Consumer perceptions of food safety in animal source foods choice and consumption in Nairobi’s informal settlements | BMC Nutrition

In total 19 FGDs, 60 IDIs and 19 KII were conducted. From the FGDs and IDIs, the mean age of the women was 32.7 years (range 18–73 years). Most of them were casual workers and only five were employed in the government or private sector. The mean age of the male respondents was 34.3 years (range 17–59 years). The majority of the men were also casual workers with only seven employed in the government or private sector. The majority of the respondents (98%) were Christians. The KII participants’ socio-demographics were not collected except for their livelihood activities which included: clinicians and nutritionists, local community leaders including community health volunteers, community health assistants and chief, meat retailers, slaughterhouse manager and meat inspector.

Food safety perceptions related to ASFs choice and consumption

Food safety concerns relating to the safety of the products, food handling and health risks were high among both men and women as illustrated in Fig. 1. Men’s main food safety concerns were linked more to safety of the products followed by food handling issues. They were less concerned about the health risks associated with ASF food safety when considering what ASF to consume. On the other hand, women’s concerns cut across the three components, with safety of food being their higher concern. However, much as health risks was third, a higher number of women mentioned it as compared to men. This may be as a result of women being more concerned about the health risks of ASFs on young children.

Frequency of the various components of food safety among men and women. Source: FGD & IDI data

Community members were increasingly concerned about food safety in relation to ASFs as illustrated in Figs. 1 and 2. While more women were interviewed in this study, both men and women informed the emic perspectives on the health risks of different ASFs. Beef and goat meat were mentioned most frequently signifying the ASFs with highest safety concerns followed by raw and vended milk and closely followed by chicken and eggs as illustrated in Fig. 2. Packaged milk was the ASF with the least food safety concerns. Uncertainties and concerns about the safety of ASFs were largely related to the traceability of the source of these products within the informal settings. Most of the consumers accessed these products from informal markets and vendors and could therefore neither follow the value chain from production to the market hence their uncertainty about the content, quality and safety of the ASFs nor the processes used in their handling, storage and packaging: “Those ASF foods can be made safer by investigating where they come from and the cleanliness when handling them and their storage too.” (Male KII 018). Additional concerns were also linked to the fear of possible health risks presented by the continued intake of such foods.

Perceptions of men and women on ASFs with the highest food safety concerns. Source: FGD & IDI data

Perceptions on food safety linked to milk consumption

Milk was the most consumed ASFs in the households, mainly taken in tea for breakfast, as an accompaniment to some meals like ugali (stiff porridge) and most importantly, as a core meal for children under 5 years. For milk supply, there were many varieties including raw fresh milk sold by roadside vendors or from milk ATMs (Milk vending/dispensing machines); packaged (fresh) milk from supermarkets or retail shops and processed long-life milk from retail shops or supermarkets. Preference for where to purchase the milk varied across the study participants but was often driven by the concern of the safety of the milk hence opting to go for what was perceived as a safer option. The safety concerns were compressed under broader themes of production, processing and health risks (Table 1).

Overall, women were more concerned about the safety of milk especially for feeding young children. Across the different age groups of female respondents, raw/fresh milk was mentioned more frequently as more prone to contaminants and adulteration than packaged milk as illustrated in Fig. 3.

Frequency of women’s food safety perceptions on type of milk across age groups. Source: FGD & IDI data

Reasons for consumer preference of packaged milk

For participants who preferred packaged milk as a safer option, concerns in relation to the source of product, hygiene, food handling processes as well as adulteration of milk with margarine, water and wheat flour were some of the reasons that were cited for the avoidance of raw and ATM dispensed milk as illustrated in these excerpts:

“Though the packed one [milk] is a bit more expensive than the fresh one from informal milk vendors, I would rather spend more on the packaged one because of the hygiene issues.” (Female FGD09)

“I know that packaged milk contains some chemicals but I prefer it to fresh / raw milk…I consider it as the safest option because as I told you earlier water is added to the raw milk. Not only water but also blue band [margarine]. Milk is also handled by a lot of people, from the one who milks to the different brokers and you never know what happens during the process of transferring the milk.” (Female IDI018)

Reasons for consumer preference of raw milk

Those who preferred raw or ATM dispensed milk cited the presence of chemical preservatives as the main reason for not choosing packaged/processed milk.

