Safety of ready-to-eat foods in highway tourist stopover food service establishments in Uganda

Abstract

In Uganda, highway tourist stop-over food service establishments (HTSFEs) are frequented by tourists to and from upcountry destinations. Their setup and operations are, therefore, critical in ensuring food safety. The HTSFEs had previously not been profiled, and their operations were poorly documented. This study focused on profiling these establishments, evaluating food safety knowledge, attitudes, and practices of food handlers, and analyzing the microbiological quality and aflatoxin levels of RTE foods and the potential carcinogenic risk leading to hepatocellular carcinoma as a result of the consumption of such foods. The study adopted a cross-sectional design involving the collection of quantitative data from managers (n = 30) of HTSFEs. An interviewer-administered questionnaire and an observational checklist were used to collect data. The research also explored food handlers' (n = 108) food safety knowledge, attitudes, and practices, using a structural equation model. Data was collected using a self-administered structured questionnaire. The study further evaluated the microbiological quality of 100 samples of Ready-To-Eat (RTE) foods in highway tourist stop-over food service establishments in Uganda, following International Standards Organisation (ISO) protocols. The RTE foods included fresh fruit juice, vegetable salads, fried eggs, and vegetables wrapped in a chapati (‘Rolex’), beef samosas, roasted chicken, and roasted beef. The samples were examined for the presence of Enterobacteriaceae, fungi, presumptive Escherichia coli, Staphylococcus spp., Salmonella spp., and Total Plate Count (TPC). A total of 84 food samples of maize bread (posho) and groundnut sauce were collected from 15 purposively selected HTSFEs. Samples from both foodstuffs were assessed for total aflatoxins (TAFs) and aflatoxin B1 (AFB1) using the Enzyme-Linked Immunosorbent Assay (ELISA technique). The risk of developing primary liver cancer (hepatocellular carcinoma) was computed using models recommended by the joint FAO/WHO expert committee on food additives based on Estimated Dietary Intake (EDI) and average potency. The EDI was determined based on daily food intake, mean level of AFB1, and average body weight. Based on the food safety compliance scores, none of the HTSFE belonged to grade A, and the rest were as follows: B (36.6%), C (30%), and Non-graded (33.3%). Most of the HTSFE were located in Western (47.6%) and Eastern Uganda (36.7%). None of the HTSFE had a food safety management system. A substantial percentage (58.6%) was inspected by the Uganda Tourism Board (UTB) in addition to either the local council or the city council. Half of the food handlers had adequate knowledge of food safety and good practices. Food safety knowledge significantly influenced practices (β = 0.37, p < 0.05), while attitude had an insignificant and negative effect on practices (β = -0.04, p > 0.05). Overall, the microbiological standard set for RTE foods by the Uganda National Bureau of Standards (UNBS) and the East African Community (EAC) was violated in 40% of the food samples tested. All fresh fruit juices exceeded specifications for TPC and fungi. Some of the vegetable salads (44.4%), ‘Rolex’ (25%), beef samosas (75%), roasted chicken (80%), and roasted beef (38.5% conformed to the specifications for Staphylococcus spp. All the Rolex and beef samosas conformed to the specifications for E. coli. Some of the fresh fruit juices (13%), vegetable salad (38.9%), roasted chicken (50%), and roasted beef (38.5%) conformed to the standard specifications for E. coli. All the beef samosas conformed to the specifications for Enterobacteriaceae. Salmonella spp. were not detected in any of the food samples. There was a significant difference (p < 0.05) in the microbiological quality of RTE from the different grades of HTSFE. RTE food samples from grade B HTSFE presented with better microbiological quality. All groundnut sauce samples had quantifiable levels of total aflatoxins (TAFs) ranging from 20.64 - 193.7µg/kg and AFB1 ranging from 12.82 – 53.95µg/kg, well above the regulatory limits of 10µg/kg and 5µg/kg, respectively. Similarly, all posho samples had TAFs (13.79 – 95.98 µg/kg) above the regulatory limits of 10µg/kg. Only 15.6% of the posho samples were within the regulatory limit for AFB1 of 5µg/kg There was no significant difference (p < 0.05) in total aflatoxin concentration and AFB1 in food samples from the different grades of HTSFE. The estimated dietary intake (EDI) for AFB1 ranged between 26.15 and 45.43 ng/kg bw/day, resulting from the consumption of groundnut sauce and posho, respectively. The margin of exposure was 15.29 (groundnut sauce) and 8.8 (posho). The derived risk of developing primary liver cancer was 1.0208 and 0.5876 cases per 100,000 people per year from posho and groundnut sauce consumption, respectively. This is potentially dangerous to the consumers This study emphasizes the importance of letter-grading of HTSFE, implementation of food safety management systems, law enforcement, consideration of the microbiological quality of RTE foods in the grading criteria, sensitization of key stakeholders in the food value chain on proper food handling, and better training of food handlers to ensure the safety of RTE foods in Uganda’s HTSFE, contributing to consumer protection and sustainable tourism