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Seidu 2020

The thesis by Judith Amma Seidu investigates the food safety knowledge and practices of food handlers in restaurants in the Tamale Metropolis, Ghana. It reveals that while 77% of food handlers possess knowledge about food safety, there is a significant gap in the application of this knowledge in practice, particularly in areas like thawing and storage of food. The study identifies barriers such as time constraints and lack of enforcement of safety regulations, recommending improved monitoring and practical training for food handlers to enhance food safety practices.

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73 views245 pages

Seidu 2020

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Mark Sandow

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© University of Cape Coast https://erl.ucc.edu.

gh/jspui

UNIVERSITY OF CAPE COAST

FOOD SAFETY KNOWLEDGE AND PRACTICES OF FOOD HANDLERS

IN RESTAURANTS IN THE TAMALE METROPOLIS, GHANA

JUDITH AMMA SEIDU

2020

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UNIVERSITY OF CAPE COAST

FOOD SAFETY KNOWLEDGE AND PRACTICES OF FOOD HANDLERS

IN RESTAURANTS IN THE TAMALE METROPOLIS, GHANA

JUDITH AMMA SEIDU

Thesis submitted to the Department of Hospitality and Tourism Management,

Faculty of Social Sciences, College of Humanities and Legal Studies,

University of Cape Coast, in partial fulfilment of the requirements for the

award of Doctor of Philosophy in Hospitality Management

JULY 2020

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DECLARATION

Candidate’s Declaration

I hereby declare that this thesis is the result of my own original research and

that no part of it has been presented for another degree in this university or

elsewhere

Candidate‟s Signature……………………… Date…………………………..

Name: Judith Amma Seidu

Supervisors’ Declaration

We hereby declare that the preparation and presentation of the thesis were

supervised in accordance with the guidelines on supervision of thesis laid

down by the University of Cape Coast.

Principal Supervisor‟s Signature…………………………Date………………

Name: Professor Francis Eric Amuquandoh

Co-Supervisor‟s Signature………………………….Date……………………

Name: Professor Ishmael Mensah

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ABSTRACT

This study assessed the food safety knowledge and practices of food handlers

in restaurants in the Tamale Metropolis. A descriptive research design was

employed for the study. Data were collected from 214 food handlers in 23

restaurants within Tamale Metropolis through a multi-stage sampling method.

Data were analyzed, using STATA version 15. Frequency, percentage, means,

independent sample t-test, chi square and one-way ANOVA were the main

tools used for the analysis. The results showed that the 77% of the food

handlers in the restaurants were knowledgeable in food safety issues but this

did not translate into food safety practices. Thus, there exist a gap between

knowledge and practice. They were found to be more knowledgeable in

environmental hygiene issues but fell short in some food hygiene issues such

as knowledge on thawing frozen foods and storage of food items under

appropriate refrigeration temperatures. The study also identified five major

barriers to food safety practices such as time constraint and busy work

schedule, lack or inadequate knowledge, lack of enforcement of food safety

rules and regulations, inadequate resources or supplies and forgetfulness or

lack of reminders. Based on these findings, it was concluded that, food

handlers were knowledgeable about food safety issues, but did not put the

knowledge into practice. It was therefore recommended that, facility managers

in collaboration with the environmental health officers, and Food and Drugs

Authority (FDA) put in place more stringent monitoring and supervision

measures to improve on the food safety practices of food handlers in

restaurants. More practical work be included in the curriculum for training

manpower for the hospitality industry.

iii

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ACKNOWLEDGEMENTS

I wish to acknowledge some individuals and organizations for their

immense support which led to the completion of this thesis.

I would like to express my profound gratitude to my supervisors:

Professor Francis Eric Amuquandoh (principal supervisor) for his great

commitment, supervision, helpful comments and suggestions and continuous

encouragement. I am highly grateful. I am equally indebted to Professor

Ishmael Mensah (co-supervisor) for his constructive comments, suggestions

and encouragement.

I am greatly indebted to Professor George K.T. Oduro and Dr. (Mrs.)

Georgina Yaa Oduro for their enormous support, suggestions and unfailing

encouragement throughout the entire work. My gratitude also goes to Dr.

Amos Alae Asamari of the University for Development Studies for reading

through the work. I wish to express my profound gratitude to Rev. Dr.

Solomon Sumani Sule Saa for the great concern, encouragement and prayer

support.

My special thanks goes to the facility managers for allowing me to use

their premises and to the food handlers in the facilities for providing

invaluable information for the study. I am as well grateful to my family for

their co-operation, patience, encouragement and all manner of support they

offered me. I sincerely thank all those who gave me pieces of advice and help

in any form whose names are not specifically mentioned.

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DEDICATION

My family and children; Ivy A. Kpebu, Sophia A. Kpebu and Jude-

Dan Kodje Kpebu.

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TABLE OF CONTENTS

Content Page

DECLARATION ii

ABSTRACT iii

ACKNOWLEDGEMENTS iv

DEDICATION v

TABLE OF CONTENTS vi

LIST OF TABLES xi

LIST OF FIGURES xii

LIST OF PLATES xiii

LIST OF ABBREVIATIONS xiv

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Research Questions 12

Objectives of the Study 12

Hypotheses of the Study 13

Significance of the Study 13

Delimitation of the Study 14

Definition of Terms 15

Limitations of the Study 15

Organization of the Study 16

CHAPTER TWO: THEORETICAL APPROACHES TO FOOD SAFETY

KNOWLEDGE AND PRACTICE

Introduction 18

Theory of Reasoned Action (TRA) 18

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Theory of Planned Behaviour (TPB) 21

The Health Belief Model (HBM) 27

Knowledge, Attitude and HACCP Practice Model 30

Conceptual Framework for the Study 32

Chapter Summary 35

CHAPTER THREE: FOOD SAFETY KNOWLEDGE, PRACTICES AND

STANDARDS

Introduction 36

Global Situation on Food-borne Illness Outbreaks 36

Restaurants and Food-borne Disease Outbreaks 37

Food Safety Knowledge of Food Handlers 42

Food Safety Practices of Food Handlers 46

Observed Food Safety Practices of Food Handlers 47

Food Safety Knowledge Versus Practices 53

Sources of Contamination of Food 58

Food Safety Standards and Regulations 63

Sources of Food Safety Information 70

Barriers to Food Safety Practices 71

Gaps in the Existing Literature 74

Chapter Summary 74

CHAPTER FOUR: METHODOLOGY

Introduction 75

Profile of the Study Area 75

Rationale for Selecting the Study Setting 78

Research Philosophy 80

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Research Design 82

Sources of Data 83

Population 83

Sample and Sampling Procedure 84

Sampling Procedure 86

Pre-testing of Instrument 95

Training of Field Assistants 96

Data Collection Procedure 97

Ethical Issues 98

Fieldwork and Related Challenges 99

Data Processing and Analysis 100

Chapter Summary 102

CHAPTER FIVE: FOOD SAFETY KNOWLEDGE OF RESPONDENTS

Introduction 103

Background Characteristics of Respondents 103

Work-Related Characteristics of Respondents 105

Food Safety Knowledge of Respondents 108

Personal Hygiene Knowledge of the Respondents 108

Environmental Hygiene Knowledge of Respondents 111

Food Hygiene Knowledge of Respondents 113

Levels of Food Safety Knowledge of Respondents 115

Food Safety Knowledge by Socio-demographic Characteristics 116

Food Safety Knowledge by Work Related Characteristics 121

Respondents‟ Sources of Information on Food Safety Issues 125

Chapter Summary 127

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CHAPTER SIX: FOOD SAFETY PRACTICES AND RELATED

BARRIERS

Introduction 129

Respondents‟ Food Safety Practices 129

Food Hygiene Practices of the Respondents 135

Environmental Hygiene Practices 140

Respondents‟ Food Safety Knowledge Versus Practices 142

Food Hygiene Knowledge Versus Practice 147

Barriers to Respondents‟ Food Safety Practices 151

Barriers to Practices by Food Safety Domains 155

Barriers to Food Safety Practices by Facility Type 158

Chapter Summary 164

CHAPTER SEVEN: SUMMARY, CONCLUSIONS AND

RECOMMENDATIONS

Introduction 165

Summary 165

Summary of Main Findings 166

Relevance of Conceptual Framework 174

Conclusions 175

Recommendations 177

Contribution to Knowledge 179

Suggestions for Further Research 180

REFERENCES 181

APPENDICES 212

APPENDIX A: Questionnaire for Food Handlers 212

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APPENDIX B: Barriers to Food Safety Practices 224

APPENDIX C: Introductory Letter 229

APPENDIX D: Food and Drugs Authority 230

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LIST OF TABLES

Table Page

1 Distribution of Restaurants by Zones 87

2 Distribution of Sampled Restaurants by Zones 89

3 Selected Facilities and Sample Sizes 91

4 Background Characteristics of Respondents 104

5 Work Related Characteristics of Respondents 106

6 Personal Hygiene Knowledge of Food Handlers 109

7 Environmental Hygiene Knowledge of Respondents 112

8 Food Hygiene Knowledge of Respondents 114

9 Respondents‟ Food Safety Knowledge Levels 116

10 Food Safety Knowledge by Respondents‟ Socio-Demographic

Characteristics 117

11 Food Safety Knowledge by Work Related Characteristics 123

12 Respondents‟ Main Sources of Information on Food Safety Issues 126

13 Personal Hygiene Practices of the Respondents 130

14 Food Hygiene Practices of Respondents 136

15 Environmental Hygiene Practices in Restaurants 140

16 Respondents‟ Personal Hygiene Knowledge Versus Practice

144

17 Food Hygiene Knowledge Versus Practice 149

18 Barriers to Respondents‟ Food Safety Practices 152

19 Barriers to Practice by Food Safety Domains 157

20 Barriers to Practices by Facility Type 162

21 Distribution of Sampled Restaurants by Zones 228

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LIST OF FIGURES

Figure Page

1 Out Patient Cases of Diarrhea and Food Poisoning in TTH 8

2 Out Patient Cases of Diarrhea and Food Poisoning in TCH 8

3 Theory of Reasoned Action 19

4 Theory of Planned Behaviour 22

5 Model of Food Safety Knowledge, Attitude and HACCP Psractice 32

6 Conceptual Framework of the Study 33

7 Map of Tamale Metropolis 77

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LIST OF PLATES

Plate Page

1 Use of Gloves During the Cutting of Pizza 134

2 Correct Practice (Using Gloves) 134

3 Incorrect Practice (Using Bare Hands) 134

4 Preparing Vegetable Salad with Bare Hands 139

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LIST OF ABBREVIATIONS

CODEX – Latin for “Book of Food”

CDC - Centre for Disease Control Prevention

EFSA - European Food Safety Authority

EHD - Environmental Health Department

EPA – Environmental Protection Agency

FAO – Food and Agriculture Organization

FDA – Food and Drugs Authority

FSK – Food Safety Knowledge

FSB - Food Safety Behaviour

FSMS - Food Safety Management System

GTA – Ghana Tourism Authority

GSA - Ghana Standards Authority

HACCP - Hazard Analysis Critical Control Point

HBM – Health Belief Model

KAP – Knowledge, Attitude and Practice

MOH - Ministry of Health

NRA – National Restaurant Association

PHU – Public Health Unit

TCH – Tamale Central Hospital

TRA – Theory of Reasoned Action

TPB – Theory of Planned Behaviour

TTH – Tamale Teaching Hospital

VSD - Veterinary Services Department

WHO - World Health Organization

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CHAPTER ONE

INTRODUCTION

Background to the Study

The World Health Organization [WHO] (2006) defines food safety as

the conditions and measures that are necessary during the production,

processing, storage, distribution and preparation of food with the aim of

ensuring that it is safe, sound, wholesome and fit for human consumption. In

other words, it is a situation that gives an assurance that when food is eaten, it

will not affect the health and well-being of the individual. For food to be

considered safe, it should be devoid of any biological, chemical or physical

hazards capable of causing food borne illness.

In the United States of America (USA), the Centre for Disease Control

and Prevention (CDC), (2011) reported that about 48 million food-borne

illnesses occur yearly; with over 128,000 individuals hospitalized and 3,000

resulting in death. According to the WHO (2015) report, approximately two

million deadly cases of food poisoning occur in developing countries every

year. The Ministry of Health (MOH, 2014) indicated that Malaysia recorded

about 49.8 cases of food poisoning per every 10,000 population. In Ghana,

Ababio and Adi (2012), Mahami and Odonkor (2012), and Salas, (2011)

found that about 420,000 cases of food borne illnesses occur every year with

an annual death rate of about 65,000 which was projected to cost 69 million

US dollars to the Ghanaian economy.

It is noted from the foregoing that unsafe food has become a human

health problem and the frequency of the outbreak of food-borne illness is a

worldwide public health concern. This has led to the need to ensure food

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safety in food service establishments and institutions (Sanlier & Konaklioglu,

2012; Lues & Van-Tonder, 2007). Consequently, governments, international

organizations and local authorities have intensified their efforts to ensure food

safety in the food chain process (Sanlier, 2010; Sanlier & Turkmen, 2010).

The strategies used included the adoption and enforcement of food

safety laws and regulations, health education for food service employees and

consumers as well as the adoption and implementation of food safety

management systems (FSMS) and good hygiene practice standards (Moreaux,

2014). WHO (2010) suggested that raw foods be separated from cooked ones,

separate equipment and utensils be used for different categories of food,

foods be stored in separate containers to avoid cross contamination. Other

recommendations indicate that fruits and vegetables that are eaten raw be

thoroughly washed, cooking and reheating of foods be thoroughly done and

promptly refrigerating all foods that will not be used immediately.

Based on the developments in the global market, the Government of

Ghana also established regulatory bodies such as Environmental Protection

Agency (EPA); Food and Drugs Authority (FDA); Ghana Tourism Authority

(GTA); Ghana Standards Authority (GSA), Veterinary Services Department

(VSD), Metropolitan, Municipal and District Assemblies (MMDAs) and the

Public Health Units (PHU) of the Environmental Health Department (EHD)

to enforce rules and regulations enacted by the government. This is intended

to control or regulate the activities of food handlers to ensure the production

and service of safe food.

Nevertheless, cases of food-borne illnesses continue to be on the

increase especially in developing countries, serving as a threat to public

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health globally (Tieyiri, 2008; Panchal, Bonhote, & Dworkin, 2013). This

could be attributed to the presence of microbes, parasites, physical hazardous

materials, and chemicals which are intentionally or unintentionally added to

food or might occur naturally in the food or found in the environment (World

Bank, 2000). These risk factors could be as a result of improper handling of

food, inadequate cooking, addition of additives, the use of food and water

from unsafe sources, improper holding temperatures, cross contamination

between raw and cooked foods, as well as unclean equipment, poor sanitation

and personal hygiene practices and ineffective food handling training

(Askarian, Kabir, Aminbaig, Meish & Jafari, 2004; Barrabeig et al., 2010;

Beatty et al., (2009) cited in Thelwell-Reid, 2014; Bryan, (1988) as cited in

Brar, 2016; Coleman & Roberts, 2005; Grintzali & Babatsikou, 2010; MOH,

2012; WHO, 2010).

The MOH (2007) annual report confirmed this with the indication that

more than 50% of all food poisoning cases were as a result of improper food

handling by food handlers. Bolton et al. (2008) and Sanlier and Turkmen,

(2010) also reported that poor food handling practices contribute to 97% of

food borne illnesses during food preparation in food service establishments.

Beatty et al., (2009) as cited in Thelwell-Reid (2014) linked food-borne

disease outbreaks in US to the mishandling of food by food handlers as

eleven food handlers were found to have positive stool cultures for Samonella

enteritidis. The World Health Organization (WHO) also established that both

food-borne and water-borne illnesses, jointly cause 2.2 million deaths every

year; including the deaths of 1.9 million children (WHO, 2012).

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Adams and Moss, (2008) explained that food handlers carry food

borne pathogens in their hands, mouths, cuts, skins and hair which are

transferred into foods during preparation. It was noted that infected food

handlers were able to spread agents of gastrointestinal infectious diseases to

consumers (Abdalla, Suliman, & Bakhier, 2009; Micheals et al., 2004). Thus,

a single food safety error by an employee in any food service establishment

has the tendency of affecting many consumers (Knight, Worosz & Todd,

2007).

Also, in Malaysia, the MOH (2012) found ineffective food handling

training, the use of untreated water, and poor sanitation and hygiene as the

main causes (risk factors) of food poisoning. Newman, (2005) indicated that

even the way farming is done has a distinct effect on the quality of food

items, especially vegetables, which makes them unsafe for consumption. This

suggests that food contaminants can be introduced into different areas of the

food supply chain from the farm to the table.

The foregoing implies that by the time any food item arrives at any

food service establishment, it might be carrying some load of contaminants. It

is therefore incumbent on food handlers to either control the load of

contaminants that already exist in the food or prevent any further

contamination. For this to be possible, it is very important that food handlers

have very good knowledge of food safety issues and practices as well as

understand the risks involved in serving unsafe food to the public.

Knowledge can be explained as the possession of factual information,

experiences and know-how on some phenomena. It connotes the ability to

acquire, retain and use information as well as a blend of understanding,

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experiences, discernment and skill. Food safety knowledge refers to the level

of awareness of food safety issues and practices. It is associated with the

application of rules, knowledge and skills that lead to action (Kaliyaperumal,

2004). As indicated by a Chinese philosopher, knowledge is the beginning of

practice and practice is the end of knowledge (Yambo, 2016). Thus it is

anticipated that individuals will put their food safety knowledge into practice

to reduce incidence of food borne illnesses. In this regard, food handlers‟

knowledge is regarded as a fundamental and most important factor in the

production of quality food throughout the food chain (Joseph, 2018; Panchal,

Carli & Dworkin, 2014). Thus, food handlers with good knowledge on the

hazards capable of contaminating food as well as appropriate food handling

practices could be in the position of controlling or preventing food borne

illnesses (Angelillo, Viggiani, Rizzo & Bianco, 2000).

However, researchers have identified inadequate or lack of food

hygiene knowledge, poor food handling practices, non-compliance to food

safety rules and regulations coupled with non-enforcement of food safety

laws and regulations by the enforment agencies as factors contributing to

food borne infections (Askarian, Kabir, Aminbaig, Meish & Jafari, 2004;

Coleman & Roberts, 2005; Grintzali & Babatsikou, 2010).

In addition to lack of knowledge and supervision, Yatsco (2000) as

cited in Paez and Ortiz (2011), identified lack of food safety training and

certification; problems with equipment and layout of facilities as factors that

affect the possibility of offering safe food in Costa Rica. Consequently, a

number of researches have identified training as a way of improving food

handlers‟ food safety knowledge and a means of reducing the risk of food

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borne diseases (Averett, Nazir & Neuberger, 2011; Finch & Daniel, 2005;

Lynch et al., 2005; Roberts et al., 2008). Thus, it is highly important that food

handlers receive appropriate training on food safety issues to help in the

prevention food borne illnesses.

Universally, it has been noted that institutional food service and

catering establishments are major sources of food-borne outbreaks in both

developed and developing countries (EFSA, 2010). CDCP (2010) reported

that about 41% out of 1,097 food borne illness outbreaks in the United States

of America (USA), were specifically linked to restaurants.

In an attempt to prevent or reduce incidences of food-borne diseases,

restaurants are an important setting to target since they have been identified

as one of the most frequent outlets for food-borne illness outbreaks (CDC,

2013; Knight, Worosz & Todd, 2007). One of such instances is the Jack in

the Box E. coli outbreak in the US where about 700 people fell ill and four

children died after the consumption of contaminated meat purchased from the

73 Jack in the Box restaurants (Golan et al., 2004).

Similarly, Barnes, (2005) reported that over 400 suspected cases of

food poisoning were traced to two Turkish restaurants in Melbourne,

Australia; which resulted in at least seven people being hospitalized. In

addition, it was noted that over 600 consumers were infected with norovirus

after eating in two Lansing restaurants in Michigan, US, (Clark, 2010).

According to Charnley, (2008). Frederict Accum (a German chemist)

investigated into the usage of adulterants and identified many toxic colouring

in foods and drinks. The study indicated that in 2003 Sudan dye (industrial

dye) was found in foods such as chilli powder and foods containing chilli

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powder in the European Union. This led to the issuance of notification by

several EU member states on the presence of Sudan IV and Sudan I in foods

like curry powder, chilli powder, sumac, curcuma, processed products

containing chilli and palm oil (RASFF, 2005).

In Ghana, Amoako-Mensah (2016) assessed the prevalence of palm oil

adulteration with Sudan IV dye in the Greater Accra Region. The study

revealed that 96% of sampled palm oil drawn from the open market tested

positive for Sudan IV dye. Thus adulteration of food poses a risk to food

safety.

Also, it was reported that due to poor sanitary conditions, the

occurrence of cholera outbreak in Accra claimed about 130 lives and more

than 12,000 people were hospitalized. The report added that the cases

increased to as high as 17,000 with 150 deaths (Myjoyonline, 2014). It is

worth noting that there have been reported cases of foodborne illnesses

including food poisoning (a kind of food borne illness); where the affected

people show syptoms such as abdominal cramps, diarrhea, cholera,

vomiting, loss of appetite, mild fever and nausea in Tamale metropolis.

The results from an enquiry made into the situation of food borne

illnesses in two public hospitals (Tamale Teaching Hospital- TTH and

Tamale Central Hospital-TCH) in the metropolis are presented in Figures 1

&2. The graphical representations show fluctuating (rise, fall and rise) trends

in both diarrhea and food poisoning cases in the metropolis over a three year

period (2014 - 2016). This means that issues on food borne diseases in Ghana

is not a sectorial but national issue.

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Figure 1: Out Patient Cases of diarrhea and food poisoning in TTH

Source: Hospital records (2017)

Figure 2: Out Patient Cases of diarrhea and food poisoning in TCH

Source: Hospital records, (2017)

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Existing studies such as those by Alqurashi, Priyadarshini and Jaiswal

(2019), FAO, (2012), Glanz, et al., (2002) and Onyango, Kieti, and Mapelu

(2016) suggest that good levels of knowledge on food safety among food

handlers and effective application of such knowledge to food handling are

vital in ensuring safe food production in any catering operations. It is

therefore very important that food handlers have knowledge on food safety

issues either through education/training, experiences and research information

which could go a long way to influence their practices and minimize food-

borne disease outbreaks. In other words, there is the need for restaurant

operators and their employees to appreciate the interaction of prevalent food

safety beliefs, knowledge and practices. Onyango et al. (2016), through the

use of self-administered questionnaires and observation checklist, found that

high food safety knowledge impacted positively on attitudes towards

temperature control and personal hygiene.

Statement of the Problem

As a result of rapid urbanization many people eat outside the home;

and this has made food establishments to become more important than ever

(Feldman, 2015). Unfortunately, the increase dependence on food from food

establishments including restaurants has been linked to a number of health

challenges including typhoid, cholera, diarrhea in several countries including

United States of America (Cates et al., 2009; Howells, 2005; Jones & Angulo,

2006), United Kingdom, Canada (Mathias et al., 1995), Australia (Morrison,

1998), Nigeria (Onyeneho & Hedberg, 2013) and Ghana (Salas, 2011).

Studies on the outbreak of food borne diseases indicate that eating food

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prepared in food establishments continues to be a major source of infection

(Jones & Angulo, 2006).

Specifically, food handlers‟ failure to follow acceptable food safety

standards in the preparation, processing, cooling and storing of food

(Tomohide, 2010) causes food borne illnesses. Other common food safety

breeches that have been identified to characterize their operations are

obtaining food from unsafe sources, inadequate cooking, improper

temperature holdings, and the use of contaminated equipment (Adams &

Moss, 2008; EFSA, 2009; WHO, 2002).

Since eating out, including eating in restaurants, is associated with ill-

health and frequent outbreak of foodborne illnesses, it is required that attention

be paid to food safety training, knowledge and practices of all individuals who

prepare food for public consumption on regular basis. This is premised on the

fact that health education for food service employees and consumers has been

found to be central in the prevention of frequent outbreak of foodborne

illnesses. (Alqurashi, Priyadarshini & Jaiswal, 2019; FAO, 2012; Glanz et al.

2002; Onyango, Kieti, & Mapelu, 2016).

Unfortunately, in Ghana researchers have paid much attention to food

safety knowledge and related issues among street food vendors, traditional

caterers and chopbars with little attention on food safety in restaurants. In

their review of literature on food safety issues in Ghana, Ababio & Lovatt

(2015) indicated that most of the research efforts on commercial food

operations have focused on street foods and microbiological safety with

limited information from institutional catering and other forms of food

hazards. For instance, King, Awumbila, Canacoo, and Ofosu-Amaah, (2000)

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assessed the safety of street foods in five sub-districts in the city of Accra

while Mensah et al. (2002) investigated into microbial quality of foods sold

on the streets of Accra and factors predisposing them to contamination.

Again, Ayeh-Kumi et al. (2009) through screening assessed the prevalence of

intestinal parasitic infections among 204 food vendors from seven

metropolitan areas of Accra. Similarly, Ackah et al. (2011) carried out a study

to determine the hygienic knowledge and food safety practices among street

food vendors in Accra.

With the influx of non-governmental organizations (NGOs) and the

adoption of tourism as a development option by Ghana in 1983 there has been

an increasing popularity of tourism in the northern half of the country;

particularly in the Tamale Metropolis. As a result a number of restaurants

have sprung up to meet the food needs of guests that visit the area. Despite

the increase in the number of restaurants and their potential health threats to

the public, no detailed studies have been conducted into the food safety

knowledge and practices of this group of food handlers.

In Ghana most researchers have focused on food safety issues in the

southern sector of the country at the expense of the northern half. This is

against the background that the occurrence of food borne illnesses remains a

significant health issue in the entire country including the northern region.

Outpatients records compiled by the two main hospitals in the Tamale

Metropolis from 2014-2016 indicate that diarrhoea and food poisoning are

common in the area (Fig. 1 & 2). Accordingly, for the knowledge base on

food safety in Ghana to be complete there is the need to have a

comprehensive information on food safety knowledge of food service

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operators including restaurant operators in the northern region. It is on these

grounds that this study sought to explore the food safety knowledge and

practices of food handlers in restaurants in the Tamale metropolis in the

Northern region of Ghana.

Research Questions

The research questions that guided the study were;

1. What are the food safety knowledge dimensions of food handlers in

restaurants in the Tamale metropolis?

2. Which sources do food handlers obtain food safety information from?

3. What are the food safety practices of food handlers in the restaurants?

and

4. How is food safety knowledge related to practices of food handlers in

restaurants?

5. What are the barriers to food safety practices in restaurants?

Objectives of the Study

The main aim of the study was to assess the food safety knowledge

and practices of food handlers in restaurants in the Tamale Metropolis. The

specific objectives were to:

1. assess the food safety knowledge of food handlers in restaurants

2. identify the sources from which food handlers obtain food safety

information

3. examine the food safety practices of food handlers in the restaurants

4. analyze the relationship between food safety knowledge and practices

of food handlers in restaurants

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5. find out the barriers to food safety practices in restaurants

Hypotheses of the Study

H1: There will be a significant difference in the personal hygiene knowledge

by the sex of the food handlers.

Ho: There will be no significant difference in the personal hygiene knowledge

by the sex of the food handlers.

H1: There will be a significant difference in the food hygiene knowledge by

the religion of the food handlers.

Ho: There will be no significant difference in the food hygiene knowledge by

the religion of the food handlers.

H1: There will be a significant difference in the environmental hygiene

knowledge by the educational status of the food handlers.

Ho: There will be no significant difference in the environmental hygiene

knowledge by the educational status of the food handlers.

H1: There will be a significant difference between food safety knowledge and

food safety practices of the food handlers.

Ho: There will be no significant difference between food safety knowledge and

food safety practices of the food handlers.

Significance of the Study

The study will contribute both to theory and practice. In terms of

theory this study will address the imbalances in food safety research which

focused on the food safety knowledge of street food vendors at the expense of

food handlers in restaurants.

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The study will also address the concentration of research efforts on

food safety knowledge and practices in Southern Ghana especially the capital

city of the country, thus, addressing the gaps in the available literature on

food safety knowledge and practices in restaurants.

With reference to practice, the study provides valuable information to

policy makers and planners to design and introduce appropriate food safety

interventions to address the factors mitigating against the food safety practices

of food handlers in restaurants. This would enable them to design and modify

their plans and policies towards effective regulation and monitoring of

activities.

It is anticipated that the findings of the study will inform the facility

managers of their employees‟ level of food safety knowledge and practices to

enable them to take steps to address or overcome shortfalls.

In addition, the study would help in identifying the training needs of

food handlers which will help managers and stakeholders to initiate suitable

food safety interventions including health education programmes to improve

upon the food safety knowledge and practices in restaurants.

Finally, the results of the study will be a source of valuable

information to the Ghana Tourism Authority, Foods and Drugs Authority and

Health and Sanitation officers to redesign or modify their regulatory and

monitoring strategies and schedules to bring about effective monitoring to

ensure appropriate food safety practices.

Delimitation of the Study

Though there are different categories of hotels and restaurants, the

study focused on grades 1-2 independent restaurants and 1-2 star hotel

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restaurants in the Tamale Metropolis to ensure effective work within the time

available. In all, eleven independent restaurants and 12 hotel restaurants were

used for the study. Nevertheless, the findings may be adapted to other

facilities with similar characteristics as well as other districts, municipalities

and metropolises.

Definition of Terms

Food handlers: refers to all persons who work in the facilities‟ kitchens and

have access to or come into contact with the food, equipment or utensils and

food contact surfaces as well as those involved in packaging or un-packaging

foods.

Food hygiene practice: Activities carried out by food handlers to protect foods

from contamination.

Qualified food handlers: for the purpose of this study refers to employees in a

restaurant who handled, prepared and served food; especially potentially

hazardous foods.

Limitations of the Study

The study concentrated on the food safety knowledge and practices of

food handlers leaving out their attitudes which is an important variable

highlighted in all the theories and models associated with the study. Also,

purposive and accidental sampling was used to select the respondents and the

restaurants. This excluded the knowledge and practices of workers who were

not carrying out activities that were not directly linked to food preparation and

service. In other words workers such as bar operators, cashiers, grocery shop

attendants and all other workers who were not handling food and equipment

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in the kitchen and restuarant at the time of visit were not included in the study.

These limitations prevent the generalization of the findings of the study

beyond the food handlers in the restaurants who have direct link with the

processing and cooking and serving of food.

Organization of the Study

The study is organized into seven chapters. The first chapter which

introduces the study covers the background of the study, the statement of the

problem, the research questions, the objectives of the study, significance of the

study, delimitations, limitations of the study, and the definition of terms.The

second chapter focuses on related theories, models and conceptual framework

guiding the study. The theories and models discussed included the Theory of

Reasoned Action, Theory of Planned Behaviour, the Health Belief Model and

the KAP model.

The third chapter discusses relevant literature on food safety

knowledge and practices of food handlers. The areas of attention were the

concepts related to food safety and empirical findings on food safety standards

and regulations, food safety knowledge and practices in restaurants, sources of

information on food safety, effects of knowledge on food safety practices and

barriers to food safety practices.

Chapter four covers the research methodology adopted for the study

which includes the profile of the study area, research design, population,

sample and sampling procedure, data collection and data analysis procedures.

Even though the objectives of the study presented in chapter one did

not focus on the socio-demographic characteristics of the respondents, they

emerged as an opportunistic data relevant to the study. Consequently, Chapter

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five presents the socio-demographic analysis of the respondents as well as the

theoretical approaches to the study and food safety knowledge of the

respondents.

Chapter Six deals with the findings and discussion in relation to the

food safety practices of the respondents and the barriers to the respondents‟

food safety practices. Chapter Seven covers the summary, conclusions and

recommendations based on the findings and suggestions for further studies to

be conducted.

