Review of microbial food contamination and food hygiene in selected capital cities of Ghana

Food poisoning is a nationwide challenge that arises from both formal and informal sector in the food industry. This review presents a general overview of microbial food safety and hygiene in Ghana. Information available shows that most microbial food researches were highly concentrated on the regional capitals of Ghana with particular emphasis on the capital cities. Commercial food operations, specifically street foods have received the most concern. However, there was limited information from institutional catering and other forms of food hazards. Based on the review, the most predominant bacteria isolated in Ghanaian foods were Enterobacter spp., Escherichia spp., Staphylococcus spp. and Pseudomonas spp. which were found to be present in 20, 16, 12 and 11%, respectively. The most contaminated food samples were soup, stew, “fufu”, macaroni, salad, and “waakye”. Most of the research articles did not present clearly, whether the bacteria isolated were above set standards from the World Health Organisation and Ghana Standard Authority and also did not give directions for future research. Hence, a concerted effort in research on food safety is needed in Ghana to prevent the incidence of food-borne diseases particularly the preventable ones. Subjects: Environment & Agriculture; Environmental Studies & Management; Food Science & Technology


ABOUT THE AUTHORS
Enoch Yeleliere has BSc in Renewable natural resources option in Environmental management from the University for Development Studies. Samuel Jerry Cobbina (Phd) is a Senior Lecturer. He has been the principal researcher in UNICEF funded studies on hand washing in basic schools and the CIDA-funded FARMER project on the Quality of water in dugouts both in northern Ghana.
Together, Enoch Yeleliere and Dr Cobbina have written four articles; three on microbial quality of food and one on water resources management in Ghana. These articles are all submitted to recognized journal awaiting publication.
The incidence of microbial food contamination is a common case Ghana. However, not much has been seen with regards to sustainable strategies to curb it. This research seeks to make available information for the general public to be guided as well as prompting government of Ghana to take serious initiative in curbing this menace.

PUBLIC INTEREST STATEMENT
The incidence of food poisoning is a common case in many hospitals in Ghana. However, not much has been seen with regards to sustainable strategies to curb it. It seems that, for the general public and for that matter government of Ghana to take an issue serious, there must be wide publicity about it. Consequently this work sought to make available comprehensive information about the extent of food poisoning cases and the microbes involved. After analyzing published literature we report that, foods that one has to be cautious of at public eateries include soup, stew, fufu, macroni, salad and waakye. Also, information reviewed showed that, these foods were mostly contaminated with Enterobacter spp. (20%), Esherichia spp. (16%), Staphylococcus spp. (12%) and Pseudomonas spp. (11%) amongst other bacteria. By this work we advise that, caterers should practice proper food handling techniques and that the national campaign on hand washing should be sustained.

Introduction
In a report given by the Ministry of Food and Agriculture and World Bank in 2007, one out of every 40 persons in Ghana suffers from food borne illness annually with over 420,000 year round reported cases.
Out of this number, 65,000 persons die resulting in economic loss of about US $ 6,900,000.00. Some of the foodborne pathogens that account for these foodborne diseases include Staphylococcus aureus, Listeria, Salmonella, Bacillus and Escherichia coli (Ababio, 2014). Also, Saba and Gonzalez-Zorn (2012) reported that the most predominant bacteria in Ghanaian foods were Enterobacter spp., Citrobacter spp., Klebsiella spp., and Escherichia spp. Saba and Gonzalez-Zorn (2012) asserted that studies on microbiological food safety are were on the decline and highly centered in the capital city of the country. Food and Agricultural Organisation (FAO) and World Health Organisation (WHO) 2005 regional report on food safety for Africa recorded microbiological hazards as the most eminent risk from street foods. Also, WHO 2005 reported the danger of high levels of some heavy metals and pesticide residues from raw materials, utensils or transport methods used.
The problem of food safety is not a preserve of developing countries alone. There are recorded numbers of significant food poison cases and cholera in developed countries regardless of their advancement in food chain monitoring systems (Scallan, Griffin, Angulo, Tauxe, & Hoekstra, 2011).The problem is persistent despite significant efforts made to reduce the incidence of certain diseasecausing pathogens in foods through better farm practices and food regulations. In Ghana, food laws and regulations include the Food and Drugs Law, 1992 (PNDCL 305B), Animals (Control and Importation) Ordinance (Cap 247), Diseases of Animals Act, 1961 (Act 83), Food and Drugs (Amendment) Act, 1996 (Act 523),Tourist Board Decree 1973 (NRCD 224), Ghana Tourist Board (Amendment) Decree, 1977 (SMCD 80) and the Local Government Act, 1961 (Act 54); 1993 (Act 462) (Sefa-Dedeh, 2009). The hygiene principles currently in existence are not legally binding (Ghana Standard Authority, 2013) but are protocols which the industry is supposed to use to ensure food safety.
The Food and Drugs Authority (FDA) is the national regulatory body under the Ministry of Health with the responsibility of implementing food policies and ensuring the safety and wholesomeness of food for consumers. Ghana Standard Authority develops and promotes international and locally acceptable standards for the industry with the help of agencies including Ministry of Food and Agriculture, Ministry of Health, Ghana Tourist Authority and Environmental Protection Agency. The Ghanaian government has empowered Metropolitan and Districts Assemblies to actively control and monitor food vendors, who sell ready to eat foods.
The object of this work is to provide a review on microbial food safety and hygiene researches in Ghana. It is the hope of the researchers that this work will guide future researches and provide a comprehensive data base for policy makers.
For lunch, the most popularly consumed dish was banku with tomato stew and dishes made with rice such as "waakye" and jollof rice (12%).
For dinner, the main dishes were "banku", "fufu" and yam served with tomato stew. In the case of snacks: pastries are the favourite ones, followed by ice cream. Only very few consumed fruits (mostly cocoa, then orange, banana, and papaya). Soft drinks (16%) were the most consumed fluids, followed by juice (9%) and sachet water (7.5%). (Table 1)

