Health effects of street vended fresh cut fruits: A randomized controlled trial in Bangladesh

Foodborne infections, particularly from street-vended fresh-cut fruits, are a growing public health concern in urban settings of developing countries. This study evaluated the gastrointestinal effects of consuming street-vended fruits in a randomized controlled trial (RCT) in Mymensingh, Bangladesh. A total of 300 participants were recruited and randomized into Treatment (n = 150) and Control (n = 150) groups. Treatment participants consumed guava, pineapple, or watermelon purchased from street vendors, while Control participants avoided street-vended fruits. Microbial analysis of fruits included total viable count (TVC), S. aureus, and E. coli. Participants recorded GI symptoms for 4 days post-intervention, with a 10-day follow-up. At least one GI symptom occurred in 41 (27.3%) treatment participants compared with 15 (10%) controls. Nausea affected 20 (13.3%) versus 2 (1.3%) participants (RR = 10, 95% CI: 2.38-42.03, p < 0.001), abdominal cramps 13 (8.7%) versus 0 (0%) participants (p < 0.001), and diarrhea 7 (4.7%) versus 0 (0%) participants (p = 0.02). Cox modeling indicated a markedly higher hazard of symptom development in the Treatment group (HR = 162.68, 95% CI: 21.53-1229.43, p < 0.001), while higher hygienic practice scores modestly reduced risk (HR = 0.90, 95% CI: 0.82-0.99, p = 0.028). Higher total viable counts (TVC 5.78-5.86 log CFU/ml) were strongly associated with weakness (r = 0.66, p < 0.001, OR=11.28), abdominal cramps (r = 0.56, p < 0.001, OR=6.16), and diarrhea (r = 0.51, p < 0.001, OR=6.73). E. coli (6-10% prevalence) showed the strongest correlations with abdominal cramps, weakness, and diarrhea (ρ = 0.69-0.78, p < 0.001), whereas S. aureus (20-34%) correlated primarily with weakness and abdominal cramps (ρ = 0.44-0.47, p < 0.001). Abdominal cramps, weakness, and diarrhea demonstrated the highest sensitivity to microbial contamination (AUC = 0.801-0.908). These findings provide robust evidence that consumption of street-vended fresh-cut fruits is associated with a significant increase in GI symptoms linked to microbial contamination, supporting behavioral interventions, such as consumer awareness and improved hygiene practices, and informing policy measures to enhance food safety and protect public health.