A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers

Food Safety Knowledge, Attitudes, and Practices among Vegetable Handlers in Bangladesh

This study delves into the Knowledge, Attitudes, and Practices of vegetable handlers in Jashore Sadar, Bangladesh, specifically focusing on the crucial significance of food safety across the entire farm-to-fork process. Integrating quantitative and qualitative data provides a multifaceted depiction of this pivotal component within the food supply chain. Ten focus group discussions were conducted, and in total, 50 vegetable handlers were interviewed separately. In the survey, there were 17 questions on food safety knowledge, 16 on food safety attitudes, and 17 on food safety-related practices followed by vegetable handlers. We found that while approximately 60% of handlers had good knowledge about food safety, only about one-quarter of the interviewed vegetable handlers had good attitudes and practices toward food safety. The attitudes and practices of individuals involved in handling vegetables demonstrate a complex range of variations shaped by factors such as educational background, prior experience, and availability of food safety training. Concerns regarding the rising expenses linked to adherence to food safety regulations and a perceived lack of accountability among those involved were also noted. The interviewed wholesaler group reported that approximately BDT 100-150 (USD 0.91-1.371)/maund1 was incurred in maintaining proper safety practices, while the interviewed retailer group said costs would increase by BDT 20-40 (USD 0.18-0.36)/maund if they followed proper handling practices. It is important to note that vegetable handlers recognize the favorable economic consequences of implementing appropriate food safety measures. This study highlights the significance of implementing focused educational and policy interventions to address knowledge disparities and encourage the adoption of food safety procedures among individuals involved in handling vegetables.

Impact of Metabolites from Foodborne Pathogens on Cancer

Foodborne pathogens are microorganisms that cause illness through contamination, presenting significant risks to public health and food safety. This review explores the metabolites produced by these pathogens, including toxins and secondary metabolites, and their implications for human health, particularly concerning cancer risk. We examine various pathogens such as Salmonella sp., Campylobacter sp., Escherichia coli, and Listeria monocytogenes, detailing the specific metabolites of concern and their carcinogenic mechanisms. This study discusses analytical techniques for detecting these metabolites, such as chromatography, spectrometry, and immunoassays, along with the challenges associated with their detection. This study covers effective control strategies, including food processing techniques, sanitation practices, regulatory measures, and emerging technologies in pathogen control. This manuscript considers the broader public health implications of pathogen metabolites, highlighting the importance of robust health policies, public awareness, and education. This review identifies research gaps and innovative approaches, recommending advancements in detection methods, preventive strategies, and policy improvements to better manage the risks associated with foodborne pathogens and their metabolites.

Fast food over safe food? A qualitative evaluation of a food safety training intervention for street vendors applying the COM-B model in Ouagadougou, Burkina Faso

The safety of ready-to-eat food sold in urban informal markets in low and middle-income countries is a pressing public health challenge, that needs to be addressed if we are to establish healthy food systems. Guided by the Capability, Opportunity, and Motivation model for Behavior change (COM-B), this qualitative study aimed to explore perceptions of street vendors on their participation in a food safety capacity building intervention, consisting of training and provision of food safety equipment. The intervention aimed to improve food safety behavior of vendors of ready-to-eat chicken in informal markets in Ouagadougou, Burkina Faso. A total of 24 vendors selling ready-to-eat chicken at street restaurants participated in semi-structured interviews after training, which focused on vendors' stories of change related to food safety capabilities, opportunities, motivation, and behaviors. Data were thematically analyzed following COM-B components. Vendors noted improvements in psychological (i.e., knowledge, awareness, self-efficacy, perceptions) and physical capabilities (i.e., equipment useability and applicability), and motivations (perceived responsibility, reputation, client satisfaction, profits, consumer demand). Moreover, training and provision of equipment, spill-over effects to employees or neighboring outlets, and social support were perceived as key social and physical opportunities, while structural challenges such as market infrastructure, regulations, financial resources, cost of living, and outlet culture were physical barriers to implement lessons learnt. This study provides insights into the impact of engaging vendors in improving food safety behavior through training and equipment provision. Improvements in vendors' perceived capabilities and motivation contributed to improved food safety behavior, while contextual barriers hindered the perceived adoption of food safety behaviors.

