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Factors Associated With Meat Safety Knowledge and Practices

Among Butchers of Ratnanagar Municipality, Chitwan, Nepal: A
Cross-sectional Study

Article  in  Asia-Pacific Journal of Public Health · November 2017

DOI: 10.1177/1010539517743850

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Among Butchers of Ratnanagar journals.sagepub.com/home/aph

Municipality, Chitwan, Nepal:

A Cross-sectional Study

Gayatri Khanal, MPH1 and Sunita Poudel, BPH1

Abstract
Butchers have a huge role in prevention of meat-borne diseases and illness. Hence, this study
was conducted to ascertain factors associated with meat hygiene among the butchers. A cross-
sectional study was conducted among goat and poultry butchers. None of the butchers fall into
“adequate” knowledge and “good” practice category. Butchers who had no side job other than
butchering (adjusted odds ratio [aOR] = 3.04, CI = 1.11-8.33), had secondary or higher education
(aOR = 3.17, CI = 2.60-14.72), greater workload (aOR = 5.45, CI = 1.01-29.57), and whose
shop were closed shop (aOR = 3.33, CI = 1.10-10.38) were more likely to have fair knowledge.
Butchers whose shop were temporarily constructed close shop (aOR = 3.07, CI = 1.04-9.06),
permanently constructed close shop (aOR = 23.56, CI = 1.91-291.11), and whose ethnicity was
Brahmin/Chhetri (aOR = 3.39, CI = 1.10-10.46) were more likely to have satisfactory practices.
Despite regular handling of meat, butchers had lack of knowledge and practice on meat hygiene.

Keywords
meat hygiene, butchers, practices, Chitwan, knowledge

Introduction
Food-borne diseases are a common in both developed and developing countries but are more
common in the latter because of poor food handling and sanitation practices, inadequate food
safety laws, and lack of education among food handlers.1 Contaminated meat is one of the major
causes of the global burden of foodborne diseases. According to the World Health Organization
(2015), almost 1 in 10 people fall ill and 420 000 die every year from eating contaminated food.2
Bacterial contamination of meat products is an unavoidable consequence of handling meat
and animal products. Meat is regarded as high-risk commodity for food-borne diseases.3,4
Livestock production is also an important agricultural subsector in Nepal, accounting for
11.5% of total GDP. Meat production and consumption in Nepal is projected to grow each year.
There is also a high prevalence of meat-borne zoonotic diseases in Nepal.5,6

1Chitwan Medical College Teaching Hospital, Chitwan, Nepal

Corresponding Author:
Gayatri Khanal, Department of Community Medicine, School of Public Health, Chitwan Medical College Teaching
Hospital, PO Box 42, Bharatpur 13, Chitwan, Nepal.
Email: khanalgayatri2@gmail.com
2 Asia Pacific Journal of Public Health 00(0)

In Nepal, standards for meat handling and hygiene practices of butchers are not adequate.7
Chitwan is one of the highest meat-consuming districts in the country and with a high number of
butcheries in municipal areas, including Ratnanagar of Chitwan District, but the lack of well-
managed slaughterhouses and the hygiene practices of meat handlers’ means residents often con-
sume unhealthy meat.8,9
The objective of this study was to identify knowledge of meat handling and hygiene practices
among the butchers of Ratnanagar Municipality.

Methods
Study Design and Selection of Participants
A cross-sectional field-based study was conducted in Ratnanagar Municipality of Chitwan
District. The study population included butchers who had been involved in goat and poultry
slaughtering practice for more than 6 months. A total study population of 114 butchers were
selected from Ratnanagar Municipality. There were 19 wards and from each ward 6 butcher
shops were selected by using a lottery method. From each shop, we selected a butcher who was
predominantly involved in slaughtering.

Data Collection
A semistructured close-ended questionnaire and observational checklists were prepared with the
help of standard guidelines of Codex Alimentarius Commission of Food and Agriculture
Organization with reference to slaughterhouse and meat inspection regulations, 2001.10,11 Face to
face interviews were undertaken with the butchers’ to assess knowledge on meat hygiene and
observation to assess the hygiene practices, including the use of personal protective equipment
(PPE) used while handling meat. Data collection was undertaken by the researcher herself. The
semistructured questionnaire was first developed in English and then translated to Nepali lan-
guage and back-translated.
Data were collected on demography, meat shop profile, butchers’ profile, awareness of meat
hygiene, knowledge of health effects of inadequate meat handling, wearing of PPE, cleanliness
of equipment, and by-product disposal.
Observations were made of personal hygienic practices and prevailing environmental condi-
tions. The PPE assessed included the use of an apron, gloves, foot wear, mask, and head cap.
Pilot-testing was undertaken using a convenience sample of 15 butchers from the Bharatpur
Municipality of Chitwan District. After the pilot testing, the questionnaires were modified as
necessary to clarify language and meaning.

