The role of theoretical food safety training on Brazilian food handlers' knowledge, attitude and practice

Food handlers' lack of knowledge, and misunderstanding of safe food temperatures: An analysis using the theory of social representations

Comprehension is the ability to understand and be familiar with situations and facts. A critical factor causing foodborne diseases is the inadequate temperature during food storage and handling; food handlers often fail to understand this. Therefore, in this study, we investigated how technical language and everyday knowledge operate in the comprehension of safe food temperatures among food handlers in food services. To achieve this, data collection was carried out in two stages. In the first stage, a survey was conducted to 206 food handlers from 14 food service working in the city of São Paulo. Through this survey, we gathered information to characterize the socio-demographic profile of the sample, details about participation in training, and knowledge of technical terms related to safe food temperatures. In the second stage, individuais interviews were conducted on the same day following the questionnaire administration in each food service. A total of 29 interviews were carried out An interview script was developed containing two storylines based on the Fourth Key: "Keep food at safe temperatures," which is part of the WHO's "Five Keys to Safer Food" manual. Further, the collective subject discourse technique, which is based on the theory of social representations, was employed to analyze each interview and construct a representative collective discourse. Analysis of the results indicated that lack of knowledge about safe food temperatures is mainly a result of the misunderstanding of technical terms. The collective discourses obtained results reinforced that food handlers had diverse and erroneous information about food defrosting, and they exhibited low confidence and clarity about safe food temperatures. Overall, psychological, social, and cultural factors affect the formation of social representations that guide food handlers' decision-making.

What motivates food workers to adhere with WHO guidelines to combat the COVID-19? A social cognitive theory perspective

Background

COVID-19 has become a public health emergency and pandemic of global concern, and the hundreds of millions of foodborne illnesses that occur each year also wreak havoc on human lives, society and the economy. Promoting workers in food service establishments to adhere to the hygiene practices in the WHO guidelines is a two-birds-one-stone strategy in preventing the spread of COVID-19 and limiting the occurrence of foodborne illness. The aim of this study was to determine the drivers that motivate workers to adhere to hygiene practices based on social cognitive theory.

Methods

The cross-sectional survey targeting food workers using face-to-face interviews was conducted from July to September 2022. Stratified random sampling and convenience sampling were employed to locate survey sites and respondents, respectively. The survey uses a credible questionnaire evaluated by multiple reliability and validity measures. Binary logistic regression was employed to identify significant determinants of adherence to WHO-initiated hygiene practices.

Results

A total of 900 workers were interviewed and 609 valid questionnaires were received. The study showed that the average correct rate of knowledge about hygiene practices was only 51.09%, that perceived non-adherence to hygiene practices was most likely to result in lower customer satisfaction and the spread of COVID-19, and that only about 11.7% of the workers always adhered to hygiene practices. Three of the cognitive dimensions in the personal factors, self-efficacy, risk perception, and knowledge, had significant positive effects on adherence practices. Among the demographic variables, there were significant differences in adherence practices differing by income level and place of residence.

Conclusion

It was found that workers' knowledge of the WHO-initiated hygiene practices is insufficient and that the frequency of adherence to hygiene practices is poor and require improvement. The significant drivers and effects of demographic variables provide evidence-based guidance to identify priority intervention information and populations to improve worker hygiene practices.

Consumers' Segmentation Influences Acceptance and Preferences of Cheeses with Sanitary Inspection and Artisanal Seals

Food labeling serves as a crucial medium for industries to communicate product qualities to consumers. Sanitary inspection and artisanal seals are significant markers for traditional cheeses, yet current information on this topic is limited. Therefore, this study aims to evaluate the impact of sanitary inspection and the ARTE seal on the acceptance of artisanal cheese. To achieve this objective, four hypothetical cheese labels featuring all combinations of sanitary inspection and ARTE seals were presented to 404 consumers. These consumers rated their acceptance of each label, a conjoint analysis was conducted, and the relative importance of each seal was calculated. Subsequently, consumers were segmented using hierarchical cluster analysis. Their socio-demographic profiles were statistically correlated to the clusters through a chi-squared method. The results revealed the existence of three distinct consumer groups: those who strongly prefer cheeses with a sanitary seal (assigning a relative importance of 80.2% to the seal), those who favor cheeses with an artisanal seal (assigning a relative importance of 52.5% to the seal), and those for whom the presence of either seal did not significantly affect acceptance. Consumers residing in metropolitan areas generally placed less value on both seals, whereas frequent purchasers of artisanal foods and residents of rural areas showed a preference for the artisanal seal. Other socio-demographic variables did not statistically correlate with cluster membership. In conclusion, consumer segmentation based on preferences for sanitary inspection and artisanal seals in food labeling is vital for developing effective marketing strategies and food safety education policies.

Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.

Impact of the COVID-19 Pandemic on Food Safety Inspection Outcomes in Toronto, Canada: A Bayesian Interrupted Time Series Analysis

The coronavirus (COVID-19) pandemic resulted in major disruptions to the food service industry and regulatory food inspections. The objective of this study was to conduct an interrupted time series analysis to investigate the impact of the COVID-19 pandemic on food safety inspection trends in Toronto, Canada. Inspection data for restaurants and take-out establishments were obtained from 2017 to 2022 and summarized as weekly counts of inspections, pass ratings, and total infractions. Bayesian segmented regression was conducted to evaluate the impact of the pandemic on weekly infraction and inspection pass rates. On average, a 0.31-point lower weekly infraction rate (95% credible interval [CI]: 0.23, 0.40) and a 2.0% higher probability of passing inspections (95% CI: 1.1%, 3.0%) were predicted in the pandemic period compared to prepandemic. Models predicted lower infraction rates and higher pass rates immediately following the pandemic, with additional variability compared to the prepandemic period, that were regressing back toward pre-pandemic levels in 2022. Seasonal effects were also identified, with infraction rates highest in April and pass rates lowest in August. The COVID-19 pandemic resulted in an initial positive effect on food safety outcomes in restaurants and take-out food establishments in Toronto, but this effect appears to be temporary. This finding could be due to the beneficial impact of COVID-19 protection measures in these establishments or other factors such as less volume of customers. Additional research is needed to investigate causes of the identified differences as well as seasonal and long-term inspection trends postpandemic. Results can inform future food safety inspection planning, outreach, and pandemic preparedness.

Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda

The safety of homemade weaning foods in low- and middle-income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6-23 months of age in Amuru and Nwoya districts, Northern Uganda, between March 2019 and June 2019. A cross-sectional study was conducted involving 180 caregivers. Data were collected using semi-structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logistic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision-making on household income (p = .006) and households with older children (p = .041). A significant positive correlation was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.

Assessment of food hygiene and safety knowledge, attitude, and practices of fruit and vegetable vendors in the Ho central market, Ghana

Local markets are primarily the center for trade and distribution of fruits and vegetables in Ghana. Fruit and vegetable vendors are responsible for keeping food hygienic and safe from contamination. However, little is known about fruit and vegetable vendors' knowledge, attitudes, and practices (KAP) toward food hygiene and safety in local markets. This study aimed to assess the KAP of fruit and vegetable vendors in Ho City. Data on KAP was collected from 113 fruit and vegetable vendors in the Ho Central Market using a structured questionnaire. The data was analyzed using a two-way multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA) to examine the association of demographic variables with knowledge, attitude, and practice of food hygiene and safety. A correlation analysis was conducted to determine the intercorrelation among the KAP variables. The results suggest significant differences for vendors with medical examination certificates on knowledge (Wilks = 0.60, F = 2.82, p˂0.00), attitude (Wilks = 0.71, F = 2.10, p˂0.01), and practice (Wilks = 0.59, F = 1.79, p˂0.01). A significant correlation was found between the three domains, but the influence of knowledge and attitude on practice was weak. Fruit and vegetable vendors' knowledge and attitudes toward food hygiene and safety were supportive and favorable. However, some practices were not supportive and encouraging toward food hygiene and safety. The lack of basic amenities in the market influenced the practice of vendors. Improved environmental sanitation conditions at local markets are vital to the practice of food hygiene and safety to prevent foodborne diseases.

Assessing the knowledge of, attitudes towards, and practices in, food safety among migrant workers in Klang Valley, Malaysia

BACKGROUND

Annually, 600 million individuals are affected by food-borne diseases (FBD), alongside 425,000 fatalities. Improving the general public knowledge of, attitudes towards, and practices in, (KAP) food safety is necessary for minimizing FBD transmission. In Malaysia, migrant workers account for 11.1% of the workforce, with a high proportion involved in food and beverage services. Therefore, this study aimed (i) to evaluate the current food safety KAP, and (ii) to identify the strategies to promote food safety awareness, among migrant workers across occupational sectors in Klang Valley.

METHOD

A survey was conducted with 403 migrant workers through phone interviews and online self-administered questionnaires. Piecewise structural equation modelling and multinomial regression were applied to identify predictor variables for food safety KAP and to explore differences across nationalities.

RESULTS

The respondents were Nepalese, Filipino and Indonesian. The majority were male, working in the services industry, had completed high school, aged between 30 and 39 years and had worked in Malaysia for less than ten years. Knowledge was significantly correlated with attitudes and practices. Female respondents had lower knowledge and attitude scores while younger respondents had lower knowledge scores. Indonesian and Filipino respondents had lower knowledge and attitudes scores than Nepalese respondents. Understanding food safety information from social media was positively correlated with the respondents' food safety knowledge and practices.

CONCLUSION

These findings highlighted: (i) the need to target female, younger, Indonesian and Filipino migrant workers, and (ii) the potential of social media to improve public awareness of food safety and hygienic practices.

COVID-19 knowledge, attitude, practices, and associated factors among Bangladeshi food handlers from various food industries

Background and objectives

It is believed that preventive safety measures are the most effective way to avoid the COVID-19. The adherence of workers to these measures is largely determined by their knowledge, attitude, and practices (KAP). Because they are in close proximity to consumable items, workers in the food industry must be especially vigilant during this period. The purpose of this present study was to evaluate the COVID-19 knowledge, attitudes, and practices of food handlers in different food industries of Bangladesh.

Study design

This was a cross-sectional study.

Methods

This included the participation of 400 food handlers from 15 food industries. The information was collected from the participants through a questionnaire prepared in Google form. Different nonparametric tests and a linear regression model were performed for statistical analysis.

Results

With a correct response rate of about 90% on average (knowledge 89.7%, attitude 93%, practices 88.2%), the participants showed an acceptable KAP (>80% correct response) regarding COVID-19. Education (p = 0.00) and working experiences (p = 0.01) had a significant association with the total KAP scores.

Conclusion

Food handlers in the food industries of Bangladesh have adequate knowledge, a positive attitude, and the desired practices regarding the COVID-19 issue.

