Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana
Identifieur interne : 000129 ( Pmc/Corpus ); précédent : 000128; suivant : 000130Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana
Auteurs : Fortune Akabanda ; Eli Hope Hlortsi ; James Owusu-KwartengSource :
- BMC Public Health [ 1471-2458 ] ; 2017.
Abstract
In large scale cooking, food is handled by many individuals, thereby increasing the chances of food contamination due to improper handling. Deliberate or accidental contamination of food during large scale production might endanger the health of consumers, and have very expensive repercussions on a country. The purpose of this study was to evaluate the food safety knowledge, attitudes, and practices among institutional food- handlers in Ghana.
The study was conducted using a descriptive, cross-sectional survey of 29 institutions by conducting face to face interview and administration of questionnaire to two hundred and thirty-five (235) institutional food-handlers. The questionnaire was peer-reviewed and pilot tested in three institutions in the Upper East Region of Ghana, before the final version was distributed to food-handlers. The questionnaire was structured into five distinctive parts to collect information on (i) demographic characteristics, (ii) employees’ work satisfaction, (iii) knowledge on food safety, (iv) attitudes towards food safety and (v) food hygiene practices.
Majority of the food-handlers were between 41–50 years (39.1%). Female respondents were (76.6%). In our study, the food-handlers were knowledgeable about hygienic practices, cleaning and sanitation procedures. Almost all of the food-handlers were aware of the critical role of general sanitary practices in the work place, such as hand washing (98.7% correct answers), using gloves (77.9%), proper cleaning of the instruments/utensils (86.4%) and detergent use (72.8%). On disease transmission, the results indicates that 76.2% of the food- handlers did not know that
In generally, the institutional food-handlers have satisfactory knowledge in food safety but this does not translate into strict hygienic practices during processing and handling food products.
Url:
DOI: 10.1186/s12889-016-3986-9
PubMed: 28061850
PubMed Central: 5219779
Links to Exploration step
PMC:5219779Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana</title><author><name sortKey="Akabanda, Fortune" sort="Akabanda, Fortune" uniqKey="Akabanda F" first="Fortune" last="Akabanda">Fortune Akabanda</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author><author><name sortKey="Hlortsi, Eli Hope" sort="Hlortsi, Eli Hope" uniqKey="Hlortsi E" first="Eli Hope" last="Hlortsi">Eli Hope Hlortsi</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author><author><name sortKey="Owusu Kwarteng, James" sort="Owusu Kwarteng, James" uniqKey="Owusu Kwarteng J" first="James" last="Owusu-Kwarteng">James Owusu-Kwarteng</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28061850</idno><idno type="pmc">5219779</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219779</idno><idno type="RBID">PMC:5219779</idno><idno type="doi">10.1186/s12889-016-3986-9</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000129</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000129</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana</title><author><name sortKey="Akabanda, Fortune" sort="Akabanda, Fortune" uniqKey="Akabanda F" first="Fortune" last="Akabanda">Fortune Akabanda</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author><author><name sortKey="Hlortsi, Eli Hope" sort="Hlortsi, Eli Hope" uniqKey="Hlortsi E" first="Eli Hope" last="Hlortsi">Eli Hope Hlortsi</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author><author><name sortKey="Owusu Kwarteng, James" sort="Owusu Kwarteng, James" uniqKey="Owusu Kwarteng J" first="James" last="Owusu-Kwarteng">James Owusu-Kwarteng</name><affiliation><nlm:aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</nlm:aff></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>In large scale cooking, food is handled by many individuals, thereby increasing the chances of food contamination due to improper handling. Deliberate or accidental contamination of food during large scale production might endanger the health of consumers, and have very expensive repercussions on a country. The purpose of this study was to evaluate the food safety knowledge, attitudes, and practices among institutional food- handlers in Ghana.</p></sec><sec><title>Methods</title><p>The study was conducted using a descriptive, cross-sectional survey of 29 institutions by conducting face to face interview and administration of questionnaire to two hundred and thirty-five (235) institutional food-handlers. The questionnaire was peer-reviewed and pilot tested in three institutions in the Upper East Region of Ghana, before the final version was distributed to food-handlers. The questionnaire was structured into five distinctive parts to collect information on (i) demographic characteristics, (ii) employees’ work satisfaction, (iii) knowledge on food safety, (iv) attitudes towards food safety and (v) food hygiene practices.</p></sec><sec><title>Results</title><p>Majority of the food-handlers were between 41–50 years (39.1%). Female respondents were (76.6%). In our study, the food-handlers were knowledgeable about hygienic practices, cleaning and sanitation procedures. Almost all of the food-handlers were aware of the critical role of general sanitary practices in the work place, such as hand washing (98.7% correct answers), using gloves (77.9%), proper cleaning of the instruments/utensils (86.4%) and detergent use (72.8%). On disease transmission, the results indicates that 76.2% of the food- handlers did not know that <italic>Salmonella</italic> is a food borne pathogens and 70.6% did not know that hepatitis A is a food borne pathogen. However, 81.7% handlers agreed that typhoid fever is transmitted by food and 87.7% agreed that bloody diarrhea is transmitted by food. Logistic regression analysis testing four models showed statistically significant differences (<italic>p</italic> < 0.05), for models in which the explanatory variable was the level of education.</p></sec><sec><title>Conclusions</title><p>In generally, the institutional food-handlers have satisfactory knowledge in food safety but this does not translate into strict hygienic practices during processing and handling food products.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Annor, Ga" uniqKey="Annor G">GA Annor</name></author><author><name sortKey="Baiden, Ea" uniqKey="Baiden E">EA Baiden</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Barrie, D" uniqKey="Barrie D">D Barrie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jay, Ls" uniqKey="Jay L">LS Jay</name></author><author><name sortKey="Comar, D" uniqKey="Comar D">D Comar</name></author><author><name sortKey="Govenlock, Ld" uniqKey="Govenlock L">LD Govenlock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fielding, Je" uniqKey="Fielding J">JE Fielding</name></author><author><name sortKey="Aguirre, A" uniqKey="Aguirre A">A Aguirre</name></author><author><name sortKey="Palaiologos, E" uniqKey="Palaiologos E">E Palaiologos</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ehiri, Je" uniqKey="Ehiri J">JE Ehiri</name></author><author><name sortKey="Morris, Gp" uniqKey="Morris G">GP Morris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Greig, Jd" uniqKey="Greig J">JD Greig</name></author><author><name sortKey="Todd, Ec" uniqKey="Todd E">EC Todd</name></author><author><name sortKey="Bartleson, Ca" uniqKey="Bartleson C">CA Bartleson</name></author><author><name sortKey="Michaels, Bs" uniqKey="Michaels B">BS Michaels</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Howes, M" uniqKey="Howes M">M Howes</name></author><author><name sortKey="Mcewen, S" uniqKey="Mcewen S">S McEwen</name></author><author><name sortKey="Griffiths, M" uniqKey="Griffiths M">M Griffiths</name></author><author><name sortKey="Harris, L" uniqKey="Harris L">L Harris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ansari Lari, M" uniqKey="Ansari Lari M">M Ansari-Lari</name></author><author><name sortKey="Soodbakhsh, S" uniqKey="Soodbakhsh S">S Soodbakhsh</name></author><author><name sortKey="Lakzadeh, L" uniqKey="Lakzadeh L">L Lakzadeh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ba, M" uniqKey="Ba M">M Baş</name></author><author><name sortKey="Ersun, A" uniqKey="Ersun A">AŞ Ersun</name></author><author><name sortKey="K Vanc, G" uniqKey="K Vanc G">G Kıvanç</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Capunzo, M" uniqKey="Capunzo M">M Capunzo</name></author><author><name sortKey="Cavallo, P" uniqKey="Cavallo P">P Cavallo</name></author><author><name sortKey="Boccia, G" uniqKey="Boccia G">G Boccia</name></author><author><name sortKey="Brunetti, L" uniqKey="Brunetti L">L Brunetti</name></author><author><name sortKey="Buonomo, R" uniqKey="Buonomo R">R Buonomo</name></author><author><name sortKey="Mazza, G" uniqKey="Mazza G">G Mazza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jevsnik, M" uniqKey="Jevsnik M">M Jevšnik</name></author><author><name sortKey="Hlebec, V" uniqKey="Hlebec V">V Hlebec</name></author><author><name sortKey="Raspor, P" uniqKey="Raspor P">P Raspor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martins, Rb" uniqKey="Martins R">RB Martins</name></author><author><name sortKey="Hogg, T" uniqKey="Hogg T">T Hogg</name></author><author><name sortKey="Otero, Jg" uniqKey="Otero J">JG Otero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seaman, P" uniqKey="Seaman P">P Seaman</name></author><author><name sortKey="Eves, A" uniqKey="Eves A">A Eves</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharif, L" uniqKey="Sharif L">L Sharif</name></author><author><name sortKey="Al Malki, T" uniqKey="Al Malki T">T Al-Malki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boateng, Ae" uniqKey="Boateng A">AE Boateng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kunadu, Ap H" uniqKey="Kunadu A">AP-H Kunadu</name></author><author><name sortKey="Ofosu, Db" uniqKey="Ofosu D">DB Ofosu</name></author><author><name sortKey="Aboagye, E" uniqKey="Aboagye E">E Aboagye</name></author><author><name sortKey="Tano Debrah, K" uniqKey="Tano Debrah K">K Tano-Debrah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soares, Ls" uniqKey="Soares L">LS Soares</name></author><author><name sortKey="Almeida, Rc" uniqKey="Almeida R">RC