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Shumi Abe1 and Godana Arero1*

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Citation:

Shumi Abe and Godana Arero, Food Handlers Safety Practice and Associated Factors in the Public Food Establishments in Batu Town, Central Oromia, Ethiopia. Special Journal of Public Health, Nutrition, and Dietetics. 2021, 2(1): 1-18

 Highpoints

  • Public food establishments and food handlers safety practices in Oromia, Ethiopia
  • The strength of association between food safety practice and hygiene estimated
  • Knowledge and training in food safety practice impacted food safety and hygiene

 Abstract

Background: Food safety is a scientific discipline describing the handling, preparation, and storage of food in ways that prevent foodborne illnesses. There remain knowledge gaps regarding food safety practices among communities in the Batu Town of Oromia Regional State in Ethiopia.

Objective:

to assess the magnitude of food safety practice and associated factors among food handlers in public food establishments in Batu town, Central Oromia.

Methods:

A qualitative technique with a cross-sectional study design was conducted on 302 food handlers working in the 151 public food establishments in Batu Town. A simple random sampling technique was used to select a representative sample. A structured questionnaire was used after pretesting on 5% of the total sample. Data normality was checked using histogram, and Shapiro Wilk Test.

Data were entered into EpI-Info version 7.0 and exported to SPSS version 21 software for analysis. Descriptive statistics were used to describe the characteristics of study participants. A bivariable logistic regression analysis was done to detect out confounder.  All variables with a p-value <0.25 during bivariable analysis were entered into multiple logistic regression models to control any confounders. Odds ratio along with 95%CI were estimated to measure the strength of the association between predictive and outcome variables. Summary statistics were declared at p-value <0.05.

Results:

The proportion of food safety practices was 176(58%) of which 52% had good knowledge and 126(47%) of the study participants had poor food safety practices. Those who had training on food safety practice were 3.1 more likely to keep food hygiene than those who didn’t get training with (AOR 3.10, 95%CI (1.30, 7.38), Those who had good knowledge on food safety practice were 3.90 times at higher odds of observing food safety practice as compared to their counterparts with poor knowledge (AOR =3.897, 95%CI (2.28, 6.70).

Those who had training on food safety practice were 3.1 more likely to keep food hygiene than those who didn’t get training on food safety practice with AOR 3.10, 95%CI (1.30,7.38), Value 0.01. Regarding food handlers, those who had good knowledge of food safety were 3.90 times at higher odds of food safety  practice compared to those who had poor knowledge of food safety practice [AOR =3.897, 95%CI (2.28, 6.70)]

Conclusion:

The study indicated that food safety practice was medium or moderate in the studied location.

Keywords: Food safety, knowledge, attitude, practice, public food establishments, Batu town, Ethiopia

Addresses(1) Batu Town General Hospital, Batu, Central Oromia, Ethiopia, (2) Adama Hospital Medical College, Department of Public Health Nutrition, Adama, Oromia, Ethiopia

Correspondence: Godana Arero*E-mail Address: garero2015@gmail.com

Article history:

Received: September 17, 2021: Accepted: October 18, 2021:  Published: November 2nd, 2021

Distribution and usage license:

This open-access article is distributed by the terms and conditions of the Creative Commons Attribution 4.0 International License seen in this link (http://creativecommons.org/licenses/by/4.0/ ). You are free to use, distribute, and reproduce this article in any medium, provided you give correct credit to the original author(s) and the source, including the provision of a link to the Creative Commons license website. Pls show any modification’s

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 Introduction

Food safety is the utmost public health concern. It is a scientific discipline describing the handling, preparation, and storage of food in ways that prevent foodborne illnesses(1).  An adequate supply of safe, wholesome, and healthy food is essential to the health and well-being of humans. Sometimes, the food itself can cause a threat to health People can get sick when they eat food contaminated with hazards; this is referred to as foodborne disease (2).

Nowadays, more than 200 foodborne diseases caused by 31 pollutants (bacteria, viruses, parasites, toxins, and chemicals) have been identified, whose manifestations range from gastrointestinal symptoms such as diarrhea to long-term chronic diseases such as cancer(3). Furthermore, Food safety continues to be a public health problem worldwide because foodborne illnesses are widespread. Consequently, consumers are increasingly concerned about food safety and quality; and demand more transparency in production and distribution.

