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Eslami H, Nasirzadeh M, Nabizadeh F, Salari M, Alinaghizadeh Z. Food Safety and Hygiene Knowledge and Attitudes among the Health-Care Staff in the Southeast Area of Iran. JNFS 2022; 7 (2) :200-207
URL: http://jnfs.ssu.ac.ir/article-1-410-en.html
URL: http://jnfs.ssu.ac.ir/article-1-410-en.html
Department of Environmental Health Engineering, School of Health, Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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1 Department of Environmental Health Engineering, School of Health, Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2 Department of Health Education and Health Promotion, School of Health, Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
3 Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Introduction
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Food Safety and Hygiene Knowledge and Attitudes among the Health-Care Staff in the Southeast Area of Iran
Hadi Eslami; PhD *1, Mostafa Nasirzadeh; PhD 2, Firozeh Nabizadeh; BSc 3,
Mahnaz Salari; BSc 3 & Zahra Alinaghizadeh; BSc 3
Hadi Eslami; PhD *1, Mostafa Nasirzadeh; PhD 2, Firozeh Nabizadeh; BSc 3,
Mahnaz Salari; BSc 3 & Zahra Alinaghizadeh; BSc 3
1 Department of Environmental Health Engineering, School of Health, Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2 Department of Health Education and Health Promotion, School of Health, Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
3 Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: This study aimed to determine the level of knowledge and attitude towards food safety and hygiene among the health-care staff in Rafsanjan University of Medical Sciences, Iran. Methods: This survey-descriptive was conducted on 101 staff working in primary health-care centers of Rafsanjan University of Medical Sciences who were selected taking a census. Data collection was also performed by a researcher-made questionnaire. Results: The results showed that the mean score of knowledge and attitude of the staff was 13.36 ± 2.44 and 37.19 ± 3.74, which obtained 70.31% and 74.38% of the total score, respectively. The lowest level of knowledge towards food safety and hygiene among the staff was about the reuse of foods, such as cheese (solid), jam, yogurt, tomato paste (liquid), as well as the need to store some foods refrigerated. The mean score of knowledge in the subjects with a history of food poisoning was also lower, which was statistically significant (P = 0.03). The most common wrong attitudes among the staff included rinsing vegetables in sufficient water (85.1%), putting raw and cooked foods together (82.2%), and using foods in bulging cans (75.2%). However, the staff’s attitudes regarding personal hygiene were appropriate. Conclusion: Finally, education about correct food storing and reusing, correct washing and consuming of raw foods and vegetables is recommended. Keywords: Food safety; Food hygiene; Knowledge; Attitude; Healthcare staff |
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| Article history: Received: 17 May 2021 Revised: 28 Jun 2021 Accepted: 29 Aug 2021 |
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| *Corresponding author h.eslami@rums.ac.ir Department of Environmental Health Engineering, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. Postal code: 43431315243 Tel: +98 9177094695 |
Introduction
| F |
ood-borne diseases are the most important problems related to health and economic in today’s world. Therefore, food safety and hygiene is a critical issue in developing and industrial countries (Baser et al., 2017, Moreb et al., 2017). Food safety and hygiene includes the control of physical, chemical, and biological hazards related to farm-to-table foods (Barjaktarović-Labović et al., 2018).
Today, food poisoning caused by consuming unsafe food is significantly increasing and it can have adverse effects on public hygiene and health (Taha et al., 2020). According to the world health organization (WHO), more than 600 million food-borne diseases and more than 420 thousand deaths occur in the world each year (World health organization, 2015b). In European :union: (EU) countries, annually, 33 million people are infected with food-borne diseases and 5,000 of them die (World health organization, 2015a). Developing countries, especially in the middle east, are more at risk of food-borne diseases due to restrictions on surveillance and control systems (Taha et al., 2020, WHO, 2015). Annually, more than one-third of the world's developing population are infected with food-borne diseases (Al-Shabib et al., 2016). The most common causes of food-borne diseases include inadequate cooking, insufficient heating, long time between food preparation and consumption, improper storage, inadequate washing of equipment, and contaminated raw materials (Baser et al., 2017). Therefore, three factors which play an important role in the prevalence of food-borne diseases include people's knowledge, attitude, and behavior or performance (Al-Shabib et al., 2016). Any lack of knowledge, attitude and inappropriate performance about the preparation, transportation, and consumption of food can increase the risk of food-borne diseases from the producer to consumer (Huang et al., 2017, Lange et al., 2016).
The staff of primary health-care centers play an important role in improving the knowledge and attitude of the society, which can lead to the correct behavior about food safety and hygiene (Irani et al., 2015, Ovca et al., 2018). Therefore, educational activities that lead to behavior changes are a significant strategy in reducing foodborne diseases; however, in most cases, due to low knowledge, these activities do not lead to a change in attitude or behavior (Baser et al., 2017, Ovca et al., 2018). Lack of necessary knowledge and attitude about food safety and hygiene is a very important gap among health-care staff which can have irreparable effects on the society behavior. Thus, this study aimed to determine the level of knowledge and attitude towards food safety and hygiene among the health-care staff of Rafsanjan University of Medical Sciences.
Materials and Methods
Research design: This survey-descriptive and cross-sectional study was conducted from May to December 2019 in Rafsanjan, southeast of Iran. In this study, 101 staff of primary health-care centers of Rafsanjan University of Medical Sciences (7 urban primary health-care centers) were participated taking a census method. The researcher referred to the primary health-care centers and the questionnaire was completed by the centers’ staff.
