food safety practices research paper

• Research article
• Open access
• Published: 03 May 2021

Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana

• Lawrence Sena Tuglo 1 ,
• Percival Delali Agordoh 2 ,
• David Tekpor 3 ,
• Zhongqin Pan 1 ,
• Gabriel Agbanyo 3 &
• Minjie Chu   ORCID: orcid.org/0000-0002-7533-9119 1  

Environmental Health and Preventive Medicine volume  26 , Article number:  54 ( 2021 ) Cite this article

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Metrics details

Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana.

This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization’s Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed.

The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p =0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p =0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p =0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p <0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p <0.001].

Conclusions

Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Introduction

A report by the World Health Organization (WHO) (2015) showed that about two million incurable cases of food poisoning materialize annually in unindustrialized nations. The WHO further estimates that 600 million food-borne diseases (FBDs) each year were related to poor food safety and hygiene practice with 420,000 deaths [ 1 ], the majority attributed to meat-related vulnerabilities [ 2 ]. About, 76 million FBDs caused 325,000 hospitalizations in the USA which led to 5000 deaths [ 3 ]. The source was associated with the consumption of turkey contaminated by Salmonella enterica serovar Heidelberg , responsible for salmonellosis in the USA [ 4 ]. Almost, 1.3 million FBDs resulted in 21,000 hospital stays reported in England which led to 500 deaths. The contamination was due to sprouts by Escherichia coli O104 [ 3 ]. Around 53% of the food-borne problems and 31% of its associated illness were attributed to meat consumption in the Netherlands [ 2 ]. The rate of FBDs in Malaysia was 47.8% out of 100,000 people who patronized street-cooked foods [ 5 ]. In Ghana, about 65,000 persons including 5000 kids below 5 years died yearly due to FBDs [ 6 ].

The risk factors such as inappropriate time interval, unsuitable temperature, weather condition, unhygienic activities, unacceptable handling of foods, foodstuff from insecure origins, impoverished self-cleanliness, improper cleaning of cooking materials, using untreated water, and improper food storages were attributed to the causes of FBDs [ 7 , 8 , 9 ]. Also, neglect of hygienic measures by food handlers has been implicated as enablers for the spread of pathogenic microorganisms [ 10 ] and the cause of infections among consumers [ 11 ].

Studies recount that 12 to 18% of food-borne illnesses are attributable to contaminations [ 12 , 13 ], poor food safety, and inappropriate hygiene practices which were accredited to street-cooked food handlers (SCFHs) [ 14 , 15 ]. These SCFHs are people who are wholly or partly engaged in the food preparation, processing, and production value chain and who have a direct touch on food and cooking utensils [ 9 , 16 ]. Foods prepared by food handlers under unhygienic conditions become a public health concern both in industrialized and low-income countries [ 17 ]. Food safety and hygienic practices of SCFHs are essential to ensure that food is free from any forms of contamination through preparation and processing for consumption and to prevent the spread of FBDs [ 18 , 19 ].

Food safety knowledge (FSK) is the understanding of food learned from skills or schooling, food safety attitude (FSA) refers to sensation or belief about food safety, and food safety practice refers (FSP) to the act or use of food safety [ 20 ]. Food safety knowledge, attitude, and practices (KAP) are important because inadequate knowledge, poor attitude, and poor sanitation practices by SCFHs have a severe danger to food safety applications in food companies [ 21 ]; hence, KAP of food safety contributes significantly to the occurrence of food poisoning and FBDs among consumers [ 22 ].

A study conducted in Brazil among food truck food handlers revealed poor hygiene, poor clean observes, poor environments, and higher contaminated meals [ 23 ]. The problem of FBDs was higher in Southeast Asian and African counties [ 24 ]. Ma et al. [ 25 ] study in China, among street food vendors, revealed poor behaviour practices and knowledge of food safety among the respondents. Tabit and Teffo [ 26 ] in South Africa found over 60% of the respondents keep good knowledge and acceptable hygiene performance of food safety. Lema et al. [ 27 ] in Ethiopia reported that below half of the respondents obtained good food cleanliness applications. The effects of food-related illness expenditures in hospital treatments are about US$ 110 billion annually in developing countries, which resulted in decreasing production [ 28 ].

The recurrent happenings of food-related illnesses brought in its wake concerns about the food safety knowledge and hygiene among SCFHs [ 29 ]. Maintaining food safety involves establishing global laws conferring to an agreement between institutions that actualized this agenda [ 30 , 31 ]. The Government of Ghana affirmed food safety regulations in collaboration with the Food and Drug Authority (FDA) [ 30 ]. Yet, its application is undermined due to ineffective supervision by appropriate agencies [ 32 ]. The problem was due to the broad governmental assembly in cities and communities under the local administration [ 31 ]. Some local studies conducted in the four regions of Ghana such as Greater Accra, Northern, Western, and Central have reported adequate knowledge, good attitude, and positive behavioural practices of food safety and handling practices [ 11 , 33 , 34 , 35 ]. Studies have shown that SCFHs were not knowledgeable about the WHO’s Five Keys to Safer Food for food handlers [ 33 , 36 ] which include keeping clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials [ 37 ].

Hence, the acceptance and the use of the KAP instrument as a problem-solving approach in this study are validated from previous researches [ 23 , 38 , 39 ]. This would adequately support the policymaking development and the change of embattled intervention policies for the prevention and control of FBDs. The KAP’s tool assessment defined in this study is considered appropriate to other frameworks if the statements in the KAP’s sections are validated. To our knowledge, no research has yet been done on KAP of food safety among SCFHs selling commonly consumable foods on the street in Volta Region, Ghana. Hitherto, the high cases of FBDs such as diarrhoea, cholera, and typhoid fever outbreak occurrences in the district are presumed to be influenced by SCFHs. The KAP of SCFHs on food safety and hygiene precautions ruins uncertainty in the district, and a swift policy to mend some causes central to the occurrence of FBDs is obligatory. This would help the District Health Directorate’s regulatory agency to plan the prevention methods. Therefore, this study assessed knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District, Ghana.

Materials and methods

Study design and setting.

This study was a descriptive cross-sectional carried out between August and November 2020 and used a validated, pretested, and structured questionnaire to collect data from stationary SCFHs along the principal streets within North Dayi District. North Dayi District is one of the 18 administrative districts in the Volta Region, Ghana [ 40 ]. It shares boundaries with Kpando Municipal to the north, South Dayi District to the south, and Afadzato South District to the east. The entire residents of the North Dayi District are 39,913 covering 46.7% men and 53.3% women [ 40 ]. The people of the District constitute 1.9% of the total population of the Volta Region [ 40 ]. Farming is the foremost financial activity, making it one of the main sources of income in the district [ 40 ]. We carried out this study because of the recent cases of food-borne illness reported among the residents such as diarrhoea, cholera, and typhoid fever in the district [ 41 ].

Eligibility criteria

Stationary SCFHs who directly served already cooked food to customers and those who owned their outlets were included in the study. SCFHs who dissented to partake in the research were excepted including all assistants and helpers. The assistants and helpers were excluded because not all vendors had assistants or helpers and they tend to be more in numbers than the vendor-owners themselves. So for as not to allow bias in the results, we chose to sample only the vendor-owners. Moreover, vendor-owners tend to have direct responsibility for monitoring the food safety environment of their vending sites; hence, we chose to sample them as the focus of this study.

Sample size and sampling

Cochran’s formula Z 2 p  (1 −  p )/ e 2 [ 42 ] for unknown study populations was used. Since a similar study in the Volta Region of Ghana among the population subgroup is unavailable, 50% was used for response distribution, with 95% confidence level, and a margin of error of 5% for the populace, plus 10% non-response rate which gave us a sample size of 423.

Data collection tools

A structured questionnaire was designed based on different studies conducted globally [ 16 , 20 , 38 , 39 , 43 , 44 , 45 , 46 ]. Similar versions of the questionnaires were used in studies conducted in Ghana [ 47 , 48 , 49 ]. The instrument was distributed into 4 parts: socio-demographics, knowledge, attitude, and hygiene practices. The statements on KAP were adapted from the WHO’s Five Keys to Safer Food guidebook for food handlers [ 37 ]. The questionnaire was firstly designed in English, then converted to local dialects, and translated back to English to ensure reliability and simplicity of the question. Four professionals in the field of the study assessed the face and the content validity of the questionnaire. The questionnaire was pretested on 12 stationary SCFHs in Tanyigbe located 7 km from the study area. The pretesting findings were not added to the main study but were used to modify some questions to improve their clarity. The most pertinent modifications done on the study instrument were a cooked meal should stay hot more than 60°C before serving, putting uncooked and prepared meal separating prevent cross-contamination, and checking and dispose of meal that past their expiry date. The data were collected through trained research assistant-led interviews which lasted for about 25 min per respondent. The interviewer-administered questionnaire was given to the SCFHs who could read and write to answer by themselves while those SCFHs who could not read and write have been aided by the research assistants in answering the questionnaire.

Determination of knowledge, attitude, and hygiene practices on food safety

Section 2 of the questionnaire contained 10 structured questions on knowledge of food safety with 3 likely responses; “true”, “false”, and “do not know”. The questions precisely covered the respondents’ knowledge of individual cleanliness, food-borne illnesses, microbes, infection control, and sanitary practices. Each correct knowledge item reported was awarded a score of 1 point. Incorrect knowledge was awarded a 0 score (including “do not know”). In this study, if “true” is the correct answer, then “true” is score 1 point while “false” is score 0 point or otherwise reverse.

Queries relating to attitudes in the third segment of the questionnaire were designed to assess the knowledge of SCFHs on food wellbeing and hygiene. This part of the section assessed psychological state concerning views, opinion, morals, and characters to act in particular [ 21 , 48 ]. It contains 10 structured queries with 3 likely answers: “agree”, “disagree”, and “not sure”. Each correct attitude reported was awarded a score of 1 point while the other incorrect attitude option was rated a 0 score (including “not sure”). In this study, if “agree” is the correct answer, then “agree” is score 1 point while “disagree” is score 0 point or otherwise reverse.

• Hygiene practice

Section 4 of the questionnaire measured food hygiene and sanitation practices of SCFHs. It contained 10 structured queries with 2 likely answers: “yes” and “no”. Each correct hygiene practice reported was awarded a score of 1 point while incorrect hygiene practices reported were awarded a score of 0. This method of assessment was used in previous studies [ 28 ]. In this study, if “yes” is the correct answer, then “yes” is score 1 point while “no” is score 0 point or otherwise reverse.

The grouping method is appropriate and suitable for studies allied to the assessment “of food handlers” KAP of food safety and hygiene [ 27 , 28 , 34 , 46 , 47 , 50 , 51 , 52 ]. The knowledge and attitude questions with “do not know” or “not sure”, thus the third option, had been presented to enable simplicity of responding by SCFHs for fascinating for thoughts considered by an undecided or doubtfulness [ 28 ]. This third option “do not know” or “not sure” always scores a 0 point due to the cumulative percentage approach adapted which considers only the acceptable response or the correct answer [ 53 ]. The cumulative percentage scoring method of assessment considers only the acceptable answer and the total cumulative score is converted to 100% [ 53 ]. The cumulative scores below 70% of the acceptable responses on WHO’s Five Keys to Safer Food-related knowledge, attitude, and hygiene practices were considered as “poor”, and cumulative scores 70% and higher were considered as “good” [ 27 , 34 , 39 , 46 , 48 ].

Data analysis

Questionnaires were checked manually before entering into Microsoft Excel 2016 spreadsheet. Coding and analysis were done in IBM Statistical Package for Social Sciences (SPSS Inc., Chicago, USA; https://www.spss.com ) version 24.0. Categorical variables were expressed as frequency and percentage. The disparity between categorical variable groups was verified using the Fisher exact or chi-square test where appropriate. Significant parameters were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. A p -value <0.05 was considered statistically significant.

Ethical consideration

Approval was sought from Ghana Health Service, North Dayi District Health Directorate, with the identity (NDDHD/GR/002/20) 15/07/2020. The research assistants introduced themselves and written informed permission was sought from the respondents. The research method was plainly explained to the respondents in their native dialects (English, Ewe, or Twi). Participants were identified by study numbers. The study numbers of the participants were kept in both locked files and secured computer files and accessible only to key investigators. All data were anonymized and unlinked to the respondents’ identities during the data analysis.

Demographic data

A total complete of 423 questionnaires were conveniently distributed for data collection based on the availability of SCFHs at their dedicated vending sites. Questionnaires of 407 were fully answered and collected from the respondents with a 96.2% (407/423) success rate. n = Z 2 p  (1 −  p )/ e 2   = 1.96 2 0.5 (1 − 0.5)/0.05 2 =384.16+38.416 =422.576. The majority ( n =343; 84.3%) of SCFHs were female, were between the age range of 26 and 35 years ( n =153; 37.6%), and were married ( n =311; 76.4%). Over one-third ( n =144; 35.4%) of SCFHs had attained secondary education. Most ( n =168; 41.3%) of SCFHs earned an average monthly income between GHc501 and GHc1000. Over half ( n =217; 53.3%) of SCFHs had 3–10 years of working experience. Regarding SCFH registered, n =297 (73.0%) reported that they have registered. More than half ( n =228; 56.0%) of SCFHs had not attended a food safety training course (Fig. 1 ).

Demographic data of respondents

Food safety knowledge

Almost all ( n = 381; 93.6%) of SCFHs knew about the washing of hands for 1 min using water and soap before touching food. The majority ( n =313; 76.9%) of SCFHs knew that similar chopping board should not be used for uncooked and prepared foods if it appears wash; n = 336 (82.6%) knew that cooked meal should stay hot before serving (more than 60°C); and n = 275 (67.6%) knew that excess meal should be kept at zone temperature and eat for the following mealtime. Most ( n =239; 58.7%) of SCFHs knew that uncooked meal should be kept individually from a prepared meal; n = 363 (89.2%) knew that treated water should be used for cooking; n = 363 (89.2%) knew that cockroach and house flies should not be allowed into the kitchen; and n = 274 (67.3%) knew that wiping cloths can spread microorganisms and cause disease. However, the majority ( n =235; 57.7%) of SCFHs did not know that food cooking utensils should not be cleaned using tap water only. Also, n = 202 (49.6%) of SCFHs did not know that fresh meat should not be stowed anyplace in the fridge once it is cool (Table 1 ).

Food safety attitude

The majority ( n =277; 68.1%) of SCFHs disagreed that regular hand cleaning throughout meal processing is needless; n = 323 (79.4%) agreed that cleaning kitchen shells lessen the danger of infection, and n = 355 (87.2%) agreed that putting uncooked and prepared meal separating stop infection. Below half ( n =181; 44.5%) of SCFHs agreed that they should be able to differentiate healthy diets and rotten food through eyeing; n =262 (64.4%) disagreed that using different knives and chopping materials for a fresh and prepared meal require more time; n = 366 (89.9%) agreed that they cough or sneeze inside the elbow if towel or paper not available; n = 291 (71.5%) agreed that checking meal for cleanliness and healthiness is important; and n =377 (92.6%) agreed that it is vital to dispose of meals that have gotten to expiring date. Nevertheless, n = 332 (81.6%) of SCFHs agreed that it is acceptable to use the same cloth for dusting and drying and n =217 (53.3%) disagreed that is unhealthy to allow prepared meal stay outside of the fridge for over 2 h (Table 2 ).

Food safety hygiene practice

The majority ( n =343; 84.3%) of SCFHs cleaned their fingers throughout meal cooking; n = 267 (65.6%) washed their cooking utensils used to cook a meal before using for a different meal; n =234 (57.5%) used different cooking bowls and chopping material if cooking a fresh and prepared meal; and n =359 (88.2%) dispersed uncooked and prepared meal before preservation. Also, n =278 (68.3%) keep prepared food at room temperature for 2 h when finished cooking; n =269 (66.1%) checked and disposed of meal past its expiry date; n =372 (91.4%) cleaned fresh food that needs no cooking before consumption; n =320 (78.6%) inspected if a meal is cooked by eyeing; and n =359 (88.2%) examined if a meal is grilled by touching it. Moreover, n =253 (62.2%) used similar kitchen cloth to clean shells and hands (Table 3 ).

