Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013

Foodborne Microbiological Hazards in Ghana: A Scoping Review

Background

Foodborne diseases pose a significant public health threat, particularly in regions with poor sanitation and food handling practices. These diseases, mainly caused by microbiological hazards like bacteria, fungi, and parasites, affect millions globally. Despite the global burden, the true extent of these hazards remains underestimated, especially in low- and middle-income countries like Ghana. This study aimed to map the available literature on foodborne microbiological hazards in Ghana, providing an overview of the evidence and identifying areas where further research is needed.

Method

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. A detailed search was done in PubMed, Scopus, Web of Science, and Google Scholar, and articles were exported to Rayyan for screening. A three-phase screening process was used to identify relevant articles. Data from the included articles were extracted and analysed, with specific information related to food type, specific hazards, sample population, and hazard groups summarised using proportions and tables.

Results

This review included 72 studies which were published between 2001 and 2023. Eighty-five percent of these studies (85%) reported on bacterial hazards, while 19%, 11%, and 6% reported on fungi, parasites, and mycotoxins, respectively. The most reported bacterial, fungal, and parasitic hazards were Escherichia coli, Aspergillus spp. and Trichuris trichiura, respectively. Aflatoxins were reported in maize, groundnut, and spices, with prevalence ranging from 61% to 100% and at levels exceeding standards set by Ghana Standards Authority and European Food Safety Authority.

Conclusion

This review highlighted the spectrum of microbiological hazards in foods in Ghana. The hazards identified pose significant public health risks, particularly among vulnerable populations. It is crucial that stricter enforcement of food safety laws and improved food handling practices are implemented in the country, particularly in the informal food sector, to protect consumers.

Food safety knowledge and practices among raw meat handlers and the microbial content of raw meat sold at Kumasi Abattoir Butchery Shops in Kumasi, Ghana

BACKGROUND

Foodborne diseases affect nearly 600 million people each year, that is, one in every ten people, and their outbreaks are most common in low- and middle-income countries, particularly in Africa. This study investigated the food safety practices among raw meat handlers and the microbial quality of the meat from the butchery shops in Kumasi Abattoir, Ghana.

METHODS

This study employed a descriptive cross-sectional study and collected quantitative data on factors associated with food safety and hygienic practices among raw meat handlers and the microbial quality of the raw meat using a structured questionnaire and standard laboratory methods, respectively. The study used all 50 beef vending shops in the butchery for questionnaire aspect and fresh beef samples were obtained from 10 vendors in the butchery shop. Appropriate methods were followed to analyse questionnaire data and meat samples.

RESULTS

Most of the butchers (72%) were between the ages of 31 and 45, and they were predominantly Muslims (68%). Most of the respondents (48%) had basic education. All the respondents had food safety certificates from the local authority but needed adequate knowledge of meat safety. Most respondents (90%) handled meat and money with the same bare hands, thus contaminating the meat. The study showed that the maximum Total Viable Count (TVC), Total Staphylococcus Count (TSC), and Total Escherichia coli Count (TEC) were 5.60, 4.39 and 5.13 cfu/g, respectively. The study also revealed that all the meat samples were Salmonella species-free.

CONCLUSIONS

Microorganisms in raw beef indicate a public health hazard. It gives a signal of a possible occurrence of food-borne intoxication and infection if not controlled. Environmental health officers in the Greater Kumasi area should organize food safety training and educate raw meat handlers on the importance of food safety and its consequences.