Food Safety Knowledge, Attitude, and Hygienic Practices of Food Handlers in Yeka Sub-city, Addis Ababa, Ethiopia: A Descriptive Cross-sectional Study

Introduction

Foodborne diseases pose a significant global public health threat, often originating from improper food handling practices. Given the crucial role of food handlers in preventing transmission of foodborne diseases, this study assessed the food safety knowledge, attitudes, and hygiene practices related to foodborne diseases among food handlers in food service establishments in Yeka Sub-city, Addis Ababa, Ethiopia.

Method

A descriptive cross-sectional study was conducted among 373 randomly selected food handlers. Data collection involved observing the kitchen hygiene practices and food handling practices through an observational checklist, and administering structured/standardized questionnaires. Statistical analysis was performed using SPSS version 20, with associations examined using the linear by linear association test. Spearman's correlation assessed relationships between knowledge, attitude, and practice cut points. Pre-testing and Cronbach's alpha were used to ensure the reproducibility, and reliability of the questionnaire.

Results

Majority of food handlers (50.1%) were aged less than 25 years, with 78.8% being female, and attended secondary school (46.4%). The overall knowledge (65%), positive attitude (92.2%), and hygiene practices (44%) of the food handlers toward food safety were good. Regarding the knowledge perspective, gaps existed in understanding disease transmission, notably Hepatitis A and tuberculosis. Although positive attitudes toward food safety were reported, observed practices were inconsistent, with a significant proportion admitting to working while ill. Compliance with uniform and protective gear was lacking. Marital status, Experience in food safety, and Work satisfaction has been shown to affect the knowledge, attitude, and hygiene practices of food handlers in this study.

Conclusion

This study highlights critical gaps in understanding disease transmission, and hygiene practices of food handlers in Yeka sub-city. Addressing these gaps will necessitate targeted interventions, including continuous education and training programs. Enhanced regulatory oversight is also needed to ensure compliance with food safety standards in public food establishments.

Implementation of School Nutrition Policies to Address Noncommunicable Diseases in Uzbekistan and Kyrgyzstan

Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, and diabetes, account for over 80% of mortality in Uzbekistan and Kyrgyzstan in 2019, and unhealthy dietary behaviors are a major risk factor for NCDs in both countries. In 2021, national stakeholders, in consultation with the World Health Organization, identified school nutrition policies (SNPs) as a major approach to reducing the burden of NCDs in both countries. The SNPs included interventions implemented through a multistakeholder and multisectoral arrangement that aimed to improve the health and nutrition status of children and young people by providing healthy food/beverages and restricting unhealthy foods or beverages in schools. We used a multimethod approach of document review, participatory workshops, and key informant interviews to generate theories of change for the large-scale implementation of SNPs and describe the implementation processes to date, including key implementation and health system challenges, salient implementation strategies, and implementation outcomes in both countries. Multiple pathways for enacting and implementing SNPs successfully were identified. However, significant health system challenges, such as the lack of accountability for contracting and tender processes and coordination among different sectors, continue to hamper the large-scale implementation of these policies in both countries. The pathways, theories, and implementation outcomes identified will facilitate the development of implementation strategies and systematic learning and evaluation around SNPs for NCD prevention and control programs in the Central Asian region and other low- and middle-income countries more broadly.

Evaluation of the Effects of Food Safety Training on the Microbiological Load Present in Equipment, Surfaces, Utensils, and Food Manipulator's Hands in Restaurants

Training food handlers is essential to ensure food safety. However, the efficacy of training programs relying solely on theoretical information remains uncertain and often fails to induce significant changes in inadequate food practices. Training programs in good hygiene and food safety practices that integrate theoretical and practical approaches have emerged as a vital tool, enabling food handlers to apply their knowledge during work hours and clarify doubts. This study aimed to assess the impact of food safety training based on theoretical and on-the-job training on the microbiological counts of equipment, surfaces, utensils, and food handler (FH) hands. The hygiene and food safety conditions of four restaurants were analyzed through facility checklists, employee questionnaires, and microbiological analyses conducted before and after training. Eight sample collection moments were conducted at each restaurant before and after training. The pre-training results indicate that 15% and 26% of analyses for Enterobacteriaceae and total mesophilic aerobic bacteria (TMB), respectively, did not comply with hygiene safety limits. Additionally, 31% and 64% of Enterobacteriaceae and TMB values, respectively, exceeded safety limits on food handler hands. Positive cases of coagulase-positive Staphylococcus (CoPS) resulted from unprotected wounds on some FH hands. The presence of Listeria monocytogenes in drains was also identified as a concern. Following training, significant differences in results were observed. In many cases, there was a reduction of over 80% in microbial load for Enterobacteriaceae and TMB collected from equipment, surfaces, utensils, and food handler hands. The presence of L. monocytogenes in drains was also eliminated after food safety training. In conclusion, this study underscores the importance of effective training in improving food safety practices.