Thus Governments all over the world are intensifying their efforts to improve food safety. These efforts are in response to an increasing number of food safety problems and rising consumer concerns. The action of monitoring food to ensure that it will not cause foodborne illness is known as food safety (4). Food contamination in developing countries is caused by many factors such as inappropriate handling of food, holding temperatures, and poor personal hygiene of food handlers(5). It mainly occurs through poor food handling practices which results in numerous food-borne diseases.

These diseases are a major cause of morbidity and mortality, constituting one of the greatest dangers to health worldwide and becoming a significant impediment to socio-economic development in the countries (6). As the different studies showed there were huge knowledge, attitude, and practices gap regarding food safety handling in the Ethiopian situation(7). Therefore, the present study planned to enhance the knowledge, and practices gaps among food handlers in the study area.

Statement of the problem

Everyone is entitled to the food they eat to be safe, that is, they do not cause harm to health when they are ingested because of physical contaminants (metals, stones, etc.), microbiological (bacteria, viruses, parasites), or harmful chemicals(3). It is the fact that Food is any substance which when eaten nourishes the body and sustains life.  However, problems may arise on its preparation thereby affecting the safety of foods available for consumption.  Such problems are common and have persisted which resulted in morbidity and mortality cases.

It’s also the fact that Food may be contaminated at any time during production, distribution, and preparation as a result of the use of contaminated water for preparation, poor hygiene during handling, or improper conditions during processing and storage(5). In addition to this, even though food handlers have a great responsibility in ensuring the safety of food, particularly, in public food establishments, food handlers are the first responsible bodies to contaminate food by acting as either a biological or a physical carrier for many pathogenic organisms (6).

Food contamination mainly occurs through poor food handling practices which results in numerous foodborne diseases (7). The global burden of foodborne diseases is large, 600 million cases and 420,000 deaths occur each year due to poor food handling practices, affecting health, agricultural production, and trade, thus limiting human economic development. Among ten people, one becomes ill from ingestion of contaminated food(9).

In developed countries, food-related illnesses impose an increasingly important public health problem. It is estimated that 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths result from food-borne disease annually-with a cost of $23 billion(10). In developing countries, approximately 10 to 20% of food-borne disease (FBD) outbreaks are due to food contamination. Around 700,000 people die due to FBD in sub-Saharan Africa.

In the WHO African Region, more than a 91million individuals are estimated to fall ill and 137,000 die every year due to food-borne diseases. Diarrheal diseases contribute to 70% of food-borne illnesses in the region(11). In Ethiopia, though there is limited data, there were 280,458 out-patient cases in 2013(12).

Unless food safety standards such as good food hygiene practices and supervisory system, sufficient food safety law, regular food safety surveys, and good food safety practices are maintained, poor food handling practice can result in numerous foodborne diseases cause of morbidity and mortality, constituting one of the greatest dangers to health worldwide and becoming a significant obstruction to socio-economic development in the countries. Therefore, the safety of food handling is one of the most important health and safety issues facing most developing countries since it leads to both public health and social problems(8).

In Ethiopia, the coordination activities particularly at lower levels of government bodies are so weak. There is no clearly defined responsibility to control, monitor, and evaluate food handlers of food establishments (12).In addition to this, there are gaps in the Ethiopian food safety system on food-borne diseases surveillance, coordination of organizations involved in food safety management, and legal and policy framework.

According to Several previous studies conducted in different towns of Ethiopia such as Gonder, Diredawa, Debark, Arba Minch, and Asosa, showed that prevalence of good food handling practice was 30.30%, 52.4%, 40.1%,32.6%, and 67.8%,  respectively revealed that there were the high rates of improper food handling in food and drink establishments (13), (14), (3), (15), (16). This study aimed to fill the information gaps to planners, policymakers, and environmental Health officers about food safety practices of Batu town of food handlers working in Food and Drinking Establishments.

