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A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers

Andrea insfran-rivarola.

1 Departamento de Ingeniería Industrial, Facultad de Ingeniería, Universidad Nacional de Asunción, Paraguay, San Lorenzo 2160, Paraguay; [email protected]

2 Facultad de Ingeniería, Arquitectura y Diseño–Universidad Autónoma de Baja California, Ensenada 22870, Mexico; xm.ude.cbau@adnaloy

Diego Tlapa

Jorge limon-romero, yolanda baez-lopez, marco miranda-ackerman.

3 Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Tijuana 22390, Mexico; [email protected] (M.M.-A.); [email protected] (K.A.-S.)

Karina Arredondo-Soto

Sinue ontiveros.

4 Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico; [email protected]

Associated Data

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before–after, and nonrandomized designs, including pre–post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges’s g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89–1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07–0.48), and an overall practice effect size of 0.65 (CI = 0.24–1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13–1.48) and 0.45 (CI = 0.15–0.76) respectively.

1. Introduction

Food safety is a global public health threat with frequent incidents of foodborne diseases. Additionally, the COVID-19 outbreak has put more pressure on global public health; particularly, organizations of producers and providers along the food supply chain are facing an ongoing challenge to improve and to extreme food safety and hygiene due to the pandemic. In this context, foodborne diseases are responsible for major economic costs for a country [ 1 , 2 ]. In terms of global estimates, in 2010, 31 foodborne hazards caused 420,000 deaths and 600 million foodborne illnesses derived from disease agents, such as non-typhoidal Salmonella enterica , Salmonella typhi , Taenia solium , hepatitis A, and aflatoxins, to name but a few [ 3 ]. In this regard, the application of the Hazard Analysis and Critical Control Point (HACCP) system can improve food safety; however its strength and success in preventing foodborne illnesses depend on it being applied correctly along with the provision of a sanitary infrastructure and the application of principles of good hygiene practice [ 4 ]. Current evidence suggests that a substantial number of foodborne illnesses occur through poor food handling practices of food workers [ 5 , 6 ]. Pathogens may appear in food, for instance, through unsafe farm practices, contamination during manufacturing, packaging, or distributing, or contamination in stores [ 7 , 8 ]. Additionally, food purchases from unsafe sources, inadequate cooking or reheating, holding food at room temperature, cross-contamination, poor personal hygiene, or improper food handling practices frequently contribute to foodborne illnesses [ 9 ].

To fight the battle against foodborne diseases, governments have resorted to strategies including food regulations and laws to monitor compliance with food safety standards [ 10 , 11 , 12 , 13 ]. Additionally, food companies rely on food safety methodologies, including the food Good Manufacturing Practices (GMP), the Good Agricultural Practices (GAP), the Hazard Analysis and Critical Control Points (HACCP) system, and the ISO 22000 standard to assure the safety of their food products [ 14 , 15 , 16 ]. In such methodologies, training food handlers in food safety is one of the most effective strategies for preventing foodborne diseases [ 17 ].

In an attempt to increase both knowledge and practice on food safety and hygiene, different behavioral theories have been used, including the Health Belief Model, in which an individual will perform a preventive behavior depending on their desire to avoid illness (or if ill, to get well) and the belief that a specific health action will prevent (or ameliorate) illness [ 18 , 19 ]; the KAP model, which assumes that an individual’s behavior or practice is dependent on their knowledge (K) and suggests that the mere provision of information will lead directly to a change in attitude (A) and, consequently, a change in behavior or practice (P) [ 20 ]; and the theory of planned behavior (TPB) which focuses on the individual’s intention to perform a given behavior and has been advocated by many researchers for the prediction of determinants of a food handler’s behavior [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ].

In this regard, there is an implied assumption that such training leads to changes in behavior based on the KAP model [ 28 ]. In other words, training affects knowledge [ 29 ] and increased knowledge of correct food hygiene practices may be an important factor in changing behavior [ 22 ], i.e., the provision of food safety and hygiene training and the effective enactment of safe food handling practices are important for controlling foodborne illnesses [ 30 , 31 ]. Unfortunately, in most cases, food hygiene training does not translate into positive food handling behaviors [ 25 , 30 ].

In this regard, knowledge, attitude, and practice (KAP) surveys have been used widely. They are representative of a specific population to collect information on what is known, believed, and done in relation to a particular topic [ 32 ]. In this sense, several studies use training programs based on KAP as well as TPB with the aim of teaching food handlers how to identify food safety hazards and apply good practices regarding food safety.

Knowledge is accumulated through learning processes (which may involve formal or informal instruction), personal experience, and experiential sharing [ 33 , 34 , 35 ]. Traditionally, it has been assumed that knowledge is automatically translated into behavior [ 36 ], despite studies indicating that this is not necessarily true [ 37 , 38 ]. On the other hand, attitude involves evaluative concepts associated with the way people think, feel, and behave [ 39 ]. In the food industry, food handlers must gain knowledge of food safety and be aware of and implement proper food handling practices [ 40 ]. Practice refers to how people demonstrate their knowledge and attitude through their actions [ 41 ].

Previous studies have analyzed the training interventions and relationship between KAP (knowledge, attitude, and practice) and food safety in environments such as hospitals [ 42 , 43 , 44 ], colleges [ 45 , 46 , 47 ], food establishments [ 48 , 49 , 50 ], restaurants [ 51 , 52 , 53 ], and houses [ 54 , 55 , 56 ], among others. Despite the effort made [ 57 , 58 ], further evidence of the effects of training interventions on the knowledge, attitudes and practices toward food safety and hygiene of food handlers from different processes along the food supply chain is needed. To address this gap, we conducted a systematic review and meta-analysis of studies conducting training interventions among food handlers involved in different processes including on farms, in food processing facilities, and in restaurants (i.e., from farm to fork).

2. Materials and Methods

This study adhered closely to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 59 , 60 ]. Figure 1 presents a flowchart of the stages involved in the selection process, while the resulting PRISMA checklist summarizes all of the requirements covered (see online Supplementary Table S1 ). The review was registered in the PROSPERO International Prospective Register of Systematic Reviews (Identifier CRD42019119006).

The PRISMA flow chart.

2.1. Search Strategy

We conducted a comprehensive search on the following databases: PubMed, Cochrane Controlled Register of Trials (CENTRAL), Ebsco, Scopus, and Web of Science. Also, we searched for grey literature on Google Scholar and ProQuest. In relation to the search strategy, we relied on both the Peer Review of Electronic Search Strategies (PRESS) [ 61 ] and the PICOS (population, intervention, comparator, outcome, and study design) elements. The ultimate search strategy is described in the Supplementary Data S1 . We searched for publications in English published between January 1997 and December 2019. Likewise, we examined the reference lists of the retrieved articles to look for further relevant literature. The last search was run in April 2020.

2.2. Study Selection

Two authors reviewed the titles and abstracts of the work retrieved during the search. Discrepancies were resolved by discussion and consensus with a third author. All of the reviewed works were conducted among food handlers from different steps of the food supply chain, including farms, food processing facilities, and restaurants (i.e., from farm to fork). Interventions were defined as food safety and hygiene training sessions covering aspects such as personal hygiene, hand washing, cleaning and sanitization, cross-contamination, foodborne diseases, and temperature control. Training was given in the form of talks, demonstrations, self-practice, and different sources of communication, including posters, videos, booklets, slideshows, and fact sheets. We searched for randomized controlled trials (RCTs), quasi-RCTs, and controlled before-after (CBA) studies. In addition, we searched for non-randomized designs, including uncontrolled pre-post studies, to allow a more comprehensive and complete assessment of the available evidence in the area, recognizing that RCTs may not be feasible for many large-scale food safety education interventions [ 62 , 63 , 64 , 65 , 66 ].

The reported food safety training sessions were aligned with regulations, protocols, and guidelines, including, but not limited to, the United Nations’ (UN) Codex Alimentarius, the HACCP, the Food and Drug Administration (FDA) Food Code (including the hand-washing guidelines and protocol), the FDA’s Employee Health and Personal Hygiene Handbook, the United States Department of Agriculture (SDA) Food Safety Education campaign, the European Union General Food Law, Regulation (EC) No. 852/2004, the United Kingdom’s Safety Act, the GMPs, and the Good Hygiene Practices (GHPs). In all of the studies, the comparison group included either participants (i.e., food handlers) who did not receive food safety training or those who had not yet received proper food safety training.

As the main outcomes, all included studies evaluated changes in knowledge, attitude or practice among food handlers. Knowledge refers to the degree of understanding of food handlers about the food safety information given during training sessions. In contrast, attitude refers to a predisposition or tendency to respond positively or negatively to training. Finally, practices are the actions of an individual in response to the knowledge and attitude involved in the training sessions. Similarly, food safety practices can be defined as the increased use of evidence in healthcare practice and policy when both knowledge of, and attitude toward, food safety are present.

Changes in levels of knowledge were measured in the studies through survey-questionnaire data gathered in Likert-type scales with sub-dimensions such as food poisoning, cross-contamination, temperature control, and personal hygiene. Changes in self-reported attitudes toward food safety and hygiene were also measured through survey-questionnaire data on Likert-type scales. Finally, changes in practices were measured, such as self-reported practices and observed practices, the former through survey-questionnaire data in a Likert-type scale and the latter through checklists. Both used different sub-dimensions, including personal hygiene, food safety, and hygiene, temperature control, cross-contamination, sanitation, storage, and food display. We discarded any case report/series and/or review studies with data missing (e.g., sample size, mean, standard deviation), as well as studies conducted among people other than food handlers (e.g., consumers and food transporters).

2.3. Data Extraction and Quality Assessment

Two independent reviewers screened each potential article to identify its abstract, title, keywords, and concepts reflecting both the article’s contribution and the research context. Disagreements were overcome by discussion. Then, the relevant full-text studies were retrieved and independently assessed by two reviewers against the review’s inclusion/exclusion criteria. Once more, disagreements were overcome by discussion and consensus with a third author. The data were extracted by one reviewer and checked by a second reviewer. The extracted raw data from each study included authors’ names, year of publication, country of origin, title, study setting, study length, study aim, study design, study population, participant demographics, details on the training interventions and control conditions, recruitment and study completion rates, outcomes, measurement times, and information on the risk of bias. The data were arranged manually and tabulated using standardized forms including data from studies that fulfilled our requests for additional information.

2.4. Data Synthesis and Analysis

We stratified data into comparable subgroups for meta-analysis for each outcome: knowledge, attitude, and practice. Furthermore, we separated practice into two subgroups: self-reported practices and observed practices. As in similar cases [ 57 , 66 ], due to studies using different measurement instruments and scales, we calculated the Hedge’s g standardized mean differences (SMD) to measure the effect size, as proposed by Borenstein et al. [ 67 ]. Due to variation across studies, we conducted a random effect meta-analysis using Hedges’s g with a 95% confidence interval (CI) and the two-sided p -value for each outcome [ 67 , 68 ].

Heterogeneity among the studies in terms of effect measures was assessed using the I² statistic. This index can be interpreted as the percentage of total variability in a set of effect sizes due to true heterogeneity (between-studies variability) [ 69 ]. Higgins et al. 2003 suggested the use of I 2 values of 25%, 50%, and 75% as low, moderate, and high, respectively [ 70 ]. Thus, an I 2 value greater than 50% is indicative of substantial heterogeneity. We also assessed the evidence of risk of publication bias through a funnel plot and statistical tests, including Egger’s test [ 71 ] and the Begg’s test [ 72 ] (with a 95% confidence interval). We ran the meta-analysis in RStudio using the metafor package [ 73 ] and the meta package [ 74 ]. To reduce the risk of bias, two independent reviewers assessed each study. Randomized studies were assessed by using Cochrane’s tool RoB2 [ 75 , 76 ]. Here, the judgment criteria included 3 levels (low risk of bias, some concerns, or high risk of bias) for each of the 5 bias domains. Nonrandomized studies were assessed by using the ROBINS-I tool [ 77 ]; the judgment criteria included 5 levels (low, moderate, serious, critical, and no information) for each of the 7 bias domains [ 78 ]. The risk of bias visualization was done using robvis [ 79 ]. Finally, we summarized the findings reported in each study ( Table 1 ).

Summary of Findings.

Note. SD indicates standard deviation; RCT, Randomized control trials; CS, Cross-sectional studies; TL, training length; FU, follow up; GMP, good manufacturing practices; n , sample; nc , control group sample; ni , intervention group sample; mo., Months; h, Hours; min, Minutes. The last name of the main author and the publication year are shown.

During the initial search, we found 1094 papers. Then, after removing duplicates, our database was reduced to 321 papers. Following data screening and the application of exclusion criteria, we removed 200 more studies. One hundred twenty-one studies underwent full-text review. However, after applying the inclusion criteria, only 31 papers were eligible for inclusion in the literature review (see Figure 1 ). We classified the 31 final papers into three categories based on their main outcomes: changes in knowledge, attitude, and practices toward food safety and hygiene following training interventions. Twenty-six of the 31 studies reported changes in knowledge, 12 discussed changes in attitude, and 16 reported changes in food safety practices. Regarding the publication rate, we found that food safety and hygiene training interventions seem to have increased since 2011. Regarding the country of origin, most of the studies were published in the United States (29%), followed by Malaysia (13%), and Canada, Brazil, and the United Kingdom, with equal proportions (6.5%), see Supplementary Tables S2 and S3 . As for the research settings, the studies were conducted mainly in schools or universities (5/31), food process facilities (4/31), hospitals (4/31), restaurants (3/31), street food establishments or food trucks (3/31), farms/greenhouses (2/31), and multi-settings (2/31), among others.

