Effects of health educational and participatory consumer group interventions in improving food handling practices in regional director of health services area Kalutara, Sri Lanka: non-randomized controlled community trial

INTRODUCTION

Safe and nutritious food is the key to sustaining life and promoting good health. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly, and the sick.

METHODS

The study consisted of two phases, a descriptive cross-sectional study, and an intervention study. Both studies were conducted in the Regional Director of Health Services area, Kalutara, Sri Lanka. The descriptive cross-sectional study [food handlers (n = 904), food establishments (n = 421)] was conducted with the objective of determining factors associated with food handling practices among food handlers and in food establishments. The interventional study was a three-arm non-randomized controlled community trial (n = 50 per arm) with interventions of a participatory consumer group, educational package group, and control group.

RESULTS

The food establishments assessment tool (FEAT) contained 11 domains including 75 items with more than a hundred assessment points with a guide to conduct an assessment of food handling. The descriptive cross-sectional study found that food handlers' knowledge of food handling practices of storing milk, fish, and meat and fast-food items containing fish and meat was very poor (96.6%). Visibility of the last place of processing inside the food establishments to consumers was inadequate (19.2%) and the absence of the above-mentioned factor was significantly associated with an unsatisfactory level of food handling score in food establishments (p = 0.03). The unsatisfactory level of food handling was significantly higher among food establishments with non-personal ownership (p = 0.005), a low number of notices issued by legal authorities (p = 0.02), dereliction of duty by owners/managers on supervising (p < 0.001) and lack of medical certification to food handlers (p < 0.0001). Participatory consumer group intervention and educational package interventions were effective in improving food handling practices in food establishments and among food handlers (p < 0.0001). Two independent sample analysis using the Mann-Whitney U test showed, the best improvement in food handling practices was by participatory consumer group intervention (p < 0.0001) and the second was educational package intervention (p < 0.0001).

CONCLUSIONS

Knowledge and practices of food handling among participants were poor. A participatory consumer group is more effective than an educational package on improving food handling practices both among food handlers and in food establishments.

Methods and measures in food service food safety research: A review of the published literature

Purpose

Food handlers working in food service establishments need to perform appropriate and consistent food safety practices to ensure that the prepared food is safe for consumers to eat, as a failure to do so may lead to foodborne illness. It is important to have an in-depth understanding of food handler food safety behaviour in the food service sector to design targeted educational interventions and approaches to safeguard consumers. The purpose of this review is to provide insight to the existing body of research regarding food handler food safety in the food service sector, and to identify future research needs in terms of methods and measures.

Methods

This study is a review of published food safety research studies (n = 118) focusing on food handlers in the food service sector conducted between 2001 and 2021. Data were collated regarding the methods used and the measures assessed in published studies to identify the gaps in current knowledge related to food safety in food service.

Findings

The majority of studies were conducted in the United States (29%), Brazil (17%) and United Kingdom (7%). A large proportion were carried out in restaurants (70%). Less than a third of studies (28%) relied on a mixed method approach for data collection; and only 12% of studies assessed a combination of cognitive and behavioural measures. Observation was used in only 29% of studies. A lack of observational data detailing food safety practices such as handwashing, temperature control, separation and cleaning was determined.

Significance

Such findings indicate a greater need for mixed method approach in future food safety research. It is recommended that the understanding of food handler food safety performance is best obtained through a combined assessment of cognitive and behavioural measures with subsequent triangulation of findings to reduce bias and to obtain reliable results.

Determinants of food safety knowledge and practices among food handlers in Bangladesh: An institution-based cross-sectional study

The engagement of a large number of people in big-scale cooking raises the danger of food contamination due to incorrect handling, whether deliberate or unintentional. Contamination during large-scale production poses a serious hazard to consumer health and has significant financial implications for a nation. This study aimed to investigate the food safety knowledge and practices of institutional food handlers in Bangladesh, considering the growing concern surrounding this issue and the lack of available information on foodborne illnesses related to institutions. In addition, the study aimed to determine the factors influencing both knowledge and practices. A cross-sectional study was conducted from June to September 2022, involving 408 institutional food handlers. The sample size was determined using Cochran's formula, and data was collected through purposive sampling. The participants were interviewed in person and completed a pilot-tested questionnaire. A multiple linear regression analysis was conducted to determine the factors related to food safety knowledge and practices. The majority of participants were female (71.3%) and aged between 26 and 35 (mean age 34.53 ± 9.06 years). They were most knowledgeable about hand hygiene and food separation but lacked knowledge about foodborne pathogens and food storage. Thawing food at room temperature was the most inappropriate practice (86%). The mean scores for knowledge and practice were found to be 16.11 ± 2.76 on a 26-point scale (61%), and 9.59 ± 2.07 on a 15-point scale (64%), respectively. Rural food handlers, those with higher education, working more than 10 h per day, and being familiar with HACCP, had higher knowledge. Food handlers aged 18 to 25, with higher income, working in private institutions, having food safety authority knowledge, actively engaging in food safety training, working more than 10 h per day, and having a positive health perception, had better food safety practices.The results of this study reinforce the notion that institutional food handlers would benefit from enhanced exposure to food safety interventions, active participation in training sessions, and strict adherence to food hygiene regulations in their food handling knowledge and practices.

Enteric Bacterial Infections, Antimicrobial Susceptibility Pattern, Intestinal Parasites, and Associated Factors Among Food Handlers in Yabelo Town, Borena Zone, Southern Ethiopia

Background

Foodborne illnesses are the main cause of morbidity and mortality in the twenty-first century, and food handlers are the main source of these illnesses.

Objective

The study aimed to assess the prevalence of intestinal parasites, enteric bacteria, antimicrobial susceptibility patterns, and associated factors among food handlers working in a food and drinking establishment in Yabelo town, Borena zone, Southern Ethiopia, in 2022.

Methods

A facility-based cross-sectional study design was employed to assess the food handler's state of health. Data were gathered using semistructured questionnaires and observational checklists, and 396 regular stool samples were collected. Samples were examined with microscopy and bacteriological culture to isolate enteric bacteria. Statistical Package for the Social Sciences, version 26 The factors that had a P-value of <.05 were considered statistically significant.

Result

Of the 396 stool samples collected, 164 (41.4%) were tested positive for intestinal parasites, while 40 (10.1%) were positive for enteric bacteria (Salmonella and Shigella). Among intestinal parasites, the most predominant parasite was Ascaris lumbricoides 48 (12.1%). All isolates of Salmonella and Shigella showed resistance to ampicillin. In multivariable analysis, not trimming fingernails regularly (AOR = 2.02, 95% CI 1.97-5.37), not washing hands with soap after the toilet (AOR = 3.02, 95% CI 2.37-5.62), and eating raw food (AOR = 2.1, 95% CI 1.79-6.51) have a significant association with the prevalence of bacteria and parasites.

Conclusion

The majority of food handlers had poor hygiene practices, and the prevalence of parasites and bacteria was high in the study setting. Educational status, eating raw vegetables or fruit, hand washing after the toilet, and fingernail trimming have associations with the health status of food handlers.

Food Safety Practices of Food Handlers in China and their Correlation with Self-reported Foodborne Illness

Food service facilities are important sites where foodborne diseases have been reported to occur frequently. This study aims to determine the correlation between self-reported foodborne diseases and food-safety practices followed by food handlers of various food service facilities. A cross-sectional survey was conducted from March 1, 2022 to December 30, 2022 in Wuhu City, Anhui Province, China. Data were collected through face-to-face interviews and having the selected food handlers fill in a self-compiled questionnaire. Of the 1072 food handlers included in the study, 88 (8.2%) reported having experienced symptoms of foodborne diseases in the past 4 weeks. The following food-safety practices correlated with self-reported foodborne diseases: (1) infrequently using 3-compartment sinks to separately clean different types of raw food materials (P < 0.05, OR = 2.312); (2) infrequently removing non-edible parts of aquatic products outside a specific room for food processing (P < 0.001, OR = 3.916); (3) infrequently immediately refrigerating cold dishes prepared in advance to be consumed later (P < 0.001, OR = 4.048); (4) often store perishable foods at 8-60°C in the indoor environment after cooking and before eating (P < 0.05, OR = 2.068); (5) infrequently reheating cooked perishable food stored at 8-60°C for more than 2 h before eating (P < 0.05, OR = 1.934); and (6) often storing raw and cooked food in the same container (P < 0.001, OR = 3.818). Hence, a better supervision of food-safety practices of catering workers may reduce the frequency of foodborne-disease outbreaks in food service facilities.

