Abstract
Background:
Food is an important basic necessity, its procurement, preparation and consumption are vital for the sustenance of life. Food handlers have been found to play prominent roles in the transmission of food borne diseases, therefore training of food handlers on food safety and hygiene is crucial to the prevention of food borne diseases.
Methodology:
A quasi-experimental study carried out among food handlers in boarding secondary schools in Jos North Local Government Area to determine the effect of training on the knowledge and practice of food safety and hygiene. EPI info statistical software version 3.5.4 was used for data analysis and 95% confidence interval was used in this study with a P ≥ 0.05 considered statistically significant.
Result:
The mean age of the food handlers in the study was 42.07 ± 8.71 years with the mean years of work experience as 11.59 ± 8.05 years. The level of knowledge of food safety and hygiene improved significantly after the training (P < 0.001). Majority (98.5%) of the food handlers had good practice of food safety and hygiene after the training as against 51.5% who had same before the training (χ2 = 76.6; P < 0.001).
Conclusion:
This study has demonstrated the effectiveness of training in improving the knowledge and practice of food safety and hygiene among food handlers.
Keywords: Boarding secondary schools, food handlers, food safety and hygiene
Introduction
Food is an important basic necessity, its procurement, preparation and consumption are vital for the sustenance of life.[1] Food is any substance that can be taken through ingestion to supply nutrient and energy for growth and development. Food has direct influence on health and it is therefore pertinent to keep food free from contamination.[1] Food handlers play important role in ensuring food safety throughout the chain of food production and storage.[2]
Food hygiene encompasses all conditions and measures necessary to ensure safety and suitability of food at all stages of the chain of food production.[3] Food safety is the process of handling, preparation and storage of food in ways that prevent food borne illness.[3,4] Food handlers have been found to play prominent roles in the transmission of food borne diseases and can pose a significant public health problem because of their poor of knowledge of safe food handling. It is therefore necessary to provide them with appropriate information on safe food handling in order to improve their food handling practices.[5–7] This study aimed to determine the effect of training on the knowledge and practice of food safety and hygiene among handlers providing food in boarding secondary schools.
Methodology
Study Area
The study was conducted in Jos North Local Government Area (LGA) of Plateau State. Plateau State is bounded by Bauchi State to the Northeast, Kaduna State to the Northwest, Nasarawa State to the Southwest and Taraba State to the Southeast. It has a population of 3,206,531 people with a land area of 30,913 km2.[8] Plateau State has 17 LGAs and 3 senatorial zones. There are 835 secondary schools in the state, 291 private and 544 public respectively. There are 99 boarding secondary schools in the state, out of which 61 are private schools.[9] This study was conducted in selected boarding secondary schools using simple random technique by balloting in Jos North LGAs. A total of 126 secondary schools are in the Jos North LGA, 40 of which are public and 86 private.[9,10] There are 26 boarding secondary schools in Jos North LGA.[9]
Study Population
Food handlers in the kitchens of the selected boarding secondary schools were the study population. Food handlers in 15 boarding secondary schools in Jos North LGA selected using simple random sampling technique by balloting.
Study Design
The study was a quasi-experimental study with preintervention and postintervention phases using quantitative method of data collection.
Inclusion and Exclusion Criteria
All full-time personnel who were involved in the handling and preparation of food in the kitchens of selected secondary schools and present at the time of the study were included while all food handlers providing food for the day students within the premises of the schools were excluded from the study as well as all part-time personnel involved in the handling and preparation of food in the kitchens of the selected secondary schools.
Sample Size
The sample size was calculated using standard acceptable formula and a 48.4%[11] proportions of food handlers with good knowledge of food safety from a previous similar study was used and a minimum sample size of 114 was obtained following the addition 20% of the calculated value to account for attrition and nonresponses. This was rounded up to 120 as the minimum sample size.
Sampling Technique
A multi-stage sampling technique was used in this study.
Stage I
From a list of the 17 LGAs in Plateau State, Jos North LGA was selected using simple random technique by balloting.
