PLT COLLEGE, INC.

College of Medical Laboratory Science

Bayombong, Nueva Vizcaya, 3700

Hepatitis A Screening on Selected Food Vendors of Bayombong, Nueva Vizcaya:

A Compliance for Consumers’ Safety and Awareness

A Research Paper Presented to

The Faculty of the College of Medical Technology

PLT College, Inc.

Bayombong, Nueva Vizcaya

In Partial Fulfillment

of the Course Requirements for the Degree

Bachelor of Science in Medical Laboratory Science

By

Buyucan, Diana Faith L.

Cadiente, Kristine Aiselgi C.

Labtuon, Destiny M.

Moorthy, Sabrina F.

Tamayo, Maybelle

Mr. Joel Dolado

Adviser
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

CHAPTER I
INTRODUCTION

I. Background of the Study

Food safety continues as a critical problem in developed and developing

nations for people, food companies, and food control officials (Osaili et al., 2018).

Food-borne infections are responsible for a large number of diseases that exist

worldwide. It is a growing public health concern in both developed and developing

nations, causing morbidity and mortality in the general populace, particularly in

populations that are more susceptible, such as infants, young children, the elderly, and

those with weakened immune systems.

According to the study of Gizaw (2019), Food safety in the food market is one

of the key areas of focus in public health, because it affects people of every age, race,

gender, and income level around the world. Food safety is an important issue that

affects all of the world’s people. Many countries throughout the world are

increasingly interdependent on the availability of their food supply and on its safety.

Hence, people all over the world increasingly value food safety; food production

should be done safely to maximize public health gains and environmental benefits.

In the Philippines, a national food safety program was initiated in 2013.

Collective efforts of food regulatory agencies have increased awareness and

significance of food safety in the country with the signing of the Philippine Food
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

Safety Act into law. Republic Act 10611 aims to promote the right to health of the

people and strengthen the food regulatory system in the country. The positive impact

of the food safety act of the country cannot still be fully appreciated since the law

enactment is only in its infancy. A study of Rustia et al. (2017) involving 53 street

food vendors closely monitored by their local government showed that not all

provisions in the Code on Sanitation of the Philippines are actually practiced by street

food vendors. Despite the food safety risk, many people patronize street foods

because it plays an important role in meeting the food and nutritional needs of

consumers at affordable prices. According to the World Health Organization (2010),

the Philippines has seroprevalence of HAV is 57.1%–100% among individuals aged

20–39 years. The main types of HAV outbreak were caused by the consumption of

contaminated food or drinking water, and the Philippines remains highly endemic for

type A hepatitis (David, 2004). However, there is still a lack of information regarding

the virological characteristics of the causative agent as well as the epidemiological

background, including the HAV contamination of sewage water, in the Philippines.

The transmission of hepatitis A is often related to drinking water and raw

foods contaminated by HAV. In school-aged children, hepatitis A can occur

asymptomatically and through fecal-oral route. The study of Hilario (2015) observed

that street food vendors practiced minimal hygienic and sanitary practices in certain

places near a in Manila. The hygienic practices included food preparation, handling of

utensils, place for food preparation, personal hygiene, and methods of storing cooked

food. The causes of Hepatitis A outbreak are due to insufficient hand washing

facilities and drinking water sources which are close to septic tanks. In addition, it is
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

also significantly related to the hygiene and sanitation of food sellers in different

places.

One of the safety measures to be implemented in order to stop the spread of

the Hepatitis A virus is to enforce food hygiene among food handlers, as consumers
are susceptible to food and water-borne illnesses. This study aims to screen for
Hepatitis A and assess the food hygiene practices of selected vendors of Bayombong
Nueva Vizcaya. So, this study will help the institution use the law already passed in
the country to put into place the standard guidelines for food regulatory systems and
raise awareness to improve public health at Bayombong Nueva Vizcaya. This study
will be a reference in starting future studies regarding Hepatitis A virus that the
existence of it in the community is being neglected. Lack of studies and literature on
Hepatitis A virus in the locality is one of the main reasons for conducting this
research to strengthen public health in the country.

