Consumption of porridge at Carcinogenic Temperature and Associated Factors in Esophageal Cancer Endemic Area in Ethiopia

Consumption of porridge at Carcinogenic Temperature and Associated Factors in Esophageal Cancer Endemic Area in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Consumption of porridge at Carcinogenic Temperature and Associated Factors in Esophageal Cancer Endemic Area in Ethiopia Haji Aman Deybasso, Kedir Teji Roba, Tefera Belachew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2057079/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: - The consumption of a self-reported “hot porridge” was reported as a major dietary risk factor for the increased incidence of esophageal cancerin hot spot areas in Ethiopia. However, no study has quantitatively assessed the porridge consumption temperature and associated factors among households living in endemic areas in Ethiopia and elsewhere. Methods: - A community-based cross-sectional study was conducted from November 1 to December 30, 2020. The porridge temperature was measured using a digital thermometer (HANNA instruments®, Woonsocket, RI, US). Bivariate and multivariate logistic regression analyses were used to check the association between independent and dependent variables. Adjusted odds ratio and 95% confidence interval were used to measure of strengths of the association. Statistical significance was declared at a P-value of less than 0.05. Result: - A total of 301 (149 Wheat, 88 Maize, and 64 Barley) utensils of porridge were measured for consumption temperature. Eighty-four percent ( 95% CI: (79.7, 87.7%)) of the households commenced porridge consumption at a probably carcinogenic temperature ( > 65 ℃). Serving porridge in a wooden bowl(Qorii) (AOR=2.0, (95%CI: (1.008, 4.310)) and wheat porridge (AOR=4.6, (95% CI:(1.936,11.406) were independent determinants of the consumption of porridge at a probably carcinogenic temperature. Conclusion: - Substantial number of households in the study area consume porridge at an extremely higher temperature which may cause severe thermal injury to the esophagus. Households who consume wheat porridge and use a wooden serving utensil should wait until the porridge cools down to the optimum temperature for consumption. Porridge temperature esophageal cancer endemic area Arsi Zone Ethiopia Figures Figure 1 Figure 2 Figure 3 Introduction World Health Organization(WHO) describes the consumption of foods at > 65 ℃ as a probably carcinogenic temperature[1]. The risk was further established by systematic reviews and meta-analysis studies that identified positive associations between very hot foods and increased risk of esophageal cancer[2–4]. Particularly, Squamous cell carcinoma(SCC) rises by many folds when the temperature of the foods increases from 65 ℃ to ≥70 ℃ [5,6]. Ingestion of very hot foods causes burning, odynophagia, and a feeling of foreign body sensations in the chest during swallowing[6,7]. It can also alter the esophageal epithelium into cancer cells(8,9); and/or stimulates the formation of endogenous reactive nitrogen species and nitrosamines, and impair the barrier function of the esophagus to carcinogens[8]. Esophageal cancer (EC) is a malignant tumor that develops inside the esophagus as a result of an alteration in the epithelial lining[10]. It was infrequent in East, Central, and Southern Africa until the 1930s [11]. With gradual increases over time, eastern and southern Africa became the epicenter of esophageal carcinoma [12–14]. According to studies, populations living in EC endemic areas favor very hot foods [5,15]. For instance, a significant number of residents in the Golestan province of Iran and Tanzania drank tea and coffee at a mean temperature of > 65 ℃ and 70.6 ℃ respectively [5,14]. The highest ever recorded hot beverage drinking temperature (72.1℃) was reported from EC endemic areas in Kenya[16]. Arsi Zone is one of the hot spot areas in Africa`s EC cancer corridor (17) where EC is highly predominant among farmers living in rural areas [18,19]. The consumption of a self-reported “hot porridge” was reported as a major dietary risk factor for an increased incidence of esophageal cancer in the area [18–20]. Previous studies in EC endemic areas have focused on the determination of hot beverage drinking temperatures [14,16,21]. Food consumption temperature might be affected by individual preference, food texture, heat loss mechanisms, and adaptations to hot foods [22]. However, no study has quantitatively assessed the solid food consumption temperature among households living in endemic areas in Ethiopia and elsewhere. This study assessed the porridge consumption temperature and associated factors among households living in the Arsi Zone. The findings will be valuable to design culturally acceptable interventions for the prevention and control of EC in Ethiopia. Methods Study design, and setting This was a community-based cross-sectional study conducted from November 1 to December 30, 2020, in the selected districts of the Arsi Zone. Arsi Zone is located in Oromia Regional State in central Ethiopia. Esophageal cancer is mainly known as Kaansarii liqimsaa and Kaansarii Kokkee in the local language (Afaan Oromoo). Porridge, known as Marqaa , is usually prepared from barley, wheat, and maize crops. It is consumed as a principal diet by the majority of the population, consumed during Ramadan (Muslims’ fasting month), and during special events. The types of porridge, cooking, and serving vessels vary across the ethnic and religious backgrounds of the populations in the Zone. Traditionally, the wooden bowl(Qorii) is used as a porridge serving utensil [20]. The source populations were households that lived in the selected districts. The study populations were randomly selected households in the selected districts of the Arsi Zone. The household that did not report consuming porridge as their staple diet were excluded from the study. Sample Size Determination The sample size was determined using the formula required for estimating a single population means: n = Z 2 x s 2 / E 2 where n is the sample size required, Z is an index reflecting the degree of confidence/ certainty, and E is a margin of error. Again, the margin of error (0.56) was calculated using the formula: E= Z s x / √n) [23]. Whereas, the standard deviation ( 3.9) and the number of participants (188) were taken from the study finding that determined coffee drinking temperature in Tanzania[14]. The calculated sample size was multiplied with a design effect of 1.5. A 10% non-response rate was added giving a total of 309 utensils of porridge for measurements. Finally, 301 consented households were recruited for the study for the reason that porridge is consumed in a shared manner from a single serving utensil [20]. Sampling procedure and technique Two Districts (Doddota and Sude) were randomly selected from districts that had the largest proportions of EC cases in the Zone[24]. Then, two Kebeles (lowest administrative units) were randomly selected from each District. The sampling frame was prepared from the lists of family folders used by Health Posts (HPs) in respective kebeles. The households were recruited using a computer-generated simple random sampling technique. The sample size was proportionally allocated according to the population sizes. Finally, the households were categorized according to their preferences as maize, wheat, and barley porridge consumers. Data collection instrument and procedures Data were collected by four trained public health officers through interviewer-administered structured questionnaires and temperature recordings. The data collection protocol for porridge temperature measurement was adapted from previous studies[14,16]. The questionnaires focused on socio-demographic characteristics, porridge cooking places, types of grains for porridge, source of fuels, serving utensils, porridge serving temperature, fats added, porridge consumption temperatures, porridge temperature measurement time, and households` perceptions about the beginning porridge consumption temperature. Participants freely decided on types of grains for porridge, cooking places, cooking and serving materials, and the input used to mimic their usual dietary practices. The consumption temperature was recorded at the serving, beginning, middle, and end of consumption stages using a digital thermometer (HANNA instruments®, Woonsocket, RI, US). The temperature reading and recording were immediately performed after the thermometer temperature reached the maximum reading point (82.1 ℃) and stabilized at each stage. Quality assurance The questionnaires were prepared in English and translated to the local language (Afaan Oromoo) and later back to English by two different experts who were qualified in English and fluent in Afaan Oromoo. A pre-test was conducted among 5% of the total sample size from an up-to-date list of households in other Districts. The questionnaires were amended based on the feedback of the pretest study. The accuracy of the thermometer was confirmed by using cold water before each measurement. A thermometer was placed in the thickest part of the porridge without touching the serving utensils. The thermometer was cleaned with hot and soapy water after each use. The supervisors strictly followed the data collection procedures and feedback was given daily. Data processing and analysis Data were coded and checked for completeness, and consistency and entered into the EPI info version7, and imported into SPSS for Windows Version 21(SPSS, Illinois Chicago, USA) software for cleaning and analysis. A descriptive analysis was done for categorical variables. Independent samples t-test was computed to compare the differences in the mean porridge temperature inside the serving vessels and the porridge consumption temperature between Muslims and Christian households. The analysis of variance (ANOVA) was performed to find differences between the mean temperature of maize, barley, and wheat porridges at a 95% confidence level. The posthoc test was conducted to specifically identify the types of porridge that were significantly different from one another. Finally, the consumption temperature was categorized as “Probably carcinogenic” if the porridge