Schools are generally a safe place for children, but substantial ergonomics, safety, and health challenges and risks still exist. This post, which was written by Dr Wan Zahidah Wan Zulkifle and edited by Dr Nor Diana Mohd Mahudin, discusses hygiene and food safety in school canteens as a part of Ergonomic Risk Assessment at Schools community project under PSYC 6230 Human Factors course in 2017.
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“It’s Recess!!…”
That is probably the most favourite time among school or kindergarten children. Kindergarten children, in particular, are naturally playful and at the age of rapid growth. While learning is usually associated with the classroom, recess has connotations of joy, freedom, and canteen. Therefore, most children look forward to recess as this is the time they meet their friends, replenish their energy, and share stories.
Canteen is generally a safe and fun place for children to be. However, how often do we recall hearing about news or stories of children slipped on the canteen floor or children being absent due to food poisoning after eating at their school canteen? These issues are not new or unheard of - they may be more common than we think. Some stories are just shared as a joke, while others may reflect an alarming problem that needs to be taken care of. In this post, I will be sharing my experience conducting a risk assessment on the canteen of a kindergarten. The findings of mine might not be the same as other schools or the school you are working now, but with this sharing, I hope to highlight some of the issues that may be missed or taken for granted when it comes to school canteens. At the end of the day, we want to provide the best that we can for the future generation and remove all possible hazards that could harm them while they are using the canteen.
Why is Food Hygiene and Safety in School Canteens So Important?
When we hear the word ‘canteen’, one could not avoid having a vision of a place with long tables for children to eat, with long benches placed at both sides of the table. If you are old school like me, probably you will imagine wooden furniture. At the same time, the younger generation would probably have a vision of steel tables and benches. Tile floors with a sink at the corner - garbage bin and dirty plates bin would probably come to your mind too. This typical setting of a canteen is also what we found during our risk assessment.
Canteens serve food, and who does not love food? It does not matter where we come from, or what language we speak, we need food to survive. Abraham Maslow (1943), in his famous hierarchy of needs, ranked food at the lowest level in the hierarchy along with other physiological needs such as water, warmth, and rest. This is categorised as basic needs for a person to survive. Food, however, could bring harm to the health of an individual if not properly chosen and handled. Children have rapid growing up needs, and the food we choose to feed them play a crucial role in maintaining their health and growth.
Some of us might not regard food as a hazard, but as much as we love food, we should not neglect the fact that it could bring harm. In particular, three aspects need to be considered: hygiene, nutrition, and safety.
1. Food hygiene
Food hygiene is essential because failure to implement a safe food handling practice could bring serious consequences such as food poisoning and infections. Children are vulnerable population as their immune system is not fully mature like adults. Wearing gloves while preparing foods, making sure all food handlers have taken typhoid injection, and properly cook the food served are among the practices that need to be given priority to. This is also in line with Malaysian Food Act 1983 and Food Hygiene Regulation 2009 where it is compulsory for all food handlers to have typhoid injection.
2. Nutrition
You may want to try asking any kids around you on what are their favourite food, and you will not be surprised if sweets, fried chicken, and ice cream came at the top of the list.
Many studies*, unfortunately, have shown that overnutrition and undernutrition coexist among school children in Malaysia. The recent National Health and Morbidity Survey (NHMS) 2017 also reported that the prevalence of overweight and obesity among Malaysian children aged 10 to 12 years are two times higher than thinness and stunting.
In principle, all school canteens must adhere to the Guideline on the Management of Healthy School Canteen (Panduan Pengurusan Kantin Sekolah Sihat) by MoE Malaysia. This guideline, which was implemented in 2011 and revised in 2012, outlines the type of foods that are allowed to be sold, foods that are not recommended, and foods that are not allowed to be sold in school canteens. Healthy eating habits are endorsed and encouraged by most religions and traditions too. For example, Islam provides broad guidelines on foods and eating, as stated in hadith “Man does not fill a container worse than his stomach. Merely a few morsels are sufficient for him to keep his back straight. If he cannot do so, then he should keep one-third [of his stomach] for food, one third for water and one third for air” (Sunan Ibn Mājaĥ, vol. 4, pp. 48, Ḥadīth 3349, as cited in Attar, 2012).
3. Safety
“Stay away from that, you will get hurt”. “Don’t play around the kitchen area, it is dangerous”. Try recalling how often we say this to our children. The kitchen area is generally not a place for children to play. This is because kitchen appliances involve sharp objects, and it is more dangerous to let the children around when someone is cooking. Sharp knives, hot cooking oil, heavy wok, boiling water - these are all hazards that could lead to fatal consequences. According to Finney and colleagues (1993), unintentional injury is the most prevalent child health problem.
