Heliyon 8 (2022) e11707

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Heliyon
journal homepage: www.cell.com/heliyon

Research article

Food hygiene knowledge, and practices and their associated factors of street
food vendors in Gondar city, Northwest Ethiopia, 2021: A
cross-sectional study
Jember Azanaw a, *, Garedew Tadege Engdaw a, Hanna Dejene b, Samual Bogale b, Siraye Degu b
a
Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia
b
Ethiopian Environmental Health professionals, Ethiopia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Death and illness because of food-borne diseases have greater than previously. According to WHO
Food safety 2015 report, food-borne diseases affect more than 1/3 of the total population in developing countries each year.
Food vendors Risky food preparation and handling by Street food vendors have made food safety concern for public health.
Knowledge
Most individuals nowadays have their meals outside their homes, which are vulnerable to disease caused by
Attitudes-practice
Ethiopia
contaminated food. This study aimed at assessing the food safety knowledge, and self-reported practices and their
associated factors among street food vendors in Gondar city, Northwest Ethiopia.
Methods: A cross-sectional study was conducted to assess food safety knowledge, practices, and their associated
factors among 395 street food vendors, which were selected randomly from 700 street food vendors. The data was
collected from September 10–28, 2021. Data collection was through face-to-face interview. Then, only fully
completed questionnaire were considered for analysis. The data analysis was done using Stata Version 14.
Descriptive statistics, binary logistic regression and Spearman's correlation analysis were done. Probability less
than to 0.05 was considered statistically significant.
Results: More than half of vendors are licensed (56.5%). Over three-fourths (79.7%) of the food vendors have
information about food safety and hygienic practice. Nearly half (50.6%) and 50.9% of study subjects were poor
in food hygiene knowledge and practice respectively. Significant relationships were found between knowledge
and practice (β1 ¼ 0.46, p < 0.001), and also knowledge and attitude ((β1 ¼ 0.38, p < 0.001). Male food
vendors (AOR: 2.05, 95% CI (1.25, 3.10)), food vendors with poor food hygiene attitude (AOR: 2.54, 95% CI
(1.65, 3.90)), and those not receive feedback from the customers on food hygiene (AOR: 2.14, 95% CI (1.40,
3.27)) were poor in food hygiene knowledge. Street food vendors who were non-licensed (AOR: 2.06, 95% CI
(1.33, 3.17)), no food hygiene information (AOR: 3.03, 95% CI (1.73, 5.31)), and had no training (AOR: 1.26,
95% CI (1.78, 2.04)) were poor in food hygiene practice.
Conclusion: The overall findings of this study indicated that around half of street food vendors’ food hygiene
knowledge and practices were poor. Sex, food hygiene attitude, and feedback from customers were significantly
associated factors with food hygiene knowledge. In addition, licensing status, food hygiene information, and
training related to food hygiene were statistically associated factors with the food hygiene practice. Significant
relationships were found between food safety knowledge and food safety practice and also knowledge and
attitude.

1. Background before, and food safety has developed into a key concern of healthcare
experts and organizations worldwide [3]. Food poisoning is a huge global
Eating foods contaminated with food-derived pathogens and microbial problem in terms of both human suffering and economic costs [4]. World
by-product such as toxins can lead to serious illness [1, 2]. In the past few Health Organization (WHO) estimates that about 600 million people
years, death and illness due to foodborne diseases have been greater than around the world get sick after consuming contaminated food [5]. More

* Corresponding author.
E-mail address: jemberazanaw21@gmail.com (J. Azanaw).

https://doi.org/10.1016/j.heliyon.2022.e11707
Received 9 April 2022; Received in revised form 29 June 2022; Accepted 11 November 2022
2405-8440/© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
J. Azanaw et al. Heliyon 8 (2022) e11707

than 1/3 of the total population in less developing nations are affected by to evaluate the relationship between food safety knowledge and practice
foodborne diseases each year [6]. The World Bank reports that the eco- among street food vendors and its direct effect on kitchen hygiene
nomic cost of dangerous food consumption is about $ 110 billion in pro- practices, as well as to establish how well are good hygiene practices
ductivity losses and health care costs in less developed countries [7]. predicted by knowledge.
Nowadays, street foods are becoming popular in major towns of
Hypothesis 2. (H2): Food safety knowledge is correlated with food
Ethiopia including Gondar city. Many people are involved in the prepa-
safety attitude. Positive attitude in food safety of food handlers practice
ration and sale of street foods and it becomes common practice around
through knowledge during preparation are factors that may lead to the
schools, bus stations, and other places where many people are found. But
reduction of the risk of foodborne illnesses [20, 26]. Food vendors' atti-
the matter of food safety is not a big deal among street foods vendors [8].
tude had a positive effect on good hygiene practices like washing hands,
However, food handlers play a principal role in safeguarding food safety
and also on cooking practices like washing hands continuously, cover
and the inhibition of food poisoning since they have direct –indirect
mouth and nose during coughing and sneezing.
contact with foods [9]. Which implies that food poisoning is associated
with poor food handling and hygiene practices [10, 11, 12, 13]. Hypothesis 3. (H3): Food safety attitude favorable to food safety
Study conducted in Jashore region, Bangladesh, revealed that 72.5% directly affects street food vendors' self-reported food safety practices.
vendors had good knowledge of food safety, only 33% and 0.5% had Knowledge was proven to be a significant predictor for engaging ado-
good food safety attitude and practice, respectively [14]. A study done in lescents in hygienic food handling procedures [21]. Pearson correlation
Handan city, China indicated that 53.3% stalls did not have direct access was used in evaluating the interaction among knowledge, attitude, and
to potable water and 73.3% were without adequate hand washing fa- practice towards food safety among street food vendors (Figure 1).
cilities [13]. According to conducted in North Dayi District, Ghana
indicated that, 93.6% of street food vendors knew about the washing of 2. Method
hands for 1 min using water and soap before touching food while 68.3%
keep ready to eat food at room temperature for 2 h after cooking [15]. 2.1. Study design, period, and area
The research finding from Ogun State, Nigeria, showed that, only few
(18.3%), (18.8%), (15.3%) of the participants cover their hair when they A cross-sectional study was conducted to assess the knowledge,
were cooking and serving food, did not handle money while serving, practices, and associated factors of street vendors in the field of food
keep long fingernails, respectively [16]. Another study done in Kenya hygiene from September 10–28, 2021. The study was conducted at
reported that more than half (56.9%) of the street food vendors washed Gondar city, Amhara, Northwestern Ethiopia. The city is about 750 km
their hands using cold water only and few (20.1%) of them used warm from Addis Ababa, the capital of Ethiopia. The city contains 6 sub-cities
water with soap [17]. (namely Maraki, Azezo Tseda, Arada, Jantekel, Zoble, and Fasil) and 22
The other study conducted in Gojjam Zone, Ethiopia, 51.40% street Kebeles (the lowest administrative level in Ethiopia). There are many
food vendors had good food safety practice and educational status, street food vendors in the city, and the number is increasing from time to
monthly income, inspection, training, vending experience were factors time. According to 2021 Gondar city Tourism office report, there were
showed statistical significance [18]. Previous study in Gondar town half around 700 street food vendors. All of the 403 randomly selected street
of the vendors (50%) had no frequent hand washing habit with soap and food providers were included in this study (Figure 2).
water during the preparation, collecting and displaying of food [19].
Food safety attitudes that are beneficial to food safety have a direct
impact on street vendors' food safety practices. A positive attitude to- 2.2. Sample size and sampling procedure
wards food safety by food handlers in food safety practices through
knowledge during cooking is a potential factor in reducing the risk of The sample size of the study street food vendors was determined
food-borne diseases in food facilities [20]. Knowledge is an important using a single formula of population proportions based on the following
predictor of food handlers engaged in participation in hygienic food assumptions: The 50% was chosen because no street vendor survey was
handling practices [21]. However, food service employees often have conducted in the study area. The percentage of knowledge among street
diminutive evidence around food contamination hazards and the ways of vendors is 50%, the confidence level is 95%, Z is 1.96, and 5% non-
preventing them [22]. response rate (Equation 1).
Previous studies in different parts of Ethiopia focused knowledge and
 2
practice and their associated factors among food handlers at food es- Z2α *Pð1  PÞ ð1:96Þ2 * 0:5ð1  0:5Þ
tablishments [23, 24]. As well as these studies were more focused at n¼ 2
n¼ ¼ 384 (1)
bacteriological profile of the foods [19, 25]. Moreover, in some other d ð0:05Þ2
studies, there were problems in cut of values and sample sizes. Virtually, [27] Adding a 5% non-responder rate, the final sample size is 403.
street food vendors do not fulfill the required requirements for food Street food vendors unevenly distributed in the city. They mostly found
safety. While street food vendors are expanding time to time as work around governmental institutions at Arada sub-city (Kebele 5, 7), Zoble
opportunity. Hence, this study aimed at investigating food hygiene sub-city (Kebeles 15 and 16) and Maraki sub-city (Kebele 18). Therefore,
knowledge and practices and their associated factors among street food we have selected study street food vendors using a simple random sam-
vendors, which enable in reduction of foodborne disease. The finding of pling technique until the convenient sample size is reached.
this study will provide better evidence for understanding the level of
knowledge, and practice and their predictor variables among street food
vendors. After all, this evidence is important to provide insight for policy 2.3. Questionnaire development and data collection
makers in health, local health professionals in improving food hygiene.
This is the original study conducted using the primary data sources The questionnaire was created by rewiring related types of literature
collected through face-to-face interview. [28, 29, 30, 31, 32]. The questionnaire used for this survey consisted of
four parts.
1.1. Hypotheses and research framework
Part 1: Consists of 12 questions of survey street food vendors ' socio-
demographic proles, including age, gender, education level,
Hypothesis 1. (H1): Food safety knowledge directly affects self- monthly income, feedback, food hygiene and safety information,
reported food safety practices. Hence, one of the aims of this study was and work experience in years.