Food safety alert
Food safety is a main concern for many people as almost everyone for the past years has ever experienced food borne illness at least once (WHO, 2015

Food hygiene issues
Studies shows that the food industry in Ghana has been characterized in the last fifteen years by food hygiene and safety (FHS) issues. Along with these, despite visible improvements, still require a lot more work to control.
Food is considered hygienic when there is no dangerous substance that can be injurious to the health of human or animal (Ababio & Adi, 2012). The practice or observation of food and personal hygiene are keen to the prevention of many food-borne diseases. Generally, the deliberate or accidental food contamination due to inappropriate handling of food causes potential danger to consumers' health (Annor & Baiden, 2011). Several unhygienic practices such as inappropriate storage of food and drinks, improper preparation and cooking, and poor personal and environmental hygiene are noted to compromise food safety (Odonkor, Adom, & Boatin, 2011).
Hygiene practices among food vendors and catering services have been reported to be below acceptable standards (Feglo & Sakyi, 2012). Feglo and Sakyi (2012) in their study on food vendors found that, the vendors had little education on food handling, processing and food hygienic practices.
Dun-Dery and Addo (2016) explored the practices and vendor perceptions on food and personal hygiene and the challenges faced by environmental health officers in implementing hygiene standards and policies in Ghana. They observed that majority (44%) of food vendors washed their hands every 20-30 min, whiles 42% washed at each serving and 14% washed each and every hour. They concluded that a good number of food vendors are yet to adopt basic hygiene practices in Ghana.
Also, a study by Boateng (2014) reported that 84.0% of food vendors used the same hands for serving and receiving money from buyers, 89% used their bare hands to serve or dish out food and 30.3% of vendors had not been given certificate to operate. This study also revealed that, out of 216 total food samples collected, faecal coliforms were isolated in 128 (59.3%), E. coli in 90 (41.7%), Salmonella typhi in 26 (12.0%) and S. aureus in 134 (62.0%) samples. These were slightly above acceptable limits (Boateng, 2014).
Ensuring FHS practice among vendors is very challenging however there is the need for vendors to adhere to high standards of food safety and hygienic practices (Monney, Agyei, Ewoenam, Priscilla, & Nyaw, 2014). Thus it is encouraged for continuous awareness creation and enforcement of regulation in the Ghanaian food industry.

