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The Scientific Journal of University of Benghazi
SJUOB (2024) 37 (1) Medical Sciences: 110 – 119

Elsherif et al
http://journals.uob.edu.ly/sjuob
Knowledge, Attitude, and Practices Regarding Safe and Hygienic Food among
Food Handlers in some Benghazi Hospitals
Sara Ahmed Elsherif 1 *- Aya Abdallah Mohammed 1 - Budor Omar Mansor 1 - Manar Wanis Elbarghathi 1 -
Najwa Faraj Elmodabel 1.
1 Nutrition department - Public Health - University Of Benghazi.
Received: 19 / 02 / 2024; Accepted: 09 / 05 / 2024
ABSTRACT
Background: In the healthcare sector, hospitals play a pivotal role in patient care, with food services being a vital com-
ponent.
Aim: This study focused on the knowledge, attitudes, and practices (KAP) of food handlers in some hospitals in Benghazi,
Libya, who are instrumental in preventing foodborne illnesses through proper food safety and hygiene.
Methods: A descriptive study of a cross-sectional design was conducted in Benghazi, the research assessed 70 food
handlers from Benghazi Medical Center, Benghazi Children’s Hospital, and Dar-Alshifa Hospital, aged 18 to 48 years. Data
was collected via interviews using a questionnaire covering socio-demographic information and KAP-related questions.
Results: The participants, encompassing various roles such as waiters, cooks, nutritionists, and cleaners, mostly had 1-5
years of experience, with 58.6% having undergone prior training. Despite a generally positive attitude towards food safety,
the study uncovered a deficiency in food hygiene knowledge. However, practices for periodic analysis were commendably
executed. Further scrutiny indicated that knowledge levels regarding hygiene and sanitation did not significantly differ among
food handlers based on age, gender, occupation, education, experience, training, or hospital type.
Conclusion: The findings suggest that while the attitude towards food safety is commendable, there is an imperative need
to enhance the food handlers’ knowledge of hygiene. This improvement is crucial for ensuring the implementation of safe
and hygienic food handling practices within hospital settings, thereby safeguarding patient health against foodborne diseases.
KEYWORDS: Food Safety, Food Hygiene, Food Safety Knowledge, Attitude, Practice, Food Handlers.
1. INTRODUCTION Food handlers play a crucial role in the transmission of