2
J. Azanaw et al. Heliyon 8 (2022) e11707

Figure 1. Theoretical Framework.

Figure 2. Location of Gondar City.

Part 2: Food safety knowledge was assedon't know for each food safety conduct during data collection, the objective of the study and contents of
knowledge question and a score was given for each correct the questionnaire through presentation and pre-test. Five percentage of
answer. Overall food safety knowledge performance was con- the questionnaire was pre-tested among non-participants in the final
verted to a percentage by specifying "Yes ¼ 1" and "All other survey to assess the clarity, content, placement, and adequacy of the
values (no and do not know) ¼ 0" and dividing the total score by question. All recommendations were reviewed and used to complete the
the total number of food safety knowledge items [15, 33, 34, 35]. questionnaire before actual data collection.
Part 3: Food safety attitudes were assessed by using 12 questions. As well as reliability of the questionnaire was also assessed using
Attitudes toward food safety were assessed by a ve-level Likert scale Cronbach's alpha test. The results of Cronbach's alpha were 0.94, and
question. Regarding the attitude part question, the lowest score (1 0.84 for knowledge, and practices questions, respectively. After
point) for "strongly disagree" and the highest score (5 points) for improvement and reliability check of the tool, content validation is done
"strongly agree" were given [36, 37]. to checks the questionnaire items it has and their adequateness in
Part 4: Food safety practices were assessed by using 14 questions. Self- measuring variables in the area of food hygiene knowledge and practice.
reporting practices were assessed on a five-point Likert scale, from the With the consent of the street food vendors before the start of the
lowest "never" (1 point) to the highest "always" (5 points) [36, 37]. survey, respondents can withdraw from participation at any time. Re-
spondents interviewed through face-to-face interview to fill out a ques-
The total KAP scores below 70% were considered "poor” and scores tionnaire, and the final completed questionnaire was used for analysis.
70% and higher were considered "good" [38, 39, 40]. Statistical Analysis After the collection of the data using the question-
Three 4th year environmental health students were involved in this naire, each was checked manually and entered into the EpiInfo Version.7.
data collection after a day of training. The training was on code of Then exported to Stata version 14 for analysis. Descriptive statistics such

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J. Azanaw et al. Heliyon 8 (2022) e11707

as mean standards, deviations, frequencies, and percentages were used

for continuous variables. Level of food safety knowledge (poor/good) Table 1. Socio-demographic characteristics of the food vendors in Gondar city,
2021 (N ¼ 395).
and practice (poor/good) were dependent variables of the study. While
licensing status (yes/no), sex (male/female), education level, food hy- No. Variables Category Frequency Percentage
giene information (yes/no), income (500–999, 1000–1500, 1501–5000, Q1. License status License 223 56.5
5000), food safety attitude (positive/negative), feedback from cus- Not licensed 172 43.5
tomers (yes/no), and training (yes/no), were independent variables. Q2. Sex Female 329 83.3
Bivariable binary logistic regression models was used to screen fac- Male 66 16.7
tors associated with food safety knowledge and practices of street food Q3. Age <20 57 14.4
vendors. Variables in bivariable analysis with a p-value less than 0.2 were 21–30 240 60.8
recruited for multivariable analysis. In that case multivariable analysis, if 31–40 81 20.5
the p-value is less than 0.05, then association is statistical significant. The >40 17 4.3
strength of association between predictors and outcome variables (level Q4. Religion (n ¼ 385) Orthodox 334 84.6
of food safety knowledge and practice) was evaluated by odds ratios with Catholic 3 0.8
a 95% confidence interval (CI).
Protestant 26 6.6
Spearman's correlation analysis was also done to show the relation-
Muslim 21 5.3
ships between knowledge, attitude, and practice in food hygiene. The
Other* 1 0.3
Pearson correlation test (r) was done to show strength of the associations
Q5. Level of education Not read and write 25 6.3
and corresponding likelihood of errors (p  5%). The strength was
Read and write 92 23.3
classified as insignificant (0.01–0.09), low (0.10–0.29), moderate
Primary school 78 19.7
(0.30–0.49), considerable (0.5–0.69) and strong (0.70) [41].
Secondary school 139 35.2
Higher education 61 15.4
1.4. Ethics approval and informed consent
Q6. Marital status Single 166 42.0

