.0) Small shops 71 (62.8) Medium shops 7 (6.2) License

Had License 22 (19.5) Had no License 91 (80.5)

*as outlined in the methodology

Majority of the facilities was having limited infrastructure facilities and so fell

under the small facilities group (62.8%). Only one fifth of the facilities had a license from

the Municipal authorities to do business. Sixteen per cent of shops got slaughtering

chickens from their own poultry farms.

28

4.1.2 Other facilities

It was interesting to note that all the 22 licensed shops had adequate slope in the floor,

which is an essential pre-requisite for the upkeep of cleanliness. (table. 3) According to

Ministry of Environment & Forests, India guidelines, the floor of slaughterhouses should

have a slope of 33 mm per meter to ensure the proper drainage of fluid wastes.59

Table. 3 Other facilities

Total number 113 Number (%)

Have slab in working condition 112 (99.1)

Have knife in working condition 100 (88.5) Have floor with adequate slope 93 (82.3) Have adequate lighting 71 (62.8) Presence of detergent 71 (62.8)

Availability of adequate quantity of potable water 30 (26.5) Have sewage and good drainage facilities 22 (19.5)

Presence of soap 20 (17.7) Floor have proper drainage facilities 20 (17.7) Presence of disinfectant 9 (8.0) Lairage (cage) with good drainage 2 (1.8)

Only twenty (17.7%) shops had good drainage facility in the floor. Adequate

quantity of potable water was available in thirteen (59%) licensed shops compared to

only seventeen (18.7%) of unlicensed shops. Hot water was available only in one centre.

Majority of the facilities (62.8%) had adequate lighting. In general shops had detergents

(62.8%) in their facility but only 20 (17.7%) of the facilities had soaps and only nine

(8%) had disinfectants in the facility. All nine shops which had disinfectants were among

those with license from Municipality for slaughtering business.

29

4.1.3 Cleanliness of settings

Table. 4 Cleanliness of settings

Total number 113 Number (%)

Clean and rust-free knife 22 (19.5) Clean cutting slab 00 (00.0) Clean floor 15 (13.3) Absence of insects 00 (00.0) Absence of stray animals 51 (45.1) Clean cage 17 (15.0) Lairage with clean feed 24 (21.2) Lairage with clean water 27 (23.9)

Cleanliness of the facilities was quite inadequate. Only one fifth of the facilities

had a rust-free knife. (table. 4) None of the facilities had a clean cutting slab. No shops

were free from insects including flies. Stray animals including rodents were seen in and

around in more than 50% of the facilities. Only nine (8%) butchers were frequently

disposing the poultry byproducts and waste material. Only two (1.8%) had disposed their

byproduct safely.

4.2 Butchers’ details

4.2.1 Age and sex profile

All the 113 butchers were males and their mean age was 30.7 years, minimum age

being 13 years and maximum being 55 years. (Graph.1)

30

Graph 1. Bar diagram of age groups

50-5940-4930-3920-2910-19

Age groups of butchers in years

50

40

30

20

10

0

Num

ber

of b

utch

ers

4.2.2 Education status of butchers

The mean years of education were 1.9 years, 12th standard being the maximum

level of education attained. Only a fifth of the butchers had attended schools beyond 4th

standard. (Graph. 2)

31

Graph. 2 Educational status of butchers

19%

13% 67%

beyond primary education

formal education with primary schooling

no formal education

Broad classification of educational status of

butchers (Total Number = 113)

4.2.3 Butchering experience

Table. 5 Years of butchering experience

Total number – 113 Number (%) ≤5 years 15 (13.3) 6 - 10 years 42 (37.2) 11-15 years 20 (17.7) 16 - 20 years 21 (18.6) 21 - 25 years 12 (10.6) ≥26 years 3 (2.7) Total 113 (100.0)

The mean years of experience among the butchers were 12.3 years with a

minimum of two years and maximum of 30 years. Around one third of the study

populations had 6-10 years of butchering experience. (Table. 5)

