Hygiene knowledge, attitudes and practices among dairy value chain actors in Assam, north-east India and the impact of a training intervention

Figures & data

Figure 1. Map of India showing the location of the state of Assam, and the districts within the state.

Table 1. Participants in the 2009 survey in Assam, India.

	Barpeta	Jorhat	Kamrup	Sonithpur	Total
Producers	58	46	222	79	405
Traders	27	27	84	37	175
Sweet sellers	19	30	99	72	220
Total	104	103	405	188	800

Table 2. Producers and traders interviewed in 2012 in Jorhat and Kamrup district, Assam, India, in a study of the impact of a training intervention on knowledge and attitudes.

	Jorhat	Kamrup
	Untrained	Trained	Untrained	Total
Producers	49	53	59	161
Traders	36	122	68	226

Table 3. The number of dairy cows at farms in the survey in 2009 and 2012 in Assam, India.

District	Mean cows 2009	Proportion cows currently in lactation	Mean cows 2012	Proportion cows currently in lactation
Barpeta	5.14	0.84
Jorhat	11.65	0.66	8.0	0.69
Kamrup	21.09	0.56	17.1	0.66
Sonithpur	9.72	0.57
Overall	15.53	0.62	14.3	0.67

Table 4. Producer and traders interviewed in Assam, India, for their knowledge about disease transmission from milk and dung, and the belief if milk is safe after boiling. The results from comparison between the 2009 and 2012 surveys are shown, as well as the comparison between trained and untrained participants from the 2012 survey.

	Believe diseases can be transmitted from dung	Believe diseases can be transmitted from milk	Believe milk is completely safe after boiling
Milk producers
2009	2.7% (11/404)	13.0% (52/401)	96.0% (380/396)
2012	37.2% (60/161)***	35.4% (57/161)***	93.1% (148/159)
Trained (2012)	69.8% (37/53)***	64.2% (34/53)***	86.8% (46/53)*
Untrained (2012)	21.3% (23/108)	21.3% (23/108)	96.2% (102/106)
Milk traders
2009	1.1% (2/175)	9.1% (16/175)	89.1% (156/175)
2012	47.1% (106/225)***	41.5% (93/224)***	93.8% (212/226)
Trained (2012)	63.9% (78/122)***	64.8% (79/122)***	91.8% (112/122)
Untrained (2012)	27.2% (28/103)	13.7% (14/102)	96.2% (100/104)*^a

***Significant difference at p < 0.001 between 2009/2012 or between trained/untrained. *Significant difference p < 0.05 between trained and untrained. *^aSignificant difference p < 0.05 between 2009 and untrained in 2012.

Table 5. Diseases that can be transmitted by milk suggested in two surveys among milk producers and traders in Assam, India.

	Tuberculosis	Food poisoning/gastrointestinal disease	General disease symptoms (fever, cough, cold)	Worms
Producers
2009	3.5% (14/405)	18.3% (74/405)	0.3% (1/405)	4.7% (19/405)
2012	8.7% (14/161)**	36.0% (58/161)***	11.2% (18/161)***	9.3% (15/161)*
Trained (2012)	18.9% (10/53)***	64,2% (34/53) ***	20.8% (11/53)**	9.4% (5/53)
Untrained (2012)	3.7% (4/108)	22.2% (24/108)	6.5% (7/108)***^a	9.3% (10/108)
Traders
2009	4.0% (7/175)	9.7% (17/175)	0% (0/175)	2.9% (5/175)
2012	13.7% (31/226)***	42.9% (97/226)***	11.5% (26/226)***	4.0% (9/226)
Trained (2012)	23.8% (29/122)***	61.5% (75/122)***	20.5% (25/122)***	6.6% (8/122)*
Untrained (2012)	1.9% (2/104)	21.2% (22/104)**^a	1.0% (1/104)	1.0% (1/104)

Significant differences between trained and untrained in 2012, and between 2009 and 2012 depicted by *p < 0.05, **p < 0.01, ***p < 0.001. Significant differences between 2009 respondents and untrained 2012 respondent is depicted with the same symbols and an ^a

Table 6. Attitudes and believes regarding milk hygiene among milk producers, milk traders and sweet makers in Assam, India.