SCFH knowledge, attitude, and hygiene practice on food safety classification

A high proportion ( n =274, 67.3%; n =237, 58.2%; and n =256, 62.9%) of SCFHs had good levels in knowledge, attitude, and hygiene practices on food safety (Fig. 2 ).

Levels of respondents’ knowledge, attitude, and hygiene practice on food safety

Association between knowledge, attitude, and hygiene practice and demographic data

Statistical significance was observed in the knowledge section among registered SCFHs ( p =0.031). None of the respondent’s socio-demographic data was statistically significant in the attitude section of food safety p < 0.05. The study found significant differences ( p <0.05) in the hygiene practice scores section with the educational status, average monthly income, registered SCFHs, and SCFHs completing food safety training course of food safety among SCFHs (Table 4 ). The odds ratio showed registered SCFHs were 1.6 times good at food safety knowledge likened to unregistered SCFHs [cOR=1.64 (95% CI 1.04–2.59), p =0.032]. The logistic regression analysis revealed that respondents who had secondary education were 4.1 times good at hygiene practice of food safety [aOR=4.06 (95% CI 1.63–10.11), p =0.003] compared to informal education. The respondents with average monthly income greater than GHc1500 were 4.9 times more likely to have good food safety and hygiene practices compared to those who earned less than Ghc500 average monthly income [aOR=4.89 (95% CI 1.56–15.34), p =0.006]. Meanwhile, registered SCFHs were 7.5 times more likely to have good food safety and hygiene practices compared to unregistered SCFHs [aOR=7.50 (95% CI 4.27–13.19), p <0.001]. The SCFHs who had completed a food safety training course were 6 times more likely to have good food safety and hygiene practices compared to those who had no such training [aOR=5.97 (95% CI 3.50–10.18), p <0.001] (Table 5 ).

Pearson correlation between knowledge, attitude, and hygiene practice toward food safety

The study revealed a positive correlation in the knowledge with the attitude outcomes sections (FSA) of food safety ( r =0.153, p =0.002) (Table 6 ).

The present study investigated knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District of Volta Region, Ghana. This study showed that the majority of SCFHs had good knowledge of food safety. This would help decrease the threat to contamination of foods, food poisoning, and FBDs to the consumers. Studies conducted in Saudi Arabia, Ethiopia, and Ghana have identified the importance of knowledge of food safety to SCFHs and have recommended training programmes on food safety to cultivate the knowledge into hygiene practices [ 14 , 27 , 34 ]. Our finding is inconsistent with previous studies done in Ethiopia and Jordan [ 38 , 45 ], however consistent with studies conducted in Ghana and Malaysia [ 47 , 54 ]. The possible reasons could be the type of food training courses received, the sample size, the scoring rubric applied, and understandings acquired on the subjects. This supported claims, creating an optimistic culture of food safety, inhibit food contamination if incorporated periodically [ 44 , 46 ]. This scenario affirms that the food safety training courses may remarkably enhance the knowledge of food handlers, especially concerning FBDs.

This study found that most of SCFHs knew about the washing of hands for 1 min using liquid and cleanser before touching food, which coincides with the study done in Iran [ 39 ]. The washing of hands with soap and water could reduce contamination of hands, cooking utensils, and cooking preparation surfaces leading to a substantive reduction of the risk of FBDs. Our finding does not corroborate with finding from a study done in Malaysia where a vast majority of SCFHs were knowledgeable of the 4th WHO Five Keys to Safer Food to keep the meal at healthy temperatures [ 20 ]. In our study, the SCFHs wrongly answered that fresh meat should be bestowed at any place in the fridge once it is cool. This misapplication of temperature could result in contamination and possibly proliferating of microbes in food. The reason is that appropriate temperatures can significantly lessen the risk at which foods will deteriorate, thereby preventing FBDs; hence for safety, foods must be held at an appropriate temperature sufficient to slow down the growth of microorganisms or kill microbes.

Attitude is one of the key elements that influence food safety and the practice and lessen the recurrence of food-related illnesses [ 51 ]. This study showed that most of SCFHs had a good attitude toward food safety. It means they understood their roles in food safety which was transmitted into attitude because they possibly serve as a vector for infectious pathogens which lead to food contamination. This agrees with studies conducted in Ghana and Haiti [ 48 , 55 ], but differs from a study done in Malaysia [ 36 ], where the majority of SCFHs had a poor attitude toward food safety. Possibly these could be due to the variances in socio-demographic characteristics, study population, and the study settings. These attitudinal variations could also be due to public reputation preference. Our study showed that visual checking was one of the key ways of differentiating healthy food from rotten ones, which concurs with a study conducted in Iran [ 39 ]. This finding is disturbing because the process of identifying food contamination cannot be performed by visual checking, since pathogens or toxins might be present in those foods without necessarily affecting SCFHs’ sensory aspects (smell, colour, or taste); therefore, food handlers who rely on visual checking for the identification of food contamination might expose consumers to an increased risk of contracting FBDs [ 39 , 56 ]. Therefore, the regulatory authorities must ensure that all SCFHs are trained professionally and certified.

The present study revealed a vast majority of SCFHs agreed that putting uncooked and prepared meal separating prevent cross-contamination, which corresponds to a study done in Haiti [ 55 ]. This act of putting fresh foods separating from cooked food could help prevent cross-contamination, which in turn may prevent infections from happening and halt FBDs. This is one of the highly endorsed public health measures to prevent cross-contamination [ 57 ]. This study found that almost all of SCFHs agreed that they coughed or sneezed into their elbows if a towel or paper is not available. Coughing and sneezing into the elbow or covering coughs and sneezes, and immediately washing the hands, could help to avert the spread of severe respiratory infections such as influenza and whooping cough. Our finding contradicts with other studies conducted in Malaysia and America; they reported that almost all respondents sneezed right away into their hands and never clean it [ 20 , 58 ]. This unpleasant attitude is harmful to the public since sneezing and coughing let out droplets of watery and perhaps transmittable microorganisms which can contaminate foods leading to FBDs.

Preservation of good sanitary behaviours is one of the goals for any food establishment, thereby its observance is vital to ensure safe meals for consumers [ 28 , 59 ]. The proportion of SCFHs in this current study with good hygiene practices of food safety corroborates with previous studies conducted in Saudi Arabia and Ghana [ 21 , 34 ]. This is an indication that SCFHs can be relied upon to act as the first-line responder to prevent several FBDs when they practice what they know. This would help reduce accidental contamination of foodstuffs due to improper management of cooking utensils and surroundings. Contradictory, in the present study, the scores obtained on the practices section were higher than hygiene practices of food safety reported in studies done in China and Nigeria [ 25 , 60 ]. The likely explanations of the difference reported could be as a result of the research population, the study cut-off used, the disparity in food safety courses, and differences in the law enforcement regimes. Our study revealed that the level of hygiene practices score was greater than the level of the attitude score attained by the SCFHs which corresponds to a study conducted in Malaysia [ 15 ]. The probable justification could be the SCFHs tend to provide responses they trust will create a good picture of their hygiene practices which account for the greater level score. The current study revealed that a vast majority of SCFHs washed their cooking utensils used to cook meals before using them for different meals, which is in line with a study done in Iran [ 39 ]. This act is acceptable because food handlers have been mostly identified as a significant vector for food contamination and responsible for FBDs [ 14 , 15 ]. Our study found that SCFHs practised wrongly by using similar kitchen cloth to clean shells and hands at the time which concurs with a study done in Malaysia [ 20 ]. The possible justification could be due to the non-compliance of the respondents to food safety training received. It could also be that they lack understandings of food safety education received. Hence, this displeasing practice may eventually result in contamination of hands and transfers of microorganisms to the consumers. This study showed that a vast majority of SCFHs cleaned fresh food that needs no cooking before consumption, which is in line with a study conducted in Malaysia [ 20 ]. This good hygiene practice is necessary to the elementary control of the spread of possibly FBDs.

Our study revealed a positive relationship between knowledge and the attitude of food safety which corresponds to earlier studies conducted in Malaysia, Iran, and Ghana [ 15 , 39 , 47 ]. Nevertheless, the strength of the correlation identified in the knowledge with the attitude scores of food safety was not strong, which implies that it is vital for the respective agency to monitor SCFH activities and enforce safety standards. Previous studies conducted in Malaysia and Iran found no significant relationship in the knowledge with the hygiene practices of food safety [ 20 , 39 ], which corresponds to our finding but contradicts with studies done in Malaysia and Ghana [ 15 , 47 ]. This result confirms the assertion that good knowledge does not affect the hygiene performance of food safety [ 61 ]. Hence, food handlers should be encouraged by food safety regulatory agencies to at least practise good hygiene irrespective of their levels of knowledge of food safety. In our study, no statistical association was found in the attitudes with the hygiene practice scores of food safety, which opposes earlier studies conducted in Malaysia, Iran, and Ghana [ 39 , 47 , 54 ]. These disparities could be due to their levels of knowledge of food safety and also possibly as a result of the kind of food safety training courses received. This present study found that registered SCFHs were more likely to have good food safety knowledge likened to unregistered SCFHs which is in line with earlier research in Lebanon [ 51 ] but differs in the study done in Malaysia [ 62 ]. The potential explanation is that maybe before SCFHs have been given their certification of registration, they probably have been taken through food safety training courses which provide them with adequate knowledge of food safety and offer them a good understanding of food poisoning, contamination, and hygiene. This shows the importance of registering food handlers who have successfully been through food safety training courses to acquire knowledge on food safety.

This study showed that the odds of good hygiene practices were higher among SCFHs who had secondary education likened to those with no formal education which is in line with a study conducted in Ethiopia [ 12 ]. In contrast to our findings, other studies conducted in Ethiopia and Ghana found SCFHs with primary education as more likely to have good hygiene practices of food safety likened to secondary education [ 27 , 34 ]. The possible reasons are because most food preparation skills, personal hygiene, and cleanliness are learned from friends, relatives, parents, and media but not necessarily from formal education. However, a lower level of education reduces awareness but the higher one gets educated the better the knowledge which affects their attitude and eventually may reflect into hygiene practices. It implies that food handlers should be encouraged to attain at least basic education before engaging into the cooking business, although it serves as the first sources of income for most uneducated people in the societies. Nevertheless, a study conducted in Ghana showed that regardless of educational background, the food safety actions of SCFHs remain an issue in many nations [ 48 ].

The present study showed that SCFHs who earned average monthly income above GHc1500 were more likely to have good hygiene practices compared to respondents who earned less than Ghc500. Our finding confirms a study conducted in Ethiopia and Jordan that found good hygiene practice among food handlers with higher monthly income than those with lower higher monthly income [ 27 , 63 ]. The possible justification is that SCFHs with high monthly income can afford to purchase items needed to establish themselves in hygienic environments and afford more employees to help in cleaning and waste treatment which could result in a reduction in food poisoning and cross-contamination. This means the high monthly income of food handlers determine their ways of hygiene practices, purchasing more cooking utensils for preparing different meals and managing their leftovers foods to prevent contamination.

The present study showed that registered SCFHs were in favour of good hygiene practices of food safety than the unregistered. The likely description is because of the food safety training courses they received before being registered as food handlers which provides them with an in-depth and comprehensive understanding of hygiene practices such as proper handling of food, personal cleanliness, and sanitation while preparing food. However, there is no research found relating registration of food handlers with hygiene practice scores; hence, the lack of the associated literature offers difficulties to compare our finding to collective results reasonably with concrete answered questions. Nonetheless, our finding shows the importance of registering food handlers after they have been through food safety training courses to encourage them to practise good hygiene.

This study found that SCFHs who have completed training courses on food safety were in favour of good hygiene practices of food safety likened to respondents who had not. Our finding asserts with previous studies done in Ethiopia, Malaysia, and Ghana [ 36 , 38 , 47 ]. The probable justification is that SCFHs who have completed food safety training courses had gained the talents and awareness necessary to handle food safely and sustain great ethics of self-cleanness and hygiene practices. Our finding affirms the assertion that training upsurges understanding of food safety which might reflect into hygiene practices [ 48 ]. Hence, a lack of or inadequate training of SCFHs on food safety may inadvertently result in poor hygiene practices, thereby encouraging food contamination [ 26 , 36 ]. This implies providing food safety training to food handles is important to keep consumers from food poisoning and other wellbeing dangers that could arise from eating unsafe food.

In this present study, it is significant to highpoint SCFHs’ knowledge, attitudes, and hygiene practices are unpredictable from the study conceded, though most of SCFHs properly responded by answering appropriately to related questions of WHO’s Five Keys to Safe Foods guidelines for food handlers. This theoretic-based assessment of the KAP method applied to assessed food handlers’ food safety KAP has some limitations. Firstly, the postulation that the received knowledge on food safety is translated into attitude is not entirely true. The existence of a social desirability bias could similarly have added to the discrepancy amid interview-responded KAP of SCFHs. Social desirability bias is the propensity of SCFHs to provide publically anticipated answers which will be regarded approvingly by people [ 64 ]. This proclivity has been shown by their descriptions and overrating socially anticipated KAP questions on food safety. Secondly, as we beforehand mentioned, the research assistants revealed their identities and the purpose of the study to the SCFHs; therefore, the SCFHs were mindful of the hygiene practices and the significance of observing them, but they remained keen to acknowledge their nonconformity and these could likely affect the self-reported hygiene practices. Thirdly, the unavailability of sufficient data from related studies in the district impedes an evaluative comparison of our findings to determine an improvement of food safety KAP among SCFHs; therefore, our findings ought to be interpreted with caution. However, due to the representative nature of the sample assessed, the findings of this study can be generalized to other SCFHs in the district. After all, it makes a substantial impact concerning food safety KAP in North Dayi District because it is the first study conducted in the district that presents an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Over half of the respondents had good levels of KAP of food safety. This study found a significant relationship in the knowledge and hygiene practice scores of food safety with SCFH registration. This shows the importance of strict enforcement of registration and certification of SCFHs by regulatory agencies as a means of protecting the consuming public. Therefore, the government agency through FDA should intensify the vitality of undertaking food safety training on WHO’s Five Keys to Safer Food by food handlers before being registered. Furthermore, the District Health Directorate should properly and effectively supervise food handlers engaging in cooking businesses to ensure they transmit the link between knowledge with the attitude of food safety into hygiene practice. Further studies should assess the kind of food safety training modules received and their impacts on the KAP of WHO’s Five Keys to Safer Foods as well as evaluating their hygiene practices with observational checklists.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available due to ethical consideration but are available from the corresponding author on reasonable request.

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Lawrence Sena Tuglo, Zhongqin Pan & Minjie Chu

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MC and PDA conceived and designed the study. LST drafted the manuscript. DT and GA coordinated the data collection. ZP participated in the data collection and contributed to data analysis and interpretation. All authors read and approved the final manuscript.

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Factors associated with food safety practices among food handlers: facility-based cross-sectional study

• Jember Azanaw 1 ,
• Mulat Gebrehiwot 1 &
• Henok Dagne 1  

BMC Research Notes volume  12 , Article number:  683 ( 2019 ) Cite this article

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The primary objective of this study was to assess factors associated with food safety practices among food handlers in Gondar city food and drinking establishments. The facility-based cross-sectional study was undertaken from March 3 to May 28, 2018, in Gondar city. Simple random sampling method was used to select both establishments and the food handlers. The data were collected through face-to-face interview using pre-tested Amharic version of the questionnaire. Data were entered and coded into Epi info version 7.0.0 and exported to SPSS version 22 for analysis.

One hundred and eighty-eight (49.0%) had good food handling practice out of three hundred and eighty-four food handlers. Marital status (AOR: 0.36, 95% CI 0.05, 0.85), safety training (AOR: 4.01, 95% CI 2.71, 9.77), supervision by health professionals (AOR: 4.10, 95% CI 1.71, 9.77), routine medical checkup (AOR: 8.80, 95% CI 5.04, 15.36), and mean knowledge (AOR: 2.92, 95% CI 1.38, 4.12) were the factors significantly associated with food handling practices. The owners, managers and local health professionals should work on food safety practices improvement.