Regarding the sample size, the studies varied from n = 10 to n = 194. There were 64 different interventions conducted among the 31 studies, with face-to-face/lectures (25/64) being the most frequent type of training intervention, followed by lectures combined with practice demonstrations (14/64), computer-based training (6/64), videos (4/64), videos combined with either a lecture (1/64) or a lecture and a demonstration (2/64), lectures combined with an incentive (1/64) or with demonstrations and incentives (2/64), and booklets (2/64), among others. We found that no studies used any kind of intervention involving social media. Regarding the type of study, eleven studies were pre-post studies, twelve relied on RCT, and eight performed a cross-sectional study with a trained group and a non-trained group. As for the measurement instruments, twelve studies administered surveys, one administered a test, two used checklists, and the rest did not report the used measurement instruments. Regarding gender, 13 papers reported that the majority of participants were female, while males represented the majority in nine studies, and one study had an equal proportion (50% of each). Eight studies did not report gender. The main outcomes, descriptions, statistics, and other relevant information of each study are summarized in Table 1 .

We performed a meta-analysis of the effects of food safety training interventions on the KAP of food handlers. Overall, we found that food safety training interventions had a significant effect on knowledge changes, with an SMD of 1.24 (CI = 0.89 to 1.58; p -value = 0.0001). In relation to attitude, our analysis results indicate that food safety training has a positive effect, giving an SMD of 0.28 (CI = 0.07 to 0.48; p -value = 0.008) for the attitudes of food handlers toward food safety and hygiene. Finally, with respect to practice, the overall effect size was estimated to be SMD = 0.65 (CI = 0.24 to 1.06; p -value = 0.0018). For those interventions with self-reported practices, we found an effect size of SMD = 0.80 (CI = 0.13 to 1.48; p -value = 0.0201). In contrast, for studies reporting observed practices, the effect size was SMD = 0.45 (CI = 0.15 to 0.76; p -value = 0.0035). Figure 2 , Figure 3 , Figure 4 , Figure 5 and Figure 6 show the forest plot for each outcome. Overall, food safety KAP was significantly higher as a result of training interventions. This phenomenon was particularly noticeable in the knowledge component. The forest plot in Figure 2 shows that most of the individual results lay close to 1. Such results strongly suggest that training increases knowledge of food safety and improves food safety attitudes and practices among food handlers.

Forest plot—Knowledge.

Forest plot—Attitude.

Forest plot—Overall practice.

Forest plot—Observed practice.

Forest plot—Self-reported practice.

We graphically assessed the risk of publication bias through funnel plots which, as the supplementary Figures S1–S5 depict, were symmetric. The null hypothesis for the Begg’s and Egger’s tests indicated an absence of bias in the selected studies. For knowledge, the Egger‘s test did not indicate any risk of publication bias, while the Begg’s test did indicate a moderate level of risk (i.e., Begg’s test: p -value = 0.044 and Egger’s test: p -value = 0.054); however, the data seem symmetric in the funnel plot (see Figure S1 ). As for the effects of food safety training on attitude changes, we also found no evidence of publication bias, both in tests and in the plot (Begg’s test: p -value = 0.653 and Egger’s test: p -value = 0.763). Finally, we found no statistical evidence of a risk of publication bias for the practice component (Begg’s test: p -value = 0.472 and Egger’s test: p -value = 0.608) and the graphic shows symmetry as well. In this review, the heterogeneity was considered high for knowledge (I 2 = 95.3%), attitude (I 2 = 77.7%), and for practice (I 2 = 94.9%). Regarding the risk of bias for randomized studies, six studies were evaluated with some concerns of risk of bias, four studies with low risk, and two studies with high risk. For nonrandomized studies, ten were evaluated with moderate risk of bias, nine studies with serious risk, and none as low risk. The visualization data are shown in Supplementary Tables S4 and S5 .

4. Discussion

This systematic review has summarized the effects of training interventions on the knowledge, attitudes, and practices of food handlers towards food safety and hygiene. Change in knowledge was assessed in 26 out of 31 studies; therefore, this was the most frequently reported outcome. This result is consistent with previous studies [ 58 , 107 ], and a significant amount of information is available, so it is probably easier to measure knowledge than attitude or practice. We found evidence that training interventions have a significant effect on increased knowledge toward food safety and hygiene across different type of settings such as fresh produce [ 91 ], food service operators [ 108 ], schools [ 80 ], restaurants [ 82 ], households [ 101 ], and multi-settings [ 97 ]. On the other hand, one study found no difference in knowledge between a control and an intervention group except for a positive attitude, so it can be considered to be optimistically biased [ 90 ]. This phenomenon has been demonstrated in previous research [ 90 , 109 , 110 ].

Attitude was assessed in 12 out of 31 studies, most of them assessing one intervention while some studies evaluated two [ 9 , 95 ] or three interventions [ 87 ]. Considering the summarized effect size, a SMD = 0.28 suggests a moderate effect for the positive attitude of food handlers; this is similar to previous studies [ 57 , 58 , 66 ]. Both studies [ 9 , 95 ] reported similar improvements in attitudes, either with face-to-face training or computer-based (CB) instruction. This is consistent with [ 84 ], who stated that participants learned equally well whether the instructional format was CB or instructor-led training. In addition, in studies where food handlers had attended food hygiene training previously [ 97 , 103 ], food safety attitude remained the same. According to our findings, most studies reporting an increase in knowledge also reported an increase in attitude [ 9 , 97 , 105 , 106 ]. However, an increase in knowledge might not necessarily bring about an improvement in attitude. This was the case for four studies [ 80 , 85 , 86 , 100 ]. The reason for this is unclear, yet some factors that could partially explain this could be length of the training [ 80 ], lack of repetition of the training [ 86 ], or previous hygiene enforcement program within the control group [ 85 ]. Attitude is a measure of the degree to which a person has a favorable or unfavorable evaluation of behavior [ 27 ]. In this regard, providing employees with training that does not promote a positive change with attitude [ 80 ], subjective norms, and perceptions of control may not contribute to improving intention (and ultimately behavior) to perform the behaviors [ 111 ].

Practice and behavior were measured in 16 studies, two of them assessing two outcomes (self-reported and observed practice) and the rest just one. The summarized effect of food safety training on practices showed that the interventions increased food safety practices, both for the 11 studies with self-reported practices and the seven studies with observed practices. Previous studies reported similar improvements, either self-reported or observed practices, but with a slightly smaller effect for the self-reported practices [ 38 , 97 ]; this consistent agreement between self-reported and observed behaviors was reported previously [ 23 ]. However, this is contrary to expected, since self-reported data are usually susceptible to social desirability bias [ 112 ], i.e., the tendency of respondents to give socially desirable responses in such a way as to be viewed favorably by others [ 113 ]. Thus, respondents tend to overestimate their food safety practices as being higher than their actual practices deserve [ 38 , 66 , 114 , 115 ]. On the other hand, observed practices could be affected by the “Hawthorne effect” where the changes in a person’s behavior may be due to the presence of an observer.

In this research, inconsistencies between self-reported and observed practices were detected by [ 106 ], with 95% being the self-reported rate of washing hands and 82.5% for keeping hair covered with a cap; however, the observations showed only 50% and 17.5% of compliance, respectively. For studies assessing practices thorough observations, evaluation was mainly done using a checklist [ 38 , 97 , 98 , 99 , 116 ].

The implementation of food safety and hygiene practices has the final objective of preventing foodborne illnesses. Food safety behaviors are often subdivided into specific behavioral constructs such as personal hygiene, adequate cooking of foods, avoiding cross-contamination, keeping foods at safe temperatures, and avoiding food from unsafe sources [ 117 ]. Behavior outcomes provide a more direct measure of intervention effectiveness compared to knowledge and attitudes [ 66 ]; however, food safety practices were measured in only 16 out of the 31 studies. This is consistent with the proportions reported by Viator et al. [ 107 ]. Moreover, an integrative review conducted by Zanin et al., [ 118 ] stated that 50% of the selected studies reported no translation of knowledge into attitudes/practices. In this review, we found evidence of close to 25% translation into both attitudes and practices. In addition, food safety practices of food handlers are associated with the type of management, i.e., tending to be higher in corporate-managed than owner-operated [ 31 ]. Incorporating practical assessment, such as observations, could help owner-operated organizations, since in some cases observation is more important than self-reported practices in order to represent actual behaviors [ 99 , 119 ].

4.1. Food Safety and Hygiene Training

Overall, all nine food safety training interventions that incorporated theory and practice (T&P) demonstrations were more effective in terms of knowledge gain than those that only incorporated theoretical training. This is consistent with [ 83 ], who found that training that incorporated active participation was more effective than traditional passive instruction. Nevertheless, those studies reporting T&P presented a poor improvement in attitude [ 85 , 86 ]. Finally, the seven and eleven interventions based on T&P and theory, respectively, showed similar practice improvement in 71% and 80% of the studies, respectively.

Although the ultimate goal is to prevent foodborne diseases, no study reported an impact on this goal. As expected, the results were based around the change in KAP as a mean to avoid food safety risk. Thus, theoretical training based on KAP is commonly used to improve handlers’ food safety performance [ 106 ]. However, some authors have reported flaws, mainly in the assumption that the received information is translated into practices and behaviors [ 100 , 103 ].

Food safety and hygiene are critical in all steps in the farm-to-fork chain. In an ideal scenario of the farm-to-fork continuum, a total absence of foodborne pathogens and opportunistic bacteria is obviously desired [ 120 ]. Nevertheless, despite good knowledge, attitude, and self-reported practices, there may be poor performance in hygiene [ 121 ] and food safety practices. Bacteria might exist in nature in a range of different metabolic stages, such as dormant, active, and growing; thus, it is important to detect bacteria and ascertain whether they are potentially active [ 120 ]. Despite the central role that food workers’ hands play in bacterial transfer among food and various surfaces [ 81 ], only one study assessed the number of bacteria growing on cultures obtained from the hands [ 86 ], while another demonstrated cross-contamination with hand hygiene sessions using GloGerm ® powder and UV light [ 91 ]. Both studies showed improved knowledge of food handlers. Similarly, it is well known that an effective way to control food poisoning is to maintain hygienic surroundings [ 103 ]. Thus, additional evaluations and inspections including surface cleanliness and hand cultures seem to be a suitable part of training [ 122 ]. Similarly, frequent practical and hands-on sessions will create a much more vivid experience for workers [ 83 , 89 , 91 ]. Active learning, e.g., a training session that raises awareness of the possibility that E. coli bacteria may accumulate under the fingernails should also demonstrate the correct handwashing procedure and require the learner to practice until he or she can successfully demonstrate effective performance of that procedure [ 85 ].

Also, risk perception acts as a guide for decisions about behavior and can be a barrier to following a particular activity or procedure or not [ 123 ]. In this regard, there are different approaches to food safety training. Some include cases of victims of food poisoning [ 91 ] during food safety training to connect with audiences’ lifestyles, incorporate fear, and enhance the perception of risk [ 58 ]. Moreover, to be effective, training programs should be based on appropriate adult education theory [ 124 ], the possibility of human error [ 125 ], and make sure that the reading comprehension level of the text is suitable for most food handlers [ 9 ]. Training programs that are more closely associated with a worksite are potentially more effective, especially if supported by practical reinforcement of the message [ 85 , 126 ].

The frequency [ 51 ] and length of exposure [ 127 ] for a training program are significative factors in the obtained outcome. For studies reporting the length of intervention, the majority were conducted in one day with a follow-up period between 2 and 8 weeks, with 1 year being the longest follow up period [ 82 ]. Moreover, because knowledge decreases over time [ 5 ], food safety and hygiene training should be provided frequently [ 51 ] to prevent the information from being forgotten and also to increase the level of knowledge [ 86 ]. Some studies suggest refresher retraining after 2 years [ 108 ] and before 5 years from initial certification [ 5 ]. For food establishments, we found that the educational level and professional training have significant effects on knowledge, practice [ 49 , 98 ], and food handlers’ positive attitudes [ 49 , 103 ]. However, the inclusion of adult education concepts, skill-based programs with interconnected sessions [ 85 ], and even the use of YouTube ® videos [ 91 ] can be effective for low literacy audiences. In this regard, farm employees with low educational attainment have also demonstrated significant knowledge gain [ 85 , 91 ].

Commitment and motivation from supervisors and management, as well as proper support and facilities given to staff are critical for the success of food safety and hygiene intervention. Training moves people in the right direction but not far enough [ 88 ]. In this regard, food handlers’ attitudes are significantly related to the management environment [ 31 ], thus supervisory support enforcement plays a significative role [ 85 ] in demonstrating and emphasizing the importance of following proper food safety practices [ 88 ], as well as being role models themselves [ 91 ]. Moreover, because transforming knowledge into behavior is complex, training from top management to all employees is crucial [ 128 ], inasmuch as successful food safety intervention must be based on firm theories [ 99 ]. Furthermore, additional key factors are the supervisors’ years of experience [ 5 ], clear responsibilities of food managers, and written agreement related to practicing sanitization procedures [ 99 ], as well as trained and certified managers helping to reduce critical food safety violations [ 129 ].

In terms of settings, most of the studies were carried out in restaurants and street food establishments, hospitals and schools, greenhouses and farms, and industrial food processing companies. This is in accordance with a previous study which found that the most frequently reported settings were restaurants and street food establishments [ 58 ]. In this context, the restaurant industry has been labeled as one of the most recurrent sources of foodborne illness outbreaks [ 130 ]. Therefore, food safety certification of kitchen managers appears to be a significant factor in outbreak prevention in restaurants [ 131 ]. A combination of inspection results with a mandatory training and certification program may mitigate food safety risks [ 132 ].

Many barriers and factors (environmental, social, cultural, belief systems, and so on) can affect whether food handlers effectively implement food safety practices in their workplaces [ 30 , 31 , 122 , 133 ], including a lack of adequate food safety training, time pressure, competing job tasks, lack of or inconvenient locations of equipment/resources, lack of managerial support, lack of motivation/incentive, lack of reminders, or lack of clarity in food safety messages [ 25 , 90 , 98 , 122 , 134 , 135 , 136 ]. As expected, studies from developing countries have experienced some fundamental barriers, including a lack of infrastructure, poor working conditions, ill-functioning equipment, a lack of water, and insufficient supervision [ 89 , 93 ]. Interestingly some studies from developed countries have experienced some limitations regarding literacy [ 94 ] and a potential language barrier [ 83 ], mainly because food handlers were not native speakers.