32

4.2.4 Other details of butchers

Table 6. Other details of butchers

Total number 113 Number (%) Prominent source of media TV 25 (22.1)

Radio 41 (36.3) None 47 (41.6) Ownership of shop

Yes (self) 106 (93.8) No (others) 7 (6.2) Source of training

Father 58 (51.3) Other relatives 55 (48.6) Any other business

No 100 (88.5) Yes, I have 13 (11.5)

Most of the butchers own their shops and this is the sole income earning activity

to them (Table.6)

4.2.5 Awareness level of butchers

When asked, 43 (38.1%) said that meat consumption may cause diarrhoea, five

(4.4%) suggested possibility of fever and three (2.7%) suggested coughing.

Literature attributes many occupational diseases like diarrhea, fever, cough,

itching (dermatitis), cancer, and warts to poultry butchering, but when the researcher

enquired these to the butchers, none of them were aware of these. Eleven (9.7%) of them

told that butchers frequently get affected with backache due to heavy physical work.

33

May be this is a reflection of the poor ergonometric facilities at the slaughterhouses.

Ninety one (80.5%) butchers had answered as “don’t know”.

Table 7. Attitude of butchers in maintaining meat hygiene

Total number 113 Number (%) Do you think that selection of healthy chicken is important for hygienic meat production?

106 (93.8)

Do you think cleanliness of equipment is important for hygienic meat production?

61 (54.0)

Do you think cleanliness of place is important for hygienic meat production?

26 (23.0)

Do you think personal hygiene is important for hygienic meat production?

6 (5.3)

The majority of the buthcers suggested that selection of healthy chicken is the

most crucial aspect of maintaining meat hygiene. (Table.7) Cleanliness of equipments

and place were highlighted by 54 % and 23 % respectively. Among the 113, only one

person had told that disposal of wastes and byproducts are important to maintain meat

hygiene.

4.3 Observation of hygienic practices

4.3.1 Pre-slaughter phase

Most (96.5%) of the butchers were selecting healthy birds but only sixty six

(58.4%) butchers were giving importance to clean birds. None of the butchers had

withheld feed 24-hours prior to culling. None had maintained the history of flock under

slaughter.

34

4.3.2 Slaughtering phase

Table. 8 Slaughtering practices

Total number 113 Number (%) Did ensure complete drainage of blood from the carcass 112 (99.1) Washed carcass before evisceration 19 (16.8) Washed carcass after evisceration 14 (12.4) Did immediate removal of viscera after killing the bird 109 (96.5)

Only nineteen butchers (16.8%) had washed the carcass before evisceration and

only 14 (12.4%) had washed it that after evisceration.(Table. 8) Out of 22 licensed

shops, eleven (50%) had cleaned carcass with water before evisceration where as it was

only eight (8.8%) among unlicensed shops. Among seven larger shops owned by others,

six (85.7%) had cleaned carcass with water before evisceration. Among the licensed

shops eight (36.4%) had cleaned carcass with water after evisceration whereas it was only

six (6.6%) among unlicensed shops. Inspection by competent authority was not done in

any of the facilities. .

Overall, only seventeen (15%) butchers had cleaned their knife before each new

period of work (during the slaughtering process). Among 22 licensed shops, butchers

from nine (40.9%) shops had cleaned their knife during the slaughtering in comparison

with unlicensed eight (8.8%) shops. Only two (1.8%) had cleaned their cutting slab on

each new period of work. None had disinfected the knife, cutting slab or floor.

35

4.3.3 Protective equipments of butchers

No one was having proper protective clothing like overalls, gowns etc. It was

interesting to note that only 28% were wearing at least a shirt. (table.9)

Table. 9. Protective equipments

Total number 113 Number (%) Wearing light coloured shirts 32 (28.3) Wearing Clean shirts 27 (23.9) Wearing footwear 21 (18.6) Wearing clean foot wear 8 (7.1)

None had disinfected the protective equipments. None was using gloves. Twenty one

(18.6%) butchers had worn footwear, but only eight (7.1%) were wearing clean footwear.

