Luận văn thạc sĩ food safety behavior in primary cook and health outcomes of household in ho chi minh city

This research’s objective is to find out the factors that modify the food safety practice of household primary food preparer and the effect of these behaviors on food poisoning risk.. Th

INTRODUCTION

PROBLEM STATEMENTS

The agricultural revolution significantly increased food production and improved laborers’ health, serving as a critical component of human capital development Ensuring food safety is essential, as food safety issues can negatively impact the sustainable development of developing countries and threaten national security In recent years, the rise of food-related diseases has shifted global emphasis from merely increasing food quantity to prioritizing food safety standards.

The overuse and misuse of pesticides, chemical fertilizers, and feedstuffs can enhance agricultural productivity but negatively impact food quality and safety Additionally, food preservation, processing methods, and the use of food additives contribute to reducing food safety, increasing the risk of contamination According to WHO (2015), bacteria, viruses, parasites, chemicals, and toxins are the primary causes of food-borne diseases Vulnerable populations such as children, pregnant women, and the elderly are the most at risk of food-borne illnesses.

The globalization of transportation and international trade has made food safety a critical global concern Incidents such as the Chinese milk scandal and New Zealand's material milk crisis highlight the significant economic losses for manufacturers and the health risks posed to consumers worldwide Ensuring food safety is now a shared responsibility that impacts countries everywhere, emphasizing the need for strengthened regulatory measures and quality control across supply chains.

1 World Health Organization (WHO) and Food and Agriculture Organization (FAO) defined:

“Food safety is the assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use” (WHO and FAO, 2009, p 6).

Figure 1.1: The number of food-borne cases annually (WHO, 2015)

Foodborne diseases (FBD) are a global issue, with the highest incidence in developing regions such as Southeast Asia and Africa, while developed areas like Europe and America report the fewest cases Interestingly, despite African countries facing food scarcity and weaker food safety controls, they experience fewer foodborne illness cases compared to Southeast Asia This disparity may be attributed to Southeast Asia’s diverse high-nutrition foods and tropical climate, which create ideal conditions for bacteria and other foodborne hazards to thrive and impact human health.

According to WHO (2015), food-borne diseases affect nearly 10% of the global population each year, leading to approximately 420,000 deaths, with one-third of these fatalities occurring among children Among various types of food-borne illnesses, diarrheal diseases are the most prevalent and widespread.

Africa unsafe food, accounted for half of global burden of FBD and made 550 million people falling ill (including 220 million children), cause 230,000 deaths (96,000 children’s)

Figure 1.2: The number of death caused by FBD annually (WHO, 2015)

The number of fatalities caused by food-borne diseases (FBD) mirrors the trend observed in FBD cases, with Southeast Asia and Africa experiencing the highest death tolls In contrast, Europe and the Americas report the lowest FBD-related deaths Africa has fewer FBD-related deaths than Southeast Asia, likely due to increased international medical support in Africa Additionally, differences in the physical strength and resilience of local populations between these regions may also contribute to variations in mortality rates.

The FBD caused the burden about 33 million DALYs 2 Diarrheal diseases agents were the largest contributors, accounted for 18 million DALYs, 54% of total All three

Disability-adjusted life years (DALYs) are a vital health metrics that quantify the overall burden of disease by combining years of life lost (YLL) due to premature death and years lived with disability (YLD) This comprehensive measure helps assess the impact of various health conditions on populations, providing valuable insights for public health planning and resource allocation By capturing both mortality and morbidity, DALYs enable a more holistic understanding of disease burden worldwide.

Africa figures 1.1, 1.2, 1.3 both indicated that South East Asian and African region’s food safety issue is severe and these areas suffered an enormous burden from FBD

Despite fewer death cases in Africa compared to Asia, the burden of food-borne diseases (FBD) in Africa is almost twice that of Southeast Asia and significantly higher than other regions Conversely, Europe, the Western Pacific, and the Americas have a total burden similar to Southeast Asia but only half of Africa’s FBD impact These disparities highlight the differences in healthcare infrastructure and food safety policies across regions, directly affecting population health outcomes worldwide.

FBD (functional bowel disorder) imposes a significant health burden worldwide, with varying degrees of severity that highlight the importance of measuring disease impact over time As depicted in Figure 1.3 (WHO, 2015), the burden of FBD is often assessed using the concept of DALYs, where one DALY represents the loss of one healthy year of life This metric allows for a comprehensive evaluation of the combined years of life lost due to premature death and years lived with disability, emphasizing the profound impact of FBD on global health.

Vietnam is categorized in the Western Pacific region by the WHO This region exhibits a moderate level of foodborne illnesses globally, a trend that is reflected in Vietnam’s situation The Western Pacific includes a diverse range of countries, from developed nations like Australia, Japan, and South Korea to developing countries such as Cambodia, the Philippines, and Vietnam Consequently, the contribution of each country to regional food safety varies significantly Detailed information about Vietnam’s foodborne illness case is provided in Chapter 4.

While developing countries bear the heaviest burden of food-borne diseases (FBD), developed nations also face significant challenges In 2014, the CDC reported 864 food-borne disease outbreaks in the USA, resulting in over 13,000 illnesses, 712 hospitalizations, and 21 deaths, along with 21 food recalls The majority of cases occurred in restaurants (65%), followed by private homes (12%) Bacterial infections were the leading cause, responsible for 22% of cases, highlighting that even countries with robust healthcare systems must continuously combat food poisoning threats.

CDC also predicted that food safety issue would continue emerge in the future due to:

- Changes in our food production and supply, including more imported foods

- Changes in the environment leading to food contamination

- Better detection of multistate outbreaks

- New and emerging bacteria, toxins, and antibiotic resistance

- Changes in consumer preferences and habits

- Changes in the tests that diagnose foodborne illness.

Despite the surge in immigration, increased international trade, and globalization challenges, food-borne diseases remain a critical issue that garners limited individual country attention Instead, they represent a significant concern for the modern world, necessitating global cooperation and proactive measures to ensure public health safety worldwide.

RESEARCH OBJECTIVES AND RESEARCH QUESTIONS

Vietnam’s diverse food market offers convenient options for households, leading most Vietnamese families to cook and eat at home at least once daily These eating habits, combined with external factors, influence the risk of food poisoning, which is also shaped by socio-economic status, individual characteristics, and living conditions Additionally, the longstanding tradition of home cooking in Vietnam, rooted in Asian cultural and agricultural practices, significantly impacts household food practices Cultural heritage is reflected in the community’s knowledge of food processing, preservation, and kitchen practices, reinforcing the importance of tradition in shaping food safety behaviors.

Research studies from Thua Thien Hue province (Duong, 2013) and Ho Chi Minh City (Nguyen, 2010) highlight a significant correlation between individuals' knowledge, attitudes, and food safety practices in various settings such as food factories, restaurants, and households According to the “10 Golden Principles in Food Processing” (MOH, 2005), essential food safety behaviors encompass proper handling, hygiene, contamination prevention, and adherence to safety protocols to ensure consumer health and safety.

- Clean, tidy kitchen and the cooker surface

- Using waste basket with cover

- Use clean water to handle food

- Use clean tool to prepare and divide food

- Not use forbidden food additives or out of date food

- Washing hand before cooking and after toileting

- Not smoke, spit out or nail polished while cooking

This thesis builds on widely applied principles used in numerous Vietnamese studies, primarily focusing on behavioral outcomes However, most existing research from a medical perspective tends to overlook socio-economic factors and individual characteristics As a result, the influence of these important factors on food safety behaviors has not been explicitly examined, highlighting a gap that this study aims to address.

The research findings highlight the current state of food safety issues within the community but lack comprehensive analysis of multiple factors influencing these concerns Additionally, the study did not include participant involvement in the annual survey, limiting insights into the impact of government policies and activities on food safety.

This thesis aims to identify and evaluate the key factors influencing food safety behavior, including socio-economic status, knowledge about food safety, perceptions, and information sources Understanding these factors allows the government to develop targeted strategies to modify behavior, reduce risky practices, and lower the incidence of foodborne diseases By assessing individual influences, policymakers can implement effective interventions to improve public health and decrease the burden of foodborne illnesses.

To analyze food safety behavior and health outcomes of household primary cook

- To determine the relationship between knowledge, perception of consumer and their food safety practice at household kitchen

- To evaluate the impact of individual food safety practice to their food-borne disease probability

(1) Do food safety knowledge and perception have impact on individual food safety practice?

(2) How food safety practice affect to individual food-borne poisoning risk?

SCOPE OF RESEARCH

This study analyzed data from a survey on individual food poisoning, focusing on knowledge, attitudes, and practices among households in Ho Chi Minh City in 2013 The survey was conducted across all 24 districts of Ho Chi Minh City from March to April 2013, with the primary cooks in households serving as respondents Local medical staff were responsible for collecting the data, ensuring accuracy and reliability of the survey results.

The annual survey on this topic features different participants each year, ranging from householders in 2010 and 2013 to restaurant workers in 2012, 2014, 2015, and 2016 Additionally, the specific respondents within each participant category vary annually, with the most recent data for households collected in 2013 As a result, the data is not linked across years, preventing the creation of panel data for longitudinal analysis.

