ABSTRACT- Diarrhoea disease is one of the main reasons for absenteeism at work and school in developed and
developing countries, thereby contributing to economic losses. The explosion in the number of street food vendors
hawking ready-to-eat food is reported in every local government in Nigeria including Osun. Street foods are frequently
contaminated, thereby contributing to the number of food borne diseases. Individuals who presented to the clinics with
travelers’ disease symptoms (diarrhoea and vomiting) in the randomly selected clinics in Iwo, Osogbo, Ile-Ife and Ilesha
townships in Osun State were invited to participate in the survey. In the period of July-October 2015, 57 completed
questionnaires were collected and analyzed. Overall, 42.1% were males and 57.9% were females. About 22.8% of the
participants were <5 years old, 15.8% were between 10-19 years, 36.8% were 20-40 years, 19.3% were 40-60 years.
Those that experienced symptoms of travelers disease (diarrhea and vomiting), were 87.7%, while 10.3% were unsure.
Furthermore, 59.6% consumed food purchased from street vendors and 40.4% claimed they did not consume street
vended foods. In addition, 43.9% reported >6 number of stools/24 h. The most frequently consumed foods identified were
moin-moin, amala/iyan, rice and satchet water. A strong correlation was found between having symptoms of travelers
disease and consumption of street vended foods (? (57) =0.357**, p<0.06). This study concludes that travelers’ disease
(diarrhea and vomiting) is persistent and has high prevalence in Osun State, Nigeria.
Key words- Travelers’ disease, Foodborne disease, Street- vended-foods, Osun State, Diarrhoea
1.1 INTRODUCTION
Diarrhoea disease is one of the main reasons for
absenteeism at work and school in developed and
developing countries, thereby contributing to economic
losses. It has been reported that about 2.2 million people
die every year from diarrhoeal diseases worldwide [1].
The majority of these diarrhoeal cases can be attributed to
contamination of food and drinking water. Diarrhoea is also
a major cause of malnutrition in infants and young children.
There is an explosion in the number of street food vendors
hawking ready-to-eat food because of high un-employment
and need to generate income to sustain the families in
communities of many African countries including Nigeria
[2]. Ready-to-eat food can be described as food ready for
immediate consumption at the point of sale. It could be raw
or cooked and can be consumed without further treatment
[3]. Increased patronage for street vended foods may
because of change in social patterns characterized by
increased mobility, large number of itinerary workers and
less family centered activities [4]. Furthermore, in today’s
society, it has become very common for individuals to
travel many miles from home for employment
opportunities thereby relying more on street vended foods.
Several studies have revealed street food contamination by
bacteria [5-8], thereby contributing to the number of
foodborne diseases. Consistent consumption of street
vended foods could result in increasing prevalence of
travelers’ disease (diarrhoea and vomiting) because of
contamination. Food contaminated with pathogens often
times smell, look and taste normal, plus the foodborne
pathogen and their associated toxins can survive traditional
cooking techniques [9]. Furthermore, although street food
products provide readily available nutritious meals for the
consumer, the safety and microbiological quality of these
food products is subject to debate [2]. There is dearth of data
and information linking consumption of street vended
foods to the occurrence of diarrhoeain Osun State, Nigeria.
Therefore, this research work was carried out to study
reported cases of vomiting and diarrhoea among residents
in four main towns within Osun stateand the purpose is to
identify, examine and analyze cases of diarrhoea and
vomiting in four main towns in Osun State, Nigeria.
2. MATERIAL AND METHODS
2.1. Location of the study area:
Four locations (Iwo,
Osogbo, Ile-Ife and Ilesha) in Osun State were selected.
Osogbo is the capital of Osun State, and is situated at
Longitude 4.560 E, Latitude 7.760 N 114km to Iwo. Iwo is
situated at Longitude 4.100 E, Latitude 7.630 N and is 54km
to Osogbo; Ile-Ife is situated at Longitude 7.460 N, Latitude
4.560 E and is 45km to Osogbo, the capital city of Osun
state; Ilesa is situated at Longitude 4.730 E, Latitude 7.610
N and is 25km to Osogbo; while Osogbo and a distance of
234 km to Lagos, the capital city of Lagos state.