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

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

Evaluation of Food Safety Knowledge and Attitudes Among Adults in the United Arab Emirates

Background Food is handled by many individuals in large food setups, therefore increasing the chance of contamination that leads to foodborne diseases (FBDs). This study was purposed to evaluate adults' understanding of food safety, FBDs, and hygiene practices across various demographic groups in the United Arab Emirates (UAE) and to explore the link between their knowledge of food safety and their corresponding attitudes. Methods A cross-sectional study was conducted with 402 adults using a validated, self-administered questionnaire available in both printed and online formats. The study was carried out at Gulf Medical University and Thumbay hospitals and clinics over six months, beginning in December 2022 to June 2023. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was employed to examine the association between variables, and significant associations were further analyzed through logistic regression. Results Out of the 402 participants, the population was predominantly female 275 (67.9%), and from Southeast Asia 222 (55.4%), with students comprising the largest occupational group 186 (47%). Only 106 (26.36%) had received food safety training, and a mere 187 (46.51%) demonstrated adequate knowledge. Awareness levels varied, with the highest for raw food safety (64.02%) and the lowest for canned foods (40.79%). Demographic analysis revealed significant associations: males exhibited more inadequate knowledge 79 (62.2%) than females 136 (49.4%), and students showed higher inadequacy 104 (55.9%) compared to healthcare workers 31 (35.6%). Positive attitudes towards food safety were prevalent 226 (56.2%), and positive attitudes were found in women 157 (57.1%), individuals above 30 years of age 110 (50.5%), individuals working in healthcare 140 (62%), and married individuals 117 (60.9%). With a strong correlation (p<0.001), women were 1.68 times more likely to possess adequate knowledge than men (95% CI: 1.09, 2.59), and healthcare workers were 2.33 times more likely than students (95% CI: 1.37, 3.95). Conclusion The study reveals a low level of knowledge about food safety among adults in the UAE. Therefore, emphasis should be placed on increasing awareness of these concepts to reduce the burden of FBDs on the healthcare system.

Food safety-related practices among residents aged 18-75 years during the COVID-19 pandemic: a cross-sectional study in Southwest China

BACKGROUND

Good food safety practices are essential to minimizing foodborne diseases. The present study explored the food safety-related practices of residents during the COVID-19 pandemic in Southwest China and identified the impacting factors.

METHODS

Residents aged 18-75 years from Guizhou, Yunnan, Sichuan, and Chongqing, China, were included in our study. The convenience sampling method was used to select participants, and face-to-face surveys were conducted in households and communities to collect data. Descriptive statistics including sociodemographic characteristics of respondents and weighted percentages were obtained and the log-binomial regression was used to evaluate the influencing factors associated with food safety-related practices.

RESULTS

Overall, 7,848 respondents were involved, with 97.5% efficacy. Disparities in food safety-related practices were observed between males and females, with the former performing poorer practices than the latter (70.5% vs. 68.0%, respectively). Notably, paying attention to nutrition labels when shopping for prepackaged foods was the worst practice. Age, ethnicity, region, occupation, education level, and income were identified as significant determinants of food safety-related practices. Moreover, in comparison to males, females were more likely to acquire pertinent knowledge from diverse sources, including social media, family members/ friends, books/ newspapers/ magazines, experts, and food sales staff (p < 0.05).

CONCLUSIONS

Males performed inferior food safety-related practices than females during the COVID-19 pandemic in Southwest China. It is suggested that future food safety education programs should incorporate diverse targeted approaches, with emphasis on males. The role of mainstream media in promoting food safety practices should be expanded and prioritized in the forthcoming initiatives.

