Introduction

Food safety practice is vital to minimize food-borne disease. Food-borne diseases have a huge impact on human health around the world, raising concerns among consumers, producers, and policymakers.¹ Foodborne infections and their prevention are still poorly understood in many parts of the developing world today.^2,3 Diseases caused by contaminated food and/or drink are still one of the leading causes of morbidity in several countries and, under certain circumstances, can lead to serious consequences.⁴ Food safety has become one of the 10 threats to global health in 2019 and outbreaks of foodborne diseases are major public health problems and have caused approximately 76 million illnesses, 325 000 hospitalizations, and 5000 deaths yearly.⁵

Food safety concerns have existed for a long time, as millions of people across the globe suffer from food-borne diseases every year.⁶ It is described as the degree of certainty that food will not cause illness or harm to the customer when cooked, served, and eaten as intended.⁷ Food safety is vital for consumers, food producers, and the economy.⁸ Food safety, on the other hand, has become a major concern for the food industry as contaminated food and water lead to a variety of health concerns around the world.^9,10 Food safety standards for high-risk whole products in farmers’ markets face particular issues in terms of temperature control, potable water, and contamination exposure.¹¹ The issue of food safety is an issue that is widely discussed, but cases of food poisoning in particular are still continuing.¹² In particular, meals prepared outside of the home were a risk factor for acquiring food borne illness,¹³ and had been implicated in up to 70% of traced outbreaks.^5,14

Similarly, food safety is one of the important issues that have emerged during the socio-economic development of China.¹⁵ Additionally, improper food handling practices and lack of knowledge of food hygiene among food handlers were implicated as a vehicle for the transfer of food pathogens that cause disease outbreaks.¹⁶ Similarly, lack of knowledge of food safety and poor food handling practice were the main contributors to food-borne disease and diarrheal-related morbidity in Ethiopia.¹⁷ Food safety is a serious public health issue in Ethiopia as in other developing countries and has been overlooked in the past by governments and the public in general.¹⁸ The lack of basic infrastructure and the low level of knowledge of hygiene and hygiene practices in catering establishments contribute to outbreaks of food-borne diseases.¹⁹

However, to reduce consumer health risks from food-borne diseases that result from improper handling of domestic food, consumers need to know how to handle food safely.²⁰ Risk communication and consumer education to promote safer handling of food can be the best way to manage the risk of food-borne disease at the consumer end of the food chain.²¹

In addition, a better behavior in food handling in consumers is likely to reduce the risk and incidence of food-borne disease.²² Food safety education directed toward young adults should focus on increasing awareness of FBD and knowledge of proper cross-contamination prevention procedures to help promote better compliance with actual safe food handling.²³ Efforts to improve knowledge and food safety behaviors were essential to protect the health of young adults and enable them to fulfill their role of protecting the health of their future families.²⁴ The levels of food safety levels in school food services were of great concern, as any incident can affect a large number of students.²⁵ Controlling and ensuring the safety of food play an important role in preventing foodborne illnesses.²⁶ The supply of safe and healthy food is crucial to prevent foodborne illnesses.²⁷ In addition, there are no data on the status of food safety and handling practice in relation food knowledge and the practice of food handlers at the Metropolitan University of Kotebe. The role of food handlers, effectively reducing the risk of food-borne diseases, is critically important, as they are in direct contact with food or consumers. The objective of the study is to assess the status of knowledge of food safety and practice of food safety among food handlers in the student cafeteria of Kotebe Metropolitan University.

Materials and methods

Study setting and design

The study area was Kotebe Metropolitan University (KMU), students’ cafeteria. The university was founded in Addis Ababa city, which is the capital city of Ethiopia. A cross-sectional study was conducted among 68 food handlers who had direct contact with food with at least 1 year of work experience in the cafeteria of Kotebe Metropolitan University students from 30 May, 2018 to 30 October, 2019. The 68 food handlers working in food cafeteria were used source population during the study (Figure 1).

Figure 1.

Map of study site.

Sample size determination

The sample size was calculated from the total population size of food handlers of Kotebe Metropolitan University (N): 68, based on assumption of a hypothesized % frequency of outcome factor in the population (P = 50% ± 2.5%) (because there is no similar study in the study area), confidence limits as percentage (%) of 100 (absolute ±%) (d) = 2.5%, and 97.5% confidence level, and design effect (for cluster surveys-DEFF): 1.

Then, for the analysis, the final sample size required was 68 food handlers.

Inclusion and exclusion criteria

Inclusion criteria: All food handlers who had worked for at least 1 year in the student cafeteria of Kotebe Metropolitan University during the study period were included.

Exclusion criteria: Food handlers who had less than 1 year of work experience as food handlers in the student’s cafeteria of Kotebe Metropolitan University and those absent during the data collection period were excluded from the study.

