Food Hygiene

Draft report on focus group discussion to develop a behaviour change communication model that particularly target impoverished mothers and women at the community level in Egypt

Research conducted by the WHO Regional Office for the Eastern Mediterranean (2nd final draft dated 24 January 2007) 48 pages


Background: Various studies/reports revealed that major health concerns can be prevented through the improvement of health literacy, i.e. basic health related knowledge and skills (Londen, L, and D Trifiolis, 2007; Hosny, G and M Akel, 2007; Labib, J, 2006). Yet, several other studies also highlighted a direct link between societal cultures (customs and traditions) and applied health beliefs and behaviours (Engs, 1982; Luckey & Nass, 1969; Meleis, 1981, Meleis, 1979, Al Darazi, 1984, and Daly, 1995). Consequently, health literacy of a particular culture is highly affected by the prevailing values and norms of that culture. Boosting health knowledge and related positive practices is critical for impoverished illiterate to semi-literate localities as many studies depicted that inhabitants of such areas have weak perception of control over health. Since women and mothers play key roles in their families, especially in the Arab world, as they are primary responsible for the domestic realm, health literacy among women and mothers is particularly important.  In order to be able to induce sensed positive changes in a given community’s health literacy level, effective behaviour change communication model of health information should be utilized. Information and Communication Technology proved to play a decisive role in enhancing behavioural change communication, especially amongst illiterate beneficiaries. Therefore, the unit of Women in Health and Development (WHD) in cooperation with the units of Information Technology and Telecommunications (ITT), Healthy Lifestyle Promotion (HLP), and Food and Chemical Safety (FCS) at the World Health Organization (WHO) proposed to develop a behaviour change communication model that particularly target impoverished mothers and women at the community level. The knowledge base of this model rests heavily on the WHO 5 Keys to Safer Food materials, which can be used in the different Eastern Mediterranean Region’s communities in the future. WHO chose to implement this pilot project in Shaq El Te’ban district, a slum area near Helwan, Cairo, Egypt[v1] .

Methodology: Interest is focused on understanding community level processes for addressing health and nutrition problems paying particular attention to the community’s ability and capacity to assess, analyze and act on their health and nutrition problems. This activity draws mainly on primary qualitative data collected from eight focus groups convened at Shaq el Te’ban district. The aim of the activity is twofold: first, to identify targeted barriers and enabling factors for behaviour change. Second, to draw conclusions as to which training topics and methodologies as well as awareness raising activities and materials should be adopted. It is envisaged that through executing relevant and interactive training coupled with creative and simple awareness raising activities, health literacy levels amongst impoverished women and mothers will be elevated and at the same time long lasting corresponding behaviour changes will be anticipated.

Results: a total of 96 women participants formed the sample. The average age of women was 33 years, 68% of them were married, and the majority (74%) were illiterates. Health perception and status amongst respondents were positively correlated with the ability to perform required responsibilities and tasks. In cases of sever illnesses, decisions to seek medical help depended largely on age in favour of children. On the average, children visited physicians twice/month. Major illnesses amongst children pertained to: diarrhoea, high fever, and vomiting. While adults reported being diagnosed by a physician as having anaemia (75%), salts in urine (70%), and stomach ulcer and blood pressure (30%).  A direct relationship between illness’s severity and therapy choices was depicted. In mild cases, alterative therapy (herbs-man and elderly women advice) was commonly sought. In severe cases, the sick person was provided medication at home, and if the case did not improve after 24 hours, then medical help was sought. Medical therapy choice, whether public or private facilities, was in favour of the private facilities, though more expensive.

With regard to the nutritional status of the sample, findings corresponded with other studies’/reports’ findings carried out in similar communities. Basically, respondents depended heavily in their diet on carbohydrates (mainly bread). Meat products (mainly chicken) as well as cooked vegetables and rice are consumed on a weekly basis. However, high daily consumption rates of greenleaf vegetables were noted. Respondents explicitly related their inability to intake balanced diet with financial constraints.

The sample’s food safety knowledge is considered inadequate based on the reported practices and behaviours. This is apparent from their inability to: operationalize notions of cleanliness and sanitation with food safety, associate storing food at right temperatures with avoiding food poising, and relating food safety to proper food handling practices.  Moreover, all dwellings in the community are equipped with piped water and taps, yet water is often disconnected. Thus, water is stored in buckets/containers. Daily needs of stored water ranged from 10 -15 buckets/containers. No special measures were reported to ensure using clean water for drinking or cooking. Even infants were provided water directly taken from the bucket/container.

Similarly, personal hygiene is another area that should be attended to. All respondents reported washing their hands frequently, yet the method and procedure they mentioned were incorrect. All of them washed their hands with water only, and did not dry their hands. None of the sample brushed their teeth, even the five who mentioned having teeth brushes. Bathing frequency was directly linked to age in favour of children also. Children bath daily in the summer and day after day in the winter, while adults bath day after in the summer to one/week in the winter. It is worth noting that the water used for washing hands and bathing was taken from the remaining water at the bottom of the water buckets that was not used for cooking or drinking as being turbid and full of dirt.

As in many countries of the world, especially Arab countries, families are considered the primary social unit. It appeared that women connected with their families through a variety of gathering activities, such as weekly meals, and less formal get-togethers in the evenings to watch TV. These were reported as enjoyable times where family members interacted and shared information and experiences.

Preferred media channels (audio/visual) were directly related with type of responsibilities women undertook. It was found that the audio media, in particular the radio and the cassette recorder, was preferred by respondents while finishing up their domestic household responsibilities. While in the afternoon or in the evening women preferred the visual media (television) as they enjoyed sitting with other family members to watch serials, and movies.

Women were very articulate when trying to identify their training needs. They were very analytical in prioritizing their daily faced problems and were keen on learning applicable measures to address them. On top of which came financial constraints as a problem jeopardizing health, nutrition, and hygienic status.

[v1]Linking motivation to behavioural change