Stage II
A list of 26 boarding secondary schools in Jos North LGA was made from which 15 boarding secondary schools were selected using simple random technique by balloting.
Stage III
In the selected boarding secondary schools, all the food handlers in the kitchens that met the inclusion criteria were eligible to participate in the study.
Preparation for Data Collection
Advocacy visits were paid to the State Commissioner for Education, Permanent Secretary in the State Ministry of Education, Zonal Inspector of Education for Jos North LGA Education Inspectorate divisions and principals/proprietors of all the 15 selected boarding secondary schools intimating them with the research and soliciting for their support. Four resident doctors from the Department of Community Medicine Jos University Teaching Hospital (JUTH) were trained as research assistants to aid with the administration of questionnaires as well as in the training. The tools of data collection were pretested in a boarding secondary in Mangu LGA of Plateau State. This helped in making appropriate corrections where necessary.
Ethical Consideration
Anonymity and confidentiality of the information obtained was assured and maintained. Ethical clearance was obtained from Ethical Review Committee of JUTH, Jos.
Instrument of Data Collection
A semi-structured interviewer administered questionnaire was used to obtain information from the participants.
Data Collection
Four trained research assistants participated in the data collection at both the preintervention and postintervention phases of the study after a detailed explanation as to the purpose of the study was given to all the eligible respondents and verbal informed consent was obtained from each subject before the administration of the questionnaire.
Intervention
Training was conducted for the food handlers using an adaptation of the WHO manual on five keys to safer food. Each school had two training sessions 1/day each lasting 2 h. The training focused on definition of food borne disease, types of food borne diseases, causes of food borne diseases, proper handling of food from the procurement to consumption and even on proper disposal of waste food and water. The training session consisted of lectures and practical demonstrations on proper dressing, hand washing and inspection of canned and raw food. Charts and information education communication (IEC) materials were made available for the participants. Copies of the training manuals were made available to all the kitchen supervisors and the school authorities. Posters on hand washing and appropriate dressing were made available to the participants. Some of these posters were also pasted in places chosen by the supervisors within the kitchen to serve as reminders and ways of reinforcing the training.
Post Intervention
3 months after the intervention, quantitative data was again collected with the same data collection instruments from the respondents.
Data Analysis
Data analysis was done using Epi info™ statistical software package version 3.5.4 developed by CDC 1600 Clifton Rd. Atlanta, GA 30333 USA. A 95% confidence level was used for the study and a P ≤ 0.05 (P < 0.05) was considered statistically significant.
Scoring and Grading of Responses
Knowledge of food safety and hygiene
There were 15 stem questions on food handler’s knowledge of food safety and hygiene with 77 responses. Only 42 of these responses were correct. One mark was awarded for each correct response and no mark was awarded for wrong response or I don’t know response and a total of 42 maximum attainable scores were used for knowledge of food safety and hygiene. A score of 0-14 marks out of 42 marks was graded be poor knowledge, a score of 15-28 marks out of 42 marks was graded as fair knowledge and a score of 29-42 marks out of 42 marks was graded as good knowledge.
Practice of food safety and hygiene
There were 16 questions on the practice of food safety and hygiene. A four - point rating scale was used for the responses (4 points for always, 3 points for most times, 2 points for sometimes and 1 point for never) A total of 64 maximum attainable points was used for practice of food safety. A score of 0-32 marks out of 64 marks was graded as poor practice while a score of 33-64 marks out of 64 marks was graded as good practice.
Result
132 food handlers participated in this study at the preintervention phase while 130 food handlers were available at the postintervention phase giving a response rate of 98.5% and an attrition rate of 1.5%.
The age range of the respondents in this study was 20-59 years. The mean age of the respondents was 42.07 ± 8.71 years. Majority (93.2%) of the respondents were female. Christianity was the predominant religion of the respondents while majority of the respondents 105 (79.5%) were married. The highest level of education attained by respondents (58.3%) was primary. The mean years of working experience of the respondents was 11.59 ± 8.05 [Table 1]
Table 1:
Sociodemographic characteristics of the respondents
| Variables | Frequency (%) (n=132) |
|---|---|
| Age | |
| 20-29 | 17 (12.9) |
| 30-39 | 41 (31.1) |
| 40-49 | 54 (40.9) |
| 50-59 | 20 (15.1) |
| Sex | |
| Female | 123 (93.2) |
| Male | 9 (6.8) |
| Religion | |
| Christianity | 126 (95.5) |
| Islam | 6 (4.5) |
| Marital status | |
| Divorced | 3 (2.3) |
| Married | 105 (79.5) |
| Single | 5 (3.8) |
| Widowed | 19 (14.4) |
| Level of education | |
| None | 21 (15.9) |
| Primary | 77 (58.3) |
| Secondary | 27 (20.5) |
| Tertiary | 7 (5.3) |
| Duration of working (years) | |
| 1-5 | 45 (34.1) |
| 6-10 | 36 (27.3) |
| 11-15 | 14 (10.6) |
| 16-20 | 18 (13.6) |
| >20 | 19 (14.4) |
Improvement in the level of knowledge of food safety and hygiene following the training was demonstrated in the study as the proportion of food handler who could correctly defined food borne disease increased from 36 (27.3%) before the intervention to 114 (87.7%) after the intervention (P < 0.001) which was statistically significant. The proportion of food handlers who knew that house flies could transmit food borne disease increased significantly from 58 (43.9%) before the training to 113 (86.9%) after the training. Similarly, 91 (70.0%) and 58 (44.6%) of the respondents at postintervention mentioned unclean cooking environment and sick food handlers as means of transmission of food borne disease as against 42 (31.8%) and 6 (4.5%) who mentioned same respectively at preintervention which were statistically significant.
Statistically significant improvement in knowledge of reporting illness to authority was produced by the training as 117 (90%) of the respondent knew that illness should be reported to authority while at work at postintervention as against 30 (22.7%) at preintervention in the study group. There was statistically significant improvement in the knowledge of food safety and hygiene among the respondents as 115 (88.5%) knew that medical examination should be done before employment at postintervention while only 38 (28.0%) knew that medical examination should precede employment at preintervention. There was statistically significant increase in the mean knowledge scores of the respondents from 8.91 ± 2.18 before the training to 22.20 ± 3.62 after the training (P < 0.001). At preintervention, majority of the respondents 130 (98.5%) had poor knowledge of food safety and hygiene while at postintervention there was a statistically significant improvement in the level of knowledge as 123 (94.6%) had fair knowledge of food safety and hygiene [Table 2].
Table 2:
Knowledge of food safety and hygiene by respondents
| Variables | Preintervention (n=132) frequency (%) | Postintervention (n=130) frequency (%) | χ2 value | df | P value |
|---|---|---|---|---|---|
| Definition of food safety | |||||
| Correct | 36 (27.3) | 114 (87.7) | 97.69 | 1 | <0.001 |
| Incorrect | 96 (72.7) | 16 (12.3) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| Cause of food borne disease | |||||
| House flies | 58 (43.9) | 113 (86.9) | 53.1 | 1 | <0.001 |
| Rats | 15 (11.4) | 49 (37.7) | 24.6 | 1 | <0.001 |
| Sick food handlers | 6 (4.5) | 58 (44.6) | 57.0 | 1 | <0.001 |
| Unclean cooking environment | 42 (31.8) | 91 (70.0) | 36.2 | 1 | <0.001 |
| Don’t know | 50 (37.8) | 2 (1.5) | 54.4 | 1 | <0.001 |
| Reporting of illness to authority | |||||
| Yes | 30 (22.7) | 117 (90.0) | 120.4 | 1 | <0.001 |
| No | 102 (77.3) | 13 (10.0) | |||
| Total | 132 (100) | 130 (100.0) | |||
| Medical examination | |||||
| Yes | 38 (28.0) | 115 (88.5) | 96.0 | 1 | <0.001 |
| No | 94 (77.7) | 15 (11.5) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| Level of knowledge | |||||
| Poor | 130 (98.5) | 3 (2.3) | - | - | <0.001* |
| Fair | 2 (1.5) | 123 (94.6) | |||
| Good | 0 (0.0) | 4 (3.1) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| t test | df | P value | |||
| Mean knowledge scores | 8.91±2.18 | 22.20±3.62 | 36.10 | 260 | <0.001 |
Fisher’s exact
The use of aprons and hair covers while handling food improved among the respondents after the training from 0.8% to 50.8% which was statistically significant. Similarly, 38 (29.2%) of the respondents indicated that they always practiced hand washing with soap and water after visiting the toilet, blowing of nose and handling of refuse container at postintervention as against none at preintervention which brought out significantly the effect of the training among the respondents. The mean practice scores of food safety and hygiene among the respondents increased from 32.66 ± 3.24 at preintervention to 44.46 ± 3.80 at postintervention. Training on food safety and hygiene improved the practice food safety and hygiene in this study as the proportion of food handlers who had good practice of food safety and hygiene increased from 68 (51.5%) at preintervention to 128 (98.5%) at postintervention [Table 3].
Table 3:
Practices of food safety and hygiene among respondents
| Variables | Preintervention (n=132) frequency(%) | Postintervention (n=130) frequency (%) | χ2 | df | P value |
|---|---|---|---|---|---|
| Use of apron and hair cover | |||||
| Always | 1 (0.8) | 66 (50.8) | - | - | <0.001* |
| Most times | 3 (2.3) | 4 (3.1) | |||
| Sometimes | 26 (19.7) | 0 (0.0) | |||
| Never | 102 (77.3) | 60 (46.2) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| Hand washing | |||||
| Always | 0 (0.0) | 38 (29.2) | - | - | <0.001* |
| Most times | 25 (18.9) | 90 (69.2) | |||
| Sometimes | 99 (75.0) | 2 (1.5) | |||
| Never | 8 (6.1) | 0 (0.0) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| Level of practice | |||||
| Poor | 64 (48.5) | 2 (1.5) | 76.6 | 1 | <0.001 |
| Good | 68 (51.5) | 128 (98.5) | |||
| Total | 132 (100.0) | 130 (100.0) | |||
| t-test | df | P value | |||
| Mean practice scores | 32.66±3.24 | 44.46±3.80 | 27.1 | 260 | <0.001 |
Fisher’s exact
Discussion
The mean age of the respondents was 42.07 ± 8.71 years. This was similar to findings of studies conducted among food handlers in Nigeria, Slovenia and Malaysia. This similarity indicated that majority of the food handlers were middle aged people.[12–14] Most of the respondents in this study were females, 93.2%, a similar study carried out in Ilorin reported the same finding of predominantly female respondents of 98.4%.[11] Previous studies conducted in Lagos and Owerri Nigeria had 77.6% and 66.7% of the respondents respectively as females.[5,12] In view of this, it is obvious that majority of food handlers in food service establishments are females. One hundred and twenty six (95.5%) of the food handlers were Christians in this study and is consistent with a report from Ghana.[15] More of the respondents were married which is similar to the findings of studies conducted among food handlers in Malaysia and India.[14,16]
The highest educational level of 58.3% of the respondents was primary which agreed with studies done in Turkey and Bangkok.[17,18] However, a Nigerian study carried out in Ilorin revealed that more than half of the respondent (56.8%) had no formal education.[6] Contrary to this finding another Nigerian study conducted in Owerri revealed that more than half of the respondents (52.38%) had secondary education.[12] The findings of this study and earlier studies have brought to light that educational levels of food handlers cuts across all levels with few having tertiary education. More of the respondents had been working for a period of 1-5 years. Similar studies from Malaysia and India revealed that most of the food handlers had also been working for a period of 1-5 years.[14,16] The mean year of working as food handlers by the respondents in this study was 11.59 ± 8.05 years as against an American study that put the average years the respondents had worked at 3.9 years.[19] A study from Slovenia reported average years of working of the respondents at 17.3 ± 9.9 years.[13] While another from Thailand also put the mean years of experience in career as food handlers at 5.7 ± 4.7 years.[18]
At postintervention there was an increase in level on knowledge on food safety and hygiene among the respondents as 94.6% of the respondents had fair knowledge with a mean knowledge score of 22.00 ± 3.62 showing statistically significant improvement in knowledge of food safety and hygiene (T = 36.1; P < 0.001). An Iranian study also observed significant increase in knowledge of food handlers from 20.5 ± 4.03 before intervention to 23.73 ± 3.75 after intervention.[20] Another study conducted in Korea also showed a significant improvement in the mean knowledge score of respondents in the intervention group from 49.3 before training to 66.6 after the training.[21] Also supporting this result was a study conducted among food handlers in Turkey which found a higher food safety knowledge score in the trained food handlers than untrained food handlers.[17] Training in this study produced a significant increase in the knowledge of the respondents on correct definition of food borne disease 27.3% preintervention to 87.7% postintervention (χ2 = 97.69; P < 0.001) and is consistent with the report from Iowa which revealed an improvement in knowledge on correct definition of food borne disease.[22] This study revealed a significant increase in the knowledge of hand washing before cooking among the respondents after the training to 97.7% from 46.2% before the training in the study group (P < 0.001). An Indian study reported similar statistically significant increase in knowledge of hand washing before cooking from 23.5% pre to 65.4% post training.[23] Food handlers’ knowledge of personal hygiene is very important in prevention of contamination of food. Practical demonstration and the use of IEC materials in this study were instrumental to good uptake of the content of the training. Overall, training on food safety and hygiene has been found in this study to improve the knowledge of the respondents on food safety and hygiene as it is also corroborated by findings of other similar studies.[17,20,21,24]
The training on food safety and hygiene in this study was found to improve the practice of food safety and hygiene among the respondents. At postintervention, 98.5% of the respondents had good practice of food safety and hygiene as against 51.5% at preintervention. The mean practice score of the respondents also increased from 32.66 ± 3.24 pre to 44.46 ± 3.80 post training. This result was similar to the finding of a study done in Kermanshah, Iran where there was statistically significant increase in the mean practice score of the respondents from 43.93 ± 7.6 before to 46.11 ± 8.0 after intervention.[20] Similar studies conducted in Turkey and Malaysia reported findings in agreement with this study.[17,25] On the contrary, studies done in Korea and Imo state Nigeria reported no significant change in the practices of food handlers after training.[21,26] Good practice of food safety and hygiene was also reported in a study conducted in Benin city, Nigeria.[27] The practice of hand washing with soap and water after visiting the toilet, blowing of nose or handling of refuse container was assessed among the respondents. None of the respondents at preintervention reported the act of always washings hands with soap and water after performing above activities. At postintervention, 29.2% of the respondents practiced hand washing always with soap and water after the stated activities (P < 0.001). In a study on the evaluation of health education intervention on the knowledge and attitude of food handlers in Delhi, only 24.3% of the respondents consistently practiced hand washing with soap and water under all circumstances mentioned.[23] Findings of a study done in Turkey also revealed that only 21.2% of the respondents reported hand washing after visiting the toilet.[17] In South Africa, a study on the personal and general hygiene practices of food handlers reported that 94% of the respondents washed their hands before commencement of work, after a rest period, after visiting the toilet, handling money, smoking or handling a refuse container.[28]
The practice of reporting illness to authority was significantly influenced by training among the respondents in the study group as 26% responded that they always report illness to authority at postintervention as against 0.8% at preintervention. Low level of reporting of illness to authority was also found in a study done in Ilorin as majority of the respondents did not report illness to authority.[6] Contrary to these findings, 90% of the respondents in a study conducted in South Africa did report illness to authority.[28]
This study has demonstrated the effectiveness of training as a strategy of improving knowledge and practice of food safety and hygiene among food handlers in Jos North LGA of Plateau State. The mean knowledge score on food safety and hygiene of food handlers increased significantly after the training. The practice of food safety and hygiene also improved with a statistically significant increase in mean practice scores after the training. In view of this, training of food handlers can be used as a vital and effective tool in ensuring food safety and hygiene and even offering long-term benefits to the schools.
Footnotes
Conflict of Interest: None declared
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