Data collection tools and procedures

Data were collected from food handlers using structured questionnaire through a face-to-face interview. Respondents had sufficient time (15 minutes) to answer the questionnaire. The researcher managed the general interviews and guides the general research activities. Also, data were gathered using an observation checklist and a structured pre-tested, questionnaire. The survey instruments were first produced in English before being translated into the local language (Amharic) in order to ensure the accuracy and coherence of the material. Both qualitative and quantitative survey techniques were used to acquire the data. Six distinct sections made up the questionnaire: demographics (6 questions), knowledge of food handlers regarding food safety (10 questions), food handling and food safety practices (7 statements), hand washing practices of food handlers (6 questions), food handler practices regarding contamination prevention and symptoms of food illness (14 questions), and gloves use practices (4 questions). The questionnaire was developed based on questions from previous work.^4,15,27–30 Most items were evaluated using closed-ended questions with the options “yes” or “no.” Finally, before beginning of data collection, training was given for data collectors and supervisors about data collection tools, objectives, and ethical issues that have to be taken into consideration.

Data processing and analysis

The questionnaire was checked for completeness, cleaned up, and edited. Complete items were coded and entered into Epi Info version 7.3 (2016) and transferred to the Statistical package to the Social Science (SPSS) version 20 software package for analysis. The results were presented in tables, and figures using descriptive statistics such as mean, frequency, and percentage to describe the study population in terms of relevant variables. For all analyses, P value <.05 was considered statistically significant.

Operational definitions

• Knowledge: It is the awareness of food handlers about food safety and handling. It is measured by calculating the mean score of the 10 items and classified as knowledgeable (if the participants scored the greater or equal to the mean score of the correctly answered questions) or not knowledgeable (if the participants scored the less than the mean score of the correctly answered questions). Food handlers who scored less than or equal to the mean value (⩽50%) were considered as having a “poor level of knowledge” and those who scored greater than the mean value (>50%) were considered to have a “high level of knowledge.”^27,31

• Practice: The practice of food handlers on food safety and handling. The Practice of food handlers on food safety and handling. It is measured by 31 questions with “Yes,” or “No.” Food handlers who scored less than or equal to the mean value (⩽50%) were considered to have a “poor level of practices,” and those who scored more than the mean value (>50%) were considered to have a “good level of practices.” Furthermore, if the food handlers’ answer is always, usually, or sometimes it considered to be “Yes” for food handling practices and if the food handlers’ answer is rarely or never it is considered to be “No” for food handling practices.^32–34

• Food handler: Person who is directly and indirectly in contact with food or with any equipment or utensil used in food handling.

• Food safety: is the assurance that the food will not cause any harm to the consumers when it is prepared and/or consumed according to its intended use.

Ethical considerations

The study was carried out after approval from the Vice President Office for Research and Community Service at Kotebe Metropolitan University. Written informed consent was also obtained from study participants after the purpose of the study was explained during data collection. Confidentiality was maintained by asking the participants not to write their names on the questionnaires. Further, this study was approved by the Research and Development Committee of the Metropolitan University of Kotebe.

Results

Socio-demographic characteristics of the study participants

In this study, a total of 68 study participants participated with a response rate of 100%. Demographic characteristics of the respondents’ summary were explained in Table 1. The majority of food handlers 88.2% (60) were women, while 11.8% (8) were men. Of the total of the participants, most of them were women and 79.4% (54) of the food handlers were Orthodox Christian religious followers. A higher number of participants, 58.8% (40) had between 21 and 35 years age, and 36.8% (25) had work experience between 2 and 5 years working in the foodservice. On the other hand, 57.4% (39) of the respondents were married, and almost all 89.7% (61) of the respondent were less than 12 grade education completed.

Table 1.

Percentage of socio demographic characteristics of food handlers.

As indicated in Table 2, most of the food handlers 60 (88.2%) had hand practice washing facilities with a supply of hot water, soap and 65 (95.6%), hand drying towel in or very close to the food preparation room, 56 (82.4%) had hair mask or cloth during food preparation and wear safety clothe/Cover/net cloth during food. However, most food handlers 67 (98.5%) did not always wear safety shoes during food preparation, and did not always wear safety mouth mask during food preparation 67 (98.5%). Furthermore, the results showed that there was a significant association between food handlers on food safety practices with education, specifically for appropriate hand washing facilities with a supply of hot water, soap and a means of hand drying in or very close to the preparation, and the use of disinfectant or antibacterial spray on the equipment and preparation surfaces were significant (χ² = 20.962^a; P value ⩽.000 and χ² = 7.942^a; P value ⩽.019), respectively.

Table 2.

Association between food handling practice and food safety based on education.