“I do not like the processed/ packaged milk and I also cannot drink it because of the many chemicals so I prefer the raw milk. Even the raw milk we purchase here, it is not that good it is just that you do not have your cow here.” (Male FGD01)

The packaged/ processed milk can bring you diseases because it will stay for long without being boiled unlike the fresh/ raw milk that is ATM dispensed , which must be boiled or else it will spoil by morning. That’s why I think the ATM dispensed milk is safer and it won’t bring diseases and has not been added on preservatives like the long-life/ packaged milk. which will stay for 3 or 4 days because it has preservatives. (Female FGD04)

Perceptions in relation to microbial contaminants

In addition to general concerns about the safety of milk, specific hazards such as microbiological contaminants were discussed. Some participants indicated safety concerns in relation to health risks associated with consumption of milk that may be contaminated with microorganisms and has not been prepared well. “You know milk can bring about diseases especially if not properly boiled.” (Male IDI21) Some participants had perceptions about the disease brucellosis and linked it to milk and meat: “If you have some disease, how is it called? It is a disease that is caused by milk you cannot take milk, even meat sometimes … It is Brucella.” (Male FGD05). Notably, there was no consensus on whether raw / fresh milk accessed from informal vendors or milk from dispensing machines (ATMs) in shops or the processed packaged long-life milk was better. The raw mik was faulted for possible microbial contaminants and aldulteration linked with food handling and safety of the product. On the other hand, the processed packaged milk was faulted for preservatives that enabled longer shelf life which to the consumers were seen as a health risk factor, since their emic perception on milk was that it was a fresh highly perishable food. Their concerns were that the preservatives added on to the milk to give it a longer shelf life were chemical not good for health and well being. There remains a dilemma in the study population on which milk is safer especially for consumption by young children.

Perceptions on food safety linked to consumption of meat from cattle and goats

Participants talked of food safety concerns linked to red meat and related by-products like soup, and black pudding (− ‘mutura’_an intestine-encased mixture of minced cow or goat meat, tripe, and cooled blood, flavored with spices). In the meat value chain trust in the food supply channels also represented an important issue, as consumers sighted food source, preparation including hygiene as key factors influencing their food safety considerations as summarized in Table 2 and illustrated in the following excerpt

“For me, I can talk about meat generally. I am cautious when it comes to buying foods derived from animals from places like kiosks or informal vendors and especially when I am buying food for my children. This is because I lack confidence, to some extent, in such vendors when it comes to matters of hygiene and sources from where they get what they sell. The foods that I have a problem with are beef soup, roasted meat and cooked/fried meat. I prefer when they are prepared at my home rather than when they are prepared by these vendors.” (Male IDI 014)

In addition to concerns about the source and hygiene practices, some participants showed concern about the health risks associated with meat that has not been well prepared: “… beef has negative effects if you eat a lot of it. If it has not been cooked well it also causes gout,” (Female FGD012). Meat also be infected with pathogens, “Meat will give you brucellosis.” (Female FGD 011).

All the study participants were concerned by the perceived lack of/limited validation of the meat products’ quality by the relevant government bodies. Participants were not sure whether the beef and related products they consumed met the quality standards. They even questioned the inspection role of the concerned departments as they perceived that there were many invalidated reports around the safety and risk of beef as illustrated in the following excerpts:

We have lost trust in the meat inspection office! Sometimes one is not very sure of the process and criteria used. Sometimes you may find stamped meat in the evening and yet the meat inspector leaves around morning hours after inspection. We are not sure where these other stamps come from.” (Male FGD01)

Before I get meat from the slaughterhouse, I make sure that it is stamped. That shows that the meat has been inspected and has not come through the backdoor … you know good quality meat even if you look you just see this is good. … Let me not mention names but there’s meat that is sold without inspection I know of some. (Male KII 02)

Perceptions on food safety linked to consumption of chicken and eggs

A common belief among the participants was that broiler chicken and eggs were exposed to additives including hormones to boost growth as well as unregulated use of antibiotics for disease management as summarized in Table 3.

Indigenous eggs and chicken were considered safe and more nutritious yet very expensive for households in low-income settings. Subsequently the consumption of broiler chicken and eggs including chicken cut pieces ‘katakata’ was more common given the affordability. Consumers were however aware of the food safety related to their consumption. The broiler chicken and eggs were perceived to contribute to the increased cases of non-communicable diseases such as cancer, diabetes and obesity as in the excerpt:

“… the eggs of recent times are questionable. The chicken has been injected with growth-enhancing hormones so you find the chicken laying three eggs in a day; you find that when you consume them you start getting sick, with diseases like cancer.” (Male FGD02)

“We have said that we will not give the child soup from the broiler because he or she will have diarrhea because the chickens have been injected.” (Female FGD04)

In most households, ‘Katakata’ was mostly consumed as it was a cheaper option than a whole chicken. Food safety concerns with ‘katakata’ were often linked to hygiene, handling and preparation as in the excerpts:

“The environment in which ‘katakata’ [chicken cut pieces] are prepared is sometimes not clean.” (Male FGD07)