II. Statement of the Problem

The study aims to determine the food vendor’s compliance to consumers’

safety and awareness through Hepatitis A screening. Specifically, it seeks to answer

the following questions:

1. What is the demographic profile of the respondents in terms of:

1. Age

2. Sex

3. Number of years as food vendor

4. Employment Status

2. Is there a significant difference in the hygiene practices of food

vendors regarding handling of food in the locality when group

according to demographic profile?

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

3. What is the level of compliance of food vendors on food hygiene

among the consumers’ safety and awareness?

4. What recommendations may be proposed for the improvement of the

study?

III. Statement of the Null Hypothesis

There are no significant differences on the hygiene practices of food vendors

regarding handling of foods to demographic profile.

IV. Conceptual and Analytical Framework

Hepatitis A disease is a common form of viral hepatitis and is transmitted

through contaminated food and water or through close contact with an infected

person. The virus withstands high temperatures and can survive on surfaces for long

periods of time.

According to Shenoy, et. al., (2022), the burden of hepatitis A has shifted

from children to adolescents and adults who are more vulnerable to infection. The

prevention of the disease has often been neglected, inadequate safety measures for the

preparation of food (via food handlers) is a known risk factor for the transmission of

hepatitis A.

The complexities related to food regulations, poor knowledge, general

awareness about hygiene, and the improper safety practices of food handlers are

known to impede the prevention of foodborne illnesses such as hepatitis A (Dudeja,

et. al., 2017). Importantly, the lack of education or training influences the attitude of

food handlers toward implementing food safety principles.

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

One of the municipality in the Philippines where food services is working to

develop a social enterprise platform for business that employs local food suppliers and

offers community members meaningful employment opportunities is Bayombong,

Nueva Vizcaya. In terms of food services, Bayombong Nueva Vizcaya wants to

achieve the locality sustainability goals while creating a work environment that

reflects a high level of training for the diverse workforce. From creating food

packages for athletes, to building a platform to sell meal plans to students, to engaging

the university's larger community.

The study aims to screen Hepatitis A among selected food vendors in

Bayombong, Nueva Vizcaya to ensure the safety of its consumers regarding food

hygiene and practices. It will focus on food vendors because they are prone to spread

Hepatitis A virus which causes food contamination. This study will benefit the

municipality through proper implementation of food safety and handling which is

aligned to the standard of existing laws regarding the food regulatory system. It will

also benefit the consumers in ensuring food services are proper and well-served.

Although studies on the incidence of HAV among food handlers have been

undertaken, none have yet looked at and identified surfaces in the area around

Bayombong Nueva Vizcaya that have been impacted by the virus. This study is

anticipated to inform the occupational health community on the presence of HAV on

work surfaces. The study to be conducted of HAV on work surfaces inside the

vicinity will further knowledge and be a step toward exposure control. It might offer

support in educating food vendors on HAV, especially younger employees. An

unwanted exposure to a virus can be avoided by recognizing and changing behaviors,

which will protect vendors and consumers from Hepatitis A.

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

INPUT OUTPUT PROCESS

Selected Food Hepatitis A Compliance on

Vendors Screening Test Consumers' Safety
Profile and Awareness
Participant's Blood
Analysis of Data Hygiene Practices
Sample
Survey/
Questionnaires

Figure 1. Research Paradigm

Figure 1 shows the paradigm of the study. A questionnaire will be distributed

to food vendors prior to the Hepatitis A screening. Questions about socio-

demographic profiles, food hygiene, and vendor practices will be asked and gathered

in this survey. Following the survey, food vendors will be screened for Hepatitis A.

The results will be evaluated and may indicate that food vendors are in compliance

with the standard food regulatory system in the country.