Data Analysis
Data were entered into Epi-data 3.1 software and analyzed using IBM SPSS 20. Descriptive,
bivariate (chi-square test) and multivariate analyses (binary logistic regression) of the data were
carried out. Descriptive results were expressed as frequencies and percentages. For variables that
are significant (chi-square test P ≤ .05), odds ratios were calculated. In multivariate analysis, the
odds ratio was adjusted by controlling (having side job, education, workload [per kg/per day],
structure of the shop, working hours [per day], license, ethnicity, and location of the shop) and
statistically significant variables are presented in the tables.
The level of knowledge about meat hygiene was adjusted for “having a side job,” “education,”
“workload” (per kg/per day), “structure of the shop,” “working hours (per day),” “license and
location of shop.” The same factors were used to adjust data on practice on meat hygiene, Only
Khanal and Poudel 3

those butchers who were predominantly involved in slaughtering of goat and poultry products
were included in the study. Butchers who were not available in 3 subsequent visits and/or did not
give informed consent were excluded from the study.
Ethical approval was obtained from Chitwan Medical College Institutional Review Committee.
Written permission was given by the municipal authority to conduct the study. Before the survey,
the study purpose and process were clearly explained to potential participants and on giving
informed consent they were included in the study. Privacy and confidentiality of respondents was
maintained.

Operational Definition
Knowledge Level.  The level of knowledge was measured by using the scoring system based on the
study conducted in 2013 by Paudel et al.12 The responses were coded as 1 and 0 for correct opin-
ion and misconceptions, respectively. There were 31 points for the knowledge level, which were
categorized as follows:

Adequate: ≥80%, (25-31) score

Fair: 45%-79%, (14-24) score
Poor: <45%

Practice Level.  The level of practice was also measured by using the same scoring system stated
by Paudel et al.12 The correct practice was scored as 1 while wrong or nonpractice as 0. Practice
was measured with a total score of 37 and was categorized as follows:

Adequate: ≥80% (25-31) score

Fair: 45%-79% (14-24) score
Poor: <45%

Results
Males (68.4%) predominated in the meat industry and nearly half (47.3%) of the butchers were
illiterate. Majority of the butchers’ shops (83%) did not have an authorized license to run. Nearly
71.9% of butchers’ shops were located in the same area as their residence. Most of the butchers
(79.8%) fell into the age range of 25 to 49 years. On an average, butchers had 5 years of work
experience. Very few (3.5%) butchers had received formal training on safe butchering and
hygienic practices. Sixty-one percent of the butchers handled less than 15 kg meat per day. On an
average, each butcher handled around 8 kg of meat per day. More than half (59%) of the butchers
were involved in another side business. Ninety-eight butchers wore an apron, but is 51 cases it
was dirty. None of the respondents used gloves but 69.3% (79) of the respondents wore slippers.
Two of the butchers wore masks, but only one of the masks was clean (Table 1).
Butchers who worked for more than 8 hours per day (odds ratio [OR] = 4.01, CI = 1.83-9.16),
had a license for handling meat (OR = 4.93, CI = 1.71-14.25), and those working in a shop
located in a market area (OR = 2.584, CI = 1.12- 5.98) were more likely to have a higher level of
knowledge. Similarly, respondents who were solely engaged in butchering activities (OR = 2.32,
CI = 1.09-4.98), handled more than 30 kg meat per day (OR = 9.83, CI = 4.20-93.61), worked
more than 8 hours per day (OR = 6.05, CI = 2.67-3.72), had a license (OR = 8, CI = 2.18-2.34),
had secondary and above education (OR = 2.47, CI = 1.02-5.99), and had a shop located within
the market area (OR = 3.44, CI = 1.44-8.19) were more likely to have a higher level of practice
(Table 2).
4 Asia Pacific Journal of Public Health 00(0)

Table 1.  Characteristics of Butchers and Shops.