Food hygiene is a set of practices and conditions that foodborne pathogens, particularly through contaminated
are necessary to ensure food safety throughout the entire food and from raw meat to prepared-to-consume meals.
food supply chain from production to consumption. Food Food handlers can carry human-specific foodborne patho-
contamination can occur at any stage of the process, in- gens such as Hepatitis A, noroviruses, Salmonella, Staph-
cluding during slaughter or harvesting, processing, stor- ylococcus aureus, and Shigella species on their fingers,
age, distribution, transportation, preparation, and handling cuts, sores, mouth, skin, and hair, which can then be trans-
1
. mitted to food 3.
Food handlers are individuals who handle unpackaged Data indicates that foodborne illnesses are prevalent
food and beverages and are involved in various activities worldwide. However, due to limitations in surveillance
such as preparation, manufacturing, serving, testing, and systems, only a small proportion of actual cases are re-
packaging of food and beverages. Food handlers must use ported. Estimates suggest that approximately 600 million
appropriate hygiene measures when handling food to pre- people worldwide fall ill from consuming contaminated
vent the spread of foodborne illnesses 2. food annually, with diarrheal diseases being the most com-
mon form of these illnesses. It has been reported that food-
borne illnesses cause up to 70% of diarrheal sickness in
developing countries. This is due in part to a lack of per-
sonal hygiene and food safety measures among food han-
dlers 4.
*Correspondence: Sara Ahmed Elsherif.
Hospital food hygiene is critical in ensuring the health
sara.elsherif@uob.edu.ly of patients. Studies have shown that incorrect practices and
lack of knowledge among food handlers are contributing
©2024 University of Benghazi. All rights reserved. ISSN:Online 2790-1637, Print 2790-1629; National Library of Libya, Legal number : 154/2018
110
SJUOB (2024) 37 (1) Medical Sciences: 110 – 119 Elsherif et al.
factors to foodborne illnesses, which remain a common kitchen produces a large amount of ready-to-eat food that
problem in healthcare settings. Food poisoning is a condi- is particularly susceptible to contamination. Thus, food
tion caused by the ingestion of food contaminated with handlers play a critical role in preventing food poisoning
pathogenic microorganisms or toxins produced by such and promoting food safety. They must ensure that food
microorganisms in sufficient amounts to cause pathologi- preparation, processing, and serving meet hygienic stand-
cal conditions. Studies have linked lack of knowledge and ards. However, it is essential to acknowledge that food
poor handling of food as a major cause of food poisoning; handlers may carry various foodborne pathogens, which
The knowledge, attitudes, and practices (KAP) of food can pose health risks to others.
handlers have been identified as having a significant im-
The purpose of this research was to evaluate the
pact on the incidence of food poisoning 5,6,7,8.
knowledge, attitude, and practice of hospital food handlers
A cross-sectional study was conducted between Janu- about safe and hygienic food; it also aimed to explore the
ary and June 2020 to assess the food safety knowledge potential association between the hospital category and the
(FSK) of food handlers (FHs) in hospitals' food services in employees’ knowledge as well as to explore if individual
Amman, Jordan. The study included 264 FH participants characteristics influence their awareness about food safety.
and found that the overall FSK was moderate. The study
recommends additional food safety training in specific ar- 2. METHODOLOGY:
eas, including food handling operations and foodborne Designs:
pathogens 4. A cross-sectional descriptive study was utilized to conduct
a cross-sectional study conducted at a psychiatric hos- this study.
pital in Magelang, Central Java Province, Indonesia, the Setting:
researchers investigated the knowledge, attitude, and prac- The study was carried out at Benghazi Medical Center
tice of hygiene and sanitation among 37 food handlers. The (BMC), Benghazi Children’s Hospital, and Dar-Alshifa Hospital.
findings revealed that while knowledge and attitude were Study Period:
generally positive (with 89% having good knowledge The Data of the study was collected between February 2023
and 84% exhibiting a positive attitude), more than one- and June 2023.
third (38%) of food handlers had poor hygiene and sanita- Study Participants:
tion practices. Surprisingly, there were no significant cor- All food handlers who worked at the three hospitals, includ-
relations between knowledge, attitude, and practice, indi- ing cookers, cleaners, waiters, and nutritionists, were recruited
cating that knowledge did not necessarily translate into for the study. The study involved 70 food handlers who were
better practices. Additionally, the majority (73%) of food available during data collection and willing to participate in the
handlers had never received formal training related to hy- study.
giene and sanitation, which significantly impacted their Study tools and methods of data collection:
practices. In conclusion, addressing this gap between To assess the knowledge, attitude, and practices of food han-
knowledge and practice is crucial for improving food dlers in food preparation and safety, direct face-to-face inter-
safety among hospital food-handlers 9. views were conducted. A self-administered questionnaire for this