Almeida</name></author><author><name sortKey="Cerqueira, Es" uniqKey="Cerqueira E">ES Cerqueira</name></author><author><name sortKey="Carvalho, Js" uniqKey="Carvalho J">JS Carvalho</name></author><author><name sortKey="Nunes, Il" uniqKey="Nunes I">IL Nunes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Angelillo, If" uniqKey="Angelillo I">IF Angelillo</name></author><author><name sortKey="Viggiani, Nm" uniqKey="Viggiani N">NM Viggiani</name></author><author><name sortKey="Greco, Rm" uniqKey="Greco R">RM Greco</name></author><author><name sortKey="Rito, D" uniqKey="Rito D">D Rito</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bolton, D" uniqKey="Bolton D">D Bolton</name></author><author><name sortKey="Meally, A" uniqKey="Meally A">A Meally</name></author><author><name sortKey="Blair, I" uniqKey="Blair I">I Blair</name></author><author><name sortKey="Mcdowell, D" uniqKey="Mcdowell D">D McDowell</name></author><author><name sortKey="Cowan, C" uniqKey="Cowan C">C Cowan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baluka, Sa" uniqKey="Baluka S">SA Baluka</name></author><author><name sortKey="Miller, R" uniqKey="Miller R">R Miller</name></author><author><name sortKey="Kaneene, Jb" uniqKey="Kaneene J">JB Kaneene</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Son, R" uniqKey="Son R">R Son</name></author><author><name sortKey="Mohhiddin, O" uniqKey="Mohhiddin O">O Mohhiddin</name></author><author><name sortKey="Toh, P" uniqKey="Toh P">P Toh</name></author><author><name sortKey="Chai, L" uniqKey="Chai L">L Chai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cak Ro Lu, Fp" uniqKey="Cak Ro Lu F">FP Çakıroğlu</name></author><author><name sortKey="Ucar, A" uniqKey="Ucar A">A Uçar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olumakaiye, Mf" uniqKey="Olumakaiye M">MF Olumakaiye</name></author><author><name sortKey="Bakare, Ko" uniqKey="Bakare K">KO Bakare</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Webb, M" uniqKey="Webb M">M Webb</name></author><author><name sortKey="Morancie, A" uniqKey="Morancie A">A Morancie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powell, S" uniqKey="Powell S">S Powell</name></author><author><name sortKey="Attwell, R" uniqKey="Attwell R">R Attwell</name></author><author><name sortKey="Massey, S" uniqKey="Massey S">S Massey</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Xavier, Cac" uniqKey="Xavier C">CAC Xavier</name></author><author><name sortKey="Oporto, Co" uniqKey="Oporto C">CO Oporto</name></author><author><name sortKey="Silva, Mp" uniqKey="Silva M">MP Silva</name></author><author><name sortKey="Silveira, Ia" uniqKey="Silveira I">IA Silveira</name></author><author><name sortKey="Abrantes, Mr" uniqKey="Abrantes M">MR Abrantes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stepanovi, S" uniqKey="Stepanovi S">S Stepanović</name></author><author><name sortKey="Daki, I" uniqKey="Daki I">I Dakić</name></author><author><name sortKey="Morrison, D" uniqKey="Morrison D">D Morrison</name></author><author><name sortKey="Hauschild, T" uniqKey="Hauschild T">T Hauschild</name></author><author><name sortKey="Jezek, P" uniqKey="Jezek P">P Ježek</name></author><author><name sortKey="Petras, P" uniqKey="Petras P">P Petráš</name></author><author><name sortKey="Martel, A" uniqKey="Martel A">A Martel</name></author><author><name sortKey="Vukovi, D" uniqKey="Vukovi D">D Vuković</name></author><author><name sortKey="Shittu, A" uniqKey="Shittu A">A Shittu</name></author><author><name sortKey="Devriese, La" uniqKey="Devriese L">LA Devriese</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Montville, R" uniqKey="Montville R">R Montville</name></author><author><name sortKey="Chen, Y" uniqKey="Chen Y">Y Chen</name></author><author><name sortKey="Schaffner, Dw" uniqKey="Schaffner D">DW Schaffner</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Buccheri, C" uniqKey="Buccheri C">C Buccheri</name></author><author><name sortKey="Casuccio, A" uniqKey="Casuccio A">A Casuccio</name></author><author><name sortKey="Giammanco, S" uniqKey="Giammanco S">S Giammanco</name></author><author><name sortKey="Giammanco, M" uniqKey="Giammanco M">M Giammanco</name></author><author><name sortKey="La Guardia, M" uniqKey="La Guardia M">M La Guardia</name></author><author><name sortKey="Mammina, C" uniqKey="Mammina C">C Mammina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marais, M" uniqKey="Marais M">M Marais</name></author><author><name sortKey="Conradie, N" uniqKey="Conradie N">N Conradie</name></author><author><name sortKey="Labadarios, D" uniqKey="Labadarios D">D Labadarios</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walker, E" uniqKey="Walker E">E Walker</name></author><author><name sortKey="Pritchard, C" uniqKey="Pritchard C">C Pritchard</name></author><author><name sortKey="Forsythe, S" uniqKey="Forsythe S">S Forsythe</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lambiri, M" uniqKey="Lambiri M">M Lambiri</name></author><author><name sortKey="Mavridou, A" uniqKey="Mavridou A">A Mavridou</name></author><author><name sortKey="Papadakis, J" uniqKey="Papadakis J">J Papadakis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clayton, Da" uniqKey="Clayton D">DA Clayton</name></author><author><name sortKey="Griffith, Cj" uniqKey="Griffith C">CJ Griffith</name></author><author><name sortKey="Price, P" uniqKey="Price P">P Price</name></author><author><name sortKey="Peters, Ac" uniqKey="Peters A">AC Peters</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28061850</article-id><article-id pub-id-type="pmc">5219779</article-id><article-id pub-id-type="publisher-id">3986</article-id><article-id pub-id-type="doi">10.1186/s12889-016-3986-9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Akabanda</surname><given-names>Fortune</given-names></name><address><phone>+233 209087076</phone><email>fakabanda@gmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Hlortsi</surname><given-names>Eli Hope</given-names></name><address><email>hopeelihlortsi@yahoo.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Owusu-Kwarteng</surname><given-names>James</given-names></name><address><email>jowusukwarteng@uds.edu.gh</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1">Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo Campus, Ghana</aff></contrib-group><pub-date pub-type="epub"><day>6</day><month>1</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>6</day><month>1</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>17</volume><elocation-id>40</elocation-id><history><date date-type="received"><day>18</day><month>6</month><year>2016</year></date><date date-type="accepted"><day>22</day><month>12</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>In large scale cooking, food is handled by many individuals, thereby increasing the chances of food contamination due to improper handling. Deliberate or accidental contamination of food during large scale production might endanger the health of consumers, and have very expensive repercussions on a country. The purpose of this study was to evaluate the food safety knowledge, attitudes, and practices among institutional food- handlers in Ghana.</p></sec><sec><title>Methods</title><p>The study was conducted using a descriptive, cross-sectional survey of 29 institutions by conducting face to face interview and administration of questionnaire to two hundred and thirty-five (235) institutional food-handlers. The questionnaire was peer-reviewed and pilot tested in three institutions in the Upper East Region of Ghana, before the final version was distributed to food-handlers. The questionnaire was structured into five distinctive parts to collect information on (i) demographic characteristics, (ii) employees’ work satisfaction, (iii) knowledge on food safety, (iv) attitudes towards food safety and (v) food hygiene practices.</p></sec><sec><title>Results</title><p>Majority of the food-handlers were between 41–50 years (39.1%). Female respondents were (76.6%). In our study, the food-handlers were knowledgeable about hygienic practices, cleaning and sanitation procedures. Almost all of the food-handlers were aware of the critical role of general sanitary practices in the work place, such as hand washing (98.7% correct answers), using gloves (77.9%), proper cleaning of the instruments/utensils (86.4%) and detergent use (72.8%). On disease transmission, the results indicates that 76.2% of the food- handlers did not know that <italic>Salmonella</italic> is a food borne pathogens and 70.6% did not know that hepatitis A is a food borne pathogen. However, 81.7% handlers agreed that typhoid fever is transmitted by food and 87.7% agreed that bloody diarrhea is transmitted by food. Logistic regression analysis testing four models showed statistically significant differences (<italic>p</italic> < 0.05), for models in which the explanatory variable was the level of education.</p></sec><sec><title>Conclusions</title><p>In generally, the institutional food-handlers have satisfactory knowledge in food safety but this does not translate into strict hygienic practices during processing and handling food products.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Food-handlers</kwd><kwd>Food safety</kwd><kwd>Ghana</kwd><kwd>Hygienic practices</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2017</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p>When food is cooked on a large scale, it may be handled by many individuals and thus increasing the chances of contamination of the final food. Unintended contamination of food during large scale cooking, leading to food-borne disease outbreaks can pose danger to the health of consumers and economic consequence for nations [<xref ref-type="bibr" rid="CR1">1</xref>–<xref ref-type="bibr" rid="CR3">3</xref>].</p><p>Food-borne related illnesses have increased over the years, and negatively affected the health and economic well-being of many developing nations [<xref ref-type="bibr" rid="CR4">4</xref>]. The World Health Organization (WHO) states that about 1.8 million persons died from diarrheal diseases in 2005, mainly due to the ingestion of contaminated food and drinking water. Food poisoning occurs as a result of consuming food contaminated with microorganisms or their toxins, the contamination arising from inadequate preservation methods, unhygienic handling practices, cross-contamination from food contact surfaces, or from persons harboring the microorganisms in their nares and on the skin [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR6">6</xref>]. Unhygienic practices during food preparation, handling and storage creates the conditions that allows the proliferation and transmission of disease causing organisms such as bacteria, viruses and other food-borne pathogens [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR8">8</xref>]. Additionally, many reported cases of food-borne viral diseases have been attributed to infected food-handlers involved in catering services [<xref ref-type="bibr" rid="CR9">9</xref>].