Int. J. Agron. Agri. R.

International Journal of Agronomy and Agricultural Research (IJAAR)

ISSN: 2223-7054 (Print) 2225-3610 (Online)
http://www.innspub.net
Vol. 24, No. 2, p. 22-30, 2023
RESEARCH PAPER OPEN ACCESS

Hospital food safety regarding food handlers knowledge

practices in Khartoum Government Hospitals
Mona Abdalgadir Ahmed Abuagla*

Faculty of Applied Medical Sciences, Al-Baha University, KSA

Article published on February 20, 2024

Key words: Food safety, Food hygiene, Food handlers knowledge, Food handlers practices, Hospitals,
Khartoum

Abstract

Food handlers’ knowledge of safe health practices plays an important role in food safety. The aim of this cross-
sectional study was to evaluate the level of food handlers, knowledge, practices related to food safety and hygiene
for workers in government hospitals in Khartoum State - Sudan. The data was collected through a questionnaire
conducted among 105 of those who work in food preparation and distribution, cleaning, and supervisors in 10
government hospitals in December 2014. The results showed that the female was 57% ,41.7% of them were in36-
45of years, 65%, ≥ 5 of experience, 41.7% had primary education, 65% received food safety training, while 41.7%
% They do not have knowledge of the importance of food safety, as for nutrition Office. The majority of them were
women, 95.6%, and 44.4% of them in 25-35 years old. Most of them were clinical nutrition specialists, and 62.2%
of them were university graduates. They have more than five years of practical experience, and 55.5% of them
reported that the standard of meals provided to patients was satisfactory, while 13.3% reported that it was
unsatisfactory, 53.3% reported that they do not train workers on the job, while 68.9% reported that they were a
directed to the importance of obtaining a health card. The analysis also showed statistics between the age groups
of food handlers and their training at the level of 0.01, as well as between the knowledge of food handlers about
food contaminants and their training at the level of 0.01.
* Corresponding Author: Mona Abdalgadir Ahmed Abuagla  [email protected]

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Introduction the safety of foods, especially those served in

The hands of food handlers can spread foodborne hospitals, by avoiding transferring the microbe to the
diseases for reasons such as neglect of personal food and then to the consumer (Bartram et al., 2010).
hygiene or cross-contamination. For example, poor All food handlers should be trained on topics related
personal hygiene may be widespread after using the to good hygiene practices, hazard analysis and critical
toilet, or bacteria may be spread from raw to fresh control points. There is also training in identifying
foods such as green salad by the hands of food inappropriate employee behavior and explaining how
handlers (Ehiri et al., 1996). The patient in the to correct these problems (Medeiros et al., 2011). This
hospital needs safe and appropriate food so that is to impart basic knowledge about the causative
he/she does not suffer from harmful health agents of food-borne diseases (Mitchell et al., 2007)
consequences such as nutrition related disease (Sharif which should focus on the theoretical and practical
et al., 2013). Neglecting personal hygiene can also elements of training for food services (Howells et al.,
contribute to food-borne diseases in the hospital, 2008).
such as the transfer of Staphylococcus aureus
bacteria (Garcia et al., 2015). Food born disease can There is a weakness in food services in some under-
cause severe and/or long-lasting damage to health developing countries, especially for food handlers in
(Tomkins et al., 1989). Various pathogens have been hospitals and also those working to supervise them
identified as causing diarrhoeal diseases. Some of (Turnlund et al., 1983), (Abdelkadir, 2017). There is a
these include bacteria such as Escherichia coli, lot of important health knowledge and practices that
Shigella spp., Salmonella spp., Vibrio cholerae food handlers must follow, such as maintaining
,Campylobacter jejune; protozoa such as Giardia personal hygiene, which includes: bathing and
lamblia, Entamoeba histolytica, Cryptosporidium , trimming nails, treating skin allergies, wounds, using
rotavirus, Bacillus cereus, Staphylococcus aureus, hand sanitizer, washing clothes regularly, washing
Clostridium perfringens, helminths (Black et al., hands regularly, and washing the scalp. And hair,
1980), (Tardelli et al., 1991) and E. coli are probably wearing personal protective equipment, avoiding
the commonest illnesses in developing countries coughing, sneezing, spitting around food, scratching
(Esrey et al., 19858). Foodborne diseases means the skin and hair, touching wounds, applying all
diseases that result from eating contaminated foods, healthy behaviors and applying the correct service
and there are more than 250 different risks that can standards (Pilling et al., 2008).
be transmitted through food, including infectious
bacteria, viruses and parasites which can be In the context of my work in this field, there are a
transmitted through food handles ( Li et al., 2019 ). It large number of patients in public hospitals who
has been documented that many foodborne diseases depend on the free meal provided to them, but there
are transmitted by consumers when they are is little research that has been conducted in this field.
travelling to consumer such as patients in hospitals Therefore, it was necessary to shed light on the
which may worsen their condition, especially if they workers’ knowledge of the importance and
are immunosuppressed (Mohammed et al., 2020). application of food hygiene and safety, provided that
Food handlers may contaminate food by malpractices it extends to Work on the extent of the impact of this
linked to a lack of knowledge about the basics of food on the meals provided by analysing some samples
safety, including personal hygiene, proper cooking from workers and foods to determine the relationship
and storage temperature, and cross-contamination between the application of health systems and their
(Hardstaff et al., 2018). This knowledge can be impact on the safety and hygiene of the foods
enhanced by training of food handlers in food safety provided so that the patient enjoys a good meal free of
and hygiene (Addo et al., 2020). The personal contaminants and thus not wasting some meals due
hygiene of food handlers plays an important factor in to the reluctance of some patients to do so.