Furthermore, it is useful for initiating the establishment of a non-overlapped National food safety policy, regular food-borne diseases surveillance, and monitoring and evaluation system of food establishments. More importantly, Batu town, the focus of this study, is urbanizing at a very fast rate. It is the center of training for many governmental and Non-Governmental Organizations (NGOs).  And the public at large traveling to and from Moyale, Yebello, Dilla, Arbamich, Awassa, Hosena, and sheshemene cities. Hence, many people make use of the food, drink, and accommodation services in the town. It also receives many tourists due to its proximity to many rift valley lakes that attracts many tourists.

Justification

As in many parts of the world, today’s in many urban centers of our country’s Food establishments are prepared, handle and serve large quantities of food and drink to large groups of people within a short time.  Hence, unless food safety standards are not seriously implemented, they will expose users to the risk of foodborne infection(11).

Several previous studies conducted in different towns of Ethiopia revealed that there were high rates of improper food handling in food and drink establishments.  (3), (13), (14), (15), (16). Poor food handling practices can result in numerous foodborne diseases causing morbidity and mortality, constituting one of the greatest dangers to health worldwide and becoming a significant obstruction to socio-economic development in the countries. Therefore, the safety of food handlers is one of the most important health and safety issues facing most developing countries since it leads to both public health and social problems(8).

Moreover, low financial resources, the inadequacy of food safety law, the availability of food establishment guidelines and standards, as well as poor monitoring and evaluation systems of food establishments play an important role in food handling practices (13).

In Ethiopia, the coordination activities particularly at lower levels of government bodies are so weak. There is no clearly defined responsibility to control, monitor, and evaluate food handlers of food establishments(12). In addition to this, there are gaps in the Ethiopian food safety system on food-borne diseases surveillance, coordination of organizations involved in food safety management, and legal and policy framework(17).

Many of the literature reviewed indicated that the existing food practice in Ethiopia was a major risk factor to cause foodborne diseases, Even if the responsible body made a great effort likes supportive Supervision, inspection, and licensing for the establishments (17)

Rationale

So this study aimed to fill these information gaps to planners, policymakers, and environmental Health officers about food safety practices of Batu town of food handlers working in Food and Drinking Establishments. Furthermore, it is useful for initiating the establishment of a non-overlapped National food safety policy, regular food-borne diseases surveillance, and monitoring and evaluation system of food establishments.

This study has a significant input, for planners and policymakers in the formulation of appropriate strategy, to modify and facilitate the overall regulatory activity. As a result of this, Batu city  Administration  Health office, cultural and tourism office for tourism attraction are stakeholders who can use the findings. This study will also serve as baseline data for university, for researchers as reference material to subsequent studies under similar research topics and relevant for further studies in the area.

Objective:

to assess the magnitude of food safety practice and associated factors among food handlers in public food establishments in Batu town, Central Oromia.

Materials and Methods

Study Area

Batu town is located in the state of Oromia and to the southeast of Addis Ababa, capital of Ethiopia, with a distance of 163kms. The town was established in 1950. It is a flat land area located at an altitude of an average elevation of 1,646 meters above sea level, and it has a hot and windy climate. Geographically, the town is located between 7056‟ latitude North and 38043‟ East longitude in the Great Rift Valley. Its total area is 5,306.73 hectares with a total population of 73,312. According to data obtained from the projection of the central statistical Authority (CSA 1997),

It has also a population growth rate is 2.9% and the crude population density of the town is 46 people per square Km. The town has a great potential for residential, tourist, and investment attractions. Within the town, there are 118 Bar & restaurants, 48 hotels, 7 cafes, and 101 others like a bakery, snack house which provides food for the catchment population and guests. According to data from the town’s trade and industry, there are a total of 274 food establishments (restaurants, cafes, and hotels in Batu town) which are containing about 1870 food handlers.

Study Design and period:

Institutional based cross-sectional study design was conducted from May 11-31, 2020

Population:

All food handlers who were working in Batu town Public food establishments during the study period. Those food handlers who were working in the randomly selected food establishments in Batu town and available during the study period were the study population. Sampling units are those participants who gave full information to the research team.