As shown in Table 3, 49 (72.1%) of the food handlers had been washing vegetables and fruits that were used to soak in cold water. On the other hand, only 8 (11.8%) of them used detergent soak, 7 (10.3%) of them used cold water washing, and 4 (5.9%) of them used hot water washing. Most of the 35 respondents (51.5%) do not know the optimal temperature to store frozen food. Overall, 40 respondents were answered correctly section was 57.94% from all 10 questions. There was an association between knowledge of food safety and food handlers with education, and significant associations were with were particularly with the ways of food left over heating raw vegetable storage fragments and the best time to purchase frozen food from shopping (χ² = 13.115^a; P value ⩽.011, χ² = 35.249^a; P value ⩽.000, and χ² = 33.841^a; P value ⩽.000), respectively.

Table 3.

Food handlers knowledge of food safety based on education.

As shown in Table 4, concerning the practice of food handlers on hand washing; Most of them 67 (98.5%) always wash vegetables and fruits, 66 (97.1%) practiced right hand washing procedures, 66 (97.1%) washed their hands when returning from the toilet, 43 (63.2%) washed their hands after rubbing the nose or scratching their body, 63 (92.6%) washed their hands when back to work after break or rest, and 63 (92.6%) washed their hands after handling food waste or rubbish. While, 25 (36.8%) of the respondents did not wash their hands after rubbing the nose or scratching their body, and similarly very few food handlers 2 (2.9%) did not practice right hand washing procedures, 2 (2.9%) did not wash their hands when returning from the toilet, 5 (7.4%) did not wash their hands when back to work after break or rest, and 5 (7.4%) did not wash their hands after handling food waste or rubbish, respectively. There was significant (P < .05) between the practicing food handler and the education about hand washing after returning from the toilet (χ² = 10.164^a; P value ⩽.006), and hand washing when back to work after the break (χ² = 16.240^a; P value ⩽.000).

Table 4.

Association between food handlers’ practice of hand washing by food handlers and food safety practices based on education.

As indicated in Table 5, most of the food handlers 60 (88.2%) did not touch food when their hands or fingers were cut and not properly covered, whereas; 8(11.8%) the respondents were touched food when their hands or fingers were cut and not properly covered. Most food handlers 42 (61.8%) took a break if they were suffering from food-borne illness, but 26 (38.2%) of the food handlers did not take a break if they were suffering from food-borne illness. Additionally, most handlers 65 (95.6%) did not smoke when cooking. The majority of food handlers 36 (52.9%) did not practice eating, drinking, or chewing gum when preparing food, nevertheless; 31 (45.6%) of the food handlers were eating, drinking, or chewing gum when preparing food. Regarding the carrier of typhoid from food handlers, 49 (72.1%) of them were not carriers of typhoid, but 19 (27.9%) of them were carriers of a history typhoid from medical examinations. Similarly, 65 (95.6%) of food handlers were not carriers of skin infections, on the contrary, 3 (4.4%) were carriers of skin infections. Additionally, regarding then, or during those last two (2) weeks, respondents did not experience diarrhea and/or vomiting 63(92.6%); stomach pain, nausea, or fever 67 (98.5%), and suffering from typhoid history 65 (95.6%), respectively.

Table 5.

Practice of food handlers of respondents on prevention of food contamination and symptoms of food illness, and association between food safety practices based on education.

Table 6 shows the practice of food handlers on how to use the glove. Therefore, most of the food handlers the 39 (57.4%) did not wear gloves when touching ready-to-eat foods, but 29 (42.6%) of the food handlers wore gloves when touching ready to eat foods. In the same way, 41 (60.3%) did not wash their hands before putting on gloves, 48 (70.6%) did not wash their hands after removing gloves, and 58 (85.3%) did not change gloves between handling raw and read- to-eat foods.

Table 6.

Association between food handler practice on glove use and food safety practices based on education.

Moreover, based on Tables 2 and 4 to 6, the result showed that the general practice of food handlers had a good practice on food safety, as measured by the passing score of 48 (70.6%).

The student cafeteria at Kotebe Metropolitan University has a local or regional health Bureau regulatory authority’s operating license and records of food production and receipt, according to the qualitative results. However, the student cafeteria at Kotebe Metropolitan University lacks thermometers to measure temperature (degrees of heat or cold), written standard operating procedures (guidelines) on food safety and handling, method of managing liquid waste, a location to dispose leftovers from food, and regular training on food safety and handling standards were observed.

