International Journal of General Medicine

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Food Hygiene Practice and Its Determinants

Among Food Handlers at University of Gondar,
Northwest Ethiopia, 2019

Ketseladingle Lema, Negasi Abuhay, Walelign Kindie, Henok Dagne &

Tadesse Guadu

To cite this article: Ketseladingle Lema, Negasi Abuhay, Walelign Kindie, Henok Dagne &
Tadesse Guadu (2020) Food Hygiene Practice and Its Determinants Among Food Handlers at
University of Gondar, Northwest Ethiopia, 2019, International Journal of General Medicine, ,
1129-1137, DOI: 10.2147/IJGM.S262767

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ORIGINAL RESEARCH

Food Hygiene Practice and Its Determinants

Among Food Handlers at University of Gondar,
Northwest Ethiopia, 2019
This article was published in the following Dove Press journal:
International Journal of General Medicine

Ketseladingle Lema Introduction: Food hygiene is an essential matter of public health for protecting or
Negasi Abuhay preventing diseases caused by unsafe food due to lack of good quality from production to
Walelign Kindie consumption.
Henok Dagne Objective: The current study aimed at assessing the food hygiene practice and determinant
factors among food handlers working at the University of Gondar.
Tadesse Guadu
Methods: Univariate and multivariable binary logistic regression analyses were used to test
Department of Environmental and the association of covariates with the food safety practice. Variables with p-value <0.2 were
Occupational Health and Safety, Institute
of Public Health, College of Medicine and candidates for multivariable analysis. The adjusted odds ratio with 95% confidence interval
Health Sciences, University of Gondar, and p-values less than 0.05 were used to report associations in the final model.
Gondar, Ethiopia
Results: A total of 184(46.7%) of the study subjects had good self-reported food hygiene
practice. Being male [Adjusted odds ratio (AOR): 2.37, 95% confidence interval (CI) (1.34,
4.19)], educational status (primary [AOR: 2.54, 95% CI (1.16, 5.58)] and secondary [AOR:
2.20, 95% CI (1.11, 4.37)]), workers with greater than 2 years work experience [AOR: 1.86,
95% CI (1.06, 3.25)], monthly income of 2044–4867ETB/month [AOR: 2.05, 95% CI (1.01,
4.16)] were independent predictors of food safety practice of food handlers.
Conclusion and Recommendations: Below half of the study subjects had good self-
reported food hygiene practice. Sex, educational status, and income were factors associated
with the food hygiene practice. There should be continuous supportive supervision to raise
the skills of food handlers to comply to better food hygiene practice. Food hygiene training
should be given especially to female food handlers. Frequent audits are also required to
ensure the permanence of effective and continuous training. Regular medical check up and
strict hygiene follow-up should be encouraged to prevent foodborne disease outbreaks at
universities.
Keywords: food hygiene, knowledge, attitude and practice

Introduction
Food hygiene is an essential matter of public health for protecting or preventing
diseases caused by unsafe food due to lack of good quality from production to
consumption.1
Foodborne disease (FBD) is of public health significance both in developed and
developing nations. About 600 million individuals become ill every year due to
consumption of contaminated food and an approximately 420,000 of these victims
die per annum.2 The World Health Organization (WHO) disclosed that 1 in 10
Correspondence: Henok Dagne
Email [email protected] individuals worldwide are sick from foodborne illnesses.3 Foodborne infectious