“From my perspective, the hygiene and handling of ‘katakata [chicken cut pieces]’ is wanting. You find that the cooking oil used for preparation has been used repeatedly for a week and this can affect you.” (Male KII 06)

Inability to confirm the source of the chicken products or even to verify that what they were eating was actually chicken and was also a key safety concern among the participants: “You might eat it(‘katakata’) only to find out that it is contaminated with something else. For example, a person may be duped to buy chicken meat but instead, it is meat from a wild bird because differentiating the two is difficult especially if you only see the pieces of the meat and not the whole chicken.” (Male IDI48). Other participants reported being warned against consuming these chicken pieces, “We were told that ‘katakata’ belongs to some other birds, not chicken, and were advised not to eat them for fear of contracting a disease.” (Female IDI043).

Perceptions on food safety linked to consumption of fish

Fish was a delicacy considered as nutritious for children and households in general but was seen as expensive. There were also growing food safety perceptions linked to food handling and safety of the product with the increased demand for the ASF and limited capacity for consumers to verify the source of fish as summarized in Table 4:

Given that within the informal markets the fish were often sourced from roadside vendors, the consumers were concerned about the handling, hygiene and freshness of these ASFs as illustrated in the excerpts:

“We buy fish from places like Gikomba market (Informal wet market) where you see a lot of flies on those fish, things like those make me wonder about the safety of these foods.” (Male FGD 26)

Considering that most of these informal markets, are along the roads, are not sheltered, have no canopy and fish-related products are rarely covered, participants indicated that this presents a food safety concern. “These uncovered foods, like ‘omena’ [small dried fish] sold in the streets along the road gets a lot of dust which may end up contaminating them. The same applies to the big fish. Sometimes you find the oil that they are using to deep fry is dirty because it has been used over and over again. And then I don’t know if you have heard people saying that some use the electricity transformer oil to cook, even here they might be there but we don’t know.” (Female IDI07).

Additionally, consumers in the informal settings were concerned about the source and quality of fish which was once a preferred ASFs given the notion of prefence of ‘white’ to ‘red meat’ in relation to health. Increasingly, the participants raised concerns about the source of fish, indicating that genetically modified fish is being imported into the country hence can cause disease.

Mitigating food safety risks

Within the study setting consumers had developed coping measures to tackle their food safety concerns to enable them to complement their diets with ASFs nutrients as summarized in Table 5.

The relationship with the retailers or vendors of ASFs was a key coping factor. The participants would rely on a ‘trusted’ vendor from whom they could access quality ASFs products. They talked about their relationship with the butcher as a key factor they often considered as it validated the source and safety of the product. A retailer with whom they have a good relationship was defined as one who meets their expectations for the quality of the ASFs and assured them of fresh, unadulterated products with evidence that meat sold are actually from cattle, sheep, or goats.

“I trust that specific trader. Once there was a story that, in Kawangware, human meat was being sold in the market so I prefer a specific trusted trader. He usually leaves a piece of hide or skin on the meat for confirmation hence the reason I like it a lot. If it’s a goat, they leave a tail of a goat for confirmation.” (Female IDI017)

“I trust him because I know he doesn’t do anything to his meat. He has a lot of customers so he doesn’t need to inject anything into the meat so that it can stay for two or three days. He has a lot of customers so when he brings the meat, it is all bought within a day and a half. He brings new stock every two days.” (Female IDI035)

Participants reported that they also identified a ‘trusted vendor’, based on hygiene and general presentation of self and product. These, from their perspectives, influenced food quality and safety considerations. Environmental hygiene was key in perceptions of choice of where to purchase ASFs and was seen as a key issue to both women and men as per the following quotes, “If I look at the butchery and see houseflies on whatever I am going to buy, then I will not buy it.” (Female IDI026). You may find that the retailer is selling meat in a dirty place or where there are a lot of flies that will land on the meat and get germs.” (Male IDI019). Environmental hygiene besides being represented by the vendor’s physical place/site and the display was also extended to the equipment used to contain the ASFs especially milk. “Cleanliness is key; things like milk require a clean environment. You also need to check … the containers he/she [vendor] is using.” (Male IDI 02).