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Materials and methods questions that include demographics characteristic

The study was carried out in 10 Khartoum state data of the participants and information related to
hospitals which are all public hospital including: food safety and the practices deal with it. Table 1
Khartoum Hospital, Khartoum Bahri, Ben Sinan, shows the demographic characteristics of the
Jaafar bin Auf for children, Corn treatment, Ear, nose handling workers participating in the questionnaire,
and throat, Dermatology, Omdurman hospital, dental whose oldest age was between 36 - 45 years (41.7%),
hospital. which was the largest hospitals in the most of them (57%) were women ,working in food
capital of Sudan Participants (105) were nutrition distributions (45%) and (41.7) of them had primary
office staff ,food handlers Those who were present at education. The number of them living in villages was
the time of the visit and agreed to answer, Those who about (66.7%) and the number of married was 83.3%,
were not present and who did not have the desire to those with more than five years’ experience were
answer the questions were excluded. According to (65%).
certain inclusion and exclusion criteria, this study is a
cross sectional hospital-based study, designed to Table 2 shows the extent of food workers’ knowledge
evaluate knowledge, attitudes and practices of the about food safety which shows that 65% of them were
nutrition office staff towards food safety practices and given training on food hygiene (16.7% not formal).
food handlers, The procedures include primary data However, (16.7%) of them had no information about
collected through a structured questionnaire in the food contamination, and 25% of them reported that
form of interviews that contains a number of they were not sure about it , and 81.7% of them
questions about participants’ demographic data, such reported that they were followed up by food
as age and gender, training, and etc. It also contained supervisors on this matter. Also, 56.7% of food
a set of questions about the food handlers’ knowledge, handlers responded that they know the importance of
practice of handling food in healthy ways and their wearing gloves, while 33.3 do not know the
behaviors. The questionnaire also contained another importance of that, and 10% are not sure of the
part to interview the supervisors at the Nutrition importance of wearing gloves. The table above also
Office, in addition to the notes that were taken during shows that 78.3% of the participants in the
the visit. The second method of collecting data is questionnaire answered that they know the
secondary data, which was collected from A collection importance of personal hygiene in food safety, while
of references and books related to the topic. All 13.3% of them did not know that, and 8.3% reported
primary data were analyzed by using Statistical that they were not sure of the importance of this
Package for social Science (SPSS V22) and Excel. relationship to food contamination.