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CHAPTER TWO

THEORETICAL APPROACHES TO FOOD SAFETY KNOWLEDGE

AND PRACTICE
Introduction
This chapter discusses relevant theoretical issues and models

underpinning the study. According to Denison (1996) as cited in

Amuquandoh, (2006) it is common for researchers to merge components from

various theories to enable them get a better understanding of how behaviour

change occurs. Consequently, a variety of theories and models have been

discussed to help explain a multiplicity of human behaviours and how human

actions are guided (Rennie, 1995) as well as the relationship between food

safety knowledge and practices of food handlers. Thus, some of the theories

that informed this study include the Theory of Reasoned Action (TRA), the

Theory of Planned Behaviour (TPB), the Health Belief Model (HBM), and the

Knowledge, Attitude and Practice (KAP) model.

Theory of Reasoned Action (TRA)

This theory was first presented by Fishbein (1967) in an attempt to

understand the relationship between attitude and behaviour. McKemey &

Sakyi-Dawson (2000) as cited in Rehman et al., (2003) described TRA as an

important sequence of related concepts and assumptions developed by social

psychologists to understand and predict human behaviours as displayed in

Figure 3. According to Ajzen (1988), the theory is based on the assumption

that human beings are rational and so they conduct themselves in a sensible

way taking into account the availability of logical information as well as the

implications of their behaviour. This suggests that individuals consider the

repercussions of their actions before they decide whether or not to behave in a

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given way. In other words, food handlers will have to consider the

consequences or effects of their actions in relation to food safety measures

before they decide to obey or not to obey food safety rules and regulations.

Beliefs

Attitude

Evaluation

Intention Behaviour

Normative

Beliefs
Subjective

Norm
Motivation
to comply

Figure 3: Theory of reasoned action

Source: Ajzen & Fishbein (1980)

According to Tlou (2009), the precise determinant of an individual‟s

behaviour in the TRA is considered as the individual‟s behavioural intention

and the condition most likely to predict behaviour will be provided when

appropriate measures of behaviour have been obtained. The theory

endeavours to explain the relationship between beliefs, attitudes, intentions

and behaviour as indicated in the figure. Nevertheless, the extent of the

individual‟s intension will not always be an accurate predictor of behaviour.

To buttress this assertion, Ajzen and Fishbein (1980) indicated that the

intention-behaviour relationship is important in the prediction of outcomes, as

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the desire for a specific outcome will determine whether or not a person

engages in a particular behaviour. Thus, in relation to food safety, it is what

the food handler is aware of or the goal or name the facility wants to attain

that motivates the employees to take action in an expected manner.

Tlou (2009) is of the view that the immediate determinants of an

individual‟s behavioural intentions are his or her attitudes towards performing

the behaviour and the subjective norms associated with the behaviour. In

other words the food handlers‟ attitude to food safety practice is determined

by their expected outcomes as well as whether the people who matter

(managers, facility owners) support or do not support the action. For instance

if a food handler has a positive attitude towards the use of hand gloves or

food thermometers to check temperatures of incoming foods before storage

and the facility owner or manager does not see the need, the item will not be

provided and the intention of the food handlers will not be fulfilled. Thus,

attitude is determined by one‟s belief about the consequences or attributes of

performing a specific behaviour while a person‟s subjective norm is

determined by whether important people support or do not support the

behaviour coupled with the person‟s motivation to comply with what they

suggest (Montano & Kasprzyk, 2002).

In effect, the theory assumed a fundamental linkage that associates

behavioural and normative beliefs to behavioural intention and behaviour

through attitude and subjective norm. This means that food handlers will put

food safety measures into practice when they evaluate them positively and

believe that significant others (facility managers and owners, chefs,

regulatory agencies) think they should execute them. Montano and Kasprzyk

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(2002) indicated that the TRA is appropriate in explaining behaviour when

there is high control over the individual‟s freedom to choose something or

make own decisions.

The implication is that, in this situation of food safety knowledge and

practices, there is a high degree of perceived and actual control over the

internal and external factors that may get in the way of the performance of the

intended action. For instance, coupled with the dictates of significant others,

barriers such as inadequate supplies, busy work schedules, working within

time limits and work culture could support or defeat the intended action.

The limitation associated with this theory is that, it tends to eliminate

human nature, which also plays a role in decision making processes and

focuses on only the strong cognitive orientation (Dutta-Bergman, 2005). The

theory assumes that human intentions exclusively influence their behaviours.

It looses sight of the fact that past behaviour can also best predict future

behaviour based on the reason that environmental stimuli may habitually

trigger a behavioural response (Sutton, McVey & Glarz, 1999).

Another setback of the theory is that it assumes that when an

individual forms an intention to act, he or she will be free to act without

restrictions; whereas in reality, conditions such as rigid ability, time,

environmental, organizational limits and lack of awareness will restrict the

individual from acting or behaving in a specific planned manner or way.

Theory of Planned Behaviour (TPB)

According to Armitage and Conner (2001), the theory of planned

behaviour (TPB) was developed by Ajzen and Fishbein (1980) out of the

theory of reasoned action. Ajzen & Fishbein modified the TRA to include

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perceived behavioural control. Thus, the TPB describes how attitude,

subjective norms and perceived behavioural control could influence

behavioural intentions as well as guide actual behaviour outcomes (Park &

Levine, 1999) as illustrated in Figure 4.

Attitude
towards
behaviour

Intention Behaviour
Subjective
norms

Perceived
behaviour

Figure 4: Theory of Planned Behaviour

Source: Ajzen (1991)

The underlying principle of including perceived behavioural control in

the theory was that it will allow the prediction of behaviours that were not

under complete authority to make decisions that affect intention towards

behaviour (Armitage & Conner, 200I). This means that the theory of planned

behaviour is more appropriate to explain behaviour in conditions where power

to choose or volitional control is low (Ajzen, 1991). Thus, the perceived

behavioural control is determined by control beliefs concerning the presence

or absence of facilitators and barriers to behavioural performance, influenced

by the perceived power or input of each factor to facilitate or inhibit

behaviour.

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The perceived behavioural control is likened to Bandura‟s concept of

self-efficacy which refers to one‟s belief in his or her ability to perform a

particular action under different conditions (Montana & Kasprzyk, 2002).

This indicates that perceived behavioural control can be considered as an

individual‟s perception of his or her ability to perform or not to perform an

action. Ajzen (1991) and Montana & Kasprzyk (2002) further explained that

the perceived behavioural control is determined by control beliefs in relation

to the power of both situational and internal factors as inhibitors, barriers, or

facilitators to the performance of the behaviour. Thus, it can be concluded that

persons with strong control beliefs about factors that assist behaviour will

have high perceived control which in turn translates into an increased

intention to perform the behaviour.

According to Fishbein and Ajzen (l975), attitudes toward behaviour

involves individual's assessment of how positive or negative performing the

behaviour would be and how subjective norms reflect individual‟s perceptions

of social pressure to either perform or not to perform an action. They

indicated that both attitudes and subjective norms are based on beliefs and that

the individual‟s intentions serve as mediation point for behaviour to be carried

out. Consequently, Ajzen (1991) conceptualized subjective norms as an

individual‟s perception about a given behaviour which is influenced by the

judgment of significant others, such as facility owners, managers, restaurant

and hoteliers‟ association, GTA, FDA and other regulatory agencies.

Therefore, the fundamental feature in the TPB is the individual‟s intention to

execute a given behaviour such as putting food safety rules and regulations

into practice. In his opinion, intentions are supposed to cover the motivational

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issues that influence behaviour; their indications of how hard individuals are

ready to try, how much effort they are prepared to exert, in order to perform

the behaviour. Therefore, the individual is motivated to behave in a way based

on the benefits he or she is likely to derive from it; coupled with the social

pressure to act.

In terms of food safety practices, the theory suggests that the food

handler‟s personal attitude towards food safety would determine the hygiene

practices adopted. In addition, the vendor‟s perception, such as the necessity

for safe sanitary practices, the health implications of certain cooking methods,

and the dietary implications of the choices of cooking ingredients, which has

been formed from the influence of others, would also influence the hygienic

quality of the food. Moreover, the ease with which the food handler can

practice food safety measures is also a determinant of intended or actual food

safety practices.

The intended action articulates the nature of the attitude and the

subjective norm wherein the subjective norm is basically the perception

formed by the individual about undertaking or not undertaking that behaviour

due to the social pressure. One prominent observation by the theory of

planned behaviour is that behaviour may also depend on other factors such as

availability of appropriate opportunities and resources which collectively

correspond to the people‟s actual control over the behaviour (Liska, 1984;

McConnon & Nichols, 2012).

In this sense, the practice of food safety measures by food handlers

could also be conditioned by the availability of effective monitoring

institutions, official standards of operating food service outlets and facilities

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as well as effective information dissemination and communication channels

for educating food vendors on food safety practices. .

Importantly, the theory of planned behaviour takes care of the

weakness in the previous theory to deal with incomplete volitional control

and indicates that individuals perform certain acts under the assumption that

people behave rationally (Ajzen, 1991), considering the ramification of their

actions (Ramayah, Lee & Lin, 2012). However, some behaviours are non-

volitional and may seem to be outside the scope of a planned behaviour,

which stipulates that the more favourable the attitude toward behaviour and

subjective norm, and the greater the perceived behavioural control, the

stronger the person‟s intention to perform a particular behaviour.

The theory of planned behaviour, however, accounts for non-volitional

behaviour in the sense that not all behaviours or actions can be controlled by

the performer of the action. Within the context of non-volitional behaviours,

the theory suggests that the sanitary conditions of the foods served would also

be associated with the unintended actions of the food handlers. For example,

the food handler might use vegetables that were sprayed with insecticides a

few days back for food, which might lead to food poisoning. It might be

argued that the sourcing of the vegetables and ingredients are planned and

rationalized by the food handler, although the farmer is more likely to be

responsible for the contaminated state of the vegetables. This means that not

all behaviours and actions can be planned.

The questions that come to mind based on the theory of planned

behaviour in relation to food safety practice are: does the intention to maintain

safe hygienic conditions actually lead to how well food handlers practice food

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safety measures? Will attitudes, subjective norms and perceived behavioural

control account for the challenges or barriers to the hygienic practices among

food handlers? It was noted that the theory of planned behaviour overlooks

emotional variables such as threat, fear, mood and negative or positive feeling

and assessed them in a limited fashion. For example, Conner et al., (2003)

maintain that some health behaviours may be largely influenced by emotions.

Strong emotions are relevant to this model because they can influence beliefs

and other constructs, such as attitudes and perceptions.

TPB is also limited by the fact that it did not consider demographic

factors and at the same time failed to clearly outline the perceived

behavioural control, thus making it difficult to measure. Like the theory of

reasoned action, the theory of planned behaviour assumes that people are

rational and make systematic decisions based on available information and

ignores unconscious motives. The theory did not consider the fact that the

more the time between behavioural intent and actually exhibiting the

behaviour, the less likely the behaviour will happen.The theory is also

criticized for its failure to fully mediate the influence of past behaviour,

particularly when a meta-analysis conducted by Conner and Armitage (2003)

revealed that past behaviour accounts for an additional 13% of variance in

behaviour.

The implication is that as rational human beings, food handlers are

required to make decisions on food safety practices bearing in mind available

information (both internal and external factors) and the time within which to

carry out the action or behaviour. If the interval between the plan or intention

to act and the time of action is too long, there is the likelihood that the action

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may not come on. Thus, there is the need for food handlers to act promptly

when the intention is formed otherwise the action is less likely to take place.

The emotional influence of past experiences and practices as well as the

approval of certain food safety practices were considered in this study.

The Health Belief Model (HBM)

The Health Belief Model (HBM) was developed in the 1950 by a

group of social psychologists in United States (Hochbaum, Rosenstock and

Kegels) to explain and predict health behaviours (Glanz et al., 2002). It was

meant to address the failure to free tuberculosis (TB) health screening

programme in the USA. The model has since, then, been adopted to explore a

variety of health behaviours such as sexual risk behaviour and transmission of

HIV and AIDS (Hanson & Benedict, 2002) as well as in the identification of

the attitudes of older adults towards the adoption of safe food-handling

practices.

The original goal for developing the HBM was to focus the efforts of

researchers who aimed at improving public health by understanding why

people do not take preventive measures to health promotion. It is based on the

assumption that health behaviour is more likely to occur when the following

are present: someone perceives that failure to act will make the individual

vulnerable to illness or disease; the consequences of failure to act will be

serious; there are perceived benefits to taking actions; the perceived benefits

outweigh the perceived cost. There is the belief that the action will be

successful in achieving the desired outcome.

According to Denison (1996) as cited in Amuquandoh, (2006), the

HBM explains and predicts people‟s health behaviours by focusing on their

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attitudes and beliefs. The model illustrates that a person‟s behaviour and

attitudes are influenced by his or her background such as education, sex, age,

race and tribe or ethnicity and that the background has an impact on one‟s

perceptions and attitudes which result in practice or action. Denison (1996)

cited in Amuquandoh, (2006) indicated that external motivators such as

public education; seeing an image of a person dying from AIDS or informal

support groups may cause individuals to examine and possibly change their

sexual actions.

Similarly, Abraham and Sheeran (2005) said the HBM postulates that

an individual is likely to engage in a health related behaviour based on

perceived susceptibility, perceived severity, perceived benefit and perceived

barrier which have been categorized as perceived threat and behavioural

evaluation. The model consists of variables that explain why some people

who are healthy adopt health protective behaviours while others are not

prepared to do so.

It is based on the assumption that an individual is likely to adopt

health behaviour when he or she perceives that his or her failure to act will

make him or her susceptible to an illness or a disease, the outcome of failing

to act will be serious, as well as the perceived benefits for taking actions.

Also, when the individual knows that the perceived benefits out-weigh the

perceived cost, there is the belief that the action taken will bring about

success in achieving the desired results (Abraham and Sheeran, 2005). Thus,

in HBM, human behaviour is seen to be dependent on two variables such as

the value an individual places on a particular outcome and the person‟s

estimate of likelihood that a given behaviour will result in that outcome.

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The HBM is adopted due to its simplified health related concepts that

make it easy to implement, apply and test (Conner, 2010). At the same time

has provided a useful framework for investigating the intellectual basis for a

wide range of behaviours. The model has also created awareness among

researchers and health professionals on changeable situations that are

prerequisites for health behaviour. It has no strict laid down rules for

combining variables which makes it flexible to be adaptable and applicable to

many different health behaviours and groups.

For this reason, the model is considered appropriate for this study

because unsafe food handling practices expose both the food handlers and the

customers to food borne illnesses which represents the perceived threts

outlined in the model; such as threat to individual, customers and the food

service business. On the contrary, if food handlers employ hygienic practices,

customers may be saved from food borne illness, the business is saved from

court suits, food spoilage, and help to earn a good reputation. However, some

factors such as inadequate knowledge, time constraint, and limited resource

supplies may militate against the compliance with hygiene practices.

Nevertheless, a limitation of this model is that it does not clearly show

the relationships between the variables and there are no strong rules for

combining the formulated variables (Armitage & Conner, 2000). Another

short fall is its predictive capability; which suggests that the primary variables

(severity, vulnerability, benefits and barriers) were significant predictors of

health-related behaviour in most cases but their effects are usually

insignificant (Abraham and Sheeran, 2005). The implication is that there are

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other important variables that determine healthy behaviour which the model

has not accounted for; which means that the model is not complete.

Knowledge, Attitude and HACCP Practice Model

A number of models from the behavioural sciences have been

projected to improve the understanding or explain how human behaviour or

actions are guided as well as the relationship between food handlers‟ food

safety knowledge and practice (Rennie, 1995). Nevertheless, this study was

guided by the knowledge, attitude and hazard analysis and critical control

point (HACCP) practice model developed by Ko (2013). This has been

identified as a model often used to explain the relationship between

knowledge, attitude and practice (Simelane, 2005) as envisaged in Figure 5.

The model describes the interrelationship between knowledge, attitude and

HACCP practices among food handlers in food service establishments and

assumes that there is a strong inter-relationship between food safety

knowledge, attitude and HACCP practices. Rennie (1995), postulated that the

knowledge, attitude and practice (KAP) model is built on the notion that an

individual‟s behaviour or practice depends on his or her knowledge and that

simply providing information will lead directly to a change in attitude and

subsequently a change in behaviour.

The assumption drawn from this model is that practice can be changed

when the individual‟s knowledge increases it is anticipated to change attitude

so that an individual is more inclined to performing the expected behaviour.

Thus, the higher or the more the individuals‟ knowledge increases the better

their attitudes and practice. It has been noted that the knowledge, attitude and

practice model (KAP) is based on four relationships that exist between the

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main variables such as knowledge, attitude and behaviour inherent in the

model. The four relationships identified by Schwardtz (1975) as cited in Ko,

(2011: 744-745) include:

a. a relationship that exists where knowledge can directly influence

attitude but not directly influence behaviour;

b. a relationship where knowledge and attitude influence each other

concurrently;

c. a relationship where knowledge and attitude independently influence

behaviour; and

d. a type of relationship that exists where knowledge shared direct and

indirect influences on behavoiur.

In all the relationships outlined, attitude was identified as a mediating

variable between knowledge and behaviour. Consequently, the food safety

knowledge, attitude and HACCP practice model is meant to find inter-

relationship among knowledge, attitudes and HACCP practices of food

handlers in restaurants. The model specified that food safety knowledge,

attitude and HACCP practice have a strong correlation with each other.

Accordingly, attitude is regarded as an important supplementary factor to

knowledge and practice; this is essential to reduce the risk of food-borne

illnesses. In this fashion, food handlers‟ attitude to food safety practices

mediates the relationship between knowledge and HACCP practices.

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Food Safety
Attitude

HACCP Practice

Food Safety
Knowledge

Figure 5: Model of Food Safety Knowledge, Attitude and HACCP Practice

Source: Ko (2013)

Lin and Chen (2004) found out that the factors interacted with each in

a positive manner. However, a flaw identified in the model is its assumption

that knowledge is the main antecedent to behavioural change (Ehiri, Morris,

and McEwen, 1997). The model also failed to anticipate that there could be

barriers or challenges that can militate against practice.

Conceptual Framework of the Study

After assessing the various theories and models based on their

strengths and weaknesses, Ko‟s (2013) food safety knowledge, attitude and

HACCP practice (KAP) model was selected and modified as the framework

for the study (see Fig 6). As indicated earlier, the model was modified to

make it more suitable for this study. The modification included the

introduction of barriers to food safety practices and the exclusion of attitudes

to limit the scope for the study. The modified framework therefore focused on

food handlers‟ knowledge of food safety issues in the three domains, their

food safety practices observed during food preparation and service as well as

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the barriers militating against their food safety practices. Thus, the framework

dwelt on the fourth relationship identified by Schwardz (1975) as cited in Ko

(2013) which indicates that there exists a relationship where knowledge

shared direct and indirect influences on behaviour.

Institutional
/External Barrires:
Knowledge Practice
Work schedules/
Personal
hygiene time constraint, Personal
inadequate hygiene
Food hygiene
equipment and
Environmental Food hygiene
hygiene supplies
Personal/ Internal Environmental
Barriers: hygiene
Inadequate
knowledge, skills,
motivation

Figure 6: Conceptual Framework of the Study

Source: Adapted from Ko‟s (2013) KAP model

The variables (Knowledge and Practice) in the framework were

measured in relation to the food safety domains such as personal hygiene,

environmental hygiene and food hygiene, and showed the interrelatedness of

the variables that could result in the production of safe or unsafe foods. In

other words, the framework looked at the relationship between food handlers‟

knowledge of food safety based on the three domains in relation to their food

safety practices. The relationship was also considered in the area of the

barriers that impeded food safety knowledge and practices of food handlers.

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In the knowledge area it was anticipated that the respondents‟ sources

of food safety information, including education, training, experiences and

subjective norms from the theory of planned action will supply the knowledge

required. Based on normal thinking, the knowledge is supposed to move the

food handler into action and continuous practice is expected to improve on

knowledge through the experience gained. However, personal barriers such as

inadequate knowledge and skills, as well as facility or institutional barriers

includings time constraint due to busy work schedules, inadequate equipment

and supplies, inadequate training, lack of motivation and nature of work place

could prevent expected practice and even knowledge. Nevertheless it is

assumed that practice can have a weak influence on barriers. For instance,

when the individual is able to put knowledge into practice a number of times

inadequate knowledge as a barrier will be reduced.

In a nutshell, the framework assumes that knowledge which is acquired

through training and experiences is supposed to influence or translate into

practice directly while practice also influences food handlers‟ knowledge.

Nevertheless, barriers could serve as obstacles to putting knowledge into

practice as well as obtaining more knowledge. It also shows that barriers

impede food safety practice whereas constant practice could cause individuals

to overcome some barriers. The broken lines indicate a weak influence of

practice on barriers.

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Chapter Summary

This chapter discussed relevant theories and models as well as the

conceptual framework guiding the study. The chapter highlighted related

theoretical approaches and models related to food safety knowledge and

practice and the conceptual frame work guiding the study. Relevant theories

such as the theory of reasoned action (TRA) and theory of planned behaviour

(TPB) were explained in relation to food safety knowledge and practices of

food handlers.

The relevant models used to explain how human actions are guided

include the health belief model (HBM), the food safety knowledge, attitude,

and HACCP practice model (KAP) and the conceptual framework

underpinning the study were also discussed. These theories and models were

considered appropriate to enhance ones understanding, and possibly the

explanation of the potential results and findings that may emerge from the

study. The next chapter focuses on related literature on food safety concepts

and empirical review on food handlers‟ food safety knowledge and practice.

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CHAPTER THREE

FOOD SAFETY KNOWLEDGE, PRACTICES AND STANDARDS

Introduction

This chapter presents relevant literature on food safety knowledge,

practices of food safety and rules and regulations governing food service

establishments. The relevant areas covered were organized into two sections.

The first part focuses on empirical information on food safety situation in food

service establishments including restaurants, the role of food handlers in food

borne disease outbreaks, food safety knowledge of food handlers in restaurants

and the sources of food handlers‟ information on food safety in restaurants.

The second section discusses relevant food safety practices, empirical

issues in relation to appropriate food safety practices of food handlers in food

service facilities, especially restaurants, relevant literature on food safety

standards, related barriers or factors that hinder compliance with appropriate

food safety practices and the conceptual framework underpinning the study.

Global Situation on Food-borne Illness Outbreaks

The outbreak of food-borne illnesses has become a global issue.

According to Mahami and Odonkor (2012) food borne diseases are possibly

the most prevalent health problem in contemporary world. It was noted that

about 30% of the population in industrialized countries suffer from food borne

diseases each year (WHO, 2007). The WHO, (2014) shared that globally the

burden of infectious diarrhea involves 3-5 billion cases and about 1.8 million

deaths annually as a result of contaminated food and water. In a further study,

WHO (2015) reported that approximately two million fatal cases of food

poisoning occur yearly; especially in developing countries. For instance, the

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MOH health facts (2014) showed that in 2014, Malaysia recorded about 49.8

thousand cases of food poisoning per every 100,000 population.

According to the CDC update in 2017 about 50 million people are

prone to food-borne ailments which leads to about 3,000 deaths. The WHO

(2017) report indicated that one in every ten people in the world gets sick after

eating contaminated food and 420,000 people die every year out of food borne

illness with children aged five years and below representing 40% of the

foodborne ailment burden. In Ghana, Salas (2011) also shared that the

incidence of food poisoning is estimated to be 5.8million annually.

The issue of food borne illness outbreaks is prominent in Africa where

a deeper gap in education, poverty, public health policies and financing health

system exits (Ferron et al., 2000 and Ferron et al., 2007). Studies conducted to

inspect facilities and practices of food vendors in Africa revealed that unclean

or inadequately cleaned cooking equipment have been known as a source of

bacterial contamination in processed foods (Boateng, 2014; Nigusse & Kumie,

2012; Rane, 2011). It has been noted that containers, pumps or tanks used for

holding or transporting unprocessed raw food items, have occasionally been

used for processed products without any cleaning and disinfection (Rane,

2011). This scenario could be associated with the poor state of food safety and

hygiene in the countries.

Restaurants and Food-borne Disease Outbreaks

Food contamination is a widespread issue in both industrialized and

developing countries. Currently, due to urbanization, majority of people all

over the world spend huge sums of money purchasing food from various food

service establishments including restaurants (National Restaurant Association

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(NRA), 2010). For instance, in the United States people spend approximately

$580 million on food (NRA, 2010) from food service establishments and an

estimated 46 % of Americans patronize a restaurant each day.

In Ghana a great variety of foods are prepared and served in varied

food service facilities including restaurants, which are often formal and

regulated (Boateng, 2014). However, restaurants have consistently been

implicated in the outbreak of food borne illnesses and have been identified as

one of the most frequent supports for food-borne illness outbreaks (CDC,

2013; Knight, Worosz & Todd, 2007). Wheeler et al. (2005) reported a food

borne outbreak at a restaurant in Pennsylvania, US, where 601 customers

were found to have contracted Hepatitis A; out of which 124 were

hospitalized and three died. Barnes (2005), identified over 400 suspected

cases of food poisoning in two Turkish restaurants in Australia; with at least

seven people hospitalized. Also, over 600 patrons reported ill after eating in

two Lansing restaurants in Michigan, US. The report indicated they were

infected with norovirus (Clark, 2010). Clapham et al. (2006) also indicated

that 324 consumers were noted to have Salmonella enteritidis after eating at

an Asian restaurant in Bradford, UK.

It was observed that about 59% reported cases of food borne illness in

Kansas State were associated with restaurants (Howells, 2005). It was aso

noted that in the USA, 41% of the 1,097 food borne illness outbreaks reported

to the Centers for Disease Control and Prevention were associated with

restaurants (CDCP, 2010). Thus, restaurants were identified as an important

source of infection (Jones and Angulo, 2006; Howells, 2005).

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In all these, food handlers have been implicated in the outbreak of

food borne illnesses by their actions and inactions. In a study conducted in a

local Canadian jurisdictions using 141 representatives responsible for

restaurant inspections, it was found that 41% of the inspected restaurants in 24

jurisdictions had one or more time and temperature violations, while the

percentage was between 21% and 40% in 48 other jurisdictions. Additionally,

10% of restaurants in Canada were classiﬁed as having critical problems with

another 21% classiﬁed as having moderately severe violations (Mathias et al.,

1995). Though this study was carried out long ago, the researcher referred to

it because the information is relevant to this study.

In another study of four restaurants in Australia, Morrison et al. (1998)

observed that each restaurant had problems in relation to hygienic practices

consistent with unnecessarily high risk to consumers. Furthermore, Walczak

(2000) indicated that an investigative reporter at the Orlando Sentinel

reviewed Florida state restaurant inspections in 1997, and found out that many

restaurants routinely ignored rules for safe food preparation. The study found

that 43% or 2,400 restaurants received violations for preparation temperature

abuse or for inadequate refrigeration equipment.

Other common food safety breeches that were identified to

characterize their operations are: obtaining food from unsafe sources,

inadequate cooking, improper temperature holdings and the use of

contaminated equipment (Adams & Moss, 2008; EFSA, 2009; WHO, 2002).

Michaels et al., (2004) found out that infected food handlers were able to

transmit agents of gastrointestinal infectious diseases through poor personal

hygiene practices.

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It has been reported that food handlers contaminated the foods they

came in contact with through their digestive systems or respiratory tracts,

skins, hair, hands, nose, ears and mouths where germs can readily accumulate

to contaminate food (Aanisalo et al., 2006; Bas, Ersun & Kivanc, 2006;

Dugassa, 2007 and Sprenger, 2010). Therefore, food handlers‟ poor personal

hygiene practices such as ignoring the washing of hands during food

preparation, touching parts of the body, clothing, money, contaminated

equipment and work surfaces can be sure ways of contaminating food (Bas,

Ersun & Kivanc, 2006; Taylor, 2001).

In Nigeria, Isara, Isah, Lofor, and Ojide (2009) conducted a study on

the role of food handlers in food contamination in fast food restaurants using a

semi-structured questionnaire, food sampling and stool analysis. The results

showed that the food handlers reported lack of training in food hygiene (53%),

no pre-employment medical examination (70.3%), and no knowledge that

microbes can contaminate food (57.4%) as characteristics that could influence

food contamination. This suggests the need for medical examination and pre-

employment training of food handlers.

In another study that targeted food handlers using interviews and stool

analyses in Spain, it was observed that an outbreak that was associated with

food-borne norovirus in Barcelona in 2005 was linked to asymptomatic food

handler (Barrabeig et al., 2010). This means that infectious agents are possible

in asymptomatic food handlers, which demands the practicing of safe food

handling techniques, especially hand washing at all times.

Consequently, several studies have associated the outbreak of food-

borne diseases with a number of factors in relation to the food handlers in food

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service establishments. Beatty et al. (2009) as cited in Thewell-Reid (2014) in

a study to determine the cause of the largest Salmonella outbreak in Texas,

found the mishandling of food by a food handler to be responsible for the

outbreak. It was noted that the situation came to a halt only when policies to

screen food handlers were implemented and those infested with Salmonella

were excluded from handling food. Thus, it was noted that food handlers

failed to follow acceptable food safety standards in the preparation,

processing, cooling and storing of food (Tomohide, 2010).

The 2010 Ministry of Health (MOH) annual report, also identified

ineffective food handling training, the use of untreated water for non-drinking

purposes, and poor sanitation and hygiene as the primary risk factors of food

poisoning in Malaysia (MOH, 2010). This implies that, food handlers are

paramount in ensuring food safety and prevention of food poisoning.

Onyeneho and Hedberg, (2013) identified lack of current knowledge

on food safety issues among restaurant staff to have highlighted increased risk

of food borne illnesses associated with fast foods and restaurants in Owerri,

Nigeria. For instance, an outbreak of food poisoning in Ibadan, Nigeria,

claimed about 20 lives and a new phage type U282 of Salmonella

typhimurium isolated from a sandwich filling was identified as the causative

organism (Osagbemi, Abdullahi & Aderibigbe, 2010; Onyeneho & Hedberg,

2013).

In an attempt to find solution to the outbreak of foodborne diseases, the

WHO identified five important practices of food handlers that could prevent

foodborne illness. These include: keeping food clean, separating raw and

cooked foods, cook foods thoroughly, keeping food at safe temperatures and

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the use of safe water and raw materials (WHO, 2006). It is anticipated that

when food handlers observe these rules the incidence of food borne illness will

reduce.

Food Safety Knowledge of Food Handlers

According to Needham, (1959) as cited in Yambo (2016) a Chinese

thinker said “knowledge is the beginning of practice and practice is the

completion of knowledge.” Thus, knowledge is linked to existing practices

which go a long way to affect individual‟s readiness to change prevailing

practices if they are known to be unsafe (McIntosh, Christensen & Acuff,

1994). Angelillo et al. (2000) indicated that food handlers with good

knowledge of proper food handling practices could be in a position to control

food poisoning cases. This suggests that food handlers ought to have requisite

knowledge and skills in food safety practices as well as understanding the role

of food in the spread of food borne illness (Glanz, Lewis & Rimer, 2002;

Alqurashi, Priyadarshini and Jaiswal, 2019). Knowledge is gained through

formal or informal learning processes, personal experiences, perceptions,

reason and experiential sharing (Glanz, Lewis & Rimer, 2002).

Studies have been conducted in different countries to assess food

handlers‟ food safety knowledge on areas such as hand washing, temperature

control, cross contamination, food storage, and some aspects of food

microbiology. In a study conducted to assess food safety knowledge of

restaurant employees, Panchal, Bonhote and Dworkin (2013) observed that the

overall food safety knowledge score of the food handlers was high (71%).

They noted that no one scored above the maximum score of 37 points and that

restaurant cuisine was the only characteristic significantly associated with the

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knowledge score. It was noted that larger-sized restaurants had slightly higher

knowledge scores than restaurants that were small or medium-sized.

In Edmonton, Canada, Hislop and Shaw (2009) conducted a study to

determine the food safety knowledge of food handlers in the food service

industry using both certified and noncertified food handlers. The results

showed that 98% of the certified food handlers achieved scores higher than

50% and 94% had scores higher than 70%. They found that food handlers

training (certified food handler) was significantly associated with passing at

the 50% (p = 0.007) or 70% (p = 0.015) cut-off points.

