The Water Hygiene of Street Food Vendors in Southeast Asia: A Review

The safety of street food vendors in Southeast Asian countries is of concern as many do not follow basic food safety principles. The water used to wash cutlery that is not hygienic may cause foodborne illnesses. Therefore, the general aim of this study was to summarize the water hygiene of street vendors in Southeast Asia. PRISMA guidelines were used to find suitable sources for this systematic review. Relevant studies are retrieved from several databases, such as Science Direct, PubMed, SAGE, EBSCOhost, Taylor and Francis, and Scopus. The keywords used to identify the relevant studies were water, water quality, hygiene, sanitation, street vendor, and food safety. The initial search in the databases yielded 80 articles. After the screening process based on the criteria of the article, only 9 articles were used in the final systematic review. The results showed that the water hygiene system in street vendors in Southeast Asia is still relatively unhygienic because most still use bucket water (non-tap water), which can contaminate food and lead to foodborne illness.


Introduction
"Street food" describes a broad range of prepared foods and drinks sold and occasionally cooked in public areas.You may eat street food there or take it with you and eat it somewhere else [1].However, due to microbial contamination, some foods sold by street vendors might pose a serious risk to customers [2].The World Health Organization (WHO) indicated that as many as 600 million people fall ill each year, of which 420,000 die after consuming contaminated food.Southeast Asia is believed to have the highest incidence and death rates associated with foodborne diseases [3].The recurrence of foodborne illnesses has raised awareness of food safety and cleanliness among food handlers worldwide.However, given that instances frequently go unreported or uninvestigated, epidemiological statistics on foodborne diseases still need to be examined [4].The hygiene of street food vendors in Southeast Asia is critical, especially regarding water hygiene.It starts from the water used to wash equipment to the water used to process food.The water used to wash cutlery and processed food that is not hygienic may cause foodborne illnesses since food will be contaminated with bacteria [5].Ensuring the availability of clean water, its management, and sustainable sanitation is one of the goals of the Sustainable Development Goals (SDGs), which consist of various universal goals by 2030 to balance the three dimensions of sustainable development: environmental, social, and economic.
Qualitative and quantitative techniques are used to evaluate the water hygiene of street food sellers.An observational study was conducted to assess the methods used by street food sellers to prepare, cook, and serve food safely.Laboratory testing is also conducted with a presumptive Coliform Test to determine water hygiene.Based on [1], a survey was conducted to observe the water source and change the water for cleaning plates, which were then analyzed using statistics.The results showed that all street food vendors use bucket water sparingly to save money, and there is a tendency to recycle wash water many times.Laboratory testing was done on water samples obtained from street food sellers to identify the total number of microorganisms in the water and to check for Salmonella sp.bacteria using the SSA (Salmonella Shigella Agar) and TSIA (Triple Sugar Agar) media.It was found that all street vendors used water with microbial content that exceeded the limit of 0 CFU/gr and was positive for Salmonella sp.[6].Another study showed that an epidemiologist and qualitative research led quantitative research by a sociologist guided by the IBM-WASH theoretical framework.Water hygiene practices carried out by street food vendors are still classified as concerning where there is no tap water around the street food vendor place.The low availability of tap water is likely a vehicle for pathogens, so the food sold by street food vendors is vulnerable to contamination and causes foodborne illness [7].
Previous research only mentions the importance of proper cutlery washing and presents data on microorganisms found in cutlery that need to be washed with clean water [7].The level of microbial contamination in bucket water, which street sellers frequently utilize, was not covered in the study's data [8].Meanwhile, another research is limited to the water type at one location only.Therefore, the type of water used to wash cutlery comes from the same source, which causes an unknown type of water that should be used to wash cutlery [9].The other research showed that the sample was constricted to the northern region of Kuching City, where the community is predominantly Malay, with the sample size being purposively selected.Hence, the research only focuses on one area.Furthermore, self-reported bias makes evaluating food safety practices more complex [10].Research on food hygiene and safety measures among street food vendors and food handlers of food establishments needs to discuss the condition of the water used by the street food vendors studied and observed.Hence, the information presented needs to be completed [3].
From the research mentioned in the previous paragraph, this is the first time anyone has explicitly displayed the type of water that should be used to prepare food ingredients, food processing, and washing equipment at street food vendors.To our knowledge, a study has yet to be conducted on the water hygiene system of street food vendors in Southeast Asia.Such data is necessary to ensure the design of effective intervention methods to improve food hygiene and safety among food handlers to prevent the occurrence of foodborne diseases.Therefore, a summary of the water hygiene of street food vendors in Southeast Asia is needed to complete the areas that still need to be analyzed in the existing literature.In-depth, this summary focuses on more than just street food vendors in one region of the country.However, it discusses ten countries: Indonesia, Singapore, Malaysia, Vietnam, Myanmar, Brunei Darussalam, Laos, Cambodia, Philippines, and Thailand.In addition, valid and reliable measurement tools will support the discussion of the possibility of microbial contamination of water in street food vendors presented in this summary.Existing data results can be analyzed qualitatively using observation and quantitatively with laboratory experimentation.After obtaining the data, it can be analyzed and discussed in detail about the water hygiene of street food vendors in Southeast Asia.That way, foodborne illnesses caused by bacterial contamination from the water of street food vendors can be prevented.The entire discussion was then summarized into a summary featuring the water hygiene of street vendors in Southeast Asian countries.
Based on the facts above, as many as 600 million people fall ill each year, of which 420,000 die after consuming contaminated food [3].Moreover, the cleanliness of the water used to process food and wash equipment is very important for street food vendors.Facts show that unclean water and lack of attention can lead to foodborne illness.In researching the water hygiene of street food vendors, observation and laboratory experimentation were used to obtain data on water hygiene practices and microbial contamination of the water used.According to previous research, it has yet to explicitly discuss the water hygiene of street food vendors in Southeast Asia.They tend to discuss hygiene practices in a particular region.Furthermore, the discussion on water hygiene and sanitation is aligned with goal 6 of the 17 Sustainable Development Goals (SDGs), namely "Clean Water and Sanitation," which ensures the availability and sustainable management of clean water and sanitation.Therefore, this research aims to summarize the water hygiene of street food vendors in Southeast Asia.