Public health concerns for food contamination in Ghana: A scoping review

Nutrition is sturdily and rapidly becoming the foremost determinant of health in today's Sars-Cov-2 and climate change ravaged world. While safe food sustains life, contamination obliterates its values and could result in death and short to long term morbidity. The purpose of this scoping review is to explore food contamination in Ghana, between 2001-2022. Using Arksey and O'Malley's procedure, a systematic literature search from PubMed, JSTOR, ScienceDirect, ProQuest, Scopus, Emeralds Insight, Google Scholar, and Google was carried out. Following the inclusion criteria, 40 published and grey literature were covered in this review. The review revealed the following: Studies on food contamination involving Greater Accra, Ashanti, Central, and Eastern Regions alone account for over 50% of the total number of such studies conducted in Ghana; regulators failed in enforcing regulations, monitoring and supervision; managers failed to provide adequate infrastructure and facilities. The most common food safety risks of public health concern are: i) micro-organisms (E. coli/faecal coliforms, Staphylococcus aureus, Salmonella spp, Bacillus cereus, and Viral hepatitis); ii) drugs (Amoxicillin, Chlortetracycline, Ciprofloxacin, Danofloxacin, and Doxycycline) and; iii) chemicals (Chlorpyrifos). Salad, vegetables, sliced mango, meat pie, and snail khebab are of high public health risks. The following deductions were made from the review: Highly contaminated food results in death, short to long term morbidity, economic loss, and threatens to displace Ghana's efforts at achieving the Sustainable Development Goals (SDG) 2. Thus, Government must resource key regulatory bodies to enhance their operational capacity, regulators must foster collaboration in monitoring and supervision of food vendors, and managers of food service outlets must provide adequate facilities to engender food safety culture.

Food hygiene research: a bibliometric comparison in Iranian and international "Environmental Health" journals

BACKGROUND

Food hygiene is one of the specialized fields of environmental health, and despite the problems associated with foodborne illnesses, there is no evaluation available that would focus on specialized environmental health journals. The purpose of the present survey is a comparison of the status of food hygiene articles published in Iranian and international journals of environmental health.

METHODS

This cross-sectional descriptive study was performed on all published articles in five Iranian environmental health journals and three international environmental health journals that are among the top 5% and 10% based on SNIP, emphasizing the issue of food. Our data were collected by searching relevant keywords in the articles published during the years (2008-2021), with emphasis on food hygiene. In the checklist, journal and articles information was collected by year of publication, a number of articles, information on authors' participation status in terms of number, gender, organizational affiliation, country and continents, and research centers according to authors' authorship. Statistical analysis of data was performed using descriptive and inferential statistical indices. VOSviewer software was also used to visualize the data.

RESULTS

In Iranian environmental health journals, out of 2305 articles (7.3%) and out of 6898 articles in international environmental health journals (2.4%) dealt with food hygiene. Food hygiene articles were divided into seven categories, with the largest number of articles on aquatic and agricultural products each with a frequency of 48 articles. Articles related to heavy metals in food were provided by 30.81%. In this study, out of 150 articles, 15 articles were written with the participation of 30 authors from seven continents (Asia, America, and Europe), most of which were from Asia and India. In international environmental health journals, among the main research topics in articles related to food hygiene, the highest number (52.5%) was related to a determination about pollution such as heavy metal concentrations in food.

CONCLUSIONS

Articles published in Iranian and international environmental health journals about food hygiene were limited. According to the increasing prevalence of foodborne illnesses, especially in recent decades, and the importance of paying attention to food hygiene, more targeted studies are needed.

Evaluating the Spatial Risk of Bacterial Foodborne Diseases Using Vulnerability Assessment and Geographically Weighted Logistic Regression

Foodborne diseases are an increasing concern to public health; climate and socioeconomic factors influence bacterial foodborne disease outbreaks. We developed an “exposure–sensitivity–adaptability” vulnerability assessment framework to explore the spatial characteristics of multiple climatic and socioeconomic environments, and analyzed the risk of foodborne disease outbreaks in different vulnerable environments of Zhejiang Province, China. Global logistic regression (GLR) and geographically weighted logistic regression (GWLR) models were combined to quantify the influence of selected variables on regional bacterial foodborne diseases and evaluate the potential risk. GLR results suggested that temperature, total precipitation, road density, construction area proportions, and gross domestic product (GDP) were positively correlated with foodborne diseases. GWLR results indicated that the strength and significance of these relationships varied locally, and the predicted risk map revealed that the risk of foodborne diseases caused by Vibrio parahaemolyticus was higher in urban areas (60.6%) than rural areas (20.1%). Finally, distance from the coastline was negatively correlated with predicted regional risks. This study provides a spatial perspective for the relevant departments to prevent and control foodborne diseases.

Diarrhoeagenic E. coli occurrence and antimicrobial resistance of Extended Spectrum Beta-Lactamases isolated from diarrhoea patients attending health facilities in Accra, Ghana

INTRODUCTION

Diarrhoea accounts for high morbidity and mortality in children and adults worldwide. Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL-PE) and Diarrhoeagenic Escherichia coli (DEC) contribute to prolonged hospitalization because of their resistance and virulence properties aiding in the spread of diarrhoeal disease and delayed treatment.