It was however realized that, length of time since the certified or

noncertified food handlers received training had no significant influence on

their passing scores (p = 0.821, p = 0.543 respectively). Nevertheless, there

was a significant difference of failure rates between certified and noncertified

food handlers as the failure rates for the noncertified were between two to five

times that of the certified food handler (Hislop and Shaw, 2009). The highest

failure rates were for those with over 10 years of experience; which suggests

that the higher the number of years at work, the lower the knowledge level.

This could be associated with lack of in-service training. Thus the food

handlers do not learn new things and they are not abreast with current food

safety information. This implies that the food handlers are engrossed in work

to meet targets as against building their capacities.

Jianu and Chis (2012) used a cross-sectional quantitative study to

determine food hygiene knowledge levels of food handlers to provide baseline

data for training programmes for food handlers in Romania. Structured, self-

administered questionnaires were used to collect information on demographics

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and level of knowledge concerning food poisoning, cross contamination, time

temperature control, and personal hygiene. The findings indicated that there

were no significant differences in level of food handlers‟ knowledge based on

their socio-demographic characteristics or professional experience.

Nevertheless, their knowledge levels were significantly greater based

on educational levels, with food handlers with higher education achieving

higher knowledge scores (F= 3.779, p = 0.011) (Jianu & Chis, 2012). It was

noticed that production staff displayed significantly higher levels of

knowledge on food poisoning, cross-contamination and sanitation, time

temperature control, and personal hygiene. However, there was a low-level of

knowledge on the importance of good drainage systems and the best way of

thawing frozen foods which implies that, there is the need to retrain food

handlers using different methodologies.

In another cross-sectional study conducted to assess food hygiene

knowledge of food handlers in a catering company in Portugal, Martins

Martins, Hogg and Otero, (2012) found that the average score was 56.5%,

with scores ranging from 87% to just over 4%. Knowledge level scores for

temperature control questions were significantly lower than the average score

for the full questionnaire (p < 0.001). Temperature control is vital in

controlling microbial growth in food (Jay, Loessner, & Golden, 2005) and

improper holding temperatures have been linked to food-borne disease

outbreaks.

Furthermore, in assessing food safety knowledge in relation to socio-

demographic characteristics of respondents, a number of studies found females

to possess higher food safety knowledge as compared to their male

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counterparts. (Byrd-Bredhenner et al., 2009; Sanlier & Konaklioglu, 2012).

This could probably be because traditionally females are known to be involved

in cooking than their male counterparts. However, Akonor and Akonor (2013)

found that both male and female respondents were equally knowledgeable in

terms of the food safety measures examined; thus they were statistically

independent of food safety knowledge.

Age was noted to have a rippling relationship with food safety

knowledge; but Sanlier and Konaklioglu, (2012) revealed that food safety

knowledge tends to increase with age and younger respondents show the need

for more training. On the contrary, Sun, Wang and Hang (2012) reported that

younger respondents have higher food safety knowledge than their older

counterparts; whereas Annor and Baiden, (2011), Martins, et al. (2012)

reported that age had no influence on food safety knowledge.

Generally, it has been observed that the higher the individuals‟

educational attainment the more knowledgeable the person. For instance, a

cross sectional study of women conducted by Farahat et al. (2015) in Saudi

revealed that the respondents with high educational attainment showed higher

mean knowledge scores in the overall food safety parameters measured than

those with low educational attainment (p< 0.05).

Similarly, Martins et al. (2012) found a significant difference

(p<0.025) between the educational levels of respondents and their food safety

knowledge. This implies that the educational attainment of food handlers is an

important prerequisite to the success of food safety practices.

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Food Safety Practices of Food Handlers

According to Singh et al. (2011), practice refers to applied skills,

techniques, methods or standard operating procedures. To assess food

handling practices of food handlers, researchers employed the self-reported

questionnaires and observation methods. In other words the self-reported

practices were assessed using questionnaires and the actual practices were

obtained through observation.

With respect to the self-reported aspect of assessing food safety

practices, Green and Selman (2005) conducted a study among food service

facility workers to gauge the self-reported occurrence of safe and unsafe food

handling practices at nine Foodborne Active Surveillance Network (Food Net)

sites. Data were collected in relation to four food handling practices such as

hand washing, use of gloves when handling ready-to-eat foods, temperature

assessment of prepared foods, and working in food preparation areas when ill.

The results showed that 40% of the workers handling ready-to-eat

foods wore gloves and changed them on an average, about 15.6 times during

an 8 hour shift. It was also noticed that food service workers washed hands on

an average 15.7 times during the same time interval while 71% of the workers

who handled both raw and ready-to-eat foods indicated that they always

washed their hands, and 67% change gloves between touching foods to avoid

cross contamination.

The results also indicated that about 47% of respondents used

thermometers to check internal temperatures of food, while 5% never worked

while ill. Green and Selman, (2005) shared that age, restaurant type, and work

responsibilities brought about significant differences in food handling

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practices. However, the weakness of Green and Selman‟s (2005) study was

that self-reported data are prone to response/social desirability bias with

individuals reporting desirable behavior rather than the actual behavior.

In South Africa, Van Tonder et al. (2007) carried out a study on

personal and general hygiene practices and the level of training of food

handlers in 35 food outlets using self-administered questionnaires. Data were

collected from 50 randomly selected food handlers and it was found that most

food handlers reported a satisfactory level of food handling practices such as

washing hands after visiting the toilet or before each shift (100%), wearing

and frequently changing protective clothing such as gloves (82%), never

suffered cough or diarrhea on the job (92%), reported illness to management

(82%), and cleaned work surfaces (92%).

Observed Food Safety Practices of Food Handlers

According to Clayton and Griffith, (2004) observations are more

reliable in the collection of data on practice, as respondents tend to

overestimate their actual behaviours in self-reported practice, thereby

introducing social desirability bias. Thus, some researchers have used

observational studies to determine food handling practices. For instance,

Clayton and Griffith (2004) observed 29 catering establishments which had

received some form of food hygiene training, for food safety practices. In that

study, each food handler was observed on three separate occasions performing

over 270 actions. The areas of observation focused on hand hygiene practices,

cleaning of work surfaces and equipment, washing of utensils and use of

different utensils for preparing raw and ready-to-eat foods.

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The results revealed that hand hygiene malpractice was more frequent

than the other two food hygiene behaviours observed. Correct hand hygiene

practice was observed on only 31% of the required occasions and were not

attempted on most of the required occasions, such as after touching potentially

contaminated surfaces, after touching hair and face, as well as after handling

potentially contaminated food (Clayton & Griffith, 2004). However, the

respondents failed to use soap during hand washing and failed to dry hands.

With respect to cleaning of food contact surfaces, 31% of caterers carried out

this action adequately 33% of the time and failed to attempt cleaning in 60%

of the required times (Clayton & Griffith, 2004).

Lubran et al. (2010) also conducted an observational study to examine

the behaviour of food handlers in deli departments in nine stores in Maryland

and Virginia, and to ascertain the level of compliance with the Food Code.

The results revealed that all employees used gloves on all occasions when

handling ready-to-eat foods but hand washing was observed in only17% of

recommended times at the independent stores. It was noted that the majority

of times the food handlers washed their hands were when gloves were changed

and the food handlers cleaned and sanitized food contact surfaces throughout

the (100%) recommended times (Lubran et al., 2010). The major limitation of

this study was the use of one observer which limited ability to obtain a

reliability estimate of the study.

Roberts et al. (2012) conducted a study in U.S. to assess the safety

practices per the Food Code in ethnic and non-ethnic restaurants in Kansas.

They used 424 ethnic and 500 non-ethnic restaurants which were further

classified as independent or chain restaurants. A data collection form was

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used to capture violation information from inspection reports done over a one

year period (2007-2008). The results showed that, independent ethnic

restaurants had the highest number of critical (4.52 ± 2.85) and noncritical

(2.84 ± 2.85) violations (p < 0.001).

It was noted that critical violations are more likely to contribute to

foodborne illnesses and independent restaurants were found to have a greater

number of violations than chain restaurants. The violations were directly

related to food handling practices, such as time and temperature abuse,

personal hygiene, and cross-contamination. Independent ethnic restaurants

also had a greater number of annual inspections (2.29 ± 1.63) (p < 0.001),

indicating the presence of food safety problems within these facilities. While

Roberts et al. (2012) did not explore the knowledge of food handlers with

respect to food hygiene or the Food Code, it was expected that improved

knowledge and culturally relevant training would improve food safety

practices and reduce food violations.

This study included the use of observation as the preferred method for

collecting practice data. Food handlers were not interviewed as it was not

feasible to interview the numerous participants on their practices. The

observation was performed on a limited number of variables within a

particular time, while self-reported data captured more information on more

variables.

It is assumed that individuals‟ level of knowledge can be influenced

through education, training, experiences and subjective norms. Grujic et al.

(2013) indicated that lack of knowledge in one of the stages of the food chain

can compromise all the efforts made to improve the safety of food. It was

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noted that food handlers with good knowledge of proper food handling

practices could help control food poisoning cases (Angelillo et al., 2000).

In Owerri (Nigeria), Chukuezi, (2010) conducted a study on food

safety and hygiene practices of street food vendors using interviews, semi-

structured questionnaire and observations. The findings of the study showed

that averagely, less than half of the food vendors put on protective clothing

during food preparation and service. For instance, it was observed that about

43% and 53% of the vendors wore aprons and hair restraints respectively and

19% also put on jewelry during food preparation and service.

The study also revealed that majority (86%) of the food vendors did

not clean work surfaces regularly during food preparation. They prepared food

on the same surface more than twice without cleaning. It was also noted that

33% of the work surfaces were dirty which means that they did not pay

attention to hygiene and sanitation practices during food preparation. In

addition, it was realized that about 48% of the respondents handled food with

bare hands while the majority (61-90%) handled money while serving food

and 28.6% tried opening polythene bags for serving and storing food by

blowing air into them. Generally it was noticed that about 24% of the vendors

prepared food in unhygienic environments amidst poor food hygiene practices.

They had poor storage facilities and about 48% of the respondents washed

their utensils with recycled water which is used severally (Chukuezi, 2010).

Furthermore, in Ramallah and Al-Bireh (Palestine), Al-Khatib and Al-

Mitwali (2009) examined food safety knowledge and practices in restaurants

and found that the majority of food handlers indicated they always washed

their hands with soap before beginning to work and in-between handling raw

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and cooked foods. About 68% of the food handlers always washed their hands

after coughing and sneezing, and 56% never reported for work when they

were sick. Thus, they took precaution not to contaminate the food. However,

11% of the respondents never washed their hands with soap during food

preparation.

On the contrary, 51% of the respondents said they never washed their

hands even after touching body parts, handling money, garbage and unclean

utensils while 19% never washed their hands at intervals of handling raw and

cooked food (Zain & Naing, 2002). It was also noted in a study by

Mukhopadhyay et al, (2012) that about 26% of the food handlers were seen

wearing unclean clothing. Thus, a reasonable number of food handlers never

paid much attention to food safety matters.

In Ghana, Ababio and Adi (2012) assessed some food handlers‟

knowledge and practices of food hygiene in the Kumasi metropolis. The

results revealed that majority of the food handlers purchased and used meat

daily while 11% reported storing uncooked meat in their kitchens. As regard

the practice of temperature control, the results showed that about 83% and

11% of the food handlers served food hot and warm respectively. It was

explained further that while 37% of the food handlers reheated food that had

gone cold before serving; 38% of them served the food without reheating.

Only a small percentage (1%) of the food handlers indicated they discarded

any food that stayed within the danger zone beyond two hours. Thus, most of

the food handlers violated the rule and served leftover foods to consumers

which puts them at risk of contracting food borne illness.

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In terms of routine medical examination or check-ups, a study carried

out in secondary schools in Ilorin (Nigeria) to assess the practice among food

vendors, showed that even though as many as 141 (76%) vendors went

through initial medical examination, they never went back for the periodic

checks. The report indicated that 23.8% of the vendors indicated they never

had any medical examination (Musah & Akande, 2002); yet they were

operating. This is risky for consumers and the industry and calls for managers

and regulatory agencies to put in efforts to guarantee the safety of what

customers eat. Zain and Naing (2002) also found out that about 62% of the

food handlers went for routine medical examination. In India (Kolkata) it was

noted that 22.4% of the respondents continued to work even when they were

ill.

In terms of food storage as part of food hygiene practices, it is required

that foods are kept at safe temperatures as microorganisms multiply very

rapidly at room temperature (between 4.5o C and 57oC; food danger zone).

Appropriate temperatures for freezing and cold food storage as well as hot

food holding and cooking temperatures are between -18o C and 4.5o C and 60o

C to 100oC for freezing and cold storage and hot holding and cooking

respectively (Spears & Gregoire, 2007). WHO (2006) cautioned that foods

should not be cooked and kept at room temperature for more than two hours

before service. Perishable and cooked foods should be refrigerated promptly

(especially below 5oC) to slow down or stop the growth of microorganisms.

In addition, food handlers are warned not to store food for long even in

the refrigerator since some dangerous microorganisms still grow below 5oC. In

storing leftover foods, they should be cooled quickly and stored. However,

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they should not be stored beyond three days and they should not be reheated

more than once (WHO, 2006). Hence, any cooked food stored for more than

three days be discarded.

During storage, foods get frozen and they need to be thawed before

use. McSwane, Rue and Linton (2003) indicated that frozen foods should be

thawed slowly to retain moisture and original structure of food. Nevertheless,

WHO (2006) is of the view that rapid thawing prevents the growth of

microorganisms and suggested that food should be thawed either in a

refrigerator, under cool running water or in a microwave oven followed by

immediate cooking. Thawing can also be done as part of the cooking process

(McSwane et al., 2003).

McSwane et al, (2003) suggested that, during the purchasing of food,

there is the need to select fresh and wholesome foods as well as check the

expiry dates of foods to prevent the use of foods beyond their expiry dates. It

is also very important that food handlers take time to inspect incoming food

supplies to make sure they are not spoilt and that they are at the right

temperature.

Food Safety Knowledge Versus Practices

Conventionally, it is assumed that knowledge is automatically

translated into behaviour (Glanz, Lewis & Rimer, 2002) which subsequently

changes into practice. Nonetheless several studies reported that inspite of the

fact that food handlers had correct scores for food safety related questions, in

reality they did not usually translate their knowledge into practice (Clayton et

al., 2001; Moreaux et al., 2018; Omemu & Aderoju, 2008; Sun, Wang &

Huang, 2012; Zeru & Kumie, 2007).

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In a study conducted by Kibret and Abera (2012) in Ethiopia on the

sanitary conditions of food service establishments and food safety knowledge,

and practices of food handlers, it was realized that most of the food handlers

had good knowledge of food hygiene issues. They however, exhibited poor

knowledge in practice as they handled raw food items without washing their

hands (75%), wore hand jewelries and fondled parts of their bodies during

food preparation and service (53%). Thus, the food handlers practice scores

were lower than their knowledge scores.

A study conducted by Azanza, Gatchalian and Ortega (2005) in the

Philipines, revealed that inspite of being knowledgeable in some aspects of

food safety (personal hygiene, food contamination, food handling procedures),

the food handlers did not put the food safety knowledge into practice, but

compromised food safety for financial reasons. This shows that it is not only

ignorance that causes food poisoning but also failure to apply the acquired

knowledge (Bryan, 1988 as cited in Brar, 2016; Ehiri & Morris, 1996). Thus,

it was established that a significant gap existed between the food providers‟

knowledge and practice which could be attributed to noncompliance to

regulations and the tendencies of compromising food safety for financial

issues.

Onyango et al. (2016) also assessed the relationship between

knowledge and practice of food handlers in selected hotels in Kenya and it

was observed that knowledge of double hand washing techniques was

significantly related to practice of food safety management. For instance, they

found that the food handlers‟ knowledge on the ways of contaminating food

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and their knowledge of vehicles for food contamination were significantly

related to the practice of temperature control.

Onyango et al. (2016) noted that knowledge of stages in food flow that

are likely to cause contamination in food is significantly related to practice of

food safety management in the areas of personal hygiene, cross contamination,

purchasing and storage. Thus, the knowledge of the factors that cause food

borne illnesses is significantly related to practice of personal hygiene and

temperature control. In other words when the individual is aware of the factors

that cause food borne illness, the individual takes precaution during practice.

Though there were significant relationships between specific food

safety knowledge and specific practices of food safety management, in general

terms, there was no significant relationship between food safety knowledge

and practice (Onyango et al., 2016). Several other studies on knowledge and

practice of food safety management came out with similar findings (Sneed,

Strohbehn & Gilmore, 2004; Seaman & Eves, 2010; Howells et al., 2008;

Roberts et al., 2008; Neal, Binkley, & Henroid, 2012) which are in

consonance with Onyango et al,‟s views.

According to Chapman et al, (2010), the influence of a food safety

information sheet on practices within the food service environment showed

that the information had a positive effect on food handlers‟ behaviours. In

assessing food safety knowledge, attitudes and practices of food handlers in

Bangkok, it was realized that only 13% of the food handlers had good

knowledge, 19% had good attitude and 15% had good practice. Statistically,

there was a significant relationship between food safety knowledge and food

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safety practices as well as between food safety attitudes and food safety

practice (Cuprasitrut, Srisorrachatr & Malai, 2011).

Schwardtz (1975) as cited in Ko (2011) identified four types of

relationships between knowledge, attitude and behaviour or practice. It was

found that, in some instances, knowledge could directly influence attitude but

not directly influence behaviour; whilst in another instance knowledge and

attitude influence each other at the same time. In a third relationship,

knowledge and attitude independently influenced behaviour or practice

whereas in the fourth relationship, knowledge had direct and indirect

influences on behaviour with attitude acting as a mediating variable between

knowledge and behaviour.

This could be associated with the training the workers received which

has been found to improve food safety knowledge and hygienic practices that

could have resulted in better food safety practices. For instance, Griffith and

Clayton (2005) reported that improved knowledge leads to behavioural

changes while staff attitudes can limit or prevent improvement in practices;

but employee training has been found to improve food safety knowledge and

hygienic awareness which could result in better food safety practices.

In order to improve on food safety situation, WHO (2007) identified

training as one of the ways of equipping food handlers with knowledge and

practices; and emphasized that training programmes that are linked to

behaviour change theories are more effective in improving knowledge and

practice. It has been found that, training helps food handlers to get familiar

with work tasks, improve their professional and food safety knowledge, their

skills and capabilities as well as increases their productivity (Ackah et al.,

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2011; Afolarannie et al., 2014; Xiao, 2010). Thus, training is generally

believed to help in reducing the occurrence of food-borne illnesses (Acikel et

al, as cited in Alqurashi, Priyadarshini & Jaiswal, 2019).

Researchers such as Alqurashi et al (2019), Chapman et al. (2010),

Glanz and Lewis (2002), and Xiao, (2010) shared that it is important for

workers in the food industry to have the required skills and knowledge to

ensure good hygiene practices and the safety of food within food service

facilities. Nevertheless, studies on knowledge and practice of food safety

management have shown that knowledge does not necessarily translate into

practice (Howells et al. 2008; Neal, Binkley & Henroid, 2012; Onyango et al.

2016; Robert et al. 2008; Seaman & Eves, 2010; Sneed, Strohbehn & Gilmore,

2004). According to MacAuslan (2003) this is so because training in food

safety relies heavily on attaining a certificate rather than paying attention to

achieving competency in food hygiene practices. Egan et al. (2007) buttress

this by indicating that the majority of food safety courses rely solely on the

dissemination of information with very little emphasis on practice.

Furthermore, Panchal, Liu, and Dworkin (2012) conducted a survey to

assess baseline food safety knowledge of 508 food handlers in 125 restaurants

in Chicago and it was realized that the mean knowledge score was 71%. The

results showed that, food handlers with training scored higher than those

without training (76% versus 63%, p < 0.05). This is in consonance with the

results of a study conducted by Joseph (2018) to assess food safety knowledge

among restaurant workers in Chennai, India. The results indicated that, the

respondents who received training were more knowledgeable than those who

did not receive any training. Thus, food handlers need to be given some form

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of education and practical training on food safety to prevent the spread of food

borne diseases.

On the contrary, Clayton and Griffith (2008), were of the view that

training alone cannot bring about behavioural changes in food safety. There is

therefore the need to develop new behaviour-based strategies that include food

safety education as part of the culture of the organization (Neal et al., 2012).

Sources of Contamination of Food

Food is supposed to be handled safely throughout the food chain, to

avoid contamination which leads to food-borne illness (Moreaux, 2014). Food

is considered wholesome or safe when it is free from any biological, chemical

or physical hazards which cause food-borne illness (FDA, 2009; Kitagwa,

2005; McSwane, Rue & Linton, 2003). Getachew (2010) revealed that the

presence of contaminants in food at unacceptable levels is likely to cause harm

or illness.

Nigusse and Kumie (2012) reviewed literature on global outbreaks of

food borne diseases and found that, in nearly all instances, food borne illnesses

are caused by failure to observe satisfactory standards in the preparation,

processing, cooking, storing or retailing of food. Disease causing organisms

may be introduced into the food chain from a variety of sources and at

different stages. For instance, it has been noted that gastrointestinal pathogens

may be derived from animal sources, the environment or, occasionally, from

humans (WHO, 2012; Lambrechts et al. 2014).

Biological hazards refer to living organisms (microorganisms) that can

render food unsafe for consumption and lead to food-borne illnesses (USDA,

1997). According to McSwane et al. (2006), microorganisms are mostly found

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in faeces, soil, water, rats, mice, insects and pests, domestic, marine and farm

animals. They are also available in human bowels, mouth, nose, intestines,

hands, fingernails and skin (WHO, 2006). When these hazards come into

contact with food they cause foods to deteriorate, develop bad odour and cause

food borne illness (Eubanks et al., 2009). This explains why food premises

should be devoid of pests and animals. It is also important that food handlers

avoid touching parts of the body while preparing and serving food.

Chemical hazards are substances or elements found or introduced into

the food system which may cause illness in the consumer (ISO 22000:2005;

FDA, 2002; WHO, 2002). They constitute agricultural chemicals (including

pesticides, fungicides and veterinary drugs), plant chemicals, cleaning agents

(soaps, sanitizers and oils), naturally occurring toxicants (mycotoxins, marine

toxins, aflatoxins and histamine), food chemicals such as food additives and

preservatives, chemicals from packaging materials (polymers, lacquers) and

tar from wood used in the smoking of foods such as fish and meat (ISO

22000:2005; FDA, 2002; WHO, 2002; Smith, 2005; Grintzali & Babatsikou,

2010). Chemical hazards can also occur through the pollution of water, air and

soil which render food unsafe for consumption.

According to Foskett, Ceserani and Kinton (2007) and McSwane, Rue,

and Linton (2003) individuals get foodborne illnesses through poisonous

chemicals which are naturally found in some foods including cassava and

some mushrooms. For instance, natural toxins such as cyanide are found in

some cassava and gyromitrin, coprine, and orellanine in some mushrooms

have serious health effects such as gastrointestinal toxicity, neurotoxicity,

nausea, headaches and death (Foskett et al., 2007).

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Chemicals can also be applied to food intentionally or unintentionally,

to a storage cabinet to ward off or kill pests /insects and when the contents of

the cabinet (glass, utensils or cutlery) are unintentionally used during food

preparation and service, they contaminate the food. Consequently, it is

important that food handlers wash utensils before they are used for food

preparation and service.

Similarly, nitrate can intentionally be added to meat or fish to inhibit

the growth of microorganisms (Clostridium botulinum) as well as give the

product colour. Nevertheless, the chemical reacts with the amines in the meat

or fish to form nitrosamines which can harm the consumer (McSwane et al.,

2003). Thus, when chemical compounds or substances are applied to food

beyond acceptable dosage levels they may become hazardous.

However, when foods are well processed during preparation and

cooking, the toxins become deactivated and harmless (Foskett et al. 2007).

Simple measures such as washing and peeling may reduce the risk from

chemicals that are found on the surface of foods. Appropriate storage can

prevent or reduce the formation of some natural toxins. It is, therefore,

imperative that food handlers understand this and take great care through all

levels of food preparation and service to ensure safety.

Physical hazards refer to any foreign objects present or introduced into

the food system during food preparation and handling processes which may

cause illness or injury to the individual using the product (National Restaurant

Association Educational Foundation (NRAEF), 2010; ISO, 22000, 2005).

They include foreign objects in the form of glass fragments or chips, stones,

wood, metals (jewelry), needles, pins, insects, bones, acrylic finger nails,

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flakes of nail polish, human hair and insulation which accidentally get into

food (ISO 22000, 2005; McSwane et al., 2003; Moreaux, 2014; Nyamari,

2013 and Tan et al., 2015).

The hazard may become part of food during harvesting, handling and

processing. When these physical hazards are not noticed in food and they are

consumed with the food, they can cause cuts in the mouth or throat, injure the

intestines and the teeth or gums (Grintzali & Babatsikou, 2010; Musa et al.,

2010; Jay, 2000).

According to Getachew (2010), food safety hazards are human and

product induced and the most common sources of contamination are hazards

caused by humans, which occur through poor food handling practices (such as

unhygienic environment and poor personal hygiene practices) as well as

obtaining food from unsafe sources (Fawzi, Gomaa & Bakr, 2009; FDA, 2008;

Siddiqui et al., 2006). Thus, food service workers require conscious effort

throughout the entire food chain to be able to produce safe food for

consumers. They need to conform to acceptable food safety measures such as

personal hygiene practices, environmental hygiene, food hygiene and HACCP

practices. Any mishandling and disregard for these safety and hygiene

measures can lead to contamination and food-borne illnesses.

Environmental hygiene is of great importance as unclean work

surfaces and equipment can be sources of direct contamination of food (Evans,

Rusell, James & Corry, 2004). For instance, it is reported that bacteria from

dirty dish washing water and other sources adhere to the utensil surface and

can constitute a risk during the food vending process (Rane, 2011). Thus,

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standard requirements for food facility environment need to be followed with

all seriousness.

According to Hutter (2011), unclean work surfaces and equipment can

bring about food safety hazards resulting in food contamination, food

poisoning, loss of product quality, increased food spoilage and waste as well

as customer complaints, litigations, reduced customer patronage, loss of

reputation and reduced sales. The underlying fact is that harmful

microorganisms can be transmitted through hands, wiping cloths, utensils, and

cutting boards into foods, which can cause food borne diseases.

Rane (2011) also found that serving utensils used at the vending sites

are often contaminated with Micrococcus spp. and Staphylococcus aureus spp.

which may have originated from the vendors hands, food preparation surfaces,

dish cloths, or the water used for dish washing or hand washing. This suggests

cross contamination between dish washing water, food preparation surfaces,

and the food itself as bacteria from dirty dish washing water and other sources

adhere to the utensil surface and can constitute a risk during the food vending

process (Rane, 2011).

Another means of promoting food borne disease outbreak is ignoring

food hygiene measures. Food hygiene is a practice that involves proper

preparation, washing, cooking, storing and preservation of food in order to

prevent cross contamination and spread of bacteria which could lead to food

poisoning (Etim, et al. 2017). Good food hygiene is an important practice that

needs to be observed by food handlers to ensure that food is safe for

consumption. It is therefore the full responsibility of food handlers to keep to

food hygiene rules on a daily basis (Etim et al. 2017).

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Accordingly, Hayter (2006) is of the view that the hygiene standards

and cleanliness in food preparation centers of any food services facility could

be maintained if there are cleaning schedules in place with the cleaning

protocols outlining the equipment, supplies and methods to be used in detail.

This ensures that the various areas receive the necessary and adequate

attention.

Food Safety Standards and Regulations

In the wake of frequent out-breaks of food borne illnesses, food safety

has become a public health challenge which has made it necessary for

governments to develop strategies to bring the situation under control (Sanlier,

2010; Sanlier & Turkmen, 2011). Among the strategies put in place are: the

development and enforcement of safety standards and rules and regulations on

food safety, adequate health education for both consumers and food handlers

and ensuring the implementation of food safety management systems (FSMS)

(Moreaux, 2014).

Consequently, regulatory agencies in Ghana (Ghana Standards

Authority (GSA), Food and Drugs Authority (FDA), Ghana Tourism

Authority (GTA), Environmental Protection Agency (EPA), Environmental

Health Units (EHU) and the Districts, Metropolitan and Municipal

Assemblies (DMMAs) have been mandated to carry out various

responsibilities to ensure compliance with the food safety regulations. For

example, GSA is charged to coordinate the development and implementation

of all national standards while FDA is authorized to regulate foods, drugs,

medical devices, cosmetics and household products. To intensify its activities

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FDA is to collaborate with Environmental Health Officers to ensure food

safety and quality.

Globally, WHO (2010) recommended hygienic practices in relation to

food safety to be adopted for practice by all food handlers in food service

facilities. For instance, in Australia, food safety standard sets out specific

requirements for food businesses and food handlers with the belief that, if

operators and workers comply food safety will be guaranteed.

WHO (2010) recommended the following measures of ensuring

hygienic environment for safe food preparation and service:

 adequate drainage and waste disposal system in facilities;

 adequate supply of potable water and the construction of drainage

systems that safeguard and avoid contamination of potable water;

 Washing and sanitizing all surfaces and equipment used for food

preparation.

The standard requires that process control requirements be satisfied at

each step of the food handling process (receipt, storage, processing, display,

packaging, distribution, disposal and the recall of food). Other requirements

relate to the knowledge and skills of food handlers and their supervisors, the

health and hygiene of food handlers and the cleaning, sanitizing, and

maintenance of premises and equipment.

Consequently, the key practices involved in ensuring food safety are:

controlling time and temperature, practicing good personal hygiene,

preventing cross-contamination and purchasing food supplies from approved

dealers. In order to give attention to these areas, there is the need to follow

established standard operation procedures.

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According to Tieyiri (2008) and Amoako-Mensah (2016), it is

mandatory for all food service establishments to adhere to food safety

standards since they relate to the health and wellness of people and are backed

by law; thus making compliance obligatory. In support of the foregoing, FDA

(2013) demands that before a food service facility is established for

preparation, packaging, distribution, storage or sale of food for human

consumption, there is the need for a health permit in addition to Ghana

Standards and Code of Hygienic practice. Thus, the health status of food

handlers is of extreme importance in the food service industry as they could

serve as carriers of organisms that cause food borne illnesses.

ISO 22000, (2005) requires that people who handle food in the food

service facility should have a medical examination before they are employed

and routine examination be carried out every six months. This is because

medical examination is a way of regulating food providers in order to prevent

and control the transfer of communicable diseases to customers (Musa &

Akande, 2002). Thus, it is a public health requirement which is mandatory for

all food handlers.

In Ghana, the food safety legislation in the Food and Drugs ACT, 1992

(PNDCL 305B), is classified as standards legislation, food and drugs

legislation and legislation on the environment. Consequently, food handlers

are required by law to keep clean work environment, protect food from

contamination, and follow good personal hygiene practices as the most

effective means of preventing the spread of micro-organisms and the

contamination of food (Curtis & Cairncross, 2003; Green et al. 2007).

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FDA (2001) and WHO (2006) also recommended that food service

workers use fresh clean kitchen clothes or disposable towels to thoroughly dry

their hands during each meal preparation process, and gloves to handle cooked

foods and foods that are to be eaten raw. This is because they serve as a barrier

between bare hand contacts and the foods to be served (Green & Selman,

2005; Green et al., 2007). The caution is that gloves be utilized by each person

and per single use. In other words, one pair should not be used over and over

again or given to another person to use; they are disposable items and should

be used once.

Food handlers are also cautioned not to fondle with any part of the

body such as their nostrils, ears, mouth or hair as well as spit, sneeze or cough

over food as some bacteria that cause food poisoning have been found in the

nose and throats of humans; therefore sneezing and coughing should be away

from food into disposable napkins (Hayter, 2006 & McSwane et al., 2003).

Again, food handlers are expected to wear clean clothes and hair

restraints to prevent hair from dropping into food. Clothing that cover body,

hairs and beard restraints are recommended to prevent contamination of food

(Simonne et al., 2008).

Knowles (2002) suggested the erection of a ventilation system by

placing hoods over stoves and using extractor fans to suck out the fumes or

stale air. However, Foskett, Ceserani and Kinton (2007) cautioned that hoods

and fans in the kitchen be given constant cleaning as accumulated grease and

dirt drawn by the fans can drop into foods to get them contaminated.

