Hygiene practices in abattoir and slaughter slab, determinants and assessment of abattoir and slaughter slab facilities in Abakaliki, Ebonyi State South-East Nigeria

Background Workers in slaughterhouses engaging in unhygienic practices create conducive environments for zoonoses and meat contamination. Knowledge of hygiene practices and their determinants provides evidence for the design of targeted interventions. Objectives We investigated knowledge and determinants of hygiene practices among workers in slaughterhouses and assessed slaughterhouse facilities in Abakaliki. Methods Workers in the Central Meat Market abattoir and Slaughter slab Abakaliki were interviewed in a cross-sectional quantitative study to ascertain their knowledge and hygiene practices while abattoir facilities were assessed using a checklist. Associations were analysed with Chi-square while predictors were determined using binary logistic model. Results We interviewed 188 workers 75.5% and 85.6% of whom had good knowledge and good hygiene practices respectively. However, hand-washing before and after handling meat (44.1%), cleaning work surfaces with soap and water (45.2%) and sanitary disposal of waste (6.9%) were suboptimal. Knowledge of good hygiene practice was a predictor of good hygiene practice (AOR: 4.6, 95% CI: 2.0–11.3, p=0.001). Well water and borehole were present in both slaughterhouses and cold rooms were available in Central Meat market abattoir. Conclusions The level of good knowledge was high and this was a determinant of good hygienic practices. Training on hygiene practices is recommended to prevent meat contamination and zoonoses.


Introduction
An issue of great interest and growing concern is the spread of infectious diseases that emerge or re-emerge from the interfaces between animals and humans and the ecosystems in which they live. Emerging and existing infectious diseases at the animal-human-ecosystem interface have been of growing concern because of their epidemic and endemic potential as well as their adverse socioeconomic consequences 1 . Key examples are zoonoses and foodborne diseases of animal origin which are of public health and animal health importance. Prevention of these diseases by controlling hazards in meat production processes and improving food safety has been recognized as an effective strategy 2,3 .
Hazard analysis control points (HACCP) systems which prevent and reduce food safety hazards through critical control points (CCP) 5 , as well as good hygiene practices, are both parts of an effective food safety management system 6 . Despite the importance of optimum levels of food safety (meat safety) in abattoirs, reports have shown it to be poor in some abattoirs in Nigeria, with interventions needed in the food safety plan 6,7 .
Workers in abattoirs who engage in unhygienic practices, create a conducive environment for zoonoses among the workers and contamination of the meat for sale 8 . Unfortunately, the microbial profile of meat in abattoirs and butchery shops in sub-saharan countries including Nigeria, is higher than standards set by World Health Organization (WHO) 9, 10 and there have been occurrences of zoonoses among abattoir workers and in cattle in abattoirs across Nigeria [11][12][13] . Studies in Nigeria have also reported substandard facilities, unsanitary environments and poor hygienic practices in abattoirs and slaughterhouses [14][15][16][17][18][19][20] even though abattoir sanitation is an essential component of The National Environmental Sanitation Policy of Nigeria 21 .
The focus of the few published research on abattoirs in Ebonyi State has been on isolation of micro-organisms in the environment 22 , antimicrobial resistance to antibiotics 23,24 and isolation of helminths in ruminants 25 . A study 23 on the assessment of bacteria effluent qualities reported the presence of antibiotic-resistant bacteria in untreated abattoir wastewater at the abattoir in the Central Meat Market, Abakaliki but an assessment of the facilities was outside its scope. A similar study 24 on the antibiotic susceptibility pattern of Salmonella and Pseudomonas species isolated from the effluents from the Central Meat Market abattoir and the slaughter slab in Abakaliki described the bacterial profile and multidrug-resistant traits of the species found. In contrast, there is much less information on hygienic practices of the workers in these slaughterhouses in Abakaliki.
The purpose of this study was to investigate the knowledge and determinants of hygiene practices among workers in abattoir and slaughter slab in Abakaliki, Ebonyi State and assess the facilities. The findings could serve as a baseline in the design of interventions to protect the meat from contamination and the workers from zoonoses.