V. Importance of the Study

The future findings of this study will be beneficial to the following:

Municipality of Bayombong, Nueva Vizcaya. This study will help the

municipality in establishing and determining plans and actions on how to promote
food safety among consumers and proper handling/ preparation of foods among food
vendors..

Consumers. This study will be beneficial to the consumers as it will raise

safety awareness regarding food safety and possible infection of Hepatitis A
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

Future Researchers and the Researchers. This research study is open for
innovation and can serve as a basis for them upon conducting related studies in the
future. This study will be a basis for them to be able to propose improvements for
programs that aim to reduce occurrences of Hepatitis A among consumers.

VI. Scope and Delimitation

The general intent of this study is to know the food regulatory safety of
selected street vendors of Bayombong, Nueva Vizcaya with the focus on
screening of Hepatitis A and food hygiene practices of selected vendors. Also, this
study yearns to bring into light the Hepatitis A virus for the awareness and safety
of the consumers.

This study will be conducted with limited amount of financial resources and time
framework.

CHAPTER 11
REVIEW OF RELATED LITERATURE

Hepatitis A Virus

Hepatitis A virus (HAV) is one of the most common infectious etiologies of

acute hepatitis worldwide. According to the WHO estimates, HAV resulted in

13.7 million illnesses and 28000 deaths in 2010 (Havelaar, et. al., 2015). HAV is

primarily transmitted fecal-orally via contaminated food or water, or through

close contact with an infected person. According to Centers for Disease Control

and Prevention, if symptoms develop, they usually appear 2 to 7 weeks after

infection. Symptoms usually last less than 2 months, although some people can

be ill for as long as 6 months. Unlike hepatitis B and C, hepatitis A does not cause

chronic liver disease but it can cause debilitating symptoms and rarely fulminant
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

hepatitis (acute liver failure), which is often fatal. With improved sanitation and

provision of HAV vaccination, areas or populations with high HAV endemicity

show patterns of declining endemicity, according to their socioeconomic

backgrounds. (Aggarwal, et. al., 2015).

Moreover, predictors of past or recent infection with hepatitis A virus

include low household socioeconomic status (low income, wealth, and/or

educational level), a larger household size and crowding, residence in a rural

area, membership in certain ethnic groups, limited access to improved water

sources, and limited access sanitation facilities (Jacobsen, 2004). Several

additional high-risk population groups have been identified, including those who

travel or immigrate from a non-endemic region to an endemic region and those

who work in certain high-risk occupations. (Franco, et. al, 2003).

According to the Centers for Disease Control and Prevention, in United

States, less than 10% of Hepatitis A cases are associated with food-borne

outbreaks. Substantial costs are incurred by both society and the food industry

as a result of these outbreaks. The foods implicated in these outbreaks include

shellfish, sandwiches, dairy products, baked products, salads, fruits, and

vegetables. Examples of such outbreaks include the recent outbreak in Michigan,

which resulted in more than 200 cases of infectious hepatitis in school children,

due to the consumption of imported contaminated strawberries (Hutin, et. al.,

n.d.). In nearly 50% of hepatitis A cases, the mode and vehicle(s) of virus spread

remain unidentified. A number of reports have suggested that infected food

handlers may play an important role in food contamination in many cases.

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

However, our understanding of the ability of hands to transfer viruses such as

HAV to foods is limited, and this in turn hampers the institution of proper hand

hygiene measures to reduce the risk of food contamination.