study was prepared based on the questionnaires used in studies
A cross-sectional descriptive study was conducted in undertaken in Italy, and Turkey(24,22);consisting of 25 multiple-
governmental hospitals affiliated with Daqahlia Gover- choice questions, which were divided into four sections. The first
norate, Egypt, to assess the knowledge, attitude, and prac- section of the questionnaire comprised seven questions that fo-
tices of food handlers regarding safe and hygienic food in cused on the demographic information of the participants, includ-
Egyptian government hospitals. The study involved 542 ing gender, age, type of employment, educational level, number
food handlers, and the findings showed that the overall of years of service, previous training, and hospital sector. The
knowledge, attitude, and practices of food handlers were second section of the questionnaire was designed to test the par-
less than half of what they should be. Based on the findings ticipants' knowledge of food safety in hospital kitchens, and it
included nine questions. The third section focused on the atti-
of the study, there was a strong correlation between food
tudes of food handlers toward food safety. Finally, the fourth sec-
handlers' knowledge, attitude, and practices, which sug- tion assessed the practices of food handlers related to food safety,
gests that improving one of these factors may lead to im- and it included six questions
provements in the others. Therefore, the study recom-
Statistical Analysis:
mends that educational and training programs be imple-
The gathered data were organized, encoded, and processed
mented to improve food handlers' knowledge, attitudes,
using IBM SPSS Statistics for Windows, Version 21. Descriptive
and practices. To achieve this goal, the study suggests that statistical measures such as frequency and percentage were com-
community health nurses use a variety of teaching methods puted for all pertinent variables. Additionally, the chi-square test
and modes to ensure that the training is effective 10. was employed to assess the statistical significance of relation-
ships between various variables, with a threshold for significance
Hospitals serve a significant population, including pa-
set at (P < 0.05).
tients, doctors, nurses, and visitors, and the hospital
111
Ethical consideration: Table 1 provides details of the demographic profile for each
Before conducting the study, ethical approval was obtained hospital included in the study. The BMChad the largest number
from the Faculty of Public Health, Benghazi Medical Centre, of participants (n=27), followed by Dar Al Shifa (n=24). The pe-
Dar-Alshifa, and Benghazi Children’s Hospital. In addition, in- diatric hospital had 19 participants. Notably, Dar-Alshifa is the
formed consent was obtained from food handlers before admin- only private-sector hospital in this study. The highest age group
istering the questionnaires. of employees who participated in the study were aged 38-48
years for BMC, 28-38 years for the Benghazi Children’s Hospi-
3. RESULTS tal, and 18-28 years for Dar Al Shifa, constituting 37.3%, 36.8%,
and 37.5%, respectively. The table also reveals that 55.6%,
Demographic Characteristics 75.9%, and 54.2% of the participants in BMC, Benghazi Chil-
In this study, participants were70 food handlers from three dren’s Hospital, and Dar Al Shifa hospitals were male. Among
hospitals in Benghazi. Specifically, there were 24 from Dar- the food handlers, 51.9% worked as waiters in BMC, 36.8%
Alshifa, 27 from Benghazi Medical Centers, and 19 from Ben- worked as cleaners in Benghazi Children’s Hospital, and 41.7%
ghazi Children’s Hospital. The gender distribution among the worked as cooks in Dar-Alshifa.
surveyed food handlers was 39 males and 31 females. The par- Regarding education, 48.1% of participants in BMC had a
ticipants held various occupations: 24 were waiters, 23 were secondary degree, 42.1% had a basic degree in pediatric hospital
cooks, 9 were nutritionists, and 14 were cleaners. The age range employment, and 45.8% had a secondary degree of employment
of the participants was 18 to <48 years, with the majority falling in Dar-Alshifa. According to (Table 1) Examining employment
between 18 and 38 years, followed by those aged between 38 and experience, 40.7% of BMC participants had 6-10 years of expe-
48. In terms of education, 34.3% (n=24) had less than a high rience, whereas 63.2% and 62.5% of those in the Benghazi Chil-
school education, 42.9% (n=30) held a high school certificate, dren’s Hospital and Dar-Alshifa Hospital, respectively, had 1-5
and 22.9% (n=16) were BSc certified. Their employment experi- years of experience. Additionally, 51.9%, 36.8%, and 83.3% of
ence varied from 1 to 20 years, with the majority having 1 to 5 food handlers received training in BMC, Pediatric, and Dar-
years of experience. Additionally, 58.6% of the participants re- Alshif Hospital, respectively.
ceived previous training, and most of them worked in the public
sector (66%), (see Table 1).
Table 1. Sociodemographic & Setting States Overview (n=70)
Hospitals No (%) Total No (%)
Benghazi Chil-
Dar-Alshifa BMC
dren’s
Sample size 24 (34.3) 27 (38.6) 19 (27.1) 70 (100)
Variables
18 - 28 9 (37.5) 5 (18.5) 8 (42.1) 22 (31.4)
28 - 38 6 (25.0) 9 (33.3) 7 (36.8) 22 (31.4)
Age
38 - 48 5 (20.8) 10 (37.0) 3 (15.8) 18 (25.7)
<84 4 (16.7) 3 (11.1) 1 (5.3) 8 (11.4)
Male 13 (54.2) 15 (55.6) 11 (57.9) 39 (55.7)