consumption temperature is > 65 ℃ and not probably carcinogenic temperature if it is <65 ℃ [1]. The probably carcinogenic temperature was coded as `1’and not probably carcinogenic temperature was coded as ‘0’. Bivariate analysis was carried out to assess the crude association between the independent and the outcome variable. Variables with a p-value of up to 0.25 at the bivariate analysis were selected as candidates for multivariable logistic regression analysis to identify independent determinants of porridge consumption temperatures at a probably carcinogenic range. Hosmer–Lemeshow goodness-of-fit test was checked for the model. Multi-collinearity between the independent variable was also checked using standard error (≥2). The odds ratio with its 95% confidence interval was used as a measure of strengths of association. A P-value of less than 0.05 was used to declare statistical significance. Results Socio-demographic characteristics of the participants A total of 301 households were involved in this study giving a 97.4% response rate. The mean age of the participants was 43.1(±12.01) years. The majority of the participants (87.7%) were Muslims and all of them were married farmers residing in rural areas. Regarding their ethnicity, 297(98.6%) were from the Oromo ethnic group. The mean (± Standard deviation) family size of the households was 4.5(±1.1) (Table1). Porridge cooking processes Concerning the types of porridge, 149(49.5%), 88(29.2%), and 64(21.3%) were wheat, maize, and barley porridges respectively. The largest proportion of the households (95.3%) cooked their porridge in unventilated rooms. The overall average cooking time was 61.08 (±13.55) minutes. Muslim households completed cooking at 62.2(±13.6) minutes. The corresponding cooking time for Christian households was 52.5(±8.9) minutes [P<0.0001]. Of the total, 217(72.1%) households used firewood while others cooked porridge by using animal manure. Of the total households, 151 ( 50.2%) and 150 (49.8%) used butter and oil mixed with butter as added fats respectively. Porridge serving time and utensils The mean time from completing cooking to serving a maize porridge was 5.25(±3.1) minutes. The comparable serving time for wheat and barley porridge was 6.46(±4.0) and 6.6(±2.4) minutes respectively. A wooden bowl (Qorii) was used by 223 (74.0%) households as a porridge serving utensil while others used metal and plastic dishes [Additional file 1] . Porridge consumption temperature by serving utensils The average serving temperature inside wooden utensils and dishes was 75.05 (±3.7) ℃ and 73.6(±4.4) ℃ respectively. Households who used a wooden bowl began consumption at a temperature of 69.6(±4.1) ℃. On the other hand, households that used metal dishes consumed porridge at 67.6(±4.5) ℃ [P<0.001] (Table2). Porridge consumption temperature by types of porridge The overall mean (±SD) temperature upon beginning consumption was 69.1 (CI: 68.6, 69.6) 0 C. Wheat porridge consumers began consumption at 70.4 (95% CI: 69.7, 71.1) ℃. Whereas, barley and maize porridge consumers started at 67.1(95% CI: 66.3, 67.9) ℃ and 68.4(±4.2) (95% CI: 67.5, 69.3) ℃. The mean porridge consumption temperature at the middle stages was 65.4(95% CI: 64.5, 66.2) ℃, 63.6 (95% CI: 62.7, 64.6) ℃, and 64(95% CI: 63.0, 65.0) ℃, for wheat, barley, and maize porridges respectively. Furthermore, wheat and barley porridge consumers completed consumptions at a temperature of 61.01(95% CI:59.0, 62.4) ℃and 60 (95% CI: 58.8, 61.1) ℃ respectively. Maize porridge was consumed at 56.6(95% CI: 56.6,57.7)℃ at the end consumption stage (P<0.001) (Figure 1). Porridge consumption temperature by households’ characteristics Muslim households consumed porridge at 69.7(±4.1), 65.4(±4.4), and 59.7(±5.3) ℃ at the beginning, middle, and end consumption stages respectively. The porridge consumption temperature for Christian households at corresponding stages was 64.8(±3.3), 58.9(±4.4), and 53.9(±5.6) ℃ respectively (Figure2). Participants` perceptions of the porridge consumption temperature Participants were asked to designate the porridge consumption temperature as very hot, hot, warm, and cool compared to their usual eating patterns. Accordingly, 148(49.2%) reported that they consumed very hot porridge at the beginning consumption stage. On the other hand, 160(53.2%) and 144(47.8%) perceived that they consumed hot and warm porridge at the half and end consumption stage respectively. Porridge consumption at a probably carcinogenic temperature Of the total households, 84% (95% CI: (79.7, 87.7%)) began porridge consumption at a probably carcinogenic temperature. The practice was predominant among Muslim households where 230 (87.1%), 137(51.9%), and 49(18.6%) consumed porridge at a probably carcinogenic temperature at the beginning, middle, and end consumption stages respectively ( Figure 3). Factors associated with the consumption of porridge at a probably carcinogenic temperature On bivariable analysis, cooking places, religion, age of the participants, types of porridge, serving vessels, time from serving to beginning consumptions, fats added into the porridge, and source of fuels had a P-value ≤ of 0.25. The religious backgrounds of the households were removed from the analysis because of evidence of the multicollinearity with porridge serving vessels (SE> 2). Then, variables that had a P≤ of 0.25 were entered into the multivariable regression analysis. On the multivariable analysis, porridge serving utensils and types of porridge persisted to be significant predictors of the consumption of the porridge at a probably carcinogenic temperature. Accordingly, the odds of consuming porridge at a probably carcinogenic temperature were higher (AOR=2.0, (95%CI: (1.008, 4.310]) for households who consumed porridge from a traditional wooden bowl as compared to those who consumed porridge from dishes. Besides, wheat porridge consumers had higher odds of consuming porridge at a probably carcinogenic temperature (AOR=4.6, (95%CI :(1.936,11.406]) compared to maize porridge consumers (Table 3). Discussion This study assessed the consumption of porridge at a probably carcinogenic temperature and associated factors among households living in EC endemic areas in Ethiopia. In this study, households began porridge consumption at a temperature of 69.1℃. The porridge consumption temperature was the second hottest food consumption temperature ever recorded in EC endemic area [16] and comparable to the very hot coffee drinking temperature in endemic areas in Tanzania[14]. Moreover, the porridge consumption temperature in this study was hotter than the maximum thresholds for hot potatoes, the temperature that was linked to tongue injury and mouth pain [25,26]. The study showed that 84% of the households in the study area consumed porridge at a probably carcinogenic temperature. The practice of consuming porridge at a carcinogenic temperature was higher than the proportion of households who consumed very hot foods in Iran [7] but lower than the study result in Kenya[16]. On the other hand, the finding supports a qualitative study that reported preferences for very hot porridge by the majority of households living in the study areas[20]. In this study, there were statistically significant differences in the mean porridge temperature between different types of porridges. Hence, wheat porridge was significantly hotter than barley and maize porridge in the beginning and end consumption stages. Furthermore, barley porridge was also significantly hotter than maize porridge at the end consumption stage. However, in further analysis, only wheat porridge had a significant positive association with the consumption of porridge at a probably carcinogenic temperature compared to maize porridge. The finding supports a qualitative study in the area that demonstrated the perceived heat retention ability of wheat porridge compared to porridge cooked from barley and maize [20]. The probable explanation could be porridges cooked from different grains may display disparities in the convective and/or evaporative heat loss mechanisms. This study exhibited that porridge served in a wooden utensil was persistently hotter by 1.9 0 C, 2.8 0 C, and 3.0 0 C at the beginning, middle, and end of porridge consumption stages respectively compared to porridge served in dishes. Furthermore, there was a statistically significant positive association between serving porridge in a wooden utensil and increased odds of consuming porridge at a probably carcinogenic temperature. The finding is in line with a study that reported disparities in hot food temperature that are associated with heat energy transfer of the food containers [27]. Besides, cultural variation across ethnic and religious backgrounds could be a possible reason for such differences. The consumption of porridge at a very hot temperature could be the major culprit behind the increased incidences of EC in the study area for the following conceivable reasons. Because of its solid nature, increased surface area, and contact time very hot porridge may be more carcinogenic than hot beverages that rapidly fall to the stomach[27]. Additionally, cooking porridge at a higher temperature may generate heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons which are highly damaging carcinogens [1]. Besides, repeated inflammations from frequent consumption of very hot porridge may augment tumorigenesis, cellular transformation, proliferation, invasion, and metastasis of the cancer cells among exposed populations[8]. Strength and limitation The strength of the study is that it is the first study that verified the porridge consumption temperature among populations living in the EC endemic area in Ethiopia. The study covered porridge cooked from different grains. We acknowledge the following limitations. Since porridge consumption is traditionally practiced in a shared manner, it was difficult to measure the differences in the porridge consumption temperature between family members. Determining the exact contact temperature for porridge was beyond the capacity of the researchers. Future research should focus on investigating the presence of PAHs and potential chemical contaminants in porridge. Conclusion A substantial number of households in the study area consume porridge at an extremely higher temperature which may cause severe thermal injury to the esophagus. Serving utensils and the type of porridge showed significantly positive associations with the consumption of porridge at a probably carcinogenic temperature. Households who consume wheat porridge and use a wooden serving utensil should wait until the porridge cools down to the optimum temperature for consumption. Abbreviations ANOVA: Analysis of variance AOR: Adjusted odds ratio EC: Esophageal cancer HCA: Heterocyclic amines HPs: Health Posts OR: Odds Ratio PCA: Polycyclic aromatic hydrocarbons SCC: Squamous cell carcinoma SPSS: Statistical Package for the Social Science USA: United States of America WHO: World Health Organization Declarations Acknowledgments The authors are very grateful to the Arsi Zonal, District health offices, and local administrations for their support and contributions. Data collectors, health extension workers, and participants deserve special appreciation. Authors' Contributions Deybasso HA contributed to the study conception, design, data acquisition, analysis, and drafting of the first version of the manuscript. Kedir.t.roba and BT advised on the study design, data acquisition, statistical analysis, and the final version to be published. All authors read and approved the final manuscript. Funding No fund was received. Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients. Ethical permission to carry out the study was obtained from the Institutions Research Board (IRB) of Jimma University. Approval of the research activity was sought from Zonal, District health, and administration offices before the study was carried out. Confidentiality of the data was maintained by avoiding names and other personal identifiers known or written in the questionnaires. Consent for publication Not applicable. Competing interests The authors declare no competing interests Authors details 1 Adama Hospital Medical College, Department of Public Health, Adama, Ethiopia 2 Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia 3 Jimma University, Department of Human Nutrition and Dietetics, Jimma, Ethiopia References IARC. Working Group on the Evaluation of Carcinogenic Risks to Humans, International Agency for Research on Cancer, World Health Organization (Eds.). Household use of solid fuels and high-temperature frying, IARC monographs on the evaluation of carcinogenic risks to humans. International Agency for Research on Cancer; Distributed by WHO Press, Lyon, France : Geneva.2010. Zhang J, Zhou B, Hao C. Coffee consumption and risk of esophageal cancer incidence: A meta-analysis of epidemiologic studies. Medicine (Baltimore) [Internet]. 2018;97(17):e0514. Available from: http://journals.lww.com/00005792-201804270-00051 . Chen Y, Tong Y, Yang C, Gan Y, Sun H, Bi H, et al. Consumption of hot beverages and foods and the risk of esophageal cancer: a meta-analysis of observational studies. BMC Cancer [Internet]. 2015;15(1):449. Available from: http://www.biomedcentral.com/1471-2407/15/449 . Islami F, Pourshmas A, Semnani S. Prevalence of esophageal cancer risk factors among Turkmen and non-Turkmen ethnic groups in a high incidence area in Iran. Arch Iran Med. 2010;13(2):111. Islami F, Boffetta P, Ren JS, Pedoeim L, Khatib D, Kamangar F. High-temperature beverages and foods and esophageal cancer risk-A systematic review. Int J Cancer [Internet]. 2009;125(3):491–524. Available from: https://onlinelibrary.wiley.com/doi/ 10.1002/ijc.24445 Wu M, Liu A-M, Kampman E, Zhang Z-F, van’t Veer P, Wu D-L, et al. Green tea drinking, high tea temperature and esophageal cancer in high- and low-risk areas of Jiangsu Province, China: A population-based case-control study. Int J Cancer. 2009;124(8):1907–13. Islami F, Malekshah AF, Kimiagar M, Pourshams A, Wakefield J, Goglani G, et al. Patterns of Food and Nutrient Consumption in Northern Iran, a High-Risk Area for Esophageal Cancer. Nutr Cancer. 2009;61(4):475–83. Aggarwal BB, Shishodia S, Sandur SK, Pandey MK, Sethi G. Inflammation and cancer: How hot is the link? Biochem Pharmacol [Internet]. 2006;72(11):1605–21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0006295206003893 Silberman M, Jeanmonod R. Aerodigestive Tract Burn from Ingestion of Microwaved Food. Case Rep Emerg Med [Internet]. 2013:1–3.: http://www.hindawi.com/journals/criem/2013/781809/ Napier, K.J. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J. Gastrointest. Oncol. 2014. 6, 112. https://doi.org/10.4251/wjgo.v6.i5.112 . Sammon, A.M., scoafrica.org (Organization). Squamous cancer of the oesophagus in Africa. gjhs.ccsenet.org Global Journal of Health Science. 2009. Vol. 13. Parkin, D.M., Bray, F., Ferlay, J., Jemal, A. Cancer in Africa 2012. Cancer Epidemiol. Biomarkers Prev. 2014; 23, 953–966. https://doi.org/10.1158/1055-9965.EPI-14-0281 . Middleton, D.R.S., Bouaoun, L., Hanisch, R., Bray, F., Dzamalala, C.,et.al. Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends. Cancer Epidemiol. 2018;53, 119–128. https://doi.org/10.1016/j.canep.2018.01.020 . Munishi MO, Hanisch R, Mapunda O, Ndyetabura T, Ndaro A, Schüz J, et al. Africa’s oesophageal cancer corridor: Do hot beverages contribute? Cancer Causes Control. 2015 ;26(10):1477–86. Available from: http://link.springer.com/ 10.1007/s10552-015-0646-9 Lin J, Zeng R, Cao W, Luo R, Chen J. Hot Beverage and Food Intake and Esophageal Cancer in Southern China. Asian Pac J Cancer Prev. 12(9):2189–92 Mwachiro MM, Parker RK, Pritchett NR, Lando JO, Ranketi S, Murphy G, et al. Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Cancer Epidemiol [Internet]. 2019;60:60–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1877782119300153 . Schaafsma T, Wakefield J, Hanisch R, Bray F, Schüz J, Joy EJM, et al. Africa’s Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies. Meliker J, editor. PLOS ONE [Internet]. 2015;10(10):e0140107. Available from: https://dx.plos.org/10.1371/journal.pone.0140107 . Shewaye AB, Seme A. Risk factors associated with oesophageal malignancy among Ethiopian patients: a case control study. East Cent Afr J Surg [Internet]. 2016;21(2):33. Available from: http://www.ajol.info/index.php/ecajs/article/view/147682 . Bulcha G., Leon M., Gwen M, Abnet C., Sime A, Pritchett N., et al. Epidemiology of Esophageal Cancer (EC) In Oromia Region, Ethiopia 2016: A 4-Year Medical Record Review. J Glob Oncol [Internet]. 2018;4(Supplement 2):14s–14s. Available from: https://ascopubs.org/doi/10.1200/jgo.18.41700 . Deybasso, H.A., Roba, K.T., Belachew, T., Perceived role of hot food in the pathogenesis of oesophageal cancer: a qualitative study in the Arsi Zone, Oromia, Central Ethiopia. J. Nutr. Sci. 10, e1. 2021; https://doi.org/10.1017/jns.2020.53 . Castellsague, X., Munoz, N., De Stefani, E., Victora, C.G., Castelletto, et.al. Influence of mate drinking, hot beverages and diet on esophageal cancer risk in South America. Int. J. Cancer.2000; 88, 658–664.4. Food, Health and Safety in Cross-Cultural Consumer Contexts [Internet]. MDPI; 2021 [cited 2022 Apr 1]. Available from: http://www.mdpi.com/books/pdfview/book/4040 Arifin WN. Introduction to sample size calculation. Educ Med J. 2013 ;5(2). Available from: http://eduimed.usm.my/EIMJ20130502/EIMJ20130502_10.pdf . Deybasso HA, Roba KT, Nega B, Belachew T. Clinico-Pathological Findings and Spatial Distributions of Esophageal Cancer in Arsi Zone, Oromia, Central Ethiopia. Cancer Manag Res. 2021;13:2755–2762 https://doi.org/10.2147/CMAR.S301978 . Lachenmeier, D., Lachenmeier, W. Injury Threshold of Oral Contact with Hot Foods and Method for Its Sensory Evaluation. Safety. 2018; 4, 38. https://doi.org/10.3390/safety4030038 . Lee, H.S., O’Mahony, M.. At What Temperatures Do Consumers Like to Drink Coffee?: Mixing Methods. J. Food Sci. 2002; 67, 2774–2777. https://doi.org/10.1111/j.1365-2621.2002.tb08814.x . Dirler, J., Winkler, G., Lachenmeier, D. What Temperature of Coffee Exceeds the Pain Threshold? Pilot Study of a Sensory Analysis Method as Basis for Cancer Risk Assessment. Foods. 2018; 7, 83. https://doi.org/10.3390/foods7060083 . Tables Table 1 : Sociodemographic characteristics of the participants, Arsi Zone, Oromia, Ethiopia Variables Frequency (%) Age category 18-27 years 32(10.6) 28-37 years 76(25.2) 38-47 years 95(31.6) 48-57 years 65(21.6) 58 Years and above 33(11.0) Religion Muslim 264(87.7) Christians (Orthodox) 37 (12.3) Ethnicity Oromo 297(98.6) Amhara 2 (0.7) Gurage 2 (0.7) Family size family members 144(47.8) Table 2: Porridge consumption temperature by serving vessels in the Arsi Zone, Oromia, Ethiopia Mean porridge consumption temperature in ℃ Variables t df P-Value Mean Difference Std.Error Difference 95 % CI Serving temperature Wooden vessel 75.0(3.7) 2.626 299 0.009 1.368 0.52131 0.342 2.395 Dishes 73.6(4.4) At the beginning consumption stages Wooden vessel 69.6(4.1) 3.536 299 <0.0001 1.984 0.56136 0.829 3.139 Dishes 67.6(4.5) In the middle consumption stages Wooden vessel 65.3(4.4) 4.624 299 <0.0001 2.89 0.62506 1.51 4.27 Dishes 62.4(5.5) At the end consumption stages Wooden vessel 59.8(5.0) 4.122 299 <0.0001 3.009 0.73006 1.346 4.672 Dishes 56.8(6.7) Table 3: Factors associated with the consumption of porridge at a probably carcinogenic temperature in the Arsi Zone, Oromia, Ethiopia Porridge consumption temperature at a probably carcinogenic range AOR(95% CI) Yes No COR(95% CI) N(%) N(%) Serving utensils Wooden bowl(Qorii) 192(86) 31(14) 1.7(.894, 3.333) 2.0(1.008,4.310) Dishes 61(78.2) 17(21.8) 1 1 Types of porridge Maize 70(79.5) 18(20.5) 1 1 Barley 43(67.2) 21(32.8) .5(.252,1.098) 0.5(0.245,1.135) Wheat 140(94) 9(6) 4.0(1.710,9.359) 4.6(1.936,11.406) Cooking places Ventilated 13(93) 1(7) 1 1 Unventilated 240(83.6) 47(16.4) .4(.050,3.075) 0.3(0.039,2.941) Family size 5 family members 121(84) 23(16) 0.9(.537,1.848) 0.9(0.496,1.899) Source fuels Firewood 178(82) 39(18) 1 1 Animal manure 75(89.3) 9(10.7) 1.8(.843,3.957) 1.8(0.750,4.450) Perception of beginning consumption temperatures Very hot 121(81.8) 27(18.2) 1 1 Hot 99(86.1) 16(13.9) 1.4(.749,2.639) 1.5(.766,2.979) Warm 33(86.8) 5(13.2) 1.3(.155,11.583) 1.6(.176,16.113) Variable(s) entered: Types of porridge, serving vessels, Fuels used, perceptions, family size, and cooking place. a Additional Declarations No competing interests reported. 