Study Area and Design
We conducted a total population cross-sectional quantitative study among workers in the abattoir and slaughter slab in Abakaliki city which spans parts of Abakaliki and Ebonyi Local Government Areas (LGAs) of Ebonyi State, South East Nigeria. Ebonyi State is one of the 36 states of the Federal Republic of Nigeria with its capital as Abakaliki. Abakaliki had a projected population of 172,176 in 2011 26 . The inhabitants are mostly farmers, traders and civil servants. The temperature in Abakaliki varies from 65○F to 89○F 27 . The sliding 31-day rainfall is at least 0.5 inches in the rainy season (February to November) and most rain falls during the 31 days centered around September 22 with an average total accumulation of 8.9 inches 27 . The study sites were the major meat processing points in Abakaliki city located in the abattoir in the Central Meat Market, Abakpa market (in Ebonyi LGA) and the Slaughter slab on Ogoja road (in Abakaliki LGA). The animals slaughtered in Central Meat Market abattoir are cow, sheep and occasionally goats (180 to 450 animals monthly) while only cows (180 to 360 monthly) are slaughtered at the Slaughter slab. The survey was on the abattoir workers' knowledge and practice of good hygiene and sanitation. All the workers in the selected abattoirs who gave informed consent were eligible for study which took place during their monthly meetings in February and March 2016. Workers who were absent during the February meeting were reached in their workplace in March. People who sell food and other items in and around the premises were excluded from the study.

Data Collection and Management
Data were collected using pre-tested interviewer-administered questionnaires. The questionnaire was designed by the researchers using published related research 28, 29 and reviewed by experts in public health, microbiology and sociology disciplines for content validity. A pre-test of the questionnaire was carried out on ten workers in a nearby town -Ezzamgbo in Ebonyi State and a few of the questions were modified to improve understanding. A double translation of the questionnaire was done between English and the local dialects of the Igbo language. Five trained research assistants with tertiary education in medical and para-medical sciences administered the questionnaire in the local dialect of the Igbo language. The questionnaire had sections on socio-demographic and work characteristics, knowledge, attitude and practices of good hygiene and sanitation. We assessed the availability of the abattoir and slaughter slab facilities using a checklist adapted from the Policy guidelines on market and abattoir sanitation developed by the Nigerian Federal Ministry of Environment 21 .

Statistical Analysis
Data analysis was carried out with IBM SPSS Statistics version 20. Knowledge questions were scored zero for incorrect and one for accurate response; total overall possible knowledge score was 23. Scores of 11.5 marks and above were graded as good knowledge while those below were graded as poor. Similar to knowledge, practice questions were also scored zero for incorrect and one for an accurate response; scores of 8.5 marks up to a maximum of possible 17 were graded as good practice while those below 8.5 were categorized as poor. The modified Bloom's cut-off was used to categorize these variables 30 . Statistically significant relationships of independent variables with knowledge and practice were determined at p < 0.05 and a cut-off of p=0.2 was the criteria for inclusion of independent variables into binary logistic model for determination of predictors of knowledge and practice.

Results
All the workers (188) in the abattoir and slaughter slab were interviewed and all responded adequately to the questions, giving a response rate of 100%. One hundred and eighteen (62.8%) of the respondents were -workers in the Central Meat Market abattoir while 70 (37.2%) were in Slaughter slab. The majority of the abattoir workers were males 136 (72.3%) and Christians 168 (89.4%) between the ages of 21 and 40 years 137 (72.9%). The abattoir workers were mostly retailers 93 (49.5%) and butchers 83 (44.1%) and many of them had received training on abattoir work 149 (79.3%) which was majorly provided by their employers 121 (81.2%). Table 1 shows that majority 161 (85.6%) of the abattoir workers used personal protective equipment (PPE) and apron is the most commonly used. Over 70% of them used these PPE regularly of which 78% of them are provided by the workers themselves. Over 70% of the workers knew proper waste disposal, proper storage of leftover meat and regular hand-washing as food safety and environment safety measures while the least known measure was wiping of surface with soap and water, known only to 43.6%. About 70% agreed that government and health agencies are actively involved in making sure that proper hygiene is observed in the abattoir. Generally, the abattoir workers had good knowledge level of good hygiene practices (75.5%).     As shown in Table 3, a greater proportion (57.0%) of abattoir workers who had good knowledge of abattoir hygiene practices were aged less than 30 years. Being a meat product retailer and having had a previous training on abattoir hygiene had a statistically significant relationship with the knowledge of good hygiene practice (p<0.05). It was shown that a greater proportion of workers (56.3%) who had good knowledge of hygiene practices were retailers.  Table 4 revealed the relationship between socio-demographic characteristics of the respondent and good hygiene practices. It shows that 130 (80.7%) abattoir workers who had good hygiene practices also had good knowledge about good hygiene practices compared to only 9.3% who had poor knowledge. Only knowledge had statistically significant association with good abat-toir hygiene practices (p< 0.05). Good knowledge of good hygiene practices is the only statistically significant (AOR: 4.58; CI:1.8-11.7); p=0.001) predictor of good abattoir hygiene practice ( Table 5). Those that have good knowledge have 5 times higher odds of engaging in good hygiene practices compared to those with poor knowledge.

