Study design, period, and area
A community-based cross-sectional study was conducted from February 21 to March 21, 2022, in Mettu and Bedelle towns. The two towns are located in the Oromia Regional State of southwest Ethiopia. Mettu is the capital of the Ilubabor Zone, and Bedelle is the capital of the Buno Bedelle Zone. Mettu and Bedelle towns are located about 600 and 480 km southwest of Addis Ababa, respectively. The two towns are home to different institutions and factories like Mettu University, Mettu Karl Comprehensive Specialized Hospital, Bedelle General Hospital, Bedelle Brewery Factory that provide services for a large number people in the southwest region of the country. There were 188 food establishments and 1015 food handlers in the study area, according to data gathered from the trade and industry bureaus of the two towns.
Populations and eligibility criteria
All food handlers who worked in food and drink establishments in Mettu and Bedelle towns were considered the source population, whereas all selected food handlers who worked in selected food and drink establishments in the two towns were study participants in this study.
Food handlers working in preparation, cleaning, and service areas of food establishments at the time of the study were included in the study. However, food handlers who were not available during the data collection period and who could not give a response due to severe illness were excluded from the study.
Sample size determination and sampling procedure
The sample size was determined using a single population proportion formula:
$$n={\left(z\frac{\alpha }{2}\right)}^2\frac{(pq)}{d^2}$$
Where Z = 1.96, the confidence limits of the survey result (value of Z at α/2 or critical value for normal distribution at 95% confidence interval).
p = 0.5 (50%), the population proportion of food safety practices from study conducted in Fiche town [5].
d = 0.05, the desired precision of the estimate
q = 1-p
So the calculated sample size was, \(n={(1.96)}^2\frac{\left(0.5\ast 0.5\right)}{0.05^2}=384\)
Since the total number of food handlers in the study area was less than 10,000, we have utilized correction formula, that gives nf =288. After adding a 5% non-response rate and a design effect of 1.5, the final sample size of 453 was used for this study.
The list of existing food establishments and the number of food handlers currently working in food establishments were obtained from Mettu and Bedelle towns’ Trade and Industry Office. Then, food establishments for this study were randomly selected from a total list of food establishments. Next, study participants were proportionately allocated to each selected food establishment based on the number of food handlers. Then, an updated list of food handlers was taken from the manager or owner of the selected establishment. Finally, study participants were selected using a simple random method from each establishment.
Study variables
The dependent variable of this study was food safety practice, and the independent variable includes socio-demographic factors (educational level, age, gender, marital status, and work experience), institutional factors (training, supervision, and availability of guidelines for food safety), health-related factors (medical check-ups and sick leave during illness), knowledge-related factors (knowledge of methods to prevent contamination and knowledge of food safety practices), and sanitary facility-related factors (three-compartment dishwashing systems, refrigerators in the kitchen, and water supply).
Data collection tools and procedure
Data were collected using an interviewer-administered standardized questionnaire adapted and modified from previously published studies [3, 8, 9, 13]]. The questionnaire was structured into six parts: socio-demographic parts with six questions, food safety knowledge with nine questions, basic sanitary facilities with seven questions, institutional factors with four questions, health-related with two questions, and food safety practice with twelve questions.
Food safety knowledge was assessed using nine closed-ended questions with two possible answers: “yes” or “no.” The questions mainly focus on the personal hygiene of food handlers, temperature control, cross-contamination, food storage, and equipment hygiene. In assessing knowledge, one score was given for every correct answer and zero score for incorrect answers or unanswered questions. Then, the responses to these questions were added together to generate a knowledge score. Food handlers who obtained a total score greater than the mean value were considered to have good food safety knowledge, and those who had scores less than the mean value were considered to have “poor food safety knowledge.”
Food safety practices were also assessed using 12 closed-ended questions with two possible answers: “yes” or “no.” One score was given for every standard practice and zero for every unsafe practice. Food handlers with a total score greater than the mean were considered to have “good food safety practices,” while those with a score less than the mean were considered to have “poor food safety practices.” The data was collected by three diploma nurses, and the overall data collection processes were supervised by one health officer after two days of training.
Data quality assurance
The quality of the data was ensured through all data collection tools and was translated into the local language and back-translated to English by language experts to ensure its consistency. Training of data collectors and supervisors was conducted to enable them to acquire the basic skills necessary for data collection and supervision, respectively. A pre-test was done on 5% of the sample in Gore town, and based on the results of the pre-test, necessary modifications were made. After data collection, the completeness of the data was checked by the principal investigator ahead of data entry. Incomplete and inconsistent questionnaires were excluded from the analysis.