Introduction

Food safety continues as a critical problem in developed and developing nations for people, food companies and food control officials [ 1 , 2 ]. Food-borne diseases (FBD) are associated with outbreaks and threatens global public health security and has got an international concern [ 3 ]. Food safety is a growing public health issue [ 4 ]. FBD is responsible for significant morbidity and mortality rates [ 5 ]. The worldwide incidence and financial expenses of food-borne diseases are hard to determine [ 6 ]. However, reports estimate that 2.1 million individuals died each year as a result of foodborne disease [ 5 ].

According to the WHO, FBDs in developing nations are serious because of bad hygienic food handling methods, bad understanding and absence of infrastructure [ 7 ]. This is due to the prevailing poor food handling and sanitation practices, inadequate food safety laws, weak regulatory systems, lack of financial resources, etc. [ 6 , 8 ]. Evidence revealed that around 70% of diarrhoea cases were attributed to food-borne routes in developing countries [ 6 ]. Like other developing countries, the burden of food-borne diseases is growing in Ethiopia [ 18 ].

Approximately 10 to 20% of FBD outbreaks are because of contamination due to poor food handling practice of the food handlers [ 9 ]. In the absence of well-maintained and proper food handling practices in mass catering establishments have the potential to impart a disastrous effect on human health [ 6 , 11 ].

Good personal hygiene and food handling practices are important for preventing the transmission of pathogens from food handlers to the consumers [ 12 , 13 , 14 ]. Close to 75% of food-borne illness outbreaks are attributed to lack of safe food handling practices by food handlers in food service establishments [ 5 ]. Food handlers play a key role in ensuring strict adherence to food safety principles throughout the whole process [ 15 ].

There is a high expansion of food establishments observed in the country including Gondar city. But ensuring safe food service has been one of the major challenges and concerns for producers, consumers and public health officials. Studies revealed that lack of basic sanitary facilities/infrastructures, poor knowledge and practice of hygiene and sanitation among food handlers in food service establishments, and negligence in safe food handling are major reasons of poor food safety practice in food establishments [ 16 , 17 ]. Therefore, it is very essential to identify factors affecting safe food handling practices, especially during preparation and serving. Thus, this study aimed to evaluate factors associated with food safety practice among food handlers in Gondar city food establishments.

This facility-based cross-sectional study was conducted from March 3 to May 28, 2018 at Gondar city. Gondar city is one of the highly populated cities in northwest Ethiopia. There were a total of 326 food establishments and 4232 food handlers in Gondar city according to tourism office data. The city is found at 738 km away from Addis Ababa the capital city of Ethiopia. Ninety-eight food establishments were included using the rule of thumb by taking 30% of the total food establishments. n = N × 30% = 326 × 30/100 = 97.8 ≈ 98 none star food establishments.

The sample size was computed using a single population proportion formula with 95% CI, 5% marginal error (d) and p = 52% proportion of food handlers having good food handling practice from the previous study [ 19 ]. Based on these assumptions, 384 food handlers were included in the study.

To select food establishments and food handlers, a simple random sampling technique was used. In each institution, four food handlers were interviewed. After adaptation from similar literature [ 12 , 19 , 20 , 21 ], the questionnaire was first prepared in English and translated to local language Amharic version. The pre-test was performed on 5% food handlers out of the study area before actual data collection. Then, correction and modification were undertaken based on the gaps identified during the pre-test. Reliability of the questionnaire was also evaluated. The information was gathered via a face-to-face interview using the questionnaire’s Amharic version. Four Environmental Health Officers have been engaged as data collectors and the principal investigator was involved as a supervisor. Food safety practice was the dependent variable in this research. Socio-demographic variables and behavioural factors were the independent variables. Food handling practice: food handlers were asked seventeen questions and those who scored less than or equal to the mean value were considered as having poor practice and those who scored greater than the mean value were considered as having good practice [ 19 , 21 ]. Knowledge: Respondents were asked ten questions and those who scored less than or equal to the mean value were considered as having a poor knowledge [ 12 , 22 ].

Consistency and completeness of data were verified during collection, entry and analysis. Data were entered and coded into version 7.0.0 of Epi Info and exported for evaluation to version 22 of SPSS. The data were analysed using descriptive (frequency and proportion), bivariate, and multivariable regression analysis. Variables with p-value < 0.25 during bivariate analysis were included in multivariable regression to assess the independent effect after controlling other variables [ 23 ].

We did Hosmer and Lemeshow test to check the model fitness. SPSS Cronbach’s Alpha test result for practice questionnaire was 0.83. Finally, 95% confidence level, AOR and p-value less than 0.05 were considered for determining statistically significant variables.

Sociodemographic characteristics of study participants

Of the three hundred eighty-four food handlers, 338 (88%) were females, 300 (78.1%) were unmarried; and 318 (82.8%) had an income of 500–1000 Ethiopian birr (28 ETB = 1 USD) (Table  1 ).

Knowledge of food handlers regarding the cause of food-borne disease, mode of transmission and way of food contamination

Three hundred sixteen (82.29%) of food handlers stated that food-borne diseases are caused by germs. More than half 199 (51.8%) of food handlers found this information from health center about food safety practices (Table  2 ).

Food handling practice of food handlers in food and drinking establishments

More than half of (51.5%) food handlers use hair net during food preparation. One hundred ninety (49.5%) of food handlers did not attend routine medical checkups. About 37% of the respondents were not wearing a uniform during handling and preparation of food (Table  3 ).

Factors associated with food safety practices

Multivariable logistic regression analysis revealed that marital status, food safety training, routine medical checkup, supervision by health professionals and knowledge were statistically associated variables with food safety practices.

Single food handlers were 64.0% less likely to practice food safety than the single food handlers (AOR: 0.36, 95% CI 0.05, 0.85). Food handlers supervised by health professionals were 4.10 times more likely to practice good food safety than non-supervised (AOR: 4.10, 95% CI 1.71, 5.27). Knowledgeable food handlers were 2.92 times more likely to practices good food safety than non-knowledgeable (AOR: 2.92, 95% CI 1.38, 4.12). Trained food handers were 4.01 times more likely to have good food handling practice than non-trained food handlers (AOR: 4.01, 95% CI 2.71, 9.77). Food handers followed routine medical checkup had 8.80 times more likely to have good food handling practice than not- followed food handlers (AOR: 8.80, 95% CI 5.04, 15.36) (Table  3 ).

One hundred eighty-eight (49.0%) food handlers had good food safety practice. This finding is lower than the findings of studies in Bahir Dar (67.6%) [ 24 ], Arba Minch (67.4%) [ 21 ] and in Dubai (81.74%) [ 17 ]. While the finding was close with studies in Dangila town (52.5%), Addis Ababa (52.3%), Imo State, Nigeria (50%) and Turkey (48.4%) [ 6 , 19 , 25 , 26 ], respectively. However, it is higher than the studies done in Gondar town (22.1%) [ 5 ], South-Western Nigeria (19.0%) [ 27 ], Ogun, Nigeria (31.5%) [ 19 ]. These variations might be due to the difference in the study design, variation in training, and the provision of food hygiene and safety inputs. About 109 (28.4%) of the food handlers were certified in food safety training. This result is higher as compared with findings from Bahir Dar (21.8%) and Mekelle (15.7%) [ 12 , 28 ]. Food handler training is seen as one strategy whereby food safety practice can be increased, offering long-term benefits to the food establishments [ 29 ]. This finding is supported with studies conducted India [ 10 ], Nigeria [ 30 ], Ghana [ 31 ] and Dubai [ 32 ]. The number of food handlers who recieved food safety training in the current study is higher than with findings from Bahir Dar (21.8%), and Mekelle (5.4%) [ 12 , 28 ]. Food handlers who received training would have a better understanding of safe food handling practice as they might get professional advice during training. Training could enhance food handlers overall performance in safe food handling practice [ 21 ]. In this study, food handlers who got safety training had higher odds of good food safety practice. This might be due to trained food handlers gain good awareness through training. This supported with other similar study done in Sarawak [ 33 ]. Training programs are important for improving the knowledge of food handlers [ 34 ]. Food safety practice was also positively associated with the level of knowledge. The probability of having a good food safety practice among participants with good level of knowledge was 2.39 times higher with compared to those with a poor level knowledge (AOR = 2.39, 95% CI 1.38, 4.12). Food handlers are expected to have substantial knowledge and skills for handling foods hygienically [ 12 ]. This might be due to those food handlers who had a good level knowledge might have a higher chance of good food handling practice. This finding was supported studies conducted in Gondar town, and Malaysia [ 5 , 15 ]. Marital status was another significantly associated factor with food safety practices. Single food handlers had lower probability of good food safety practices compared with divorced handlers. This is supported with the study done in Gondar town and Dangila town [ 19 ].

Food safety practice was significantly associated with supervision by health professionals. The probability of having good food safety practice was higher among food handlers supervised by health professionals as compared with non-supervised. This finding was supported by the study conducted in Arba Minch [ 21 ]. This might be due to supervisors give advice for food handlers, the owners and to the managers. A routine medical checkup was also another factor significantly associated with good food handling practice. The probability of having good food safety practice among food handlers engaged with routine medical checkup was higher than food handlers not engaged in routine medical checkup. This could be the health care workers gave advice for food handlers during examination. This finding is in line with studies conducted in Arba Minch and Dessie towns [ 20 , 21 ]. This study revealed that there was poor food handling practice among food handlers. Marital status, food safety training, supervision by health professionals, routine medical checkup, and level of knowledge of food handlers were significantly associated with good food handling practice. Owners, managers and local health professionals should enhance the level of knowledge of food handlers, provide food hygiene, safety training, undertake periodic supervision, and routine medical checkup.

Limitations

This study was not without limitations. Some of the limitations include inherent weakness of cross-sectional study to establish a cause–effect relationship, social desirability bias and recall bias.

Availability of data and materials

We will make data available upon request the primary author.

Abbreviations

World Health Organization

adjusted odds ratio

confidence interval

crude odds ratio

Statistical Package for Social Sciences

Ethiopian Birr

Institutional Review Board

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Acknowledgements

The authors are grateful to all study participants, data collectors, food establishment owners and the University of Gondar for their willingness and support to the success of this study.

The authors of this study have received no funds from anywhere but the University of Gondar has covered questionnaire duplication fees.

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JA took part in the research development proposal, data collection tools, entered data into Epi-info, analyse and interpret the data, and write various parts of the research report. MG and HD advised from the starting to the end. All authors read and approved the final manuscript.

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We got ethical clearance from the Institutional Review Board (IRB/47/2010) of the Institution of Public Health, University of Gondar. Written informed consent was obtained from each study participants. The consent of the city administrator, the manager of the food and drinking establishments, and the respondents took part willingly. We kept the confidentiality of the respondents and for the food and drinking establishments by asking the participants not to write their names on the questionnaires and codes to conceal the identity of the food and drinking establishments. We used the collected data for this research purpose only. We forwarded health educations to the study participants by data collectors and the principal investigator at the end of the data collection.

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Azanaw, J., Gebrehiwot, M. & Dagne, H. Factors associated with food safety practices among food handlers: facility-based cross-sectional study. BMC Res Notes 12 , 683 (2019). https://doi.org/10.1186/s13104-019-4702-5

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

• Alyne Gomes da Vitória 1 ,
• Jhenifer de Souza Couto Oliveira 1 ,
• Louise Caroline de Almeida Pereira 2 ,
• Carolina Perim de Faria 3 &
• Jackline Freitas Brilhante de São José   ORCID: orcid.org/0000-0002-6592-5560 3  

BMC Public Health volume  21 , Article number:  349 ( 2021 ) Cite this article

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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.

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.

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.

Peer Review reports

According to the World Health Organization (WHO), millions of people are affected annually by diseases associated with the consumption of contaminated food, particularly in developing countries. These illnesses mainly affect children and other vulnerable groups, such as pregnant women, the sick and the elderly [ 1 ].

In the Brazilian context, children’s vulnerability is linked to another concerning issue, according to data from the Ministry of Health, the fifth most frequent location of outbreaks of foodborne diseases (FDs) in nurseries and schools [ 2 ]. The adoption of correct food handling practices is recommended by the legislation in force and covers a series of determinations. Precautions in food handling are necessary and must be adopted by all food service facilities, including school kitchens, to minimize the risk of FD occurrence [ 3 ].

Considering these aspects, the evaluation of the factors involved in safe food production is of great importance. Good practices contribute to one principle of the National School Feeding Program (NSFP), which aims to meet the needs of students through the provision of healthy and safely handled food. It is one of the largest school food programs in the world and is the only such program with universal participation [ 4 ].

Quality control of school meals is imperative because dangers from different sources can cause contamination between the food preparation and distribution stages and culminate in the occurrence of FDs. FDs are a major consequence of the lack of sanitary control in food service environments [ 5 , 6 ].

Although food safety in food services is a relevant issue and measures are taken to guarantee food quality [ 7 , 8 , 9 ], studies conducted in different Brazilian locations have reported that food handlers’ behavior has an important influence on contamination and can reduce the quality of the final products [ 7 , 10 , 11 , 12 , 13 ]. Then, food handlers have different food safety knowledge levels, and sometimes, an adequate knowledge level does not translate into good hygienic practices when processing and handling food products [ 13 , 14 , 15 , 16 ]. Thus, training programs contribute to knowledge about food safety, although knowledge acquisition does not always result in positive changes in good handling practices [ 14 , 15 , 16 ]. Given food handlers’ role in improving hygiene and sanitation in School Feeding Service (SFS) and considering the vulnerability of the public served by NSFP, the present study aimed to verify the level of food safety knowledge, attitudes and practices (KAP) among food handlers in schools in Vitória, Brazil. We aimed to verify three hypotheses in this study: i) food handlers don’t have a satisfactory knowledge level; ii) food handlers don’t have a satisfactory attitudes and practices level; iii) sociodemographic variables are related with food handler’s knowledge, practices and attitudes.

Study design

A cross-sectional study was conducted to evaluate the KAP related to food safety through a specific questionnaire for food handlers. This work is part of a larger project entitled “Evaluation of the level of knowledge, attitudes and practices of food handlers in food services”, which was presented to and approved by the Municipal Secretary of Education (MSE) of Vitória-ES. Following this approval, invitation letters were e-mailed to school managers with the MSE’s authorization to commence the project. The managers were also contacted via telephone or in person for permission to visit the schools.

Study area, sample size and sampling

Data were collected at SFS from schools within the municipal network in Vitória, Espírito Santo, Brazil. There are 100 municipal schools in Vitória, Brazil and all were invited to participate in this study. The school units are distributed among nine administrative regions. The composition of the sample was determined by considering the total number of school units and the proportion of units in each administrative region. The participation of 50% of the schools in each region was required to demonstrate representativeness. Fifty-two eligible schools were sampled using simple cluster sampling; schools were stratified according to the regions of the municipality and randomly selected from each region. The municipal school units are distributed among nine administrative regions: Region 1 – Total = 8 ( n  = 4); Region 2 – Total = 15 ( n  = 8); Region 3 – Total 16 (n = 8); Region 4 – Total = 22 ( n  = 12); Region 5 – Total = 2 (n = 1); Region 6 – Total = 7 (n = 4); Region 7 – Total = 18 ( n  = 9); Region 8 – Total = 6 ( n  = 3); Region 9 – Total = 6 (n = 3). All administrative regions are located in the urban area and the region 5 and region 9 have the highest incomes in the city.

The sample of food handlers was obtained by convenience and comprised those carrying out food preparation and other kitchen-related activities in 52 municipal schools. All food handlers who were available at the time of collection in schools were invited to participate. Each school had 2 to 5 food handlers.