Regarding the training interventions among the selected studies, 27% were based on international guidelines (including WHO, HACCP, GMP, and ServSafe ® ), 18% on national guidelines, 18% on previous studies, and the remaining studies did not report this information. The guidelines vary by sector (restaurants, meat industry, dairy industry, etc.), legislation, or requirements of the country or region in which a company is located, market conditions, and certifications. Despite the frequent food-related incidents attaching great importance to the certification system [ 137 ], only 41% of the included studies awarded some national or international certification for food handlers. High costs could discourage companies from implementing certifications. In this sense, local governments should support organizations [ 137 ], mainly those that rarely invest in training or certification. A powerful way to win the interest of politicians and policy makers is to be able to attach a monetary value to food-related illness [ 138 ]. In this regard, the overall annual estimated cost of foodborne illness has remained relatively constant since 2005 at approximately GBP 1.5 billion in England and Wales and 152 billion USD in the USA [ 138 ]. Even though regulations and voluntary certifications are commonly thought of as driving forces to improve the safety and quality of food products [ 137 ], legislation might lead food handlers to undergo training only for certification without being motivated to acquire and use new knowledge [ 97 ]. A study found that the number of food safety violations did not differ as a function of certification [ 129 ]. Thus, certifications and legal requirements may not guarantee food safety [ 139 ].

4.2. Limitations

Our study has several major limitations. Firstly, differences in data (settings and data collection/processing approaches) and the multi-component nature of food safety and hygiene training makes it difficult to generalize the results. Second, most studies used observational pre–post designs. As a result, the absence of matched comparison groups, the potential presence of confounding variables, and the lack of randomization prevented the reported outcome improvements from being causally linked to the interventions. Third, the evaluation of KAP limited our ability to make conclusions about the behavior of the food handler. Fourth, knowledge, attitude, and practice are often subdivided into specific constructs; however, our ability to investigate these concepts in detail was limited by the availability and reporting of primary research, as many studies only reported overall scores or scales. Moreover, the determination of workers’ behavior using the self-reported technique before education was an important limitation in some included studies. Finally, there is a possibility that the “Hawthorne effect” led to the improvements reported in the studies.

5. Conclusions

Foodborne diseases continue to be a global problem, causing substantial morbidity and mortality and significant costs. According to our results, food safety and hygiene training have positive impacts on food handlers’ knowledge, attitude, and practice. Effective and frequent food safety training of food handlers continues to be an initial step in ensuring that food safety concepts are at least introduced. Despite knowledge being delivered by training, it cannot just be translated into desired changes in attitudes and practice. The inclusion of practical demonstration and continuous support might increase positive attitudes towards food safety and hygiene practices among food handlers with the ultimate goal of minimizing the incidence and prevalence of foodborne hazards. Moreover, effective food safety training should be relevant to the situation, promote active learning, increase risk perception, and consider the work environment. Because computer-based (CB) training was not found to differ from face-to-face training in terms of the outcome obtained, CB programs could be used more extensively, since they are an efficient and cost-effective way to educate staff.

In this regard, we identified several barriers to attaining proper food safety and hygiene practices, which should be considered by educators with appropriate adjustments according to the stage of the food supply chain, as well as the market, regional, and cultural characteristics. Similarly, training interventions should be based on international or national guidelines and adapted to different sectors, legislations, and certifications. Furthermore, local governments should support organizations, especially those that rarely invest in training and certification like SMEs, small farms, restaurants, or street food services. Finally, certifications and legal requirements may not guarantee food safety and hygiene, but when properly supported by resources, commitment, leadership, and a receptive management culture, food safety and hygiene practices may improve.

Acknowledgments

This study was supported by Mexico’s National Council of Science and Technology, the Programa para el Desarrollo Profesional Docente, para el Tipo Superior (PRODEP) Program and the Universidad Autónoma de Baja California.

Supplementary Materials

The following are available online at https://www.mdpi.com/2304-8158/9/9/1169/s1 , Table S1: PRISMA checklist, Data S1: Search strategy, Table S2: Geographical distribution of studies selected, Table S3: Distribution per year of studies selected, Figure S1: Funnel plot for knowledge, Figure S2: Funnel plot for attitude, Figure S3: Funnel plot for overall practice, Figure S4: Funnel plot for self-reported practice, Figure S5: Funnel plot for observed practice, Table S4: Risk of bias for randomized studies, and Table S5: Risk of bias for nonrandomized studies.

Author Contributions

Conceptualization, A.I.-R. and D.T.; methodology, D.T. and J.L.-R.; formal analysis, A.I.-R., D.T., J.L.-R., M.M.-A., and K.A.-S.; investigation, A.I.-R., D.T., Y.B.-L., and S.O.; writing—original draft preparation, A.I.-R., D.T., J.L.-R., and M.M.-A.; writing—review and editing, Y.B.-L., K.A.-S., and S.O.; supervision, D.T., Y.B.-L., K.A.-S., and S.O. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Environment and food safety: a novel integrative review

• Review Article
• Published: 25 August 2021
• Volume 28 , pages 54511–54530, ( 2021 )

Cite this article

• Shanxue Jiang 1 , 2 , 3 ,
• Fang Wang 1 , 2 , 3 ,
• Qirun Li 1 ,
• Haishu Sun 4 ,
• Huijiao Wang 5 &
• Zhiliang Yao   ORCID: orcid.org/0000-0001-5125-8245 1 , 2 , 3  

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Environment protection and food safety are two critical issues in the world. In this review, a novel approach which integrates statistical study and subjective discussion was adopted to review recent advances on environment and food safety. Firstly, a scientometric-based statistical study was conducted based on 4904 publications collected from the Web of Science Core Collection database. It was found that the research on environment and food safety was growing steadily from 2001 to 2020. Interestingly, the statistical analysis of most-cited papers, titles, abstracts, keywords, and research areas revealed that the research on environment and food safety was diverse and multidisciplinary. In addition to the scientometric study, strategies to protect environment and ensure food safety were critically discussed, followed by a discussion on the emerging research topics, including emerging contaminates (e.g., microplastics), rapid detection of contaminants (e.g., biosensors), and environment friendly food packaging materials (e.g., biodegradable polymers). Finally, current challenges and future research directions were proposed.

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Introduction

Environment and food safety have been two important topics in the world (Zhang et al. 2015 ; Bilal and Iqbal 2020 ; Liu et al. 2020b ; Song et al. 2020 ; Ye et al. 2020 ; Qin et al. 2021 ). Human activities have posed great threats on environment and food safety. For example, due to the intensive use of disposable masks which are mainly made of non-biodegradable polymers, massive amount of waste is produced. In fact, environment and food safety are closely intercorrelated (He et al. 2016 ; Sagbara et al. 2020 ). As shown in Figure 1 , on the one hand, food safety is strongly affected by environment (Lu et al. 2015 ). Contaminants from polluted soil, water, and air could migrate into crops, vegetables, fish, animals, and so on (Lu et al. 2015 ; Sun et al. 2017 ; Li et al. 2020a ). On the other hand, in order to ensure food safety and quality, various processing procedures are carried out, which increase the burden on the environment and even cause environmental pollution (Yao et al. 2020 ). For example, food processing industry produces a huge amount of wastewater (Li et al. 2019 ; Ahmad et al. 2020 ; Akansha et al. 2020 ; Boguniewicz-Zablocka et al. 2020 ). If the wastewater is discharged into rivers directly, the rivers will be polluted. As food industry wastewater typically contains high concentrations of organic matters, eutrophication can easily take place (Feng et al. 2021 ; Jiang et al. 2021 ). In addition, food packaging materials are widely used as food containers and to preserve food from decay (Vitale et al. 2018 ; Wohner et al. 2020 ; Zeng et al. 2021 ). When the food is consumed, a mass of packaging waste is produced, which will cause environmental problems if not disposed properly (Poyatos-Racionero et al. 2018 ; Bala et al. 2020 ; Brennan et al. 2020 ; Liu et al. 2020a ). However, plastics, as one of the most commonly used packaging materials, cannot be disposed easily and can exist in the environment for hundreds of years (Barnes 2019 ; Chen et al. 2021b ; Mulakkal et al. 2021 ; Patrício Silva et al. 2021 ).

Illustration of the relationship between environment and food safety and their impacts on human health

Environment and food safety have strong impacts on human health (Fung et al. 2018 ; Gallo et al. 2020 ). Many studies are conducted to investigate the migration of contaminants from the environment to food, and finally to human beings. For example, it is reported that heavy metals in the aquatic environment can migrate into fishes via bioaccumulation and bioconcentration (Baki et al. 2018 ; Korkmaz et al. 2019 ; Arisekar et al. 2020 ). When these polluted fishes are consumed, the heavy metals will migrate into human bodies (Saha et al. 2016 ; Gholamhosseini et al. 2021 ). Although the concentrations of heavy metals in the fishes are usually below the maximum allowed level (Velusamy et al. 2014 ; Safiur Rahman et al. 2019 ), the fact that humans are at the top of the food chain cannot be ignored. In other words, as there are various food sources for human beings, the heavy metals in our bodies could accumulate and finally reach a level that causes serious health risks, such as cancer (Badamasi et al. 2019 ; Yu et al. 2020a ). In addition to the common types of contaminants (e.g., heavy metals, pesticides, pathogen, particulate matter), there are also some emerging types of contaminants (e.g., microplastics, personal care products, pharmaceuticals), and more efforts are needed to study their effects on human health (Aghilinasrollahabadi et al. 2020 ; Li et al. 2020b ; Zhang et al. 2020 ).

Given the importance of environment and food safety, it is not surprising that a lot of related studies have been published, including many review studies. For example, Qin et al ( 2021 ) reviewed the effects of heavy metals in soil on food safety in China and discussed the sources (e.g., pesticides, fertilizers, vehicle emissions, coal combustion, sewage irrigation, mining) and remediation strategies (e.g., soil amendments, phytoremediation, foliar sprays). Suhani et al. (Suhani et al. 2021 ) reviewed the effects of cadmium pollution on food safety and human health with a focus on the mechanisms (e.g., cellular or molecular alterations). Deshwal et al. (Deshwal and Panjagari 2020 ) reviewed the effects of metal-based packaging materials on food safety and health issues (e.g., bisphenol A migration, metal migration, dissolution, blackening, and corrosion). Sun et al. (Sun et al. 2017 ) reviewed the relationship between air pollution and food security with a focus on the food system (e.g., the effect of agricultural policy on food security). However, most of these review studies only focus on certain subfields (Ayelign and De Saeger 2020 ; Endersen and Coffey 2020 ; Imathiu 2020 ; Nelis et al. 2020 ; Singh et al. 2020a ). In addition, most of these reviews are based solely on the subjective experiences of the researchers in the related fields. In the age of big data, it is necessary to give a timely update on the research of environment and food safety through objective data analysis. The scientometric-based statistical method provides a powerful tool to disclose research trends and progress on certain research areas through data analysis of published documents. However, although there are already quite a few scientometric studies on other research areas (Jiang et al. 2018 ; Li et al. 2018 ; Kamali et al. 2020 ; Khalaj et al. 2020 ; Zakka et al. 2021 ; Zeb et al. 2021 ; Ni et al. 2021 ), the scientometric studies on environment and food safety are very limited. Therefore, the aim of this study is to provide an integrative review on environment and food safety via objective statistical analysis coupled with subjective review on strategies to protect the environment and ensure food safety, followed by a discussion on emerging research topics.

A scientometric review

As shown in Figure 2 , during the past 20 years, there were nearly 5000 publications on the topic of environment and food safety (detailed method was provided in the Supplementary Information ). From 2001 to 2020, there was a steady increase in publications every year. Meanwhile, it was indicated that the increase in research output slowed down in 2020, possibly due to the terrible coronavirus pandemic which suspended researchers’ lab work. In terms of document types, the 4904 publications were categorized into 10 types, where research article, review, and proceedings paper were the top three, accounting for 73.23%, 16.54%, and 13.09% of the total publications, respectively (Supplementary Table 1 ). In terms of languages, most of the documents were published in English, accounting for 96.76% of the total publications (Supplementary Table 2 ). The following languages were German (0.67%), Chinese (0.57%), Portuguese (0.43%), Spanish (0.41%), French (0.39%), etc. The language analysis revealed that a SCIE journal is not necessarily an English journal. For example, among the journals included in the data, the SCIE journal Berliner und Munchener Tierarztliche Wochenschrift publishes research results in German, and the SCIE journal Progress in Chemistry publishes research results in Chinese. To be available to researchers from all over the world, an English version of the titles, keywords, and abstracts of these publications are also provided. However, as the main text is not written in English, the impact of these publications is usually limited to the local research community, i.e., the papers written in German is normally only read by German researchers while the papers written in Chinese is normally only read by Chinese researchers.

Number of publications per year and cumulative number of publications from 2001 to 2020

In terms of journals, about 165 journals published at least 5 papers, and the total papers published in these journals accounted to about half of the total publications (more details are provided in supplementary data ). Furthermore, as shown in Figure 3 , the total papers published in the top 20 most publishing journals accounted to about one-fourth of the total publications. These results revealed that the research on environment and food safety is of broad interest.

Number of publications and cumulative percentage of the top 20 most publishing journals

In terms of publishing countries/regions, more than 100 countries/regions contributed to these publications (more details are provided in supplementary data ). Especially, more than 50 countries/regions contributed at least 20 publications to the research on environment and food safety during the past 20 years. These results again revealed that the research on environment and food safety is of global interest. As shown in Figure 4 , in terms of research output, the USA and China were leading the research on environment and food safety. Specifically, among the countries/regions, the USA was undoubtedly the most publishing country, which accounted for nearly one-fourth of the total publications. The runner-up was China, which contributed to around 15% of the total publications. However, it does not mean that the USA and China have contributed to around 40% of the total publications because many papers are published as a result of collaborations among several countries.