4.3.4 Practices of butcher

The overall hygienic conditions were quite dismal and the chance for cross-

contamination of meat was present in almost all facilities. In a majority of the settings

(64.6 %), the butchers were so careless that the slaughtered meat came in contact with the

floor. None had disinfected their hands even when they were doing other work during the

slaughtering. All butchers had wiped their hand with feathers which was a peculiar

behavior of butchers from Patna. None of them had a medical certificate showing they

did not had communicable diseases during the previous three months. (Table. 10) Open

cuts in hands of the butchers were not a problem in majority of the facilities. The

situation was much better in licensed facilities, as expected.

36

Table. 10 Practices of butchers

Total number 113 Number (%) Butcher did not touch own nasal cavity while at work 105 (92.9) No open cuts in the hands of butchers, or if so, it was covered with wash proof covering while at work

104 (92)

They did wash hands during the work 72 (63.7) Butcher did not spit in between the work 67 (59.3) Butcher did not use tobacco products in between the work 63 (55.8) Meat did not touch the floor 40 (35.4) Butcher did not wipe hands with same cloth in between the work 11 (9.7) Butcher did not count money in between the work 7 (6.2) They did wash hands before start of the work 13 (11.5)

Only 13(11.5%) butchers had cleaned their hand before start of work. This was

86% in medium size shops, 41 % in shops with licenses and only four % in unlicensed

shops. However, a majority of the workers (64%) had cleaned their hands during work, in

the licensed sector (82%) than in the unlicensed sector (59%). None had washed their

body and body parts before start of work or during the work. None had disinfected their

hands in between the work or before start of work.

4.4 Hygienic score

The Hygienic score was computed for the purpose of description and comparison

of the hygienic practices with other study variables. Positive responses to all 69 variables

were given an equal score of one and the grand score was computed by adding all the

values. The mean score was 17 with a minimum value of nine and maximum value of

33. Majority (85%) of the butchers got scores between 11 to 22. Only 9.7% butchers had

a hygienic score of above 22. The distributions of the hygienic scores are given in

Graph.3.

37

Graph 3. Distribution of hygienic scores

Total hygeinic score

32.530.027.525.022.520.017.515.012.510.0

50

40

30

20

10

0

Std. Dev = 4.84 Mean = 17.0

N = 113.00

A total of 27 variables were used to capture infrastructural adequacy and its mean

score was 6.6 (range 1, 19). Forty two variables were used to capture the hygienic

practices of the workers, and its mean score was 10.5 (range 6, 16).

For single man facilities, the average total hygienic score was 16.2 (range 9, 28)

whereas in bigger facilities the average score was 29 (range 20, 33). Mean score was 22.8

(range 13, 33) for the licensed centers, whereas it was 15.6 (range 9, 24) for the

unlicensed ones. Average hygienic score for infrastructure details was only 9.8 (range 3,

19) out of a total of 27 for the licensed facilities whereas it was further low at 5.8 (range

1, 12) for facilities without license.

38

4.4.1 Bivariate analysis

For comparison purposes, the total hygienic score was grouped into poor hygiene

(below average) and good hygiene (above average). It was compared with various study

variables such as the source of training, location of shops, butchers’ experience, age,

education, structure of shop, license, source of chicken, work load and butchers’

perception to maintain hygiene. Significant associations were found only in a few

variables such as the structure of the shop, having proper license, source of chicken,

butchers’ perception to maintain hygiene and the number of chickens slaughtered/sold.

The following tables give the details.