Ethical clearance was obtained from the Department of Environ- Married 160 40.5

mental and Occupational Health and Safety, the University of Gondar Widowed 36 9.1
with Ref. No:EOHS/302/2021. First, respondents were described to and Divorced 30 7.6
guaranteed that the data collected was treated with utmost privacy, Separated 3 0.8
hence it was the duty of the investigator. Then, we provided information Q7. Average monthly income <500 20 5.1
on the purpose, procedures, advantages, and disadvantages of the study, 500–999 162 41.0
and informed written consent was obtained from each study participant. 1000–1500 193 48.9
Participation was fully voluntary and partakes were knowledgeable that >1500 20 5.1
they could withdraw participation and asking any question not clear at Q8. Vending experience <1 year 47 11.8
any time of the interview were the rights they have. 1–5 years 265 67.0
>5 years 84 21.2
2. Results Q9. The respiratory problem Yes 112 28.4
within 2 weeks No 283 71.6
2.1. Socio-demographic characteristics of the street food vendors Q10. Have food safety and Yes 315 79.7
hygiene information No 80 20.3
From 403 samples, 395 street vendors responded to the survey with a
Q11. Source of information (n ¼ Mass media 97 30.8
98% response rate. Table 1 shows the demographics of food stall food 315) Training 50 15.9
vendors. More than half of the respondents have a license (56.5%)
Health extension 58 18.4
(Table 1). The majority of street food vendors were female and Orthodox workers
(83.3%) (87.1). Of the street food vendors surveyed, 42.0% (n ¼ 166)
Friends 67 21.3
were single-marriage history. The majority of street food vendors
Parents 43 13.7
(67.0%, 265/395) have 1–5 years of street sales experience. Almost one-
Q12. Get feedback from the Yes 204 51.6
fifth (6.3%) of street vendors cannot read or write. More than three- costumers No 191 48.4
quarters (79.7%) of food vendors have information on food safety and
1 USD ¼ 47 Ethiopian Birr,* ¼ Jewish, Q ¼ Question
hygiene practices, and nearly half (51.6%) of them receive customer
feedback (Table 1).
Majority of respondents performed best in the personal hygiene The average practical values for washing hands before and after
practice (mean score ¼ 97.7  11.4%). Street food vendors asked about cooking food and not washing eggs before cooking or frying were (4.43 
how to use the same chopping board for raw and cooked foods related to 1.00) and (2.46  1.61), respectively. Approximately 80 (81.78%) of the
food contamination issues related to cross contamination. Only 42.5% of survey street food vendors cleaned and washed the cutting boards, kni-
respondents knew that using the same chopping board for raw and ves, and plates used for raw meat before using them in other foods.
cooked foods as it has problems with food contamination. Of the total Among 395 study street food vendors, nearly half of them (50.9 %, 45.8,
participants, nearly half of the participants responded (50.6%, 46.1%, 55.7% CI) were poor in food hygiene practice (Table 4).
55.9% CI) were poor in food hygiene knowledge (Table 2).
The average score of the questions about towels used to clean food
contact surfaces to avoid cleaning hands was 3.64  1.39 for street 2.2. Interrelationships between food safety knowledge, attitude, and
vendors. The minimum average of street food vendors (1.37  0.71) practice
answered the question of whether washing hands after using the toilet
could prevent secondary contamination. Street vendors also showed a To test the proposed hypothesis of knowledge, attitudes, and practices
positive attitude towards safe foods when it came to washing their hands in food safety were created using Pearson correlation. A P-value  0.05
after using the toilet (95.9%). Knowledge of food safety is important for was considered statistically significant. Knowledge of food safety has a
food handlers (95.7%) (Table 3). positive and significant association with food safety practices (β1 ¼ 0.46,

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J. Azanaw et al. Heliyon 8 (2022) e11707

Table 2. Food hygiene knowledge and frequency with correct answers of street Table 3. Percentage, mean scores of questions in food safety attitude towards
food vendors. food safety.
No. Variables Correct answers Cronbach's No. Variables Percentage Mean Std. Cronbach's
Frequency (%) Alpha dev Alpha
Q1. The use of gloves while handling food 232 (58.7) 0.94 Q1. Washing hands after toilet 95.9 1.37 0.71 0.84
reduces the risk of food contamination prevent cross-contamination
Q2. Children, pregnant women, and older 320 (81.0) Q2. Handling food safely is 95.7 1.41 0.73
individuals are more at risk of food important to food handlers
poisoning Q3. Consumption of expired food 74.5 1.93 1.17
Q3. Do raw foods need to be stored separately 337 (85.3) can cause foodborne illness
from cooked foods? Q4. Defrosted food should not be 30.1 3.02 1.26
Q4. Refrigeration eliminates harmful germs in 82 (20.8) frozen again
food Q5. Food and personal hygiene 87.4 2.54 1.06
Q5. Hand washing before cooking reduces the 361 (91.4) training is important for food
risk of food contamination handlers
Q6. The diarrheal disease can be transmitted 377 (95.4) Q6. Clean hand towels should be 72.6 2.07 1.25
through contaminated food used to wipe hands after
Q7. Potentially food contaminant 287 (72.7) washing
microorganisms are present on human Q7. The best place to store raw 36.2 2.89 1.32
skin meat or chicken in the
Q8. Personal hygiene can prevent food 360 (91.1) refrigerator is on the bottom
contamination part

Q9. Using the same cutting board for raw and 168 (42.5) Q8. Proper cooking of food could 86.1 1.60 1.08
cooked foods has no problems with food prevent foodborne disease
contamination Q9. The food preparation area must 88.4 1.48 0.99
Q10. Foodborne illness can be acquired from 338 (85.6) be cleaned before and after
the consumption of contaminated food preparing food

Q11. Inadequate cooking of raw food like meat, 307 (77.7) Q10. Towel used to clean food 21.3 3.64 1.39
chicken, and vegetable can cause the contact surfaces should not be
outbreak of foodborne illness used to clean hands