Number of publications and corresponding percentage of the top 20 most publishing countries/regions

Generally, over 400 research institutes had contributed at least 5 publications to the research on environment and food safety, and nearly 50 research institutes published at least 20 papers during the past 20 years (more details are provided in supplementary data ). The top 20 most publishing research institutes were summarized in Table 1 . Chinese Academy of Sciences (CAS), which ranked the first place based on number of publications, is the largest cluster of research institutes in China. The research conducted by CAS is quite diverse and multidisciplinary. Especially, the research on environment and food safety is loosely conducted by different CAS research institutes, including but are not limited to Research Center for Eco-Environmental Sciences (RCEES), Institute of Urban Environment, and Institute of Soil Science. For example, researchers from RCEES found that water pollution and soil pollution had serious effect on food safety and human health (Lu et al. 2015 ). The next one, USDA ARS, short for United States Department of Agriculture Agricultural Research Service, is a leading research institute in the USA focusing on food safety and human health from the aspect of agriculture. Similarly, US FDA is short for United States Food and Drug Administration and is exclusively focusing on food and drug-related research so as to protect public health. INRA, short for French National Institute of Agronomic Research, is a very famous research institute in Europe focusing on agricultural research. Similarly, Istituto Superiore di Sanità is a leading research institute in Italy focusing on public health. In addition to the above 5 research institutes, the remaining 15 research institutes are all universities, and their research on environment and food safety is mainly conducted by the related departments or research centers of the universities. For examples, the Department of Food Technology, Food Safety and Health at Ghent University (located in Belgium) is renowned for its state-of-the-art research on food technology, food microbiology, food chemistry, food safety, etc. Similarly, Wageningen University (located in Netherlands) has a research institute named Wageningen Food Safety Research. Another two European universities were both from Denmark, namely University of Copenhagen and Technical University of Denmark. The Department of Food Science at University of Copenhagen and the National Food Institute at Technical University of Denmark are mainly responsible for food-related research. Besides, there were also two universities from China (i.e., China Agricultural University and Zhejiang University) and one university from Canada (i.e., University of Guelph). The remaining 8 universities all came from the USA, accounting for over half of the universities in the top 20 most publishing research institutes, which corresponded well with the above countries/regions analysis.

Table 2 summarized the top 20 most-cited articles on environment and food safety. As revealed by Table 2 , the research on environment and food safety is diverse, and there are quite a few research directions which received a lot of attention. Generally, the research topics disclosed by the most cited papers included food inspection/detection technique, heavy metal pollution, food additives, food packaging, food allergy, food pesticide, foodborne pathogen and diseases, microplastics, food processing, and production. Various food inspection/detection techniques have been reported, including electrochemical strategies to detect gallic acid in food (Badea et al. 2019 ), thermal imaging technique coupled with chemometrics (Mohd Ali et al. 2020 ), paper-based analysis device for rapid food safety detection (Qi et al. 2020 ), line-scan spatially offset Raman spectroscopy technique for subsurface inspection of food (Qin et al. 2017 ), surface-enhanced Raman spectroscopy for detection of mycotoxins in food (Wu et al. 2021b ), chromatography, and mass spectrometry (Pauk et al. 2021 ; Suman et al. 2021 ). In addition, heavy metal pollution has posed great threats on food safety, and a lot of studies are conducted, including the soil heavy metal pollution and food safety (Qin et al. 2021 ) and the impacts of various heavy metals (e.g., cadmium, lead, arsenic) on food safety and human health (Corguinha et al. 2015 ; Suhani et al. 2021 ). Furthermore, there are a variety of food additives used in different situations. For example, feed additives such as antibiotics have been used in animal nutrition; however, the use of antibiotics can cause antimicrobial resistance which can further increase the morbidity and mortality of diseases (Silveira et al. 2021 ). Therefore, as will be discussed below, laws and regulations are needed to strictly control the use of food additives. Furthermore, foodborne pathogen also has strong impacts on food safety. As an effective way to kill or inhibit foodborne pathogen, antimicrobial food packaging is gaining growing research interest in recent years (Woraprayote et al. 2018 ; Motelica et al. 2020 ; Alizadeh-Sani et al. 2021 ).

TC , total citations; the TC data was collected based on Web of Science core collection; PY , publishing year

As shown in Supplementary Figure 1 and Supplementary Figure 2 , food, safety, and environment were the top three most common words in titles. The following ones were assessment, health, risk, and environmental. It is well known that environmental pollution can pose risks on food safety and finally threatens human health. A further analysis revealed that a lot of studies were related to risk assessment, such as risk assessment of antimicrobial resistance (Likotrafiti et al. 2018 ; Pires et al. 2018 ), risk assessment of heavy metals (Yasotha et al. 2020 ), risk assessment of pesticide (Frische et al. 2014 ), risk assessment of veterinary drugs (Tsai et al. 2019 ), environmental risk assessment (More et al. 2020 ), and health risk assessment (Akhbarizadeh et al. 2020 ). The next one was efficacy, which was usually combined together with safety, such as safety and efficacy of feed additives (Bampidis et al. 2020 ). Besides, Listeria monocytogenes was intensively studied by researchers (Anast et al. 2020 ; Kawacka et al. 2020 ; Wu et al. 2020b ). Another common word was analysis, such as analysis of herbicide (Pan et al. 2020 ), analysis of bacteria (Kang et al. 2020 ), and analysis of microplastics (Primpke et al. 2020 ). Other common research topics revealed by title analysis included but are not limited to food quality, food production, food processing, food additive, food contamination, detection of food contaminants, food microbiology, environmental impact, as well as water, soil, animal, fish, meat, and dairy.

The top 20 most used keywords were listed in Table 3 (more details are provided in supplementary data ). It could be seen that microbiology was closely related to food safety, and a lot of studies were conducted on Listeria monocytogenes, biofilm, salmonella, and antibiotic resistance. In addition, additives, such as zootechnical additives and nutritional additives, were also intensively investigated by researchers. Other topics included aquaculture, poultry, and agriculture. Another keyword worth mentioning was food security. Food security is different with food safety. Briefly, food security is a more inclusive term and focuses more on the availability of food while food safety is about the quality of food. On the other hand, food security and food safety are closely related to each other (Vipham et al. 2020 ). For instance, if food security becomes a big issue, then usually food safety is not guaranteed, and vice versa. Generally, the results revealed by keywords analysis were in consistent with the above title and keywords analysis.

The keywords network graph revealed some interesting results. As shown in Figure 5 , the network had three centers, namely the “ food safety ”-centered network, the “ safety ”-centered network and the “ efficacy ”-centered network. Interestingly, the “ safety ”-centered network and the “ efficacy ”-centered network were closely related, while they were relatively unrelated with the “ food safety ”-centered network. Furthermore, the results again uncovered that food safety involved many aspects, many of which were already discussed above.

Keywords network graph. Keywords whose cooccurrence exceeded 10 times were connected with lines

The publications in this study were divided into over 200 Web of Science categories (more details are provided in supplementary data ). The top 20 Web of Science categories were shown in Figure 6 . Undoubtedly, the Food Science & Technology category ranked the first place, followed by the Environment Sciences category. As revealed by Figure 6 , food safety was closely related to microbiology, chemistry, and agriculture. Microorganisms such as foodborne pathogens pose great threats on food safety and a lot of studies are focusing on it. For instance, Lin et al (Lin et al. 2021 ) studied the role of Salmonella Hessarek, an emerging foodborne pathogen, in egg safety. Anyogu et al. (Anyogu et al. 2021 ) reviewed the microorganisms and indigenous fermented foods with a focus on microbial food safety hazards. Van Boxstael et al. ( 2013 ) studied the impacts of bacterial pathogens and viruses on food safety in the fresh produce chain. Also, a lot of studies are focusing on food safety and chemistry, such as untargeted food chemical safety assessment (Delaporte et al. 2019 ), chemical safety of recycled food packaging (Geueke et al. 2018 ), and chemical food safety hazards of sausages (Halagarda et al. 2018 ). Furthermore, studies on food safety and agriculture include but are not limited to chemical and biological risks in urban agriculture (Buscaroli et al. 2021 ), biosensors for sustainable agriculture and food safety (Griesche and Baeumner 2020 ), agricultural soil contamination, and the impact on food safety (Wang et al. 2019b ). In addition, the Materials Science category was also on the top list, which indicated that materials are also important research directions in environment and food safety. A further analysis revealed the common materials studied by researchers, including biomaterials, food packaging materials, biodegradable materials, coating materials, sensors and biosensors for food detection, and nanoparticles. The research area analysis showed similar results with Web of Science categories (Supplementary Table 3 ).

Number of publications and corresponding percentage of the top 20 Web of Science categories

Strategies to protect environment and ensure food safety

The above scientometric analysis revealed that the studies on environment and food safety were diversified and multidisciplinary. Further analysis of the above results disclosed the challenges and strategies to protect environment and ensure food safety. As discussed earlier, environment and food safety are closely related to each other. It should be noted that the environment here is not limited to the broad environment (e.g., air, water, soil) which the public are familiar with. In other words, in addition to the broad environment, there are also food-related environments which exist in various processes, including but are not limited to food processing, food packaging, food transportation, food storage, and food consumption. In order to ensure food safety, contaminants/pollutants from the environmental side should be prevented from reaching the food side. An example of food chain pollution control is presented in Figure 7 . It can be seen that from growing wheat to making bread, there are a variety of processes which could cause pollution and control strategies are needed, which are summarized as follows. Firstly, from wheat growing to wheat harvesting: the pollutants/contaminants could be taken in or migrate into the wheat via contaminated soil, water, and air, and therefore strategies are needed to prevent soil, water, and air from being contaminated, such as reducing the use of pesticides and fertilizers. Secondly, initial processing of wheat: after the wheat is harvested, traditionally it needs to be dried by the farmers before it is sold. During this process, contamination can easily occur if the wheat is dried directly on the road which is common in rural China. In addition, the containers of the harvested wheat are also sources of pollution which should be carefully controlled. Alternatively, the pollution can be avoided if the wheat is directly sold and transported to the flour mill from the farm without being dried by the farmers. Thirdly, during the transportation processes (e.g., from farm to flour mill, from flour mill to bread bakery, from bread bakery to supermarkets), contamination can also take place and control strategies are needed. Fourthly, during the wheat processing at the mill and bread baking at the bakery, contamination can take place due to environment exposure, insufficient frequency and quality of facility washing and cleaning, use of additives, etc. Fifthly, during the bread packaging process, the workers can be an important source of bread contamination if the bread is packed manually. Finally, when the consumers buy the bread and do not consume the bread timely, the bread can decay. Based on the above discussion, the food chain pollution control can be generally categorized into the following sections: source pollution (i.e., soil, water, air) control, pollution control during food processing, pollution control during food packaging, pollution control during transportation, pollution control during storage, and pollution control during consumption.

Demonstration of the whole food chain pollution control from wheat growing to bread consuming

Especially, based on the type of chemicals, the contaminants/pollutants can be categorized into pesticides and herbicides, heavy metals, food additives, pathogens, microplastics, antibiotics, and so on (Van Boxstael et al. 2013 ; Tóth et al. 2016 ; He et al. 2019b ; Rajmohan et al. 2019 ; Bonerba et al. 2021 ). Therefore, the corresponding strategies are to control the use of chemicals and materials which can produce these contaminates. For example, as will be discussed in the following section, microplastics come from the wide use of plastics and are receiving growing concern. In order to reduce the amount of microplastics, the use of plastics should be controlled or restricted. Based on the media of migration, these contaminants can reach at the food side via air, water, and soil. Therefore, the corresponding strategies are to remove contaminants from air, water and soil. Alternatively, strategies can be deployed to prevent these contaminants from contacting the food. For example, as will be discussed later, food packaging is a common strategy to protect food from being contaminated by the environment (Risyon et al. 2020 ). To sum up, by controlling the sources and migration routes of food contaminants, food safety can be improved. Furthermore, in order to ensure food safety, whole process monitoring techniques and platforms are necessary. A lot of studied have been conducted on food safety monitoring. For example, De Oliveira et al. ( 2021 ) proposed that environmental monitoring programs (EMPs) are necessary to ensure food safety and quality. The EMPs are used to prevent environmental contamination of the finished product, via checking the cleaning-sanitation procedures, and other environmental pathogen control programs with a range of sampling analysis. Medina et al. (Medina et al. 2019 ) proposed food fingerprints as an effective tool to monitor food safety. Weng et al. (Weng and Neethirajan 2017 ) reviewed microfluidics as an effective method to realize rapid, cost-effective, and sensitive detection of food contaminants such as foodborne pathogens, heavy metals, additives, and pesticide residues. Other monitoring methods/techniques/devices include but are not limited to pH-sensitive smart packaging films (Alizadeh-Sani et al. 2020 ), point-of-care detection devices (Wu et al. 2017 ), and real-time pathogen monitoring via a nanotechnology-based method (Weidemaier et al. 2015 ). Food safety monitoring can be done by either government officials or the relative bodies (e.g., self-monitoring), or both. Furthermore, from the time the food raw materials are being cultivated in the farmland, pasture, fishing ground or other places, to the time the food is being consumed by customers, inspecting and detecting should be deployed. This can be done by the government officials and/or the stakeholders. Although the term “inspection” and “detection” are often used as the same, here, food safety inspection is regarded as an administrative strategy, which is carried out by governmental officials to check whether the relative workers/factories/bodies have followed the food safety requirements/regulations, while food safety detection is regarded as a technique-based strategy, which is used to detect food contaminants and check whether the quality of the food meets the relative standards. Meanwhile, food safety laws need to be enacted to discourage or prevent the relative workers/factories/bodies from affecting the food safety, whether purposely or not.