Inclusion and Exclusion Criteria

Food handlers who were working in preparation and service areas of food and drink establishments during the study period regardless of their sex and employment status were included. Food handlers who were unable to hear, mental illness, or generally those who could not communicate due to serious illness during data collection time were excluded

Sample size and Sampling Procedures

The sample size is determined using the formula for single population proportion and assuming that the proportion of practicing safe food handling among food handlers is  (p = 30.30% taken from similar institutional-based cross-sectional study conduct at Gonder, 95% level of confidence and 5% margin of error(13).

The sample size for the first objective is determined by using single population proportion formula.

Where    n = required sample size,   d = the margin of error (precision) 5%, Z = standard score corresponding to 95% confidence interval, P = proportion of food handlers who had good food safety practice, 1-P = proportion of food handlers who had no  good food safety practice, Hence, the total population is less than 10,000; the final sample size needs to be corrected using the correction formula:  = 325, Hence, the total population is less than 10,000; the final sample size needs to be corrected using the formula: Equation 1 

Where; nf= the desired sample size: 277, (equation 3, 4, 5) Where; nf= desired sample size= 277

First objective sample size with 10% non-response rate is n = 277 + 28 = 305

The sample size for the second objective will be calculated using double population proportion formula using the Stat-calc Epi-Info statistical Software version 7.0 with the following assumptions: Confidence level = 95%, Power = 80%, Ratio (unexposed: exposed) = 1, The proportion of good food safety practice among an unexposed group (who had training) = 0.54, Proportion of good food safety practice among the exposed group (who had no training) = 0.37,

Table 1: Sample size calculation for different associated factors of food handler on food safety practice among food handler in Batu town, 2020

Variable Magnitude Power CI level The ratio of unexposed to exposed OR Sample Size Reference
Exposed Unexposed
Supervision 0.14 0.53 80% 95% 1 2 138 (14)
Training 0.37 0.54 80% 95% 1 1.75 23 (34)

Since objective one (305) is greater than the sample size for objective two (Table 1). So, the actual sample sizes for the first objective with 10% non-response rate will be n = 277 + 28 = 305

Sampling Procedure

According to data from the town’s trade and industry, there are a total of 274 food establishments (restaurants, cafes, and hotels, and others in Batu town) which are containing about 1870 food handlers.  All lists of food establishments and their food handlers working during the study period were the sampling frame. At the first step, the required number of establishments was selected by using a simple random sampling technique. Secondly, two food handlers; one cooker and one waiter were selected by using simple random sampling from each of the selected food establishments.

 Study variables

Dependent Variables was food safety practice while the independent variables include: age, sex, educational status, marital status, religion, work experience, training, toilet facility, water supply, food storage facilities/shelf cupboard, refrigerator, knowledge & attitude of safe food practice, manager/supervisor inspection

Statistical Analysis

Data were collected using a structured and pre-tested standard questionnaire which have been developed based on the related published studies with certain modification. The questionnaires were prepared in the English version and then translated to local language and, back to English to confirm the correctness of the translation.

The questionnaires were composed of five parts as the basic socio-demographic characteristics and questions related to the knowledge, Attitude, and practice of the study population towards safe food practice as well as Observation checklist.  Data collection was administered by data collectors.  The legal permission of the establishments to serve food and drink was checked by observing the approved certificate by the legal authority.  The interview was employed by data collectors to the selected Food and Drinking Establishments (FDE) to collect the data.

Two supervisors having BSc degrees in public health science and 2 diploma nurse data collectors have participated in the data collection process. Training for data collectors and supervisors was also given for one day by the investigator. The questionnaire was pre-tested to identify potential problem areas, unanticipated interpretations, and cultural objections to any of the questions for food handlers in Adami Tulu town by taking 10% of the sample size. Based on the pre-test results, the questionnaire was additionally adjusted contextually and terminologically and administered on the whole sample size questioners.  Counter-checking of the daily filled questionnaire and regular supervision was made by the supervisor and by the investigator.

A structured questionnaire was developed for data collection after reviewing relevant literature and views of professionals in the area. The questionnaire will be structured and designed to accommodate the response of respondents and physical observation by data collectors. And it was also designed to generate such pertinent information as the basic socio-demographic characteristics and questions related to the knowledge and practice of the study population towards safe food practice. It was prepared originally in English and then translated to Afan Oromo and Amharic and again back to English to obtain content validity.