Evaluation of food quality and safety parameters and food safety knowledge and practices of food handlers at fast foods restaurants at universities in Jordan during COVID-19

The quality and the safety of the foods that are served at fast foods restaurants and their effect on the consumer health could become a matter of concern during COVID-19. Therefore, the objectives of this study were i) to evaluate the quality and safety of raw foods, suitability and availability of manufacturing places, physical facilities, drinking water and waste management system, and processing conditions, and ii) to assess the knowledge, attitudes, practices regarding food safety and hygienic practices among food handlers at fast foods restaurants in the different universities in Jordan during COVID-19. The study was conducted in 12 fast foods restaurants of 3 different universities in Jordan which are located in different places in Jordan. A desirable practice was given a score of one while no score will be allotted for an undesirable practice through using a standard questionnaire for all the food establishments. This was used to compare with the maximum score obtainable for that relevant operation and the percentage scores was calculated for each operation. Analysis of Variance (ANOVA) of the data was performed to study the significant differences at P ≤ 0.05 in all the evaluated properties among the food establishments in the different universities. The results showed that low percentage scores were obtained with 68%, 75%, 32% and 56% for the production area, waste management, product evaluation (chemical, microbial) and food safety program application, respectively. Also, it was found that there were insignificant differences at P ≤ 0.05 among different food serving establishments in different universities in all the safety properties. This means that all the food establishments in all the universities suffer from the same problems with the same degree. As a conclusion, more work should be done to produce safe food in the different food establishments that were studied in the different universities.

Factors associated with recent iodine intake level among household food handlers in Southwest Ethiopia: a cross-sectional study

BACKGROUND

Iodine deficiency is a global public health threat, affecting an estimated two billion people. The median urinary iodine concentration is more reliable in determining recent iodine intakes and the risks of iodine deficiency. Therefore, this study was aimed to identify the factors associated with recent iodine intake level using median urinary iodine concentration as an indicator among household food handlers in southwest Ethiopia.

METHODS

A community-based survey was conducted with selected households using a pretested interviewer-administered questionnaire in southwest Ethiopia. A 20-gram sample of table salt and a 5 ml causal urine samples were also collected and analyzed using rapid test kit and a Sandell-Kolthoff reaction, respectively. A salt iodine concentration above 15 ppm was classified as adequately iodized and a median urinary iodine concentration between 100 and 200µgl^- 1 was considered as adequate iodine intake. A bivariable and multivariable logistic regression model was fitted. Crude and adjusted odds ratios with their 95% confidence levels were reported. Associations with a p-value ≤ 0.05 were used to declare statistical significance.

RESULTS

A total of 478 women were included, with a mean age of 33.2 (± 8.4 years). Only 268 (56.1%) of the households had adequately iodized salt (> 15 ppm). The median urinary iodine concentration (interquartile range) was 87.5 µg l^- 1 (45.6-107.6). In a fitted multivariable logistic regression model (p-value = 0.911), illiterate women (AOR = 4.61; 95% CI: 2.17, 9.81), poorly iodized salt in the household (AOR = 25.0; 95% CI: 13-48), salt purchased from open market (AOR = 1.93; 95% CI: 1.0, 3.73) and women who do not read the label during purchasing the salt (AOR = 3.07; 95% CI: 1.31, 7.17) were important predictors of the risk of Iodine deficiency.

CONCLUSION

Despite public health efforts to improve iodine intake, its deficiency is still a major public health problem among southwest Ethiopian women.

Food hygiene knowledge and behaviour among domestic food handlers during COVID 19 pandemic in Bangladesh

The COVID-19 pandemic reshaped every aspect of life, including food safety. Understanding food safety behaviour at home is necessary for developing effective strategies to mitigate foodborne disease during and after this pandemic. This study administered a cross-sectional survey among 503 domestic food handlers to examine the food handlers' food safety concerns during the pandemic and pandemic-related knowledge and hygiene behaviour (PRKHB) in Bangladesh. The results found that only 35.8% of respondents in this study were more concerned about food safety because of the COVID-19 pandemic. Although the results found a good PRKHB among 95.8% of urban food handlers, overall, 62% showed a poor level of PRKHB. Only 38.8% reported washing their hands after returning home or preparing meals every time. The regression model found that food safety concerns positively related to the PRKHB, and participants who lived in rural areas had a negative association with the PRKHB. The study also explored sociodemographic variations and significant differences observed between urban and rural areas. Meticulous educational campaigns and targeted messages to the food handlers on food safety risks, food handling practices and hand hygiene are necessary to minimise the foodborne disease burden in this region.

COVID-19 knowledge, attitude, practices, and associated factors among Bangladeshi food handlers from various food industries

Background and objectives

It is believed that preventive safety measures are the most effective way to avoid the COVID-19. The adherence of workers to these measures is largely determined by their knowledge, attitude, and practices (KAP). Because they are in close proximity to consumable items, workers in the food industry must be especially vigilant during this period. The purpose of this present study was to evaluate the COVID-19 knowledge, attitudes, and practices of food handlers in different food industries of Bangladesh.

Study design

This was a cross-sectional study.

Methods

This included the participation of 400 food handlers from 15 food industries. The information was collected from the participants through a questionnaire prepared in Google form. Different nonparametric tests and a linear regression model were performed for statistical analysis.

Results

With a correct response rate of about 90% on average (knowledge 89.7%, attitude 93%, practices 88.2%), the participants showed an acceptable KAP (>80% correct response) regarding COVID-19. Education (p = 0.00) and working experiences (p = 0.01) had a significant association with the total KAP scores.

Conclusion

Food handlers in the food industries of Bangladesh have adequate knowledge, a positive attitude, and the desired practices regarding the COVID-19 issue.

Intestinal parasite infection and associated factors among food handlers in Feres Bet town, North West Amhara, Ethiopia, 2021

Introduction

Intestinal parasite infections are one of the most serious public health issues in the globe. Individuals' health is harmed by a high prevalence of intestinal parasite infections, which primarily affect physical and mental growth, resulting in malnutrition, anemia, stunting, cognitive impairment, reduced educational achievement, and inefficiency.

Objective

The aim of this study is to determine the prevalence of intestinal parasite infection and associated factors among food handlers in Feres Bet town, North West Amhara, Ethiopia, 2021.

Methods

From March to April 2021, a facility-based cross-sectionalstudy was undertaken in Feres Bet town among food handlers and drinking establishments. A total of 370 study participants were enrolled in the study utilizing a basic random sampling procedure. Epi data version 3.1 was used to enter the data, and statistical product service solution version 25 was used to clean and analyze it. To show the relationship between dependent and independent variables, a binary logistic regression statistical model was built. Adjested odd ratios with a 95% confidence interval and a p-value of less than 0.05 were declared statistically significant. Tables and graphs were used to convey the report.

Result

The study included 370 food handlers out of a total of 399. Approximately 166 (44.9%) of food workers tested positive for at least one intestinal parasite. Hand washing practice after toilet [(AOR: 6.25, 95% CI: 2.05-19.02)], hand washing practice after touching dirty materials [(AOR: 3.71, 95% CI: 1.72-8.03)], hand washing practice before meal (AOR = 12.49, 95% CI = 4.92-31.72), periodic medical checkup [(AOR = 3.42, 95% CI = 1.29-9.06)], were variables significantly associated with intestinal parasite.

Conclusions

The prevalence of intestinal parasite infection among food and drink handlers was found to be 44.9% in this investigation.

Hand hygiene product use by food employees in casual dining and quick-service restaurants

Hand hygiene product usage characteristics by food employees when hand sanitizers are made available are not well understood. To investigate hand hygiene product usage in casual dining and quick-service restaurants, we placed automated monitoring soap and sanitizer dispensers side-by-side at handwash sinks used by food employees in seven restaurants. Dispenses were monitored, and multiple dispenses that occurred within 60 s of each other were considered a single hand hygiene event. This resulted in 186,998 events during the study (149,779 soap only, 21 985 sanitizer only, and 15,234 regimen [defined as soap followed by sanitizer at the same sink within 60 s]) over 15,447 days of use. Soap was the most frequently used hand hygiene method by food employees in both restaurant types. Regimen use, despite being the preferred hand hygiene method by both restaurant chains, was the least used hand hygiene method. When pooled over restaurant types, the median daily usage for soap was statistically significantly highest of all methods at 23.5 dispenses per sink per day (p < 0.0001), the sanitizer median daily usage was 4.27 dispenses per sink per day, and regimen use was statistically significantly lowest of all methods at 4.02 dispenses per sink per day (p < 0.0001). When hand hygiene event types were pooled, casual dining restaurants had similar median hand hygiene event rates (11.4 dispenses per sink per day) compared to quick-service restaurants (11.9 dispenses per sink per day; p = 0.890). The number of events by sink location varied, with sinks located at a warewash station having the highest number of events (19.3 dispenses per sink per day; p < 0.0001), while sinks located by a ready-to-eat food preparation area had the lowest number of events (6.8 dispenses per sink per day; p < 0.0001). These data provide robust baseline benchmarks for future hand hygiene intervention studies in these settings.

Hygiene practices and factors influencing intestinal parasites among food handlers in the province of Belgarn, Saudi Arabia

Background

This study aimed to evaluate the association between socio-demographic status, and hygienic habits among food handlers with intestinal parasitic infections.

Methods

It was a cross-sectional study in which 112 participants were recruited, from Belgarn province of Saudi Arabia. The descriptive analysis was used to evaluate demographic data and categorical variables. The association between sociodemographic characteristics and Relative Risk regression analysis was performed for each investigated factor. p-value of <0.05, was assumed to be statistically significant.

