Knowledge, attitude, and practices of butcher shop workers about foodborne pathogens and safety measures in Addis Ababa city and Burayu town, Ethiopia

Abstract

Foodborne diseases are an increasing public health issue worldwide. Inadequate food safety laws and weak regulatory systems make it difficult to control food-related morbidity. Understanding the practices of meat handlers and materials used in the butcher shops is a critical input for appropriate intervention. This study aimed to assess butcher shop workers’ knowledge, attitudes, and practices on foodborne pathogens and safety measures to be implemented at the butcher shop level. A cross-sectional survey was carried out among 126 butcher shop workers. A structured questionnaire and observation were used. Interview was conducted face to face during working hours. Questions on food safety knowledge, attitude, and practices were valued 0 and 1 for wrong and correct answers, respectively. One hundred twenty-four (98.4%) of the study participants were male and the mean age was 29.1 ± 8 years. Fifty (40%) of butcher shop workers have unsatisfactory knowledge level of foodborne diseases with mean score of 6.2 ± 0.8 below the cut of points < 68% accuracy. Ninety-two (73%) respondents have a good attitude on food safety. Seventy -four (59%) of participants were not maintaining food safety practices. In conclusion, the knowledge level of respondents on the role of personal hygiene in reduction of foodborne diseases was unsatisfactory. Periodic training on food safety measures is critical to increase awareness of the butcher shop workers.

Introduction

Annually, 420,000 deaths, 600 million illnesses, and 33 million lost years of healthy life are attributed to foodborne diseases, affecting one in 10 people worldwide. These morbidity and mortality are mainly attributed to poor handling practices along the food chain system¹. Foodborne illnesses are a significant public health problem in Ethiopia, mainly due to widespread unsafe food handling practices. These practices, which occur at every stage of the food chain from farm to table, lead to contamination by harmful bacteria². Poor practices of food handlers below standards contributed to about 75% of the total food-borne illness outbreaks globally³.

Ethiopia as one of the low-income countries faces a similar challenge of foodborne illnesses accounting for a significant proportion of reported illnesses. These foodborne diseases result in a substantial economic loss of at least 723 million USD annually and cause an estimated 1,570 deaths and 3.1 million illnesses per year⁴.

The nutritive composition of meat makes it an ideal medium for the growth of many number of microorganisms including commonly disease causing pathogens⁵. Bucher shop workers’ health status and regular hygienic practices at the Bucher shop are the foremost determinants to reduce raw beef contamination⁶. Meat-related infections happen as a result of ingesting meat defiled with pathogenic microorganisms. The contamination springs from inadequate protection styles and poor hygienic practices resulting in cross-contamination from equipment used for processing carcasses⁷. Personal hygiene and keeping clean butcher shop facilities plays a critical role in reduction of food contaminations especially availability of functional hand washing facilities⁸. Butcher shops with trained food handlers in sanitation and hygiene showed good food safety practices compared to butcher shops workers without food handling training⁹.

Hygienic and quality control styles for meat and meat products in food catering have been recommended in numerous countries. Knowledge, attitude and practices are the most common three factors that play a fundamental role in food contamination related outbreaks¹⁰.

Because meat is mostly perishable, handling personnel in the meat sector need to be knowledgeable about food safety, hygiene, and hygienic practices in order to ensure the consumer’s health and safety¹¹. Continuous auditing of butcher shop workers hygienic practices, and food handling habits can assist to forecast the likelihood of food contamination and direct policy makers to launch the proper interventions¹⁰.Though studies have been conducted in Ethiopia on these issues, continuous assessment is required to fill gaps of knowledge, attitude and practice to compare existing situation and what was reported previously. Therefore, the goal of the current study was to evaluate knowledge, attitude and practices of butcher shop workers about foodborne pathogens and safety precautions in a subset of Addis Ababa city and Burayu town.

