Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana

Table 1 presents the summarized demographic profile of respondents in this study. Out of the 235 food-handlers who participated in this study, 76.6% (n = 180) were female while 23.4% (n = 55) were males. Most studies have reported higher proportion of females [22, 25, 26] involvement in food handling. A greater number (39.1%) of the participants were in the age bracket of 41–50 years with average age of 41.5 ± 9.5 years. Similar studies showed that workers in older age brackets had better hygiene scores than their younger colleagues [27, 28]. Approximately 14.5% of the participants in this study did not have any formal education. However, a previous study demonstrated that irrespective of educational level, employees performance in food safety knowledge was not satisfactory and thus a cause for public concern [29]. A greater number of participants (76.2%) had >5 years of experience working in the foodservice industry with an average length of 11 ± 7.8 years. Eighty three percent were full time workers in the institutions whiles the rest were part time workers. Only a few (8.1%) of the respondents self-reported that they have ever received training in food safety. Although several studies have shown that training may contribute to upgrading the food safety knowledge of food-handlers, this does not always translate into a positive change in food handling behavior and attitudes [12, 30].

Work satisfaction was surveyed to ascertain institutional food-handler’s satisfaction with the conditions, work load, work relations and other people reaction toward them (Table 2). In general, 24.7% of the institutional food-handlers affirmed that if they had to choose a profession again, they would choose the same profession, 48.5% said they would not choose the same profession, whiles 26.8% were indifferent about the issue of choosing a profession again.

In answering the question; would you quit this work if you are offered something better at a different place, about 95.3% affirmed they will leave while 4.7% were not certain. About 62.1% said the workplace make available all the necessary conditions for guaranteeing food safety. On the issue of sharing problems, 64.3% agreed that they do share their personal problems with their head of departments.

In our study, the food-handlers were knowledgeable about hygiene practices, cleaning and sanitation procedures (Table 3). Majority of food-handlers in this study knew the importance of general sanitary practices such as regular hand washing at the work place (98.7% correct answers), wearing of gloves (77.9% correct answers), proper cleaning (86.4% correct answers) and detergent use (72.8%).

The awareness of such important hygienic procedures by majority of the institutional food-handlers in this study is very appropriate. This is because the hands of food-handlers can serve as vectors in the spread of foodborne diseases due to poor personal hygiene or cross-contamination [14, 31]. Proper hand washing by food-handlers has been reported to significantly decrease the threat of diarrheal disease in child care facilities [32] and can therefore be encouraged as it could similarly help minimize the risk of diarrhea and other foodborne diseases in similar institutions. Despite a self-reported hand washing practiced by food-handlers, many employees’ in a study by Stepanović et al. [33] had coagulase-positive staphylococci isolated from their hands, and this could be a source of food contamination. Therefore, it is prudent to combine proper hand washing with the wearing of gloves and other hygienic practices in order to minimize the risk of contamination during food handling [34].

Regarding foodborne disease transmission, 76.2% of the food-handlers (respondents) did not know or remember that Salmonella is a food-borne pathogens and 70.6% did not know/remember that hepatitis A is a foodborne pathogen. On the other, 81.7 and 87.7% of respondents agreed that typhoid fever and bloody diarrhea respectively can be transmitted by food. The majority (86.8%) of respondents disagreed that HIV/AIDS is transmitted by food, which is an indication that public education on HIV/AIDS by the Ghana AIDS commission could be yielding results. These results support recently published work where majority of the respondents did not know if Salmonella, hepatitis A and B viruses, and Staphylococcus caused foodborne diseases [13, 22]. Over ninety percent (90%) of respondents agreed that taking leave from work in periods of infectious skin disease was necessary (Table 3). Additionally, 71.5% knew that microorganisms can be found on the skin and in the mouth and nose of healthy looking individuals. They also recognize that the health status of food-handlers should be assessed prior to employment.

On the other hand, food-handlers were less familiar with time and temperature abuse and its effect on food safety (Table 3). Anon [35] reported that improper handling of food, including the abuse of time-temperature, account for most food-borne disease outbreak. In this study, respondents had insufficient knowledge on time-temperature controls. This result is supported by others [14, 29] whose report show that knowledge of critical temperatures were insufficient amongst food-handlers. Similar findings on the lack of adequate knowledge on temperature controls by food-handlers have also been reported from different countries [36‐38].

A reduction in the incidence of food-borne illnesses is strongly influenced by the attitudes of food-handlers towards the implementation of food safety plans. Thus, there is a strong linkage between positive behavior, attitudes and education of food-handlers in maintaining safe food handling practices [12].

Table 4 shows the attitudes of the food-handlers toward the prevention and control of food-borne diseases. About 60% of respondents indicated that using caps, masks, protective gloves and proper clothing can minimize the risk of food contamination, which is a positive attitude reported by majority of the respondents. Similarly, majority of respondents (93.6%) agreed that knives and cutting boards should be properly sanitized to prevent cross contamination of foods. Respondents also agreed that individuals with abrasions or cuts on their fingers or hands should not touch unwrapped foods (87.2%). The majority (88.1%) of food-handlers were aware that food should not be handled with long and painted fingernails. They were also mindful of the fact that dish towels could cross-contaminate foods (71.5%) and that well-cooked foods are free of contamination (86.4%). Thus, the general attitudes of the food-handlers toward food safety was satisfactory, except on issues relating to refrozen of defrosted food. About 81.7% of food-handlers had unsatisfactory attitude towards defrosted and refrozen foods. Refreezing a completely thawed food can present a serious health risk, as this process leads faster growth of contaminating bacteria. Freezing food only slows bacterial growth and does not necessarily kill the pathogens [39]. Respondents (86.4%) did not find it necessary to check the temperatures of refrigerators and freezers periodically (86.4%).

Table 5 shows the food safety practices by institutional food-handlers. In assessing the food safety practices of the institutional food-handlers, 88.1% reported that they do not use gloves during the distribution of unpackaged foods. Majority (61.7%) of the food-handlers do not use aprons or wear mask when necessary. Additionally, they eat and drink during working hours. On sanitizer use, 61.7% reported that they do not use sanitizer in washing utensils such as plates, mugs and spoons. All respondents reported that they do not use sanitizer when washing fruits or vegetables. About 83.8% of the institutional food-handlers do prepare meals in advance. Only 17% of respondents reported that they look out for the shelf-life of foods when taking delivery of them.

Some previous studies suggest that the lack of knowledge in food safety can lead to poor hygienic practices by food-handlers [27, 40]. However, Clayton et al. [41] reported that about 63% of food-handlers demonstrating knowledge in food safety did not demonstrate a corresponding positive behavior towards food safety/hygienic practices. This shows that food-handlers might not necessarily be practicing strict food safety procedures during food handling, even when they provide answers to show that they are knowledgeable in a survey. Therefore, other factors such as employee motivation and continuous education and training on the job should be provided to inspire food-handlers, which will affect attitudes and subsequently food-safety practices [42].

Logistic regression analysis testing four models to identify the variables that impacted on the observed results are shown in Table 6. All models tested except model 2 showed statistically significant differences (p < 0.05). The significant differences were only observed for models in which the explanatory variable was the level of education. Thus with the exception of model 2, respondents having advanced specific knowledge demonstrated significantly better understanding of food safety issues. For example, in model 1, the results indicate that food-handlers that demonstrate good knowledge of Hepatitis A virus as a food-borne pathogen had an adjusted OR of 14.3 (CI₉₅, P = 0.002). Thus, these food-handlers have 14.3 more times possibilities of having good level of food safety knowledge when compared with food-handlers lacking sufficient level of knowledge for the same variable.