From farm to table: exploring food handling and hygiene practices of meat and milk value chain actors in Ethiopia

Livestock value chains constitute a source of livelihood for meat and milk value chain actors in Ethiopia, from dairy farmers to other associated value chain actors such as milk traders, abattoir workers, public health officials, veterinarians, butcheries selling meats, milk cooperatives, artisanal milk processors, and transporters. The development of these livestock value chains, however, is constrained by poor food safety and quality, while consumers are also exposed to public health risks due to milk and meat value chain actors' food handling and hygiene practices.This study used Photovoice and participant observation to explore meat and milk value chain actors' food handling and hygiene practices in suburban areas of Addis Ababa and neighbouring Oromia in Ethiopia. The results of this study reveal that milk and meat value chain actors' food handling practices are not aligned with the recommended Ethiopian food safety and quality standards. Low compliance with food safety and quality standards reflected a combination of factors such as lack of incentives, poor road infrastructure and low enforcement of food safety standards.Participatory and visual research methods enable a researcher to collect context-aware data that can lead to the development of policies and intervention strategies that reflect local needs and priorities. The results of this study affirm the need to identify socially acceptable and economically viable policies and intervention strategies that are acceptable to all chain actors; and suggest there is an imperative to train milk and meat value chain actors on good hygiene handling practices, improve road infrastructure, and facilitate access equipment such as fridges and freezers that can contribute to maintaining food safety and quality.

Development of an Educational Gamification Strategy to Enhance the Food Safety Practices of Family Farmers in Public Food Markets of Northeast Brazil: A Case Study

This study aimed to develop an educational gamification strategy to enhance the food safety practices of family farmers in public food markets in a city in Northeastern Brazil (João Pessoa, PB, Brazil). A good manufacturing practices (GMP) checklist was used to verify hygienic-sanitary conditions in the food markets. Educational game tools addressing foodborne diseases and GMP with information about the prevention of foodborne diseases, good food handling practices, and safe food storage were developed. Pre- and post-training assessments were done to evaluate food handlers' knowledge and food safety practices. Microbiological parameters of food samples were analyzed before and two months after the training. Results indicated unsatisfactory hygiene conditions in the examined food markets. There was a very strong positive correlation between "implementation of GMP" and "production and process controls" (R = 0.95; p ≤ 0.05) and between "production and process controls" and "hygiene habits of handlers" (R = 0.92; p ≤0.05). There was no homogeneity between answers before and after the training for the knowledge of family farmers regarding "prevention of foodborne diseases" and "safe food handling". There were improvements in the measured microbiological parameters of foods sold by family farmers after the application of the developed educational gamification training. These results showed the developed educational game-based strategy as being effective in raising awareness of hygienic sanitary practices, helping to promote food safety, and reducing risks for the consumers of street foods at family farmers' markets.

Food handlers' practices and associated factors in public food establishments in Gondar, Ethiopia 2021/2022

Food safety is crucial to avoid foodborne illness and improve human wellbeing. Millions of people get sick, and many of them pass away due to eating unhealthy food. Foodborne diseases are still a public health problem in developing countries like Ethiopia. The objective of this study was to assess food handlers' practices and associated factors in public food establishments in Gondar, Northwest Ethiopia. Across-sectional study was conducted among 417 food handlers in food and drink service establishments. The data were collected using a structured interview-administered questionnaire and an observational checklist. Multivariable logistic regression was used to identify predictors. The prevalence of food safety practice among food handlers was 37.6%, with a 95% CI of (32.9, 42.7). More than half of the study participants had good knowledge and attitude. Sex (female) [AOR = 0.40, 95%CI: (0.23, 0.92)], educational status (diploma and above) [AOR = 1.50, 95%CI: (1.21, 3.10)], and good attitude [AOR = 0.25 95%CI: (0.12, 0.89)] were predictors of food safety practices. The prevalence of food safety practices among food handlers in Gondar food establishments was low. The provision of education and on-the-job training on food safety and personal hygiene is advised to enhance good food handling practices.

Food safety culture in food companies: evaluation of the perception of food safety culture in three Tuscan food companies

The Commission Regulation (EU) No. 2021/382 (European Commission, 2021), amending the Regulation (EC) No. 852/2004 (European Commission, 2004), introduced the obligation for companies to establish and maintain a food safety culture (FSC). The methodology to evaluate, implement, and enhance the level of FSC is up to the individual companies. This study aimed to investigate the perception of FSC among the employees of 3 Tuscan medium-sized enterprises in the food sector, producing cured meat (A), dairy products (B), and frozen fish products (C). The survey was conducted through the development and administration of a questionnaire based on a 5 points Likert scale, referring to different aspects of FSC, organized in 6 sections with 5-6 statements each and subjected to a percentage of employees between 76 and 85%, classified also by the length of service (≤3 and >3 years). For all the companies, the minimum median and mode value for scores obtained by the different sections was 4, and the minimum median and mode value for the single statement was 3 (A, B; except for a bimodal value 2-4) and 4 (C). The section awareness and perception of risk showed the highest mean scores in all companies. As for the length of service, senior employees gave lower scores than junior ones in all sections in B and 3 sections in C. Overall, the results of the questionnaires showed a good perception of FSC, even though it was possible to identify some partial weaknesses.

Mechanisms linking individual and organizational culture change through action research: Creating change agents for organizational and food safety culture development

This article proposes a more individualized approach to organizational and food safety culture development through the creation of culture change agents. The study used action research with individual therapeutic training of sensory and emotional skills as the action intervention to reveal underlying mechanisms of the culture and create long-term culture change. The study was conducted with a group of voluntary employees over a 3-year period at a department under Food Safety and Veterinary Issues in Danish Agriculture and Food Council. Data was collected using individual in-depth qualitative interviews with a novel questionnaire technique that facilitated participants to bring otherwise unconscious underlying assumptions to awareness. The study found that working intensely and therapeutically on an individual and group level, had a significant impact on the surrounding culture and social capital. Five underlying mechanisms were revealed linking individual culture change to changes in the social capital and culture of the department. Going through the five underlying mechanisms may enable individuals to get to the root causes of issues, facilitate more sharing and collaboration to learn from near-misses and failures, and take action despite facing uncomfortable situations, all important abilities to develop FSC. Based on the underlying mechanisms a 'Change Agent Model' was developed. The model illustrates the important underlying mechanisms that any individual or group can work through to become culture change agents and drivers for organizational culture and FSC development. This is the first of two articles.