Measurements: Data collection was conducted by a researcher-made questionnaire used in previous studies (Eslami et al., 2015), the reliability and validity of which were confirmed by Cronbach's content (0.74) and relevant specialists. The questionnaire included demographic, knowledge (19 Qs), and attitude (10 Qs) questions. The correct answers to each knowledge question were scored 1 point, and incorrect and unanswered answers were scored 0 point, which in total the score range of knowledge questions was from 0 to 19 (Razeghi et al., 2018, Safari et al., 2018, Sayuti et al., 2020, Taha et al., 2020). Attitude questions were also in the form of Likert scale, including completely disagree (score 1), disagree (score 2), no idea (score 3), agree (score 4), and completely agree (score 5), and the total range of which was from 10 to 50 (Al-Kandari et al., 2019, Baptista et al., 2020, Kwol et al., 2020, Ma et al., 2019, Ovca et al., 2018, Safari et al., 2017, Zanin et al., 2017).
Ethical considerations: This study is the result of a research project which approved by Rafsanjan
University of Medical Sciences with the ethics code of IR.RUMS.REC.1398.055.
Data analysis: After completing and collecting the questionnaires, the data were analyzed by SPSS18 statistical software using Mann-Whitney and Kruskal-Wallis nonparametric tests. The
P-value<0.05 was considered statistically significant.
Results
The results showed that out of the 101 staff of primary health-care centers in Rafsanjan, 82.2% were females and 18.8% were males, and most of them (53.4%) were in the age group of 30 to 40 years. Moreover, 17.8% of the staff had a history of food poisoning (Table 1). Table 1 shows the mean score of knowledge and attitude of health-care staff towards food safety and hygiene and its relationship with demographic characteristics of the participants. The results showed that the knowledge was 13.36 ± 2.44, which was 70.31% of the total score. The mean score of the staff attitude was 37.19 ± 3.74, which was 74.38% of the total score. The mean score of knowledge in the subjects with a history of food poisoning was lower and this relationship was statistically significant (P = 0.03). However, there was no significant relationship between gender, age, and level of education with the mean score of the staff knowledge and attitude (P ≥ 0.05).
Table 2 shows the percentage of correct answers given by health-care center staff to knowledge questions regarding food safety and hygiene. The knowledge level of the staff in most cases of food safety and hygiene was over 90%, such as paying attention to food production and expiration date when purchasing, food poisoning and its symptoms, paying attention to fast-spoiling foods, such as milk or meat, and safety of bread consumption. However, the lowest knowledge level of the staff was about cheese hygiene and also moldy foods that are solid can be eaten by separating the moldy part as long as they are refrigerated, but foods, such as jam, yogurt, and tomato paste are no longer edible in case of
mold.
The levels of the staff’s answers to attitude questions in the field of food safety and hygiene are presented in Table 3. The most important wrong attitudes among the staff included rinsing vegetables only with water is enough (85.1%), putting raw and cooked foods together (82.2%), not discarding bulging cans (75.2%), food additives are not important in food safety, consuming traditional ice-cream and cheese has no problem (68.3%), storing pasteurized milk at room temperature for a day (64.4%), respectively. However, the staff’s attitude in the field of personal hygiene was appropriate.
Today, food poisoning caused by consuming unsafe food is significantly increasing and it can have adverse effects on public hygiene and health (Taha et al., 2020). According to the world health organization (WHO), more than 600 million food-borne diseases and more than 420 thousand deaths occur in the world each year (World health organization, 2015b). In European :union: (EU) countries, annually, 33 million people are infected with food-borne diseases and 5,000 of them die (World health organization, 2015a). Developing countries, especially in the middle east, are more at risk of food-borne diseases due to restrictions on surveillance and control systems (Taha et al., 2020, WHO, 2015). Annually, more than one-third of the world's developing population are infected with food-borne diseases (Al-Shabib et al., 2016). The most common causes of food-borne diseases include inadequate cooking, insufficient heating, long time between food preparation and consumption, improper storage, inadequate washing of equipment, and contaminated raw materials (Baser et al., 2017). Therefore, three factors which play an important role in the prevalence of food-borne diseases include people's knowledge, attitude, and behavior or performance (Al-Shabib et al., 2016). Any lack of knowledge, attitude and inappropriate performance about the preparation, transportation, and consumption of food can increase the risk of food-borne diseases from the producer to consumer (Huang et al., 2017, Lange et al., 2016).
The staff of primary health-care centers play an important role in improving the knowledge and attitude of the society, which can lead to the correct behavior about food safety and hygiene (Irani et al., 2015, Ovca et al., 2018). Therefore, educational activities that lead to behavior changes are a significant strategy in reducing foodborne diseases; however, in most cases, due to low knowledge, these activities do not lead to a change in attitude or behavior (Baser et al., 2017, Ovca et al., 2018). Lack of necessary knowledge and attitude about food safety and hygiene is a very important gap among health-care staff which can have irreparable effects on the society behavior. Thus, this study aimed to determine the level of knowledge and attitude towards food safety and hygiene among the health-care staff of Rafsanjan University of Medical Sciences.
Materials and Methods
Research design: This survey-descriptive and cross-sectional study was conducted from May to December 2019 in Rafsanjan, southeast of Iran. In this study, 101 staff of primary health-care centers of Rafsanjan University of Medical Sciences (7 urban primary health-care centers) were participated taking a census method. The researcher referred to the primary health-care centers and the questionnaire was completed by the centers’ staff.