Sex
female 11 (45.8) 12 (44.4) 8 (42.1) 31(44.3)
cooker 10 (41.7) 7 (25.9) 6 (31.6) 23 (32.9)

cleaner 5 (20.8) 2 (7.4) 7 (36.8) 14 (20.0)
Occupation
Waiter 5 (20.8) 14 (51.9) 5 (26.3) 24 (34.3)
Nutritionist 4 (16.7) 4 (14.8) 1 (5.3) 9 (12.9)
Basic 7 (29.2) 9 (33.3) 8 (42.1) 24 (34.3)

Education Secondary 11 (45.8) 13 (48.1) 6 (31.6) 30 (42.9)
Higher 6 (25.0) 5 (18.5) 5 (26.3) 16 (22.9)
1–5 15 (62.5) 7 (25.9) 12 (63.2) 34 (48.6)

6 - 10 2 (8.3) 11 (40.7) 5 (26.3) 18 (25.7)
Years of experience
11 - 15 5 (20.8) 7 (25.9) 1 (5.3) 13 (18.6)
16 - 20 2 (8.3) 2 (7.4) 1 (5.3) 5 (7.1)
No 4 (16.7) 13 (48.1) 12 (63.2) 29 (41.4)

Previous training
Yes 20 (83.3) 14 (51.9) 7 (36.8) 41(58.6)
Public - 27 (100) 19 (100) 46 (66)