This research examines the behavior and incidence of acute food poisoning among the community in Ho Chi Minh City from March to April 2013, utilizing secondary data to assess influencing factors The study employs a combination of descriptive statistics and advanced econometric techniques—including factor analysis, multivariate probit models, and propensity score matching—to provide a comprehensive analysis of the factors impacting food safety and community health.

THESIS STRUCTURE

Due to the available of the data, thesis is composed as the structure below:

This chapter introduces the research problem related to Functional Behavioral Disorders (FBD), highlighting their global prevalence and significant psychosocial burden It emphasizes the importance of understanding FBD to improve diagnosis and treatment strategies, and outlines the scope and objectives of the thesis The chapter provides a comprehensive overview of FBD's impact worldwide and sets the foundation for exploring effective intervention methods, aiming to contribute valuable insights to mental health research and clinical practice.

Chapter 2: Literature Review examines the foundational concepts and definitions relevant to the study, providing a comprehensive overview of previous research on key factors and models This chapter highlights the importance of these factors and models as the basis for developing the analytical framework and methodology By reviewing existing studies, it establishes a solid foundation for analyzing how each component influences the overall system, ensuring a well-informed and credible approach to the research.

Chapter 3: Research Methodology outlines the framework and econometric tools employed in the study, providing a clear understanding of the analytical approach It details the data sources and collection methods used to ensure data quality and reliability Additionally, the chapter includes comprehensive descriptions of the variables involved, emphasizing their relevance and role within the research.

Chapter 4 presents the research results, including a comprehensive analysis of the data, key findings, and a comparison with existing studies Descriptive statistics of the variables are provided to illustrate the data distribution and trends, offering valuable insights into the research topic.

- Chapter 5: Conclusion and policy implications This chapter concludes the research finding, provides implication, further suggestion as well as the research limitations

LITERATURE REVIEW

FOOD SAFETY AND FOOD-BORNE DISEASES

Food-borne diseases (FBD) are conditions transmitted primarily through ingested food, caused by enteric pathogens, parasites, chemical contaminants, and biotoxins (WHO, 2007) There are two main methods to estimate the burden of FBD: the etiologic agent or risk assessment approach, which starts with exposure levels and identifies the proportion related to food, and the syndromic or epidemiological approach, which begins with disease outcomes like gastroenteritis and attributes a portion to food-borne causes A comprehensive assessment of the disease burden combines both approaches to provide accurate insights.

In 2015, WHO estimated approximately 600 million cases of foodborne illnesses and 420,000 related deaths worldwide, with 40% of the disease burden affecting children under five years old (WHO, 2015) The data used in this thesis were collected through participant interviews via questionnaires, without any laboratory food testing As a result, the diagnosis of foodborne disease relied on responders’ self-assessment combined with medical staff evaluations based on individual symptom descriptions.

Food safety is defined as “the assurance that food will not cause harm to human health or life,” according to the Vietnam Ministry of Health (2010) This comprehensive definition encompasses the entire food supply chain, including growing, harvesting, preservation, and processing, rather than focusing solely on preparation and consumption Due to its broad scope and the widespread implementation of food safety regulations in Vietnam, this definition is adopted in this thesis to represent the concept of food safety.

THE HEALTH BELIEF MODEL

The Health Belief Model (HBM) originated from psychological and behavioral theories that explain decision-making under uncertainty by evaluating the “value-expectancy” of potential outcomes (Maiman & Becker, 1974) When adapted to health contexts, the HBM suggests that individuals strongly assess the benefits of illness prevention and health improvement actions Their health-related behaviors are influenced by their perceptions of their susceptibility to illness, the seriousness of potential diseases, and the likelihood of becoming sick based on their actions According to Glanz et al (2008), the main components of the HBM include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Table 2.1: The concepts of Health Belief Model

Perceived susceptibility Belief about the chances of experiencing a risk or getting a condition or disease

Define population(s) at risk, risk levels

Personalize risk based on a person’s characteristics or behavior

Make perceived susceptibility more consistent with individual’s actual risk

Perceived severity Belief about how serious a condition and its sequelae are

Specify consequences of risks and conditions

Perceived benefits Belief in efficacy of the advised action to reduce risk or seriousness of impact

Define action to take: how, where, when; clarify the positive effects to be expected

Perceived barriers Belief about the tangible and psychological costs of the advised action

Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance

Cues to action Strategies to activate

Provide how-to information, promote awareness, use appropriate reminder systems

Self-efficacy Confidence in one’s ability to take action

Provide training and guidance in performing recommended action Use progressive goal setting

Give verbal reinforcement Demonstrate desired behaviors

The components of this framework are categorized into three groups: modifying factors, individual beliefs, and actions These elements interact with personal characteristics to influence behavior, as illustrated in the accompanying figure Understanding the relationship and impact of each group is essential for a comprehensive view of the overall process.

Figure 2.1: Health Belief Model Components and Linkages (Glanz et al, 2008)

Numerous studies have applied the Health Belief Model (HBM) to analyze food safety behaviors across diverse groups, including restaurant workers (Cho et al., 2010), primary food preparers in families with young children (Lum, 2013; Meysenburg et al., 2013), and older adults (Hanson and Benedict, 2002) These studies demonstrate that the components of HBM interact and influence individual behavior, with food safety knowledge notably exerting a strong impact on personal perceptions of food safety.

EMPIRICAL REVIEWS ON DRIVERS OF FOOD SAFETY PRACTICES

Participants with a college degree or higher demonstrated significantly better scores in food safety knowledge and behaviors compared to those with lower education levels (Meysenburg et al., 2013) The study employed the Health Belief Model combined with mixed methods analysis, including script interviews and group discussions, to examine a sample of 72 participants These findings highlight the positive correlation between higher education levels and improved food safety awareness and practices.

Modifying factors Individual Beliefs Action

Perceived susceptibility to and severity of disease

According to Unusan (2005), higher education levels positively influence confidence in food safety practices and reduce risky behaviors, highlighting the importance of education in promoting safe food handling However, the study found no significant correlation between socio-economic status and individual food safety practices Unusan analyzed data collected from Turkish households using MANOVA techniques, providing valuable insights into the factors influencing food safety behaviors.

Research by Unusan highlights that gender and education level significantly influence food safety knowledge, with women and highly educated individuals typically possessing greater awareness due to their roles as primary food preparers and their attentiveness to information Similar findings by Byrd-Bredbenner et al (2007) and Mullan et al (2014) indicate that age also impacts food safety knowledge, with older individuals generally demonstrating higher understanding Additionally, women tend to be more responsible for food safety issues than men, as confirmed by Jevsnik et al (2006) through ANOVA analysis.

Research by Langiano et al (2012) found that married participants exhibited more accurate food behaviors compared to singles Additionally, larger family sizes were associated with better food practices, as primary cooks in bigger families demonstrated more precise and attentive dietary habits.

Food preparers primarily acquire food processing knowledge from family members and relatives, highlighting the重要 role of family as a key resource for food safety information (Meysenburg et al., 2013) Research indicates that family influences individual food safety behaviors, serving as a vital source of knowledge that impacts how people handle and prepare food (Kwon et al., 2008; Trepka et al., 2006) Specifically, Kwon’s study on participants of the WIC program used questionnaires to assess food knowledge and behavior, revealing that individuals with higher food safety knowledge tend to follow proper food preparation practices more accurately.

(T H Vo et al, 2015) These authors group investigated in the canteens’ and restaurant’s workers by using logistic regression model to get this finding

Research by Cho et al (2010) indicates that food safety knowledge among participants does not significantly influence their food practices, particularly among restaurant workers Their study utilized multiple regression and maximum likelihood estimation to support these findings Additionally, Roberts et al (2008) demonstrated that food workers exhibit only limited behavioral change even after receiving food safety training and education These studies collectively support the understanding that knowledge alone has minimal impact on actual food handling behaviors.

High self-efficacy individuals are confident in their ability to prevent health threats, such as foodborne diseases (FBD), through proper food handling (Meysenburg et al., 2013) This confidence tends to decrease when they rely on others to prepare food Additionally, experiencing or causing a foodborne illness for themselves or family members due to improper food handling can further diminish their confidence in their food preparation skills.

Research on food safety perception and behavior presents mixed findings Nesbitt et al (2013) revealed that many consumers believe food contamination occurs before it reaches their kitchen, and those who experienced foodborne diseases (FBD) often attributed their illness to food prepared outside the home Conversely, Unusan (2007) found that consumers tend to underestimate the health risks of food poisoning, often viewing it as a normal occurrence rather than a serious issue This lack of awareness leads to a low tendency among consumers to adopt proper food safety practices or prioritize food safety concerns.

Jevsnik et al (2006) found that household cooks prefer farmer’s products over industrially produced food, believing that farm-sourced food is safer However, consumers largely deny responsibility for food safety, attributing it instead to food handlers like farmers, food factories, retailers, catering services, and the government Additionally, their research revealed that individuals under 30 tend to overestimate their ability to handle food safely, despite evidence to the contrary (Byrd-Bredbenner et al., 2007).