Instrument for data collection

The KAP questionnaire applied in this research was subjected to a reproducibility test given the limitations associated with the use of such instruments, such as imprecise answers and failure to understand the material. This process allows the reproducibility levels of a questionnaire to be determined, which leads to obtaining better quality data [ 17 ].

Test-retest reliability was determined with 29 food handlers from one food service unit and were not part of the research sample. The questionnaires were administered at the participants’ workplace, and the retest procedure took place 15 days after the first administration.

The instrument consisted of a structured questionnaire based on related studies [ 15 , 18 , 19 ]. The content related to KAP issues and the correct answers was determined considering the Brazilian resolution of good practices for food service [ 3 ], the Codex Alimentarius [ 20 ], and the five keys to safer foods established by the WHO [ 21 ] and adapted from Cunha et al. [ 15 ]. Additionally, six questions assessed the following sociodemographic characteristics of the handlers: age, sex, education, participation in food safety training and amount of experience as a food handler.

The KAP evaluation was organized into three blocks following Cunha, Stedefeldt & Rosso [ 15 ]. The block related to knowledge evaluation comprised 10 objective questions related to the daily practices of food preparation and addressing the concepts of personal hygiene, food hygiene, cross-contamination and the thawing of food. The three answer options were “yes”, “no” and “I do not know”.

The attitude assessment block included 10 questions related to the importance of hygiene procedures, food handlers’ responsibility for avoiding foodborne illnesses and the importance of ongoing training about food safety. In this block, attitude was considered a way of thinking that is reflected by a person’s behavior. The food handlers indicated their level of agreement on a three-point scale that reflected the following response options: “I agree,” “disagree,” and “I do not know.”

The last block of the questionnaire referred to the evaluation of self-reported practices and comprised 10 questions about daily practices that addressed the same themes as the knowledge block. A five-point rating scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often and 5 = always) was used to evaluate each practice. For practices that are considered inadequate, the scale was scored following an inverse order.

For the knowledge questions, one point was assigned for each correct answer; each incorrect or “I do not know” answer received zero points. The range of possible scores for the knowledge block was 0 to 10 points. The possible score for the attitude questions ranged from 0 to 100 points. For the practice’s questions, the possible score was from 10 to 50. For the evaluation of each block based on the sum of the final scores for each block, an adequate grade was 70% or higher based on a study by Soares et al. [ 19 ]. Completing the questionnaires took approximately 15 min and was performed by the participants themselves in the presence of the researchers. In situations of doubt or reading difficulties, the researchers read the questions to avoid providing further explanations that would influence the answers.

Data analysis

Data were tabulated in Microsoft Office Excel spreadsheets and analyzed using IBM SPSS Statistics software, version 22 (IBM Corporation, Armonk, NY, USA).

Questionnaire reproducibility test

After an exploratory analysis of the data, reproducibility was assessed using the intraclass correlation coefficient and interpreted according to the criteria proposed by Cicchetti [ 22 ] using the following scale: poor (< 0.40), reasonable (between 0.40 and 0.59), good (between 0.60 and 0.74), and excellent (between 0.75 and 1.00).

Analysis of the data collected from the questionnaires

The normality of the data was tested with the Kolmogorov-Smirnov test, and when nonnormal distribution was present, the data were log normalized before the parametric tests were performed. Descriptive statistics were found using the frequency, percentage, mean, and standard deviation for the scores and sociodemographic characteristics.

To evaluate the correlation between the scores obtained for KAP, the Pearson correlation test (r) was performed considering the strength of the correlations and respective probability of errors ( p  ≤ 5%). The strength of the correlations was classified as negligible (0.01 to 0.09), low (0.10 to 0.29), moderate (0.30 to 0.49), substantial (0.5 to 0.69) and strong (≥0.70), as suggested by Davis [ 23 ].

T-test and analysis of variance (ANOVA) were conducted, followed by Tukey’s test, to compare the means of the KAP score while considering sociodemographic variables. A multiple linear regression analysis was performed to identify the variables that impacted the KAP scores. The model for the multiple linear regression analysis was established to identify the impact of the explanatory variables (schooling, experience, participation in training, time since the previous training, knowledge and attitudes) on KAP scores. All analyses adopted a significance level of 5%.

Ethical aspects

The participants were informed about the study objectives and methodologies and signed the Free and Informed Consent Form if they agreed to participate in the study. The study was approved by the Ethics and Research Committee of the Federal University of Espírito Santo (UFES) in number 1.632.711.

Evaluation of the knowledge, attitudes and practices of food handlers

Questionnaire reproducibility.

The reproducibility and internal consistency analyses showed that the questionnaire applied in the present study falls within the range of accepted repeatability. The intraclass correlation coefficient was 0.64.

Application of the questionnaire

Sociodemographic characteristics of the food handlers.

The sociodemographic variables obtained from 172 food handlers via the questionnaire are shown in Table  1 . The majority (96.5%, n  = 166) of the participants were female, aged between 40 and 49 years (44.8%, n  = 78). Regarding education, most of the participants (57.9%, n  = 99) attended high school, and 40.7% ( n  = 70) attended only elementary school.

Most of the participants had up to 5 years of experience in the role (39.5%, n  = 68) and had participated in at least 4 training sessions (74.4%, n  = 128), the most recent of which had occurred within 3 months (52.0%, n  = 44).

KAP questionnaire performance

An evaluation of the results obtained through the KAP questionnaire found that the lowest scores were obtained on the knowledge assessment block (73.3%) (Table  2 ).

Boards 1, 2 and 3 present the results for the KAP questionnaire responses and their respective evaluation blocks (see Additional file 2 ). The questions that yielded a high percentage of correct responses in the knowledge-related block (Board 1) addressed the risk of food contamination from food handlers through disease, nonuse of good food-handling practices, and food defrosting and risk of disease due to the consumption of expired foods.

Question 1 on this topic (Board 1) had the highest proportion of incorrect answers (91.8%). Most of the participants stated that hand washing with soap is sufficient to avoid food contamination, which raises the question of whether the low number of correct answers was related to lack of knowledge (because they considered the use of detergent to be a correct practice) or was due to misinterpretation of the question.

In question 4 (Board 1), food handlers had the low number of correct answers (39%) may have been a consequence of doubt about the effects of the water phase change on microbiological risks.

Regarding the risks of using foods the day after their expiration date, addressed in question 7 (Board 1), 90.7% ( n  = 156) of the food handlers answered this question correctly. However, on question 6, only 25% ( n  = 43) of the participants reported that foods unfit for consumption always have a bad smell and a spoiled taste.

In contrast to the results for the knowledge block, the participants demonstrated good performance on the questions about attitudes (Board 2), especially question 10, to which all participants responded correctly. Only question 5 received less than 90% correct answers. A high percentage of correct responses (> 90%) was also observed by other authors [ 14 , 15 ].

Among the most frequent correct practices by food handlers (Board 3) was the use of cleansing solutions when washing vegetables and fruits (91.9%, n  = 158), addressed in question 6.

The correlation between the scores obtained for KAP was considered low (Table  3 ). Knowledge scores were not related to self-reported practices scores.

Table  4 presents the comparison of the mean scores obtained by the food handlers considering sociodemographic variables. The data indicate significant differences in knowledge scores according to the amount of experience in the role and the time since the most recent training. A significant difference in attitudes was observed according to schooling and the time since the most recent training. There was no significant difference in the scores obtained for practices.

The model for the multiple linear regression analysis was established to identify the impact of the explanatory variables (schooling, experience, participation in training, time of the previous training, knowledge and attitudes) on KAP scores. For this analysis, only the variables that presented statistically significant results were included in the bivariate analysis. To identify the association between the variables, the KAP score considered the assumption of the effect of knowledge on the change in attitudes and practices as well as the influence of attitudes on practices.

All the models presented significant results on the F-test, indicating good model fit, and results ranging from 1.5 to 2.5 on the Durbin Watson test of residual autocorrelation.

The linear regression analysis (Table  5 ) allowed us to identify that the knowledge score increased according to greater experience, but this increase was significant only for those who had spent up to 10 years in the role.

About questionnaire reproducibility, intraclass correlation coefficient was a good index of reproducibility according to Cicchetti [ 22 ]. Bas et al. [ 18 ], Nee and Sani [ 24 ], Halim et al. [ 25 ] and Mohd et al. [ 26 ] also tested the reliability of the questionnaires with food handlers and found good indexes of between 0.70 and 0.78.

Majority of food handler were female, aged between 40 and 49 years and attended high school. These results are similar to those found in other studies [ 15 , 19 , 27 , 28 ], which also observed a predominance of females in food services in schools. Food service sector is usually dominated by the female labor force. Although the inclusion of women in the labor market has been marked by several changes, reports still indicate that women predominantly work in fields associated with domestic employment, such as the preparation of food [ 29 , 30 ].

Regarding education, most of the participants (57.9%) attended high school, and 40.4% attended only elementary school. These levels of schooling are characteristic of the profile of these professionals, as shown in other Brazilian studies [ 15 , 19 ] and studies in other countries [ 27 ]. Brazilian legislation does not establish a specific schooling level for food handlers [ 3 ]; however, it requires that these professionals be subject to periodic training. Because this work does not require a high level of education and qualification, remuneration is low. This factor negatively affects the training and interventions performed in food services because it can influence the motivation of workers and consequently interfere with the adoption of appropriate attitudes and practices [ 31 , 32 ]. There is a linear relationship between food handlers’ educational level and the implementation of good practices in food services. Consequently, access to food handler’s education levels is important when planning training strategies. According Akabanda et al. [ 33 ], training can improve the food safety knowledge of food handlers, but this does not guarantee a positive adjustment in food handling behavior and attitudes.

Most of the food handlers of this study had up to 5 years of experience in the role and participated in at least 4 training. Cunha et al. [ 15 ], Soares et al. [ 19 ] and Vo et al. [ 34 ] also reported a high number of food handlers who underwent training, indicating good compliance with Brazilian legislation [ 3 ] regarding periodic training for food handlers. Hygiene training and education can be understood as a planned learning event intended to improve their knowledge about work-related activities; it can also be viewed as a source of perpetual changes in practices and attitudes [ 32 , 33 ]. It is a requirement in the food production environment and provides continuous improvement opportunities for food handlers. Instruction should be offered every 6–12 months and its efficacy must be evaluated. It is important to mentioned that food safety education need to be conducted with methods that encourage behavioral change and purchase practical abilities [ 35 ].

Results obtained through the KAP questionnaire indicated that the lowest scores were found on the knowledge block. A similar result was found in studies by Soares et al. [ 19 ] and Lee et al. [ 36 ], which verified that the participants’ level of knowledge was insufficient and moderate, respectively. It is important to highlight that within the food service environment, it is necessary to seek continuous improvement. These results point to the need for improvements in food handlers’ knowledge. The findings show that food handlers have adopted attitudes that helped produce safe food, but they provided incorrect answers to questions directly related to food quality control. According to Soares et al. [ 19 ], self-reported practices tend to be overstated by respondents, i.e., they responded what is probable rather than what they truly do within the food service environment. It is important to emphasize that the food handlers’ participation in this research and the fact that the questionnaire was self-applied may have influenced the large number of adequate answers.

Seven knowledge questions presented a high percentage of correct answers (Board 1). However, a question about hand hygiene has high percentage of incorrect answers. Highest proportion of food handlers stated that hand washing with soap is sufficient to avoid food contamination. According to Brazilian legislation, hand sanitation should be performed with an antiseptic and odorless liquid soap or an odorless liquid soap and an antiseptic product [ 3 ]. Incorrect knowledge and interpretation of food handling practices could lead to lower awareness of good handling procedures and false ideas about food safety [ 16 ]. It is important to mention that the question about hand washing may have been misunderstood by food handlers. The lack of hand hygiene is a critical aspect. Food handlers’ hands can be as vectors in the spread of foodborne diseases due to inadequate individual hygiene or cross contamination behavior [ 37 , 38 , 39 ].

Although the subject of hand hygiene is constantly addressed with food handlers, this does not guarantee that will perform the procedure correctly and then can be a source of contamination. This fact can be justified by the food handlers’ low perception of the risks associated with incorrect practices or by work overload that causes employees to prioritize other activities that are considered more relevant [ 15 ]. Adopting correct hand hygiene practices is essential because failures of personal hygiene can cause food handlers to become sources of pathogenic microorganisms and cross-contamination [ 18 ]. Appropriate hand washing practices by food handlers can significantly decrease the risk of diarrheal disease and other foodborne diseases [ 33 ].

Another question with incorrect answers was related to the quality of water. According to legislation, ice for use in food must be made from drinking water and maintained in hygienic and sanitary conditions to prevent contamination [ 3 ]. Although the use of ice was been observed in the visited SFS, it is imperative that the entire food safety concept is conveyed to food handlers. Water supply is a relevant aspect, since is one of the main causes of foodborne diseases outbreaks in Brazil.

Food handlers reported that contaminated food always have a bad smell and a spoiled taste. This finding represents a relevant problem because it indicates that the food handlers do not perceive the risks associated with using contaminated foods. This result similar to those of Soares et al. [ 19 ] in a study of 166 food handlers in public schools in Camaçari, Bahia, in which only 16.3% of the participants were aware that contaminated food does not necessarily show changes in color, odor or taste. A different result was obtained by Walker et al. [ 35 ], in which 57% of the participants stated that they would know if the food were contaminated via sensory verification.

About attitudes, food handlers presented a better result than knowledge block (Board 2). A high percentage of correct responses for attitudes (> 90%) was also observed by other authors [ 14 , 15 ]. According Akabanda et al. [ 33 ], the food handlers’ attitudes can influence the occurrence of foodborne diseases. Thus, they need to follow the food safety plans. However, it is important to declare that the attitudes were self-reported. Thus, there is a possibility that the participants answered something that in their day-to-day lives they do not effectively accomplish.

Practices evaluation about washing food was considerably higher than that obtained by Soares et al. [ 19 ]. These authors found that 48.2% of the participants conducted incorrectly sanitization procedure because the great majority did not have a consistent supply of cleanser in the SFS. The attitudes of food handlers are known to be important in the application of knowledge and can have a significant impact on individuals’ behavior and practices [ 36 ]. The inadequate of knowledge level can culminate to poor hygienic practices by food handlers [ 33 ]. However, food handlers’ reported practices may not be essentially coherent with procedures performed during food handling. Inspiration and motivation during hygiene training and education could be a strategy to positively affect attitudes and practices and conduct to an appropriate behavior on kitchens. It is important to mentioned that food handlers may have an over-report of good performances contrasted to their usual practices when not asked or observed.

In this study, knowledge scores were not correlated to self-reported practices scores. This corroborating the results obtained in studies by Cunha et al. [ 15 ] and Park, Kwak & Chang [ 40 ]. However, contradictory results are described by Rahman et al. [ 41 ] and Vo et al. [ 34 ]. Rebouças et al. [ 42 ] did not observe a significant association between knowledge, attitudes and self-reported practices among food handlers, head chefs and managers in hotel restaurants in Salvador, Brazil. The low correlation between knowledge and attitude scores shows that the food handlers’ knowledge about food safety can influence their food handling attitudes. In other words, food handlers with low knowledge levels may have inappropriate attitudes.

Another point observed in this study was a significant difference in knowledge scores according to the amount of experience in the role and the time since the most recent training. A significant difference in attitudes was observed according to schooling and the time since the most recent training. There was no significant difference in the scores obtained for practices. Nee and Sani [ 24 ] observed that food handlers with less than one year of experience had lower scores for knowledge than those who had more than 6 years of experience. In addition, as the time since the previous training increased, the knowledge score decreased, becoming statistically significant when the training had been conducted more than 1 year previously. Cunha et al. [ 15 ] found a difference in knowledge scores between recently trained food handlers and those with a longer time interval since training (18, 24, 36 months), suggesting a possible recommendation of biannual training with a maximum interval of one year to maintain the food handlers’ working knowledge.