Good lighting in the kitchen is of equal importance to enable workers

to see any physical contaminants in foods as well as work without straining

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their eyes. Hence adequate natural or artificial lighting should be provided to

enable staff to see even in corners and crevices in the kitchen (Foskett et al.,

2007).

Some researchers are of the view that toilets, hand washing and drying

facilities for both staff and customers, should be far away from food storage

and preparation Centres or rooms and that workers who clean toilet rooms

should not be allowed to clean the kitchen since micro-organisms can easily be

transferred into food unknowingly (Cesserani, Kinton & Foskett, 2000;

McSwane et al, 2003; Sprenger, 2009; Knowles, 2002;).

It is further recommended that the floors and walls in food service

facilities should be waterproof, non-absorbent, washable and without crevices

or cracks or opened joints and should be easy to clean and disinfect. Floors

should be made of non-slip materials and should slope well for liquids to drain

to trapped outlets (ISO 22000, 2005).

Another regulation is that the kitchen and restaurant environment

should be clean and free from cobwebs and pests to prevent contamination and

food borne illnesses. The floors and walls be cleaned with hot detergent

solution and dried, the ceilings should be smooth (no cracks and flaking) to

prevent concealing of dirt, doors and windows should fit well in place to

prevent vermin in the kitchen (Knowles, 2002).

The food facility environment should be free from a wide range of

pests by keeping the premises in good repair, scraps of food be removed

promptly and rubbish not be left to accumulate outside the facility; so that

there is no means for the pests to have access to the premises; especially the

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kitchen and storerooms (Kibert & Abera, 2012; WHO, 2006; McSwane et al.,

2000).

It is recommended that solid and liquid (water) waste materials are

removed from processing areas without contaminating products and the

environment. ISO 22000 (2005) & ISO 22000 (2015) suggested the use of

waste bins with appropriate lids and that the re-usable containers should be

cleaned and disinfected each time after use.

Kitchen equipment, utensils and dishes require constant cleaning. They

should be washed and sanitized after each use and well stored to prevent

contamination (Spears & Gregoire, 2007). It is required that different cutting

boards of different colours be used for different foods and they are required to

be washed properly between each use, as they are likely to harbour

microorganisms. The caution is that as they age, they usually develop some

cuts and nicks from knives. If the gouges become deep, it will be difficult to

sanitize the boards properly and they will have to be replaced.

Due to the fact that kitchen cloths are one of the top causes of cross-

contamination in the kitchen, Hill (2011) suggested that food handlers use

different dish cloths and kitchen towels for different purposes. For instance, a

cloth used to clean a work surface with fresh meat should not be used to wipe

a plate for service. On the other hand, disposable cloths can be used for each

task and re-usable cloths should be thoroughly washed, disinfected and dried

properly between tasks; not just when they look dirty.

Hazard Analysis Critical Control Point (HACCP)

Hazard analysis critical control point is an internationally recognised

food safety management system which focuses on the safety of food through

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the analysis and control of biological, chemical and physical hazards from raw

materials, production, procurement and handling, manufacturing, distribution

and consumption of finished products (Saucer, 1998; Sohrab, 1999). It is a

structured approach that is used in identifying these hazards and preventive

methods and strategies to be used in controlling the hazards during food

processing and preparation.

The HACCP system is based on seven standard risk management

principles recommended by FDA Food Code (Taylor, 2008; McSwane et al.,

2003). They include:

 Conduct a hazard analysis.

 Identify the critical control points (CCPs) at which contrpl can be

applied to prevent, eliminate or reduce food safety hazards to

acceptable levels during food preparation.

 Establish critical control limits (tresh holds) which must be met at each

identified critical control point to prevent, eliminate or reduce to an

acceptable level the occurrence of any food hazard.

 Establish procedures to monitor CCPs to assess whether they are under

control

 Establish the corrective action to be taken when monitoring indicates

that a critical limit has been exceeded.

 Establish procedures to verify that the HACCP system is working.

 Establish an effective record keeping and documentation procedures

that will document the HACCP system.

According to McSwane et al. (2003), the HACCP system is required in

every food service facility to enable food facility managers to identify foods

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and processes that are likely to cause food borne illnesses, initiate procedures

to reduce or eliminate the danger of food borne illness as well as monitor to

ensure that procedures are followed. The system requires that food handlers go

through the menu to check for hazardous foods (meat, poultry, eggs, dairy

products and cooked foods like beans) so that their critical control points could

be identified to prevent, eliminate or reduce hazards to acceptable levels (

McSwane et al., 2003).

The critical control point could be measured on features such as time,

temperature, moisture level and organoleptic parameters. The food handlers

would have to list the various foods served, find the possible CCPs and the

control limits, monitoring the CCPs, taking corrective actions if problems

occur, validating the HACCP plan and keeping records accurately (Sun &

Ockerman, 2005)

In order for the implementation of HACCP to be successful, the facility

management must be committed to the application of the HACCP concept at

each stage of food processing and production. This will afford the food

handlers the sense of the importance of producing safe food.

Sources of Food Safety Information

Naturally, individuals obtain information or knowledge through formal

training and observation. Omemu and Aderoj, (2008) found that 12% of their

respondents acquired knowledge through training while 72% obtained

knowledge through observation. Shelley (2015) identified a variety of sources

of food safety knowledge such as food safety news, magazines, blogs for

groups and individuals, FDA food safety alert and market withdrawals, food

processing industry and food quality and safety units.

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Similarly, Muinde and Kuria, (2005), indicated that a study conducted

in Nairobi, Kenya revealed that 61% of food vendors acquired knowledge on

cooking principles through observation while 33% were taught by parents and

6% learnt by trial and error.

A study conducted by Apanga, Addah and Sey (2014) on food safety

knowledge and practice of street food vendors in the Nadowli district of the

Upper West region of Ghana, revealed that their respondents obtained

information on food safety practices through television, radio, their interaction

with health officials, experience from family business and formal training.

This shows that food handlers had limited sources of information or channels

of obtaining food safety information which could limit their knowledge levels

or amount of information they possess. It is surprising that there was not much

emphasis on posters, internet and social media as sources of food safety

information since these are the current sources of information most people are

using. The implication is that the respondents in the previous studies were not

familiar with them or were not aware that they could be possible sources of

information on food safety issues.

Barriers to Food Safety Practices

In the midst of food safety standards and regulation as well as training

and the activities of regulatory bodies, there are still reported cases of food

borne illnesses in developed and developing countries. According to Ajzen

(1991), the best predictor of a person‟s behaviour in a given situation is the

person‟s behavioural intention which is based on the perceived behavioural

control of the person. This means that a person puts up a behaviour based on a

motivating factor or what he/she anticipates to gain from it. Thus, any

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behaviour exhibited has a control point or a source and reason behind it. For

this reason Layton, Griffith, Price and Peters (2002) are of the view that food

handlers need to develop appropriate perception for food hygiene practices to

be able to reduce the risk of food borne diseases. Consequently, people will

not engage in behaviours they cannot perform but rather their perception of

performing an action can be affected by lack of resources, time pressures, or

competing job demands (Brannon et al., 2009).

Some researches have been carried out to delve into hindrances to food

safety practices. For instance, in the US, Hertzman and Barrash (2007)

evaluated the food safety knowledge, and practices of catering workers in Las

Vegas city. The result showed that the workers engaged in inappropriate

practices such as improper covering of foods when warming and refrigerating,

not washing hands and not wearing gloves when it was required to do so. The

workers argued that they had busy schedules in carrying out their paramount

responsibility of food preparation and services. Thus, in trying to meet their

target, they intentionally or unintentionally use inappropriate safety and

sanitation practices (Hertzman and Barrash, 2007).

Still in USA, Arendt, Strohbehn and Jun (2015) tried using observation

and interview to find out employees‟ motivators and barriers to following food

safety practices in food service operations. It was observed that the employees

attempted to follow proper hand hygiene but did not meet the 2005 food code

requirements as their non-compliance rates with food safety practices ranged

between 23% (personal hygiene practices) to 69.4% (cleaning and sanitizing

procedures). The workers indicated that their reasons for complying with

recommended practices were to avoid bacteria growth and cross-

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contamination; not harming customers; satisfying requirement by law,

regulations, and procedures. They also complied due to the knowledge and

training they received; good practices/habits; rewards; culture of work place

and satisfying customers (Arendt, Strohbehn and & 2015, p365).

Furthermore Arendt, Strohbehn and Jun (2015) identified six barriers

to food safety practices such as forgetfulness, busy work schedules;

inadequate or lack of knowledge; consequence of following safe food

practices; unavailability and use of resources, and culture of the work place.

This means that there is the need for managers to keep promoting safe food

handling practices as well as apply identified motivators to address barriers to

promoting work place culture to make food safety paramount.

Additionally, in trying to assess interventions that could improve

restaurant employees‟ rate of compliance to food safety practices, a group of

researchers (York et al., 2009) in Kansas, Missouri and Iowa (USA) identified

lack of training on food safety guidelines and practices as a barrier to

compliance to food safety regulations. Again, in discussing food handlers‟

views on hand washing behaviour in restaurants, the barriers identified were

the unavailability of supplies and sinks; time pressure; high volume of work

and stress; lack of accountability; type of establishment; and inadequate

training on food handling and safety (Pragle, Harding & Mack, 2007).

In Ghana, Ackah et al (2011) realized that over half (60%) of

respondents did not have certificates for medical examination due to lack of

funds, unawareness and lack of strict enforcement of regulations by

authorities. Still on the barriers to food safety practices, Green and Selman,

(2005) buttress Ackah‟s views as they listed factors such as inadequate

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provision of equipment and resources, lack or poor enforcement of law by

management and lack of food safety education and training as barriers to food

safety practices. Thus, the foregoing factors militate against appropriate food

safety practices of food handlers.

Gaps in the Existing Literature

Existing literature on food safety issues in Ghana was mostly on street

food vending and vendors. It was also realized that the literature was on

studies conducted in the regional capital cities in the southern sector of the

country. Additionally, the literature from both the international and local

scenes shared the findings of researchers with scientific perceptions away

from the practitioners‟ stance. Thus, there is limited food safety literature from

the regions in the northern part of the country; especially the northern region.

Chapter Summary

This chapter discussed relevant food safety concepts, food safety

knowledge and practice, empirical information on food safety knowledge and

practices, sources of food safety information and barriers to food safety

practices. The chapter started with global food safety situation, factors

associated with food borne illnesses, food safety knowledge and practices, and

sources of food safety information. The food safety standards and regulations

and the barriers or challenges to food safety practices were also discussed. The

next chapter covers a description of the study area and the methodology

employed for the study.

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CHAPTER FOUR

METHODOLOGY

Introduction

This chapter describes the various procedures employed and the

methods used in conducting this research. The study sought to assess the food

safety knowledge and practices of food handlers in restaurants in the Tamale

metropolis in the Northern Region. The chapter presents an overview of the

study area featuring the occupational and cultural environment, research

design used, data sources, the target population and the sample and sampling

procedure. Subsequently, the methods used for data collection, the research

instruments used in collecting primary data, the approaches used for

processing and analysing the data and presentation as well as ethical concerns

are presented. Finally, the challenges encountered during the collection of data

and how reliability and validity were ensured are discussed.

Profile of the Study Area

The study was conducted in the Tamale Metropolis, the capital city of

the Northern Region of Ghana (Figure 7). According to the United Nations

Settlement programme (UN-Habitat) (2009) the size of Tamale is

approximately 922km2 and has been identified as Ghana's fourth-largest city

(Ghana-largest cities 2014; UN-Habitat, 2009). The Metropolis has an

estimated total population of 371,351 people (185,995 males and 185,356

females); with about 74% of them in the urban area and 26% as rural dwellers

(Ghana Statistical Service (GSS), 2013; Population and Housing Census

(PHC), 2010).

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Tamale Metropolis is bordered on the north by the Savelugu-Nanton

district, on the south by Central and East Gonja districts, to the east by Yendi

Municipality and to the west by Tolon and Kumbugu districts. Tamale is a

cosmopolitan city with about 48% of the proportion of urban literate persons

in the Northern Region.

In recent years, there has been an increase in human population,

commercial activities, influx of foreign merchants, expansion of

infrastructure, increase in number of vehicles, emergence of new human

settlements among others in the metropolis (GSS, 2013). It has been noted

that a total of about 39,248 non-Ghanaians were recorded in the northern

region with the majority based in the metropolis (GSS, 2013; PHC, 2010).

Due to the fact that Tamale has the highest population density as well as the

most urbanized district in the Northern Region where economic opportunities

abound, the metropolis has been identified to have the greatest proportion

(14.3%) of economically active population in the region (GSS, 2013).

As a result of the central location of the Metropolis, the sprawling city

serves as a hub for manufactured goods, all administrative and commercial

activities as well as educational and medical center; thus doubling as the

political, economic and financial capital of the Northern Region. The Centre

of Tamale hosts regional branches of financial institutions and a considerable

number of international non-governmental organizations (NGOs) (GSS, 2013;

UN-habitat, 2009).

Though the Ghana Statistical Service (GSS) (2013) indicated that the

2010 population and housing census (PHC) shows that the local economy is

predominantly agrarian, the major industry in the Tamale metropolis was

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repair of motor vehicles and motorcycles (30.4%), followed by agriculture,

forestry and fishery (19.6%), manufacturing (13.1%), education (7.6%) and

hospitality (7.1%).

Figure 7: Map of Tamale Metropolis

Source: Department of Geography & Regional Planning, Remote Sensing and
Cartography Unit, University of Cape Coast, 2017

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Over the years, the hospitality industry has grown significantly, with

new hotels, guest houses and restaurants springing up in the Metropolis. At

the time of recognisance study there were 86 hotel facilties and 43 prominent

restaurants in the metropolis that were serving meals to all categories of

people.

The 2010 PHC report shows that Tamale metropolis recorded the

largest proportion of persons working in the public sector due to its highly

urbanized nature. In the last few years Tamale has developed and transformed

significantly due to the rush by various companies to open branches in the

city. Tamale developed from a collection of towns and villages where one

could find an architectural blend of traditional mud houses and more modern

buildings.

Rationale for Selecting the Study Setting

The Tamale Metropolis was selected for this study based on a number of

reasons: First, the metropolis falls within the catchment area where there is

limited research on food safety issues even though there are reported cases of

food borne illnesses which calls for attention. Information from two

government hospitals (TTH & TCH in Fig.1 & 2) revealed reported incidences

of borne illnesses. For instance, in 2013 there was an incident of food borne

illness when adulterated margarine was used to prepare a birthday cake for

students.

Secondly, the metropolis is surrounded by historical and tourist

attractions such as Mole National Park located in the West Gonja district,

Nankpanduri water falls, Nalerigu Defence Wall, Gambaga Escarpment,

Yendi German Settlement, Bui National Park, Salaga Slave Heritage Site,

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Ancient mosques such as the 13th century mosque of Sudanese architecture in

Laribanga, Bole mosque, Banda Nkwanta and Malewe mosque. Others include

myths such as the Mystical Rock in Laribanga, the Tikpirah sacred grove in

Zabzugu, the Kpalvogu grove at Katariga in the Tamale metropolis and

peculiar architecture, archaeology and culture (Ghana Statistical Service

(GSS), 2013). All these draw a large number of people including both

domestic and foreign tourists from various parts of the country and the world

who need to be catered for as they transit in Tamale.

Thirdly, the metropolis is where most of the prominent hotels and

restaurants are concentrated and they are likely to attract both foreign and

local tourists who will need to be accommodated and fed. Also, there is a wide

range of non-governmental organizations and businesses which have made the

metropolis a business destination of many multinational and Ghanaian

companies which for many years have limited their activities to the Southern

part of Ghana.

The fourth reason is that, apart from the increase in human population,

Tamale and its environs for almost a decade now has also experienced a very

significant growth in the hospitality industry, physical infrastructure and

increased business and other human activities in all spheres of the local

economy, making it the fastest growing city in the West African Sub-Region

(UN-Habitat 2013).

Finally, the only airport in the northern sector of Ghana is located in

the metropolis and it serves as a transit point for travelers; both foreign and

locals who wish to travel to other areas of northern Ghana. Thus the

hospitality industry has the responsibility of catering for these visitors.

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Consequently, there are a number of hotels and restaurants that serve a variety

of meals to cater for both local and foreign visitors.

Research Philosophy

Neuman (2000) indicated that the basic approaches to social research are

the Positivist, Interpretivist and Critical Social Science (realist) approaches.

The Positivist approach is an organized method which combines deductive

logic with precise empirical observation of individual behaviour in order to

discover and confirm a set of probabilistic causal laws that can be used to

predict a general pattern of human activity.

The Interpretive approach refers to a systematic analysis of socially

meaningful action through the direct detailed observation of people in natural

settings in order to arrive at understanding and interpreting how people create

and maintain their social worlds. The Critical Social Science approach refers

to the critical process of inquiry that goes beyond surface illusions to uncover

the real structures in the material world in order to help people change

conditions and build a better world for themselves (Neuman, 2000). In other

words, the critical realist goes beyond what is observed about food handlers to

seek meanings and reasons for their actions.

In view of the forgoing approaches put forward by Crotty (1998), and

Neuman (2000); coupled with the objectives and research questions guiding

the study, the positivism paradigm was considered appropriate. This is because

the study aimed at assessing the food safety knowledge, and practices among

food handlers in restaurants as well as investigating the association or linkages

between food safety knowledge and practices among food handlers.

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Furthermore, Hughes (2001) explained that the positivist paradigm

sees the world as being based on unchanging, universal laws and the view

that everything that occurs around us can be explained by knowledge of these

universal laws. Thus, food handlers‟ actions and inactions can be explained in

relation to the laws and regulation in the industry.

Consequently, the assumption that knowledge transcends into action

or practice may remain unchanged or otherwise in this study. Food safety

knowledge therefore may bring about change or influence food safety

practices which could be explained through knowledge and application of

universal food safety laws. To understand how food handlers use these laws

the individual needs to observe and record events and phenomena in a

systematic way and then work out the underlying principle that has caused the

event to occur.

Moreover, the positivism perspective is in line with the quantitative

methods employed for this study. A quantitative research is employed for this

study in order to generate in-depth information and get a better understanding

of the research problem (Creswell, 2009). This study involves measuring

variables, assessing the relationship between food handlers‟ knowledge and

practices or impact of the variables, testing hypotheses and applying the

results to a large number of people. The quantitative approach will also enable

the researcher to measure the knowledge and practices of a great number of

people; precisely the food handlers in restaurants to a limited set of questions

which facilitate comparison and statistical aggregation of the data.

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Research Design

The choice of the positivist paradigm has implications for the study, in

terms of the research design, methodology, the kind of data to be collected,

sample size and the validity of the measurement. According to Sarantakos,

(2005) an important aspect of a research design is the logical sequence of

linking empirical data to the initial question or problem of the study and

ultimately to its conclusions. Naturally, the research design had to be

consistent with the chosen paradigm. Thus, bearing in mind the research

questions, the objectives of the study and the research philosophy, the

descriptive research design which describes and interprets what exists was

adopted for this study.

The descriptive research design was adopted to help specify the nature

of a given phenomenon as it determines and reports the way things are.

According to researchers such as Creswell (2003) and Best and Khan (1998),

descriptive research is concerned with the conditions or relationships that

exist; such as determining the nature of prevailing conditions, practices and

attitudes; opinions that are held; processes that are on-going; effects that are

evident or trends that are developing.

The purpose of this design is to observe, describe and document facets

of a situation as it naturally occurs. Thus, the objective of descriptive design is

to give accurate description of activities, objects, processes and persons. It

deals with determining or interpreting the degree of association or

relationships between variables and describing their relationships (Malhotra &

Birks, 1999; Amedahe, 2002). The design is deemed appropriate because the

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study sought to ascertain the food safety knowledge and practices of food

handlers in restaurants in the Tamale metropolis.

Sources of Data

The data for the study were obtained mainly from primary sources.

The data were obtained from a survey and field observations of selected food

handlers in 23 restaurants in Tamale Metropolis. Questionnaires and an

observation checklist were used to record procedures and practices employed

by food handlers. The use of primary data provided the researcher first hand

information on the food handlers in terms of their actual knowledge, practices

and the barriers to their food safety practices. Additional information was

obtained from existing documents such as a food safety and sanitation

checklist from FDA (modified based on the research objectives and

questions), the 2010 Ghana Population Census Report, statistical information

on hotel and restaurant facilities in Ghana from GTA, and statistics on food-

borne illnesses from the Ministry of health and the internet.

Population

The target population for this study was all food handlers in restaurants

in the Tamale Metropolis. As at the time of this study there were 85 hotel

facilities (comprising 9 two star, 13 one star, 58 budget and 5 guest house

categories) and 22 restaurants (made up of 10 grade-three and 12 grade-two

categories) with a total number of 419 workers (GTA). However, the

accessible population was all food handlers in one and two star hotels with

restaurants and grade two and three independent restaurants.

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These classes or ratings of restaurants identified as the accessible

population were the highest rating categories in the Tamale Metropolis. The

rest of the facilities were either budget hotels or guest houses which did not

serve meals as expected. Some of them served only breakfast while others did

not serv any meal at all; thus it was impossible to consider them as a source of

information for this study. The segment of the population selected was

considered appropriate to provide information for this study because aside

being the highest ranking facilities, they have facilities for hosting events or

programmes such as workshops, seminars, wedding receptions, and general

meetings which gave them the opportunity to always have patronage.

At the time of the study there were 22 one and two star hotel

restaurants with about 284 food handlers and 21 grades two and three

independent restaurants with about 135 food handlers which gave a total of 43

restaurants with 419 food handlers. Thus, the accessible population could give

the number of food handlers required for a quantitative study such as this.

Sample and Sampling Procedure

According to Aaker, et al. (2007), the size of a sample can be

determined either by using statistical techniques or adhoc approaches when the

researcher knows from experience the sample size to adopt. Peng, et al. (2006)

indicated that, aminimum sample size of hundred respondents is needed for

any quantitative study to reach a significant result.

Based on the list of licensed and registered hotels and restaurants

received from the GTA office, it was noted that a total number of food

handlers in the hospitality facilities in the Tamale Metropolis at the time of the

study (2016/2017) was 419 (284 from hotel restaurants and 135 in

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independent restaurants). Since it was practically not possible to involve all

the target population in the study, a sample was selected.s. This choice of the

samle size was guided by what the researcher thought would be representative,

credible, what could be done within the time and resources available (Patton,

1990), the variance in the population, and the proposed strategy of analysis.

To calculate the minimum sample size required for accuracy in

estimating proportions, the inconsistency of food safety knowledge or

awareness within the population (0.60), the acceptance margin of error of the

estimate (0.06) and the degree of confidence of 95% was considered

appropriate. The selection of the margin of error (0.05) for the calculation was

guided by recommendations by Malhotra and Birks, (2000). According to

these researchers a margin of error within the range of 0.01 to 0.05 is

considered appropriate in social science and the formula below portrays the

practical requirements needed for the calculation of the minimum sample size.

Consequently, the sample for this study was pegged at 229 food

handlers. The choice of a sample size was informed by factors such as

representativeness, the size of the population and the confidence level

required. The estimation of the sample size of 229 was based on Fisher‟s

(1950) formula for determining sample size for a population less than 10,000

as follows:

n= z 2 pq
d2
Where n= the required sample size

z = the standard normal deviation usually set at 1.96 with a confidence

level at 95%

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p= the population of the target population estimated to have peculiar

characteristics

q= 1.0 – p

d = the degree of accuracy desired; usually set at 0.05 (margin of error at

5%)

Given the proportion in the target population that is estimated to have peculiar

characteristics as 0.60, the z statistic being 1.96 and desired accuracy at 0.065,

then the sample size is:

1.96 2 (0.60)(0.40)
n
0.065 2
=218
Adding 5% for non-response
5/100 *218 =10.9
=218 +10.9 =228.9 (approx. 229)

The calculated value of „n‟ means that at least 218 food handlers were

targeted to be selected within the categories of facilities in the metropolis to

get a representative population. It is worth mentioning that 5% of the

estimated sample size (10.9) was added to the desired number in order to

account for non-response rate.

Sampling Procedure

This study employed a multi-stage sampling technique in the selection

of the sample of restaurants for the study as there was the need to go beyond

two stages in cluster sampling before getting the sample for the study

(Neuman, 2000). Based on the list of hotels and restaurants received from the

GTA office in Tamale metropolis (the sampling frame), it was noted that the

number of restaurants (hotel restaurants and independent restaurants) in the

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Tamale Metropolis was 43 (comprising 22 restaurants from 2 and 3 star hotels

and 21 grades 2 and 3 independent restaurants), with a total number of 419

food handlers (284 from hotel restaurants and 135 in independent restaurants)

(GTA). The sample of 229 food handlers was drawn from a total of 23

restaurants bearing in mind what would be representative, credible and could

be done within the given time.

In the first stage a cluster sampling procedure was used to group the

restaurants into two clusters: hotel restaurants and independent restaurants.

Secondly, through stratified sampling the restaurants in each cluster were put

into two strata based on their class or rating. Thus, all one and two star hotel

restaurants were categorized as group one and the second group comprised all

grade 2 & 3 independent restaurants. Thirdly, the restaurants were grouped

based on their location in the metropolis (Tamale North, Tamale South and

Tamale Central (see Table 1). With the support of three Field Assistants, a list

of names of the restaurants in the various locations were compiled. The

restaurants in the Northern zone were 21; 17 in the Central zone while those in

the southern zone were 5.

Table 1: Distribution of Restaurants by Zones

Zone Hotel Independent Total Percentage
Restaurant Restaurant Restaurants (%)
(1& 2 Star) (Grades 2&3)
Tamale North 13 8 21 48.84

Tamale Central 7 10 17 39.53

Tamale South 2 3 5 11.63

Total 22 21 43 100.00

Source: Field survey. Seidu, (2017)

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The fourth stage was the use of simple random sampling technique

(lottery) for the selection of 23 (12 hotel restaurants and 11 independent

restaurants) restaurants based on a proportion (54% and 52% respectively) of

restaurants in each cluster. Consequently, the names of the restaurants were (in

the two categories within the zones were) written on strips of paper and put in

two containers and mixed well. The strips of paper were picked one by one

and the names selected were recorded until the required numbers were

obtained and each name was recorded once.

The researcher purposely selected these sample sizes (a little above

half of each population in the two categories) in order to obtain appropriate

number of respondents for a quantitative study like this. The sample size for

the first and second groups or strata were allocated 0.54 and 0.52 proportion

rates respectively to ensure that each class of restaurant was adequately

represented (Table 2). Accordingly, the researcher assigned proportions to the

number of restaurants to be selected from each category of restaurants within

the zones as the number of restaurants in the zones were not equal. The sample

for the restaurants was obtained based on proportion in which the elements

occur in the total population. Thus, the zone with more facilities had high

numbers selected.

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Table 2: Distribution of Sampled Restaurants by Zones

Zone Hotel restaurant Sample from Percentage Independent restaurant Sample from Percentage Total Percentage

(1&2star-first first group Sampled (%) (Grade 2&3- second second group Sampled (%) Sample (%)

group) group)

Tamale North 13 7 58.4 8 4 36.3 10 47.35

Tamale Central 7 4 33.3 10 5 45.5 9 39.40

Tamale South 2 1 8.3 3 2 18.2 3 13.25

Total 22 12 100.0 21 11 100.0 22 100.0

Source: Field survey, Seidu (2017)

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Finally, purposive and accidental or convenient sampling were

employed to draw the required sample (229) of food handlers from the

selected restaurants for this study. According to Babbie (2010), a purposive

sample is a nonrandom sample where the units of observation are selected

based on the “researcher‟s judgement about which ones will be most useful or

representative” (p193). The purposive and convenient sampling procedures

were employed as the researcher sought to observe specific activities during

the handling and preparation of specific foods such as ready-to-eat food,

salads, sandwiches, and soups. Therefore, all qualified food handlers who

were present and working at the research team visited the restaurants were

selected for the study (see Table 3). This was in anticipation of whatever

number that happened to be available and carrying out activities related to

food preparation and service at the time of visit.

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Table 3: Selected Facilities and Sample Sizes

S/N Facility H&R Population Sample Observed
(PRH&R) Size (SS) Sample size
1 H001 33 18 4
2 H002 27 15 4
3 H003 13 7 2
4 H004 11 6 2
5 H005 27 15 4
6 H006 38 20 5
7 H007 49 26 5
8 H008 15 8 2
9 H009 9 5 2
10 H010 15 8 2
11 H011 13 7 2
12 H012 18 10 3
13 R013 18 10 3
14 R014 31 17 4
15 R015 26 14 3
16 R016 7 4 1
17 R017 11 6 2
18 R018 13 7 2
19 R019 9 5 1
20 R020 15 8 3
21 R021 11 6 2
22 R022 5 3 1
23 R023 7 4 1
Total 419 229 60
Source: Field survey, Seidu (2017)

Where: SS = Sample Size;

TSS = Total Sample Size (229);
TP = Total Population (419);
PRH/R = Population of Respondents in Hotels/Restaurants

Based on the perception that food preparation is usually undertaken by

women, the researcher did not allocate any special quotas to the sexes.

However, any male food handler who was willing to take part in the study was

selected. Due to the fact that the surveyed facilities were running the shift

system, the researcher used both the morning and afternoon shift food handlers

so that they could stand the chance of being selected for the study. Thus, all

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chefs, chief cooks, cooks, kitchen helps in charge of washing up and

waiters/waitresses who were at work at the time the research team visited the

facility were selected for the study. The chefs were specifically included in the

sample as they were the first point of contact and had a greater responsibility

of seeing to it that safe food is produced and served.

In addition, a sample of 60 food handlers were purposively selected from

the 23 restaurants for the observation of their food safety practices. The

researcher purposely observed chefs, food handlers working on foods eaten

raw and any other activity that could bring about food safety. The 60 food

handlers represented over a quarter of the 229 respondents selected for the

study. The fact that observation is a technique that is used for small numbers

and takes prolonged periods (Fisher, Laing, Stoeckel & Townsend, 1991)

accounts for the reduction in the number of respondents for the observation

section. The 60 food handlers who also completed the questionnaire were

observed for food safety practices using a check list covering personal hygiene

and food hygiene measures. The researcher purposively selected food handlers

based on proportions of elements in the facilities.

Environmental hygiene practices were observed on facility bases

because the sanitation of both the outside and inside the facility could not be

linked to a specific food handler since that work was assigned to a different

category of people. Thus, the research team observed the environmental

hygiene practices inside and outside of the 19 selected facilities. The observed

food handlers were linked with their knowledge scores to find the difference

between their food safety knowledge and practices.

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Research Instrument

In line with positivist tradition, the survey method was used for

gathering data for this study. Consequently, questionnaire and an observation

checklist were used to obtain information for this study. The two research

instruments were chosen because it was anticipated that the questionnaire

alone could not bring out the actual practices of the food handlers; thus

deeming it necessary to use the observation method to ascertain them.

Questionnaire

The questionnaire approach was used because it is able to measure the

reactions of a great number of people which makes the comparison and

statistical aggregation of the data simple (Bryman, 2004). According to Patton

(2002) it is possible to obtain the right information from respondents when

questionnaires are used. In terms of structure, the questionnaire consisted of

four sections where the first section gathered information on the socio-

demographic characteristics of the respondents such as gender, age, marital

status, education, working experience, food safety and sanitation training

obtained. The second part covered 33 questions relating to food safety

knowledge of food handlers (ranging from the three main domains including

personal hygiene, environmental hygiene to food hygiene) as well as the

sources of information on food safety. The third section sought information on

practices of respondents towards food safety while the fourth section solicited

views on barriers to food safety practices in terms of personal hygiene,

environmental and food hygiene measures. The items measuring each of these

issues were largely adapted from the literature (Malik, 2014; Ghazali, Othman,

Hashuki & Roslan, 2012).

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The questionnaire was made up of open and close-ended questions in

the three major sections (socio-demographic characteristics and employment

profile of respondents, food safety knowledge of food handlers, food safety

practices and barriers to food safety practices). The few open-ended questions

were to offer participants the opportunity to express their views.