On the other hand, during the process of food production, the environment can be polluted as well. For example, in order to increase crop yield, a lot of fertilizers are used, which will migrate into the soil and water bodies, and cause soil and water pollution. Therefore, the use of fertilizers should be restricted, which can be realized through agricultural innovations (Liu et al. 2021 ), government policies (van Wesenbeeck et al. 2021 ), etc. Furthermore, during food processing, a large amount of solid waste or/and wastewater are produced which can cause environmental pollution. Therefore, techniques are needed to dispose the food waste properly. Especially, food waste usually contains high amount of organic compounds and therefore falls into the category of biomass, which can be used to produce useful biochemicals like biofuels (Wainaina et al. 2018 ; Chun et al. 2019 ). For example, agro-food waste is an important source of lignocellulosic biomass; the valorization of lignocellulosic biomass is regarded as a sustainable source of energy and has the potential to replace conventional fossil fuels (Ong and Wu 2020 ; Lee and Wu 2021 ; Lee et al. 2021 ; Mankar et al. 2021 ; Zhenquan et al. 2021 ). Furthermore, the concepts of recycling and sustainable development can be deployed. For example, food packaging materials can be recycled and used again. Another example is to use cloth bags to replace plastic bags when shopping. These strategies can reduce the burden on the environment as the amount of food-related waste can be reduced. In addition, novel environment-friendly materials (e.g., biodegradable polymers) can be developed and used in food industries (Stoica et al. 2020 ; Cheng et al. 2021 ). To summarize, the above strategies to protect environment and ensure food safety are presented in Figure 8 .

Emerging studies on environment and food safety

Scientometric analysis is powerful in disclosing the research trend and is relatively subjective compared to conventional type of review. However, as it is essentially a statistical study which relies on a huge amount of data, it is less effective to reveal the emerging research directions which could be ignored in the scientometric study. Therefore, it is necessary and important to carry out a subjective discussion on emerging studies on environment and food safety as an indispensable supplement (Figure 9 ).

Emerging contaminants

There are various contaminants affecting environment and food safety. Among the various types of contaminants, emerging contaminants, such as microplastics, are receiving growing concern due to their potential effects on human health (Sarker et al. 2020 ). Because of the wide application of plastics, microplastics are found almost everywhere in the environment, including soil, water, and air (Álvarez-Lopeztello et al. 2020 ; Chen et al. 2020 ; Wang et al. 2021c ). For example, microplastics are reported to exist in bottled water (Zhou et al. 2021 ) and take-out food plastic containers (Du et al. 2020 ). Furthermore, researchers have found that microplastics could serve as the carrier for many other contaminants such as heavy metals and antibiotics (Zhou et al. 2019 ; Purwiyanto et al. 2020 ; Yu et al. 2020b ). Studies reveal that the ability to absorb heavy metals increase as the microplastics age (Lang et al. 2020 ). As a result, the risks of microplastics on environment, food safety, and human health could be significantly increased. However, the research on microplastics is still at an early stage, and more efforts are needed to uncover the world of microplastics. For example, there is no standard procedures to extract, identify, and quantify microplastics so results by different methods could be different and uncomparable (Kumar et al. 2020 ; Zhou et al. 2020 ). Meanwhile, due to the various sizes, shapes, forms, sources, and types of microplastics, it is difficult and time-consuming to characterize microplastics (Wu et al. 2020a ). Therefore, it is important to develop new methods for rapid and effective detection of microplastics (Li et al. 2020c ).

In addition to microplastics, there are other emerging contaminants which can have negative effects on the environment, food safety, and human health. These emerging contaminants include but are not limited to persistent organic pollutants (Titchou et al. 2021 ), antibiotics (Koch et al. 2021 ), personal care products (Scaria et al. 2021 ), pharmaceuticals (Chaturvedi et al. 2021 ), endocrine-disrupting compounds (Kasonga et al. 2021 ), and non-nutritive artificial sweeteners (Praveena et al. 2019 ). More research efforts are needed to gain a better understanding of the migration, degradation, accumulation characteristics, as well as the potential risks of these contaminants.

Rapid detection of contaminants

Not limited to the detection of microplastics, it is also necessary to develop rapid detection methods for common contaminants. For example, due to the widespread application of pesticides in agriculture, pesticide residue is becoming a serious environment and food safety issue (Farahy et al. 2021 ). Traditionally, food contaminants are detected by instrumental analysis, such as chromatography and mass spectrometry (Ye et al. 2019 ). However, the instrumental analysis process is expensive, complicated, and time-consuming (Zhang et al. 2019 ). Furthermore, the contaminants are usually in low concentration, but can accumulate gradually in human bodies via bioconcentration. Therefore, it is important to develop rapid method to detect trace-level concentration of food contaminants. Biosensor is an emerging and promising technology in detecting food contaminants such as pesticides, and a variety of biosensors have been developed in recent years (Majdinasab et al. 2018 , 2019 ). For example, Ouyang et al. (Ouyang et al. 2021 ) developed a sensitive biosensor to detect carbendazim pesticide residues based on luminescent resonance energy transfer from aptamer-labelled upconversion nanoparticles to manganese dioxide nanosheets. Capobianco et al. (Capobianco et al. 2021 ) developed an enzyme-linked immunoelectrochemical biosensor to detect pathogenic bacteria in large volume food samples without subsampling. Wang et al. (Wang et al. 2019a ) developed a magnetic quantum dot-based lateral flow biosensor to detect protein toxins in food samples. Kaushal et al. (Kaushal et al. 2019 ) developed a novel biosensor using gold nanorods capped by glycoconjugates which demonstrated potential in optical detection and ablation of foodborne bacteria. Generally, a biosensor is mainly composed of a biological sensing element (also known as bioreceptor), a transducer, and an electrical output system (Santana Oliveira et al. 2019 ; Majdinasab et al. 2021 ). The bioreceptor will interact with the analyte, and the transducer will convert the interaction into a detectable signal, which is then processed and displayed on the output system. Common materials used in the biological element include antibodies, enzymes, nucleic acids, antigens, aptamers, whole cells, and bacteriophage (Arora et al. 2011 ; Rotariu et al. 2016 ; Griesche and Baeumner 2020 ; Singh et al. 2020b . Biosensor technology has obvious advantages compared to traditional detection technologies. It is rapid, highly sensitive and selective, accurate, relatively compact, and easy to operate (Dominguez et al. 2017 ). However, there are still some challenges to widely commercialize biosensors, such as limited lifetime of the biological sensing elements and limited range of analytes that can be detected (Di Nardo and Anfossi 2020 ). Furthermore, as a specific type of biosensor is only effective in detecting a specific type of contaminant, more efforts are needed to develop integrated biosensors which can detect different types of containments simultaneously (Majdinasab et al. 2020 ). In addition to biosensors, there are also a variety of other reported methods for rapid detection of food contaminants, such as surface-enhanced Raman scattering (SERS) (Yao et al. 2021 ), optical sensors based on nanomaterials (Chen et al. 2021a ), hyperspectral imaging technology (He and Sun 2015 ), and perfluorinated compounds (PFCs) (Cai et al. 2021 ).

Environment friendly food packaging materials

As revealed above, food packaging is closely related to food safety. Although there are different kinds of food packaging materials, the non-biodegradable plastic materials (e.g., polyethylene, polypropylene, polyvinyl chloride, polystyrene, polyethylene terephthalate) are the most common ones and are widely used in our daily life (Cazón and Vázquez 2021 ). However, the non-biodegradable plastic materials have caused serious environmental problems, commonly known as white pollution. Especially, because of the coronavirus pandemic, take-out food becomes more popular. As plastic materials are the most common packaging materials for take-out food, the demand for plastic materials increases dramatically. Meanwhile, plastic materials also have food safety issues. It is found that the monomer residues used to make plastic polymers could migrate into food, which could cause health problems (Pilevar et al. 2019 ). Especially, the migration rate is not only affected by the quality of these materials, but also affected by the food properties. In addition to monomer residues, additives in these plastic materials could also migrate into food, causing health risks (Hahladakis et al. 2018 ). For example, bisphenol A, a common additive used in plastics, can adversely affect human endocrine system, block normal cell function, affect thyroid hormone, affect testosterone levels, and could also possibly induce cancer (Huang et al. 2019 ; Vilarinho et al. 2019 ). Another very common additive in plastics is phthalates, which is used as plasticizer to soften the plastics. It is reported that phthalates in plastic bottles could migrate into water, and the amount of migration increases as the storage time increases (Luo et al. 2018 ). Similar to bisphenol A, phthalates can also disrupt human endocrine system and cause bad effects on human health (Wang et al. 2018 ). Not limited to bisphenol A and phthalates, there are many types of plastic additives which could migrate into food and cause food safety issues.

As the conventional non-biodegradable plastics can cause both environmental problems and food safety issues, a lot of studies are carried out to find alternatives to non-biodegradable plastics for food packaging. Biodegradable polymers are regarded as the one of the most promising alternatives for food packaging (Othman 2014 ). As its name indicates, biodegradable polymers can be decomposed by microorganisms. Common biodegradable polymers studied as food packaging materials include but are not limited to polylactic acid (PLA) (Swaroop and Shukla 2018 , 2019 ; Mohamad et al. 2020 ), polybutylene adipate terephthalate (PBAT) (Pattanayaiying et al. 2019 ), polysaccharides (such as starch (Osorio et al. 2019 ; Menzel 2020 ; Saraiva Rodrigues et al. 2020 ), cellulose (Balasubramaniam et al. 2020 ; Riaz et al. 2020 ), pectin (Nešić et al. 2018 ), chitosan (Haghighi et al. 2020 ; Priyadarshi and Rhim 2020 )), polyhydroxyalkanoates (PHAs) such as polyhydroxybutyrate (PHB) (Adeleye et al. 2020 ; Fernandes et al. 2020 ; Shahid et al. 2020 ), polycaprolactone (PCL) (Khalid et al. 2018 ; Mugwagwa and Chimphango 2020 ), and cellulose acetate (Xie and Hung 2018 ; Rajeswari et al. 2020 ).

However, in addition to high production cost, there are some critical technical challenges which must be solved so as to widely commercialize biodegradable polymers and replace conventional plastics (Pérez-Arauz et al. 2019 ). Generally, biodegradable polymers have low thermal stability, low mechanical stability, and poor barrier properties (Risyon et al. 2020 ). One way to improve its performance is to add additives during production. For example, Risyona et al. (Risyon et al. 2020 ) prepared PLA-based film using different concentrations of halloysite nanotubes as additives. They found that the PLA film with 3.0 wt.% of halloysite nanotubes demonstrated optimal properties. Dash et al. (Dash et al. 2019 ) prepared starch and pectin-based film using different concentrations of titanium dioxide nanoparticles. They found that addition of the nanoparticles could effectively improve the mechanical properties and moisture barrier properties of the films. However, similarly to conventional plastics, these additives might also migrate into food (He et al. 2019a ). Another strategy being intensively studied is polymer blending, which integrates the merits of different polymers (de Oliveira et al. 2020 ). For example, Rajeswari et al. (Rajeswari et al. 2020 ) blended polysaccharides and cellulose acetate together, and the resulting film showed improved thermal stability and tensile strength. The prepared films also demonstrated antimicrobial properties towards certain types of microorganisms. Sangroniz et al. (Sangroniz et al. 2018 ) blended poly(butylene adipate-co-terephthalate) with poly(hydroxi amino ether), and the resulting film showed great improvement of barrier properties. However, polymer blending could also have its drawback. For example, if the blending polymers are immiscible with each other, the mechanical strength and barrier properties of the resulting materials will be affected (Corres et al. 2020 ).

Conclusions, challenges, and future research directions

In this review, a scientometric-based statistical study was firstly conducted on the research of environment and food safety, which revealed that the research on environment and food safety was growing steadily from 2001 to 2020. Interestingly, statistical analysis of the most-cited papers, titles, abstracts, keywords, and research areas revealed that the research on environment and food safety is diverse and multidisciplinary. Furthermore, strategies to protect the environment and ensure food safety are discussed, such as controlling the use of chemicals and materials which can produce environment and food contaminates, preventing these contaminants from contacting the food, developing whole process monitoring techniques and platforms, and utilizing the food waste properly. In addition, emerging research topics are discussed, such as emerging contaminants, rapid detection of contaminants, and environment friendly food packaging materials.

Although environment and food safety are receiving growing concern, there are still some very challenging issues. These challenges can be categorized into four parts. Firstly, it is challenging to eliminate environmental pollutions (Hao et al. 2018 ; Christy et al. 2021 ). Air pollution, water pollution, and soil pollution are still serious environmental problems in many parts of the world (Wu et al. 2016 , 2021a ; Rajeswari et al. 2019 ; Shen et al. 2021b ). Although a lot of studies have been carried out, the mechanisms of some pollutions (e.g., haze weather) are still unclear (Shen et al. 2020 ; Wang et al. 2021a ). Secondly, it is challenging to dispose food waste effectively and efficiently. It is reported that a substantial amount of food waste is produced along the food supply chain (Aschemann-Witzel 2016 ; Li et al. 2019 ). Especially, food wastewater typically contains very complex components, and the treatment process is very energy intensive and costly. Thirdly, it is challenging to realize whole-process monitoring of contaminants, due to the diverse contaminants during food cultivation, processing, packaging, transportation, and retailing. Fourthly, the accurate effects of environmental pollution on human health are still unclear, and it is challenging to establish procedures to accurately assess the risks of environmental pollution on human health. For example, it is well reported that ozone pollution and PM2.5 pollution can cause negative effects on human health (Guan et al. 2021 ; Shen et al. 2021a ; Wang et al. 2021b ). However, the underlying mechanisms, accurate assessment procedures, and quantitative studies are still lacking. In order to address these challenges, more research efforts are needed to (1) uncover the underlying mechanisms of contaminant formation, migration and fate; (2) develop more cost-effective and sustainable food waste treatment and utilization technologies, targeting net zero emissions; (3) develop rapid detection methods and in situ monitoring technologies for environment and food safety; and (4) establish health risk assessment models and procedures.

Data availability

All data generated or analyzed during this study are included in this published article.

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This work was supported by the Beijing Municipal Commission of Education (grant no. PXM2019_014213_000007) and School Level Cultivation Fund of Beijing Technology and Business University for Distinguished and Excellent Young Scholars (grant no. BTBUYP2020).

