Good Hygiene Practice Interventions for Safer Pork at Traditional Markets in Cambodia

Study Overview
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Brief Summary
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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
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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. Intervention description 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. 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.

Official Title
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Safe Food, Fair Food For Cambodia

Conditions
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Food Borne Diseases, Food Safety

Intervention / Treatment
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* Behavioral: Improve hygiene practice of pork sellers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Under selected markets Selling pork only Daily selling Voluntary Exclusion Criteria: Out of the age range 18-65

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Two groups of pork retailers will be recruited: control group and intervention group
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>No intervention in this group | |
| Experimental: Intervention<br>Hygiene package, training, branding, and certification | Behavioral: Improve hygiene practice of pork sellers<br>* includes 5 keys actions (Handbook) and provision of equipment incentive and training on good hygiene practices, branding, and certification<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of samples fulfill Cambodian microbiological standards for pork | Total bacterial count in pork samples will be measured from both trial and control groups to assess level of compliance with national standards | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in knowledge of pork retailers | There are 8 questions on the knowledge part. Each correct answer is given 1 score. The minimum and maximum scores of each participant are 0 and 8, respectively. The means of knowledge score will be compared to see the difference between the 2 groups. | 16 weeks | 
| Change in practice of pork retailers | The practice will be observed using a checklist during the selling time of the sampling day. There are 20 items on the checklist. Each appropriate practice is given 1 score per item. Practice score will be ranged from 0 to 20. The difference between the 2 groups will be compared using means of practice score. | 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hygiene Practice, Bacterial Contamination, Traditional Market, Pork Shop, Cambodia