Perception and attitudes of street food vendors toward the healthiness of meals prepared and sold in Dodoma

Abstract Consumption of street meals among urban dwellers has become inevitable, especially in low‐ and middle‐income countries. It has been linked to higher incidence of dietary‐related diseases. Vendors' perceptions and attitudes toward the healthiness of meals can influence nutritional quality of the offered meals. Therefore, the study aimed to assess perceptions and attitudes of vendors toward healthy and unhealthy meals as well as the healthiness of meals they prepare and sell. A cross‐sectional study was carried out among 384 street food vendors. Face‐to‐face interviews were conducted using semistructured questionnaire. Pearson Chi‐square test and logistic regression analysis were used in comparing and testing for the association of perceptions and attitudes to vendors' characteristics. Street food vendors that took part in this study demonstrated good perceptions based on what they perceived to be healthy meals (58.33%) and positive attitudes (95.57%) toward preparation and provision of healthy meals. Perceptions were associated with sex (p = .007), education level (p = .002), and investment cost (p = .000). Results from logistic regression showed that better perceptions of healthy meals were associated with being female (OR = 2.46, p‐value < .031), having higher education (OR = 11.88, p‐value < .042), and vending experience of 1–5 years and more than 5 years (OR = 3.17, 2.95, p‐value < .019, .039, respectively) while having moderate investment cost showed significant lower chances of having better perceptions (OR = 0.33, p‐value < .001). Attitudes were associated with sex (p = .002), age (p = .002), marital status (p = .013), education (p = .009), and vending experience (p = .008). Female vendors, having 25 years of age and above, living with partners, with tertiary education, and having vending experience of more than 1 year had shown to have more positive attitudes toward healthy meals. Generally, street food vendors had good perceptions and attitudes toward healthy meals. This implies possible room for change and adoption of better ways of preparing meals. These findings could be used as a stepping stone in improving nutritional and healthy quality of street meals. Increased efforts are needed on the inclusion of nutritional aspects of healthy meals as they were merely considered by vendors. Future interventions on these vendors should focus more on male vendors, vendors with little vending experience, and little education as they had shown to have relatively poorer attitudes and perceptions compared to other groups.

meals. Perceptions were associated with sex (p = .007), education level (p = .002), and investment cost (p = .000). Results from logistic regression showed that better perceptions of healthy meals were associated with being female (OR = 2.46, p-value < .031), having higher education (OR = 11.88, p-value < .042), and vending experience of 1-5 years and more than 5 years (OR = 3.17, 2.95, p-value < .019, .039, respectively) while having moderate investment cost showed significant lower chances of having better perceptions (OR = 0.33, p-value < .001). Attitudes were associated with sex (p = .002), age (p = .002), marital status (p = .013), education (p = .009), and vending experience (p = .008). Female vendors, having 25 years of age and above, living with partners, with tertiary education, and having vending experience of more than 1 year had shown to have more positive attitudes toward healthy meals. Generally, street food vendors had good perceptions and attitudes toward healthy meals. This implies possible room for change and adoption of better ways of preparing meals. These findings could be used as a stepping stone in improving nutritional and healthy quality of street meals. Increased efforts are needed on the inclusion of nutritional aspects of healthy meals as they were merely considered by vendors. Future interventions on these vendors should focus more on male vendors, vendors with little vending