The socio-demographic information included the respondents‟ gender,

age, marital status, educational attainment and religion. Their employment

profile consisted of their work status (position), work experience (number of

years), training received, facilty type and their sources of knowledge on food

safety and preparation.

As indicated earlier, the information on food safety knowledge of respondents

was examined in three domains such as personal hygiene, food hygiene and

environmental hygiene. A „true‟ or „false‟ scale was used to measure the

respondents‟ food safety knowledge. The respondents were to indicate

whether the 33 statements were „true‟ or „false.‟ The statements were assigned

one mark each and the number of correct scores obtained by each respondent

was calculated out of the total statements to ascertain how knowledgeable the

respondent was.

As regards the barriers to food safety practices the major barriers

deduced from reviewed literature were listed and the respondents were

required to tick the applicable ones that resulted in their inability to practice

food safety. The respondents were also given the opportunity to write some

barriers to their practices that were not on the list provided.

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Observation Checklist

Observation method was used as a data collection tool because it

provides rich, detailed and context specific descriptions which are close to the

inside perspectives (Sackmann, 1991 cited in Altinay & Paraskevas, 2008).

Thus, observation was employed to gather data on food handlers‟ food safety

practices which they were otherwise reluctant or incapable of providing. The

checklist was also made up of food safety measures in relation to the three

domains of food safety. The researcher was to indicate „Yes‟ if the food

handler‟s practice was observed to be right and „No‟ if the practice was not

right by food safety standards.

A structured observation checklist was adapted from the food safety

and sanitation compliance checklist from the Food and Drugs Authority. It

was modified in relation to the study objectives and research questions. The

use of exploratory and general observation was carried out to enable the

researcher obtain first-hand information (Sarantakos, 2005) on the practices of

the respondents which otherwise would be difficult to get as well as offer data

when respondents are unable or unwilling to give information.

However, it cannot be employed when large groups or extensive

events are studied. In spite of its shortfalls it is considered appropriate as it

approaches reality in its natural structure and studies events as they evolve.

Pre-testing of Instrument

According to Sarantakos (2005), pretests are small tests of single

elements of a research instrument that are mostly used to check the mechanical

structure of the instrument. As regards this study a pretest was carried out in

October 2016 to ensure that the instrument was clear enough to be able to

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draw information or answers from the respondents. The pre-testing was meant

to check the clarity of the items and identify ambiguities, misunderstandings

or other inadequacies to make the instrument more relevant and appropriate

for the actual data collection.

The questionnaire was self-administered to 20 food handlers in two

restaurants (one hotel restaurant and one independent restaurant) in the Cape

Coast Metropolis. The food handlers were asked to complete the questionnaire

as well as comment on the time it took to complete it. The researcher spent

three days in each facility to observe the participants as well as administer the

questionnaire. At the end of the third day in each facility the questionnaires

were retrieved from the respondents and scored.

The major issues identified during the pre-test were that: some of the

questions were not properly stated. Others were ambiguous and irrelevant. The

instrument was revised by re-phrasing the ambiguous questions, addition of

some items, deletion of some unrelated items, re-arranging some items to

ensure logical ordering and revising the layout to ensure consistency.

Training of Field Assistants

In order to collect relevant data and on time, three Research Assistants

were given a two-day training to be in a position to assist with the data

collection. The researcher recruited field assistants who had first degree,

experience in data collection and could speak Dagbani and Twi in addition to

English. They were taken through questionnaire administration techniques as

well as translation of the questionnaire into the two local dialects to ease and

fasten interaction, especially in administering the questionnaire to food

handlers who could not read and write. After the training the research

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assistants had a mock data collection section using Level 400 Family and

Consumer Sciences students in the University for Development Studies to

demonstrate their understanding of the issues discussed.

Data Collection Procedure

Data were collected in two stages using questionnaire and observation

check-list from November 2016 to March, 2017. The first stage was the

observation section where the researcher, with the consent of the management

of the establishments, observed the activities of food handlers while

participating in the activities with them. All observed practices were recorded

in the observation check-list in order to get information in an organized

manner. The observation gave the researcher the chance to have a good

observation of the food handlers as they worked. The observation took the

whole working period for the day; following the shift system schedules. Each

participant was observed for two hours during meal preparation and service

(either the noon or evening meal) and two food handlers were observed

concurrently if they were close to each other. A maximum of four days was

used in each establishment. With permission from participants, pictures were

taken to confirm the practices.

After the first day‟s observation, the three trained research assistants

distributed the questionnaire to the selected participants and followed up for

collection after the second day. The three trained field assistants administered

the questionnaire to food handlers who could read and write and had face to

face interviews with respondents who could not read and write using the

questionnaire. The distribution of the questionnaires was done early before the

start of work and after the peak hours of meal preparation and service.

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This strategy was employed to get the attention of the participants as

the service pressure would have gone down and participants would be relaxed

to respond to the questions. To avoid employee nervousness, the researcher

employed a number of strategies such as: 1) dressing in similar clothing like

the employees, 2) researcher and assistants initiated small talk with food

handlers and other staff, 3) recorded observations in a small note pad and

check lists and 4) extended period of observation. The researcher observed the

preparation and service of dishes such as Salads, meat, fish, snacks and the

storage of food. The actual field work for this study was undertaken from

November 2016 to March 2017 in the Tamale Metropolis of Ghana.

Ethical Issues

The study considered the issue of informed consent, anonymity and

confidentiality. As indicated by Newman (2007), researchers must not compel

people to participate in a study. Also, in social science, it is unethical to collect

information without the knowledge of the participants (Schinke & Gilchrist,

1993). Hence, participants should at all times willingly or voluntarily take part

in research. Consequently, a letter of introduction was taken from the

Department of Tourism and Hospitality Management of the University of

Cape Coast to the Ghana Tourism Authority (GTA), FDA, Northern Regional

Restaurant and Hoteliers‟ Association and the facility managers for their

consent before the field work began.

In addition, informed consent was also obtained from the managers of

the participating restaurants and the food handlers before the instruments were

administered. Permission was sought from them to record and take pictures of

observed practices as well as present pictures in the work where necessary

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with their faces covered. The purpose of the study was clearly explained to

them and the issue of anonymity was also assured. Anonymity protects

privacy by not disclosing a respondents‟ identity. Thus, the names of the food

handlers were not associated with the responses given. The names of the

respondents and the participating restaurants were rather given codes for the

sake of anonymity.

Fieldwork and Related Challenges

In the field of research, data collection comes with some challenges

which are unavoidable and this study was no exception. This study faced the

following challenges:

First, on arrival at the premises of selected hotels and restaurants the

research team could not gain easy access to the kitchen area as it was difficult

for the workers to allow the team into the kitchen without permission. To

resolve this, the team first met with the facility managers who then introduced

the team and explained the purpose of the visit to the employees. Initially it

was taken for granted that since permission was sought from them through

letters and personal contacts they had informed the workers but it was not so

in some of the selected facilities.

Secondly, the research team was also suspected by some of the

employees to have been sent by some regulatory bodies like GTA and FDA on

monitoring. Thus the workers did not want to open up and tried to pretend. To

address this constraint, the team had to explain the nature and purpose of the

research to them over and over again. They were also told how the study could

serve as a way of identifying their training needs as well as serve as a medium

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for them to communicate some of their concerns to management, their

professional associations and the regulatory bodies.

Thirdly, due to the busy schedule of the food handlers especially

during the peak hours, the participants did not have time to fill out the

questionnaires as expected. The team had to revisit facilities a number of times

in order to retrieve questionnaires. There were occasions that team members

had to administer the questionnaires to some respondents. In this regard, the

questionnaires were hand delivered to each available food handler shortly after

observing their practices.

Finally, the respondents wanted to know what they could benefit from

responding to the questions before answering the questions. To this the team

promised to show them their scores so that they could know their knowledge

levels and the areas they need to improve upon. This motivated them to fill the

questionnaire.

Amidst these challenges, the participants responded to the questions as

expected and out of the 229 questionnaires administered, 214 of them were

retrieved; representing a response rate of 94%. On the whole the data collected

were reliable and therefore could be used.

Data Processing and Analysis

Both descriptive and inferential statistical techniques were applied for

the analysis of the data collected from the field. In order to ensure quality, the

data were coded and entered into STATA version 15 software for analysis.

Accordingly, the data were carefully edited or cleaned to remove all outliers or

extreme values which could have affected the validity of the results.

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Descriptive statistics such as means, percentages, frequencies, cross

tabulations and standard deviations were used in analyzing the socio-

demographic, work related characteristics of respondents, their food safety

knowledge and practices as well as the barriers to food safety practices.

The independent samples t-test and one-way analysis of variance

(ANOVA) were used to test for mean differences in the dimensions of food

safety knowledge across the background characteristics (such as sex, age, and

type of restaurant) of the respondents. The significance in the mean

differences of the groups was estimated using a probability value of 0.05. The

food safety knowledge dimensions were personal hygiene knowledge, food

hygiene knowledge, and environmental hygiene. The t-test was used in

instances when the independent variable had two categorical outcomes/groups,

for example, sex: male and female and ANOVA when the categories were

more than two (Pallant, 2018).

The continuous outcome for each of the food safety knowledge

dimensions was computed by totaling the number of correct responses of each

question under each knowledge domain. The total number of items for

personal hygiene knowledge was thirteen (13), food hygiene knowledge was

twelve (12), and environmental knowledge was eight (8). Therefore, the total

number of questions used to measure food safety knowledge was thirty-three

(33). The same principle was applied in determining the number of correct

practices. In sum, thirty-eight (38) questions through observation were used to

gauge food safety practices. This was made up of eleven (11) items for the

personal hygiene practices, twelve (12) for the food hygiene practices, and

fifteen (15) for environmental hygiene.

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Chapter Summary

This chapter was devoted to the methodology of the study. The areas

discussed included the study area, the research philosophy and design guiding

the study, the population, sample size and the procedures followed in

collecting and analysing the field data. The study followed a descriptive

research design and primary data was the main source of data; supported with

secondary information from GTA, FDA, Ghana statistical service and 2010

PHC report.

The researcher used questionnaire and observation check-list to collect

data from food handlers in restaurants. Both probability and non-probability

sampling procedures were employed to select the sample of 229 food handlers.

The chapter also discussed issues related to pretesting of the research

instrument and the outcome as well as the field work and the challenges

associated with the data collection and how they were addressed.

Additionally, the chapter identified data analysis methods used and

how the results were presented. The next chapter presents the analysis, results

and discussion of the findings in relation to the socio-demographic and work-

related characteristics of the respondents.

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CHAPTER FIVE

FOOD SAFETY KNOWLEDGE OF RESPONDENTS

Introduction
The chapter presents the respondents‟ food safety knowledge and

related issues. The issues covered included a description of the socio-

demographic characteristics and work profile of the respondents, their food

safety knowledge and the sources of the food handlers‟ information on food

safety. As regards the respondents‟ food safety knowledge, the issues

considered were the food safety knowledge in relation to their socio-

demographic characteristics and the categories of restaurant as well as their

sources of information on food safety knowledge.

Background Characteristics of Respondents

Although the study is not specifically on the personal characteristics of

food handlers, the opportunistic data as indicated in Chapter One (pg. 20) is

essential to highlight some factors that are associated with the respondents‟

knowledge base and the sources of information that in turn affect their food

safety practices. The specific elements covered under the background

characteristics were gender, age, marital status and educational attainment of

the respondents as shown in Table 4.

According to Mason and Cheyne (2000), cited in Amuquandoh (2006),

gender has been found to influence individuals‟ needs and aspirations as well

as their perceptions and attitudes towards issues and events; thus the need to

give attention to the gender of the respondent. In Africa, the popular notion is

that food preparation and service is the primary responsibility of women and

the belief is that restaurant work is often reserved for females. Out of the 214

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individuals who engaged in the study, 30.4% were males while 69.6% were

females.

Table 4: Background Characteristics of Respondents

(N=214) Percentage
Background Characteristics Frequency (n) (%)
Gender
Male 66 30.8
Female 148 69.2
Age group
18-27 128 59.8
28-37 61 28.5
38-47 18 8.4
48 and above 7 3.3
Marital status
Single 130 60.7
Married 84 39.3
Religion
Christianity 109 50.9
Islam 105 49.1
Level of Educational
No Formal Education 9 4.2
JHS/MSLC 18 8.4
SHS 105 49.1
Tertiary 82 38.3
Source: Field survey, Seidu (2017)

Traditionally, age has been found to influence individuals‟ knowledge,

perceptions, attitudes towards issues and ability to take risks, and accept or

reject change. Age has also been associated with individual‟s ability to seek

and obtain information and services (Awusabo-Asare, Biddlecom, Kumi-

Kyereme & Patterson, 2006). Consequently, age was considered as an

important variable in this study that could influence respondents‟ ability to

take decisions to bring about change in food safety practices. The results show

that, 59.8% (128) were aged between 18-27years, 28.5% (61) were within 28-

37 years, and 8.4% (18) were aged between 38-47years while 3.3% (7) were

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48 years and above. Based on the data obtained the estimated mean age of the

respondents of the study was 28years.

The results depict that over one-sixth of the respondents (60.7%) were

single whilst the rest (39.3%) were married. This finding reinforces that of

Kibret and Abera„s (2012) who observed that most of the food handlers (77%)

in their study were single; which implies that they were more likely to have

time for knowledge acquisition and practice compared to their counterparts

who were married.

Education is regarded as the ladder to achieve higher heights as it

provides people with the knowledge and skills that can lead to better

employment opportunities and a better quality of life. Educational attainment

is known to be an important determinant of knowledge and practice (Ackah et

al. 2011). Information regarding the educational level of the respondents

showed that 49.1% of the food handlers in the restaurants were senior high

school certificate holders, 38.3% (82) had tertiary (polytechnic degree holders)

education and 8.4% (18) were JHS/MSLC certificate holders while 4.2% of

the respondents had no formal education. This conforms to the assertion by

Jianu and Chis (2012) that food handlers with higher education had higher

knowledge; which could be regarded as the bases of the respondents‟

knowledge.

Work-Related Characteristics of Respondents

The work-related characteristics included the respondents‟ professional

qualification, the positions held, their work experience, and the in-service

trainings received. The results in Table 5 revealed that, 60.7% of the

respondents were professionals (14.5% HND in Hotel/Institutional

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management, marketing, 23.4% advanced catering, 16.4% intermediate

catering and NVTI, 6.5% Home Economics) and 39.3% non-professionals.

Over half (63.6%) of the respondents were from hotel-based

restaurants while the remaining 36.4% (78) were in independent restaurants.

This is due to the fact that, at the time of the survey, there were more 1and 2

star hotels than grades one and two restaurants from which the sample was

selected.

Table 5: Work Related Characteristics of Respondents

Work related characteristics N=214 Percentage
Frequency (n) (%)
Professional qualification
Professionals 130 60.7
Non professionals 84 39.3
Type of facility
Hotel restaurants 136 63.6
Independent restaurants 78 36.4
Position in the organization
Chef 19 8.9
F&B supervisor/manager 7 3.3
Cook 124 57.9
Waiter/ waitress 64 29.9
Work experience
1-6months 101 47.2
7-12months 44 20.6
13-18months 38 17.8
19 months and above 31 14.5
Routine medical check-ups in a year
No medical check-ups 23 10.7
Does medical check-ups at intervals 191 89.3
In-service training on food safety practices
during the past year
Received in-service training 90 42.1
Not received in-service training 124 57.9
Source: Field survey, Seidu (2017)

In terms of the respondents‟ position in the work place, it was found

that 57.9% of the respondents were cooks, 29.9% (64) waiters/waitresses, with

a few respondents in the managerial positions as chefs and food and beverage

supervisors/managers (9.3%; 8.4%) respectively.

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As regards the respondents work experience, it was realized that 47.2%

of the respondents had worked for between 1-6 months, 20.6% had worked

between 7-12 months, 17.8% worked between 13-18 months while 14.5% had

worked for 19 months and above. Thus, most of the respondents had worked

for less than a year. This could be associated with widespread turn overs in the

food service industry.

Medical examination and routine check-ups are public health

requirements for all food handlers in the hospitality industry to ensure that

food handlers with infectious diseases are excluded from handling food

(Ackah et al., 2011; CCMA, 2012; GTA, 2012). The analysis shows that, the

majority (89.3%) of the respondents did have routine medical check-ups in the

year while 10.7% did not. This result is in consonance with Addison‟s (2015)

findings that 59% of the respondents undertook routine medical screening at

intervals while 19.2% did not. Although the number (10.7%; 23) may be

considered small it is still risky for consumers. This is due to the fact that the

risk of contaminating food is often linked to food handlers who could be

asymptomatic carriers of microorganisms that cause food borne illnesses

(Walker, Pritchard, & Forsythe, 2003).

Education and training are considered key to food safety knowledge

and practice as training enables workers to be conversant with work tasks, new

knowledge and techniques to improve on their performance and demands of

the establishment (McSwane, Rue & Linton, 2003). According to Gul (2012)

education is an effective determinant of acceptable food safety and hygiene

practices. In this regard, the respondents were asked to indicate whether they

received in-service training on food safety and hygiene practices or not. The

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result indicates that, 42.1% (90) of the respondents received in-service training

while over half (57.9%; 124) did not. This suggests a high risk of

contamination of food since most of them have not received training and may

not be familiar with appropriate food handling techniques.

Food Safety Knowledge of Respondents

The respondents‟ food safety knowledge was assessed in three main

areas namely personal hygiene, environmental hygiene and food hygiene.

Thirty-three statements were used to gauge the respondents‟ food safety

knowledge in the three domains. The responses on the three domains are

discussed in this section.

Personal Hygiene Knowledge of the Respondents

Thirteen statements were used to gauge the respondents‟ personal

hygiene knowledge and the results are presented in Table 6. Overall, about

76% (162) (a mean or average of all correct responses) of the respondents

were found to be knowledgeable in personal hygiene issues as they gave

correct responses to the 13-personal hygiene-related statements. This gives

some assurance of safety as it has been noted by Clayton et al., (2002) that

when food handlers have appropriate personal hygiene perceptions, the risk of

food-borne illnesses might be minimised.

Segregating the personal hygiene knowledge by specific personal

hygiene measures, it was noted that the majority of the respondents were

knowledgeable in areas such as the importance of medical examination as a

requirement for employment in the food industry (95%), coughing and

sneezing directly on food during food preparation and service not being a

hygienic practice (92%).

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Table 6: Personal Hygiene Knowledge of Food Handlers

Number with Number with
Personal Hygiene Statements correct incorrect
Responses (%) Responses (%)
Food handlers are at liberty to put on hair 35 (16.4) 179 (83.6)
restraints/caps during food preparation and
service
Using aprons or overcoats during food 143 (66.8) 71 (33.2)
preparation is a luxury
It is optional to wear hand gloves when 130 (60.7) 84 (39.3)
preparing foods that are eaten raw/fresh
A food handler cannot continue to wear soiled 158 (73.8) 56 (26.2)
clothing to work until he/she is off duty
It is compulsory for food handlers to have 194 (90.7) 20 (9.3)
jewelries on during food preparation

Hand washing with soap and warm water 195 (91.1) 19 (8.9)
before commencing and during cooking and
service reduces the risk of food contamination

Hand washing is necessary only after visiting 174 (81.3) 40 (18.7)

the toilet

Food handlers are at liberty to scratch skin, 195 (91.1) 19 (8.9)

touch hair, nostrils and ears during food
preparation and service
Food handlers are at liberty to wear long 192 (89.7) 22 (10.3)
finger nails
A food handler is at liberty to lick fingers 160 (74.8) 54 (25.2)
during food preparation and service
Coughing or sneezing directly on food during 197 (92.1) 17 (7.9)
preparation and service has no effect on the
food
Medical examination is not a requirement for 203 (94.9) 11 (5.1)
employment in the food production and
service industry
Regular or routine medical examination is
130 (60.7) 84 (39.3)
optional in the food production and service
unit
Overall Score 162 (75.7) 52 (24.3)
Source: Field survey, Seidu (2017)

They were also aware of the need to wash hands with soap and warm water

before, and during food preparation and service (92%), the need to avoid

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scratching parts of the body during food preparation and service (91%), not

wearing jewellery during food preparation (91%), and the necessity of

avoiding long finger nails (89.7%) and washing hands after visiting the toilet

(81%).

Their knowledge on the medical issues suggests that a good proportion

of them were aware of the public health requirements which demand that all

individuals who handle food in the industry undergo a medical examination

and routine check-ups (Ackah et al., 2011; CCMA, 2012; GTA, 2012). They

were also aware that a food handler who is ill or shows symptoms should

abstain from handling food (FDA, 2001; Kitagwa, 2005).

Respondents‟ knowledge in relation to coughing and sneezing directly

onto food can be said to be in consonance with the popular notion that

coughing and sneezing should be done away from food or into disposable

napkins since body fluids such as saliva and sweat have the potential to

contaminate food (Hayter, 2006 and McSwane et al., 2003). Similarly, their

responses relating to scratching body parts and the wearing of jewelleries

during food preparation and service indicates that they agree with the

suggestion from Sprenger (2009) and McSwane et al. (2003) that food

handlers should not wear rings and other jewellery during food preparation

and service as they can harbour germs that could cause food-borne illness.

The knowledge demonstrated by the majority of the respondents

(91%) with regards to hand washing was found to be consistent with the

observations made by Onyango et al. (2016), Apanga, Addah & Raymond

(2014) and Ackah et al. (2011); that most respondents had very good

knowledge on the need to wash hands after visiting toilet, blowing nose,

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counting money, and sneezing into handkerchiefs before and during food

preparation and service.

On the other hand, a little over half of the respondents demonstrated

good knowledge in areas such as the need to use protective clothing such as

aprons/overcoats (67%) and gloves (61%) during cooking as well as undertake

routine medical examination (61%). It is expected that food handlers should

have high knowledge on the use of protective clothes as they serve as barriers

between bare hands and the food being handled (FDA, 2001, Green & Selman,

2005; Green et al., 2007).

Thus, the level of knowledge exhibited by the respondents on the need

to use these hair restraints falls below the recommended knowledge level. On

the whole, as high as 83.6% of the respondents did not know the importance

and urgency of putting on hair restraints during food preparation and service.

Only a small proportion of the respondents (16%) were knowledgeable in this

regard. This could perhaps, be attributed to the food handlers‟ ignorance of the

fact that the wearing of hair restraints (scarfs, hair nets, hats, caps, and hair

bands) during food preparation and service is obligatory as they prevent hair

from falling into the food.

Environmental Hygiene Knowledge of Respondents

Eight environmental related items were employed to elicit respondents‟

knowledge on environmental hygiene. Table 7 presents the distribution of

scores in relation to the physical surroundings of the food service facilities

(both inside and outside the kitchen as well as the work surfaces, kitchen linen

and equipment used).

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In total, 78% of the respondents gave correct responses to the

statements on environmental hygiene, indicating that they were

knowledgeable in environmental hygiene issues.

Table 7: Environmental Hygiene Knowledge of Respondents

Number with Number with
Environmental Hygiene Statements correct incorrect
Responses Responses (%)
(%)
Food preparation and service area should be 194 (90.7) 20 ( 9.3)
free from pests and rodents

Adequate and clean toilet facilities is a luxury 192 (89.7) 22 (10.3)

Proper cleaning of premises reduces the risk of 180 (84.1) 34 (15.9)

food contamination

All kitchen cloths must be washed with 165 (77.1) 49 (22.9)

soap/detergent once a week

All garbage bins in the food preparation and 189 (88.3) 25 (11.7)
service area should be left opened for easy
usage

Garbage bins should be emptied once a week 193 (90.2) 21 ( 9.8)

Hand washing stations should be equipped with 171 (79.9) 43 (20.1)

sanitary towels/drying services

Good drainage system can limit the spread of 56 (26.2) 158 (73.8)
microorganisms

Overall Score 167.5 (78.3) 46.5 (21.7)

Source: Field survey, Seidu (2017)

In specific terms, the majority of them had high knowledge in areas

such as: keeping the kitchen free from pests and rodents (90.7%), the need to

have a clean toilet facilities (89.7%) and emptying garbage bins regularly

(90%). This finding is consistent with the normative knowledge that proper

waste disposal guards against the breeding of insects and pests in the

environment (McSwane et al. 2000 & WHO, 2006). This knowledge is also in

line with the ISO 22000 (2015) standard that waste bins should have

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appropriate lids and that liquid and solid waste be removed from food

processing area without contaminating products and the environment.

In addition, most of the respondents (90%) were aware that unclean

work surfaces and kitchen cloths are vehicles of contamination as well as

major sources of cross-contamination (Hill, 2011); consequently, they were

not in favour of washing kitchen cloths once a week. An appreciable

percentage (84.1%) of them agreed that proper cleaning of premises reduces

the risk of food contamination. Likewise they affirmed the need to equip hand

washing stations with sanitary towels/drying service (79.9%). However, it is

worth noting that as many as 158 (73.8%) respondents were not aware that

good drainage systems limit the spread of microorganisms. This suggests that

the food handlers are likely to ignore their drainage systems which could lead

to the accumulation of waste and subsequently lead to contamination.

Food Hygiene Knowledge of Respondents

As regards the food handlers‟ food hygiene knowledge, twelve

measurement items were used to gauge it and the results are presented in

Table 8. In all, 75% of the respondents gave correct responses on the food

hygiene knowledge statements. This observation shows that they are

knowledgeable in food hygiene issues. The majority of them displayed high

knowledge on issues such as washing, rinsing equipment and serving dishes

under running water (95%), the importance of using separate chopping boards

during food preparation (90%), not mixing raw food and cooked foods during

storage (87.4%) and the need to reheat leftover cooked foods well to reduce

the risk of food contamination (81.8%).

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Their knowledge on separating cooked and raw foods during storage

reinforces the observation made by Ko (2011) that most restaurant staff in

China are aware that salads and vegetables should not be stored with fresh

meat in the same container.

Table 8: Food Hygiene Knowledge of Respondents

Food Hygiene Knowledge Statements Number with Number with
correct incorrect
Responses (%) Responses
(%)
Reheating cooked food contribute to food 175 (81.8) 39 (18.2)
contamination
Appropriate refrigeration temperatures 117 (54.7) 97 (45.3)
(freezing) kills all bacteria that may cause
food-borne illness
Raw/fresh foods and cooked ones (vegetables,
187 (87.4) 27 (12.6)
meat) can be put together during storage
Cooked foods (meat, soups and sauces) can be
117 (54.7) 97 (45.3)
left out of the fridge to cool overnight before
refrigeration (stacking discipline)
Cooked food should be very hot (at a
181 (84.6) 33 (15.4)
temperature of 65 oC) before serving
Food items purchased from reliable sources
158 (73.8) 56 (26.2)
need no cleaning before storage
The best way to thaw frozen food is to put it in 108 (50.5) 106 (49.5)
a bowl and leave it in the open
It is a luxury to use separate chopping boards
188 (89.9) 26 (12.1)
during food preparation
Food handler is not obliged to wash and rinse 204 (95.3) 10 (4.7)
equipment and serving dishes under running
water
It is not important to heat or sanitize serving
166 (77.6) 48 (22.4)
plates and dishes before they are used for
service
The manipulation of food with uncovered
170 (79.5) 44 (20.6)
hands increases the risk of food contamination
Overall Score 161 (75.2) 53 (24.8)
Source: Field survey, Seidu (2017)

Similarly, about 84.6% agreed that cooked foods be served very hot and also

food should not be manipulated with bare hands to avoid contamination

(79.5%).

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Furthermore, about 78% (166) of the respondents displayed awareness

of the importance of sanitizing serving plates and dishes before they are used

for service. Surprisingly, only a little over half (54.7%) of the respondents

knew that appropriate refrigeration temperatures or freezing does not kill all

microorganisms in food. This means that an appreciable number of the

respondents (45.3%) were not aware of the fact that some microorganisms are

only inactivated under cold or freezing conditions and will revive when they

get favourable conditions. Similarly, about half (49.5%) of the respondents

had no knowledge of the right way to thaw frozen foods. Thus, they stand a

chance of contaminating foods during the thawing process.

Levels of Food Safety Knowledge of Respondents

In order to establish the levels of food safety knowledge of the

respondents, they were asked to respond to thirty-three items on food safety

and the number of correct responses obtained out of the thirty-three was

considered as the level of the individuals‟ knowledge. The scores were put in

ranges between 0-10 representing low knowledge, 11-21 moderate knowledge

and from 22-33 for high knowledge level and the results are presented in

Table 9.

As evident in the Table, the respondents‟ knowledge on food safety

issues ranged between moderate (19%) and high (81%). The results showed

marked differences in the levels of the respondents‟ knowledge where 81% of

the respondents had high knowledge while 19 % had moderate knowledge.

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Table 9: Respondents’ Food Safety Knowledge Levels

Knowledge Level Frequency (n) Percentage (%)
Moderate 41 19.00
High 173 81.00
Overall score 214 100.00
Source: Field survey, Seidu (2017)

There was no respondent within the low knowledge level category. This

implied that the respondents were knowledgeable in food safety issues.

Consistent with the KAP model (Ko, 2013) which informed this study,

the respondents were expected to exhibit good food safety practices given that

nobody showed low or poor knowledge on food safety issues. The KAP model

assumes that an individual‟s behaviour or practice depends on his or her

knowledge and that the mere provision of information to an individual can

lead directly to change in attitudes and practice. Thus, the high knowledge

levels could influence their food safety practices.

Food Safety Knowledge by Socio-demographic Characteristics

Individuals‟ knowledge on issues, events and phenomenon including

food are known to vary across their background characteristics (Ko, 2013;

Rennie, 1995). In order to gain insights into the differences in food safety

knowledge (using the continuous measure of knowledge, which was computed

as the number of correct responses) among the food handlers, an independent

samples t-test and one-way analysis of variance (ANOVA) were used to

explore such possible variations across their socio-demographic

characteristics. The results of these analyses are presented in Table 10.

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Table 10: Food Safety Knowledge by Respondents’ Socio-demographic Characteristics

Socio- Personal hygiene Food hygiene Environmental hygiene
demographic Pooled Hotel Independent Pooled Hotel Rest. Independent Pooled Hotel Rest. Independent
Characteristics sample Restaurants Restaurants sample M(SD) Rest. sample M(SD) Rest.
Mean Mean Mean Mean Mean Mean Mean Mean Mean
Sex
Male 11.04 11.23 10.57 9.07 9.06 9.10 6.46 6.59 6.15
Female 10.35 10.43 10.24 9.06 9.16 8.91 6.16 6.23 6.06
t(p-value) 2.35(0.01*) 2.28(0.02*) 0.63(0.52) 0.00(0.48) 0.08(0.77) 0.12(0.72) 2.33(0.12) 2.50(0.11) 0.06(0.81)
Age
18-27 10.41 10.38 10.45 8.88 8.80 9.02 6.15 6.19 6.09
28-37 10.68 10.95 10.16 9.32 9.34 9.29 6.34 6.58 5.87
38-47 10.82 11.12 10.14 8.73 9.75 6.42 6.30 6.25 6.42
48 and above 11.14 12.33 10.25 10.57 10.33 10.75 7.00 7.33 6.75
F(p-value) 0.64(0.59) 1.81(0.14) 0.12(0.94) 2.24(0.08) 1.74(0.16) 6.90(0.07) 1.04(0.37) 1.51(0.21) 0.60(0.61)
Marital status
Single 10.59 10.62 10.53 8.95 8.96 8.93 6.24 6.29 6.15
Married 10.53 10.84 10.00 9.25 9.40 9.00 6.28 6.46 6.00
t(p-value) 0.20(0.83) 0.63(0.52) 1.08(0.27) 1.10(0.29) 1.59 (0.21) 0.02(0.89) 0.04(0.83) 0.55(0.46) 0.22(0.63)
Religion
Christianity 10.80 11.05 10.19 9.28 9.52 8.67 6.45 6.63 6.03
Islam 10.36 10.32 10.41 8.87 8.66 9.15 6.06 6.01 6.13
t(p-value) 1.95(0.14) 3.12(0.04*) 0.22(0.63) 1.36 (0.25) 3.62(0.02*) 0.97(0.32) 2.35(0.09) 4.07 (0.01)* 0.09(0.76)

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Table 10: Continued

Level of education
No formal education 11.11 11.16 11.00 9.55 9.66 9.33 6.66 6.50 7.00
JHS/MSLC 9.33 9.50 9.25 8.94 8.00 9.41 5.88 5.50 6.08
Senior High School 10.59 10.64 10.46 8.91 9.05 8.56 6.34 6.52 5.90
Tertiary 10.75 10.90 10.53 9.24 9.32 9.12 6.19 6.20 6.18
F(p-value) 5.41(0.14) 1.04 (0.37) 1.46(0.23) 0.61(0.61) 0.98(0.40) 0.64(0.58) 0.94(0.42) 1.59(0.19) 0.63(0.59)
Professional
qualification
HND, Institutional 10.96 11.16 10.69 9.19 9.50 8.76 6.35 6.33 6.38
management
Advanced catering 10.20 10.28 10.00 9.10 8.91 9.53 6.12 6.17 6.00
Intermediate catering 10.54 10.39 10.83 9.28 9.39 9.08 6.34 6.52 6.00
NVTI, DBS, Home 11.20 11.37 10.50 9.40 9.70 9.25 6.42 6.50 6.25
Economics
Nonprofessional 10.52 10.82 10.06 8.83 8.92 8.69 6.25 6.39 6.03
training
F(p-value) 12.35(0.03)** 1.02 (0.40) 0.72 (0.56) 0.63(0.63) 0.70(0.59) 0.46(0.76) 0.26(0.90) 1.73(0.78) 0.19(0.94)

Source: Field survey, Seidu (2017)

Asterisks (*) indicate areas of significant differences.