Table. 11 Cross tabulation between Total hygienic score and structure of shop

Total Hygienic Score Structure of shop Total Open Structured Poor Hygiene 25 (71.4%) 37 (47.4%) 62 (54.9%) Good hygiene 10 (28.6%) 41 (52.6%) 51 (45.1%) Total 35 (100.0%) 78 (100.0%) 113 (100.0%) χ2 = 5.62, df (degree of freedom) = 1, P = 0.02

The average hygienic score was found to be associated with the physical structure

of the facilities. Centers with better facilities seemed to have better hygienic scores.

(Table.11)

39

Table.12. Cross tabulation between Total hygienic score and license

License Total Hygienic Score Unlicensed Licensed

Poor hygienic score 57 (62.6%) 5 (22.7%) 62 (54.9%) Good hygienic score 34 (37.4%) 17 (77.3%) 51 (45.1%) Total 91 (100.0%) 22 (100.0%) 113 (100.0%) χ2 = 11.4, df (degree of freedom) = 1, p = 0.001 (Fisher’s Exact test)

Having a valid license from Municipal authorities was a clear indicator of better

hygienic score as revealed in the statistically significant association seen in Table. 12.

The ownership of the shop was found to have a significant difference with total

hygienic score P= 0.003, (Fisher’s Exact test). All shops which were not owned by the

butcher had good hygienic score whereas 41.5% of shops having single man facilities had

good hygienic score.

Table 13. Cross tabulation between Total hygienic score and source of chicken

Source of chickens Total

Hygienic Score Own farm From others Poor hygienic score 3 (18.8%) 59 (60.8%) 62 (54.9%) Good hygienic score 13 (81.3%) 38 (39.2%) 51 (45.1%) Total 16 (100.0%) 97 (100.0%) 113 (100.0%) χ2 = 9.82, df (degree of freedom) = 1, P = 0.002 (Fisher’s Exact test)

It was interesting to note that shops which use chicken from their own farms had

an overall poorer score than those who were getting chicken from farms owned by others.

(Table. 13)

40

Table 14 Cross tabulation between Total hygienic score and butcher’s perception on

maintaining hygiene

Butcher’s perception about maintaining hygiene Total

Hygienic score No Yes Poor hygienic score 27 (69.2%) 35 (47.3%) 62 (54.9%) Good hygienic score 12 (30.8%) 39 (52.7%) 51 (45.1%) Total 39 (100.0%) 74 (100.0%) 113 (100.0%) χ2 = 9.96, df (degree of freedom) = 1, P = 0.03

Another interesting finding was the statistically significant association between

overall hygienic score and butchers’ perception of maintaining hygiene. Those who

presume that they were maintaining hygiene were really having better hygienic scores.

(Table. 14)

4.4.2 Correlations

It was heartening to observe that a statistically significant correlation was found

between sales measured in terms of number of chicken slaughtered in a day and the

overall hygienic score. (Graph 4) This signifies that hygienically better facilities were

preferred by customers and facilities with better hygienic scores have more business.

41

Graph. 4 Correlation between quantum of sales and hygienic scores

Spearman's rank correlation – 0.44, P= 0.000

Number of chickens sold per day

140 120 100 80 60 40 20 0

40

30

20

10

0

Total hygienic score

42

Chapter 5

Discussion and conclusion

Maintenance of hygienic practices at butcher shops is essential to provide healthy

meat for public consumption. Butchers’ shop is one place where there is maximum

chance for contamination of meat. Ironically, this is the place wherein one has to

ascertain suitability of meat for human consumption. This study explored how far the

poultry butchers in Patna city were observing hygienic practices and assessed their

awareness about potential health hazards involved with unhygienic slaughtering of birds.