Variable (n = 114) Frequency Percent

Age, years  
 <25 8 7.0
 25-49 91 79.8
  ≥50 15 13.2
Sex  
 Male 78 68.4
 Female 36 31.6
Ethnicity  
 Brahmin/Chhetri 29 25.4
  Disadvantaged non-Dalits/minority/Terai caste/Janjatis 85 74.6
Education  
 Illiterate 54 47.4
  Primary level 26 22.8
  Secondary level and above 34 29.8
Experience, years  
 <5 58 50.9
 5-10 35 30.7
 >10 21 18.4
  Mean ± SD 5.47 ± 5.22  
Location  
  Market area 32 28.1
  Residential area 82 71.9
License  
 Yes 19 16.7
 No 95 83.3
Shop type  
  Open space 49 43.0
  Temporarily constructed closed shop 48 42.1
  Permanently constructed closed shop 17 14.9
Source of training  
 Parental 10 8.8
 Relatives/Friends/Self 100 87.7
  Formal training 4 3.5
Time spent in butchering, hours)  
 <8 65 57.0
 >8 49 43.0
Side job  
 Yes 67 58.8
 No 47 41.2
Workload, kg/day  
 <15 70 61.4
 15-29 25 21.9
 >30 19 16.7
Personal protective wear worn by butchers
  Use of apron 98 86
   Clean apron (n = 98) 47 48
  Use of footwear 79 69.3
   Clean footwear (n = 79) 36 45.6
  Use of masks 2 1.8
  Clean masks 1 0.9
Khanal and Poudel 5

Table 2.  Predictors of Knowledge and Practice Levels of Meat Hygiene.

Level of Knowledge

Unadjusted Odds
  Poor, n (%) Fair, n (%) Ratio (95% CI) P
Working hours (per day) <8 50 (76.9) 15 (23.1) 1  
  ≥8 22 (44.9) 27 (55.1) 4.011 (1.827-9.160) .001
License Yes 6 (31.6) 13 (68.4) 4.931 (1.706-14.252) .003
  No 66 (69.5) 29 (30.5) 1  
Location Market 15 (46.9) 17 (53.1) 2.584 (1.117-5.977) .026
  Residential 57 (69.5) 25 (30.5) 1  

Level of Practice

Satisfactory, Unadjusted Odds

  Poor, n (%) n (%) Ratio (95% CI) P
Side job Yes 41 (61.2) 26 (38.8) 1  
  No 19 (40.4) 28 (5.6) 2.324 (1.085-4.980 .030
Workload (per kg/per day) <15 49 (70.0) 21 (30.0) 1  
  15-29 9 (36.0) 16 (64.0) 4.148 (1.583-10.871) .004
  >30 2 (10.5) 17 (89.5) 9.833 (4.202-93.611) <.0001
Working hours (per day) <8 46 (70.8) 19 (29.2) 1  
  ≥8 14 (28.6) 35 (71.4) 6.053 (2.670-3.721) <.0001
License Yes 3 (15.8) 16 (84.2) 8 (2.181-2.344) .002
  No 57 (60.0) 38 (40.0) 1  
Education Illiterate 31 (57.4) 23 (42.6) 1  
  Primary 17 (65.4) 9 (34.6) 0.714 (0.270-1.885)  
  Secondary 12 (35.3) 22 (64.7) 2.471 (1.018-5.996) .45
and above
Location Market 10 (31.2) 22 (68.8) 3.437 (1.441-8.199) .005
  Residential 50 (61.0) 32 (39.0) 1  

Butchers who were solely engaged in butchering activities (adjusted odds ratio [aOR] = 3.04,
CI = 1.11-8.33), had secondary and above education (aOR = 3.17, CI = 2.60-14.72), handled
more than 30 kg meat per day (aOR = 5.45, CI = 1.01-29.57), and those whose shops were tem-
porarily constructed closed shop (aOR = 3.33, CI = 1.10-10.38) were more likely to have fair
level of knowledge. Butchers whose shops were a temporarily constructed closed shop (aOR =
3.07, CI = 1.04-9.06), permanently constructed closed shop (aOR = 23.56, CI = 1.91-291.11),
and who belonged to Brahmin/Chhetri caste (aOR = 3.39, CI = 1.10-10.46) were more likely to
have satisfactory level of practice (Table 3).
A total of 72 (63.2%) butchers had a poor level of knowledge on meat hygiene. A total of 42
(36.8%) butchers had a fair level knowledge on meat hygiene. A total of 60 (52.6%) butchers had
poor level of practice on meat hygiene. A total of 54 (47.4%) respondents had a satisfactory level
of practice on meat hygiene, respectively. None of the respondents acquired an adequate level of
knowledge and practice