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Deybasso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACAwaGhAMQJvPBB0CSh48ELWzJBiAtbERogQEeMwmwTkJazNkPPDzwg8Eumn92j1nl1xw7GTYG5oePbuDRYtmTkHCwhyE5d8adY2W3ZbclAx3GZmycg89hBxISDvAwMOc23EjedltyGzNQCw+bNF4t5x8kHPzDUJ87/0aCWbHktnoitNxISDjMw3A4d8ONFDPGj9sOE6PlQcJhGYPjuRtvpCVLM247zsPGTMgv53OSP76pqM6ddyP54Mef26rt+dmbHz7GpwUYHQnw2GHmAZN4lYMA+wE4k/EHQdWjYBSMglEwEgEA0n5NCbzRTGgAAAAASUVORK5CYII=","orcid":"","institution":"Adama Hospital Medical College,Department of the public health","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Haji","middleName":"Aman","lastName":"Deybasso","suffix":""},{"id":136350709,"identity":"8b364d17-b832-4127-93f4-c71be74b1fd5","order_by":1,"name":"Kedir Teji Roba","email":"","orcid":"","institution":"Haramaya University, College of health and medical Science, Department of public Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kedir","middleName":"Teji","lastName":"Roba","suffix":""},{"id":136350710,"identity":"6716a6b2-430e-449e-a966-e46cf3fd3f81","order_by":2,"name":"Tefera Belachew","email":"","orcid":"","institution":"Jimma University,Department of Human Nutrition and Dietetics","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tefera","middleName":"","lastName":"Belachew","suffix":""}],"badges":[],"createdAt":"2022-09-12 13:59:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2057079/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2057079/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":26524857,"identity":"ceaf309f-9e2e-474f-bdcc-3ee6536dc76a","added_by":"auto","created_at":"2022-09-15 20:53:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18274,"visible":true,"origin":"","legend":"\u003cp\u003ePorridge consumption temperature by types of porridge at different stages, \u0026nbsp;Arsi Zone, Ethiopia, 2020.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2057079/v1/e1cb4766eda39149a341b616.png"},{"id":26524858,"identity":"47a97d1c-0e33-470a-ab17-d48bfe5a89e4","added_by":"auto","created_at":"2022-09-15 20:53:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17524,"visible":true,"origin":"","legend":"\u003cp\u003ePorridge consumption temperature in degree centigrade by households characteristics in Arsi Zone, Ethiopia, 2020.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2057079/v1/ebc8ddf31a18b8cce64ce687.png"},{"id":26524859,"identity":"caa490cc-b19d-48c6-b12a-be560dbac20a","added_by":"auto","created_at":"2022-09-15 20:53:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24845,"visible":true,"origin":"","legend":"\u003cp\u003eThe proportion of households consuming porridge at a probably carcinogenic temperature in Arsi Zone, Ethiopia,2020.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2057079/v1/ee33be7f37a7f6e8cb9708cb.png"},{"id":34159023,"identity":"5d969ddc-23a9-45b3-af0c-0c76cd912248","added_by":"auto","created_at":"2023-03-13 12:30:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":633165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2057079/v1/ef3a48e4-5259-420d-ad5c-f496ff04582c.pdf"},{"id":26524860,"identity":"35355c9c-0205-467a-8587-2fb55722ae31","added_by":"auto","created_at":"2022-09-15 20:53:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":370584,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-2057079/v1/fd8e6100694e900352278257.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Consumption of porridge at Carcinogenic Temperature and Associated Factors in Esophageal Cancer Endemic Area in Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWorld Health Organization(WHO) describes the consumption of foods at \u003cu\u003e\u0026gt;\u003c/u\u003e65 ℃ as a probably carcinogenic temperature[1]. The risk was further established by systematic reviews and meta-analysis studies that identified positive associations between very hot foods and increased risk of esophageal cancer[2\u0026ndash;4]. Particularly, Squamous cell carcinoma(SCC) \u0026nbsp;rises by many folds when the temperature of the foods increases from \u0026nbsp;65 ℃ \u0026nbsp; to \u0026nbsp;\u0026ge;70 ℃\u0026nbsp;[5,6].\u003c/p\u003e\n\u003cp\u003eIngestion of very hot foods causes burning, odynophagia, and a feeling of foreign body sensations in the chest during swallowing[6,7]. It can also alter the esophageal epithelium into cancer cells(8,9); and/or stimulates the formation of endogenous reactive nitrogen species and nitrosamines, and impair the barrier function of the esophagus to carcinogens[8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEsophageal cancer (EC) is a malignant tumor that develops inside the esophagus as a result of an alteration in the epithelial lining[10]. It was infrequent in East, Central, and Southern Africa until the 1930s\u0026nbsp;[11]. With gradual increases over time, eastern and southern Africa became the epicenter of esophageal carcinoma\u0026nbsp;[12\u0026ndash;14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to studies, populations living in \u0026nbsp;EC endemic areas favor very hot foods\u0026nbsp;[5,15]. For instance, a significant number of residents in the Golestan province of Iran and Tanzania drank tea and coffee at a mean temperature of \u0026nbsp;\u003cu\u003e\u0026gt;\u003c/u\u003e65 ℃ and 70.6 ℃ respectively\u0026nbsp;[5,14]. The highest ever recorded hot beverage drinking temperature (72.1℃) was reported from EC endemic areas in Kenya[16].\u003c/p\u003e\n\u003cp\u003eArsi Zone is one of the\u0026nbsp;hot spot areas\u0026nbsp;in\u0026nbsp;Africa`s EC cancer corridor\u0026nbsp;(17)\u0026nbsp;where EC is highly predominant among farmers living in rural areas\u0026nbsp;[18,19]. The consumption of a self-reported \u0026ldquo;hot porridge\u0026rdquo;\u0026nbsp;was reported as a major dietary risk factor for an increased incidence of esophageal cancer in the area\u0026nbsp;[18\u0026ndash;20].\u003c/p\u003e\n\u003cp\u003ePrevious studies in EC endemic areas have focused on the determination of hot beverage drinking temperatures [14,16,21]. Food consumption temperature might be affected by individual preference, food texture, heat loss mechanisms, and adaptations to hot foods [22]. However, no study has quantitatively assessed the solid food consumption temperature among households living in endemic areas in Ethiopia and elsewhere. This study assessed the porridge consumption temperature and associated factors among households living in the Arsi Zone. The findings will be valuable to design culturally acceptable interventions for the prevention and control of \u0026nbsp;EC in Ethiopia.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003eStudy design, and setting\u003c/h3\u003e\n\u003cp\u003eThis was a community-based cross-sectional study conducted from November 1 to December 30, 2020, in the selected districts of the Arsi Zone. Arsi \u0026nbsp;Zone is located in Oromia Regional State in central Ethiopia. Esophageal cancer is mainly known as \u003cem\u003eKaansarii liqimsaa\u003c/em\u003e and \u003cem\u003eKaansarii Kokkee\u003c/em\u003e in the local language (Afaan Oromoo). Porridge, known as\u003cem\u003e\u0026nbsp;Marqaa\u003c/em\u003e, is usually prepared from barley, wheat, and maize crops. \u0026nbsp;It is consumed as a principal diet by the majority of the population, consumed during Ramadan (Muslims\u0026rsquo; fasting month), and during special events. The types of porridge, cooking, and serving vessels vary across the ethnic and religious backgrounds of the populations in the Zone. Traditionally, the wooden bowl(Qorii) is used as a porridge serving utensil [20]. \u0026nbsp;The source populations were households that lived in the selected districts. The study populations were randomly selected households in the selected districts of the Arsi Zone. The household that did not report consuming porridge as their staple diet were excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined using the formula required for estimating a single population means: \u003cstrong\u003en\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;= Z\u003csup\u003e2\u003c/sup\u003e x\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;/ E\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e where\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003en\u003c/strong\u003e is the sample size required, \u003cstrong\u003eZ\u0026nbsp;\u003c/strong\u003eis an index reflecting the degree of confidence/ \u0026nbsp;certainty, and \u003cstrong\u003eE\u003c/strong\u003e is a margin of error. Again, the margin of error (0.56) was calculated using the formula: E= \u0026nbsp;Z\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003cstrong\u003ex\u003c/strong\u003e /\u003cstrong\u003e\u0026nbsp;\u0026radic;n)\u003c/strong\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[23]. Whereas, the standard deviation (\u003cstrong\u003e3.9)\u0026nbsp;\u003c/strong\u003eand the number of participants (188) were taken from the study finding that determined coffee drinking temperature in Tanzania[14]. The calculated sample size was multiplied with a design effect of 1.5. \u0026nbsp;A 10% non-response rate was added giving a total of 309 utensils of porridge for measurements. Finally, 301 consented households were recruited for the study for the reason that porridge is consumed in a shared manner from a single serving utensil [20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling procedure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and technique\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo Districts (Doddota and Sude) were randomly selected from districts that had the largest proportions of \u0026nbsp;EC cases in the Zone[24]. Then, two Kebeles (lowest administrative units) were randomly selected from each District. The sampling frame was prepared from the lists of family folders used by Health Posts (HPs) in respective kebeles. The households were recruited using a computer-generated simple random sampling technique. The sample size was proportionally allocated according to the population sizes. Finally, the households were categorized according to their preferences as maize, wheat, and barley porridge consumers.