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

Bacterial foodborne illness and Escherichia coli O157:H7 strain infection among asymptomatic food handlers in Northeast Ethiopia: Implication for hygienic practices and mass-screening

Background and Aims

Food-borne illness is a public health concern in developing countries because of improper food handling and sanitation practices, irregular medical checkups, lack of clean water supplies, and inadequate education among food handlers. This study investigated the burden of bacterial food-borne illness, antibiotic resistance patterns, and associated factors among food handlers in prison and nonprison food establishment settings.

Methods

A cross-sectional study was conducted from August 2022 to January 2023 among asymptomatic food handlers in Shewa Robit town. A total of 384 food handlers participated. Data were collected using structured questionnaires. Stool and hand swab samples were collected and cultivated onto MacConkey agar, xylose-lysine-deoxycholate, Mannitol salt agar, and blood agar, and incubated at 37°C. Bacterial species were identified using biochemical tests and gram staining. Mueller-Hinton agar was used in Kirby Bauer's disk diffusion method. Data were entered and analyzed using SPSS. Descriptive and logistic regression analysis were performed.

Results

Fecal and hand carriage rate of bacterial isolates were 106 (27.6%), and 214 (55.7%), respectively. Out of the 102 bacterial isolates, the most common ones from stool samples were Escherichia coli 71 (18.5%), Klebsiella aerogenes 12 (3.1%), and Salmonella spp. 7 (1.8%). Among 214 bacterial isolates, coagulase-negative Staphylococci 115 (29.9%) and Staphylococci aureus 66 (17.3%) were identified from hand swab samples. Hand washing practice after restroom with water (adjusted odds ratio [AOR] = 2; 95% confidence interval [CI]: 1.16-3.45), irregular medical checkups (AOR = 2.49; 95% CI: 1.35-4.59), and did not receive food safety and hygiene training (AOR = 2.33; 95% CI: 1.34-4.05) were statistically significant association with food-borne illness.

Conclusions

Foodborne pathogens pose a serious health risk in the study areas. The level of antimicrobial resistance are also concerning. Food handlers should therefore get strict regular health education, medical checkups, and training programs to prevent the spread of infections to the customers.

Effectiveness of Online Food-Safety Educational Programs: A Systematic Review, Random-Effects Meta-Analysis, and Thematic Synthesis

Online food-safety educational programs are increasingly important to educate different populations as technology and culture shift to using more technology. However, the broad effectiveness of these programs has yet to be examined. A systematic review, random-effects meta-analysis, and thematic synthesis are conducted to identify the effect size of online food-safety educational programs on knowledge, attitudes, and practices of consumers, food workers, and students and their respective barriers and recommendations. Online food-safety education was found to be of moderate and low effectiveness, with attitudes being the lowest in all populations. Consumers struggled with staying focused, and it was found that messaging should focus on risk communication. Students struggled with social isolation and a lack of time, and it was recommended that videos be used. Food workers struggled with a lack of time for training and difficulty understanding the material, and future programs are recommended to implement shorter but more frequent trainings with simple language. Future online food-safety educational programs should focus on incorporating social elements, as they can remain a huge barrier to learning. They should also focus on changing the participant's attitude to risk perception and beliefs in the importance of food safety.

Value chain hygiene practices and microbial contamination of street and market vended ready-to-eat grasshopper, Ruspolia differens in Uganda: Implications for food safety and public health

Food safety is a major public health issue particularly in developing countries. Ready-to-eat street-vended foods contribute significantly to dietary intake in urban and peri-urban areas, but with elevated public health risk. In this study, hygiene and food safety practices as well as the microbial contamination in Uganda's edible grasshopper value chain were evaluated."A total of 29 grasshopper-processing households participated, and grasshopper samples collected. Indicator pathogens were analyzed using standard microbiological methods. In Kampala 50% and in Masaka 12% households had earth floors. All households in Kampala were one or two-roomed dwellings with no separate room as a kitchen, and shared a toilet. In contrast, 59% of households in Masaka had three or more rooms, 35% had a separate room for a kitchen and 47% did not share a toilet. 83% households in Kampala and 56% in Masaka obtained drinking water from public taps. Handwashing was inadequate and none of the actors was observed to wash their hands after taking a break or handling waste. For vendors, wearing protective clothing was not common, with only 28.5% in Kampala and 30.8% in Masaka wearing an apron. Containers for vending grasshoppers were largely uncovered and the utensils for measuring the grasshoppers were left mainly uncovered. Indicator organisms, Escherichia coli and Salmonella typhimurium, were detected. E. coli was the most common contaminant, but with lower levels in Masaka compared to Kampala. S. typhimurium was mainly a burden in Kampala. Our findings demonstrate that there are enormous contributors to poor hygiene and sanitation along the edible grasshopper value chain. The existence of pathogenic bacteria such as E. coli in ready-to-eat foods imply that their consumption poses a health risk.