Food safety knowledge and practices among food handlers and consumers in Gulf countries: An integrative review

Foodborne illnesses result from inadequate food handling practices, but prevention is possible through implementing food safety principles by handlers and consumers. This paper presents an overview of food safety knowledge and practices among food handlers and consumers in the Gulf countries, identifies factors affecting knowledge and practice, and offers recommendations for promoting food safety among handlers and consumers. A literature search was conducted using an integrative review method. Various combinations of the following descriptors were used: (food safety, food hygiene), (knowledge, practice), and (Saudi Arabia, Qatar, UAE, Bahrain, Oman, and Kuwait). Out of 164 studies screened, 37 met the eligibility criteria. Food handler studies reported insufficient food safety knowledge, with poor translation of existing knowledge into practice. Consumer studies showed varying levels of food safety knowledge, and the translation of existing knowledge into practice was also found to be inconsistent. Training and educational level were the primary factors positively affecting food safety knowledge and practices. Overall, significant gaps in knowledge and practices were identified among food handlers and consumers in the Gulf. These gaps require urgent attention from the Gulf regulatory bodies to develop targeted food safety training and education programs to enhance awareness and implementation of food safety principles.

A systematic review of the knowledge, attitude, and practices (KAP) of food safety among street food handlers

Foodborne diseases are commonly reported from various food establishments; however, little information has been obtained on this topic from the street food industry. Therefore, the present systematic review aimed to provide an overview of the knowledge, attitude, and practices (KAP) of food safety among street food handlers to highlight relevant gaps in the safety and quality of food handling. Articles included in the present systematic review were extracted from several electronic databases based on the PRISMA protocol and CASP checklist. By applying inclusion criteria, twelve peer-reviewed studies from 2010 to 2020 were included in the present systematic review. Results revealed that the food safety KAP level among street food handlers varied across the study settings. It was also found that training plays an essential role in improving food safety practices. KAP assessment is essential as an initial diagnosis to guide and prioritise appropriate strategies based on the food safety aspect that requires the most attention. It also provides a decision-making basis for food safety authorities to develop relevant policies, and organise food safety training.

A cross-sectional study on food safety knowledge and practices among food handlers in tertiary and second circle institutions in Ho municipality, Ghana

In recent years, incidences of food poisoning have been reported in some schools across the country. However, little attention has been paid to the hygiene practices of food vendors in the schools. This study, therefore, investigates the food safety knowledge and practices of food vendors catering for tertiary and second cycle students in the Ho municipality. The piloted and validated questionnaire used to sample 608 respondents revealed that the majority of the respondents sampled were female (76.0%), between the ages of 26 and 40 (51%), married (47.4%), and have tertiary or senior high school certificate (60.7%). They have been in business for not more than 2 years (36.2%) and had neither food safety (62.3%) nor good manufacturing practice (81.9%) training. However, they have sufficient knowledge in food safety regarding purchasing, storage, cooking and reheating, and personal hygiene, but exhibited poor knowledge and practice of food temperature control protocols. Both Kendall's tau-b coefficient correlation and linear regression model revealed a significant positive correlation between food safety knowledge and practices of the vendors. Nevertheless, regular training and monitoring are necessary to enable the vendors to fully implement the food temperature control protocols, which is one of the major causes of food poisoning in the country.

Food Safety Practice and Its Associated Factors among Meat Handlers in North Shewa Zone, Oromia, Ethiopia

Background

Foodborne illness is one of the major public health problems globally. The majority of foodborne diseases arise from foods of animal origin. Hence, this study was proposed to evaluate meat handling practices and associated factors working in butcher shops in North Shewa Zone.

Methods

Data were collected through face-to-face interviews using a pretested structured questionnaire. Data were entered into a computer and analyzed using SPSS version 26. Binary logistic regression was used to identify factors associated with meat handling practice.

Result

The majority, 128 (57.1%), of meat handlers smoke in workplaces, and 20 (8.9%) of meat handlers handled money while processing meat. 180 (80.4%) of meat handlers process/handle meat when they had cuts, wounds, bruises, or injuries on their hands. 12.1% and 15.6% of meat handlers took food safety training and medical checkups, respectively. 51.3% of meat handlers had good meat handling practices. Knowledge (adjusted odds ratio [AOR] 2.99, 95% confidence interval [CI] 1.73-5.15), attitude (AOR = 1.94, 95% CI: 1.12-3.37), experience (AOR = 4.27, 95% CI: 2.34-9.85), medical checkup (AOR = 3.87, 95% CI: 1.67-8.96), and educational status (AOR = 5.50, 95% CI: 1.05-28.75) were significantly associated with meat handling practices.

Conclusions

Food hygiene training before employment and awareness creation for meat handlers should be strengthened. Routine inspections by responsible authorities are also recommended. Future studies should focus on the enumeration of bacterial load from utensils and meat handlers.

