food safety and sanitation research paper

Food Safety and Sanitation

• First Online: 29 May 2022

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• Richard Owusu-Apenten 4 &
• Ernest Vieira 5  

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Food safety is a concern at every stage of the Agri-food industry. This chapter considers the topic of food safety, which refers to any activity, intended to reduce the risk of from foodborne hazards. The chapter is divided into four sections. (1) Introduction, safety and the Agri-food industry, food safety oversight by the FDA, trending new challenges in food safety, sanitary and phytosanitary measures, risk assessment for foodborne infections. (2) Principles of food hygiene, home hygiene and food safety, proper food handling, cleanliness and cleaning, cross contamination prevention, cooking to high internal temperatures, cooling and chilling, risky food handling. (3) Retail hygiene and food handling, fresh meat handling, safe handling fresh produce, canned foods, food manufacturing plant sanitation. (4) Foodservice hygiene, premises and utensils, equipment and facilities, food preparation and handling, personnel health and personal hygiene, waste disposals, cleaning and sanitization, sources of advice for food businesses. With 67 reference citations.

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Personal hygiene should be expanded to consider personnel (or employee) hygiene to more accurate capture the magnitude and generic nature of the underlying food safety issues. Cambridge Online dictionary defines personal as “relating or belonging to a single or particular person”. https://dictionary.cambridge.org/dictionary/english/personal

Food Safety is also discussed with a focus on foodservices in Chap. 30 .

Increasingly wealthy consumers may eat out of home more often and be exposed to greater likelihood of foodborne illness.

Risk assessment is one of the three steps required for Risk Analysis; risk management (RM) and risk communication (RC) follow risk assessment. Some authorities see the three stages as interactive, rather than sequential.

From basic algebra, 2 × 3 = 6, and so 2 and 3 are factors of 6. The multiplication rule from algebra means that any number multiplied by “zero” is zero.

The topic of home hygiene is surprisingly under investigated in modern times and so evidence based recommendation are lacking. A PubMed search for the topic “home or domestic and hygiene yielded ~300 references, with most dealing with care homes.

The changes in rates of deterioration with temperature is often discussed in terms of the Q10, which the chages in rate observed with a 10 °C rise in temperature. For frozen foods the Q10 value ranges from 2–20 meaning a 10 °C rise in temperature may produce a 2–20 fold change in shelf-life depending on the product. See Erickson, M. C. and H. Yen-Con ( 1997 ). “Quality in frozen food.” Pg. 385 for more discussions.

The food safety guidelines for foodservices are based on the food code, and good manufacturing practice (GMP) guidelines detailed in Chap. 10.

Al-Sakkaf A (2013) Domestic food preparation practices: a reviewof the reasons for poor home hygiene practices. Health Promot Int 30(3). https://doi.org/10.1093/heapro/dat051 . Retrieved from https://academic.oup.com/heapro/article/30/3/427/617876/Domestic-food-preparation-practices-a-review-of

Anon (1977) Home canning. A scientific status summary by the Institute of Food Technologist’s Expert Panel on Food Safety & Nutrition and the Committee on Public Information. Food Technol 31(6):43–47

Google Scholar  

Aung MM, Chang YS (2015) Traceability in a food supply chain: Safety and quality perspectives. Food Control 39:172–184. https://doi.org/10.1016/j.foodcont.2013.11.007

Article   Google Scholar  

Aunger R, Greenland K, Ploubidis G, Schmidt W, Oxford J, Curtis V (2016) The determinants of reported personal and household hygiene behaviour: a multi-country study. PLoS One 11(8):e0159551. https://doi.org/10.1371/journal.pone.0159551

Article   CAS   PubMed   PubMed Central   Google Scholar  

Avena-Bustillos RJ (2011) Establishment of an FDA-approved international Better Process Control School for food canning supervisors. Prog Nutr 13(3):155–159

Beuchat LR, Ryu JH (1997) Produce handling and processing practices. Emerg Infect Dis 3(4):459–465

Article   CAS   Google Scholar  

Bloomfield SF, Carling PC, Exner M (2017) A unified framework for developing effective hygiene procedures for hands, environmental surfaces and laundry in healthcare, domestic, food handling and other settings. GMS Hyg Infect Control 12 Doc08. https://doi.org/10.3205/dgkh000293

Boyce JM (2016) Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 5:10. https://doi.org/10.1186/s13756-016-0111-x

Article   PubMed   PubMed Central   Google Scholar  

Buchanan RL (2000) The development of science-based food safety regulations in the United States. Irish J Agric Food Res 39(2):331–342. https://www.jstor.org/stable/25562399

Chambers E, Godwin S, Terry T (2018) Recipes for determining doneness in poultry do not provide appropriate information based on US government guidelines. Foods 7(8):126

Charbonneau DL, Ponte J M, Kochanowski BA (2000). A method of assessing the efficacy of hand sanitizers: use of real soil encountered in the food service industry. J Food Prot 63(4): 495-501. https://doi.org/10.4315/0362-4028X-4363.4314.4495

Choi J, Norwood H, Seo S, Sirsat SA, Neal J (2016) Evaluation of food safety related behaviors of retail and food service employees while handling fresh and fresh-cut leafy greens. Food Control 67:199–208. https://doi.org/10.1016/j.foodcont.2016.02.044

Cogan TA, Bloomfield SF, Humphrey TJ (1999) The effectiveness of hygiene procedures for prevention of cross-contamination from chicken carcases in the domestic kitchen. Lett Appl Microbiol 29(5):354–358

Cross HR, Stanfield MS, Koch EJ (1976) Beef palatability as affected by cooking rate and final internal temperature. J Anim Sci 43(1):114–121

Curtis V, Biran A, Deverell K, Hughes C, Bellamy K, Drasar B (2003) Hygiene in the home: relating bugs and behaviour. Soc Sci Med 57(4):657–672

de Jong AE, Verhoeff-Bakkenes L, Nauta MJ, de Jonge R (2008) Cross-contamination in the kitchen: effect of hygiene measures. J Appl Microbiol 105(2):615–624. https://doi.org/10.1111/j.1365-2672.2008.03778.x

Article   PubMed   Google Scholar  

Derossi A, Fiore AG, De Pilli T, Severini C (2011) A review on acidifying treatments for vegetable canned food. Crit Rev Food Sci Nutr 51(10):955–964. https://doi.org/10.1080/10408398.2010.491163

Article   CAS   PubMed   Google Scholar  

DuPont HL (2007) The growing threat of foodborne bacterial enteropathogens of animal origin. Clin Infect Dis 45(10):1353–1361

Environmental Protection Agency (2021) Determining if a cleaning product is a pesticide under FIFRA. Retrieved from https://www.epa.gov/pesticide-registration/determining-if-cleaning-product-pesticide-under-fifra

Erickson MC, Yen-Con H (1997) Quality in frozen food. xxi + 484pp

Evans JA (2008) Frozen food science and technology. x + 355pp

Food and Agriculture Organization of the United Nations (1991) Guidelines for slaughtering, meat cutting and further processing. Retrieved from http://www.fao.org/3/T0279E/T0279E00.htm#TOC

Food and Drug Administration (2007) Food Protection Plan of 2007. Retrieved from http://www.fda.gov/Food/GuidanceRegulation/FoodProtectionPlan2007/ucm132565.htm#

Godwin SL, Fur-Chi C, Coppings RJ (2006) Correlation of visual perceptions of cleanliness and reported cleaning practices with measures of microbial contamination in home refrigerators. Food Prot Trends 26(7):474–480

Hui YH, Cornillon P, Guerrero-Legaretta I, Lim MH, Murrell KD, Wai-Kit N (2004) Handbook of frozen foods. xi + 735pp

Hwang JH, Yoon JH, Bae YM, Choi MR, Lee SY, Park KH (2017) Effect of the precutting process on sanitizing treatments for reducing pathogens in vegetables. Food Sci Biotechnol 26(2):531–536. https://doi.org/10.1007/s10068-017-0073-7

Insfran-Rivarola A, Tlapa D, Limon-Romero J, Baez-Lopez Y, Miranda-Ackerman M, Ontiveros A-SK (2020) A systematic review and meta-analysis of the effects of food safety and hygiene training on food handlers. Foods 9(9):24pp. https://www.mdpi.com/2304-8158/2309/2309/1169

Jacob M, World Health Organization (1989) Safe food handling: a training guide for managers in food service establishments. World Health Organization, Geneva, 142pp. https://apps.who.int/iris/handle/10665/36870

Jacob CJ, Powell DA (2009) Where does foodborne illness happen-in the home, at foodservice, or elsewhere-and does it matter? Foodborne Pathog Dis 6(9):1121–1123. https://doi.org/10.1089/fpd.2008.0256

Kambhampati A, Shioda K, Gould LH, Sharp D, Brown LG, Parashar UD, Hall AJ (2016) A state-by-state assessment of food service regulations for prevention of norovirus outbreaks. J Food Prot 79(9):1527–1536. https://doi.org/10.4315/0362-028x.Jfp-16-088

Karel M, Lund DB (2003) Chatper 3: Heat transfer in foods. Physical principles of food preservation: revised and expanded. Retrieved from http://books.google.co.uk/books?id=FTJ4h-cMOYUC

Keener L, Nicholson-Keener SM, Koutchma T (2014) Harmonization of legislation and regulations to achieve food safety: US and Canada perspective. J Sci Food Agric 94(10):1947–1953. https://doi.org/10.1002/jsfa.6295

Kennedy CJ (2000) Managing frozen foods. Woodhead Publishing, Cambridge, 304pp

Book   Google Scholar  

Lane RH, Muir WM, Mullins SG (1980) Correlation of minimum sensory doneness with internal temperature of deep fat fried chicken thighs. Poult Sci 59(4):719–723

Li D, De Keuckelaere A, Uyttendaele M (2015) Fate of foodborne viruses in the Farm to Fork chain of fresh produce. Compr Rev Food Sci Food Saf 14(6):755–770. http://dx.doi.org/710.1111/1541-4337.12163

Li M, Baker CA, Danyluk MD, Belanger P, Boelaert F, Cressey P, Gheorghe M, Polkinghorne B, Toyofuku H, Havelaar AH (2018) Identification of biological hazards in produce consumed in industrialized countries: a review. J Food Prot 81(7):1171–1186. https://doi.org/1110.4315/0362-1028X.JFP-1117-1465

Lindsay RE, Krissinger WA, Fields BF (1986) Microwave vs. conventional oven cooking of chicken: relationship of internal temperature to surface contamination by Salmonella typhimurium. J Am Diet Assoc 86(3):373–374

Lupien JR (2005) Food quality and safety: traceability and labeling. Crit Rev Food Sci Nutr 45(2):119–123. https://doi.org/10.1080/10408690490911774

Lupien JR (2007) Prevention and control of food safety risks: the role of governments, food producers, marketers, and academia. Asia Pac J Clin Nutr 16(Suppl 1):74–79

PubMed   Google Scholar  

Medeiros LC, Hillers VN, Kendall PA, Mason A (2001) Food safety education: what should we be teaching to consumers? J Nutr Educ 33(2):108–113

Morrison E, Young I (2019) The missing ingredient: food safety messages on popular recipe blogs. Food Prot Trends 39(1):28–39