Discussion
Butchers’ shops are places where there is a high chance for contamination of meat. Maintenance
of proper hygienic practices at the shop while handling is essential to provide fresh and
healthy meat for public consumption. In this study, we have explored the factors associated
6 Asia Pacific Journal of Public Health 00(0)

Table 3.  Independent Predictors of Knowledge and Practice Level of Meat Hygiene.
Level of Knowledgea
Unadjusted Adjusted Odds
  Poor, n (%) Fair, n (%) Odds Ratio Ratio (95% CI) P

Side job Yes 51 (76.1) 16 (23.1) 1b .031

No 21 (44.7) 26 (55.3) 3.946 3.04 (1.11-8.33)
Education Illiterate 39 (72.2) 15 (27.8) 1b  
Primary 19 (73.1) 7 (26.9) 0.958 0.60 (0.16-2.26) .452
Secondary and above 14 (41.2) 20 (58.8) 3.714 3.17 (2.60-14.7) .039
Workload <15 54 (77.1) 16 (22.9) 1b  
(per kg/per day) 15-29 14 (56.0) 11 (44.0) 2.652 1.28 (0.39-4.16) .68
≥30 4 (21.1) 15 (78.9) 12.65 5.45 (1.01-29.5) .048
Shop structure Open space 42 (85.7) 7 (14.3) 1b  
Temporarily constructed 24 (50.0) 24 (50.0) 6.00 3.33 (1.10-10.38) .041
closed shop
Permanently constructed 6 (35.3) 11 (64.7) 11.00 2.08 (0.35-12.54) .424
closed shop

  Level of Practicec
Unadjusted Adjusted Odds
  Poor, n (%) Fair, n (%) Odds Ratio Ratio (95% CI)  P

Ethnicity Brahmin/Chhetri 10 (34.5) 19 (65.5) 2.714 3.39 (1.10-10.4) .033

  Minority/Terai caste/Janajati 50 (58.8) 35 (41.2) 1b  
Shop structure Open space 39 (79.6) 10 (20.4) 1b  
Temporarily constructed 20 (41.7) 28 (58.3) 5.46 3.07 (1.04-9.06) .043
closed shop
Permanently constructed 1 (5.9) 16 (94.1) 62.4 23.56 (1.9-291.1) .014
closed shop
aAdjusted with side job, education, workload (per kg/per day), structure of the shop, working hours (per day), license, and location.
bReference category.
cAdjusted with side job, education, workload (per kg/per day), structure of the shop, working hours (per day), license, location, and

ethnicity.

with hygiene practices and knowledge of meat hygiene among the meat handlers. In this
study, majority of the butchers (83%) did not have an authorized license to run their shop.
This may be due to either inadequate legislation or weak implementation of the law. There is
strong evidence that having licensed facilities is associate with improved hygiene conditions
in the premises of butchers’ shops.13 Very few (3.5%) butchers had received formal training
on butchering practices. Studies conducted in Dharan, Nepal in 2012, Patna, India in 2006,
Nairobi and Isiolo, Kenya in 2015, and Gondar town, Ethiopia in 2015 revealed that none of
the meat handlers or butchers had any formal training on meat handling hygiene.14-17 A study
conducted in Chhattisgarh, India (2015) reported similar results stating that 4% of the slaugh-
ter men were not trained for slaughtering operations.18 Handling meat without any training
could enhance the risk of cross contamination. According to Adams and Moss,19 training of
food handlers regarding the basic concepts and requirements of personal hygiene plays an
integral part in ensuring safe products to consumers. On an average, butchers handle about 8
kg of meat per day, which a very low amount. This may be attributed to the fact that butchers
had other side businesses as well and so were opening their shop only in leisure time (before
9 am and after 4 pm).
More than half (59%) of the butchers were involved in other side business. This may indicate
the difficulty of establishing a viable industry in the Nepalese context. This may be because
Nepal is predominantly a Hindu country and most prefer a vegetarian diet. Another reason may
be that Nepalese people do not consume animal protein on a regular basis because the price of
meat is quite high compared with vegetable protein.
Khanal and Poudel 7