</p><p>In Ghana, both public and private institutions often have food service or catering units where meals are served to both staff and clients. Such institutions may include schools, research institutes, hospitals and prisons. To prevent outbreak of food-borne diseases in these institutions, high standards of hygienic and safety practices by food-handlers are essential parts of an overall food safety program implemented by these institutions. Although institutional food-handlers may possess the required knowledge and skills needed in food safety practice, errors due to human handling are often cited in several food-borne disease outbreaks [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR12">12</xref>]. As Greig et al. [<xref ref-type="bibr" rid="CR11">11</xref>] reports, about 97% of reported food poisoning cases are due to the improper handling of foods by persons involved in catering services.</p><p>The knowledge, attitudes and practices of food-handlers have been reported in studies from different countries around world [<xref ref-type="bibr" rid="CR13">13</xref>–<xref ref-type="bibr" rid="CR18">18</xref>]. This is because a combination the three factors: knowledge, attitude and practice of food-handlers, play dominant role in food safety with regards to food service industry [<xref ref-type="bibr" rid="CR19">19</xref>]. In Ghana, previous studies have evaluated the knowledge, attitudes and practices of food-handlers in selected hotels in Accra [<xref ref-type="bibr" rid="CR2">2</xref>], and food hygiene practices by street food vendors [<xref ref-type="bibr" rid="CR20">20</xref>]. Recently, food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra-Ghana has also been reported [<xref ref-type="bibr" rid="CR21">21</xref>]. All these studies were however limiting in scope as they were restricted to only Accra, the capital city. At the moment, there is no published report on the knowledge, attitude and practice of food-handlers in institution selected from different geographical regions of Ghana. Such studies are however, important as they provide a nation-wide assessment of training needs, attitudinal changes and effectiveness of training and education to provide continuous consumer assurance of the safety of food. Such investigations will also provide better understanding of the interactions of prevailing food safety knowledge, attitudes and practices of food-handlers throughout the country, Ghana.</p><p>This study therefore sought to assess the knowledge, attitudes, and practices of institutional food-handlers in Ghana, with regard to food hygienic practices and over-all safety.</p></sec><sec id="Sec2"><title>Methods</title><sec id="Sec3"><title>Study population</title><p>A total of 235 institutional food-handlers participated in the study. A descriptive, cross-sectional survey of 29 institutions was employed in this study. The institutions included ten (10) Senior High Schools, nine (9) District Hospitals, two (2) Prison Services, six (6) Universities/Polytechnics and one (1) Health Research Center located in 5 administrative regions including Upper East, Northern, Ashanti, Volta, Brong-Ahafo and Eastern regions of Ghana (Fig <xref rid="Fig1" ref-type="fig">1</xref>).<fig id="Fig1"><label>Fig. 1</label><caption><p>Administrative regions of Ghana. Blue dot-circles indicate the regions from which institutional food handlers were sampled for the studies</p></caption><graphic xlink:href="12889_2016_3986_Fig1_HTML" id="MO1"></graphic></fig></p></sec><sec id="Sec4"><title>Interviews</title><p>Face-to-face interviews were conducted using structured questionnaire to collect information on the knowledge, attitudes and practices of the food-handlers on food safety. The questionnaire was peer-reviewed and pilot tested in three institutions in the Upper East Region of Ghana, before a final version was administered to food-handlers. Participants were interviewed by the researchers and trained research assistants using the structured questionnaire. Data was collected between December 2014 and June 2015.</p><p>The questionnaire was structured into five distinctive sections. Section one was to collect information on respondents’ demographic characteristics such as gender, age, level of education and length of employment in the food service business. Section two was concerned with information on the employees’ work satisfaction while sections 3, 4 and 5 were concerned with information on employees’ knowledge of food safety, attitude towards food safety and food hygiene practices respectively.</p><p>Questions pertaining to demographic information of respondents and employees’ work satisfaction were adapted from Soares et al. [<xref ref-type="bibr" rid="CR22">22</xref>] and Jevšnik et al. [<xref ref-type="bibr" rid="CR16">16</xref>]. Answers were graded on a scale of five, with 1 indicating “strongly disagree” and five indicating “strongly agree”. Questions on food safety knowledge, attitudes and practices were adapted from previously published works [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR22">22</xref>–<xref ref-type="bibr" rid="CR24">24</xref>].</p><p>The section of questionnaire dealing with food safety knowledge comprised 25 close-ended questions with three possible answers; “true”, “false”, and “do not know”. These questions specifically dealt with respondents’ knowledge of personal hygiene, cross contamination, food-borne diseases, microorganisms, temperature control and hygienic practices. A scale ranging between 0 and 24 (representing the total number of questions on food safety knowledge) was used to evaluate the overall knowledge of respondents. Food-handlers that obtained total score ≤16 points were considered to have “insufficient” knowledge and those that had scores ≥17 points (≥68% accuracy) were considered to have “good” knowledge of food safety.</p><p>Questions pertaining to attitudes (section 4) were aimed at determining the understanding of food-handlers about food safety. Here, attitudes was used to mean “a complex mental state involving beliefs, feelings, values and dispositions to act in certain ways” [<xref ref-type="bibr" rid="CR19">19</xref>]. This section had 20 statements/questions that required three possible responses: “agree”, “disagree”, and “don’t know or remember”. For evaluation, food-handlers that answered to 13 or less statements/questions correctly were measured to have “insufficient or poor” understanding, whereas those that responded to 14 or more statements/questions correctly were measured to have “good” understanding.</p><p>In section five, which dealt with food hygiene practices, the good hygienic practices of respondents (institutional food-handlers) were assessed and evaluated based on self-reporting of personal hygiene and other safe food handling practices. The section had 11 statements/questions with two possible responses: “yes”, and “no”. Each correct practice reported scored one (1) point. For evaluation, a score ≥ 70% by an individual respondent was considered as having “good” food hygienic practice.</p></sec><sec id="Sec5"><title>Statistical analyses</title><p>The statistical package for social science (SPSS) for Windows (version 11.0, 2001, Chicago, IL) was used for analyses of data. Difference in means were considered statistically significant at <italic>p</italic> < 0.05. Mean scores of responses were converted into percentages for purposes of easy interpretation of results. One way analysis of variance (ANOVA) was used to compare the mean scores of knowledge, attitude, and practice among the different educational levels of respondents. The mean score of knowledge, attitude, and practice were compared by <italic>t</italic>-test. The responses were also reclassified into two categorical responses ‘yes’ and ‘no’ for correct and incorrect responses respectively.</p><p>In order to identify the variables that impacted on the observed results, four logistic regression analysis models were developed. The four models included knowledge of foodborne diseases, knowledge and attitudes regarding personal hygiene, knowledge and attitudes regarding temperature control, and knowledge and attitudes towards food hygienic practices. Predictive variables including age, length of employment and education level were incorporated into all models with general knowledge on food safety as the dependent variable.</p></sec></sec><sec id="Sec6" sec-type="discussion"><title>Results and discussion</title><sec id="Sec7"><title>Demographic characteristics</title><p>Table <xref rid="Tab1" ref-type="table">1</xref> presents the summarized demographic profile of respondents in this study. Out of the 235 food-handlers who participated in this study, 76.6% (<italic>n</italic> = 180) were female while 23.4% (<italic>n</italic> = 55) were males. Most studies have reported higher proportion of females [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR26">26</xref>] involvement in food handling. A greater number (39.1%) of the participants were in the age bracket of 41–50 years with average age of 41.5 ± 9.5 years. Similar studies showed that workers in older age brackets had better hygiene scores than their younger colleagues [<xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR28">28</xref>]. Approximately 14.5% of the participants in this study did not have any formal education. However, a previous study demonstrated that irrespective of educational level, employees performance in food safety knowledge was not satisfactory and thus a cause for public concern [<xref ref-type="bibr" rid="CR29">29</xref>]. A greater number of participants (76.2%) had >5 years of experience working in the foodservice industry with an average length of 11 ± 7.8 years. Eighty three percent were full time workers in the institutions whiles the rest were part time workers. Only a few (8.1%) of the respondents self-reported that they have ever received training in food safety. Although several studies have shown that training may contribute to upgrading the food safety knowledge of food-handlers, this does not always translate into a positive change in food handling behavior and attitudes [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR30">30</xref>].