Methods
The methodology for this systematic review utilized the PRISMA protocol.In summarizing and evaluating previous research on the water hygiene conditions of street food vendors in Southeast Asia, this study follows the PRISMA guidelines, as shown in figure 1.A thorough search will be conducted in electronic databases, including Science Direct, PubMed, SAGE, EBSCOhost, Taylor and Francis, and Scopus, to determine the purpose of identifying related research.The search will be conducted by searching several key search terms: Hygiene, Food Safety, Sanitation, Street Food Vendors, and Water Quality.The studies should be included in peer-reviewed publications.Studies presented in Bahasa Indonesia or focusing on water hygiene in other food vendors will also be considered.Reviewers will assess the titles, abstracts, and discussion of the retrieved publications under the inclusion and exclusion criteria.Data from existing studies will be analyzed to obtain important information, such as water type, water hygiene parameters, water characteristics, and results related to water commonly used by street food vendors in Southeast Asia.Data synthesis will be conducted to present findings, highlight recurring themes and trends, and identify gaps in the literature.Data extraction from previous studies was conducted to determine how the type of water used by street food vendors in Southeast Asia can affect the hygiene of the food products they sell.Ethics approval is not required for this study as it will look at published material, but accurate citations and references are required to honor the work of the original authors.

Results and Discussion
In many nations, the street food industry is crucial, giving families who would otherwise have no source of income significant cash.It is a sensible choice for many suppliers because it requires no tax payments and only a little upfront expenditure.Hawking, often known as street food, is essential to Southeast Asia's social, cultural, and economic system.[11].A critical aspect of street food vendors is water.Here are the research results on the hygiene of water used by street food vendors in Southeast Asia.
In this review, the classification of water types in street food vendors in Southeast Asia is divided into tap water and bucket water.Tap water comes from the public water supply system in an area or building.This water is usually obtained through pipes connected to the clean water network.Tap water is generally filtered and treated to make it safe for consumption and use in street food activities [12].Street food vendors in Southeast Asia frequently use bucket water in a bucket or other container.Bucket water can serve as a breeding environment for bacteria that, when consumed, can colonize the gut and alter the microbiota there, as well as be in charge of several metabolic processes linked to human health [13] Through the research findings, the types of water used by Southeast Asian street food vendors can be seen in figure 2. In this review, 78% of studies mentioned that street food vendors use bucket water, followed by tap water at 11% and mix (tap and bucket water) at 11%.This percentage shows that most street food vendors in Southeast Asia use tap water as the primary water resource for washing equipment and water-related activities.Many street food vendors put water in buckets to be used repeatedly so that harmful microbes easily contaminate the water and can jeopardize food safety.Water that has been used before is reused for the washing process afterward.Microbes that grow in bucket water can stick to cutlery or other equipment that is washed using that water.Of course, these conditions can cause foodborne diseases in consumers.