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It was observed that on the whole, the knowledge on personal hygiene

varied by sex (p = 0.01) as well as respondents who worked in hotel

restaurants (p = 0.02) but not for those who worked in independent restaurants

(p = 0.52). On the whole, while both sex cohorts scored high on personal

hygiene issues, the mean rating for males (mean =11.04) was higher than their

female (mean =10.35) counterparts. The overall finding confirms the

hypothsis that there will be a significant difference in the personal hygiene

knowledge by the sex of the food handlers. This agrees with Byrd-Bredhenner

et al.‟s (2009) finding that male food handlers were likely to be more

knowledgeable than the female respondents. Similarly, it was noted that the

male food handlers in hotel restaurants (mean =11.23) were more

knowledgeable as compared to the females (mean = 10.43) in the same

facility. It can also be inferred that the male food handlers who work in hotel

restaurants are more likely to have high knowledge on personal hygiene

compared to their female counterparts in the same facility. The trend was

similar to that of food handlers in independent restaurants. In addition, it was

clear from Table 10 that the male respondents from hotel restaurants had more

knowledge in personal hygiene issues than their counterparts in independent

restaurants.

The results further indicated that significant differences (p=0.04)

existed between respondents from different religious groups as well as the

category of facilities they worked in. Regarding personal hygiene, it was

observed that Christians (mean=11.05) had higher knowledge scores

compared to food handlers affiliated to the Islamic religion (mean =10.32) in

hotel restaurants. This indicates that food handlers who are Christians tend to

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have more knowledge on personal hygiene compared to their colleagues from

other religious backgrounds.

As regards the overall food hygiene knowledge and religious

affiliation, no significant variation was observed (p>0.05), such that those

respondents who were Christians (mean =9.52) exhibited similar knowledge

levels as that of their Moslems (mean =8.66) colleagues. This observation

reinforces the null hypothesis that there will be no significant difference in the

food hygiene knowledge by the religion of the food handlers. This is possibly

attributed to the fact that all religious frateneties in Ghana emphasis the need

for cleanliness since it is next to Godliness.

Though there was no significant difference in the food safety

knowledge of the respondents in terms of their ages, it was clear from Table

10 that food handlers within 48 years and above had higher mean scores. This

is in consonance with Sanlier and Konaklioglu‟s (2012) finding that

knowledge increased with age but contrary to Sun et al.‟s (2012) finding that

younger respondents have higher knowledge scores.

While the study hypothesized that there will significant difference in

the environmental hygiene knowledge by the educational status of the food

handlers, the contrary was established (p = 0.42). This gives credence to the

null hypothesis. However, the variation existed for personal hygiene

knowledge (p = 0.03) in relation to the various professional qualifications. It

was observed that food handlers with NVTI/DBS/Home Economics (mean =

11.20) had the highest mean score, followed by those with HND/Institutional

Management (mean = 10.96) and then Intermediate catering (mean = 10.54). It

can be said that food handlers with NVTI/DBS/Home Economics

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qualifications tend to be more knowledgeable in personal hygiene issues as

compared to food handlers with other qualifications.

This could be as a result of the training they received (hospitality

programme) as it was noted that some of the food handlers offered other

courses than hospitality but found themselves working in the industry. Thus,

the information they acquired during training accounted for their knowledge

level.

Food Safety Knowledge by Work Related Characteristics

With regard to the location of the facility the respondents worked in, it

was observed that food handlers‟ knowledge on the environment hygiene

varied (p = 0.04). On the average, food handlers in the Tamale South (mean =

6.69) and Tamale North (mean = 6.21) zones exhibited high knowledge of the

environmental hygiene issues than their colleagues in the Tamale Central area

(mean = 5.89) (Table 11). It can be inferred that food handlers working in the

Tamale South are more knowledgeable on environmental hygiene in relation

to the safety of food. In terms of the categories of restaurants, the food

handlers in hotel restaurants in the three zones were noted to possess more

knowledge on environmental hygiene (mean =4.03) as compared to their

counterparts in the independent restaurants (mean =0.76). It was evident that

those in hotel restaurants in Tamale south were more knowledgeable (mean =

6.70).

As shown in Table 11, food handlers‟ knowledge on environmental

hygiene also varied by their work experiences (p = 0.00). It was observed that

respondents‟ knowledge increased by their work experience in the field; four

years and above (mean = 6.78), 3 years (mean = 6.29), 1year (mean = 6.18)

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and below a year (mean = 5.85). This means that food handlers who had

worked longer tend to have more knowledge on food safety than their

counterparts; which possibly might be as a result of experiences gained with

time. However, this finding is at variance with Hislop and Shaw‟s (2009)

observation that the longer a food handler is at the work place the lower the

knowledge level. This could be because they are not retrained as expected.

Lastly, significant differences were noted across the in-service training

status (p = 0.03) of the respondents in relation to their knowledge on food

hygiene in general but not across the category of facility they worked in.

Respondents who had received training were more knowledgeable (mean =

9.41) than those who had not received training (mean = 8.82). It can be

concluded that food handlers who have received training have more

knowledge due to the lessons they had received, as a significant increase in

knowledge was noted after training an intervention group in personal hygiene

and food handling and service (Thelwell-Reid, 2014).

In terms of the category of restaurants, the results indicated that the

food handlers in the hotel restaurants in the Tamale north and Tamale south

zones were more knowledgeable in almost all domains than their counterparts

in the independent restaurants. This agrees with Panchal et al. (2001) as they

identified high knowledge scores among large size restaurant employees in

Switzerland. Nevertheless, those in independent restaurants in the Tamale

central zone were knowledgeable in personal hygiene and environmental

hygiene domains.

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Table 11: Food Safety Knowledge by Work Related Characteristics

Personal hygiene Food hygiene Environmental hygiene
Pooled Hotel Independent Pooled Hotel Independent Pooled Hotel Independent
Facility characteristics Restaurants Restaurants Restaurant Rest. Restaurant Restaurant
Mean Mean Mean Mean Mean Mean Mean Mean Mean
Location
Tamale north 10.68 10.82 10.43 9.15 9.12 9.09 6.21 6.35 5.98
Tamale south 10.48 10.67 9.75 8.79 8.93 8.25 6.69 6.70 6.62
Tamale Central 10.07 9.83 10.25 9.21 9.66 8.87 5.89 5.50 6.18
F(p-value) 1.17(0.31) 1.36(0.25) 0.42(0.66) 0.47(0.62) 0.58(0.55) 0.59(0.55) 3.25(0.04) * 4.03(0.02)* 0.76(0.47)
Position
Chef 10.90 10.80 11.20 9.25 9.40 8.80 6.80 6.73 7.00
F&B 9.72 11.00 8.20 8.45 8.33 8.60 6.09 6.66 5.40
Supervisor/manager
Cook 10.31 10.40 10.15 8.93 9.06 8.68 6.06 6.08 6.03
Waiter/waitress 11.00 10.60 13.00 10.00 10.00 10.00 6.50 6.40 7.00
Kitchen help 10.92 11.13 10.62 9.23 9.32 9.11 6.39 6.59 6.11
F(p-value) 1.27 (0.27) 0.66 (0.65) 1.98(0.09) 0.66(0.65) 0.68(0.63) 0.47(0.79) 1.25(0.28) 1.14(0.34) 0.74(0.59)
Work experience
Below 1yr (1- 6months) 10.61 11.07 10.23 9.11 9.60 8.70 5.85 6.10 5.64
1 year 10.43 10.54 10.25 9.01 8.90 9.20 6.18 6.15 6.25
2 years 10.41 10.15 10.90 9.03 9.00 9.10 6.41 6.15 6.90
3 years 10.54 10.73 10.22 8.79 8.80 8.77 6.29 6.26 6.33

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Table 11: Continued

4+ years 10.78 10.83 10.25 9.23 9.16 10.00 6.78 6.80 6.50
F(p-value) 0.24(0.91) 0.70(0.59) 0.23(0.92) 0.21(0.93) 0.63(0.64) 0.46(0.76) 3.49(0.00) * 1.97(0.10) 1.96(0.11)
In-service training
Received 10.79 11.03 10.39 9.41 9.50 9.27 6.35 6.44 6.21
Not-received 10.40 10.48 10.27 8.82 8.87 8.72 6.19 6.29 6.00
t(p-value) 2.01(0.15) 2.63(0.10) 0.07(0.79) 4.56 (0.03*) 3.32 (0.07) 1.31(0.25) 0.82(0.36) 0.45(0.50) 0.42 (0.51)
Number in a year
Once 10.71 11.18 9.78 9.50 9.78 8.94 6.32 6.51 5.94
Twice 11.46 11.90 10.25 9.66 9.45 10.25 6.60 6.63 6.50
Thrice or more 11.20 9.66 11.85 9.00 7.66 9.57 6.40 6.00 6.57
Four times 10.33 9.66 11.00 9.16 9.00 9.33 6.16 5.66 6.66
F(p-value) 1.07 (0.36) 2.27(0.09) 3.94(0.01) 0.34(0.79) 1.48(0.23) 0.64(0.59) 0.27(0.84) 0.75(0.53) 0.66(0.58)
Area of in-service
training
Food hygiene and safety 10.88 11.13 10.56 9.56 9.60 9.52 6.39 6.40 6.39
Customer care and 10.44 10.57 10.00 8.66 9.00 7.50 5.66 5.57 6.00
waiting
Facility management 11.20 11.20 9.66 8.60 8.60 8.66 6.80 6.80 -
Food handling and 10.50 10.33 11.00 9.50 9.33 10.00 6.87 6.83 -
preservation
F(p-value) 0.41(0.80) 2.04(0.10) 0.63(0.60) 0.91(0.46) 1.63(0.18) 1.13(0.35) 1.39(0.24) 2.07(0.09) 1.51(0.23
Source: Field survey, Seidu (2017)
Asterisks (*) show areas of significant differences

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Although on the whole, there was no significant difference in the food

handlers‟ knowledge in relation to their status at work, there were slight

differences between them in terms of their specific positions. Surprisingly, the

results revealed that waiters/waitresses were more knowledgeable in personal

hygiene and food hygiene issues than the chefs and the other food handlers. It

is evidents from Table 11 that the chefs and waiters/waitresses in independent

restaurants were more knowledgeable in personal hygiene and environmental

hygiene issues than those in hotel restaurants. On the contrary, chefs and

waiters/waiteresses in hotel restaurants had high knowledge in food hygiene

measures than their counterparts in independent restaurants.

Respondents’ Sources of Information on Food Safety Issues

In identifying the sources by which food handlers obtained food safety

information, they were asked to state their main sources of food safety

information and the results are presented in Table 12. The results show that the

food handlers obtained information from five main sources including:

lecturers or teachers (42%), in-service training or workshops (26.2%), friends

and colleagues (15.4%), health personnel (14.5%) and the media including

television and radio (1.9%). Thus, the least patronized source of information

was the electronic media (Television, Radio). It was noted that 42 % (90) of

the respondents identified lecturers and teachers as the most popular source of

food safety information.

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Table 12: Respondents’ Main Sources of Information on Food Safety

Issues
Sources N Frequency Percentage (%)

Lecturers/Teachers 214 90 42.0

Training (In-service/On the job) 214 56 26.2

Friends/Colleagues 214 33 15.4

Health personnel 214 31 14.5

Media (Electronic) 214 4 1.9

Total 214 100

Source: Field survey, Seidu (2017)

This is an indication that most of the food handlers relied on the

knowledge and skills they acquired from school at the workplace. Also 26.2%

(56) of the food handlers indicated they obtained information on food safety

through in–service training and workshops. Deductively, it can be said that

lecturers, teachers and the training workshop facilitators are identified as the

most popular source of food safety information probably because they believe

that lecturers, teachers and facilitators are well informed and as such they are

likely to give accurate information.

It was noted that 15.4% of the food handlers acquired food safety

information from friends/colleagues. The respondents who obtained food

safety information from health personnel formed about 14.5%. These findings

are inconsistent with observations made by Apanga et al. (2014), who found

health officials (67%), television (38.5%) and radio (14.0%) as the main

sources of information among food vendors in rural northern Ghana.

Surprisingly, the food handlers did not indicate reading of books and other

print media as well as the use of internet and social media as their sources of

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information. The implication is that the respondents are probably not aware

that they could obtain food safety information from these sources. It could also

be that they are not familiar with searching for information from these sources

(books, internet, print and social media). Thus, it can be concluded that the

respondents‟ source of information is narrow.

Chapter Summary

This chapter highlighted the socio-demographic and work related

characteristics with regards to food safety knowledge of the respondents. The

socio-demographics and work characteristics provided the needed context for

analyzing or discussing the respondents‟ food safety knowledge levels in

relation to the type of facilities they worked in. The specific socio-

demographic and work related characteristics discussed included: gender, age,

marital status, religion, educational attainment, professional qualification,

position at work and work experience and in-service training. The

respondents‟ food safety knowledge was discussed based on three domains in

food safety (personal hygiene, environmental hygiene and food hygiene) in

relation to the categories of restaurants. The sources of the respondents‟ food

safety information were also discussed.

The results showed that the respondents were knowledgeable in all

domains of food safety and there was no significant difference in the food

safety knowledge levels of respondents and their socio-demographics

characteristics. Nevertheless, more males were found to be knowledgeable

than their female counterparts. Respondents also obtained food safety

information from varied sources including lecturers/teachers, friends and

colleagues, health personnel, training and electronic media. Surprisingly, the

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respondents did not rely on books, internet and social media for food safety

information. The next chapter describes the food safety practices of the

respondents and the barriers to food safety practices as well as the

relationships that exist between the variables.

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CHAPTER SIX

FOOD SAFETY PRACTICES AND RELATED BARRIERS

Introduction
According to Singh (2011) practice refers to the application of skills,

techniques, methods or standard operating procedures. It involves putting rules

and knowledge into action. The conceptual framework guiding the study is

based on the assumption that knowledge from all sources will translate into

appropriate action or practice. Nevertheless, the framework is mindful of the

fact that there are barriers that could thwart practice. This chapter examined

the food safety practices, the relationship between food safety knowledge and

practice, and factors that pose as barriers to food safety practices among food

handlers in restaurants in the Tamale Metropolis.

Respondents’ Food Safety Practices

The assumption is that individuals‟ knowledge on food safety across

all dimensions will translate into appropriate practices that will lead to safe

food. In this section, the respondents‟ food safety practices were assessed

using an observation checklist on personal hygiene, environmental hygiene

and food hygiene issues. The observation was limited to sixty respondents

drawn from the original sample of 214 given the time available to the

researcher.

In this section, eleven personal hygiene related items were used to

assess the respondents‟ practical application of personal hygiene measures

during food preparation and service and the results are presented in Table 13.

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Table 13: Personal Hygiene Practices of the Respondents

Personal Hygiene practices Correct Incorrect
practices practices n (%)
n (%)
Food handler wears a cap or hair restraint 29 (48.3) 31 (51.7)
during food preparation

Food handler wears clean apron/over 28 (46.7) 32 (53.3)

coat

Food handler wears clean and neat 55 (91.7) 5 (8.3)

clothes during food preparation and
service

Food handler wears hand gloves during 2 (3.3) 58 (96.7)

food preparation; especially during the
preparation of food eaten raw

Food handler did not wear jewelry (large 44 (73.3) 16 (26.7)

and dangling) during food preparation
and service

Food handler wears trimmed finger nails 56 (93.3) 4 (6.7)

Food handler washes hands with soap 60 (100.0) 0 (0.0)

and warm water before food preparation
and service

Food handler washes hands in between 26 (43.3) 34 (56.7)

handling raw and cooked foods

Food handler does not scratch parts of 56 (93.3) 4 (6.7)

the body (hair, skin, nose, ears) during
food preparation and service

Food handler does not cough/sneeze 60 (100.0) 0 (0.0)

directly on to food during food
preparation and service

Food handler does not lick fingers during 58 (96.7) 2 (3.3)

food preparation and service

Overall 43 (71.7) 17(28.3)

Source: Field survey, Seidu (2017).

On the whole 72 percent of the food handlers observed were found to

exhibit correct personal hygiene practices during food preparation and service.

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Specifically, it was realized that all the sixty food handlers (100%) washed

their hands with soap and warm water before starting food preparation and did

not cough or sneeze directly on food during food preparation and service

(100%). In contrast, 43% of the respondents were observed to wash their

hands when they shifted from handling raw food to cooked or ready to eat

foods. However, none of them was noticed using soap during the hand

washing.

Generally, it was observed that after the first wash with soap and

water, no respondent washed his or her hands with soap again during food

preparation and serving process. They just rinsed their hands in water or wiped

them with kitchen cloth or their aprons. This observation is consistent with

Green et al.‟s (2006) finding that, proper hand washing (using soap and warm

water) was usually carried out prior to food preparation and that the food

handlers often omitted the use of soap as they progressed during the

preparation of dishes. This means that the respondents probably did not know

the importance of hand washing with soap and the implications of their

actions.

Similarly, the respondents were not found to have coughed or sneezed

directly on food. The few (7%) individuals who had to cough or sneeze moved

away from the food and wiped their mouths and noses with tissue. They also

washed their hands with water but did not use soap. As stipulated in the Health

Belief Model (HBM) individuals will behave appropriately when they know

the health benefits of their actions. Thus, if the food handlers knew the

repercussions of their actions they would have probably acted right. In terms

of hand washing and glove-use it was noted that employees who wore gloves

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were less likely to wash their hands before and after performing tasks that

required hand washing. This observation may be linked to the fact that

employees do not understand the importance of hand washing and the use of

gloves.

A high number of the employees were observed to have well-trimmed,

unpolished finger nails (93.3%) as well as wearing clean clothes (uniform)

during food preparation and service (91.7%). This could be attributed to the

fact that the food handlers are aware that adverse practices could contaminate

the foods they were handling. Aside these, it was noted that 96.7% of the

respondents did not lick their fingers during food preparation and service nor

did they scratch parts of their bodies (93.3%).

In-spite of FAO‟s (1999) recommendation that food handlers should

not wear jewelry such as rings, bracelets and large/dangling earrings during

food preparation and service as this could be a source of contamination, it was

observed that 27% of the employees had their jewelry on whilst cooking. This

finding is similar to Cuprasitrut, Srisorrachatr and Malai‟s (2011) observation

from a study in Bangkok, Thailand that 50% of food handlers wore jewelry

during food preparation. This indicates that a reasonable number of the food

handlers in restaurants do not comply with the rules and regulations of the

industry and thereby constitute a potential source of spreading food-borne

illness.

Though the food handlers were provided with protective clothing to

prevent contaminating food with hair and other contaminants from the body, it

was observed that a good number of them did not pay much attention to the

use of protective clothing during food preparation and service. Specifically,

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less than half of the food handlers (48%) were identified to use hair restraints

and aprons/overcoats (46.7%). This finding is contrary to the observation

made by Cuprasitrut, Srisorrachatr and Malai (2011), that about 66% and 84%

of their respondents wore aprons and hair nets respectively. There is therefore

the need to create more awareness on the importance of using protective

clothing during food preparation and service to prevent the contamination of

food.

With respect to the need to wear hand gloves to reduce cross

contamination of food, only 3% of the food handlers were noted to use them.

This finding is at variance with the observation made by Arendt, Strohbehn

and Jun (2015), where 63% of the respondents were reported to put on gloves

during food preparation. The very low usage of hand gloves can also be said to

be inconsistent with the recommendation by FDA (2001) that gloves be used

in handling cooked foods as well as those eaten raw because they serve as

barriers between food handlers hands and the food.

In plate 1, the food handler put on gloves during the handling of

cooked food (cutting up of cooked pizza for service) while plate 2 shows a

food handler preparing cole slaw with covered hands. This indicates how some

food handlers tried to follow best practices.

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Plate 1: Use of gloves during the cutting of Pizza

Plate 2: Correct Practice (Using Gloves) Plate 3: Incorrect Practice (Using Bare hands)
Source: Field survey, Seidu (2017)

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Plate 3 shows an incorrect practice of food handlers during the preparation of

vegetable salad with bare hands. This implies that there is a high risk of

contaminating food by the food handlers in restaurants.

Food Hygiene Practices of the Respondents

The food hygiene practices of the food handlers were assessed using

eleven (11) food hygiene related items and the results are shown in Table 14.

It was noted that all the food handlers (100%) separated raw food from cooked

ones before and during storage. The practice may be linked to the high level of

awareness that mixing different food items during storage leads to cross-

contamination as linked to HACCP practices. This finding is contrary to the

observation made by Onyango, Kieti and Mapelu (2016) that 30% of their

respondents did not practice the storage of food items correctly as they were

probably not aware that food could be a vehicle for food contamination.

In view of the fact that the WHO recommended that foods should not

be cooked and kept at room temperature for more than two hours before

service, it was observed that the food handlers prepared and served food close

to or just at the time of request. Thus, they were mindful of HACCP principles

as well as their time for service.

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Table 14: Food Hygiene Practices of Respondents

Food Hygiene practices Correct Incorrect
Practice Practice
n (%) n (%)

Food handler reheated/microwaved 15 (25.0) 45 (75.0)

leftover foods before service

Separated raw foods such as meat, 60(100.0) 0 (00.0)

vegetables and salads from cooked foods
during storage

Cooked foods served hot and cold foods 60(100.0) 0 (00.0)

served cold

Food items are cleaned/washed before 58 (96.7) 2 (3.3)

use/storage

Food handler thawed frozen foods in cold 46 (76.7) 14 (23.3)

water baths or in refrigerator

Food handler used separate chopping 10 (16.7) 50 (83.3)

boards for raw meat and ready to eat foods

Food handler manipulated cooked and 3 (21.7) 47 (78.3)

ready to eat foods with covered
hands/tongs

Food handlers used calibrated food 0 (00.0) 60 (100.0)

thermometer to check food temperatures
(CCPs)

Equipment and serving dishes washed and 60 (100.0) 0 (00.0)

rinsed under running water

Plates and serving dishes were heated or 0 (00.0) 60 (100.0)

sanitized before they were used for service

Food handler washed and ironed kitchen 22 (36.7) 38 (63.3)

linen daily

Overall 31 (51.7) 29 (48.3)

Source: Field survey, Seidu (2017).

Additionally, it was observed that all the food handlers ensured that

cooked foods were hot during service. They ensured this by storing cooked

food in food warmers and chafing dishes with heat under them to keep them

hot throughout the service period.

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Nevertheless, it was observed that 25% of the food handlers prepared

foods like T.Z and Banku well ahead of the peak hours and they

reheated/microwaved them and served steaming hot. However, no food

handler was observed to have used food thermometers to measure critical

control points of foods (meat, eggs, beans) they were handling. This was

because it was noted that they were not available in any of the selected

facilities. In the same vein, it was realised that no food handler heated nor

sanitized equipment, plates and serving dishes by passing them through a

source of heat (dish warmer) before using them. On the contrary, all (100%)

the observed respondents washed and rinsed serving dishes and equipment

under running water as none of the facilities had a dish washing machine.

Evidence from the Table (14) indicates that 96.7% (58) of the food

handlers washed food items before using them. This finding is consistent with

the observation made by Apanga et al. (2014) and Omemu, and Aderoju

(2008) where majority of their participants (100% and 70%) respectively

washed their food items before use. On the other hand, this finding was found

to contradict the observation made by Muinde and Kuria (2005) that most of

the food handlers did not wash their food items before using them. Similarly,

the finding can be said to be at variance with the findings of Abdalla et al.

(2009) where only 34% of respondents washed food items before use.

In order to maintain safety standards, it is required that different

cutting boards of different colours be used for different foods (Spears and

Gregoire, 2007). It was observed that only 16.7% (10) of the respondents used

separate chopping boards for preparing separate food items. This means that,

most of the food handlers used one chopping board for all foods during food

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preparation. This did not buttress the fact that the majority (95%) of the food

handlers were knowledgeable on the use of separate chopping boards during

food preparation. It is also defeated the idea behind having well labeled

chopping boards for different food items and activities such as those used for

raw meat and fresh fish, for vegetables and ready -to-eat foods as identified in

all the selected facilities. This could probably be due to time constraint or lack

of supervision on the use of equipment.

In terms of the proper usage of chopping boards, it was observed that,

the majority (83.3%) of the respondents often just wiped the surface of the

board or turned it and continued to work; which has a high risk of

contaminating ready to eat foods. This practice is contrary to a suggestion by

Spears and Gregoire (2007) that cutting boards be washed properly between

each use because they are likely to harbour microorganisms. The finding is a

pointer to the fact that it is not sufficient to supply the necessary materials and

equipment to be used in the restaurants but to ensure their proper usage.

It was however observed that a large number of food handlers (78.3%)

manipulated cooked and ready to eat foods with their bare hands as shown in

Plates 4. This means that there is a high chance of contaminating the foods as

the hands are noted to have several loads of micro-organisms.

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Plate 4: Preparing vegetable salad with bare hands

Source: Field survey. Seidu, (2017)

It was also observed that 76.7% (46) of the food handlers thawed

frozen foods under running water or a bath of cold water while the rest of the

respondents (23.3%; 14) thawed frozen foods in bowls or basins outside the

storage facility. Thus, most of the respondents followed the recommendation

by McSwane et al. (2003) and WHO (2006) that frozen foods be thawed in a

refrigerator, under cool running water or in a microwave oven.

Although food handlers are required to wash their kitchen linen or

cloths on daily basis, it was noted that less than half (36.7%) of them washed

and ironed them as expected. Only 27% of the food handlers were noted to

have adequate kitchen linen. Individuals were noticed to use one kitchen

napkin throughout the day which gives a high chance of contamination. This

finding is at variance with Hill‟s (2011) suggestion that different kitchen

cloths including dish cloths and kitchen towels should be used for different

purposes and that re-usable cloths be washed thoroughly, disinfected and dried

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between tasks, not when they look dirty. On the whole, it was noted that, about

52% (31) of the respondents observed good food hygiene practices while the

remaining 48% (29) ignored the best practices.

Environmental Hygiene Practices

Under the environmental hygiene domain 19 facilities were observed

using eight (8) items and the results are presented in Table 15.

Table 15: Environmental Hygiene Practices in Restaurants

Environmental hygiene practices Correct Incorrect
practices n (%) practices n (%)

Food handlers operate in clean facility 19 (100.0) 0 (00.0)

environment (inside, outside and
equipment)

Facility has adequate and appropriate 17 (89.5) 3 (15.8)

drainage system

Kitchens provided with adequate 18 (94.7) 1 (5.3)

windows and self-closing doors to
eliminate flies and pests

Equipment, walls and ceilings kept 17 (89.5) 2 (10.5)

clean; free from stains and cobwebs

Waste bins have fitting lids 3 (15.8) 16 (84.2)

Waste bins are emptied daily 19 (100.0) 0 (00.0)

Availability of adequate toilet 14 (73.7) 5 (26.3)

facilities

Provision of adequate hand washing 0 (00.0) 19(100.0)

stations for kitchen staff.

Overall 13 (68.4) 6 (31.6)

Source: Field survey, Seidu, (2017)

Overall, 68.4% (13) of the selected facilities maintained standard

environmental hygiene practices. In relation to the specific areas, the results

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showed that all nineteen (19) facilities had clean environment (inside and

outside), they had large waste bins outside the kitchen and medium size ones

inside to hold solid waste generated. It was also observed that all waste bins

were emptied on daily basis. However, only 15.7% (3) of the waste bins in the

kitchens had fitting lids. The rest had the lids put aside because the workers

wanted easy assess into the bins. The practice of not covering waste bins is

contrary to ISO 22000, (2005 & 2015) recommendation that waste bins should

be fitted with lids at all times. Consistent with best practices, all the waste bins

in the kitchens were emptied on a daily basis. This may be linked to their

awareness that proper waste disposal prevents insects and pests invasion as

well as bad odour in the premises (WHO, 2006; McSwane et al. 2003).

In addition, it was noted that the majority of the facilities (94.7%) had

adequate windows for ventilation and well netted self-closing doors to

eliminate flies and pests. The provision of adequate windows and hoods and

extractor fans to remove fumes and odour by most of the facilities can be in

line with ISO standards (Foskett et al, 2007; ISO 2000, 2005).

It was also evident that seventeen (17) representing 89.5% of the

facilities had adequate and appropriate drainage systems, 74% had adequate

(4-8 seated) and well-kept toilet facilities for staff and customers. It was noted

that the toilet facilities were kept clean and in good state of repair. Unlike the

others, 26% of the facilities had only two seated toilet facilities for both staff

and customers and they were not very clean. On the whole, none of the

facilities had adequate hand washing stations in the kitchen for the food

handlers to readily wash their hands during food preparation and service. This

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might have accounted for the respondents‟ inability to easily and regularly

wash their hands during food preparation and service.

Respondents’ Food Safety Knowledge Versus Practices

According to Glanz, Lewis and Rimer (2002) practice is influenced by

knowledge. In terms of the KAP model adapted for this study, it is assumed

that the individual‟s food safety practices can change when knowledge

increases. Thus, knowledge gives individuals confidence to act or carry out

activities rightly. This section sought to identify the gaps between the

respondents‟ food safety knowledge and their food safety practices along the

personal hygiene and food hygiene domains.

As indicated earlier, sixty respondents were used for this exercise. The

actual correct practice scores of the sixty respondents were computed and the

number of respondents who were knowledgeable in a food safety practice

were deducted from the number who actually practiced to ascertain the gaps or

differences. In this vein, all the negative score differences indicate that the

respondents‟ knowledge exceeded their practices whereas positive differences

means the practice outweighed respondents‟ knowledge in the various

domains.

Generally, a significant difference was observed between food safety

knowledge (mean =48) and food safety practices (mean =40.5) of the food

handlers (gap = -7.5; p= 0.00). Since their food safety knolwdege level was

higher than their practices, it implied that they were not able to translate their

knowledge into practice. This outcome failed to reject the alternate hypothesis

that significant difference will exist between the food safety knowledge and

food safety practices of the food handlers. Several pevious studies (including

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Moreaux, 2014; Ababio & Lovatt, 2015; Moreaux et al., 2018) have

confirmed this food safety knowledge and practice gap.

With regards to the personal hygiene domain, the differences between

the respondents‟ personal hygiene knowledge and practices were obtained by

comparing the number of respondents who were knowledgeable in personal

hygiene issues with their actual personal hygiene practices and the results are

presented in Table 16.