Q12. Cooked foods should be reheated 356 (90.1) Q11. Should not rub your hand on 86.1 1.59 0.98
thoroughly your face, or hair, while
working
Q13. Contaminated water can be a vehicle for 314 (79.5)
food contaminants Q12. During coughing or sneezing 90.1 1.56 0.87
food handlers need tissue or
Q14. Uncovered abrasion or cuts on fingers and 328 (83.0)
cloth
hands can cause food contamination
Total food hygiene attitude Poor 240
Total food hygiene knowledge Poor 200 (50.6%)
(60.8)
Good 195 (49.4%)
Good 155
(39.2)

p < 0.001). Knowledge of food safety has a negative and significant

relationship with attitudes towards food safety (β1 ¼ 0.38, p < 0.001). Study participants who did have not food hygiene information were 3.03
The results showed that while increasing in knowledge, attitudes towards (AOR: 3.03, 95% CI (1.73, 5.31)) times more likely to have poor food
food safety can decrease by 0.38 units. However, there was no significant hygiene practice than their counterparts having food hygiene informa-
association between attitude and practice (p-value ¼ 0.062) (Table 5). tion. Study participants who did not receive any training in food hygiene
were 1.26 (AOR: 1.26, 95% CI (1.78, 2.04)) times more likely to have
2.3. Factors associated with food hygiene knowledge poor food hygiene practice than their counterparts who received any
training in food hygiene (Table 7).
Sex, food hygiene attitude, and feedback from customers were
significantly associated factors with the food hygiene knowledge in the 3. Discussion
multivariable logistic regression.
The odds of poor food hygiene knowledge were 2.05 times more Inappropriate the hygienic actions of the food handlers may lead
likely compared to male food vendors (AOR: 2.05, 95% CI (1.25,3.10)). pathogenic microorganisms to spread, stay animated and reproduce to
Respondents who have a poor food hygiene attitude were 2.54 (AOR: abundant extents to source disease to humans [42]. Street food services
2.54, 95% CI (1.65, 3.90)) times more likely to have poor food hygiene acting a significant role in least developing countries like Ethiopia, feeding
knowledge than their counterparts having a good attitude toward food millions of metropolitan inhabitants daily a wide variety of foods that are
hygiene. Study participants who did not receive feedback from the cus- relatively cheap and easily accessible [43, 44]. But there are substantial
tomers on food hygiene were 2.14 (AOR: 2.14, 95% CI (1.40, 3.27)) times shreds of evidence of health-related difficulties that have been connected
more likely to have poor food hygiene knowledge than the respondents with those street foods [45, 46, 47]. Improving and monitoring food safety
who received feedback on food hygiene (Table 6). programs is important to reduce the incidence of food-borne diseases [48].
Therefore the objective of this study is to investigate food hygiene
2.4. Food hygiene practice predictors knowledge and practice and their factors associated among street food
vendors that are linked with the foodborne disease in Gondar city.
Licensing status, food hygiene information, and training related to These results indicate that most street food vendors (91.4%) knew the
food hygiene were statistically associated factors with the food hygiene importance of washing their hands before cooking to reduce the risk of
practice in the multivariable logistic regression. food contamination. There is evidence that inadequate personal hygiene,
The odds of poor food hygiene practice were 2.06 times more likely especially inadequate handwashing, is known to be a major risk factor for
compared to licensed food vendors (AOR: 2.06, 95% CI (1.33, 3.17)). food contamination leading to food poisoning [49, 50].

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J. Azanaw et al. Heliyon 8 (2022) e11707

Table 4. Percentage and Mean scores of the correct answer of items in food safety Table 6. Bivariable and multivariable results of factors associated with food
practices. hygiene knowledge among street food vendors, 2021(N ¼ 395).
No. Variables Percentage Mean Std. Cronbach's Variables Food hygiene COR (95% AOR (95% CI)
dev Alpha knowledge CI)
Q1. Do you wash your hands 88.35 4.43 1.00 0.71 Poor Good
before and after cooking
Sex Male 36 30 1.21 2.05
food?
(1.71,3.05) (1.25,3.10)*
Q2. Do you keep cooked food at 56.72 2.07 1.51
Female 164 165 1 1
room temperature for a long
time? Marital status (n ¼ Single 95 71 1.52 1.03
392) (0.98,2.35) (0.78,3.40)
Q3. Do you use your hand to 73.64 3.98 0.96
cover your mouth while Windowed 16 20 0.91 0.86
coughing or sneezing? (0.81,3.46) (0.78,2.52)
Q4. Do you wash fruits and 75.35 3.94 1.31 Divorced 14 16 0.99 1.23
vegetables before eating? (0.70,3.34) (0.69,2.67)
Q5. Do you read labels with the 53.28 3.52 1.25 Married 75 85 1 1
use by and/or expiry date of Food hygiene Poor 145 95 2.77 2.54
packaged food before Attitude (1.83,4.22) (1.65,3.90)**
purchasing? Good 55 100 1 1
Q6. Do you read the conditions of 44.56 3.15 1.43 Feedback from No 126 78 2.55 2.14
use and storage of packaged customers about (1.70,3.83) (1.40,3.27)*
food? your hygiene Yes 74 117 1 1
Q7. Do you wash eggs before 30.88 2.46 1.61 practice
cooking or frying them? Received any No 129 151 0.53 0.63
Q8. Do you wash and rinse 81.78 4.15 1.06 training in food (0.21,2.94) (0.39,1.20)
cutting boards, knives, and hygiene Yes 71 44 1 1
plates used for raw meat
before using them for other Food hygiene No 35 45 0.71 0.65
food? information (0.43,1.16) (0.32,2.27)

Q9. Do you wear accessories like 38.99 3.09 1.37 Yes 165 150 1 1
rings, and bracelets when Type of food Ambulatory 122 131 1.14 1.3
cooking food? vendor (0.75,1.71) (0.56,2.30)
Q10. Do you use an apron when 41.27 3.16 1.46 Stationary 63 79 1 1
cooking food? Key:1 ¼ reference, * ¼ p-value at <0.05, ** p-value at <0.001
Q11. Do you store raw chicken or 71.14 3.93 1.30
meat separately from cooked
food?
Q12. Do you cover your cut with a 84.30 4.37 0.89 Table 7. Bivariable and multivariable results of factors associated with food
bandage and use gloves? hygiene practice among street food vendors, 2021(N ¼ 395).
Q13. Do you wash your hands 85.40 4.33 0.93 Variables Food hygiene COR (95% AOR (95% CI)
before handling raw food? practice CI)
Q14. Do you wash dishes with 87.60 4.42 0.91 Poor Good
detergent and water or in a
Licensing status Not 104 68 1.99 2.06
dishwasher after preparing
licensed (1.33,2.98) (1.33,3.17)**
food and before the next use?
Licensed 97 126 1 1
Total food hygiene practice Poor 201 (50.9)
Sex Male 36 30 1.20 1.85
Good 194 (49.1)
(2.49,5.43) (2.49,5.43)*
Female 165 164 1 1
Level of income in 500-999 11 9 2.92 2.60
ETB (0.52,6.43) (0.79,7.52)
Table 5. Pearson correlation of KAP in food safety among street vendors
1000-1500 92 70 2.44 1.86
Hypothesis.
(0.52,3.35) (0.75,4.67)
Hypothesis Paths Standardized Standard 95% CI P 1501-5000 91 102 1.66 2.43
estimate error value (0.42,2.69) (0.65,3.71)
H1 Knowledge to 0.4555 0.0861 (0.29, 0.001 5000 7 13 1 1
Food safety 0.63)
Food hygiene No 57 23 2.94 3.03
practice
information (1.73,5.01) (1.73,5.31)**
H2 knowledge <–> -0.3790 0.0725422 (-0.52, 0.001
Yes 144 171
attitude -0.24)
Received any No 155 125 1.86 1.26
H3 Attitude to Food -0.1917 0.0710 (-0.33,- 0.062
training in food (1.20,2.89) (1.78,2.04)*
safety practice 0.05)
hygiene Yes 46 69 1 1
Type of food Ambulatory 122 131 1.35 1.12
Three hundred-eight (83.0%) of street food vendors knew they were vendor (0.89,2.04) (0.75,2.13)
found because scratches and cuts on their fingers and hands could Stationary 79 63 1 1
contaminate food. This finding was similar to other studies conducted in Key:1 ¼ reference, * ¼ p-value at <0.05, ** p-value at <0.001
Qatar, suggesting that 80% of street food vendors covered their hands
and fingers while preparing the food [51]. hygiene [52]. About cross-contamination (Does raw food need to be
Similar results were found in other studies in which street food ven- stored separately from cooked food? Is it safe to use the same cutting
dors provided more accurate answers to questions about good personal board for raw and cooked food?)