Results

One hundred and twelve food handlers with a mean age of 33.5 ± 9.2 years were included in this study. The food handlers were from 15 different countries (11 Asians and four Africans). The majority of the food handlers were cooks (87, 77.7%), and waiters and dish washers (24, 21.4%). Among them, 106 (94.6%) used uniforms, and gloves at work. In hand washing practices, 104 (92.9%) wash their hands with soap before handling and preparing food and eight (7.1%) wash without soap, 98 (87.5%) wash with soap before meals and 14 (12.5%) wash without soap, 105 (93.8%) wash with soap after visiting toilets and seven (6.2%) wash without soap. Twenty-five (42.3%) of infected food handlers are not used to trim their fingernails. Intestinal infection was observed in 59 (52.68%) participants with mean age (32.5 ± 8.1 years) for infected participants.

Conclusion

In this study, food handlers had a high prevalence of intestinal parasites. Although some of the food handlers had a high level of education, the infection with intestinal parasites was detected. In addition to regular screening for intestinal parasites among food handlers, there is a need for educational programs on proper hygiene habits, modes of transmission and prevention of the infection.

Determinants of safe food handling practice among food handlers in food establishments, Yeka sub city, Addis Ababa, Ethiopia

Background

Poor food handling practice is a key cause of foodborne diseases notably in developing countries like Ethiopia. This study aimed to assess food safety knowledge, attitude and practice of food handlers, establishments' status and determinants of safe food handling practice.

Methods

The study utilized institution based cross-sectional study among food handlers working in Cafeterias, Restaurants and Hotels in Yeka sub city, Addis Ababa. A total of 284 food handlers: 69 from Cafeterias, 89 from Restaurants and 126 from non-stared Hotels were enrolled using stratified random sampling technique. Data were collected in observational checklist and through structured-questionnaire via face to face interview. A binary and multivariate logistic regression was used and adjusted for cofounders. A P-value of less than 0.05 was considered statistically significant.

Result

The present study has indicated 42.6% of food handlers had good food handling practice. Food handling practice in the establishments were significantly associated with sex, monthly income, availability of functional pipe water supply, availability of soap and/or detergents and presence of insects or rodents.

Conclusion

Food handlers in the study area were executing in a poor food handling practice, as most of them were not knowledgeable as needed. In fact, revising the salary of food handlers based on their work load could be valid, as there is existing worldwide economic inflation. Likewise enhancing pipe water availability in the food premises and dispatching sufficient soaps and detergents coupled with eradicating ubiquitous insects and rodents are key.

Food safety practice and its associated factors among food handlers in food establishments of Mettu and Bedelle towns, Southwest Ethiopia, 2022

BACKGROUND

Food safety and hygiene are currently a global health concern, especially in unindustrialized countries, as a result of increasing food-borne diseases (FBDs) and accompanying deaths. It has continued to be a critical problem for people, food companies, and food control officials in developed and developing nations.

OBJECTIVE

The objective of the study was to assess food safety practices and associated factors among food handlers in food establishments in Mettu and Bedelle towns, south-west Ethiopia, 2022.

METHODS

A community-based cross-sectional study was conducted from February to March 2022, among 450 randomly selected food handlers working in food and drink establishments in Mettu and Bedelle towns, Southwest Ethiopia. Data was collected using an interviewer-administered structured questionnaire. The data was coded and entered into Epi Data version 3.1 before being exported to SPSS version 20 for analysis. Both bivariate and multivariable logistic regression models were fitted. An adjusted odds ratio and a 95% confidence level were estimated to assess the significance of associations. A p-value of < 0.05 was considered sufficient to declare the statistical significance of variables in the final model.

RESULT

A total of 450 food handlers participated in the study, making the response rate 99.3%. About 202 (44.9%) of respondents had poor practices in food safety. Lack of supervision (AOR = 6.2, 95% CI: 3.37, 11.39), absence of regular medical checkups (AOR = 1.98; 95% CI: 1.14, 3.43), lack of knowledge of food safety practices (AOR =2.32; 95% CI: 1.38, 3.89), availability of water storage equipment (AOR =0.37; CI: 0.21, 0.64), and unavailability of a refrigerator (AOR =0.24; 95% CI: 0.12) were factors significantly associated with food safety practices.

CONCLUSION

The level of poor food safety practices was remarkably high. Knowledge of food safety, medical checkups, service year as food handler, availability of water storage equipment, availability of refrigerator, and sanitary supervision were all significantly associated with food safety practice. Hence, great efforts are needed to improve food safety practices, and awareness should be created for food handlers on food safety.

Prevalence, type of infections and comparative analysis of detection techniques of intestinal parasites in the province of Belgarn, Saudi Arabia

Background

The study was conducted to observe the prevalence and type of infection caused by intestinal parasites and to compare the techniques that are available for the detection.

Method

A total of 112 stool samples were obtained from study participants, and the laboratory examinations were performed at Special Infectious Agents Unit, King Abdulaziz University, Jeddah. One hundred and twelve participants were included in this study.

Result

The color of positive specimens was mainly brown (86.4%). Stool consistency in infected cases was soft in (64%) samples. There was no statistically significant difference with the physical characteristics of the stool (P > 0.05). In total, 59 of the 112 participants were infected with intestinal parasites, representing 52.7%. Different intestinal protozoa parasites were identified in which Blastocystis hominis (86.4%) was highest. None of the intestinal helminths were detected. Out of the 59 infected cases, single infections were found in (62.7%) samples. The intestinal protozoan parasites in single infections were B. hominis (78.4%), Giardia lamblia (8.1%), and (2.7%) from each Entamoeba histolytica, Cryptosporidium parvum, Entamoeba coli, Endolimax nana, and Chilomastix mesnili. Microscopy, RDTs, and real-time PCR were used for detection and identification of G. lamblia, E. histolytica, and C. parvum.

Conclusion

The study reported a high rate of intestinal parasitic infections, mainly with B. hominis. There were no statistical differences in parasite detection between the three techniques in detection of the thirteen cases infected with the pathogenic protozoa.

A scoping review protocol on food handlers' knowledge, attitude, and practices towards food hygiene and safety in low and middle-income countries

BACKGROUND

Food safety and hygiene has emerged as the foremost cause of concern in recent time, especially post-pandemic and has changed the eating out behaviour of the consumers. Consumers often consider food safety and hygiene as one of the most prominent factors and hence it is important for food handlers to have adequate knowledge and the right attitude towards food safety and food hygiene. The review will summarise the evidence on food handlers' behaviours towards food safety and hygiene and associated factors that inhibit positive behaviour towards following food safety protocols and standards.

METHODS

 This scoping review protocol is guided by updated methodology from Joanna Briggs Institute (JBI). The search will be conducted on Medline (PubMed), Scopus and Web of Science. Google Scholar will be used to locate pertinent grey literature. A citation search will also be employed for identifying additional relevant studies. Quantitative and qualitative studies published from 2011- present will be included. Two reviewers will independently screen and extract the data. A third reviewer will be involved in resolving disagreements between reviewers. A two-stage screening including title/abstract and full-text will be conducted. Data extraction will be done using a pilot-tested data extraction form. The data extracted from included studies will be organised and presented using narrative synthesis. The review will also attempt to identify the unaddressed gaps in the literature with the available evidence.

ETHICS AND DISSEMINATION

An ethical clearance is not required for this scoping review as findings from existing published literature will be summarised. The review findings will be disseminated through conference presentations and journal publications.

Food handling practice and associated factors among food handlers in public food establishments of Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Food handlers are individuals who are involved in food preparation, storage or service of food in a food facility. Unless they keep their personal hygiene, they are highly responsible for contaminating food or transmitting microbes to consumers. Thus, the main aim of this review was to pool the level of good food handling practice among food handlers working in public food establishments in Ethiopia.

DESIGN

A systematic review and meta-analysis using the Joanna Briggs Institute (JBI) Critical Appraisal tool.

DATA SOURCES

PubMed, Google Scholar and Advanced Google were searched up to the end of February 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Publication status, publication language, type of study participants and the type of article were used to screen the article.

DATA EXTRACTION AND STUDY QUALITY ASSESSMENT

All reviewers collected data independently and merged them together. A tool called the JBI Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of each research article. The assessment was performed by two reviewers.

RESULT

A total of 16 research articles were included in the review. The pooled level of good food handling practice was 50.72% with 95% CI (43.84% to 57.6%). Training (adjusted OR (AOR)=3.4, 95% CI (2.33 to 4.95)), attitude (AOR=3.62, 95% CI (2.23 to 5.85)) and medical check-up (AOR=5.12, 95% CI (2.93 to 8.95)) were identified as factors affecting good food handling practice with 95% CI at p<0.05.

CONCLUSION

The level of good food handling practice among food handlers working in public food establishments of Ethiopia was very low compared with literature, and variables such as food handler training, attitude towards good food handling practice and the existence of regular medical check-ups were factors affecting good food handling practice. Provision of training that could change the attitude and regular medical check-ups for food handlers has to be in place.

Personal hygiene and bowls sanitation of meatball cart traders

OBJECTIVE

The purpose of this study is to describe the personal hygiene and sanitation of food cutlery (bowl) on meatball cart traders at Makassar City.