Ethical consideration Table 3 shows the practices of food handlers during

According to the research criteria, a letter was written the food preparation and distribution process, which
to the Ministry of Health Then, after approval and shows that 53.3% of food handlers believe that they
the signature of the Director of Curative and wear appropriate clothing for work; while 46.7% said
Preventive Medicine, the letter was submitted to all that it is not appropriate for work. Also, 50% of them
the authorities from which the data was collected, answered that the kitchen is cleaned once, while
which are a number of hospitals in Khartoum State. 36.6% reported that it is cleaned twice a day, and
Work began after their approval. 13.4% responded that the kitchen is cleaned more
than 3 times a day, Also, 60% of the participants in
Results the questionnaire reported that washing hands occurs
The following are the results obtained from a before and after work in preparing and distributing
questionnaire cove ring 105 workers, including 60 food, while 38.3% preferred not to implement this, as
workers in food preparation and distribution, and 45 6.7% of them responded that washing hands occurs at
from the Nutrition Office. It includes a different set of some times.

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Table 1. Characteristic of the participants

Characteristic (N=60) Variables Frequency Percentage Valid percent Cumulative
percent
Male 26 43 43 43
Sex
1 Female 34 57 57 100
Total 60 100 100
25-35 21 35 35 35
36-45 25 41.7 41.7 41.7
Age distributions
2 46-55 5 8.3 8.3 8.3
≥ 55 9 15 15 100
Total 60 100 100
Preparing foods 26 43.3 43.3 43.3
Type of work Distribution of food 27 45 45 45
3
other 7 11.7 11.7 100
Total 60 100 100
primary 25 41.7 41.7 41.7
Education level of
Secondary 10 33,3 33,3 33,3
4 Participant’s
illiterate 15 25 25 100
Total 60 100 100
Village 40 66.7 66.7 66.7
Residence
5 City 20 33.3 33.3 100
Total 60 100 100
Married 50 83.3 83.3 83.3
Marital status
6 single 10 16.7 16.7 100
Total 60 100.0 100.0
≤5 years 21 35 35 35
Years of experience
7 More than 5 years 39 65 65 100
Total 60 100 100

Table 2. Knowledge of food handlers in the hospital

Characteristic (N=60) Variables Frequency Percentage Valid percent Cumulative
percent
Receive food hygiene Yes 35 65 65 65
1 training No 25 35 35 100
Total 60 100 100
Follow up with your Yes 49 81.7 81.7 81.7
supervisor on food safety 11 18.3 18.3 100
2 No
Total 60 100 100
Yes 25 71.4 71.4 71.4
Received formal training Not formal 10 16.7 16.7 16.7
3
None 25 28.6 28.6 100
Total 60 100 100 58.3
Yes 35 58.3 58.3 16.7
Knowledge of food
No 10 16.7 16.7 25
4 contaminants
not sure 15 25 25 100
Total 60 100 100
Yes 34 56.7 56.7 56.7
The importance of wearing
Not 20 33.3 33.3 33.3
5 gloves
not sure 6 10 10 100
Total 60 100 100
The relationship between Yes 47 78.3 78.3 78.3
personal hygiene and food No 8 13.3 13.3 13.3
6 contamination
not sure 5 8.3 8.3 100
Total 60 100 100

Regarding the materials used in cleaning, 73.3% of 25% of them reported that they wear them often, and
the workers responded that they use soap and 25% also reported that they do not wear the gloves.
lukewarm water, and 18.4% reported that they use
hot water with soap, while only 8.3% responded that Table 4 shows the health status of food handlers,
they use other materials. Also, 50% of them which shows that 50% of them get the health card
responded that they wear gloves sometimes, while once a year, 36.7% get it twice a year, while only 6.7%

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get the card three times a year, as 6.7% are not sure of them were not vaccinated, while 40% had been
the number. The times the cards are made for them, vaccinated, while 6.7% reported that they were not
Regarding the validity of health cards, most of the sure about that. Also, 91.7% of food handlers reported
workers, 56.7%, reported that their cards were valid, that they do not suffer from an infectious disease,
while 35% reported that they were invalid, and 8.3% while 8.3% reported that they were not sure about
of them were not sure about that, the table also that.
includes workers’ reports of vaccination, as most of