<table-wrap id="Tab1"><label>Table 1</label><caption><p>Demographic characteristics of institutional food-handlers in Ghana (<italic>n</italic> = 235)</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Characteristics</th><th>Number</th><th>Percent</th><th>Mean ± SD</th><th>Range</th></tr></thead><tbody><tr><td colspan="5">Gender</td></tr><tr><td> Female</td><td>180</td><td>76.6</td><td></td><td></td></tr><tr><td> Male</td><td>55</td><td>23.4</td><td>N/A</td><td>N/A</td></tr><tr><td colspan="5">Age (years)</td></tr><tr><td> 21–30</td><td>18</td><td>7.7</td><td></td><td></td></tr><tr><td> 31–40</td><td>78</td><td>33.2</td><td></td><td></td></tr><tr><td> 41–50</td><td>92</td><td>39.1</td><td></td><td></td></tr><tr><td> 51–60</td><td>47</td><td>20.0</td><td>41.5 ± 9.5</td><td>22–60</td></tr><tr><td colspan="5">Marital status</td></tr><tr><td> Single</td><td>24</td><td>10.2</td><td></td><td></td></tr><tr><td> Married</td><td>161</td><td>68.5</td><td></td><td></td></tr><tr><td> Divorced</td><td>19</td><td>8.1</td><td></td><td></td></tr><tr><td> Widow/widower</td><td>31</td><td>13.2</td><td></td><td></td></tr><tr><td colspan="5">Education</td></tr><tr><td> No formal education</td><td>34</td><td>14.5</td><td></td><td></td></tr><tr><td> Basic</td><td>91</td><td>38.7</td><td></td><td></td></tr><tr><td> JHS/JSS</td><td>57</td><td>24.3</td><td></td><td></td></tr><tr><td> SHS/SSS</td><td>13</td><td>5.5</td><td></td><td></td></tr><tr><td> Post-secondary/Vocational</td><td>22</td><td>9.4</td><td></td><td></td></tr><tr><td> Tertiary</td><td>18</td><td>7.6</td><td></td><td></td></tr><tr><td colspan="5">Length of employment (years)</td></tr><tr><td> <5</td><td>56</td><td>23.8</td><td></td><td></td></tr><tr><td> 5–10</td><td>61</td><td>25.9</td><td></td><td></td></tr><tr><td> 11–20</td><td>109</td><td>46.4</td><td></td><td></td></tr><tr><td> 21–30</td><td>9</td><td>38.3</td><td>11 ± 7.8</td><td>0.5–30</td></tr><tr><td colspan="5">Employment status</td></tr><tr><td> Full-time</td><td>197</td><td>83.8</td><td></td><td></td></tr><tr><td> Part-time</td><td>38</td><td>16.2</td><td></td><td></td></tr><tr><td colspan="5">Food safety training course</td></tr><tr><td> Yes</td><td>19</td><td>8.1</td><td></td><td></td></tr><tr><td> No</td><td>216</td><td>91.9</td><td></td><td></td></tr></tbody></table></table-wrap></p></sec><sec id="Sec8"><title>Employees’ work satisfaction</title><p>Work satisfaction was surveyed to ascertain institutional food-handler’s satisfaction with the conditions, work load, work relations and other people reaction toward them (Table <xref rid="Tab2" ref-type="table">2</xref>). In general, 24.7% of the institutional food-handlers affirmed that if they had to choose a profession again, they would choose the same profession, 48.5% said they would not choose the same profession, whiles 26.8% were indifferent about the issue of choosing a profession again.<table-wrap id="Tab2"><label>Table 2</label><caption><p>Employees’ work satisfaction</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Statement/question</th><th colspan="3">Response % (n)</th></tr><tr><th>Yes</th><th>No</th><th>Don’t know</th></tr></thead><tbody><tr><td>If you could choose a profession, would you choose this same profession?</td><td char="(" align="char">24.7 (58)</td><td char="(" align="char">48.5 (114)</td><td>26.8 (63)</td></tr><tr><td>When you have personal trouble, do you share with your colleagues?</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">40.0 (94)</td><td>0 (0)</td></tr><tr><td>When you have personal trouble, did you share with your head of department?</td><td char="(" align="char">64.3 (151)</td><td char="(" align="char">35.7 (84)</td><td>0 (0)</td></tr><tr><td>Would you leave this work if you are offered something better at another place?</td><td char="(" align="char">95.3 (224)</td><td char="(" align="char">0.0 (0)</td><td>4.7 (11)</td></tr><tr><td>Is the work load adequate?</td><td char="(" align="char">92.3 (217)</td><td char="(" align="char">7.7 (18)</td><td>0 (0)</td></tr><tr><td>Is the kitchen staff respected by other workers of the institution?</td><td char="(" align="char">14.9 (35)</td><td char="(" align="char">85.1 (200)</td><td>0 (0)</td></tr><tr><td>Does the workplace provide all the necessary conditions to guaranteeing food safety?</td><td char="(" align="char">62.1 (146)</td><td char="(" align="char">37.9 (89)</td><td>0 (0)</td></tr><tr><td>Do the meals served present health risks to the people?</td><td char="(" align="char">0 (0)</td><td char="(" align="char">100.0 (235)</td><td>0 (0)</td></tr></tbody></table></table-wrap></p><p>In answering the question; would you quit this work if you are offered something better at a different place, about 95.3% affirmed they will leave while 4.7% were not certain. About 62.1% said the workplace make available all the necessary conditions for guaranteeing food safety. On the issue of sharing problems, 64.3% agreed that they do share their personal problems with their head of departments.</p></sec><sec id="Sec9"><title>Food safety knowledge of food-handlers</title><p>In our study, the food-handlers were knowledgeable about hygiene practices, cleaning and sanitation procedures (Table <xref rid="Tab3" ref-type="table">3</xref>). Majority of food-handlers in this study knew the importance of general sanitary practices such as regular hand washing at the work place (98.7% correct answers), wearing of gloves (77.9% correct answers), proper cleaning (86.4% correct answers) and detergent use (72.8%).<table-wrap id="Tab3"><label>Table 3</label><caption><p>Food safety knowledge of institutional food-handlers in Ghana</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Statement</th><th colspan="3">Response % (n)</th></tr><tr><th>Correct</th><th>Incorrect</th><th>Don’t know/remember</th></tr></thead><tbody><tr><td>Washing hands before work reduces the risk of food contamination.</td><td char="(" align="char">98.7 (232)</td><td char="(" align="char">0.0 (0)</td><td>1.3 (3)</td></tr><tr><td>Using gloves while handling food reduces the risk of food contamination.</td><td char="(" align="char">77.9 (183)</td><td char="(" align="char">17.4 (41)</td><td>4.7 (11)</td></tr><tr><td>Proper cleaning and sanitization of utensils increase the risk of food contamination.</td><td char="(" align="char">4.7 (11)</td><td char="(" align="char">86.4 (203)</td><td>8.9 (21)</td></tr><tr><td>Eating and drinking at the work place increase the risk of food contamination.</td><td char="(" align="char">25.1 (59)</td><td char="(" align="char">60.9 (143)</td><td>14.0 (33)</td></tr><tr><td>Food prepared in advance reduces the risk of food contamination.</td><td char="(" align="char">21.3 (50)</td><td char="(" align="char">68.1 (160)</td><td>10.6 (25)</td></tr><tr><td>Reheating cooked foods can contribute to food contamination.</td><td char="(" align="char">11.5 (27)</td><td char="(" align="char">70.6 (166)</td><td>17.9 (42)</td></tr><tr><td>Washing utensils with detergent leaves them free of contamination.</td><td char="(" align="char">72.8 (171)</td><td char="(" align="char">26.8 (63)</td><td>0.4 (1)</td></tr><tr><td>Children, healthy adults, pregnant women and older individuals are at equal risk for food poisoning.</td><td char="(" align="char">60.9 (143)</td><td char="(" align="char">37.9 (89)</td><td>1.2 (3)</td></tr><tr><td>Typhoid fever can be transmitted by food.</td><td char="(" align="char">81.7 (192)</td><td char="(" align="char">13.6 (32)</td><td>4.7 (11)</td></tr><tr><td>AIDS can be transmitted by food.</td><td char="(" align="char">8.5 (20)</td><td char="(" align="char">86.8 (204)</td><td>4.7 (11)</td></tr><tr><td>Bloody diarrhea can be transmitted by food.</td><td char="(" align="char">87.7 (206)</td><td char="(" align="char">8.1 (19)</td><td>4.2 (10)</td></tr><tr><td>Salmonella is among the food-borne pathogens.</td><td char="(" align="char">18.3 (43)</td><td char="(" align="char">5.5 (13)</td><td>76.2 (179)</td></tr><tr><td>Hepatitis A virus is among the food-borne pathogens.</td><td char="(" align="char">11.5 (27)</td><td char="(" align="char">17.9 (42)</td><td>70.6 (166)</td></tr><tr><td>Swollen cans may contain the microorganism, <italic>Clostridium botulinum</italic>, which causes botulism.</td><td char="(" align="char">13.6 (32)</td><td char="(" align="char">10.2 (24)</td><td>76.2 (179)</td></tr><tr><td>Microbes are on the skin, in the nose and mouth of healthy food handlers.</td><td char="(" align="char">71.5 (168)</td><td char="(" align="char">25.1 (59)</td><td>3.4 (8)</td></tr><tr><td>Clean is the same as sanitized.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">33.6 (79)</td><td>6.4 (15)</td></tr><tr><td>Cross contamination is when microorganisms from a contaminated food are transferred by the food handler’s hands or kitchen utensils to another food.</td><td char="(" align="char">4.7 (11)</td><td char="(" align="char">8.9 (21)</td><td>86.4 (203)</td></tr><tr><td>The correct temperature for storing perishable foods is 5 °C.</td><td char="(" align="char">33.6 (79)</td><td char="(" align="char">6.4 (15)</td><td>60.0 (141)</td></tr><tr><td>Hot, ready-to-eat food should be kept at a temperature of 65 °C.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">6.4 (15)</td><td>33.6 (79)</td></tr><tr><td>Freezing kills all the bacteria that may cause food-borne illness.</td><td char="(" align="char">59.1 (139)</td><td char="(" align="char">39.2 (92)</td><td>1.7 (4)</td></tr><tr><td>Contaminated foods always have some change in color, odor or taste.</td><td char="(" align="char">60.4 (142)</td><td char="(" align="char">39.2 (92)</td><td>0.4 (1)</td></tr><tr><td>Raw vegetables are at higher risk of contamination than undercooked beef</td><td char="(" align="char">40.9 (96)</td><td char="(" align="char">28.9 (68)</td><td>30.2(71)</td></tr><tr><td>During infectious disease of the skin, it is necessary to take leave from work.</td><td char="(" align="char">93.6 (220)</td><td char="(" align="char">0.0 (0)</td><td>6.4 (15)</td></tr><tr><td>The health status of workers should be evaluated before employment.</td><td char="(" align="char">99.6 (234)</td><td char="(" align="char">0.4 (1)</td><td>0.0 (0)</td></tr><tr><td>The ideal place to store raw meat in the refrigerator is on the bottom shelf.