MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY NGO HOANG TUAN HAI FOOD SAFETY BEHAVIOR IN PRIMARY COOK AND HEALTH OUTCOMES OF HOUSEHOLD IN HO CHI MINH CITY MASTER OF ECONOMICS THESIS Ho Chi Minh City - Year 2016 TIEU LUAN MOI download : skknchat@gmail.com MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY NGO HOANG TUAN HAI FOOD SAFETY BEHAVIOR IN PRIMARY COOK AND HEALTH OUTCOMES OF HOUSEHOLD IN HO CHI MINH CITY Major: Development Economics ID: 60310105 MASTER OF ECONOMICS THESIS SUPERVISOR: DR. PHAM KHANH NAM Ho Chi Minh City - Year 2016 TIEU LUAN MOI download : skknchat@gmail.com COMMITMENT I commit the thesis “Food safety behavior of primary cook and health outcomes of household in Ho Chi Minh city” is my own research. Except the references which are extracted in this thesis, there is no any others research or documents which is used in the thesis against regulatory. I would bear the full responsibility of my research.
The data, conclusion in this thesis is fidelity and not published in any research yet. Ho Chi Minh City, October 31st, 2016. Ngo Hoang Tuan Hai TIEU LUAN MOI download : skknchat@gmail.com TABLE OF CONTENT COMMITMENT TABLE OF CONTENT ACKNOWLEDGEMENT LIST OF ABBREVIATIONS LIST OF FIGURES LIST OF TABLES CHAPTER 1 : INTRODUCTION.2 RESEARCH OBJECTIVES AND RESEARCH QUESTIONS .3 SCOPE OF RESEARCH. 9 CHAPTER 2 : LITERATURE REVIEW .1 FOOD SAFETY AND FOOD-BORNE DISEASES .2 THE HEALTH BELIEF MODEL: .3 EMPIRICAL REVIEWS ON DRIVERS OF FOOD SAFETY PRACTICES:.
13 CHAPTER 3 : RESEARCH METHODOLOGY. 25 CHAPTER 4 : RESEARCH RESULTS .1 FOOD SAFETY PROBLEMS IN VIETNAM .3 RESULTS FROM MULTIVARIATE PROBIT MODELS .4 RESULTS FROM PROPENSITY SCORE MATCHING MODEL. 45 CHAPTER 5 : DISCUSSION AND IMPLIED POLICY .1 DISCUSSIONS AND CONCLUSIONS. 49 TIEU LUAN MOI download : skknchat@gmail.3 LIMITATION AND IMPLICATIONS FOR FURTHER RESEARCH.
51 Appendix 1: The correlation matrix of perception’s factors .53 Appendix 2: PCA result .54 Appendix 3: MVP regression (reduced form) .55 Appendix 4: MVP regression (original form) .56 Appendix 5: Poisson regression .57 Appendix 6: Questionaire form .67 TIEU LUAN MOI download : skknchat@gmail.com ACKNOWLEDGEMENT Firstly, I would like to express my gratitude to Dr Pham Khanh Nam, my supervisor, for all the suggestions, recommendations, knowledge and guidance that he did to support me to finish the thesis. Secondly, I am very grateful to doctor, MPH Nguyen Thi Huynh Mai, vice director of Safety Hygiene Food Branch of Ho Chi Minh city, for the permission as well as the advice to use the food safety data. Thirdly, I would like to thankful to my colleagues, my friend for all the encouragement and support they gave to me during the thesis processing. Lastly, my sincere thanks are all to the member of School of Economics – University of Economic Ho Chi Minh city for their effort to create the best environment for studying and researching for me as well as other students during the course.