Murray K, Wu F, Shi J, Jun Xue S, Warriner K (2017) Challenges in the microbiological food safety of fresh produce: limitations of post-harvest washing and the need for alternative interventions. Food Qual Saf 1(4):289–301. https://doi.org/210.1093/fqsafe/fyx1027

Ncube F, Kanda A, Mpofu MW, Nyamugure T (2019) Factors associated with safe food handling practices in the food service sector. J Environ Health Sci Eng 17(2):1243–1255. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985409/

Parrish FC Jr, Olson DG, Miner BE, Rust RE (1973) Effect of degree of marbling and internal temperature of doneness on beef rib steaks. J Anim Sci 37(2):430–434

Partnership for Food Safety Education (2010) Fight Bac! Retrieved from http://www.fightbac.org/

Prado-Silva L, Cadavez V, Gonzales-Barron U, Rezende AC, Sant’Ana AS (2015) Meta-analysis of the effects of sanitizing treatments on Salmonella, Escherichia coli O157:H7, and Listeria monocytogenes inactivation in fresh produce. Appl Environ Microbiol 81(23):8008–8021. https://doi.org/10.1128/aem.02216-15

Ramalho V, de Moura AP, Cunha LM (2015) Why do small business butcher shops fail to fully implement HACCP? Food Control 49:85–91

Redmond EC, Griffith CJ (2003) Consumer food handling in the home: a review of food safety studies. J Food Prot 66(1):130–161

Schmidt JG, Kline EA, Parrish FC Jr (1970) Effect of carcass maturity and internal temperature on bovine longissimus attributes. J Anim Sci 31(5):861–865

Scott E (1996) Foodborne disease and other hygiene issues in the home. J Appl Bacteriol 80(1):5–9

Silverglade BA (2000) The WTO agreement on sanitary and phytosanitary measures: weakening food safety regulations to facilitate trade? Food Drug Law J 55(4):517–524. https://www.jstor.org/stable/26660192

CAS   PubMed   Google Scholar  

Simmons SL, Carr TR, McKeith FK (1985) Effects of internal temperature and thickness on palatability of pork loin chops. J Food Sci 50(2):313–315

Singh RP, Heldman DR (2008) Chapter 4 Heat transfer in food processing. In: Introduction to food engineering. Elsevier Science, Amsterdam, pp 247–401

Sneed J, Strohbehn CH (2008) Trends impacting food safety in retail foodservice: implications for dietetics practice. J Am Diet Assoc 108(7):1170–1177. https://doi.org/10.1016/j.jada.2008.04.009

Snyder PO, Matthews ME (1984) Microbiological quality of foodservice menu items produced and stored by cook/chill, cook/freeze, cook/hot-hold and heat/serve methods. J Food Prot 47(11):876–885

Sun W (ed) (2012) Handbook of frozen food processing and packaging, 2nd edn. CRC Press, New York, 936pp

Sundberg AD, Carlin AF (1978) Relation of final internal temperature to Clostridium perfringens destruction in beef loaves cooked in a crockery pot or conventional oven. J Food Sci 43(2):285–288. https://doi.org/10.1111/j.1365-2621.1978.tb02286.x

Tamimi AH, Carlino S, Edmonds S, Gerba CP (2014) Impact of an alcohol-based hand sanitizer intervention on the spread of viruses in homes. Food Environ Virol 6(2):140–144. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032461/

Thaivalappil A, Waddell L, Greig J, Meldrum R, Young I (2018) A systematic review and thematic synthesis of qualitative research studies on factors affecting safe food handling at retail and food service. Food Control 89:97–107

Towns RE, Cullen RW, Memken JA, Nnakwe NE (2006) Food safety-related refrigeration and freezer practices and attitudes of consumers in Peoria and surrounding counties. J Food Prot 69(7):1640–1645

U.S. Food and Drug Administration (2013) Food code (2013) Retrieved from http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm374275.htm

U.S. Food and Drug Administration (2017) Managing food safety: a manual for the voluntary use of HACCP principles for operators of food service and retail establishments. Retrieved from http://www.fda.gov/Food/GuidanceRegulation/HACCP/ucm2006810.htm

U.S. Food and Drug Administration (2017a) Annex 5. Conducting risk-based inspection. Food Code 2017:645–678. https://www.fda.gov/media/110822/download

US Food and Drug Administration (2017b) Food code (2017). Retrieved from https://www.fda.gov/media/110822/download .

U.S. Government Publishing Office (2019) Electronic Code of Federal Regulations. TITLE 9—Animals and animal products. CHAPTER III—Food Safety and Inspection Service, Department of Agriculture. SUBCHAPTER A—Agency organization and terminology; mandatory meat and poultry products inspection and voluntary inspection and certification. PART 416—SANITATION. Retrieved from https://www.ecfr.gov/cgi-bin/text-idx?SID=6a7ee18da35a7f2af8de2e936e0d904c&mc=true&node=pt9.2.416&rgn=div5

USDA (2017) Shelf-stable food safety. Retrieved from https://www.fsis.usda.gov/wps/wcm/connect/77ffde83-dc51-4fdf-93be-048110fe47d6/Shelf_Stable_Food_Safety.pdf?MOD=AJPERES

USDA Food Inspection Services (2008, 2013) Doneness versus safety. Retrieved from https://webcache.googleusercontent.com/search?q=cache:fBhdxIN-en4J:https://www.fsis.usda.gov/wps/wcm/connect/6cece12d-a1b9-43c3-9306-b163ea46e82b/Doneness_Versus_Safety.pdf%3FMOD%3DAJPERES+&cd=3&hl=en&ct=clnk&gl=us

USDA Food Inspection Services (2011) Kitchen thermometers. Retrieved from http://extension.umd.edu/sites/extension.umd.edu/files/_images/programs/FOODSAFETY/Kitchen_Thermometers.pdf

USDA Food Safety and Inspection Service (2014a) Beef from farm to table. Retrieved from http://www.fsis.usda.gov/wps/wcm/connect/c33b69fe-7041-4f50-9dd0-d098f11d1f13/Beef_from_Farm_to_Table.pdf?MOD=AJPERES

USDA Food Safety and Inspection Service (2014b) Chicken from farm to table. Retrieved from https://www.fsis.usda.gov/wps/wcm/connect/ad74bb8d-1dab-49c1-b05e-390a74ba7471/Chicken_from_Farm_to_Table.pdf?MOD=AJPERES

USDA Food Safety and Inspection Service (2015a) Basics for handling food safely. Retrieved from http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling

USDA Food Safety and Inspection Service (2015b) Safe food handling fact sheets. Retrieved from http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling

USDA Food Safety and Inspection Service (2015c) Safe food handling fact sheets/safe food handling/safe minimum internal temperature chart. Retrieved from https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/safe-minimum-internal-temperature-chart/ct_index

USDA Food Safety and Inspection Service (2016, Jan 15, 2015). Safe minimum internal temperature chart. Retrieved from http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/safe-minimum-internal-temperature-chart/ct_index

Van Pelt AE, Quiñones B, Lofgren HL, Bartz FE, Newman KL, Leon JS (2018) Low prevalence of human pathogens on fresh produce on farms and in packing facilities: a systematic review. Front Public Health 6(40):10pp. https://www.frontiersin.org/articles/10.3389/fpubh.2018.00040/full

Wei W, Wang X, Xie Z, Wang W, Xu J, Liu Y et al (2017) Evaluation of sanitizing methods for reducing microbial contamination on fresh strawberry, cherry tomato, and red bayberry. Front Microbiol 8:2397. https://doi.org/10.3389/fmicb.2017.02397

World Health Organization (2006) Food safety risk analysis: a guide for national food safety authorities. Retrieved from https://apps.who.int/iris/handle/10665/43718

World Health Organization (2015) Food safety; fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs399/en/

World Trade Organization (2015a) Current issues in SPS. Retrieved from https://www.wto.org/english/tratop_e/sps_e/sps_issues_e.htm

World Trade Organization (2015b) Sanitary and phytosanitary measures. Retrieved from https://www.wto.org/english/tratop_e/sps_e/sps_e.htm

WTO (2021) Sanitary and phytosanitary measures: introduction. Understanding the WTO agreement on sanitary and phytosanitary measures. Retrieved from https://www.wto.org/english/tratop_e/sps_e/spsund_e.htm

Yang S, Leff MG, McTague D, Horvath KA, Jackson-Thompson J, Murayi T, Boeselager GK, Melnik TA, Gildemaster MC, Ridings DL, Altekruse SF, Angulo FJ (1998) Multistate surveillance for food-handling, preparation, and consumption behaviors associated with foodborne diseases: 1995 and 1996 BRFSS food-safety questions. MMWR CDC Surveill Summ 47(4):33–57. https://www.cdc.gov/mmwr/preview/mmwrhtml/00054714.htm

Young I, Waddell L (2016) Barriers and facilitators to safe food handling among consumers: a systematic review and thematic synthesis of qualitative research studies. PLoS One 11(12):e0167695. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132243/

Zink DL (1997) The impact of consumer demands and trends on food processing. Emerg Infect Dis 3(4):467–469

Zylberman P (2004) Making food safety an issue: internationalized food politics and French public health from the 1870s to the present. Med Hist 48(1):1–28

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Owusu-Apenten, R., Vieira, E. (2023). Food Safety and Sanitation. In: Elementary Food Science. Food Science Text Series. Springer, Cham. https://doi.org/10.1007/978-3-030-65433-7_9

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Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana

• Lawrence Sena Tuglo 1 ,
• Percival Delali Agordoh 2 ,
• David Tekpor 3 ,
• Zhongqin Pan 1 ,
• Gabriel Agbanyo 3 &
• Minjie Chu   ORCID: orcid.org/0000-0002-7533-9119 1  

Environmental Health and Preventive Medicine volume  26 , Article number:  54 ( 2021 ) Cite this article

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Metrics details

Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana.

This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization’s Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed.

The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p =0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p =0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p =0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p <0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p <0.001].

Conclusions

Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Introduction

A report by the World Health Organization (WHO) (2015) showed that about two million incurable cases of food poisoning materialize annually in unindustrialized nations. The WHO further estimates that 600 million food-borne diseases (FBDs) each year were related to poor food safety and hygiene practice with 420,000 deaths [ 1 ], the majority attributed to meat-related vulnerabilities [ 2 ]. About, 76 million FBDs caused 325,000 hospitalizations in the USA which led to 5000 deaths [ 3 ]. The source was associated with the consumption of turkey contaminated by Salmonella enterica serovar Heidelberg , responsible for salmonellosis in the USA [ 4 ]. Almost, 1.3 million FBDs resulted in 21,000 hospital stays reported in England which led to 500 deaths. The contamination was due to sprouts by Escherichia coli O104 [ 3 ]. Around 53% of the food-borne problems and 31% of its associated illness were attributed to meat consumption in the Netherlands [ 2 ]. The rate of FBDs in Malaysia was 47.8% out of 100,000 people who patronized street-cooked foods [ 5 ]. In Ghana, about 65,000 persons including 5000 kids below 5 years died yearly due to FBDs [ 6 ].