Food handlers' lack of knowledge, and misunderstanding of safe food temperatures: An analysis using the theory of social representations

Comprehension is the ability to understand and be familiar with situations and facts. A critical factor causing foodborne diseases is the inadequate temperature during food storage and handling; food handlers often fail to understand this. Therefore, in this study, we investigated how technical language and everyday knowledge operate in the comprehension of safe food temperatures among food handlers in food services. To achieve this, data collection was carried out in two stages. In the first stage, a survey was conducted to 206 food handlers from 14 food service working in the city of São Paulo. Through this survey, we gathered information to characterize the socio-demographic profile of the sample, details about participation in training, and knowledge of technical terms related to safe food temperatures. In the second stage, individuais interviews were conducted on the same day following the questionnaire administration in each food service. A total of 29 interviews were carried out An interview script was developed containing two storylines based on the Fourth Key: "Keep food at safe temperatures," which is part of the WHO's "Five Keys to Safer Food" manual. Further, the collective subject discourse technique, which is based on the theory of social representations, was employed to analyze each interview and construct a representative collective discourse. Analysis of the results indicated that lack of knowledge about safe food temperatures is mainly a result of the misunderstanding of technical terms. The collective discourses obtained results reinforced that food handlers had diverse and erroneous information about food defrosting, and they exhibited low confidence and clarity about safe food temperatures. Overall, psychological, social, and cultural factors affect the formation of social representations that guide food handlers' decision-making.

Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study

BACKGROUND

In Japan, incidents of falsified expiration dates on popular cookie brands and health hazards associated with frozen Chinese dumplings have raised food safety awareness. To prevent the intentional contamination of food by foreign substances, large food manufacturing companies have adopted the concept of food defense.

OBJECTIVE

The aim of this study was to assess people's willingness to pay for food protection measures. In addition, the impact of participants' personalities and considerations regarding their purchase choices on how much they were willing to pay when shopping for food and other products were measured.

METHODS

A questionnaire on willingness to pay for food hygiene and food defense was administered via a web survey and 1414 responses were included in the analysis. Univariate logistic regression analyses were performed with individuals willing and unwilling to pay additional costs as the objective variable and other questionnaire items as explanatory variables. A principal component analysis was performed on 12 questions regarding how much additional money people were willing to pay, and the principal component scores and other questions were examined for implications and other information.

RESULTS

Approximately one-third of the respondents stated that they were unwilling to pay additional costs and reported a willingness to consume delivery food even if it contained items that were not part of the original order. The first principal component reflected the extent to which people were willing to pay additional money, and if so, how much. This tendency existed even if the individual foods and amounts varied. The third principal component reflected the amount of extra money that people were willing to pay, which was determined by the amount people had to pay toward food safety measures. Those who answered "zero" were more likely to believe that consumers should not have to pay to ensure food safety. The second principal component reflected an axis separating food defense and food hygiene. Some items not directly related to food were correlated with this axis.

CONCLUSIONS

In Japan, the concept of food hygiene is well-established and is generally taken for granted. In contrast, the concept of food defense is relatively new and has not yet fully penetrated the Japanese market. Our research shows that people who think that clothing brands provided added value to clothing products may have similar feelings about food defense. In addition, food hygiene efforts to prevent outbreaks of food poisoning are common in Japan and have been established as the basis of food safety. While food defense efforts are spreading, mainly in companies, it is presumed that they are valuable for the general public as supplementary measures to routine (or basic) food hygiene.

Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study

BACKGROUND

Various stages of the food chain, from production to processing to distribution, can impact food safety. The concept of "food defense" has emerged as a countermeasure against intentional contamination of food with foreign substances. Although knowledge of food hygiene is common among consumers, there are currently no reports of consumer surveys on food defense.

OBJECTIVE

This study aims to investigate consumer awareness of food defense and food safety. We analyzed the results focusing on how consumers behave when they find abnormalities in food to further our knowledge on promoting food defense measures.

METHODS

Participants completed a web-based questionnaire that included items related to awareness of food safety and food defense, as well as actions to be taken in cases of food abnormalities, such as contamination by foreign substances, the presence of a bad smell in purchased food, and the inclusion of extra items not selected by the individual. The participants were asked to indicate their preference among the 5 suggested actions in each case using a 6-point Likert scale. Data analysis involved aggregating responses into binary values. Stepwise linear regression analysis was conducted to examine the relationship between selected actions and questionnaire items, such as sex, age, and personality.