Measurements: Data collection was conducted by a researcher-made questionnaire used in previous studies (Eslami et al., 2015), the reliability and validity of which were confirmed by Cronbach's content (0.74) and relevant specialists. The questionnaire included demographic, knowledge (19 Qs), and attitude (10 Qs) questions. The correct answers to each knowledge question were scored 1 point, and incorrect and unanswered answers were scored 0 point, which in total the score range of knowledge questions was from 0 to 19 (Razeghi et al., 2018, Safari et al., 2018, Sayuti et al., 2020, Taha et al., 2020). Attitude questions were also in the form of Likert scale, including completely disagree (score 1), disagree (score 2), no idea (score 3), agree (score 4), and completely agree (score 5), and the total range of which was from 10 to 50 (Al-Kandari et al., 2019, Baptista et al., 2020, Kwol et al., 2020, Ma et al., 2019, Ovca et al., 2018, Safari et al., 2017, Zanin et al., 2017).
Ethical considerations: This study is the result of a research project which approved by Rafsanjan
University of Medical Sciences with the ethics code of IR.RUMS.REC.1398.055.
Data analysis: After completing and collecting the questionnaires, the data were analyzed by SPSS18 statistical software using Mann-Whitney and Kruskal-Wallis nonparametric tests. The
P-value<0.05 was considered statistically significant.
Results
The results showed that out of the 101 staff of primary health-care centers in Rafsanjan, 82.2% were females and 18.8% were males, and most of them (53.4%) were in the age group of 30 to 40 years. Moreover, 17.8% of the staff had a history of food poisoning (Table 1). Table 1 shows the mean score of knowledge and attitude of health-care staff towards food safety and hygiene and its relationship with demographic characteristics of the participants. The results showed that the knowledge was 13.36 ± 2.44, which was 70.31% of the total score. The mean score of the staff attitude was 37.19 ± 3.74, which was 74.38% of the total score. The mean score of knowledge in the subjects with a history of food poisoning was lower and this relationship was statistically significant (P = 0.03). However, there was no significant relationship between gender, age, and level of education with the mean score of the staff knowledge and attitude (P ≥ 0.05).
Table 2 shows the percentage of correct answers given by health-care center staff to knowledge questions regarding food safety and hygiene. The knowledge level of the staff in most cases of food safety and hygiene was over 90%, such as paying attention to food production and expiration date when purchasing, food poisoning and its symptoms, paying attention to fast-spoiling foods, such as milk or meat, and safety of bread consumption. However, the lowest knowledge level of the staff was about cheese hygiene and also moldy foods that are solid can be eaten by separating the moldy part as long as they are refrigerated, but foods, such as jam, yogurt, and tomato paste are no longer edible in case of
mold.
The levels of the staff’s answers to attitude questions in the field of food safety and hygiene are presented in Table 3. The most important wrong attitudes among the staff included rinsing vegetables only with water is enough (85.1%), putting raw and cooked foods together (82.2%), not discarding bulging cans (75.2%), food additives are not important in food safety, consuming traditional ice-cream and cheese has no problem (68.3%), storing pasteurized milk at room temperature for a day (64.4%), respectively. However, the staff’s attitude in the field of personal hygiene was appropriate.
| Table 1. The mean (±SD) score of knowledge and attitude of health–care staff about food safety and hygiene. | |||
| Variables | N (%) | Knowledge score (Rang 0-19) | Attitude score (Range 10-50) |
| Gender | |||
| Male | 19 (18.8) | 13.47±2.69 | 37.05±3.29 |
| Female | 82 (82.2) | 2.39±13.36 | 37.23±3.85 |
| P-valuea | 0.31 | 0.21 | |
| Age )year) | |||
| Less than 30 | 14 (13.9) | 13.07±2.36 | 37.38±3.33 |
| 30 to 40 | 54 (53.4) | 13.63±2.34 | 37.33±3.83 |
| More than 40 | 33 (32.7) | 13.12±2.67 | 36.91±3.88 |
| P-valueb | 0.58 | 0.61 | |
| Educational level | 4 (4) | 13.01±2.16 | 38.03±4.24 |
| Less than BSc | 73 (73.2) | 13.34±2.48 | 37.32±3.86 |
| BSc | |||
| MSc and higher | 24 (23.8) | 13.58±2.44 | 36.66±3.33 |
| P-valueb | 0.41 | 0.45 | |
| Food poisoning history | |||
| Yes | 18 (17.8) | 12.38±3.25 | 36.61±3.69 |
| No | 83 (82.2) | 14.49±2.24 | 37.32±3.76 |
| P-valuea | 0.03 | 0.46 | |
| a:Mann- Whitney test; b: Kruskal-Wallis test | |||
| Table 2. Knowledge questions about food safety and hygiene and true answers of health–care staff . | |
| Knowledge questions | N (%) |
| 1. Do you consider production and expiration date when you buy some foods? | 101 (100) |
| 2. Are fever and vomiting the symptoms of food poisoning? | 91 (9.0) |
| 3. Should the refrigerator temperature be below 5 °C? | 65 (64.4) |
| 4. Is botulism transferred through canned food? | 92 (91.1) |
| 5. Do botulism symptoms appear immediately after eating canned puffy? | 51 (50.5) |
| 6. Is refrigerator more suitable than storage cans? | 26 (25.7) |