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diseases have been estimated to affect 550 million persons and determinant factors among food handlers at the
and cause 230,000 deaths globally in 2010 although it is University of Gondar.
difficult to determine the exact mortality associated with
foodborne diseases.4 It is difficult to quantify the burden Method
of foodborne diseases since most of the hazards that cause
Study Design, Area and Period
foodborne diseases are not transmitted exclusively by food.5 An institution-based cross-sectional study design was used
The consumption of contaminated food is correlated to assess food hygiene practice and determinant factors
with an estimated 70% of diarrheal diseases in developing among food handlers at the University of Gondar (UoG)
countries. The occurrence of foodborne illnesses is more from April 1 to April 15, 2019. The UoG currently has five
common in developing nations because of poor hygiene, campuses; Atse Fasil campus (Technology College),
absence of drinking water, contaminated and inappropriate College of Medicine and Health sciences (CMHS), Tseda
food storage equipment and absence of food safety Campus (Agriculture College), Atse Tewodros Campus
education.6 In addition in low-income countries, in parti­ (College of Natural and Computational Sciences), and
cular, FBDs outbreak is more serious due to inadequate Maraki Campus (College of Social Sciences and
sanitation, insufficient food safety regulations, weak reg­ Humanities). A total of 645 food handlers (492 females
ulatory structures, unsafe raw food, abused temperature, and 153 males) are serving the five campuses.17
poor storage infrastructures, inadequate cooking, poor per­
sonal hygiene, improper handling methods, and cross- Study Population and Unit
contamination of cooked food with uncooked raw food.7–9 All food handlers in the UoG students’ cafeteria, 645 in
Potential FBDs in institutions with a high number of total, were the source of our study population. The study
people is a public health concern, since outbreaks in those units were all randomly selected food handlers from the
places may affect a large number of consumers at once. study population. Workers who were absent during data
Food handlers are expected to have excellent hygiene collection time due to different reasons (maternity leave,
practice to reduce cross contamination and protect the sick and absent from work for any reason) were excluded
consumers from foodborne diseases.10,11 Poor personal from the study.
hygiene frequently contributes to foodborne illness which
indicates that food handlers’ knowledge and handling
Sample Size Determination
practices needs to be improved. Studies on the conditions
Sample size (n) was determined by using a single population
of food and drink establishments have been scanty in proportion formula,18 based on the following assumptions.
Ethiopia.12,13 The proportion of good food hygiene practice (p) was 47.7%
In most developing countries hygiene is important from a study conducted among Addis Ababa university food
since hygiene preventable diseases are prevalent. In handlers,19 standard normal distribution confidence interval
Ethiopia these diseases account for 80% of the illnesses (za=2 Þ (1.96), and margin of error (d) = 0.05.
together with other infectious diseases and malnutrition.14 �2
Food handlers with poor personal hygiene and lack of za=2 � pð1 pÞ ð1:96Þ2 � 0:477ð1 0:477Þ
n¼ n¼
awareness of important issues in preventing foodborne d 2
0:052
¼ 384
diseases, working in food establishments could be poten­
tial sources of infections of many intestinal helminthes of
Taking 5% none response, the total sample size became
protozoa and estrogenic pathogens.15
403.
Institutional foodservice is an important sector of the
food industry. Foods consumed at such institutions have
been identified as important sources of foodborne disease Sampling Technique and Procedures
outbreaks and often feature prominently in many national A simple random sampling technique was employed for
statistics on outbreaks of foodborne illness.16 Food poison­ selecting the study units and self-reported food hygiene
ing could result in the institutional food service suffering practice was assessed. The total sample size was propor­
huge financial losses and public confidence.10 This study, tionally distributed in the five campuses based on the
therefore was aimed at assessing the food hygiene practice number of food handlers at each campus.

