Chapter one
Introduction
1.1 Introduction of the study
Food and drink are part of human basic needs as mentioned in Maslow's Theory of Needs. The hierarchy of human basic needs have five stages, such as biological and physiological needs, safety needs, love and belonging needs, esteem needs, and self-actualization needs (Maslow, 1943). Food and drink needs is part of biological and physiological needs which at the most bottom stage in the hierarchy of needs. It is the biggest part among others, meaning that it is the most basic needs that will motivate human behavior. Every human will have new motivation into the next basic needs, after they fulfilled the most basic needs and so on.
It is true customer will positively perceive food with good in its appearance, smell, texture or taste, if not they unlikely to eat (Hetherington and Rolls, 1996). Gillis (2009) argues that customer will consume food base on the quality of the food that is safe and has a nutrition value. Food has nutrition but there are two basic nutrients: macro and micronutrient that needed in human body (Guy, 2011). There are five main food groups which called as the best balanced nutrition from the food that are: carbohydrates, protein, fruits, vegetables, and dairy product as reported by United States Department of Agriculture (Anonymous, 2010). Consumers refers to that USDA food patterns to help them grab the most variety, nutritious, and moderation dietary guidelines. Some nutrition are gone while food processed, even though this procedure keep the food safe from the unnecessary substances. All the processed foods from the manufacturer have food labels to tell about ingredient list, serving sizes, nutrition fact for daily values. However, some manufacturer did not mention several item in their food labeling. This behavior can lead the hidden allergen react with the sensitive person that could represent a major problem (A”barro et al., 2007).
In the 1960s, FDA (Food and Drug Administration) recommended to Pillsbury company for developing an innovative method to make sure the food safety of NASA space program. This method name is Hazard Analysis Critical Control Point (HACCP). This method has seven main principles to guarantee the food quality and purity by focusing on personnel hygiene of food handler, food hygiene, pest control, waste control, and sanitary condition of the kitchen (McDonough, 2001). By following the 7 principles of HACCP system, the food handler can control and cut the cause of food borne illness. As noted by Pearson and Dutson (1995), the food borne hazard refers to biological, chemical, or physical hazard that can cause illness or injury when consumed with the food. The chemical hazard can identify from naturally or added toxic substance. Food allergen can characterized enough by the chemical hazard which is from a plant bearing a toxin, pollutants, or geological origins (Renwick et al., 2003). According to FDA of United States graphics found that millions of Americans have allergic reactions that cause minor and mild symptoms, severe reactions, and even be life-threatening to food in every year (Anonymous, 2017).
1.2 Background of the study
Food allergy differ from food intolerant as stated by the National Institute of Allergy and Infectious Diseases (NIAID), a food allergy define as an adverse health response (Chaudhry and Oppenheimer, 2012). This reaction arise from a specific immunology that reproductive while exposure to a food given (Sackeyfio et al., 2011). Although only a small pieces of allergic food, there still have some response produce as the result between IgE antibodies and food protein (Gelinick et al., 2008). There are 170 and above foods that identified to stimulate food allergic reactions (Boye, 2012). The United States law identifies this eight foods (milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans) design as a "major food allergens" (FALCPA, n.d.). The most severe form of food allergy is anaphylaxis, that may lead to death within minutes or hours (Sampson et al., 2006). Anaphylaxis is combining two or more following features after exposure such as involvement of skin, respiratory compromise, cardiovascular compromise, and/or persistent gastrointestinal symptoms (Ben-Shoshan and Clarke, 2011). In the United States Food and Drug Administration result (2017), they estimated that anaphylaxis to food results in 30,000 people go to emergency room visits, 2,000 people are hospitalizations, and 150 people deaths every year. Families genes can contribute allergic diseases with different percentage of the risk to developed allergies for every child from either allergic or nonallergic parent. For every parents who suffer food allergies (their children occur 40-60% risk), if only one (the risk falls become 20-40%), however if both are nonallergic (the offspring still have 5-15% risk). Base on Medical Student Association of India statistic above, all infants without exception are justify to have the allergy prevention (Anonymous, 2013).
