Knowledge and Behavior as Risk Factors for Intestinal Worm Contamination on Raw Vegetables Food Traders in Pakusari District Jember Regency

Intestinal parasites are one of the leading public health problems worldwide, with an incidence of 24% worldwide and 45-65% in Indonesia. Intestinal parasites, especially intestinal worms, or soil-transmitted helminths (STH), significantly contribute to gastrointestinal diseases worldwide. Intestinal worm infections occur in rural and urban populations, especially in people who have the habit of eating with dirty hands, using unhygienic toilets, and consuming contaminated food, water, or soil. Fresh vegetables are a means that support parasitic intestinal infections, especially for traders who must be able to prevent intestinal worm contamination in fresh vegetables. Consumption of raw vegetables can be a source of intestinal worm infection, thereby increasing the prevalence of foodborne diseases. This type of research is analytic observational with a cross-sectional study design. Samples in the form of fresh vegetables were taken from fresh vegetable traders in Pakusari District, Jember Regency and then processed by the sedimentation method and then observed using a microscope to identify intestinal protozoa. Food safety knowledge was assessed using a questionnaire, and the behavior of food traders was assessed by researchers using observation sheets. The bivariate analysis showed that proper handwashing behavior was related to intestinal worms in fresh vegetables (p<0,05). Other knowledge and behavior variables were unrelated to intestinal worms' presence. The intestinal worm species found is a type of Hookworm.


INTRODUCTION
Intestinal parasites are one of the leading public health problems worldwide, with an incidence of 24% worldwide and 45-65% in Indonesia (Nasution et al., 2019). Fresh vegetables are a means that support the occurrence of parasitic intestinal infections, especially for traders who must be able to prevent intestinal worm contamination in fresh vegetables supported by contamination as much as intestinal worms have contaminated 61.2% of fresh vegetables in 128 samples (Karuppiah, 2017).
Intestinal worms, especially the Soil Transmitted Helminths (STH) group, are highly infectious microbes that can cause disease, especially in developing countries. Roundworms (Ascaris lumbricoides), hookworms (Necator americanus and Ancylostoma duodenale), and whipworms (Trichuris trichiura) are worms that cause infections in the human intestine. Infections due to intestinal worms seriously impact health problems, especially in Indonesia. Intestinal worm contamination in fresh vegetables can occur due to traders' lack of food safety knowledge regarding intestinal worm contamination in fresh vegetables sold and traders' need for hygiene behavior in cleaning fresh vegetables, handling unhealthy food, and unclean food equipment (Alfiani & Ginandjar, 2018 Research result (Alfiani and Ginandjar, 2018) 22 samples were examined, and there were 12 positive samples contaminated with parasites in fresh vegetable. Prior research (Wantini et al., 2019) found that there were 12 samples, and there were (58.3%) parasites in all samples tested on cabbage and (91.7%) on basil in this study. (Adrianto, 2018) there are four samples with a parasitic contamination level of (61.9%).
Based on statistical data from Pakusari District, Jember Regency, the number of residents who work as the second largest trader in Jember Regency and the geographical location of Pakusari Subdistrict, which is the main road between Jember Regency and Banyuwangi Regency makes Pakusari Subdistrict widely traversed by vehicles and stop by to buy food containing fresh vegetable. The lack of research on food safety knowledge and clean and healthy hygiene behavior among traders in Pakusari District, Jember Regency, makes researchers want to discuss knowledge and behavior as risk factors for intestinal worm contamination in fresh vegetable in Pakusari District, Jember Regency.

METHOD
This research is an observational analytic study with a cross-sectional approach. The population in this study were food sellers who contained fresh vegetables in Pakusari District, Jember Regency. Sampling in this study used a simple random sampling technique. Calculation of the sample size in this study using the Factors of food safety knowledge in fresh vegetable traders with the most yes answers were the components of the presence of animals and the risk of food contamination through disease (n=29; 96.7%).
The statement with the most no answers, namely the components of healthy food sellers, can also be carriers of disease 21 (70%), and those who answered yes were only nine respondents (30%).
Individual behavioral factors of research subjects were obtained through observations which included food sellers wearing clean clothes/aprons or head coverings, food sellers washing their hands properly every time they wanted to touch food, traders keeping their nails clean (not dirty and long nails), traders not using jewelry (rings)/bracelet), the food seller has no wounds or ulcers on his hands. The    The Chi-Square test was used to analyze the relationship between risk factors for the behavior of fresh vegetables sellers and STH in the fresh vegetable. The inspection of fresh vegetables is taken from fresh vegetables sold by traders. The analysis showed a relationship between knowledge of food safety and the presence of STH on the handwashing behavior factor (p = 0.005). Details of the risk factors for the behavior of fresh vegetable sellers with STH contamination can be seen in table 5.
A multivariate test was performed on variables that met the requirements of the bivariate test (p<0.25).
This study shows that there is only one variable with a significance value of <0.25, so the data in this study cannot be tested with multivariate.