| 7. Is there any need to use the refrigerator for storage of sterilized milk? | 40 (39.6) |
| 8. Does sterilized milk have preservative materials? | 64 (63.4) |
| 9. Can milk and meat be corrupted quickly? | 97 (96.0) |
| 10. Is minced meat corrupted faster? | 75 (74.3) |
| 11. Is the slimy surface of meat represented as the symptoms of rotten meat? | 76 (75.2) |
| 12. Is it true the use of healthy cheese that storage in the refrigerator and has passed its expiration date? | 88 (87.1) |
| 13. Is it true the use of moldy cheese if correction (removing the mold) and kept in the refrigerator? | 5 (5.0) |
| 14. Is it true the use of moldy tomato paste and jam if correction (removing the mold) and kept in the refrigerator? | 85 (84.2) |
| 15. Are plastic containers suitable for food storage in terms of health? | 84 (83.2) |
| 16. Is the use of plastic containers in the microwave correct? | 89 (88.1) |
| 17. Does Staphylococcus was entering in the food through that blisters on the hands and face and nasal mucus? | 58 (57.4) |
| 18. Is washing eggs before putting them in the refrigerator correct? | 68 (67.3) |
| 19. Is eating moldy bread correct? | 97 (96.0) |
| Table 3. Frequency distribution of health-care staff answers to attitude questions in the field of food safety and hygiene. | |||
| Attitude questions | Agree | No idea | Disagree |
| 1. Food safety and hygiene is an important issue | 2 (2.0)a | 2 (2.0) | 97 (96.0) |
| 2. It is necessary to wash your hands with soap and water before cooking. | 4 (4.0) | 2 (2.0) | 95 (94.1) |
| 3. Reheating food to ensure about its hygiene. | 37 (36.6) | 20 (19.8) | 44 (43.6) |
| 4. Discarding bulging cans. | 17 (16.8) | 8 (7.9) | 76 (75.2) |
| 5. Food additives are not very important in food safety | 69 (68.3) | 15 (14.9) | 17 (16.8) |
| 6. Raw foods can be placed next to cooked foods. | 83 (82.2) | 12 (11.9) | 6 (5.9) |
| 7. Pasteurized milk can be kept at room temperature for a day. | 65 (64.4) | 16 (15.8) | 20 (19.8) |
| 8. There is nothing wrong with putting bread in recycled bags. | 97 (96.0) | 1 (1.0) | 3 (3.0) |
| 9. Consuming traditional ice cream, milk, and cheese causes malaria. | 17 (16.8) | 15 (14.9) | 69 (68.3) |
| 10. Rinsing vegetables with water is enough. | 86 (85.1) | 4 (4.0) | 11 (10.9) |
| a: N (%) | |||
Discussion
The level of knowledge and attitude of the health-care staff in this study was in appropriate status. In the study by Taha et al., conducted on food safety knowledge among food handlers in food service in the United Arab Emirates, they showed that the level of knowledge in more than 70% of these individuals was appropriate, which is consistent with the results of the present study (Taha et al., 2020). It is also consistent with studies conducted among the EU countries with 70.5% (Smigic et al., 2016) and Kuwait with 70% knowledge (Al-Kandari et al., 2019). On the other hand, the food safety knowledge level of food handlers in Lebanese hospitals was 59.2% (Bou-Mitri et al., 2018), in food services staff in the University of Camerino was 68.12% (Grappasonni et al., 2018), and in food handlers in hotel kitchens in Turkey was 53.91% (Tuncer and Akoğlu, 2020), which were in line with present study. It can be concluded that the difference between the level of food safety knowledge in other countries is due to the difference in the culture and customs of each area as well as the type and manner of training (Young et al., 2020).
However, in this study, there was no significant relationship between demographic characteristics with the staff’s knowledge and attitude. In several studies, the relationships between demographic characteristics of individuals and the level of knowledge and attitude about food safety and hygiene were not significant (Alqurashi et al., 2019, Gruenfeldova et al., 2019, Kunadu et al., 2016, Woh et al., 2016), which was consistent with the results of the present study. This could be due to the same conditions and position of respondents as the staff of primary health-care centers (Taha et al., 2020).
The staff’s knowledge was low towards foods needing to be refrigerated, such as the need to store sterilized milk refrigerated or it is better to store canned food in the refrigerator. Studies have shown that food storage temperature is a critical control point, and most studies have reported low knowledge towards food storage temperatures (Kunadu et al., 2016, Osaili et al., 2017, Zhang et al., 2015). The study by Ovca et al., on food safety knowledge and attitudes among professional food handlers showed that the knowledge was low towards food storage condition and temperature control (Ovca et al., 2018). Osili et al., studied food safety knowledge in foodservice staff at the universities in Jordan and showed that the lowest level of knowledge score was related to the correct storing, cooking, and reuse of foods (53.5%) (Osaili et al., 2018). It can be concluded that the importance of temperature in controlling food-borne pathogens by health-care staff in the present study was not well understood. Thus, it seems that the need for education with training towards these fields is required.
