1060149

research-article2021
EHI0010.1177/11786302211060149Environmental Health InsightsDagne et al

Food Safety Attitude and Associated Factors Environmental Health Insights

Volume 15: 1–6

Among Mothers of Under 5 Children, Debarq Town: © The Author(s) 2021

Article reuse guidelines:

Community-Based Cross-Sectional Study, 2019 sagepub.com/journals-permissions

DOI: 10.1177/11786302211060149
https://doi.org/10.1177/11786302211060149

Henok Dagne1, Jember Azanaw1 , Tesfaye Hagos2

and Kidstemariam Addis2
1Department of Environmental and Occupational Health and Safety, Institute of Public Health,
College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. 2Ethiopian
Environmental Health, Addis Ababa, Ethiopia.

ABSTRACT

Background: Food-borne diseases represent a widespread and growing public health problem, both in developed and developing
countries. However, this problem has more impact on health and economy in developing countries than in developed countries but reliable
data is not available.

Methods: A cross-sectional study was done in 2019 at Debarq town, Amhara region, Northwest Ethiopia. A questionnaire prepared in Eng-
lish after adapted from previous studies then translated in to local language Amharic was used in order to collect the data. Data were
checked manually for completeness, coded, and entered in to Epi Info version 7.1 and then exported in to SPSS version 26 statistical pack-
age for analyze. Descriptive statistics, percentage, frequency, standard deviation, and mean were analyzed. Likewise, bivariable and multi-
variable binary logistic regression analysis were done to know the relationship between the independent variables and attitude of food safety
among mothers. The variables found having a P-value <.2 in the bivariable analysis were further analyzed in multivariable binary logistic
regression. The variables with P-value <.05 were considered as significantly associated with food safety attitude of mothers.

Results: About 423 mothers of under-5 children were involved in this study. The mean age of the participants was 39.844 ± 11.02. In this
study, educational status (primary education (Adjusted Odds Ratio [AOR]: 2.66; 95% Confidence Interval [CI] [1.42-4.97]), secondary edu-
cation (AOR: 2.66; 95% CI [3.35-14.05]), and diploma and above (AOR: 4.07; 95% CI [1.65-10.06])), higher income (AOR: 3.58; 95% CI [1.54-
8.29]), good food safety knowledge (AOR: 3.08; 95% CI [1.51-6.242]) and good food hygiene practice (AOR: 3.97; 95% CI [2.33-6.75]) were
factors associated with food safety attitude in the current study.

Conclusion: Significant proportion of participants in the study area had poor food safety attitude. Educational status, income, food safety
knowledge, and food safety practice were significantly associated with food safety attitude among mothers. Food hygiene practice, knowl-
edge, and level of education should be increased in order to improve food safety attitudes among mothers who were responsible in food
processing at household level.

Keywords: Food borne illness, food safety attitude, food handlers, household level

RECEIVED: August 6, 2021. ACCEPTED: October 13, 2021. Declaration of Conflicting Interests: The author(s) declared no potential
conflicts of interest with respect to the research, authorship, and/or publication of this article.
TYPE: Original Research
CORRESPONDING AUTHOR: Jember Azanaw, Department of Environmental and
Funding: The author(s) received no financial support for the research, authorship, and/or Occupational Health and Safety, Institute of Public Health, College of Medicine and Health
publication of this article. Sciences, University of Gondar, Gondar 196, Ethiopia. Email: jemberazanaw21@gmail.
com

Background with significant foodborne illness risk. First, the greatest pro-
Food safety is defined as food that is free from all risk, whether portion of the food we eat is prepared at home, thereby increas-
long term or acute that may make food deleterious to health of ing the opportunities for food handling errors to occur. The
the consumer.1 Food-borne diseases represent a widespread emphasis frequently placed on how often people “eat out”
and growing public health problem, both in developed and causes many to not realize that the home food environment
developing countries. However, this problem has more impact provides 72% of the food, by weight, consumed by Americans
on health and economy in developing countries than in devel- and accounts for 93% of the food consumed by those who eat
oped countries but reliable data is not available.2 most meals at home.7
World Health Organization (WHO) recognized foodborne Household kitchens are often used as a many purposes
illnesses and occurrences as a foremost public health threat where the risk of food contamination and spread of foodborne
globally of the 21st century.3 Although experts generally agree disease is high.8,9 Many food borne disease and their related on
that homes are one of the primary locations where most food- economic costs may be the consequence of preventable food
borne illness cases occur,4-6 many consumers do not consider handling mistakes in the kitchen.10 Everyone at each food pro-
the home to be a risky place with regard to foodborne illness. cessing chain should have their own role. Because it is impos-
There are many reasons why home is the location associated sible for food producers only to secure a pathogen-free food