Non-potable Non-potable Non-potable
Non-potable There are numerous street food purveyors in Indonesia, and most Indonesians prefer to purchase food from them.However, street food vendors in Indonesia are associated with inadequate handwashing practices and facilities and direct food-to-hand contact.65% of the water, 91% of the dishwater, and 100% of the ice from these street vendors were contaminated with faecal coliforms.The risk factors for typhoid fever following two geographically distinct disasters varied.Sixty percent of diarrhoea cases have been linked to contaminated water (poor water quality and inadequate sanitation).Lack of clean water is a significant typhoid fever risk factor [14].A total of 149 street food vendors surveyed reported refilling water containers 0-20 times during working hours, with stalls and pushcarts having the lowest average frequency.Bottled water (2), bucket water (49), and pump-collected groundwater (98) were the sources of potable water utilized.Sixty-five percent of the 149 samples examined contained faecal coliforms, with a median concentration of 39/100 ml [interquartile range (IQR): 17-450] in contaminated samples.In addition, 157 (91%) of 172 samples of dishwater were contaminated, with a median faecal coliform count of 140/100 ml (IQR 23-1600) in the contaminated samples.Among 172 samples of dishwater, 157 (or 91%) were contaminated.The mean faecal coliform count in contaminated samples was 140/100 ml (IQR 23-1600).Counts of faecal coliforms in dishwater from pushcarts and stalls were more significant than those from restaurants and stalls (P = 0.01, Mann-Whitney U test).In 46 buckets used for hand and dishwashing, the mean faecal coliform count was higher than in 17 buckets used only for dishwashing [323/100 ml (IQR 28-1600) vs. 20/100 ml (IQR 15-1600)].(P = 0.06, Mann-Whitney U test).The presence of detergent considerably reduced faecal coliform counts in dishwashing water [median 40/100 ml (IQR 17-1600) vs. 900/100 ml (IQR 34-1600)] in comparison to the absence of soap.Most street food purveyors in Indonesia use unsafe water, such as bucket and non-potable water [15].
Malaysia's most notable characteristic is that it is one of the few Asian nations to recognize street vendors in some capacity.Malaysia formulated its National Policy on Hawkers in 1990.This is an allinclusive strategy for addressing the social and economic issues associated with street vending.Since the Asian financial crisis, Kuala Lumpur's street vendor population has increased dramatically, as it has in other Southeast Asian nations.Salmonella nontyphoid (57%), enteropathogenic E. coli (14%), Shigella (11%), Campylobacter (5%), and Aeromonas (5%), were the five most significant pathogens isolated from Malaysian street food vendors, along with their isolation rates.From 2003 to 2005, the four most frequently isolated Salmonella serotypes were S. enteritidis, weltervreden, corvallis, and typhimurium.These findings support the notion that S. enteritidis is the most commonly isolated serotype in most of Asia.In cases where protozoa such as Cryptosporidium and Giardia have been isolated from humans, it is assumed that they originated in water.In 2015, the Malaysian Ministry of Health (MOH) reported that street food was the country's leading cause of food poisoning and foodborne illness.Since food handlers are frequently unlicensed or inadequately trained, the likelihood of foodborne diseases like diarrhoea, vomiting, stomach cramps, and nausea increases.In addition to a lack of awareness, this situation is greatly influenced by sociodemographics, selling experience, water availability, personal hygiene, and cultural food handling customs.In some areas of Malaysia, the water used by street vendors is quite good, as they use tap water (potable).Tap water use positively affects street food selling because the water is always running, thereby reducing the likelihood of microbial contamination [16].
Vietnam, like the majority of Southeast Asian nations, is renowned for its vast selection of inexpensive street cuisines.Street food vendors show no clean (potable) water available at vending locations, waste is dumped on the ground and in the streets, and food is exposed to dust and insects that could carry infections.52.5% (21/40) of the stalls lacked direct access to potable water, 47.5% (19/20) lacked adequate hand cleansing facilities, and 30% (12/40) lacked wastewater and food disposal facilities.Proper hygiene and sanitation can be maintained with a substantial amount of potable water.
Vendors at these stalls disposed of waste food and water beside their stalls as they lacked adequate waste management collection and disposal facilities.As a result, flies were attracted, indicators of poor hygiene and sanitary conditions, and carriers of faecal pathogens.However, it was observed that most vendors reused the same water to cleanse their utensils throughout the day.Repetitive usage of identical water can result in cross-contamination between water and food through the cleaned utensils [17].
The street food sector in Thailand is essential.There are approximately 90,000 food trucks in the United States.Twenty-four hundred and forty-four street food vendors pay little heed to clean water supply and wastewater management.The merchants continue disregarding the marketplace's sanitation, particularly the water's hygienic state.Water for washing is typically collected in small containers rather than being available in flowing water.The same water is utilized multiple times to clean dishes [18].According to another study, plates, cups, glasses, forks, spoons, and other eating implements and utensils are sometimes washed repeatedly using the same tiny water container.This substantiates the food's high microbial contamination [19].