2.2. Study population:
The survey was conducted
between July-October 2015, to evaluate the prevalence of
travelers’ diarrhoea symptoms and eating behavior among
residents of Osun State, Nigeria. For a period of 3 months,
anyone who came for consultation at the randomly selected
private clinics with complaints of diarrhoea/vomiting with
or without other symptoms were subjected to a questionnaire
designed by the research team, but administered by
the medical/nursing staff of the clinic after obtaining their
informed consents. The questionnaire was pre tested for
clarity and validity on 20 randomly selected individuals in
Iwo, Osun State. Results of the pre-test were used in the
revision of the initial survey tool. The final version of the
survey tool contained 39 questions from four sections.
Namely, i) demographic characteristics, ii) occurrence of
symptoms of travelers’ disease and travel information, iii)
food consumption habits and type of food consumed and
iv) severity of symptoms and home remedies applied to
ameliorate condition. Two clinics were randomly selected
in each town for the survey, but only six clinics participated
and completed the questionnaires. For this study, diarrhoea
was defined as three or more loose or liquid stools in a
24-hour period or two or more loose stools accompanied by
fever or other gastrointestinal symptoms including
abdominal cramps, nausea, or vomiting. Participants who
claim to have less than 3 stools within 24 h period and not
having other gastrointestinal symptoms were eliminated
from the study.
2.3. Limitation of the study:
Study was conducted during a religious fasting period and
dry weather season in the year.
2.4. Statistical Analysis:
Data obtained were subjected to descriptive statistical
analysis (frequency distributions) and Spearman’s rank
correlation coefficient ( p ), between symptoms of travelers’
disease, consumption of street vended food and type of
food using IBM SPSS statistical software version 20.
3. RESULTS AND DISCUSSION
Table 1 is the summary of the demographic characteristics of the individuals. A total of 57 respondents met the inclusion
criteria for the study. Overall, 42.1% were males and 57.9% were females. About 22.8% of the participants were below or
<5 years old, 15.8% were between 10-19 years, 36.8% were 20-40 years, 19.3% were 40-60 years and 5.3% were >60
years. When asked about their level of education, 40.4% did not respond, because more than half are less than 5 years old.
However, out of those who responded, 26.3% had Secondary (high) school, 10.5% had Bachelor’s degree and 8.8% had
Primary or elementary school certificate.
Table 1. Demographics of respondents in the survey (N = 57)
| S. No. | Parameter | N (%) |
|---|---|---|
Prevalence of Travelers’ disease symptoms- When asked if respondents experienced symptoms of diarrhoea and vomiting in the past seven days, 87.7% said yes, 10.3% don’t know and 1.8% said no. Of these, 56.1% experienced diarrhea first while 42.1% first experienced vomiting (Figures 1 and 2).
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Figure 1. Percentage of respondents with travelers’ symptoms
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Figure 2. Percentage of respondents indicating symptom initially experienced
When asked if participants were still experiencing the symptoms, 77.2% said yes while 22.8% said no. About 35.1% travelled in the past seven days before the onset of symptoms while 64.9% did not (Figures 3 and 4).
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Figure 3. Percentage of respondents presenting to clinics with symptoms
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Figure 4. Travel history of respondents before onset of symptoms
Furthermore, (34) 59.6% consumed food purchased from street vendors and (23) 40.4% claimed they did not consume street vended foods. Maximum number of stools in a 24 h period for the (34), who consumed street vended foods reported were 14.7%, 41.2% and 44.1% for 3, 4-6 and >6 number of stools respectively. Those who did not consume street vended foods, Out of the 23 individual who did not consume street vended foods but had symptoms of travelers’ disease, 21.7%, 34.8% and 43.5% also self-reported 3, 4-6 and >6 number of stools respectively (Figures 5, 6a and 6b).
