Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online)

Sch. J. App. Med. Sci., 2015; 3(3G):1539-1542 ISSN 2347-954X (Print)

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Research Article
Hygiene Behaviour and Food Quality in Lahore, Pakistan
Stephen Mortlock
Global Infectious Diseases and Microbiology Liaison, Laboratory of Environmental Microbiology
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

*Corresponding author
Stephen Mortlock

Abstract: Food contaminated with pathogenic micro-organisms is a serious threat to human health, particularly in some
developing countries. This study was designed to evaluate the quality of food at various outlets around Lahore, Pakistan.
Food samples were collected and analysed for total viable count, coliforms, faecal coliforms and Escherichia coli using
standard methods. Overall, the food from established outlets was of an acceptable quality with an occasional
unacceptable result and only one instance of Salmonella enteritidis isolated.
Keywords: Food quality; Microbial contamination; Pakistan.

INTRODUCTION or bathing while ten yards downstream a mother will be

Food is a basic human need and many washing clothes, children or cooking utensils. Because
developed countries have increased production to meet of this both the river and canal have been found to
the growing demand from consumers. With this contain high levels of Escherichia coli, salmonella,
increase has come controversy about food safety that campylobacter and shigella[7]. Even the potable
has occasionally had a huge impact on the food drinking water supplies have been found with faecal
industry. In less developed countries, however a large pathogens and concentrations of lead and chromium
proportion of the food produced may be spoilt before it well in excess of WHO guidelines[8]. A report in the
can be consumed and the need to simply obtain food late 1990’s by the Epidemiological Laboratory, Institute
often outweighs concern about food safety. Pakistan is of Public Health in Lahore analysed 57 water samples
becoming an important destination for business taken from around the city and found 30 contaminated
travellers and holiday makers alike, there has certainly with unacceptable levels of Escherichia coli [9].
been an increase in travellers over the last fifteen years: Unfortunately, there are still many uncovered refuse
nearly 910,000 international visitors arrived in 2010 dumps throughout the city and there is an indiscriminate
(compared to 369,000 tourists for 1996)[1]. Because the disposal of human and animal excrement in the streets,
standard of hygiene may be below the travellers’ ideals, the fields and adjacent to the slum areas.
many of them will suffer from one or more episodes of
Along many of the streets and roads can be found
diarrhoea and although unpleasant and debilitating is
street vendors (photograph 2) serving a variety of
not generally life-threatening[2,4]. It is easy to forget,
cooked and fresh food, from the ‘halva poori’ (deep
however that although nearly three-quarters of the
fried bread served with a savoury dish of diced potatoes
indigenous population has access to safe drinking water,
and chickpeas) to ‘katlamas’ (fried bread stuffed with
more than half have no proper sanitation and 32% are
mincemeat, or lentil paste). Another favourite is the
classified as living below the absolute poverty level
dish ‘chikkar cholay’, made from chickpeas cooked in
(Photograph 1)[5,6].
yoghurt and spices eaten with ‘naan ‘ bread. Lahore is
Lahore is a bustling metropolis located on the banks also renowned for its fresh water fish, which when fried
of the river Ravi, and although smaller in size and in a chickpea batter tends to disappear remarkably
population than Karachi is considered to be the cultural, quickly. Although there are new air-conditioned
educational and artistic capital of Pakistan. A myriad supermarkets being opened, to sell food under more
variety of wheeled vehicles compete for road space with hygienic conditions, with chilled and frozen meat on
cars, scooters and trucks travelling alongside donkey, sale, much of the population still buys food from open-
ox and horse-carts. The river and canal (which runs fronted shops or market stalls (Photograph 3). These
through most parts of the city) are both used by humans shops have little protection from the heat or flies and
and animals for swimming, bathing and washing the domestic animals which may be roaming freely
purposes; it is not uncommon to find buffaloes drinking around. Most of the meat is classified as ‘halal’ meat,
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where the animal is slaughtered by a transverse cut to MPN (most probable number) method where a series of
the throat. The animal is often slaughtered, butchered, fermentation tubes containing lauryl tryptose broth were
sold and eaten within 24 hours, with no refrigeration. inoculated with varying amounts of the prepared food
sample and incubated for 24 hours at 35°C. Each
Because of the increasing tourism a number of the fermentation tube contained an inverted tube to trap
larger hotels and restaurants in Lahore wanted to gases produced by any coliform bacteria present in the
include food monitoring to ensure that business sample. After 24 hours, the fermentation tubes were
travellers and holiday-makers were ensured of good examined for gas production. If there was no gas
quality food from their kitchens. The food monitoring production, the samples were incubated for another 24
was carried in the Laboratory of Environmental hours and re-examined. Gas production after 48 hours
Microbiology at the Shaukat Khanum Memorial Cancer was considered a positive result, indicating the presence
Hospital using guidelines set out in the UK[10-11]. of coliform bacteria. A confirmatory test using the API
METHODOLOGY 20E for enterobacteriacae then performed to identify the
Each month, food samples were collected from the bacteria.
hospital kitchen, some designated restaurants, three
RESULTS
international hotels and occasionally a street trader. At Table 1 shows the aerobic plate count results with
each collection, the food was collected into sterile food over 60% obtaining a satisfactory result, even from the
bags and transported in a cool container (4-10C) to the street vendor. There were 17 (10%) of samples with
laboratory. These samples were then assigned a specific unsatisfactory counts which were found to have high
code number for processing. The food was weighed out levels of coliforms/E.coli (Table 2) and were cultured
and a representative sample of about 10grams taken. from a range of different foods. Only one sample was
This was macerated into 100mL of sterile phosphate found to contain a Salmonella enteritidis and this was
buffered saline and cultured onto Plate Count Agar from an ‘egg-burger’ bought from a street trader.
(PCA), or Standard Methods Agar (SMA). This is a Although the hospital food had been often been the
microbiological growth medium commonly used to subject of complaints from both staff and patients it was
assess or to monitor "total" or viable bacterial growth of found to be the best quality (80% satisfactory). A
a sample, it is not a selective medium. The total viable surprising find was high levels of Staphylococcus
count (TVC) of microorganisms was carried out at both simulans from a gulab jamun dish collected from a local
30C and 37C and at two dilutions (the initial 1:10 and restaurant. This organism has been implicated as a
1:100). It was a rare occurrence if the food sample had potential cause of food poisoning if they produce
to be diluted any further to obtain a countable value. enterotoxin[12].
The TVC was reported as colony forming units per
gram (cfu/g). The test for coliforms was the standard