Table 3. Food handler’s practices

Characteristic (N=60) Variables Frequency Percentage Valid percent Cumulative
percent
Use appropriate clothing Yes 32 53.3 53.3 53.3
1 for work No 28 46.7 46.7 100
Total 60 100 100
Once 30 50 50 50
Twice 22 36.6 36.6 36.6
How many times is the
three times 4 6.7 6.7 6.7
2 kitchen cleaned per day?
more than three 4 6.7 6.7 100
times
Total 60 100 100
Wash your hands before Yes 33 55 55 55
preparing and distributing No 23 38.3 38.3 38.3
3
foods Some times 4 6.7 6.7 100
Total 60 100 100
yes 16 26.7 26.7 26.7
use tobacco or cigarettes
No 40 66.6 66.6 66.6
4 while working?
Some times 4 6.7 6.7 100
Total 60 60 100 100
Soap and lukewarm 44 73.3 73.3 73.3
Types of materials used in water
5 cleaning Soap and worm water 11 18.4 18.4 18.4
Other material 5 8.3 8.3 100
Total 60 100 100
I always 15 25 25 25
How often do you wear
I don't use it 15 25 25 25
6 gloves when handling food?
sometimes 30 50 50 100
Total 60 100 100

Table 4. Health information for hospital food handlers

Characteristic (N=60) Variables Frequency Percentage Valid percent Cumulative
percent
Once time 30 50 50 50
Card renewal times per Twice 22 36.7 36.7 36.7
1 year three times 4 6.7 6.7 6.7
Not sure 4 6.7 6.7 100
Total 60 100 100
yes 34 56.7 56.7 56.7
Health card validity No 21 35 35 35
2
Not sure 5 8.3 8.3 100
Total 60 100 100
Yes 24 40 40 40
Get vaccinations when
No 32 53.3 53.3 53.3
3 starting work
Not sure 4 6.7 6.7 100
Total 60 100 100
Conduct health checks Yes 45 75 75 75
4 when starting work No 15 25 25 100
Total 60 100 100
Now suffering from an Yes 5 8.3 8.3 8.3
5 infectious disease No 55 91.7 91.7 100
Total 60 100 100

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Table 5. Characteristic of the participants (nutrition office)

Characteristic (N=45) Variables Frequency Percentage Valid percent Cumulative
percent
Female 43 95.6 95.6 95.6
Sex
1 Male 2 4.4 4.4 100
Total 45 100 100
25-35 20 44.4 44.4 44.4
age distributions 36-45 15 33.3 33.3 33.3
2
≥ 46 10 22.2 22.2 100
Total 45 100 100
Clinical nutrition 23 51.1 51.1 51.1
Type of work
3 Nutrition technician 22 48.9 48.9 100
Total 45 100 100
Education level of University 28 62.2 62.2 62.2
4 Participant’s Secondary 17 37.8 37.8 100
Total 45 100 100
Village 5 11.1 11.1 . 11.1
Residence
5 City 40 88.9 88.9 100
Total 45 100 100
Married 25 55.6 55.6 55.6
Marital status
6 single 20 44.4 44.4 100
Total 45 100.0 100.0
≤5 years 10 22.2 22.2 22.2
Years of Experience
7 More than 5 years 35 77.8 77.8 100
Total 45 100 100
yes 25 55.6 55.6 55.6
Food hygiene training
8 no 20 44.4 44.4 100
Total 45 100 100

Table 6. Food safety related questions (nutrition office)

Characteristic (N=45) Variables Frequency Percentage Valid percent Cumulative
percent
Good 12 26.7 4.4 4.4
Quality of patients meal Acceptable 27 60 95.5 100
1
Not acceptable 6 13.3 113.3 100
Total 45 100 100
Inside hospital 39 86.7 86.7 86.7
Meal preparation place
2 Outside hospital 6 13.3 13.3 100
Total 45 100 100
Good 13 28.9 28.9 51.1
Food safety Acceptable 25 55.5 55.5 55.5
3
Not acceptable 7 15.6 15.6 100
Total 45 100 100
Standard 4 8.9 8.9 8.9
Kitchen design
4 Not standard 41 91.1 91.1 100
Total 45 100 100
Conduct training for Yes 21 46.7 46.7 46.7
5 workers No 24 53.3 53.3 100
Total 45 100 100
directing food handlers to Yes 31 68.9 68.9 68.9
6 health card No 14 31.1 31.1 100
Total 45 100.0 100.0
Yes 21 46.7 46.7 46.7
Shortage of workers
7 No 24 53.3 53.3 100
Total 45 100 100
Guiding workers in food Yes 30 6.7 6.7 66.7
8 hygiene and safety No 15 33.3 33.3 100
Total 45 100 100