The risk factors such as inappropriate time interval, unsuitable temperature, weather condition, unhygienic activities, unacceptable handling of foods, foodstuff from insecure origins, impoverished self-cleanliness, improper cleaning of cooking materials, using untreated water, and improper food storages were attributed to the causes of FBDs [ 7 , 8 , 9 ]. Also, neglect of hygienic measures by food handlers has been implicated as enablers for the spread of pathogenic microorganisms [ 10 ] and the cause of infections among consumers [ 11 ].

Studies recount that 12 to 18% of food-borne illnesses are attributable to contaminations [ 12 , 13 ], poor food safety, and inappropriate hygiene practices which were accredited to street-cooked food handlers (SCFHs) [ 14 , 15 ]. These SCFHs are people who are wholly or partly engaged in the food preparation, processing, and production value chain and who have a direct touch on food and cooking utensils [ 9 , 16 ]. Foods prepared by food handlers under unhygienic conditions become a public health concern both in industrialized and low-income countries [ 17 ]. Food safety and hygienic practices of SCFHs are essential to ensure that food is free from any forms of contamination through preparation and processing for consumption and to prevent the spread of FBDs [ 18 , 19 ].

Food safety knowledge (FSK) is the understanding of food learned from skills or schooling, food safety attitude (FSA) refers to sensation or belief about food safety, and food safety practice refers (FSP) to the act or use of food safety [ 20 ]. Food safety knowledge, attitude, and practices (KAP) are important because inadequate knowledge, poor attitude, and poor sanitation practices by SCFHs have a severe danger to food safety applications in food companies [ 21 ]; hence, KAP of food safety contributes significantly to the occurrence of food poisoning and FBDs among consumers [ 22 ].

A study conducted in Brazil among food truck food handlers revealed poor hygiene, poor clean observes, poor environments, and higher contaminated meals [ 23 ]. The problem of FBDs was higher in Southeast Asian and African counties [ 24 ]. Ma et al. [ 25 ] study in China, among street food vendors, revealed poor behaviour practices and knowledge of food safety among the respondents. Tabit and Teffo [ 26 ] in South Africa found over 60% of the respondents keep good knowledge and acceptable hygiene performance of food safety. Lema et al. [ 27 ] in Ethiopia reported that below half of the respondents obtained good food cleanliness applications. The effects of food-related illness expenditures in hospital treatments are about US$ 110 billion annually in developing countries, which resulted in decreasing production [ 28 ].

The recurrent happenings of food-related illnesses brought in its wake concerns about the food safety knowledge and hygiene among SCFHs [ 29 ]. Maintaining food safety involves establishing global laws conferring to an agreement between institutions that actualized this agenda [ 30 , 31 ]. The Government of Ghana affirmed food safety regulations in collaboration with the Food and Drug Authority (FDA) [ 30 ]. Yet, its application is undermined due to ineffective supervision by appropriate agencies [ 32 ]. The problem was due to the broad governmental assembly in cities and communities under the local administration [ 31 ]. Some local studies conducted in the four regions of Ghana such as Greater Accra, Northern, Western, and Central have reported adequate knowledge, good attitude, and positive behavioural practices of food safety and handling practices [ 11 , 33 , 34 , 35 ]. Studies have shown that SCFHs were not knowledgeable about the WHO’s Five Keys to Safer Food for food handlers [ 33 , 36 ] which include keeping clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials [ 37 ].

Hence, the acceptance and the use of the KAP instrument as a problem-solving approach in this study are validated from previous researches [ 23 , 38 , 39 ]. This would adequately support the policymaking development and the change of embattled intervention policies for the prevention and control of FBDs. The KAP’s tool assessment defined in this study is considered appropriate to other frameworks if the statements in the KAP’s sections are validated. To our knowledge, no research has yet been done on KAP of food safety among SCFHs selling commonly consumable foods on the street in Volta Region, Ghana. Hitherto, the high cases of FBDs such as diarrhoea, cholera, and typhoid fever outbreak occurrences in the district are presumed to be influenced by SCFHs. The KAP of SCFHs on food safety and hygiene precautions ruins uncertainty in the district, and a swift policy to mend some causes central to the occurrence of FBDs is obligatory. This would help the District Health Directorate’s regulatory agency to plan the prevention methods. Therefore, this study assessed knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District, Ghana.

Materials and methods

Study design and setting.

This study was a descriptive cross-sectional carried out between August and November 2020 and used a validated, pretested, and structured questionnaire to collect data from stationary SCFHs along the principal streets within North Dayi District. North Dayi District is one of the 18 administrative districts in the Volta Region, Ghana [ 40 ]. It shares boundaries with Kpando Municipal to the north, South Dayi District to the south, and Afadzato South District to the east. The entire residents of the North Dayi District are 39,913 covering 46.7% men and 53.3% women [ 40 ]. The people of the District constitute 1.9% of the total population of the Volta Region [ 40 ]. Farming is the foremost financial activity, making it one of the main sources of income in the district [ 40 ]. We carried out this study because of the recent cases of food-borne illness reported among the residents such as diarrhoea, cholera, and typhoid fever in the district [ 41 ].

Eligibility criteria

Stationary SCFHs who directly served already cooked food to customers and those who owned their outlets were included in the study. SCFHs who dissented to partake in the research were excepted including all assistants and helpers. The assistants and helpers were excluded because not all vendors had assistants or helpers and they tend to be more in numbers than the vendor-owners themselves. So for as not to allow bias in the results, we chose to sample only the vendor-owners. Moreover, vendor-owners tend to have direct responsibility for monitoring the food safety environment of their vending sites; hence, we chose to sample them as the focus of this study.

Sample size and sampling

Cochran’s formula Z 2 p  (1 −  p )/ e 2 [ 42 ] for unknown study populations was used. Since a similar study in the Volta Region of Ghana among the population subgroup is unavailable, 50% was used for response distribution, with 95% confidence level, and a margin of error of 5% for the populace, plus 10% non-response rate which gave us a sample size of 423.

Data collection tools

A structured questionnaire was designed based on different studies conducted globally [ 16 , 20 , 38 , 39 , 43 , 44 , 45 , 46 ]. Similar versions of the questionnaires were used in studies conducted in Ghana [ 47 , 48 , 49 ]. The instrument was distributed into 4 parts: socio-demographics, knowledge, attitude, and hygiene practices. The statements on KAP were adapted from the WHO’s Five Keys to Safer Food guidebook for food handlers [ 37 ]. The questionnaire was firstly designed in English, then converted to local dialects, and translated back to English to ensure reliability and simplicity of the question. Four professionals in the field of the study assessed the face and the content validity of the questionnaire. The questionnaire was pretested on 12 stationary SCFHs in Tanyigbe located 7 km from the study area. The pretesting findings were not added to the main study but were used to modify some questions to improve their clarity. The most pertinent modifications done on the study instrument were a cooked meal should stay hot more than 60°C before serving, putting uncooked and prepared meal separating prevent cross-contamination, and checking and dispose of meal that past their expiry date. The data were collected through trained research assistant-led interviews which lasted for about 25 min per respondent. The interviewer-administered questionnaire was given to the SCFHs who could read and write to answer by themselves while those SCFHs who could not read and write have been aided by the research assistants in answering the questionnaire.

Determination of knowledge, attitude, and hygiene practices on food safety

Section 2 of the questionnaire contained 10 structured questions on knowledge of food safety with 3 likely responses; “true”, “false”, and “do not know”. The questions precisely covered the respondents’ knowledge of individual cleanliness, food-borne illnesses, microbes, infection control, and sanitary practices. Each correct knowledge item reported was awarded a score of 1 point. Incorrect knowledge was awarded a 0 score (including “do not know”). In this study, if “true” is the correct answer, then “true” is score 1 point while “false” is score 0 point or otherwise reverse.

Queries relating to attitudes in the third segment of the questionnaire were designed to assess the knowledge of SCFHs on food wellbeing and hygiene. This part of the section assessed psychological state concerning views, opinion, morals, and characters to act in particular [ 21 , 48 ]. It contains 10 structured queries with 3 likely answers: “agree”, “disagree”, and “not sure”. Each correct attitude reported was awarded a score of 1 point while the other incorrect attitude option was rated a 0 score (including “not sure”). In this study, if “agree” is the correct answer, then “agree” is score 1 point while “disagree” is score 0 point or otherwise reverse.

• Hygiene practice

Section 4 of the questionnaire measured food hygiene and sanitation practices of SCFHs. It contained 10 structured queries with 2 likely answers: “yes” and “no”. Each correct hygiene practice reported was awarded a score of 1 point while incorrect hygiene practices reported were awarded a score of 0. This method of assessment was used in previous studies [ 28 ]. In this study, if “yes” is the correct answer, then “yes” is score 1 point while “no” is score 0 point or otherwise reverse.

The grouping method is appropriate and suitable for studies allied to the assessment “of food handlers” KAP of food safety and hygiene [ 27 , 28 , 34 , 46 , 47 , 50 , 51 , 52 ]. The knowledge and attitude questions with “do not know” or “not sure”, thus the third option, had been presented to enable simplicity of responding by SCFHs for fascinating for thoughts considered by an undecided or doubtfulness [ 28 ]. This third option “do not know” or “not sure” always scores a 0 point due to the cumulative percentage approach adapted which considers only the acceptable response or the correct answer [ 53 ]. The cumulative percentage scoring method of assessment considers only the acceptable answer and the total cumulative score is converted to 100% [ 53 ]. The cumulative scores below 70% of the acceptable responses on WHO’s Five Keys to Safer Food-related knowledge, attitude, and hygiene practices were considered as “poor”, and cumulative scores 70% and higher were considered as “good” [ 27 , 34 , 39 , 46 , 48 ].

Data analysis

Questionnaires were checked manually before entering into Microsoft Excel 2016 spreadsheet. Coding and analysis were done in IBM Statistical Package for Social Sciences (SPSS Inc., Chicago, USA; https://www.spss.com ) version 24.0. Categorical variables were expressed as frequency and percentage. The disparity between categorical variable groups was verified using the Fisher exact or chi-square test where appropriate. Significant parameters were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. A p -value <0.05 was considered statistically significant.

Ethical consideration

Approval was sought from Ghana Health Service, North Dayi District Health Directorate, with the identity (NDDHD/GR/002/20) 15/07/2020. The research assistants introduced themselves and written informed permission was sought from the respondents. The research method was plainly explained to the respondents in their native dialects (English, Ewe, or Twi). Participants were identified by study numbers. The study numbers of the participants were kept in both locked files and secured computer files and accessible only to key investigators. All data were anonymized and unlinked to the respondents’ identities during the data analysis.

Demographic data

A total complete of 423 questionnaires were conveniently distributed for data collection based on the availability of SCFHs at their dedicated vending sites. Questionnaires of 407 were fully answered and collected from the respondents with a 96.2% (407/423) success rate. n = Z 2 p  (1 −  p )/ e 2   = 1.96 2 0.5 (1 − 0.5)/0.05 2 =384.16+38.416 =422.576. The majority ( n =343; 84.3%) of SCFHs were female, were between the age range of 26 and 35 years ( n =153; 37.6%), and were married ( n =311; 76.4%). Over one-third ( n =144; 35.4%) of SCFHs had attained secondary education. Most ( n =168; 41.3%) of SCFHs earned an average monthly income between GHc501 and GHc1000. Over half ( n =217; 53.3%) of SCFHs had 3–10 years of working experience. Regarding SCFH registered, n =297 (73.0%) reported that they have registered. More than half ( n =228; 56.0%) of SCFHs had not attended a food safety training course (Fig. 1 ).