Hospital sector
Private 24 (100) - - 24 (34)
112
Respondent's Food Safety Knowledge of correct responses regarding food items associated with
Table 2 indicates that the majority of food handlers in the transmission of Vibrio cholera was observed across all
the study had knowledge about the preparation of food in three hospitals (as indicated in Table 2).
advance and how it can contribute to food poisoning and This table presents the knowledge of food handlers re-
contamination, as well as the importance of wearing gloves garding temperature and its impact on food safety (Table
(with 100% correct answers) in all three hospitals. Addi- 2).
tionally, 86.4% of food handlers knew about proper clean- Among the participants at Dar-Alshifa, 45.8% cor-
ing, and 72.8% knew about detergent use. rectly identified the appropriate refrigerator temperature
In terms of foodborne disease transmission, the study as 8°C. In BMC, 40.7% of participants answered incor-
found that 50% of food handlers in Dar-Alshifa and 40.7% rectly or were unsure, while in Benghazi Children’s Hos-
in BMC were incorrect in believing that hepatitis B could pital, 68.4% of respondents provided the correct answer.
be transmitted through food. However, in Benghazi Chil- However, across all three hospitals, most participants were
dren’s Hospital, 73.7% of respondents correctly recog- unaware that cold ready-to-eat foods should be maintained
nized that hepatitis B can indeed be transmitted via food. at -11°C.
Additionally, 54.2%, 40.7%, and 73.7% of food han- Additionally, food items associated with the transmis-
dlers in Dar-Alshifa, BMC, and Benghazi Children’s Hos- sion of Vibrio cholera were correctly identified by 50% of
pital, respectively, were aware that cholera can also be Dar-Alshifa participants, 48.1% of BMC participants,
transmitted through food. Notably, the highest percentage and 73.7% of Benghazi Children’s Hospital respondents.
Table 2. Assessment of Food Handlers’ Safety Awareness
Hospitals
Statements Benghazi Children’s
Dar-Alshifa BMC
Hospital
N (%) N (%) N (%)
Preparation of food in advance is likely to contribute Correct 21 (87.5) 18 (66.7) 19 (100)
to food poisoning Incorrect 3 (12.5) 9 (33.3)
I don’t know
Total 24 27 19
Reheating food is likely to contribute to food contami- Correct 15 (62.5) 17 (63.0) 16 (84.2)
nation Incorrect 6 (25.0) 10 (37.0) 3 (15.8)
I don’t know 3 (12.5)
Total 24 27 19
Wearing gloves while handling food minimizes the Correct 24(100%) 27 (100) 19 (100)
risk of transmitting the infection to food-service staff Incorrect
I don’t know
Total 24 27 19
Correct 11 (45.8) 5 (18.5) 13 (68.4)
The correct temperature for a refrigerator is (8°C)
Incorrect 7 (29.2) 11 (40.7) 4 (21.1)
I don’t know 6 (25.0) 11(40.7) 2 (10.5)
Total 24 27 19
Correct 10 (41.7) 10 (37.0) 10 (52.6)
Hot ready to eat foods should be maintained at (40°C)
Incorrect 10 (41.7) 11 (70.7) 4 (21.1)
I don’t know 4 (16.7) 6 (22.2) 5 (26.3)
Total 24 27 19
Cold ready to eat foods should be maintained at (- Correct 4 (16.7) 7 (25.9) 4 (21.1)
11°C) Incorrect 17 (70.8) 13 (48.1) 11 (57.9)
I don’t know 3 (12.5) 7 (25.9) 4 (21.1)
Total 24 27 19
Correct 9 (37.5) 8 (29.6) 14 (73.7)
Hepatitis B can be transmitted by food
Incorrect 12 (50.0) 11 (40.7) 4 (21.1)
I don’t know 3 (12.5) 8 (29.6) 1 (5.3)
Total 24 27 19
Correct 13 (54.2) 11 (40.7) 14 (73.7)
Cholera can be transmitted by food
Incorrect 2 (8.3) 7 (25.9) 4 (21.1)
I don’t know 9 (37.5) 9 (33.3) 1 (5.3)
Total 24 27 19
Food items associated with the transmission of Vibrio Correct 12 (50.0) 13(48.1) 14 (73.7)
cholera Incorrect 2 (8.3) 5 (18.5) 4 (21.1)
I don’t know 10 (41.7) 9 (33.3) 1 (5.3)
Total 24 27 19
113
Table (3) conducted a chi-square test of independence P- knowledge levels across the different hospitals. In other words,
value in the table indicates whether there is a statistically signif- the type or name of the hospital does not seem to affect the
icant difference in knowledge levels across different hospitals. knowledge levels of the employees.
The test did not find a statistically significant difference in
Table 3. Hospital Knowledge Comparison Overview
Classification of knowledge
Total P –value
Hospitals Poor knowledge Moderate knowledge Good knowledge
10 13 1 24
Dar-alshifa
41.7% 54.2% 4.2% 100.0%
10 15 2 27
BMC
37.0% 55.6% 7.4% 100.0% 0.221
Benghazi Children’s Hos- 3 16 0 19

pital 15.8% 84.2% 0.0% 100.0%
23 44 3 70
Total
32.9% 62.9% 4.3% 100.0%
* (significant at p-value< 0.05).
Food Safety Attitudes Of Food Handlers food should not be refrozen. The agreement rates varied across
hospitals: 70.8% in Dar-Alshifa, 74.1% in BMC, and a
Table (4) regarding the attitudes of food handlers toward the higher 84.2% in the Benghazi Children’s Hospital. Furthermore,
prevention and control of foodborne diseases; The study exam- findings emphasized the importance of hygiene: food handlers
ined the attitudes of food handlers across three hospitals concern- with abrasions or cuts on their fingers or hands
ing food safety practices. Notably, all respondents unanimously should avoid touching unwrapped foods. Compliance rates
agreed that raw foods should be kept separate from cooked foods, were 83.3% in Dar-Alshifa, 96.3% in BMC, and a per-
demonstrating a 100% consensus on this crucial practice. Addi- fect 100% in Benghazi Children’s Hospital.
tionally, the majority of food handlers concurred that defrosted
Table 4. Food Safety Attitudes Among Handlers