A Study on Perception and Exposure to Occupational Risks at Public School Food Services in Bahia, Brazil

Food service work is hazardous due to the intense rhythm of food production, and the working conditions can cause discomfort, fatigue, and occupational accidents and illnesses. For the perception of exposure to occupational hazards, workers must participate in continuing education programs. This study aimed to verify the perception and exposure to occupational risks at school food services (SFS) in Bahia, Brazil. This cross-sectional study was conducted in SFS from public schools in Bahia/Brazil. Researchers identified sociodemographic variables, occupational characteristics, and the Perception of Exposure to Occupational Risks by SFS food handlers. Also, anthropometric assessment (weight, height, and waist circumference), the presence of comorbidities, and the identification of exposure to occupational risks and measures of environmental comfort were evaluated. Most workers were female (98.6%; n = 140), mean age of 46.85 y/o, working as SFS food handlers between 1 and 5 years (50.7%; n = 72) but with no training on occupational risks (52.8%; n = 75). This lack of training is not associated with demographic or other occupational variables. The majority of the food handlers present a fair or good perception of exposure to occupational risk. These food handlers are also mostly overweight, and higher BMI was associated with hypertension and edema. The SFS were classified as of high occupational risk (mean of 31.24% of adequacy) environments. Ergonomic Risks had the lowest percentage of adequacy (7.69%, very high risk) regarding occupational risks, followed by chemical risks (31.5% of adequacy, high risk), accident risk (32.19%, high risk), and physical risk (36.89%, high risk). The excess of activities associated with precarious physical structure, insufficient number of equipment and utensils (in inadequate conservation) favors the exposure to occupational risk in SFS.

Food hygiene practices and determinants among food handlers in Ethiopia: a systematic review and meta-analysis

Background

Food-borne diseases are a major public health concern worldwide, particularly in low and middle-income countries (LMICs), such as Ethiopia. Poor food hygiene practices primarily exacerbate food-borne illness transmission. Prior studies on the food hygiene practices among food handlers in Ethiopia were inconsistent. Therefore, this meta-analysis and systematic review aimed to estimate the pooled proportion of good food hygiene practices and identify the determinants in Ethiopia.

Methods

The preferred reporting items for systematic review and meta-analysis (PRISMA) instruments were used, and a systematic search was performed in the PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases, and Google Scholar were systematically last searched on the 24th February 2022 for relevant articles. Only the observational studies that reported the proportion of good food hygiene practices and their associated factors among food handlers were included. The quality of the included studies was assessed by two independent authors. Articles with unclear methodologies and did not report the overall proportions of good food hygiene practice were excluded. The effect estimates for pooled proportion and pooled odds ratio (POR) along with a 95% confidence interval (CI) were determined conducting using DerSimonian–Laird's random effect model.

Results

Among 817 retrieved studies, 23 eligible articles with a total sample size of 7153 study participants were included in the meta-analysis. The pooled proportion of good food hygiene practices among food handlers was 50.5% [95% CI: (41.6, 59.4%]; I² = 98.7%, p value = 0.001]. Food handlers with formal education (POR = 4.60, 95% CI: 3.05, 6.93), good knowledge (POR = 1.98, 95% CI: 1.26, 3.11), training (POR = 3.52, 95% CI: 2.35, 5.28), and a positive attitude (POR = 3.41, 95% CI: 2.52, 4.61) about food hygiene components, as well as regular medical checkups (POR = 6.75, 95% CI: 4.49) were significantly associated with good food hygiene practice.

Conclusions

Only half of Ethiopia's food handlers had good food hygiene practice.

Implication of the study

The key elements of effective food hygiene practice that will aid in the development of feasible interventions to increase food handler compliance with food hygiene components have been identified.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-022-00423-6.

Structural modeling to understand the relationship among food safety knowledge, attitude, and self-reported HACCP practices in restaurant employees in Bangladesh

In this materialistic era, a substantial number of people are likely to have their meals outside of their homes and largely depend on the restaurants' made food due to the prolonged working hours and tremendous pressure in workplace. Consequently, consumers expose themselves to risk and become vulnerable to illness caused by food. Unsafe food preparation and handling by restaurants' workers have made food safety concern for public health. The study was aimed to examine the relationships among food safety knowledge, attitude, and Hazard Analysis Critical Control Point (HACCP) practices in restaurant employees in Bangladesh. A total of 360 employees from 120 restaurants participated in a face-to-face interview through a structured questionnaire comprising four sections: demographic characteristics, food safety knowledge, attitudes and practices. The mean scores for each survey item were calculated and used in Structural Equation Modeling (SEM), designed to assess interrelationships among the three sections related to food safety. Participants obtained a correct average score of 53.32% in food safety knowledge, with the highest and lowest correct scores in Good Hygiene Practices (GHPs) and HACCP practices, respectively. The highest score in the attitude section belonged to "self-improvement", followed by "food safety concern". A negative correlation was observed between knowledge with practices, knowledge with attitudes, and a positive correlation was observed between practices with attitudes. A significant positive correlation was observed between HACCP practices with shelf improvement (r = 0.54, p < 0.05) and the knowledge toward food poisoning with GHP practices (r = 0.55, p < 0.05). Self-improvement and food safety concerns are negatively correlated with food poisoning, GHP, and HACCP practice. This study demonstrated that restaurant employees in Bangladesh often lack knowledge regarding food safety and HACCP. So, in order to improve knowledge and attitude on safe HACCP practice among the restaurants employees', proper education and interactive training sessions can be conducted.

Assessing Producers’ Knowledge in Good Manufacturing Practices during the Production of a Traditionally Fermented Food (Ga Kenkey) in the Ho Municipality, Ghana

Good manufacturing practice (GMP) is the primary sanitary and processing requirement necessary to ensure the production of safe foods. It ensures that the production facilities and processes have the necessary conditions to prevent potential hazards from contaminating foods. However, little is known about its application in the production of a traditionally fermented and well-patronized food like the Ga kenkey. This study was therefore designed to evaluate the knowledge and practices of Ga kenkey producers in GMPs. A self-administered questionnaire was prepared and used to recruit 42 Ga kenkey producers using convenient sampling techniques. Out of the 42 producers, 83.3% were females, between 18 and 33 years (61.9%) and single (42.9%), and have been in the business for about 0 to 5 years (69.1%). A significant number of producers had neither GMP, food safety nor HACCP training. The producers have inadequate knowledge of GMPs since majority of them do not use gloves and consider wearing them unnecessary. Even though the producers agreed that GMPs improve product qualities, the establishment of reputation, and customer satisfaction and identify problems within the production process, they however did not pay attention to any form of hazards during the production process. Therefore, since education, training, and experience had a significant ( $P\le 0.05$ ) positive influence on the producers’ knowledge and practices, sufficient training in GMPs coupled with regular supervision should be provided to the producers for the hygienic and safe production of this commonly patronized food.