On the whole, it was detected that there was a slight difference in

respondents‟ personal hygiene knowledge (79.6%) and their actual practices

(71.8%) of personal hygiene. Thus, the respondents‟ personal hygiene

knowledge exceeded their practice (K/P gap of -7.8%). This suggests that, not

all individuals put their personal hygiene knowledge into practice.

It is obvious from Table 16 that seven (7) of the items exhibited

negative K/P gaps while the remaining four showed positive differences.

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Table 16: Respondents’ Personal Hygiene Knowledge versus Practice

Knowledge statements n=60 (%) Actual Practice n=60 (%) Gap (P-K)
n (%)

Food handlers are at 6 (10.0) Food handler 29 (48.3) 23 (38.3)

liberty to put on hair wore a cap or
restraints/caps during hair restraint
food preparation and during food
service preparation

Using aprons or 46(76.7) Food handler 28 (46.7) -18 (-30.0)

overcoats during food wore clean
preparation is a luxury apron/over coat

It is optional to wear 40 (66.7) Food handler 2 (3.3) -38 (-63.4)

hand gloves when wore hand
preparing foods that gloves during
are eaten raw/fresh food preparation;
especially during
the preparation
of food eaten
raw

A food handler can 48 (80.0) Food handler 55 (91.7) 7 (11.7)

continue to wear soiled wore clean and
clothing to work until neat clothes
he/she is off duty during food
preparation and
service

It is compulsory for 58 (96.7) Food handler did 44 (73.3) -14 (-23.4)

food handlers to have not wear jewelry
jewellery on during during food
food preparation preparation and
service

Hand washing with 55 (91.7) Food handler 60 (100.0) 5 (8.3)

soap and warm water washed hands
before commencing with soap and
and during cooking warm water
and service reduces before food
the risk of food preparation and
contamination service

Food handlers are at 58 (96.7) Food handler did 56 (93.3) -2 (-3.4)

liberty to scratch skin, not scratch parts
touch hair, nostrils of the body (hair,
and ears during food skin, nose, ears)
preparation and during food
service preparation and
service

Food handlers are 42 (70.0) Food handler 26 (43.3) -16 (-26.7)

obliged to wash hands washed hands in
when shifting from between
raw food to cooked or handling raw and
ready to eat foods cooked food

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Table 17 Continued

Coughing or 55 (91.7) Food handler 60 (100.0) 5 (8.3)

sneezing directly on did not
food during cough/sneeze
preparation and directly on to
service has no effect food during
on the food food
preparation and
service

Food handlers are at 59 (98.3) Food handler 58 (96.7) -1 (-1.6)

liberty to taste food did not lick
using fingers fingers during
food
preparation and
service

Food handlers are 58 (96.7) Food handler 56 (93.3) -2 (-3.4)

obliged to wear wore trimmed
trimmed finger nails finger nails

Overall 48 (79.6) 45 (71.8) -3 (-7.8)

Note: P=Practice, K=Knowledge, P-K= Practice – Knowledge scores, Difference= Gap

Source: Field survey, Seidu, (2017)

The measures with negative K/P gaps indicate that the number of respondents

who were knowledgeable in personal hygiene issues outweighed the number

that put personal hygiene measures into practice. The few positive differences

indicate that the number of respondents who practiced correctly exceeded

those who are knowledgeable in the specific areas of personal hygiene.

The areas where respondents‟ practices exceeded the number with high

knowledge included: putting on hair restraints (10% as against 48.3%

practice), awareness of the inappropriateness of wearing soiled clothes during

food preparation and service (80.0% as against 91.7% practice), washing

hands with soap before and during cooking (91.7% against 100% actual

practice) and inappropriate to cough and sneeze directly on food during food

preparation (91.7% against 100% practice).

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Evidence shows that more food handlers put on caps, scarfs or hair

restraints as against the number that got the statement correct; hence they had

the highest positive K/P gap (38.3%); followed by the wearing of neat clothes

(11.7%), the washing of hands with soap and water before and during food

preparation (8.3%) and awareness of the dangers associated with coughing and

sneezing directly on food (8.3%). This means that the food handlers‟ practice

of personal hygiene measures outweighed their knowledge. This could be

attributed to the work place culture which compels individuals to carry out

practices without really understanding the implications. It could also be that

the practice has become a routine one and so it has become a normal practice

for them.

Even though not all of the food handlers (91.7%) had good knowledge

on the dangers of coughing and sneezing directly over food but in practice,

none of them coughed nor sneezed directly on food. This means that even

those who got the statement wrong acted appropriately; probably by observing

others or by instinct. Additionally, 80% of the food handlers had knowledge

on the need to wear clean clothing during food preparation as against 91.7%

who actually put on clean clothing during food preparation and service.

As regards the use of hair restraints, only 10.0% (6) of the food

handlers had the statement correct while 48.3% (29) of them put on hair

restraints during food preparation and service. This suggests that the

respondents did not actually know the importance of putting on hair restraints

during food preparation and service. Thus, they felt it was optional for them.

Nevertheless, 48% of them put on hair restraints (correct practice) probably

due to the culture of the work place; thus they were just obeying rules at the

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work place. The practice could also be as a result of the cultural and religious

influence on individuals in the study area; where females are always expected

to have their hair covered. Thus, the use of hair restraints has become a normal

practice. The implication is that most of the respondents practiced the

activities including hand washing as a routine.

The areas where differences or negative gaps were recorded included

the use of aprons or overcoats (76.7%, against 46.7% practice) with a negative

gap (-30.0%), the wearing of gloves (66.7 against 3.3% practice), the use of

jewelry during food preparation was not compulsory (96.7% as against 73.3%

practice). Other areas where negative differences were detected were the

scratching and touching of body parts (96.7% against 93.3% practice), the

need to wash hands when shifting from raw food to cooked food (70% as

against 43.3% practice), the wearing of trimmed finger nails (96.7% against

93.3% practice) and the licking of fingers (98.3% as against 96.7% practice).

This means that the food handlers‟ knowledge exceeded their practices; which

means that although food handlers possessed high knowledge of food safety,

they did not always put the knowledge into practice (Ramirez et al. 2010).

Food Hygiene Knowledge Versus Practice

The food hygiene knowledge of the respondents was compared with

their practices and the results are presented in Table 17. On the whole, more

respondents (79.2%) were knowledgeable in food hygiene measures as

against 59.3% who put the measures into practice. It is evident from the

results that the respondents who were knowledgeable in food hygiene issues

outweighed those who practiced the measures; thus, indicating a negative gap

(-20.0%).

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Specific areas where most food handlers with high knowledge exceeded those

who put the knowledge into practice were: reheating of leftover foods

(85.0%) against 25% practice, the need to use thermometers for testing the

temperature of food (50.0%) against the actual use of thermometers, the need

to use separate chopping boards for food preparation (95.0%) as against

16.7% practice. Other areas included the importance of sanitizing serving

dishes (78.3%) against the actual practice of sanitizing dishes and the

importance of manipulating food with covered hands (90.0%) as against

78.3% in practice. The implication is that the food handlers may have the

knowledge but will not be able to put it into practice if the facility

management does not provide the logistics such as thermometers, gloves, dish

washers and sanitizers. For instance, it was realised that none of the

respondents used thermometers as well as sanitized any serving dishes and

tools before use.

Though majority of the respondents know the importance of using

separate chopping boards, only 16.7% actually used separate chopping

boards. This could probably be because the facilities did not have many

chopping boards as required or the food handlers felt it was a waste of time.

These observations support the opinion that knowledge does not always

translate into practice. This could be because some of the facilities did not

have many chopping boards as required.

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Table 17: Food Hygiene Knowledge versus Practice

Knowledge n=60 (%) Actual Practice n=60 (%) Gap (P-
statements K) n (%)

Reheating / 51 (85.0) Food handler 15 (25.0) -36

Microwaving reheated/ (60.0)
leftover cooked microwaved cold
food reduces the leftover foods
risk of food before service
contamination

Thermometers are 30 (50.0) Food handler 0 (0.0) -30 (-

necessary for used calibrated 50.0)
checking the food thermometer
temperatures of to check food
food temperatures

Raw food and 57 (95.0) Separated raw 60(100.0) 3 (5.0)

cooked/ready to eat foods such as
food cannot be put meat from
together during cooked/ready to
storage eat foods during
storage

Food items 47 (78.3) Food items are 58 (96.7) 11 (18.4)

purchased from washed before
reliable sources storage and use
need no cleaning
before storage

Cooked food 52 (86.7) Cooked foods are 60(100.0) 8 (13.3)

should be very hot served hot and
(at a temperature of cold foods are
65oC) before served cold
serving

It is compulsory to 57 (95.0) Food handler 10 (16.7) -47 (-

use separate used separate 78.3)
chopping boards chopping boards
during food for raw meat and
preparation ready to eat foods

It is inappropriate 25 (41.7) Food handler 46 (76.7) 21 (35.0)

to thaw frozen food thawed frozen
in a bowl or foods in a bowl
plate/tray outside outside the
the storage facility refrigerator or
freezer

Serving dishes and 55 (91.7) Equipment and 60(100.0) 5 (8.3)

equipment should serving dishes are
not be washed and washed and
rinsed in basins rinsed under
running water

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Table 17: Continued

It is not optional to 47 (78.3) Plates and 0 (00.0) -47 (-78.3)

heat/sanitize serving serving dishes
dishes and tools were heated or
before service sanitized before
they were used
for service

The manipulation of 54 (90.0) Food handler 47 (78.3) -7 (-11.7)

food with uncovered manipulated
hands increases the cooked and
risk of food ready to eat
contamination foods with
covered
hands/tongs

Overall 48 (79.2) Overall 36 (59.3) -12 (-19.9)

Note: P=Practice, K=Knowledge, P-K= Practice – Knowledge scores, Difference= Gap

Source: Field survey, Seidu (2017)

The food hygiene knowledge and practice gap identified include five

negative and five positive areas. The areas where practice exceeded

knowledge (indicating positive gaps) were the separation of raw food from

cooked food during storage with a gap of (5.0%), washing food items before

use/storage (18.4%), serving cooked food hot and cold food cold (13.3%),

appropriate thawing of frozen foods (35.0%) and washing and rinsing serving

dishes and equipment under running water (8.3%). The greatest gap was

associated with the procedure of thawing frozen foods. The positive

differences imply that practice exceeded knowledge. This suggests that, in

some cases practice is not dependent on knowledge but acting according to

the dictates of the work place.

The negative gaps identified in relation to food hygiene knowledge

and practice were clearly exhibited in the use of thermometers (-50.0); as

nobody used thermometers during food preparation even though about 30

respondents have knowledge on it. Other areas that showed negative gaps

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include the respondents‟ awareness of the importance of reheating or

microwaving leftover foods (-60.0%), using separate chopping boards (-

78.3%), heating and sanitizing serving dishes (-78.3%), and manipulating

foods with covered hands (-11.7%).

These observations support a number of studies that have shown that

knowledge does not always result in a positive change or translate into

practice of handling food safely (Arendt et al. 2015; Robertson et al. 2013;

Strohbehn et al. 2011; Ko, 2011; Sanlier & Konaklioglu, 2010). For instance,

though half (50%) of the food handlers have high knowledge on the need to

use food thermometers to check the temperatures of foods, none of them

practically made use of thermometers. This could probably be because the

food handlers were not familiar with them and besides the tools were not

available for use in any of the facilities.

Barriers to Respondents’ Food Safety Practices

In consistent with the conceptual framework that was adapted to guide

the study, it became necessary to assess the barriers that hinder food safety

practices among food handlers in restaurants in the Tamale Metropolis. In

several situations some form of obstacles often obstructed individuals

including food handlers from putting whatever knowledge they had into

practice. In this section fifteen (15) items were employed to gauge the barriers

to food safety practices. This was examined in relation to the three domains of

food safety (personal hygiene, environmental hygiene and food hygiene).

However, due to multiple responses in this section, a multiple response set

analysis was employed and Table 18 presents the results as well as the ranking

order of the identified barriers to food safety.

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The results identified six (6) elements including time constraints/busy

work schedules, inadequate training and knowledge, poor enforcement of rules

and regulations, inadequate resources and supplies, and forgetfulness or no

reminders as barriers to food safety practices.

Table 18: Barriers to Respondents’ Food Safety Practices

N=214
Percentage Ranking
Construct Frequency (%)

Time constraints 60 28.0 1st

Inadequate training or knowledge 54 25.2 2nd

Inadequate resources or supplies 31 14.5 3rd

Lack of enforcement of rules and 4th

regulations 23 10.7

Lack of reminders/forgetfulness 16 7.5 5th

Criticism from colleagues 1 0.5 6th

Source: Field survey, Seidu (2017)

The findings confirm that of Arendt, Strohbehn and Jun, (2015),

Howells et al. (2008) and Pragle, Harding and Mack, (2007) who observed

similar barriers in a study on motivators and barriers to food safety practices in

USA. In specific terms about 28% (60) out of the 214 respondents identified

time constraints and busy work schedule as the predominant barrier to their

food safety practices. For they just wipe hands insteaded of washing or picked

cooked food (turnovers, meat) with bear hands onto serving trays. This

supports Hertzman and Barrash‟s, (2007) findings that in the US, food

handlers violated food safety practices whenever they had busy schedules

carrying out their paramount responsibility of food preparation and service.

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Thus, in trying to meet their target, they intentionally or unintentionally use

inappropriate safety practices.

Similarly, the speed at which food service is carried out, especially

during meal service can affect the food handlers‟ ability to practice safe food

handling. For instance, Rajagopal and Strohbehn (2013) reported that higher

non-compliance rates in relation to hand washing and the use of gloves was

found to occur during peak hours. Similarly, Arendt et al. (2015) indicated,

their respondents reported that, it was the need to save time that made them to

deliberately ignore safe food handling practices. Thus, when food handlers or

operators are busy they tend to forget or put aside standard practices.

The next popular and second ranking barrier was inadequate training

and knowledge (4.3%; 51). This finding reinforced an observation by Arendt

et al. (2015) that their respondents did not know the reason for putting on

aprons and the need to wash their hands inspite of the fact that they put on

gloves.

The emergence of inadequate training and knowledge as a second

popular barrier could be linked to the fact that over a quarter (39%) of the

respondents were found to be non-professionals and also more than half of

them did not receive in-service training on food hygiene issues which impeded

their compliance to food safety guide lines (York et al. 2009). Relating this to

the conceptual framework guiding this study, the implication is that, when

people are educated or receive training on how to ensure food safety practices

in the restaurants, it is likely that they would adhere to such directives.

Furthermore, inadequate resources and supplies was also identified as

the third ranking factor that prevented the respondents from adhering to food

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safety practices. It was noticed that 2.5% (31) of the food handlers were

unable to put their food safety knowledge into practice due to inadequate

resources and supplies such as hand washing sinks, calibrated food

thermometers and gloves. This is in consonance with Arendt et al.‟s (2015)

finding that the unavailability of hand washing sinks, supplies such as

sanitizing wipes for use on thermometers prevented them from making use of

them during food production. To promote food safety practices it is important

to provide the needed resources and supplies in the reach of employees (Green

et al. 2007).

Though food handlers are required to wash their hands at intervals

during food preparation as well as keep the doors to the food preparation area

shut always, most of them ignored the rules. Consequently, it was noticed that

about 2.0% (23) of the respondents acknowledged lack of enforcement of rules

and regulations as the fourth barrier to food safety; especially in keeping

vermin out of food preparation and service area as well as proper hand

washing practices during food preparation and service. This is in agreement

with a report by Arendt, Strohbehn and Jun (2015) that their respondents did

not follow safe food handling regulations and that nobody cared or checked

that the right thing was done. This suggests that there is the need for managers,

supervisors and regulatory agencies to have constant checks to ensure that the

food handlers follow food safety measures.

In terms of forgetfulness and lack of reminders as barriers to food

safety practices, it was noted that 1.3% (16) of the food handlers associated

the barriers to the practice of wearing jewelry during food preparation and

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service, inappropriate waste management, the laundering of kitchen linen and

improper maintenance of finger nails.

Criticism from colleagues was the least patronized barrier among the

respondents. Only one (1) food handler identified this as a barrier to food

safety practices. This means that the respondents did not really care about

whatever comments their colleagues made about their food safety practices;

they continued to work the way they intended to work (Appendix D).

Barriers to Practices by Food Safety Domains

Segregating the food handlers‟ responses by the three food safety

domains, it was generally realized that the food handlers identified time

constraint or busy work schedule as the most prominent barrier to their

personal hygiene (40.2%) and environmental hygiene (38%) practices.

Inadequate knowledge was identified as the main barrier to food hygiene

practices (30%); followed by time constraint (28.7%) and inadequate

resources (28.5%). It was realized that criticisms from colleagues and lack of

motivation were not popular barriers among food handlers in all the domains

of food safety (Table 19).

With reference to the personal hygiene it was noted that time constraint

was the most prominent barrier. Specifically over half (58%) of the food

handlers indicated that time constraint prevented them from changing their

work clothing as well as engaging in regular hand washing during food

preparation and service (53%). This could probably be due to the fact that the

facilities did not have enough hand washing sinks close by for food handlers

to easily turn and wash their hands at regular intervals.

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Time constraint or busy work schedule also inhibited food handlers to

regularly maintain short finger nails (33%). Apart from lack of time, forty-two

percent of the respondents linked their non-use of hair restraints during food

preparation and service to inadequate knowledge. In terms of the use of

jewelries during food preparation, 31% of the respondents indicated they

usually forgot to remove them before the commencement of food preparation

and there were no reminders, which could prompt them to remove the

jewelries. No food handler identified criticism as barriers to personal hygiene

practices.

As depicted in Table 19, seventy percent of the food handlers were of

the view that poor enforcement of rules and regulations militated against

keeping vermin out of the food preparation and service area. Thus, even

though the rule is to always keep the doors shut, some food handlers moved in

and out without ensuring that the trap doors are shut. Another 69 percent of

the respondents were of the view that inadequate knowledge affected their

waste management practices; thus, they left their waste bins opened for easy

dropping of waste. Probably they were ignorant of the fact that such practice

could bring about contamination of food. Similarly, 38% of the respondents

flagged time constraint as the main barrier to environmental hygiene practices.

Specifically, time constraint was identified as barrier to the cleaning of work

surfaces (68%) and cleaning of equipment (64%). Thus, due to busy work

schedule the food handlers could not pay attention to cleaning work surfaces

and equipment as expected.

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Table 19: Barriers to Practice by Food Safety Domains

Constructs Time constraint/ Busy Inadequate Poor enforcement of Inadequate Criticism from No reminders/
work schedule (%) Knowledge (%) rules/regulations (%) resources/supplies colleagues (%) Forgotten (%)
(%)
Personal hygiene
Hand washing 53.0 11.0 25.0 6.0 0.0 4.0
Use of hair restraints 29.0 42.0 8.0 4.0 0.0 17.0
Changing work clothing 58.0 21.0 11.0 11.0 0.0 0.0
Maintaining short finger 33.0 33.0 10.0 0.0 0.0 24.0
nails
Removal of Jewelry 28.0 28.0 9.0 3.0 0.0 31.0
Overall 40.2 27.0 12.6 4.8 0.0 15.2
Environmental Hygiene
Waste management 10.0 69.0 3.0 10.0 0.0 3.0
Cleaning of work surfaces 68.0 16.0 5.0 5.0 0.0 5.0
Cleaning/sanitizing equipt. 64.0 18.0 5.0 5.0 0.0 9.0
Keeping vermin out 10.0 13.0 70.0 3.0 0.0 3.0
Overall 38.0 29.0 20.8 5.8 0.0 5.0
Food hygiene
Wearing gloves 11.0 16.0 5.0 62.0 0.0 5.0
Laundering Kitchen linen 62.0 8.0 12.0 4.0 0.0 19.0
Use of food thermometer 3.0 9.0 3.0 84.0 0.0 0.0
Storage of items 7.0 69.0 3.0 14.0 0.0 3.0
Storage temperatures 46.0 32.0 11.0 7.0 0.0 4.0
Preparation techniques 43.0 46.0 7.0 0.0 0.0 4.0
Overall 28.7 30.0 6.8 28.5 0.0 5.8
Source: Field survey, Seidu (2017)

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As regards food hygiene domain, inadequate resources and supplies

was identified as the dominant barrier to food hygiene practices. In specific

terms, inadequate resources and supplies was flagged as the major barrier to

the use of thermometers (84%) and gloves (62%) during food preparation. In

addition, sixty-nine percent of the respondents linked inadequate knowledge as

a barrier to their appropriate storage of food items (69%) and food preparation

techniques (46%). This indicates that inadequate knowledge on the storage of

the different food items is a constraint that could bring about food spoilage.

Inadequate knowledge also affected the respondents‟ food preparation

techniques (46%).

Barriers to Food Safety Practices by Facility Type

To assess the barriers to the respondents‟ food safety practices by the

type of facility, fifteen food safety items were examined using the chi-square

test and the results are presented in Table 20. The results, generally indicated

that food handlers from both hotel-based-restaurants and independent

restaurants showed no significant differences in the factors that posed as

barriers to their food safety practices. Thus, the food handlers in both

categories of restaurants experienced similar challenges in their attempt to

follow food safety practices.

However, five of the items including: hand washing during food

preparation (p=0.001), wearing of gloves (p=0.001), use of thermometer

(p=0.04), laundering of kitchen linen (p=0.001) as well as food preparation

and service techniques (p=0.04) showed significant differences at a significant

levels of p<0.005. The rest of the items showed no significant differences.

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The barriers to the food handlers‟ hand washing practices showed a

significant difference of p=0.001. Whereas 63% of the food handlers in hotel

restaurants identified time constraint as a major barrier to hand washing

practices, only 16% of their counterparts in independent restaurants considered

it as a barrier. On the contrary, seventy-six percent of the respondents

identified poor enforcement of rules and regulations as the main constraint to

regular hand washing; hence the significant difference.

In terms of the use of gloves and food thermometers, a greater

percentage of respondents identified inadequate resources and supplies as a

barrier to their use. For instance, more than half (66.3%) of respondents

identified inadequate resources and supplies as a barrier to the use of gloves

while 88.5% of the food handlers associated the factor with the use of food

thermometers. However, significant differences existed between the

respondents from independent restaurants and their counterparts in hotel

restaurants. A greater percentage of the respondents from the independent

restaurants identified inadequate resources and supplies as a barrier to the use

of gloves (78%) and food thermometers (91%) as against 55% for the use of

gloves and 86% for thermometers by the respondents from hotel restaurants.

This showed a significant difference between those in hotel restaurants and

independent restaurants (p = 0.002) as those from independent restaurants

scored about 78% as against 55% from hotel restaurants. Similarly, the use of

thermometers showed a significant difference (p = 0.04) with independent

restaurants having 91% against 86% of food handlers in hotel restaurants.

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Respondents from both types of facilities identified time constraint as a

major barrier militating against food safety practices. The food handlers were

specifically of the view that time constraint was a barrier to regular hand

washing (63%; 16.0%) with a significant difference of p = 0.00, maintaining

short finger nails, removal of waste and cleaning of equipment before use. The

results revealed that independent restaurants had more respondents reacting in

this regard. It is worth noting that it was only with the changing of work

clothes that hotel restaurants scored higher (59.6%) than their counterparts in

independent restaurants (54.1%). With the remaining items, the food handlers

from the independent restaurants scored higher than the hotel restaurants.

Inadequate knowledge and training was recognized by food handlers in

both categories of restaurants as a dominant factor that hindered food safety

practices. They specifically indicated that inadequate knowledge and training

was a barrier to the use of hair restraints, storage of food items, appropriate

storage temperatures and inappropriate food preparation techniques. For

instance, about 41% of the respondents from hotel restaurants and 37.3% from

the independent restaurants saw knowledge and training as a barrier to the use

of hair retraints. Whereas about 67% of respondents in hotel restaurants

identified inadequate knowledge and training as a barrier to the storage of food

items, 74.6% considered knowledge and training as such. However, a greater

percentage of the respondents were from the independent restaurants while

respondents from hotel restaurants said inadequate knowledge prevented them

from wearing hand gloves and maintaining short nails. This buttresses Grujic

et al‟s., (2013) finding as in Joseph, (2018) that lack of knowledge in one of

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the stages of the chain can jeopardize all the efforts made to improve the

safety of food products.

Finally, a significant difference was found between food handlers from

hotel restaurants and independent restaurants in relation to the care of kitchen

linen with a p-value at 0.001. The result showed that about 52% of the

respondents from hotel restaurants and about 82% from independent

restaurants identified time constraint as the main barrier to laundrying their

kitchen linen. This suggests that the respondents in the hotel restaurants were

more committed to washing and ironing their kitchen linen than their

counterparts in independent restaurants. This could probably be because they

were aware of the effects of using soiled kitchen linen and also, each food

handler was responsible for taking care of his or her used kitchen linen. Inspite

of the (5) significant differences that were noted, the respondents in both

categories of restaurants faced similar challenges in their attempt to put food

safety measures into practice.

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Table 20: Barriers to Practices by Facility Type

Activities n Time Inadequate Poor Inadequate Lack of No χ2(p-value)

Constraint Knowledge enforcement resources or motivation reminder
(%) (%) (%) supplies (%) (%) (%)
Hand washing 53.20 11.10 24.60 6.30 0.80 4.00 44.97(0.00*)
Hotel restaurant 105 63.00 12.00 12.00 8.00 1.00 5.00
Independent restaurant 23 16.00 8.00 76.00 0.00 0.00 0.00
Using hair restraints 27.70 39.90 8.70 5.80 0.60 16.2
Hotel restaurant 122 26.23 40.98 7.38 5.74 0.82 17.21 2.79(0.83)
Independent restaurant 51 31.27 37.25 11.76 5.88 0.00 13.71
Changing work clothes
Hotel restaurant 96 59.57 21.28 8.51 10.64 0.00 2.13 1.68(0.89)
Independent restaurant 37 54.05 24.32 8.11 13.51 0.00 0.00
Maintaining short nails
Hotel restaurant 83 30.12 36.14 12.05 1.20 0.00 20.48 8.35(0.30)
Independent restaurant 43 43.90 26.83 7.32 0.00 0.00 26.83
Wearing of hand glove
Hotel restaurant 138 12.41 21.17 7.30 54.74 0.00 5.11 21.74(0.002*)
Independent restaurant 81 11.69 7.79 0.00 77.92 0.00 7.79
Removal of jewelry
Hotel restaurant 130 28.57 28.57 10.32 3.17 1.59 30.59 7.80 (0.45)
Independent restaurant 61 30.51 25.42 8.47 0.00 0.00 38.89
Use of thermometers
Hotel restaurant 140 1.46 10.22 2.92 86.13 0.00 1.46 14.40(0.04*)
Independent restaurant 83 5.19 10.39 0.00 90.91 0.00 1.30
Cleaning of equipment before use
Hotel restaurant 106 56.00 20.75 6.60 3.77 0.00 12.26 6.33(0.71)
Independent restaurant 48 75.00 16.67 2.08 0.00 0.000 6.25

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Table 20 : Continued
Storage of food items
Hotel restaurant 163 9.02 66.92 0.00 12.78 0.00 4.51 5.25(0.38)
Independent restaurant 67 7.46 74.63 5.26 11.94 0.00 5.96
Appropriate storage temperatures
Hotel restaurant 133 10.69 67.18 6.11 12.21 0.00 4.58 6.85(0.44)
Independent restaurant 67 7.46 74.63 0.00 11.94 0.00 5.96
Food preparation and service
techniques
Hotel restaurant 128 36.72 51.56 7.03 1.56 0.78 2.34 14.33(0.04*)
Independent restaurant 69 59.70 32.84 4.48 1.49 0.00 4.48
Appropriate storage facilities
Hotel restaurant 132 43.65 34.92 12.70 5.56 0.79 4.76 10.43(0.23)
Independent restaurant 63 57.38 29.51 4.92 6.56 0.00 4.92
Keeping out vermin
Hotel restaurant 138 11.03 18.38 62.50 4.41 0.00 5.15 13.47(0.06)
Independent restaurant 74 9.59 6.85 80.82 4.11 0.00 0.00
Cleaning of work area and surfaces
Hotel restaurant 95 65.26 12.63 10.53 3.16 0.00 8.42 0.14(6.85)
Independent restaurant 41 78.05 14.63 0.00 4.88 0.00 2.44
Laundering of kitchen linen
Hotel restaurant 128 51.56 9.38 14.84 7.03 0.00 17.19 22.06(0.001*)
Independent restaurant 57 81.48 1.85 1.85 1.85 0.00 18.52
Waste management
Hotel restaurant 73 45.21 4.11 10.96 2.74 0.00 36.99 7.77(0.10)
Independent restaurant 35 68.57 0.00 2.86 5.71 0.00 22.86
Source: Field survey, Seidu (2017) Asterisks (*) show areas of significant differences

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Chapter Summary

This chapter presented the analysis of the food safety practices of food

handlers and the related barriers to food safety practices in the selected

restaurants in Tamale Metropolis. The report discussed the actual practices

where activities were physically observed to verify the food handlers‟ food

safety knowledge.

Consequently, the observed practices were compared with the

respondents‟ knowledge scores to ascertain the relationship between food

safety knowledge and practice. Specific mention has been made of the factors

that militated against food safety practices among food handlers. It was noted

that even though the surveyed food handlers had good food safety knowledge

they did not put the knowledge into practice. However, there are a few

instances where their practices exceeded what they knew; which could be due

to the influence of significant others as well as past experiences and the

culture at the work place which caused them to act as expected. The

knowledge gap was also analyzed and the results showed gaps between

knowledge and practice; indicating that knowledge does not always translate

into practice.

This situation could be associated with the barriers the respondents

identified to be impeding their ability to practice food safety fully. The next

chapter gives a summary of the major findings of the study, draws conclusions

and makes constructive recommendations and suggesting areas for further

research.

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CHAPTER SEVEN

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Introduction
This chapter presents the summary of the main findings of the study,

the conclusions drawn, and the recommendations in relation to respondents‟

food safety knowledge, practices and constraints in restaurants within the

Tamale metropolis.

Summary

The study, which was based on a descriptive design with a mixed

method of data collection and analysis, sought to assess the food safety

knowledge and practices among food handlers in restaurants in the Tamale

Metropolis. The study specifically aimed at assessing the food safety

knowledge of food handlers in restaurants, identifying food handlers‟ sources

of food safety information, examining the food safety practices of food

handlers, analyzing the relationship (gaps) between food safety knowledge and

practices of food handlers and assess (finding out) the barriers to food safety

practices; assessing the food safety knowledge of food handlers.

The study was guided by a conceptual framework adapted from the

food safety knowledge, attitude and HACCP practice model (KAP) by Ko

(2013); with knowledge, practice and barriers as the main variables. The food

safety knowledge and practices were examined in relation to personal hygiene,

food hygiene and environmental hygiene issues.

It involved 214 respondents selected through a multi-stage sampling

procedure. They included food handlers in one star and two star hotels with

restaurants and grades two and three independent restaurants within the

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Tamale metropolis. Data were gathered through questionnaire and observation

checklist. The questionnaire was administered with the help of three trained

field assistants while the researcher carried out the observation using an

observation checklist. Simple random sampling was used to select twelve

hotel restaurants and eleven independent restaurants for the study while

accidental and purposive sampling were used to select the participants.

Statistical analyses were conducted using STATA version 15 and both

descriptive and inferential statistical techniques such as frequency, percentage,

means, independent sample t-test, chi square and ANOVA were employed in

analyzing the data.

Summary of Main Findings

The main findings of this study are summarized based on the

objectives of the study and the conceptual framework that guided the study.

Food Safety Knowledge of Respondents

Overall, approximately 77% of the food handlers showed significant

knowledge on food safety issues but in specific terms, it was noted that most

of the respondents (78%) were more knowledgeable in environmental hygiene

issues. Most (92%) of the food handlers were aware of the importance of

washing hands with soap and warm water before commencing and during food

preparation and service. They were however, not very informed about the need

to use hair restraints.

Inspite of the fact that food hygiene knowledge score fell below the

other areas of food safety, most of the respondents were aware of the need to

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wash equipment under running water (95%) as well as the need to use separate

chopping boards (89.9%).