The results of this study also indicated that an increase in the level of schooling was associated with an increase attitude score. The results differ from those of other authors, who did not show a significant relationship between level of schooling and attitudes but did find a relationship between schooling and the knowledge and practices of food handlers [ 19 , 35 ]. The reduction in the attitudes score was more significant among those who had undergone retraining in the previous 6 months. This result may have been influenced by the self-reported nature of these responses because the attitudes score was higher among those who had undergone training more recently (in the previous 3 months).

Given the results presented, suitable solutions are necessary. These results can contribute to future research as well as to the planning of training and guidance about food safety. Food handlers must receive information to apply it to their work routine.

The present study was subject to limitations, such as the impossibility of visiting all schools in the municipality and reliance on the answers of the participants. The food handlers may have answered some questions correctly, which may or may not truly reflect what they do on a daily basis. To get closer to the reality of food handlers’ practices, it would be necessary to observe their entire daily work routine. In addition, it is known that the presence of a researcher in the work environment may influence participants’ responses to a questionnaire.

The results obtained in this study indicated that, although the level of knowledge of the participants in general was sufficient, it was inferior when compared to scores on the comprehension of attitudes and practices of the food handlers on certain concepts related to food safety. The association of the KAP score with the sociodemographic variables indicates the need for training programmes on good practices to consider these factors. In addition, the specifics (themes, difficulties, motivation) in the effectiveness of the program’s impact on knowledge acquisition must be taken into account but are mainly important in changing the attitudes, practices and understanding of the food handlers regarding their role in school food preparation.

In this context, the adoption of evaluative methods before and after training to identify the aspects to be improved and the relevance of the training programme for food handlers is suggested. An intervention strategy with the involvement of all social actors of National School Feeding Program is essential, given the importance of the program, the appropriate responsibilities within it and in view of the irregularities observed. Consequently, the results of improvements will be more effective. We recommended a training schedule for food handlers to guarantee their continued training in food safety. In addition, the professional nutritionists, who are responsible for monitoring this food service, should regularly supervise the routine of school kitchens. Intervention activities aimed at food safety must be constant and monitored, even during the work routine, so that, from the moment of identifying the failures, corrective actions occur immediately. Thus, in order to not only indicate the food handlers about the mistake, but also to guide him on why and the importance of correcting certain incorrect behavior.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Foodborne diseases

National School Feeding Program

School Food Service

Municipal Secretary of Education

Centers for Early Childhood Education

Municipal Schools of Elementary Education

Knowledge, attitudes and practices

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Acknowledgements

The authors gratefully acknowledge the Foundation for the Support of Research and Innovation of Espírito Santo ( Fundação de Amparo a Pesquisa e Inovação do Espírito Santo- FAPES ) for the scholarship grant for the first author. We thank Coordination for the Improvement of Higher Education Personnel ( Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) for support to the Graduate Program in Nutrition and Health of Universidade Federal do Espírito Santo. We thank Secretaria Municipal de Educação de Vitória-ES for the authorization to execute the project. We thank Pro-Reitoria de Extensão of Universidade Federal do Espírito Santo for all their support.

Foundation for the Support of Research and Innovation of Espírito Santo ( Fundação de Amparo a Pesquisa e Inovação do Espírito Santo- FAPES ) for the scholarship grant for the first author.

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AGV, and JFBSJ conceived the study and its original design, drafted the initial form and all revisions of this paper. AGV, JSCO and LCAP collected the data. AGV and CPF analyzed the data. AGV, JSCO, LCAP, CPF and JFBSJ reviewed and approved the final manuscript.

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Additional file 1..

Questionnaire: Evaluation of Knowledge, Attitudes and Practices of Food Handlers.

Additional file 2. Board 1

Knowledge of food safety by food handlers from 52 schools in in Vitória, Espírito Santo, Brazil. Board 2 Evaluation of food safety attitudes by food handlers from 52 schools in Vitória, Espírito Santo, Brazil. Board 3 Evaluation of food safety practices by food handlers from 52 schools in Vitória, Espírito Santo, Brazil.

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da Vitória, A.G., de Souza Couto Oliveira, J., de Almeida Pereira, L.C. et al. Food safety knowledge, attitudes and practices of food handlers: A cross-sectional study in school kitchens in Espírito Santo, Brazil. BMC Public Health 21 , 349 (2021). https://doi.org/10.1186/s12889-021-10282-1

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ORIGINAL RESEARCH article

Food safety knowledge, attitudes, and practices among jordan universities students during the covid-19 pandemic.

• Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan

Objective: This study aimed to evaluate food safety knowledge, attitudes and practices (KAP) amongst university students in Jordan and changes in food-related behaviors during the COVID-19 pandemic. Correlation between food safety KAP scores and general characteristics of university students was also evaluated.

Methods: A cross-sectional study was conducted where an Internet-based questionnaire was distributed through social media platforms. The sample consisted of 1,739 respondents from 29 Jordanian universities. The participants completed a 58-item questionnaire covering demographical characteristics and different food safety aspects which were namely “COVID-19 food-related attributes,” “food cooking and storage,” “personal hygiene.” “cross-contamination prevention/disinfection procedures.” and “restaurant hygiene.” Descriptive statistics, Chi square tests and binary logistic analysis were used to assess the data.

Results: The sample consisted of 67.2% females with a mean age of 21.3 ± 1.8 years. The average overall score of the tested aspects was 14.1/34.0 which corresponds to 41.3% of the questions being answered correctly. The percentage of correct answers of “COVID-19 food-related attributes,” “food cooking and storage,” “cross-contamination prevention/disinfection procedures,” “personal hygiene” and “restaurant hygiene” was 56.8, 36.6, 28.4, 44.6. and 36.9%, respectively. A significant ( P <0.05) association between respondents' food safety KAP scores and gender, marital status, university degree, employment status, self-rating of food safety knowledge, and the source of food safety information.

Conclusion: University students in Jordan had insufficient KAP scores which is a concerning trend during the pandemic. Teaching fundamentals of food safety in the form of short courses/ lectures is recommended.

Introduction

Outbreaks associated with food pose a great threat to public health. As per the World Health Organization (WHO), on an annual basis, about 600 million cases and 420,000 deaths are associated with the consumption of contaminated food and water ( 1 ). Foodborne outbreaks affect 48 million Americans, 4 million Canadians and 2.4 million Britons each year ( 2 – 4 ). A recent food poisoning outbreak in Jordan (Ain Al-Basha region) associated with contaminated Shawerma resulted in 700 infections and two deaths. The Shawerma was reported to be infected with Enterococcus Faecalis and Campylobacter ( 5 ).

Food can get contaminated during various stages of production, distribution, and storage ( 1 ). Measures commonly recommended to combat foodborne outbreaks include frequent/ correct technique of hand washing, appropriate cleansing of kitchen surfaces, storing food at suitable temperatures and the separation of raw and cooked food ( 6 , 7 ).

The advent of COVID-19 has been reported to impact people's food preparation/ eating habits, consumer food safety awareness, food and hygiene related attitude and food purchasing behavior ( 8 – 11 ). The primary mode of transmission of the virus has been reported to be through person to person contact and via respiratory droplets generated by coughing or sneezing. Untrue to common belief, the COVID-19 virus is not foodborne ( 12 ). However, the entire affair revolving around food could act as a vehicle for transfer, for example, an infected individual could transfer the virus on to the food package, the utensils, table tops, cash, machinery or even via a simple handshake ( 13 ).

A previous study has reported that young adults (18 to 29 years old) are more likely to take the concept of food safety lightly ( 14 ). This could be because (with a probable exception of personnel whose predominant occupation revolves around food), this section of the population usually do not possess appropriate training/certifications ( 14 ). An area of concern is that it is this section of the population who tend to work in food service establishments (part- or full-time job) during their course of study. Moreover, they tend to cook for themselves and their colleagues (roommates/ friends etc.). They are also more likely to attend parties and take the seriousness of the pandemic lightly because of their belief of higher immunity in young adults ( 15 ). Hence, it is highly possible that they act as a vehicle for the transfer of this virus.

Multiple studies pertaining to food safety knowledge amongst different population strata have been conducted previously in Jordan ( 16 – 19 ). However, none of them have assessed the impact of the COVID-19 pandemic in university student's food safety knowledge, attitudes, and practices (KAP). Therefore, the present study aimed to (i) evaluate food safety KAP among Jordan universities students during the COVID-19 pandemic, (ii) determine the changes in food-related behaviors during the COVID-19 pandemic, and (iii) assess the correlation between food safety KAP scores and general characteristics of university students.

Materials and Methods

Study design.

A cross-sectional study was performed from March 2021 to April 2021 to assess food safety knowledge, attitudes, and practices amongst Jordan universities students during the COVID-19 pandemic. Any student currently studying at a Jordanian University ( n = 29) above 18 years was considered to be eligible to take part in the study regardless of gender, academic year, full time/ part time or academic program. The total number of students in all public and private universities (inclusive of all degrees) at the beginning of the academic year of 2020–2021 was announced to be 322,349. The universities are spread throughout the country thereby increasing the representativeness of the sample.

Questionnaire

The questionnaire was designed by adapting some existing questions from validated and reliable questionnaires used in prior studies pertaining to food safety ( 10 , 16 , 20 – 28 ). All authors went through the questionnaire in-tandem to discuss the questions that need to be included in the study. The questions were revised to remove the ambiguity and ensure that they were short and clear. This was done to avoid self-reported bias such as social desirability and acquiescent responding ( 29 ). The questionnaire was translated from English to Arabic. It was tested by four bilingual academicians specialized in food safety, for its understandability. The final questionnaire consisted of 58 items ( Supplementary Material ) starting with a cover page which explained the nature and purpose of the study besides the confidentiality statement. The Cronbach alpha coefficient value (used to check questionnaire reliability) was observed to be 0.774. The questionnaire was composed of four sections; demographic information (13 items), food safety knowledge (12 items), attitudes (7 items) and practices (26 items) during COVID-19. A combination of multiple-choice, true-false-not sure, and Likert-scale questions were used in the questionnaire. The questionnaire covered the following food safety aspects: “COVID-19 food-related attributes,” “food cooking and storage,” “personal hygiene,” “cross-contamination prevention/disinfection procedures,” and “restaurant hygiene.” The total score of students' knowledge, attitudes and practices was calculated by the summation of correct answers from each aspect. Each correct answer was given 1 point while incorrect and not sure answers were given a score of 0. Finally, the practice part consisted of questions pertaining to behavioral changes during the COVID-19 pandemic where the answer choices were “Less than before,” “About the same” and “More than before”, respectively. The final questionnaire draft was then piloted amongst students ( n = 30). This involved completing the survey using different computers or phones at different locations. No further adjustments on the questions were needed as per the feedback.

Data Collection

The data were collected via an Internet-based link (Google Forms). The invitation link was primarily distributed via students' groups on social media platforms namely Facebook and Twitter. The link was shared by the researchers, as well as willing participants—who forwarded it to other potential participants from the same or other universities (snowball approach).

On the first page of the questionnaire, participants had been informed that their participation was purely on a voluntary basis and their consent was taken prior to starting the questionnaire. The participants were given all information deemed necessary about the study on the consent form. They were informed of their right to withdraw from the survey at any time. There was no possibility of placing any undue pressure on the respondents as the survey had to be completed via an online link. All responses were kept confidential. The study and the protocol were approved by the Department of Nutrition and Food Technology (#26/2021) and Deanship of Graduate Studies (#7/2021) at Jordan University of Science and Technology.

Data Analysis

All survey responses were exported from the Google Forms platform into SPSS Version 26.0 (SPSS Inc., USA) for analysis. Descriptive statistics of means, standard deviation, variation ratio, frequencies and percentages were used for variables as appropriate. Chi-square test was conducted to explore the difference between categorical variables. Binary logistic analysis was used to assess the contributing factors affecting students' knowledge, attitudes and practices (KAP) scores. A p -value < 0.05 was considered to be significant. A cut-off point of 50% was used to calculate the total participant score and a sufficient KAP score was considered when the participant correctly answered more than 50% of the questions.). A score of <50% was considered as inefficient knowledge, attitude and practice.

Demographic Characteristics

A total of 1,739 students from 29 private and public universities in Jordan participated in this study. The sample consisted of 67.2% females with a mean age of 21.3 ± 1.8 years ( Table 1 ). More than half (57.8%) of the participants studied at public universities. Most of the participants lived with their family (89.1%), did not work (77.4%), and helped in preparing food (83.6%). Only 12.0% of the participants rated themselves to have “excellent” knowledge of food safety. The main sources of food safety information were reported to be the internet (43.2%) ( Table 1 ).

Table 1 . Demographic characteristics of university students ( n = 1739).

Overall Food Safety Knowledge, Attitudes, and Practices Score of University Students During the COVID-19 Pandemic

The overall food safety KAP score of university students during the COVID-19 pandemic was calculated by the summation of correct answers (34 questions) in the tested food safety aspects: “COVID-19 food-related attributes,” “food cooking and storage,” “personal hygiene,” “cross-contamination prevention/disinfection procedures,” and “restaurant hygiene.” The average overall KAP score of the tested aspects was 14.1/34.0 which translates to 41.3% of the questions being answered correctly ( Figure 1 ). The food safety aspect with the highest percentage of correct answers was for “COVID-19 food-related attributes” (56.8%) while the aspect with the lowest percentage of correct answers was “cross-contamination prevention/disinfection procedures” (28.4%).

Figure 1 . Food safety knowledge, attitudes and practices scores among university students during COVID-19 pandemic ( n = 1,739).

COVID-19 Food Related Attributes

Query statements and responses of the COVID-19 food related attributes are presented in Table 2 . More than 75% of the respondents possessed the knowledge that the COVID-19 virus flourishes in the nose and mouth of the infected person and it could be transmitted upon coughing or sneezing. A good number of participants (70%) correctly believed that the vaccine solitarily would not be protective against the COVID-19 infection, without compliance to general safety measures (masks, gloves etc.). More than half (62.4%) of the participants correctly believed that COVID-19 does not grow in food; however, only 27.0% believed that it cannot be transmitted through it. A similar number (28.8%) knew that COVID-19 virus could not be found in drinking water ( Table 2 ).

Table 2 . Query statements and responses of “COVID-19 food-related attributes” aspect.

Food Cooking and Storage KAP During the COVID-19 Pandemic

Regarding the appropriate temperature for killing viruses such as COVID-19 during cooking, only 33.2% knew the correct answer ( Table 3 ). And, about 33.5% believed that cooling food in a refrigerator or keeping it in the freezer was ineffective in inhibiting or killing COVID-19. Only 17.0% knew that the best way to check for meat readiness was with the help of a food thermometer. However, the majority of our respondents (89.9%) believed that the number of people involved in food preparation should be reduced in an event where a family member is infected with COVID-19. Moreover, majority (90.4%) of the students did not wash the animal products like eggs before storing them in the refrigerator.

Table 3 . Query statements and responses of “food cooking and storage” aspect.

Cross-Contamination Prevention/Disinfection Procedures KAP During the COVID-19 Pandemic

In general, the results indicated very low KAP score with respect to cross-contamination prevention and disinfection procedures (28.4%) amongst the students. A very small percentage of the participants (19.8%) were aware about washing of vegetables under running water prior to usage ( Table 4 ). Approximately, 58.1% of the respondents agreed that using the same chopping board to cut vegetables (post raw meat cutting) resulted in cross-contamination. A quarter of the participants (25.4%) falsely believed that using salt, vinegar, pepper or lemon juice was effective in destroying COVID-19 on food-contact surfaces. However, only 42.0% of our respondents knew the correct procedure for cleaning the kitchen surfaces. Less than quarter of our respondents disposed empty shopping bags (19.0%) and disinfected food packages prior to use (23.0%). A lower percentage (11.5%) of our participants used separate sponges for the dishes and the sink.

Table 4 . Query statements and responses of “cross-contamination prevention/disinfection procedures” aspect.