Hospitals
Respondent's food safety attitudes Dar-Alshifa BMC Benghazi Children’s Hospital
Answer
N (%) N (%) N (%)
No
Raw foods should be kept separate from cooked
Yes 24 (100) 27 (100) 19 (100)
foods
Uncertain
Total 24 27 19
No 5 (20.8) 4 (14.8) 3 (15.8)
Defrosted food should not be refrozen Yes 17 (70.8) 20 (74.1) 16 (84.2)
Uncertain 2 (8.3) 3 (11.1)
Total 24 27 19
No 4 (16.7)
Food service staff with abrasions or cuts on their
Yes 20 (83.3) 26 (96.3) 19 (100)
hands should not touch unwrapped food
Uncertain 1 (3.7)
Total 24 27
114
Food Safety Practices However, when it comes to the practice of thawing frozen
food at room temperature, there are variations across hospitals.
The study on self-reported hygienic practices among partici-
pants in three hospitals revealed several noteworthy trends. At Dar-Alshifa, 41.7% of food handlers reported always fol-
Firstly, most participants in these hospitals diligently wash their lowing this method.
hands before and after handling unwrapped raw and cooked food,
In contrast, at BMC, the percentage was higher,
emphasizing the importance of this practice for preventing cross-
with 74.1% answering always, while in Benghazi Children’s
contamination and maintaining food safety. Additionally, a sig-
Hospital, 52.6% responded similarly. These findings underscore
nificant number of food handlers in all three hospitals use sepa-
the need for consistent adherence to hygienic practices among
rate kitchen utensils when preparing cooked and raw food, mini-
food handlers, ensuring the well-being of both patients and staff
mizing the risk of transferring harmful microorganisms between
see Table (5).
different food items.
Table 5. Food Safety Practices Among Handlers
Hospitals
Respondent's food safety practices Dar-Alshifa BMC Benghazi Children’s Hospital
Answer
N (%) N (%) N (%)
Always 23 (95.8) 19 (70.4) 19 (100)
Do you wash your hands before touching unwrapped
Often 1 (4.2) 5 (18.5)
raw food?
Occasionally 3 (11.1)
Total 24 27 19
Always 22 (91.7) 20 (74.1) 18 (94.7)
Do you wash your hands after touching unwrapped
Often 1 (4.2) 4 (14.8) 1 (5.3)
raw food?
Occasionally 1 (4.2) 3 (11.1)
Total 27 19
Always 22 (91.7) 19 (70.4) 18 (94.7)
Do you wash your hands before touching unwrapped
Often 1 (4.2) 5 (18.5) 1 (5.3)
cooked food?
Total 24 27 19
Always 22 (91.7) 18 (66.7) 18 (94.7)
Do you wash your hands after touching unwrapped
Often 1 (4.2) 5 (18.5) 1 (5.3)
cooked food?
Total 24 27 19
Always 19 (79.2) 17 (63.0) 14 (73.7)
Do you use separate kitchen utensils to prepare
Often 5 (20.8) 7 (25.9) 5 (26.3)
cooked and raw food?
Occasionally 3 (11.1)
Total 24 27 19
Always 10 (41.7) 20 (74.1) 10 (52.6)
Often 10 (41.7) 4 (14.8) 9 (47.4)
Do you thaw frozen food at room temperature?
No answer 2 (8.3)
Total 24 27 9
115
Individual Characteristics and Knowledge of Hygiene and the knowledge levels of food handlers. The findings summa-
and Sanitation rized in Table 6 indicate that there is no significant difference in
hygiene and sanitation knowledge across various individual char-
During the interview, several participants highlighted that in- acteristics, including (age, sex, occupation, education, years of
dividual characteristics could be linked to one’s hygiene experience, previous training, and hospital sector).
knowledge. Subsequently, a more detailed analysis was con-
ducted to explore the relationship between these individual traits
Table 6. Individual Variability in Hygiene & Sanitation Knowledge
Poor knowledge Moderate knowledge Good knowledge Total