Finally, the questionnaires have been administered in Afan Oromo and Amharic. Data were entered into Epi info version 7.0 computer software and exported to SPSS version 20 computer software for analyzes. Descriptive statistics of the collected data were done for most variables in the study using statistical parameters: percentages, mean and standard deviations. Accordingly, descriptive statistics were used to describe the independent variables concerning the outcome variable. Bivariate and multivariate analysis was used primarily to check which variables have an association with the dependent variable individually.

Variables found to have an association with the dependent variables have been entered into multivariate logistic regression for controlling the possible effect of confounders and finally the variables which have significant association was identified based on AOR, with 95%CI, AOR, and p-value to fit into the final regression model. All variables with a p-value  <0.25  during bivariable were entered into multiple logistic regression models to control for all possible confounders and to identify factors associated with the outcome variable. Odds ratio along with 95%CI were estimated to measure the strength of the association.  Finally, the level of statistical significance was declared at a p-value <0.05.

Results

A total of 305 workers working in restaurants/food establisher centers were participants with a response rate of 99%. About 147 (48.7%) respondents had ages between 25 to 29 years old. The mean age of study participants was (28 ±5) years. Out of the total 302 interviewees, 149(49.3%), and 153(50.9%) were males and females respectively. About, 154(51%), 102 (33.8%), and 36(11.9%) were Orthodox, Protestant, and Muslim religion followers respectively. Regarding their education, more than half 155(51.3%)  had attended primary school (1-8), 51(16.9%) cannot read and write, 65 (20.2%), attended secondary high school, and 31(10.3%) were diploma and above or at the College level.

In the case of ethnicity about one-third, 111(36.8%) of the participants were Oromo, Looking into marital status, around 164(54.3%) of participants were married. In the case of food safety training, 257 (85.1%) of food handlers did not attend food safety training (Table 2, n=302). Concerning their marital status, 164(54.3%), and 138(45.7%) were married and unmarried respectively. Of those study participants 257 (85.1%) had food safety training, and the remaining 45(14.9%) food handlers had never attended food safety training.

Knowledge of food handlers about food safety

 Out of the total 302 respondents, 282(93.4%) did know that food with sufficient pathogens make people sick may look good or test well while 291 (96.3%) mentioned that fresh food can cause food poisoning if it is not properly handled (Table 3).

Out of the  302 study participants, 282(93.4%) knew food with sufficient pathogens makes sickness that may look good or test better, while 291(96.3%) mentioned that fresh food can cause food poisoning if it is not properly handled(Table 3).

Table 2: Sociodemographic characteristics of food handlers studied in Batu Town, (n=302)

    
VariablesFrequencyPercent
Age
650.215
25-291470.487
≥30900.298
Sex
Male1490.493
Female1530.507
Educational status
No formal Education510.169
Primary 1-81550.513
Secondary 9-10650.215
College/above310.103
Marital status
Married1640.543
Not married1380.457
Work experience in years
1160.384
≥41860.616
Monthly income in ETB
1330.44
≥20001690.56
Had food safety training
Yes450.149
No2570.851

Table 3: Food safety practice knowledge  of food handlers studied in Batu May 2020 (n=302)

VariablesKnowledge status of the study participants  
CorrectIncorrectdon’t know
N0 (%)N0 (%)N0(%)
Food with sufficient pathogens that make you sick may look good, or test well.282 (93.40)19 (6.3)1(0.3)
Fresh food can cause food poisoning if it is not properly handled.291 (96.40)11 (3.60)0(0.0)
Fresh meat always has microbes on the surface281 (93)19 (6.30)2(0.70)
Canned foods may have harmful microbes292 (96.70)8 (2.60)2(0.70)
Lettuce and other raw vegetables might have harmful microbes 285 (94.40)16 (5.30)1(0.30)
Foods can be contaminated with microbes by coming in contact with unsafe foods285 (94.40)16 (5.30)1(0.30)
Ready to eat foods (e.g. vegetables) cannot be prepared on the same cutting board that was used to prepare meat 270 (89.40)32 (10.60)0(0.0)
Cutting boards, meat slicers, and knives should disinfect after each use272 (90.10)30 (9.90)0(0.0)
Refrigeration may not kill all the bacteria that might cause food-borne illness. 185 (61.30)103 (34.10)14(4.60)

On the overall knowledge level of study participants, the food safety knowledge of food handlers was assessed based on nine food safety knowledge questions.  Each question has three options  (correct,  incorrect and don’t know). Thus,  the knowledge status of all study participants was calculated using the average score for questions assessing the knowledge of respondents on food safety practice which was calculated at 8.3. Based on the result of knowledge assessments, from the 302 food handlers, 133 (44%)  had good knowledge while 169 (56%)  had poor knowledge.