In terms of respondents‟ knowledge levels, it was evident that 81 % of

the respondents had high knowledge while 19% exhibited moderate levels.

The analysis showed no significant differences between the

respondents‟ level of food safety knowledge and some of their socio-

demographic characteristics. For instance, there was no significant difference

in terms of the respondents‟ food hygiene knowledge and their religious

affiliation. There was also no significance difference in the environmental

hygiene knowledge and educational attainment of the respondents. On the

contrary, there existed a significant difference between the personal hygiene

knowledge and the sex of the respondents. It was realized that more male

respondents (11.23) had high knowledge levels as compared to their female

counterparts (10.35). This implies that the male respondents are passionate

about the job and are putting in their best while their female counterparts

probably hold the view that food preparation and service is a job for women so

they know all. Also, a significant difference was noted between food safety

knowledge and food safety practices of food handlers. This implies that the

respondents‟ knowledge exceeded their practices.

The respondents within the age range of 18-37years demonstrated

high levels of food safety knowledge. However, it was observed that the

higher the age of the respondents, the less knowledgeable they were and vice

versa.

No significant difference was realized between the levels of food

safety knowledge and the food handlers‟ educational attainment. The

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implication is that the educational programmes pursued by the food handlers

were probably not related to the hospitality industry but they found themselves

working there. As a result, the SHS holders were noted to have the highest

level of knowledge as compared to the tertiary holders. Thus, in this study,

knowledge did not increase with educational attainment.

As regards the level of the respondents‟ food safety knowledge and the

type of facility, it was found that no significant differences existed in the

overall food safety knowledge and the type of facility. However, majority of

respondents (82%) in hotel restaurants were more informed on food safety

issues than their counterparts in independent restaurants (79%). This suggests

that food handlers from the hotel restaurants are likely to follow food safety

measures than their counterparts who are less knowledgeable.

The appreciable number (84) of non-professional food handlers in the

study area coupled with the percentage (58%) that had not received in-service

training suggests that, there is a high chance of contaminating foods as they

may not be in a position to apply the food safety standards as required.

Respondents’ Sources of Food Safety Information

The respondents obtained food safety information from five prominent

sources with lecturers/ teachers (42%) and in-service training (26.2%) being

the most common sources. The least patronized sources were the media (6%)

and the reading of books. None of the surveyed food handlers mentioned

books or print media as sources of food safety information which suggests that

they were not familiar with seeking for information through those means; or

they were probably not enthusiastic about reading. This probably means that

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the food handlers could be limited in current information since they are no

longer in school to receive from lecturers or teachers.

Respondents’ Food Safety Practices

On the whole, 63% of the respondents carried out acceptable practices

of food safety measures. It was specifically noted that 75% of the food

handlers exhibited correct practices of personal hygiene issues as against 53%

on food hygiene issues.

Nevertheless, it was realized from the observation that over half (57%)

of the respondents never washed their hands when shifting from handling raw

food to cooked or ready to eat foods. In addition, less than half (43%) of the

respondents who washed their hands never used soap. This could be a recipe

for cross contamination and subsequently, cause food borne illness.

In terms of protection, it emerged that the respondents did not pay

much attention to the use of protective clothing as less than half of them put

on hair restraints/caps and aprons/over coats.

Inspite of the fact that gloves serve as barriers between the bare hands

and especially ready-to-eat foods, it became evident that the food handlers

were not familiar with the use of gloves as only three percent of them actually

used them during food preparation. Most of the food handlers (78%)

manipulated ready-to-eat foods (cooked foods and those eaten raw) with bare

hands.

Although over half (58%) of the observed food handlers were aware

that wearing jewelry during food preparation and service could be a source of

contamination, over a quarter (27%) of them put on jewelry during food

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preparation and service; indicating that, it is not always that food handlers put

what they know into practice.

As regards food hygiene practices, it was noticed that all the selected

facilities had adequate and good food storage facilities; thus food items were

stored at appropriate compartments and temperatures. Food items were

washed before storage.

The results revealed that none of the selected restaurants had a food

thermometer; so no food handler used food thermometers to monitor or check

critical control points or appropriate temperatures at which foods should be

stored or cooked. Again, though all respondents washed and rinsed serving

dishes under running water, none of them heated or sanitized equipment,

plates and serving dishes before service.

It was observed that most often the foods were served hot in all the

restaurants as they prepared and served foods on request. However, a few (15)

respondents tried to maintain standard temperatures by microwaving foods

that might have gone cold before service.

Even though it is a requirement to use separate chopping boards for

different foods, majority (83%) of the respondents did not comply; while the

knowledge results indicated majority (95%) of them were aware of the need to

separate them. This situation indicates that knowledge does not always have

an influence on practice as assumed by the KAP model and the conceptual

framework guiding the study.

Inspite of the fact that kitchen linen have been identified among the top

causes of cross contamination as well as perfect environment for the breeding

of bacteria, only 27% of the respondents had adequate kitchen linen and they

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washed and used them without ironing. This is a situation that may have a

high chance of contaminating work surfaces, equipment and the food.

In addition, it was observed that about 77% of the respondents thawed

frozen foods appropriately.

With regards to environmental hygiene practices, all selected

restaurants had very clean environment; both inside and outside, with adequate

and appropriate drainage, toilet facilities and waste collecting bins.

Although all the waste bins had fitting lids, only 16 % of them in the

kitchens had their lids on. Most of the food handlers preferred leaving the

waste bins opened for easy reach or accessibility. However, this practice could

pollute the atmosphere with the odour from the waste as well as attract flies

and other pests into the premises.

Most of the facilities (74%) had adequate and clean toilet facilities for

both staff and customers; but none of the surveyed facilities had adequate hand

washing stations (sinks) for the staff. This probably made it difficult for food

handlers to carry out proper hand washing practices and also links to the

influence of subjective norms (role of significant others as indicated in the

TPA) in the food handlers preparedness to practice appropriately. The facility

owners did not make enough provision for food handlers to practice as

expected.

This situation coupled with the use of waste bins without fitting lids

poses the risk of contamination and food poisoning. The areas that showed

gaps between the respondents‟ food safety knowledge and practices suggests

that there are grey areas to be worked on in the quest to improve food safety

practices among food handlers in restaurants.

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Food Safety Knowledge Versus Practice

Generally, most (80%) of the respondents were knowledgeable in food

safety issues as against those who put the measures into practice (65%). Thus,

there existed a negative gap (-15%) between the overall food safety

knowledge and practice. This suggests a significant difference between the

food safety knowledge and practices of the food handlers.

The number of food handlers who were knowledgeable on personal

hygiene issues exceeded those who practiced personal hygiene by 5.5% while

those knowledgeable in food hygiene issues surpassed those who put food

hygiene measures into practice by 19.1%. This implies that, food handlers‟

knowledge exceeded their practices. For instance, the respodents with

knowledge on the use of gloves far exceeded those who practically used them.

With reference to specific food safety areas, there existed significant

differences between personal hygiene knowledge and personal hygiene

practice (p = 0.001) as well as food hygiene knowledge and food hygiene

practices (p = 0.001) of food handlers.

There was a positive relationship with regards to the food handlers‟

knowledge and their practices which indicates that practice exceeded

knowledge. However, there was no significant difference between the

respondents‟ food safety knowledge and their practices.

This suggests that practice does not always depend on knowledge as

for instance, the food handlers‟ actual use of hair restraints (48.3%) far

exceeded their knowledge (10%). This could mean that due to work culture,

food handlers might carry out activities correctly without actually knowing the

reason behind their action.

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Barriers to Food Safety Practices

Six main barriers were identified to account for the inability of food

handlers in restaurants to carry out food safety measures correctly. Prominent

among the barriers were time constraints/busy work schedule (60; 4.8%),

inadequate knowledge/training (54; 4.3%), inadequate resources or supplies

(31; 2.5%) and lack of enforcement of rules and regulations (23; 1.8%). These

affected the practice of a variety of food safety activities.

In specific terms, time constraints/busy work schedule was identified

(28%) as the leading barrier to food safety practices such as the cleaning of

work surfaces and equipment, regular hand washing, laundering of kitchen

linen, changing of work clothes and proper waste management.

Inadequate training and knowledge was found to affect the storage of

food items (70%): use of appropriate storage temperatures (69%), the use of

appropriate food preparation techniques (45%) and the use of hair restraints

during food preparation and service (40%).

Furthermore, inadequate provision of resources and supplies prevented

respondents from using calibrated food thermometers (84%) and gloves (62%)

during food preparation and service.

Also, lack of enforcement of rules and regulations affected the

prevention of vermin from the food preparation and service area as well as

prevented the respondents from being enthusiastic about washing their hands

properly and regularly during food preparation and service.

Forgetfulness and lack of reminders hindered the removal of jewellery

during food preparation and service, the proper management of waste,

maintenance of short and neat finger nails (22%), and the washing of kitchen

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linen regularly (17%). Respondents needed reminders to be able to comply

with appropriate food safety practices.

The finding that food handlers in the surveyed restaurants have high

food safety knowledge levels gives an impression that foods from these

facilities will be safe for consumption; nonetheless there is the need to put

strategies in place for food handlers to put the knowledge into practice. There

is the need for further and continuous education or awareness creation on the

importance and regular use of protective clothing (hair restraints, aprons or

overcoats, hand gloves) as well as the use of soap for hand washing at all

times. As implied in the HBM guiding the study, when food handlers

understand the health implications (perceived susceptibility, severity and

benefits) of their actions and inactions they will act appropriately.

Relevance of Conceptual Framework

The findings of the study fitted well into the conceptual frame work

that guided the study, particularly, in terms of the barriers that militated

against practices of the food handlers in all the domains of food safety. The

food handlers had good knowledge on all the domains of food safety but they

could not put all the knowledge into practice due to the barriers identified.

This confirms the framework for the study which postulated that

knowledge from all the areas could be obtained through education, training

and experiences from practice but facility or institutional and personal barriers

such as time constraint, inadequate supplies of logistics, lack of motivation

and knowledge and skills could prevent employees from practicing

appropriately. For instance, the food handlers‟ knowledge on the use of food

thermometers, gloves and dish washers did not automatically allow them to

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practice accordingly. Similarly, personal barriers such as inadequate

knowledge, forgetfulness and intrinsic motivation could militate against food

handlers‟ practices.

Institutional
/External barrires
KNOWLEDGE PRACTICE
e.g: work schedules/
Personal hygiene
time constraint, Personal hygiene
Food hygiene inadequate equipment
Food hygiene
Environmental and supplies
Personal/ Internal Environmental
hygiene
barriers hygiene
e.g: inadequate
knowledge, skills,
motivation

Source: Field survey, Seidu (2017)

Conclusions

Based on the findings of the study, the following conclusions were drawn:

Food handlers in restaurants in the Tamale Metropolis have high food

safety knowledge compared to practice therefore they need more practice

oriented training.

The food handlers were limited in their sources of information as their

overriding sources of information were lecturers/teachers and training.

Food handlers carried out limited acceptable food safety practices.

Food safety practices among food handlers were more inclined to personal

hygiene issues.

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Though the restaurants operated in clean environment, there is the

likelihood of contaminating food since food handlers manipulated ready-to-eat

foods with bare hands.

There is the likelihood of attracting pestes into the premises as well as

polluting the kitchen environment since waste bins were left open during food

preparation.

In terms of the relationship between the food handlers‟ food safety

knowledge and their practices, a significant difference was observed between

the food handlers‟ food safety knowledge and their practices. Their food safety

knowledge exceeded their practices; suggesting that their food safety

knowledge did not always translate into practice.

Seggregating by the domains, there existed a significant difference in

personal hygiene knowledge by the sex of the respondents. The male

respondents were more knowledgeable than their female counterparts.

No significant difference was observed in terms of the respondents‟ food

hygiene knowledge and their religious affiliation.

There was also no significant difference in the environmental hygiene

knowledge and the educational attainment of the food handlers.

There was no significant difference in respondents‟ food safety

knowledge and the type of restaurants they work in. Nevertheless respondents

from hotel restaurants were more knowledgeable than their counterparts from

the independent restaurants.

Time constraint/busy, inadequate supplies, inadequate knowledge and

training and lack of enforcement of rules and regulations are barriers to food

safety knowledge and practice.

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Recommendations

Base on the major findings and the conclusions drawn, the following

recommendations are made:

1. It is clear from the conclusions that most of the restaurant food handlers had

high knowledge in food safety issues. Yet, they did not translate all the

knowledge into practice due to poor enforcement of rules and regulations by

supervisory agencies as elicited from the identified barriers. It is therefore

recommended that the facility managers and supervisors and regulatory

agencies (GTA, FDA and Environmental Health and Sanitation Unit (EHSU)

of the Tamale Metropolis should intensify their regulatory and monitoring

visits to restaurants to ensure that food handlers adhere to acceptable food

safety practices.

2. GTA, in collaboration with FDA and EHSU should build the capacities of

facility managers and unit supervisors to make them see supervision and

monitoring as part of their duty and ensure that their employees follow good

food safety practices.

3. The EHSU of Tamale Metropolis in collaboration with FDA and academia

(FCS-UDS) plan and carry out regular (quarterly) health education for

restaurant employees to remind them of the implications of their actions and

inactions. They should be educated and linked to current sources of food

safety information to enable them to be abreast with current principles and

tecniques.

4. In accordance with the finding that most of the food handlers did not have

in-service training on food safety, it is recommended that Tamale metropolis

in collaboration with the Restaurant and Hoteliers‟ Association, facility

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management and academia (UDS) plan and implement a mandatory well-

structured practical food safety training programs (based on HACCP and the

five keys to safer food) for restaurant employees to improve on their practices.

5. It is further recommended that the trainers develop a check list to ensure

that all food safety components are covered during the training and orientation

period.

6. Policy makers and curriculum planners in the Ministry of Education should

give paramount attention to more practical (vocational) training from the JHS

to the tertiary levels for the graduates to have appropriate skills for the job

market.

7. Facility owners and managers, need to ensure that food handlers have

appropriate and adequate tools, equipment and resources to carry out their

work as expected; as lack or inadequate supplies mitigate against appropriate

practice.

8. Finally, food handlers need to pay attention to food safety standards as well

as bear in mind the perceived susceptibilty, perceived severity of their actions

during food food prearation and service. They should also make conscious

effort to regulary wash their hands with soap and water during food

preparation. Furthermore, food handlers should seek to improve on their skills

by taking short skill training courses to help them operate up to standard.

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Contribution to Knowledge

The contribution this study makes to knowledge include the following:

This study has tested the usefulness of the theories and models in food

safety context

The conceptual framework made the relationships that existed between the

variables simple. It draws attention to the fact that there exist barriers

mitigating practice.

The expansion of the knowledge base of food safety knowledge and

practices of food handlers in restaurants within the African context such as

Ghana. This is based on the fact that most of the studies related to food and

safety practices have focused on restaurant employees in developed countries.

On the local scene most of the focus has been on street food venders,

sanitation and hygiene practices of street food venders, street food vending

and the quality of street foods against limited studies on restaurant employees.

Specifically, through the data drawn from the Northern Region, the study

contributes to existing literature on food safety knowledge and practice in

Ghana.

The study has brought to light information on food safety knowledge and

practices of food handlers from a practitioner's view point to complement the

scientists‟ findings

In terms of evolving theories, models and concepts, the study‟s

contribution lies in the development of a modified model which made the

relationships that exist between the variables (Knowledge and Practice) simple

and easy to follow. The relationship between food handlers‟ knowledge and

practice with the barriers playing an intermediary role and mitigating against

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practice draws attention to the fact that knowledge can not translate fully into

practice unless the barriers (institutional and personal barriers) are removed.

Suggestions for Further Research

The study did not examine the wholesomeness of the end results of food

handlers‟ practices, thus it is suggested that a further study should be

conducted to ascertain the microbial quality of foods prepared and served in

the restaurants in the Tamale metropolis.

The focus of this study was limited to food safety knowledge and practices

of food handlers in restaurants in Tamale Metropolis in relation to the KAP

model. It is thus proposed that a further study should focus on food handlers‟

attitudes towards food safety practices to allow for correlation of knowledge,

attitude and practices of food handlers in restaurants.

The researcher employed the quantitative approach to the study, it is

suggested that a further study should be carried out using qualitative or mixed

method to be able to get detailed explanations to restaurant food handlers

actions and inactions.

As regards the inclusion criteria, this study focused on star 1&2 hotel

restaurants and grades 2 & 3 independent restaurants in Tamale metropolis.

Consequently, a further study should include guest houses and budget

categories so as to generate more data on the knowledge and practices of food

handlers in that area of the hospitality industry.

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APPENDICES

APPENDIX A

UNIVERSITY OF CAPE COAST

FACULTY OF SOCIAL SCIENCES

DEPARTMENT OF HOSPITALITY AND TOURISM MANAGEMENT

Food Safety Knowledge and Practices in Restaurants in the Tamale

Metropolis

Questionnaire for Food Handlers

Dear Sir/Madam,

This study aims at assessing the food safety knowledge and practices of food

handlers in restaurants in the Tamale Metropolis of Ghana. It would be very

much appreciated if you could take time off your busy schedule to complete

this questionnaire. Your confidentiality is assured, as the information you

provide will not be disclosed to any party. The information will be treated

confidential, and will be used only for academic purposes.

Thank you

SECTION A꞉ BACKGROUND OF RESPONDENTS

Socio-demographic Characteristics
Please make a tick (√) in the space provided and write out your response
where required
1. Gender

i. Male [ ] ii. Female [ ]

2. Age……………………………..

3. Marital status

i. Single [ ] ii. Married [ ] iii. Widowed [ ]

iv. Divorced [ ] v. Separated [ ]

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4. Religion

i. Christianity [ ] ii. Islam [ ] iii. Traditional [ ]

iv. Others (Please Specify)…………………………………………………

5. Level of Education Attained

i. No formal education [ ]

ii. JHS /MSLC [ ]‟

iii. SHS [ ]

v. Tertiary (University, Polytechnic, Teacher Training college) [ ]

vi. Others (Please specify)……………………………………………………

Work Related Characteristics

6. Professional Qualification

i. HND Hotel, Institutional management [ ]

ii. Advanced catering [ ]

iii. Intermediate catering [ ]

iv. NVTI [ ]

v. Others (please specify)………………………………………………

7. Facility in which you are working꞉

i. Hotel restaurant [ ]

ii. Independent restaurant [ ]

8. Location………………………………………………………………………

9. What is your position in the facility?

…………………………………………………….

10. How long have you been working here?

…………………………………………………

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11. How many times do you go for medical check-up in a year?

i. None [ ] ii. Once [ ]

iii. Twice [ ] iv. Three times [ ]

v. Four times [ ]
12. Have you received any in-service training on food safety and hygiene
practices?
i. Yes [ ] ii. No [ ]
13. If yes, when (how long ago) and how many times in a year?
………………………………………………………………………………
14. What is the area of in-service training you received?
…………………………………………………………………………………
15. Who or which organization/institution offered the training?
…………………………………………………………………………………
16. What was the duration of the training?
…………………………………………………………………………………
SECTION B꞉

KNOWLEDGE OF FOOD SAFETY ISSUES

Please indicate the extent to which you agree or disagree with the following

statements by putting a tick (√) under True, False or Don‟t know

S/N Statement True False Don’t

know
Personal Hygiene
1 Food handlers are at liberty to put on hair
restraints/caps during food preparation
and service
2 Using aprons or overcoats during food
preparation is a luxury
3 It is optional to wear hand gloves when
preparing foods that are eaten raw/fresh
4 A food handler can continue to wear
soiled clothing to work until he/she is off

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duty
5 It is compulsory for food handlers to have
jewelries on during food preparation
6 Hand washing with soap and warm water
before commencing and during cooking
and service reduces the risk of food
contamination
7 Hand washing is necessary only after
visiting the toilet
8 Food handlers are at liberty to scratch
skin, touch hair, nostrils and ears during
food preparation and service
9 Food handlers are at liberty to wear long
finger nails
10 A food handler is at liberty to lick fingers
during food preparation and service
11 Coughing or sneezing directly on food
during preparation and service has no
effect on the food
12 Medical examination is a requirement for
employment in the food production and
service industry
13 Regular or routine medical examination is
optional in the food production and
service unit
Environmental hygiene (Kitchen and
Restaurant)
14 Food preparation and service area should
be free from pests and rodents
15 Un-cleaned work surfaces and kitchen
cloths are vehicles of contamination
16 Proper cleaning and sanitization of
utensils increase the risk of food

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contamination
17 All kitchen cloths must be washed once a
week
18 All garbage bins in the food preparation
and service area should be left opened for
easy usage
19 Garbage bins should be emptied once a
week
20 Hand washing stations should be equipped
with sanitary towels/drying services
21 Good drainage system can limit the spread
of micro-organisms
FOOD HYGIENE
22 Foods prepared a day or more before they
are served reduces the risk of food
contamination
23 Reheating cooked food contribute to food
contamination
24 Appropriate refrigeration temperatures
(freezing) kills all bacteria that may cause
food-borne illness
25 Raw food and cooked food can be put
together during storage
26 Cooked meat can be left out of the fridge
to cool overnight before refrigerating
27 Cooked food should be very hot (at a
temperature of 65o C) before serving
28 Food items purchased from reliable
sources need no cleaning before storage
29 The best way to thaw frozen food is to put
it in a bowl and leave it in the open
30 It is a luxury to use separate chopping
boards during food preparation

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31 Food handlers are not obliged to wash and

rinse equipment and serving dishes under
running water
32 It is not important to heat or sanitize
serving plates and dishes before they are
used for service
33 The manipulation of food with uncovered
hands increases the risk of food
contamination

Sources of Food Safety Information

21. Please tick the main source from which you got food safety information

i. Teachers [ ] ii. Lecturers [ ]

iii. Health personnel [ ] iv. Friends/colleagues [ ]

v. Media (TV, Radio) [ ] vi. Posters/billboards [ ]

vii. Internet [ ] viii. Training/workshops [ ]

22. Are you aware of the five keys to safer food?

i. Yes [ ] ii. No [ ]

23. Please if yes, name the five keys

i…………………………………………………………………………………

ii…………………………………………………………………………………

iii………………………………………………………………………………

iv………………………………………………………………………………

v…………………………………………………………………………………

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SECTION C꞉ BARRIERS TO FOOD SAFETY PRACTICES

Please indicate by ticking (√) in the appropriate column the barriers to food safety practices in your facility

PRACTICES BARRIERS

Time Inadequate training / Poor Inadequate resources or Criticism Little or No

constraints: knowledge: enforcement of supplies: from Lack of Reminde
rules and colleagues staff rs
regulations motivati
on
Hand washing
Using hair restraints
Changing work
clothes
Maintaining short
nails
Wearing hand gloves

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during food
preparation
Removal of jewelry
during food
preparation
Use of thermometers
Cleaning of equipment
before use
Storage of food items
at appropriate storage
temperatures
Using appropriate
food preparation and
service techniques
Managing storage
facilities
Keeping out vermin
Cleaning of work area

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and surfaces
Laundering of kitchen
linen daily
Appropriate waste
management

Others (Please Specify)

……………………………………………………………………………………………………………………………………………

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UNIVERSITY OF CAPE COAST

DEPARTMENT OF HOSPITALITY AND TOURISM MANAGEMENT

OBSERVATION CHECKLIST ON THE FOOD SAFETY PRACTICES

OF FOOD HANDLERS IN RESTAURANTS IN THE TAMALE

METROPOLIS

Date: ………………………………………………………………………….

Time: …………………………………………………………………………

Type of Facility: ……………………………………………………………..

Area: ………………………………………………………………………….

Location………………………………………………………………………

General Outlook of Facility and Personnel Yes No Comment

practices
A Facility (Environmental hygiene and
Sanitation)
1 Food handlers operate in a clean environment
(inside and outside)
2 Adequate and appropriate drainage system
provided
3 Kitchen provided with self-closing doors
4 Doors, windows and other openings protected
to eliminate pests
5 Adequate ventilation in kitchen to remove heat
and odor
6 Floors, Walls and Ceilings kept clean; free
from dirt, stains and cobwebs
7 Waste bins are large enough to handle volume
of refuse generated in the facility provided
8 Waste bins with Fitting lids available

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9 Waste bins in the kitchen are emptied regularly

10 Main waste bins outside are emptied daily
11 Provision of adequate toilet facilities and
accessories (for staff and customers)
12 Toilet facilities kept clean and in a good state
of repair
13 Provision of hand washing stations for use by
kitchen staff
14 Hand washing stations have been equipped
with sanitary towel or suitable drying service
15 Adequate refrigerators and freezers
B Personal hygiene
16 Food handler wears a cap or hair restraint
during food preparation and service
17 Food handler wears clean apron/over coat
during food preparation and service
18 Food handler wears clean clothing
(uniform/own outfit) during food preparation
and service
19 Food handler wears gloves during the
preparation and serving of ready to eat foods
or foods eaten raw
20 Food handler wears jewelry during food
preparation
21 Food handler wears trimmed and neat finger
nails
22 Food handler washes hands with soap and
warm water before and during food
preparation and service
23 Food handler washes hands in between
handling raw and cooked food
24 Food handler scratches parts of the body (hair,
skin, ears, eyes, nose) during food preparation

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and service
25 Food handler coughs/sneezes directly on to
food during food preparation and service
26 Food handler licks fingers during food
preparation and service
C Food Hygiene Practices
27 Food handler reheats/microwaves cold/leftover
foods before service
28 Food handler separated raw foods such as
meat, vegetables and salads from cooked foods
during storage
29 Cooked foods are served hot
30 Food items are washed before use/storage

31 Food handler thawed frozen foods in a

bowl/basin outside refrigerator or freezer
32 Food handler used separate chopping boards
for raw meat/ fish and ready to eat foods
33 Food handler manipulated cooked and ready to
eat foods with covered hands/tongs
34 Food handler used calibrated food
thermometers for checking appropriate
temperatures of food
35 Serving dishes are washed in a dish washing
machine
36 Equipment and serving dishes are washed and
rinsed under running water
37 Serving plates and dishes are heated or
sanitized before they are used for service
38 Food handlers washed and ironed kitchen linen
daily

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APPENDIX B

Barriers to food safety practices

Yes response No response Yes response No response

Construct/ Item N % N % Construct/ Item N % N %
Hand washing Storage of food items at appropriate
storage temperatures
Time constraint 11 53 24 12.5 Time constraint 2 7 28 15
Inadequate training or knowledge 2 11 33 17.3 Inadequate training/ knowledge 20 69 11 6
Poor enforcement of rules and 5 25 31 15.8 Poor enforcement of rules and regulations 1 3 30 16
regulations
Inadequate resources or supplies 1 6 34 17.8 Inadequate resources or supplies 4 14 27 15
Lack of motivation 0 1 36 18.4 Criticism from colleagues 0 0 30 16
No reminder/Forgotten 1 4 35 18.1 Lack of motivation 0 0 31 17
Using hair restraints No reminder/Forgotten 1 3 29 16
Time constraint 7 29 24 13 Using appropriate food preparation and
service techniques
Inadequate training/ knowledge 10 42 21 11 Time constraint 12 43 18 10
Poor enforcement of rules and 2 8 28 15 Inadequate training/ knowledge 13 46 18 10
regulations
Inadequate resources or supplies 1 4 29 15 Poor enforcement of rules and regulations 2 7 29 16
Criticism from colleagues 0 0 30 16 Inadequate resources or supplies 0 0 30 16

224

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Lack of motivation 0 0 30 16 Criticism from colleagues 0 0 31 17

No reminder/Forgotten 4 17 27 14 Lack of motivation 0 0 30 16
Changing work clothes No reminder/Forgotten 1 4 30 16
Time constraint 11 58 20 10 Managing storage facilities
Inadequate training/ knowledge 4 21 26 13 Time constraint 13 46 18 10
Poor enforcement of rules and 2 11 29 15 Inadequate training/ knowledge 9 32 22 12
regulations
Inadequate resources or supplies 2 11 28 14 Poor enforcement of rules and regulations 3 11 28 15
Criticism from colleagues 0 0 31 16 Inadequate resources or supplies 2 7 29 16
Lack of motivation 0 0 31 16 Criticism from colleagues 0 0 30 16
No reminder/Forgotten 0 0 30 15 Lack of motivation 0 0 30 16
Maintaining short nails No reminder/Forgotten 1 4 29 16
Time constraint 7 33 29 15 Keeping out vermin
Inadequate training/ knowledge 7 33 29 15 Time constraint 3 10 28 15
Poor enforcement of rules and 2 10 33 17 Inadequate training/ knowledge 4 13 26 14
regulations
Inadequate resources or supplies 0 0 35 18 Poor enforcement of rules and regulations 21 70 10 5
Criticism from colleagues 0 0 0 0 Inadequate resources or supplies 1 3 29 16
Lack of motivation 0 0 36 19 Criticism from colleagues 0 0 31 17
No reminder/Forgotten 5 24 31 16 Lack of motivation 0 0 31 17
Wearing hand gloves during food No reminder/Forgotten 1 3 30 16
preparation
Time constraint 4 11 31 17 Cleaning of work area and surfaces

225

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Inadequate training/ knowledge 6 16 30 17 Time constraint 13 68 17 9

Poor enforcement of rules and 2 5 34 19 Inadequate training/ knowledge 3 16 28 14
regulations
Inadequate resources or supplies 23 62 13 7 Poor enforcement of rules and regulations 1 5 29 15
Criticism from colleagues 0 0 36 20 Inadequate resources or supplies 1 5 30 15
Lack of motivation 0 0 0 0 Criticism from colleagues 0 0 31 16
No reminder/Forgotten 2 5 34 19 Lack of motivation 0 0 31 16
Removal of jewelry during food No reminder/Forgotten 1 5 29 15
preparation
Time constraint 9 28 27 15 Laundering of kitchen linen daily
Inadequate training/ knowledge 9 28 27 15 Time constraint 16 62 15 8
Poor enforcement of rules and 3 9 33 18 Inadequate training/ knowledge 2 8 29 15
regulations
Inadequate resources or supplies 1 3 35 19 Poor enforcement of rules and regulations 3 12 28 15
Criticism from colleagues 0 0 0 0 Inadequate resources or supplies 1 4 29 15
Lack of motivation 0 0 35 19 Criticism from colleagues 0 0 30 16
No reminder/Forgotten 10 31 25 14 Lack of motivation 0 0 31 16
Use of thermometers No reminder/Forgotten 5 19 26 14
Time constraint 1 3 30 16 Appropriate waste management
Inadequate training/ knowledge 3 9 27 15 Time constraint 3 10 28 15
Poor enforcement of rules and 1 3 30 16 Inadequate training/ knowledge 20 69 11 6
regulations
Inadequate resources or supplies 27 84 4 2 Poor enforcement of rules and regulations 1 3 29 16

226

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Criticism from colleagues 0 0 30 16 Inadequate resources or supplies 3 10 27 15

Lack of motivation 0 0 31 17 Criticism from colleagues 0 0 30 16
No reminder/Forgotten 0 0 30 16 Lack of motivation 0 0 30 16
Cleaning of equipment before use No reminder/Forgotten 1 3 29 16
Time constraint 14 64 17 9
Inadequate training/ knowledge 4 18 26 14
Poor enforcement of rules and 1 5 29 15
regulations
Inadequate resources or supplies 1 5 30 16
Criticism from colleagues 0 0 30 16
Lack of motivation 0 0 31 16
No reminder/Forgotten 2 9 28 15

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Table 21: Distribution of Sampled Restaurants by Zones

Zone Hotel Sample Percentage Independent Sample Percentage Total Percentage
restaurant from firstSampled (%)restaurant from Sampled Sample (%)
(1&2star-first strata (Grade2&3- second (%)
strata) second strata) strata
Tamale North 13 7 58.4 8 4 36.3 11 47.83
Tamale Central 7 4 33.3 10 5 45.5 7 30.43
Tamale South 2 1 8.3 3 2 18.2 5 21.74
Total 22 12 100.0 21 11 100.0 23 100.0
Source: Field survey, Seidu (2017).

228

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APPENDIX C

INTRODUCTORY LETTER

229

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APPENDIX D

FOOD AND DRUGS AUTHORITY

230

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