Individual characteristic P-value
No No No No
18-28 7 14 1 22
28-38 4 17 1 22
Age 0.579
38-48 8 9 1 18
<84 4 4 0 8
Male 13 24 2 39 0.916
Sex
Female 10 20 1 31
cooker 7 15 1 21
cleaner 5 9 0 14
0.656
Occupation Waiter 10 13 1 24
Nutritionist 1 7 1 9
Basic 8 13 2 23
Education Secondary 15 17 12 44 0.117
Higher 1 0 2 3
1–5 13 20 1 34
6 - 10 5 13 0 18
Years of
experience 0.205
11 - 15 2 9 2 13
16 - 20 3 2 0 5
Yes 15 24 2 41
Previous train-
0.672
ing
No 8 20 1 29
Public 13 34 2 49
Hospital sector 0.211
Private 10 10 1 21
116
4. DISCUSSION improving food safety knowledge among food handlers to ensure

the proper handling and preparation of food.
The frequency of food poisoning outbreaks and related con-
cerns is increasing, leading to demands for improved hygiene and In a study conducted in a hospital in Turkey, 93.2% of food
quality practices. The European Commission has recognized the handlers considered that reheating food might contribute to food
importance of limiting food poisoning outbreaks, particularly due contamination, This finding corresponds to the result of the pre-
to the rise in meals consumed outside the home and the availabil- sent study conducted in Benghazi Children’s Hospital, where
ity of pre-prepared meals. This changing consumer behavior 84.2% of food handlers held the same belief 19.These findings
highlights the need for more effective food hygiene controls. 10,11. suggest that food handlers have an understanding of the risks as-
sociated with improper food handling practices, such as reheat-
According to statistics, caterers are responsible for the ma- ing, but further education and training may be necessary to ensure
jority of food poisoning outbreaks compared to any other food that food safety protocols are followed correctly.
industry, accounting for 70% of all bacterial food poisoning inci-
dents. Inadequate time and temperature management of food ac- The transmission of Hepatitis B, primarily through blood and
counts for 70% of food poisoning outbreaks, while cross-contam- body fluids rather than food, is a fact grasped by nearly half
ination is responsible for the remaining 30% 8. (50%) of the food handlers in Dar-Alshifa. Similarly, 40.7% of
their counterparts at BMC are also aware of this truth. Intri-
Indeed, the study aimed to assess the knowledge, attitudes, guingly, these findings echo a prior study conducted in Turkish
and practices of food handlers concerning safe and hygienic food hospitals, where up to 41.1% of food handlers held the correct
preparation in Benghazi Medical Center, Dar-Alshifa, and Ben- understanding of this matter 19. This thread of knowledge, weav-
ghazi Children’s Hospital. ing its way through different cultures and countries, underscores
Previous studies have suggested that inadequate knowledge the importance of accurate health awareness in the global com-
of food safety can result in poor hygienic practices among food munity.
handlers 12,13. However, Clayton et al., 14 reported that 63% of The majority of the food handlers in Dar-Alshifa, BMC Cen-
food handlers demonstrated knowledge of food safety but did not ter, and Benghazi Children’s Hospital (54.2%, 40.7, and 73.7%,
exhibit a corresponding positive behavior towards food safety respectively) knew that food could be a mode of cholera trans-
and hygiene practices. This finding contrasts with the present mission. This finding is in line with a study in Turkey that re-
study, which showed good practice among food handlers despite ported a 64.4% rate of correct knowledge about food-borne chol-
moderate knowledge of food safety. era. The same study in Turkey also revealed that the percentage
In a study conducted by Akabanda et al., 15 the majority of of food handlers who had good knowledge scores on hygiene and
food handlers demonstrated knowledge of the importance of gen- sanitation was 89.19%. This differed from the knowledge level
eral sanitary practices, such as wearing gloves (77.9% correct an- of this study, which was only fair and had a low percentage of
swers). This finding is consistent with the present study which good knowledge 19.
also reported a high level of knowledge (100%) and another study The findings of a study conducted in Pakistan were similar to