Discussion
This study was designed to investigate the knowledge and hygiene practices and its determinants among workers in the abattoir and slaughter slab in Abakaliki, Ebonyi State and to assess the facilities. Although there was overall good knowledge and hygienic practices, some essential hygiene practices were poorly practised in our study (  (27.8%). Although the study in Abuja was self-reporting, their higher rates of PPE use and hand-washing after operations may be due to the re-ported attendance of public health education programs on abattoir operations by 54.2% of the workers. The overwhelmingly common practice of open dumping by the respondents appears to be a systemic problem of poor waste management practices in Nigeria 37,38 . Expectedly, the majority (81.3%) of the abattoir workers reported the apron as the most common PPE used, though this was much higher than was found in Southeast and North Central Nigeria 15,35 . In one of the studies in North central Nigeria 35 , safety boots was the most commonly used PPE. Protective clothing protects the meat from contamination and the workers from zoonoses.
The predictor of good hygiene practice being good knowledge accords with the observation by Alhaji and Baiwa 15 which showed that workers who knew the correct definition of slaughterhouse hygiene were less likely to demonstrate poor preventive practices but differs from those of Junaidu 39 where the predictor of good hygiene practice among the abattoir workers was a positive attitude not good knowledge. Our finding of previous training being significantly associated with good hygiene practice is similar to that of a study in Kenya where longer years of experience and increased capacity through training were significantly associated with good hygiene practices 40 . Training is expected to improve knowledge and practice when done adequately and other factors are in place. Only the Central meat market had available cold rooms and this may account for why the practice of storing meat in the cold room was not universal. The two cold rooms were not in the abattoir but adjoining streets and owned by individuals. The government has however built a cold room and other infrastructure in the Central meat market after this study soon to be commissioned, justifying the perception by a good majority of the respondents that the government is actively involved in ensuring good hygiene practice in the abattoir. The positive results of knowledge and hygiene practices may be attributed to the daily inspection of the slaughterhouses by officials of the Ministry of Health and Ministry of Environment as regulatory agencies and the occasional health talks given as 70.2% of them asserted government involvement in ensuring good hygiene practices. However, it is noted that observation of the workers is needed to confirm the reports of good hygiene practices. Good personal hygiene, other hygiene practices and standard facilities are all necessary for avoidance of contamination by microorganisms and transmission of zoonoses. The gaps we have identified in knowledge and practice, provide evidence for use in the design of intervention programmes for this group of workers.

Conclusion
There is an overall good knowledge of hygiene practices as well as appreciably good hygiene practices possibly due to the health talks by the supervisory ministry officials. However, serious gaps in practice by more than half of the respondents were noted in some essential practices. The determinant of good hygienic practice was a good knowledge of hygienic practices. Notwithstanding the limitation from the self-reporting bias, this work contributes to our understanding of the knowledge and practice of hygienic practices with its determinants among workers in the abattoir and slaughter slab in Abakaliki and the practical implication suggests a basis for the immediate implementation of targeted interventions by government and stakeholders starting with training on the importance of good hygiene and sanitation. We recommend that a policy priority among policy-makers in the state be, developing and ensuring the implementation of policies that will safeguard our meat from contamination and protect the abattoir workers from zoonoses.