Perspectives about Food Safety in Diverse Low- and Middle-income Countries

OBJECTIVES: Concerns about unsafe food influence food choice and consumption of unsafe foods increase morbidity and mortality, particularly in low- and middle-income countries. Addressing unsafe food is dominated by mitigation of biological and chemical hazards through supply-side risk management, with less emphasis on individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries. METHODS: Five studies designed to address drivers of food choice in low- and middle-income countries provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent coding techniques that involved a constant comparative method. RESULTS: Individuals constructed meaning about food safety through personal experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with vendors. Concerns were amplified by mistrust of vendors’ purposeful adulteration, unsafe selling practices, and new methods to produce food. Individuals were reassured of food safety by positive relationships with vendors; home-cooked meals; implementation of policies and regulations being followed; vendor adherence to environmental sanitation and food hygiene practices; cleanliness of vendors’ appearance; vendors’ or producers’ agency to use risk mitigation strategies; and transparency in production, processing, and distribution of food. CONCLUSIONS: Individuals’ perspectives about food safety influence food choice behaviors. The success of food-safety policies hinges on consideration of these perspectives. FUNDING SOURCES: The Drivers of Food Choice (DFC) Competitive Grants Program, funded by the Bill & Melinda Gates Foundation and the UK Government's Foreign, Commonwealth & Development Office.