Food hygiene practices and determinants among food handlers in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Food-borne diseases are a major public health concern worldwide, particularly in low and middle-income countries (LMICs), such as Ethiopia. Poor food hygiene practices primarily exacerbate food-borne illness transmission. Prior studies on the food hygiene practices among food handlers in Ethiopia were inconsistent. Therefore, this meta-analysis and systematic review aimed to estimate the pooled proportion of good food hygiene practices and identify the determinants in Ethiopia.

Methods: The preferred reporting items for systematic review and meta-analysis (PRISMA) instruments were used, and a systematic search was performed in the PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases, and Google Scholar were systematically last searched on the 24th February 2022 for relevant articles. Only the observational studies that reported the proportion of good food hygiene practices and their associated factors among food handlers were included. The quality of the included studies was assessed by two independent authors. Articles with unclear methodologies and did not report the overall proportions of good food hygiene practice were excluded. The effect estimates for pooled proportion and pooled odds ratio (POR) along with a 95% confidence interval (CI) were determined conducting using DerSimonian-Laird's random effect model.

Results: Among 817 retrieved studies, 23 eligible articles with a total sample size of 7153 study participants were included in the meta-analysis. The pooled proportion of good food hygiene practices among food handlers was 50.5% [95% CI: (41.6, 59.4%]; I² = 98.7%, p value = 0.001]. Food handlers with formal education (POR = 4.60, 95% CI: 3.05, 6.93), good knowledge (POR = 1.98, 95% CI: 1.26, 3.11), training (POR = 3.52, 95% CI: 2.35, 5.28), and a positive attitude (POR = 3.41, 95% CI: 2.52, 4.61) about food hygiene components, as well as regular medical checkups (POR = 6.75, 95% CI: 4.49) were significantly associated with good food hygiene practice.

Conclusions: Only half of Ethiopia's food handlers had good food hygiene practice.

Implication of the study: The key elements of effective food hygiene practice that will aid in the development of feasible interventions to increase food handler compliance with food hygiene components have been identified.

Keywords: Ethiopia; Food handler; Food hygiene; Food safety; Good practice.

Fig. 1

Flow chart of study selection for systematic review and meta-analysis of food hygiene practice among food handlers in Ethiopia

Fig. 2

Forest plot of pooled prevalence of good food hygiene practice among food handlers in Ethiopia

Fig. 3

Sensitivity analysis of the level of food hygiene practice removed at a time: Prevalence and 95% confidence interval of good food hygiene practice among food handlers in Ethiopia

Fig. 4

Funnel plot with 95% confidence limits of the pooled proportion of food hygiene practice among food handlers in Ethiopia

Fig. 5

The pooled adjusted odds ratio of the association between good knowledge of food handlers and food hygiene practice in Ethiopia

Fig. 6

The pooled adjusted odds ratio of the association between positive attitude of food handlers and food hygiene practice in Ethiopia

Fig. 7

The pooled adjusted odds ratio of the association between training of food handlers and food hygiene practice in Ethiopia

Fig. 8

The pooled adjusted odds ratio of the association between routine medical checkup of food handlers and food hygiene practice in Ethiopia

Fig. 9

The pooled adjusted odds ratio of the association between educational status of food handlers and food hygiene practice in Ethiopia