Food Handling Practices

Numerous studies have been conducted on the knowledge, attitudes, and

practices of food handlers from various nations, each of which has produced a

different set of findings (Akabanda, Hlortsi, Owusu-Kwarteng, 2017; Cortese,

Veiros, Feldman, & Cavalli, 2016; Ansari-Lari, Soodbakhsh, & Lakzadeh, 2009;

and Baş, afak,) According to the research study by Akabanda et al. (2016), food

handlers were aware of sanitary methods, cleaning techniques, and sanitation

activities. Furthermore, the study found that almost all of the food handlers were

aware of the importance of standard hygienic procedures in the workplace, such

as washing hands, wearing gloves, cleaning tools and utensils properly, and using

detergent. Moreover, handlers exhibit a high degree of expertise together with

great techniques, according to Jianu & Goleţ's (2014) study. Additionally,

research findings typically reveal considerable gaps between knowledge and

practice (Scott & Vanick, 2007). In contrast, the study by Baş, afak, & Kvanç

(2006) showed that food handlers in Turkish food enterprises frequently lack

knowledge about the fundamentals of food hygiene. According to a different

study, food handlers were well-versed in hygiene procedures but had little

awareness of food safety (Webb, M., & Morancie, A. (2015). Global research has

been done over the years to identify the root of food-borne illnesses.
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

The knowledge, attitudes, and practices of food handlers in Accra have

previously been evaluated in Ghana (Boateng, 2014). However, these studies are

crucial because they offer a national assessment of the training requirements,

changes in attitudes, and efficiency of education and training to continuously

assure consumers that food is safe. These investigations will also help us

understand the relationships among the prevailing attitudes, practices, and

knowledge of food safety among food handlers across the nation.

Inadequate practices and a lack of awareness were examined in the

literature review, along with common food handling errors and human food

borne diseases (Sharif, Obaidat, & Al-Dalalah, 2013). Studies have shown that

educational initiatives are highly important for enhancing knowledge and

preventing foodborne illnesses (Angelillo et al., 2000; Bas et al., 2006; Osaili et

al., 2013; Martins et al., 2012). Additionally, numerous studies claimed that

excellent hygiene practices are directly influenced by one's degree of education

(Ababio, Adi, & Commey, 2012; Ackah et al., 2011; Tomlins, Johnson, Aseidu,

Myhara, & Greenhalgh, 2002).

In a study conducted by Fasanmi et al. (2018), it was stated that food-

borne illnesses in developing nations are serious because of bad hygienic food

handling methods, bad understanding, and absence of infrastructure. According

to Meleko et al. (2015) and Manes et al. (2016), globally, poor food hygiene

practices have been observed among some commercial and domestic food

handlers, resulting in an increased food-borne disease burden. The absence of

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

well-maintained and proper food handling practices in mass catering

establishments has the potential to have a disastrous effect on human health.

Compliance on Health Requirement of Food Handlers

Pascual and Abenis (2016) stated that the majority of the food handlers

reached tertiary education and reported having a fair knowledge of food safety

and having previously attended several food safety training, which do not

necessarily translate to satisfactory attitudes and practices in food safety. Thus,

continuous food safety education and subsequent monitoring and evaluation are

a must. Strategies to motivate food handlers to pursue general and personal

hygiene, cleaning, and sanitation procedures, including food safety procedures,

are recommended.

According to Matriano, Bersamina et al. (2017), The hygiene and food

sanitation knowledge and practices of food-handlers was generally

unsatisfactory among the restaurants surveyed. Restaurant inspections should

ensure awareness among patrons and food handlers about food sanitation and

safety in restaurants. All factors that influence the uniformity and reliability of

routine inspections by health inspectors should be modified. This could be

achieved by policies and regulations designed to ensure periodic training,

inspection and systematic standardization among inspection evaluations.

According to Howes et al. a study in the USA showed that approximately

97.0% of food borne outbreaks were due to improper food handling. Previous

reports indicate that besides poor hand and surface hygiene, lack of personal
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

hygiene amongst food handlers was also one of the most commonly reported

practices that gave rise to food borne illness. This shows that if food handlers

take serious note of the cleanliness of their hand, body and clothing, this will help

in preventing incidence of cross-contamination from occurring. It is thus

imperative that an assessment be conducted to assess what information food

handlers have, in relation to food safety.

