Good Hygiene Practice Interventions for Safer Pork at Traditional Markets in Cambodia
Condition: Food Borne Diseases; Food Safety
MeSH terms: Foodborne Diseases
Study type: Interventional

Summary: 
      Safe Food Fair Food for Cambodia (SFFF) is a Feed the Future Innovation Lab project funded by
      USAID. This 3-year project aims to improve food safety of animal source food (ASF) in
      Cambodia. SFFF was awarded to the International Livestock Research Institute (ILRI), National
      Animal Health and Production Research Institute (NAHPRI) and Livestock Development for
      Community Livelihood Organization (LDC) and in collaboration with Cambodian Ministry of
      Health CDC and NIPH. Based on the findings and consultations with food safety stakeholders in
      Cambodia, we have developed a set of interventions to improve hygienic practice and pork
      safety at the traditional markets in Cambodia. Those interventions will be introduced and
      tested at retail in six selected provinces using Randomized Controlled Trials (RCT). To
      ensure compliance of targeted actors (e.g. retailers), participatory methods (e.g. FGD) were
      used to validate intervention packages. There are two steps of intervention which contain of
      part 1) Retailer formative research for SFFF Cambodia and 2) Interventions for Good Hygiene
      Practices for Safer Pork at Traditional Markets.

      Part 1. Retailer formative research for SFFF Cambodia: We will implement an intervention
      package to this trial group and collect biological sampling to determine the hygienic status
      before and after the intervention. The intervention packages will be developed for SFFF
      Cambodia in consultation with partners and based on findings of SFFF Cambodia project.

      Part 2. Intervention for Good Hygiene Practices for Safer Pork at Traditional Markets: A
      randomized controlled trial (RCT) intervention will be conducted in 12 markets in 6
      provinces. Those provinces were selected based on the prevalence of Salmonella in a market
      survey study, namely Kampot, Kampong Cham, Kampong Speu, Takeo, Siem Reap, and Phnom Penh.
      Another 12 markets, in the same provinces, will be used as a control group. In total 24
      traditional wet markets will be included in the sampling, by selecting the 4 largest
      traditional markets in the six provinces with at least 15 pork shops. At each market, 15 pork
      shops were selected for sampling. The intervention package includes 5 keys actions (Handbook)
      and provision of equipment incentive (e.g. inox tray, easy-clean surface material), and
      training on good hygiene practices.
    

Detailed description: 
      1. Selection of provinces, markets and retailers

           Six provinces were selected including Phnom Penh, Siem Reap, Takeo, Kampong Cham,
           Kampot, Kampong Speu with the following selection criteria: i) The number of markets in
           provinces, ii) Salmonella prevalence (above 50%), iii) Population density and risk,
           urban - rural, iv) Distance from laboratory, v) Compliance of market board and traders,
           local animal health workers. Phnom Penh had a reported Salmonella prevalence of less
           than 50% in the recent market study but was included as an urban center with expected
           high output of pork sells. In each province, four markets which have at least 15 pork
           shops will be selected. Among those markets, two markets will be assigned for control
           and trial groups.

           Group of retailers will be chosen from selected markets for the intervention based on
           their "similarity" (e.g., environment, shop facilities, sells volume) and their
           compliance to participate. Intervention package includes providing incentive equipment
           and training on good hygiene practice. Equipment provision comprise: (i) equip the shops
           with inox trays and advise them to separate raw pork/processed pork and intestines; (ii)
           In case the surface of the shop is not made from granite or inox, we will provide them
           with feasible surface cover material; (iii) Apron to retailers with the project
           logo/brand; (iv)Shop's banner with our logo; (v) Hand washing soap (antibacterial) and
           dish detergent; (vi) Disinfectant spray (Anolyte).

           Guide retailers to rearrange their shops to suit their own facility and space. Introduce
           plastic cutting boards for light cut, check currently used wooden cutting boards at shop
           to advice to use properly. Introduce frequent washing and disinfection of sale place and
           shop equipment. Washing with dish detergent and disinfection using spray disinfectant
           (Electrochemically activated water, pH=7). This shall include:

             -  Cutting boards. Washing with dish detergent (soap) and water with scrub, then
                disinfection using spraying bleach. Leave for five minutes then rinse with water
                (can also be a spray) and let it air dry. At least prior to open or after closing
                the shop and once in between.

             -  Knives. At least prior to open or after closing the shop and once in between.

             -  Cloth. Guide how to use cloth. Each shop should have 2-3 cloth to wipe separate
                surfaces/tools.

             -  Table surface. Require retailers to wash and disinfect throughout at the end of
                selling day; and apply disinfectant spray at the beginning of the selling day. Only
                retailers with an easy to clean surface (inox, granite or plastic etc.) shall be
                selected.

             -  Training. Introduce frequent washing of hands, at least once within each selling
                hour, with clean water and liquid soap, and dry by tissue paper. Proper disposal of
                tissue paper in closed top bin

           For control group: No intervention or training activities for this group but collection
           of biological samples and observation checklist to determine hygienic status at their
           shops over three consecutive days.

        2. Intervention description

             1. Procedure to introduce the intervention:

                  -  Introduce and discuss trial with market authorities and vets (as appropriate)

                  -  Identify potential retailers, discuss and make plan with them

                  -  Pre- evaluate current knowledge and practice of selected retailers.

                  -  Procure suitable (shop size) equipment for "trial" retailers

                  -  Provide training, instructions and guidelines for selected retailers and
                     introduce equipment

                  -  Monitoring of hygienic practice, sampling and checking practice of retailer

                  -  Timelines: "Training and equipment" in the 1st week, follow up, and supervise
                     in week 2-4, sampling will be conducted in the fourth week.

                  -  Summary report, sharing and discussion with trial retailers to re-evaluate
                     their knowledge.

             2. Procedure for sampling and analysis:

                  -  At each market, 15 of pork vendors will be selected for sampling.

                  -  From each vendor, one specimen will be purchased approximately 300 to 400
                     grams each.

                  -  All pork samples (n=360) from trial and control groups will be tested for
                     total bacteria count (TBC).

                  -  In addition, a sub-set of 60 cut pork samples of trial group will be also
                     analyzed for Salmonella Yes/No (qualitative), 30 out of 60 of these samples
                     will be quantified for Salmonella concentration using MPN method.
    

Intervention name(s): Improve hygiene practice of pork sellers
Intervention type(s): Behavioral
Intervention description(s): includes 5 keys actions (Handbook) and provision of equipment incentive and training on good hygiene practices, branding, and certification
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups of pork retailers will be recruited: control group and intervention group
Masking: None (Open Label)
Primary purpose: Other
Keywords: Hygiene Practice; Bacterial Contamination; Traditional Market; Pork Shop; Cambodia