Interactions between Street Food and Food Safety Topics in the Scientific Literature—A Bibliometric Analysis with Science Mapping

Street food (SF) consists of ready-to-eat food prepared and sold on the street. This food constitutes the food traditions of local populations in many countries of the world. SF characterizes a large number of cities around the world, from New York to Paris, from Palermo to cities of North Africa, China, India and Japan. SF is inexpensive and prepared following traditional methods that meet local consumer preferences, culinary culture and lifestyles. Moreover, SF allows a unique experience for tourists who also want to experience a destination through traditional food consumed on the street together with the locals. Nevertheless, SF is linked to several health hazards. Hence, several studies discussed on the compliance with hygiene and food quality requirements that SF vendors should guarantee, to ensure human health. So far, there is no bibliometric review attempting to provide an objective and comprehensive analysis of the existing scientific documents that simultaneously study the scientific topic of SF linked to that of Food Safety (FS). Therefore, the objective of this paper is to provide a theoretical framework of the interactions between studies on SF and FS topics, in order to discover if the combined topic of “Street Food Safety” (SFS) was investigated as a topic in its own right. A bibliometric analysis was carried out analyzing 276 scientific contributions from the last 21 years, indexed in the Elsevier Scopus database and in the Clarivate Web of Science database. The results showed a very strong interaction between the two topics and many others in several scientific sectors; In particular, the topic of SFS involves many disciplines of social sciences. The results highlight that the scientific topic of SFS exists but not consciously, and it is believed that the research interest in this topic can grow considerably in the coming years, also because of the current COVID-19 pandemic situation that we are experiencing.

Behavioral predictors of household food-safety practices during the COVID-19 pandemic: Extending the theory of planned behavior

The epidemiological scenario of COVID-19, social distancing, and business restrictions has increased food preparation and consumption at home. Food mishandling at home can significantly raise the risk of foodborne diseases. This study investigates food-mishandling behavior predictors by applying the extended theory of planned behavior (TPB), with the addition of knowledge and risk perception, to households during the COVID-19 pandemic. One thousand and sixty-eight consumers (n = 1068) in Brazil participated in this study before the COVID-19 vaccination period. Data were collected using an online questionnaire with 40 questions and different anchors; they were analyzed using structural equation modeling. The following original TPB factors positively affected the intention to implement safe food-handling practices: attitude (p < 0.001), perceived behavioral control (p < 0.001), and subjective norms (p < 0.001). More robust effects of attitude and perceived behavioral control on intention were also observed. Although food-safety knowledge did not affect intention (p = 0.30), it positively affected the other TPB factors. Perceived risk positively affected all TPB factors. The results of this study support the usefulness of TPB and its extension, providing evidence that public-health crises can contribute to changes in food-safety-related consumer behavior.

An Evaluation of the Hygiene Practices of Polish Street Food Vendors in Selected Food Trucks and Stands

Today, street food vending is becoming a dynamically developing food industry in Europe, including Poland. Lifestyle changes and socioeconomic factors, especially among young consumers, make it a convenient food alternative, even in countries without this tradition. The aim of the study was to evaluate hygiene conditions and practices in selected street food facilities in Poland. The study was carried out in accordance with an observation checklist developed on the basis of the hygienic requirements of the European Union. The study covered 550 randomly selected street food vendors in Poland in 10 cities. The hygiene of street food outlets was assessed in three aspects: ensuring proper production conditions, hygiene of production and distribution, and hygiene of personnel. The evaluation of street food outlets showed that the level of hygiene was not fully acceptable. A small percentage of the examined objects satisfactorily fulfilled the requirements of the production conditions, production and distribution hygiene, and staff hygiene. The proposed hygienic checklist for quick daily monitoring of street food outlets can be used to perform internal and external inspections. It seems that specific codes of conduct for European street foods facilities are necessary.

Specific Hygiene Procedures and Practices Assessment: A Cross-Sectional Study in Fresh Fishery Product Retailers of Lisbon's Traditional Food Markets

This study aimed to assess the compliance of specific hand hygiene and food contact surfaces hygiene in fresh fishery product retailers (FFPR) and its relation to socio-demographic characteristics that might influence the observed procedures and practices. A cross-sectional study was conducted in traditional food markets’ FFPRs (N = 74) using interviews and audits for data collection purposes. Results revealed that women were overrepresented among FFPR managers; most were over 50 years of age and had a long working experience in fish retail activities, despite a low educational level. The majority had attended training courses in food hygiene, safety, and Hazard Analysis and Critical Control Points-based procedures. Both documental assessment and hand hygiene procedures and practices verification revealed a low level of compliance. Many documents supporting hygiene practices were lacking. Several non-conforming requisites were identified related to the handwashing procedure and equipment and to glove wearing practices. A higher level of compliance was obtained in food contact surfaces hygiene procedures and practices verification, with complete hygiene procedures applied and proper cleaning of utensils and chemical products management in several cases. These findings reflect an ambiguous understanding and misconceptions related to hygiene procedures and practices, suggesting the need to improve and update FFPR food handler training regarding basic food hygiene and safety.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic

The restaurant business has turned into a dynamic and ever‐growing industry. So, food safety must be a priority for these establishments, especially during the COVID‐19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self‐reported practice (KAP) of restaurant food handlers during the COVID‐19 pandemic. This quasi‐experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher's exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self‐reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA. Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID‐19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

What changed between 2008-2020 about Employees' perception of hygiene in the catering industry in Ankara (Turkey)?