RESULTS

A total of 1442 respondents completed the survey, and the majority of participants placed importance on food safety when making food purchases. The recognition of each term was as follows: 95.2% (n=1373) for "food security and safety," 95.6% (n=1379) for "food hygiene," and 17.1% (n=247) for "food defense." The percentages of those who answered that they would "eat without worrying" in the case of "contamination by foreign substances," "bad smell," or "including unpurchased product" in the frozen food they purchased were 9.1% (n=131), 4.8% (n=69), and 30.7% (n=443), respectively. The results showed that contacting the manufacturer was the most common action when faced with contaminated food or food with a bad smell. Interestingly, a significant percentage of respondents indicated they would upload the issue on social networking sites. Logistic regression analysis revealed that male participants and the younger generation were more likely to choose the option of eating contaminated food without worrying. Additionally, the tendency to upload the issue on social networking sites was higher among respondents who were sociable and brand-conscious.

CONCLUSIONS

The findings of this study indicate that if food intentionally contaminated with a foreign substance is sold and delivered to consumers, it is possible consumers may eat it and experience health problems. Therefore, it is crucial for not only food manufacturers but also food delivery service providers to consider food defense measures such as protecting food from intentional contamination. Additionally, promoting consumer education and awareness regarding food defense can contribute to enhancing food safety throughout the food chain.

Development of an Educational Gamification Strategy to Enhance the Food Safety Practices of Family Farmers in Public Food Markets of Northeast Brazil: A Case Study

This study aimed to develop an educational gamification strategy to enhance the food safety practices of family farmers in public food markets in a city in Northeastern Brazil (João Pessoa, PB, Brazil). A good manufacturing practices (GMP) checklist was used to verify hygienic-sanitary conditions in the food markets. Educational game tools addressing foodborne diseases and GMP with information about the prevention of foodborne diseases, good food handling practices, and safe food storage were developed. Pre- and post-training assessments were done to evaluate food handlers' knowledge and food safety practices. Microbiological parameters of food samples were analyzed before and two months after the training. Results indicated unsatisfactory hygiene conditions in the examined food markets. There was a very strong positive correlation between "implementation of GMP" and "production and process controls" (R = 0.95; p ≤ 0.05) and between "production and process controls" and "hygiene habits of handlers" (R = 0.92; p ≤0.05). There was no homogeneity between answers before and after the training for the knowledge of family farmers regarding "prevention of foodborne diseases" and "safe food handling". There were improvements in the measured microbiological parameters of foods sold by family farmers after the application of the developed educational gamification training. These results showed the developed educational game-based strategy as being effective in raising awareness of hygienic sanitary practices, helping to promote food safety, and reducing risks for the consumers of street foods at family farmers' markets.

Food safety culture in food companies: evaluation of the perception of food safety culture in three Tuscan food companies

The Commission Regulation (EU) No. 2021/382 (European Commission, 2021), amending the Regulation (EC) No. 852/2004 (European Commission, 2004), introduced the obligation for companies to establish and maintain a food safety culture (FSC). The methodology to evaluate, implement, and enhance the level of FSC is up to the individual companies. This study aimed to investigate the perception of FSC among the employees of 3 Tuscan medium-sized enterprises in the food sector, producing cured meat (A), dairy products (B), and frozen fish products (C). The survey was conducted through the development and administration of a questionnaire based on a 5 points Likert scale, referring to different aspects of FSC, organized in 6 sections with 5-6 statements each and subjected to a percentage of employees between 76 and 85%, classified also by the length of service (≤3 and >3 years). For all the companies, the minimum median and mode value for scores obtained by the different sections was 4, and the minimum median and mode value for the single statement was 3 (A, B; except for a bimodal value 2-4) and 4 (C). The section awareness and perception of risk showed the highest mean scores in all companies. As for the length of service, senior employees gave lower scores than junior ones in all sections in B and 3 sections in C. Overall, the results of the questionnaires showed a good perception of FSC, even though it was possible to identify some partial weaknesses.

Training for Food Handlers at Production Level in Italian Regions

Food safety has always been a public health challenge. Globally, food safety control is supported by laws and preventive measures, such as inspections conducted from primary production to market, "from farm to fork" as emphasized by the European Union and training of Food Handlers (FHs). This latter preventive measure plays a very important role, and for this reason a review of training courses regulations provided in the different Italian regions was conducted. Analysis of the results shows that the Italian regions approach this issue in different ways: some regions provide only general guidelines, while others offer detailed instructions. The most significant differences concern the topics dealt with, the stakeholders, the staff training and the verification of results; topics such as allergens and gluten are often absent. More detailed guidelines tailored to fit the local scenario could provide better support to FHs, thus leading to real changes in their behaviors and mindsets and promoting the development of an actual "prevention culture".