Knowledge, Attitude, and Practices on Food Safety among Food Handlers Working in Public Food Service Establishments in Lemi Kura Subcity, Addis Ababa, Ethiopia

Foodborne diseases, resulting from poor food handling and sanitation practices, are common public health problems globally. The primary contributing factors to potential foodborne disease outbreaks are often attributed to the poor perception and practices of food handlers regarding food safety. This study is aimed at assessing the knowledge, attitude, and practices of food handlers working in public food service establishments in Lemi Kura subcity, Addis Ababa, Ethiopia. A cross-sectional study was conducted from December 2022 to September 2023, involving 400 food handlers from 20 randomly selected public food service establishments. Data were collected using a structured interview-administered questionnaire and an observational checklist. The collected data were entered into Microsoft Excel and then transferred to SPSS version 20 for analysis. Descriptive statistics were employed to summarize the data, and Pearson's chi-square test was used to evaluate the association of sociodemographic factors with the knowledge, attitude, and practices of food handlers towards food safety. Of the 400 food handlers, 65.5% had good knowledge about food safety. All food handlers were knowledgeable that washing hand before handling food will reduce risk of poisoning, bacteria are the main cause of food poisoning, and temperature plays a big role in bacterial growth. This study also revealed that 65.3% of the food handlers had good attitude towards food safety and 55.3% of food handlers had good food handling practice. Based on the observation, 38.5% of food handlers had good food handling practice. Taking training, age, and work experience of food handlers have statistically significant (P < 0.05) association with good attitude towards food safety. Additionally, taking training, educational level, employment, and work experience of food handlers have statistically significant (P < 0.05) association with good practice towards food safety. However, there was no statistically significant association between all sociodemographic factors and knowledge about food safety. Good knowledge and attitude were also associated with good food handling practices of the respondents. Based on the observation, there was a statistically significant association between employment status and good food handling practice. In conclusion, the findings suggest the necessity for implementing formal educational and training programs aimed at positively influencing the knowledge and attitude of food handlers, subsequently improving their food handling practices.

A systematic review and meta-analysis of food handling practices in Ghana vis-a-vis the associated factors among food handlers during 2009 and 2022

Foodborne diseases (FBDs) are a major public health concern, especially in Sub-Saharan African (SSA) countries, such as Ghana, where poor food handling practices (FHPs) are prevalent. To estimate the pooled proportion of good FHPs and the associated factors among Ghanaian food handlers, this systematic review and meta-analysis was conducted to aid scholars, practitioners and policymakers in devising FBD-preventable interventions. The scientific databases PubMed, Google Scholar, Science Direct, African Journals Online, ProQuest, and Directory of Open Access Journals were systematically searched until April 19, 2023, for relevant literature. Observational studies meeting the inclusion criteria of reported good FHPs among food handlers were included. Three authors independently searched the database, assessed the risks of bias and extracted the data from the shortlisted articles. A random-effects model with the DerSimonian and Laird model was used to estimate the pooled effect size of FHPs and the pooled odds ratio (POR) of FHP-associated factors. Out of the 2019 records collated, 33 with a total sample size of 6095 food handlers met the inclusion criteria for meta-analysis. The pooled proportion of good FHPs among Ghanaian food handlers was 55.8% [95% Cl (48.7, 62.8%); I2 = 97.4%; p < 0.001]. Lack of food safety training [POR = 0.10; 95% CI (0.03, 0.35); p = 0.001] and inadequate knowledge of food hygiene [POR = 0.36; 95% CI (0.01, 10.19); p < 0.001] were identified as the critical good FHP-associated factors. The study showed that the proportion of good FHPs among Ghanaian food handlers was 55.8%. To increase knowledge of food hygiene among food handlers, the Ghanaian Food and Drugs Authority (FDA) is recommended to provide regular training on food safety for the well-being of the general public.

The Rise of Non-typhoidal Salmonella Infections in India: Causes, Symptoms, and Prevention

Non-typhoidal Salmonella infections (NTS) are a growing concern in India, posing a significant health risk to the population. These infections are becoming more common at worrisome rates, primarily because of inadequate surveillance. Salmonella non-typhoidal causes severe gastroenteritis and can even cause invasive infections, such as bacteremia, and focal infections, such as meningitis and septic arthritis, and is acquired through contaminated food and water sources. From moderate to severe, the symptoms might vary. Certain serovars exhibit a stronger propensity for specific syndromes, with serious infections more commonly observed in vulnerable populations. Consuming contaminated food, using inadequate sanitation procedures while handling meat from animals slaughtered, and contaminated water supplies are some of the causes of these diseases. Proper food and water treatment, better sanitary facilities, public awareness campaigns, and adherence to food safety laws are all part of prevention measures. The issue of antimicrobial resistance further emphasizes the necessity for prudent antibiotic usage. The Indian government has put in place programs including public awareness campaigns, better sanitary facilities, and stricter food safety laws. In the future, efforts should, however, concentrate on improving laws, boosting hygienic practices, and funding the development of new medicines and vaccines. These actions will lessen the burden of NTS infections in India by assisting in their prevention and management. This review aims to understand the reasons for this growing tendency, which is essential for creating efficient control and prevention strategies.