Demographic data of respondents

Food safety knowledge

Almost all ( n = 381; 93.6%) of SCFHs knew about the washing of hands for 1 min using water and soap before touching food. The majority ( n =313; 76.9%) of SCFHs knew that similar chopping board should not be used for uncooked and prepared foods if it appears wash; n = 336 (82.6%) knew that cooked meal should stay hot before serving (more than 60°C); and n = 275 (67.6%) knew that excess meal should be kept at zone temperature and eat for the following mealtime. Most ( n =239; 58.7%) of SCFHs knew that uncooked meal should be kept individually from a prepared meal; n = 363 (89.2%) knew that treated water should be used for cooking; n = 363 (89.2%) knew that cockroach and house flies should not be allowed into the kitchen; and n = 274 (67.3%) knew that wiping cloths can spread microorganisms and cause disease. However, the majority ( n =235; 57.7%) of SCFHs did not know that food cooking utensils should not be cleaned using tap water only. Also, n = 202 (49.6%) of SCFHs did not know that fresh meat should not be stowed anyplace in the fridge once it is cool (Table 1 ).

Food safety attitude

The majority ( n =277; 68.1%) of SCFHs disagreed that regular hand cleaning throughout meal processing is needless; n = 323 (79.4%) agreed that cleaning kitchen shells lessen the danger of infection, and n = 355 (87.2%) agreed that putting uncooked and prepared meal separating stop infection. Below half ( n =181; 44.5%) of SCFHs agreed that they should be able to differentiate healthy diets and rotten food through eyeing; n =262 (64.4%) disagreed that using different knives and chopping materials for a fresh and prepared meal require more time; n = 366 (89.9%) agreed that they cough or sneeze inside the elbow if towel or paper not available; n = 291 (71.5%) agreed that checking meal for cleanliness and healthiness is important; and n =377 (92.6%) agreed that it is vital to dispose of meals that have gotten to expiring date. Nevertheless, n = 332 (81.6%) of SCFHs agreed that it is acceptable to use the same cloth for dusting and drying and n =217 (53.3%) disagreed that is unhealthy to allow prepared meal stay outside of the fridge for over 2 h (Table 2 ).

Food safety hygiene practice

The majority ( n =343; 84.3%) of SCFHs cleaned their fingers throughout meal cooking; n = 267 (65.6%) washed their cooking utensils used to cook a meal before using for a different meal; n =234 (57.5%) used different cooking bowls and chopping material if cooking a fresh and prepared meal; and n =359 (88.2%) dispersed uncooked and prepared meal before preservation. Also, n =278 (68.3%) keep prepared food at room temperature for 2 h when finished cooking; n =269 (66.1%) checked and disposed of meal past its expiry date; n =372 (91.4%) cleaned fresh food that needs no cooking before consumption; n =320 (78.6%) inspected if a meal is cooked by eyeing; and n =359 (88.2%) examined if a meal is grilled by touching it. Moreover, n =253 (62.2%) used similar kitchen cloth to clean shells and hands (Table 3 ).

SCFH knowledge, attitude, and hygiene practice on food safety classification

A high proportion ( n =274, 67.3%; n =237, 58.2%; and n =256, 62.9%) of SCFHs had good levels in knowledge, attitude, and hygiene practices on food safety (Fig. 2 ).

Levels of respondents’ knowledge, attitude, and hygiene practice on food safety

Association between knowledge, attitude, and hygiene practice and demographic data

Statistical significance was observed in the knowledge section among registered SCFHs ( p =0.031). None of the respondent’s socio-demographic data was statistically significant in the attitude section of food safety p < 0.05. The study found significant differences ( p <0.05) in the hygiene practice scores section with the educational status, average monthly income, registered SCFHs, and SCFHs completing food safety training course of food safety among SCFHs (Table 4 ). The odds ratio showed registered SCFHs were 1.6 times good at food safety knowledge likened to unregistered SCFHs [cOR=1.64 (95% CI 1.04–2.59), p =0.032]. The logistic regression analysis revealed that respondents who had secondary education were 4.1 times good at hygiene practice of food safety [aOR=4.06 (95% CI 1.63–10.11), p =0.003] compared to informal education. The respondents with average monthly income greater than GHc1500 were 4.9 times more likely to have good food safety and hygiene practices compared to those who earned less than Ghc500 average monthly income [aOR=4.89 (95% CI 1.56–15.34), p =0.006]. Meanwhile, registered SCFHs were 7.5 times more likely to have good food safety and hygiene practices compared to unregistered SCFHs [aOR=7.50 (95% CI 4.27–13.19), p <0.001]. The SCFHs who had completed a food safety training course were 6 times more likely to have good food safety and hygiene practices compared to those who had no such training [aOR=5.97 (95% CI 3.50–10.18), p <0.001] (Table 5 ).

Pearson correlation between knowledge, attitude, and hygiene practice toward food safety

The study revealed a positive correlation in the knowledge with the attitude outcomes sections (FSA) of food safety ( r =0.153, p =0.002) (Table 6 ).

The present study investigated knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District of Volta Region, Ghana. This study showed that the majority of SCFHs had good knowledge of food safety. This would help decrease the threat to contamination of foods, food poisoning, and FBDs to the consumers. Studies conducted in Saudi Arabia, Ethiopia, and Ghana have identified the importance of knowledge of food safety to SCFHs and have recommended training programmes on food safety to cultivate the knowledge into hygiene practices [ 14 , 27 , 34 ]. Our finding is inconsistent with previous studies done in Ethiopia and Jordan [ 38 , 45 ], however consistent with studies conducted in Ghana and Malaysia [ 47 , 54 ]. The possible reasons could be the type of food training courses received, the sample size, the scoring rubric applied, and understandings acquired on the subjects. This supported claims, creating an optimistic culture of food safety, inhibit food contamination if incorporated periodically [ 44 , 46 ]. This scenario affirms that the food safety training courses may remarkably enhance the knowledge of food handlers, especially concerning FBDs.

This study found that most of SCFHs knew about the washing of hands for 1 min using liquid and cleanser before touching food, which coincides with the study done in Iran [ 39 ]. The washing of hands with soap and water could reduce contamination of hands, cooking utensils, and cooking preparation surfaces leading to a substantive reduction of the risk of FBDs. Our finding does not corroborate with finding from a study done in Malaysia where a vast majority of SCFHs were knowledgeable of the 4th WHO Five Keys to Safer Food to keep the meal at healthy temperatures [ 20 ]. In our study, the SCFHs wrongly answered that fresh meat should be bestowed at any place in the fridge once it is cool. This misapplication of temperature could result in contamination and possibly proliferating of microbes in food. The reason is that appropriate temperatures can significantly lessen the risk at which foods will deteriorate, thereby preventing FBDs; hence for safety, foods must be held at an appropriate temperature sufficient to slow down the growth of microorganisms or kill microbes.

Attitude is one of the key elements that influence food safety and the practice and lessen the recurrence of food-related illnesses [ 51 ]. This study showed that most of SCFHs had a good attitude toward food safety. It means they understood their roles in food safety which was transmitted into attitude because they possibly serve as a vector for infectious pathogens which lead to food contamination. This agrees with studies conducted in Ghana and Haiti [ 48 , 55 ], but differs from a study done in Malaysia [ 36 ], where the majority of SCFHs had a poor attitude toward food safety. Possibly these could be due to the variances in socio-demographic characteristics, study population, and the study settings. These attitudinal variations could also be due to public reputation preference. Our study showed that visual checking was one of the key ways of differentiating healthy food from rotten ones, which concurs with a study conducted in Iran [ 39 ]. This finding is disturbing because the process of identifying food contamination cannot be performed by visual checking, since pathogens or toxins might be present in those foods without necessarily affecting SCFHs’ sensory aspects (smell, colour, or taste); therefore, food handlers who rely on visual checking for the identification of food contamination might expose consumers to an increased risk of contracting FBDs [ 39 , 56 ]. Therefore, the regulatory authorities must ensure that all SCFHs are trained professionally and certified.

The present study revealed a vast majority of SCFHs agreed that putting uncooked and prepared meal separating prevent cross-contamination, which corresponds to a study done in Haiti [ 55 ]. This act of putting fresh foods separating from cooked food could help prevent cross-contamination, which in turn may prevent infections from happening and halt FBDs. This is one of the highly endorsed public health measures to prevent cross-contamination [ 57 ]. This study found that almost all of SCFHs agreed that they coughed or sneezed into their elbows if a towel or paper is not available. Coughing and sneezing into the elbow or covering coughs and sneezes, and immediately washing the hands, could help to avert the spread of severe respiratory infections such as influenza and whooping cough. Our finding contradicts with other studies conducted in Malaysia and America; they reported that almost all respondents sneezed right away into their hands and never clean it [ 20 , 58 ]. This unpleasant attitude is harmful to the public since sneezing and coughing let out droplets of watery and perhaps transmittable microorganisms which can contaminate foods leading to FBDs.

Preservation of good sanitary behaviours is one of the goals for any food establishment, thereby its observance is vital to ensure safe meals for consumers [ 28 , 59 ]. The proportion of SCFHs in this current study with good hygiene practices of food safety corroborates with previous studies conducted in Saudi Arabia and Ghana [ 21 , 34 ]. This is an indication that SCFHs can be relied upon to act as the first-line responder to prevent several FBDs when they practice what they know. This would help reduce accidental contamination of foodstuffs due to improper management of cooking utensils and surroundings. Contradictory, in the present study, the scores obtained on the practices section were higher than hygiene practices of food safety reported in studies done in China and Nigeria [ 25 , 60 ]. The likely explanations of the difference reported could be as a result of the research population, the study cut-off used, the disparity in food safety courses, and differences in the law enforcement regimes. Our study revealed that the level of hygiene practices score was greater than the level of the attitude score attained by the SCFHs which corresponds to a study conducted in Malaysia [ 15 ]. The probable justification could be the SCFHs tend to provide responses they trust will create a good picture of their hygiene practices which account for the greater level score. The current study revealed that a vast majority of SCFHs washed their cooking utensils used to cook meals before using them for different meals, which is in line with a study done in Iran [ 39 ]. This act is acceptable because food handlers have been mostly identified as a significant vector for food contamination and responsible for FBDs [ 14 , 15 ]. Our study found that SCFHs practised wrongly by using similar kitchen cloth to clean shells and hands at the time which concurs with a study done in Malaysia [ 20 ]. The possible justification could be due to the non-compliance of the respondents to food safety training received. It could also be that they lack understandings of food safety education received. Hence, this displeasing practice may eventually result in contamination of hands and transfers of microorganisms to the consumers. This study showed that a vast majority of SCFHs cleaned fresh food that needs no cooking before consumption, which is in line with a study conducted in Malaysia [ 20 ]. This good hygiene practice is necessary to the elementary control of the spread of possibly FBDs.