\u003c/p\u003e\n\u003ch1\u003eData collection instrument and procedures\u003c/h1\u003e\n\u003cp\u003eData were collected by four trained public health officers through interviewer-administered structured questionnaires and temperature recordings. The data collection protocol for porridge temperature measurement was adapted from previous studies[14,16]. The questionnaires focused on socio-demographic characteristics, porridge cooking places, types of grains for porridge, source of fuels, serving utensils, porridge serving temperature, fats added, porridge consumption temperatures, porridge temperature measurement time, and households` perceptions about the beginning porridge consumption temperature. Participants freely decided on types of grains for porridge, cooking places, cooking and serving materials, and the input used to mimic their usual dietary practices. The consumption temperature was recorded at the serving, beginning, middle, and end of consumption stages using a digital thermometer (HANNA instruments\u0026reg;, Woonsocket, RI, US). The temperature reading and recording were immediately performed after the thermometer temperature reached the maximum reading point (82.1 ℃) and stabilized at each stage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality assurance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires were prepared in English and translated to the local language (Afaan Oromoo) and later back to English by two different experts who were qualified in English and fluent in Afaan Oromoo. A pre-test was conducted among 5% of the total sample size from an up-to-date list of households in other Districts. The questionnaires were amended based on the feedback of the pretest study. The accuracy of the thermometer was confirmed by using cold water before each measurement. A thermometer was placed in the thickest part of the porridge without touching the serving utensils. The thermometer was cleaned with hot and soapy water after each use. The supervisors strictly followed the data collection procedures and feedback was given daily.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and\u0026nbsp;analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were coded and checked for completeness, and consistency and entered into the EPI info version7, and imported into SPSS for Windows Version 21(SPSS, Illinois Chicago, USA) software for cleaning and analysis. A descriptive analysis was done for categorical variables. Independent samples t-test was computed to compare the differences in the mean porridge temperature inside the serving vessels and the porridge consumption temperature between Muslims and Christian households. The analysis of variance (ANOVA) was performed to find differences between the mean temperature of maize, barley, and wheat porridges at a 95% confidence level. The posthoc test was conducted to specifically identify the types of porridge that were significantly different from one another. Finally, the consumption temperature was categorized as \u0026ldquo;Probably carcinogenic\u0026rdquo; if the porridge consumption temperature is \u003cu\u003e\u0026gt;\u003c/u\u003e65 ℃ and not probably carcinogenic temperature if it is \u0026lt;65 ℃ [1]. The probably carcinogenic temperature was coded as `1\u0026rsquo;and not probably carcinogenic temperature was coded as \u0026lsquo;0\u0026rsquo;. Bivariate analysis was carried out to assess the crude association between the independent and the outcome variable. Variables with a p-value of up to 0.25 at the bivariate analysis were selected as candidates for multivariable logistic regression analysis to identify independent determinants of porridge consumption temperatures at a probably carcinogenic range. \u0026nbsp;Hosmer\u0026ndash;Lemeshow goodness-of-fit test was checked for the model. Multi-collinearity between the independent variable was also checked using standard error (\u0026ge;2). The odds ratio with its 95% confidence interval was used as a measure of strengths of association. A P-value of less than 0.05 was used to declare statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 301 households were involved in this study giving a 97.4% response rate. The mean age of the participants was 43.1(\u0026plusmn;12.01) years. The majority of the participants (87.7%) were Muslims and all of them were married farmers residing in rural areas. Regarding their ethnicity, 297(98.6%) were from the Oromo ethnic group. The mean (\u0026plusmn; Standard deviation) family size of the households was 4.5(\u0026plusmn;1.1) \u003cstrong\u003e(Table1). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePorridge cooking processes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcerning the types of porridge, 149(49.5%), 88(29.2%), and 64(21.3%) were wheat, maize, and barley porridges respectively. The largest proportion of the households (95.3%) cooked their porridge in unventilated rooms. The overall average cooking time was 61.08 (\u0026plusmn;13.55) minutes. Muslim households completed cooking at 62.2(\u0026plusmn;13.6) minutes. The corresponding cooking time for Christian households was 52.5(\u0026plusmn;8.9) minutes \u003cstrong\u003e[P\u0026lt;0.0001].\u003c/strong\u003e Of the total, 217(72.1%) households used firewood while others cooked porridge by using animal manure. Of the total households, 151\u003cstrong\u003e(\u003c/strong\u003e50.2%) and 150 (49.8%) used butter and oil mixed with butter as added fats respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePorridge serving time and utensils\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean time from completing cooking to serving a maize porridge was 5.25(\u0026plusmn;3.1) minutes. \u0026nbsp;The comparable serving time for wheat and barley porridge was 6.46(\u0026plusmn;4.0) and 6.6(\u0026plusmn;2.4) minutes respectively. A wooden bowl (Qorii) was used by 223 (74.0%) households as a porridge serving utensil while others used metal and plastic dishes \u003cstrong\u003e[Additional file 1]\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePorridge consumption temperature by serving utensils\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The average serving temperature inside wooden utensils and dishes was 75.05 (\u0026plusmn;3.7) ℃ and 73.6(\u0026plusmn;4.4) ℃ respectively. Households who used a wooden bowl began consumption at a temperature of 69.6(\u0026plusmn;4.1) ℃. On the other hand, households that used metal dishes consumed porridge at 67.6(\u0026plusmn;4.5) ℃\u003cstrong\u003e\u0026nbsp;[P\u0026lt;0.001]\u003c/strong\u003e \u003cstrong\u003e(Table2).\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePorridge consumption temperature by types of porridge \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall mean (\u0026plusmn;SD) temperature upon beginning consumption was 69.1 (CI: 68.6, 69.6)\u003csup\u003e0\u003c/sup\u003eC.\u0026nbsp;Wheat porridge consumers began consumption at 70.4 (95% CI: 69.7, 71.1) ℃. Whereas, barley and maize porridge consumers started at 67.1(95% CI: 66.3, 67.9) ℃ and 68.4(\u0026plusmn;4.2) (95% CI: 67.5, 69.3) ℃.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean porridge consumption temperature at the middle stages was 65.4(95% CI: 64.5, 66.2) ℃, 63.6 (95% CI: 62.7, 64.6) ℃, and 64(95% CI: 63.0, 65.0) ℃, for wheat, barley, and maize porridges respectively. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, wheat and barley porridge consumers completed consumptions at a temperature of 61.01(95% CI:59.0, 62.4) ℃and 60 (95% CI: 58.8, 61.1) ℃ respectively. \u0026nbsp; Maize porridge was consumed at 56.6(95% CI: 56.6,57.7)℃ at the end consumption stage (P\u0026lt;0.001)\u003cstrong\u003e\u0026nbsp;(Figure 1).\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePorridge consumption temperature by households\u0026rsquo; characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMuslim households consumed porridge at 69.7(\u0026plusmn;4.1), 65.4(\u0026plusmn;4.4), and 59.7(\u0026plusmn;5.3) ℃ at the beginning, middle, and end consumption stages respectively. The porridge consumption temperature for Christian households at corresponding stages was 64.8(\u0026plusmn;3.3), 58.9(\u0026plusmn;4.4), and 53.9(\u0026plusmn;5.6) ℃ respectively \u003cstrong\u003e(Figure2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants` perceptions of the porridge consumption temperature\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were asked to designate the porridge consumption temperature as very hot, hot, warm, and cool compared to their usual eating patterns. Accordingly, 148(49.2%) reported that they consumed very hot porridge at the beginning consumption stage. On the other hand, 160(53.2%) and 144(47.8%) perceived that they consumed hot and warm porridge at the half and end consumption stage respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; Porridge consumption at a probably carcinogenic temperature\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the total households, 84%\u0026nbsp;(95% CI: (79.7, 87.7%)) began porridge consumption at a probably carcinogenic temperature. The practice was predominant among Muslim households where 230 (87.1%), 137(51.9%), and 49(18.6%) consumed porridge at a probably carcinogenic temperature\u0026nbsp;at the beginning, middle, and end consumption stages respectively\u0026nbsp;(\u003cstrong\u003eFigure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with the consumption of porridge at a probably carcinogenic temperature\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn bivariable analysis, cooking places, religion, age of the participants, types of porridge, serving vessels, time from serving to beginning consumptions, fats added into the porridge, and source of fuels had a P-value \u0026le; of 0.25. The religious backgrounds of the households were removed from the analysis because of evidence of the multicollinearity with porridge serving vessels (SE\u0026gt; 2). Then, variables that had a P\u0026le; of 0.25 were entered into the multivariable regression analysis. \u0026nbsp;On the multivariable analysis, porridge serving utensils and types of porridge persisted to be significant predictors of the consumption of the porridge at a probably carcinogenic temperature. Accordingly, the odds of consuming porridge at a probably carcinogenic temperature were higher (AOR=2.0, (95%CI: (1.008, 4.310]) for households who consumed porridge from a traditional wooden bowl as compared to those who consumed porridge from dishes. Besides, wheat porridge consumers had higher odds of consuming porridge at a probably carcinogenic temperature (AOR=4.6, (95%CI :(1.936,11.406]) compared to maize porridge consumers \u003cstrong\u003e(Table 3).