Out of the 113 butcher points studied across 57 wards of Patna city, one third

(31%) had no physical infrastructure and about two thirds (62.8 %) had bare minimum

facilities. Only a small number of (6.2%) shops were having some basic amenities. All

the butchers were male, mostly in the age group of 20-50 years. Two thirds of the

butchers were without any formal education and none had received any formal training in

butchering practices. In other studies almost half of the food handlers had received

formal health education on food hygiene.60 In this regard, the hygienic situation of the

slaughterhouses in Patna city is worse than that in many underdeveloped countries like

Nigeria. However, most (86%) of the butchers in this study were involved in

slaughtering business for more than five years. Hygienic practices of the butchers are

discussed in the following subdivisions including infrastructure details, slaughtering

practices, unhealthy habits of butchers, butchers’ awareness level and overall hygienic

scores.

43

5.1 Hygienic practices and Infrastructure

Overall, the cleanliness in all 113 study samples was very poor. In none of the

facilities were the cutting slabs clean; only one fifth of the shops had a clean knife and

floors were cleaned only in one eighth of the facilities. This is similar to the earlier study

done in United Kingdom which had shown that surfaces of retail food premises,

equipments, cutting boards and food containers were dirty and had higher levels of

bacteria on microscopic examination.42 Most shops in the present study also lacked

drainage facilities on the floor or adequate sewage facilities. Shortage of potable water

and proper lighting added to the inadequacies. Only a few facilities had detergent

powders, disinfectants and many other prerequisites of hygienic practices. An earlier

study in United Kingdom had established the association of such deficiencies at food

premises and the higher chance for microbial contamination42. In the present study all the

facilities had insects and flies inside the shops, where as in another study done in Accra,

Ghana, among food venders on the street, it was found that only 35% shops had problem

with flies and insects.61

5.2 Hygienic practices during slaughtering

By interviewing butchers and observing the way they practice, the researcher

found that generally butchers were selecting healthy birds but were not giving any

importance to the cleanliness of birds. Many studies have shown that unclean

birds/animals can be a source of meat contamination62. None of them were aware of the

history of flock nor of any diseases the birds might have had. Added to this neglect, none

of the facilities had any system for poultry inspection and meat certification by any

44

competent authority at all. A study by Bisaillon JR et al had highlighted the importance

of meat inspection.63 Washing of the poultry carcass before and after the evisceration was

being followed at a few shops in the present study. A South African study in 1995 had

demonstrated that spray washing of carcass before and after evisceration would reduce

bacterial count in the carcass and consequent meat contamination.64

5.3 Unhealthy habits of butchers

In the present study, the poultry meat from all the shops were found to be

contaminated with birds’ feathers, intestinal contents or both of them. This is similar to a

study in Argentina wherein 11.3% of chicken carcasses were contaminated with birds’

faeces after evisceration.49 In the present study, most of the butchers were having

unhealthy habits during work such as spitting, the use of tobacco products, counting

money, wiping hands with a common cloth, and finger poking of nasal cavity, etc. which

are potential sources of contamination. This is in contrary to what researchers had

observed with US mobile food venders wherein no one had spitted or used smoking

during 20 minutes of their study-observation.65 Wiping hands with a common cloth

during work is a hazardous practice, as revealed by a study in year 1986 that wiping

cloths were heavily contaminated with E. coli, and Clostridium perfringens.66 Wiping

hands with feathers was a peculiar behavior of all of the butchers from Patna city which

could be a potential source of meat contamination as feathers of poultry may contain a

large amount of bacteria like Staphylococci. An UK study in 1988 had identified 580

strains of staphylococci from the de-feathering machine.67 In the present study none of

the 113 butchers studied were using hand-gloves and only a few were using clean

45

footwear. The study on mobile food vendors in US also had demonstrated such

unhealthy trends. In their study only 50% of the food venders were using hand-gloves.65

In the present study only 64% butchers had washed their hands during work time.