Ho Chi Minh city, October 31st, 2016. Ngo Hoang Tuan Hai TIEU LUAN MOI download : skknchat@gmail.com LIST OF ABBREVIATIONS FBD: Food-borne disease WHO: World Health Organization FAO: Food and Agriculture Organization HBM: Heal Belief Model MVP: Multivariate Probit KAP: Knowledge, Attitude and Practice PSM: Propensity Score Matching CDC: Center for Disease Control and Prevention TIEU LUAN MOI download : skknchat@gmail.com LIST OF FIGURES Figure 1.1: The number of food-borne cases annually (WHO, 2015) .2: The number of death caused by FBD annually (WHO, 2015) .3: The burden of FBD (WHO, 2015) .1: Health belief Model Components and Linkages (Glanz et al, 2008) .1: The Health Belief Model application in food safety .1: The number of food poisoning cases in Vietnam (MOH, 2016) .2: The number of food poisoning outbreaks and death in Vietnam (MOH, 2015).3: The number of food poisoning cases in HCM city (FSBDH, 2016) .4: The nonparametric relationship between food safety practice and knowledge, perception. 38 TIEU LUAN MOI download : skknchat@gmail.com LIST OF TABLES Table 2.1: The concepts of Health Belief Model .1: Demographic characteristics of participants (category variables) .2: Demographic characteristics of participants (continuous variables) .3: Factor analysis result.4: Food safety practices.5: MVP regression reduced form .6: MVP regression original form .7: Marginal effect after MVP regression .9: Probit regression result .10: Differences of continuous variables .11: Correlations between binary variables and FBD. 48 TIEU LUAN MOI download : skknchat@gmail.com ABSTRACT Nowadays food safety issue appeals a lot of attention from the global organization to local authorities.
Each year, the food-borne diseases cause an enormous burden on people heath as well as national’s economy. As climate change suffered country with the developing economy, Vietnam has to face to many food safety challenges. In recent years, the Vietnam government has invested much effort in order to maintain the rate of economic growth while trying to improve the people’s health by a lot of new law and institutions. However, the food safety policy does not focus on adjusting the consumer’s behavior.
As a result, the impact of individual’s practice on their health was not determined clearly in Vietnamese community. This research’s objective is to find out the factors that modify the food safety practice of household primary food preparer and the effect of these behaviors on food poisoning risk. The results show that the food safety knowledge and perception have significant effect on household cook’s practices while their behaviors do not have the explicit impact on the food poisoning’s risk. Keywords: food safety, food knowledge, perception and behavior, food poisoning TIEU LUAN MOI download : skknchat@gmail.com 1 CHAPTER 1 : INTRODUCTION 1.1 PROBLEM STATEMENTS The agricultural revolution has brought a large amount of food, rations for human and improved laborer’s health, a fundamental factor of human capital.
Therefore, food safety1 problem would give negative impact to the sustainable development of developing countries as well as the national’s security. The fact that many diseases related to food demonstrated recently has driven many countries’ attention from food quantity to food safety. The usage of pesticides, chemical fertilizer and feedstuff improve agriculture’s capacity. However, the overuse and misuse of them affect the quality of food.
In addition, the preservation and processing method as well as food additive exploitation both make food become less safety. According to WHO (2015), the main factors cause food-borne disease are bacteria, virus, parasites, chemicals and toxins. The most dedicated people of food-borne illness are children, pregnant women and the elder. Due to the development of transportation and international trade, food safety issue is not only the problem of any countries but also a global problem.
For examples: Chinese milk scandal, New Zealand material milk crisis caused an enormous loss for the manufacturer and impinge on other countries as well as consumer’s health. 1 World Health Organization (WHO) and Food and Agriculture Organization (FAO) defined: “Food safety is the assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use” (WHO and FAO, 2009, p. TIEU LUAN MOI download : skknchat@gmail.com 2 700,000,000 600,000,000 500,000,000 400,000,000 300,000,000 200,000,000 100,000,000 0 Global total Eastern Europe Western America South East Africa Mediterranea Pacific Asia Figure 1.1: The number of food-borne cases annually (WHO, 2015) FBD occur in all countries in the world. However, the developing regions, such as South East Asia and Africa, distributed the majority of food-borne cases while the developed areas, such as Europe and America, had the least number of food-borne cases.