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J. Azanaw et al. Heliyon 8 (2022) e11707

Raw food although isolated from ready-to-eat foods, only 42.5% of [74]. But this was lower than the finding of the study done among street
respondents have the problem of food contamination on the same cutting food vendors regarding food safety knowledge, and practices in the
board for raw and cooked foods. According to surveys conducted in Jashore region, Bangladesh [14].
Johannesburg and Ghana, street food sellers' knowledge of this topic was Sex, food hygiene attitude, and feedback from customers were
greater than this result, at 89% and 92%, respectively [53, 54]. significantly associated factors with the food hygiene knowledge in the
Attitude is an important predictor that can affect the performance and multivariable logistic regression.
practice of food safety for food handlers and, as a result, reduce the In this study, there was a statistically significant difference in food
incidence of foodborne illnesses [29, 52]. Most of the surveyed street hygiene knowledge between males and females, which indicated that
food vendors (95.7%) agreed that knowledge of food safety is important males were poor in food hygiene knowledge than females. This finding
for food handlers. Improper food handling practices were observed in was consistent with other previous studies [75, 76]. However, this
several findings as to the leading cause of foodborne disease in food finding contradicted the study was done in Vietnam [35]. The possible
services establishments [55, 56]. Street food vendors' mean score of explanation for this variation might be that females get further involved
washing their hands before and after cooking food was 4.43  1.00 with food handling and may consequently be more knowledgeable [75].
(St.d). To maintain safe food during preparation, personal hygienic Food hygiene attitude was another important predictor of food safety
practices among the food handlers are important components [51]. knowledge among street food vendors. Study subjects with poor attitudes
According to these results on hand washing practices, 88.35% of the were poor in food hygiene knowledge. This finding was in line with
study street food vendors were washed their hands before and after another previous study [71]. This might be due to that attitude involves
preparing food which was lower than the other prior findings, wherein shaping notions related to the way people think, feel and behave which
similarly high scores of 93% [51] and 94.5% [57]. Hand hygiene among encompasses a reasoning, responsive, and behavioral component sug-
food handlers is the most basic critical criterion in safe food handling gesting what should know in the area of food hygiene knowledge [77].
[58]. Although hand washing is known to be a vital preventive measure Street food vendors who did not get feedback from customers were more
in health care scenarios [59], but this works also in the kitchen, for likely in poor food hygiene knowledge. In other words, street food vendors
inhibiting the spread of communicable disease through human to human who got the customers' feedback about their drawbacks enhance them in
or human to food contact [60, 61]. knowledge sharingand makecorrective measures for customer gratification.
More than half (56.72%) of study street food vendors keep cooked
foods at room temperature for extended periods, which is inconsistent 3.3. Food hygiene practice predictors
with the very key factors that make foods safer. It is a dangerous habit to
leave cooked food in the kitchen for a long time [62]. Of the total study subjects, nearly half of them (50.9 %) were poor in
The majority of street food vendors wash their hands before and after food hygiene practice. This finding was higher than other previous
handling food to ensure safe practices such as wearing protective studies conducted in Ghana [15], and Bangladesh [14]. This is compa-
clothing and maintaining work clothes and surface cleanliness. Most of rable with the finding of Dessie town, Ethiopia [78], and Dangila,
the respondents (87.60%) washed the dishes with detergent and water or Ethiopia [73]. These disparities could be due to the difference of the
in the dishwasher after preparing the food and before using it again, sociodemographic charactestics, study period, study settings.
which helped reduce food poisoning. In general, even if the majority KAP Licensing status, food hygiene information, and training related to
related questions are good, some other practices, knowledge, and atti- food hygiene were statistically associated factors with the food hygiene
tudes questions were lower among study street food vendors that can practice in the multivariable logistic regression. Study participants
bring foodborne disease. In general, even if the majority KAP related without a license were poor in Food hygiene practice as compared with
questions are good, some other practices, knowledge, and attitudes licensed counterparts. This finding was consistent with the study con-
questions were lower among street food vendors that can bring food- ducted in Addis Ababa, Ethiopia, Ghana, and USA [15, 79, 80]. This
borne disease. might be due to that licensed food vendors' checkups by the regulatory
body, training may be given which enhance them to practice good food
3.1. The findings on food safety-related KAP correlations hygiene and general conditions required from street food vendors. As
well since licensed food vendors are subjected to rules and regulations to
The outcomes of this look at Table 5 revealed that meals protection fulfill criteria by the regulatory body, especially regarding hygiene and
information does now no longer translate into secure meals dealing with sanitation to safeguard customers' health.
practices. Substantial relationships have been determined between in- Food hygiene-related information looked to be a significant predictor
formation, exercise, additionally information, and attitude: those have of food hygiene practices. Street Food vendors who have no food
been (p < 0.001) and (p < 0.001) respectively. That there are good-sized hygiene-related information had higher odds of poor food hygiene
relationships between information and exercise is steady with research practice. The possible justification for this could be that food hygiene-
via way of means of a few preceding researches [63, 64, 65, 66, 67]. The related information might aid street food vendors to get improved
results clearly show that knowledge of food safety has a direct impact on practice regarding food hygiene as compared to non-informed study
food safety practices. participants. The sources of information might be any of the following,
There was no significant association between attitude and practice (p media, education, friends, families, and training.
¼ 0.062). This finding has been refuted by a similar previous study [29, Food hygiene training seemed to be a strong predictor of food hygiene
39, 68] but it was consistent with other studies [30, 69]. A significant practices. Non-trained street food vendors were poor in food hygiene
relation was found between knowledge and attitude at p < 0.001: this practices. Similar research results were observed in a study on the effect
finding was in line with other previous studies [29, 69] but is inconsistent of training to improve the food hygiene practice amongst food handlers
with other studies done in Malaysia [70]. The finding of this study in Ethiopia [71, 76] and street food vendors in Sarawak [81]. This could
indicated that food safety knowledge affects directly food safety practice be that the food safety training may curiously improve the practices of
and indirectly through attitude. street food vendors. The limitation of this study is the inherent limitation
of cross-sectional study design.
3.2. Food hygiene knowledge predictors
4. Conclusion
The current finding revealed that around half (50.6%) of street food
vendors had poor knowledge of food hygiene. This result is lower than The current findings showed that street food vendors were good in
with studies done in different parts of Ethiopia [71, 72, 73], and India knowledge towards separating cooked foods from raw foods, washing