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2 Environmental Health Insights 

supply, due to this at home food preparer is a critical link in the data collection tool, on method of collecting data and ethical
chain to prevent food-borne illness.11 issues accomplished the data collection. The study Participants
Mothers have many more activities at household including were enrolled by using simple random sampling technique.
their children care, show them the correct way of food hygiene Then, those respondents were interviewed after explained
practices and performing many activities a time.12 As well, moth- statements in the questionnaire.
ers are primarily food handlers at home and their knowledge, atti-
tudes, and practices (KAP) in prevention of diarrhea influence Data analysis
child health and wellbeing. Good attitudes can give more impact
to food handlers practices in food safety.13 Therefore, more than Data were checked manually for completeness, edited, coded,
knowledge mothers’ attitude toward food safety in the kitchen and entered in to EpiInfo version 7.1 and then exported in to
and environmental conditions on how food becomes contami- Statistical Package for the Social Sciences (SPSS) version 26
nated at home is essential in order to reduce food hazards related statistical package for analyze. For each question the partici-
with food contamination.14 There is no published article regard- pants were given 1 point the correct answered and a 0 when
ing food safety attitude among mothers at the study area. Hence, the answers were incorrect answers. Descriptive statistics, per-
the main interest of this research was to understand mothers’ atti- centage, frequency, standard deviation, and mean were ana-
tude and factors associated in food safety at household level. lyzed. Likewise, bivariable and multivariable logistic regression
was analyzed to know the relationship between the socio-
Methods demographic variables and attitude of food safety in homes
Study design, period, and area kitchen. The variables found having a P-value <.2 in the
bivariable analysis were further analyzed by multivariable
A descriptive cross-sectional study method was done in 2019 at logistic regression. The variables at adjusted odds ratio (AOR)
Debarq town, Amhara region, Northwest Ethiopia. Debarq with 95% confidence interval (CI) and P < .05 were consid-
town located at 830 km far from Addis Ababa, the capital city ered as statistically significant association with food safety
of Ethiopia. The district has latitude of about 13.133°N and attitude of mothers.
longitude of about 37.900°E and an elevation ranging from
2712 to 3122 m above sea level. A total of 423 mothers were Operation definitions.  When the score of food safety practice is
participated in this study. lower than to the mean value were “poor food safety practice”
and when it is equal or higher than the mean value, it was cat-
Data collection instrument egorized as good in food safety practice.
The value lower than to mean were “poor food safety knowl-
A questionnaire prepared in English after adapted from previ- edge” and equal or higher than the mean value were “good food
ous studies15,16 then translated in to local language Amharic. safety knowledge.”
First, demographic information of each participant, such as age, Scores less than the mean score were “poor attitude” and
educational level, income level, number of family, and food equal to or higher score referred “good attitude.”
safety related training were asked. The questionnaire then
lookup informations about the mothers’ attitude, practice, and Results
knowledge of food safety in home kitchens through face to face The results of demographic variables revealed that the mean
interview. There were 31 question to assess knowledge (10 age was 39.844 ± 11.02 (SD) years old and 57.2% of the
items as yes/no), attitude (9 items with 5-levels Likert scale), women were married. Only a few of the participants had the
and practice (12 items). In the attitude section, the question- highest educational level (16.8%) and the largest proportion
naire provided 9 Likert scale item questions ranging from (40.7%) of participants not read and write. Ninety-one
“strongly agree” to “strongly disagree” and food safety knowl- (21.5%) of the respondents had training related food safety.
edge also asked using Likert scale from rarely to always. The Level of income of the participants was the same in propor-
questionnaire was tested with a pilot sample (N = 21). Details tion (Table 1).
about the data collection tool is presented elsewhere.17 The
validity of the questionnaire, which is measured in the type of Food safety knowledge, attitude, and practice levels
content validity, was acquired by the experts and its reliability of mothers
was established using internal stability method (Cronbach’s
alpha coefficient). Then Cronbach’s alpha value was .744. Of the 423 participants, 321 (75.9%) had a good level of
knowledge, and 210 (49.6%) mothers had a good level of food
safety practice. Mean attitude score among participants was
Data collection procedure
28.78 (±SD = 4.99). The overall positive attitude toward food
Three fourth year Environmental and occupational health and safety in the current study was 50.4% at 95% CI (45.9%-55.3%)
safety students, who were well-trained on the content of the and 210 (49.6%) negative attitude (Table 2).
Dagne et al 3

Table 1.  Socio-demographic information of study participants (n = 423).