Materials and methods

Study area

The study was carried out in Addis Ababa city and Burayu town. Addis Ababa is Ethiopia’s capital located on the highland close to the Great Rift Valley at 2,355 m above sea level. It is the center of commerce and culture for the nation. Population of Addis Ababa is estimated to be 5,70, 628 in 2024¹². There are two primary abattoirs in Addis Ababa city that supply the city’s more than 4,000 registered butcher shops. There are currently ten sub cities, of which eight sub cities were included in the current study. Burayu is located at an elevation of 2,399 m above sea level and a projected population of 96,604 in 2021, The town is one of the first-level regional metropolitan centers under the Oromia National Regional State. According to Ethiopian statistics from 2021, the town contains about 800 butcher shops and one abattoir¹³.

Study design and period

Across-sectional study was conducted to assess the knowledge, attitude and practices of butcher shop workers on foodborne pathogens in Addis Ababa city and Burayu town from November 2021 to April, 2022.

Source population and study subjects

The source population for this investigation was all butcher shop workers working in Burayu town and Addis Ababa city administration. The study subject was butcher shop workers working in Addis Ababa city and Burayu town.

Sample size determination and sampling technique

Sample size was calculated using a single population proportion formula with 95% CI, 5% marginal error, and p = 9% proportion of food handlers having good food safety knowledge, attitude, and practices, from the previous study¹⁴; n=(z² * p(1-p)/d^2; where n = total number of samples; p  =  expected prevalence from previous study; Z = 95 confidence interval; ,d = margin of error. Hence calculated sample size was 126.

The butcher shop workers were selected conveniently from 8 sub cities in Addis Ababa and Burayu town.

Number of butcher shops involved in the study from Addis Ababa (n = 83) and Burayu (n = 43) was distributed proportionally based on the total number of butcher shops in Addis Ababa and Burayu. Interviewer-administered data collection technique was used to collect epidemiological and other required information. Only butcher shop workers involved in processing of the raw beef were selected in a single Bucher shop. Usually, two workers are assigned in a single butcher shop to serve the customers: the one who is mainly involved in cutting of the carcasses was considered for the study. The butcher shop workers who were willing to participate in the study were included in current study.

Data collection procedure

The questionnaire was originally prepared in English and then translated into local language (Amharic), and Oromifa. A pretested interviewer-based structured questionnaire adapted from different literatures to fit with both the subject area, and local context was used. Close-ended questions focusing on personal hygiene, cross-contamination, safe food handling, and hand-washing practices were employed. Each knowledge question was followed by three implicit responses (yes, no, and I don’t know), Attitude was measured using two alternatives (agree or disagree) and the practice was using questions geared to practices and supplemented with observation during data collection time.

Study variables

Dependent variables

The response variables of this study were food safety practices, such as using plastic handled or wooden knife, knowledge in this aspect the participants were checked whether they know or not commonly known foodborne pathogens name, impact of food borne diseases, and attitude of butcher shop workers towards the role of regulatory bodies, the advantage and disadvantage of consuming raw meat over cooked one to reduce foodborne diseases were assessed.

Independent variables

The predictor variables of this study were sex, age, frequency of hand washing, distance of sink from the butcher shops formal educational level of the butcher shopworkers.

Measurement method and scoring

The questionnaire was divided in to four sections, Demographic information, Knowledge, Attitude and Practices. In addition, observational checklists were used to collect relevant data. Butcher shop workers were interviewed and observation was made using a value of 0 and 1. One and zero score was given to the wrong (No and do not know) and correct answers respectively. A total number of 11 questions on food safety knowledge were used. Meat handlers who scored overall score < 7.5 points were considered to have “unsatisfactory” and those who scored ≥ 7.5 points (≥ 68%) accuracy) “satisfactory” knowledge of food safety. The third part of the questionnaire was about the food safety attitude of meat handlers. It comprises 11 questions related to hand washing, cross-contamination, food handling, storage, etc. In this section, the respondents’ answers were “agreed”, “disagree”, and “don’t know”. The response was analyzed as categorical variables (Yes, no, or Don’t Know). A score of one was given to the right answer and zero to the wrong and I do not know answers.

The butcher shop workers were interviewed for their attitude towards raw meat consumption in the community, importance of training to improve food quality was assessed using11 questions. Food handlers who answered 7.7 or more questions correctly were considered to have a “good” attitude, whereas respondents who answered less than 7.7 questions correctly were considered to have a “poor” attitude.