Food safety is a public health concern because foodborne diseases have been increasing in recent years due to several factors such as urbanization, globalization and changes in consumer habits. Many countries in the world, including Turkey have upgraded their laws about food and personnel hygiene in the catering industry and undertaken changes to the organizational structure of their regulatory institutions to protect consumers' health. In this study, it was aimed to evaluate the perceptions of food processors on food safety and to determine whether there has been a change in this matter over the last 12 years. The data has been collected by conducting face to face interviews and having 500 employees from the sector fill in a questionnaire constructed for this purpose. The responses to the questionnaire have been measured by assigning 'hygiene perception points' to each respondent according to their replies. These hygiene perception points have been analysed in terms of gender, age, educational level and work experience of the employees involved. The results have revealed that employees between the ages of 26-34, women, university graduates have a higher level of perception of hygiene than other age groups, men, those with lower education levels, respectively. Hygiene perception points were found to be higher compared to the results obtained 12 years ago. The positive changes observed in the hygiene perception points are thought to result from the differences in the legislation of the years in which both studies were conducted. It is thought that the obligatory of providing hygiene and food safety training to individuals working in the catering sector with law changes leads to positive changes in the employees. Legally compulsory training activities can overcome many sanitation and safety problems that result from misinformed or uninformed employees.

Food safety practices of food handlers at home engaged in online food businesses during COVID-19 pandemic in the Philippines

This study was conducted to assess the self-reported and observed food safety practices (FSP) of food handlers, who deliver food products that are prepared and cooked at home during the COVID-19 pandemic in the Philippines. 751 participated in the online survey who were selected using criterion sampling. A questionnaire developed by the researcher was used to gather data with Cronbach Alpha of 0.91. t-test, ANOVA, and Fleiss kappa were performed to treat data. There were no significant differences between self-reported FSP in four dimensions and demographic characteristics, except for age, where a significant difference exists between the FSP of the four age groups along food preparation (F ​= ​4.530,ρ<0.01). The FSP in the four dimensions obtained a weighted x¯ and σ of 1.72 ​± ​0.69 which is interpreted as Sometimes Practiced. The food handlers at home inadequately and inappropriately practiced the protocols in keeping the food safe to eat. The observed reports showed that the food handlers at home do not meet food safety standards as indicated in the weighted x¯ and σ in the four dimensions 1.63 ± 0.11, with a description of Sometimes Practiced. Observed practices further show very poor adherence to guidelines. Test for inter-rater reliability yielded almost perfect agreement (κ ​= ​0.81, ρ<0.05). There exists a significant difference with the FSP in personal hygiene (t ​= ​0.964, ρ<0.05), cross-contamination prevention and sanitation (t ​= ​0.815, ρ<0.05), food preparation (t ​= ​0.753, ρ<0.05), and food delivery (t ​= ​0.794, ρ<0.05). Government and non-government agencies should work together towards educating the food handlers at home on effective ways to learn about food safety concepts so they could become advocates of safer food practices.

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Online food business is growing due to restrictions brought about by the pandemic.

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Self-reported FSP of food handlers reveal compliance to food safety standards.

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Food handlers violate food safety protocols based on expert observations.

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There is significant difference between the self-reported and the observed FSP.

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Food safety training involving food handlers in online businesses is imperative.

Design and Development of an Instrument on Knowledge of Food Safety, Practices, and Risk Perception Addressed to Children and Adolescents from Low-Income Families

In the fight against foodborne diseases, expanding access to information for different groups is needed. In this aspect, it is crucial to evaluate the target audience’s particularities. This study constructed and validated an instrument containing three questionnaires to identify the level of knowledge, practices, and risk perception of food safety by low-income students between 11 and 14 years old. The following steps were used: systematic search of the databases; conducting and analyzing focus groups; questionnaires development; and questionnaires analysis. After two judges’ rounds, the final version was reached with 11 knowledge items, 11 practice items, and five risk perception items. The content validation index values were higher than 0.80. The adopted methodology considered the students’ understanding and perceptions, as well the appropriate language to be used. Besides, it allowed the development of questionnaires that directly and straightforwardly covers the rules set by the World Health Organization for foodborne disease control called Five Keys to Safer Food (keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials). Its use can result in a diagnosis for elaborating educational proposals and other actions against foodborne illness in the most vulnerable population.

Food safety knowledge, attitudes and practices of food handlers: A cross-sectional study in school kitchens in Espírito Santo, Brazil

BACKGROUND

The adoption and evaluation of good practices in food handling in food service are essential to minimizing foodborne diseases. The present study aimed to evaluate food safety knowledge, attitudes, and practices of food handlers in schools in Vitória, Brazil.

METHODS

A cross-sectional study was carried out in the school food services of the municipal network of Vitória-ES. The sample of food handlers was obtained by convenience and comprised food handlers involved with preparation and other kitchen-related activities. The instrument consisted of a structured questionnaire with 36 six questions that included sociodemographic characteristics, knowledge, attitudes, and practices (KAP) related to good practices and food safety. The questionnaire was answered by 172 food handlers. Pearson correlation test, T-test, Tukey's test and multiple linear regression analysis were conducted. Data entry and analysis were done using SPSS v.20 software.