</td><td char="(" align="char">40.9 (96)</td><td char="(" align="char">28.9 (68)</td><td>30.2(71)</td></tr></tbody></table></table-wrap></p><p>The awareness of such important hygienic procedures by majority of the institutional food-handlers in this study is very appropriate. This is because the hands of food-handlers can serve as vectors in the spread of foodborne diseases due to poor personal hygiene or cross-contamination [<xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR31">31</xref>]. Proper hand washing by food-handlers has been reported to significantly decrease the threat of diarrheal disease in child care facilities [<xref ref-type="bibr" rid="CR32">32</xref>] and can therefore be encouraged as it could similarly help minimize the risk of diarrhea and other foodborne diseases in similar institutions. Despite a self-reported hand washing practiced by food-handlers, many employees’ in a study by Stepanović et al. [<xref ref-type="bibr" rid="CR33">33</xref>] had coagulase-positive staphylococci isolated from their hands, and this could be a source of food contamination. Therefore, it is prudent to combine proper hand washing with the wearing of gloves and other hygienic practices in order to minimize the risk of contamination during food handling [<xref ref-type="bibr" rid="CR34">34</xref>].</p><p>Regarding foodborne disease transmission, 76.2% of the food-handlers (respondents) did not know or remember that <italic>Salmonella</italic> is a food-borne pathogens and 70.6% did not know/remember that hepatitis A is a foodborne pathogen. On the other, 81.7 and 87.7% of respondents agreed that typhoid fever and bloody diarrhea respectively can be transmitted by food. The majority (86.8%) of respondents disagreed that HIV/AIDS is transmitted by food, which is an indication that public education on HIV/AIDS by the Ghana AIDS commission could be yielding results. These results support recently published work where majority of the respondents did not know if <italic>Salmonella</italic>, hepatitis A and B viruses, and <italic>Staphylococcus</italic> caused foodborne diseases [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR22">22</xref>]. Over ninety percent (90%) of respondents agreed that taking leave from work in periods of infectious skin disease was necessary (Table <xref rid="Tab3" ref-type="table">3</xref>). Additionally, 71.5% knew that microorganisms can be found on the skin and in the mouth and nose of healthy looking individuals. They also recognize that the health status of food-handlers should be assessed prior to employment.</p><p>On the other hand, food-handlers were less familiar with time and temperature abuse and its effect on food safety (Table <xref rid="Tab3" ref-type="table">3</xref>). Anon [<xref ref-type="bibr" rid="CR35">35</xref>] reported that improper handling of food, including the abuse of time-temperature, account for most food-borne disease outbreak. In this study, respondents had insufficient knowledge on time-temperature controls. This result is supported by others [<xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR29">29</xref>] whose report show that knowledge of critical temperatures were insufficient amongst food-handlers. Similar findings on the lack of adequate knowledge on temperature controls by food-handlers have also been reported from different countries [<xref ref-type="bibr" rid="CR36">36</xref>–<xref ref-type="bibr" rid="CR38">38</xref>].</p></sec><sec id="Sec10"><title>Food safety attitudes of food-handlers</title><p>A reduction in the incidence of food-borne illnesses is strongly influenced by the attitudes of food-handlers towards the implementation of food safety plans. Thus, there is a strong linkage between positive behavior, attitudes and education of food-handlers in maintaining safe food handling practices [<xref ref-type="bibr" rid="CR12">12</xref>].</p><p>Table <xref rid="Tab4" ref-type="table">4</xref> shows the attitudes of the food-handlers toward the prevention and control of food-borne diseases. About 60% of respondents indicated that using caps, masks, protective gloves and proper clothing can minimize the risk of food contamination, which is a positive attitude reported by majority of the respondents. Similarly, majority of respondents (93.6%) agreed that knives and cutting boards should be properly sanitized to prevent cross contamination of foods. Respondents also agreed that individuals with abrasions or cuts on their fingers or hands should not touch unwrapped foods (87.2%). The majority (88.1%) of food-handlers were aware that food should not be handled with long and painted fingernails. They were also mindful of the fact that dish towels could cross-contaminate foods (71.5%) and that well-cooked foods are free of contamination (86.4%). Thus, the general attitudes of the food-handlers toward food safety was satisfactory, except on issues relating to refrozen of defrosted food. About 81.7% of food-handlers had unsatisfactory attitude towards defrosted and refrozen foods. Refreezing a completely thawed food can present a serious health risk, as this process leads faster growth of contaminating bacteria. Freezing food only slows bacterial growth and does not necessarily kill the pathogens [<xref ref-type="bibr" rid="CR39">39</xref>]. Respondents (86.4%) did not find it necessary to check the temperatures of refrigerators and freezers periodically (86.4%).<table-wrap id="Tab4"><label>Table 4</label><caption><p>Food safety attitudes of institutional food-handlers</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Statement</th><th colspan="3">Response % (n)</th></tr><tr><th>Agree</th><th>Disagree</th><th>Don’t know/remember</th></tr></thead><tbody><tr><td>Well-cooked foods are free of contamination</td><td char="(" align="char">86.4 (203)</td><td char="(" align="char">8.9 (21)</td><td>4.7 (11)</td></tr><tr><td>Proper hand hygiene can prevent food-borne diseases.</td><td char="(" align="char">93.6 (220)</td><td char="(" align="char">0.0 (0)</td><td>6.4 (15)</td></tr><tr><td>When cleaning products are closed, they can be stored with cans and jars of food that are also closed.</td><td char="(" align="char">28.9 (68)</td><td char="(" align="char">30.2(71)</td><td>40.9 (96)</td></tr><tr><td>Raw and cooked foods should be stored separately to reduce the risk of food contamination.</td><td char="(" align="char">40.9 (96)</td><td char="(" align="char">28.9 (68)</td><td>30.2(71)</td></tr><tr><td>It is necessary to check the temperature of refrigerators/freezers periodically to reduce the risk of food contamination.</td><td char="(" align="char">33.6 (79)</td><td char="(" align="char">8.9 (21)</td><td>86.4 (203)</td></tr><tr><td>Defrosted foods should not be refrozen.</td><td char="(" align="char">13.6 (32)</td><td char="(" align="char">81.7 (192)</td><td>4.7 (11)</td></tr><tr><td>The health status of workers should be evaluated before employment.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">6.4 (15)</td><td>33.6 (79)</td></tr><tr><td>The best way to thaw a chicken is in a bowl of cold water.</td><td char="(" align="char">87.7 (206)</td><td char="(" align="char">8.1 (19)</td><td>4.2 (10)</td></tr><tr><td>Wearing masks is an important practice to reduce the risk of food contamination.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">6.4 (15)</td><td>33.6 (79)</td></tr><tr><td>Wearing gloves is an important practice to reduce the risk of food contamination.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">6.4 (15)</td><td>33.6 (79)</td></tr><tr><td>Wearing caps and adequate clothing is an important practice to reduce the risk of food contamination.</td><td char="(" align="char">60.0 (141)</td><td char="(" align="char">6.4 (15)</td><td>33.6 (79)</td></tr><tr><td>Safe food handling is an important part of my job responsibilities</td><td char="(" align="char">40.9 (96)</td><td char="(" align="char">28.9 (68)</td><td>30.2 (71)</td></tr><tr><td>Learning more about food safety through training courses is important to me</td><td char="(" align="char">30.2 (71)</td><td char="(" align="char">28.9 (68)</td><td>40.9 (96)</td></tr><tr><td>Beards could contaminate food with foodborne pathogens</td><td char="(" align="char">13.6 (32)</td><td char="(" align="char">10.2 (24)</td><td>76.2(179)</td></tr><tr><td>Long and painted fingernails could contaminate food with foodborne pathogens.</td><td char="(" align="char">88.1 (207)</td><td char="(" align="char">11.9 (28)</td><td>0 (0)</td></tr><tr><td>Food handlers can be a source of foodborne outbreaks</td><td char="(" align="char">64.3 (151)</td><td char="(" align="char">35.7 (84)</td><td>0 (0)</td></tr><tr><td>Eggs must be washed immediately after delivery.</td><td char="(" align="char">24.7 (58)</td><td char="(" align="char">48.5 (114)</td><td>26.8 (63)</td></tr><tr><td>Dish towels can be a source of food contamination.</td><td char="(" align="char">71.5 (168)</td><td char="(" align="char">25.1 (59)</td><td>3.4 (8)</td></tr><tr><td>Knives and cutting boards should be properly sanitized to prevent cross contamination.</td><td char="(" align="char">93.6 (220)</td><td char="(" align="char">0 (0)</td><td>6.4 (15)</td></tr><tr><td>Food handlers who have abrasions or cuts on their hands should not touch foods without gloves.</td><td char="(" align="char">87.2 (207)</td><td char="(" align="char">0 (0)</td><td>12.8 (30)</td></tr></tbody></table></table-wrap></p></sec><sec id="Sec11"><title>Food safety practices by food-handlers</title><p>Table <xref rid="Tab5" ref-type="table">5</xref> shows the food safety practices by institutional food-handlers. In assessing the food safety practices of the institutional food-handlers, 88.1% reported that they do not use gloves during the distribution of unpackaged foods. Majority (61.7%) of the food-handlers do not use aprons or wear mask when necessary. Additionally, they eat and drink during working hours. On sanitizer use, 61.7% reported that they do not use sanitizer in washing utensils such as plates, mugs and spoons. All respondents reported that they do not use sanitizer when washing fruits or vegetables. About 83.8% of the institutional food-handlers do prepare meals in advance. Only 17% of respondents reported that they look out for the shelf-life of foods when taking delivery of them.<table-wrap id="Tab5"><label>Table 5</label><caption><p>Food safety practices among institutional food-handlers</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Question</th><th colspan="2">Response % (n)</th></tr><tr><th>Yes</th><th>No</th></tr></thead><tbody><tr><td>Do you use gloves during the distribution of unpackaged foods?