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J. Azanaw et al. Heliyon 8 (2022) e11707

hands before cooking, in uncovered as abrasion or cuts on fingers and [7] S. Jaffee, S. Henson, L. Unnevehr, D. Grace, E. Cassou, The Safe Food Imperative:
Accelerating Progress in Low-And Middle-Income Countries, World Bank
hands can cause food contamination. The overall findings of this study
Publications, 2018.
indicated that around half of street food vendors’ food hygiene [8] A.N.T. Thi, P. Kittirath, S.D. Abiola, N.C. Ha, Evaluation of street food safety and
knowledge and practices were poor. Sex, food hygiene attitude, and hygiene practices of food vendors in can Tho city of Vietnam, Current Research in
feedback from customers were significantly associated factors with Nutrition and Food Science Journal 9 (1) (2021) 158–171.
[9] H.K. Lee, H. Abdul Halim, K.L. Thong, L.C. Chai, Assessment of food safety
food hygiene knowledge. In addition, licensing status, food hygiene knowledge, attitude, self-reported practices, and microbiological hand hygiene of
information, and training related to food hygiene were statistically food handlers, Int. J. Environ. Res. Publ. Health 14 (1) (2017) 55.
associated factors with the food hygiene practice. Significant relation- [10] M. Haileselassie, H. Taddele, K. Adhana, S. Kalayou, Food safety knowledge and
practices of abattoir and butchery shops and the microbial profile of meat in
ships were found between food safety knowledge and food safety Mekelle City, Ethiopia, Asian Pac. J. Trop. Biomed. 3 (5) (2013) 407–412.
practice and also knowledge and attitude. The current result indicated [11] E.C. Todd, J.D. Greig, C.A. Bartleson, B.S. Michaels, Outbreaks where food workers
that there is a need improve food safety knowledge and practice among have been implicated in the spread of foodborne disease. Part 6. Transmission and
survival of pathogens in the food processing and preparation environment, J. Food
street food vendors. Moreover, this will help in reduce the illness and Protect. 72 (1) (2009) 202–219.
death related with food-borne diseases. [12] E.C. Todd, J.D. Greig, C.A. Bartleson, B.S. Michaels, Outbreaks where food workers
have been implicated in the spread of foodborne disease. Part 5. Sources of
contamination and pathogen excretion from infected persons, J. Food Protect. 71
Declarations (12) (2008) 2582–2595.
[13] L. Ma, H. Chen, H. Yan, L. Wu, W. Zhang, Food safety knowledge, attitudes, and
Author contribution statement behavior of street food vendors and consumers in Handan, a third tier city in China,
BMC Publ. Health 19 (1) (2019) 1–13.
[14] M. Hossen, M. Ferdaus, M. Hasan, N.N. Lina, A.K. Das, S.K. Barman, et al., Food
Jember Azanaw: Conceived and designed the experiments; Performed safety knowledge, attitudes and practices of street food vendors in Jashore region,
the experiments; Analyzed and interpreted the data; Contributed re- Bangladesh, Food Science and Technology 41 (2020) 226–239.
[15] L.S. Tuglo, P.D. Agordoh, D. Tekpor, Z. Pan, G. Agbanyo, M. Chu, Food safety
agents, materials, analysis tools or data; Wrote the paper. knowledge, attitude, and hygiene practices of street-cooked food handlers in North
Garedew Tadege Engdaw: Conceived and designed the experiments; Dayi District, Ghana, Environ. Health Prev. Med. 26 (1) (2021) 1–13.
Performed the experiments; Wrote the paper. [16] A. Leslie Tabitha, S. Bitrus Hannah, E. Abaribe Chidinma, I. Okwuikpo Margaret,
O. Maitanmi Julius, PATTERNS OF FOOD SAFETY AND HYGIENE PRACTICES
Hanna Dejene; Samual Bogale; Siraye Degu: Performed the experi-
AMONG FOOD VENDORS IN GOVERNMENT PRIMARY SCHOOL, IKENNE LOCAL
ments; Wrote the paper. GOVERNMENT, OGUN STATE, 2020.
[17] M. Johnson, I. Samuel, O. Irene, K. Paul, Food safety knowledge and practices of
street food vendors in selected locations within Kiambu County, Kenya, Afr. J. Food
Funding statement Sci. 14 (6) (2020) 174–185.
[18] C. Chalachew, FOOD SAFETY PRACTICE AND ASSOCIATED FACTORS AMONG
STREET FOOD VENDORS IN CITY ADMINISTRATIONS OF WEST GOJJAM ZONE,
This work was supported by the University of Gondar College of NORTHWEST ETHIOPIA, 2022, p. 2021.
Medicine and Health Sciences. [19] A. Amare, T. Worku, B. Ashagirie, M. Adugna, A. Getaneh, M. Dagnew,
Bacteriological profile, antimicrobial susceptibility patterns of the isolates among
street vended foods and hygienic practice of vendors in Gondar town, Northwest
Data availability statement Ethiopia: a cross sectional study, BMC Microbiol. 19 (1) (2019) 1–9.
[20] M. Tomaszewska, J. Trafialek, P. Suebpongsang, W. Kolanowski, Food hygiene
knowledge and practice of consumers in Poland and in Thailand-A survey, Food
The data that has been used is confidential. Control 85 (2018) 76–84.
[21] B.A. Mullan, C. Wong, E.J. Kothe, Predicting adolescents' safe food handling using
an extended theory of planned behavior, Food Control 31 (2) (2013) 454–460.
Declaration of interest's statement [22] D. Al-Kandari, D. Jukes, A situation analysis of the food control systems in Arab Gulf
Cooperation Council (GCC) countries, Food Control 20 (12) (2009) 1112–1118.
The authors declare no conflict of interest. [23] A. Zelalem, K. Abegaz, A. Kebede, Y. Terefe, C.L. Schwan, J.L. Vipham, Food safety
knowledge, attitudes, and hygienic practices of abattoir workers in Ethiopia: a
cross-sectional study, Food Protect. Trends 41 (5) (2021) 501–509.
[24] Z. Gizaw, Food Safety Practice and Associated Factors of Food Handlers Working in
Additional information Substandard Food Establishments in Gondar Town, Northwest Ethiopia, 2013/14,
2014.
No additional information is available for this paper. [25] A. Adimasu, B. Mekonnen, T. Guadu, Z. Gizaw, T. Adane, Bacteriological Quality
Assessment of Selected Street Foods and Their Public Health Importance in Gondar
Town, North West Ethiopia, 2016.
Acknowledgements [26] M.A. Shapiro, N. Porticella, L.C. Jiang, R.B. Gravani, Predicting intentions to adopt
safe home food handling practices. Applying the theory of planned behavior,
Appetite 56 (1) (2011) 96–103.
We are highly indebted to acknowledgements College of Medicine [27] S.K. Sharma, S.K. Mudgal, K. Thakur, R. Gaur, How to calculate sample size for
and Health Sciences, University of Gondar, Gondar Ethiopia for sup- observational and experimental nursing research studies, Natl. J. Physiol. Pharm.
porting this research project. We would also like to extend our ac- Pharmacol. 10 (1) (2020) 1–8.
[28] L. Sharif, M.M. Obaidat, M.-R. Al-Dalalah, Food hygiene knowledge, attitudes and
knowledgments to street food vendors.
practices of the food handlers in the military hospitals, Food Nutr. Sci. 4 (3) (2013)
245.
References [29] S.O. Nee, N.A. Sani, Assessment of knowledge, attitudes and practices (KAP) among
food handlers at residential colleges and canteen regarding food safety, Sains
Malays. 40 (4) (2011) 403–410.
[1] M. Webb, A. Morancie, Food safety knowledge of foodservice workers at a
[30] A. George Amponsah, B. Ekua Anamoaba, Evaluation of Food hygiene Knowledge
university campus by education level, experience, and food safety training, Food
Attitudes and Practices of Food Handlers in Food Businesses in Accra, Ghana, 2011,
Control 50 (2015) 259–264.
Food and Nutrition sciences, 2011.
[2] N. Raju, C. Roopavathi, K.R. Kini, S. Niranjana, Assessment of Coliform
[31] M. Chijokwe, Assessment on the knowledge and practices of registered restaurants
Contamination in Drinking Water from Source to point of Use in Mysore City of
with regard to hygiene and food safety. A Case Study of Bindura, BUSE, Town,
Karnataka, India, 2011.
2018.
[3] W.H. Organization, WHO Estimates of the Global burden of Foodborne Diseases:
[32] J. Azanaw, H. Dagne, Z. Andualem, T. Adane, Food Safety Knowledge, Attitude, and
Foodborne Disease burden Epidemiology Reference Group 2007-2015, World
Practice of College Students, Ethiopia, 2019: A Cross-Sectional Study, BioMed
Health Organization, 2015.
Research International, 2021, p. 2021.
[4] S.R. Vemula, R.N. Kumar, K. Polasa, Foodborne diseases in India–a review, Br. Food
[33] F. Akabanda, E.H. Hlortsi, J. Owusu-Kwarteng, Food safety knowledge, attitudes
J. (2012).
and practices of institutional food-handlers in Ghana, BMC Publ. Health 17 (1)
[5] W.H. Organization, WHO Estimates of the Global burden of Foodborne Diseases:
(2017) 1–9.
Executive Summary, World Health Organization, 2015.
[34] J. Nkhebenyane, O. Thekisoe, Street food handlers' food safety knowledge, attitudes
[6] D.I. Ellis, H. Muhamadali, M. Chisanga, R. Goodacre, Omics methods for the
and self-reported practices and consumers' perceptions about street food vending in
detection of foodborne pathogens, Encyclopedia of food chemistry 1 (2019)
Maseru, Lesotho, Br. Food J. (2021).
364–370.