Food safety knowledge, attitude, and practice of street food vendors and associated factors in low-and middle-income countries: A Systematic review and Meta-analysis

Access to safe food is considered a basic human right, but food-borne disease presents a significant public health concern globally. The problem is exacerbated in low- and middle-income countries. Due to the rise in urbanization and the popularity of street food in low- and middle-income countries, understanding the Knowledge, Attitude, and Practice (KAP) of street food vendors is crucial to ensuring food safety. Therefore, this review was aimed to estimate the pooled proportion of KAP of street food vendors toward food safety and its associated factors in low- and middle-income countries. A comprehensive search of published studies before January 30, 2023, was identified using databases like PubMed/MEDLINE, Cochrane Library, HINARI, Science Direct, and African Journals Online, as well as other sources. The preferred reporting items for systematic reviews and meta-analysis guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 14/SE software. The quality of the included studies was assessed using the Joanna Briggs Institute's quality appraisal tool. A random-effects model was used to estimate the pooled proportion of KAP of street food vendors toward food safety and associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics were used to assess heterogeneity. Furthermore, sensitivity analysis and subgroup analysis was also conducted. In this study, fourteen eligible studies with a total of 2,989 study populations were included. The pooled proportions of good knowledge 62% (95% CI: 51-73), positive attitude 66% (95% CI: 47-86), and good practice 51% (95% CI: 36-65) toward food safety were found among street food vendors. Being of secondary school education (OR = 5.95, 95% CI: 4.05-7.85), having training in food safety (OR = 4.64, 95% CI: 2.62-6.67), having a higher monthly income (OR = 2.98, 95% CI: 1.06-4.9), and having good knowledge of food handling (OR = 2.26, 95% CI: 1.17-3.16) were found to be associated factors in the food safety practice of street food vendors. Based on the findings of this study, there was a significant gap in the KAP of street food vendors toward food safety. Therefore, the provision of training and strengthening health education about food safety are invaluable strategies for improving food safety.

Food safety knowledge, attitude, and practice among male and female food handlers: Evidence from fruit and vegetable producers in Ethiopia

Studies on the level of knowledge, attitude and handling practice towards food safety would help to determine the associated factors of knowledge, attitude and practice towards food safety; however, these studies did not explicitly address food safety concerns related to fruit and vegetables in Ethiopia. Men and women could have different levels of knowledge, attitude, and handling practice; however, these gendered effects were not addressed in previous studies. Using data collected in 2021 from 311 farm households in Ethiopia, this study aimed to analyze the level of knowledge, attitude, and handling practice of fruit and vegetable and associated factors among male and female food handlers. Data was analyzed using descriptive statistics, spearman's correlation, and econometric models (logit, multinomial logit and ordered probit). Education has a positive significant effect on knowledge, attitude and handling practices of fruit and vegetable handlers. However, the effect was higher in the females. No correlation could be obtained between knowledge and practices for the total respondents. However, knowledge had a positive but weak significant association with practices in the female group. We found a significant positive correlation between knowledge and attitude. These findings indicated that food safety knowledge of fruit and vegetable handlers will influence their attitude and a positive attitude would influence the practice in safe handling of fruit and vegetables. It therefore may require more targeted campaigns (i.e. from awareness creation to behavior change) to increase the ability of the community members to adopt best practices while reducing the barriers associated with consuming unhealthy diets.

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 Behaviours among Food Handlers in Different Food Service Establishments in Montenegro

Foodborne diseases in food facilities are a major public health problem, due mostly to the limited surveillance and educational level of food-handling workers. This study was conducted in 220 food service locations in Montenegro. Participants’ behaviour was assessed by a survey using the specifically designed structured questionnaire, administered before and after the training. To determine the effect of the training on the performance of food handlers, a microbiological analysis of food contact surfaces and food handlers’ hands was also performed. The behaviour of food handlers, viewed as a whole, is unacceptable. There was a statistically significant difference (<0.05) among participants who completed catering school compared with those who did not, regarding hand washing. The type of facility in which participants worked (restaurant, bakery, or pastry shop) revealed statistically significant differences (<0.05) in relation to hand washing, that is, restaurant employees had better habits than those from bakeries and pastry shops. Before the training, participants showed acceptable behaviour regarding hand hygiene, but it was much better after the training. Results of microbiological analyses of food contact surfaces and food handlers’ hands indicated better results after the education, especially with regard to hand swabs. The results of this study indicate the importance of education to improve food handling practices among food handlers, which might also decrease the possibilities for contamination of food.