Figure 1.1: Anaphylaxis Information from Icon Pediatrics (Anonymous, 2015)
The common allergy responses in children are asthma, food allergy, and others (Masoli et al., 2004). The prevalence of allergic diseases and asthma has increased sharply during the last decades, in developed and industrialized countries (Bateman, Jithoo 2007). An increasing trend of food allergy are expanding worldwide and affecting world population around 30 to 35 % throughout their lives, said Prof. Madya Dr. Intan Hakimah Ismail, a clinical specialist in pediatric allergy and immunology, Universiti Putra Malaysia (Anonymous, 2016). According to the past study that published in pediatric reported that more than 30% of children are the victims of bullying by their friends because of food allergies (Alvarez, 2013).
Figure1.2: The hiden allergens in food (A”barro et al., 2007)
Around 119 cases (22.4%) occur because of hidden allergens distribution (A”barro et al., 2007). In United States restaurants, most of reported allergic reactions to peanuts cases occur cause of the hidden food allergen instead of cross-contamination cases (DeSimone et al., 2001). According to the Journal of Allergy and Clinical Immunology, these reactions occurred in restaurants and other food provider because of unclear communication between patron and food provider (Anonymous, 2001).
The increasing prevalence of food allergies in recent years has led food manufacturers to be more responsible and performing the effective allergen control programs (Chang, Sreedharan and Schneider, 2013). United Kingdom Committee on Toxicity approved the basic advise from European Union food information and follow the rule. This rule (No. 1169/2011) regulate food businesses to give labeling on unpackaged food, in example catering, bakeries, and sandwich bar (Anonymous, 2014).
Figure 1.3: List of countries participated in food allergy prevalence survey by World Allergy Organisation (Prescott, 2013)
World Allergy Organization and Worldwide Universities Network collect data from 89 countries to pile up a global picture of food allergy including Malaysia (Anonymous, 2013). According to Taylor et al. (2001) eating habit, age, and ethnicity may affecting the prevelance of food allergy. Peanut allergy is the most common among American citizen, and seafood allergy is the most common in Malaysian people (Taylor et al., 2001; Noor et al., 2008). In Malaysia’s neighbour, Singapore, recently had a case of food allergies. Ms Khoo, 60 years old, who moved around in a wheelchair and unemployed are died because of consuming prawn dumpling (Alkhatib, 2017).
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1.3 Problem Statement
According to Assoc. Prof. Dr. Ranbir Kaulsay, the president of Malaysia Society of Allergy and Immunology (MSAI) around 15-20% of Malaysians population are suffering from food allergy. These figure will increase rapidly to 50% in the year 2020 if Malaysians population are not noticeable to food allergy. They assume there is a cure for food allergy, while Dr. Amir Hamzah Datuk Abdul Lattif argue "There is only preventive action that can be done". Based on that statement, the MSAI made Malaysian allergy road Map to promoted awareness on prevention of food allergies (Murugappan, 2016). All Malaysians must support that goal, especially this three group that are parents, government, and food handlers. As for parents who must focus more to their children and take intensive on allergy prevention because once triggered, the allergic march will continue, and eventually affect their quality of life (Stick et al., 1996). Government responsible to educate Malaysians people through a proper training on food allergens prevention, prompt recognition of allergic symptoms, and treatment to conquer it (Wan et al., 2016). For food handler who responsible to provide food outside home, must achieve the customer's needs and satisfaction by preserve food safety and allergen prevention especially for food allergic customers (Bailey et al., 2011).
Noor et al. (2008) said Malaysian population usually consume several allergic food in their diet menu there are 13 types. Food’s sensitivity vary in every country and it is influence by culture, genetic, dietary habits including the first time exposure to the new allergenic food (Sicherer and Teuber, 2004; Kumar et al., 2007). Malaysian Society of Allergy and Immunology recently listed seafood, nuts, soybean, wheat, and eggs as the most five food allergens from the first result on Malaysia allergy awareness survey on 8,000 response applicants nationwide. Admittedly, the most common food allergy for allergic people in Hospital Universiti Sains Malaysia (HUSM) Kelantan is clam and shrimp and the least is citrus mix (Noor et al., 2008). Further, most patients in Perak, Malaysia had allergens in crab either raw or cooked crab (Rosmilah et al., 2012). However most people in Malaysia consume processed crab which has more little Ig-E binding or less allergic compare to the raw one (Samson et al., 2004). Those food allergens were not heat-resistance (Chatterjee et al., 2006) and the cause of allergic reaction can decrease along the food processing (Boxtel et al., 2008; Liu et al., 2010b; Yadzir et al., 2010).