8
J. Azanaw et al. Heliyon 8 (2022) e11707

[35] S. Samapundo, T.C. Thanh, R. Xhaferi, F. Devlieghere, Food safety knowledge, [60] L. Gibson, J. Rose, C. Haas, C.P. Gerba, P. Rusin, Quantitative assessment of risk
attitudes and practices of street food vendors and consumers in Ho Chi Minh city, reduction from hand washing with antibacterial soaps, J. Appl. Microbiol. 92
Vietnam, Food Control 70 (2016) 79–89. (2002) 136S, 43S.
[36] N. Naeem, S. Raza, H. Mubeen, S.A. Siddiqui, R. Khokhar, Food safety knowledge, [61] F. Perez-Rodríguez, A. Valero, E. Carrasco, R.M. García, G. Zurera, Understanding
attitude, and food handling practices of household women in Lahore, J. Food Saf. and modelling bacterial transfer to foods: a review, Trends Food Sci. Technol. 19 (3)
38 (5) (2018), e12513. (2008) 131–144.
[37] W.N.F. Wan Nawawi, V. Ramoo, M.C. Chong, N.H. Zaini, P.L. Chui, Z. Abdul Mulud [62] M. Fawzi, M.E. Shama, Food safety knowledge and practices among women
(Eds.), The Food Safety Knowledge, Attitude and Practice of Malaysian Food Truck working in Alexandria University, Egypt, Egypt Public Health Assoc 84 (1) (2009)
Vendors during the COVID-19 Pandemic. Healthcare, MDPI, 2022. 95, 17.
[38] S.T. Odonkor, N. Kurantin, A.M. Sallar, Food safety practices among postnatal [63] M. Baş, A.Ş. Ersun, G. Kıvanç, The evaluation of food hygiene knowledge, attitudes,
mothers in Western Ghana, Int. J. Nutr. Food Sci. (2020) 2020. and practices of food handlers’ in food businesses in Turkey, Food Control 17 (4)
[39] R. Fariba, J.K. Gholamreza, N. Saharnaz, H. Ehsan, Y. Masoud, Knowledge, attitude, (2006) 317–322.
and practice among food handlers of semi-industrial catering: a cross sectional [64] A. Fadaei, Assessment of knowledge, attitudes and practices of food workers about
study at one of the governmental organization in Tehran, J. Environ. Health Sci. food hygiene in Shahrekord restaurants, Iran, World Appl. Sci. J. 33 (7) (2015)
Eng. 16 (2) (2018) 249–256. 1113–1117.
[40] T.M. Osaili, D.O.A. Jamous, B.A. Obeidat, H.A. Bawadi, R.F. Tayyem, H.S. Subih, [65] M. Ansari-Lari, S. Soodbakhsh, L. Lakzadeh, Knowledge, attitudes and practices of
Food safety knowledge among food workers in restaurants in Jordan, Food Control workers on food hygienic practices in meat processing plants in Fars, Iran, Food
31 (1) (2013) 145–150. Control 21 (3) (2010) 260–263.
[41] J.A. Davis, P. Burglin, Levantamento de Dados em Sociologia: uma analise [66] I.F. Angelillo, N.M. Viggiani, L. Rizzo, A. Bianco, Food handlers and foodborne
estatística elementar, Zahar, 1976. diseases: knowledge, attitudes, and reported behavior in Italy, J. Food Protect. 63
[42] S. Rane, Street vended food in developing world: hazard analyses, Indian J. (3) (2000) 381–385.
Microbiol. 51 (1) (2011) 100–106. [67] D.A. Clayton, C.J. Griffith, P. Price, A.C. Peters, Food handlers' beliefs and self-
[43] D. Privitera, F.S. Nesci, Globalization vs. local. The role of street food in the urban reported practices, Int. J. Environ. Health Res. 12 (1) (2002) 25–39.
food system, Procedia Econ. Finance 22 (2015) 716–722. [68] R. Son, O. Mohhiddin, P. Toh, L. Chai, Food court hygiene assessment and food
[44] C.O. Chukuezi, Food safety and hyienic practices of street food vendors in Owerri, safety knowledge, attitudes and practices of food handlers in Putrajaya, Int. Food
Nigeria, Stud. Sociol. Sci. 1 (1) (2010) 50–57. Res. J. 22 (5) (2015).
[45] D. Tambekar, V. Jaiswal, D. Dhanorkar, P. Gulhane, M. Dudhane, Identification of [69] A.H. Rosnani, R. Son, O. Mohhidin, P. Toh, L. Chai, Assessment of knowledge,
microbiological hazards and safety of ready-to-eat food vended in streets of attitude and practices concerning food safety among restaurant workers in
Amravati City, India, Int. J. Zool. Appl. Biosci. 7 (3) (2008) 195–201. Putrajaya, Malaysia, Food Sci. Qual. Manag. 32 (20) (2014) e27.
[46] D. Muleta, M. Ashenafi, Bacteriological profile and holding temperatures of street- [70] J.M. Soon, I.R.A. Wahab, R.H. Hamdan, M.H. Jamaludin, Structural equation
vended foods from Addis Ababa, Int. J. Environ. Health Res. 11 (1) (2001) 95–105. modelling of food safety knowledge, attitude and practices among consumers in
[47] P. Mensah, D. Yeboah-Manu, K. Owusu-Darko, A. Ablordey, Street foods in Accra, Malaysia, PLoS One 15 (7) (2020), e0235870.
Ghana: how safe are they? Bull. World Health Organ. 80 (2002) 546–554. [71] Z.A. Tadege Alemayehu, M. Giza, G. Diress, Food safety knowledge, handling