METHODS

This research using descriptive observational with non-probability sampling techniques and accidental sampling method.

RESULTS

80% respondents had good personal hygiene. Almost all respondents qualify the requirement of hand and finger hygiene, as well as hair hygiene. For clothes hygiene indicators, most qualify the requirements. As for the indicators of handwashing practices and the use of gloves, all respondents did not qualify the requirements. While the results of research related to food cutlery sanitation showed that knowledge that 86.7% were high, but many still did not know washing water requirements and bowl conditions when in storage.

CONCLUSION

Most handlers attitude was categorized as adequate. It is suggested that the meatball cart traders always pay attention to hand hygiene and sanitation of cutlery to avoid bacterial contamination.

Cross sectional study on food safety knowledge, attitudes, and practices of food handlers in Lahore district, Pakistan

Annually, millions of the people suffer from foodborne diseases which are mainly associated with poor food handling practices. The poor food safety knowledge and practices increase the risk of food contamination and foodborne diseases. The aim of this study was to evaluate the relationship between demographic attributes and food safety knowledge, attitudes, and practices (KAP) of food handlers (chefs and servers) working in small-scale restaurants, hotels and eateries in Lahore, Pakistan. A structured questionnaire including questions related to demographic characteristics and food safety KAP attributes of food handlers (n = 202) was used to collect the responses. The responses of food handlers were statistically analyzed using Spearman Correlation and Chi-Square tests. The results showed that a large proportion of food handlers had good attitudes towards food safety and followed good food safety practices (FSP) but had poor food safety knowledge (FSK). Demographic characteristics of food handlers i.e. level of education, professional category, current job tenure, and total food service industry experience were significantly (p < 0.05) associated with FSK, FSA, and FSP. FSK was found to be moderate to strongly correlated with FSP of food handlers (rs = 0.675), whereas FSA was found to be strongly correlated with FSP (rs = 0.733). The study highlighted the importance and impact of food safety knowledge on food safety practices and overall perspective of food handlers working in restaurants.

Food safety knowledge, attitudes, and practices of food handlers at kitchen premises in the Port 'X' area, North Jakarta, Indonesia 2018

Improper food handling can be a major cause of food contamination. To prevent food contamination, the food handler should have good knowledge, display a positive attitude, and practice proper food handling practices. This study aimed to evaluate the food safety and personal hygiene knowledge, attitudes, and practices of food handlers at kitchen premises in the Port ‘X’ area in North Jakarta, Indonesia. This study uses a cross-sectional design. The research was conducted in April 2018 and May 2018. Data were collected from 72 food handlers from kitchens located in the Port ‘X’ area in North Jakarta. Data collection was performed through interviews and observations, using questionnaires and checklists as research instruments. The results show a significant correlation between the level of knowledge about food safety and the attitude of food handlers (p=0.01), and attitude scores were significantly higher among food handlers who reported attending a previous food safety training course (p=0.002) with (r=0.302) it means a weak uphill (positive) linear relationship attitude scores and training that food handlers attended. This study found a significant relationship between the knowledge and attitude of food handlers, but there was no significant relationship between knowledge or attitude and food handling practices. Thus, it is recommended that training activities for food handlers be held regularly, as the food safety knowledge obtained from training or courses can translate into the improvement of attitudes and food handling practices.

Food handling practices and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia

INTRODUCTION

foodborne disease (FBD) is a major public health problem globally. Inadequate food workers' knowledge, attitude, and low level of food handling practices (FHPs) may all contribute to the possibility of FBD outbreaks in public food service establishments. This study aimed to assess FHPs and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia.

METHODS

an institutional-based cross-sectional study was conducted from 01 to 29, January 2017. A total of 288 food handlers were recruited through a simple random selection method. A structured interviewer-administered questionnaire and observation checklists were used to collect the respondents' socio-demographic characteristics, knowledge status on FHPs, and food handling working practices data. Descriptive statistics, bivariate and multivariate logistic regression analysis were employed using SPSS version 20 software. Those variables with a p< 0.05 were considered statistically significant.

RESULTS

out of 288 participants, 91.7% were female, and 82.3% were single, while 69.8% were literate. One hundred eighty-four (63.9%) of them were under 15-25 years of age, with a median age of 23.3 years. The proportion of good FHP was (n=134, 46.5%) (95% CI: 41.00-52.4%). Advanced age (adjusted odds ratio (AOR) =12.01, 95% CI: 1.96-73.52), education (participants who attend grades 7-12 (AOR=2.33, 95% CI: 1.14-4.79), and above secondary education (AOR=2.29, 95% CI: 1.05-4.61), work experience above six years (AOR=2.43, 95% CI: 2.08-3.17), received formal training (AOR=1.79, 95% CI: 1.68-4.71), and inspection visits by a concerned body (AOR=2.24, 95% CI: 1.05-3.09) were factors positively associated with handling practices.

CONCLUSION

the study revealed that FHP in the study area was low. Age, education, service year, training received and sanitary inspection visits by the regulatory personnel were factors significantly associated with FHPs. This finding highlights the importance of employing regular sanitary inspection visits to public food service establishments by the concerned authority to ensure that all food handlers have the knowledge and the skill to provide safe food.

Monitoring antibiotic resistance profiles of faecal isolates of Enterobacteriaceae and the prevalence of carbapenem-resistant isolates among food handlers in Kuwait

OBJECTIVES

Carbapenem-resistant Enterobacteriaceae (CRE) have become one of the most challenging problems in infectious diseases worldwide. Unrecognised personnel such as food handlers (FHs) colonised with CRE serve as a reservoir for transmission. This study assessed the prevalence and susceptibility patterns of CRE isolates from FHs working in commercial eateries in the community (CFHs) and healthcare settings (HCFHs) in Kuwait over the period 2016-2018.

METHODS

Representative colonies from faecal samples were identified by API 20E and a VITEK®2 ID System. Susceptibility testing against 21 antibiotics was performed by Etest and agar dilution.

RESULTS

A total of 681 isolates of the family Enterobacteriaceae were isolated from 405 FHs, of which 425 (62.4%) were Escherichia coli and 126 (18.5%) were Klebsiella pneumoniae. The prevalence of CRE among FHs was 7.7% (31/405), comprising 32% CFHs (10/31) and 68% HCFHs (21/31). Ampicillin, tetracycline and cefalotin showed very poor activities against most isolates with resistance rates of 63.3%, 41.7% and 40.8%, respectively. The prevalence of multidrug-resistant (MDR) isolates was 30.5%, including 130 E. coli (30.6%) and 22 K. pneumoniae (17.5%). An alarming level of colistin resistance (11.3%) was noted. A significant proportion of FH isolates (13.2%) exhibited extended-spectrum β-lactamases (ESBL) phenotypes, including 80 E. coli (18.8%) and 5 K. pneumoniae (4.0%).

CONCLUSION

This study revealed that asymptomatic intestinal carriage of CRE, including MDR and ESBL isolates, was relatively common in our community. It is conceivable that FHs may pose a significant risk to consumers for the acquisition and spread of resistant strains.

Bacterial contamination of Nigerian currency notes: A comparative analysis of different denominations recovered from local food vendors

Microbial transmission, on the surface of any currency note, can either be through direct (hand-to-hand contact) or indirect (food or other inanimate objects) means. To ascertain the degree of bacterial load enumerated during the handling of money and food items, particularly on currency note by denominations, should be of public health importance. Despite the available literature regarding microbial contamination of Nigerian currency notes, there is still paucity of information about how microbial contamination/load differ across the denominations specific to different food vendors. In this context, therefore, the current study investigated bacterial contamination of Nigerian currency notes via a comparative study of different denominations (₦1,000, ₦500, ₦200, ₦100, ₦50, ₦20, and 10, and ₦5) recovered from local food vendors. Specifically, the different food handlers/vendors included fruit, meat, vegetable, fish, and grain/cereal sellers. All emergent data from 8 × 5 factorial design of experiment were of duplicate measurements. To consider the currency denominations and food vendor type, a one-factor-at-a-time analysis of variance (ANOVA) was conducted. Results showed that about 81.7% of currency notes were contaminated with either Escherichia coli, Klebsiella spp. or Staphylococcus spp. in varying degrees. The higher denominations of ₦500, ₦200, and ₦100 note, with the exception of ₦1,000 note, recorded increased degree of contamination over the lower denominations of ₦50, ₦20, ₦10, and ₦5 note. Based on the total viable count (TVC), the ₦100 currency note appeared the most contaminated (1.32 × 10⁵ cfu/ml) whereas ₦5 note appeared the least contaminated (1.46 × 10⁴ cfu/ml). The frequency of isolated bacteria on currency notes from vegetable, meat, and fish sellers were significantly higher (p < 0.05) compared to other food vendors. The degree of bacterial contamination of the current work appears chiefly dependent on the food vendor type and currency denomination(s). This work calls for increased awareness and education among food vendors and ready-to-eat food sellers. Doing this would help mitigate the possible cross-contamination between currency notes and foodstuff. Through this, consumers would know more about the potential health risks such simultaneous activities (of handling currency notes and foodstuff) do pose on food safety.