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Figure 5. Eating habit of respondents with travelers’ disease symptoms
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Figure 6a. Maximum number of stool/24 h reported by respondents who consumed street vended foods
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Figure 6b. Maximum number of stool/24 h reported by respondents who did not consume street vended foods
From Figure 6, 40.4% of respondents did not consume street vended foods and claimed not to have eaten the food items listed. Therefore, the food vehicle could not be determined. Data not included. The frequencies of the type of food consumed are presented in Table 2. Some of the most common food and beverage consumed are moin-moin (35.1%); iyan/eba/amala/lafu (24.6%); watermelon (24.6%); rice (21.1%) and satchet (35.1%) and bottled (22.8%) water.
Table 2.Frequency of respondents who consumed food and beverage
| Food item consumed | ||
| N =Yes (%) | N = No (%) | |
| Food Yoghurt | 9 (26.5) | 25 (73.5) |
| Wara/Fura/Nono milk | 8 (14.0) | 49 (86.0) |
| Egg/Egg buns | 10 (17.2) | 47 (82.5) |
| Meat pie/Fish pie | 9 (15.8) | 48 (84.2) |
| Carrot | 4 (7.0) | 53 (93.0) |
| Paw Paw | 3 (5.2) | 54 (93.1) |
| Pine-apple | 9 (15.8) | 48 (82.8) |
| Watermelon | 14 (24.6) | 43 (75.4) |
| Chicken/Turkey | 4 (7.0) | 53 (93.0) |
| Goat meat/Beef | 3 (5.3) | 54 (94.7) |
| Roasted Fish | 6 (10.5) | 51 (89.5) |
| Suya | 4 (7.0) | 53 (93.0) |
| Iyan/Eba/Amala/Lafu | 14 (24.6) | 43(74.1) |
| Rice | 12 (21.1) | 45 (78.9) |
| Moin-Moin | 20 (35.1) | 37 (64.9) |
| Beverage | ||
| Municipal tap water | 6 (10.5) | 51 (87.9) |
| Private well water | 9 (15.8) | 48 (84.2) |
| River/Pond/Stream | 3 (5.2) | 54 (94.7) |
| Bottled water | 13 (22.8) | 44 (77.2) |
| Satchet water | 20 (35.1) | 37 (64.9) |
| Kunu | 3 (5.3) | 54(94.7) |
| Sobo/Zobo | 5 (8.8) | 52 (91.2) |
| Pito | 2 (3.5) | 55 (96.5) |
A spearman rho correlation coefficient was calculated for the relationship between having symptoms of travelers’ disease, consumption of food from street vendors and the food items with highest frequencies of consumption (Table 3).
Table 3. Spearman correlation (p) between symptoms of travelers’ disease, consumption of street food and type of food (N=57)
| Are you having symptoms of vomiting and diarrhoea | Did you consume food from street vendor | Iyan /Eba /Amala /Lafu | Rice | Moin- Moin | Satchet water | Watermelon | |
| Are you having symptoms of vomiting and diarrhea | p= 1000 | p=.357** Sig .06 |
p=.102 Sig .449 |
p =.193 Sig .150 |
p=.175 Sig .194 |
p =.175 Sig .194 |
p =.102 Sig .449 |
| Did you consume food from street vendor | p=.357** Sig .06 |
p = 1000 | p=.303* Sig .022 |
p=.337* Sig .010 |
p=.530** Sig .00 |
p=.455** Sig .00 |
p =.386** Sig .003 |
*, ** = Correlation is significant at the 0.05 and 0.01 level (2-tailed)
A strong correlation was found between having symptoms of travelers’ disease and consumption of street vended foods (p =.357**, p=0.06). Further analysis showed that consumption of street food and the food item were also significantly strong (Table 3).
Table 4 is the cross tabulation results between travelers’ disease symptoms, consumption of street food and maximum number of stools. More people 15 out of 57 who consumed street foods and having symptoms of travelers’ disease had >6 stools/24 h, compared to 9 respondents out of 57 who did not consume street food.