| INTRODUC TI ON
Globally, noncommunicable diseases (NCDs) have become among the major public health challenges (Budreviciute et al., 2020;WHO, 2013). They are accountable for about 71% (41 million people) of deaths worldwide, 77% of which occur in low-and middleincome countries (LMICs). In Tanzania, NCDs account for 27% of all deaths (MoHCDGEC, 2016). There are several key risk factors for NCDs such as the use of tobacco, excessive alcohol intake, physical inactivity, genetics, as well as unhealthy eating (WHO, 2021).
Unhealthy diets are of particular concern, and these diets are the ones with inadequate amount of fruits and vegetables, excess amount of salt and sugar, and constitute high amount of carbs, saturated fats, and trans fats (World Heart Federation, 2011). These diets are associated with higher risk of developing NCDs such as heart diseases, stroke, cancer, and diabetes and their consumption has also risen significantly, especially in urban areas (GBD Diet Collaborators, 2017).
The nutritional and health status of individuals is affected by the quality of meals that are available in the places they live, with urban areas being no exception (Sawyer et al., 2021). The rapid urbanization and economic improvement in urban areas of LMICs have led to a dietary transition due to an increased demand for meat, sugarsweetened beverages, and processed foods (Popkin, 2015;Sousa et al., 2022). Studies in low-and middle-income countries such as Tanzania, Uganda, and Nigeria have shown that there is an increase in consumption of meals lacking adequate fruits and vegetables, soft drinks, and sugar-sweetened beverages, as well as high consumption of fast foods (Dolislager et al., 2022;Pallangyo et al., 2020).
Nowadays, people increasingly spend more time away from homes due to income-generating activities and therefore have limited time to prepare meals (Hawkes et al., 2017). This has led to the need for inexpensive, convenient, and ready-to-eat meals that are offered around streets.
Street food vendors have become vital in the provision of daily meals among urban dwellers, especially in LMICs, where approximately 70% of the population depends on them (Rosales Chavez et al., 2021). However, its consumption has been linked to the provision of unhealthy and nutritionally unbalanced meals (Mamiro et al., 2019), making it a public health concern. The nutritional composition of street meals is contributed by both homemade and processed foods which are characterized by energy-dense foods per servings due to high carbohydrates and fat content in foods such as cakes, sweets, snacks, chips, pancakes, fried pastries, and main dishes. High sugary foods obtained from ultra-processed foods such as soft drinks and also from traditional/homemade beverages due to additional sugar in the drinks Bouafou et al., 2021;Steyn et al., 2014).
High sodium per serving which is highly contributed by salt used in meal preparations. Sources of protein in street meals are majorly of animal origin, foods like stewed meat, and sandwiches, with less from vegetables and plant sources (Albuquerque et al., 2020). Also, street meals are characterized by low provision of fruits and vegetables on servings offered and sometimes are not provided at all . The healthiness of street food meals is not only a result of its constituents, but it is also partly a result of the individual handlers who prepare and serve the food, i.e., street food vendors (Hossen et al., 2021). These vendors have not yet broadly embraced their roles in enhancing population and environmental health of the food system (Khongtong et al., 2014;Kolanowski et al., 2020). A report by WHO (2019c), has shown the nutritional inadequacy of street meals due to poor food preparations as conducted by vendors. Nutrition composition of these foods was found to be high in trans fatty acids and sodium due to the use of unhealthy ingredients during preparation such as too much salt and unhealthy fats.
While the increasing availability of street meals facilitates their consumption (Baidoe et al., 2020), the perception and attitudes of street food vendors on what it means in terms of the healthiness of the foods they prepare and sell are important. Most studies that have been conducted on street food vendors focused on their food safety and hygiene practices (Hassan & Fweja, 2020;Letuka et al., 2019;Ma et al., 2019;Madaki & Bavorova, 2019;Marutha & Chelule, 2020). Yet, street food vendors' perceptions and attitudes on the healthiness of foods being sold and provided are lacking. Their perceptions and attitudes on what healthy meals are, their composition, and their methods of preparation lead to meals being healthier have a great influence on the nutritional quality of the foods offered (Pinto et al., 2021).
Efforts on increasing street food vendors' perceptions and attitudes can be helpful in improving the nutritional quality of meals.
People tend to adapt what are perceived to be good practices and avoid the ones that are perceived to be bad (Aggarwal et al., 2014;Gebremariam et al., 2018;Van Der Velde et al., 2019). In Tanzania and other LMICs, studies on perceptions and attitudes have been useful in improving the quality of street foods, especially on the hygienic and sanitary practices (Letuka et al., 2021;Mlay, 1993;Ncube et al., 2020). Similar approaches can be useful in improving nutritional quality of these foods. Thus, to promote healthy eating as a global goal in tackling NCDs, a better understanding of street food experience, and little education as they had shown to have relatively poorer attitudes and perceptions compared to other groups.

K E Y W O R D S
attitudes, healthy meals, perceptions, street food vendors vendors' perception and attitudes on the healthiness of the foods they provide is needed. This will aid in planning better public health interventions that are based on pre-existing perceptions and attitudes consequently enhancing the quality of diets being offered in streets. Therefore, this study investigated street food vendors' perceptions and attitudes on healthy and unhealthy meals as well as the healthiness of foods offered in Dodoma.

| Study setting
This research was carried out in Dodoma Urban district, located in the central part of Tanzania ( Figure 1). It has a fast-growing population of approximately 2,083,588 as reported in the latest census (URT, 2013). It was selected for this study because it serves as the government's administrative center and as a result, immigration of human labor is a common feature in this area. Within the district, four wards (Nzuguni, Makole, Chang'ombe, and Majengo) were selected due to the high concentration of street food vendors and convenience for data collection.