Foodborne zoonoses control in low- and middle-income countries: Identifying aspects of interventions relevant to traditional markets which act as hurdles when mitigating disease transmission

Globally, foodborne zoonoses are responsible for approximately one third of all foodborne disease burden and this picture is likely to worsen if consumption of animal source foods continues to rise with insufficient attention to risk mitigation. Traditional markets represent highly important nodes that can be targeted for risk mitigation; in this series of case studies, we discuss food safety interventions relevant to this nexus. We illustrate that to improve food safety within traditional markets it is essential to consider some of the motivations and incentives of the stakeholders involved and the cultural, social, and economic context in which interventions are undertaken, highlighting barriers, enablers future interventions should aim to avoid, embrace. We also conclude that a holistic approach to foodborne zoonoses control will require the institutionalization of One Health across food systems of which traditional markets are part.

Food Safety Practices and Associated Factors in Food Operators: A Cross-Sectional Survey in the Students' Cafeteria of Woldia University, North Eastern Ethiopia

The food safety issue is often overlooked in countries where food shortages, natural disasters, political tensions, and other major concerns dominate government and media agendas. As a result, the current study sought to assess food safety practices and associated factors among food handlers at Woldia University's student cafeteria. An institutional cross-sectional study was conducted between May and July 2021, and a sample of 291 subjects was recruited through a simple random sampling technique. Questionnaires, focus group discussions, interviews, and observation methods were used as data collection tools. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20 software. Bivariate and multivariate logistic regressions were used to determine the effect of various factors on the outcome variable and control for confounding effects. p < 0.05 was considered statistically significant. However, some variables are significant even at p < 0.001. The results were described by frequencies and percentages. The current study found that the factors of not having had food hygiene training (AOR = 2.111, 95% CI = (1.029 - 4.428)), less than or equal to one year of work experience (AOR = 3.070, 95% CI = (2.020 - 10.246)), poor knowledge (AOR = 1.285, 95% CI = (0.125 - 0.849)) and poor attitude (AOR = 1.190, 95% CI = (1.361 - 9.393)), not keeping cooked food at a safe temperature (AOR = 3.037, 95% CI = (1.021 - 12.096)), failure to respect the safety of cooking utensils and surfaces (AOR = 2.022, 95% CI = (1.551 - 9.689)), insufficient cleanliness of eating areas (AOR = 2.430, 95% CI = (1.983 - 6.217)), not covering hair when cooking food (AOR = 5.903, 95% CI = (2.243 - 9.621)), and not washing hands before starting to handle food (AOR = 10.019, 95% CI = (4.031 - 24.063)) were statistically associated with unhygienic food handling practices. The results of this study indicated that the state of food safety practices was poor. Therefore, food safety assurance must comply with modern food safety frameworks such as Hazard Analysis and Critical Control Points (HACCP). In addition, addressing knowledge and skill gaps among food handlers, regular inspection services, and effective enforcement of food safety regulations are extremely essential. Finally, future studies should focus on enumerating bacteria and protozoa in unsanitary foods and utensils.

Occupational factors affecting the decline in pulmonary function among male farmers using occupational pesticide in Gyeonggi-do, South Korea

Background

Occupational pesticide exposure is a potential risk for respiratory health effects. Most clinical studies on pesticide exposure were related to acute exposure, and only a few studies on chronic exposure have been conducted. This study investigated the chronic respiratory health status and the chronic effects of occupational pesticide exposures of farmers in Gyeonggi-do.

Methods

Surveys and pulmonary function tests were conducted on 1,697 farmers in 16 regions of Gyeonggi-do. The structured questionnaire included demographic characteristics, medical history, recent respiratory symptoms and diseases, and work-related conditions, and was conducted through one-on-one interviews. The prevalence of respiratory diseases was compared by the odds ratios (ORs) at 95% confidence intervals (CIs) estimated by logistic regression analysis. Additional multivariate logistic regression analysis was also conducted.

