Food handlers' knowledge, attitudes and self-reported practices regarding safe food handling in charitable food assistance programmes in the eThekwini District, South Africa: cross-sectional study

Abstract

Objective This study aimed to assess food handlers' knowledge, attitudes and self-reported practices towards safer donated foods. Design This cross-sectional study was conducted from January to May 2021. Setting This study was conducted in the eThekwini District, South Africa. Participants A convenience sampling-based cross-sectional survey of food handlers (n=252) served as the study's main source of data. A total of eight study sites across five municipal planning regions of eThekwini District were visited. The principal investigator administered the validated structured standardised questionnaire, using participants' language of choice, which was either English or isiZulu. All the questions in the questionnaire were asked in exactly the same manner, following the same flow, in order to avoid bias and ensure consistency. Furthermore, the close-ended nature of questions in the questionnaire mitigated the risks of question manipulation. The questionnaire was adapted from the WHO's five keys to a safer food manual. Primary and secondary outcome measures The primary outcome was the knowledge, attitudes and self-reported practices towards safer donated foods. The secondary outcomes were the sanitary conditions of infrastructure and facilities, food handlers' observed food handling behaviour and nutritional information/labelling. Results The results show that the food handlers had good knowledge, positive attitude and acceptable behaviours towards safe food handling and general hygiene, with mean scores (SD) of 62.8 (14.6), 92.5 (14.1) and 80.4 (13.3), respectively. Significant correlations were found between knowledge and attitudes (p=0001), knowledge and practices (p<0001), and attitudes and practices (p=0.02). However, the correlations between knowledge versus attitude and attitude versus practice were poor (Spearman's r<0.3), and the association between knowledge versus practice was moderate (0.3-0.7). The majority of food handlers (92.5%) did not understand the value of thorough cooking and temperature control. About 53% of respondents acknowledged to never adequately reheating cooked meals, 5% did not see the significance of preventing cross-contamination and 5% were unsure. Conclusions Despite the relatively positive knowledge, attitude and practice levels of the food handlers, safe food handling and hygiene practices, such as thorough cooking and temperature control, properly reheating cooked meals and taking precautions to prevent cross-contamination, require some emphasis.