| Study design and sampling procedure
A cross-sectional study using quantitative and qualitative approaches was used in a population-based sample between February and March 2022. The study included street food vendors based on the definition of street foods by FAO and WHO "ready-to-eat foods and beverages prepared and/or sold by vendors or hawkers, especially in the streets and other similar places" (FAO, 1988;WHO, 1996). Mobile street food vendors were excluded from the study. This study aimed at stationary vendors who permanently and on daily bases provide food to people around the markets and shops. Presumably, consumers can regularly and at any time obtain meals from these vendors. Therefore, their overall nutritional status is largely influenced by the consumption of these meals. A purposive sampling technique was employed to recruit the study participants. A total sampling size of 384 participants was calculated using Equation 1 (Kothari, 2004).
where n is the desired sample size. The presumptions that served as the foundation for the estimation were as follows: z is the standard normal deviation set as 1.96 corresponding to a 95% confidence interval, p is the proportion of expected attitudes and perceptions of street food vendors set as 50% (since there were no similar studies in Tanzania), and d is the margin of error set at 5%.
Because the majority of vendors were concentrated around the markets, sampling procedure started with the identification of the major markets present in Dodoma Municipal. From the selected markets, all the vendors that were in and around the markets were approached for consent to participate in the study and those who agreed were included. Thus, convenience sampling was used in the study. But due to demolitions of some of the markets, vendors kept on shifting from the market to other places. Taking into consideration the intended sample size, street food vendors who were out of the intended radius were also included in the study.

| Statistical analysis
Data were coded, entered, and analyzed using IBM SPSS statistics for Windows software, version 25 (IBM cop., Armonk, NY, USA).
Categorical variables were summarized using frequencies (n) and percentages (%). Attitude variables toward healthy meals were categorized into positive (score ≥4), neutral (score 3-3.9), and negative attitudes (score <3) (Alhashim et al., 2022). Perception questions that were used for categorizations were based on three items, which are (1) their idea of a healthy meal, (2) which food groups a healthy meal comprises, and (3)

| Ethical considerations
The study was conducted according to research criteria on studies involving human participants and approved by the Tanzania National Nzuguni, and Chang'ombe). All the street sellers were informed of the study's goals, were given the opportunity to ask any questions they had, and provided informed verbal and written consent.

| Vendors' perceptions on healthy and unhealthy meal
According to FAO (2019)

| Attitudes toward healthy meals and their provision
Most street food vendors agreed or strongly agreed that a healthy meal has a variety of foods/ingredients or food groups, is safe, right proportioned, promotes and sustains health (99.0%), and that vendors should provide healthy meals to consumers (99.0%) (Figure 3).
Most respondents agreed that unhealthy diets can cause healthrelated diseases (96.0%), particularly that a lot of fats/oils in food are bad for one's health (99.0%). The majority of respondents also considered that they prepare healthy meals (89.0%). Around 93.0% of the respondents agreed that the inclusion of fruits and vegetables is a required part of meals served; however, a lower proportion (74.0%) agreed that it is important to consider the energy content of the meals being served.
There was a significant association between vendors' attitudes and the respondent's sex, age, marital status, education, and vending experience ( Table 4). Participants who had a higher positive attitude TA B L E 1 Sociodemographic characteristics of the street food vendors interviewed (n = 384).

| DISCUSS ION
This study explored the perceptions and attitudes toward healthi-

| Perception of street food vendors
The perceptions of healthy meals that were found in this study were related to the improvement of health of the consumers as healthy meal is considered to be the one that can protect one from malnutrition and dietary-related diseases. However, it was found that vendors still lack adequate information pertaining to a healthy meal. This was observed when vendors explained their perception of a balanced meal where some perceived it to be the one having more than two kinds of foods regardless of the food groups, e.g., a meal consisting of stiff porridge, meat, and beans would be considered as balanced. In order to ensure accurate information, especially regarding a balanced diet, it is important for vendors to be introduced to and be familiarized with "My Plate Guidelines", which gives a proper guide in ensuring meals prepared are adequate (Cohen et al., 2017).
Safety of the food from proper preparation to clean utensils were also among the aspects considered by vendors. This is in contrast with the vendor's perspectives obtained in the study conducted in Nigeria, where vendors did not show concern on hygiene, cleanliness, and safety issues (Nordhagen et al., 2022). Although studied vendors were concerned, ensuring clean environment during meal preparation and meal serving is still a challenge due to a lack of appropriate facilities such as sewage and proper waste disposal systems, as well as lack of clean and safe water. The way foods are F I G U R E 2 Vendors' perceptions about the meaning of (a) healthy and (b) unhealthy meals (n = 384).
prepared and cooked is an essential step in ensuring the healthiness of a meal (Mills et al., 2017) This is most likely due to women being more concerned with the healthiness of diets taken and thus being more aware of healthy meals (Perry et al., 2016). These results call for more efforts toward male vendors whose contribution to provision of street meals is not negligible.
Formal education was found to play a part in influencing better perceptions of healthy meals among the vendors. This is most likely due to their exposed knowledge of issues related to food and health.
In schools, people get exposed to issues related to safe and healthy meals and particularly on how to ensure food safety and appropriate food preparations. Education can influence perception, as was found in the study by Williams et al. (2014) in which health perceptions of individuals improved after an education intervention was con- that meal providers preferred to consider their customers' needs and provide meals and food items that meet those needs.