The last section was hygienic practices. It comprises the issues of personal hygiene, hand washing practices against foodborne diseases, and cross-contamination. With 16 questions with possible responses: “yes”, and “no”. For evaluation, a score ≥ 70% means food handlers practiced 11.2 or more out of 16 hygienic practices which are listed in the questions were considered as having “good” hygienic practices. The result interpretation was done based on the previous study cut of value.

Statistical analysis

Descriptive statistics was computed to summarize data, including frequencies, percentages for categorical, and mean for continuous variables respectively using Statistical Package for Social Sciences (SPSS) version 26. Bivariable and multivariable logistic regression analysis was conducted to identify factors associated with the dependent variable such as practice, Knowledge and Attitude and independent variables such as age, education, frequency of practices that showed 0.2 odd’s ratio were examined using multivariate analysis was done to avoid confounder’s risk. The strength of the association was presented by the odds ratio with 95% CI, a p-value of less than 0.05 was considered statistically significant.

Ethical considerations

The protocol was approved by the Institutional Review Board of Addis Ababa University, Aklilu Lemma Institute of pathobiology, with minute reference number (ALIPB-IRB/59/2013/21 dated 25/06/2021) and from Ethiopian Public Health Institute with reference no (EPHI/6.13/565 dated 22/09/2021). Written informed consent was obtained from the butcher shop workers and the butcher shop owners. The confidentiality of data was assured by deidentifying of each participant. In addition, the information was accessed only by the investigators and the hard copy of the information was physically locked.

Guidelines and regulations

The work has performed based on materials and methods previously published and in accordance with country’s relevant research guidelines and data confidentiality regulation.

Results

The socio-demographic characteristics of study participants are summarized in Table 1. Of 126 butcher shop workers interviewed, 124 (98.4%) were male, with age distribution 21–30 years accounted for 59.5% (n = 75) followed by the age group of 31–40 which comprised 27% (n = 34). The mean ± SD age was 29.1 ± 8. The youngest age of the participants was 17 and the oldest 60 years.

Table 1.

Summary of socio-demographic characteristics of interviewees in Addis Ababa city and Burayu town Oromia regional state, Ethiopia, August 2022 to December, 2022. (n = 126)

Characteristics	n	%
Gender
Male	124	98.4
Female	2	1.6
Age
< 20	9	7.1
20–30	75	59.5
31–40	32	25.4
> 41	10	8.0
Level of education
Illiterate	2	1.6
Primary education	44	34.9
Secondary education	70	55.6
Diploma	6	4.8
Frist degree	4	3.1
Formal food safety training
Yes	36	28.8
No	90	71.2
Health status checkup
Yes	118	93.6
No	8	6.4

The educational level was secondary school 55.6% (n = 70) followed by primary 44 (33%), and only 2(1.6%) participants had not attended any level of educational program. Ninety (71.2%) of the butcher shop workers never get any formal training on food safety. However, 118(93.6%) have checked their health status in regular manner every 6 months (Table 1).

Knowledge attitude and practices of butcher shop workers

Knowledge

The overall knowledge level of respondents about personal hygiene, cross-contamination, some common etiologic agents, and transmission of foodborne diseases are summarized in Table 2. Fifty-one (40.5%) of butcher shop workers have unsatisfactory knowledge level on the common foodborne pathogen transmission, types of possible foodborne diseases causing organisms which is below the cutoff point 7.5 (≥ 68% accuracy). Ninety-four (74.6%) of them have never heard about common bacterial foodborne disease-causing agents such as Salmonella, E. coli o157, Brucella, and Listeria. In addition to this, 67(53.2%) of the butcher shop workers were not aware of the advantage of plastic-handled knife and cutting boards during the processing of raw meat to reduce the risk of contamination. One hundred nineteen (94.4%) butcher shop workers responded that foodborne diseases can pose a high economic burden at individual level and in the country at large. Washing of carcass at arrival was not supported by 97(77%) of the study participants. One hundred fourteen (90.5%) butcher shop workers agreed that cattle to be slaughtered should undergo anti-mortem and postmortem inspections. The educational level and age, of the respondents was not significantly associated with their knowledge of food safety and hygiene (OR = 0.9, 95% CI = 0.44–1.9).

Table 2.