RESULTS

Most of the participants were female (96.5%, n = 166), were 40 to 49 years old (44.8%, n = 78), attended high school (57.9%, n = 99), had up to 5 years of experience in the role (39.5%, n = 68). Some of them had participated at least 4 times in training (74.4%, n = 128) of which the most recent session had occurred within 3 months (52.0%, n = 44). The lowest score was obtained for knowledge (7.1 ± 1.22). All the models presented significant results for the F-test. This result show good model fit and results ranging from 1.5 to 2.5 on the Durbin Watson test of residual autocorrelation. The linear regression analysis allowed us to identify that the knowledge score increased with experience, but it was significant only for those who had spent up to 10 years in the role. The knowledge score was associated with experience and training time. Attitudes were significantly related to the schooling and training time. The increase in the classification of practices is shown only through a classification of attitudes.

CONCLUSIONS

Although the food handlers' knowledge level in general was considered as sufficient, it was inferior to their scores for attitudes and practices regarding certain food safety concepts. Food safety training is ongoing in these units and covers the main aspects that favour the transformation of knowledge into appropriate attitudes and practices.

Consumer Eating Behavior and Opinions about the Food Safety of Street Food in Poland

Street food plays an increasingly important role in the nutrition of the inhabitants of European cities. Our study aimed to analyze Polish consumers’ attitudes toward food offered in street food outlets, consumers’ eating out behavior, and the factors that determine their choice of meals from street food vendors. A survey was conducted of 1300 adult respondents who eat street food in Poland. The research enabled a detailed and comprehensive assessment of consumer behavior toward the use of street food outlets, as well as consumer opinions on vendors’ functioning, including hygiene and meals offered. Factors determining the frequency of street food consumption, preferred food types, and factors influencing the use of such outlets were identified. The most important factors were the quality of services and meals, personal preferences and price. Using cluster analysis, consumer profiles based on the types of street food outlets and food preferred were identified. Four main street food consumer preference profiles were identified: ‘burger-enthusiasts’, ‘kebab-enthusiasts’ and ‘ice-cream enthusiasts’, and ‘no specific-oriented consumers’. The Internet and social media were identified as information and promotion channels for this form of gastronomy. Results also revealed Polish consumer behavior and opinions about the food safety of street food in Poland. In summary, in Poland the habits of eating typical Polish homemade dishes is being replaced by eating meals in street food outlets, which can be classified as fast food. Increasing consumer knowledge and awareness of the quality and safety of street food may counteract improper hygiene practices of sellers.

Effect of food safety training on behavior change of food handlers: A case of orange-fleshed sweetpotato purée processing in Kenya

Sweetpotato purée processing is new to Kenya and a rapidly growing value addition activity among informal, small, and medium-sized food enterprises (SMEs) in sub-Saharan Africa (SSA). Inadequate knowledge of food safety and poor hygiene practices by food handlers, low level of compliance with Good Manufacturing Practices (GMPs), and microbial contamination are major food safety challenges in orange-fleshed sweetpotato (OFSP) purée processing in Kenya. The extent of food safety training in enhancing food safety in rural-based SMEs and food processing environments has not been fully investigated. This study aimed at evaluating the impact of food safety training on food safety knowledge and hygiene practices of food handlers and in control of microbial contamination in OFSP purée processing in Kenya. Pre- and post-food safety training assessments were conducted to determine food handler's (N = 14) knowledge and practices on food safety. Food, water, and swab samples (n = 62) from the processing environment were collected before and two months after the training and analyzed for food hygiene indicator microorganisms. The findings indicate a significant (p < 0.05) improvement in overall food safety knowledge and practices of food handlers after the training. Poor knowledge scores were exhibited on aspects of cross-contamination, cleaning, and sanitation but these significantly (p < 0.05) improved after the training. Similarly, microbial counts on food equipment surfaces, installations, personnel hands, and in the final product (OFSP purée) significantly (p < 0.05) declined to acceptable levels after the food safety training. Total counts, yeasts and molds, S. aureus, Enterobacteriaceae, and total coliforms counts in the packaged OFSP purée were 2.6, 1.8, 1.5, 1.9, and 1.2 LOG CFU/g respectively hence suitable for its current application as an ingredient in baked products. The findings from this study indicate food safety training as an appropriate tool for improving food handler's knowledge and hygiene practices as well as enhancing microbial safety and quality of processed foods in SMEs if necessary food safety support resources are provided.

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler

BACKGROUND

Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics.

METHODS

We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire.

RESULTS

82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training."

CONCLUSION

Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Evaluation of food safety knowledge, attitude, and self-reported practices of trained and newly recruited untrained workers of two baking industries in Dhaka, Bangladesh

In Bangladesh, with the mounting esteem of bakery products, food safety issues in bakery industries are a paramount concern nowadays. In this regard, this current study was performed to evaluate food safety knowledge, attitude, and self-reported practices of two groups (160 trained and 55 new untrained) of workers from two popular baking industries in Dhaka, Bangladesh. A self-administrated questionnaire was used to acquire the data during the study. On food safety knowledge, attitude, and self-reported practices, trained workers' scores (33.01 ± 0.09, 14.86 ± 0.03, 10.66 ± 0.25, respectively) were significantly higher than the scores (9.82 ± 0.23, 10.44 ± 0.26, 5.91 ± 0.33, respectively) of newly appointed untrained workers. The quality assurance department displayed better knowledge, attitude, and self-reported practices scores than the rest of the departments of the industries. However, compared to knowledge and attitude, the self-reported practice was not up to a satisfactory level. According to the study, training can be proved effective for improving knowledge and attitude but does not always translate those into self-reported practice and behaviors. The results also reinforce the importance of conducting training for untrained workers and suggest further behavior-based food safety training for all employees.