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School of Ecology and Environment, Beijing Technology and Business University, Beijing, 100048, China

Shanxue Jiang, Fang Wang, Qirun Li & Zhiliang Yao

State Environmental Protection Key Laboratory of Food Chain Pollution Control, Beijing Technology and Business University, Beijing, 100048, China

Shanxue Jiang, Fang Wang & Zhiliang Yao

Key Laboratory of Cleaner Production and Integrated Resource Utilization of China National Light Industry, Beijing Technology and Business University, Beijing, 100048, China

Department of Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China

School of Chemical and Environmental Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China

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Conceptualisation: SJ and ZY; methodology: SJ; writing—original draft preparation: SJ; writing—review and editing: FW, QL, HS, HW, and ZY; supervision: ZY; funding acquisition: ZY. All authors read and approved the final manuscript.

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Jiang, ., Wang, F., Li, Q. et al. Environment and food safety: a novel integrative review. Environ Sci Pollut Res 28 , 54511–54530 (2021). https://doi.org/10.1007/s11356-021-16069-6

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Article Contents

Publication overview, authorship and affiliation origins, keywords and sdg-related publications analysis, conflict of interest.

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Publication review of Food Quality and Safety during 2017–2022

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Tianle Xia, Chengcheng Gong, Jianlin Zeng, Publication review of Food Quality and Safety during 2017–2022, Food Quality and Safety , Volume 7, 2023, fyad062, https://doi.org/10.1093/fqsafe/fyad062

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Nowadays, food quality and safety are the main targets of investigation in food production. Therefore, reliable paths to detect, identify, quantify, characterize, and monitor quality and safety issues occurring in food are of great interest. To report on growing food researches in the field of food quality and food safety, Zhejiang University launched the journal, Food Quality and Safety (FQS), in 2017, co-published by Zhejiang University Press (China) and Oxford University Press (UK). The journal aims to provide a platform to highlight emerging and innovative science and technology in the agro-food field, publishing up-to-date research and serving as a unique complementary information center in the areas of food quality and safety, food nutrition and human health, including food material, food chemistry, food microbiology and safety, food engineering, and nutritional value, and to promote food and health equity which will consequently promote human health. As an open-access journal that can provide researchers an easy path to knowledge dissemination, readers and authors have free access to read and download the full texts of FQS publications ( Shen et al. , 2023 ). To visualize the publishing overview of FQS, we conclude the publication statistics in the perspectives of publication types, amount, authors, keywords and topics.

Over the past six years, FQS has become an effective channel of communication among food scientists, nutritionists, public health professionals, food producers, food marketers, policy makers, governmental and non-governmental agencies, and others concerned with the food safety, nutrition, and public health dimensions. During 2017–2022, FQS published 220 papers, including 153 research papers and 67 review papers ( Table 1 ). In the first three years, the annual publications were about 30 papers, with 6–8 papers per issue. When FQS was not included in influential international databases such as SCI-E, only a few high-quality research articles were attracted. Thus, the publications were mainly contributed by the editorial board and their invited contributions in the related academic circles, and most were review articles. In August 2020, FQS was officially indexed in the SCI-E database, and the number of submissions increased significantly from then on. While continuing to ensure high quality, the number of publications increased in the second year (2021). In 2022, the number of published papers reached 70, indicating an increase of 84% over the previous year. In addition, the proportion of research papers increased significantly from 2019, reaching 93% by 2022. It is worth noting that from 2021, FQS has published papers directly online without issues, which is a new measure to ensure a faster publication process from acceptance to formal publishing. That is, after acceptance, the accepted version of each manuscript will be published online in the ‘Advance articles’ section within three days.

Annual publications of FQS during 2017–2022

From 2017 to 2022, FQS has received more than 1000 submissions from all continents except Antarctica. Regarding authorship origins, China dominates with 114 publications, followed by 27 from the USA, 20 from India, 14 from Canada, 11 from Nigeria, and 9 from Brazil ( Figure 1 ). After counting author affiliations, it is found that because authors from China have published the most papers, among the top 10 affiliations, five are from China, namely Zhejiang University, which published 29 papers, others are Qingdao Agricultural University (eight), China Agricultural University (seven), and Chinese Academy of Agricultural Sciences (six). Regarding international affiliations, Agriculture and Agri-Food Canada, with eight papers, is ranked in third place among the top 10 affiliations, followed by Natural Resources Institute Finland Luke (seven), Prince of Songkla University (six), and California State Polytechnic University (five).

Top 20 author origins of the publications of FQS from 2017 to 2022.

By analyzing the keywords of the published articles, we found that the articles published in the first six years of FQS were all within the scope of the journal. The top five keywords are ‘Food’ (occurring>42 times), ‘acid’ (occurring>42 times), ‘fruit’ (occurring>28 times), ‘quality’ (occurring>23 times), and ‘safety’ (occurring>20 times) ( Figure 2 ). FQS did not organize any special issue initially. We recognize that FQS has a relatively broad scope, and organizing special issues can bring together the latest research on specific topics in a shorter time and attract specific readers in a faster time than regular submissions ( Li and Jiang, 2022 ). Thus, according to the research focus and the field of FQS authors, we organized two Special Issues, which published in March and September 2022, namely ‘Fruit Quality and Healthy Nutrition’ and ‘Microbial Food Safety’, respectively, with 10 high-quality research and review papers for each ( Feng and Ding, 2022 ; Li and Hu, 2022 ). In addition, since 2022, regarding the increasing amount of submissions year by year, to better and faster process the manuscripts in related fields, we set up a position named ‘Section Editor-in-Chief’ in the fields of food safety, food chemistry, food nutrition, food processing, postharvest technology, and food crossing field, and each field has two Section Editors-in-Chief.

Frequency of keywords used over 5 times during 2017–2022 in FQS. ‘Food’>42 times, ‘acid’>42 times, ‘fruit’>28 times, ‘quality’>23 times, and ‘safety’>20 times.

In 2015, the United Nations adopted ‘The 2030 Agenda for Sustainable Development’. Its heart is the 17 sustainable development goals (SDGs) that are a blueprint for a better and more sustainable future for all human beings. The SDGs address the global challenges we face, including those related to poverty, inequality, climate, environmental degradation, prosperity, and peace and justice ( UN, 2015 ). Among articles published in FQS during 2017–2022, as shown in Table 2 , eight of the 17 SDGs were covered, including 03 Good Health and Well Being, 02 Zero Hunger, 13 Climate Action, 11 Sustainable Cities and Communities, 14 Life Below Water, 15 Life on Land, 06 Clean Water and Sanitation, and 12 Responsible Consumption and Production. Among those, most publications (133 articles in total, accounting for 58%) covered the goal of ‘03 Good Health and Well Being’. Specially, microbial contamination is a significant challenge to food safety and public health and causes a great number of foodborne diseases worldwide; FQS published several studies on Escherichia coli and Listeria monocytogenes in ready-to-eat foods ( Salamandane et al ., 2021 ; Cheng et al ., 2022 ; Webb et al ., 2022 ) and E. coli O157:H7, Salmonella , and Shigella in fruits and vegetables ( Srisamran et al ., 2022 ; Wang et al ., 2022 ), reporting the progress of microbial food safety research and detection and prevention measures. Besides, publications in food nutritional value and health benefits, especially on the potential development of new functional foods, are of great interest; for example, Geng and co-workers’ review work on barley ( Geng et al ., 2022 ), research on invasive species Polygonum cuspidatum ( Zhang et al ., 2022 ), and study on the effect of raspberry extract on wound healing ( Lu et al ., 2021 ).

Papers that fit SDGs published in FQS during 2017–2022

As stated in the journal aims, as an international academic journal, we should not only publish high-quality scientific research and provide an international academic platform for scientists to communicate, but also shoulder the human mission to improve human health and equality by focusing on food quality, food safety, food nutrition and other related issues. We will endeavor to fulfill our journal aims in the future.

The authors declare no conflict of interest.

Cheng , Y. , Dong , Q. L. , Liu , Y. T. , et al.  . ( 2022 ). Systematic review of Listeria monocytogenes from food and clinical samples in Chinese mainland from 2010 to 2019 . Food Quality and Safety , 6 : fyac021 .

Google Scholar

Feng , J. S. , Ding , T. ( 2022 ). Guest editorial: Special issue on microbial food safety . Food Quality and Safety , 6 : fyac054 .

Geng , L. , Li , M. D. , Zhang , G. P. , et al.  . ( 2022 ). Barley: a potential cereal for producing healthy and functional foods . Food Quality and Safety , 6 : fyac021 .

Li , C. L. , Jiang , Y. Q. ( 2022 ). The enlightenment of the pattern of organizing special issue regularly of SCI journals for Chinese core food journals to enhance international influence . Public Communication of Science & Technology , 14 ( 9 ): 9 – 13 .

Li , Y. Y. , Hu , D. G. ( 2022 ). Guest editorial: Special issue on fruit quality and healthy nutrition . Food Quality and Safety , 6 : fyac018 .

Lu , W. J. , Xu , M. , Yuan , Y. W. , et al.  . ( 2021 ). Effect of raspberry extract on wound healing . Food Quality and Safety , 5 : fyab013 .

Salamandane , A. , Silva , A. C. , Brito , L. , et al.  . ( 2021 ). Microbiological assessment of street foods at the point of sale in Maputo (Mozambique) . Food Quality and Safety , 5 : fyaa030 .

Shen , C. H. , Zhao , S. X. , Zhou , X. L. ( 2023 ). The effect of journal competition on research quality with endogenous choices of open access or restricted access . Journal of Informetrics , 17 ( 3 ): 101429 .

Srisamran , J. , Atwill , E. R. , Chuanchuen , R. , et al.  . ( 2022 ). Detection and analysis of indicator and pathogenic bacteria in conventional and organic fruits and vegetables sold in retail markets . Food Quality and Safety , 6 : fyac013 .

UN (United Nations) . ( 2015 ). Do you know all 17 SDGs? [Online]. https://sdgs.un.org/goals . Accessed on November 24, 2023 .

Wang , H. X. , Li , Y. X. , Xi , Q. , et al.  . ( 2022 ). Application of plasma-activated water for Escherichia coli decontamination and shelf-life extension of kale . Food Quality and Safety , 6 : fyac041 .

Webb , L. , Ma , L. Y. , Lu , X. N. ( 2022 ). Impact of lactic acid bacteria on the control of Listeria monocytogenes in ready-to-eat foods . Food Quality and Safety , 6 : fyac045 .

Zhang , Y. T. , Song , C. W. , Du , H. Z. , et al.  . ( 2022 ). Novel functional food from an invasive species Polygonum cuspidatum : safety evaluation, chemical composition, and hepatoprotective effects . Food Quality and Safety , 6 : fyac032 .

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• Research article
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• Published: 03 May 2021

Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana

• Lawrence Sena Tuglo 1 ,
• Percival Delali Agordoh 2 ,
• David Tekpor 3 ,
• Zhongqin Pan 1 ,
• Gabriel Agbanyo 3 &
• Minjie Chu   ORCID: orcid.org/0000-0002-7533-9119 1  

Environmental Health and Preventive Medicine volume  26 , Article number:  54 ( 2021 ) Cite this article

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Metrics details

Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana.

This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization’s Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed.

The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p =0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p =0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p =0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p <0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p <0.001].

Conclusions

Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Introduction

A report by the World Health Organization (WHO) (2015) showed that about two million incurable cases of food poisoning materialize annually in unindustrialized nations. The WHO further estimates that 600 million food-borne diseases (FBDs) each year were related to poor food safety and hygiene practice with 420,000 deaths [ 1 ], the majority attributed to meat-related vulnerabilities [ 2 ]. About, 76 million FBDs caused 325,000 hospitalizations in the USA which led to 5000 deaths [ 3 ]. The source was associated with the consumption of turkey contaminated by Salmonella enterica serovar Heidelberg , responsible for salmonellosis in the USA [ 4 ]. Almost, 1.3 million FBDs resulted in 21,000 hospital stays reported in England which led to 500 deaths. The contamination was due to sprouts by Escherichia coli O104 [ 3 ]. Around 53% of the food-borne problems and 31% of its associated illness were attributed to meat consumption in the Netherlands [ 2 ]. The rate of FBDs in Malaysia was 47.8% out of 100,000 people who patronized street-cooked foods [ 5 ]. In Ghana, about 65,000 persons including 5000 kids below 5 years died yearly due to FBDs [ 6 ].

The risk factors such as inappropriate time interval, unsuitable temperature, weather condition, unhygienic activities, unacceptable handling of foods, foodstuff from insecure origins, impoverished self-cleanliness, improper cleaning of cooking materials, using untreated water, and improper food storages were attributed to the causes of FBDs [ 7 , 8 , 9 ]. Also, neglect of hygienic measures by food handlers has been implicated as enablers for the spread of pathogenic microorganisms [ 10 ] and the cause of infections among consumers [ 11 ].

Studies recount that 12 to 18% of food-borne illnesses are attributable to contaminations [ 12 , 13 ], poor food safety, and inappropriate hygiene practices which were accredited to street-cooked food handlers (SCFHs) [ 14 , 15 ]. These SCFHs are people who are wholly or partly engaged in the food preparation, processing, and production value chain and who have a direct touch on food and cooking utensils [ 9 , 16 ]. Foods prepared by food handlers under unhygienic conditions become a public health concern both in industrialized and low-income countries [ 17 ]. Food safety and hygienic practices of SCFHs are essential to ensure that food is free from any forms of contamination through preparation and processing for consumption and to prevent the spread of FBDs [ 18 , 19 ].

Food safety knowledge (FSK) is the understanding of food learned from skills or schooling, food safety attitude (FSA) refers to sensation or belief about food safety, and food safety practice refers (FSP) to the act or use of food safety [ 20 ]. Food safety knowledge, attitude, and practices (KAP) are important because inadequate knowledge, poor attitude, and poor sanitation practices by SCFHs have a severe danger to food safety applications in food companies [ 21 ]; hence, KAP of food safety contributes significantly to the occurrence of food poisoning and FBDs among consumers [ 22 ].