Our study revealed a positive relationship between knowledge and the attitude of food safety which corresponds to earlier studies conducted in Malaysia, Iran, and Ghana [ 15 , 39 , 47 ]. Nevertheless, the strength of the correlation identified in the knowledge with the attitude scores of food safety was not strong, which implies that it is vital for the respective agency to monitor SCFH activities and enforce safety standards. Previous studies conducted in Malaysia and Iran found no significant relationship in the knowledge with the hygiene practices of food safety [ 20 , 39 ], which corresponds to our finding but contradicts with studies done in Malaysia and Ghana [ 15 , 47 ]. This result confirms the assertion that good knowledge does not affect the hygiene performance of food safety [ 61 ]. Hence, food handlers should be encouraged by food safety regulatory agencies to at least practise good hygiene irrespective of their levels of knowledge of food safety. In our study, no statistical association was found in the attitudes with the hygiene practice scores of food safety, which opposes earlier studies conducted in Malaysia, Iran, and Ghana [ 39 , 47 , 54 ]. These disparities could be due to their levels of knowledge of food safety and also possibly as a result of the kind of food safety training courses received. This present study found that registered SCFHs were more likely to have good food safety knowledge likened to unregistered SCFHs which is in line with earlier research in Lebanon [ 51 ] but differs in the study done in Malaysia [ 62 ]. The potential explanation is that maybe before SCFHs have been given their certification of registration, they probably have been taken through food safety training courses which provide them with adequate knowledge of food safety and offer them a good understanding of food poisoning, contamination, and hygiene. This shows the importance of registering food handlers who have successfully been through food safety training courses to acquire knowledge on food safety.

This study showed that the odds of good hygiene practices were higher among SCFHs who had secondary education likened to those with no formal education which is in line with a study conducted in Ethiopia [ 12 ]. In contrast to our findings, other studies conducted in Ethiopia and Ghana found SCFHs with primary education as more likely to have good hygiene practices of food safety likened to secondary education [ 27 , 34 ]. The possible reasons are because most food preparation skills, personal hygiene, and cleanliness are learned from friends, relatives, parents, and media but not necessarily from formal education. However, a lower level of education reduces awareness but the higher one gets educated the better the knowledge which affects their attitude and eventually may reflect into hygiene practices. It implies that food handlers should be encouraged to attain at least basic education before engaging into the cooking business, although it serves as the first sources of income for most uneducated people in the societies. Nevertheless, a study conducted in Ghana showed that regardless of educational background, the food safety actions of SCFHs remain an issue in many nations [ 48 ].

The present study showed that SCFHs who earned average monthly income above GHc1500 were more likely to have good hygiene practices compared to respondents who earned less than Ghc500. Our finding confirms a study conducted in Ethiopia and Jordan that found good hygiene practice among food handlers with higher monthly income than those with lower higher monthly income [ 27 , 63 ]. The possible justification is that SCFHs with high monthly income can afford to purchase items needed to establish themselves in hygienic environments and afford more employees to help in cleaning and waste treatment which could result in a reduction in food poisoning and cross-contamination. This means the high monthly income of food handlers determine their ways of hygiene practices, purchasing more cooking utensils for preparing different meals and managing their leftovers foods to prevent contamination.

The present study showed that registered SCFHs were in favour of good hygiene practices of food safety than the unregistered. The likely description is because of the food safety training courses they received before being registered as food handlers which provides them with an in-depth and comprehensive understanding of hygiene practices such as proper handling of food, personal cleanliness, and sanitation while preparing food. However, there is no research found relating registration of food handlers with hygiene practice scores; hence, the lack of the associated literature offers difficulties to compare our finding to collective results reasonably with concrete answered questions. Nonetheless, our finding shows the importance of registering food handlers after they have been through food safety training courses to encourage them to practise good hygiene.

This study found that SCFHs who have completed training courses on food safety were in favour of good hygiene practices of food safety likened to respondents who had not. Our finding asserts with previous studies done in Ethiopia, Malaysia, and Ghana [ 36 , 38 , 47 ]. The probable justification is that SCFHs who have completed food safety training courses had gained the talents and awareness necessary to handle food safely and sustain great ethics of self-cleanness and hygiene practices. Our finding affirms the assertion that training upsurges understanding of food safety which might reflect into hygiene practices [ 48 ]. Hence, a lack of or inadequate training of SCFHs on food safety may inadvertently result in poor hygiene practices, thereby encouraging food contamination [ 26 , 36 ]. This implies providing food safety training to food handles is important to keep consumers from food poisoning and other wellbeing dangers that could arise from eating unsafe food.

In this present study, it is significant to highpoint SCFHs’ knowledge, attitudes, and hygiene practices are unpredictable from the study conceded, though most of SCFHs properly responded by answering appropriately to related questions of WHO’s Five Keys to Safe Foods guidelines for food handlers. This theoretic-based assessment of the KAP method applied to assessed food handlers’ food safety KAP has some limitations. Firstly, the postulation that the received knowledge on food safety is translated into attitude is not entirely true. The existence of a social desirability bias could similarly have added to the discrepancy amid interview-responded KAP of SCFHs. Social desirability bias is the propensity of SCFHs to provide publically anticipated answers which will be regarded approvingly by people [ 64 ]. This proclivity has been shown by their descriptions and overrating socially anticipated KAP questions on food safety. Secondly, as we beforehand mentioned, the research assistants revealed their identities and the purpose of the study to the SCFHs; therefore, the SCFHs were mindful of the hygiene practices and the significance of observing them, but they remained keen to acknowledge their nonconformity and these could likely affect the self-reported hygiene practices. Thirdly, the unavailability of sufficient data from related studies in the district impedes an evaluative comparison of our findings to determine an improvement of food safety KAP among SCFHs; therefore, our findings ought to be interpreted with caution. However, due to the representative nature of the sample assessed, the findings of this study can be generalized to other SCFHs in the district. After all, it makes a substantial impact concerning food safety KAP in North Dayi District because it is the first study conducted in the district that presents an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Over half of the respondents had good levels of KAP of food safety. This study found a significant relationship in the knowledge and hygiene practice scores of food safety with SCFH registration. This shows the importance of strict enforcement of registration and certification of SCFHs by regulatory agencies as a means of protecting the consuming public. Therefore, the government agency through FDA should intensify the vitality of undertaking food safety training on WHO’s Five Keys to Safer Food by food handlers before being registered. Furthermore, the District Health Directorate should properly and effectively supervise food handlers engaging in cooking businesses to ensure they transmit the link between knowledge with the attitude of food safety into hygiene practice. Further studies should assess the kind of food safety training modules received and their impacts on the KAP of WHO’s Five Keys to Safer Foods as well as evaluating their hygiene practices with observational checklists.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available due to ethical consideration but are available from the corresponding author on reasonable request.

World Health Organization WHO. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015: World Health Organization; 2015.

Brandwagt D, van den Wijngaard C, Tulen AD, Mulder AC, Hofhuis A, Jacobs R, et al. Outbreak of Salmonella Bovismorbificans associated with the consumption of uncooked ham products, the Netherlands, 2016 to 2017. Eurosurveillance. 2018;23:317–35.

Google Scholar  

Navarro-Garcia F. Escherichia coli O104: H4 pathogenesis: an enteroaggregative E. coli/Shiga toxin-producing E. coli explosive cocktail of high virulence. Enterohemorrhagic Escherichia coli Other Shiga Toxin-Producing E coli. 2015;1:503–29.

Etter AJ, West AM, Burnett JL, Wu ST, Veenhuizen DR, Ogas RA, et al. Salmonella Heidelberg food isolates associated with a Salmonellosis outbreak have enhanced stress tolerance capabilities. Appl Environ Microbiol. 2019;85:1–22.

WPSE, Netty D, Sangaran G. Paper review of factors, surveillance and burden of food borne disease outbreak in Malaysia. Malaysian J public Heal Med. 2013;13:98–105.

Monney I, Agyei D, Owusu W. Hygienic practices among food vendors in educational institutions in Ghana: the case of Konongo. Foods. 2013;2(3):282–94. https://doi.org/10.3390/foods2030282 .

Fan YX, Liu XM, Bao YD. Analysis of main risk factors causing foodborne diseases in food catering business. Zhonghua Yu Fang Yi Xue Za Zhi. 2011;45:543–6.

Cheng Y, Zhang Y, Ma J, Zhan S. Food safety knowledge, attitude and self-reported practice of secondary school students in Beijing, China: a cross-sectional study. PLoS One. 2017;12:1–13.

Saad M, See TP, Adil MAM. Hygiene practices of food handlers at Malaysian government institutions training centers. Procedia-Social Behav Sci. 2013;85:118–27. https://doi.org/10.1016/j.sbspro.2013.08.344 .

Abdalla MA, Suliman SE, Bakhiet AO. Food safety knowledge and practices of street foodvendors in Atbara City (Naher Elneel State Sudan). African J Biotechnol. 2009;8:6967–71.

Ayeh-Kumi PF, Quarcoo S, Kwakye-Nuako G, Kretchy JP, Osafo-Kantanka A, Mortu S. Prevalence of intestinal parasitic infections among food vendors in Accra, Ghana. J Trop Med Parasitol. 2009;32:1–8.

Dagne H, Raju RP, Andualem Z, Hagos T, Addis K. Food safety practice and its associated factors among mothers in Debarq Town, Northwest Ethiopia: community-based cross-sectional study. Biomed Res Int. 2019;1:1–9.

Kuchenmüller T, Hird S, Stein C, Kramarz P, Nanda A, Havelaar AH. Estimating the global burden of foodborne diseases-a collaborative effort. Eurosurveillance. 2009;14:1–13.

Ayaz WO, Priyadarshini A, Jaiswal AK. Food safety knowledge and practices among Saudi mothers. Foods. 2018;7(12):193–208. https://doi.org/10.3390/foods7120193 .

Sani NA, Siow ON. Knowledge, attitudes and practices of food handlers on food safety in food service operations at the Universiti Kebangsaan Malaysia. Food Control. 2014;37:210–7. https://doi.org/10.1016/j.foodcont.2013.09.036 .

Oridota SE, Ochulo NF, Akanmu ON, Olajide TO, Soriyan OO. Food hygiene and safety practices of food handlers and its determinants in Lagos State. J Med Res Pract. 2014;3:37–41.

Chukuezi CO. Food safety and hyienic practices of street food vendors in Owerri, Nigeria. Stud Sociol Sci. 2010;1:50–7.

Dun-Dery EJ, Addo HO. Food hygiene awareness, processing and practice among street food vendors in Ghana. Food Public Heal. 2016;6:65–74.

Tefera T, Mebrie G. Prevalence and predictors of intestinal parasites among food handlers in Yebu town, southwest Ethiopia. PLoS One. 2014;9:1–13.

Soon JM, Wahab IRA, Hamdan RH, Jamaludin MH. Structural equation modelling of food safety knowledge, attitude and practices among consumers in Malaysia. PLoS One. 2020;15:1–12.

Sharif L, Al-Malki T. Knowledge, attitude and practice of Taif University students on food poisoning. Food Control. 2010;21(1):55–60. https://doi.org/10.1016/j.foodcont.2009.03.015 .

Kim J, Cho Y. Convergence evaluating food safety knowledge, attitude, and practice regarding food handler. J Korea Converg Soc. 2019;10:73–8.

Isoni Auad L, Cortez Ginani V, Stedefeldt E, Yoshio Nakano E, Costa Santos Nunes A, Puppin Zandonadi R. Food safety knowledge, attitudes, and practices of Brazilian food truck food handlers. Nutrients. 2019;11(8):1784–803. https://doi.org/10.3390/nu11081784 .