AIM

To determine DEC and the antimicrobial resistance of ESBL-PE isolated among diarrhoea patients attending two health facilities in Ghana.

METHODS

Stool samples were collected from 122 diarrhoeal patients who attended Maamobi General Hospital and Kaneshie Polyclinic between January 2019 and March 2020. Identification of bacteria was performed by using the Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Using disk diffusion, antimicrobial susceptibility testing (AST) was conducted and interpreted according to the 2018 CLSI guidelines. Detection of ESBL and DEC genes was performed using Polymerase chain reaction (PCR).

RESULTS

A total of 80.3% (98/122) Enterobacteriaceae was recovered from the patients in the study with an overall ESBL occurrence of 20.4% (20/98), predominantly among E. coli showed 13.2% (10/76), Klebsiella pneumoniae,35.7%(5/14) and Proteus mirabilis, 57.1%(4/7). Among the ESBL genes detected, blaTEM (n = 14) was common, followed by blaCTX-M (n = 13) and blaSHV (n = 4). Thirty-four E. coli isolates possessed the heat labile (Lt) gene of Enterotoxigenic E. coli (ETEC).

CONCLUSION

Our findings confirm the existence of DEC and the antimicrobial resistance patterns of ESBL-PE among stool isolates, limiting the options of commonly used drugs for diarrhoeal treatment in Ghana. Routine laboratory testing in health care facilities and strengthened surveillance systems among hospital networks are encouraged for a better understanding of their epidemiology and clinical implications.

The surveillance and prediction of food contamination using intelligent systems: a bibliometric analysis

Purpose

This paper aims to report on the bibliometric research trends on the application of machine learning/intelligent systems in the prediction of food contamination and the surveillance of foodborne diseases.

Design/methodology/approach

In this study, Web of Science (WoS) core collection database was used to retrieve publications from the year 1996–2021. Document types were classified according to country of origin, journals, citation and key research areas. The bibliometric parameters were analyzed using VOSviewer version 1.6.15 to visualize the international collaboration networks, citation density and link strength.

Findings

A total of 516 articles across 6 document types were extracted with an average h-index of 51 from 10,570 citations. The leading journal in publications was Science of the Total Environment (3.6%) by Elsevier and the International Journal of Food Microbiology (2.5%). The United States of America (USA) (24%) followed by the People's Republic of China (17.2%) were the most influential countries in terms of publications. The top-cited articles in this study focused on themes such as contamination from packaging materials and on the strategies for preventing chemical contaminants in the food chain.

Originality/value

This report is significant because the public health field requires innovative strategies in forecasting foodborne disease outbreaks to advance effective interventions. Therefore, more collaboration need to be fostered, especially in developing nations regarding food safety research.

Confirmed Foodborne Hepatitis A in Saudi Arabia, 2005-2015

Background Foodborne hepatitis A has major health and economic impacts. Pathogen-specific surveillance based on laboratory findings is conducted to detect and confirm cases of foodborne hepatitis A. Foodborne hepatitis A is on the priority list of diseases in the Kingdom of Saudi Arabia (KSA). Objectives This study aimed to describe the characteristics of confirmed foodborne hepatitis A in the KSA from 2005 to 2015. Methods A cross-sectional study of confirmed foodborne hepatitis A in the KSA from 2005 to 2015 was conducted, and data collection was through retrospective chart review. Results The number of hepatitis A cases that have been confirmed and reported to the Ministry of Health during the study period was 11148, and the Riyadh health region had more reported cases (1353 cases; 12.1%) than any other region. The highest number of cases (2631 cases; 23.6%) was recorded in 2006, and the incidence of foodborne hepatitis A was found to be highest in the month of March (1439; 12.9%). Further, the incidence of foodborne hepatitis A was highest in the five-to-14-years age group, in male individuals, and in Saudi nationals at 59% (6556 cases), 55% (6076 cases), and 88% (9775 cases), respectively. Conclusion The characteristics of foodborne hepatitis A vary according to time, place, and person. These variations may reflect differences in reporting systems and in preventive measures between health regions, seasons, and habits of the Saudi population.

