Introduction

Food safety is the process of defending the food supply against microbiological, chemical, allergic, and physical hazards that could arise throughout all stages of food production and handling.^1-3 Food safety management systems comprise the implementation of good manufacturing practices, good hygienic practices, hazard analysis, and critical control points in the food industries.³

The provision of numerous activities including food supply, production, harvesting, processing, packaging, transportation, distribution, consumption, and disposal makes the food business a fundamental and significant organization in any country. In contrast, the food business faces serious problems with product quality, consumer health, and sanitation.⁴ As a matter of public health, all nations must prioritize food safety⁵ and in recent years, there have been several extremely serious outbreaks of foodborne illnesses, the outbreaks frequently affect multiple countries and even continents.^5-7 The contributing factors for the outbreak include poor food handling and sanitation practices,⁸ lack of basic infrastructure such as kitchen sanitation and hygiene⁹ the lack of clean water for washing food and utensils,⁸ lack of regulatory systems, lack of financial resources to invest in safer equipment, and lack of training for food handlers make this situation even worse in developing countries.^10-13 Additionally, due to several circumstances, such as an aging population, unplanned urbanization and migration, mass food production due to population growth, and altered eating habits, concerns over food safety are growing.^4,14

One of the top 10 health hazards facing the world today is food safety, which has grown into a global problem with ramifications for both public health and international trade,^14-16 and WHO advisory board has recently declared that the biggest health challenges for the next decade increase into 13 including Climate crisis, Health care delivery in areas of conflict and crisis, Health care equity, Access to treatments, Infectious disease prevention, Epidemic preparedness, Unsafe products, Underinvestment in health workers, Adolescent safety, Improving public trust of health care workers, Capitalizing on technological advancements, Threat of anti-microbial resistance and other medicines, and Health care sanitation.¹⁷

An estimated 600 million—almost 1 in 10 people in the world—fall ill after eating contaminated food and 420 000 die every year, resulting in the loss of 33 million healthy life years (DALYs). US$ 110 billion is lost each year in productivity and medical expenses resulting from unsafe food in low- and middle-income countries.^18-20 Poor food safety practices in the food processing industries have also resulted in food contamination and approximately 49% of foodborne diseases in consumers as a result of improper food handling practices and a lack of safety management practices, which account for nearly 75% of foodborne illness outbreaks.^6,20-22

Due to widespread poor food handling and sanitation practices, insufficient food safety laws, weak regulatory systems, a lack of financial resources to invest in safer equipment, and a lack of education for food handlers²³ (#54), foodborne diseases pose a serious threat to public health in Africa, resulting in 700 000 deaths and 91 million illnesses annually.^24,25

Moreover, in the food industry, food handlers’ poor handwashing practices, personal hygiene, cleanliness of the working unit, and use of personal protective equipment during food preparation, preservation, production processes, packaging, and labeling have been responsible for the majority of outbreaks of foodborne diseases.^21,26 As a result, proper personal hygiene and sanitary handling habits are critical to food safety prevention efforts.

Ethiopia’s food industry is rapidly expanding including in the administrative city of Bahir Dar.²⁷ However, ensuring food safety practices among those involved in the food industry has been one of the main issues that producers, consumers, public health officials, and regulatory agencies have been concerned about.^23,28 Ethiopian Food, Medicine, & Health Care Control Administration Authority (EFMHCA) post-marketing surveillance report in the Amhara region showed that the total Aflatoxin in domestically processed selected food items was found to be 312.97 g/kg, and the total coliform count was 2.4 × 104 cfu/g,²⁹ indicating how serious the problem is. Little is known about the food safety practices used by food handlers employed in the food industries in the study area as well as nationally. As a result, the goal of this study was to identify food safety practices and associated factors among food handlers employed in food businesses in the city of Bahir Dar, Ethiopia.

Methods

Sample size and sampling technique

To determine the required number of study participants, the sample size was calculated using a single population proportion formula.³²

We considered good food safety practices at 50% (no previous study), Zα/₂ at = 95% confidence level (CL), d = margin of error of 5% and 10% non-response rate, the final sample size calculated was 422. A simple random sampling method was used to select 20% from 39 food industries. The sample sizes were proportionately allocated to the selected food industries and study participants were selected using a simple random sampling technique by obtaining the list of employees from their payroll.

Results

Socio-demographic characteristics

Four hundred twenty-two individuals in this study were surveyed, and 100% completed the interview. The majority (82.9%) were between the age of 19 and 29 years, and nearly half (47.4%) were female by gender. Regarding educational status, 166 (39.3%) were certificate holders and above, and 238 (54.6%) of the respondents were married. About two-thirds (61.4%) of respondents worked in the food production area (Table 1).

Table 1.

Socio-demographic characteristics of food handlers working in food industries in Bahir Dar city administration, Amhara region, Ethiopia, 2021 (n = 422).