Research by T H Vo et al (2015) highlights a significant link between food safety knowledge and positive attitudes toward food safety issues, though it finds no significant correlation between attitude and actual food handling practices Additionally, Cho et al (2010) reveal that individuals with better food safety knowledge are more likely to perceive the severity and likelihood of food poisoning accurately Consumers with precise food safety knowledge also face fewer difficulties when handling food securely However, the study indicates that knowledge alone does not directly influence perceptions of foodborne disease (FBD) prevention or safe food practices, but perceiving the benefits of avoiding food poisoning encourages more consistent and safer behaviors.

Hanson and Benedict (2002) found that increased awareness of foodborne disease (FBD) severity can lead to improved individual behaviors However, their study also revealed that the correlation between perceptions of FBD hazard and actual food safety practices was relatively weak These findings were derived using nonparametric statistical methods, specifically Spearman rank correlation coefficients, highlighting the nuanced relationship between awareness and safe food handling behaviors.

Research by Cho et al (2010) highlights a strong correlation between food safety cues and proper food handling practices Individuals who have previously experienced foodborne disease (FBD) are more likely to adopt safe food safety behaviors (Lum, 2010) However, Lum also notes that experiencing symptoms of illness does not always result in improved food safety practices, emphasizing the complex relationship between past experiences and behavior change.

A similar result from Hanson and Benedict (2002) showed that the cue, content of

Research indicates that males are less affected by education compared to females, while the impact of education becomes stronger with increasing age Additionally, this influence varies depending on an individual's food handling frequency, highlighting the importance of tailored educational interventions in food safety practices across different demographic groups.

Research by Byrd-Bredbenner et al (2013) demonstrates that food labels conveying messages about risky foods or recommended practices positively influence consumer behavior The study also found that individuals across different age groups are concerned about food safety knowledge, but their awareness and responsiveness are heightened when information is tailored specifically to their age group Effective labeling and targeted communication can therefore enhance consumer understanding and promote safer food choices.

Research by Mullan et al (2014) indicates that past behavior and habits are significant predictors of current actions Habits develop through the repeated performance of behaviors within consistent contexts or in response to specific cues A lack of cues or reminders at home may prevent individuals from practicing essential food safety behaviors regularly.

RESEARCH METHODOLOGY

ANALYTIC FRAMEWORK

Based on related research and thesis studies, the HBM framework was implemented to evaluate food safety behaviors using specific variables Modifying factors include participants' individual and demographic characteristics and their family backgrounds, while knowledge concentrates solely on food safety issues Individual beliefs are assessed through attitudes and awareness regarding food safety, and actions are evaluated by various food safety practices Cues that trigger these behaviors are primarily derived from information sources, highlighting the importance of awareness and proper information dissemination in promoting food safety.

Due to the limitation of the secondary data, the components from HBM measured in several variables:

- Modifying factors: age, gender, residential location, occupation, education level, number of family’s member and the knowledge about food safety issue

- Individual belief: the awareness about the food safety problem, risky group and reason of food poisoning; attitude about food selection and processing; food source chosen

- Individual behavior: hygiene, process, preserve practice

- Cues to action: the food safety information source

The relatives and interactions of those components illustrated in the figure below:

Figure 3.1: The Health Belief Model application in food safety

ECONOMETRIC MODELS

This study employs the multivariate probit model (MVP) to analyze how independent variables influence different food safety behavior groups The research focuses on three key aspects of food safety practices: hygiene kitchen practices, food processing and preservation techniques, and personal hygiene practices By utilizing a system of three equations within the MVP framework, the study provides comprehensive insights into the interrelated factors shaping each behavior category, enhancing understanding of food safety compliance.

+ TV, newspaper + Local food safety communicator

Perceived susceptibility to and severity of disease

- Attention about food safety problem

Individual beliefs significantly predict dependent variables in the study The trivariate probit model, as outlined by Cappellari and Jenkins (2003), estimates three related binary outcomes using the equation y_im* = β_m X_im + ϵ_im, where y_im equals 1 if y_im* exceeds zero, and 0 otherwise Error terms (ϵ_im) are assumed to follow a multivariate normal distribution with a mean of zero and a variance-covariance matrix V, which has ones on the diagonal and correlations (ρ_jk) off-diagonal, capturing the interdependence between the three outcomes This model effectively accounts for correlations among the dependent variables influenced by individual beliefs.

The log-likelihood function for the sample of N independent observation is given by:

Where ωi is an optional weight for observation i=1,…, N, and ϕ3 is the trivariate standard normal distribution with arguments ài and Ω, where

𝜇 𝑖 = (𝐾 𝑖1 𝛽 1 ′ 𝑋 𝑖1 , 𝐾 𝑖2 𝛽 2 ′ 𝑋 𝑖2 , 𝐾 𝑖3 𝛽 3 ′ 𝑋 𝑖3 ) With Kik=2yik – 1, for each I, k = 1,…,3 Matrix Ω has constituent elements Ωjk, where: Ωij = 2 for j =1,…,3 Ω21 = Ω12 = Ki1Ki2ρ21 Ω31 = Ω13 = Ki3Ki1ρ31 Ω32 = Ω23 = Ki3Ki2ρ32

The probability of every outcome is given by:

This study examines nine key food safety practices, categorized into three behavior groups: hygiene kitchen practices ("kprac"), process and preserve practices ("pprac"), and hygiene individual practices ("iprac") Each practice is assigned a binary value—1 for correct implementation and 0 for incorrect—based on whether all behaviors within a group are correctly followed The criteria define "right practice" as the accurate execution of all behaviors in a group, while any deviation is considered a "wrong practice." The practices are rooted in the "10 golden principles in food processing," with specific emphasis on maintaining a clean, tidy kitchen and cooker surface, and properly separating well-cooked food from raw food during processing and preservation To facilitate easy assessment, some behaviors, such as cleaning and tidiness, and separating food types, are broken down into multiple specific actions.

- “sex” is the dummy variable indicate the sexuality of participant, 0 for male and

1 for female The expected regression coefficient of this variable is predicted insignificant, due to the fact that most of the responders were females;

The variable "loc" serves as a dummy indicator of respondents' locations, where 0 represents suburban participants—including districts such as Binh Tan, Binh Chanh, Thu Duc, Go Vap, 9, 12, 6, 8, Nha Be, Can Gio, Cu Chi, and Hoc Mon—and 1 signifies urban participants from the designated districts This coding facilitates analysis of geographical differences in responses across suburban and urban areas.

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𝑁 , where: ρ: difficulty index nc: the number of right answer

N: the total number of responders

The term “per” indicates participants’ perceptions related to food safety issues, assessed through a questionnaire covering four key areas: susceptibility to and severity of foodborne diseases (FBD), perceived benefits of safety practices, perceived barriers, and self-efficacy Due to limited data, the study utilized Factor Analysis to identify underlying perception factors from three of these four groups, excluding the perception of benefits.

The variable “cue” represents the source of information regarding food safety, including categories such as TV, radio, newspaper, local medical staff, and food documentaries For analytical purposes, these sources are encoded as dummy variables—TV, radio, news, local_staff, and food_doc All variables utilized in the model are detailed in the accompanying table.

Sex Gender of participant 0 for male, 1 for female

Location Residential place 0 for suburb, 1 for urban

Age The age of participant Years old

Expenditure Amount of money for food consumption Hundred thousand VND Family member Number of family member Person

Education Education level The number of schooling years

Job Occupation of participant Category variable: common labor, householder, other

Knowledge Food safety knowledge Food safety knowledge point Perception Awareness about food safety issue 3 point Likert’s scale

Cue to action Food safety information source Category variable: TV, radio, newspaper, local medical staff, food documentary

Multicollinearity occurs when explanatory variables in a regression model are linearly related, impacting the stability of coefficient estimates There are two types: perfect multicollinearity, where regression coefficients become indeterminate with infinite standard errors, and imperfect multicollinearity, where coefficients are still determinable but have large standard errors, reducing the precision and accuracy of estimates (Gujarati, 2004) Addressing multicollinearity is essential for reliable regression analysis and accurate interpretation of variable effects.

Research by Cho et al (2010) and T H Vo et al (2015) identified a relationship between knowledge and perception of food safety Perception was measured using a Likert scale, indicating the trend rather than the magnitude of its impact on behavior Due to the large sample size of over 1,000 observations, the influence of multicollinearity in the regression model was minimized Additionally, the thesis employed both the reduced and original forms of the MVP to estimate regression coefficients, ensuring robust analysis.

3.2.3 Propensity Score Matching (PSM) Method

Chow and Mullan (2009) highlight that past behavior is a strong predictor of food safety practices, emphasizing the importance of providing cues to help individuals develop lasting food safety habits and modify primary cooking behaviors Additionally, consumers often lack awareness of their crucial role in the food safety chain (Jevsnik et al., 2007), which can contribute to the risk of foodborne disease (FBD).