Trends of potential waterborne diseases at different health facilities in Bamboutos Division, West Region, Cameroon: a retrospective appraisal of routine data from 2013 to 2017

Many Cameroonian cities lack access to potable drinking water where populations rely on alternative water sources of doubtful quality. This study aimed at describing the trends and patterns of waterborne diseases (WBDs) reported in some health facilities in Bamboutos Division between 2013 and 2017 as baseline data towards understanding the profile of WBDs in this area. A retrospective review of clinical data kept on patients who visited the main health facilities in Bamboutos Division from January 2013 to December 2017 was conducted. Overall, 39.1% (n = 8,124) of total patients were positive for at least one WBD. Categories of WBDs were dysenteries (18.6%), gastroenteritis (4.2%), viral hepatitis (0.2%) and typhoid was the most preponderant (24.4%). The most affected age groups were those above 24 years but significant differences were observed only in 2013 and 2017. Distribution of potential WBDs was locality dependent. The highest prevalence of typhoid fever was recorded in Bameboro (35.4%), dysenteries in Bamedjinda (20.4%) and gastroenteritis (17.3%) in Bamekoumbou. The study shows very high overall prevalence of WBDs in some localities which could be considered as 'hotspots' of WBDs in Bamboutos. This suggests the urgent need for setting up measures to tackle the challenges of potable drinking water supply.

Food safety knowledge and practice among pregnant women: a cross sectional study in Ghana

Background: Foodborne disease is a growing public health concern worldwide, especially among vulnerable populations. Improved understanding of food safety practices is fundamental to addressing the phenomenon. This study aimed to assess the sociodemographic factors influencing knowledge and practice of food safety among pregnant women in Ghana.

Design and Method: This is a cross-sectional study. Selfadministered questionnaires were distributed in person to participants during data collection. Data was entered and analysed in Epi Data version 3.1 and Stata 12, respectively. Chi square test and Fischer’s exact test were used to determine association between independent variables and outcome variables (knowledge and practice). Binary logistic regression was used to test the strength of the association between independent and outcome variables at 95% confident interval. A p-value of 0.05 or less was considered significant.

Results: Findings were: about 87.06% of the respondents had satisfactory knowledge on food safety; approximately 58.2% of respondents knew how to prevent foodborne disease but about 51.18% had unsatisfactory practice about food safety; about 28.2% of participants had experienced foodborne disease before in the past 6 months. Also, employment status and period of pregnancy were found to have significant influence on food safety knowledge whereas educational level and employment status also had significant influence on food safety practice.

Conclusion: Improved understanding about food safety will not necessarily lead to high food safety practices. In the quest to effectively prevent foodborne disease, we recommend an increase in awareness creation regarding foodborne disease and its associated socio-demographic risk factors like employment status, period of pregnancy and educational level.

Food Safety Practices among Postnatal Mothers in Western Ghana

Food safety has become a global issue due to the morbidity and mortality associated with it, particularly in developing countries. The objective of this community-based study is to examine food safety practices and its associated factors among postnatal mothers in the Western Region of Ghana. A cross-sectional survey study was conducted from August 1 2019 to January 31, 2020 from which data was obtained from the postnatal mothers (N = 300). The data was analysed using SPSS v.23. The findings suggest that majority (86%) of the respondents exhibited good food handling practices. Also, 66.3% and 91.7% of the respondents exhibited good food preparation and proper storage practices, respectively. Results also revealed that the odds of performing good handling practice among respondents within the age group of 36-45 years were five times higher compared to those within the age group of 18-25 years [OR = 4.92 (95% CI: 1.44–16.86), p = 0.011]. Moreover, respondents who had tertiary education qualifications were more likely to have proper food handling practices compared to those with primary education [OR = 0.27 (95% CI: 0.09–0.71), p = 0.009]. These findings provide useful insights for policy directions. The government of Ghana and other stakeholders should develop a communication strategy to increase and sustain publicity and education on food safety particularly to postnatal mothers and the citizenry in general.