Prevalence and factors associated with intestinal parasites among food handlers in Medebay Zana District, north West Tigray, northern Ethiopia

INTRODUCTION

Intestinal parasites are amongst the major public health challenges facing Sub-Saharan Africa. The aim of the study was to determine the prevalence of intestinal parasites and its associated factors among food handlers in Medebay Zana District, Tigray, Ethiopia.

METHODS

A cross-sectional study was conducted among 401 food handler individuals selected by systematic random sampling. Binary and multivariable logistic regression was used to determine the possible association between the independent variable and outcome variables. Statistical significance was declared at p-value < 0.05 with a 95% confidence interval.

RESULT

The prevalence of intestinal parasites was 33.2% within this sample. The dominant parasite was Entamoeba coli 50(37.4%), followed by Entamoeba histolytica/dispar 24(18%), Entamoeba hartmanni 18(13.5), Giardia lamblia 17(12.8%), Schistosoma mansoni 8(6%), Hymenolepis nana 7(5.3%), Entervious vermicularies 6(4.5%) and Taenia species 3(2.5%).

CONCLUSION

This study revealed a high prevalence of intestinal parasites among food handlers for a range of intestinal parasites. The significant predictors were the source of water, washing hands before food preparation, washing hands with soap and water after visiting the toilet, shower installation at the workplace, washing the body regularly and eating raw vegetables and raw meat. Hence, local health planners should implement appropriate interventional measures for the novel risk factors to mitigate the problem.

Molecular detection and characterization of norovirus in asymptomatic food handlers in Chiang Mai, Thailand

Norovirus (NoV) is the leading cause of nonbacterial foodborne outbreaks of gastroenteritis. Individuals who are asymptomatically infected may act as reservoirs to facilitate transmission of NoV. This retrospective study was conducted to identify the viral agent and investigate potential transmission of NoV infection in a foreigner patient who had severe acute gastroenteritis after having a meal in a restaurant in Chiang Mai province, Thailand. The fecal specimens collected from the patient and 26 restaurant staffs were tested for the presence of gastroenteritis viruses by PCR and RT-PCR. The NoV positive cases were confirmed by real-time PCR and IC kits. The sensitivity of detection of IC kit B, as compared to those of real-time PCR, could detect the viral load down to at least 2.1 × 10⁴ copies/g of stool. The diarrheic patient was infected solely with GII.3 NoV without co-infection with any other gastroenteritis viruses while 4 staffs (15.4%) were positive for different NoV strains (3 with GII.4 and 1 with GII.17) and all were asymptomatic. Interestingly, the GII.3 NoV strain detected in fecal sample of the patient was closely related to GII.3 NoV strains detected previously in fecal samples of children hospitalized with acute diarrhea in Chiang Mai, in the same year and the same geographical area where the patient was infected, suggesting the circulation and transmission of GII.3 NoV in this area. In conclusion, our data indicated that the patient was infected with GII.3 NoV and the virus was not directly transmitted to the patient by asymptomatic food handlers instead it might be transmitted by consumption of NoV-contaminated food provided by the restaurant. In addition, the existence of NoV in asymptomatic food handlers could be a potential source of NoV transmission. Therefore, strict adherence to hand hygiene practices should be reinforced to prevent foodborne outbreaks.

Intestinal parasites among food handlers in Iran: A systematic review and meta-analysis

Regarding preparing and serving foods, food handlers have an influential role in the spreading of foodborne infections. Due to the great potential to cause foodborne infections, intestinal parasites (IPs) are considered a significant public health problem in today's societies. In Iran, despite several regional reports, national data on IPs prevalence in food handlers are lacking. The aim of the present study, therefore, is to estimate the pooled prevalence of IPs infections and associated pooled odds ratio of educational level among food handlers in Iran. PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and SID and Magiran databases (national) were systematically searched for studies that reporting the prevalence of IPs in food handlers in Iran, published between 2000 and 2020. Pooled prevalence was estimated using a random-effects model with a 95% confidence interval (CI) and depicted as a forest plot, while heterogeneity was evaluated using Cochran's Q-test. The overall pooled prevalence estimate for IPs was 19.3% (95% CI = 14.9-23.7%). Prevalence of the protozoan parasites (20%, 95% CI = 13.7-26.3%) was significantly higher than that of the helminthic parasites (1.6%, 95% CI = 1.1-2.0%). Giardia lamblia (5.2%), Entamoeba coli (5.0%), and Blastocystis spp. (4.4%), as protozoan parasites, and Ascaris lumbricoides (1.4%), Enterobius vermicularis (0.9%), and Hymenolepis nana (0.5%), as helminthic parasites, were the most commonly reported species. Food handlers with low educational levels were 20% more exposed to IPs infection, compared to those with high educational levels (OR = 1.21, 95% CI = 0.88 to 1.65). The prevalence of IPs infections among food handlers in Iran is significant. Besides taking into account this epidemiologic information, a holistic approach, including periodic stool screening, health education, and treatment of infected food handlers, will help in the control of these infections in Iran.

Assessment of food safety knowledge, attitudes and practices of fish farmers and restaurants food handlers in Bangladesh

The study was conducted to assess the present status of knowledge, attitudes and practices (KAP) concerning the food safety and hygiene issues among fish farmers and food handlers in Noakhali, Bangladesh. Data were collected from 100 respondents (50 fish farmers and 50 food handlers) through face to face interviews. All the respondents agreed that training on hygiene practices was necessary and they were interested to attend training in their spare time. Food handlers (88%) agreed that raw foods must be kept separate from prepared foods and 68% of them believed that improper preservation of foods is harmful to health. About 52% of farmers used a face mask when spreading insecticides, fertilizers, and chemicals. Food handlers were wearing protective clothing (32%) and masks (12%) when touching and distributing unwrapped foods, however no handlers used a cap. A significant strong correlation coefficient (rs) was found between knowledge with attitudes, knowledge with practices and attitudes with practices of 0.73-0.99 among the three domains for fish farmers and food handlers. The correlation among the three levels was satisfactory, however, some food safety concepts and practices regarding hygiene were still insufficient. Therefore, an effective and appropriate training program on food safety and hygiene should be launched in a holistic approach for all fish farmers and food handlers to increase awareness and ensure safe food for consumers with a view to reducing the possibility of disease outbreak.

Evaluation of food safety knowledge, attitude, and self-reported practices of trained and newly recruited untrained workers of two baking industries in Dhaka, Bangladesh

In Bangladesh, with the mounting esteem of bakery products, food safety issues in bakery industries are a paramount concern nowadays. In this regard, this current study was performed to evaluate food safety knowledge, attitude, and self-reported practices of two groups (160 trained and 55 new untrained) of workers from two popular baking industries in Dhaka, Bangladesh. A self-administrated questionnaire was used to acquire the data during the study. On food safety knowledge, attitude, and self-reported practices, trained workers' scores (33.01 ± 0.09, 14.86 ± 0.03, 10.66 ± 0.25, respectively) were significantly higher than the scores (9.82 ± 0.23, 10.44 ± 0.26, 5.91 ± 0.33, respectively) of newly appointed untrained workers. The quality assurance department displayed better knowledge, attitude, and self-reported practices scores than the rest of the departments of the industries. However, compared to knowledge and attitude, the self-reported practice was not up to a satisfactory level. According to the study, training can be proved effective for improving knowledge and attitude but does not always translate those into self-reported practice and behaviors. The results also reinforce the importance of conducting training for untrained workers and suggest further behavior-based food safety training for all employees.

Prevalence, antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella among food handlers in Adigrat University student's cafeteria, northern Ethiopia, 2018

BACKGROUND

Food handlers play a significant role in the transmission of foodborne infections. Salmonella and Shigella are the most common foodborne pathogens and their infections are a major public health problem globally. Thus, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of Salmonella and Shigella colonization among food handlers.

METHODOLOGY

A cross-sectional study was conducted from March to August 2018 at Adigrat University student cafeteria, Northern Ethiopia. Data on socio-demographic and associated factors were collected using a structured questionnaire. Fresh stool samples were collected from 301 food handlers and transported to Adigrat University Microbiology Laboratory. Bacterial isolation and antimicrobial susceptibility test were performed using standard bacteriological methods. Data analysis was performed using SPSS version 22 and P < 0.05 where a corresponding 95% confidence interval was considered statistically significant.

RESULTS

A total of 301 food handlers were included in this study. The majority of study participants were females 265 (88.0%). About 22 (7.3%) and 11 (3.7%) of food handlers were found to be positive for Salmonella and Shigella respectively. Hand washing after using a bathroom with water only, no hand washing after using the bathroom, no hand washing after touching dirty materials, no hand washing before food handling, and untrimmed fingernails were significant associated factors identified. None of the Salmonella and Shigella isolates were sensitive to ampicillin, yet low resistance against chloramphenicol, ceftriaxone, and ciprofloxacin was found.