Attitude on food safety practice of food handlers was assessed based on 5 attitude questions. The questions on Likert’s scale had positive and negative responses that ranged from strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree. As shown in Table 3, more than half, 202 (66.9%), of the respondents agreed that Temperature Controls are an effective method of reducing the number of cases of food Poisoning. However, 29 (9.6%) of the respondents agreed that it is not as important. On another side, 199 (65.9%) had agreed that it was important that all food handlers should have a food safety training qualification. Around 190 (62.9%) agreed that lack of food safety training affects Safe food practice (Table 4).

able 4. Showed the attitude of food safety practice of food handlers in Batu Town, 2020 (n=302)

VariablesStrongly Disagree (%)Disagree (%)Neutral (%)Agree (%)Strongly Agree (%)
Temperature controls are an effective method of reducing the number of cases of food poisoning.1 (0.3)29(9.6)42(13.9)202 (66.9)28 (9.3)
All food handlers should have a food safety training qualification0(0.0)22(7.3)15(5)199(65.9) 66 (21.9)
Lack of food safety training affects Safe food Handling014 (4.6)12(4)190 (62.9)85 (28.1)
Unavailability of food handling guideline can8 (2.6)12 (4)9 (3)116 (38.4)157 (52)
Affect food safety
Lack of supervisor commitment affects Safe12(4)16 (5.3)12(4)99 (32.8)171 (56.6)
Food handling.
Insufficient wet storage can affect food handling practice3(1)14(4.)16 (5.3)85 (28.1)184(60.9)

Food handlers safety practice

Of all the study participants, 300(99.3%) had washed their hands properly before starting work, 295(97.7%) used separate utensils when preparing raw and cooked food, 223(73.8%) had not ever had a medical check-up in the course of their work in the kitchen. The study also showed that only a few participants 5(1.7%) did not use separate utensils when they were preparing raw and cooked foods.  To ward checking the expiration date of the product, only 19(6.3%) never checked the expiry date of the products. However, 283(93.7%) participants did not use a thermometer to check the temperature.

Of the total participants, the majority of them, 219(72.5%) said that they came to work when they have diarrhea. Furthermore, 258(85.4%) participants reported that they always covered their heads during food serving while 44(14.6%) of the participants did not. Few of them, 63(20.9%)  participants reported that they had a habit of making their nails long and 239(79.1%) participants never did it. In addition from the total, only a few of them 40(13.2%) reported never disinfecting cutting boards after each use (Table 5).

Table 5. Showed food safety practices of food handlers in Batu town, 2020 (n=302)

S/NQuestionsYes Numb (%)No: Numb (%)
1Do you wash your hands before starting your Work? 300(99.3) 2 (0.7)
2Do you wash your hands before touching cooked foods?295 (97.7)7 (0.7)
3Do you use separate utensils to prepare raw/cooked food? 297 (98.3) 5 (1.7)
4Do you check the expiry dates of all products? 283 (93.7) 19 (6.3)
5Do you wear a uniform when serving food? 268 (88.7) 34 (11.3)
6Do you use a thermometer to check the temperature? 19 (6.3) 283 (93.7)
7Do you sanitize utensils after washing them 268 (88.7) 34 (11.3)
8Don’t come to work when you have pain & diarrhea? 219 (72.5) 83 (27.5)
9Do you wear a hat or head covering when serving food? 258 (85.4) 44 (14.6)
10Don’t you wear jewelry when serving food? 262 (86.8) 41 (13.6)
11Do you disinfect cutting boards after each use? 262 (86.8) 40 (13.2
12Don’ makes your nail long? 239 (79.1) 63 (20.9)
13Ever had any med-checkup as you work in the kitchen? 79 (26.2) 223 (73.8)
14Good(yes)/Poor (No) total food handlers safety practice 176 (58.3)126 (41.7)