conducted in Al Madinah Hospitals in Saudi Arabia which also this study's results regarding knowledge and attitudes but differed
found that all food handlers demonstrated knowledge regarding in practices 20.
the importance of sanitary practices.
According to a report from Ghana, 96% of uncooked food
Food composition varies, and as a result, a single cooking was separated from cooked food, which is consistent with the
temperature cannot ensure both the desired culinary quality and current study. However, the current study had higher rates of sep-
safety for all types of food. To inactivate pathogenic vegetative aration in three hospitals (Dar-Alshifa, BMC Hospital, and Ben-
bacteria, different combinations of time and temperature are re- ghazi Children’s Hospital), where 100% of food handlers fol-
quired; Temperature treatment is often the critical control point lowed this practice. The Ghana report also showed that 87.2% of
in the food production process, and a lack of understanding of food handlers agreed with the current study that unwrapped food
temperature-related issues could significantly hinder the effec- should not be touched by staff with abrasions or cuts on their
tive implementation of Hazard Analysis and Critical Control hands. However, Contrary to the current study, the Ghana study
Points (HACCP) 17. reported that only 30% of food handlers supported the idea that
According to the present study, a lack of knowledge existed defrosted food should not be refrozen. Meanwhile, in Dar-
among food handlers regarding acceptable refrigerator tempera- Alshifa, BMC, and Children’s Hospitals, )70.8%, 74.1%, and
ture ranges and the critical temperatures of hot ready-to-eat foods 84.2%( of food handlers, respectively, agreed with this statement
15.
in Benghazi Children’s Hospital (68.4%, 52.6%) and Dar-Alshifa
hospitals (41.8%, 45.7%), as a significant proportion of food han- A study in a Brazilian hospital found that 41.0% of food han-
dlers provided incorrect answers; Similar findings have been re- dlers thawed frozen food at room temperature. This practice
ported in other studies. For instance, in a study conducted by (Baş aligns with a recent study conducted at Dar-Alshifa Hospital,
M et al.,2006) in Turkey, only 42% of food handlers knew the BMC, and Benghazi Children’s Hospital, where 41.7%, 74.1%,
correct temperature for food storage. In addition, a study by and 52.6% of food handlers, respectively, consistently thawed
(Walker et al., 2003); found that less than half of the 444 food frozen food at room temperature 21.
handlers surveyed knew the correct temperature of hot food hold-
ing. 17,18 Both the studies by Baş et al. in Turkey and Walker et A study conducted in a military hospital reported the food
al. reported a lack of knowledge regarding critical temperatures handling practices of food handlers, where almost all staff
among food handlers, which is consistent with the findings of the (94.5%) reported that they always wash their hands before pre-
present study conducted in Benghazi Children’s Hospital and paring food. This finding is consistent with the results of the cur-
Dar-Alshifa hospitals; These studies highlight the importance of
117
rent study, in Dar-Alshifa, BMC, and Benghazi Children’s Hos- 8. REFERENCES:

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The Scientific Journal of University of Benghazi

SJUOB (2024) 37 (1) Medical Sciences: 110 – 119

1. INTRODUCTION Food handlers play a crucial role in the transmission of

Male 13 (54.2) 15 (55.6) 11 (57.9) 39 (55.7)

cooker 10 (41.7) 7 (25.9) 6 (31.6) 23 (32.9)

Basic 7 (29.2) 9 (33.3) 8 (42.1) 24 (34.3)

1–5 15 (62.5) 7 (25.9) 12 (63.2) 34 (48.6)

No 4 (16.7) 13 (48.1) 12 (63.2) 29 (41.4)

Public - 27 (100) 19 (100) 46 (66)

Table 3. Hospital Knowledge Comparison Overview

Benghazi Children’s Hos- 3 16 0 19

Table 4. Food Safety Attitudes Among Handlers

Table 6. Individual Variability in Hygiene & Sanitation Knowledge

Poor knowledge Moderate knowledge Good knowledge Total

Education Secondary 15 17 12 44 0.117

4. DISCUSSION improving food safety knowledge among food handlers to ensure

rent study, in Dar-Alshifa, BMC, and Benghazi Children’s Hos- 8. REFERENCES:

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