Summary of meat handlers’ food safety knowledge in Addis Ababa city and Burayu town, Oromia Regional State, Ethiopia, August 2022 to December, 2022. (n = 126)

S#	Question	Response n (%)
		Yes	No	Do not know
1	Foodborne disease is a disease that arises from animal or inanimate object related to food	111(88.1)	10(7.9)	5(4.0)
2	Some of the etiologic agents for foodborne diseases are bacterial species such as Salmonella, E.coli 0157, Brucella and Listeria	21(16.7)	11(8.7)	94(74.6)
3	Foodborne diseases can pose high economic burden?	118(93.7)	8(6.3)	0(0)
4	Eating raw meat and meat products can predispose to foodborne diseases	91(72.2)	27(21.4)	8(6.4)
5	Unhygienic handling practices, and contact with infected animal can be risk factor for foodborne diseases	111(88.1)	15(12.9)	0(0)
6	Washing the carcass with water will improve the beef hygiene	97(77)	29(23)	0(0)
7	Raw meat is germ free unless flies land on it	101(80.1)	24(19.1)	1(0.8)
8	Do you think postmortem inspection of slaughtered cattle is important	114(90.5)	12(9.5)	0(0)
9	Using hygienic materials to process the meat will help to avoid FBD transmitted by raw meat	61(48.4)	65(51.6)	0(0)
10	Avoiding stress for the cattle during slaughtering will help to reduce FBD transmitted by raw meat	6(4.8)	120(95.2)	0(0)
11	Covering raw meat until sold is important	86(68.3)	40(31.7)	0(0)

Attitude

The attitude of butcher shop workers on the burden of foodborne diseases for the economy, possible risk factors to acquire foodborne diseases, and the advantage of regulatory authority to control the sanitary conditions are summarized in Table 3. Ninety-four (74.6%) of respondents have a good attitude towards food safety with a mean total score of 7.3 ± 0.6. The advantage of covering the carcass until it gets sold is not supported by 87(69%) of the butcher shop workers. Ninety-three (73.8%) butcher shop workers have positive attitude towards training of abattoir and butcher shop workers to decrease the risk of foodborne diseases raised from beef contamination. One hundred twenty-four (98.4%) and 118 (93.7%) agreed on the necessity of a strong regulatory body that checks the health of animals to be slaughtered and the health status of butcher shop workers. The butcher shop workers’ attitude towards the consumption of raw meat as a risk of acquiring foodborne diseases was 102 (81%). On the other hand, 93(73.8%) of the butcher shop workers replied that public awareness of the risk of consuming raw meat to foodborne diseases never decreases the established cultural habits of the urban community. Eighty (63.5%) of the participants believe that raw meat is more delicious than cooked meat. Educational level of the respondents was not significantly associated with their attitude toward food safety and hygiene (OR = 0. 75, 95% CI = 0.36–1.5).

Table 3.

Summary of meat handlers’ food safety attitude in Addis Ababa city and Burayu Town Oromia Regional State, Ethiopia, August 2022 to December, 2022. (n = 126)

S#	Question	Response
		Yes (%)	No (%)	Do not know (%)
1	Do you think increased FBD can create economic challenges?	118(93.6)	8(6.4)	0(0)
2	Do you think raw beef is delicious than cooked meat?	78(61. 9)	44(34.9)	4(3.1)
3	Do you think people commonly consume raw meat have increased risk of getting FBD?	90(71.4)	34(27)	2(1.6)
4	Do you think using painted displaying rack has impact on beef quality	14(11.1)	112(88.9)	0(0)
5	Do you think improved public awareness will decrease the consumption of raw beef meat?	22(17.5)	93(73.8)	11(8.7)
6	Do you think conducting ante mortem inspection at abattoir before slaughtering is important?	124(98.4)	2(1.6)	0(0)
7	Do think regulatory butcher shop sanitary check for cleanness is important?	120(95.2)	6(4.8)	0(0)
8	Do you think covering the beef carcass until it gets sold?	87(69)	36(28.6)	3(2.4)
9	Do you think raw meat by itself is not a risk for FBD unless flies carry germs and contaminate it?	100(79.4)	25(19.8)	1(0.8)
10	Do you think washing carcasses at arrival is important?	26(20.6)	93(73.8)	7(5.6)
11	Do you think using plastic cutting board is better than wood?	78(61.9)	48(38.1)	0(0)

Practices

Seventy-six (60.3%) butcher shop workers were not maintaining food safety practices with a mean score of 8.3 ± 1.9 (95% CI: 7.9–8.7). The mean percentage scores of the participants on safety practices was 60.2 ± 13.3. Hundred-twenty-four (98.4%) of respondents were sitting inside the butcher shop until the customer visits their shop.

Hundred-Twenty-five (99.2%) of the butcher shop workers wear a white coat when they process the meat in the butcher shops. One hundred seventeen (94.4%) check their health status as one of the requirements set by Addis Ababa city and Burayu town regulatory authority. One hundred twenty-two (96.8%) of the butcher shop workers were not putting on head covers during the visit while they process the carcasses. Eighty-four (67.7%) and 53(42.1%) of butcher shop workers were not implementing rodent and insect control systems in the butcher shops respectively. Seventy-nine (62.7%) and 57(45.2%) butcher shops were using wood, cutting boards and knife handles respectively. Nitty (71.4%) of butcher shop workers reported they had never received a formal type of training on food safety and meat handling practices. One hundred twenty-one butcher shops (96%) load off the carcasses from the lorry using abattoir workers who were responsible for the distribution of the carcasses in each butcher shops. In this study, educational level was not significantly associated with food safety and hygienic practices (OR = 0. 9, 95% CI = 0.4–1.9). One hundred three (82%) of butcher shops, keep offal separated from other carcasses on the same cabinet (Table 4).

Table 4.

Summary of meat handlers’ food safety practices in Addis Ababa city and Burayu Town Oromia Regional State, Ethiopia, August 2022 to December, 2022. (n = 126)

S.#	Food safety practices questions	Responses n (%)
		Yes	No
1	Is practical and theoretical training on how to handle beef carcass common in your butcher shop?	36(28.6)	90(71.4)
2	Do you use water to wash the carcass before hanging on the carcasses?	29(23)	97(77)
3	Do they sit outside of the shop and getting in when costumers come?	29(23)	97(77)
4	Do you use plastic board to the cut the carcasses?	121(96)	5(4)
5	Do you cover carcass until sold?	64(50.8)	62(49.2)
6	Do the butcher shops have insect control system?	74(58.7)	52(41.3)
7	Do the butcher shops have rodent control system?	42(33.3)	84(66.7)
8	Do you use tap water in your butcher shop to wash your utensil?	120(95.2)	6(4.8)
9	Do you have hand washing sink?	102(81)	24(19)
10	Do the butcher shop workers wear jewelry on their hand? (observation)	4(3.2)	122(96.8)
11	Do butcher workers check health status?	119(94.4)	7(5.6)
12	Do butcher workers wear head cover? (observation)	4(3.2)	122(96.8)
13	Do butcher workers wear apron when they are processing? (observation)	126(100)	0(0)
14	Do they use plastic handled knife? (observation)	70(55.6)	56(44.4)
15	Do they sell offal’s at the butcher shop? (observation)	116(92.0)	10(8,0)
16	Metal unpainted display racks?	75(59.5)	(40.5)

Hand washing is one of the best means in preventing of cross contamination among carcasses. In this survey, 51(40.5%), 49(38.9%,) 20(15.9%) and 6(5.0%) of the butcher shop workers replied that they wash their hands while they process carcasses four to six times, seven to nine, when they, think their hand is dirty and one to three times per day respectively Fig. 1.

Fig. 1.

Hand washing practices of butcher shop workers per day at selected butchers of Addis Ababa city and Burayu town.

Discussion

A butcher shop is a place where raw beef is primarily prepared and distributed to customers on the spot and taken to be served at home. Unless proper hygienic practices are implemented, there is high risk of dissemination of food borne pathogens through meat from the butcher shops. This situation could contribute to the possible foodborne diseases and health hazards dissemination through raw beef consumption where the main sources implicated were supposed carrier food handlers this was indicated in Mizan-Aman, southwest Ethiopia¹⁵. Handling of carcasses with unwashed hands could be good sources of contamination as reported previously¹⁶. In current study, 96.7% of carcasses were loaded off at the butcher’s house by slaughter house workers, which could contribute to cross-contamination of the carcass. This finding is in line with study done in Ghana¹⁷. Unlike other occupations, 98% of butcher shop workers were men in the current study which is similar to a previous study in Lebanon¹⁸.The mean age of the butcher shop workers in our study was 29.1 years which is the same as the study conducted by Tegegne and Phyo in Ethiopia 29.7years, but higher than study conducted and reported as 22.7 years in South Africa¹⁹. Studies showed that food handlers at their older age have better hygienic practice scores than their younger colleagues as described²⁰.