Also, the most common cause of injuries is different for the different age group. Injuries related to playing outside usually occurred among school-aged children. In contrast, younger children commonly injured at home, including in the kitchen area. In their study on children’s knowledge of home-safety rules, Morrongiello, Midgett, and Shields (2001) found that children’s understanding of the safety measure is not a predictor for reducing home-related injuries. In fact, knowledge alone is not adequate - the more critical parts are the children’s compliance with the rules and the extent of parent’s supervision.
What Does the Law Say?
Food laws and canteen/cafeteria management in Malaysia are principally governed by the Malaysian Food Act 1983, Food Regulations 1985, Food Hygiene Regulation 2009, the National Nutrition Policy of Malaysia, the National Plan of Action for Nutrition of Malaysia, the Guideline on the Management of Healthy School Canteen 2012, and the Malaysian Dietary Guidelines for Children and Adolescents 2013 among others. Some local or state policies or jurisdictions regarding this aspect may also be applicable.
Canteen Risk Assessment
Following the Guidelines on Ergonomics Risk Assessment at Workplace 2017 by the Department of Occupational Safety and Health (DOSH), we conducted a risk assessment to record the ergonomics, safety, and health hazards observed at a kindergarten canteen in Selangor. We observed the children while they are using the setting and identified the associated risks and persons at risk. Through a semi-quantitative risk rating system, we weighed the hazard severity and their likelihood to derive an overall risk exposure score. Three important aspects emerged from this assessment:
Keep It Clean, Nutritious, and Healthy
Know the greens, the yellows, and the reds. Foods can be categorised into three categories using traffic light- colours: green, amber, and red. Green Foods are everyday foods such as grains, vegetables, fruits, legumes, beans, milk, and water that should be promoted and encouraged for the children to consume. Yellow or Amber Foods are foods that contain some nutrition but may also include unhealthy ingredients, e.g., some breakfast cereals, savoury breads, canned fruit with added sugar, regular-fat plain or flavoured yoghurt, meat or poultry with visible skin or fat, salted nuts and seeds, and others. Red foods, on the other hand, are foods that are not in line with the dietary guidelines, e.g., all types of confectioneries, foods containing saturated, trans fats, and oils, fried foods, soft drinks, flavoured waters, and others. Red food items are not permitted to be sold in canteens.
To provide the best nutritious and healthy food for the children, it is recommended that grilled or roasted meat be served since it is found that the retention of the nutrient is highest in this way of cooking (Dominguez et al., 2015). This should be complemented with serving of fresh fruits or vegetables as outlined by Malaysian Dietary Guidelines for Children and Adolescent 2013. A balanced diet of carbohydrates, fish, poultry, and meat is essential for optimum growth of children. Daily intake of dairy products such as reduced-fat plain milk is also recommended in the Guidelines.
Choosing nutritious foods and properly handling the foods before serving is the key to ensure that we provide the best for children’s growth and health. It is important to keep their tummy happy, but it is more important to keep their body healthy. They may throw a tantrum to eat those green foods now, but they will thank you later.
A Spill, A Slip, A Hospital Trip
Let us be honest, it is almost impossible to supervise children all times. Thus, safety measures need to be taken to prevent accidents from happening. Based on the risk assessment conducted, some good practices were identified that could serve as a guide.
First, placing sharp appliances at higher shelves that are unreachable to children is one of the easiest precautions. In addition, properly labelling and maintaining a checklist of sharp appliances available is also important. This is because it can ensure that nothing is misplaced and reduces the risk of accidentally placing the sharp appliances within the reach of children. The use of sharp appliances poses a health risk to children and adults alike. Therefore, training on how to properly use and store kitchen appliances is needed for all canteen staffs. As they are required to cut the foods into smaller pieces for younger children, this repetitive meticulous action can be time-consuming and may fatigue the staffs. In particular, using scissors for a long duration could lead to fatigue in the thenar area.
One way to reduce this problem is to mechanise the process by using a food processor. This investment does not only can facilitate the process, but it can shorten the time to complete the task too; hence, saving time and energy. Sharp appliances are needed to increase the effectiveness of our work (e.g., in cutting, chopping, slicing, etc.), thus totally removing it from everyday use will not be of question. With the necessary steps taken, we could prevent the risk associated with it.