CHAPTER III

RESEARCH METHODOLOGY

Research Design

A quantitative study design utilizing a descriptive survey method to assess

hepatitis A screening among selected food vendors was adopted. This design provides
information on the attitude and practices of food vendors in compliance with safety
and awareness of the consumers.

An experimental research design will also be utilized through the use of a

hepatitis A kit to test the virus among food vendors. This procedure provides
information if the food vendors are positive or negative for the virus.

Research Environment

The study will be conducted at Bayombong Nueva Vizcaya, It includes

particularly the food stalls near schools and colleges. These food stalls serve the
community specially students by offering a selection of a variety of foods and
beverages. As a result, food handlers should practice food safety. Since students may
be more prone to food-borne infections like the hepatitis A virus, food safety is
especially crucial in schools.

Research Participant
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

The study’s respondents are the food vendors of Bayombong, Nueva vizcaya.
The researchers will gather 30 respondents or more to answer the survey regarding
their demographic profile, practices, and attitude towards food hygiene. The
researchers consider conducting this study among food vendors because they handle
and serve foods, making them capable of transmitting the Hepatitis A virus to
consumers.

Research Instrument

A survey questionnaire will be utilized to gather necessary information to

answer the research questions. The questionnaire items are divided into three
categories: demographic profile, food handlers’ practices in food hygiene, and level of
compliance of food vendors on food hygiene. The survey questionnaire will be
adopted from the study of Ifebajo and Eboh (2021) to achieve the objectives of the
study. A set of questionnaires will also be adopted from Santos (2006) and is
described in Soares (2013). The questions are concerned in personal hygiene,
handlers, clothing and the basic knowledge about: food handling hygiene and cross
contamination.

Data Gathering Procedure

Figure 2. Flowchart of the Study

In the data gathering procedure, it will start from ad questionnaires from the
study of Ifebajo and Eboh (2021) and Santos (2006) regarding food vendors’ practices
and level of compliance of food vendors on food hygiene. The research instructor,
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

research adviser and panel members will validate the questionnaires if it is free from
errors and related to the study.

Upon the assessment, the researchers will be ready to float the questionnaires
to random food vendors accompanied with informed consent. The researchers discuss
the instructions to food vendors regarding the questionnaires and how to properly
collect a stool sample to prevent contamination and error of result. The information
will be kept highly confidential and private wherein researchers, research adviser,
coordinator and food vendors have access to the information. The researchers will
examine the stool sample using Hepatitis A kit to test if a food vendor is positive or
negative in Hepatitis A virus.

Hepatitis A Virus (HAV) IgG/IgM Rapid Test Kit

The thirty or more (>30) food vendors will sign an informed consent that they
voluntarily willing to participate in this study. A survey questionnaire is first
disseminated prior Hepatitis A screening test to ensure that they handle food services
within the university. The Hepatitis A screening test will be conducted before a new
semester for Academic Year 2022-2023 starts to ensure that food vendors are healthy
and safe to handle food services for the consumers in the university. The Hepatitis A
virus (HAV) IgG/IgM rapid test kit will be used as a parameter to detect both current
infection (IgM) and history of infection (IgG) to ensure that food vendors are safe to
handle food services.

Specimen Collection and Handling

Collect blood specimens into a collection tube containing EDTA, citrate or

heparin for plasma or collection tube containing no anticoagulants for serum by
venipuncture. To make plasma specimens, a centrifuge collects specimens and
carefully withdraws the plasma into a new pre-labeled tube. To make serum
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

specimens, allow blood to clot, then centrifuge collected specimens and carefully
withdraw the serum into a new pre-labeled tube. Test specimens as soon as possible
after collecting.