2007) Due to these reason, the consumers could hardly change their behavior in a short time period after suffering food poisoning

People tend to use rationality when they understand the cause-effect relationship between proper food handling practices and health benefits (Mari et al., 2008) However, household cooks may find it challenging to identify which incorrect practices lead to foodborne diseases (FBD) Additionally, since the food poisoning data only covers a two-week period, this study assumes that the incident did not influence individual behavior Consequently, the paper estimates the probability of food poisoning based on individual behavior using the Propensity Score Matching (PSM) method, ensuring a more accurate analysis of behavioral factors and health outcomes.

Khandker et al (2009) explain that propensity score matching (PSM) creates a statistical comparison group by modeling the likelihood of treatment participation based on observed characteristics Participants are then matched with nonparticipants according to their propensity scores to ensure comparable groups In this study, PSM was employed in four steps to effectively assess the impact of food practices on food poisoning risk, enhancing the accuracy of the analysis.

- Step 1: establish the logit regression model with the dependent variable receive value as “0” if the participant had not suffer FBD within 2 week at the survey time, and

“1” otherwise The explanatory variables are individual food safety behaviors

- Step 2: using the probit regression model to predict the FBD possibilities of each responder in the survey data

- Step 3: remove all observations with too high or too low prediction among the sample

- Step 4: compare the food safety practices between 2 groups “suffer FBD” or

“non suffer FBD” in order to evaluate the impact of behavior to FBD probability of individual

The relative of continuous variables would check by the t-test while the bivariate variables’ tests by the Chi-square test.

DATA

This study analyzes data from the 2013 investigation into individual food poisoning incidents in Ho Chi Minh City and the 2013 KAP survey on food safety among households The findings provide valuable insights into the prevalence and causes of food poisoning, as well as the community’s knowledge, attitudes, and practices related to food safety in the region By examining these surveys, the research highlights critical areas for improving food safety awareness and implementing effective prevention strategies in Ho Chi Minh City.

- Data source: Safety Hygiene Food Branch of Ho Chi Minh city

- Data description: the data had two parts:

+ Part 1 is the investigation in individual food poisoning and the relevant symptoms, included: individual characteristic, demographic information, food poisoning statement and clinical symptoms

+ Part 2 is the KAP survey of primary cook of household, included: individual characteristic, food safety knowledge, food safety attitude and examining the food safety practicing of primary cook

- Size of samples: 1,174 households and 4,593 individual participate in the survey The households were chosen by Probability Proportional to Size sampling technique (PPS):

Researchers randomly selected 30 out of 319 wards in Ho Chi Minh City for the study In each ward, surveyors randomly investigated the first household and then interviewed the next 39 households on the right side Data collection involved four questionnaires: acute food poisoning investigation, food knowledge assessment, attitude survey, and food practice evaluation The surveyors directly assessed food practices using a checklist, while respondents answered the other questionnaires Local medical staff responsible for food safety within each ward conducted the interviews, ensuring data accuracy and relevance.

Households participating in the survey were required to meet specific criteria, including that all members had resided at the same address for at least six months prior to the investigation Participation was voluntary, with households needing to approve their involvement Household members were defined as individuals living in the same residence, sharing at least one meal daily, and engaging in shared household chores and responsibilities Additionally, households that could not be reached after three attempts were replaced by other eligible households to ensure data completeness.

Participants in the survey do not have mental illness, deafness, or speech impairments Children included in the study are at least 6 months old, as their diet primarily consists of lac fibrinum during infancy For children under 10, parental or primary caregiver confirmation was used to ensure accurate responses.

+ The symptoms to diagnose food poisoning case: after having meal, the patient had the stomach-intestine symptoms (colic, vomit, diarrhea…), nerve symptoms

Food poisoning symptoms such as stiff tongue, illusion, less visible signs, delirium, and convulsions vary depending on the type of pathogen involved A food poisoning case is typically confirmed only if the affected individual consumed the meal at home prior to symptom onset Household food poisoning is identified when the primary cook or any family members develop symptoms after eating the same meal at home, indicating a link between the illness and the home-cooked dish.

This study integrates data from two sources to assess the relationship between knowledge, perceptions of food safety, and individual behaviors It aims to understand how these factors influence personal food safety practices and their impact on the likelihood of food poisoning The findings highlight the importance of proper food safety behaviors in reducing foodborne illness risk, emphasizing the need for targeted educational interventions to improve knowledge and perceptions related to food safety.

RESEARCH RESULTS

FOOD SAFETY PROBLEMS IN VIETNAM

According to WHO (2016), food-borne diseases in Vietnam impose an economic burden of approximately 1 billion USD annually, accounting for 2% of the country's GDP This figure encompasses costs related to lost work time, decreased productivity due to illness, and market losses Additionally, Vietnam Food Administration (VFA) statistics from 2007 to 2015 indicate that there are between 150 to [missing data] cases of food-borne illnesses each year, highlighting the ongoing public health challenge posed by food safety issues in Vietnam.

Vietnam experiences approximately 250 mass food poisoning outbreaks annually, affecting over 5,000 people each year Despite the implementation of the National Strategy on Food Safety since 2006 and its validation during the 2011–2020 period, the number of food poisoning cases in the country remains consistently around 5,000 annually This persistent issue highlights ongoing challenges in ensuring food safety and requires strengthened preventive measures.

The stagnation in food safety progress can be attributed to the weaknesses of legacy institutions Although the Food Safety Law was enacted in 2011, related regulatory documents remain insufficient to meet current needs, leaving the Food Safety Department without adequate institutional support Additionally, manufacturers and consumers lack comprehensive information and guidance on proper food safety practices The complex Food Safety Administration network, involving multiple ministries and departments, further hampers effective regulation The tropical climate and climate change pose increased risks of food poisoning, while Vietnam’s diverse cuisine and limited consumer knowledge heighten the likelihood of foodborne diseases Despite a stable number of food poisoning cases, the decline in related fatalities has been gradual, with approximately half of the deaths caused by natural toxins (Nguyen, 2016).

Figure 4.2: The number of food poisoning outbreaks and death in Vietnam

Food poisoning incidents in Ho Chi Minh City have steadily declined over the years, with only 20 cases recorded between 2012 and 2016 and no reported fatalities The majority of these incidents, 19 out of 20, were caused by bacterial contamination, while the cause of the remaining case remains unidentified This trend highlights significant improvements in food safety and public health efforts in the region.

Figure 4.3: The number of food poisoning cases in HCM city (FSBDH, 2016)

Food poisoning cases in Vietnam and Ho Chi Minh City are often underreported due to limited attention from government agencies and researchers, resulting in insufficient educational programs and assessments of household food preparation and cooking practices Most government resources are allocated toward managing manufacturers and the food industry, leaving individual food safety less prioritized However, a 2013 survey revealed an individual food poisoning rate of 2.18%, indicating a significant risk of foodborne diseases among the population.

4.1.2 Problems with household’s cooking behavior

Due to insufficient attention from the Vietnamese government regarding household food safety, primary cooks often practice inadequate food handling techniques A 2010 investigation by the Safety Hygiene Food Branch of Ho Chi Minh City revealed that many household food practices do not meet safety standards, highlighting the need for increased awareness and regulatory focus to improve overall food safety at home.

54.3% of consumers in Ho Chi Minh city behave accurately in cooking The figures for Lao Cai province and Dong Thap Province are 67.7% and 76%, respectively (Nguyen,

Most communication and education strategies primarily target food producers and workers, often overlooking household cooks despite the need for specific education programs to improve their food safety behaviors While food poisoning risks in households are generally perceived as less severe compared to schools and factories, the increasing urban work pressures lead consumers to frequently eat outside their homes, such as in company canteens, schools, or food shops Consequently, the significant impact of household cooking practices on public health is underestimated, resulting in minimal government efforts to promote safer household food handling and preparation.

DESCRIPTIVE STATISTICS

The data includes 1,174 households primary cooks with the characteristics listed in Table 4.1 and Table 4.2

Table 4.1: Demographic characteristics of participants (category variables) Demographic characteristics Number of participants (n) %

The data indicates that females are the primary household cooks, accounting for 93.02%, highlighting their dominant role in meal preparation Additionally, householders constitute the majority of respondents at 69.78%, reflecting their central role in household decision-making While most respondents are either householders or engaged in common labor, other occupations are relatively rare Consequently, the regression analysis simplifies occupation variables into three categories: householder, common labor, and others, to better analyze their impact on the study outcomes.

The majority of respondents have completed Junior and High School education, despite varying educational backgrounds across all levels The sampling method resulted in a nearly equal urban and suburban representation, with 53.53% from urban areas and 46.47% from suburbs Television emerges as the primary source of food safety information for households, with 87.31% of respondents citing it, followed by newspapers However, only 24.19% of responders obtain food safety information from local medical staff The household food poisoning rate stands at 5.11%, while the individual rate is 2.18%, with the difference due to some households experiencing multiple food poisoning cases.