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Dovepress Lema et al

Operational Definitions Results

Food Hygiene Practice Overall, 394 study participants (98.2% response rate) were
The food handlers were asked 19 questions regarding their included in thecurrent study. About 263 (66.8%) were
food hygiene practice. Study subjects who scored less than female. The mean age of the study participants was 28
the mean value of the score of the practice questions were years. The majority of participants (62.4%) were married.
considered as having “poor food hygiene practices” and About half of the participants (53.6%) had over 2 years’
those who scored mean and above the mean value of the experience (Table 1).
practice questions were considered as having “good food Above three-fifths (61.9%) of the study subjects had
hygiene practice.”20–22 good knowledge. Above half (54.8%) of the respondents
had a desirable/good attitude but only 46.7% of the parti­
Food Hygiene Knowledge cipants had good practice regarding food hygiene
Food hygiene knowledge was assessed by asking food (Figure 1).
handlers 16 knowledge items (yes or no questions).
Study subjects who scored below the mean score were
considered as having “poor knowledge” and those who
Factors Associated with Food Hygiene
had a score of mean and above the mean were classified Practice
as having “good knowledge” about food hygiene.21,23,24 Sex, age, educational status, work experience, monthly
income, family size, knowledge, attitude, job category
Food Hygiene Attitude and orientation about food hygiene had a p-value <0.2 in
Food hygiene attitude was measured by asking respon­ the univariate binary logistic regression and hence were
dents 14 questions about their attitude. Study subjects candidates to be used in the multivariable logistic analysis.
with mean and above score of the attitude questions were Only monthly income, work experience, educational sta­
considered as holding desirable (good) attitude and other­ tus, age and sex were associated with the food hygiene
wise “poor attitude” towards food hygiene practice.21,22 practice in the final model (p-value <0.05).
Male food handlers were 2.37 times more likely to
Data Collection Tool and Procedure have better food hygiene practice than females [AOR:
Data were collected using a self-administered structured 2.37, 95% CI (1.34, 4.19)].
questionnaire which included: sociodemographic character­ Study subjects with primary educational status were 2.54
istics, 19 practice questions with a three-point Likert scale times more likely to have better food hygiene practice [AOR:
(1=always, 2=sometimes and 3=never), 16 knowledge items 2.54,95% CI (1.16, 5.58)] and respondents with secondary
(yes/no) regarding food-borne disease transmission, knowl­ educational status were 2.20 times more likely to have better
edge of personal hygiene, knowledge of cross contamination food hygiene practice [AOR: 2.20, 95% CI (1.11, 4.37)] than
and knowledge of temperature control and 14 attitudinal those with college and above educational status.
questions with a four-point Likert scale (1-strongly agree, Study subjects who had more than 2 years work experi­
2-agree, 3-disagree strongly and 4-disagree). The data collec­ ence were 1.86 times more likely to have better food
tion tool was prepared after a careful literature survey.21–27 hygiene practice than those with 2 years and less than
Content validity was done by doing a pretest. The pretest was 2 years’ experience [AOR:1.86, 95% CI (1.06, 3.25)].
done among 5% (ie, 21 food handlers out of the study Study subjects with 2044–4867 ETB average monthly
population) and editorial and language adjustments were income were 2.05 times more likely to report good food
done based on the pretest results. hygiene practice than those with an average income of
1100–1743 ETB [AOR: 2.05, 95% CI (1.01, 4.16)] (Table 2).
Data Processing and Analysis
Complete items were coded and entered onto Epi Info ver­ Discussion
sion 7 and transported to Statistical Package for the Social This study was aimed at assessing the food safety practice
Science (SPSS) version 21 software for analysis. Univariate and associated factors among food handlers in the
and multivariable binary logistic regression were employed University of Gondar. Accordingly, 46.7% with 95% CI
to test the association of covariates with the outcome vari­ (42.4%, 51.5%) of UoG food handlers had good food
able. Association was declared at p-value< 0.05. hygiene practice. Sex, work experience, educational status,

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Table 1 Sociodemographic Characteristics of University of