The most important wrong attitudes among the staff included rinsing vegetables only with water and putting raw and cooked foods together. However, the staff’s attitude in the field of personal hygiene was appropriate. This finding is consistent with the study by Osaili et al., on the level of food safety knowledge among Jordanian university staff. In this study, personal hygiene (74.9%) and food-borne pathogens and their signs and symptoms of poisoning (74.3%) had the highest score on the level of knowledge. Moreover, the level of knowledge was low about correct washing and household disinfection methods (Osaili et al., 2018). It seems that there is no adequate understanding towards eating raw foods risks, such as vegetables in communities. In another study, attitudes of food handlers were low in relation to the risks associated with food storage (Ovca et al., 2018). In the study by Al-Shabib et al., the knowledge and attitude of food handlers in restaurants towards personal hygiene and food storage temperature required training and promotion (Al-Shabib et al., 2016). In the study by Jianu and Chiş, only 44% of the food handlers had the necessary knowledge about keeping raw and cooked food separately (Jianu and Chiş, 2012). In the present study, 82.2% of the subjects did not have proper knowledge and attitudes in this regard. The results of the present study explained the importance of training/retraining as an intervention tool for improving the level of knowledge and attitude towards food safety and hygiene among the staff of primary health-care centers. Many factors, such as training strategy, optional or compulsory participation in training, training location and level of work culture can be effective in training efficiencies and changing the attitud and behavior of health-care staff (Taha et al., 2020).
The main limitation in this study was the low initial tendency to complete the questionnaire, which was solved with a full explanation of the importance of the study by the researcher. Moreover, investigating food safety behavior in health-care staff was suggested for future studies.
Conclusion
This study evaluated the level of knowledge and attitude towards food safety and hygiene among the health-care staff in Rafsanjan, Iran by a researcher-made questionnaire. The assessment results showed that the knowledge level of health-care center staff in most cases of food safety and hygiene was over 90%, such as paying attention to food production and expiration date when purchasing, food poisoning and its symptoms, and safety of bread consumption. There were wrong attitudes towards rinsing vegetables, proper storage, controlling raw and cooked foods, and using canned foods among the health-care staff. Thus, education with training/retraining is essential for improving the level of knowledge and attitude towards food safety and hygiene among the staff of primary health-care centers.
Acknowledgments
This study is the result of a research project with the code number of 98031 approved by Rafsanjan University of Medical Sciences with the ethics code of IR.RUMS.REC.1398.055. Thanks are owed to the Research Deputy of Rafsanjan University of Medical Sciences.
Authors' contributions
Eslami H, designed and conducted the research, wrote the original draft, reviewed, and edited. Nasirzadeh M, Nabizadeh F, Salari M and Alinaghizadeh Z, conducted the research, analyzed the data and wrote the original draft. Eslami H had primary responsibility for final content. All authors read and approved the final manuscript.
Conflicts of interest
All authors declared that there are no conflict of interest
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Smigic N, et al. 2016. The level of food safety knowledge in food establishments in three European countries. Food control. 63: 187-194.
Taha S, et al. 2020. Food safety knowledge among food handlers in food service establishments in United Arab Emirates. Food control. 110: 106968.
Tuncer T & Akoğlu A 2020. Food safety knowledge of food handlers working in hotel kitchens in Turkey. Food and health. 6 (2): 67-89.
WHO 2015. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who. int/foodsafety/areas_work/foodborne-diseases/ ferg/en/.
Woh PY, Thong KL, Behnke JM, Lewis JW & Zain SNM 2016. Evaluation of basic knowledge on food safety and food handling practices amongst migrant food handlers in Peninsular Malaysia. Food control. 70: 64-73.
World health organization 2015a. Food Safety: What you should know. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/foodsafety/areas_work/foodborne-diseases/ferg/en/.
World health organization 2015b. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/foodsafety/ areas_work/foodborne-diseases/ferg/en/.
Young I, Waddell LA, Wilhelm BJ & Greig J 2020. A systematic review and meta-regression of single group, pre-post studies evaluating food safety education and training interventions for food handlers. Food research international. 128: 108711.
Zanin LM, da Cunha DT, de Rosso VV, Capriles VD & Stedefeldt E 2017. Knowledge, attitudes and practices of food handlers in food safety: An integrative review. Food research international. 100: 53-62.
Zhang H, Lu L, Liang J & Huang Q 2015. Knowledge, attitude and practices of food safety amongst food handlers in the coastal resort of Guangdong, China. Food control. 47: 457-461.
The level of knowledge and attitude of the health-care staff in this study was in appropriate status. In the study by Taha et al., conducted on food safety knowledge among food handlers in food service in the United Arab Emirates, they showed that the level of knowledge in more than 70% of these individuals was appropriate, which is consistent with the results of the present study (Taha et al., 2020). It is also consistent with studies conducted among the EU countries with 70.5% (Smigic et al., 2016) and Kuwait with 70% knowledge (Al-Kandari et al., 2019). On the other hand, the food safety knowledge level of food handlers in Lebanese hospitals was 59.2% (Bou-Mitri et al., 2018), in food services staff in the University of Camerino was 68.12% (Grappasonni et al., 2018), and in food handlers in hotel kitchens in Turkey was 53.91% (Tuncer and Akoğlu, 2020), which were in line with present study. It can be concluded that the difference between the level of food safety knowledge in other countries is due to the difference in the culture and customs of each area as well as the type and manner of training (Young et al., 2020).
However, in this study, there was no significant relationship between demographic characteristics with the staff’s knowledge and attitude. In several studies, the relationships between demographic characteristics of individuals and the level of knowledge and attitude about food safety and hygiene were not significant (Alqurashi et al., 2019, Gruenfeldova et al., 2019, Kunadu et al., 2016, Woh et al., 2016), which was consistent with the results of the present study. This could be due to the same conditions and position of respondents as the staff of primary health-care centers (Taha et al., 2020).