CONCLUSION

The present study revealed that the prevalence of Salmonella and Shigella among food handlers was 22 (7.3%) and 11 (3.7%) respectively. Such colonized food handlers can contaminate food, and drinks and could serve as a source of infection to consumers. This indicates that there is a need for strengthened infection control measures to prevent Salmonella and Shigella transmission in the students' cafeteria.

Work Conditions, Social Incorporations, and Foodborne Diseases Risk: Reflections About the (Non)Compliance of Food Safety Practices

The number of foodborne diseases has increased in all continents, and efforts must be made to control this urgent and expressive public health problem. This article aims to present and discuss situations related to the compliance and noncompliance of food safety practices (FSPs) in light of Bourdieu's social theory. This qualitative study was conducted in commercial restaurants in two cities in São Paulo, Brazil. Participant observation was used in the restaurants, and notes referring to the kitchen workers and their bosses' work processes were registered in field journals. Thematic type content analysis was used to determine the meaning cores of field journals. It was found that aspects inherent to convenience and haste at work, deficient infrastructure, lack of employees, negative boss examples, exposure to noise, and body pain experienced by workers can contribute to noncompliance of FSPs and consolidate in the habitus and practical sense some dispositions that can increase the risk of foodborne diseases. This study highlights the necessity of creating environments that address food safety, which means being able to perform a service properly.

Norovirus infections and knowledge, attitudes and practices in food safety among food handlers in an informal urban settlement, Kenya 2017

Introduction

A leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers but norovirus outbreaks are not routinely investigated in Kenya. We estimated norovirus prevalence and associated factors among food handlers in an informal urban settlement in Nairobi, Kenya.

Methods

We conducted a cross-sectional survey among food handlers using pretested questionnaires and collected stool specimens from food handlers which were analyzed for norovirus by conventional PCR. We observed practices that allow norovirus transmission and surveyed respondents on knowledge, attitudes, and practices in food safety. We calculated odd ratios (OR) with 95% confidence intervals (CI) to identify factors associated with norovirus infection. Variables with p < 0.05 were included in multivariate logistic regression analysis to calculate adjusted OR and 95% CI.

Results

Of samples from 283 respondents, 43 (15.2%) tested positive for norovirus. Factors associated with norovirus detection were: reporting diarrhea and vomiting within the previous month (AOR = 5.7, 95% CI = 1.2–27.4), not knowing aerosols from infected persons can contaminate food (AOR = 6.5, 95% CI = 1.1–37.5), not knowing that a dirty chopping board can contaminate food (AOR = 26.1, 95% CI = 1.6–416.7), observing respondents touching food bare-handed (AOR = 3.7, 95% CI = 1.5–11.1), and working in premises without hand washing services (AOR = 20, 95% CI = 3.4–100.0).

Conclusion

The norovirus infection was prevalent amongst food handlers and factors associated with infection were based on knowledge and practices of food hygiene. We recommend increased hygiene training and introduce more routine inclusion of norovirus testing in outbreaks in Kenya.

The role of Optimistic Bias in safe food handling behaviours in the food service sector

This study evaluates the influences on food handlers' intention to conduct safe handling behaviours in food service settings in Brazil and the United Kingdom, focusing on Optimistic bias (OB). Although OB has been identified in food handlers in other studies, this is the first study evaluating the role of OB in determining behavioural intention. Three hundred participants, from the United Kingdom (n = 150) and Brazil (n = 150), completed a Theory of Planned Behaviour - based questionnaire, including additional questions about OB. For Brazilian food handlers, Attitude had a significant influence on Behavioural Intention followed by Subjective Norm, while Perceived Behavioural Control and OB did not significantly influence Behavioural Intention. For the United Kingdom, Perceived Behavioural Control had the largest influence, followed by Attitude, and then OB. Results suggest that cultural differences may influence predictors of behavioural intention, and that OB can contribute to predicting engagement in safe handling behaviours. Results contribute to a better understanding of the influences on food safety related behaviours.

Intestinal parasites among food handlers of food service establishments in Ethiopia: a systematic review and meta-analysis

Background

Intestinal parasites remain considerable public health problems in low-income countries where poor food hygiene practice is common. Food handlers, people involved in preparing and serving food, working with poor personal hygiene could pose a potential threat of spreading intestinal parasites to the public in a community. The aim of this systematic review and meta-analysis was, therefore, to synthesize the pooled prevalence estimate of intestinal parasites and associated pooled odds ratio of hygienic predictors among food handlers of food service establishments in Ethiopia that could aid to further bringing down the burden of intestinal parasites and it can also be used as a springboard for future studies.

Methods

We searched exhaustively for studies Published before 20 April 2019 using eight Databases; PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE® complemented by the gray literature search. In the final synthesis, we included twenty study reports. We used the Cochrane Q test and I² test to assess heterogeneity of studies, while we employed a funnel plot followed by Egger’s regression asymmetry test and Begg rank correlation methods to evaluate publication bias. We also performed a point estimates and 95% confidence interval for each study using STATA version 14 statistical software.

Results

The overall pooled prevalence estimate of intestinal parasites among food handlers of food service establishments in Ethiopia was 33.6% (95%CI: 27.6–39.6%). Among ten intestinal parasites identified from food handlers, Entamoeba histolytica/ dispar (11, 95%CI: 7.9–14.1%) and Ascaris lumbricoides (8.8, 95%CI: 6.4–11.2%) were the most predominant intestinal parasites. Food handlers who washed hands after toilet use had 54% (OR, 0.46, 95% CI: 0.23–0.94) protection from intestinal parasites compared to those who did not.

Conclusions

This study revealed that intestinal parasitic infections are notable among food handlers of food service establishments in Ethiopia, which may be a risk for transmitting intestinal parasites to food and drinks consumers through the food chain. Thus, periodic stool checkup, training on intestinal parasitic infections and personal hygiene should be applied to reduce public health and socio-economic impacts of parasitic infections.

Food Safety Performance in Food Manufacturing Facilities: The Influence of Management Practices on Food Handler Commitment

The purpose of the study was to investigate the influence of management practices on food handler commitment and, ultimately, food safety performance in food manufacturing facilities. Two focus groups, one with six food handlers and the other with six food safety professionals, were used to develop a conceptual model that measured the effect of management practices on food handler commitment and organizational performance. The fitness of the structural model was measured via a survey with 945 respondents from 189 food manufacturing facilities and official food inspectors in the Emirate of Dubai, United Arab Emirates. The study found that training, communication, employee involvement, and organizational management support positively and significantly influenced employee commitment, and employee commitment positively and significantly influenced facilities' food safety performance. These results indicate food handler commitment is a critical factor in the relationship between all of the studied management practices and facilities' food safety performance. The study may have implications for food safety inspectors, enforcement officers, training agencies, and food manufacturing managements to consider human aspects in their work.

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

Objectives

The main aim of this study was to assess the Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia. Institutional based cross-sectional study was conducted among 256 study participants in Woldia university student’s cafeteria, Northern Ethiopia. Systematic random sampling method was used to select the study participants. Data was collected using a standardized questionnaire by direct interviewing of study participants. Logistic regression was carried out to identify factors associated with intestinal parasitic infections.

Results

A total of 256 food handlers were enrolled making the overall magnitude of the intestinal parasite which was stool specimens positive for different diagnostic stages of parasites was found to be 43 (16.8%). Entamoeba histolytica/dispar was the most prevalent parasites 14 (5.5%), followed by Giardia lamblia 10 (3.9%). Lack of food safety training (AOR = 6.58; 95% CI 2.46–17.62), no regular medical checkup (AOR = 2.41; 95% CI 1.47–4.24), no handwashing practice after toilet by soap (AOR = 3.24; 95% CI 1.28–8.19), no handwashing practice before eating by soap (AOR = 4.03; 95% CI 1.64–9.91) and haven’t food preparation license (AOR = 6.13; 95% CI 2.18–17.22) were significantly associated with parasitic infection among food handlers.

Prevalence and antimicrobial susceptibility profile of Salmonella and Shigella among food handlers working in food establishment at Hawassa city, Southern Ethiopia

OBJECTIVE

The aim of this study was to determine the prevalence of Salmonella and Shigella, antibiotic susceptibility profile and associated factors among food handlers working in food establishment from June to December 2018 at Hawassa city, Southern Ethiopia.

RESULTS

Out of the 236 food handlers screened for stool culture, 5 (2.12%) were positive for Salmonella species and all of them were negative for Shigella species. All Salmonella species isolated were susceptible to ciprofloxacin and ceftriaxone but among the five isolated Salmonella species, 4 (80%), 3 (60%), 2 (40%), 2 (40%), and 2 (40%) were resistant to tetracycline, ampicillin, amoxicillin-clavulanic acid, cotrimoxazole, and chloramphenicol respectively. Only food handlers hand washing the habit after toilet had a significant association with the prevalence of Salmonella species (P = 0.03).

Factors associated with food safety practices among food handlers: facility-based cross-sectional study

Objective

The primary objective of this study was to assess factors associated with food safety practices among food handlers in Gondar city food and drinking establishments. The facility-based cross-sectional study was undertaken from March 3 to May 28, 2018, in Gondar city. Simple random sampling method was used to select both establishments and the food handlers. The data were collected through face-to-face interview using pre-tested Amharic version of the questionnaire. Data were entered and coded into Epi info version 7.0.0 and exported to SPSS version 22 for analysis.