Institutional and environmental-related characteristics

Of the 18 food industries assessed, 66.6% had separate food storage rooms, and 72.2% had easily cleanable walls, floors, and ceilings. During the survey, all the food industries had a latrine, shower facilities, and piped water supply sources. However, 3 (16.6%) food industries’ handwashing facilities were inside/near the food processing area. Additionally, solid waste storage and liquid waste disposal facilities were present in 77.7% and 88.8%, respectively, of the food industry. Regarding standard operating procedures (SOP), only 8 (44% of the food businesses) had the necessary professionals, even though 72% of the food industries had established SOPs for food safety. Additionally, only 5 (28%) of the food companies provided personal protective equipment for their food handlers, and 78% of those who handled food were not trained in food safety (Table 2).

Table 2.

Institutional and working environment of food handlers working in the food industries, Bahir Dar city administration, Ethiopia, 2021 (n = 422).

Food handlers’ attitudes, knowledge, and practice regarding food safety

Of the total number of food handlers employed in the food industry, 376 (89.1%) were knowledgeable about food safety. The majority of food handlers 392 (92.2%) have favorable attitude toward the concept that food safety must be upheld during production and packaging. However, less than half (47.6%, 95% CI: 42.8, 52.5) of the respondents have good food safety practices (Figure 1).

Figure 1.

Attitude, knowledge, and practice of food handlers on food safety, Bahir Dar City Administration, Ethiopia, 2021.

Factors associated with food safety practice

Sex, age, educational status, employment types, work experience, working environment, monthly salary, working hours, regular supervision, knowledge, training, and attitude were factors associated with poor food safety practices in the bi-variable binary logistic regression analysis, with a p-value of less than .25. While sex, working unit, monthly salary, regular supervision, food safety training, and attitude were significantly associated with poor food safety practices at a p-value <.05 in the multivariable logistic regression analysis. Gender has had a role in food safety practices, as male food handlers were about 3 times more likely than female food handlers to have poor food safety practices [AOR: 2.92 (CI: 1.77, 4.82)]. The study also found that food handlers with monthly wages of 2000 Birr or less (about $39) were twice as likely to practice poor food safety as those with higher monthly salaries [AOR: 2.02 (CI: 1.18, 3.44)]. Similarly to this, food handlers who did not receive regular health supervision were 3.4 times more likely to have subpar food safety practices [AOR: 3.43 (CI: 1.97, 5.97)] than those who did. When compared to food handlers working in the packaging unit, those working in the production unit were 2.44 times [AOR: 2.44 (CI: 1.45, 4.13)] more likely to have poor food safety practices (Table 3).

Table 3.

Factors significantly associated with food safety practice among food handling workers in Bahir Dar City, Northwest, Ethiopia, 2021.

Discussion

The results of this cross-sectional study showed that there were poor food safety practices, and that sex, working unit, monthly wage, routine health supervision, training, and attitude were connected with poor food safety practices. Nearly half (47.6%, 95% CI: 42.8, 52.5) of the food handlers in the current study who work in the food industry follow good food safety practices. The results were lower than those of studies conducted in Tehran (73%),³⁵ and Jessore, Bangladesh (83.5%) of food handlers had good safety practices¹⁸ which might be due to the different socioeconomic status, educational backgrounds as well as the availability of food safety training. However, the results of this study were better than those of previous studies conducted in Fars, Iran, with only 8% of food handlers practicing good safety practices.²¹

Food handlers need to have a fundamental awareness of the importance of food safety, the spread of foodborne illnesses, and the methods of food contamination to address poor food safety practices.³⁶ The majority of the participants in the current study had a strong awareness of food safety (87.4%, 95% CI: 83.9-90.4). Compared to research conducted in Jessore, Bangladesh (91.6%), this study’s findings were less favorable.¹⁸ According to our findings, 59.2% of respondents who reported they always washed their hands before beginning work is still less than the research conducted in southern Iran where 91.7% reported wash hands before beginning their work.²¹ In the current studies, a majority (91.3%) of food handlers claimed to wash their hands after using the restroom, although only 47.6% of them used detergent. About 63.5% of food handlers said that they handled food despite having diarrheal disease. The discrepancy may be brought about by differences in respondents’ sociodemographic characteristics and level of food safety training, as well as the regulatory system in place.

Regarding food handlers’ personal protective equipment utilization (PPE), the finding of current studies revealed that 36.5% of the food handlers reported that they used a mask, 43.8% used an apron, 46.9% used cap, and only 10.7% used gloves for their day-to-day activities. The findings were lower than studies conducted in Jessore, Bangladesh 91.6% of food handlers reported they washed their hands after visiting the restroom, 83.6% used a mask, 95.5% used an apron, 93.6% used a cape, 84.6% used gloves.¹⁸ The study in Iran also reported that the majority (91.7%) of food handlers washed their hand after visiting the restroom, 56.5% used masks, 95.9% used aprons, 92.8% used a cape, and 69.1% used gloves.²¹ The study’s setting and better application of food safety laws and regulations may be the causes of this discrepancy.