\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the consumption of porridge at a probably carcinogenic temperature\u0026nbsp;and associated factors among households living in EC endemic areas in Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, households began porridge consumption at a temperature of 69.1℃. The porridge consumption temperature was the second hottest food consumption temperature ever recorded in EC endemic area\u0026nbsp;[16]\u0026nbsp;and comparable to the very hot coffee drinking temperature in endemic areas in Tanzania[14]. Moreover, the porridge consumption temperature in this study was hotter than the maximum thresholds for hot potatoes, the temperature that was linked to tongue injury and mouth pain\u0026nbsp;[25,26].\u003c/p\u003e\n\u003cp\u003eThe study showed that 84% of the households in the study area consumed porridge at a probably carcinogenic temperature. The practice of consuming porridge at a carcinogenic temperature was higher than the proportion of households who consumed very hot foods in Iran\u0026nbsp;[7]\u0026nbsp;but lower than the study result in Kenya[16]. On the other hand, the finding supports a qualitative study that reported preferences for very hot porridge by the majority of households living in the study areas[20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, there were statistically significant differences in the mean porridge temperature between different types of porridges. Hence, wheat porridge was significantly hotter than barley and maize porridge in the beginning and end consumption stages. Furthermore, barley porridge was also significantly hotter than maize porridge at the end consumption stage. However, in further analysis, only wheat porridge had a significant positive association with the consumption of porridge at a probably carcinogenic temperature compared to maize porridge. The finding supports a qualitative study in the area that demonstrated the perceived heat retention ability of wheat porridge compared\u0026nbsp;to porridge cooked from barley and maize\u0026nbsp;[20]. The probable explanation could be porridges cooked from different grains may display disparities in the convective and/or evaporative heat loss mechanisms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study exhibited that porridge served in a wooden utensil was persistently hotter by 1.9 \u003csup\u003e0\u003c/sup\u003eC, 2.8 \u003csup\u003e0\u003c/sup\u003eC, and 3.0 \u003csup\u003e0\u003c/sup\u003eC at the beginning, middle, and end of porridge consumption stages respectively compared to porridge served in dishes. Furthermore, there was a statistically significant positive association between serving porridge in a wooden utensil and increased odds of consuming porridge at a probably carcinogenic temperature. The finding is in line with a study that reported disparities in hot food temperature that are associated with heat energy transfer of the food containers\u0026nbsp;[27].\u0026nbsp;Besides, cultural variation across ethnic and religious backgrounds could be a possible reason for such differences.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The consumption of porridge at a very hot temperature could be the major culprit behind the increased incidences of EC in the study area for the following conceivable reasons. \u0026nbsp;Because of its solid nature, increased surface area, and contact time very hot porridge may be more carcinogenic than hot beverages that rapidly fall to the stomach[27]. \u0026nbsp;Additionally, cooking porridge at a higher temperature may generate heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons which are highly damaging carcinogens\u0026nbsp;[1]. Besides, repeated inflammations from frequent consumption of very hot porridge may augment tumorigenesis, cellular transformation, proliferation, invasion, and metastasis of the cancer cells among exposed populations[8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength and limitation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strength of the study is that it is the first study that verified the porridge consumption temperature among populations living in the EC endemic area in Ethiopia. The study covered porridge cooked from different grains. \u0026nbsp;We acknowledge the following limitations. Since porridge consumption is traditionally practiced in a shared manner, it was difficult to measure the differences in the porridge consumption temperature between family members. Determining the exact contact temperature for porridge was beyond the capacity of the researchers. Future research should focus on investigating the presence of PAHs and potential chemical contaminants in porridge.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA substantial number of households in the study area consume porridge at an extremely higher temperature which may cause severe thermal injury to the esophagus. Serving utensils and the type of porridge showed significantly positive associations with the consumption of porridge at a probably carcinogenic temperature. Households who consume wheat porridge and use a wooden serving utensil should wait until the porridge cools down to the optimum temperature for consumption.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA:\u0026nbsp;Analysis of variance\u003c/p\u003e\n\u003cp\u003eAOR: Adjusted odds ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEC: Esophageal cancer\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCA: Heterocyclic amines\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHPs:\u0026nbsp;Health Posts\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePCA: \u0026nbsp; Polycyclic aromatic hydrocarbons\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSCC: Squamous cell carcinoma\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for the Social Science\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUSA: United States of America\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are very grateful to the Arsi Zonal, District health offices, and local administrations for their support and contributions. Data collectors, health extension workers, and participants deserve special appreciation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeybasso HA \u0026nbsp;contributed to the study conception, design, data acquisition, analysis, and drafting of the first version of the manuscript. Kedir.t.roba and BT advised on the study design, data acquisition, \u0026nbsp;statistical analysis, and the final version to be published. \u0026nbsp;All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fund was received.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients. Ethical permission to carry out the study was obtained from the Institutions Research Board (IRB) of Jimma University. Approval of the research activity was sought from Zonal, District health, and administration offices before the study was carried out. Confidentiality of the data was maintained by avoiding names and other personal identifiers known or written in the questionnaires. \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003ch3\u003eAuthors details\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Adama Hospital Medical College, Department of Public Health, Adama, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eJimma University, Department of Human Nutrition and Dietetics, Jimma, Ethiopia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIARC. Working Group on the Evaluation of Carcinogenic Risks to Humans, International Agency for Research on Cancer, World Health Organization (Eds.). Household use of solid fuels and high-temperature frying, IARC monographs on the evaluation of carcinogenic risks to humans. International Agency for Research on Cancer; Distributed by WHO Press, Lyon, France : Geneva.2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Zhou B, Hao C. Coffee consumption and risk of esophageal cancer incidence: A meta-analysis of epidemiologic studies. Medicine (Baltimore) [Internet]. 2018;97(17):e0514. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://journals.lww.com/00005792-201804270-00051\u003c/span\u003e\u003cspan address=\"http://journals.lww.com/00005792-201804270-00051\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y, Tong Y, Yang C, Gan Y, Sun H, Bi H, et al. Consumption of hot beverages and foods and the risk of esophageal cancer: a meta-analysis of observational studies. BMC Cancer [Internet]. 2015;15(1):449. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.biomedcentral.com/1471-2407/15/449\u003c/span\u003e\u003cspan address=\"http://www.biomedcentral.com/1471-2407/15/449\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslami F, Pourshmas A, Semnani S. Prevalence of esophageal cancer risk factors among Turkmen and non-Turkmen ethnic groups in a high incidence area in Iran. Arch Iran Med. 2010;13(2):111.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslami F, Boffetta P, Ren JS, Pedoeim L, Khatib D, Kamangar F. High-temperature beverages and foods and esophageal cancer risk-A systematic review. Int J Cancer [Internet]. 2009;125(3):491\u0026ndash;524. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ijc.24445\u003c/span\u003e\u003cspan address=\"10.1002/ijc.24445\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu M, Liu A-M, Kampman E, Zhang Z-F, van\u0026rsquo;t Veer P, Wu D-L, et al. Green tea drinking, high tea temperature and esophageal cancer in high- and low-risk areas of Jiangsu Province, China: A population-based case-control study. Int J Cancer. 2009;124(8):1907\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslami F, Malekshah AF, Kimiagar M, Pourshams A, Wakefield J, Goglani G, et al. Patterns of Food and Nutrient Consumption in Northern Iran, a High-Risk Area for Esophageal Cancer. Nutr Cancer. 2009;61(4):475\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAggarwal BB, Shishodia S, Sandur SK, Pandey MK, Sethi G. Inflammation and cancer: How hot is the link? Biochem Pharmacol [Internet]. 