Variables Category Frequency Percentage

Age <30 103 24.3

30-40 129 30.5

40.5-48 89 21.0

>48 102 24.1

Mean age = 39.8440 ± 11.02 (SD)

 Marital status Married 242 57.2

Unmarried 181 42.8

Level of education Not read and write 172 40.7

Primary education 96 22.7

Secondary education 84 19.9

Diploma and above 71 16.8

Level of income <800 111 26.2

800-1100 103 24.3

1101-2145 104 24.6

>2145 105 24.8

Food safety training in the past 2y Yes 91 21.5

No 332 78.5

Religion Christian 333 78.7

Muslim 90 21.3

Table 2.  Food safety knowledge, attitude, and practice magnitude of this study, participants who had primary education 2.66 times
study participants. (AOR: 2.66; 95% CI [1.42-4.97]), those with secondary edu-
cation 6.86 times (AOR: 2.66; 95% CI [3.35-14.05]) and those
Variables Categories Frequency Percentage
who had diploma and above educational status were 4.07 times
Knowledge Good 321 75.9 (AOR: 4.07; 95% CI [1.65-10.06]) more likely to hold positive
Poor 102 24.1 food safety attitude than those who were unable to read and
write. Study participants whose income was more than or equal
Attitude Positive 213 50.4
to 2145 birr were 3.58 (AOR: 3.58; 95% CI [1.54-8.29]) times
Negative 210 49.6 more likely to have positive attitude toward food safety com-
Practice Good 210 49.6 pared with those study participants whose income was less 800
ETB. Mothers with good food safety knowledge had 3.08
Poor 213 50.4
times higher positive food safety attitudes as compared with
their counterparts poor food safety knowledge (AOR: 3.08;
95% CI [1.51-6.242]). As well as those study subjects who had
Factors associated with mothers’ food safety attitude
good food hygiene practice were 3.65 times higher than in food
In bivariable binary logistic regression analysis, age, educational safety attitude as compared with those who had poor food
level, income, marital status, knowledge, food hygiene practice, hygiene practice (AOR: 3.97; 95% CI [2.33-6.75]) (Table 3).
attending food safety training in the past 2 years and ever
attended food safety training were associated with mothers’ Discussion
food safety attitude. From these variables, food safety knowl- This study was designed to assess food safety attitude and covar-
edge, food safety practice, level of education, and income were iates among mothers who were responsible for food processing
significantly associated food safety attitude among mothers. In at Debarq town. The overall positive attitude toward food safety
4 Environmental Health Insights 

Table 3.  Factors associated among mothers food safety attitude at Debarq town, Northwest Ethiopia, 2019.

Variables Food safety attitude COR (95% CI) AOR (95% CI)

Positive Negative

Age in year

<30
   62 41 1 1

  30-40 73 56 0.86 (0.51, 1.46) 1.16 (0.60, 2.26)

  40.5-48 42 47 0.59 (0.33, 1.05) 1.26 (0.61, 2.616)

>48
   36 66 0.36 (0.21, 0.64) 1.21 (0.56, 2.62)

Educational level

 Not read and write 44 128 1 1

 Primary 46 50 2.168 (1.87, 5.36) 2.66 (1.42, 4.97)*

 Secondary 62 22 8.20 (4.52, 14.86) 6.86 (3.35, 14.05)**

  Diploma and above 57 14 11.84 (6.02, 23.32) 4.07 (1.65, 10.06)*

Income

<800
   46 65 1 1

 800-1100 44 59 1.05 (0.61, 1.81) 0.97 (0.51, 1.85)

 1101-2145 51 53 1.36 (0.79, 2.33) 0.96 (0.49, 1.88)

  >2145 72 33 3.08 (1.76, 5.39) 3.58 (1.54, 8.29)*

Marital status

 Married 121 121 1 1

 Unmarried 92 89 1.03 (0.70, 1.52) 1.06 (0.65, 1.75)

Knowledge

 Poor 27 75 1 1

 Good 186 135 3.83 (2.34, 6.26) 3.08 (1.51, 6.242)*

Food hygiene practice

 Poor 151 62 1 1

 Good 59 151 6.23 (4.09, 9.50) 3.97 (2.33, 6.75)**

Ever attended food safety hygiene training

 No 153 179 1 1

 Yes 60 31 2.26 (1.40, 3.68) 1.67 (0.97, 2.88)

1 = reference group, reliability statistics, 1 ETB (Ethiopian Birr) = 0.03 USD, Hosmer and Lemeshow test = 0.589.
*Significant at P < .05. **Significant at P < .001.