Gondar Food Handlers, 2019 (n=394) 53.3%
practice
46.7%
Variables Category Frequency Percent
(n) (%)
45.2%
Sex attitude poor
54.8%
Female 263 66.8 good
Male 131 33.2
38.1%
Age in years knowledge
61.9%
19–26 108 27.4
27–28 92 23.4 0 20 40 60 80
29–32 78 19.8
33–58 116 29.4 Figure 1 Knowledge, attitude and practice of food hygiene among University of
Gondar food handlers 2019 (n=394).
Marital status
Single 118 29.9
Married 246 62.4
and monthly income were factors associated with food
Divorced 30 7.6
hygiene practice.
Educational level
The proportion of food handlers with good food hand­
Primary 123 31.2
ling practice in the current survey is consistent with
Secondary 208 52.8
College and above 63 16.0 studies conducted in Ghana16 and Addis Ababa,
Ethiopia.28 However, the current food hygiene practice
Religion
is lower than the practice levels reported in Malaysia,29
Orthodox 376 95.4
Muslim 5 1.3 and Nigeria.30 The discrepancy in food hygiene practice
Protestant 13 3.3 level might be due to variations in the study tool used,
time of the study and variation in sociodemographic and
Experience in
years the socioeconomic status. Above half of the study sub­
<2 211 53.6 jects had poor food hygiene practice which could have
≥2 183 46.4 a huge impact in the disease pathogenesis. According to
Income per month the Codex Alimentarius Commission (2003), poor food
in ETB handling is a main reason for the occurrence of foodborne
1100–1743 136 34.5 diseases.31 A study done in Gondar town among food
1743–2000 146 37.1 handlers earlier in 2008 indicated that 29.1% and 3.1%
2000–2043 16 4.1
of the study subjects were positive for stool parasites and
2043–4867 96 24.4
enteropathogenic bacterial species respectively.32 A study
Family size among Arba Minch University food handlers also
1–2 113 28.7
revealed that among stool cultures 6.9% of Salmonella
2–3 102 25.9
3–4 117 29.7
and 3% Shigella isolates were reported.33 Several other
4–9 62 15.7 studies conducted among food handlers at universities in
Ethiopia also revealed that food handlers were vehicles of
Job category
Ticker/shift leader/ 61 15.5
disease causing microorganisms such as Shigella and
manager Salmonella.34–38 Food safety culture is required to create
Waiter 111 28.2 proper food handling and establishing regulations con­
Cooker/baker/chef 153 38.8 cerning food hygiene and safety.39,40
Laborer 69 17.5
Male study participants had better food hygiene
Food hygiene practice than females in the current study. This is in
orientation line with a study conducted regarding food hygiene
Monthly 109 27.7
practice in Iran.41 But in other studies29,42 females had
Biannually 114 28.9
better food hygiene practice than males. There was no
Annually 171 43.4
significant difference regarding food safety and hygiene

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Table 2 Factors Associated with Food Hygiene Practice Among University of Gondar Food Handlers, 2019 (n=394)
Variables Categories Practice COR (95% CI) AOR (95% CI)

Good (%) Poor (%)

Sex
Male 89(67.9%) 42(32.1%) 3.75(2.40,5.85) 2.37(1.34,4.19)***
Female 95(36.1%) 168(63.9%) 1 1

Age
19–26 41(38.0%) 67(62.0%) 1 1
27–28 44(47.8%) 48(52.2%) 1.50(0.85,2.63) 1.14(0.60,2.15)
29–32 65(56.0%) 51(44.0%) 2.08(1.22,3.56) 1.64(0.83,3.25)
33–58 34(43.6%) 44(56.4%) 1.26(0.70,2.28) 0.96(0.44,2.13)

Educational status
Primary 65(52.8%) 58(47.2%) 2.41(1.27,4.56) 2.54(1.16,5.58)*
Secondary 99(47.6%) 109(52.4%) 1.95(1.08,3.55) 2.20(1.11,4.37)*
College and above 20(31.7%) 43(68.3%) 1 1

Experience
≤2 89(42.2%) 122(57.8%) 1 1
>2 95(51.9%) 88(48.1%) 1.48(0.99,2.20) 1.86(1.06,3.25)*

Monthly income ETBa

1100–1743 49(36.0%) 87(64.0) 1 1
1744–2000 74(50.7%) 72(49.3%) 1.82(1.13,2.94) 1.69(0.97,2.94)
2001–2043 10(62.5%) 6(37.5%) 2.96(1.01,8.64) 2.11(0.60,7.39)
2044–4867 51(53.1%) 45(46.9%) 2.01(1.18,3.43) 2.05(1.01,4.16)*

Family size
1–2 54(47.8%) 59(52.2%) 1.55(0.82,2.92) 2.03(0.94,4.39)
2–3 45(44.1%) 57(55.9%) 1.34(0.70,2.56) 1.28(0.61,2.71)
3–4 62(53.0%) 55(47.0%) 1.91(1.02,3.60) 1.63(0.80,3.33)
4–9 23(37.1%) 39(62.9%) 1 1

Knowledge
Good 102(55.4) 142(67.6%) 0.60(0.40,0.90) 0.78(0.49,1.26)
Poor 82(44.6%) 68(32.4%) 1 1