Discussion

The main goal of this study was to evaluate the general level of food handler practice and awareness of food safety in the student cafeteria at Kotebe Metropolitan University. Most of the participants, who handled food were women and this was similar to research in Debre Markos town, Ghana, and Slovenia, where more women handled food.^27–29 In the cafeteria there were 57.94% and 70.6% food handlers had good knowledge of food safety and good practice of food safety, respectively. The finding of this work was similar with another study conducted in Debre Markos northwest, Ethiopia where 53.7% of food workers used good and safe food handling techniques²⁷and (72%) of food handlers in food establishments had a good level of food hygiene and safety practices compared to almost half 53% of the street food vendors in the city of Dessie. Likewise, another study conducted in Oman Muscat reported that 58.6% food handlers had knowledge food safety as compared to region 2 and region 3 which were 52.1% and 53.2%, respectively.³⁵ Also, another study conducted in Egypt’s Sohag Governorate reported that out of the 994 food handlers included in the survey, 39.2% strong understanding of food safety, 61.2% had favorable attitudes, and 56.3% had good food safety practices.³⁶

In the cafeteria of student from Addis Ababa University, the research found that 93.7% of food handlers had adequate knowledge of food-borne diseases.³⁰ Most food handlers were washing hands before food preparation to reduce the risk of food contamination.²⁸ Another study reported that the evaluation of food safety knowledge and practices of food handlers and hygienic sanitary conditions improved the quality of meals served.¹³ Food hygiene and food safety are of paramount importance in a hospice setting, especially since reducing microbial hazard is vital in a context where health-compromised patients are treated.^37,38 Most food handlers washed their hands after visiting the restroom, before preparing food in general and raw meat or poultry specifically, and when they changed tasks, work stations, or items they were handling.³⁹ Lack of knowledge of food safety and poor food handling practices are the main contributors to food-borne diseases and diarrheal-related morbidity in Ethiopia.²⁷ As in the study conducted in Kuala Pilah, Malaysian food handlers have excellent knowledge and attitude and good practices in food hygiene.⁴⁰

Most respondent food handlers do not know the optimal frozen temperature for food storage. Most food handlers had knew that bacteria in food can be completely killed by freezing at 18°C. Our study is consistent with the study conducted at the University of South Africa.⁴¹ As in a study conducted on national young adults in United States, 60% of the participants correctly answered the knowledge questions and were more knowledgeable about the groups at the greatest risk for foodborne disease and less knowledgeable about the common food sources of foodborne disease pathogens.²⁴ Most food handlers did not touch food when their hands or fingers were cut or not covered properly, and most food handlers took leave if they suffered from food-borne illness. Most of the respondents showed average practices in food handling of with 68.0% in hand washing; 66.5% in personnel hygiene; 66.2% in raw material management; 59.3% in food safety control and 52.3% in gloves use in Malaysiana.³⁴ Other study reported that food-borne illness have a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home.⁴² Additionally, most food handlers did not wear gloves when touching ready-to-eat foods. Our study is consistent with the study conducted by only 54.9% of those involved in touching or serving unwrapped raw or cooked foods that routinely used gloves during food preparation; this practice was significantly greater among younger respondents.⁴

Food handlers may be aware of the need for personal hygiene, but do not understand critical aspects of personal hygiene, such as cleaning work surfaces and controlling the food temperature while cooking.⁴³ The market of minimally processed fruits as street foods, despite numerous benefits, can cause food-borne illnesses due to poor hygiene practices and unsanitary conditions.⁴⁴ However, as research conducted in Bahir Dar town, the lack of basic infrastructure, poor hygiene knowledge, and practices in food service establishments can contribute to outbreaks of food-borne illnesses.⁴⁵ Additionally, an unsanitary environment, lack of awareness of food safety regulations, poor hygiene knowledge, and improper food handling practices among food vendors can contribute to outbreaks of foodborne illnesses.⁴⁶ Foodborne diseases, including food poisoning, are becoming a concern due to the increasing prevalence of food poisoning and incidents worldwide.⁴⁷

Conclusions and Recommendations

The current study revealed that the level of knowledge and good handling practice in food safety was relatively high. Most food handlers had good knowledge of food safety and handling practice with student cafeteria of Kotebe Metropolitan University. Also, during food preparation, most food handlers wash vegetables and fruits and use a hair mask or cloth, as well as wear protective clothing. Most of the respondents followed proper hand washing procedures, washing their hands after using restroom, rubbing their noses or scratching their bodies, and handling food waste or trash. However, most food handlers did not always wear safety shoes and mouth mask when preparing food. Proper food safety and handling practice minimize the likelihood of food-borne disease and prevent food contamination. Thus, concerted effort among environmental health expert, public health expert, student cafeteria managers, and food handlers in student cafeteria should be in place to prevent potential food-borne diseases. Inspections should be conducted on a regular basis to ensure effective liquid waste management and food waste management. Furthermore, the authors recommend future work based on detailed laboratory analysis of food and water quality analysis for Kotebe Metropolitan University and other universities in Ethiopia to better understand and abate food safety and handling related issues.