<break></break>If no, go to question 3.</td><td>11.9 (28)</td><td>88.1 (207)</td></tr><tr><td>Do you wash your hands properly before or after using gloves?</td><td>64.2 (18)</td><td>35.7 (10)</td></tr><tr><td>Do you wear an apron while working?</td><td>38.3 (90)</td><td>61.7 (145)</td></tr><tr><td>Do you wear a mask when you distribute unwrapped foods?</td><td>38.3 (90)</td><td>61.7 (145)</td></tr><tr><td>Do you eat or drink at your work place?</td><td>93.6 (220)</td><td>6.4 (15)</td></tr><tr><td>Do you wear nail polish when handling food?</td><td>16.2 (38)</td><td>83.8 (197)</td></tr><tr><td>Do you prepare a meal in advance (i.e., from one shift to another)?</td><td>83.8 (197)</td><td>16.2 (38)</td></tr><tr><td>Do you properly clean the food storage area before storing new products?</td><td>87.2 (207)</td><td>12.8 (30)</td></tr><tr><td>Do you use the sanitizer when washing service utensils (plates, mugs and spoons)?</td><td>61.7 (145)</td><td>38.3 (90)</td></tr><tr><td>Do you use the sanitizer when washing fruits?</td><td>0.0 (0)</td><td>100 (235)</td></tr><tr><td>Do you check the shelf life of foods at the time of delivery?</td><td>17 (40)</td><td>83 (195)</td></tr></tbody></table></table-wrap></p><p>Some previous studies suggest that the lack of knowledge in food safety can lead to poor hygienic practices by food-handlers [<xref ref-type="bibr" rid="CR27">27</xref>, <xref ref-type="bibr" rid="CR40">40</xref>]. However, Clayton et al. [<xref ref-type="bibr" rid="CR41">41</xref>] reported that about 63% of food-handlers demonstrating knowledge in food safety did not demonstrate a corresponding positive behavior towards food safety/hygienic practices. This shows that food-handlers might not necessarily be practicing strict food safety procedures during food handling, even when they provide answers to show that they are knowledgeable in a survey. Therefore, other factors such as employee motivation and continuous education and training on the job should be provided to inspire food-handlers, which will affect attitudes and subsequently food-safety practices [<xref ref-type="bibr" rid="CR42">42</xref>].</p></sec><sec id="Sec12"><title>Logistic regression analyses</title><p>Logistic regression analysis testing four models to identify the variables that impacted on the observed results are shown in Table <xref rid="Tab6" ref-type="table">6</xref>. All models tested except model 2 showed statistically significant differences (<italic>p</italic> < 0.05). The significant differences were only observed for models in which the explanatory variable was the level of education. Thus with the exception of model 2, respondents having advanced specific knowledge demonstrated significantly better understanding of food safety issues. For example, in model 1, the results indicate that food-handlers that demonstrate good knowledge of Hepatitis A virus as a food-borne pathogen had an adjusted OR of 14.3 (CI<sub>95</sub>, <italic>P</italic> = 0.002). Thus, these food-handlers have 14.3 more times possibilities of having good level of food safety knowledge when compared with food-handlers lacking sufficient level of knowledge for the same variable.<table-wrap id="Tab6"><label>Table 6</label><caption><p>Logistic regression analyses</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Variables</th><th>OR adjusted</th><th><italic>P</italic>-value</th></tr></thead><tbody><tr><td colspan="3">Model 1</td></tr><tr><td> Knowledge about risk group for food-borne disease</td><td>14.2</td><td>0.001</td></tr><tr><td> Knowledge about HIV as a food-borne disease</td><td>8.4</td><td>0.004</td></tr><tr><td> Knowledge about Hepatitis virus as a food-borne pathogen</td><td>14.3</td><td>0.002</td></tr><tr><td> Knowledge about Staphylococcus as a food-borne pathogen</td><td>3.9</td><td>0.017</td></tr><tr><td> Knowledge about Clostridium as a food-borne pathogen</td><td>7.6</td><td>0.002</td></tr><tr><td> Knowledge about microorganisms versus health of food handlers</td><td>13.2</td><td>0.003</td></tr><tr><td> Level of education</td><td>5.1</td><td>0.000</td></tr><tr><td colspan="3">Model 2</td></tr><tr><td> Knowledge of gloves use</td><td>0.8</td><td>0.104</td></tr><tr><td> Knowledge of masks use</td><td>1.3</td><td>0.052</td></tr><tr><td> Knowledge about eating or drinking during working hours</td><td>1.4</td><td>0.080</td></tr><tr><td> Practice about eating or drinking during working hours</td><td>2.5</td><td>0.063</td></tr><tr><td> Level of education</td><td>4.2</td><td>0.030</td></tr><tr><td colspan="3">Model 3</td></tr><tr><td> Knowledge about freezing versus microorganisms</td><td>3.8</td><td>0.003</td></tr><tr><td> Knowledge about refrigeration temperature</td><td>3.5</td><td>0.001</td></tr><tr><td> Level of education</td><td>3.9</td><td>0.004</td></tr><tr><td colspan="3">Model 4</td></tr><tr><td> Knowledge about food contamination versus attributes of food that may indicate contamination</td><td>6.4</td><td>0.010</td></tr><tr><td> Knowledge of shelf-life</td><td>3.5</td><td>0.003</td></tr><tr><td>Level of education</td><td>4.5</td><td>0.001</td></tr></tbody></table></table-wrap></p></sec></sec><sec id="Sec13"><title>Conclusions</title><p>In general, institutional food-handlers in Ghana had satisfactory knowledge in the areas of food safety, general and personal hygiene, cleaning and sanitation procedures. However, this did not translate into strict food hygiene practices. Therefore continuous food safety education and motivation for food-handlers of various demographic backgrounds with special attention paid to those with lower levels of education would complement other interventions that pursue the enhancement of food safety systems in Ghana.</p></sec></body><back><glossary><title>Abbreviations</title><def-list><def-item><term>AIDS</term><def><p>Acquired immune deficiency syndrome</p></def></def-item><def-item><term>HACCP</term><def><p>Hazard analysis critical control point</p></def></def-item><def-item><term>JHS/JSS</term><def><p>Junior high school/junior secondary school</p></def></def-item><def-item><term>KAP</term><def><p>Knowledge attitude and practice</p></def></def-item><def-item><term>SHS/SSS</term><def><p>Senior high school/senior secondary school</p></def></def-item><def-item><term>WHO</term><def><p>World health organization</p></def></def-item></def-list></glossary><ack><title>Acknowledgements</title><p>The authors would like to thank the staff and the participants of the various institutions visited for their contributions.</p><sec id="FPar1"><title>Funding</title><p>None.</p></sec><sec id="FPar2"><title>Availability of data and materials</title><p>The authors declare that the data supporting the findings of this study are fully described within the manuscript.</p></sec><sec id="FPar3"><title>Authors’ contributions</title><p>FA and JOK designed the study, analyzed and interpreted the data, discussed the results, wrote, edited and drafted the paper with equal contributions at all levels. EHH participated in the design of questionnaire, collected and complied the data. All authors have read and approved the final version of the manuscript.</p></sec><sec id="FPar4"><title>Author details</title><p>FA and JOK are both lecturers at the Department of Applied Biology, Faculty of Applied Sciences, University for Development Studies, P. O. Box 24, Navrongo-campus, Ghana. EHH is a graduate assistant at the University for Development Studies, Ghana.</p></sec><sec id="FPar5"><title>Competing interests</title><p>All the authors declare that they do not have any competing interests.</p></sec><sec id="FPar6"><title>Consent to publish</title><p>Not applicable. The published data does not contain details that could be traced to any individual respondent.</p></sec><sec id="FPar7"><title>Ethics approval and consent to participate</title><p>All respondents provided written informed consent before participating in the study. The study was considered to belong to exempt category review for ethical approval due to minimal risk to respondents. Waiver from approval was discussed with, and granted by the Navrongo Health Research Center Institutional Review Board (NHRCIRB), Ghana.</p></sec></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><mixed-citation publication-type="other">Adams M, Motarjemi Y. Basic food safety for health workers. Geneva: World Health Organization; 1999. p. 113–4.</mixed-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Annor</surname><given-names>GA</given-names></name><name><surname>Baiden</surname><given-names>EA</given-names></name></person-group><article-title>Evaluation of food hygiene knowledge attitudes and practices of food handlers in food businesses in Accra, Ghana</article-title><source>Food Nutr Sci</source><year>2011</year><volume>2</volume><issue>8</issue><fpage>830</fpage><pub-id pub-id-type="doi">10.4236/fns.2011.28114</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><mixed-citation publication-type="other">Omaye ST. Food and nutritional toxicology. Boca Raton: CRC press; 2004. p. 163–73.</mixed-citation></ref><ref id="CR4"><label>4.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>WHO</collab></person-group><source>Food Safety and Foodborne Illness. Fact sheets No. 237</source><year>2007</year><publisher-loc>Geneva</publisher-loc><publisher-name>World Health Organization</publisher-name></element-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barrie</surname><given-names>D</given-names></name></person-group><article-title>The provision of food and catering services in hospital</article-title><source>J Hosp Infect</source><year>1996</year><volume>33</volume><issue>1</issue><fpage>13</fpage><lpage>33</lpage><pub-id pub-id-type="doi">10.1016/S0195-6701(96)90026-2</pub-id><pub-id pub-id-type="pmid">8738199</pub-id></element-citation></ref><ref id="CR6"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jay</surname><given-names>LS</given-names></name><name><surname>Comar</surname><given-names>D</given-names></name><name><surname>Govenlock</surname><given-names>LD</given-names></name></person-group><article-title>A video study of Australian domestic food-handling practices</article-title><source>J Food Prot</source><year>1999</year><volume>62</volume><issue>11</issue><fpage>1285</fpage><lpage>1296</lpage><pub-id pub-id-type="doi">10.4315/0362-028X-62.11.1285</pub-id><pub-id pub-id-type="pmid">10571318</pub-id></element-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fielding</surname><given-names>JE</given-names></name><name><surname>Aguirre</surname><given-names>A</given-names></name><name><surname>Palaiologos</surname><given-names>E</given-names></name></person-group><article-title>Effectiveness of altered incentives in a food safety inspection program</article-title><source>Prev Med</source><year>2001</year><volume>32</volume><issue>3</issue><fpage>239</fpage><lpage>244</lpage><pub-id pub-id-type="doi">10.1006/pmed.2000.0796</pub-id><pub-id pub-id-type="pmid">11277681</pub-id></element-citation></ref><ref id="CR8"><label>8.