| Attitudes of street food vendors
Based on the results from this study, vendors have a generally positive attitude toward preparation of nutritious and healthy meals. The attitudes of the vendors were satisfactory, except for the healthiness of their own meals, as well as the importance of considering the energy content of the foods they offer, which were slightly lower.
The attitudes of street food vendors regarding healthy eating have a significant impact on how well meals are prepared. Thus, there is a strong linkage between positive attitudes of street food vendors in preparing, offering, and maintaining healthy street meals (Tuglo et al., 2021). This could be an opportunity to intervene with street food vendors, who might be more willing to take part, for instance, in nutritional education efforts meant to change and adopt better meal preparations. serve. Calorie/energy content of food is an important nutritional aspect that needs to be considered when serving meals to people of different age groups and occupations (Institute of Medicine, 2011).
Street food vendors that participated in this study seemed to be less troubled by this fact; therefore, efforts should be made during interventions to ensure maximum coverage of necessary nutritional aspects that are required in preparing and serving nutritious and healthy meals.
The findings of the current study showed that positive attitudes toward healthy meals and the healthiness of meals prepared and sold by street food vendors were significantly associated with participants' sex (females), education level (primary to tertiary education), and vending experience (more than 1 year). Relatively more female vendors had a positive attitude than male vendors. This finding aligns with the traditional social context, where females typically seek healthier meals than males (Oakes & Slotterback, 2001). It also urges any future interventions made to motivate the male vendors. It has been claimed that education is crucial in raising street food vendors' awareness of food nutrition and thereby improving their attitudes to healthy meals (WHO, 2015). In Vietnam (Huynh- Van et al., 2022) and Bangladesh (Hossen et al., 2021), for example, significant effects of education level on food safety attitudes of food handlers were observed. Although marital status was not statistically significant, it has been identified that married individuals are often linked to more access to health information and resources (Sujarwoto et al., 2022).
Previous studies have found a statistically significant association between marital status and vendor attitudes, with those married having a more positive attitude (Alhashim et al., 2022;Mukherjee et al., 2018). This is in agreement with the present study's findings, as those who were married had higher attitude scores. TA B L E 4 Distribution of street food vendors' attitudes toward healthy meals and healthiness of the meals they prepare and sell.
that concern for healthy meals exists within the street food sector of the informal economy, but is still to a large extent market-driven, as attitudes most likely relate to the desires and economic capacity of the consumers of street food.

| CON CLUS ION
This study concludes that the majority of vendors had good perceptions and positive attitudes toward healthy meals, although nutritional aspects of healthy meals were not of much concern. These findings imply that there is a chance for willingness of street food vendors to improve the quality of their meals.

| Strengths and limitations
This was one of the few studies to explore perceptions and attitudes of street food vendors regarding the healthiness of meals sold in Urban Area -Tanzania. Thus, the findings may provide baseline information for public health practitioners to design and implement an evidence-based intervention across the country to improve the quality of meals offered on the streets. Additionally, the study employed a population-based sampling procedure that aptly represented the population of street food vendors' perspectives and attitude in Tanzania in general and specifically in Dodoma city. The limitations of this study include the cross-sectional nature of the study design, which does not allow establishment of cause and effects of the obtained information. Further studies that incorporate a longitudinal observational design should be looked into. This will provide more insights into the cause-effect relationship in regard to the perceptions and attitudes of street food vendors toward the healthiness of meals prepared and sold and their changes over time.

ACK N OWLED G M ENTS
The authors would like to thank the street food vendors for their participation and to all those who contributed to the accomplishment of this work in one way or another.

FU N D I N G I N FO R M ATI O N
This study was privately sponsored by the authors.

CO N FLI C T O F I NTE R E S T S TATE M E NT
The authors declare no conflict of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.