A study conducted in Brazil among food truck food handlers revealed poor hygiene, poor clean observes, poor environments, and higher contaminated meals [ 23 ]. The problem of FBDs was higher in Southeast Asian and African counties [ 24 ]. Ma et al. [ 25 ] study in China, among street food vendors, revealed poor behaviour practices and knowledge of food safety among the respondents. Tabit and Teffo [ 26 ] in South Africa found over 60% of the respondents keep good knowledge and acceptable hygiene performance of food safety. Lema et al. [ 27 ] in Ethiopia reported that below half of the respondents obtained good food cleanliness applications. The effects of food-related illness expenditures in hospital treatments are about US$ 110 billion annually in developing countries, which resulted in decreasing production [ 28 ].

The recurrent happenings of food-related illnesses brought in its wake concerns about the food safety knowledge and hygiene among SCFHs [ 29 ]. Maintaining food safety involves establishing global laws conferring to an agreement between institutions that actualized this agenda [ 30 , 31 ]. The Government of Ghana affirmed food safety regulations in collaboration with the Food and Drug Authority (FDA) [ 30 ]. Yet, its application is undermined due to ineffective supervision by appropriate agencies [ 32 ]. The problem was due to the broad governmental assembly in cities and communities under the local administration [ 31 ]. Some local studies conducted in the four regions of Ghana such as Greater Accra, Northern, Western, and Central have reported adequate knowledge, good attitude, and positive behavioural practices of food safety and handling practices [ 11 , 33 , 34 , 35 ]. Studies have shown that SCFHs were not knowledgeable about the WHO’s Five Keys to Safer Food for food handlers [ 33 , 36 ] which include keeping clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials [ 37 ].

Hence, the acceptance and the use of the KAP instrument as a problem-solving approach in this study are validated from previous researches [ 23 , 38 , 39 ]. This would adequately support the policymaking development and the change of embattled intervention policies for the prevention and control of FBDs. The KAP’s tool assessment defined in this study is considered appropriate to other frameworks if the statements in the KAP’s sections are validated. To our knowledge, no research has yet been done on KAP of food safety among SCFHs selling commonly consumable foods on the street in Volta Region, Ghana. Hitherto, the high cases of FBDs such as diarrhoea, cholera, and typhoid fever outbreak occurrences in the district are presumed to be influenced by SCFHs. The KAP of SCFHs on food safety and hygiene precautions ruins uncertainty in the district, and a swift policy to mend some causes central to the occurrence of FBDs is obligatory. This would help the District Health Directorate’s regulatory agency to plan the prevention methods. Therefore, this study assessed knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District, Ghana.

Materials and methods

Study design and setting.

This study was a descriptive cross-sectional carried out between August and November 2020 and used a validated, pretested, and structured questionnaire to collect data from stationary SCFHs along the principal streets within North Dayi District. North Dayi District is one of the 18 administrative districts in the Volta Region, Ghana [ 40 ]. It shares boundaries with Kpando Municipal to the north, South Dayi District to the south, and Afadzato South District to the east. The entire residents of the North Dayi District are 39,913 covering 46.7% men and 53.3% women [ 40 ]. The people of the District constitute 1.9% of the total population of the Volta Region [ 40 ]. Farming is the foremost financial activity, making it one of the main sources of income in the district [ 40 ]. We carried out this study because of the recent cases of food-borne illness reported among the residents such as diarrhoea, cholera, and typhoid fever in the district [ 41 ].

Eligibility criteria

Stationary SCFHs who directly served already cooked food to customers and those who owned their outlets were included in the study. SCFHs who dissented to partake in the research were excepted including all assistants and helpers. The assistants and helpers were excluded because not all vendors had assistants or helpers and they tend to be more in numbers than the vendor-owners themselves. So for as not to allow bias in the results, we chose to sample only the vendor-owners. Moreover, vendor-owners tend to have direct responsibility for monitoring the food safety environment of their vending sites; hence, we chose to sample them as the focus of this study.

Sample size and sampling

Cochran’s formula Z 2 p  (1 −  p )/ e 2 [ 42 ] for unknown study populations was used. Since a similar study in the Volta Region of Ghana among the population subgroup is unavailable, 50% was used for response distribution, with 95% confidence level, and a margin of error of 5% for the populace, plus 10% non-response rate which gave us a sample size of 423.

Data collection tools

A structured questionnaire was designed based on different studies conducted globally [ 16 , 20 , 38 , 39 , 43 , 44 , 45 , 46 ]. Similar versions of the questionnaires were used in studies conducted in Ghana [ 47 , 48 , 49 ]. The instrument was distributed into 4 parts: socio-demographics, knowledge, attitude, and hygiene practices. The statements on KAP were adapted from the WHO’s Five Keys to Safer Food guidebook for food handlers [ 37 ]. The questionnaire was firstly designed in English, then converted to local dialects, and translated back to English to ensure reliability and simplicity of the question. Four professionals in the field of the study assessed the face and the content validity of the questionnaire. The questionnaire was pretested on 12 stationary SCFHs in Tanyigbe located 7 km from the study area. The pretesting findings were not added to the main study but were used to modify some questions to improve their clarity. The most pertinent modifications done on the study instrument were a cooked meal should stay hot more than 60°C before serving, putting uncooked and prepared meal separating prevent cross-contamination, and checking and dispose of meal that past their expiry date. The data were collected through trained research assistant-led interviews which lasted for about 25 min per respondent. The interviewer-administered questionnaire was given to the SCFHs who could read and write to answer by themselves while those SCFHs who could not read and write have been aided by the research assistants in answering the questionnaire.

Determination of knowledge, attitude, and hygiene practices on food safety

Section 2 of the questionnaire contained 10 structured questions on knowledge of food safety with 3 likely responses; “true”, “false”, and “do not know”. The questions precisely covered the respondents’ knowledge of individual cleanliness, food-borne illnesses, microbes, infection control, and sanitary practices. Each correct knowledge item reported was awarded a score of 1 point. Incorrect knowledge was awarded a 0 score (including “do not know”). In this study, if “true” is the correct answer, then “true” is score 1 point while “false” is score 0 point or otherwise reverse.

Queries relating to attitudes in the third segment of the questionnaire were designed to assess the knowledge of SCFHs on food wellbeing and hygiene. This part of the section assessed psychological state concerning views, opinion, morals, and characters to act in particular [ 21 , 48 ]. It contains 10 structured queries with 3 likely answers: “agree”, “disagree”, and “not sure”. Each correct attitude reported was awarded a score of 1 point while the other incorrect attitude option was rated a 0 score (including “not sure”). In this study, if “agree” is the correct answer, then “agree” is score 1 point while “disagree” is score 0 point or otherwise reverse.

• Hygiene practice

Section 4 of the questionnaire measured food hygiene and sanitation practices of SCFHs. It contained 10 structured queries with 2 likely answers: “yes” and “no”. Each correct hygiene practice reported was awarded a score of 1 point while incorrect hygiene practices reported were awarded a score of 0. This method of assessment was used in previous studies [ 28 ]. In this study, if “yes” is the correct answer, then “yes” is score 1 point while “no” is score 0 point or otherwise reverse.

The grouping method is appropriate and suitable for studies allied to the assessment “of food handlers” KAP of food safety and hygiene [ 27 , 28 , 34 , 46 , 47 , 50 , 51 , 52 ]. The knowledge and attitude questions with “do not know” or “not sure”, thus the third option, had been presented to enable simplicity of responding by SCFHs for fascinating for thoughts considered by an undecided or doubtfulness [ 28 ]. This third option “do not know” or “not sure” always scores a 0 point due to the cumulative percentage approach adapted which considers only the acceptable response or the correct answer [ 53 ]. The cumulative percentage scoring method of assessment considers only the acceptable answer and the total cumulative score is converted to 100% [ 53 ]. The cumulative scores below 70% of the acceptable responses on WHO’s Five Keys to Safer Food-related knowledge, attitude, and hygiene practices were considered as “poor”, and cumulative scores 70% and higher were considered as “good” [ 27 , 34 , 39 , 46 , 48 ].

Data analysis

Questionnaires were checked manually before entering into Microsoft Excel 2016 spreadsheet. Coding and analysis were done in IBM Statistical Package for Social Sciences (SPSS Inc., Chicago, USA; https://www.spss.com ) version 24.0. Categorical variables were expressed as frequency and percentage. The disparity between categorical variable groups was verified using the Fisher exact or chi-square test where appropriate. Significant parameters were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. A p -value <0.05 was considered statistically significant.

Ethical consideration

Approval was sought from Ghana Health Service, North Dayi District Health Directorate, with the identity (NDDHD/GR/002/20) 15/07/2020. The research assistants introduced themselves and written informed permission was sought from the respondents. The research method was plainly explained to the respondents in their native dialects (English, Ewe, or Twi). Participants were identified by study numbers. The study numbers of the participants were kept in both locked files and secured computer files and accessible only to key investigators. All data were anonymized and unlinked to the respondents’ identities during the data analysis.

Demographic data

A total complete of 423 questionnaires were conveniently distributed for data collection based on the availability of SCFHs at their dedicated vending sites. Questionnaires of 407 were fully answered and collected from the respondents with a 96.2% (407/423) success rate. n = Z 2 p  (1 −  p )/ e 2   = 1.96 2 0.5 (1 − 0.5)/0.05 2 =384.16+38.416 =422.576. The majority ( n =343; 84.3%) of SCFHs were female, were between the age range of 26 and 35 years ( n =153; 37.6%), and were married ( n =311; 76.4%). Over one-third ( n =144; 35.4%) of SCFHs had attained secondary education. Most ( n =168; 41.3%) of SCFHs earned an average monthly income between GHc501 and GHc1000. Over half ( n =217; 53.3%) of SCFHs had 3–10 years of working experience. Regarding SCFH registered, n =297 (73.0%) reported that they have registered. More than half ( n =228; 56.0%) of SCFHs had not attended a food safety training course (Fig. 1 ).

Demographic data of respondents

Food safety knowledge

Almost all ( n = 381; 93.6%) of SCFHs knew about the washing of hands for 1 min using water and soap before touching food. The majority ( n =313; 76.9%) of SCFHs knew that similar chopping board should not be used for uncooked and prepared foods if it appears wash; n = 336 (82.6%) knew that cooked meal should stay hot before serving (more than 60°C); and n = 275 (67.6%) knew that excess meal should be kept at zone temperature and eat for the following mealtime. Most ( n =239; 58.7%) of SCFHs knew that uncooked meal should be kept individually from a prepared meal; n = 363 (89.2%) knew that treated water should be used for cooking; n = 363 (89.2%) knew that cockroach and house flies should not be allowed into the kitchen; and n = 274 (67.3%) knew that wiping cloths can spread microorganisms and cause disease. However, the majority ( n =235; 57.7%) of SCFHs did not know that food cooking utensils should not be cleaned using tap water only. Also, n = 202 (49.6%) of SCFHs did not know that fresh meat should not be stowed anyplace in the fridge once it is cool (Table 1 ).

Food safety attitude

The majority ( n =277; 68.1%) of SCFHs disagreed that regular hand cleaning throughout meal processing is needless; n = 323 (79.4%) agreed that cleaning kitchen shells lessen the danger of infection, and n = 355 (87.2%) agreed that putting uncooked and prepared meal separating stop infection. Below half ( n =181; 44.5%) of SCFHs agreed that they should be able to differentiate healthy diets and rotten food through eyeing; n =262 (64.4%) disagreed that using different knives and chopping materials for a fresh and prepared meal require more time; n = 366 (89.9%) agreed that they cough or sneeze inside the elbow if towel or paper not available; n = 291 (71.5%) agreed that checking meal for cleanliness and healthiness is important; and n =377 (92.6%) agreed that it is vital to dispose of meals that have gotten to expiring date. Nevertheless, n = 332 (81.6%) of SCFHs agreed that it is acceptable to use the same cloth for dusting and drying and n =217 (53.3%) disagreed that is unhealthy to allow prepared meal stay outside of the fridge for over 2 h (Table 2 ).

Food safety hygiene practice

The majority ( n =343; 84.3%) of SCFHs cleaned their fingers throughout meal cooking; n = 267 (65.6%) washed their cooking utensils used to cook a meal before using for a different meal; n =234 (57.5%) used different cooking bowls and chopping material if cooking a fresh and prepared meal; and n =359 (88.2%) dispersed uncooked and prepared meal before preservation. Also, n =278 (68.3%) keep prepared food at room temperature for 2 h when finished cooking; n =269 (66.1%) checked and disposed of meal past its expiry date; n =372 (91.4%) cleaned fresh food that needs no cooking before consumption; n =320 (78.6%) inspected if a meal is cooked by eyeing; and n =359 (88.2%) examined if a meal is grilled by touching it. Moreover, n =253 (62.2%) used similar kitchen cloth to clean shells and hands (Table 3 ).

SCFH knowledge, attitude, and hygiene practice on food safety classification

A high proportion ( n =274, 67.3%; n =237, 58.2%; and n =256, 62.9%) of SCFHs had good levels in knowledge, attitude, and hygiene practices on food safety (Fig. 2 ).

Levels of respondents’ knowledge, attitude, and hygiene practice on food safety

Association between knowledge, attitude, and hygiene practice and demographic data

Statistical significance was observed in the knowledge section among registered SCFHs ( p =0.031). None of the respondent’s socio-demographic data was statistically significant in the attitude section of food safety p < 0.05. The study found significant differences ( p <0.05) in the hygiene practice scores section with the educational status, average monthly income, registered SCFHs, and SCFHs completing food safety training course of food safety among SCFHs (Table 4 ). The odds ratio showed registered SCFHs were 1.6 times good at food safety knowledge likened to unregistered SCFHs [cOR=1.64 (95% CI 1.04–2.59), p =0.032]. The logistic regression analysis revealed that respondents who had secondary education were 4.1 times good at hygiene practice of food safety [aOR=4.06 (95% CI 1.63–10.11), p =0.003] compared to informal education. The respondents with average monthly income greater than GHc1500 were 4.9 times more likely to have good food safety and hygiene practices compared to those who earned less than Ghc500 average monthly income [aOR=4.89 (95% CI 1.56–15.34), p =0.006]. Meanwhile, registered SCFHs were 7.5 times more likely to have good food safety and hygiene practices compared to unregistered SCFHs [aOR=7.50 (95% CI 4.27–13.19), p <0.001]. The SCFHs who had completed a food safety training course were 6 times more likely to have good food safety and hygiene practices compared to those who had no such training [aOR=5.97 (95% CI 3.50–10.18), p <0.001] (Table 5 ).