In this study, butchers did not properly follow the PPE guidelines, which is important not only
to prevent cross-contamination of meat but also to prevent butchers from injuries and fatalities.
This indicates a lack of training on butchering practices. It is important for the municipal author-
ity to properly monitor the PPE guidelines. None of the butchers had adequate knowledge and
good practice. Most of the butchers had a poor level of knowledge (63.2%) and practice (52.6%).
A study conducted in Kathmandu, Nepal by Poudel et al12 reported similar results stating that
none of the butchers had an adequate knowledge and good practice on meat hygiene. More than
half of the butchers had a poor level of knowledge (62.2%) and practice (55.4%) according to a
study by Poudel et al12 (2013). Another study conducted in Nigeria by Alhaji and Baiwa20 reported
a slightly higher proportion with 75% poor knowledge and 82.2% poor practice level. A study
done in Kerala, India revealed that butchers hardly knew anything on scientific and hygienic
aspects of animals slaughtering.21 The scenario of poor knowledge and practice skills of the meat
handlers may be due to illiteracy and weak meat hygiene legislation.
Other studies reported similar scenarios of lacked low level of knowledge and hygienic prac-
tices among the butchers on meat hygiene, exposing the community toward potential meat-borne
illnesses.2,16,20,22,23 It is inevitable that improper handling and unsafe hygiene lead to contamina-
tion of meat eventually affecting the health of consumers.24 In this study, knowledge and practice
level were inconsistent. This may be attributed to either butchers’ negligence in daily practices or
inefficient supervision from the concerned authority. Moreover, inconsistency could also be
explained by the low income–low investment trend resulting into a low standard in butchers’
shops where the maintenance of adequate practice level is impossible. Higher level of education
is a strong predictor for enhancing knowledge regarding meat hygiene in selected areas. Similar
finding was found in a study conducted in north central Nigeria by Alhaji and Baiwa.20 Ability to
read and understand can be advantageous, especially in terms of comprehension of written/oral
messages given on meat hygiene. These messages are usually available through mass media and
could positively reshape the mind-set of butchers for maintenance of meat hygiene. Butchers
without a side job had a greater knowledge on meat hygiene. They regularly try to enhance their
business and profits by adopting new techniques. One focus of attracting customers could be by
maintaining and promoting meat hygiene. In this study, significant associations were observed in
the practice of meat hygiene between ethnicity and caste. Brahmin/Chhetris are more likely to
have a satisfactory practice. Brahmin and Chhetris are considered as an upper class and are more
educated and equally conscious on hygiene/sanitation than others. This observation signals us to
the cultural differences in perception, belief, and practice in meat hygiene.
One strength of this study is the random sampling method, which reduced the selection bias
thus enhancing our quality of research. Data were analyzed using multivariate analysis, which
helped us to explore associations with knowledge and practice level of meat hygiene. There are
some limitations to be considered. Some aspects of hygienic practices were evaluated on the
basis of information provided by the butchers, instead of by observation. This could lead to bias.
A cross-sectional study design instead of a longitudinal study was used to collect the data on
knowledge and hygienic practice on meat hygiene. A longitudinal study could have helped us to
better evaluate and observe on a follow up basis for meat hygiene practices. In Nepal, very few
articles have been published regarding meat hygiene and therefore it was difficult for us to com-
pare and contrast the findings with other research work. The findings of this study are difficult to
generalize as it was conducted only in a small-scale population of Ratnanagar, Chitwan, Nepal.
Further study could be done to identify the health status of the butchers and prevalence of meat-
borne diseases caused by poor handling. Additional research could be done to study the presence
of microorganisms in the available meat of butchers’ shops. Policy makers should focus on vac-
cination of the butchers for meat-borne diseases on a periodic basis. The municipality should
make a mandatory registration and licensing of the meat shops and permit only those workers
who had received a proper training on meat hygiene. Understanding and collecting evidence of
the butchers’ knowledge and existing precautionary practices is crucial for drawing the attention
8 Asia Pacific Journal of Public Health 00(0)

of the concerned authority in order to protect the vulnerable groups (butcher and consumer) from
meat borne diseases. The findings of this study may be useful for the policy makers in determin-
ing intervening strategies for improvising meat hygiene practices.

Conclusion and Recommendation

This study found that the majority of butchers in Ratnanagar were unaware of the hygiene aspects
of meat handling exposing them and the public to threats of meat-borne diseases. Having a side
job, poor education, workload, and structure of shop were the determinants of knowledge and
practice levels in meat hygiene. These components must be taken into consideration while pre-
paring the policy and plan for meat hygiene guidelines. Proper registration and licensing of the
meat shops should be made mandatory by the municipal authority and only those who have
undergone a proper training on meat hygiene should be permitted to work as butchers.

Acknowledgments
We acknowledge Mr Govinda Prasad Dhungana and Dr Suman Thapa for helping in data analysis and
manuscript writing process. We would like to thank Ratnanagar municipality of Chitwan for providing the
information regarding butchers and meat business. Last, but not least, we would like to thank all the butch-
ers who participated in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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