Results

Pesticide work groups showed significant association with an obstructive pattern in the lung function test (unadjusted OR, 2.38; 95% CI, 1.17-5.52). Selected work-related variables of pesticide exposure were 'start age,' 'cumulative duration,' 'mixing pesticides,' and 'protection(goggle).' The obstructive pattern of lung function test showed significant associations with mixing pesticides (OR, 2.30; 95% CI,1.07-5.46), and protection (goggle) use (OR, 0.34; 95% CI, 0.12-0.79).

Conclusions

Mixing two or more pesticides showed a significant association. Wearing goggles can be seen as an indicator of awareness of the protective equipment and proper wearing of protective equipment, and loss of pulmonary function can be prevented when appropriate protection is worn.

Food safety-related perspectives and practices of consumers and vendors in Ethiopia: A scoping review

Despite being one of the first African countries to prioritize food safety, foodborne diseases are of acute concern in Ethiopia. This review aims to understand food safety-related perspectives and practices among consumers and food vendors in Ethiopia to identify motivations, beliefs, and values that shape and/or drive their practices. A well-defined search and review identified 116 relevant articles. These spanned eight of the ten regional states and two chartered cities, with most work focusing on urban areas and on a sample within one state or chartered city. Ninety-four studies focused on vendors or food handlers; fifteen articles examined both consumers and vendors, but only four assessed interactions between the groups. Meat, dairy products, and ready-to-eat (street) foods were the most studied food groups. Food service establishments were the most examined outlets. Forty-six studies examined generic food safety issues or concerns. Overall, 102 studies assessed food safety practices; 53 studies examined knowledge, and 19 studies assessed attitudes. A gap in vendors' observed practices versus knowledge and attitudes was noted. Consumer deductions of food safety were based on vendor practices. Both groups used physical attributes based on senses to assess quality and safety of animal-source foods, had their own 'coping' strategies to address food safety-related concerns, and had similar views on consumer choice motives. Analysis of food and the food handling environment revealed a high level of contamination. An additional study, included after the original search, identified training to be effective in influencing knowledge, attitudes, and practices - though results for attitudes and practices were not sustained in the long term. Future research should address consumers and consumer-vendor interactions and include the full triad of knowledge-attitudes-practices. It is also recommended to focus on nutrient-rich foods as well as on traditional markets and local eateries. Improving the quality of research will be critical to improve food safety in Ethiopia.

Food safety practice and associated factors in public food establishments of Ethiopia: A systematic review and meta-analysis

BACKGROUND

In terms of global impact, foodborne infections have been likened to major infectious diseases such as HIV/AIDS, malaria, and tuberculosis, with 1 in 10 people becoming ill and 420,000 deaths per year. A large number of these incidents are caused by improperly handled food in foodservice establishments. Therefore, this systematic review and meta-analysis aims to estimate the proportion of food handlers in Ethiopian commercial food service establishments who have safe food handling practices and their associated factors.

METHODS

Studies conducted before 02-05-2022 were explored in PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE®, as well as other sources. A total of fourteen studies were included in the final synthesis. Data were extracted using a standardized data extraction format prepared in Microsoft excel and the analysis was done using STATA 16 statistical software. The quality of included studies was assessed using the Joanna Briggs Institute's Critical assessment checklist for prevalence studies. To evaluate publication bias, a funnel plot and Egger's regression test were employed. The I2 statistic was calculated to examine for study heterogeneity. To assess the pooled effect size, odds ratios, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis.

RESULTS

Of 323 identified articles, 14 studies were eligible for analysis (n = 4849 participants). The pooled prevalence estimate of safe food handling practices among Ethiopian food handlers was 47.14% (95% CI: 39.01-55.26, I2 = 97.23%). Foodservice training (OR, 3.89; 95% CI: 2.37-5.40), having on-site water storage facilities (OR, 4.65; 95% CI: 2.35-6.95), attitude (OR, 4.89; 95% CI: 1.39-8.29), hygiene and sanitary inspection certification (OR, 3.08; 95% CI: 1.62-4.45) were significantly associated with safe food handling practice among food handlers.

CONCLUSION

This review identified that improvements are needed in food handling training, government regulation, and infrastructure. Standard regulations for food service enterprises must be implemented on a local and national level. Though long-term food safety requires legislation and training, failure to address infrastructure challenges can harm public health efforts. Access to safe drinking water and the presence of sanitary waste management systems should all be part of the basic infrastructure for ensuring the safety of food in food businesses.