2006;72(11):1605\u0026ndash;21. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S0006295206003893\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S0006295206003893\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilberman M, Jeanmonod R. Aerodigestive Tract Burn from Ingestion of Microwaved Food. Case Rep Emerg Med [Internet]. 2013:1\u0026ndash;3.: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.hindawi.com/journals/criem/2013/781809/\u003c/span\u003e\u003cspan address=\"http://www.hindawi.com/journals/criem/2013/781809/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNapier, K.J. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J. Gastrointest. Oncol. 2014. 6, 112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4251/wjgo.v6.i5.112\u003c/span\u003e\u003cspan address=\"10.4251/wjgo.v6.i5.112\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSammon, A.M., scoafrica.org (Organization). Squamous cancer of the oesophagus in Africa. gjhs.ccsenet.org Global Journal of Health Science. 2009. Vol.\u0026nbsp;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParkin, D.M., Bray, F., Ferlay, J., Jemal, A. Cancer in Africa 2012. Cancer Epidemiol. Biomarkers Prev. 2014; 23, 953\u0026ndash;966. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1158/1055-9965.EPI-14-0281\u003c/span\u003e\u003cspan address=\"10.1158/1055-9965.EPI-14-0281\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiddleton, D.R.S., Bouaoun, L., Hanisch, R., Bray, F., Dzamalala, C.,et.al. Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends. Cancer Epidemiol. 2018;53, 119\u0026ndash;128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.canep.2018.01.020\u003c/span\u003e\u003cspan address=\"10.1016/j.canep.2018.01.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunishi MO, Hanisch R, Mapunda O, Ndyetabura T, Ndaro A, Sch\u0026uuml;z J, et al. Africa\u0026rsquo;s oesophageal cancer corridor: Do hot beverages contribute? Cancer Causes Control. 2015 ;26(10):1477\u0026ndash;86. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://link.springer.com/\u003c/span\u003e\u003cspan address=\"http://link.springer.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10552-015-0646-9\u003c/span\u003e\u003cspan address=\"10.1007/s10552-015-0646-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin J, Zeng R, Cao W, Luo R, Chen J. Hot Beverage and Food Intake and Esophageal Cancer in Southern China. Asian Pac J Cancer Prev. 12(9):2189\u0026ndash;92\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMwachiro MM, Parker RK, Pritchett NR, Lando JO, Ranketi S, Murphy G, et al. Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Cancer Epidemiol [Internet]. 2019;60:60\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S1877782119300153\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S1877782119300153\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaafsma T, Wakefield J, Hanisch R, Bray F, Sch\u0026uuml;z J, Joy EJM, et al. Africa\u0026rsquo;s Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies. Meliker J, editor. PLOS ONE [Internet]. 2015;10(10):e0140107. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.plos.org/10.1371/journal.pone.0140107\u003c/span\u003e\u003cspan address=\"https://dx.plos.10.1371/journal.pone.0140107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShewaye AB, Seme A. Risk factors associated with oesophageal malignancy among Ethiopian patients: a case control study. East Cent Afr J Surg [Internet]. 2016;21(2):33. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ajol.info/index.php/ecajs/article/view/147682\u003c/span\u003e\u003cspan address=\"http://www.ajol.info/index.php/ecajs/article/view/147682\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBulcha G., Leon M., Gwen M, Abnet C., Sime A, Pritchett N., et al. Epidemiology of Esophageal Cancer (EC) In Oromia Region, Ethiopia 2016: A 4-Year Medical Record Review. J Glob Oncol [Internet]. 2018;4(Supplement 2):14s\u0026ndash;14s. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ascopubs.org/doi/10.1200/jgo.18.41700\u003c/span\u003e\u003cspan address=\"https://ascopubs.doi/10.1200/jgo.18.41700\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeybasso, H.A., Roba, K.T., Belachew, T., Perceived role of hot food in the pathogenesis of oesophageal cancer: a qualitative study in the Arsi Zone, Oromia, Central Ethiopia. J. Nutr. Sci. 10, e1. 2021; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/jns.2020.53\u003c/span\u003e\u003cspan address=\"10.1017/jns.2020.53\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastellsague, X., Munoz, N., De Stefani, E., Victora, C.G., Castelletto, et.al. Influence of mate drinking, hot beverages and diet on esophageal cancer risk in South America. Int. J. Cancer.2000; 88, 658\u0026ndash;664.4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFood, Health and Safety in Cross-Cultural Consumer Contexts [Internet]. MDPI; 2021 [cited 2022 Apr 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.mdpi.com/books/pdfview/book/4040\u003c/span\u003e\u003cspan address=\"http://www.mdpi.com/books/pdfview/book/4040\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArifin WN. Introduction to sample size calculation. Educ Med J. 2013 ;5(2). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://eduimed.usm.my/EIMJ20130502/EIMJ20130502_10.pdf\u003c/span\u003e\u003cspan address=\"http://eduimed.usm.my/EIMJ20130502/EIMJ20130502_10.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeybasso HA, Roba KT, Nega B, Belachew T. Clinico-Pathological Findings and Spatial Distributions of Esophageal Cancer in Arsi Zone, Oromia, Central Ethiopia. Cancer Manag Res. 2021;13:2755\u0026ndash;2762 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/CMAR.S301978\u003c/span\u003e\u003cspan address=\"10.2147/CMAR.S301978\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLachenmeier, D., Lachenmeier, W. Injury Threshold of Oral Contact with Hot Foods and Method for Its Sensory Evaluation. Safety. 2018; 4, 38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/safety4030038\u003c/span\u003e\u003cspan address=\"10.3390/safety4030038\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee, H.S., O\u0026rsquo;Mahony, M.. At What Temperatures Do Consumers Like to Drink Coffee?: Mixing Methods. J. Food Sci. 2002; 67, 2774\u0026ndash;2777. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2621.2002.tb08814.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2621.2002.tb08814.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDirler, J., Winkler, G., Lachenmeier, D. What Temperature of Coffee Exceeds the Pain Threshold? Pilot Study of a Sensory Analysis Method as Basis for Cancer Risk Assessment. Foods. 2018; 7, 83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/foods7060083\u003c/span\u003e\u003cspan address=\"10.3390/foods7060083\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Sociodemographic characteristics of the participants, Arsi Zone, Oromia, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"80.51470588235294%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"19.485294117647058%\"\u003e\n \u003cp\u003eFrequency (%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 18-27 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e32(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 28-37 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e76(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 38-47 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e95(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 48-57 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e65(21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;58 Years and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e33(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e264(87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003eChristians (Orthodox)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e37 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e297(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003eGurage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u0026lt; 5 family members\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e157(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80.51470588235294%\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e family members\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.485294117647058%\"\u003e\n \u003cp\u003e144(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Porridge consumption temperature by serving vessels in the Arsi Zone, Oromia, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"26.498422712933753%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"54.41640378548896%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean porridge consumption temperature in\u0026nbsp;\u003c/strong\u003e℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"19.085173501577287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"26.456692913385826%\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.661417322834646%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.874015748031496%\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.023622047244094%\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.858267716535433%\"\u003e\n \u003cp\u003eMean Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.070866141732283%\"\u003e\n \u003cp\u003eStd.Error Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"19.055118110236222%\"\u003e\n \u003cp\u003e95 % CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"88.801261829653%\"\u003e\n \u003cp\u003e\u003cstrong\u003eServing temperature\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp;Wooden vessel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e75.0(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e2.626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e1.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e0.52131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e2.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp;Dishes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e73.6(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"88.801261829653%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt the beginning consumption stages\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp;Wooden vessel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e69.6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e3.