Table 4. Cross tabulation of symptoms of vomiting and diarrhoea, consume food from street vendor and maximum # of stools/24 h period
| Did you consume food from street vendor |
Are you having any symptoms of vomiting and diarrhoea | Total | ||||
| Yes | No | Don't know | ||||
| Yes | Maximum # of stools/24 h period |
3stools | 5 | 0 | 5 | |
| 4-6stools | 13 | 1 | 14 | |||
| >6stools | 15 | 0 | 15 | |||
| Total | 33 | 1 | 34 | |||
| No | Maximum # of stools/24 h period |
3stools | 2 | 3 | 5 | |
| 4-6stools | 6 | 2 | 8 | |||
| >6stools | 9 | 1 | 10 | |||
| Total | 17 | 6 | 23 | |||
| Total | Maximum # of stools/24 h period |
3stools | 7 | 0 | 3 | 10 |
| 4-6stools | 19 | 1 | 2 | 22 | ||
| >6stools | 24 | 0 | 1 | 25 | ||
| Total | 50 | 1 | 6 | 57 | ||
Other symptoms experienced and self- reported by respondents are presented in Figure 7. Most respondents (75.4%) complained of abdominal cramps, (59.6%) had fever and about 10.5% reported bloody diarrhoea.
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Figure 7. Other symptoms self-reported by respondents with travelers’ disease
When asked if respondents were taking medication to treat the symptoms at home, several responses were conveyed as listed in Table 5.
Table 5.Various methods of home treatment and frequency of respondents
| Method of home treatment | Frequency | Percentage |
|---|---|---|
Celucite Amalar Flagyl Teething syrup Paracetamol Anti-malaria Ciprofloxacin Amoxycycline Mist Mag Metronidazole Vomirex syrup Chloramphenicol Local herb (Agbo) |
1 1 2 3 1 7 2 2 4 3 1 1 1 1 |
1.8 1.8 3.5 5.3 1.8 12.3 3.5 3.5 7.0 5.3 1.8 1.8 1.8 1.8 |
When asked if anyone else was experiencing symptoms in their household, 15.8% said yes (Figure 8), while 82.5% indicated that no one else was experiencing symptoms. About 80.7% of respondents said they are aware of food borne hazards in food (Figure 9).
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Figure 8. Other members of household with symptoms
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Figure 9. Awareness of hazards in foods
One of limitations was the time of the commencement of study, since it was during the religious fasting period, most people eat very early at home and many other activities such as travelling and snacking is eliminated during the day at workplace. Also study was carried out during the dry season. However, it has been demonstrated that attack rates of traveler’s diarrhoea are highest during the summer months and in rainy seasons [10-11].Groups of individuals at the greatest risk of diarrhoea and vomiting from contaminated food and water include young, old, pregnant and the immuno-compromised. The largest group of people presenting for travelers’ disease symptoms from this study is aged 20-40 years (36.8%), followed by children under the age of 5(22.8%). Epidemiological evidence has shown that diarrhoea is a major problem, with children under the age of five years, experiencing at least one episode every fortnight [12]. Furthermore, foods such as moin-moin, amala/iyan/eba/lafu, rice, watermelon and satchet water are high risk foods and prone to contamination. Sources of potential hazards in food are unclean processing equipment, untreated water, mishandling by food preparers and vendors [13, 2] and much more. According to [13], even if cooking temperatures reached levels capable of destroying many vegetative forms of foodborne pathogens, a marked concentration of microorganisms may persisted in the food after cooking. Additionally, indigenous materials such as polythene bags, leaves and old newspaper used for packaging food undoubtedly contribute to the contamination of the said food. It is also not unusual that many individuals suffering from food borne disease or travelers’ disease do not initially seek medical attention but try home remedies first. Most of the individuals would visit government run hospitals rather than private clinics because of the economic status. It is therefore believed that the diarrhoea and vomiting cases presenting to government hospitals would be more than in private run clinics.
CONCLUSIONS
This study concludes that travelers’ disease (diarrhoea and vomiting) is a persistent and has high prevalence in Osun State, Nigeria. Also, that there are strong relationships between consumption of high risk foods such as moin-moin, amala/eba and rice and having symptoms of travelers’ disease. Street food preparers and vendors need to be trained in proper food handling techniques, as most of them handle food and money simultaneously. Since the consumer has no way of knowing if the food is contaminated, the food safety arm of public health needs to improve.
ACKNOWLEDGEMENT
The authors are grateful to Bowen University, Iwo for funding, the clinics for accommodating our request and all those who contributed to the success of the research.
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