Factors of Food Safety Knowledge and Individual Behavior
The knowledge factor of using gloves when cooking can reduce the risk of food contamination in this study was dominated by respondents who agreed with the statement, namely 28 respondents (93.3%) and two respondents (6.7%). The percentage is the same as the research conducted by Irianti (2022), which is equal to (93.3%) who agree and (6.7%) who disagree. The understanding of fresh vegetable sellers regarding the use of gloves when processing food, of course, can prevent the transmission of STH from humans to vegetables and vice versa.
The knowledge factor about the use of jewellery on the hands can increase the risk of food contamination in this study; most of them agree with the 20 respondents (66.7%), and those who do not agree with as many as 10 respondents (33.3%). These results align with Sitepu's research (2015) jewellery when touching food can lead to cross-contamination between jewellery and food. The skin under jewellery is a good place for microbes to breed (Triandini, 2015).
The knowledge factor of respondents in using different cooking utensils in handling raw and cooked food can minimize the risk of food contamination. In this study, 28 respondents (93.3%) agree, and 2 respondents (6.7%) disagree. This study aligns with research conducted by Ncube (2020) (Restianida, 2018).
The knowledge factor about putting unprocessed food in the refrigerator can prevent food poisoning in this study. Most respondents agreed with 26 (86.7%) respondents, and 4 disagreed (13.3%). These results are slightly different from the research conducted by Khotimah (2015), with results with all respondents agreeing to all respondents (100%). The difference in results can be caused by the number of respondents being much less than in this study, and the respondents in this study were under the supervision of certain agencies.
The knowledge about raw vegetable is more potentially infectious than as many as 25 respondents answered cooked vegetables agreed (83.3%), and 5 respondents disagreed (16.7%). This study result is more than the research conducted by Akabanda (2017), in which only 40.9% agree. Vegetables served cooked will eliminate the benefits of these vegetables than served raw. Raw and fresh vegetables can potentially transmit the disease; therefore, raw vegetables must be washed using running water to avoid the transmission (Adrianto, 2017).
The knowledge factor about a food handler who suffers from diseases such as diarrhea, sore throat, syphilis and flu poses a risk of food contamination in this study, almost all respondents agreed with a total of 29 respondents (96.7%), and only one disagreed (3,3%). This study is the same as the research conducted by Ncube (2020), with 99% of respondents agreeing. Pathogens in traders who suffer from infectious diseases can contaminate the food these traders are processing. These pathogens can transfer to food consumers from processing traders with infectious diseases (Okarini, 2017).
The sellers' knowledge that healthy food can be a carrier of diseases was disagreed with by most respondents (70%), and only 9 respondents agreed (30%  (2020), with the percentage of respondents who agree as much as 78.2%. Food handlers who carry pathogens can contaminate the products or foodstuffs they process and endanger consumers' health.
The habit of smoking, whistling, coughing, sneezing, and not wearing PPE when touching food can contaminate food even though the food handler is in good health (Tappes et al., 2019).
The behavioural factors of food sellers who wear clean clothes/aprons or head coverings in this study were 14 respondents (46.7%), and more respondents who did not do so were 16 respondents (53.3%). The results of this study are less than the research conducted by Suryani (2019), with as many as 60% of respondents wearing clean clothes or head coverings. Food handlers are recommended to use clean clothes/aprons when processing food so that no remnants of dirt attached to the clothes do not transfer to the processed food and the use of head coverings for traders, can avoid the risk of dirt on the head hair being transferred to the processed food (Nurhayati, 2020).
The results of the observation of the behavior of food sellers who wash their hands properly each time they want to touch food in this study are as many as 21 respondents washing their hands properly (70%) and respondents who still have not washed their hands properly and correctly, as many as 9 respondents (30%).
The behavior of the respondents in this study was more than the research conducted by Mulyani (2020); as many as 41.9% of the respondents had clean and healthy handwashing behavior. Proper handwashing behavior is significant for traders before and after processing food. Because proper handwashing can eliminate microorganisms on hands, prevent cross-infection, and maintain sterile conditions (Kurniawati et al., 2022).
The behavior of traders who keep their nails clean when processing food in this study, 23 respondents (76%), and those who have not kept their nails clean are 7 respondents (23.3%). This study aligns with research conducted by Augustin (2015), which is as much as 80% of traders' behavior in maintaining nail hygiene. Traders with long nails can make it easier for microbes to stick to and increase the risk of transferring these microbes to processed foods, so keeping nails clean by trimming them regularly can prevent and reduce the risk of contamination of food (Retno Hestiningsih et al., 2019). STH can enter between the leaves of cabbage vegetables and also stick to the basil leaves (Lobo, 2019).
Climate factors and high humidity are suitable for developing STH eggs and larvae into infective forms (Nugraheni et al., 2018).