An unexpected result is that although African countries are lack of food source and food safety control, this region had less amount of food-borne illness cases than the South East Asian region. The reasons of this phenomenon may be due to the diversity of high nutrition food and the tropical weather in the Asian area. These two factors are the ideal condition for bacteria and other food risky factors to affect the human health. Among all FBD, diarrheal diseases are the most common illnesses resulting from TIEU LUAN MOI download : skknchat@gmail.com 3 unsafe food, accounted for half of global burden of FBD and made 550 million people falling ill (including 220 million children), cause 230,000 deaths (96,000 children’s) 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 Global total Eastern Europe Western America South East Africa Mediterranea Pacific Asia Figure 1.2: The number of death caused by FBD annually (WHO, 2015) Similar with the number of food-borne cases, the number of death caused by FBD showed the same trend.
South East Asian and African regions continued to distribute the largest number of death cases while the European and American had the least amount of death by FBD. The African region also had less number of death case than the South East Asian. This consequence may be the effect of many international medical supports to the Africa than the Asian. In addition, the distinction of physical strength of local population between these two regions is another fundamental reason.
The FBD caused the burden about 33 million DALYs2. Diarrheal diseases agents were the largest contributors, accounted for 18 million DALYs, 54% of total. All three 2 DALYs: Disability-adjusted life year, a health gap measure that combines the years of life lost due to premature death (YLL) and the years lived with disability (YLD) from a disease or condition, for TIEU LUAN MOI download : skknchat@gmail.3 both indicated that South East Asian and African region’s food safety issue is severe and these areas suffered an enormous burden from FBD. However, despite of the number of death cases in Africa was less than Asia, the burden of FBD in this area was almost twice than the South East Asian and much more than other areas.
The European, Western Pacific and American total burden was almost equal to the South East Asia’s and half than the Africa’s burden. These figures exposed the distance of the health care facilities as well as the food safety controlled policy between each areas and their impact of population’s health outcomes. 3000 2500 2000 1500 1000 DALYs per 100,000 population 500 0 Figure 1.3: The burden of FBD (WHO, 2015) varying degrees of severity, making time itself the common metric for death and disability. One DALY equates to one year of healthy life lost (WHO, 2015).
TIEU LUAN MOI download : skknchat@gmail.com 5 According to the region category of WHO, Vietnam is categorized in the Western Pacific areas. In the general view of this organization, food-borne illness figure’s of this area is at the middle level of the world. The similarity result repeated in Vietnam case. However, this region includes various kinds of countries, from developed countries such as Australia, Japan, Republic of Korea to the developing ones such as Cambodia, Philippines, Vietnam.
Thus, the contribution of each country has a huge distinction. The specific information of Vietnam case showed in Chapter 4. Although the developing countries suffer the most from FBD, the developed countries also have difficulty with food-borne illness. According to Center for Disease Control and Prevention (CDC), The USA had 864 food-borne disease outbreaks, resulting in 13,246 illnesses, 712 hospitalizations, caused 21 deaths, and 21 food recalls in 2014.
In detail, the majority of the food poisoning cases occurred in restaurant (485 cases, accounted for 65%), followed by private home (86 cases, accounted for 12%). The most popular causes of food-borne illness in 2014 was bacteria (149 cases, confirmed and suspected) distributed 22% of total cases. Those figures proved that even the country with well-organized healthcare system and policy has to struggle with food poisoning. CDC also predicted that food safety issue would continue emerge in the future due to: - Changes in our food production and supply, including more imported foods.
- Changes in the environment leading to food contamination. - Better detection of multistate outbreaks. - New and emerging bacteria, toxins, and antibiotic resistance. - Changes in consumer preferences and habits.
- Changes in the tests that diagnose foodborne illness.