Personal Hygiene KAP During the COVID-19 Pandemic

In terms of personal hygiene, due to the pandemic, all the respondents recorded not using a mobile phone while preparing food (OR = −0.013, CI = −0.061–0.035), and not using bare hands (OR = −0.133, CI = −0.194-−0.071) while sharing a dish with several people (a common Arab custom), in other words all the respondents used a spoon while sharing a dish with several people ( Table 5 ). As a response to the pandemic, approximately, 90% of our respondents knew that washing hands after handling raw food would aid in reduction of microbial transfer. About half of our respondents (51.8%) agreed that it is was necessary to wash hands after touching the face during food preparation in an effort to prevent spread of the virus. About 44% of our respondents reported washing their hands after touching the outer bags and covers, upon returning home (52.4%), prior to food preparation (43.5%), and eating during the COVID-19 pandemic (51.3%). However, only 36.2% of our participants knew the appropriate duration of handwashing. Approximately, 74 and 78% of our respondents did not agree that hand sanitizers could replace hand washing and knew the best way to dry hands post washing (using a tissue), respectively ( Table 5 ). Only 15.2% of our respondents reported wearing gloves when touching raw food.

Table 5 . Query statements and responses of “personal hygiene” aspect.

Restaurant Hygiene Behavior in Response to COVID-19

Regarding restaurant hygiene during the COVID-19 pandemic, 35.0% of the university students checked tables and chairs (if they were sanitized) before sitting, 38.9% checked the bathroom (for sanitization) before using it, 39.6% paid attention to the safety measures taken by workers at restaurants, such as the use of masks, gloves and physical distancing, and 34.2% observed whether the restaurant followed social distancing protocols for visitors ( Table 6 ).

Table 6 . Query statements and responses of “restaurant hygiene” aspect.

Behavioral Changes During the COVID-19 Pandemic

The results regarding food-related practices during COVID-19 pandemic suggest clear changes in student behaviors. As shown in Figure 2 , 79.5 and 70.8% of the participants reported reduced eating and gathering with friends and family members, respectively during the COVID-19 pandemic. Moreover, 78.0% of respondents reported dining out less than before. In this study about half (42.4%) of the students shifted toward buying groceries online and only 28.9% of participants paid their bills by credit card more than that before the pandemic. In our study, buying from a large shopping mall or a small grocery store stayed approximately the same while comparing the pre and post pandemic periods. However, 69.2% of our participants reduced the frequency of their shopping visits while another 48.1% reduced the time spent during shopping because of the pandemic ( Figure 2 ).

Figure 2 . Changes of food-related behaviors during COVID-19 pandemic ( n = 1,739).

The Association Between Overall Food Safety Knowledge, Attitudes, and Practices Scores and General Characteristics of University Students During the COVID-19 Pandemic

In this study, no significant ( P ≥ 0.05) association was observed between overall food safety knowledge, attitudes, and practices ( KAP) score of university students during the COVID-19 pandemic and age, university type, college, studying year, living status and the enrollment in a food preparation course ( Table 7 ). Significant associations ( P < 0.05) were found between respondents' food safety KAP scores and gender, marital status, university degree, employment status, self-rating of food safety knowledge, and the source of food safety information. The current study found that females (18.0%) had higher food safety KAP scores than males (5.6%). In other words, 18.0% of all female participants answered more than half of the questions correctly. In the current study, being a female was not only significantly associated with higher food safety KAP scores but also was a predictor that effected KAP results. Married students in this study scored a higher KAP ( P < 0.05) than single students; more than one third of the married participants answered more than 50% of the questions correctly while less than a quarter of the single participants got correct answers. The current study showed that there was a direct relationship ( P < 0.05) between the educational level and KAP scores. Higher education program (Masters) students had a higher score than their undergraduate counterparts (2.6 vs. 21% respectively). Students who work in part time jobs had higher ( P < 0.05) KAP scores compared to full time and unemployed students. This study showed a strong association ( P < 0.05) between self-rated food safety knowledge and KAP scores. Those who rated themselves to have higher knowledge indeed got higher KAP scores. Majority of the students in this study agreed that their major source of food safety information was the Internet (43.2%) followed by family (22.3%). In this study taking courses/workshops and consulting a healthcare professional about food safety information were significantly associated with higher ( P < 0.05) food safety KAP scores.

Table 7 . Association between food safety knowledge, attitudes, and practices scores and general characteristics of university students.

Logistic regression results ( Table 8 ) showed that male respondents had a lower Odds ratio compared to females (0.5) ( P -value < 0.05). This analysis indicated that males were 0.5 times less likely to have good KAP scores than females. Moreover, in this study, unemployed and full-time employee students were 0.6 times less likely to have good KAP scores in comparison with part time employee students. This finding was unique to our study and has not been observed in previously published work to the best of our knowledge.

Table 8 . Predictors of food safety KAP using logistic regression analysis.

This study aimed to investigate the level of KAPs of Jordan universities students during COVID-19 pandemic. Gaps in food safety knowledge, attitudes and practices were identified in this population, as the participants were found to have insufficient scores of overall food safety KAP. This level of food safety knowledge amongst university students has been previously reported ( 14 , 16 , 22 , 23 , 30 ). A meta-analysis reported overall KAP scores regarding COVID-19 to be 78.9, 79.8, and 74.1, respectively ( 31 ).

COVID-19 transmission route is reported to be either by person to person contact or via droplet transfer upon sneezing and coughing ( 12 ), the majority of our participants knew the way of COVID-19 transmission. In Saudi Arabia, it was reported that 94.8% of the participants knew that COVID-19 spread could be via the transfer of respiratory droplets upon coughing or sneezing, and only a small number (14.9%) knew that infected people with no fever could transmit the virus to others ( 32 ). While, amongst the South East Asian consumers, about half of the respondents (50.3%) were unaware that asymptomatic infected food handlers could transmit COVID-19 ( 33 ). The respondents of this study wrongly knew that food and water were vehicles for virus transfer. Official records report that there is no evidence that people can be infected with COVID-19 via food or water consumption, as it is a respiratory disease. Moreover, COVID-19 cannot multiply in foods (as correctly thought by our respondents), as the viruses need a human or an animal host to grow ( 34 ). A large number of participants believed that the vaccine alone will not be protective against getting infected without complying to safety measures, CDC and WHO also recommend following safety precautions at public places even after being fully vaccinated ( 35 , 36 ).

With regards to food cooking and storage during the COVID-19 pandemic, KAP score about appropriate cooking temperature for killing viruses was relatively low. South East Asian population showed that (41.2%) of participants believed that cooking at a temperature of >70°C destroyed the coronavirus ( 33 ). It is documented that coronavirus is a thermolabile virus and it is susceptible to traditional cooking temperatures (70°C) ( 37 ). However, when talking about refrigeration and freezing one third of our participants believed that these cooling techniques is not effective against COVID-19 virus. This proportion is lower than previously published studies where 64 and 52% of university students in Lebanon and Jordan knew that freezing does not kill harmful germs in food, respectively ( 16 , 22 ). The authors expected respondents to cook meat well as a response to the belief that the heat would kill the virus present in the meat. Hence, it was expected that they use a thermometer to check for meat wellness. Contrary to the assumption, students demonstrated a low knowledge about using a food thermometer as an accurate way of determining whether meat are cooked enough to prevent food poisoning. Previous studies also testify to this premise; university students were reported to have limited knowledge about the suggested use of food thermometer for such a purpose ( 16 , 22 , 23 , 38 ). Our results showed a good attitude toward food preparing situations which harmonizes with the general recommendation from WHO to limit the number of persons involved in food preparation during COVID-19 pandemic ( 12 ). Mishandling of food can occur at any stage during preparing and storage, for example, not washing the eggs is encouraged as washing could make them more porous and would result in microbial transfer to the internal section of the egg ( 39 ). The authors expected the respondents to wash animal products like eggs prior to storage as a precautionary measure to combat the virus, but surprisingly the majority of students did not.

Surfaces contaminated with COVID-19 may act as vehicles for spread of the virus. The virus could be present on chopping boards, knives etc. More than half of the students knew that they should use different chopping boards for vegetables and meat. This is in accordance with previous studies ( 23 , 38 , 40 ). Students displayed poor knowledge regarding cross contamination prevention and disinfection procedures. For instance, the respondents have a poor knowledge about the correct way to wash vegetables, where running water is expected to aid in washing away the virus. The majority of respondents have wrong information about the use of salt, vinegar, pepper and lemon juices as cleaning items. Such measures have officially been reported to be ineffective ( 34 ). Cleaning surfaces with detergent, water and then a disinfectant would be the most appropriate way for reducing the presence of the virus on kitchen surface tops. The authors expected students to dispose/disinfect shopping bags/ other food packaging to prevent virus transfer from outside to homes. Most of the respondents did not dispose empty shopping bags and disinfect food packaging, a similar pattern was observed in Jordanian participants where only 15.2% of the reported disposing of all boxes, packages, and covers of food while 13.4% reported always disinfecting food packaging prior to home storage ( 10 ). In contrast, about 40% of the consumers in Indonesia and Malaysia washed or wiped food jars and cans before using them ( 33 ), and 71.9% of United Arab Emirates residents sanitized or cleaned groceries before storing them ( 41 ). A higher percentage of our participants have insufficient knowledge on the proper use of reusable kitchen sponges as they reported using them for multiple purposes such as dishes and sink. This finding contrasts with a previous study that showed that a high percentage (74%) of female students in university dormitories used different sponges for cleaning utensils and the sink ( 26 ).

Unexpectedly, our university students exceeded other populations in not using their mobile phones while preparing food, and not using hand in a one-dish shared meal. Our results differ considerably from another study which reported 81.4% of the respondents used their cellphone during food preparation, cooking and packaging ( 42 ). It is expected that consumers sans a pandemic would use their cell phones during food preparation for various purposes (checking recipes, posting food pictures etc.); however, as the cellphone/ spoon could have remnant virus on its surface, if not disinfected, the respondents seem to exercise caution, which is encouraging. The majority of the respondents agreed that washing hands regularly and after touching the face and raw foods is important in preventing COVID-19 spreading. Similarly, Italian undergraduate students agreed that handwashing, wearing masks and avoiding close contacts were good protective measures to prevent the spread of COVID-19 ( 43 ). Only half of the respondents wash their hands before eating, and the same percentage wash their hands after returning home. It is not only handwashing but rather the time spent doing this activity that is equally important. In North Central Nigeria, majority (82.3 %) of respondents agreed that handwashing should last from a minimum of 20 s to 1 minute ( 44 ). Less than half of our participants knew how long they should wash their hands. This is a matter of grave concern as handwashing is one of the best front-line approaches to combat the virus. The respondents need to be educated about the correct handwashing technique/ time. In a multi-country study, 36.3% of Jordanian community washed their hands after returning home before the COVID-19 pandemic, this percentage increased to 53% during COVID-19 ( 10 ). This is still a low number considering the perilous behavior of this virus. A large number of participants have a good knowledge about the effectiveness of hand sanitizers but agreed with the need for hand washing. This is in accordance with the WHO recommendations which highlight that hand sanitizers should not replace washing hands with water and soap ( 12 ). It is possible that the virus transfers from the contaminated food surface to the respondent's hand which could then infect the person via oral orifices. The respondents were hence expected to use gloves while handling raw foods. It was noted that only a small number ( n = 265) wore gloves when dealing with raw foods. On similar lines, 98.4% Philippine food handlers who were engaged in an online food business, reported that they did not use gloves when handling raw food during the COVID-19 pandemic ( 42 ). However, it is agreed upon that although gloves are an important hygienic measure, they cannot replace hand washing. Hands need to be washed prior to wearing gloves and also after their removal ( 45 ).

Approximately more than one third of the participants checked restaurants hygienic measures such as tables, chairs and toilet sanitization, as well as workers' safety precautions. CDC recommends the use of masks for both employees and customers ( 46 ). It is obvious that costumers would be more confident about going to restaurants, if the restaurant management followed hygienic/sanitizing practices besides mandating workers to wear masks and maintain social distancing ( 25 ). More than half (57.4%) of the consumers in Indonesia and Malaysia always choose to dine in restaurants that followed social distancing rules, and 37.6% always sanitized the utensils and tables before eating at restaurants ( 33 ). Most (93%) of the customers in the study expected some safety precautions by restaurants, such as hand sanitizers at the door, staff adherence to masks and gloves, social distancing and reduced costumer serving capacity ( 47 ). Such measures along with toilet disinfection, surface sanitization and ventilation limit the spread of the COVID-19 virus ( 48 ).

Indeed, there have been a noted change in students' behavior toward gatherings, eating with family and friends during COVID-19. In Qatar, people reported eating more with immediate family members during COVID-19 ( 20 ). The author highlighted a shift toward eating meals at home rather than restaurants and a significant increase in home food deliveries during the COVID-19 pandemic. A similar trend was seen in Netherlands too during the pandemic lockdown, with 29.5% of the participants using meal delivery services more frequently than usual ( 49 ). It was reported that young, educated adults, tended to use internet services like online grocery shopping and meal delivery more frequently compared to their older counterparts ( 20 ). A shift toward using an online grocery delivery is shown in the results, however, more than half of the participants did not use credit cards as a safe payment method. Payment by credit card was expected to be preferred as cash could act as a vehicle for virus exchange.

Students reported shopping from either small grocery stores or large supermarkets as before but they reduced their time and frequency of shopping. However, in an Italian community, a shift toward shopping from small grocery stores due to the pandemic was observed. This may be because small grocery stores are less crowded than large supermarkets and hence are preferred by consumers ( 50 ). During the pandemic, Spanish consumers showed a significant reduction in the frequency of shopping; however, no significant change in the food shopping location was recorded ( 51 ).

Regarding the relationship between the KAP scores and demographic characteristic, this study shows that gender, marital status, university degree, employment status, self-rating of food safety knowledge, and the source of food safety information have a significant association. Female respondents outnumbered their male counterparts in KAP scores, this result might be related to the fact that traditionally in Jordan females play a central role in food preparation, kitchen work, cleaning, as well as the cultural trend of mothers passing their food related experience to daughters. A study of university students in Indiana showed that females had a higher food safety knowledge mean score (7.41) than males (7.04) ( 52 ). However, a Greek study showed that both genders had the same knowledge level about food safety issues ( 23 ). While, female and male Lebanese university students showed an equal knowledge level about food safety; however, female students had better food safety practices ( 22 ). Students identified as married in this study obtained higher KAP scores than single students. This is probably because married couples need to take charge of housekeeping and food preparation. In contrast, in Kuwait, single students were observed to get higher scores in food handling practices compared to their married counterparts. This could probably because in the country, married couples traditionally live in an extended family home and they tend to hire domestic helpers who aid in food preparation ( 53 ).

Higher education programs students reported higher KAP scores, this can be attributed to the greater amount of knowledge of these students by their readings, studying and experience. Part-time jobs have been considered as one of the factors influencing students KAP scores. Their work experience may have contributed to this observation. This factor was also another predictor of food safety KAP results in the present study.

Higher self-rated food safety knowledge levels correspond with higher KAP scores. A similar observation amongst college and university students in the United States was observed that the lower the self-rated food safety knowledge level, the lower was the knowledge mean scores ( 54 ). Common major sources of food safety knowledge among participants are internet and family, these were also the main sources of information in a study ( 40 ). However, another study reported that people tended to trust healthcare professionals more about COVID-19 related information ( 55 ). Food safety information from courses/ workshops and healthcare professionals also correspond with higher KAP scores. Swedish university students who reported food safety education as their primary source of knowledge answered a higher number of food safety knowledge questions correctly ( 40 ). On the other hand, being informed by family about food safety was related to poorer food preparation safety knowledge ( 23 , 38 ).

The present study was limited to students who have access to social media since it was conducted online.

University students in Jordan have insufficient scores in terms of overall food safety knowledge, attitudes and practices, a matter of great concern especially during the COVID-19 pandemic. However, results of this study report positive behavioral changes due to the pandemic with study participants increasing the adoption of hygienic practices. Fundamentals of food safety should be implemented in university curricula to better educate young adults.