Overall, from the total 302 respondents, 176(58.3%) had good food safety practices within a (95%) confidence interval from (52.3% to 63.6%), whereas 126 (41.7%) of the study participants had not satisfactory food safety practice. The study was conducted at 151 public food establishments that include:34 hotels, 87 restaurants, 27 breakfast houses, and 3 cafeterias respectively. One establishment (restaurant) did not volunteer for participation. More than half 232 (76.8%) institutions had supervisions held for food handlers.

About 81 (26.8%) institutions had rodents in their kitchen. About three-fourth, 229(75.8%) and the majority 291(96.4%) respondents handled food in institutions having a handwashing facility and availability of functional toilet facility respectively. However, more than three-fourth, 231(76.5%) respondents who handled food in food establishments had no food safety guidelines (Table 6).

Table 6: Observed Institutional Facilities in Food Establishments of Batu Town 2021

S/NQuestionsYesNo
1Availability of guidelines for food establishments71 (23.5)231 (76.5)
2Presence of handwashing facility.229 (75.8)73 (24.2)
3Availability of latrine.291 (96.4)11 (3.6)
4Availability of insects/rodents81 (26.8)221 (73.2)
5Availability of insects/rodents232 (76.8)70 (23.2)

Factors Associated with food safety practice

To identify factors associated with food safety practice, bivariate and multivariate binary logistic regression analyses were conducted. The univariable data analyses were checked for data completeness and missing value of the data. At the bivariate level, nine variables: age, sex, monthly income, food safety training, knowledge, attitude, presence of handwashing, Availability of rodents, and supervisor were significantly associated (p-value less than 0.25) factors with the food safety practice of food handlers.  All of the variables with a p-value less than 0.25 at bivariate analysis were incorporated in the final multivariable logistic regression model.

After controlling for the effects of potentially confounding variables using a multivariate logistic regression model, two variables: knowledge towards food safety practice and food safety training are associated (p-value less than 0.05) factors with the food safety practice of food handlers. Therefore, in the multivariable logistic regression analysis having food safety knowledge and Food safety training were statistically significant factors for food safety practice.

The odds of having food safety practice among those who had food safety training was 3.108 times higher as compared to those who had no food safety training with an adjusted odds ratio [AOR =3.108, 95%CI (1.309,7.382)]. Food Handler who had good knowledge on food safety had 3.897 times higher odds of food safety practice as compared to those who had poor knowledge on food safety practice [AOR =3.897, 95%CI (2.280, 6.663)] (Table 7).

Table 7. Showed multivariate analysis and summary statistics of food safety KAP among study participants in Batu town, Oromia, Ethiopia, 2020

        
VariablesFood Safety Practice
AgeGood (%)Poor (%)COR (95%CI) AOR (95%CI)P-value
32(49.2)33(50.8)0.81(0.42,1.53).89(0.41,1.95)0.77
25-2995(64.6)52(35.4)1.52(0.89,2.61)1.40(0.75,2.61)0.29
≥3049(54.4)41(45.6)11
Sex
Male93(62.4)56(37.6)0.71(0.45,1.13) 1.49(0.88,2.54)0.13
Female83(54.2)70(45.8)11
Had training
Yes30(66.7)15(33.3)1.52(0.78,2.96)3.10(1.30,7.38)0.01*
No146(56.)111(42.)11
Knowledge
Good103(77.4)30(22.6)4.51(2.71,7.50) 3.89(2.28,6.66)0.001*
Poor73(43.2)96(56.8)11 
Attitude 
Positive105(64.458(35.6)1.73(1.09,2.57)1.65(0.99,2.75)0.05*
Negative71(51.1)68(48.9)11 
Availability handwashing Sink   
Yes143(62.486(37.6)2.01(1.28,3.43)1.43(0.28,7.30)0.66
No33(45.2)40(54.8)11
Available Rodents
Yes36(44.4)45(55.6)11
No140(63.381(36.7)2.01(1.28,3.62)2.01(0.68,5.94)0.2
Supervision
Yes145(62.587(37.5)2.09(1.22,3.60).95(0.16,5.78)0.96
No31(44.3)39(55.7)11 