Zhao Y, Yu X, Xiao Y, Cai Z, Luo X, Zhang F. Netizens’ food safety knowledge, attitude, behaviors, and demand for science popularization by WeMedia. Int J Environ Res Public Health. 2020;17(3):730–40. https://doi.org/10.3390/ijerph17030730 .

Ma L, Chen H, Yan H, Wu L, Zhang W. Food safety knowledge, attitudes, and behavior of street food vendors and consumers in Handan, a third tier city in China. BMC Public Health. 2019;19(1):1128–39. https://doi.org/10.1186/s12889-019-7475-9 .

Tabit FT, Teffo LA. An assessment of the food safety knowledge and attitudes of food handlers in hospitals. BMC Public Health. 2020;20:311–22.

Lema K, Abuhay N, Kindie W, Dagne H, Guadu T. Food hygiene practice and its determinants among food handlers at University of Gondar, Northwest Ethiopia, 2019. Int J Gen Med. 2020;13:1129–37. https://doi.org/10.2147/IJGM.S262767 .

Yenealem DG, Yallew WW, Abdulmajid S. Food safety practice and associated factors among meat handlers in Gondar town: a cross-sectional study. J Environ Public Health. 2020;1:1–7.

Adane M, Teka B, Gismu Y, Halefom G, Ademe M. Food hygiene and safety measures among food handlers in street food shops and food establishments of Dessie town, Ethiopia: a community-based cross-sectional study. PLoS One. 2018;13:1–13.

Ababio PF, Lovatt P. A review on food safety and food hygiene studies in Ghana. Food Control. 2015;47:92–7. https://doi.org/10.1016/j.foodcont.2014.06.041 .

Yeleliere E, Cobbina SJ, Abubakari ZI. Review of microbial food contamination and food hygiene in selected capital cities of Ghana. Cogent Food Agric. 2017;3:1–12.

Ghana Standard Authority GSA. Personal communication with standard documentation department. 2013.

Sarkodie NA, Bempong EK, Tetteh ON, Saaka AC, Moses GK. Assessing the level of hygienic practices among street food vendors in Sunyani township. Pakistan J Nutr. 2014;13(10):610–5. https://doi.org/10.3923/pjn.2014.610.615 .

Odonkor ST, Kurantin N, Sallar AM. Food safety practices among postnatal mothers in Western Ghana. Int J Food Sci. 2020;1:1–10.

Monney I, Agyei D, Ewoenam BS, Priscilla C, Nyaw S. Food hygiene and safety practices among street food vendors: an assessment of compliance, institutional and legislative framework in Ghana. Food public Heal. 2014;4:306–15.

Rahman M, Arif MT, Bakar K, bt Tambi Z. Food safety knowledge, attitude and hygiene practices among the street food vendors in Northern Kuching city, Sarawak. Borneo Sci. 2012;31:95–103.

World Health Organization WHO. Five Keys to Safer Food Manual; Department of Food Safety, Zoonoses and Foodborne Disease. 2006; www.who.int/entity/foodsafety/ .

Azanaw J, Gebrehiwot M, Dagne H. Factors associated with food safety practices among food handlers: facility-based cross-sectional study. BMC Res Notes. 2019;12(1):683–9. https://doi.org/10.1186/s13104-019-4702-5 .

Fariba R, Gholamreza JK, Saharnaz N, Ehsan H, Masoud Y. Knowledge, attitude, and practice among food handlers of semi-industrial catering: a cross sectional study at one of the governmental organization in Tehran. J Environ Heal Sci Eng. 2018;16(2):249–56. https://doi.org/10.1007/s40201-018-0312-8 .

Ghana Statistical Service GSS. Population and housing census 2010 district and analytical report. 2010.

GHS GHS. Annual report, Ghana Health Service: GHS; 2020.

Cochran WG. Sampling technique. Third edit. New York: John Wiley & Sons; 1977.

Byrd-Bredbenner C, Berning J, Martin-Biggers J, Quick V. Food safety in home kitchens: a synthesis of the literature. Int J Environ Res Public Health. 2013;10(9):4060–85. https://doi.org/10.3390/ijerph10094060 .

Hashanuzzaman M, Bhowmik S, Rahman MS, Zakaria MUMA, Voumik LC, Mamun A-A. Assessment of food safety knowledge, attitudes and practices of fish farmers and restaurants food handlers in Bangladesh. Heliyon. 2020;6:1–8.

Osaili TM, Jamous DOA, Obeidat BA, Bawadi HA, Tayyem RF, Subih HS. Food safety knowledge among food workers in restaurants in Jordan. Food Control. 2013;31(1):145–50. https://doi.org/10.1016/j.foodcont.2012.09.037 .

Soares LS, Almeida RCC, Cerqueira ES, Carvalho JS, Nunes IL. Knowledge, attitudes and practices in food safety and the presence of coagulase-positive staphylococci on hands of food handlers in the schools of Camaçari, Brazil. Food Control. 2012;27(1):206–13. https://doi.org/10.1016/j.foodcont.2012.03.016 .

Amegah KE, Addo HO, Ashinyo ME, Fiagbe L, Akpanya S, Akoriyea SK, et al. Determinants of hand hygiene practice at critical times among food handlers in educational institutions of the Sagnarigu municipality of Ghana: a cross-sectional study. Environ Health Insights. 2020;14:1–10.

Akabanda F, Hlortsi EH, Owusu-Kwarteng J. Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC Public Health. 2017;17(1):40–9. https://doi.org/10.1186/s12889-016-3986-9 .

Apanga S, Addah J, Sey DR. Food safety knowledge and practice of street food vendors in rural Northern Ghana. Food Public Heal. 2014;4:99–103.

Adesokan HK, Akinseye VO, Adesokan GA. Food safety training is associated with improved knowledge and behaviours among foodservice establishments’ workers. Int J Food Sci. 2015;1:1–8.

Bou-Mitri C, Mahmoud D, El Gerges N, Jaoude MA. Food safety knowledge, attitudes and practices of food handlers in Lebanese hospitals: a cross-sectional study. Food Control. 2018;94:78–84. https://doi.org/10.1016/j.foodcont.2018.06.032 .

Derso T, Tariku A, Ambaw F, Alemenhew M, Biks GA, Nega A. Socio-demographic factors and availability of piped fountains affect food hygiene practice of food handlers in Bahir Dar Town, northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2017;10(1):628–35. https://doi.org/10.1186/s13104-017-2965-2 .

Al RA. On the contribution of student experience survey regarding quality management in higher education: an institutional study in Saudi Arabia. J Serv Sci Manag. 2010;3:464–9.

Siau AMF, Son R, Mohhiddin O, Toh PS, Chai LC. Food court hygiene assessment and food safety knowledge, attitudes and practices of food handlers in Putrajaya. Int Food Res J. 2015;22:1843–54.

Samapundo S, Climat R, Xhaferi R, Devlieghere F. Food safety knowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti. Food Control. 2015;50:457–66. https://doi.org/10.1016/j.foodcont.2014.09.010 .

Murray R, Glass-Kaastra S, Gardhouse C, Marshall B, Ciampa N, Franklin K, et al. Canadian consumer food safety practices and knowledge: foodbook study. J Food Prot. 2017;80(10):1711–8. https://doi.org/10.4315/0362-028X.JFP-17-108 .

Zhang H, Lu L, Liang J, Huang Q. Knowledge, attitude and practices of food safety amongst food handlers in the coastal resort of Guangdong, China. Food Control. 2015;47:457–61.

Berry TD, Fournier AK. Examining university students’ sneezing and coughing etiquette. Am J Infect Control. 2014;42(12):1317–8. https://doi.org/10.1016/j.ajic.2014.09.003 .

Khanal G, Poudel S. Factors associated with meat safety knowledge and practices among butchers of Ratnanagar municipality, Chitwan, Nepal: a cross-sectional study. Asia Pacific J Public Heal. 2017;29(8):683–91. https://doi.org/10.1177/1010539517743850 .

Faremi FA, Olatubi MI, Nnabuife GC. Food safety and hygiene practices among food vendors in a Tertiary Educational Institution in South Western Nigeria. Eur J Nutr Food Saf. 2018;8(2):59–70. https://doi.org/10.9734/EJNFS/2018/39368 .

Fadaei A. Assessment of knowledge, attitudes and practices of food workers about food hygiene in Shahrekord restaurants, Iran. World Appl Sci J. 2015;33:1113–7.

Radu S, Othman M, Toh PS, Chai LC. Assessment of knowledge, attitude and practices concerning food safety among restaurant workers in Putrajaya, Malaysia. Food Sci Qual Manag. 2014;32:20–7.

Osaili TM, Al-Nabulsi AA, Krasneh HDA. Food safety knowledge among foodservice staff at the universities in Jordan. Food Control. 2018;89:167–76. https://doi.org/10.1016/j.foodcont.2018.02.011 .

Jespersen L, MacLaurin T, Vlerick P. Development and validation of a scale to capture social desirability in food safety culture. Food Control. 2017;82:42–7. https://doi.org/10.1016/j.foodcont.2017.06.010 .

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Lawrence Sena Tuglo, Zhongqin Pan & Minjie Chu

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Tuglo, L.S., Agordoh, P.D., Tekpor, D. et al. Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana. Environ Health Prev Med 26 , 54 (2021). https://doi.org/10.1186/s12199-021-00975-9

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Public health risks related to food safety issues in the food market: a systematic literature review

Zemichael gizaw.

Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Associated Data

All the extracted data are included in the manuscript.

Food safety in the food market is one of the key areas of focus in public health, because it affects people of every age, race, gender, and income level around the world. The local and international food marketing continues to have significant impacts on food safety and health of the public. Food supply chains now cross multiple national borders which increase the internationalization of health risks. This systematic review of literature was, therefore, conducted to identify common public health risks related to food safety issues in the food market.

All published and unpublished quantitative, qualitative, and mixed method studies were searched from electronic databases using a three step searching. Analytical framework was developed using the PICo (population, phenomena of interest, and context) method. The methodological quality of the included studies was assessed using mixed methods appraisal tool (MMAT) version 2018. The included full-text articles were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. We then synthesized each theme by comparing the discussion and conclusion of the included articles. Emergent themes were identified based on meticulous and systematic reading. Coding and interpreting the data were refined during analysis.

The analysis of 81 full-text articles resulted in seven common public health risks related with food safety in the food market. Microbial contamination of foods, chemical contamination of foods, food adulteration, misuse of food additives, mislabeling, genetically modified foods (GM foods), and outdated foods or foods past their use-by dates were the identified food safety–related public health risks in the food market.

This systematic literature review identified common food safety–related public health risks in the food market. The results imply that the local and international food marketing continues to have significant impacts on health of the public. The food market increases internationalization of health risks as the food supply chains cross multiple national borders. Therefore, effective national risk-based food control systems are essential to protect the health and safety of the public. Countries need also assure the safety and quality of their foods entering international trade and ensure that imported foods conform to national requirements.

Food safety is an important issue that affects all of the world’s people. Many countries throughout the world are increasingly interdependent on the availability of their food supply and on its safety. Hence, people all over the world increasingly value food safety; food production should be done safely to maximize public health gains and environmental benefits. Food safety deals with safeguarding the food supply chain from the introduction, growth, or survival of hazardous microbial and chemical agents [ 1 , 2 ].