Study Strength and Limitations

A current very important topic related to COVID-19 and food safety has been addressed in this manuscript. As the sample size was high, the generalizability of the results was at a good level. However, the findings of the study confer to the Jordanian students alone. Perhaps students from other countries would rate differently. Moreover, the survey questions pertaining to “practices” are subject to recall. Errors in recollection in terms or practice may have resulted in bias.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and the protocol were approved by the Department of Nutrition and Food Technology (#26/2021) and Deanship of Graduate Studies (#7/2021) at Jordan University of Science and Technology. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

TO, AA-N, and AT contributed to conception and design of the study. TO and AT contributed to manuscript writing. All authors contributed to manuscript revision, read, and approved the submitted version.

This work was supported by Jordan University of Science and Technology, Jordan.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2021.729816/full#supplementary-material

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Keywords: knowledge, attitude and practice, coronavirus, cross-contamination, sanitation, cooking, personal hygiene

Citation: Osaili TM, Al-Nabulsi AA and Taybeh AO (2021) Food Safety Knowledge, Attitudes, and Practices Among Jordan Universities Students During the COVID-19 Pandemic. Front. Public Health 9:729816. doi: 10.3389/fpubh.2021.729816

Received: 23 June 2021; Accepted: 04 August 2021; Published: 30 August 2021.

Reviewed by:

Copyright © 2021 Osaili, Al-Nabulsi and Taybeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Tareq M. Osaili, tosaili@just.edu.jo ; tosaili@sharjah.ac.ae

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Food Safety Culture

At a glance.

We surveyed staff members from 331 restaurants across eight states and localities. We asked what they thought about their restaurant's food safety culture. Learn what contributes to a strong food safety culture in restaurants.

Key takeaways

Restaurant managers help set the tone for a strong food safety culture by showing a personal commitment to food safety and having food safety training and policies in place. Adequate supplies for food safety practices and employee commitment to food safety are also critical to having a strong food safety culture at a restaurant.

Restaurant managers can use our tool to assess their food safety culture. Explore workers' beliefs about food safety, track progress over time, and see what practices are strengthening or weakening your restaurant's food safety culture.

Download our food safety culture tool with:

• Tab 1 – Form to give restaurant workers
• Tab 2 – Scoring tool for restaurant managers
• Tab 3 – Scoring tool with automatic tallying based on workers' responses
• Tab 4 – Example of scoring tool with automatic tallying

Why this is important

A restaurant's food safety culture is the shared beliefs of restaurant personnel that affect their practices in ways that impact food safety. A weak food safety culture is emerging as a common risk factor for foodborne outbreaks.

The food safety beliefs and behaviors of restaurant personnel could affect a restaurant's food safety practices. The food safety culture of a restaurant either promotes or discourages safe food practices.

What we learned

We found four key components of a strong food safety culture in restaurants:

• Leadership – Managers offer food safety training and policies.
• Manager Commitment – Managers are committed to and prioritize food safety.
• Employee Commitment – Employees are committed to food safety.
• Resources – The restaurant has sufficient resources to support food safety, such as enough soap and sinks for handwashing.

A study in Southern Nevada also found that training promoted a strong food safety culture, along with restaurant managers expressing appreciation for staff and routine two-way communication between managers and staff. They found obstacles to strong food safety culture included staff reluctance to talk to managers, short staffing, and lack of space and resources.

More information

Food safety culture tool for restaurant managers

Journal article this plain language summary is based on

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Persons with disabilities experiencing problems accessing the food safety culture tool for restaurant managers (spreadsheet) should contact CDC-INFO and ask for a 508 Accommodation [PR#9342] for A0209-NCEH-WBL8.

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Pesticide use, regulation, and policies in indian agriculture.

1. Introduction

2. objectives and methodology, 3.1. pesticide use in the world and in india, 3.2. pesticide consumption in india, 3.3. use of bio-pesticides, 3.4. use of integrated pest management (ipm).

• Agro-ecological methods: These methods emphasize the integration of natural processes and biodiversity to sustainably manage pests. They include crop rotation, polyculture, and the use of natural predators to reduce pest populations. By fostering a diverse ecosystem, beneficial insects and organisms thrive, which naturally keeps pest numbers in check. Additionally, practices such as habitat management and using pest-resistant crop varieties minimize the need for chemical pesticides, promoting environmental health and reducing the risk of pest resistance.
• Mechanical methods: These involve physical techniques and devices to manage and reduce pest populations, such as hand picking pests, using traps and barriers, and employing machinery like plows and cultivators to disrupt pest habitats. Techniques such as mulching and soil solarization can also create unfavorable conditions for pests. Mechanical control minimizes the use of chemical pesticides, thereby reducing environmental impact and health risks to humans and non-target species. These methods offer immediate and effective solutions, especially in smaller-scale or organic farming operations.
• Biological methods: These involve using living organisms to suppress pest populations through natural predation, parasitism, and competition. They include introducing or conserving beneficial insects like ladybugs and predatory beetles, which feed on pests such as aphids and caterpillars, and using parasitic wasps that lay eggs inside pest larvae. Microbial agents like Bacillus thuringiensis (Bt), a bacterium that produces toxins harmful to specific insects, provide targeted pest management. Biological control methods are sustainable and environmentally friendly, reducing reliance on chemical pesticides and fostering ecological balance in agricultural systems.
• In Odisha, 100% of households adopted some type of pest control measures ( Table 4 ).
• In Haryana, Punjab, and Gujarat, about 99% of farmers implemented pest control measures.
• Andhra Pradesh had a 96% adoption rate, West Bengal 94%, and Jammu 93%.
• Conversely, Uttarakhand had only 29% adoption, Uttar Pradesh 36%, and Jharkhand 58%.

3.5. Composition of Pesticide Production in India

3.6. pesticide production, imports, exports, and consumption in india, 3.7. trade in pesticides, 3.8. market share of different pesticide categories in india, 3.9. distribution of sales and reach to consumers.

• Regions with high concentrations: Jammu and Kashmir has the highest concentration with 8.9 sales points per 1000 hectares, followed by Haryana (4.1), West Bengal (4.1), Himachal Pradesh (3.9), Punjab (3.6), and Uttar Pradesh (3.4).
• Regions with low concentrations: Bihar has the lowest concentration with 0.6 sales points per 1000 hectares, followed by Jharkhand (0.9), Kerala (0.9), Madhya Pradesh (1.1), and Rajasthan (1.2).

4. Regulation, Registration, and Quality Control

4.1. labeling of pesticide products.

• Labels must prominently feature a diamond-shaped square occupying at least one-sixteenth of the total label area.
• The upper portion of the square must contain symbols and signal words indicating toxicity levels: (i). Category I (extremely toxic): Skull and crossbones symbol and “POISON” in red, with warnings “KEEP OUT OF THE REACH OF CHILDREN” and “IF SWALLOWED, OR IF SYMPTOMS OF POISONING OCCUR, CALL PHYSICIAN IMMEDIATELY”. (ii). Category II (highly toxic): “POISON” in red and “KEEP OUT OF THE REACH OF CHILDREN”. (iii). Category III (moderately toxic): “DANGER” and “KEEP OUT OF THE REACH OF CHILDREN”. (iv). Category IV (slightly toxic): “CAUTION”.

4.2. Pesticide Residues

4.2.1. vegetables, 4.2.2. fruits, 4.2.3. spices, 4.2.4. staple crops, 4.3. ban of pesticides, decision-making criteria, 4.4. bio-pesticides, 5. policy analysis, 5.1. pfa regulations on maximum residue levels (mrls), 5.2. regulations on use of pesticides, 6. conclusions and future prospects, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Reddy, A.A.; Reddy, M.; Mathur, V. Pesticide Use, Regulation, and Policies in Indian Agriculture. Sustainability 2024 , 16 , 7839. https://doi.org/10.3390/su16177839

Reddy AA, Reddy M, Mathur V. Pesticide Use, Regulation, and Policies in Indian Agriculture. Sustainability . 2024; 16(17):7839. https://doi.org/10.3390/su16177839

Reddy, A. Amarender, Meghana Reddy, and Vartika Mathur. 2024. "Pesticide Use, Regulation, and Policies in Indian Agriculture" Sustainability 16, no. 17: 7839. https://doi.org/10.3390/su16177839

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Food safety and handling knowledge and practices among university students of Bangladesh: A cross-sectional study

Md. nazrul islam.

a Department of Post-Harvest Technology and Marketing, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali 8602, Bangladesh

Hussein F. Hassan

b Department of Natural Sciences, Lebanese American University, Beirut, Lebanon

Md. Bony Amin

c Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali 8602, Bangladesh

Felix Kwashie Madilo

d Department of Food Science and Technology, Faculty of Applied Science and Technology, Ho Technical University, Volta Region, Ho, Ghana

Md. Ashiqur Rahman

Md. raisul haque, md. aktarujjaman, nawshin farjana.

e Department of Fisheries and Marine Bioscience, Jashore University of Science and Technology, Jashore, 7408, Bangladesh

f Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali 8602, Bangladesh

Associated Data

Data will be made available on request.

Our study aimed to examine the practices and knowledge of food handling and safety among 1534 university students in Bangladesh (mean age 22.09 ± 1.78), as well as the relationship between these factors and their academic and demographic backgrounds. Participants in this study were undergraduate and graduate students from four public universities in Bangladesh from different religions, income levels, years and majors of study, residential areas, living alone or not, and whose mothers are working or non-working. The questionnaire included 14 questions on food handling practices and 16 on knowledge. Questions were related to food preparation, hygiene, cross-contamination, and storage. The overall mean score for food handling practices was 34.9% (SD = 13.7), while that of knowledge was 41.8% (SD = 16.5). Female students, those from food-related majors, and those engaged in cooking activities scored significantly higher in the knowledge and practice sections ( p < 0.05) . Students who lived with their families performed significantly better on the knowledge parts, while those who shared a home with roommates in mess performed significantly better on the practice part ( p < 0.05) . Students having housewife mothers, personal poisoning experience, and continuous involvement in food purchasing scored significantly higher ( p < 0.05) in the practices section but not in the knowledge one. On the other hand, students living in urban areas scored significantly higher ( p < 0.05) in the knowledge section but not in the practices one. Our results highlight the importance of educational interventions and initiatives to enhance food safety awareness among Bangladeshi university students.

Knowledge; Practices; Food safety; Bangladesh; University students; Questionnaire.

1. Introduction

The global public health concern is foodborne infections, even in nations with sophisticated food safety systems, such as “ farm-to-fork ” in Europe and “ farm-to-table ” in the USA ( Morris, 2011 ; Lazou et al., 2012 ). Though it is difficult to measure the prevalence of foodborne diseases worldwide, it is thought that 1.6 million people each year pass away from acute gastroenteritis, primarily brought on by infected water and food. In the USA, each year, 1/3 rd of people may get a foodborne illness. This percentage is increasing due to the globalized food trade, increasing tourism, mass production, and industrialized animal production, among others ( Hassan and Dimassi, 2014 ). Therefore, safe food purchase, cooking, preparation, and handling in households are key to reducing the prevalence of foodborne illnesses ( Redmond and Griffith, 2003 ; Kennedy et al., 2005 ).

Mishandling of foods among young male adults (less than 30 years old) has been commonly reported ( Li-Cohen and Bruhn, 2002 ; Medeiros et al., 2004 ; McArthur et al., 2007 ). Despite the fact that this age group is not considered “ at-risk ” for foodborne illnesses, their poor hygienic practices have serious ramifications when they begin to provide care for other at-risk family members (children, the elderly, and pregnant women) ( Abbot et al., 2009 ; Byrd-Bredbenner et al., 2008 ). A plethora of studies on food safety knowledge and practices were conducted on youth, such as in Saudi Arabia ( Sharif and Al-Malki, 2010 ), USA ( Byrd-Bredbenner et al., 2007 ; Morrone and Rathburn, 2003 ), Turkey ( Sanlier, 2009 ), Spain ( Garayoa et al., 2005 ), Greece ( Lazou et al., 2012 ), Lebanon ( Hassan and Dimassi, 2014 ), Iran ( Eslami et al., 2015 ), Canada ( Majowicz et al., 2015 ), Bulgaria ( Stratev et al., 2017 ), Pakistan ( Zeeshan et al., 2017 ), Ethiopia ( Azanaw et al., 2019 ), Jordan ( Osaili et al., 2011 ), Kuwait ( Ashkanani et al., 2021 ), Oman ( Al Makhroumi et al., 2022 ), Serbia ( Vuksanović et al., 2022 ), and Iraq ( Muhyaddin et al., 2022 ).

Determining the actual level of food safety knowledge and practices is the starting point to improve this level among any group via educational programs. In other words, identifying the demographic factors of the handlers having the poorest knowledge of food safety is the foundation of any effective educational program. Numerous studies have documented the effect of different demographic characteristics, such as gender, income, education level, age, major of study, and residential location, on food handling knowledge and practices ( Sanlier, 2009 ; Hassan and Dimassi, 2014 ; Ovca et al., 2014 ). However, these studies showed mixed results because of variations in population characteristics, design of studies, and questions of the survey.

Foodborne diseases or illnesses and other food safety hazards are prevalent in Bangladesh due to the high population density, poor water, sanitation, and hygiene (WASH) facilities, and unfledged infrastructure ( Noor and Feroz, 2016 ). As a result, each year nearly 30 million individuals suffer from foodborne infections in Bangladesh ( Khairuzzaman et al., 2014 ). In particular, diarrheal illnesses are the most prevalent foodborne illnesses, in addition to hepatitis and enteric fever as common cases ( Food and Agricultural Organization of the United Nations, 2016 ; Suman et al., 2021 ).

Al Mamun et al. (2013) investigated food safety knowledge and awareness among school-based street food vendors in Bangladesh, whereas Al Banna et al. (2021) evaluated factors influencing food safety knowledge and behaviors among meat processors. Additionally, knowledge and practices were assessed among fish farmers/restaurants, food handlers, chotpoti vendors, street food vendors, and chicken vendors in Bangladesh by Hashanuzzaman et al. (2020) , Siddiky et al. (2022) , and Hossen et al. (2020) , respectively. Additionally, Tarannum (2021) investigated the practices, attitudes, and knowledge of food handlers in Bangladeshi households about food sanitation. As far as our search is concerned, there has not been any previous data on food safety knowledge and practices among students in Bangladeshi universities; therefore, our study assessed self-reported practices and knowledge related to food safety among four public universities in Bangladesh. Another important goal was to evaluate the impact of various demographic traits on handling behaviors and knowledge of food safety. The findings from our study can be used to set legislation, promote correct practices, design effective interventions to improve knowledge, and change false beliefs and practices related to food handling.

2. Materials and methods

2.1. study subjects.

Between January and March 2022, a cross-sectional study at four public universities in Bangladesh was carried out. These universities were Patuakhali Science and Technology University (PSTU), Jashore University of Science and Technology (JUST), Hajee Mohammad Danesh Science and Technology University (HSTU), and Islamic University (IU). The selection of universities considered those offering bachelor's degrees in both food-related (nutrition and food science, applied food technology and nutritional science, food processing and preservation technology) and non-food-related majors of study (arts, basic sciences, business studies, technology, and engineering). The inclusion criteria for the study include the following: Bangladeshi university students (both genders) registered at one of the selected universities from different majors of the study (food-related or non-food-related) and levels of the study (bachelor or master).

A total of 1650 participants were randomly selected using random number table from each major of the study, where 436 participants were from food-related majors of study, and the rest (1214 participants) were from non-food-related majors. The questionnaire was distributed to ensure diversity in terms of gender and major of study. Before filling out the questionnaire, an oral explanation of the study content, objectives, and the study protocol was given to the class teacher/instructor for initial approval. After getting the approval, the researchers met the students. They informed them about the importance, objectives and protocol of the study, and those who volunteered to take part in the study gave their written approval. Then, questionnaires were supplied to all the students in the selected classrooms so that they could be filled at the end of the sessions.