A lack of information is available about the condition of Myanmar's street food vendors, but it is believed that contaminated food is to blame for 70% of all diarrheal illnesses.The most prevalent maladies are diarrheal illnesses, food poisoning, typhoid, and paratyphoid.An outbreak of typhoid fever was reported in September 2000, and a case-control study was conducted.The identified risk factors were drinking raw river water, prior contact with other patients, and failure to cleanse hands with soap after defecation.The water hygiene used by street food purveyors has been undervalued until now.Many vendors use water unfit for human ingestion, such as river water used directly for dishwashing.This results in an increase in the incidence of diseases caused by inadequate water quality [14].
Most street vendors in the Philippines serve cuisine with disposable plates, cups, and utensils.In most cases, these utensils are cleansed with a soapy solution and cold water; in other instances, they are washed with cold water and a scouring towel.Some vendors alter the washing and rinsing twice daily, whereas others continue using the same liquids throughout the day.These practices create a conducive environment for the recontamination of food sold on the side of the road.When consumers use utensils that have not been thoroughly cleaned after being used by other consumers (washed in buckets of nonpotable water), it causes cross-contamination and the spread of infectious diseases.Typically, street food vendors do not have basic amenities such as toilets, hand-washing facilities, drinking water, adequate drainage, or sewage systems.However, they sell strategically and are readily accessible to consumers.Most retail locations lack piped water, and 97.5% lack effluent drains and toilet facilities [20].
More than ninety-five percent of respondents in the Philippines said they needed soap and clean water to cleanse their hands, and more than fifty percent of respondents identified activities that could contaminate their hands and necessitate handwashing.Over 70% of observed street vendors utilized safe water for cooking, food covers, cooked food thoroughly, thoroughly washed food to be prepared, and used fresh ingredients when preparing food.Respondents to a survey indicated that they are aware that it is insufficient to rinse cooking utensils rapidly in a water bath and use slightly soapy or oily recycled water to clean them.Because most of their food preparation occurs at home, the vendors surveyed can thoroughly clean their cooking utensils.Most vendors only sell disposable cups and utensils that do not require washing.A survey of 54 street food vendors at the University of the Philippines revealed that 94.4% wash their utensils with bucket water from restrooms.This water from toilets is not sterile, as bathrooms are synonymous with human waste disposal sites where microbial contamination of water used for commercial purposes can occur [21].
Water hygiene and sanitation feasibility is a part of the global agenda that becomes the sixth goal of the Sustainable Development Goals (SDGs), where water and sanitation are fundamental rights for every human being worldwide to fulfill a decent standard of living.The water used by street vendors in Southeast Asia is also one of the essential prerequisites in realizing the 6th goal of the SDGs.Using clean water and sanitation by street food vendors can improve public health and economic growth.Based on the previous discussion regarding the hygiene of the water used by street food vendors, it is still poorly maintained and needs to be changed to using running water and potable water.Therefore, every street food vendor in Southeast Asia must keep their water and sanitation hygienic to reduce health problems [22].
Based on this review, the water used by street food vendors has only been discussed in certain countries, namely Indonesia, Malaysia, Vietnam, Thailand, Myanmar, and the Philippines.Information on the hygiene of water used by street food vendors in other Southeast Asian countries, including Singapore, Brunei, Darussalam, and Cambodia, has not been found.On the other hand, the types of microorganisms that could grow in water and cause foodborne illness are not reported due to lack of research data.
As a recommendation, infrastructure development should provide significant initiatives by providing clean water services and improving general community hygiene and sanitation.Street food vendors need to be educated and trained, as well as the general public, on the importance of keeping water clean and the types of water that should be used.Undoubtedly, the risks associated with eating street food will be significantly reduced with strengthened policies and effective enforcement.All parties involved in the street food industry, including governments, street food vendors, consumer associations, civil society organizations, and development partners, should actively participate in changing the habit of using bucket water to tap water.It is also recommended to disseminate information on the issue of unsafe hawker food trade practices through participatory initiatives and mass media.Additionally, a more thorough investigation is required to assess the state of the water used by Southeast Asian street food sellers and the quantity and variety of bacteria present in it.

Conclusions
Most street food vendors in Southeast Asia still use bucket (non-tap) water to carry out their activities.The bucket water is used repeatedly and rarely replaced due to the lack of access to clean water around the selling area.Water used frequently will increase the growth of microorganisms, contaminating tableware and food sold by street vendors causing foodborne diseases.The awareness of vendors in terms of using clean water and the role of the government in providing clean water and sanitation that is easily accessible is needed.Street vendors can also move their selling places to places with access to proper water sanitation (such as running water faucets) so that the 6th goal of the SDGs can be achieved.
2.1.Figure Flowchart of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.

Figure 2 .
Figure 2. Types of Water In Southeast Asia, street food vendors use various types of water as their sources.Water hygiene must be a concern because it can cause foodborne illness in consumers.Some of these studies have been summarized in the following table.

Table 1 .
Southeast Asian street food vendors' water quality.