Attitude
Good 112(51.9%) 104(48.1%) 1.58(1.06,2.37) 1.36(0.84,2.20)
Poor 72(40.4%) 106(59.6%) 1 1

Job category
Ticker/shift leader/manager 30(49.2%) 31(%) 1 1
Waiter 52(46.8%) 59(53.2%) 0.91(0.49,1.70) 0.73(0.33,1.63)
Cooker/baker/chef 50(32.7%) 103(67.3%) 0.50(0.27,0.92) 0.56(0.26,1.21)

Food hygiene orientation

Monthly 59(54.1%) 50(45.9%) 1.79(1.10,2.90) 1.24(0.70,2.21)
Biannually 57(50%) 57(50%) 1.52(0.94,2.44) 1.19(0.68,2.09)
Annually 68(39.8%) 103(60.2%) 1 1
Notes: *p<0.05, ***p<0.001 Hosmer and Lemeshow goodness-of-fit 0.364, at approximately the rate of 1 USD = 27 ETB.

practice based on difference in gender in some previous Educational status was inversely associated with food
studies.6,43–47 This might be due to other factors such as hygiene practice in the current study. However, in other
educational status and work role which could predict the studies educational status was positively associated with
food safety practice better than gender. food hygiene practice.13,20,29,41,48 Other studies reported

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International Journal of General Medicine 2020:13 1133
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Lema et al Dovepress

no association between educational status and food denoting actual food safety behavior.82 The other limita­
hygiene practice.6,11,49,50 The food handlers who attended tion is the lack of generalizability to the large population
college and above education had poor food hygiene prac­ as this study was conducted among food handlers at uni­
tice. This might be due to the fact that these workers are versity colleges. Finally, cross-sectional designs lack the
not frequently engaged in food handling and preparation. capacity to definitely demonstrate cause-effect relation­
Work experience was associated with food hygiene ships because of the inherent limitation of the design.
practice of respondents. Experienced food handlers had Also, because self-reported hygiene practice was assessed
reported better food hygiene practice. This association is it may be affected by social desirability bias.
consistent with earlier studies conducted regarding food
hygiene practice and determinant factors.20,28,29,41,42,51–54 Conclusion and Recommendation
However other studies reported that work experience has Only less than half of the study participants had good food
no association with level of food safety practice.44 Work hygiene practice. Sex, educational status, work experience and
experience is important to develop better food hygiene monthly income were factors significantly associated with
practice as it enables workers better opportunity to food handlers’ food hygiene practice. Strategies targeted at
undergo food hygiene training and orientation. improving the hygienic practice of food handlers are impera­
Monthly income was another factor associated with tive. There should be continuous supportive supervision to
food hygiene practice of food handlers. Study participants raise the skills of food handlers to comply to better food
with better income had better food hygiene practice in the hygiene practice. Targeted food hygiene improvement training
current study. This is consistent with earlier studies.55–58 should be given especially to female food handlers.
But in another study income was not significantly Additionally, frequent audits are also required to ensure the
associated.22 permanence of effective and continuous training. Regular
Knowledge, attitude and practice of food safety play medical check ups and strict hygiene follow-up should be
a basic role in preventing and controlling food poisoning encouraged to prevent foodborne disease outbreaks at
outbreaks.59 Knowledge and attitude were not associated universities.
with food hygiene practice of study subjects in the current
study. Numerous other previous studies11,60–64 also indi­
Abbreviations
cated no association between knowledge and food hygiene
AOR, Adjusted odds ratio; COR, Crude odds ratio; CI,
practice. In other studies,23,29,65 however, it was signifi­
Confidence interval; SPSS, Statistical package for social
cantly associated with the participants’ food hygiene prac­
sciences.
tice. Earlier studies21,26,51,63,66–68 revealed that knowledge
has a positive correlation with food hygiene practice.
Whereas other literature11,69 showed that knowledge of
Data Sharing Statement
Data will be available upon request from the correspond­
food hygiene may not be translated to food hygiene prac­
ing author.
tice. In another study it was negatively associated with
food hygiene practice.70 The difference may be due to the
study participants having surface level knowledge that Ethics Approval and Consent to
cannot bring about behavioral change. Attitude, also was Participate
not associated with the respondents of food hygiene prac­ Ethical clearance was obtained from the Environmental
tice in the current study. This is consistent with previous and Occupational Health and Safety ethical review com­
studies.71–78 However in other studies attitude was signifi­ mittee at the University of Gondar with ethical approval
cantly associated with food hygiene practice.25,54,63,79–81 number of EOHS/841/2011. The purpose of the study was
clearly explained to the study subjects. Written consent
Limitations of the Study was obtained. Confidentiality of the information was main­
This study is susceptible to the participants being biased tained at all levels of the study. Health education was
and does not represent the actual practice because the self- given for study subjects about good food hygiene practice
reported practices and behaviors were assessed. Self- after the data collection was over. This research was car­
reported practice is usually over estimated.82 ried out in accordance with the principles of the
Observational data provide the most reliable information Declaration of Helsinki.