An UK study also observed scarcity of hand-washing among butchers.48 Washing hands

was more frequent among butchers in licensed and medium shops which could be linked

to water availability. This finding reiterates the finding of another study done in 2004

that correct hand washing is associated with availability of water and other amenities and

proper training on hand-washing given to the butchers.68 In the present study, none of the

butchers had disinfected their hands, body parts nor equipments. The potential reasons

might be due to un-availability of disinfectants or lack of awareness of its importance. A

Finland study in 1996 had demonstrated that deficient disinfection was associated with

high level of contamination of carcass and called for the enforcement of regular

disinfection of working tools to reduce microbiological contamination of meat.71 In the

present study none of the butchers had medical certification during the previous three

months of study in contrast to the finding of a Nigerian study wherein 30% of the

workers had pre-employment medical examination.60

5.4 Hygienic awareness of butchers

In the present study, butchers were found to have very poor awareness about

diseases related to meat consumption and potential occupational hazards to them. A

study in Kerala had also revealed this lack of awareness of butchers regarding scientific

or hygienic aspects of animal slaughtering.50 Both of these studies and a Ghanian study in

2000 reiterates that in general butchers are not having any sort of formal training for the

46

job.51 Thus, the lack of hygienic awareness can be attributed to the lack of formal training

in general and the poor educational status of butchers in this study. A study among street

food venders in Guatemala had shown that just bare knowledge is not adequate.71 They

found that in spite of having adequate knowledge regarding cholera and food safety

practices, the street food venders hardly practiced it. Researchers had attributed this to

the lack of effective and practical training.70 In the present study butchers were

comparatively more aware of the risk of meat borne diarrhea. It is important as the

diarrheal outbreak among children in Poland in 1995 was attributed to chicken meat

contamination.71 However, the awareness level of butchers with regards to diseases like

fever, coughing, gastritis, etc were very minimal. This is very worrisome as the above

mentioned symptoms can be manifestations of chicken borne food poisoning or zoonotic

ailments like chlamydiosis, colibacillosis, salmonellosis, campylobacteriosis, listeriosis,

and others. If not for the Indian cuisine practices of thorough cooking of meat these

unhygienic ways of poultry butchering might had resulted in many major disease

outbreaks.

In the present study, butchers’ awareness about their own health hazards were

also extremely low. No one identified warts, diarrhea, fever, dermatitis (itching), cancer,

or chronic coughing as potential health problems pertinent to poultry butchers. The above

mentioned symptoms might be manifestations of occupational hazards of poultry

butchers as mentioned in literature such as dermatitis19, warts18, cancer20 and zoonotic

diseases13. A Brazialian study in 1990 had shown that chicken borne C. jejuni can infect

both birds as well as chicken workers.72 It is interesting to note that in the present study

47

many butchers had complained of low backache which they had attributed to heavy

workload. It might be a reflection of the near total lack of infrastructural facilities, not to

mention about ergonometric approach, in most of the poultry slaughtering facilities in

Patna city.

When asked to identify the most crucial aspects to maintain meat hygiene,

butchers had picked up health of the birds and cleanliness of the equipments as the

important ones. Only a minority had stressed the importance of personal hygiene of

butchers and only one butcher had picked up safe disposal of wastes and byproducts as a

crucial component of maintenance of meat hygiene. So, it is explicit that butchers of

Patna city are not aware of the importance of butchers’ personal hygiene, hygiene of

slaughtering premises, and the need for safe disposal of slaughter wastes and byproducts.

Unless efforts are taken to remove this ignorance, one can not expect butchers in Patna

city to maintain hygiene in poultry meat processing and thus safeguard the health of the

public.

5.5 Overall hygienic score

For the quantification of overall hygienic score the present study used pertinent

recommendations of Codex Alimentarius Commission (FAO/WHO) and Export

Inspection Council of India, and modified those to suit the local environment. In general,

their overall scores were pretty low. The mean average score was one fourth of the

expected score of 69 (17.0 out of 69). Even the maximum score achieved was less than

half of the expected (33 out of 69). It was surprising to find a correlation between overall

hygienic score and the number of chickens slaughtered and sold at the facility. This

48

denotes that people prefer to buy chickens from hygienic facilities and this is a very

positive factor to count on. Better overall hygienic scores were also associated with shops

with more infrastructure facilities and shops owned by licensed people. This result is

consistent with the findings of a study in UK which has shown that introduction of

licensing had improved their hygienic conditions in premises of buchters’ shops.73 In this

study also all structured shops were found to have more sales and probably more income

and eventually they had better infrastructure. These shops were also comparatively better

prepared to ensure hygienic practices among its butchers.