</label><mixed-citation publication-type="other">Gent R, Telford D, Syed Q: An outbreak of campylobacter food poisoning at a university campus. Communicable disease and public health/PHLS 1999, 2(1):39–42</mixed-citation></ref><ref id="CR9"><label>9.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>WHO</collab></person-group><source>Strategies for implementing HACCP in small and/or less developed businesses</source><year>1999</year><publisher-loc>Geneva</publisher-loc><publisher-name>World Health Organisation, WHO/SDE/FOS/99.7</publisher-name></element-citation></ref><ref id="CR10"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ehiri</surname><given-names>JE</given-names></name><name><surname>Morris</surname><given-names>GP</given-names></name></person-group><article-title>Hygiene training and education of food handlers: does it work?</article-title><source>Ecol. Food Nutr.</source><year>1996</year><volume>35</volume><issue>4</issue><fpage>243</fpage><lpage>251</lpage><pub-id pub-id-type="doi">10.1080/03670244.1996.9991494</pub-id></element-citation></ref><ref id="CR11"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Greig</surname><given-names>JD</given-names></name><name><surname>Todd</surname><given-names>EC</given-names></name><name><surname>Bartleson</surname><given-names>CA</given-names></name><name><surname>Michaels</surname><given-names>BS</given-names></name></person-group><article-title>Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 1. Description of the problem, methods, and agents involved</article-title><source>J Food Prot</source><year>2007</year><volume>70</volume><issue>7</issue><fpage>1752</fpage><lpage>1761</lpage><pub-id pub-id-type="doi">10.4315/0362-028X-70.7.1752</pub-id><pub-id pub-id-type="pmid">17685355</pub-id></element-citation></ref><ref id="CR12"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Howes</surname><given-names>M</given-names></name><name><surname>McEwen</surname><given-names>S</given-names></name><name><surname>Griffiths</surname><given-names>M</given-names></name><name><surname>Harris</surname><given-names>L</given-names></name></person-group><article-title>Food handler certification by home study: Measuring changes in knowledge and behavior</article-title><source>Dairy, Food Environ Sanit</source><year>1996</year><volume>16</volume><issue>11</issue><fpage>737</fpage><lpage>744</lpage></element-citation></ref><ref id="CR13"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ansari-Lari</surname><given-names>M</given-names></name><name><surname>Soodbakhsh</surname><given-names>S</given-names></name><name><surname>Lakzadeh</surname><given-names>L</given-names></name></person-group><article-title>Knowledge, attitudes and practices of workers on food hygienic practices in meat processing plants in Fars, Iran</article-title><source>Food Control</source><year>2010</year><volume>21</volume><issue>3</issue><fpage>260</fpage><lpage>263</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2009.06.003</pub-id></element-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Baş</surname><given-names>M</given-names></name><name><surname>Ersun</surname><given-names>AŞ</given-names></name><name><surname>Kıvanç</surname><given-names>G</given-names></name></person-group><article-title>The evaluation of food hygiene knowledge, attitudes, and practices of food handlers’ in food businesses in Turkey</article-title><source>Food Control</source><year>2006</year><volume>17</volume><issue>4</issue><fpage>317</fpage><lpage>322</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2004.11.006</pub-id></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Capunzo</surname><given-names>M</given-names></name><name><surname>Cavallo</surname><given-names>P</given-names></name><name><surname>Boccia</surname><given-names>G</given-names></name><name><surname>Brunetti</surname><given-names>L</given-names></name><name><surname>Buonomo</surname><given-names>R</given-names></name><name><surname>Mazza</surname><given-names>G</given-names></name></person-group><article-title>Food hygiene on merchant ships: the importance of food handlers’ training</article-title><source>Food Control</source><year>2005</year><volume>16</volume><issue>2</issue><fpage>183</fpage><lpage>188</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2004.01.010</pub-id></element-citation></ref><ref id="CR16"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jevšnik</surname><given-names>M</given-names></name><name><surname>Hlebec</surname><given-names>V</given-names></name><name><surname>Raspor</surname><given-names>P</given-names></name></person-group><article-title>Food safety knowledge and practices among food handlers in Slovenia</article-title><source>Food Control</source><year>2008</year><volume>19</volume><issue>12</issue><fpage>1107</fpage><lpage>1118</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2007.11.010</pub-id></element-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Martins</surname><given-names>RB</given-names></name><name><surname>Hogg</surname><given-names>T</given-names></name><name><surname>Otero</surname><given-names>JG</given-names></name></person-group><article-title>Food handlers’ knowledge on food hygiene: The case of a catering company in Portugal</article-title><source>Food Control</source><year>2012</year><volume>23</volume><issue>1</issue><fpage>184</fpage><lpage>190</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2011.07.008</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Seaman</surname><given-names>P</given-names></name><name><surname>Eves</surname><given-names>A</given-names></name></person-group><article-title>Perceptions of hygiene training amongst food handlers, managers and training providers–A qualitative study</article-title><source>Food Control</source><year>2010</year><volume>21</volume><issue>7</issue><fpage>1037</fpage><lpage>1041</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2009.12.024</pub-id></element-citation></ref><ref id="CR19"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sharif</surname><given-names>L</given-names></name><name><surname>Al-Malki</surname><given-names>T</given-names></name></person-group><article-title>Knowledge, attitude and practice of Taif University students on food poisoning</article-title><source>Food Control</source><year>2010</year><volume>21</volume><issue>1</issue><fpage>55</fpage><lpage>60</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2009.03.015</pub-id></element-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Boateng</surname><given-names>AE</given-names></name></person-group><source>Assessment of food hygiene practices by street food vendors and microbial quality of selected foods sold. A study at Dunkwa-On-Offin, Upper Denkyira East municipality of the Central Region</source><year>2014</year><publisher-loc>Kumasi, Ghana</publisher-loc><publisher-name>Kwame Nkrumah University of Science and Technology</publisher-name></element-citation></ref><ref id="CR21"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kunadu</surname><given-names>AP-H</given-names></name><name><surname>Ofosu</surname><given-names>DB</given-names></name><name><surname>Aboagye</surname><given-names>E</given-names></name><name><surname>Tano-Debrah</surname><given-names>K</given-names></name></person-group><article-title>Food safety knowledge, attitudes and self-reported practices of food handlers in institutional foodservice in Accra, Ghana</article-title><source>Food Control</source><year>2016</year><volume>69</volume><fpage>324</fpage><lpage>330</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2016.05.011</pub-id></element-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soares</surname><given-names>LS</given-names></name><name><surname>Almeida</surname><given-names>RC</given-names></name><name><surname>Cerqueira</surname><given-names>ES</given-names></name><name><surname>Carvalho</surname><given-names>JS</given-names></name><name><surname>Nunes</surname><given-names>IL</given-names></name></person-group><article-title>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</article-title><source>Food Control</source><year>2012</year><volume>27</volume><issue>1</issue><fpage>206</fpage><lpage>213</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2012.03.016</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Angelillo</surname><given-names>IF</given-names></name><name><surname>Viggiani</surname><given-names>NM</given-names></name><name><surname>Greco</surname><given-names>RM</given-names></name><name><surname>Rito</surname><given-names>D</given-names></name></person-group><article-title>HACCP and food hygiene in hospitals knowledge, attitudes, and practices of food-services staff in Calabria, Italy</article-title><source>Infect. Control Hosp. Epidemiol.