Seasonal synchronization of foodborne outbreaks in the United States, 1996-2017

Modern food systems represent complex dynamic networks vulnerable to foodborne infectious outbreaks difficult to track and control. Seasonal co-occurrences (alignment of seasonal peaks) and synchronization (similarity of seasonal patterns) of infections are noted, yet rarely explored due to their complexity and methodological limitations. We proposed a systematic approach to evaluate the co-occurrence of seasonal peaks using a combination of L-moments, seasonality characteristics such as the timing (phase) and intensity (amplitude) of peaks, and three metrics of serial, phase-phase, and phase-amplitude synchronization. We used public records on counts of nine foodborne infections abstracted from CDC's FoodNet Fast online platform for the US and ten representative states from 1996 to 2017 (264 months). Based on annualized and trend-adjusted Negative Binomial Harmonic Regression (NBHR) models augmented with the δ-method, we determined that seasonal peaks of Campylobacter, Salmonella, and Shiga toxin-producing Escherichia Coli (STEC) were tightly clustered in late-July at the national and state levels. Phase-phase synchronization was observed between Cryptosporidium and Shigella, Listeria, and Salmonella (ρ = 0.51, 0.51, 0.46; p < 0.04). Later peak timing of STEC was associated with greater amplitude nationally (ρ = 0.50, p = 0.02) indicating phase-amplitude synchronization. Understanding of disease seasonal synchronization is essential for developing reliable outbreak forecasts and informing stakeholders on mitigation and preventive measures.

Understanding attitude, practices and knowledge of zoonotic infectious disease risks among poultry farmers in Ghana

Zoonotic infectious diseases (ZIDs) are increasing globally, and livestock farmers in low‐ and middle‐income countries are at particularly high risk. An evaluation of farmer's behaviour on farms can be used to identify the risk factors and to develop tailored control strategies. This study documents the knowledge of zoonotic poultry diseases (ZPD) among 152 poultry farm workers (respondents) from 76 farms in the Ashanti region of Ghana and assessed their on‐farm attitude and practices that increase their risk to exposure of ZPD. The median age of respondents was 29 years, 91.4% (n = 139) had a formal education, and 80.9% (n = 123) had worked on the farm for more than 1 year. The majority of farms (n = 69, 90.8%) had multiple flocks and 27.6% (n = 21) kept other animals, of which 57.1% (n = 12) were pigs. The majority of respondents had good knowledge about poultry diseases but not about ZPD. A higher level of education and longer work experience improved respondents’ knowledge of poultry and ZPD. Although respondents identified the wearing of personal protective equipment (PPE) as a major ZPD preventive measure, the majority did not put that knowledge into practice. Most farms (71.1%, n = 54) had no footbath and 55.3% (n = 42) deposited farm‐waste on the farm. While 97.4% (n = 148) of respondents washed their hands after working, only 48.7% (n = 74) wore protective footwear, 2.7% (n = 4) wore overalls, 2% (n = 3) wore nose masks and none (n = 0) wore gloves. The husbandry practices and attitude of farmers expose them to pathogens on the farm and increase their risk of becoming infected with ZPD in the sub‐region. The results from this study could be used to promote human health among farm workers in Ghana.

Continuous-Flow Separation and Efficient Concentration of Foodborne Bacteria from Large Volume Using Nickel Nanowire Bridge in Microfluidic Chip

Separation and concentration of target bacteria has become essential to sensitive and accurate detection of foodborne bacteria to ensure food safety. In this study, we developed a bacterial separation system for continuous-flow separation and efficient concentration of foodborne bacteria from large volume using a nickel nanowire (NiNW) bridge in the microfluidic chip. The synthesized NiNWs were first modified with the antibodies against the target bacteria and injected into the microfluidic channel to form the NiNW bridge in the presence of the external arc magnetic field. Then, the large volume of bacterial sample was continuous-flow injected to the channel, resulting in specific capture of the target bacteria by the antibodies on the NiNW bridge to form the NiNW–bacteria complexes. Finally, these complexes were flushed out of the channel and concentrated in a lower volume of buffer solution, after the magnetic field was removed. This bacterial separation system was able to separate up to 74% of target bacteria from 10 mL of bacterial sample at low concentrations of ≤10² CFU/mL in 3 h, and has the potential to separate other pathogenic bacteria from large volumes of food samples by changing the antibodies.

The HPAfrica protocol: Assessment of health behaviour and population-based socioeconomic, hygiene behavioural factors - a standardised repeated cross-sectional study in multiple cohorts in sub-Saharan Africa

INTRODUCTION

The objective of the Health Population Africa (HPAfrica) study is to determine health behaviour and population-based factors, including socioeconomic, ethnographic, hygiene and sanitation factors, at sites of the Severe Typhoid Fever in Africa (SETA) programme. SETA aims to investigate healthcare facility-based fever surveillance in Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar and Nigeria. Meaningful disease burden estimates require adjustment for health behaviour patterns, which are assumed to vary among a study population.