Microbial quality of street foods
A research carried out by Mensah, Yeboah-Manu, Owusu-Darko, and Ablordey (2002) in Accra found that the microbial quality of sampled salads, macaroni, "fufu", "omo tuo" and red pepper had unacceptable levels of contamination. Mesophilic bacteria were detected in 69.7% of foods. Bacillus cereus detected in 5.5% of the foods, 31.9% contained S. aureus and 33.7% contained Enterobacteriaceae. Also, Shigella sonnei and enteroaggregative E. coli were isolated from macaroni, rice, and tomato stew, and Salmonella arizonae from light soup.
Contamination does not only affect the food industry, but also sachet water sold in Ghana. A study by Kwakye-Nuako, Borketey, Mensah-Attipoe, Asmah, and Ayeh-Kumi (2007) reported the presence of contaminants of feacal and zoonotic origin in some sachet water examined. 77% of the samples analysed contained pathogenic parasitic organisms, 29.6% contained at least one, 14.8% contained at least two, 25.9% contained at least three, and 29.6% contained four types of parasites and 93% contained unidentified impurities/artifacts. As of chemical contamination, analysis of street food in Accra by Tomlins and Johnson (2004) and Tomlins (2000) found heavy metals such as lead and also the presence of mycotoxins.
Food is considered hygienic and when it does not pose any threat or risk or better still substance that cannot be injurious to the health of human or animal (Ababio & Adi, 2012). The practice or observation of food and personal hygiene are keys for the prevention of many food-borne diseases. Generally, the deliberate or accidental food contamination due to inappropriate handling of food causes potential danger to consumers' health (Annor & Baiden, 2011). Numerous hygiene practices such as inadequate storage of food and drinks, improper preparation and cooking, and poor personal and environmental hygiene are noted to compromise food safety (Odonkor et al., 2011).
Though, microbiological menaces in ready to eat food and chemical risks, particularly pesticides from agricultural foods such as fresh vegetables and fruits have been highlighted (Foriwaa & Lovatt, 2015)-some previous studies have assessed consumer behaviour for possible answers to the following questions: why, what, when, where and how vendors purchase raw materials for processing (Medeiros & Salay, 2013).
Hygiene practices among food vendors and catering services have been reported to be below acceptable standards. At the same time food vendors had little education on food handling, processing and food hygiene practices (Feglo & Sakyi, 2012). Feglo and Sakyi (2012) and Ababio, Adi, and Commey (2012) reported significant low levels of education among food vendors in the Kumasi and Accra Metropolis. They reported limited number of food safety management systems nationwide particularly among locally owned food establishments. Their report revealed that the local food industry largely lacked the capacity to implement, and maintain acceptable national and international standards as compared to their international competitors. Rheinlander, Bakang, Takyi, Konradsen, and Samuelson (2008) for instance reported that food handling practices in Kumasi did not reflect knowledge of vendors given the fact that, vendors had some level of food safety and hygiene awareness. They emphasized that both consumers and food handlers used aesthetic qualities such as appearance of environment and vendor, price and proximity to the neglect of good hygienic practices like food hygiene, vendors' personal hygiene as well as proper hand washing procedures and kitchen cleanliness to judge food safety and quality.

Food safety concerns
There has been a rising concern that food vendors and handlers in the country downplay documentation and quality assurance as an integral part of food production. This can be substantiated by the absence of a strict regulation on who can handle food on commercial bases. However, it is mandatory under the public health policy for food vendors to be medically screened before preparing food for sale or venturing into food business (Feglo & Sakyi, 2012). A research conducted by Ackah et al. (2011) showed that a little over 40% of sampled food vendors had health certificates with marked absence of periodic screening in the capital city of Ghana.

Reported cases of microbial related diseases in Ghana
According to the Ghana Health Service Annual Report (2011), the total number of diarrhoea cases recorded among persons above five years was 125,074. Out of these, 1,832 cases suffered severe dehydration and 71 died (CFR = 3.88%). The Ashanti Region recorded the highest incidence of acute watery diarrhoea disease (1,010.4 per 100,000 populations). Central Region recorded the second highest incidence (766.2 per 100,000 populations). Both regions had comparatively higher indices to national average of 609.4 per 100,000 populations.
During the year under review a total of 24,242 cases with 22 deaths were reported (CFR-0.024%) giving an incidence rate of 94.49/100,000 population. The highest incidence of bloody diarrhea was recorded in Upper East region 637.44/100,000 of the population, about seven times above the national average (Ghana Health Service Annual Report, 2011). Several major cholera outbreaks over the past three decades have been reported in Ghana. In 1982, as many as 15,032 cases the highest number of cases recorded in a single year were reported.
In 2011, 9,174 cases, in 2012, total of 9,566 cases, in 2013, 22 cases were recorded. In 2014, the index case of cholera was reported on 10 June 2014 but over a period of less than 3 months, as at 14 September 2014, 16, 527 cases including 128 deaths (CFR: 0.8%) had been reported from 8 out of 10 regions.

Conclusion
Literature reviewed in this work showed that, the most predominant bacteria isolated in Ghanaian foods are Enterobacter spp., Escherichia spp., Staphylococcus spp. and Pseudomonas spp. Whiles the most contaminated foods were stew, soup, "fufu", macaroni, salad, and "waakye". Most of the articles did not present clearly as to whether the bacteria isolated were above set standards of WHO and or that of Ghana standard authority. These works did not give directions for future research. The trend of publications on the subject of microbial food safety is centered on Accra and Kumasi with few across other regional capitals and almost none at the district level.