A Systematic Review on the Usability of Web-Based Applications in Advocating Consumers on Food Safety

Food safety is an important indicator of public health, as foodborne illnesses continue to cause productivity and economic loss. In recent years, web-based applications have been extensively used by the online users’ population. Almost one third (28.3%) of online users found web-based application to be a notable source of food safety information. The objective of the current review is to determine the effectiveness of a web-based application systems as a health promotion tool for consumers to increase their knowledge and awareness of food safety. A systematic literature review was conducted by analyzing 11 selected web-based food safety education-related articles. The studies were categorized into several themes: (1) web-based applications used in accessing food safety information; (2) food safety evaluation and perception among consumers; (3) beliefs and level of knowledge, attitude and practices (KAP) of consumers; and (4) impact and contribution of social media use. A diverse number of online applications have been utilized to promote food safety education among consumers, yet these web-based applications need to be improved with regards to social connection and integration among consumers. KAP surveys were conducted on the majority of the respondents with a particular focus on their knowledge level. Findings show that web-based applications may act as an alternative to the traditional media in enhancing food safety education among consumers, especially youths who are tech-savvy.

New Approach to Food Safety Training: A Review of a Six-Step Knowledge-Sharing Model

Significant resources, including both human and financial capital, have been dedicated to developing and delivering food handler training programs to meet government and organizational mandates. Even with the plethora of food safety-oriented training programs, there is scant empirical evidence documenting effectiveness, suggesting the need to rethink the design and delivery of food safety training for food handlers. One underlying assumption of most training programs is that food handlers engage in unsafe practices because of lack of knowledge. As a result, many training curricula are designed to improve knowledge, assuming behavior will change as knowledge increases. However, food handlers often return to the work environment and try to implement the new knowledge with minimal success. One explanation for this is that the training context and the implementation context often differ, making it difficult for the food handler to transfer what they learned into practice. Understanding the connection between knowledge, the organization, and its environment is critical to knowledge implementation. The focus of this review is to describe a six-step knowledge-sharing model. Here, knowledge sharing is broadly defined as the process of creating and then using knowledge to change a practice or behavior. Our proposed knowledge-sharing model includes six steps: generation, adaptation, dissemination, reception, adoption, and implementation. We have organized this model into two dyads: (i) transfer between researcher (i.e., knowledge generators) and educator and (ii) transfer between educator and food handler (i.e., knowledge implementers). To put into practice this proposed model for developing and delivering effective food safety training for food handlers, we have provided suggested actions that can be performed within each step of the knowledge-sharing process.

Gastrointestinal symptoms and knowledge and practice of pilgrims regarding food and water safety during the 2019 Hajj mass gathering

BACKGROUND

Food and water-borne diseases (FWBDs) are a health risk at the Hajj mass gathering. The current study documented the prevalence and management of gastrointestinal (GI) symptoms among pilgrims during the 2019 Hajj and assessed their knowledge and practice concerning food and water safety.

METHOD

An analytical cross-sectional study was conducted in Macca, Saudi Arabia, among adult Hajj pilgrims from 28 countries. Data was collected from 15th-20th August 2019 by facer-to-face interviews using an anonymous structured questionnaire. Basic demographic data as well as information regarding pilgrims' knowledge and practice relating to food and water safety and any GI symptoms experienced during the Hajj was collected and analyzed.

RESULTS

The study enrolled 1363 pilgrims with a mean age of 50.1 years (SD = 12.3) and 63.4% (n = 845) were male. At least 9.7% (n = 133) of pilgrims experience GI symptoms and 5.1% (69/1363) suffered diarrhea. Most respondents drunk bottled water (99.4%, n = 1324) and obtained their food from their hotel /Hajj mission (> 86%). In general, pilgrims had good knowledge and practice in relation to food and water safety, although risky practices were noted concerning keeping food at unsafe temperatures and hazardous sharing of food and water. Gender, nationality and suffering GI symptoms during Hajj were significantly associated with good knowledge and good practice. There was a moderate but statistically significant positive correlation between knowledge and practice scores (rs = 0.41, p < 0.0001).

CONCLUSION

Despite overall good knowledge and self-reported practice, risky behaviors relating to food and water safety were identified among pilgrims, many of whom suffered from GI symptoms during Hajj. Our results can form the basis for developing tailored, targeted and effective interventions to improve pilgrims' knowledge and behavior and reduce the burden of FWBDs at the Hajj and beyond.