In contrast, the descriptive statistic of continuous variables is show on the table below:

Table 4.2: Demographic characteristics of participants (continuous variables)

Variables Mean SD Min Max

The average age of the primary cook is 47 years old, indicating that middle-aged women are mainly responsible for food preparation in households, consistent with traditional Vietnamese family roles The typical household in Ho Chi Minh City has just over four members, aligning with government population policies promoting ideal family sizes On average, households spend nearly 100,000 VND daily on food, while the mean food safety knowledge score is 9.46 out of 14.04, suggesting that primary cooks generally possess basic food safety knowledge However, the 2010 survey assessed knowledge through the percentage of correct answers, preventing direct comparison between the two periods.

Based on the Health Belief Model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy are key latent variables influencing health behaviors However, due to data limitations, this study only evaluated four components: perceived susceptibility (3 questions), perceived benefits (3 questions), perceived barriers (1 question), and perceived self-efficacy (11 questions) The correlation coefficients ranged from -0.0004 to 0.8587, indicating significant relationships among these items A high Kaiser-Meyer-Olkin (KMO) value of 0.947 confirmed strong correlations suitable for factor analysis Additionally, the non-zero determinant of the correlation matrix (p < 0.01) and Bartlett’s test results (p < 0.01) further validated the appropriateness of the data for factor analysis.

The Cronbach alpha’s value of all components and the factor analysis result (after rotation) were showed in the table below

- Attention about food safety problem

Hygiene hand before touching food

Hygiene hand after touching food

Eating food right after processing

Among 18 factors (Appendix 2), there are three factors which Eigen value were more than one, accounted for a cumulative 66% of variance Therefore, the thesis showed all 3 factors and using only factor 1 (accounted for 50% of variance) as the indicator of perception value for the multivariate regression In summarize, the perception value varied from -3.01 to 2.36 with the average at 1 This figure implied the majority of participant perceived the threat of food safety issue

A recent survey revealed that individual hygiene practices were the most precise behavior among the three groups, accounting for 81.48% Hand washing was the most accurately performed specific behavior, with 97.77% of respondents practicing it effectively In contrast, only 78.34% of participants correctly followed processing and preserving practices, representing the lowest adherence rate Conversely, behaviors such as avoiding smoking, spitting, and nail polishing while cooking had a higher compliance rate of 81.68%, indicating better practice in these areas.

A large proportion of respondents reported practicing food safety measures correctly; however, the percentage of individuals exhibiting 100% correct behavior was significantly lower across all groups Notably, this figure has slightly increased compared to the 2010 survey, rising from 54.3% to 61.87% Despite the 2010 assessment not being conducted by medical professionals, the observed improvement in individual food safety practices highlights a positive trend The detailed results are presented in the table below.

Behavior (n68) Responder with right behavior

- Separate cooking tool for cooked and uncooked material

- Separate in preserving with enough facilities

- Use clean tool to prepare, divide food

- Not use forbidden food additives or out of date food

- Wash hand before cooking or after toileting

- Not smoke, spit out, nail polished while cooking

Figure 4.4: The nonparametric relationship between food safety practice and

Foo d s af et y K no w dle dg e v alu e

Foo d s af et y K no w dle dg e v alu e

Foo d s af et y K no w dle dg e v alu e

Figure 4.4 highlights the correlations between participants' practice evaluation, perception value, and knowledge score The data indicates that responders exhibiting correct behaviors in each practice group demonstrated higher perception values and food safety knowledge, showing more significant accumulation compared to others Although the explanatory variables varied within a similar range, the upcoming regression analysis will clarify these relationships further.

RESULTS FROM MULTIVARIATE PROBIT MODELS

According to the Health Belief Model, health-related behaviors are directly influenced by individuals' perception values and cues to action, which serve as key triggers for behavior change Modifying factors such as demographic characteristics and food safety knowledge indirectly affect these behaviors, shaping how individuals respond to health threats To analyze these relationships, the thesis employs both a reduced multivariate probit model—focusing on perception value and cues to action as primary predictors—and the original multivariate probit model incorporating all relevant independent variables, ensuring comprehensive insights into factors influencing health behaviors.

Table 4.5: MVP regression reduced form Variable Coefficient p-value Coefficient p-value Coefficient p-value

The table presents the coefficients, standard errors, and p-values for the reduced form of the multivariate probit model, indicating significant positive relationships among various hygiene practices Specifically, the estimated coefficient of 0.57 between Hygiene kitchen practice and Process/preserve practice suggests a strong positive association, while the coefficients of 0.46 between Hygiene individual practice and Hygiene kitchen practice, and 0.48 between Hygiene kitchen practice and Process/preserve practice, further confirm these linkages These positive correlation coefficients imply that a primary food preparer is more likely to engage in a group of related behaviors if they practice at least one of these hygiene practices well.

The study found that perception values have a positive and highly significant correlation with three key food safety behaviors: hygiene kitchen practices (r = 0.191), process and preservation practices (r = 0.561), and personal hygiene practices (r = 0.316) These findings suggest that higher perception levels positively influence individuals' food safety behaviors, emphasizing the importance of awareness in promoting better food handling and hygiene practices Enhancing perception and awareness can effectively improve overall food safety and sanitation.

Radio news are the most influential factors among all five cues, significantly impacting hygiene practices and food preservation, with coefficients of 0.367 and 0.511 respectively Participants who listen to radio news tend to maintain cleaner kitchens and improve their food preservation practices Conversely, exposure to food documentaries and advice from local medical staff negatively influence food preparers, with food documentaries associated with poorer hygiene practices and medical staff advice linked to worse food preservation and individual hygiene The remaining factors show no significant effect on these practices.

Table 4.6: MVP regression original form

Variable Coefficient p-value Coefficient p-value Coefficient p-value

Hygiene individual practice Food safety knowledge

- Local staff (*) -0.160 0.194 -0.611 0.000 -0.378 0.002 ρkp ρik ρip

The regression analysis revealed consistent variable coefficients across the reduced model, with only food safety knowledge significantly impacting participant behaviors in all three groups Living location influenced processing and preservation practices (p-value < 0.05), indicating that urban residents tend to process and preserve food less meticulously than those in suburban areas Additionally, the number of family members affected kitchen hygiene practices, suggesting that larger households maintain cleaner kitchens Other variables showed no statistically significant effects The table below presents the marginal effects derived from the multivariate probit regression analysis.

Table 4.7: Marginal effect after MVP regression

Variable ME p-value ME p-value ME p-value

Hygiene individual practice Food safety knowledge

- Common labor (*) 0.017 0.722 0.015 0.722 0.016 0.722 Logarithm of Age 0.038 0.400 0.035 0.400 0.035 0.400 Logarithm of Food expenditure

Notes: (*) dummy variables, ME: marginal effect

The marginal effect of each variable reflects its specific impact on food safety behavior For example, a one-point increase in participants' knowledge scores boosts the likelihood of practicing food safety measures by 1.9% in hygiene kitchen practices, 1.7% in process/preserve practices, and in individual practices Additionally, a higher number of family members is associated with improved food safety behaviors across these categories Enhanced perception also significantly increases the probability of accurate food safety practices among all three groups Furthermore, individuals who listen to radio programs about food safety are approximately 10% more likely to exhibit better hygiene kitchen practices, and about 9.1% more likely to follow proper process/preserve and individual practices compared to those who do not.

Local medical staff advice can reduce individual practice probability by 37.8%, highlighting its significant impact on personal health behaviors Additionally, food safety information from food documentaries negatively affects hygiene kitchen practices by 9.9% and process/preserve practices by 8.9%, indicating that such media may inadvertently influence unsafe food handling habits.

To assess the robustness of the regression results, the study employed a Poisson model to accurately predict the number of behaviors participants practiced, assuming each behavior has an equal effect on food poisoning risk The model used the same independent variables as the multivariate probit model, with the dependent variable being the total number of correct behaviors performed by participants, up to a maximum of 12 The regression results, summarized in the table below, provide insights into the factors influencing participants' safe food-handling practices.

Variable Coefficient p-value ME p-value

Poisson regression analysis reveals a significant association between food safety knowledge, perception value, location, and cues to action such as radio, food documentation, and local medical staff, consistent with MVP regression findings Unlike MVP regression, the Poisson model indicates that the number of family members does not influence the level of precise food safety behaviors exhibited by the primary cook in the household.

RESULTS FROM PROPENSITY SCORE MATCHING MODEL

A survey of 4,593 respondents identified 98 suspected food poisoning cases across 79 households Of these, only 60 cases reported symptoms occurring after consuming home-prepared meals These findings highlight the potential link between homemade food and food poisoning incidents, emphasizing the importance of food safety practices at home.

This study employs an MVP model where all variables are explanatory factors in the estimated probit regression To better understand the causes of FBD symptoms, the thesis introduces "food_place" as an independent variable, coded as “0” for purchases at markets or supermarkets with governance boards, and “1” for purchases at spontaneous markets without governance oversight, expecting a negative association with food poisoning The expenditure variable is excluded to ensure the model's balancing property The dependent variable in the probit regression is whether a household experienced food poisoning, coded as “1” for affected households and “0” for unaffected ones Due to the significant difference in the dependent variable’s values, the interpretation of coefficients differs from other regressions previously discussed.

