H/A: Foodborne Illness (2009)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To assess awareness of basic food hygiene and food safety among HIV-positive individuals.

Inclusion Criteria:

None specifically mentioned.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment: Subjects were approached during 1995 in a single hospital either in the walk-in clinic waiting room while waiting for routine appointments or while receiving treatment in the day-care ward. There was no selection of subjects.

Design: Cross-sectional survey

Statistical Analysis: Data only described in terms of frequencies. 

Data Collection Summary:

Timing of Measurements

Survey was carried out by personal interview.

Dependent Variables

  • Awareness of basic food hygiene and food safety. Questionnaire, which was devised based on the generally available advice given by the UK Government, sought information about:
    • Time since diagnosis of HIV status
    • Modification of diet since diagnosis
    • Advice or information received concerning food and diet
    • Knowledge and practice of food preparation and storage
    • Dietary habits with respect to consumption of certain risky foods
    • Advice about prevention of Salmonella, Listeria and Cryptosporidium infection
    • Pet ownership and pet hygiene
  • Majority of interviews were conducted by one interviewer and all were carried out in a standard manner using a questionnaire. Each interview lasted 10 to 15 minutes.

Independent Variables

HIV-infection.


 

Description of Actual Data Sample:

Initial N: 77 HIV-positive individuals

Attrition (final N): 77 subjects (72 male and 5 female)

Age: Not mentioned

Ethnicity: Not mentioned

Location: Great Britain.

 

Summary of Results:

Knowledge and Behavior on Specific Aspects of Food Safety by 77 HIV-positive Individuals

General Food Hygiene Awareness and Practice

Number (%) of subjects responding to the question in the affirmative
Check "eat by date" on food 72 (95%)
Avoid undercooked/raw meat 59 (78%)
Avoid cross-contamination with raw meat 58 (76%)
Avoid cross-contamination in refrigerator 53 (70%)
Aware that refrigerator temperature should be <5 degrees C 28 (37%)
Check refrigerator temperature regularly 14 (18%)
Wash raw vegetables and fruit before eating 71 (93%)
Wash pre-packed prepared salads before eating 7 (18%)

Eat pre-packed prepared chilled food without further cooking

29 (67%)

Avoid unpasteurized milk

74 (97%)

Other Findings

There was some confusion and lack of knowledge about aspects of food storage and, despite the fact that 74% of subjects had modified their diet since learning their HIV status (mainly for nutritional reasons), only 25% reported receiving information about food safety.

Of the subjects interviewed, 96%, 66% and 23% were aware of the risks of infection from Salmonella, Listeria monocytogenes and Cryptosporidium, respectively, although most were not aware of the UK government's advice about the consumption of eggs, soft cheese, pate and cook-chill foods.

More than 40% of those interviewed reported that they did not drink tap water (most drank bottled water instead), but few were aware of infections potentially transmitted through water.

Although pets represent a potential source of a wide variety of infectious agents, there was a high level of awareness of this problem. 36% of the interviewees kept cats, dogs or fish and 64% of the dog and cat owners reported washing their hands after handling their pets and 34% kept their pet away from kitchen surfaces.

 

Author Conclusion:

There is scope for improving the availability of information on food safety given both verbally and in written form. This study highlights the need for centrally produced written advice, such as a leaflet specifically aimed at HIV-positive individuals. Promulgating advice through voluntary organizations and, for example, the popular press is also an important route; however, it must be ensured that the information is accurate and not alarmist. The lack of knowledge surrounding infections that can be transmitted through food or water may reflect the situation in the general population. However, in view of the more serious consequences of infection in those with HIV, it is important that such individuals should at least be aware of the government's advice even if they then choose not to follow it. All health care workers have a responsibility to ensure that HIV-positive patients are aware of general food hygiene and the risks associated with the consumption of certain types of food.

Funding Source:
Reviewer Comments:

Questionnaire not shown to be valid or reliable. Subjects not well-described. Statistical analysis was not very sophisticated.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? No
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? No
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? ???
  8.1. Were statistical analyses adequately described and the results reported appropriately? No
  8.2. Were correct statistical tests used and assumptions of test not violated? ???
  8.3. Were statistics reported with levels of significance and/or confidence intervals? No
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes