Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana

Accepted Manuscript Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana Angela Parry-Hanson Kunadu, Daniel Baah Ofosu, Eurydice Aboagye, Kwaku TanoDebrah PII:

S0956-7135(16)30243-2

DOI:

10.1016/j.foodcont.2016.05.011

Reference:

JFCO 5026

To appear in:

Food Control

Received Date: 9 November 2015 Revised Date:

25 April 2016

Accepted Date: 3 May 2016

Please cite this article as: Parry-Hanson Kunadu A., Ofosu D.B., Aboagye E. & Tano-Debrah K., Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana, Food Control (2016), doi: 10.1016/j.foodcont.2016.05.011. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Food safety knowledge, attitudes and self-reported practices of food handlers in

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institutional foodservice in Accra, Ghana

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Angela Parry-Hanson Kunadua*, Daniel Baah Ofosua, Eurydice Aboagyea and Kwaku Tano-

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Debraha

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Science

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University of Ghana, College of Basic and Applied Sciences, Department of Nutrition and Food

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*Corresponding author. Tel: +233272715759, Email address: [email protected],

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[email protected] (A. Parry-Hanson Kunadu)

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Abstract

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The aim of this study was to evaluate the food safety knowledge, attitude and practices (KAP) of

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food handlers from institutional food service establishments that serve hospitals, boarding senior

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high schools and prisons in Accra, Ghana. A total of 278 food handlers (56.8% of hospital,

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30.9% of schools and 12.3% of prison food service) participated in the cross-sectional study.

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Data was collected by face-to-face interviews, and responses were scored to determine the level

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of food safety KAP. Respondents who scored ≥70% of the maximum possible score were

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adjudged to have sufficient knowledge and practices and positive attitudes. Results showed that

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respondents’ generally had insufficient food safety knowledge and practices with means scores

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of 20.99± 7.64 (46%) and 9.35±5.62 (52%) respectively. Attitudes towards food safety were

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generally negative but with a comparatively higher mean score of 12.64 ±3.06 (63%). Areas of

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most concern were 1) Lack of knowledge of sources of contamination/cross-contamination and

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appropriate holding temperatures for food. 2) Poor practices included multiple freeze-thaw

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cycles for frozen food and 3) Infrequent hand washing during food preparation after coughing or

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sneezing. There is the need for continuous risk based training to educate and effect behavioral

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changes among food handlers in order to encourage positive attitudes towards food safety and

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consequently promote good food safety practices.

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Keywords: food safety, food handlers, knowledge, attitudes and practices

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1. Introduction

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Institutional foodservice is an important sector of the food industry. It comprises those

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foodservice operations that function primarily as subsidiary or complementary to businesses or

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institutions such as schools, military, nursing homes, prisons and hospitals (Williams, 2009).

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Apart from its economic benefit, this type of catering may provide the main source of nutrition

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for large sections of the population, including vulnerable groups such as children and patients.

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However, the increasing scale and complexity of such catering services may lead to failures of

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hygiene, with serious consequences for health if the strictest principles of hygiene are not

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maintained at all stages (WHO, 1999). Foods consumed at such institutions have been identified

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as important sources of foodborne disease outbreaks and often feature prominently in many

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national statistics on outbreaks of foodborne illness (WHO, 1999, Sun and Ockerman, 2005;

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Soon et al., 2011).

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Similarly, foodborne illness outbreaks in institutional catering in Ghana have received public

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attention. In 2007, The Daily Graphic reported food poisoning in a Ghana School Feeding

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Program beneficiary school located in the Ga East District. Similarly, over one hundred students

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of the Archbishop Porter Girls Senior High School in Takoradi were hospitalized over suspected

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food poisoning which resulted in a temporary halt of academic activities in 2010 (Koomson,

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2010). The Daily Guide (2012) newspaper also reported an incidence of food poisoning in

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another Ghana School Feeding Program beneficiary school located in the Asunafo North

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Municipal Assembly. In yet another incident, over 40 students from Adonten Senior High School

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were hospitalized over suspected food poisoning (Citifm, 2013). In all these cases, the causative

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agents were not identified due to lack of systemic surveillance system. In Ghana, the Food and

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Drugs Authority (FDA), is the main institution responsible for ensuring that food produced for

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consumption is wholesome. It works in tandem with districts assemblies through the Public

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Health Units and Environmental Health Departments to ensure that the Public Health Act 2013 is

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adhered to. However, District Assembly by-laws on food safety apply to only street food

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operators. Institutional food service operators, on the other hand, are not closely monitored as

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necessary to prevent food safety malpractices. The Ghana Food and Drugs Authority recounted

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that 77% of all traceable foodborne diseases reported in Ghana result from improper handling of

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food in foodservice establishments (GNA, 2013).

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Rennie (1995) suggested that food safety knowledge influences on food safety attitudes and

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could lead to changes in behaviors. Such information is important in designing training modules

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and targeted mitigation strategies to advance food safety for food handlers. However, food safety

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knowledge, attitudes and practices in institutional catering facilities in Ghana have not been

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reported, although this sector has direct linkage to increased morbidity. Information on food

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safety knowledge attitudes and practices of institutional foodservice has been identified as an

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important gap in food safety research in Ghana (Ababio and Lovatt, 2015). This study will

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bridge the knowledge gap and would highlight areas that need critical attention. The purpose of

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this research is to evaluate the food safety knowledge, attitudes and practices of institutional

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catering establishments in the Accra Metropolis and generate baseline data for evidence-based

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improvements which will enable institutional foodservice operators to develop, implement and

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maintain effective food safety management systems.

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2. Materials and Methods

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2.1 Study design

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A cross-sectional survey was used to collect data through administration of semi-structured

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questionnaires to examine knowledge, attitudes and practices among 278 institutional food

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handlers on food safety. Institutions used for this study were hospitals, prisons and boarding

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senior high schools (SHS). These institutions were selected based on the large numbers of clients

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they serve on a regular basis, some of whom belong to vulnerable groups. A proportional random

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stratified technique was used to randomly select participants with each type of institution

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constituting a stratum. These were made up of 60.0% hospitals, 30.0% schools and 10.0%

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prisons selected from the Accra Metropolitan Assembly (AMA) database of hospitals, SHS with

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boarding facilities and prisons in Accra. A convenient sample size of 16 was selected which

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corresponded to 53.3% of the total number of institutional catering establishments in Accra

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metropolis. The proportionate stratifications were calculated and the following subsamples were

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obtained: 9 hospital catering services, 5 school catering services and 2 prison catering services. A

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simple random sampling was used to select the institutions of each subsample.

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2.2 Food handler’s questionnaire

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2.2.1

Survey instrument

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A semi-structured questionnaire was prepared based on validated questionnaires used in similar

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studies in other countries (Bas et al., 2005; Buccheri et al., 2007; Tokuc et al., 2009; Buccheri et

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al., 2010). The questions were categorized into four sections: demographic characteristics (age,

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sex, religion, marital status, level of education and institution of work) and length of employment

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in current institution and in catering profession, knowledge on food safety, attitudes towards

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food safety, and measures used in the prevention of foodborne diseases.

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Each correct answer in the knowledge, attitude and practice section of the questionnaire was

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scored 2 points. Incorrect or “don’t know” responses were scored zero points. For the section on

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practices, only the “yes” response was scored 2 points. “No”, “occasionally” and “often” were

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scored zero points. Knowledge and practices were categorized as “insufficient” when the total

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score was less than 70% of the maximum possible score for those sections. The respondents were

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categorized as having “sufficient” knowledge or practices if their total score was greater than or

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equal to 70% of the maximum possible score. Attitudes were classified as “negative” if the total

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score was less than 70% of the maximum possible score, and “positive” if it was ≥ 70%. This

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scoring system was adapted from a similar study by Sani and Siow, (2014). A stringent cut-off

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score for classification was however used in this study because the selected institutions offer

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food catering services to large populations including vulnerable groups such as sick people,

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school children and prisoners.

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2.2.2 Pilot test

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The questionnaire and the interview procedures were pre-tested in a selected institutional

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catering establishment outside the research area, to confirm question clarity, identify response

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options and estimate likely interview duration. The questionnaire was then revised on the basis

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of the pre-test results. The revised version was used for the data collection. Ethical approval for

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the study was obtained from the Institutional Review Board of the Noguchi Memorial Institute

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for Medical Research, University of Ghana. Authorization was also obtained from the Ghana

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Food and Drugs Authority and the Accra Metropolitan Directorate under whose purview the

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institutions operate.

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2.2.3 Data collection

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The selected catering establishments were visited during their normal operating hours. Informed

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consent of each of the participants was obtained by asking them to sign a written consent form.

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The questionnaire was addressed to all food handlers in the selected catering establishments who

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volunteered to participate in the study by a face-to-face interview. The inclusion criteria was all

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persons involved in food handling while the exclusion criteria was non-responsive food handlers.

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The Questionnaire was developed in English but was administered in the primary language “twi”

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on request by respondents and reported in English. Each of the questions were read aloud to the

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respondents during the interview and they were given adequate time to answer each question.

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Filled questionnaires were checked on the spot for their completeness and subsequently filed for

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ease of verification.

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2.2.4 Statistical analysis

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Data was analyzed using SPSS 16.0 (SPSS Incorporated, Atlanta, Illinois, USA) statistical

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package and in Microsoft Excel, 2013. A summary of respondent biodata and their knowledge,

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attitudes and practices scores were obtained using descriptive statistics. Predictors of knowledge,

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attitudes, and practices were examined by binary logistic regression analyses. Independent

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variables included age, gender, religion, marital status, level of education and length of service in

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the employment/institution. Spearman’s correlation coefficient was also used to test the

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association between knowledge, attitudes and practices of the respondents.

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3. Results and Discussion

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3.1 Socio-demographic profile of food handlers

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In all, 278 food handlers participated in the study. A little over half (56.8%) worked in hospital

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foodservice establishments, 30.9% from school foodservice, and 12.3% from prison foodservice.

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The socio-demographic characteristics of the food handlers are presented in Figure 3.1.1.The 7

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socio-demographic characteristics of the respondents did not significantly differ between the

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three institutional categories. The age range of the participants was from 25 to 62 years; 75.9%

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were females. Similar studies have reported a higher proportion of females to males in catering

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establishments (Buccheri et al., 2007; Buccheri et al., 2010; Ackah et al., 2011). The dominance

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of females in the catering business could be attributed to their traditional food preparation

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responsibilities at the home (Ackah et al., 2011). The majority of the respondents could be

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classified as experienced food handlers as over 60% had more than 5 years’ experience in food

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service. Though experience ranked high among respondents, level of education was rather

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moderate. The most frequently reported educational level was senior high school (SHS) while

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11% of respondents had no formal education. This was noteworthy because workers who have

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no formal education and incomplete basic school education are less likely to properly follow

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procedures on safe handling of food (Clayton et al., 2002).

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Table 3.1.1 shows results of a series of binary logistic regression models which were used to

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determine if any of the socio-demographic characteristics of the respondents could reliably

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predict the outcome of sufficient knowledge and practices as well as positive attitudes with

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regards to food safety. None of the independents variables tested in this study had any predictive

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power on the outcome of sufficient food safety knowledge and practices and on positive

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attitudes. Characteristics such as formal education, age, gender, religion or marital status would

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therefore not be suitable bases to assess whether institutional food handlers in the study area

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would have knowledge, attitudes and practices that would impact food safety.

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3.2 Food safety knowledge

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The food handlers generally had insufficient food safety knowledge levels with a mean score of

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20.99± 7.64, representing only 46% of the maximum possible score. Table 3.2.1 displays the

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food safety knowledge level of the food handlers.

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Virtually all the respondents had heard of foodborne illness. The predominant sources of

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information about foodborne illness were reported to be radio (47.7%) and television (29.5%).

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Diarrhoea was the most frequently (65.7%) identified symptom of foodborne illness. Less than

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2% of the participants included paralysis, dizziness and fatigue as symptoms of foodborne

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illnesses. This was expected since the most reported manifestation of foodborne disease in the

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media is diarrhoea. Almost all (98.2%) of the food handlers knew about germs and it was also

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the most frequently cited cause of foodborne illness. Less than 10% of the food handlers

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recognized food allergens, insecticides and extraneous matter in food as possible causes of

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foodborne illness. This is troubling because, they may neglect to take the necessary steps to

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control these hazards in the food they handle. More than three quarters of the respondents

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however knew about food safety practices such as keeping fingernails unpolished, short and

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clean; use of hair caps and masks and also about adequate personnel protective materials.

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Water used for cooking food was the most recognized route of microbial food contamination.

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More than half of the respondents however failed to recognize that disease causing

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microorganisms could get into food through raw materials/ingredients, working surfaces and

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cooking utensils. Knowledge of raw materials and food contact surfaces as possible routes of

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food contamination is important to prevent cross-contamination or recontamination of food

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during handling, preparation and storage. Cross-contamination of foods via materials/ingredients,

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utensils and work surfaces is well established as a major risk factor in the catering industry

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(Harrison et al., 2003; Redmond and Griffith, 2004; Reji and den Aantrekker, 2004).

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3.3 Food safety attitude

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Table 3.3.1 summarizes the findings on food safety attitudes of food handlers. The results

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showed an overall negative attitude towards food safety, with a mean score of 12.64 ±3.06

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(63%). Closer inspection however reveals positive attitudes particularly towards safe storage

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practices; correct handling of food, toxic chemicals, and good personnel hygiene practices.

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Almost all the respondents (93.9%) had a positive attitude towards proper storage of toxic

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chemicals in food establishments, policy on employees suffering from foodborne illness or other

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contagious illness, and use of antibacterial soap or hand sanitizers in hand washing. However, a

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negative attitude was observed for the appropriate temperature for storage of food, especially

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regarding attitudes towards refreezing of defrosted foods. Similar results were obtained from

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previous studies (Angelillo et al., 2001; Askarian et al., 2004; Buccheri et al., 2007). Substantial

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numbers of food handlers were not sure about refreezing of defrosted foods, suggesting

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insufficient knowledge on that subject. Failure to perceive such an important food handling risk

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may be an impediment to successful implementation of food safety control measures in

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institutional food service. Multiple freeze-thaw cycles have been reported to allow microbes,

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especially pathogens on the surface of thawing foods to multiply to levels that can cause food

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spoilage or illness (Schmidt and Rodrick, 2003). Hence, it is recommended that defrosted foods

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should not be refrozen.

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Additionally, only 13.7% of respondents said they intended to check the thermometer settings of

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refrigerators and freezers at regular intervals. Food handlers may not feel the need to carry out

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this practice if they cannot recognize unsafe temperatures. Other authors have reported a general

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lack of knowledge of food handlers on correct refrigeration temperatures (Angelillo et al., 2001;

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Askarian et al., 2004; Buccheri et al., 2007; Tokuc et al., 2009). The results of this study also

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revealed that 29.5% were of the impression that refrigeration could kill pathogens in foods. This

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is an attitude that could have serious implications for food safety, given the widespread use of

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refrigeration facilities in catering services.

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3.4 Food safety practices

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The importance of food safety practices in the prevention of food borne illnesses cannot be over-

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emphasized. Table 3.4.1 summarizes the responses of food handlers concerning their food safety

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practices. It was found that the self-reported practices of the food handlers were generally

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insufficient with a mean score of 9.35±5.62 (52%).

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Hand washing is a critical food safety practice that was fortunately well observed by

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respondents. It was also encouraging to note that, majority (92%) of the respondents reported

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washing their hands with antibacterial soap after visiting the toilet. Washing of food contact

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surfaces such as chopping boards, tables and knives with antibacterial soap before food

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preparation was also a very frequent practice among the respondents. The importance of regular

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hand washing with antibacterial soap was substantiated in a study by Toshima et al. (2001), who

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found that anti-bacterial soap had greater efficacy (>95%) in reducing total coliform counts on

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hands even with shorter washing times.

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The use of disposable tissue when coughing or sneezing, followed immediately by hand washing

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was however not a common practice among food handlers. A number of studies have implicated

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the hands of food handlers as a significant mode of pathogen transmission in foodservice

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establishments (Taylor, 2000; Montville et al., 2001). Food handling personnel must therefore

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carefully wash their hands when they arrive at the workplace as well as before and after they

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handle the food; every time the handling is interrupted; every time they touch any potentially

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contaminated objects; after using the bathroom and whenever else it may be found necessary.

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According to Todd et al. (2009), hand hygiene is considered more critical in the control of

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pathogens than cleaning and disinfection of environmental surfaces. Improved personal hygiene

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and scrupulous hand-washing would lead to the basic control of faeces-to-hand-to-mouth spread

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of potentially pathogenic transient microorganisms (Shojaei et al., 2006).

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Only 36.0% reported that they use separate utensils to prepare raw and ready-to-eat food.

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Checking the shelf life of food products and the integrity of food packages were less frequently

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reported. Less than half of the respondents always observed this step during food preparation.

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Figure 3.4.1 shows the incorrect responses given by food handlers on questions about their food

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safety practices.

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Improper thawing of frozen food at room temperature appeared to be widespread among

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respondents. It can be observed from Figure 3.4.1 that, over 50% of respondents always (100%

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of the time) thawed their food at room temperature. Meanwhile, a significant number of

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respondents reported that they only thawed food at room temperature occasionally (40% of the

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time). This may be indicative of the fact that, they may have been aware of the risks associated

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with this practice but may have neglected to carry it out because of certain constraints. A similar

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argument could be made for practices such as checking the integrity of packaging as well as

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checking the shelf life of foods prior to their use.

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1.5 Association among the food safety knowledge, attitudes and practices of food handlers

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There were significant positive correlations between knowledge and attitudes, knowledge and

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practices and, attitudes and practices. This suggests that food safety knowledge of respondents

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will most likely influence their attitudes and practices regarding the safe handling of foods. The

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results also insinuate that attitudes towards food safety could adequately predict the actual food

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safety practices of food handlers. These findings have been summarized in Table 3.5.1.

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The poor food safety knowledge observed among food handlers in this study would naturally

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suggest an educational intervention. The negative attitudes also realized in this study would

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however advocate motivation and training; not just education. This is because negative attitudes

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toward food safety suggest the need for behavioral changes in addition to food safety training.

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Michaels (2002) recommended that, although a certain amount of education is necessary, the

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approach must be multidisciplinary, targeting institutional or organizational change. Systems

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such as equipment and logistics supply, monitoring as well as constant reminders such as posters

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and leaflets, need to be put in place to encourage good behaviors and discourage bad ones. The

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training must be risk-based with consequences of failure clearly expressed and understood at all

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levels.

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4. Conclusion

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This study investigated the food safety knowledge, attitudes and practices of food handlers in

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institutional catering facilities in Ghana. The results highlighted significant gaps in knowledge,

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attitudes and practices of safe food handling. Areas of most concern were storage of food in the

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danger zone, practices that could lead to cross-contamination of food, multiple freeze thaw

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cycles, and thawing of frozen food at room temperature. These gaps could be resolved with risk-

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based training of food handlers in institutional catering facilities using appropriate training aids

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to encourage understanding and appreciation of the applications of food safety principles in their

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day-to-day operations. Training interventions should cover appropriate storage temperatures,

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thawing of frozen foods, and hand washing after coughing and sneezing during food preparation.

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Habits must be changed to obtain a sustained improvement in food safety practices and this can

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only be accomplished through continuous and gradual training, monitoring and resource

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improvement. Techniques employed in this process must also be tailored to accommodate the

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low education levels of the food handlers.

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Cambridge. pp 2-7.

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390

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386

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Table 3.1.1 Association between characteristics of food handlers and their food safety knowledge, attitudes and practices B

Wald chi-square

Know

Prac

Att

Know

Male Female

-20.1 -

0.0 -

18.3 -

0.0 -

Age (Years) 19-35 36-50 >50 Institution

-19.1 -19.5 -

0.0 0.0 -

-32.0 -17.7 -

0.0 0.0 -

Hospital School Prison

-3.44 0.278 -

-0.3 -0.2

0.0 0.0 -

Education Primary SHS Tertiary

-19.4 0.041 1.5

Prac

p-value Att

Know

Prac

0.9 -

1.0 -

0.0 0.0 -

0.0 0.0 -

0.0 0.0 0.0

0.0 0.0 0.0

Att

0.9 -

Know

Prac

0.0 -

1.0 -

8.8x107 -

1.0 1.0 -

0.0 0.0 -

1.0 1.0 -

0.9 0.9 -

0.0 0.0

1.0 1.0 -

1.0 1.0 -

1.0 1.0 -

0.71 1.3 -

1.0 1.0 -

0.8 1.3

0.0 0.0 0.0

1.0 1.0 1.0

1.0 1.0 1.0

1.0 1.0 1.0

0.0 0.0 4.5

1.0 1.0 1.0

7.3 3.9x109 1.48x108

Know=knowledge; Prac=practices; Att=Attitudes; SHS=Senior High School

0.0 0.0 -

Att

1.0 0.9 -

M AN U

0.0 0.0 -

TE D

2.0 19.8 21.0

AC C

0.0 0.0 0.0

EP

0.0 0.0

0.0 -

SC

Gender 0.0 -

Odds ratio

RI PT

Predictor

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Table 3.2.1. Food safety knowledge of food handlers in institutional catering in Ghana Questions

Sufficient Knowledge N (%)

Have you heard of foodborne illness What are the symptoms of foodborne illnesses? Diarrhoea Paralysis Dizziness Fatigue Jaundice

0.00±0.00

183 (65.8) 4 (1.5) 4 (1.5) 4 (1.5) 6 (2.2)

1.31±0.95 0.03±0.24 0.03±0.24 0.03±0.24 0.04±0.29

SC

What are the causes of food borne illnesses?

195 (70.1) 26 (9.4) 26 (9.4) 26 (9.4)

Germs Allergens Insecticides Extraneous matter

Have you heard about germs/microorganisms:

M AN U

1. 2. 3. 4.

278 (100)

RI PT

1. 2. 3. 4. 5.

Mean± SD

Is cooking food thoroughly the best way of killing germs in food?

TE D

Does refrigeration kill microorganisms?

1.40±0.92 0.19± 0.58 0.19± 0.58 0.19± 0.58

273 (98.2)

1.96±0.27

264 (95)

1.90±0.43

130 (46.8)

0.93±0.99

126 (45.3) 209 (75.2) 209 (75.2) 209 (75.2)

0.91±0.99 1.50±0.86 1.50±0.86 1.50±0.86

136 (48.9) 136 (48.9) 136 (48.9) 205 (73.7)

0.98±1.00 0.98±1.00 0.98±1.00 1.47± 0.88

137(49.3)

0.99 ± 1.00

26 (9.4)

20.99± 7.64 (46%)

How can you minimize the risk of food contamination?

Preparing food in advance Keeping fingernails short, unpolished and clean Using caps, masks and appropriate clothing Using potable water

EP

1. 2. 3. 4.

What are the sources of contamination in food? Raw materials/ingredients Working surfaces Cooking utensils Germs from handlers

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1. 2. 3. 4.

Which of the following temperature conditions best facilitates the growth of germs? 1. 2. 3. Total

Cold Hot Lukewarm

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Table 3.3.1: Respondent’s food safety attitudes Mean Score ±SD

Safe food handling is an important part of my job responsibility

271 (97.5)

1.95±0.31

Learning more about food safety is important to me

272 (97.8)

Raw food should be kept separated from cooked food

204 (73..4)

Toxic chemicals and cleaning solutions should be stored away from the food preparation area

261 (93.9)

RI PT

Positive Attitudes N (%)

1.96± 0.29

1.46 ± 0.89 1.77 ± 0.63

SC

Statements

55(19.8)

M AN U

Defrosted food should not be refrozen

0.40±0.80

38 (13.7)

0.27±0.69

Food-services staff with abrasion or cuts on hands should not touch unwrapped food

247 (88.8)

1.88±0.48

Employees suffering from foodborne illness and other illness should not be permitted to work in the food preparation area

261 (93.9)

1.77±0.63

It is necessary to use anti-bacterial soap when washing hands Storage of food by refrigeration kills harmful microbes or germs

261 (93.9)

1.77±0.63

48 (17.3)

1.06±0.99

Total

38 (13.7)

12.64 ±3.06 (63%)

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EP

TE D

The thermometer settings of refrigerator and freezers should be checked at regular interval

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Table 3.4.1 Food Safety Practices of Food Handlers in Institutional Catering in Ghana

Do you wash your hands before cooking or serving food?

Sufficient Practices N (%) 203 (73) 257 (92.4)

Do you wash food contact surfaces such as chopping boards, tables and knives with antibacterial soap before food preparation?

259 (93.2)

Do you use separate kitchen utensils to prepare raw and cooked food?

100 (36.0)

1.85±0.53

1.86± 0.51

M AN U

Do you cook or serve food when you fall sick?

1.46±0.89

SC

Do you wash your hands with anti-bacterial soap?

Mean Score ± SD

RI PT

Questions

0.72± 0.96

20 (7.2)

0.14± 0.52

142 (51.1)

1.02± 1.00

Do you check shelf life of food products before using them?

131 (47.1)

0.94± 1.00

Do you check the integrity of food packages before using food products?

102 (36.7)

0.73±0.97

Do you use disposable tissues when coughing or sneezing and then immediately wash hands?

85 (30.6)

0.61±0.92

Total

100 (36.0)

9.35±5.62 (52%)

EP

TE D

Do you thaw food at room temperature?

Table 3.5.1 Association among food safety knowledge, attitudes and practices Spearman’s rho 0.794**

Sig. 0.000

Knowledge vs. Practice

0.963**

0.000

AC C

Level Knowledge vs. Attitude

Attitude vs. Practice 0.812** **Correlation is significant at the 0.01 level (2-tailed)

0.000

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Religion

African Tradition al 2%

>50 12%

Gender

RI PT

Age

None 5%

Islam 21% Christiani ty 72%

SC

36-50 31%

female 76%

TE D

M AN U

19-35 57%

male 24%

Marital status

Level of Education None 13%

AC C

SHS 29%

JHS 18%

EP

Divorced 10%

Primary 24%

Tertiary 16%

Separate d 8% Single 35%

Length of Service in Food service Institution <5yrs 20%

Total 50%

6-10yrs 17%

Married 47%

11-20yrs 10%

>20yrs 3%

Figure 3.1.1: Socio-demographic data of food handlers in institutional catering facilities in Accra, Ghana (N=278).

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Check intergrity of food package before use

RI PT

Check shelf life of food before use Thaw food at room temperature

SC

Cook/serve food when sick

M AN U

Separate utensils for raw and cooked food Disposable tissue when sneeze/cough+handwash Wash food contact surfaces with soap Wash hands with antibacterial soap

TE D

Wash hands before cooking/serving

10

EP

0

20

Occasionally (40% of the time)

Never (0% of the time)

Always (100% of the time)

AC C

40

50

60

Frequency of practice (%)

Unanswered

Figure 3.4.1 Incorrect responses to questions on food safety practices

30

Often (70% of the time)

70

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Highlights: Title: Food safety knowledge, attitudes and self-reported practices of food handlers in

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M AN U TE D

• •

EP

•

Insufficient food safety knowledge, attitudes and practices were observed for food handlers in institutional food service Significant gaps remain in safe food thawing and proper hand washing practices after coughing and sneezing Consistent and efficient training on food safety important to bridge gaps Establishment of a food safety culture is necessary to enforce safe food practices

AC C

•

RI PT

institutional catering facilities in Accra, Ghana