Vendor Knowledge, Attitudes, and Practices Related to Food Safety in Low- and Middle-Income Countries: A Scoping Review.

ABSTRACT: Foodborne diseases are a significant cause of illness in low- and middle-income countries (LMICs). Poor infrastructure, lack of regulatory oversight, and environmental conditions can increase food safety risks, particularly in traditional markets. Food vendors in traditional markets shoulder a heavy responsibility to keep food safe under often challenging conditions. The ability of these vendors to ensure food is safe is shaped by their knowledge, attitudes, and practices (KAP). Hence, understanding vendor KAP is important when designing interventions to improve food safety. To date most research on food vendors in LMICs has focused on vendors of ready-to-eat street foods and not on vendors of fresh food commodities. To fill this gap, a scoping review was undertaken to compile existing research on food safety KAP of vendors of food commodities in LMICs. PubMed, Google Scholar, Ovid Medline, and institutional Web sites of major research organizations were searched for original research articles and reports. Of 17,483 titles screened, 84 relevant studies were identified. Of the studies included, most were conducted after 2014 and focused on urban and periurban Africa. Most studies had a cross-sectional design with mixed methods (e.g., quantitative and qualitative analyses of vendor KAP through interviews and observations) and had small sample sizes (<50 participants). Common food value chains studied were dairy, meat, and fruits and vegetables. Very few studies included more than one type of commodity or value chain. Food vendor knowledge typically ranged from little to none, which was evident from observations of vendors operating under unsafe and unhygienic conditions, such as poor food handling and storage practices. Poor compliance with existing food safety policies, laws, and regulations was evident in some cases primarily due to either limited awareness of their existence or limited knowledge of how to implement them. However, vendors generally had positive attitudes toward food safety. No significant gaps were found between food safety knowledge and actual practices, although this correlation was not always examined rigorously in the reviewed studies. KAP and gaps between food safety behavior did not differ with vendor age or gender, type of product sold, or geography. Local government staff were identified as key enabling actors, interacting with food market vendors to foster improved food safety practices.

A case series of Kimura's disease: a diagnostic challenge.

Kimura's disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20-30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin's disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin's disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed-Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.