The staff’s knowledge was low towards foods needing to be refrigerated, such as the need to store sterilized milk refrigerated or it is better to store canned food in the refrigerator. Studies have shown that food storage temperature is a critical control point, and most studies have reported low knowledge towards food storage temperatures (Kunadu et al., 2016, Osaili et al., 2017, Zhang et al., 2015). The study by Ovca et al., on food safety knowledge and attitudes among professional food handlers showed that the knowledge was low towards food storage condition and temperature control (Ovca et al., 2018). Osili et al., studied food safety knowledge in foodservice staff at the universities in Jordan and showed that the lowest level of knowledge score was related to the correct storing, cooking, and reuse of foods (53.5%) (Osaili et al., 2018). It can be concluded that the importance of temperature in controlling food-borne pathogens by health-care staff in the present study was not well understood. Thus, it seems that the need for education with training towards these fields is required.
The most important wrong attitudes among the staff included rinsing vegetables only with water and putting raw and cooked foods together. However, the staff’s attitude in the field of personal hygiene was appropriate. This finding is consistent with the study by Osaili et al., on the level of food safety knowledge among Jordanian university staff. In this study, personal hygiene (74.9%) and food-borne pathogens and their signs and symptoms of poisoning (74.3%) had the highest score on the level of knowledge. Moreover, the level of knowledge was low about correct washing and household disinfection methods (Osaili et al., 2018). It seems that there is no adequate understanding towards eating raw foods risks, such as vegetables in communities. In another study, attitudes of food handlers were low in relation to the risks associated with food storage (Ovca et al., 2018). In the study by Al-Shabib et al., the knowledge and attitude of food handlers in restaurants towards personal hygiene and food storage temperature required training and promotion (Al-Shabib et al., 2016). In the study by Jianu and Chiş, only 44% of the food handlers had the necessary knowledge about keeping raw and cooked food separately (Jianu and Chiş, 2012). In the present study, 82.2% of the subjects did not have proper knowledge and attitudes in this regard. The results of the present study explained the importance of training/retraining as an intervention tool for improving the level of knowledge and attitude towards food safety and hygiene among the staff of primary health-care centers. Many factors, such as training strategy, optional or compulsory participation in training, training location and level of work culture can be effective in training efficiencies and changing the attitud and behavior of health-care staff (Taha et al., 2020).
The main limitation in this study was the low initial tendency to complete the questionnaire, which was solved with a full explanation of the importance of the study by the researcher. Moreover, investigating food safety behavior in health-care staff was suggested for future studies.
Conclusion
This study evaluated the level of knowledge and attitude towards food safety and hygiene among the health-care staff in Rafsanjan, Iran by a researcher-made questionnaire. The assessment results showed that the knowledge level of health-care center staff in most cases of food safety and hygiene was over 90%, such as paying attention to food production and expiration date when purchasing, food poisoning and its symptoms, and safety of bread consumption. There were wrong attitudes towards rinsing vegetables, proper storage, controlling raw and cooked foods, and using canned foods among the health-care staff. Thus, education with training/retraining is essential for improving the level of knowledge and attitude towards food safety and hygiene among the staff of primary health-care centers.
Acknowledgments
This study is the result of a research project with the code number of 98031 approved by Rafsanjan University of Medical Sciences with the ethics code of IR.RUMS.REC.1398.055. Thanks are owed to the Research Deputy of Rafsanjan University of Medical Sciences.
Authors' contributions
Eslami H, designed and conducted the research, wrote the original draft, reviewed, and edited. Nasirzadeh M, Nabizadeh F, Salari M and Alinaghizadeh Z, conducted the research, analyzed the data and wrote the original draft. Eslami H had primary responsibility for final content. All authors read and approved the final manuscript.
Conflicts of interest
All authors declared that there are no conflict of interest
References
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Al-Shabib NA, Mosilhey SH & Husain FM 2016. Cross-sectional study on food safety knowledge, attitude and practices of male food handlers employed in restaurants of King Saud University, Saudi Arabia. Food control. 59: 212-217.
Alqurashi NA, Priyadarshini A & Jaiswal AK 2019. Evaluating food safety knowledge and practices among foodservice staff in Al madinah hospitals, Saudi Arabia. Safety. 5 (1): 9.
Baptista RC, Rodrigues H & Sant'Ana AS 2020. Consumption, knowledge, and food safety practices of Brazilian seafood consumers. Food research international. 132: 109084.
Barjaktarović-Labović S, et al. 2018. Food hygiene awareness and practices before and after intervention in food services in Montenegro. Food control. 85: 466-471.
Baser F, Ture H, Abubakirova A, Sanlier N & Cil B 2017. Structural modeling of the relationship among food safety knowledge, attitude and behavior of hotel staff in Turkey. Food control. 73: 438-444.
Bou-Mitri C, Mahmoud D, El Gerges N & Abou Jaoude M 2018. Food safety knowledge, attitudes and practices of food handlers in lebanese hospitals: A cross-sectional study. Food control. 94: 78-84.
Eslami H, Marzban A, AkramiMohajeri F, Rezaei Z & Rafati Fard M 2015. Students' knowledge and attitude of hygiene and food safety at Shahid Sadoughi University of Medical Sciences in Yazd, Iran. Journal of community health. 4 (3): 159-167.