(60 versus 1115) The table below shows the result of the probit model:

However, after estimating the propensity score and choosing the control group by radius matching (caliper is 0.0001), there are only 33 observations in treated group and

In the control group, there were 96 other participants Although the expenditure variable introduced some imbalance in the probit regression, the thesis included a test to assess its impact, ensuring it did not affect the validity of the Propensity Score Matching (PSM) results The mean differences in continuous variables between individuals who experienced FBD and those who did not were evaluated using a t-test, with findings indicating no significant disparities, thereby supporting the robustness of the analysis.

Table 4.10: Differences of continuous variables

(Not suffered FBD – Suffered FBD) p-value

Based on the analysis at a 5% significance level, the only notable differences between respondents who experienced poisoning and those who did not are the amount of money spent on food and the number of schooling years Specifically, individuals who suffered from poisoning tend to spend more on food and have more years of education, with a difference of nearly 21,000 VND Additionally, there is a distinction in the accuracy of specific behaviors between the two groups, with non-poisoned individuals demonstrating more precise practices, although this difference is statistically significant only at the 10% level.

On the other hand, the correlations between the binary variables and the FBD variable tested by the Pearson’s Chi square test:

Table 4.11: Correlations between binary variables and FBD

Variable Pearson’s Chi square value p-value

The analysis revealed that only the living place significantly influences the likelihood of Foodborne Disease (FBD) occurrence (p-value < 0.05), while other factors showed no notable association This indicates that there are minimal differences between individuals who experienced FBD and those who did not, emphasizing the impact of living location on FBD risk.

DISCUSSION AND IMPLIED POLICY

POLICY IMPLICATION

Improving the knowledge and capacity of medical staff is essential for ensuring that local personnel are responsible for food safety, alongside institutional development Enhancing communication channels—particularly increasing the quantity and quality of food safety information, especially on proper food processing methods—is crucial beyond just warning messages on national TV Radio emerges as an effective and positive communication tool, especially in remote and mountainous regions where radio signals are more accessible than television The marked increase in food safety knowledge between 2010 and 2013 indicates heightened public awareness, which the government should leverage to educate citizens and foster community involvement, such as engaging freelancers or local communicators in food safety initiatives.

The study indicates that behaviors and purchased food do not have a direct correlation with the risk of foodborne disease (FBD), emphasizing the need to control food resources and restaurant quality to prevent hazards Additionally, school education programs should incorporate everyday life skills alongside food safety awareness, while public-focused communication strategies are more effective than targeting manufacturers or restaurant staff The quality of food from supermarkets or organized markets may not necessarily surpass that of spontaneous markets, despite higher costs; therefore, governments should establish specific standards and develop quality inspection institutions for these vendors Lastly, environmental factors, particularly water sources, require frequent monitoring and improvement, as the lack of access to clean water in Ho Chi Minh City poses a significant health risk to its population.

LIMITATION AND IMPLICATIONS FOR FURTHER RESEARCH

The FBD survey relies on participants’ self-reports rather than medical doctors’ assessments, which may lead to imprecise results Additionally, the data primarily reflect a medical perspective and lack comprehensive information on economic factors and perceptions To accurately determine the factors influencing FBD probability and the impact of living environment and food resources, further research is necessary in the future.

The FBD (Foodborne Diseases) outbreak is linked not only to food poisoning but also to chronic illnesses like cancer, although identifying the specific pathogen responsible can be complex Consequently, further research is essential to advance understanding in this area and to gather more definitive evidence on the connection between foodborne illnesses and chronic diseases.

The study highlights that living environment significantly influences foodborne disease (FBD) risk, emphasizing the need for more evidence to clarify this relationship In particular, water quality used for edible purposes is a critical factor, as water sources differ between urban and suburban areas, impacting the safety and health outcomes related to food consumption.

The measurement method of variables in this research has some limitations, as many variables were assessed differently compared to similar studies This discrepancy may hinder accurate comparison of results with other research Additionally, the perception values obtained through a questionnaire with limited questions and methodology may not fully capture respondents' true perceptions, affecting the reliability of the findings.

The correlation matrix of perception’s factors

This article presents a comprehensive analysis of various factors influencing the subject matter, highlighting the significance of key variables such as a14new, which demonstrates strong correlations with numerous other factors, indicating its central role The data reveals that a13new and a12new also exhibit substantial relationships, underscoring their impact on overall outcomes Notably, a17new and a18new show moderate correlations, suggesting their contributions are relevant but less dominant Additionally, the analysis emphasizes the interconnectedness of the variables, with high correlation coefficients among a1new through a10new, reflecting their collective influence These insights underscore the importance of understanding the complex relationships between variables to optimize strategies and achieve better results Incorporating these findings can enhance decision-making processes, providing a data-driven approach to improve performance and outcomes.

PCA result

Factor Eigenvalue Difference Proportion Cumulative

MVP regression (reduced form)

Likelihood ratio test of rho21 = rho31 = rho32 = 0: rho32 4790893 0463972 10.33 0.000 3831738 564783 rho31 4570518 0457674 9.99 0.000 3628716 5419888 rho21 5779966 0398654 14.50 0.000 4945877 650856 /atrho32 5218016 0602191 8.67 0.000 4037743 6398289 /atrho31 4935782 0578527 8.53 0.000 3801891 6069673 /atrho21 659449 0598651 11.02 0.000 5421155 7767824 _cons 1.115008 131358 8.49 0.000 8575512 1.372465 loc_staff -.2856251 1125314 -2.54 0.011 -.5061825 -.0650677 doc -.2218455 1445481 -1.53 0.125 -.5051546 0614635 news -.1736675 0932207 -1.86 0.062 -.3563769 0090418 radio 1360822 106534 1.28 0.201 -.0727206 344885 tv -.0526691 1323381 -0.40 0.691 -.3120469 2067088 perc_f1 3153075 0457522 6.89 0.000 2256348 4049802 indi

_cons 8597885 1280854 6.71 0.000 6087457 1.110831 loc_staff -.3910883 1129624 -3.46 0.001 -.6124905 -.1696861 doc 0380902 1532165 0.25 0.804 -.2622086 3383889 news -.1393973 0918987 -1.52 0.129 -.3195155 040721 radio 5054202 1102772 4.58 0.000 2892808 7215597 tv 01221 1287667 0.09 0.924 -.2401682 2645881 perc_f1 5595797 0538308 10.40 0.000 4540732 6650862 proc

_cons 8138421 1249069 6.52 0.000 5690291 1.058655 loc_staff -.041626 1137304 -0.37 0.714 -.2645335 1812815 doc -.3644403 1437517 -2.54 0.011 -.6461885 -.082692 news 0023601 0902982 0.03 0.979 -.1746211 1793413 radio 3546625 1059468 3.35 0.001 1470106 5623144 tv -.0520822 1268091 -0.41 0.681 -.3006235 1964591 perc_f1 1903142 0435442 4.37 0.000 1049691 2756593 kitc

Coef Std Err z P>|z| [95% Conf Interval]

Log likelihood = -1518.5305 Prob > chi2 = 0.0000 Wald chi2(18) = 178.29Multivariate probit (MSL, # draws = 5) Number of obs = 1168

MVP regression (original form)

/atrho32 5116009 0619345 8.26 0.000 3902115 6329902 /atrho31 4838027 060206 8.04 0.000 3658011 6018044 /atrho21 7554267 0655425 11.53 0.000 6269657 8838876 _cons -.043319 1.424135 -0.03 0.976 -2.834573 2.747935 loc_dum -.1004265 0978174 -1.03 0.305 -.292145 0912921 loc_staff -.3780484 1210943 -3.12 0.002 -.6153888 -.140708 doc -.2109011 1503647 -1.40 0.161 -.5056104 0838083 news -.2908288 1000615 -2.91 0.004 -.4869457 -.0947119 radio 1352087 1093668 1.24 0.216 -.0791462 3495636 tv -.119521 136583 -0.88 0.382 -.3872188 1481768 perc_f1 2590135 0495196 5.23 0.000 1619568 3560702 lnexp 0184813 1028084 0.18 0.857 -.1830195 2199822 lnage 0848241 1683457 0.50 0.614 -.2451273 4147756 job_new2 -.1420892 1721359 -0.83 0.409 -.4794695 195291 job_new1 -.1077489 1512042 -0.71 0.476 -.4041037 188606 edu_new 0176512 0135823 1.30 0.194 -.0089696 044272 sex 1051301 1846875 0.57 0.569 -.2568508 467111 f_mem 0219332 0236432 0.93 0.354 -.0244066 068273 know2 0663949 0219701 3.02 0.003 0233343 1094554 indi