The small sample size was a major limitation of the study. There were problems

with study tools as well. Most components of the guidelines were suitable for assessing

hygiene in large scale slaughtering facilities; where as most of the facilities in Patna city

were quite small facilities. So the study guidelines might have missed to capture the

minute differences in these facilities. There was a lot of suspicion and fear among the

butchers as most of them were not having a proper license from the Municipal authorities

for slaughterhouse business. One of the butchers had objected to take part in the study as

such. The heavy rains during the study period might have altered the usual picture of the

slaughtering centers, which might have favored some facilities (by way of washing off

the debris around the slaughter centre) and or negatively affected some other facilities (by

leading to water logging and the presence of insects).

In conclusion, this field level observation study done in 113 selected poultry

slaughtering facilities in Patna city revealed the stark neglect of hygienic practices and

their potential health hazards. Availability of adequate quantity of potable water and

other basic amenities were found to be very crucial for maintaining meat hygiene.

49

Licensed and bigger facilities had better hygienic scores than the rest. Overall, the poultry

butchers in Patna city had dreadfully poor hygiene awareness which can precipitate

outbreaks and catastrophes anytime. The total absence of bird inspection and meat

certification by competent authorities should be seriously taken up by the Patna

Municipality. Proper registration and licensing of the facilities should be made

mandatory by the Municipality and only workers who had undergone proper training on

hygienic slaughtering should be allowed to work in these facilities. The only positive note

coming out of this overall bleak scenario is the fact that people in Patna city prefer

hygienic facilities as revealed by the higher sales of chicken meat at hygienic and

licensed facilities.

Economically and culturally, Patna city is similar to many other cities in India.

Thus, the alarming findings of this study should be taken up very seriously by all

Municipalities and Corporations in India and corrective measure need to be implemented

on war-foot basis. Otherwise, in this era of a boom in non-vegetarianism, India would

head towards a major disaster of meat borne outbreaks.

50

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57

Appendix -1

Informed consent

I am Rajesh Kumar, Masters in Public Health scholar from Sree Chitra Tirunal Institute

of Medical Sciences and Technology, Trivandrum, Kerala. I would like to conduct a

study on “Assessment of awareness and hygienic practices among poultry butchers in

Patna city, Bihar”. For this study I want to conduct an interview and observe your shop

and activities involved. I would like to observe your shop for one hour. I may extend time

of observation if at least five chickens are not culled in first one hour of observation. It is

expected that this interview may take around 20 minutes of your valuable time. Here I

would like to see hygienic practices involved in your occupation and your awareness of

hygienic practices and associated health problems. Though there might not be direct

benefit for you from this study but it will be useful for community. All information

given by you will be kept confidential and will be used only for research purpose.

Are you willing to participate in this research project? Yes � No �

Name and address- Phone no.