Table 5 contains other demographic questions that 33.3% were between 36-45 years, while only 10%
were conducted among employees in the nutrition were over 46 years old, 51.1% of them are
office of which 95.6% were women, only 4.4% were nutritionists, while all the rest work as nutrition
men, and the majority were between 25-35 years old, technicians. 88.9% of them live in cities, and 55.6% of

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them are married; most of them 62.2% obtained a standards, as only 8.9% reported that the kitchen in
university education. Also, 77.8 of them have more their hospitals meets the required standards
than 5 years of experience. Regarding the number of workers, whether it is
sufficient for the work, 46.7% answered that it is
Table 7. Correlation between education level and sufficient for the workflow, while 53.3% answered
received training of food handlers that the number is not sufficient. Tables 7, 8 and 9
Education Received above show significant relationship among the age
level training
groups, education level, received training and the
Education Pearson Correlation 1 .630**
level Sig. (2-tailed) .000 level of food safety knowledge of food handlers.
N 60 60
Received Pearson Correlation .630** 1
training Sig. (2-tailed) .000 Discussion
N 60 60 The research shows that many workers (25%) are
**Correlation is significant at the 0.01 level (2-tailed). uneducated, which means that they have not received
any food safety training (35%), their knowledge about
Table 8. Correlation between education level and age
food hygiene is poor. It is also the result conform
groups of food handlers
(46.7%) that those who have received training in food
Education Age
level groups safety are ignorant of much of the correct knowledge
education Pearson Correlation 1 .341** that enables them to perform in the correct ways,
level Sig. (2-tailed) .008
N 60 60 Also, some workers in the nutrition office (44.4%),
age Pearson Correlation .341** 1 did not receive appropriate training on food safety,
groups Sig. (2-tailed) .008
and some of them (33.3%) reported that they do not
N 60 60
**Correlation is significant at the 0.01 level (2-tailed). follow up on guidance for workers on things that help
food safety and not following up to renew health
Table 9. Correlation between received training and cards (31.1%) This has a negative impact on the safety
food contaminants knowledge of food handlers
Received food of the foods provided to patients. In addition, some
training contaminants observations during visits to various work sites
knowledge
confirmed some wrong practices in preparing and
Received Pearson
1 .769**
training Correlation distributing foods. Also, many kitchens are not
Sig. (2-
.000 standardized for practicing work in preparing and
tailed)
N 60 60 distributing foods in a healthy way.
food Pearson
.769** 1
contaminants Correlation
knowledge Sig. (2- Conclusion
.000
tailed)
Because of the results shown by this study, food
N 60 60
**Correlation is significant at the 0.01 level (2-tailed). handlers in a number of hospitals do not have
sufficient information about the correct methods for
Table 6 shows the answers of nutrition office preparing and distributing food, which requires
employees to some questions related to food safety, training and follow-up from the nutrition office.
where 60% of them answered that patients’ meals are Continuous training must also be followed up and
acceptable, 26.7 said that they are good, while 13.3 programs must be created to ensure the continuation
said that they are unacceptable. Regarding preparing of this.
and bringing food, 86.7% of the staff in the nutrition
department said that it is prepared inside the hospital Recommendations
kitchen, while 13.3 of them said that it is from outside There must be training regarding food health and
the hospital. Also, 91.1 of them responded that the safety, whether formal or not, creating an education
hospital kitchen does not meet the standard program about food hygiene for all employees.

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One of the conditions for employment is that the Esrey SA, Feachem RG, Hughes JM. 1985.
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administration in implementing the quality program among young children: improving water supplies and
due to its importance in food safety. The importance excreta disposal facilities. Bulletin of the World
of the nutrition office’s employees following up on
Health organization 63(4), 757.
workers inside the kitchen, paying attention to the
standard structure of kitchens. Li M, Havelaar AH, Hoffmann S, Hald T, Kirk
MD, Torgerson PR, Devleesschauwer B. 2019.
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