1134 submit your manuscript | www.dovepress.com International Journal of General Medicine 2020:13
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Dovepress Lema et al

Consent for Publication 10. Abdul-Mutalib N-A, Abdul-Rashid M-F, Mustafa S, Amin-Nordin S,
Hamat RA, Osman M. Knowledge, attitude and practices regarding
This paper does not contain any individual person’s data. food hygiene and sanitation of food handlers in Kuala Pilah,
Malaysia. Food Control. 2012;27(2):289–293.
11. Akabanda F, Hlortsi EH, Owusu-Kwarteng J. Food safety knowl­
Acknowledgments edge, attitudes and practices of institutional food-handlers in
The authors are pleased to acknowledge study participants Ghana. BMC Public Health. 2017;17(1):40. doi:10.1186/s12889-
for their unreserved contributions to the success of this study. 016-3986-9
12. Gemeda T, Asayehu T, Abdisa M, Fekadu H. Assessment of knowledge,
The authors are also pleased to acknowledge the University attitude and practices of food handlers in Nekemte Referral Hospital,
of Gondar for covering the questionnaire duplication fee. Wollega, Ethiopia. J Nutr Health Food Eng. 2018;8(1):00262.
13. Lestantyo D, Husodo AH, Iravati S, Shaluhiyah Z. Safe food
handling knowledge, attitude and practice of food handlers in
Author Contributions hospital kitchen. IJPHS. 2017;6(4):324. doi:10.11591/ijphs.
v6i4.10778
All authors made substantial contributions to conception
14. Gebreeyessus GD, Adem DB. Knowledge, attitude, and practice on
and design, acquisition of data, or analysis and interpreta­ hygiene and morbidity status among tertiary students: the case of
tion of data; took part in drafting the article or revising it Kotebe Metropolitan University, Addis Ababa, Ethiopia. J Environ
Public Health. 2018;2018:2094621. doi:10.1155/2018/2094621
critically for important intellectual content; agreed on the 15. Kubde S, Pattankar J, Kokiwar P. Knowledge and food hygiene
journal to which the article was submitted; gave final practices among food handlers in food establishments.
approval of the version to be published; and agreed to be Int J Commun Med Public Health. 2016;251–256. doi:10.18203/
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accountable for all aspects of the work. 16. Parry-Hanson Kunadu A, Ofosu DB, Aboagye E, Tano-Debrah K.
Food safety knowledge, attitudes and self-reported practices of food
handlers in institutional foodservice in Accra, Ghana. Food Control.
Funding 2016;69:324–330. doi:10.1016/j.foodcont.2016.05.011
There was no funding for this research but the University 17. University of Gondar. University of Gondar official site; 2019.
Available from: http:www.uog.edu.et.
of Gondar has covered the questionnaire duplication fee.
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2013;5(2). doi:10.5959/eimj.v5i2.130
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Disclosure conditions of catering establishments and food safety knowledge and
The authors report no conflicts of interest for this work. practices of food handlers in Addis Ababa University Students’
Cafeteria. Science. 2015;3(5):733–743.
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