Grappasonni I, et al. 2018. Knowledge and attitudes on food hygiene among food services staff on board ships. Ann Ig. 30 (2): 162-172.
Gruenfeldova J, Domijan K & Walsh C 2019. A study of food safety knowledge, practice and training among food handlers in Ireland. Food control. 105: 131-140.
Huang X-Y, et al. 2017. A large outbreak of acute gastroenteritis caused by the human norovirus GII. 17 strain at a university in Henan Province, China. Infectious diseases of poverty. 6 (1): 1-9.
Irani AD, Shahraki AH, Ghaderi E, Nasehi M & Mostafavi E 2015. Lack of optimum practice among health care workers regarding tuberculosis in Iran: a knowledge, attitude, and practice study. American journal of infection control. 43 (5): e7-e12.
Jianu C & Chiş C 2012. Study on the hygiene knowledge of food handlers working in small and medium-sized companies in western Romania. Food control. 26 (1): 151-156.
Kunadu AP-H, Ofosu DB, Aboagye E & Tano-Debrah K 2016. Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana. Food control. 69: 324-330.
Kwol VS, Eluwole KK, Avci T & Lasisi TT 2020. Another look into the Knowledge Attitude Practice (KAP) model for food control: An investigation of the mediating role of food handlers’ attitudes. Food control. 110: 107025.
Lange M, Göranzon H & Marklinder I 2016. Self-reported food safety knowledge and behaviour among Home and Consumer Studies students. Food control. 67: 265-272.
Ma L, Chen H, Yan H, Wu L & Zhang W 2019. Food safety knowledge, attitudes, and behavior of street food vendors and consumers in Handan, a third tier city in China. BMC public health. 19 (1): 1128.
Moreb NA, Priyadarshini A & Jaiswal AK 2017. Knowledge of food safety and food handling practices amongst food handlers in the Republic of Ireland. Food control. 80: 341-349.
Osaili TM, Al-Nabulsi AA & Krasneh HDA 2018. Food safety knowledge among foodservice staff at the universities in Jordan. Food control. 89: 167-176.
Osaili TM, Obeidat BA, Hajeer WA & Al-Nabulsi AA 2017. Food safety knowledge among food service staff in hospitals in Jordan. Food control. 78: 279-285.
Ovca A, Jevšnik M, Kavčič M & Raspor P 2018. Food safety knowledge and attitudes among future professional food handlers. Food control. 84: 345-353.
Razeghi F, Haghi E & Yunesian M 2018. Data about knowledge and tendency towards organic foods use in Tehran. Data brief. 16: 955-958.
Safari Y, et al. 2018. Data for interventional role of training in changing the knowledge and attitudes of urban mothers towards food hygiene (A case study of Ravansar Township, Kermanshah, Iran). Data brief. 19: 67-75.
Safari Y, et al. 2017. The role of educational intervention in changing knowledge and attitudes of rural homemakers in relation to food safety and hygiene: A case study: Iran (2016). Annals of tropical medicine and public health. 10 (4): 1024.
Sayuti Y, Albattat A, Ariffin A, Nazrin N & Silahudeen T 2020. Food safety knowledge, attitude and practices among management and science university students, Shah Alam. Management science letters. 10 (4): 929-936.
Smigic N, et al. 2016. The level of food safety knowledge in food establishments in three European countries. Food control. 63: 187-194.
Taha S, et al. 2020. Food safety knowledge among food handlers in food service establishments in United Arab Emirates. Food control. 110: 106968.
Tuncer T & Akoğlu A 2020. Food safety knowledge of food handlers working in hotel kitchens in Turkey. Food and health. 6 (2): 67-89.
WHO 2015. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who. int/foodsafety/areas_work/foodborne-diseases/ ferg/en/.
Woh PY, Thong KL, Behnke JM, Lewis JW & Zain SNM 2016. Evaluation of basic knowledge on food safety and food handling practices amongst migrant food handlers in Peninsular Malaysia. Food control. 70: 64-73.
World health organization 2015a. Food Safety: What you should know. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/foodsafety/areas_work/foodborne-diseases/ferg/en/.
World health organization 2015b. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/foodsafety/ areas_work/foodborne-diseases/ferg/en/.
Young I, Waddell LA, Wilhelm BJ & Greig J 2020. A systematic review and meta-regression of single group, pre-post studies evaluating food safety education and training interventions for food handlers. Food research international. 128: 108711.
Zanin LM, da Cunha DT, de Rosso VV, Capriles VD & Stedefeldt E 2017. Knowledge, attitudes and practices of food handlers in food safety: An integrative review. Food research international. 100: 53-62.
Zhang H, Lu L, Liang J & Huang Q 2015. Knowledge, attitude and practices of food safety amongst food handlers in the coastal resort of Guangdong, China. Food control. 47: 457-461.
Type of article: orginal article |
Subject:
public specific
Received: 2021/05/17 | Published: 2022/05/30 | ePublished: 2022/05/30
Received: 2021/05/17 | Published: 2022/05/30 | ePublished: 2022/05/30
References
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2. Al-Shabib NA, Mosilhey SH & Husain FM 2016. Cross-sectional study on food safety knowledge, attitude and practices of male food handlers employed in restaurants of King Saud University, Saudi Arabia. Food control. 59: 212-217.
3. Alqurashi NA, Priyadarshini A & Jaiswal AK 2019. Evaluating food safety knowledge and practices among foodservice staff in Al madinah hospitals, Saudi Arabia. Safety. 5 (1): 9.