_cons -1.336828 1.416824 -0.94 0.345 -4.113753 1.440096 loc_dum 7533018 1046908 7.20 0.000 5481116 9584921 loc_staff -.6107935 1252602 -4.88 0.000 -.856299 -.3652881 doc -.2434742 1594121 -1.53 0.127 -.5559162 0689678 news -.1172928 1002116 -1.17 0.242 -.3137039 0791183 radio 3673403 1156295 3.18 0.001 1407106 5939699 tv -.0984783 1385747 -0.71 0.477 -.3700797 1731231 perc_f1 4491142 0566682 7.93 0.000 3380466 5601818 lnexp -.0402706 1018324 -0.40 0.693 -.2398585 1593172 lnage 2859399 1696803 1.69 0.092 -.0466273 6185071 job_new2 -.1626987 1753452 -0.93 0.353 -.506369 1809716 job_new1 044128 1540247 0.29 0.774 -.2577549 3460109 edu_new 0365416 0138528 2.64 0.008 0093906 0636926 sex 0971573 1934886 0.50 0.616 -.2820734 476388 f_mem 0366151 0231059 1.58 0.113 -.0086717 0819019 know2 1033148 0223409 4.62 0.000 0595275 1471022 proc

_cons -.2533119 1.378816 -0.18 0.854 -2.955741 2.449118 loc_dum -.0398895 0942509 -0.42 0.672 -.2246178 1448388 loc_staff -.1597777 1228875 -1.30 0.194 -.4006328 0810774 doc -.3515957 1503444 -2.34 0.019 -.6462652 -.0569261 news -.0582825 0965137 -0.60 0.546 -.247446 130881 radio 3581531 1099266 3.26 0.001 142701 5736053 tv -.1535407 1309093 -1.17 0.241 -.4101183 1030368 perc_f1 1364628 046897 2.91 0.004 0445464 2283792 lnexp -.0294486 099663 -0.30 0.768 -.2247844 1658872 lnage 1361739 16177 0.84 0.400 -.1808894 4532373 job_new2 0605255 1698464 0.36 0.722 -.2723673 3934182 job_new1 -.1238851 1469004 -0.84 0.399 -.4118047 1640344 edu_new 0189987 0132713 1.43 0.152 -.0070125 04501 sex 021229 1788945 0.12 0.906 -.3293977 3718557 f_mem 0672752 0240019 2.80 0.005 0202324 114318 know2 0666814 0209181 3.19 0.001 0256827 1076801 kitc

Coef Std Err z P>|z| [95% Conf Interval]

Log likelihood = -1433.2637 Prob > chi2 = 0.0000 Wald chi2(45) = 273.03Multivariate probit (MSL, # draws = 5) Number of obs = 1147

Poisson regression

_cons 2.258058 2828686 7.98 0.000 1.703646 2.81247 loc_staff -.0411455 0249034 -1.65 0.098 -.0899552 0076643 doc -.0341781 0305385 -1.12 0.263 -.0940326 0256763 news -.0023822 0203121 -0.12 0.907 -.0421931 0374287 radio 0403983 0212309 1.90 0.057 -.0012136 0820101 tv 0051544 0277787 0.19 0.853 -.0492909 0595996 perc_f1 0449872 009692 4.64 0.000 0259911 0639833 loc_dum 0327238 019411 1.69 0.092 -.005321 0707687 lnexp -.0051244 0205234 -0.25 0.803 -.0453495 0351006 lnage 015889 0337333 0.47 0.638 -.0502271 0820051 job_4 -.0224146 0341957 -0.66 0.512 -.089437 0446078 job_5 -.0173529 0296353 -0.59 0.558 -.0754371 0407313 edu 0097375 0097973 0.99 0.320 -.0094648 0289399 sex 0126925 0364342 0.35 0.728 -.0587172 0841023 f_mem 00365 0045554 0.80 0.423 -.0052784 0125783 know2 0098917 004481 2.21 0.027 0011092 0186742 count Coef Std Err z P>|z| [95% Conf Interval]

Log likelihood = -2627.7535 Pseudo R2 = 0.0100 Prob > chi2 = 0.0000

LR chi2(15) = 53.01Poisson regression Number of obs = 1143

Questionaire form

BẢNG CÂU HỎI KIẾN THỨC VỀ VSATTP NGƯỜI DÂN

I ĐẶC ĐIỂM ĐỐI TƯỢNG KHẢO SÁT

A1) Họ và tên người được phỏng vấn:

A2) Địa chỉ: A3) Giới 1 Nam  2 Nữ 

A4) Tuổi người được phỏng vấn: ………

A5) Trình độ học vấn: Không  Cấp 1  Cấp 2  Cấp 3  Đại học  Khác 

1 Cán bộ 1 [ ] Lao động phổ thông 4 [ ]

A7) Số người có trong hộ: …………

A8) Số tiền đi chợ trung bình 1 ngày : đ_/ người ăn (*)

A9) Anh chị là người nấu ăn : Chính  phụ  trong gia đình

II KIẾN THỨC VỀ VSATTP: (4 Câu)

B1) Anh chị có thường để ý đến vấn đề VSATTP không ? Có  Không  B2) Anh chị có được thông tin về VSATTP từ :

TV  Đài PT  Báo chí  Sách vở  CBYT  Khác 

B3) Theo anh chị tại sao bị ngộ độc thực phẩm?

- Thực phẩm nhiễm hóa chất 

- Thực phẩm không vệ sinh , bị nhiễm vi sinh vật 

B4) Theo anh chị, làm thế nào để phòng ngừa ngộ độc thực phẩm cho gia đình :

Mua những loại thực phẩm đã được chế biến an toàn 

Rửa rau và thực phẩm kỹ 

Nấu nướng thức ăn kỹ 

Tránh đụng chạm giữa thực phẩm sống và chín 

3 Sử dụng/Ăn uống sau khi nấu: Ăn ngay thức ăn vừa được nấu chín 

Hâm nóng thức ăn trước khi ăn 

4 Ngoài việc giữ vệ sinh thực phẩm, anh chị còn chú ý giữ vệ sinh cho những việc gì khác nữa:

Giữ vệ sinh nhà bếp 

Bảo quản kỹ thức ăn đã nấu 

Không để thực phẩm bị côn trùng , súc vật gặm nhấm 

III LỰA CHỌN THỰC PHẨM (7 Câu)

C1) Anh chị thường đi chợ nào ? vì sao ?

Thường xuyên Thỉnh thoảng Giá mắc Giá rẻ ATTP Tiện lợi (ghi rõ)

C2) Khi lựa chọn thực phẩm tươi sống, Anh chị dựa vào tiêu chuẩn nào là chính :

Màu Mùi Độ chắc Mắt Mang Da Mua người quen

C3) Khi lựa chọn rau quả tươi sống , Anh chị dựa vào tiêu chuẩn nào ?

Toàn vẹn (không bị trầy xướt , dập nát , gọt vỏ , xắt mỏng, ) 

C4) Khi chọn mua thực phẩm bao gói sẵn, đồ hộp, anh chị có đọc nhãn không? Có  Không 

C5) Nếu có , Anh chị thường xem nội dung gì trên nhãn ?

- Tên hàng hóa  Tên cơ sở sản xuất 

- Thành phần cấu tạo của sản phẩm  Ngày sản xuất và hạn sử dụng 

- Hướng dẫn bảo quản sử dụng  Khối lượng 

C6) Ngoài việc đọc nội dung nhãn , Anh chị còn để ý điều gì ?

- Bao bì còn nguyên vẹn, không bể,  Hộp kim loại không bị phồng nắp, gĩ sét 

- Nắp chai kín còn niêm phong,  Khác 

C7) Anh chị có sử dụng các loại phụ gia sau trong chế biến thức ăn cho gia đình

Có Không  1 lần/tuần Thỉnh thoảng

Bột nổi (làm bánh bông lan , làm mềm thịt )

Bột nổi nâu ( làm bánh mì, )    

IV CHẾ BIẾN, SỬ DỤNG VÀ BẢO QUẢN THỨC ĂN (17 Câu):

E1) Mặt bếp nhà anh chị được xây dựng như thế nào và bếp sử dụng là loại gì?

- Gạch men  Xi măng  Gỗ  Đất  Bếp củi 

- Bếp điện  Bếp ga  Bếp dầu  Bếp than 

E2) Anh chị thường vệ sinh nhà bếp (mặt, vách bếp, bếp nấu) khi nào?

- Sau mỗi bữa nấu xong  Cuối ngày/ lần 

E3) Anh chị có mang tạp dề, găng tay khi nấu nướng không?

E4) Khi chế biến thức ăn, anh chị thường rửa tay lúc nào và rửa bằng gì?

Rửa nước sạch Rửa nước sạch với xà phòng

- Sau tiếp xúc với thực phẩm sống  

E5) Nhà Anh chị có bao nhiêu cái thớt ? …… cái Có phân biệt sống, chín (*) Không 

E6) Anh chị có dùng khăn lau chén không? Có  Không 

E7) Bao lâu giặt khăn lau chén bát một lần? mỗi ngày  vài ngày tuần/lần Khác 

E8) Anh chị xử lý rau quả (ăn sống) bằng cách nào để bảo đảm sạch và an toàn :

Rửa nước nhiều lần  Rửa thuốc tím 

- Rửa nước thuốc  Rửa nước muối  Khác 

E9) Gia đình anh chị thường bắt đầu ăn vào lúc nào, sau khi thức ăn đã nấu chín?