Pearson correlation between knowledge, attitude, and hygiene practice toward food safety

The study revealed a positive correlation in the knowledge with the attitude outcomes sections (FSA) of food safety ( r =0.153, p =0.002) (Table 6 ).

The present study investigated knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District of Volta Region, Ghana. This study showed that the majority of SCFHs had good knowledge of food safety. This would help decrease the threat to contamination of foods, food poisoning, and FBDs to the consumers. Studies conducted in Saudi Arabia, Ethiopia, and Ghana have identified the importance of knowledge of food safety to SCFHs and have recommended training programmes on food safety to cultivate the knowledge into hygiene practices [ 14 , 27 , 34 ]. Our finding is inconsistent with previous studies done in Ethiopia and Jordan [ 38 , 45 ], however consistent with studies conducted in Ghana and Malaysia [ 47 , 54 ]. The possible reasons could be the type of food training courses received, the sample size, the scoring rubric applied, and understandings acquired on the subjects. This supported claims, creating an optimistic culture of food safety, inhibit food contamination if incorporated periodically [ 44 , 46 ]. This scenario affirms that the food safety training courses may remarkably enhance the knowledge of food handlers, especially concerning FBDs.

This study found that most of SCFHs knew about the washing of hands for 1 min using liquid and cleanser before touching food, which coincides with the study done in Iran [ 39 ]. The washing of hands with soap and water could reduce contamination of hands, cooking utensils, and cooking preparation surfaces leading to a substantive reduction of the risk of FBDs. Our finding does not corroborate with finding from a study done in Malaysia where a vast majority of SCFHs were knowledgeable of the 4th WHO Five Keys to Safer Food to keep the meal at healthy temperatures [ 20 ]. In our study, the SCFHs wrongly answered that fresh meat should be bestowed at any place in the fridge once it is cool. This misapplication of temperature could result in contamination and possibly proliferating of microbes in food. The reason is that appropriate temperatures can significantly lessen the risk at which foods will deteriorate, thereby preventing FBDs; hence for safety, foods must be held at an appropriate temperature sufficient to slow down the growth of microorganisms or kill microbes.

Attitude is one of the key elements that influence food safety and the practice and lessen the recurrence of food-related illnesses [ 51 ]. This study showed that most of SCFHs had a good attitude toward food safety. It means they understood their roles in food safety which was transmitted into attitude because they possibly serve as a vector for infectious pathogens which lead to food contamination. This agrees with studies conducted in Ghana and Haiti [ 48 , 55 ], but differs from a study done in Malaysia [ 36 ], where the majority of SCFHs had a poor attitude toward food safety. Possibly these could be due to the variances in socio-demographic characteristics, study population, and the study settings. These attitudinal variations could also be due to public reputation preference. Our study showed that visual checking was one of the key ways of differentiating healthy food from rotten ones, which concurs with a study conducted in Iran [ 39 ]. This finding is disturbing because the process of identifying food contamination cannot be performed by visual checking, since pathogens or toxins might be present in those foods without necessarily affecting SCFHs’ sensory aspects (smell, colour, or taste); therefore, food handlers who rely on visual checking for the identification of food contamination might expose consumers to an increased risk of contracting FBDs [ 39 , 56 ]. Therefore, the regulatory authorities must ensure that all SCFHs are trained professionally and certified.

The present study revealed a vast majority of SCFHs agreed that putting uncooked and prepared meal separating prevent cross-contamination, which corresponds to a study done in Haiti [ 55 ]. This act of putting fresh foods separating from cooked food could help prevent cross-contamination, which in turn may prevent infections from happening and halt FBDs. This is one of the highly endorsed public health measures to prevent cross-contamination [ 57 ]. This study found that almost all of SCFHs agreed that they coughed or sneezed into their elbows if a towel or paper is not available. Coughing and sneezing into the elbow or covering coughs and sneezes, and immediately washing the hands, could help to avert the spread of severe respiratory infections such as influenza and whooping cough. Our finding contradicts with other studies conducted in Malaysia and America; they reported that almost all respondents sneezed right away into their hands and never clean it [ 20 , 58 ]. This unpleasant attitude is harmful to the public since sneezing and coughing let out droplets of watery and perhaps transmittable microorganisms which can contaminate foods leading to FBDs.

Preservation of good sanitary behaviours is one of the goals for any food establishment, thereby its observance is vital to ensure safe meals for consumers [ 28 , 59 ]. The proportion of SCFHs in this current study with good hygiene practices of food safety corroborates with previous studies conducted in Saudi Arabia and Ghana [ 21 , 34 ]. This is an indication that SCFHs can be relied upon to act as the first-line responder to prevent several FBDs when they practice what they know. This would help reduce accidental contamination of foodstuffs due to improper management of cooking utensils and surroundings. Contradictory, in the present study, the scores obtained on the practices section were higher than hygiene practices of food safety reported in studies done in China and Nigeria [ 25 , 60 ]. The likely explanations of the difference reported could be as a result of the research population, the study cut-off used, the disparity in food safety courses, and differences in the law enforcement regimes. Our study revealed that the level of hygiene practices score was greater than the level of the attitude score attained by the SCFHs which corresponds to a study conducted in Malaysia [ 15 ]. The probable justification could be the SCFHs tend to provide responses they trust will create a good picture of their hygiene practices which account for the greater level score. The current study revealed that a vast majority of SCFHs washed their cooking utensils used to cook meals before using them for different meals, which is in line with a study done in Iran [ 39 ]. This act is acceptable because food handlers have been mostly identified as a significant vector for food contamination and responsible for FBDs [ 14 , 15 ]. Our study found that SCFHs practised wrongly by using similar kitchen cloth to clean shells and hands at the time which concurs with a study done in Malaysia [ 20 ]. The possible justification could be due to the non-compliance of the respondents to food safety training received. It could also be that they lack understandings of food safety education received. Hence, this displeasing practice may eventually result in contamination of hands and transfers of microorganisms to the consumers. This study showed that a vast majority of SCFHs cleaned fresh food that needs no cooking before consumption, which is in line with a study conducted in Malaysia [ 20 ]. This good hygiene practice is necessary to the elementary control of the spread of possibly FBDs.

Our study revealed a positive relationship between knowledge and the attitude of food safety which corresponds to earlier studies conducted in Malaysia, Iran, and Ghana [ 15 , 39 , 47 ]. Nevertheless, the strength of the correlation identified in the knowledge with the attitude scores of food safety was not strong, which implies that it is vital for the respective agency to monitor SCFH activities and enforce safety standards. Previous studies conducted in Malaysia and Iran found no significant relationship in the knowledge with the hygiene practices of food safety [ 20 , 39 ], which corresponds to our finding but contradicts with studies done in Malaysia and Ghana [ 15 , 47 ]. This result confirms the assertion that good knowledge does not affect the hygiene performance of food safety [ 61 ]. Hence, food handlers should be encouraged by food safety regulatory agencies to at least practise good hygiene irrespective of their levels of knowledge of food safety. In our study, no statistical association was found in the attitudes with the hygiene practice scores of food safety, which opposes earlier studies conducted in Malaysia, Iran, and Ghana [ 39 , 47 , 54 ]. These disparities could be due to their levels of knowledge of food safety and also possibly as a result of the kind of food safety training courses received. This present study found that registered SCFHs were more likely to have good food safety knowledge likened to unregistered SCFHs which is in line with earlier research in Lebanon [ 51 ] but differs in the study done in Malaysia [ 62 ]. The potential explanation is that maybe before SCFHs have been given their certification of registration, they probably have been taken through food safety training courses which provide them with adequate knowledge of food safety and offer them a good understanding of food poisoning, contamination, and hygiene. This shows the importance of registering food handlers who have successfully been through food safety training courses to acquire knowledge on food safety.

This study showed that the odds of good hygiene practices were higher among SCFHs who had secondary education likened to those with no formal education which is in line with a study conducted in Ethiopia [ 12 ]. In contrast to our findings, other studies conducted in Ethiopia and Ghana found SCFHs with primary education as more likely to have good hygiene practices of food safety likened to secondary education [ 27 , 34 ]. The possible reasons are because most food preparation skills, personal hygiene, and cleanliness are learned from friends, relatives, parents, and media but not necessarily from formal education. However, a lower level of education reduces awareness but the higher one gets educated the better the knowledge which affects their attitude and eventually may reflect into hygiene practices. It implies that food handlers should be encouraged to attain at least basic education before engaging into the cooking business, although it serves as the first sources of income for most uneducated people in the societies. Nevertheless, a study conducted in Ghana showed that regardless of educational background, the food safety actions of SCFHs remain an issue in many nations [ 48 ].

The present study showed that SCFHs who earned average monthly income above GHc1500 were more likely to have good hygiene practices compared to respondents who earned less than Ghc500. Our finding confirms a study conducted in Ethiopia and Jordan that found good hygiene practice among food handlers with higher monthly income than those with lower higher monthly income [ 27 , 63 ]. The possible justification is that SCFHs with high monthly income can afford to purchase items needed to establish themselves in hygienic environments and afford more employees to help in cleaning and waste treatment which could result in a reduction in food poisoning and cross-contamination. This means the high monthly income of food handlers determine their ways of hygiene practices, purchasing more cooking utensils for preparing different meals and managing their leftovers foods to prevent contamination.

The present study showed that registered SCFHs were in favour of good hygiene practices of food safety than the unregistered. The likely description is because of the food safety training courses they received before being registered as food handlers which provides them with an in-depth and comprehensive understanding of hygiene practices such as proper handling of food, personal cleanliness, and sanitation while preparing food. However, there is no research found relating registration of food handlers with hygiene practice scores; hence, the lack of the associated literature offers difficulties to compare our finding to collective results reasonably with concrete answered questions. Nonetheless, our finding shows the importance of registering food handlers after they have been through food safety training courses to encourage them to practise good hygiene.

This study found that SCFHs who have completed training courses on food safety were in favour of good hygiene practices of food safety likened to respondents who had not. Our finding asserts with previous studies done in Ethiopia, Malaysia, and Ghana [ 36 , 38 , 47 ]. The probable justification is that SCFHs who have completed food safety training courses had gained the talents and awareness necessary to handle food safely and sustain great ethics of self-cleanness and hygiene practices. Our finding affirms the assertion that training upsurges understanding of food safety which might reflect into hygiene practices [ 48 ]. Hence, a lack of or inadequate training of SCFHs on food safety may inadvertently result in poor hygiene practices, thereby encouraging food contamination [ 26 , 36 ]. This implies providing food safety training to food handles is important to keep consumers from food poisoning and other wellbeing dangers that could arise from eating unsafe food.

In this present study, it is significant to highpoint SCFHs’ knowledge, attitudes, and hygiene practices are unpredictable from the study conceded, though most of SCFHs properly responded by answering appropriately to related questions of WHO’s Five Keys to Safe Foods guidelines for food handlers. This theoretic-based assessment of the KAP method applied to assessed food handlers’ food safety KAP has some limitations. Firstly, the postulation that the received knowledge on food safety is translated into attitude is not entirely true. The existence of a social desirability bias could similarly have added to the discrepancy amid interview-responded KAP of SCFHs. Social desirability bias is the propensity of SCFHs to provide publically anticipated answers which will be regarded approvingly by people [ 64 ]. This proclivity has been shown by their descriptions and overrating socially anticipated KAP questions on food safety. Secondly, as we beforehand mentioned, the research assistants revealed their identities and the purpose of the study to the SCFHs; therefore, the SCFHs were mindful of the hygiene practices and the significance of observing them, but they remained keen to acknowledge their nonconformity and these could likely affect the self-reported hygiene practices. Thirdly, the unavailability of sufficient data from related studies in the district impedes an evaluative comparison of our findings to determine an improvement of food safety KAP among SCFHs; therefore, our findings ought to be interpreted with caution. However, due to the representative nature of the sample assessed, the findings of this study can be generalized to other SCFHs in the district. After all, it makes a substantial impact concerning food safety KAP in North Dayi District because it is the first study conducted in the district that presents an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Over half of the respondents had good levels of KAP of food safety. This study found a significant relationship in the knowledge and hygiene practice scores of food safety with SCFH registration. This shows the importance of strict enforcement of registration and certification of SCFHs by regulatory agencies as a means of protecting the consuming public. Therefore, the government agency through FDA should intensify the vitality of undertaking food safety training on WHO’s Five Keys to Safer Food by food handlers before being registered. Furthermore, the District Health Directorate should properly and effectively supervise food handlers engaging in cooking businesses to ensure they transmit the link between knowledge with the attitude of food safety into hygiene practice. Further studies should assess the kind of food safety training modules received and their impacts on the KAP of WHO’s Five Keys to Safer Foods as well as evaluating their hygiene practices with observational checklists.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available due to ethical consideration but are available from the corresponding author on reasonable request.

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Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China

Lawrence Sena Tuglo, Zhongqin Pan & Minjie Chu

Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana

Percival Delali Agordoh

North Dayi District Health Directorate, Volta Region, Ghana Health Service, Accra, Ghana

David Tekpor & Gabriel Agbanyo

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MC and PDA conceived and designed the study. LST drafted the manuscript. DT and GA coordinated the data collection. ZP participated in the data collection and contributed to data analysis and interpretation. All authors read and approved the final manuscript.

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Approval was sought from Ghana Health Service, North Dayi District Health Directorate, with the identity (NDDHD/GR/002/20) 15/07/2020. Written informed permission was sought, and the research method was plainly explained to the respondents in their native dialects (English, Ewe, or Twi).

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Tuglo, L.S., Agordoh, P.D., Tekpor, D. et al. Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana. Environ Health Prev Med 26 , 54 (2021). https://doi.org/10.1186/s12199-021-00975-9

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Received : 22 February 2021

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Published : 03 May 2021

DOI : https://doi.org/10.1186/s12199-021-00975-9

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