Unsafe food containing harmful bacteria, viruses, parasites, or chemical substances causes more than 200 diseases—ranging from diarrhea to cancers. An estimated 600 million in the world fall ill after eating contaminated food and 420,000 die every year, resulting in the loss of 33 million disability adjusted life years (DALYs). Children under 5 years of age carry 40% of the food borne disease burden, with 125,000 deaths every year. Diarrheal diseases are the most common illnesses resulting from the consumption of contaminated food, causing 550 million people to fall ill and 230,000 deaths every year [ 3 ].

Food safety is being challenged nowadays by the global dimensions of food supply chains [ 1 , 4 , 5 ]. Foods in the international market may be frauded as different parties such as manufacturers, co-packers, distributors, and others along the chain of distribution involve in the national or international trade [ 6 – 8 ]. Food safety in the food market is one of the key areas of focus in public health, because it affects people of every age, race, gender, and income level around the world. The local and international food marketing continues to have significant impacts on food safety and health of the public. Food supply chains now cross multiple national borders which increase the internationalization of health risks [ 9 – 14 ]. This systematic review of literature was, therefore, conducted to identify common public health risks related to food safety issues in the food market. This review provides evidence to improve food safety in the food market using risk-based food safety strategies. Healthcare providers, researchers, and policy makers may use the results of this systematic literature review to protect the public from undue health effects due to consumption of foods with poor quality and safety.

Research question

What food safety–related public health risks are commonly found in the food market?

Analytical framework

We developed the components of the analytical framework using the PICo (population, phenomena of interest, and context) method. The population for this review was the public over the globe. The phenomenon of interest for this review was public health risks associated with food safety. The context was the food market (such as restaurants, food stores, supermarkets, shops, food processing plants, and street vending). The reviewers sat together to discuss and refine the framework.

Criteria for considering studies for this review

All published and unpublished quantitative, qualitative, and mixed method studies conducted on food safety–related health risks for the general public in the food market were included. Governmental and other organizational reports were also included. Articles published other than English language, citations with no abstracts and/or full texts, duplicate studies, and studies with poor quality were excluded.

Search strategy

We searched published articles/or reports from MEDLINE/ PubMed, EMBASE, CINAHL, Access Medicine, Scopus, Web of Science, Google Scholar, WHO Library, FAO Libraries, and WTO Library. We also searched thesis and dissertations from Worldcat and ProQuest. We used a three step searching. In the first step, we conducted an initial limited search of MEDLINE and analyzed the text words contained in the title and abstract, and of the index terms used to describe articles. Secondly, we searched across all included databases using all identified keywords and index terms. Thirdly, references of all identified articles were searched to get additional studies. The search term we used in the initial searching is presented as follows.

((((("public health"[MeSH Terms] OR ("public"[All Fields] AND "health"[All Fields]) OR "public health"[All Fields]) AND ("risk"[MeSH Terms] OR "risk"[All Fields] OR "risks"[All Fields])) OR (("public health"[MeSH Terms] OR ("public"[All Fields] AND "health"[All Fields]) OR "public health"[All Fields]) AND hazards[All Fields])) OR (("public health"[MeSH Terms] OR ("public"[All Fields] AND "health"[All Fields]) OR "public health"[All Fields]) AND problems[All Fields])) AND ((("food safety"[MeSH Terms] OR ("food"[All Fields] AND "safety"[All Fields]) OR "food safety"[All Fields]) OR ("food quality"[MeSH Terms] OR ("food"[All Fields] AND "quality"[All Fields]) OR "food quality"[All Fields])) OR (("food"[MeSH Terms] OR "food"[All Fields]) AND ("hygiene"[MeSH Terms] OR "hygiene"[All Fields])))) AND (((("food"[MeSH Terms] OR "food"[All Fields]) AND market[All Fields]) OR (("food"[MeSH Terms] OR "food"[All Fields]) AND trade[All Fields])) OR (("food supply"[MeSH Terms] OR ("food"[All Fields] AND "supply"[All Fields]) OR "food supply"[All Fields]) AND chain[All Fields]))

Assessment of methodological quality

Search results from different electronic databases were exported to Endnote reference manager to remove duplication. Two independent reviewers (ZG and BA) screened out articles using titles and abstracts. The reviewers further investigated and assessed full-text articles against the inclusion and exclusion criteria. The reviewers sat together to resolve disagreements during the review. The methodological quality of the included studies was assessed using mixed methods appraisal tool (MMAT) version 2018 [ 15 ]. This method explains the detail of each criterion. The rating of each criterion was, therefore, done as per the detail explanations included in the method. Almost all of the included full-text articles fulfilled the criteria and all the included full-text articles were found to be better quality.

Data extraction

In order to minimize bias, we the reviewers independently extracted data from papers included in the review using JBI mixed methods data extraction form [ 16 ]. The data extraction form was piloted on randomly selected papers and modified accordingly. Eligibility assessment was performed independently by the two reviewers. Information like authors, year of publication, study areas, type of studies, and focus of the study or main messages were extracted.

Synthesis of findings

The included full-text articles were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. We then synthesized each theme by comparing the discussion and conclusion of the included articles. Emergent themes were identified based on meticulous and systematic reading. Coding and interpreting the data were refined during the analysis.

The search process

The search strategy identified 2641 titles and abstracts (1890 from PubMed and 751 from other sources) as of 13 June 2019. We obtained 1992 title and abstracts after we removed duplicates. Following assessment by title and abstract, 705 articles were retrieved for more evaluation and 344 articles were assessed for eligibility. Finally, 81 articles were included for systematic literature review based on the inclusion criteria (Fig. ​ (Fig.1 1 ).

Study selection flow diagram

In this review, 81 of 1992 (4%) full-text articles matched the inclusion criteria. The overwhelming majority, 74 of 81 (91%) of the included full-text articles are research articles; 2 (3%) are short communications; 2 (3%) are regulatory papers, 1 (1%) is field inspection; 1 (1%) is research note; and the other 1 (1%) is thesis. Of the included full-text articles, 30 of 81 (37%) are conducted in Asia; 4 of 81 (5%) are conducted in multiple countries in the same region or across regions; and 1of 81 (1%) is not region specific (Fig. ​ (Fig.2 2 ).

Regions where the included full-text articles conducted

All the included full-text articles are published between 1991 and 2018 (35 (43%) between 2011 and 2015; 16 (20%) between 2000 and 2005; 16 (20%) between 2006 and 2010; 12 (15%) between 2016 and 2018; and the rest 2(2%) before 2000).

Food safety–related public health risks identified from the search process

The analysis of 81 full-text articles resulted in seven common public health risks related with food safety in the food market. Microbial contamination of foods, chemical contamination of foods, food adulteration, misuse of food additives, mislabeling, GM foods, and foods past their use-by dates were the identified food safety–related health risks in the food market (Table ​ (Table1 1 ).

Common food safety–related public health risks identified from the search process

Table ​ Table2 2 shows food safety–related public health risks in the food market by country name (countries are categorized into developed and developing based on the United Nations (UN) 2019 list). Among 21 full-text articles included for microbial contamination of foods, 13 (62%) were from developing countries. This may suggest microbial contamination of foods in the food market is a common public health risk in developing countries than the developed. Eight (53%) of 15 articles retrieved for chemical contamination of foods in the food market were from developing countries. The vast majority, 8 of 9 (89%) full-text articles retrieved for food adulteration were from developing countries, which may indicate adulteration of foods is practiced more of in developing countries. Similarly, 8 of 11 (73%) of the full-text articles included for misuse of food additives were from developing countries, which may show misuse of food additives is a common problem in developing countries. For mislabeling, 14 of 17 (82%) and 8 of 17 (47%) of the full-text articles were from developed and developing countries respectively. Four out of six (67%) of full-text articles retrieved for foods past use-by dates were from developing countries. This may show selling of outdated foods is common in developing countries than the developed.

Food safety–related public health risks in the food market by country name (countries are categorized into developed and developing based on the United Nations (UN) 2019 list)

Numbers in the bracket show the number of full-text articles included

a There are studies conducted in two and/or three different countries. In this case, we may count one study twice and /or three times.

b One study was conducted in a general context. So, we did not include it when we categorize studies in regions

Figure ​ Figure3 3 shows comparison of food safety issues in developed and developing countries. A total of 37 and 50 articles were included in this review from developed and developing countries respectively. The comparison of food safety issues among developed countries suggests that mislabeling (38%), microbial contaminations (22%), and chemical contamination (19%) are the commonest food safety issues in the food market. Similarly, the comparison of food safety issues among developing countries suggests that microbial contaminations (26%), chemical contaminations (16%), food adulteration (16%), misuse of additives (16%), and mislabeling (16%) are the commonest food safety issues in the food market.

Comparison of food safety issues in developed and developing countries

Microbial contamination of foods

In this review, 21 of 81 (26%) full-text articles reported the presence of pathogenic microorganisms in different food items in the food market. These studies identified different diseases causing bacteria mainly Salmonella spp., Escherichia coli , Klebsiella spp., Shigella spp., Enterobacter spp., Proteus spp., Citrobacter spp. Staphylococcus aureus , Campylobacter spp., Listeria spp., Vibrio , Alklegens spp., Bacillus cereus , Pseudomonas spp., Clostridium perfringens , Arcobacter spp., and Enterococcus spp. Moreover, different fungus such as Blastomyces, Fusarium spp., Mucor spp., Aspergillus niger , Fusarium avenaceum , Penicillium digitatum , Rhizopus stolonifer , Saccharomyces species, Fusarium solani , Aspergillus flavus , Saccharomyces dairensis , and Saccharomyces exiguus were identified from different food items from food stores or shops. The included studies also reported that some of the microorganisms are resistant to different antimicrobials (Table ​ (Table3). 3 ). The results also show that total coliforms, fecal coliforms, and different fungus were commonly reported in developing countries than developed countries. On the other hand, different Campylobacter species were reported in developed countries than developed countries.

Summary of full-text articles which reported microbial contamination of foods as a public risk in food marketing

Chemical contamination of foods

Fifteen (19%) of the full-text articles included in this review reported that contamination of foods with hazardous chemicals is a major public health concern associated with the food market. Heavy metals (like cadmium, nickel, lead, copper, zinc, iron, mercury, and manganese), pesticide residuals (like dichlorvos, dimethoate, parathion-methyl, pirimiphos-methyl, and parathion), persistent organic pollutants (like dichlorodiphenyltrichloroethane metabolites, polychlorinated biphenyls, perfluorooctanoic acid, endosulfans, and aldrin), organic compounds (like patulin, chloroform, formalin, and urea), volatile organic compounds (like ethyl benzene, o-xylene, and benzene), hydrocarbons (like benzo[a]pyrene and toluene), and other chemical compounds (like calcium carbide and cyanide) are chemical contaminants identified by the full-text articles included in this review. In most cases, the concentration of chemicals exceeded the tolerable limit for consumable food items (Table ​ (Table4 4 ).