The study also indicated that all food handlers reported that they abstained from smoking and drinking alcohol while in the workplace. This finding is consistent with research conducted in Bangladesh, where smoking was obtained at 100% and alcohol consumption at 96.4%,¹⁸ and also in Fars, Iran, abstinence from smoking/alcohol consumption was 96.8%.²¹

Food handlers who engage in food handling activities should cut their fingernails to prevent the spread of foodborne infections because unless fingernails are kept clean, it is most conducive to the growth of bacteria.³⁷ The majority (72.7%) of food handlers in the current study had found that they had trimmed their fingernails and removed all jewellery before starting work. However, the inadequacy of well-planned facilities, lack of management and training, as well as the poor utilization of governmental regulations and laws in the food industries, may cause not to practice food safety as planned.¹¹

The majority (90.8%) of food handlers reported that they clean their workspace before getting to work. This result was lower than that of a study conducted in Jessore, Bangladesh, where 99% of food handlers cleaned their workspace before starting work.¹⁸ Regarding medical examinations of food handlers, just 13.5% of food handlers reported they had regular checkups. This result is less than that of research conducted in Bangladesh where regular checkups were found 78.2%.¹⁸ Three hundred twenty-nine food handlers (78%) wore no jewellery while working on food preparation tasks. This finding is in line with studies done in western Romania, where it was shown that 82.14%.³⁸

Even though the Ethiopian Food and Drug Authority, the Ministries of Health and Agriculture, and other non-governmental organizations have been reported as providing training on good hygiene practices (GHP), good manufacturing practices (GMP), and hazard analysis and critical control points (HACCP).^39,40 the current study’s findings show that, while food handlers’ attitudes and knowledge of food safety were positive, their level of practice was poor. People with good knowledge are thought to have a more favorable attitude and behavior toward food safety, as well as to interact positively with one another. Despite having good knowledge and favorable attitude, the food handlers in the current study exhibit insufficient food safety practices. This could be due to long hours worked, low monthly pay,⁴¹ a lack of facilities to support food safety practices or insufficient inspection by the relevant body.⁴²

According to the results of the current study; Sex, working unit, monthly wage, regular supervision, training, and attitude were significantly associated with poor food safety practices associated with poor food safety practice, sex, working unit, monthly salary, regular supervision, training, and attitude were significantly associated with food safety practice. Gender plays a key role in ensuring the food’s safety. Our research found that male food handlers were more likely than female food handlers to have poor safety practices. This might have been because women are more sensitive to food-handling practices than men.⁴³

Working unit has also been proven to have a substantial impact on food safety practices where individuals working on the packing unit were more likely than those working in the production unit to have poor food safety practices. This may be because food handlers who work in the production area tend to be more educated (as it requires better education and knowledge on how much each component to be while preparing the packed food) and may believe that the production area requires greater attention than the packaging area. The results of our study also showed that training was strongly related to the practice of food safety. Food handlers who haven’t received food safety training are more likely to perform unsafe food handling than those who have the training. It is agreed that providing adequate food safety training to everyone who handles food in the food business is essential to protect customers from foodborne diseases and other health risks that could occur from eating contaminated food. Furthermore, training is crucial for the long-term commercial viability of food industries as well as for public health. Training also helps food industries to become more efficient, competitive, and lucrative by raising performance standards, promoting the brand, enhancing employee morale, and decreasing waste.⁴⁴ Therefore, Workers in the food industry need to receive efficient and consistent food safety training to ensure food safety practices.

Regular regulatory supervision was significantly associated with food safety practices. Food handlers who didn’t receive regular supervision had a higher likelihood of poor food safety practices than those who did. This is because inspections are typically undertaken within a regulatory framework, and compliance motivators including the public revelation of inspection results or reports, closures, monetary penalties, and other enforcement actions might aid to guarantee that standard operating procedures are being followed.⁴⁵ So supportive supervision provides practical support to food handlers on how to handle food and protect it from contamination.⁴⁶

Food safety practices were strongly associated with food handler attitudes. Food handlers with an unfavorable attitude toward food safety were more likely to have poor food safety practices than those with a favorable attitude. People who are more worried about the causes of food-borne disease, the frequency of severe episodes, and the consequences for their health made them engage in more protective behaviors.⁴⁷ Because one of the main drivers of behavior adoption is the development of attitudes, and acting in a particular manner toward a group of things.⁴⁸

Conclusion

According to the findings of this study, food safety practice among food handlers employed in the food industry was poor. Sex, working unit, regulatory supervision, monthly salary, and attitude toward the food safety practice were the main factors associated with poor food safety practices. Regular regulatory inspections, in-service training, good hygiene practices (GHP), good manufacturing practices (GMP), hazards analysis and critical control points (HACCP), and the food safety management system (ISO:22000:2018) should all be strengthened to improve food handlers’ food safety practices and bring them into compliance with the standard.