Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University student's cafeteria, Northeastern Ethiopia: an institution based cross-sectional study

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 ( $\text{AOR}=2.111$ , 95% $\text{CI}=\left(1.029-4.428\right)$ ), less than or equal to one year of work experience ( $\text{AOR}=3.070$ , 95% $\text{CI}=\left(2.020-10.246\right)$ ), poor knowledge ( $\text{AOR}=1.285$ , 95% $\text{CI}=\left(0.125-0.849\right)$ ) and poor attitude ( $\text{AOR}=1.190$ , 95% $\text{CI}=\left(1.361-9.393\right)$ ), not keeping cooked food at a safe temperature ( $\text{AOR}=3.037$ , 95% $\text{CI}=\left(1.021-12.096\right)$ ), failure to respect the safety of cooking utensils and surfaces ( $\text{AOR}=2.022$ , 95% $\text{CI}=\left(1.551-9.689\right)$ ), insufficient cleanliness of eating areas ( $\text{AOR}=2.430$ , 95% $\text{CI}=\left(1.983-6.217\right)$ ), not covering hair when cooking food ( $\text{AOR}=5.903$ , 95% $\text{CI}=\left(2.243-9.621\right)$ ), and not washing hands before starting to handle food ( $\text{AOR}=10.019$ , 95% $\text{CI}=\left(4.031-24.063\right)$ ) 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.

Prevalence and Associated Risk Factors of Intestinal Parasites and Enteric Bacterial Infections among Selected Region Food Handlers of Ethiopia during 2014-2022: A Systematic Review and Meta-Analysis

Food-borne disease due to intestinal parasites (IPs) and enteric bacterial infections (EBIs) remain a major public health problem. Food handlers, individuals involved in preparing and serving food, working with poor personal hygiene could pose a potential threat of spreading IPs and EBIs to the public. The aim of this study was to examine the overall prevalence and risk factors of IPs and EBIs among food handlers in four selected regions of Ethiopia. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, and other sources from Google Engine and University Library Databases. “Prevalence,” “Intestinal Parasites,” “Enteric Bacterial Infections,” “Associated Factors,” “Food Handlers,” and “Ethiopia” were the search terms used for this study. For critical appraisal, PRISMA 2009 was applied. Stata software version 16 was used to perform the meta-analysis. Heterogeneity and publication bias were evaluated using Cochran's Q, inverse variance (I²), and funnel plot asymmetry tests. A random-effects model was used to calculate the pooled burden of IPs and EBIs and its associated factors among food handlers, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 5844 food handlers were included in the 20 eligible studies. The overall pooled prevalence of IPs and EBIs among food handlers in four selected regions of Ethiopia was 29.16% (95% CI: 22.61, 35.71), with covering (25.77%) and (3.39%) by IPs and EBIs, respectively. Ascaris lumbricoides, Entamoeba histolytica/dispar, Giardia lamblia, and hookworm were the most prevalent IPs among food handlers with a pooled prevalence of 7.58%, 6.78%, 3.67%, and 2.70%, respectively. Salmonella and Shigella spp. were the most prevalent EBIs among food handlers with a pooled prevalence of 2.78% and 0.61%, respectively. A high prevalence of IPs and EBIs among food handlers was observed in Oromia (38.56%; 95% CI: 29.98, 47.14), while a low prevalence was observed in the Tigray region (19.45%; 95% CI: 6.08, 32.82). Food handlers who had not taken food hygiene training (OR: 0.68, 95% CI: −0.34, 1.69), untrimmed finger nail (OR: 2.23, 95% CI: 1.47, 2.99), lack of periodic medical checkup (OR: 1.52, 95% CI: 0.41, 2.64), lack of handwashing habits (OR: 1.97, 95% CI: 0.53, 3.41), and eating raw vegetables and meat (OR: 2.63, 95% CI: 0.92, 4.34) were factors significantly associated with the prevalence of IPs and EBIs. The prevalence of IPs and EBIs was high in the selected Ethiopian region (Amhara, Oromia, SNNPR, and Tigray) food handlers along an increasing prevalence trend from 2014 to 2022. Therefore, this study recommends the provision of proper health education and training regarding personal hygiene, hand washing, food handling, medical checks, as well as raw vegetable and meat safety.

Prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student's cafeterias and public food establishments in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Intestinal infection is still an important public health problem in low-income countries. Food handlers may be infected by a wide range of enteropathogens and have been implicated in the transmission of many infections to the public. Therefore, the aim of this review was to produce the pooled prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student's cafeterias and public food establishments in Ethiopia.

METHODS

Articles published in PubMed/Medline, Hinari, Web of Science, Science Direct, and Google Scholar were used using a search strategy. Observational studies (cross-sectional) revealing the prevalence and factors associated with intestinal parasitic infections at higher public University student's cafeterias and public food establishments were incorporated. Meta-analysis was computed using STATA version 14 statistical software. Heterogeneity of the study was assessed using Cochrane Q test statistics and I2 test. The pooled prevalence of the intestinal parasitic infection and associated factors among food handlers was calculated by the random-effect model.

RESULTS

Out of 138 reviewed studies, 18 studies were included to estimate the pooled prevalence of intestinal parasitic infections among food handlers in Ethiopia. All the eighteen articles were included in the analysis. This study revealed that the pooled prevalence of intestinal parasitic infections was 28.5% (95% CI: 27.4, 29.7). E. hystolitica /E. dispar complex 6.38 (95% Cl: 5.73, 7.04), A.lumbricodes 4.12 (95% Cl: 3.56, 4.67), and G. lamblia 3.12(95% Cl: 2.65, 3.60) were the most common intestinal parasitic infections in this study. Untrimmed fingernail 3.04 (95% CI: 2.19, 4.22), do not washing hands after defecation 2.71 (95% CI: 1.93, 3.82), do not washing hands after touching any body parts 2.41 (95% CI: 1.64, 3.56), do not made medical checkup 2.26 (95% CI: 1.57, 3.25), and do not receive food safety training 1.79 (95% CI: 1.30, 2.45) were factors significantly and positively associated with intestinal parasitic infections.

CONCLUSION

Parasitic infections among food handlers were significantly high. Untrimmed fingernail, do not washing hands after defecation, do not washing hands after touching any body parts, do not made regular medical checkup and do not receive food safety training were factors that increase the prevalence of intestinal parasitic infections.