Restaurants should act within the law and to protect the clientele as a restaurant's priority by controlling the successful implementation of food allergen (Choi and Rajagopai, 2013). That aim can be achieve after fulfilling the food handler’s attitude, knowledge, practices, and exact training. Therefore food allergic customer will be able to dine out safety and will not take a risk by the poor knowledge of restaurant staff (Bailey et al., 2011). Once, food allergic customer consume only a few an allergen food, it still could cause a reaction. Based on Azman and Shaffie (2015) only half response of the food handlers in Penang, Malaysia had that knowledge of safe food allergy management practices. The suitable participants for food allergens training are all the staff especially the owners and managers which will conduct training for staff in management and communication of food allergen risks (Carol and Kanchan, 2014). Dupuis et al. (2015) coded seven recommended guidelines of "best practices" in food allergy management for restaurant workers that can eliminate the failure of clear communication to the customers. Ali et al. (2011) have examine the perception of food allergen among medical students, where as Norrina, Rashid, and Ramli (2015) have studied the knowledge of food allergy among hospitality students. However, the research of knowledge, attitude, and practices among food handlers in Utropolis Glenmarie, Malaysia have not been discovered yet.
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1.4 Conceptual Framework
IV: KAP Assessment DV
Figure 1.4: Adapted from: Choi, J. H., & Rajagopal, L. (2013)
1.5 Research Objectives
The main purpose of this study is to identify all the specific reasons which may affect the awareness of food allergen among food handlers in the Utropolis Glenmarie area. There are four specific objectives from this research:
1. To assess the level of food handler's awareness towards food allergen.
2. To examine the relationship between food handler's socio-demographic, knowledge, attitude, and practices towards awareness of food allergen.
3. To evaluate the factor of KAP assessment that have the most significant relationship to awareness of food allergen.
1.6 Research Questions
1. What is the level of food handler's awareness towards food allergen?
2. What is the relationship between food handler's socio-demographic, knowledge, attitude, and practices towards awareness of food allergen?
3. Which factor of KAP assessment that have the most significant relationship with awareness of food allergen?
1.7 Significance of the study
The findings from this study benefits to different parties like food manufacturer, food handlers, consumers, government, and further researchers. The purpose of this research is to conduct the study of all the specific factors that can affected the awareness of food allergen. Utropolis Glenmarie area is include KDU University College, Paramount Utropolis Marketplace, and Paramount Utropolis Suites. The result of this investigation will show the level of understanding and awareness of food allergens. All food manufacturers who involve in this research can get a benefit, if the result is in high-level.
The relationship between food handler’s socio-demographic, knowledge, attitude, and practices towards awareness of food allergens are the purpose of this study. This study will help the food handlers become more aware to do the prevention actions toward food allergens. The consumers from university or factories around Utropolis Glenmarie will feel more secure and comfortable to dine out here. Base on the acceptable level of safeness from intervention of food allergy, eventually it will attract more customers to come.
These researchs on awareness of food allergens help the government and Malaysia Society of Allergy and Immunology to reduce the food allergens cases. This activity also eases the burden of MSAI to do the Malaysian allergy road map in Utropolis Glenmarie.
These findings useful for researcher to complete their dissertation. Moreover, these findings may be useful for other or future researchers in deeper review and develop further investigation of food allergens labels to guide consumption choices and affected their purchasing behaviour.’
1.8 Conclusion
Chapter 1 briefly discussed about the general information about food allergens among food handlers in Utropolis Glenmarie area. These section discuss about the previous findings of problem statement. Moreover, the significant of study also covered in this chapter