Sanitary hygiene also affects the presence of STH in food. The selection of good food ingredients, such as choosing clean and fresh vegetables, makes the possibility of finding STH in vegetables relatively low.
Maintaining food hygiene and reducing the risk of food contamination can be done by suitable food processing methods, such as removing damaged parts of vegetables and washing fresh vegetables using running water before serving. Worm eggs on the ground or dust will reach the food if blown away by the wind. Serving fresh vegetables to fresh vegetable traders in an open place and next to the road can be exposed them to dust (Safitri et al., 2019). The finding of STH in this study was relatively less because most traders store food in closed containers/containers making the risk of food being exposed to dust less.
Another study conducted by Mutianigsih (2016) and Safitri (2019) regarding STH identification obtained negative results; namely, no STH contamination was found in fresh vegetables. These results are also inconsistent when compared with this study. The absence of STH contamination in fresh vegetables could be due to the better sanitation of the research respondents and the smaller number of samples than in this study.
All STH species found in fresh vegetables in this study were hookworms. This research is in line with the research conducted by Amin (2021)  Sihombing (2017)  Celsius to avoid microbial contamination. In contrast, meat and fish types of food are stored in closed, frozen storage (Jiastuti, 2018).
The study's results regarding the knowledge factor about raw vegetables being more potentially infectious than cooked vegetables in this study showed no significant relationship (p = 0.414) to the presence of STH.
Twenty-five respondents agree, and five other respondents do not agree. The absence of a significant relationship between knowledge about raw vegetables being more potentially infectious than cooked vegetables and the presence of STH in this study could be caused by five respondents who disagreed and did not have a positive result of STH contamination in fresh vegetable samples. Raw vegetables are more likely to spread food-borne diseases than vegetables processed at high temperatures (Adrianto, 2017).
The results of the study regarding the knowledge factor about a food handler suffering from diseases such as diarrhea, sore throat, syphilis and flu that can pose a risk of food contamination showed that there was no significant relationship (p=0.735) to the presence of STH. Most respondents know that a food handler who suffers from an illness can pose a risk of food contamination. Twenty-nine respondents agree, and only one respondent does not agree. The absence of a significant relationship in this study could be due to the absence of STH in the vegetable samples of respondents who disagreed. Food handlers who suffer from diseases that do not maintain personal hygiene, such as not washing their hands or wearing masks, can transmit the disease through faecal-oral (Jiastuti, 2018). Food contamination can occur due to pathogens in traders, which can be transferred to consumers who consume food (Okarini, 2017 respondents in this study maintained good nail hygiene by 77.8%, which could be an insignificant relationship factor to STH contamination in fresh vegetables. Food handlers have a massive role in processing food and preventing food contamination by microbes (Pasanda, 2016).
The study's results on the behavioral factors of traders who did not use jewelry on their hands, there was no significant relationship (p=1,000) to STH contamination in fresh vegetables. Twenty respondents do not use jewelry on their hands, and ten respondents use it. Research conducted by Fitria (2018), which contains the use of jewelry on the hands of food handlers, shows that knowledge of food hygiene and poor food hygiene behavior can increase the risk of disease transmission from food. The insignificant results in this study can be caused by ten respondents using jewelry while maintaining good hygiene behavior such as washing hands (Anita et al., 2013).
The study's results on the behavior of traders who did not have wounds or ulcers on their hands, there was no significant relationship with the presence of STH in the sample of fresh vegetables (p = 0.735). Twentynine respondents do not have injuries, and only 1 respondent has wounds on his hands. These results are in line with research conducted by Efelieni (2022) with results in this study that there was no significant relationship between personal hygiene and the presence of STH in vegetables containing traders treating or closing wounds on their hands. The insignificant result in this study can be caused by respondents who have wounds on their hands and cover the wound using gloves. Wounds are a source of pathogens and a source in the chain of pathogen transfer into food (Rambe, 2021). The presence of wounds on the hands of food handlers can increase the risk of food contamination. Food handlers who have wounds on their hands must treat and cover the wounds to prevent cross-contamination.

CONCLUSION
The conclusion of this study based on the results and discussion related to factors of food safety knowledge and behavior of fresh vegetable traders with the presence of STH on fresh vegetable in Pakusari District, Jember Regency, namely the characteristics of fresh vegetables traders in Pakusari District, Jember Regency in this study dominated by women, aged 46-55 years, selling 6-10 years old, and most of them have higher education (SMA/equivalent), the distribution of STH species in fresh vegetables sold by traders in Pakusari District, Jember Regency, namely Hookworm, all factors of knowledge of food safety of fresh vegetables traders are not related to the presence STH, a behavioral risk factor associated with the presence of STH, is found in the behavioral factor of washing hands before touching food.