- Khi thức ăn còn nóng ấm  

E10) Thức ăn để nguội (> 2 giờ) , trước khi ăn anh chị có hâm lại không? Có Không  E11) Không hâm lại, vì sao? Mất công  Thấy không sao  Khác 

E12) Có hâm lại như thế nào: Hâm nóng  Nấu vừa sôi  Nấu sôi kỹ > 2 phút  Khác  E13) Thức ăn thừa của bữa ăn thường để lại hay đổ bỏ

Luôn để lại  Tùy món để lại  Luôn bỏ đi  Để lại dùng bằng cách nào? Để riêng, hâm lại Trộn với thức ăn mới, hâm lại 

E14) Anh, chị thường giữ thức ăn sau khi nấu chín ( để  1 buổi ) như thế nào?

Thức ăn cho người lớn Thức ăn cho trẻ em ( ≤ 5 tuổi )

- Cho vào tủ đựng thức ăn  

E15) Anh chị có trữ thực phẩm khô (bánh tráng, lạp xưởng, mực cá khô ) Có  Không 

E16) Bảo quản như thế nào?

Cất tủ riêng có lưới  Cất tủ riêng không lưới  Khác 

Treo ( để trần )  Treo ( có bao bọc ) 

E17) Anh chị xử lý rác, thức ăn thừa trong nhà như thế nào?

- Bỏ vào giỏ rác, xô  Khác 

- Bỏ vào thùng rác có bao nylon có nắp đậy 

- Bỏ bao nylon cột lại  Điều tra viên :………

PHIẾU ĐIỀU TRA THÁI ĐỘ CỦA NGƯỜI TIÊU DÙNG VỀ NĐTP

Theo anh/chị những việc nào cần làm để phòng ngộ độc thực phẩm :

(Chọn “ * “ : kết thúc phỏng vấn)

A1 Lựa chọn thực phẩm tươi sạch

A2 Sử dụng thực phẩm có nguồn gốc rõ ràng

A3 Không ăn tái, tiết canh…

A5 Ăn ngay thức ăn vừa chế biến xong

A6 Thức ăn nấu chín sau 2 giờ cần được hâm lại hay để vào tủ lạnh

A7 Che đậy, bảo quản cẩn thận thức ăn chín

A8 Có dụng cụ chế biến riêng cho thực phẩm chín và sống

A9 Rửa sạch tay trước khi chạm vào thực phẩm

A10 Rửa sạch tay sau khi chạm vào thực phẩm

A11 Sử dụng nước sạch để chế biến thực phẩm

A12 Giữ dụng cụ chế biến luôn sạch sẽ

A13 Giữ nơi chế biến nơi chế biến luôn khô ráo và sạch sẽ

A14 Tìm hiểu thông tin về Vệ sinh an toàn thực phẩm

Theo anh/chị làm thế nào để người dân tích cực, mạnh dạn, phát hiện với các hành vi vi phạm về VSATTP?

Kết thúc phỏng vấn, xin chân thành cảm ơn anh/chị Điều tra viên

BẢNG QUAN SÁT THỰC HÀNH CỦA NGƯỜI DÂN PHÒNG CHỐNG NGỘ ĐỘC THỰC PHẨM

STT NỘI DUNG THỰC HÀNH ĐẠT KHÔNG ĐẠT

A Vệ sinh nơi chế biến

1 Nơi chế biến gọn, sạch, ngăn nắp

2 Giữ bề mặt chế biến, bếp luôn khô ráo, sạch sẽ

3 Có dụng cụ chứa chất thải kín, có nắp đậy

4 Nhà vệ sinh không mở cửa trực tiếp vào khu vực chế biến

B Vệ sinh trong chế biến và bảo quản

1 Đủ nước sạch để chế biến

2 Thức ăn chín được bảo quản trong tủ kín sạch hoặc có lồng bàn đậy

4 Dùng dụng cụ để gắp, phân chia thức ăn chín

5 Có tủ bảo quản dụng cụ ăn uống

6 Rửa rau qua 3 lần hoặc rửa trực tiếp dưới vòi nước sạch

7 Không sử dụng phụ gia thực phẩm ngoài danh mục, thực phẩm hết hạn dùng để chế biến thức ăn

1 Có rửa tay sạch trước khi vào chế biến, sau khi đi vệ sinh và trước khi ăn

2 Không đeo đồ trang sức, giữ móng tay ngắn, sạch sẽ, không sơn móng tay

Xin trân trọng cảm ơn! Điều tra viên

PHIẾU ĐIỀU TRA TRƯỜNG HỢP NGỘ ĐỘC THỰC PHẨM

CẤP TÍNH TRONG CỘNG ĐỒNG

Để phục vụ công tác thống kê và đánh giá thực trạng ngộ độc thực phẩm cấp tính cá nhân trong cộng đồng tại TP Hồ Chí Minh, chúng tôi kính đề nghị Anh/Chị cung cấp các thông tin liên quan theo các nội dung đã yêu cầu Tất cả dữ liệu mà Anh/Chị cung cấp sẽ được đảm bảo giữ bí mật tuyệt đối, phục vụ mục đích nghiên cứu và nâng cao công tác phòng chống ngộ độc thực phẩm hiệu quả Sự hợp tác của Quý vị sẽ góp phần quan trọng vào việc phân tích chính xác tình hình ngộ độc thực phẩm tại địa phương.

Phần I: thông tin cá nhân

4 Trình độ học vấn: Dưới lớp 5  Lớp 5 – 11  12 trở lên 

5 Thu nhập bình quân hàng tháng:………VNĐ

9 Số điện thoại liên lạc khi cần………

Phần II: thông tin lâm sàng

Trong vòng 2 tuần trở lại đây, bạn có triệu chứng bất thường sau ăn như buồn nôn, nôn, đau bụng hoặc tiêu chảy nhiều lần trong 24-48 giờ không? Những triệu chứng này có liên quan đến các loại thực phẩm đã tiêu thụ trước đó và gây ra khó chịu ở ruột hoặc dạ dày sau ăn uống Nếu có, vui lòng cung cấp chi tiết để tiếp tục quá trình điều tra kiến thức về sức khỏe tiêu hóa của bạn.

11 Triệu chứng bất thường xuất hiện vào thời điểm nào?

Từ 2- 4 giờ sau khi ăn 

Trên 24 giờ sau khi ăn 

12 Mô tả thực phẩm Anh/ chị đã sử dụng Được đun nóng trước khi phục vụ 

Thức ăn đã nấu chín và nguội  Được nấu và phục vụ ngay  Được chia suất sẵn  Được cung cấp bởi người bán thức ăn nhanh 

Thức ăn được để qua đêm 

Không biết, không xác định ………

Khai thác tiền sử ăn uống của bệnh nhân có liên quan đến NĐTP bằng cách hỏi rõ về những gì bệnh nhân đã ăn, các món ăn đã tiêu thụ, cũng như những người cùng ăn để nắm bắt đầy đủ thông tin về lịch sử ẩm thực Điều tra viên cần hỏi kỹ về các loại thức ăn đã dùng, thời điểm ăn, và những người đi cùng để xác định nguyên nhân chính xác của NĐTP và xác định yếu tố nguy cơ liên quan.

14 Anh/ chị xuất hiện những triệu chứng bất thường về đường tiêu hóa có liên quan đến ăn uống: có không không rõ thời khoảng xuất hiện

Sốt 1 2 9 ……… Đau nhức mình mẩy 1 2 9 ………

Những triệu chứng khác (Ghi rõ): ………

15 Chẩn đoán của bác sĩ là gì?

16.Chỉ định điều trị của bác sĩ trực tiếp điều trị của Anh/chị?

17 Anh/ chị có phải nhập viện vì bệnh này không? có: 1 (xuống 19) không: 2, 3 Khám, lấy thuốc rồi về

18 Nhập bệnh viện vào khoa/bệnh viện:

19 Anh/ chị có tự mua thuốc uống trước khi vào khám không? có: 1 không: 2

20 Có bất kỳ ai khác tham gia bữa ăn nghi ngờ bị triệu chứng giống Anh/ chị không? có: 1 không: 2,

22 Sau khi tham gia bữa ăn người đó có triệu chứng bất thường giống Anh/ chị không? có: 1 không: 2, Không biết: 3

23 Những người cùng ăn với Anh/ chị có đi bệnh viện không? có: 1 không: 2, Không biết: 3

24 Người đó có được điều trị giống anh chị không? có: 1 không: 2, Không biết: 3 Cuộc phỏng vấn hoàn tất, cám ơn anh chị đã hợp tác với chúng tôi.

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Nguyen (2015) investigated the level of knowledge regarding food safety and hygiene among Hausholds in Cai Tac and Tan Hoa communes, Chau Thanh A district, Hau Giang province The study highlights the importance of awareness and proper practices in ensuring safe food preparation at home Findings suggest that improving food safety knowledge can significantly reduce foodborne illnesses and enhance overall public health This research emphasizes the need for targeted education programs to promote better hygiene practices among local communities Proper food safety awareness is crucial for maintaining health and preventing contamination in household food preparation.

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