No other rewards were provided since the participation was completely voluntary and anonymous. Inappropriately filled or incomplete questionnaires were excluded from the study. Hence, out of 1650 filled questionnaires, only 1534 (92.96% response rate) were valid (396 from food-related majors and 1138 from non-food-related majors). Ethical approval was granted by the ethical committee of the department of Biochemistry and Food Analysis at Patuakhali Science and Technology University (PSTU) (approval number: BFA: 10/12/2021:04).

2.2. Questionnaire

To evaluate food handling and safety knowledge and practices among Bangladeshi university students, a questionnaire was developed by including questions collected from updated, valid, and reliable instruments produced by previous studies ( Hassan et al., 2014 ; Hassan et al., 2018 ; Chuang et al., 2021 ; Lazou et al., 2012 ; Byrd-Bredbenner et al., 2007 ; Haapala and Probart, 2004 ; Ovca et al., 2014 ; Osaili et al., 2011 ). In addition, some questions related to geographical location, culture and eating habits in Bangladesh were modified. The questionnaire was piloted among 45 students to determine whether the wording was precise and appropriate and determine how long it would take to complete. Modifications were made based on the results of the pilot research.

The final questionnaire is divided into four sections: an introduction, demographic data, handling procedures for food safety, and food safety knowledge. The first part included a short introduction to the objectives of the study. The second part focused on demographic characteristics, including age, gender, religion, current educational status, residential status, monthly income (BDT), mother employment status, cooking habits, previous personal food poisoning experience, involvement in food purchasing, etc. The third part comprises the food safety practices section containing 14 questions that were divided into 4 subsections: food microbiology and cross-contamination practices (4 items), food preparation and cooking practices (4 items), food storage and chilling practices (3 items), and cleaning and hygiene practices (3 items). Most of the questions were multiple-choice based. Part 4 was designed to assess the knowledge on food safety, which included 16 questions divided into four subsections: food microbiology and cross-contamination (4 items), food preparation and cooking knowledge (5 items), food storage and chilling (4 items), and cleaning and hygiene (3 items). Most of the questions in this section were multiple-choice based. The questionnaire took approximately 20 min to be filled.

2.3. Statistical analysis

Statistical software, SPSS version 28.0, was used to analyse the data acquired. Simple descriptive tests were used to observe the frequency, percentages, mean, standard deviation, and standard error. Each correct answer to each multiple-choice question was given a score of 1, while 0 for all wrong answers. Thus, food safety practices section score varies from 0 to 14 and the knowledge section from 0 to 16. Then, normality was checked for each variable with the dependent variable to observe the distribution of scores for each category. Due to skewed distribution, non-parametric tests (Wallis H test and Mann-Whitney U test) were performed to observe the differences of the mean sum of the correct responses of knowledge (16 questions) and practice (14 questions) sections within demographics. All tests were two-sided and done with 95% confidence intervals. Tests were considered significant when the p -value was found to be less than 0.05.

3. Results and discussion

A total of 1534 valid questionnaires filled by undergraduate and graduate students were analyzed, among which 49% were females, and 51% were males. In addition, 25.8% of students were from food-related majors and 74.2% from non-food-related majors (basic sciences, arts, business, technology, and engineering). The mean student age was 22.09 (SD = 1.78). The majority of the undergraduate students were in 1 st year (36%) while the postgraduate students formed 8% of the total population. About 9% of the participants lived with their parents. However, only 8% of the subjects answered that they cook all the time, and only 17% of the participants had a working mother ( Table 1 ).

Table 1

Socio-demographic characteristics of the study population (N = 1534).

Note: a = Buddhist and Christians, Exchange rate was 15000 BDT = 174 USD.

Table 2 displays the mean score for the practices and knowledge and the significant levels for each variable. The overall mean score for best practices in food handling was 34.9% (SD = 13.7). For the food handling part, female students and students living with their families scored significantly better than their male counterparts living with friends or roommates. Older students (above 23 years old) with food-related majors performed significantly better than younger students from non-food majors ( p < 0.001 and p = 0.001, respectively). The participants with working mothers scored higher, with the significant different at ( p = 0.048). Students with personal food poisoning experience and full involvement in food purchasing scored significantly higher ( p = 0.002). On the other hand, the effects of religion, maternal education, and monthly income were not significant ( p > 0.05), meaning that they have no influence on food safety knowledge or handling practices.

Table 2

Mean scores of food handling practice and food safety knowledge sections per demographic characteristics.

Note: a = Buddhist and Christians.

The overall mean score of food safety knowledge was 41.8% (SD = 16.5). Female students and those majoring in food-related fields of study scored significantly better than males and students from non-food majors ( p = 0.005 and p < 0.001, respectively). In addition, subjects from urban areas and those who cook all the time had significantly higher score ( p = 0.007 and p < 0.001, respectively). On the other hand, age, religion, year of study, maternal education and employment status, monthly income, personal food poisoning experience, and involvement in food purchasing were not significant ( p > 0.05).

The responses reported in our study identified poor levels of food safety knowledge (41.8%) and implementation of food handling practices (34.9%). This poor food safety awareness was as well reported in the literature ( Byrd-Bredbenner et al., 2007 ; Abbot et al., 2009 ; Garayoa et al., 2005 ; Osaili et al., 2011 ; Lazou et al., 2012 ; Unklesbay et al., 1998 ; Sharif and Al-Malki, 2010 ; Hassan and Dimassi, 2014 ). For instance, among university students in Greece, the United States, and Lebanon, the mean scores for food safety knowledge were 60, 60, and 54%, respectively, whereas the mean scores for food handling procedures were 44, 50, and 49%, respectively ( Lazou et al., 2012 ; Hassan and Dimassi, 2014 ; Byrd-Bredbenner et al., 2007 ).

Students from food-related majors reported significantly ( p < 0.001) higher scores on practices (40.2%) and knowledge (47.3%) scores ( Table 2 ). This can be attributed to food safety, hygiene, and microbiology modules in the food-related major curricula. A similar conclusion was reported by Hassan and Dimassi (2014) ; Byrd-Bredbenner et al. (2007) ; Osaili et al. (2011) ; Garayoa et al. (2005) ; Unklesbay et al. (1998) ; Sharif and Al-Malki (2010) .

Female students showed significantly higher scores than their male counterparts with regard to food handling practices (35.9%; p = 0.007) and food safety knowledge (42.9%; p = 0.005) ( Table 2 ). This may be explained by the fact that women are typically in charge of maintaining the cleanliness and hygiene of the kitchen throughout East Asia, especially in Bangladesh. This goes in line with previous studies ( Unklesbay et al., 1998 ; Lazou et al., 2012 ; Byrd-Bredbenner et al., 2007 ; Hassan and Dimassi, 2014 ).

In terms of practices and knowledge, students who lived with their families performed better than those who lived with friends or roommates ( Table 2 ), and the difference was statistically significant (p = 0.003 and p 0.001, respectively). Hassan and Dimassi reported the same observation (2014). This could be because when students live with their family, a more seasoned individual (the mother in the case of Bangladesh) will prepare the meals, leading to more standardized food handling and an opportunity for the student to learn more about food safety. Participants with working mothers scored less in both practice (33.3%) and knowledge (40.2%) questions, yet the difference was borderline significant ( p = 0.048) for the practices only. The reason could be the fact that, in general, working mothers are usually educated, and therefore, they spend less time on food preparation compared to housewives, resulting in poorer food safety knowledge and food handling practices.

Concerning food handling practices, scores for each question are presented in Table 3 . For instance, among the correct practices, only 26.7% of participants reported using another chopping board when switching from cutting meat to cutting vegetables, while 45.8% reported washing the knife with soap and hot water when switching from raw meat to another food. Additionally, while only 26.4% of subjects with a wound on their hand reported handling food after wearing gloves, almost half of the respondents (49.7%) said washing their hands after touching their faces. On the other hand, only 50.8% rub their hands with soap for about 20 s when they want to wash their hands, and only 18.2% take off jewellery when preparing food. Surprisingly enough, while as low as 2.5% of participants reported checking the central temperature of the cooking pot to verify that food is sufficiently cooked, 6.8% of them thawed raw meat in the refrigerator, and 10% reported throwing meat away when it thaws and feels warm when the electricity goes off. This poor knowledge in food handling might be due to insufficient food safety and hygiene education on our tertiary education campuses.

Table 3

Score distribution to food handling practices questions.

In addition, Table 4 presents the results of food safety knowledge of the participants. The table reveals that about 44% and 41.3% of participants knew that Campylobacter is most likely associated with raw meat/fish and that raw meat/fish is most likely to become contaminated with Listeria . Only 11.7% of students knew that teenagers are the least prone to get food poisoned, and 11.1% knew that foods are safe if cooked to an internal temperature of 74 °C. On the other hand, 31.9% of the respondents knew that the maximum fridge temperature is 4 °C, and 41.7% knew that freezing does not kill harmful germs in food.

Table 4

Score distribution to food safety knowledge questions.

A comparison between our study with similar questions from a developed country, Greece ( Lazou et al., 2012 ), and a developing country, Lebanon ( Hassan and Dimassi, 2014 ), presented in Table 5 , reveals that Bangladeshi university students scored the least (20%) compared to the Greek (27%) and Lebanese (29%) students in the food storage practice, while they scored better (45%) than the Greek (37%) and Lebanese (39%) students in cross-contamination practice questions. For the cleaning and hygiene practice, Bangladeshi students scored (67%) compared to 68% in Greece and 61% in Lebanon. As for the overall mean for the food handling common practice questions (7 questions), our score was 44%, which is similar to that of Lebanon (43%) and Greece (44%).

Table 5

Comparison of food handling and safety practices and knowledge among Bangladesh, Lebanese and Greek university students.

With regards to food safety knowledge, Bangladeshi university students scored the least (32%), when compared to the Greek (37%) and Lebanese (53%) students. For cooking of food, Bangladeshi students again scored the least (46%) compared to the Greek (59%) and Lebanese (59%) students. The overall mean scores also indicated that Bangladeshi students’ score was 39%, which was the lowest when compared to Lebanon (56%) and Greece (48%) with respect to food safety knowledge ( Table 5 ).

4. Concluding remarks

The poor food safety awareness reported by Bangladeshi university students results in an increasing intake of risky foods and, therefore, a higher likelihood of foodborne diseases. This poor awareness of food safety will contribute, in the long run, to a higher likelihood of foodborne illnesses in household settings, as university students will be at some point, food handlers and caregivers for their families. Information collected from this study has identified the urgent need for food safety education among youth, in high schools and universities, on proper temperature control, prevention of cross-contamination, proper food preparation practices, cleaning, sanitation, and hygiene. Higher academic institutions can be the correct place to intervene and reach out to the uneducated and the younger generation. Although its limitations related to the design as sampling was based on four universities only in Bangladesh, in addition to the fact that we used the questionnaire of other similar studies without validating it, our study gave considerable insights to the status of food safety knowledge and practices in Bangladesh.

Declarations

Author contribution statement.

Md. Nazrul Islam: Conceived and designed the experiments; Performed the experiments; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Hussein F. Hassan: Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data analysis tools or data; Wrote the paper.

Md. Bony Amin, Felix Kwashie Madilo: Analyzed and interpreted the data; analysis tools or data; Wrote the paper.

Md. Ashiqur Rahman, Md. Raisul Haque, Md. Aktarujjaman, Nawshin Farjana: Performed the experiments; Contributed reagents, materials, analysis tools or data.

Nitai Roy: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability statement

Declaration of interest's statement.

The authors declare no conflict of interest.

Additional information

No additional information is available for this paper.

Appendix A. Supplementary data

The following are the supplementary data related to this article:

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Kolkata doctor rape-murder: R.G. Kar victim’s justice key concern, charges of unfair practices in hospitals also serious, says Lawyers

Supreme court forms national task force to ensure safety of healthcare professionals after doctor’s rape and murder in kolkata.

Updated - September 09, 2024 12:21 pm IST - Kolkata

A bench comprising Chief Justice of India (CJI) D.Y. Chandrachud, Justice J.B. Pardiwala and Justice Manoj Misra during the second day of hearing on a suo moto case related to the alleged sexual assault and murder of a postgraduate trainee doctor in Kolkata, at the Supreme Court in New Delhi, Monday, September 9, 2024. | Photo Credit: PTI

Justice for the rape and murder of a doctor in R.G. Kar Medical College and Hospital is the primary concern but the allegations that the practice of several students obtaining degrees in medicine through unfair means must not be lost sight of, according to lawyers.

They expressed optimism that the National Task Force (NTF) formed by the Supreme Court to formulate a protocol for ensuring the safety and security of doctors and other healthcare professionals will have far-reaching effects in the future.

The apex court is scheduled to hear a suo-motu petition on the matter during the day, a month after the on-duty medic was raped and murdered inside the state-run hospital on August 9. A civic volunteer was arrested by the police the next day in connection with the case which the Calcutta High Court later transferred to the CBI.

The gruesome rape and murder sparked nationwide outrage.

“I am optimistic and certain that something will come out of it,” former West Bengal Advocate General Jayanta Mitra told PTI .

Stating that the primary object is to ensure the safety of women and ensuring justice for the victim doctor, he said, “The biggest and most deep-rooted malady is the state of affairs in the field of medicine.” Mr. Mitra said that the question of allegations of some unscrupulous people obtaining degrees as doctors in some medical colleges in the state should not be lost sight of and must be taken care of.

“Who do you turn to if you feel that the person you are going to for treatment is an uneducated person who has passed the exam by paying money,” said Mr. Mitra, a barrister who had resigned as Bengal’s AG in 2017 after holding the position for a little over two years following differences of opinion with the state government over certain issues.

Following the medic’s murder, allegations have surfaced that unfair practices have been adopted in some cases during examinations for medical students.

The CBI is also investigating a case of financial irregularities in R.G. Kar Medical College and Hospital during the tenure of its ex-principal Sandip Ghosh, who was arrested by the central agency in connection with the case on September 2.

Uday Shankar Chattopadhyay, a lawyer practising at the Calcutta High Court for 22 years, said that laws to ensure women’s safety are already stringent, but the need of the hour is to ensure proper implementation of these.

Also Read: Kolkata rape-murder case LIVE updates: CBI and WB govt file status reports in Supreme Court

“Registration of FIR in a fool-proof manner, keeping away political interference and ensuring proper investigation are the requirements,” he said.

Mr. Chattopadhyay said that the newly implemented Bharatiya Nyaya Sanhita (BNS) and Bharatiya Nagarik Suraksha Sanhita (BNSS) have stringent provisions on crimes against women and children.

Maintaining that proper investigation is a must in crimes against women and POCSO cases, Mr. Chattopadhyay said that the perpetrators can get away without getting convicted if this is not done diligently.

“The Kamduni rape and murder of a 19-year-old college student is an example of such failures,” he said.

The Calcutta High Court had overturned the death penalty to three convicts by a sessions court, commuting to life imprisonment to two and acquittal of the third. The court had observed that the state failed to prove conspiracy and prior concert in the crime beyond reasonable doubt.

Maintaining that the entire world is watching the developments over the R.G. Kar hospital case, another high court lawyer Arindam Das said that the formation of the NTF is a most welcome step.

He said though legal infrastructure is there, such crimes are still taking place.

“The Supreme Court taking up the issue will definitely have a far-reaching effect in ensuring safety and security of women at the workplace,” he said.

The Supreme Court had on August 20 constituted a 10-member National Task Force to formulate a protocol for ensuring the safety and security of doctors and other healthcare professionals.

Hearing a suo-motu case related to the rape and murder of the medic in Kolkata , the apex court had expressed concern over the lack of workplace safety in healthcare institutions and said the country cannot wait for rape or killing for real changes to take place on the ground.

A three-judge bench headed by Chief Justice D.Y. Chandrachud had said that nationwide protests following the brutal incident have brought the issue of lack of institutional safety for doctors to the forefront.

The 10-member task force headed by Vice Admiral Arti Sarin was asked to submit its interim report within three weeks.

The Supreme Court, which directed the Central Bureau of Investigation (CBI) to submit a status report on the progress made in its investigation into the killing, also asked the state government to submit a report on the action it has taken against the vandals.

Published - September 09, 2024 11:34 am IST

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