The characteristics of the vendor in relation to personal hygiene was also noted and extensively demonstrated in different quotes:

“When you go to buy meat in a butchery, you can’t go to a trader who is just sweating all over and is wearing a jacket that has blood stains all over. He needs to be clean.” (Male FGD03)

“The people cutting the meat should ideally put on white coats. They are not supposed to stay with these coats on till evening. Flies will bet following him all over. If they see that it is getting dirty they should change it because they are attending to many people. They should also cut their nails. They should be clean people. If you are clean, then the meat will also be clean. And if you are dirty, flies will be on the meat.” (Female FGD 09)

Another coping measure was the avoidance of the ASFs including eliminating them from one’s diet or reducing the quantity and frequency of their consumption. In the case of milk, noteworthy was the avoidance of feeding children with processed milk as it was perceived as being harmful to them. This behavior was noted by a majority of the women:

A small child will have challenges with long life milk because the child is small and that milk has preservatives which can bring problems to the child and that is why we prefer to give fresh milk because it does not have a lot of preservatives that can harm the child unless you contaminate it yourself by the way you handle it and how you boil it. (Female FGD011)

Nowadays they use those preservatives in milk so that it can stay for ninety days without going bad. (Female IDI044)

For me, I think it is not safe because for one it has chemicals, you can’t keep milk all that time without adding chemicals to it. I cannot give it to my baby because she is still too young to consume those chemicals. I would rather take it myself but not give it to my child, she is still growing.” (Female IDI017)

For chicken and eggs, broiler chicken and eggs tended to be avoided by most consumers for the preference of indigenous chicken and eggs, this they reported to be mainly fueled by food safety concerns. Indigenous chicken and eggs were perceived to be safer as they are raised more naturally than the improved broiler chicken:

“The broiler chicken has a lot of chemicals and it is like you are giving someone chemicals, but the indigenous one is left alone to grow naturally, so the eggs from the indigenous ones are tastier than the other eggs.” (Male FGD01)

“I will prefer the indigenous eggs because they do not have a lot of chemicals like the grade chickens because we are told those chicken are given a lot of medicine. That is why I think the indigenous one is safer.” (Female FGD 06)

Processing the ASFs by cleaning and boiling was also another coping measure mentioned to eliminate contaminants or reduce the risks of getting diseases. Washing with water and boiling seemed to be common ways to deal with the risk of getting a disease. For meat-related ASFs, participants indicated, “… meat, mostly beef, we are told should not be eaten in large quantities because they have some worms and even if we are to eat the meat, we need to boil it thoroughly to remove the worms.” (Male FGD03). In addition, “From the butchery, I will boil water and wash the meat with hot water because it has been held by dirty hands. My hands are also dirty”. (Female FGD012). These practices are passed on from one generation to the next especially mother to daughter, “My mother used to say that if meat doesn’t cook well, it will bring diseases, though I don’t know which disease. So meat has to boil first so that it does not bring diseases.” (Female IDI044).

With regards to milk, boiling was a common way to eliminate contaminants or reduce the risks of getting diseases:

“You boil milk because when you boil you kill the germs. Maybe the cow you are getting milk from has a certain disease on the breast and it has affected the udder, you will milk it and then make sure you boil milk.” (Female FGD06)

“We are always told that you must boil milk thoroughly because it has so many diseases, the germs in the milk do not die easily.” (Female IDI036)

Besides boiling the raw milk, packaged milk was also boiled severally with the view to eliminate the chemicals used in their preservation as elucidated in the following excerpt:

“I usually don’t boil packed [long life] milk first. I allow the water to boil, after boiling I add the milk to the water then let the mixture boil further, when it’s about to spill over, I reduce the flame of the stove, then allow it to boil again, the second time when it’s about to spill over that is when I remove it. The first time I believe that the chemicals in the milk have not been eliminated, so I have to boil it twice. (Male IDI 04)

Food safety vs food quality and quantity

Notably, however, despite the food safety concerns raised by the consumers they still accessed and consumed these products. The low economic status of most of these participants seemed to drive their purchasing power and influenced their choice and consumption of ASFs within their informal settings. Although they were often aware of the risk of consuming some foods given the lack of validation for quality and safety, they still consumed these as they were affordable and easily accessible to supplement their food and nutrition needs as well as give, especially, their children balanced diets:

“If I had enough money I would also buy foods from a different place since I do not trust what we eat in Kawangware.” (Male FGD 05)

On my side food is any kind of substance that can keep the day going. Sometimes it can make you satisfied but not all times. This is especially when you have a large family to provide for. It also does not matter if the food is healthy or not as long as you get to live to fight for another day.” (Male FGD).

The participants wished that the government would look into the issue of food safety and perhaps enforce some regulations to safeguard their wellbeing. The need for government enforcement of the food safety measures for ASFs especially in informal markets to trace and validate the ASFs value chain from production to consumption is necessary as in the key informant excerpt:

“Before I get meat from the slaughterhouse, I make sure that it is stamped. That shows that the meat has been inspected and has not come through the backdoor … . Depending on how I have learnt the market there are many such cases especially in … let me just not mention names but there’s meat that is sold without inspection I know some.” (Male KII 02)