Discussions:

In this study, the prevalence of good food safety practices was (58.3%). This study result was concordant with other similar studies from Malaysia 59.30% (33), Addis Ababa (52.3%),(34), Dire Dawa 52.4% (15), Dilla town 52.5% (6). However, it is dissimilar with studies conducted in  Ethiopia towns such as Arba Minch(67.4%) (14), Bahir Dar (67.6%) (35), Asosa (67.8%) (16), and from UAE in Dubai (81.74%) (31). On the other side, the study result was higher than the study conducted in Gondar (30.30%),49%, Turkey 48.4% (18), Jamaica 50%  (21), and Nigeria (50%,(24). These differences may be due to variation of socio-demographic characteristics, the regulatory system of food establishments, and access to different training.

This study showed that 300(99.3%) respondents had washed their hands (i.e. they did food safety practice of food handlers) before starting work. This finding is in line with the study conducted in Mekele Town which showed (99.5%) participants had hand washing (30), and (98.7%) in Ghana, Accra city had hand washing (27). However, it is lower than a study conducted in Iran which showed (85.1% of respondents had hand washing (20). The difference may be due to better knowledge, better health infrastructure, and a living environment. The study finding showed that about 295(97.7%) respondents used different utensils when preparing raw and cooked food.

This is similar to the study conducted in Ghana 86.4%(27), and Iran (83.68%) (20), but higher than the study done in  Jamaica (76%)  (21). Among study participants 223(73.8%) had no ever medical checkup on the other hand study done in  Nigeria showed (71.4%)  of them underwent regular medical checkups (25). The difference may be due to the variation of socio-demographic variations and regulatory systems of food establishments. In this study, about three fourth of study participants 219(72.5%) said that they came to work when they had diarrhea which is the potential channel for food-borne diseases transmission. This finding was supported by the study done in Nigeria, (68.5%) (25).

However, it is higher than a study conducted in Nigeria (49%) in which food handlers reported that they would allow a sick person with bloody diarrhea to handle food (24). The difference may be due to food safety training and the regulatory system of food establishments. In this study, food handlers didn’t use a thermometer to check the temperature of food, 283(93.7%) which is different from the study conducted in Jamaica which showed (33%) of food workers used a thermometer to control temperature (21), and this difference might be due to related to the local trend in the study area in which thermometers were not available in the market.

In this study, 239(79.1%) participants reported that they had no habit of making their nail long, which was supported by the study conducted in Mekele town, Ethiopia which showed (75.9%) study participants kept their hygiene in proper ways, whereas 261(86.4%) didn’t wear jewelry in this study that was supported by a study conducted in the  Mekele town (71%) never wore jewelry when serving in food establishment centers (30). In this study (77.4%) study participants had good knowledge of food handlers.

This finding is supported by the study conducted in Asosa town, western Ethiopia which indicated the level of knowledge among food handlers was (75.8%) (16). The probability of having a good food safety practice among participants with good knowledge was 3.89 times higher than those with a piece of poor knowledge (AOR = 3.89, 95% CI). This showed the possibility that having good knowledge of something would ensure uptake of services.

Conclusion:

The magnitude of food safety practice among food handlers at Batu town public Food and drinking establishment was medium as compared to previous studies.

Almost all of the food handlers were washing their hands before starting work and using separate utensils when preparing raw and cooked food and as well as making their nail short.

However, the majority of the food handlers didn’t use a thermometer to check the temperature and even came to work when they have diarrhea, which is the potential channel for food-borne diseases transmission.

Conflict of Interest: N/A

Acknowledgment: We would like to acknowledge Adama Hospital Medical College that gave us this Golden opportunity to conduct this research; gave ethical clearance through Institutional Review Board., and conducted all necessary reviews. We also gently acknowledge all study participants and all governance bodies at each step who gave us a support letter.

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Food handlers safety practices and related factors in the public food establishments in Batu Town, Central Oromia, Ethiopia

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