Results

One hundred and eighty-eight (49.0%) had good food handling practice out of three hundred and eighty-four food handlers. Marital status (AOR: 0.36, 95% CI 0.05, 0.85), safety training (AOR: 4.01, 95% CI 2.71, 9.77), supervision by health professionals (AOR: 4.10, 95% CI 1.71, 9.77), routine medical checkup (AOR: 8.80, 95% CI 5.04, 15.36), and mean knowledge (AOR: 2.92, 95% CI 1.38, 4.12) were the factors significantly associated with food handling practices. The owners, managers and local health professionals should work on food safety practices improvement.

Effectiveness of Food Handler Training and Education Interventions: A Systematic Review and Meta-Analysis

Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings. We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment. We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I² = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases. Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.

Magnitude of enteropathogens and associated factors among apparently healthy food handlers at Wolkite University Student's Cafeteria, Southern Ethiopia

Objective

The study aimed to assess enteropathogens carriage rate and risk factors among apparently healthy food handlers at Wolkite University cafeteria, Southern Ethiopia.

Results

Cross-sectional study was conducted among 170 food handlers to collect socio-demographic and related data by using structured questionnaires. Stool samples were collected and subjected to microscopic examination and cultured to determine intestinal parasites. Among the total study participants, 66% of them were found to be carriers of enteropathogens: bacteria (Salmonella typhi, Shigella species), and intestinal parasites (Ascaris lumbricoides,Taenia species, Giardia lamblia, Entameoba histolytica/dispar, Enterobius vermicularis, Hook worm and Trichuris trichiura). All Salmonella and Shigella isolates were sensitive to ceftriaxone, ciprofloxacin, and gentamicin. A significant association was found between hand washing practice before food preparation and isolated pathogens [p = 0.013]. A significant proportion of food handlers were found to be carriers of pathogens which require a periodic screening and antibiotic therapy monitoring.

Implementing a skill development program among food handlers in tertiary care hospital to improve their personal hygiene: A pilot study

INTRODUCTION

Food handlers with poor personal hygiene and lack of awareness in preventing foodborne diseases working in hospitality sectors or hospitals could spread foodborne infections.

OBJECTIVE

Our study objective was to ascertain the impact of a video-based educational intervention program and administrative measures on improvement in personal hygiene of food handlers in hospital.

METHODOLOGY

We conducted this pilot study among all 103 food handlers who were working in a tertiary care hospital. A checklist-based scoring and physical examination were conducted by the investigator for the food handlers. After baseline scoring S1, intervention 1 and 2 was implemented, and score was obtained as S2 and S3, respectively. Descriptive statistics was calculated, and score was compared by repeated measures ANOVA test using SPSS-22 software.

RESULTS

Our study revealed that a total of 19.2% of food handlers had health complaints. More than half (54.8%) admitted that they had suffered from any kind of illness since last 6 months. Common illness was viral fever (40.3%) followed by typhoid (5.7%), dengue (4.8%) and urinary tract infection (3.8%). Most of the food handlers had long hair (62.5%) followed by long nail (57.69%). Nearly, one-fifth (20.1%) of food handlers nail was infected with fungus. Worm was found in 14.4% cases by stool examination. Statistically significant (P < 0.05) improvement in score was observed after each intervention.

DISCUSSION

Poor hygiene (Score-1 = 23.76) was observed at baseline study although there was a mechanism in place for a yearly health checkup and regular (6 monthly) hygiene training. After interventions (video-based training and administrative measures), the score was improved to Score-3 (42.57). Statistically significant (P < 0.05) differences in hygiene score were observed for variables such as state of residence, education level, and working experiences (inside or outside the hospital).

CONCLUSION

It is possible to improve personal hygiene among food handlers using video-based interactive training methods and administrative measures with no extra or minimal cost.

RECOMMENDATIONS

This "piggyback" approach of training can be imparted in addition to routine training measures among the food handlers for improving their personal hygiene in the hospital setting.

Prevalence of enteric bacteria and their antimicrobial susceptibility patterns among food handlers in Gondar town, Northwest Ethiopia

Background

Enteric bacterial pathogens are the major causes of food-borne gastroenteritis in humans and remain important public health problems worldwide. The emergence of antimicrobial resistance is a global concern, particularly in developing countries. The aim of this study was to determine the prevalence of enteric bacteria pathogens and their antimicrobial susceptibility patterns among food handlers in Gondar town, Northwest Ethiopia.

Methods

A cross-sectional study was conducted from February 4 to April 16, 2018. A total of 257 food handlers were selected using a multistage sampling technique. Data on socio-demographic characteristics were collected using a structured questionnaire. Stool samples were collected and inoculated into appropriate media. Enteric bacterial pathogens were identified using standard microbiological methods. Antimicrobial susceptibility tests were performed using the disk diffusion technique as per the standard Kirby-Bauer method. Data were entered and analyzed using SPSS version 20 software.

Results

The overall prevalence of enteric bacteria was 34/257 (13. 2%, [95% CI, 8.9-17.5%]). Shigella species was the leading isolate that accounted for 26/257 (10.1%) followed by Enterohemorrhagic Escherichia coli (EHEC) O157: H7 5/257 (1.9%) and Salmonella species 3/257 (1.2%). Shigella spp. was susceptible to ciprofloxacin 26 (100%), ceftriaxone 25 (96.1%), chloramphenicol 24 (92.3%), nalidixic acid 24 (92.3%), and gentamicin 20 (76.9%). Escherichia coli O157: H7 and Salmonella spp. showed the maximum (100%) susceptibility results to ceftriaxone, chloramphenicol, ciprofloxacin, and gentamicin. The overall prevalence of Multidrug resistance (MDR) in the current study was 14/34 (41.2%).

Conclusion

Our study showed high prevalence of enteric bacterial pathogens among food handlers. All isolates were susceptible to ciprofloxacin. However, a substential number of isolates were resistant to commonly prescribed antibiotics and the prevalence of MDR was high.

The prevalence of intestinal parasite infection and associated factors among food handlers in eating and drinking establishments in Chagni Town, Northwest Ethiopia

OBJECTIVES

This study aimed to determine the prevalence of intestinal parasites and associated factors among food handlers in Changni district, Awi zone Ethiopia.

RESULTS

A total of 442 food handlers were included in the study with a response rate of 90%. The prevalence of infection with at least one of the intestinal parasites was 14.8% [95% CI (11.5%, 18.0%)]. According to multivariable logistic regression analysis, lack of regular hand washing before meal [AOR = 4.77, 95% CI (2.09, 10.87)], regular hand washing after visiting toilets, [AOR = 3.39, 95% CI (1.52, 7.57)], trimmed fingernails, [AOR = 2.39, 95% CI (1.29, 4.42)], and frequent medical check-ups for intestinal parasites [AOR = 3.54, 95% CI (1.11, 11.31)] were significantly associated with the infection of intestinal parasitosis.

Prevalence and associated risk factors of intestinal parasitic infections among asymptomatic food handlers in Wollo University student's cafeteria, Northeastern Ethiopia

Objective

Intestinal parasitic infections (IPIs) are among the major public health and socioeconomic problems in developing countries like Ethiopia. Food-handlers that directly deal with production and distribution of foods between societies are one of the most important sources to transmit parasitic infections to humans. The aim of this study was to assess the prevalence and associated risk factors of intestinal parasites among asymptomatic food-handlers working in students’ cafeteria of Wollo University, Northeastern Ethiopia.

Result

A cross-sectional study was conducted among 200 asymptomatic food handlers at Wollo University from January 1 to February 20, 2018. Among the total participants 30 (15%) were infected with at least one intestinal parasites. The dominant parasite was E. histolytica (5.5%) followed by A. lumbricoides (4%) and then G. lamblia (3%). Finger nail trimming (p = 0.002, AOR: 4.35, 95% CI 1.71–11.04), medical checkup (p = 0.012, AOR: 4.01, 95% CI 1.37–12.25) and residence (p = 0.014, AOR: 3.16, 95% CI 1.26–7.95) were independent predictors of intestinal parasitic infection among the food handlers.

Investigation of Giardia intestinalis Genotypes among the Food Handlers of Qazvin, Iran

BACKGROUND

We aimed to investigate the genotypes of Giardia intestinalis among the food handlers in Qazvin, Iran.

METHODS

Overall, 1530 stool specimens were collected from the food handlers who visited Shahid Bolandian Health Center, Qazvin, Iran during 2016. Specimens were evaluated by microscopic and concentration methods. Twenty specimens with appropriate number of giardia cysts were selected followed by DNA extraction. Determination of giardia genotypes was achieved through PCR and sequencing the glutamate dehydrogenase gene. The phylogenetic tree was drawn using the MEGA7 software. Finally, the data were analyzed statistically with a P-value<0.05 was considered as significant.