Assay Procedure

Using the Hepatitis A virus (HAV) IgG/IgM rapid test kit, bring the specimen
and test components to room temperature. Mix the specimen well prior to performing
the assay. When ready to test, open the pouch at the notch and remove the device.
Place the device on a clean, flat surface. Make sure to label the device with the name
of food vendor. Transfer the specimen using a pipette capable of delivering the
volume needed. Dispense the specific volume of specimen needed into the center of
the sample well, making sure that there are no air bubbles. Immediately add 2 drops
of sample diluent into the buffer well with the bottle positioned vertically.

Read the results in 15 minutes. Positive results may be visible as soon as 1

minute. Negative results must be confirmed at the end of the 20 minutes only.
However, any results interpreted outside 15-20 minutes should be considered invalid
and must be repeated. Discard used devices after interpreting the results following
local laws governing the disposal of devices.

Interpretation of assay result

If only the C line develops, the test indicates that anti-HAV antibodies are not
detected in the specimen. The result is negative or non-reactive. The presence of the C
line and when G line develops, the test result indicates the presence of anti-HAV IgG.
The result is HAV IgG positive or reactive, suggesting past infection. However, the
presence of the C line and when M line develops, the test indicates the presence of
anti-HAV IgM. The result is HAV IgM positive or reactive, suggesting active
infection. The presence of C line and both the G and M lines develop, the test
indicates the presence of anti-HAV IgG and anti-HAV IgM. The result is HAV IgG
and HAV IgM positive or reactive, suggesting active infection.

Statistical Treatment of Data

 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

The researchers will use the following statistical tools to analyze the gathered
data: Frequency count and Percent Distribution, Mean and Standard Deviation, and t-
Test and Analysis of Variance (ANOVA). In summarizing the demographic profiles,
frequency count and percentage distribution will be used. In determining the level of
compliance of food vendors on food hygiene among the consumers’ safety and
awareness, computation of mean and standard deviation will be used. The researchers
will use t-Test and Analysis of Variance (ANOVA) to test the significant difference
on the hygiene practices of food vendors regarding handling food in the university
when group according to demographic profile. In interpreting the result whether a
food vendor is positive or negative on Hepatitis A virus, the researchers will use
Hepatitis A virus IgG/IgM rapid test kit.

In addition, the researchers will use SPSS because it is a program for

quantitative analysis and is used as a comprehensive statistical package with a point-
and-click interface for a flexible, customizable way to get enormously granular on
even the most complex data sets. This provides the researchers with better data sets
for measuring and assessing out food handlers' practices and attitudes toward food
hygiene.

Ethical Considerations

This study will be approved by the PLT College Inc. Research Ethics Board at
PLT Colloge Inc. Nueva Vizcaya.

The respondents will receive a form requesting their informed permission. In

order to protect the respondents' privacy, the study's purpose and significance are
discussed with the interested participants. In order to label data without revealing the
respondents' names or making it optional instead. By making sure that access to any
sensitive information that would be gathered and will stay confidential, the data
obtained were safeguarded. All of the data will be permanently deleted once the study
is finished and bound into a book.

The study calls for the use of questionnaires and interviews. The researchers
will employ hepatitis A kit to assess if the responders are positive or negative for
 PLT COLLEGE, INC.
College of Medical Laboratory Science
Bayombong, Nueva Vizcaya, 3700

hepatitis A as part of the study's phlebotomy component. During the visit, the study's
schedule is flexible to accommodate the participants. Since the respondents are the
study's primary informants, they will be chosen as participants. Their involvement is
voluntary, and they are free to end it whenever they choose without giving a reason.

Given that the study will deal with blood, the researchers will execute the
universal precautions and treat all blood as infectious to minimize the risk. Blood, in
particular, poses high environmental risks as well as health risks to laboratory users if
accidentally exposed through splashes in the eyes or mouth. The researchers are
trained and well-equipped to handle the blood in testing for hepatitis A using the
hepatitis A kits. The CNS laboratory has an established Hazardous and Biological
Waste Management Policy (2020). All procedures where potentially infectious and
hazardous splashes are created will be conducted in biologically and chemically safe
laboratory benches and/or stations.