Signature or left thumb mark of the participant Signature of the investigator

Time Date

58

Appendix -2

Interview schedule

1. Location of shop –

a. Market area b. Residential area c. others, specify

2. Construction of shop

a. Open space

b. Small constructed shop with single butcher doing all jobs like

butchering and meat selling

c. Medium level constructed shop having where butcher does

slaughtering job only

d. Others specify…

3. Sex - Male/ Female

4. Age in completed years -

5. What is your highest level of schooling?

6. What do you have among followings?

a. News paper, b. TV, c. Radio, d. Others, specify… e. none

7. Is it your own shop? Yes/ No

8. How long you are involved slaughtering job (in years)?

9. From where have you learnt butchering?

a. Father b. relatives and friends c. Formal (institutional) training

d. no any training e. others, specify…

10. Have you owned another job? Yes / No

11. What is average workload (per day)? a. In Kg____ b. In numbers

59

12. From where do you get the chickens? – Own poultry farms / Buy from others

13. Is your shop has license? - Yes / No

Awareness

15. Among the following diseases, which can occur among humans because of eating

meat? a Diarrhea b. fever c. cough d. itching

d Gastritis f. others specify… g. none h. don’t know

16. Among the following, which are the diseases that can be seen among butchers?

a. Diarrhea b. fever c. cough d. itching e. Cancer f. warts

g. none h. don’t know i. Others, specify…

17. What are the reasons why the butchers get it?

18. What are the hygienic aspects, which is/are essential to maintain the meat hygiene

while slaughtering? (Multiple answering)

a. Cleanliness of equipment b. Cleanliness of setting

c. personal hygiene d. poultry and meat hygiene

e. Disposal of by products f. others specify…

19. Are you able to maintain hygienic practice (what ever you have mentioned

above)? Yes/ No

20. If not then, what type of improvement, you want to do in your shop?

21. What type of improvement do you want to do for your butchering job in order to

maintain the hygienic practices?

60

Appendix -3 Hygienic practices (observation checklist)

Main topic

Sub topic Codex Alimentarius Commission and EICI (a),

Yes (1), No (0)

Remark, if any

Facilities and setting Cleanliness of equipments

Knife Good state of repair (a) Corrosion resistance (a) Clean before each new period of work (a) Sanitized before each new period of work (a) or immersion in hot water in between the work

Slab/cutting board/ dressing board

Good state of repair (a) Corrosion resistance (a) Clean before each new period of work Sanitized before each new period of work (a) or immersion in hot water during and between the work

Cleanliness of setting

Floor Clean Good drainage Sloppy Disinfected

Sewage Good drainage (a) Animals and insects

No Insects including flies should be there No animals

Lairage (cage) Sufficiently clean Clean feed Clean drinking water Good drainage

Others facilities

Water Easily available hot water all the time Easily available cold water all the time

Lightening Adequate (natural or artificial) Disposal of byproducts

Frequent Safe

Cleaning and sanitations

Soap For washing the body parts Disinfectant Using for sanitation Use of detergent Using for cleaning

Poultry and meat health Poultry and meat

Slaughtering birds Healthy Clean

61

health With held feed before culling

24 h before32

History of flock Should be there Screening of birds On arrival of birds and valid for 72 hr

(a)

Ante mortem inspection By competent person* with in 24 hour

Killing Rapid decapitation or stunning Bleeding Complete bleeding for at least 90 sec. Washing of carcass

Before evisceration

With potable water

After evisceration

With potable water

Evisceration Immediate after bleeding Post mortem inspection By competent person* Byproduct inspection Viscera inspection (a)

Inedible product Cross contamination

Mixing of GIT content or feathers or both with meat

Should not there

Meat touches to floor No Other sources@ No any direct contact

Butcher’s health Butchers

Protective clothing Light colored (a) Clean Easily cleanable Sanitized

Personal habits Spitting in between Use of tobacco products Wiping hand with cloths Counting money in between Doing other work in between without sanitizing

Nose picking Others

Protective equipments like

Gloves Clean Cleanable Sanitized

Gumboot or Shoe or at least Slipper

Clean Cleanable Sanitized

Medical certificate No communicable disease during work Cuts and injury Wash proof covering during slaughter Washing of body Before start of work

Body parts on every episode of work

62

Clean hands Clean before start of the work Sanitize before start of the work Clean during the work Sanitized during the work or Frequent clean with hot water

@ Other meat handler, dust, cloths, table and one which will be observed in that context and it

will be mentioned in column of remark.

*Competent person means person under the authority to inspect the meat and specially

trained for meat inspection that might be veterinarian.

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