RESULTS

Twenty stool samples (1.3%) were positive for Giardia cyst. All positive specimens were obtained from male participants with abdominal cramp being their most common symptoms. The mean age for infected individuals was 32 yr. Molecular characterization was successfully performed for 17 isolates and two genotypes A (AII, 65%) and B (BIII, 35%) were identified.

CONCLUSION

The most prevalent giardia genotypes among the food handlers in Qazvin were A (AII) and B (BIII) genotypes with A (AII) genotype as the dominant one in the region. Considering the direct association between the food handlers and public health as well as the impact of geographical and host conditions on dispersion and pathogenicity of various genotypes and their zoonotic aspects, further investigations are necessary.

Prevalence of intestinal parasites in food handlers of the city of Saqqez in 2016

This study was aimed at determining the prevalence of parasitic infections among the food handlers of Saqqez County in 2016. Stool samples collected from 1530 food handlers. All samples were examined by both direct technique and sedimentation technique using formalin-ethyl acetate for detecting the intestinal parasites. Of total participants, 1462 (95.6%) were male and 62 (4.4%) female. Intestinal parasitic infections were found in 92 (6.01%) individuals. The highest infection rate was due to Giardia lamblia (4.1%) and the lowest associated with Endolimax nana, Iodamoeba butschlii, and Hymenolepis nana (0.1%). No significant correlation between the intestinal parasitic infections and age, gender, education level, gastrointestinal signs and symptoms, and the type of profession, was established. The results of the present study revealed that only a small number of food handlers in Saqqez County were infected with intestinal parasites with G. lamblia as the most common cause of infection. More strict health control for those working in food industries is of vital importance and continuous education to improve the level of general health in these people is undoubtedly considered as a key determinant towards lower number of parasitic infections.

Knowledge, attitude, and practice among food handlers of semi-industrial catering: a cross sectional study at one of the governmental organization in Tehran

PURPOSE

food handlers have an important role in transmitting pathogens from raw materials to cooked ones. This study was conducted to determine the knowledge, attitude, and practice (KAP) of 95 food handlers on five keys to safer food based on World Health Organization questionnaires in semi-industrial catering in a government office in Tehran.

MATERIALS AND METHODS

specialists reviewed the validity of questionnaires and reliability was measured using determination of inter rater agreement, relevancy and clarity of each question, and the tool as a whole was evaluated by the content validity method. The Cronbach's alpha and repeatability were measured with intra-cluster correlation through repeated test-piloting after one month.

RESULTS

In spite of good levels of KAP, lack of knowledge was observed in some items such as cooking thoroughly and keeping food at safe temperatures. All of the participants had good knowledge about washing hands (100% correct answers) and Low level of knowledge with 46.3% correct answers belonged to put cooked meat at room temperature question; in attitude section, 99% of the food handlers were regarded a positive attitude about the cleaning of surface in the kitchen to reduces the risk of illness; a worrying issue is 57% of participants agreed that by looking at foods can distinguish safe and spoiled ones finally 100% of the respondents were considered to have good behavior. Significant relations were found between knowledge and attitude (p < 0.001) and between attitude and practice (p = 0.001).

CONCLUSIONS

Educational training and creating motivation to promote knowledge and turning it into practice seem necessary.

High prevalence of methicillin resistant and enterotoxin gene-positive Staphylococcus aureus among nasally colonized food handlers in central Iran

This study defined the prevalence of enterotoxin gene-positive Staphylococcus aureus strains among food handlers and non-food processing healthy nasal S. aureus carriers in central Iran. Meticillin-resistant S. aureus (MRSA) strains were diagnosed by cefoxitin disk diffusion. PCR was used to detect the mecA, Sa442, and enterotoxin genes. Out of the 1113 food handlers, 224 (20.1%) were nasal carriers of S. aureus and 157 (70.1%) of these isolates were positive for one or more enterotoxin genes. The most prevalent enterotoxin gene was sei (40.2%), followed by seg (35.3%), sea (23.5%), seb (15.2%), sec (5.5%), and seh (2.7%). See and sed genes were not found. Sixty seven (42.7%) of enterotoxin gene-positive isolates possessed a single enterotoxin gene, and 64 (40.8%), 23 (14.7%), and 3 (1.9%) contained two, three, or four enterotoxin genes, respectively. The most frequently detected gene combination was sei/seg (n = 35, 22.3%). Thirty seven (16.5%) isolates were diagnosed as MRSA, and 27 (73%) of these strains were positive for at least one enterotoxin gene. Out of 546 healthy controls, 100 individuals were identified as S. aureus nasal carriers; among the strains, 39 (39%) were positive for at least one enterotoxin gene. Only one (1%) CA-MRSA was identified among the strains from the volunteers. A high prevalence of meticillin resistant and enterotoxin-positive S. aureus were documented in food handlers. We suggest that this may be due to the frequent handling of contaminated foodstuffs and that this is possibly related to the elevated frequencies of acquired staphylococcal food poisoning in this population.

Wearable Technology Effects on Training Outcomes of Restaurant Food Handlers

Food safety training does not always result in behavior change, perhaps because of flaws inherent in traditional training designs. New technologies such as augmented reality headsets or head-mounted action cameras could transform the way food safety training is conducted in the food industry. Training conducted with wearable technology presents visual content in the first-person or actor's perspective, as opposed to the traditional third-person or observer perspective. This visual hands-on first-person perspective may provide an effective way of conveying information and encouraging behavior execution because it uses the mirror neuron system. There is little published literature about the impact of perspective on food safety training outcomes, such as motivation. The present study included a repeated-measures design to determine how first- and third-person camera angles affected hand washing training reactions among 108 currently employed restaurant food handlers. Participants were assessed on their posttraining compliance intentions, compliance self-efficacy, perceived utility of the training, overall satisfaction with the training, and video perspective preference. A significant proportion of food handlers (64%) preferred the first-person video perspective ( z = 5.00, P < 0.001), and a significant correlation was found between compliance intentions and compliance self-efficacy ( r(108) = 0.361, P < 0.001) for the first-person video. No significant differences in video preference were found for demographic variables, including age (χ² (2, n = 104) = 1.69, P = 0.430), which suggests that the first-person training format appeals to a diverse workforce. These findings support the application of wearable technology to enhance hand washing training outcomes across a wide range of demographic groups. This research lays the framework for future studies to assess the impact of instructional design on compliance concerning hand washing and other food handling behaviors.

Burden of intestinal pathogens and associated factors among asymptomatic food handlers in South Ethiopia: emphasis on salmonellosis

Objective

The study aims to assess the burden of intestinal parasites and Salmonellosis among asymptomatic food handlers at meal serving facilities in Sodo town. Antibiotic resistance was also common and increasing among Salmonella isolates with multidrug resistance as current concern.

Result

Community based cross-sectional study was carried out from 387 food handlers working in meal serving facilities. Food handlers, 159(41%) had one or more intestinal parasites. A. lumbricoides was the most prevalent parasite 30(7.8%), followed by Taenia species 26(6.7%) and Hook worm 23(5.9%). A total number of 35 Salmonella isolates were found of which Sero-group D was the most frequent, 17(48.5%) followed by Sero-group C, 12(34.3%), and B 6(17.1%). Ten (2.5%) isolates were Salmonella typhi. Raw meat eating, hand washing after toilet and after touching dirty materials showed significant association with intestinal pathogens. Salmonella isolates were highly resistant to ampicillin (85.7%), amoxicillin and tetracycline 74.3% each. Multidrug resistance prevalence of 81.8% was identified. Periodic screening of food handlers is important in order to prevent the transmission of intestinal parasites and Salmonellosis. Treatment needs to be based on accurate laboratory detection to mitigate the spread of drug resistant Salmonella strains.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3610-4) contains supplementary material, which is available to authorized users.

Prevalence of antibiotic resistant Escherichia coli isolates from fecal samples of food handlers in Qatar

Background

It is well documented that food handlers harbor and shed enteric foodborne pathogens causing foodborne disease outbreaks. However, little known on enteric antibiotic resistant (AR) bacteria carriage in food handlers. The objective of this study was to establish a baseline prevalence of fecal AR E. coli among food handlers in Qatar.

Methods

Fecal samples were collected from 456 migrant food handlers of different nationalities arriving in Qatar on a work permit between January 2015 and December 2016. These samples (25 g each) were collected based on the availability and examination schedule at the Medical Commission facility from those consented to participate. Isolated E. coli bacteria were tested for antibiotic susceptibility against nine antibiotics using the E-test method and Double Disc Synergy Test (DDST) for extended-spectrum beta-lactamase (ESBL) production.

Results

From the 78 E. coli positive samples (17.1%, n = 456), 60% of the isolates were resistant to at least one antibiotic, whereas, 27% were multi-drug resistant (MDR). Seven isolates (9%, n = 78) were ESBL producers of which five were MDR. Individual AR E. coli frequencies to the nine antibiotics were not significantly (P > 0.05) different by nationality.

Conclusions

Based on our findings, we revealed that individual resistant E. coli and MDR resistant E. coli were common in fecal samples of food handlers in Qatar. This may indicate that food handlers can potentially contaminate foods with AR E. coli, a possible public health concern.