4. Baptista RC, Rodrigues H & Sant'Ana AS 2020. Consumption, knowledge, and food safety practices of Brazilian seafood consumers. Food research international. 132: 109084.
5. Barjaktarović-Labović S, et al. 2018. Food hygiene awareness and practices before and after intervention in food services in Montenegro. Food control. 85: 466-471.
6. Baser F, Ture H, Abubakirova A, Sanlier N & Cil B 2017. Structural modeling of the relationship among food safety knowledge, attitude and behavior of hotel staff in Turkey. Food control. 73: 438-444.
7. Bou-Mitri C, Mahmoud D, El Gerges N & Abou Jaoude M 2018. Food safety knowledge, attitudes and practices of food handlers in lebanese hospitals: A cross-sectional study. Food control. 94: 78-84.
8. Eslami H, Marzban A, AkramiMohajeri F, Rezaei Z & Rafati Fard M 2015. Students' knowledge and attitude of hygiene and food safety at Shahid Sadoughi University of Medical Sciences in Yazd, Iran. Journal of community health. 4 (3): 159-167.
9. Grappasonni I, et al. 2018. Knowledge and attitudes on food hygiene among food services staff on board ships. Ann Ig. 30 (2): 162-172.
10. Gruenfeldova J, Domijan K & Walsh C 2019. A study of food safety knowledge, practice and training among food handlers in Ireland. Food control. 105: 131-140.
11. Huang X-Y, et al. 2017. A large outbreak of acute gastroenteritis caused by the human norovirus GII. 17 strain at a university in Henan Province, China. Infectious diseases of poverty. 6 (1): 1-9.
12. Irani AD, Shahraki AH, Ghaderi E, Nasehi M & Mostafavi E 2015. Lack of optimum practice among health care workers regarding tuberculosis in Iran: a knowledge, attitude, and practice study. American journal of infection control. 43 (5): e7-e12.
13. Jianu C & Chiş C 2012. Study on the hygiene knowledge of food handlers working in small and medium-sized companies in western Romania. Food control. 26 (1): 151-156.
14. Kunadu AP-H, Ofosu DB, Aboagye E & Tano-Debrah K 2016. Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana. Food control. 69: 324-330.
15. Kwol VS, Eluwole KK, Avci T & Lasisi TT 2020. Another look into the Knowledge Attitude Practice (KAP) model for food control: An investigation of the mediating role of food handlers’ attitudes. Food control. 110: 107025.
16. Lange M, Göranzon H & Marklinder I 2016. Self-reported food safety knowledge and behaviour among Home and Consumer Studies students. Food control. 67: 265-272.
17. Ma L, Chen H, Yan H, Wu L & Zhang W 2019. Food safety knowledge, attitudes, and behavior of street food vendors and consumers in Handan, a third tier city in China. BMC public health. 19 (1): 1128.
18. Moreb NA, Priyadarshini A & Jaiswal AK 2017. Knowledge of food safety and food handling practices amongst food handlers in the Republic of Ireland. Food control. 80: 341-349.
19. Osaili TM, Al-Nabulsi AA & Krasneh HDA 2018. Food safety knowledge among foodservice staff at the universities in Jordan. Food control. 89: 167-176.
20. Osaili TM, Obeidat BA, Hajeer WA & Al-Nabulsi AA 2017. Food safety knowledge among food service staff in hospitals in Jordan. Food control. 78: 279-285.
21. Ovca A, Jevšnik M, Kavčič M & Raspor P 2018. Food safety knowledge and attitudes among future professional food handlers. Food control. 84: 345-353.
22. Razeghi F, Haghi E & Yunesian M 2018. Data about knowledge and tendency towards organic foods use in Tehran. Data brief. 16: 955-958.
23. Safari Y, et al. 2018. Data for interventional role of training in changing the knowledge and attitudes of urban mothers towards food hygiene (A case study of Ravansar Township, Kermanshah, Iran). Data brief. 19: 67-75.
24. Safari Y, et al. 2017. The role of educational intervention in changing knowledge and attitudes of rural homemakers in relation to food safety and hygiene: A case study: Iran (2016). Annals of tropical medicine and public health. 10 (4): 1024.
25. Sayuti Y, Albattat A, Ariffin A, Nazrin N & Silahudeen T 2020. Food safety knowledge, attitude and practices among management and science university students, Shah Alam. Management science letters. 10 (4): 929-936.
26. Smigic N, et al. 2016. The level of food safety knowledge in food establishments in three European countries. Food control. 63: 187-194.
27. Taha S, et al. 2020. Food safety knowledge among food handlers in food service establishments in United Arab Emirates. Food control. 110: 106968.
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29. WHO 2015. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who. int/foodsafety/areas_work/foodborne-diseases/ ferg/en/.
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33. Young I, Waddell LA, Wilhelm BJ & Greig J 2020. A systematic review and meta-regression of single group, pre-post studies evaluating food safety education and training interventions for food handlers. Food research international. 128: 108711.
34. Zanin LM, da Cunha DT, de Rosso VV, Capriles VD & Stedefeldt E 2017. Knowledge, attitudes and practices of food handlers in food safety: An integrative review. Food research international. 100: 53-62.
35. Zhang H, Lu L, Liang J & Huang Q 2015. Knowledge, attitude and practices of food safety amongst food handlers in the coastal resort of Guangdong, China. Food control. 47: 457-461.
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