Knowledge is a base to implement food safety measures to reduce food-borne diseases. The knowledge level in our study was 59.4% with a mean total score of 8.3 ± 1.9. The knowledge deficiency in this study was lower than the study conducted in Jigjiga town by Tegegne and Phyo¹⁹. The difference could be due to health education exposure between the study participants from the two study sites. The mean total percentage scores of the participants on safety practices were 60.2% ± 13.3. Majority of the butcher shop workers were not putting head covers while working in the butcher shops which is more than the study conducted in Mekelle city 50.7% the difference could be the strength of law enforcement among those study sites.

Unlike the study by Haileselassie et al.²¹ that reported none of the butcher shops were implementing rodent and insect control systems, our study showed that, 33.6% and 58.6% of the butcher shops implemented rodent and insect control measures, respectively.

The butcher shops commonly used a wood cutting board and wood handled knife 61.7% and 44.5%, respectively. Some reports suggested wood cutting boards and knife handles are more labial to contamination because of difficulty to wiping out the particles easily²². The butcher shop workers involved in this study was not trained compared to study conducted by HaileSelassie et al.²¹ in Mekelle town. The difference could be due to variation in availability of trainers in different study areas²¹. In our study, (98%) of butcher shop workers had good attitude towards taking regular animal health status checkups at the abattoir to avoid risk of contaminated food to acquire infectious diseases. However, in our study only 18.7% of them had a good attitude towards the importance of public awareness to decrease the consumption of raw meat which could be risk to acquire foodborne diseases similar to study conducted in Sweden²³.

All the butcher shops were using tap water for processing and cleaning of utensils in their day-to-day activities. 98% of butcher shops have hand washing sinks inside and near to butcher shops. This is similar with study conducted in Uganda²⁴. The poor hygienic practices of abattoir workers have potential to contaminate meat during processing. Unclean slaughter men’s hands, clothing, and equipment, accounted for microbial contamination²⁵. 85% of butcher shop workers, replied, washing carcasses at arrival using hot or cold water is not recommended to avoid spread of contaminants to the rest part of the carcasses. Offal’s are utilized in 62% of the butcher shops and none of the butcher shops reported use of bone and blood. 82% of butcher shops, keep offal separated from other carcasses on the same cabinet; however, they use the same knife to cut the offal and other types of carcasses which could serve as source for contamination. This finding is similar with a study reported from Brazil²⁶.

Conclusion

The knowledge level of butcher shop workers about foodborne pathogens and safety measures, personal hygiene, cross-contamination, common etiologic agents, and transmission of pathogens was unsatisfactory. The overall attitudes of the food handlers to implement prevention strategies about foodborne diseases were favorable. The study participants perceive that raw beef is more delicious than cooked beef. Therefore, continuous food safety awareness creation will be critical among butcher shop workers to reduce the burden of meat borne diseases.

Author contributions

NAA: Conceptualization (lead); data curation (lead); formal analysis (lead); investigation (lead); methodology (lead); validation (lead); writing original draft (lead); writing review and editing (lead). TE: Conceptualization (lead); data curation(lead); formal analysis (lead); funding acquisition (lead); investigation(equal); methodology (equal); resources (lead); supervision(lead); validation (lead); writing – original draft (lead); writing – review and editing (equal).AkFH: Data curation (equal); formal analysis (equal); (equal); methodology (equal); validation (equal); writing– review and editing (equal).

Funding

This study was supported by the Addis Ababa University student research mini grant project and Ethiopian Public Health Institute facility and reagent support.

Data availability

Data availability Raw data is available upon request can be obtained from the corresponding author.

Declarations

Competing interests

The authors declare no competing interests.