	Year	Agree	Neutral	Disagree
Milk producers
Good for cow to add water	2009	290 (71.9%)	77 (19.1%)	36 (9.0%)
	2012	115 (71.9%)	4 (2.5%)	41 (25.6%)
Cow manure is sacred*	2009	392 (97.3%)	9 (2.2%)	2 (0.5%)
You can tell if milk is safe by taste or sight	2009	387 (96.3%)	0 (0%)	15 (3.7%)
	2012	145 (90.1%)	2 (1.2%)	14 (8.7%)
A few specks of dirt in the milk is not harmful	2009	186 (46.1%)	83 (20.6%)	134 (33.2%)
	2012	54 (33.5%)	3 (1.8%)	104 (64.6%)
Costumers prefer cheap to good quality milk	2009	8 (2.0%)	19 (4.7%)	376 (93.3%)
	2012	4 (2.5%)	29 (18.0%)	128 (79.5%)
Milk traders
Good for cow to add water to the milk	2009	71 (40.6%)	77 (44.0%)	27 (15.5%)
	2012	139 (61.8%)	29 (12.9%)	57 (25.3%)
Cow manure is sacred*	2009	168 (96.0%)	6 (3.4%)	1 (0.6%)
You can tell if milk is safe by taste or sight	2009	174 (99.4%)	0	1 (0.6%)
	2012	208 (92.4%)	5 (2.2%)	12 (5.3%)
A few specks of dirt in the milk is not harmful	2009	44 (25.1%)	58 (33.1%)	73 (41.7%)
	2012	73 (32.4%)	1 (0.4%)	151 (67.1%)
Costumers prefer cheap to good quality milk	2009	0	12 (6.9%)	163 (93.1%)
	2012	10 (4.4%)	38 (16.2%)	178 (78.8%)
Sweet makers*
You can tell if milk is safe by taste or sight	2009	122 (55.7%)	41 (18.7%)	56 (25.6%)
A few specks of dirt in the milk is not harmful	2009	104 (47.3%)	26 (11.8%)	90 (41.0%)
Costumers prefer cheap to good quality milk	2009	6 (2.7%)	21 (9.6%)	193 (87.7%)

*Only assessed in 2009.

Table 7. Observations regarding cleanliness and hygiene among milk producers, milk traders and sweet makers in 2009 and 2012 in Assam, India.

	Barpeta	Jorhat		Kamrup		Sonitpur
	2009	2009	2012	2009	2012	2009
Milk producers, number*	58	46	47	220	111	79
Udder clean and dry*	41.4%^a	30.4%^a		43.2%^a		60.8%
Hygienic manure disposal	6.9%^a	2.2%^a		4.1%^a		0.0%^a
Milk free from dirt	89.7%	60.9%^ab	97.9%	57.7%^ab	97.3%	75.9%
Milk containers free from dirt and cracks	93.1%	58.7%	12.8%	79.7%	6.3%	26.6%
Clean clothes	12.1%^a	17.4%^a	70.8%	7.2%^ab	72.1%	2.5%^b
Milk traders, n	27	27	34	84	192	37
Milk free from dirt	100.0%^a	92.6%^a	100%	92.9%^a	94.8%	89.2%^a
Clean clothes	100.0%	29.6%^a	44.1%	22.6%^a	71.4%	2.7%
Hands free from jewellery*	92.6%	88.9%		78.6%		78.4%
Sweet makers*	19	30		88		72
Clean clothes	63.2%^a	30.0%^b		51.1%^a		27.8%^b

Numbers with the same superscript are not significantly different in the same row in 2009 (p < 0.05).

*This observation was only made in 2009.

Table 8. Laboratory results from analyzed milk from milk producers and milk traders in 2009 and 2012 in Assam, India.

Districts	Milk samples (in 100x dilution) containing Escherichia coli		Milk samples containing added water
Milk producers	2009	2012	2009	2012
Kamrup	96.4%	100%	97.8%	58.6%
Jorhat	100%	100%	89.4%	33.3%
Milk traders
Kamrup	100%	100%	98.8%	80.0%
Jorhat	100%	100%	100%	62.5%