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e1.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e0.56136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e3.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp;Dishes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e67.6(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"88.801261829653%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn the middle consumption stages\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp;Wooden vessel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e65.3(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e4.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e0.62506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Dishes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e62.4(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"88.801261829653%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt the end consumption stages\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Wooden vessel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e59.8(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e4.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e3.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e0.73006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e1.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e4.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.722397476340694%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Dishes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.618296529968454%\"\u003e\n \u003cp\u003e56.8(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.675078864353312%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.8801261829653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091482649842272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.886435331230284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFactors associated with the consumption of porridge at a probably carcinogenic temperature in the Arsi Zone, Oromia, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.09833585476551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.183055975794254%\"\u003e\n \u003cp\u003ePorridge consumption temperature at a probably carcinogenic range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAOR(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.67820773930754%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.940936863543786%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.922606924643585%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25.45824847250509%\"\u003e\n \u003cp\u003eCOR(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"51.38121546961326%\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"48.61878453038674%\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eServing utensils\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eWooden bowl(Qorii)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;192(86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;31(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1.7(.894, 3.333)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e2.0(1.008,4.310)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eDishes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;61(78.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;17(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of porridge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eMaize\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;70(79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;18(20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eBarley\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;43(67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;21(32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;.5(.252,1.098)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e0.5(0.245,1.135)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eWheat\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;140(94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;9(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;4.0(1.710,9.359)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e4.6(1.936,11.406)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCooking places\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eVentilated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;13(93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;1(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eUnventilated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;240(83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;47(16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;.4(.050,3.075)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e0.3(0.039,2.941)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003e\u0026lt;5 family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;132(84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;25(15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e5 family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;121(84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;23(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;0.9(.537,1.848)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e0.9(0.496,1.899)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource fuels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eFirewood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;178(82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;39(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eAnimal manure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;75(89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;9(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1.8(.843,3.957)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e1.8(0.750,4.450)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003ePerception of beginning consumption temperatures\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eVery hot\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;121(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;27(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eHot\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;99(86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;16(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1.4(.749,2.639)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e1.5(.766,2.979)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.987897125567322%\"\u003e\n \u003cp\u003eWarm\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003e\u0026nbsp;33(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.313161875945537%\"\u003e\n \u003cp\u003e\u0026nbsp;5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.910741301059%\"\u003e\n \u003cp\u003e\u0026nbsp;1.3(.155,11.583)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.71860816944024%\"\u003e\n \u003cp\u003e1.6(.176,16.113)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eVariable(s) entered: Types of porridge, serving vessels, Fuels used, perceptions, family size, and cooking place. a\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Porridge temperature, esophageal cancer, endemic area, Arsi Zone, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-2057079/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2057079/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e- The consumption of a self-reported “hot porridge” was reported as a major dietary risk factor for the increased incidence of esophageal cancerin hot spot areas in Ethiopia. \u0026nbsp;However, no study has quantitatively assessed the porridge consumption temperature and associated factors among households living in endemic areas in Ethiopia and elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: -\u003c/strong\u003e A community-based cross-sectional study was conducted from November 1 to December 30, 2020. The porridge temperature was measured using a digital thermometer (HANNA instruments®, Woonsocket, RI, US). Bivariate and multivariate logistic regression analyses were used to check the association between independent and dependent variables. Adjusted odds ratio and 95% confidence interval were used to measure of strengths of the association. Statistical significance was declared at a P-value of less than 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: - \u003c/strong\u003eA total of 301 (149 Wheat, 88 Maize, and 64 Barley) utensils of porridge were measured for consumption temperature. Eighty-four percent\u003cstrong\u003e (\u003c/strong\u003e95% CI: (79.7, 87.7%)) of the households commenced porridge consumption at a probably carcinogenic temperature (\u003cu\u003e\u0026gt;\u003c/u\u003e65 ℃). Serving porridge in a wooden bowl(Qorii) (AOR=2.0, (95%CI: (1.008, 4.310)) and wheat porridge (AOR=4.6, (95% CI:(1.936,11.406) were independent determinants of the consumption of porridge at a probably carcinogenic temperature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: -\u003c/strong\u003eSubstantial number of households in the study area consume porridge at an extremely higher temperature which may cause severe thermal injury to the esophagus.\u003cstrong\u003e \u003c/strong\u003eHouseholds who consume wheat porridge and use a wooden serving utensil should wait until the porridge cools down to the optimum temperature for consumption.\u003c/p\u003e","manuscriptTitle":"Consumption of porridge at Carcinogenic Temperature and Associated Factors in Esophageal Cancer Endemic Area in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-15 20:53:50","doi":"10.21203/rs.3.rs-2057079/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"207fd615-b729-495d-8ca4-d7b58011ec6a","owner":[],"postedDate":"September 15th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-03-13T12:29:46+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-15 20:53:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2057079","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2057079","identity":"rs-2057079","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}