Table-1: Aerobic plate counts of prepared foods

Microbiological Quality (cfu/g)
Number of Satisfactory Fairly Satisfactory Unsatisfactory
Samples (<104) (104- 106) (>106)
Hotel A 60 36 60.0% 17 28.4% 7 11.6%
Hotel B 56 41 73.2% 12 21.4% 3 5.4%
Hotel C 13 10 76.9% 2 15.4% 1 7.7%
Local Restaurants 15 7 46.4% 4 26.7% 4a 26.7%
Street Trader 7 4 57.1% 1 14.3% 2 28.6%
Hospital Kitchen 15 12 80.0% 3 20.0% - 0.0%
Total 166 110 66.3% 39 23.5% 17 10.2%
a: Staphyloccus simulans found in one sample
Table 2: Samples containing unsatisfactory or unacceptable levels of coliforms/ Eschericheria coli
Unsatisfactory (102- Unacceptable
Food Number of Samples
104cfu/g) (>104cfu/g)
Chicken dishes 2 2 -
Chicken with yoghurt 1 1 -
Mutton curry 3 2a 1
Egg-burger 1 - 1c
Beef kofta 1 1 -
Vegetable dhal 1 1b -
Chocolate mousse 2 2 -
Total 11 9 2
a: Enterobacteram nigenus and E. coli, b: Enterobactersa kazaki and E. coli, c: Salmomella enteritidis, Enterobacter sp.

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DISCUSSION
Overall the foods from the hotels gave very
good results, while some of the restaurants produced
some of the worst aerobic plate counts. And it was
from a street trader that the only case of Salmonella
enteritidis was isolated.

In South Asia, including countries like Pakistan,

social and environmental changes are occurring rapidly,
with increasing urbanization, changing lifestyles, higher
energy density of diets and reduced physical activity.
Higher incomes and falling food prices are boosting the
consumption of meat, milk and fatty or sugary foods.
Recently, however there has also been the introduction
of western style fast food outlets, serving pizzas,
Fig-1:Women washing in a drainage ditch burgers, fried chicken, French fries and milkshakes.
With the exception of a few changes to accommodate
local dietary customs, for example the Hawaiian pizza
has spicy chicken instead of ham; they bear a
remarkable similarity to anything offered in the UK or
the USA.

Although the introduction of these food outlets

may improve the problem of food supply and hygiene to
those who can afford it, if the trend towards ‘fast-food’
continues this could increase other problems for people
who are not used to a deep fried, excessive meat-and-fat
highly refined diet. As the number of supermarkets have
increased so has come the reliance on packaged foods
and the use of salt as a preservative. The need to make
retail food cheap has necessitated the use of
hydrogrenated oil instead of butter and the concept of
Fig-2: Mobile food vendor convenience products in food and saving costs by mass
preparation of foods is driving people to buy more fast
food. Moreover, larger portion sizes offered in
restaurants in an attempt to add value is making people
eat more.

Certainly, obesity, diabetes and heart

complaints have been shown to be more prevalent in
this type of society when western-style foods have
begun to replace the traditional fare. Already reports
make much of the increase in obesity due to poor diet
and lack of exercise[13,14]. This change is certainly
more noticeable in the metropolitan areas like Lahore,
where there is a gradual shift from joint families to
nuclear households. There has also been an increase in
the number of working women or with both parents
working, so eating out has become a frequent
phenomenon with the local fast food outlet often being
the first point of call[15].

Although many of the hotels and restaurants

still offer traditional fare cooked from fresh produce
with generally a high standard of quality, how long can
this continue if they are competing against the more
westernized fast food outlets. And how long before
oven-chips replace rice and naan bread?

Fig-3: Butcher at work

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