</source><year>2001</year><volume>22</volume><issue>06</issue><fpage>363</fpage><lpage>369</lpage><pub-id pub-id-type="doi">10.1086/501914</pub-id><pub-id pub-id-type="pmid">11519914</pub-id></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bolton</surname><given-names>D</given-names></name><name><surname>Meally</surname><given-names>A</given-names></name><name><surname>Blair</surname><given-names>I</given-names></name><name><surname>McDowell</surname><given-names>D</given-names></name><name><surname>Cowan</surname><given-names>C</given-names></name></person-group><article-title>Food safety knowledge of head chefs and catering managers in Ireland</article-title><source>Food Control</source><year>2008</year><volume>19</volume><issue>3</issue><fpage>291</fpage><lpage>300</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2007.04.006</pub-id></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Baluka</surname><given-names>SA</given-names></name><name><surname>Miller</surname><given-names>R</given-names></name><name><surname>Kaneene</surname><given-names>JB</given-names></name></person-group><article-title>Hygiene practices and food contamination in managed food service facilities in Uganda</article-title><source>Afr J Food Sci</source><year>2015</year><volume>9</volume><issue>1</issue><fpage>31</fpage><lpage>42</lpage><pub-id pub-id-type="doi">10.5897/AJFS2014.1170</pub-id></element-citation></ref><ref id="CR26"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Son</surname><given-names>R</given-names></name><name><surname>Mohhiddin</surname><given-names>O</given-names></name><name><surname>Toh</surname><given-names>P</given-names></name><name><surname>Chai</surname><given-names>L</given-names></name></person-group><article-title>Food court hygiene assessment and food safety knowledge, attitudes and practices of food handlers in Putrajaya</article-title><source>Int Food Res J</source><year>2015</year><volume>22</volume><issue>5</issue><fpage>1843</fpage><lpage>54</lpage></element-citation></ref><ref id="CR27"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Çakıroğlu</surname><given-names>FP</given-names></name><name><surname>Uçar</surname><given-names>A</given-names></name></person-group><article-title>Employees’ perception of hygiene in the catering industry in Ankara (Turkey)</article-title><source>Food Control</source><year>2008</year><volume>19</volume><issue>1</issue><fpage>9</fpage><lpage>15</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2007.01.001</pub-id></element-citation></ref><ref id="CR28"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olumakaiye</surname><given-names>MF</given-names></name><name><surname>Bakare</surname><given-names>KO</given-names></name></person-group><article-title>Training of food providers for improved environmental conditions of food service outlets in urban area Nigeria</article-title><source>Food Nutr Sci</source><year>2013</year><volume>4</volume><issue>07</issue><fpage>99</fpage><pub-id pub-id-type="doi">10.4236/fns.2013.47A012</pub-id></element-citation></ref><ref id="CR29"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Webb</surname><given-names>M</given-names></name><name><surname>Morancie</surname><given-names>A</given-names></name></person-group><article-title>Food safety knowledge of foodservice workers at a university campus by education level, experience, and food safety training</article-title><source>Food Control</source><year>2015</year><volume>50</volume><fpage>259</fpage><lpage>264</lpage><pub-id pub-id-type="doi">10.1016/j.foodcont.2014.09.002</pub-id></element-citation></ref><ref id="CR30"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Powell</surname><given-names>S</given-names></name><name><surname>Attwell</surname><given-names>R</given-names></name><name><surname>Massey</surname><given-names>S</given-names></name></person-group><article-title>The impact of training on knowledge and standards of food hygiene Eth a pilot study</article-title><source>Int J Environ Health Res</source><year>1997</year><volume>7</volume><issue>4</issue><fpage>329</fpage><lpage>334</lpage><pub-id pub-id-type="doi">10.1080/09603129773788</pub-id></element-citation></ref><ref id="CR31"><label>31.</label><mixed-citation publication-type="other">Fuerst R. Frobisher and FuerstÕs microbiology in health and disease: Foods as vectors of microbial disease. Sanitation in food handling (15th ed.). Philadelphia: W.B. Saunders Company; 1983. p. 418–33.</mixed-citation></ref><ref id="CR32"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Xavier</surname><given-names>CAC</given-names></name><name><surname>Oporto</surname><given-names>CO</given-names></name><name><surname>Silva</surname><given-names>MP</given-names></name><name><surname>Silveira</surname><given-names>IA</given-names></name><name><surname>Abrantes</surname><given-names>MR</given-names></name></person-group><article-title>Prevalência de Staphylococcus aureus em manipuladores de alimentos das creches municipais da cidade do Natal/RN</article-title><source>Revista Brasileira de Análises Clínicas</source><year>2007</year><volume>39</volume><issue>3</issue><fpage>165</fpage><lpage>168</lpage></element-citation></ref><ref id="CR33"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stepanović</surname><given-names>S</given-names></name><name><surname>Dakić</surname><given-names>I</given-names></name><name><surname>Morrison</surname><given-names>D</given-names></name><name><surname>Hauschild</surname><given-names>T</given-names></name><name><surname>Ježek</surname><given-names>P</given-names></name><name><surname>Petráš</surname><given-names>P</given-names></name><name><surname>Martel</surname><given-names>A</given-names></name><name><surname>Vuković</surname><given-names>D</given-names></name><name><surname>Shittu</surname><given-names>A</given-names></name><name><surname>Devriese</surname><given-names>LA</given-names></name></person-group><article-title>Identification and characterization of clinical isolates of members of the Staphylococcus sciuri group</article-title><source>J Clin Microbiol</source><year>2005</year><volume>43</volume><issue>2</issue><fpage>956</fpage><lpage>958</lpage><pub-id pub-id-type="doi">10.1128/JCM.43.2.956-958.2005</pub-id><pub-id pub-id-type="pmid">15695717</pub-id></element-citation></ref><ref id="CR34"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Montville</surname><given-names>R</given-names></name><name><surname>Chen</surname><given-names>Y</given-names></name><name><surname>Schaffner</surname><given-names>DW</given-names></name></person-group><article-title>Glove barriers to bacterial cross-contamination between hands to food</article-title><source>J Food Prot</source><year>2001</year><volume>64</volume><issue>6</issue><fpage>845</fpage><lpage>849</lpage><pub-id pub-id-type="doi">10.4315/0362-028X-64.6.845</pub-id><pub-id pub-id-type="pmid">11403136</pub-id></element-citation></ref><ref id="CR35"><label>35.</label><mixed-citation publication-type="other">Anon.: Acute gastroenteritis in Ireland, north and south: a telephone survey. In: Health Protection Surveillance Centre. 25e27 Middle Gardiner Street, Dublin I, Ireland; 2003.</mixed-citation></ref><ref id="CR36"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Buccheri</surname><given-names>C</given-names></name><name><surname>Casuccio</surname><given-names>A</given-names></name><name><surname>Giammanco</surname><given-names>S</given-names></name><name><surname>Giammanco</surname><given-names>M</given-names></name><name><surname>La Guardia</surname><given-names>M</given-names></name><name><surname>Mammina</surname><given-names>C</given-names></name></person-group><article-title>Food safety in hospital: knowledge, attitudes and practices of nursing staff of two hospitals in Sicily, Italy</article-title><source>BMC Health Serv Res</source><year>2007</year><volume>7</volume><issue>1</issue><fpage>1</fpage><pub-id pub-id-type="doi">10.1186/1472-6963-7-45</pub-id><pub-id pub-id-type="pmid">17199886</pub-id></element-citation></ref><ref id="CR37"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marais</surname><given-names>M</given-names></name><name><surname>Conradie</surname><given-names>N</given-names></name><name><surname>Labadarios</surname><given-names>D</given-names></name></person-group><article-title>Small and micro enterprises–aspects of knowledge, attitudes and practices of managers\’and food handlers\’knowledge of food safety in the proximity of Tygerberg Academic Hospital, Western Cape</article-title><source>South Afr J Clin Nutr</source><year>2008</year><volume>20</volume><issue>2</issue><fpage>50</fpage><lpage>61</lpage></element-citation></ref><ref id="CR38"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Walker</surname><given-names>E</given-names></name><name><surname>Pritchard</surname><given-names>C</given-names></name><name><surname>Forsythe</surname><given-names>S</given-names></name></person-group><article-title>Food handlers’ hygiene knowledge in small food businesses</article-title><source>Food Control</source><year>2003</year><volume>14</volume><issue>5</issue><fpage>339</fpage><lpage>343</lpage><pub-id pub-id-type="doi">10.1016/S0956-7135(02)00101-9</pub-id></element-citation></ref><ref id="CR39"><label>39.</label><mixed-citation publication-type="other">Julie GR: Food Safety Basics. A Reference Guide for Foodservices Operators. In., vol. 1; 2012: 5–6</mixed-citation></ref><ref id="CR40"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lambiri</surname><given-names>M</given-names></name><name><surname>Mavridou</surname><given-names>A</given-names></name><name><surname>Papadakis</surname><given-names>J</given-names></name></person-group><article-title>The application of hazard analysis critical control point (HACCP) in a flight catering establishment improved the bacteriological quality of meals</article-title><source>J R Soc Promot Heal</source><year>1995</year><volume>115</volume><issue>1</issue><fpage>26</fpage><lpage>30</lpage><pub-id pub-id-type="doi">10.1177/146642409511500109</pub-id></element-citation></ref><ref id="CR41"><label>41.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Clayton</surname><given-names>DA</given-names></name><name><surname>Griffith</surname><given-names>CJ</given-names></name><name><surname>Price</surname><given-names>P</given-names></name><name><surname>Peters</surname><given-names>AC</given-names></name></person-group><article-title>Food handlers' beliefs and self-reported practices</article-title><source>Int J Environ Health Res</source><year>2002</year><volume>12</volume><issue>1</issue><fpage>25</fpage><lpage>39</lpage><pub-id pub-id-type="doi">10.1080/09603120120110031</pub-id><pub-id pub-id-type="pmid">11970813</pub-id></element-citation></ref><ref id="CR42"><label>42.</label><mixed-citation publication-type="other">Huda N: Tahap pengetahuan, sikap dan amalan kebersihan dan keselamatan makanan di kalangan pengendali makanan di hospital. MSc Thesis, Universiti Kebangsaan Malaysia, Bangi; 2008</mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaGhanaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000129 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000129 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaGhanaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:5219779
|texte= Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:28061850" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaGhanaV1
| This area was generated with Dilib version V0.6.31. |  |