METHODS AND ANALYSIS

For the minimum sample size of household interviews required, the assumptions of an infinite population, a design effect and age-stratification and sex-stratification are considered. In the absence of a population sampling frame or household list, a spatial approach will be used to generate geographic random points with an Aeronautical Reconnaissance Coverage Geographic Information System tool. Printouts of Google Earth Pro satellite imagery visualise these points. Data of interest will be assessed in different seasons by applying population-weighted stratified sampling. An Android-based application and a web service will be developed for electronic data capturing and synchronisation with the database server in real time. Sampling weights will be computed to adjust for possible differences in selection probabilities. Descriptive data analyses will be performed in order to assess baseline information of each study population and age-stratified and sex-stratified health behaviour. This will allow adjusting disease burden estimates. In addition, multivariate analyses will be applied to look into associations between health behaviour, population-based factors and the disease burden as determined in the SETA study.

ETHICS AND DISSEMINATION

Ethic approvals for this protocol were obtained by the Institutional Review Board of the International Vaccine Institute (No. 2016-0003) and by all collaborating institutions of participating countries. It is anticipated to disseminate findings from this study through publication on a peer-reviewed journal.

Environmental surveillance for Vibrio cholerae in selected households' water storage systems in Accra Metropolitan Area (AMA) prior to the 2014 cholera outbreak in Accra, Ghana

Cholera is a global public health problem with high endemicity in many developing countries in Africa. In 2014, Ghana experienced its largest epidemic with more than 20,000 cases and 200 deaths; most of it occurred in the Accra Metropolitan Area (AMA). Ghana's disease surveillance system is mainly clinically based and focused on case detection and management. Environmental exploration for the etiological agents is missing from the surveillance strategy. This study therefore assessed the occurrence of toxigenic Vibrio cholerae in water storage systems in selected high risk areas in the AMA area prior to the 2014 outbreak. Three hundred twenty water samples from 80 households' water storage systems were analyzed for toxigenic Vibrio cholerae using the bacterial culture method. Presumptive V. cholerae was isolated from 83.8% of households' water storage systems. The viable cells ranged from 1 to 1400 CFU/100 ml. Vibrio cholerae O1 serotype was isolated from five households in Old Fadama, one household in Shiabu, and one household in Bukom in the month of May and a similar trend was observed for the months of June and July. The presence of Vibro cholerae in the water storage vessels used for drinking confirms the need to consider environmental surveillance for toxigenic Vibro cholerae particularly in high-risk areas to strengthen the existing surveillance system.

Self-reported functional, communicative, and critical health literacy on foodborne diseases in Accra, Ghana

Background

Although substantial progress has been made in reducing total mortality resulting from foodborne diseases, diarrheal illness are still the second most common illnesses among children. In Ghana, foodborne diseases have consistently been among the top 20 causes of outpatient illness over the last couple of decades. This study, therefore, examines health literacy on foodborne diseases and the relative effects of health literacy on self-rated health.

Methods

Foodborne diseases are major causes of morbidity and mortality globally. A mixed-method approach was used for this study. A survey questionnaire and an in-depth interview guideline were administered to samples of 401 and 30 individuals, respectively. We undertook reliability and validity analyses. ANOVA and chi-square tests were undertaken to assess bivariate association between health literacy and demographic variables as well as health status. Ordinal logistic regression models were used to examine the relative effects of health literacy on self-rated health status controlling for individual characteristics.

Results

The instrument was internally consistent (Cronbach alpha = 0.744) and valid. On health literacy, 40% of the respondents reported not to require help when they are given information on foodborne diseases to read by a doctor, nurse, or pharmacist. Approximately 60% of respondents need help with completing or filling out hospital documents. Educational level was found to be positively related to functional health literacy. Ordinal logit regression models showed that health literacy is a predictor of self-rated health after controlling for demographic variables.

Conclusion

Functional literacy is relatively low in the community. There is a positive association between educational level and functional health literacy. The study has also demonstrated the direct positive relationship between health literacy and health status controlling for covariates. Subsequent studies will need to examine multiple level dimensions of health literacy with direct link between specific foodborne diseases and health literacy.