in the current study was 50.4% at 95% CI (45.9%-55.3%). There gastrointestinal diseases.19 Food safety plays a vital role in the
is a continuing need to increase the collection and reporting of prevention of stunting which is exacerbated during COVID-19
data on linear child development.18 Poor food safety attitude pandemic because it affects affordability and access to safe food in
might act as factors causative to the high problem of child under- general.18 The COVID-19 may also result in poor food safety
nourishment include the high prevalence of transmissible dis- due to lack of access to food as well as discrimination due to fear
eases such as diarrheal diseases, poor infant, and young child of the pandemic as evidenced from a study.20 Hygienic practices
feeding practices, as well as poor water, sanitation, and hygiene. including hand washing, proper sanitation, and other basic behav-
The poor attitude toward food safety may result in ioral changes are among the proven method of reducing child-
health catastrophes including to malnutrition and multiple hood malnutrition.21 However, during COVID-19, lockdowns
Dagne et al 5

and movement restrictions may further complicate access clean good attitude toward food safety. Other studies26,29,37 also
water and safe sanitation services which could contribute to a revealed that educated mothers had more positive attitudes in
child’s poor health, leading to a higher rate of morbidity and mor- relation to food safety and those with respondents that have
tality.21 During pandemics such as COVID-19, one of the inter- low educational level had less good attitude level compared to
ventions is providing basket food to poor people, which is essential the respondents that have high education level.
to maintain food security and this requires at most care to prevent In this study food safety related training was not significantly
food spoilage due to poor food handling practices.22 associated with food handlers’ food safety attitude. However,
Educational status, income, and food safety knowledge and other earlier studies39,40 revealed that food safety training and
food safety practice were significantly associated with food food safety attitude were significantly correlated. However, this
safety attitude among mothers of under-5 children in the cur- finding contradicted with the other study done in Brazil.41 The
rent study. possible explanation for this difference is, the training given for
The proportion of mothers with positive food safety atti- participants might be superficial and inconsistent type training.
tude in this study was lower than reports from studies con-
ducted among women in Ghana Accra,23 Egypt,24 Khaza bazar, Limitation
India,25 and Ankara, Turkey26 whereas this result was in line
with a study conducted in Nigeria.27 However it was higher There are some limitation of this study. Respondents’ bias was
than the studies done among food handlers in Gondar, not address. Since the exposure and outcome are assessed at the
Ethiopian,28 and women in Lahore.29 The possible explanation same time, there may not be evidence of a temporal relation-
for their difference might be due to the study population dif- ship between exposure and outcome.
ference, data collection instrument, time, and study setting.
Different studies had shown that, there are multiple covariates Conclusion
that affect food safety knowledge, attitude, behaviors, percep- This study was designed to assess the food safety attitude of
tion, and practice. From these, sociodemographic variables mothers at Debarq town. Study participants in the study area
were the most importantly significant factors.30-32 But in this were poor in attitude food safety. Educational status, level of
study, only income and educational level were statistically sig- income, food safety related knowledge and food safety practice
nificant socio-demographic factors affecting food safety atti- were significantly associated factors in food safety attitude
tude among study participants. among mothers. Food hygiene practice and knowledge should
In this study, participants at higher income were more likely be increased in order to improve food safety attitudes among
to have positive attitude in food safety as compared with those mothers who were responsible in food handling practice.
of study participants less income counterparts. This result was
Acknowledgements
supported with the study that reveled attitude was improved as
The authors are grateful to all study participants.
income level increased.33 However, another study showed that
individuals with a higher income are less worried about food
Author Contributions
safety attitudes than those with a lower income.34
All authors contributed to conceptualization, methodology,
In addition, participants with good food hygiene practice
analysis, data curation, validation, and conception, writing, and
had good food safety attitude likely in experiencing good atti-
approving the final manuscript.
tude in food safety practice. This funding was supported by
other study done in Palestine.33 Ethical Consideration
Mothers with good level of knowledge had more positive Ethical clearance was obtained from the ethical committee of
attitude as compared with those who had poor level of knowl- the Department of Environmental and Occupational Health
edge toward food safety. This funding revealed that good and Safety of the University of Gondar and an official letter
knowledge level in food safety among study subjects is manda- was submitted to the town and kebeles administrators.
tory for having good attitude, even alone does not enough to
develop proper behaviors in food safety. A possible explanation Consent
for good level of knowledge among participants might enable This manuscript does not contain an individual participant
and will influence participants food safety attitude.35,36 This data.
result was in line with other similar study done in Tehran, Iran,
Malaysia, and Palestine.33,37,38 ORCID iD
Educational status was another statistically significant fac- Jember Azanaw https://orcid.org/0000-0001-5702-1476
tor with food safety attitude among study subjects. Mothers
with higher education had higher probability having positive Data Availability
attitude toward food safety. It could be due to that higher edu- Data will be available upon request to the primary and corre-
cation might help to shape or change in behavior of mothers in sponding authors.
6 Environmental Health Insights 

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