Summary of full-text articles which reported chemical contamination of foods as a public risk in food marketing

Food adulteration

In 9 (11%) of full-text articles included in this review, food adulteration has been discussed as a major public health risk associated with food safety issues in the food market. Most of the foodstuffs in the market are adulterated in varying degrees. Chemicals (like urea fertilizer, artificial color flavors, textile dye, formalin, chlorofluorocarbon; DDT powder, sodium bicarbonate, neutralizers, detergents, hydrogen peroxide, caustic soda, sodium chloride, boric acid, ammonium sulfate, sorbitol, metanil yellow, ultramarine blue, rhodamine B., maleic anhydride, copper chlorophyll, dimethyl/diethyl yellow, argemone oil, burnt mobil, and burnt oil); items which are not the genuine component of foods (like potato smash, cow’s fat and intestine in ghee, water in milk, sugar in honey, etc.); poor-quality products; and physical or inert agents (like saw dust and brick powder) are the commonest adulterants added to different food items (Table ​ (Table5 5 ).

Summary of full-text articles which reported food adulteration as a public risk in food marketing

Misuse of food additives

In this systematic review of literature, 11 of 81 (14%) full-text articles showed that misuse of food additives in the food market endangers public health. As reported in the included full-text articles, even though some food colorants and sweeteners are permitted to use such as sunset yellow FCF (SSYFCF), tartrazine, erythrosine, new coccine, ponceau, and saccharin (some may not be permitted based on countries food regulation), their concentration exceeded the prescribed limit. Moreover, use of non-permitted colorants and sweeteners such as rhodamine B, metanil yellow, orange II, malachite green, auramine, quinoline yellow, amaranth, carmoisine, Sudan dyes, and cyclamate (some may be permitted based on countries food regulation) is also commonly reported in the included studies (Table ​ (Table6 6 ).

Summary of full-text articles which reported misuse of food additives as a public risk in food marketing

Mislabeling

Mislabeling of food products has been mentioned as a major public health risk associated with food safety in the food market in 17 of 81 (21%) full-text articles included in this review. All of the 17 studies reported that significant proportion of food samples collected from supermarkets, food stores, shops, and restaurants were genetically identified as entirely different species from that identified on the product labels, and therefore were considered as mislabeled. The studies witnessed that seafood is the most commonly mislabeled food product (Table ​ (Table7 7 ).

Summary of full-text articles which reported mislabeling as a public risk in food marketing

Genetically modified foods

In this systematic review of literature, 4 of 81 (5%) of the included full-text articles discussed that GM foods are becoming an increasing public health risk. Hypertension, stroke, diabetes, obesity, lipoprotein metabolism disorder, Alzheimer’s, Parkinson’s, multiple sclerosis, hepatitis C, end-stage renal disease, acute kidney failure, cancers of the thyroid/liver/bladder/pancreas/kidney, myeloid leukemia, diarrhea, vomiting, difficulty in breathing, respiratory problems, hormonal imbalances and susceptibility to infection or immunosuppression, allergenic or rashes, and chemical toxicity are health problems reported in the included full-text articles (Table ​ (Table8 8 ).

Summary of full-text articles which reported genetically modified foods as a public risk in food marketing

Foods past their use-by dates

Six (7%) of the included full-text articles revealed that outdated or foods past their use-by dates are being sold in food stores, shops, and restaurants which are contributing huge public health and environmental problems (Table ​ (Table9 9 ).

Summary of full-text articles which reported foods past their use-by dates as a public risk in food marketing

This review identified that microbial contamination, chemical contamination, adulteration, misuse of food additives, mislabeling, genetically modified foods, and outdated foods are common public health risks related with food safety issues in the food market. In the food market, food can become contaminated in one country and cause health problems in another. These food safety issues cause exposure of consumers to biological, chemical, and physical hazards [ 91 – 95 ] so that endanger health of the public. The origin of food hazards can be described as a chain which commences on the source and continues with transportation, further processing steps, merchandising events and finally ends with the consumer [ 96 – 100 ]. Overall, this review suggested that food safety–related public health risks are more common in developing countries than developed countries. This can be justified that foods get easily contaminated with microbes due to the poor hygiene and sanitation in developing countries [ 101 – 104 ]. Moreover, hence the regulatory services are weak in developing countries, most food sellers may not comply with food hygiene and safety requirements or standards [ 105 – 107 ]. In developing countries, the legislation enforcement is still weak about administrating the concentration of harmful contaminants in the food [ 108 , 109 ]. In addition, there is inadequate information and technology to detect fake and fraud products [ 110 – 112 ] .

This review identified that microbial contamination of foods in the food market is commonly reported in many studies. Different bacterial species and funguses were the commonest diseases causing pathogens identified [ 17 – 35 , 113 ]. Failure to apply food safety strategies in every stage of the food supply chain, for example bad food handling practices, poor production process, poor agricultural practices, poor transportation system, poor marketing practices, and poor sanitation lead to microbial contamination of foods [ 114 – 118 ]. Moreover, fraud of foods such as adulteration, mislabeling, and selling of spoiled or expired foods are also causing microbial contamination [ 36 , 119 – 122 ]. Microbial contamination of foods causes millions of diseases and thousands of deaths [ 123 ]. This review also shows that total coliforms, fecal coliforms, and different fungus were commonly reported in developing countries than developed countries. This might be due to the fact that fecal contamination of foods and the environment is common in developing countries due to poor sanitation condition [ 124 – 126 ]. Moreover, the temperature and air system of food storage areas are not well regulated in developing countries. This situation creates favorable condition for molds. On the other hand, different Campylobacter species were reported in developed countries. This might be due to the fact that advancement of molecular techniques to identify these microorganisms. Developing countries lack specialized cultivation techniques to culture these organisms [ 127 ]. The standard culture–based technique, which is a predominant detection method in developing countries, is not effective for Campylobacter species [ 128 – 130 ].

Contamination of foods with hazardous chemicals has been reported as a major public health concern associated with the food market in individual studies included in this review [ 37 – 46 , 48 , 131 – 133 ]. The phases of food processing, packaging, transportation, and storage are significant contributors to food contamination [ 109 ]. Food contaminants include environmental contaminants, food processing contaminants, unapproved adulterants and food additives, and migrants from packaging materials. Environmental contaminants are impurities that are either introduced by human or occurring naturally in water, air, or soil. Food processing contaminants include those undesirable compounds, which are formed in the food during baking, roasting, canning, heating, fermentation, or hydrolysis. The direct food contact with packaging materials can lead to chemical contamination due to the migration of some harmful substances into foods. Use of unapproved or erroneous additives may result in food contamination [ 134 – 138 ]. Chemical contamination of foods is responsible millions of cases of poisoning with thousands of hospitalizations and deaths each year [ 139 ].

Nine of the full-text articles included in this review reported that food adulteration is a major public health risk associated with food safety issues in the food market. Chemicals, items which are not the genuine component of foods, poor-quality products, and physical or inert agents are the commonest adulterants added [ 47 , 49 – 56 ]. Food adulteration involves intentional or unintentional addition of useless, harmful, unnecessary chemical, physical, and biological agents to food which decreases the quality of food. It also includes removal of genuine components and processing foods in unhygienic way [ 119 , 140 ]. However, removal of genuine components of food is not considered in this review. Food is adulterated to increase the quantity and make more profit, which is economically motivated adulteration [ 141 – 143 ]. Chemicals which are being used as adulterants have a wide range of serious effects on the health of consumers including cancer [ 119 , 144 – 147 ].

In this systematic review of literature, 11 of the full-text articles reported that misuse of food additives in the food market endangers public health [ 57 – 67 ]. Food additive is any substance not normally consumed as a food by itself; not normally used as a typical ingredient of the food (whether or not it has nutritive value); and added intentionally to food for a technological purpose in the production process for the purpose of maintaining a food’s nutritional quality, for example by preventing the degradation of vitamins, essential amino acids, and unsaturated fats; extending the shelf life of a product, for example by preventing microbial growth; and maintaining and improving a product’s sensory properties, such as texture, consistency, taste, flavor, and color; Being able to provide products [ 148 , 149 ]. Substances generally recognized as safe (GRAS) can be used as food additives [ 150 , 151 ]; however, misuse of substances such as using more than the maximum allowable concentration; using non-permitted substances; and blending of permitted and non-permitted substances together causes health hazards [ 152 , 153 ].

Mislabeling of food products has been mentioned as a major public health risk associated with food safety in the food market in 17 of the full-text articles included in this review [ 68 – 82 , 154 ]. Mislabeling of food products includes false advertising, deliberately or accidentally leaving out ingredients, not listing potential health effects, and claiming a food contains ingredients that it does not for financial gain with the intent of deceiving the consumer regarding what is actually in the package [ 155 ]. These acts of fraud have increased overtime as different parties such as manufacturers, co-packers, distributors, and others along the chain of distribution involve in the national or international trade. Mislabeling leads to cross-contamination, poor food quality, degradation of nutrients, and even adverse effects on human health, serious financial, and legal consequences [ 69 , 154 ].

In this systematic review, we identified that GM foods are becoming an increasing public health risk. The included full-text articles reported that a wide range of health consequences associated with consumption of GM foods [ 83 – 86 ]. Possible hazards of GM foods include the potential for pleiotropic and insertional effects (silencing of genes, changes in their level of expression or, potentially, the turning on of existing genes that were not previously being expressed), effects on animal and human health resulting from the increase of anti-nutrients, potential effects on human health resulting from the use of viral DNA in plants, possible transfer of antibiotic-resistant genes to bacteria in gastrointestinal tract, and possible effects of GM foods on allergic responses [ 156 – 161 ]. However, the health effects of genetically modified foods are still debatable. Different lab-animal-based studies reported that there is no safety difference between GM and non-GM foods or the health concerns are not confirmed well [ 162 – 165 ]. Some others argue that despite the advances in food crop agriculture, the current world situation is still characterized by massive hunger and chronic malnutrition, representing a major public health problem. Biofortified GM crops have been considered an important and complementary strategy for delivering naturally fortified staple foods to malnourished populations [ 164 ].

This review revealed that foods past their use-by dates in the food market are major threats for consumers. This malpractice is more common in less developed countries and rural markets [ 36 , 67 , 87 – 90 ]. Growth of microorganisms in expired foods is very common. Most of these microorganisms are pathogenic and some microorganisms produce toxic substances as they develop [ 36 , 121 , 166 – 169 ].

Limitation of the review

We entirely relied on electronic databases to search relevant articles. We did not include articles available in hard copy. We believed we could get more relevant articles if we had access to hard prints.

This systematic literature review identified common food safety–related public health risks in the food market. The results imply that the local and international food marketing continues to have significant impacts on health of the public. The food market increases internationalization of health risks as the food supply chains cross multiple national borders. Therefore, effective national food control systems are essential to protect the health and safety of the public. Countries have to implement and enforce risk-based food control strategies. Countries need also assure the safety and quality of their foods entering international trade and ensure that imported foods conform to national requirements. Moreover, food producers and retail sectors have to respect the national food safety guideline and have to work to protect the safety of their customers Additional file 1 .

List of full text articles included in the review

The full text articles included in this review are attached as a supplementary file (see supplementary file).

Supplementary information

Acknowledgements.

The author would like to thank The Ohio State University Health Science Library for helping him to access different electronic databases.

Abbreviations

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The author of this review did not receive funds from any funding institution.

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Supplementary information accompanies this paper at 10.1186/s12199-019-0825-5.