[48] C.A. Wallace, W.H. Sperber, S.E. Mortimore, Food Safety for the 21st century: practices and associated factors among food handlers working in food
Managing HACCP and Food Safety throughout the Global Supply Chain, John Wiley establishments in Debre Markos town, Northwest Ethiopia, 2020: Institution-based
& Sons, 2018. cross-sectional study, Risk Manag. Healthc. Pol. 14 (2021) 1155.
[49] M.F. Scarborough, Hand Washing in Georgia’s Public Schools–A Community Needs [72] F.A. Chekol, M.F. Melak, A.K. Belew, E.G. Zeleke, Food handling practice and
Assessment and Intervention Study. Unpubl Grad thesis, Emory Univ Atlanta GA, associated factors among food handlers in public food establishments, Northwest
USA, 2002. Ethiopia, BMC Res. Notes 12 (1) (2019) 1–7.
[50] V. Curtis, S. Cairncross, Effect of washing hands with soap on diarrhoea risk in the [73] A.G. Tessema, K.A. Gelaye, D.H. Chercos, Factors affecting food handling Practices
community: a systematic review, Lancet Infect. Dis. 3 (5) (2003) 275–281. among food handlers of Dangila town food and drink establishments, North West
[51] T.Elobeid,I.Savvaidis,V.Ganji,Impactoffoodsafetytrainingontheknowledge,practice, Ethiopia, BMC Publ. Health 14 (1) (2014) 1–5.
and attitudes of food handlers working in fast-food restaurants, Br. Food J. (2019). [74] S.R. Kubde, J. Pattankar, P.R. Kokiwar, Knowledge and food hygiene practices
[52] N.A. Al-Shabib, S.H. Mosilhey, F.M. Husain, Cross-sectional study on food safety among food handlers in food establishments, Int J Community Med Public Health 3
knowledge, attitude and practices of male food handlers employed in restaurants of (2016) 251–256.
King Saud University, Saudi Arabia, Food Control 59 (2016) 212–217. [75] S. Syahira, B. Huda, M.R. Bb, Factors associated with level of food safety knowledge
[53] P.T. Campbell, Assessing the Knowledge, Attitudes and Practices of Street Food among Form four students in Hulu Langat District, Selangor, Int. J. Public Health
Vendors in the City of Johannesburg Regarding Food hygiene and Safety, University Clinical Scie. 6 (2) (2019) 252–265.
of the Western Cape, 2011. [76] J. Azanaw, M. Gebrehiwot, H. Dagne, Factors associated with food safety practices
[54] S. Apanga, J. Addah, D.R. Sey, Food safety knowledge and practice of street food among food handlers: facility-based cross-sectional study, BMC Res. Notes 12 (1)
vendors in rural Northern Ghana, Food Publ. Health 4 (3) (2014) 99–103. (2019) 1–6.
[55] E.C. Todd, J.D. Greig, C.A. Bartleson, B.S. Michaels, Outbreaks where food workers [77] N. Schwarz, Attitude construction: evaluation in context, Soc. Cognit. 25 (5) (2007)
have been implicated in the spread of foodborne disease. Part 3. Factors 638–656.
contributing to outbreaks and description of outbreak categories, J. Food Protect. [78] M. Adane, B. Teka, Y. Gismu, G. Halefom, M. Ademe, Food hygiene and safety
70 (9) (2007) 2199–2217. measures among food handlers in street food shops and food establishments of
[56] A. Sabbithi, S.L. Reddi, R.N. Kumar, V. Bhaskar, G.S. Rao, S. Rao, Identifying critical Dessie town, Ethiopia: a community-based cross-sectional study, PLoS One 13 (5)
risk practices among street food handlers, Br. Food J. (2017). (2018), e0196919.
[57] K. Soares, I. Oliveira, A. Esteves, M.C. Fontes, C. Saraiva, Knowledge level and self- [79] A.M. Girmay, S.R. Gari, B. Mengistie Alemu, M.R. Evans, A.G. Gebremariam,
reported attitudes of food handlers: case study of a university campus, Health 8 (13) Determinants of sanitation and hygiene status among food establishments in Addis
(2016) 1383. Ababa, Ethiopia, Environ. Health Insights 14 (2020), 1178630220915689.
[58] I. El-Nemr, M. Mushtaha, P. Irungu, H. Asim, P. Tang, M. Hasan, et al., Assessment [80] N.J. Vickers, Animal communication: when i’m calling you, will you answer too?
of food safety knowledge, self-reported practices, and microbiological hand hygiene Curr. Biol. 27 (14) (2017) R713–R715.
levels of produce handlers in Qatar, J. Food Protect. 82 (4) (2019) 561–569. [81] M.M. Rahman, M.T. Arif, K. Bakar, Z. bt Talib, Food Safety Knowledge, Attitude and
[59] W.H. Organization, Evidence of Hand hygiene to Reduce Transmission and hygiene Practices Among the Street Food Vendors in Northern Kuching City,
Infections by Multi-Drug Resistant Organisms in Health-Care Settings, WHO, 2014. Sarawak, Borneo Science, 2016.