Good Form, Good Function, Good Health
Besides children, another population worth scoping into their exposure to kitchen area hazards is the canteen staffs. In our assessment, the risks associated with these hazards include anthropometry and work design.
Anthropometry is a study of measurement of proportions of the human body according to sex, age, volume, the centre of gravity, masses of body segment for identification purposes. Its application can be seen in manual handling and work posture. In this risk assessment, we observed that the canteen staffs are exposed to back pain and muscle fatigue because most of the table and benches they use are designed for children. In particular, they have to accommodate to lower seating area and table that are not appropriate for their size. To accommodate, they have to do a lot of bending and crouching. One might argue that if we replace the table to an adult’s size, then it is not ergonomically appropriate for the children, who are the core population in the kindergarten. This dilemma could be solved by providing another table of adult size for the staffs to rest or to do work such as slicing and cutting. In this way, fatigue caused by prolonged standing could also be reduced.
Repeated strain injury (RSI) should be taken into consideration among the canteen staffs as they need to lift the children to wash their hands at the sink. They also have to lift the children from one place to another when they throw a tantrum. This repeated action of lifting can lead to muscle strain and injury. Possible solution? Provide an adjustable stool for children to reach the sink as well as training and practice in safe-lifting techniques.
Due to the nature of work done by the canteen staffs, it is difficult to avoid fatigue, reduced attention, distraction, or boredom. These aspects can be mitigated by ensuring that the work distributions among the staffs are equal. Balancing staffs’ workload through a job rotation may also help. Distraction caused by the noise of upset children is a hazard by itself. Children, especially the younger ones, communicate through crying or throwing a tantrum, so reducing the noise by asking them to change is almost impossible. However, possible solutions could be arranging the recess in several sessions so that children will not scramble to get their food and to occupy them with less noisy activity during the food preparation. Having a wall and door to separate the compartment of the kitchen area and dining table and other areas could also help reduce the noise.
In a nutshell, hazards are inevitable; however, taking necessary precautions could reduce the risk that the hazards carry. What’s outlined in this post is from the Author’s observation and findings during the risk assessment. This is intended to spark the idea of how certain hazards may be perceived as harmless but could lead to serious consequences if not properly managed.
Hazards may be inevitable, but risks are preventable.
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*Studies conducted by:
Khambalia, A. Z., Lim, S. S., Gill, T., & Bulgiba, A. M. (2012). Prevalence and sociodemographic factors of malnutrition among children in Malaysia. Food and Nutrition Bulletin, 33(1), 31-42.
Poh, B. K., Ng, B. K., Haslinda, M. D. S., Shanita, S. N., Wong, J. E., Budin, S. B., ... & Norimah, A. K. (2013). Nutritional status and dietary intakes of children aged 6 months to 12 years: Findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). British Journal of Nutrition, 110(S3), S21-S35.
Teo, C. H., Chin, Y. S., Lim, P. Y., Masrom, S. A. H., & Shariff, Z. M. (2019). School-based intervention that integrates nutrition education and supportive healthy school food environment among Malaysian primary school children: A study protocol. BMC Public Health, 19(1), 1-10.
References:
Domínguez, R., Borrajo, P., & Lorenzo, J. M. (2015). The effect of cooking methods on nutritional value of foal meat. Journal of Food Composition and Analysis, 43, 61-67.
Finney, J. W., Christophersen, E. R., Friman, P. C., Kalnins, I. V., Maddux, J. E., Peterson, L., Roberts, M. C. & Wolraich, M. (1993). Society of Pediatric Psychology Task Force report: Pediatric psychology and injury control. Journal of Pediatric Psychology, 18(4), 499-526.
Institute of Public Health. (2017). National Health & Morbidity Survey (NHMS) 2017: Adolescent Nutrition Survey 2017. Malaysia: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia.
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.
Morrongiello, B. A., Midgett, C., & Shields, R. (2001). Don't run with scissors: young children's knowledge of home safety rules. Journal of Pediatric Psychology, 26(2), 105-115.
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About the Author
Wan Zahidah Wan Zulkifle is currently a research officer at Sejahtera Centre for Sustainability and Humanity, International Islamic University Malaysia (IIUM). She holds a medical degree from Universiti Sains Islam Malaysia and a MHSc (Industrial & Organisational Psychology) from IIUM.
Note: This article gives the views of the Authors, and not the position of the Department of Psychology IIUM Blog, nor of the Department of Psychology IIUM.