FST3 11192342
FST3 11192342
org
DOI: 10.13189/fst.2023.110203
1Faculty of Administrative Science & Policy Studies (FSPPP), Universiti Teknologi Malaysia, Kelantan’s Branch,
Machang, Kelantan, Malaysia
2Faculty of Law, Universiti Teknologi Malaysia, Kelantan’s Branch, Machang, Kelantan, Malaysia
3Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kelantan, Malaysia
Received September 21, 2022; Revised February 15, 2023; Accepted March 21, 2023
Abstract Food safety is an important social and public Keywords Attitude, Food Safety, Food Handlers,
health agenda that affects people worldwide. Studies have Knowledge, Practice
shown that the awareness of food safety knowledge has
increased even before the COVID-19 pandemic. However,
the public awareness of food safety in Malaysia is
considered low. Most consumers are less concerned with
the preparation of food. Hence, this study aims to measure
1. Introduction
the level of awareness of foodborne diseases among food The COVID-19 pandemic has fueled food business
handlers by using the knowledge, attitudes, and practices expansion, especially among home-based food handlers.
(KAP) model. This is a nationwide, cross-sectional study The World Health Organisation (WHO), Food and
involving 281 food handlers who attended food handler Agriculture Organization (FOA) of the United Nations and
training between July and November 2021. Based on the the United States Food and Drug Administration (USFDA)
overall results of the respondents' knowledge, attitudes, have stated that COVID-19 is not transmitted by
and practices, the researchers believe that attending contaminated food. Despite the fact that COVID-19 is not a
training on safe food handling courses contributes to better foodborne virus, it still can be transferred through food
food hygiene and safety. These findings suggest that manufacturing and processing, thus it is vital to prioritize
prevention and intervention strategies to prevent food personal hygiene and kitchen sanitation. The safety,
poisoning should emphasize food hygiene and safety. They cleanliness and hygiene during the food preparation need
should constantly exercise the five good food handling to be highlighted. However, some food handlers neglect
practices to ensure the food prepared is clean and safe to these aspects of food preparation therefore increasing
consume. However, the limitation of this study is that it consumers' risk of foodborne illness while a majority of
does not cover all the food handlers in Malaysia, although them lack hygienic skills [1].
it helps in getting an initial picture of the current situation. This paper proposes to measure the level of awareness of
In addition, this study was conducted during the the foodborne disease among food handlers using
COVID-19 outbreak and post-COVID-19 studies are knowledge, attitudes and practices (KAP) model in
needed to enable comparisons to be made. Kelantan, Malaysia.
126 The Awareness of Food Safety Knowledge, Attitudes and Practices among Food Handlers during COVID-19
2. Level of Awareness on the and food processing operations to ensure foods produced
and prepared are not contaminated by bacteria, viruses, and
Foodborne Diseases other germs. Else those who consume the food are in
There are different levels of awareness on foodborne danger of contracting foodborne diseases.
disease globally. In the African continent, consumers in According to the Knowledge, Attitude, and Practice
Cameroon had the least knowledge on food safety (KAP) model, proper food handling behaviour is
compared to Ghana and Nigeria whereas in the Asian developed based on a positive attitude. A positive attitude
continent, consumers in Iran had the least knowledge on is derived from solid knowledge of nutrition and food
food safety compared to consumers in Malaysia and safety. The KAP model can be used to effectively change
Pakistan [2]. It was also found that university students in human health habits whereby the change process is divided
Jordan were not aware of food safety requirements during into three parts which are acquiring knowledge, developing
the COVID-19 pandemic [3]. attitudes/ beliefs and forming practice/ behaviors [10].
In recent years, the level of knowledge and awareness of Therefore, it is a prerequisite for food handlers to be
food safety has increased globally. In Malaysia, consumers trained in food safety and hygiene to ensure good food
were showing a positive food safety attitude and adopting handling practices. However, there are divided findings on
good practices during the COVID-19 pandemic [4] even the role of food safety knowledge and attitude as
though public awareness on food safety before COVID-19 determinants for food safety practices.
was considered low [5]. Moreover, there has been a decline Previous studies proved that food safety knowledge is
in number of food poisoning cases in 2019 (516), 2020 necessary to influence food safety practices. Toh and
(288) and 2021 (197). Nevertheless, this declining number Birchenough believed that the lack of knowledge in food
of cases has not stopped the government's efforts to protect safety could lead to poor hygienic practices by food
the people and prevent food poisoning. This was done by handlers [11]. This proposition was supported by
conducting various promotional activities and intervention Abdul-Mutalib et.al. [12] and Abd et al. [13] when their
programs [6]. studies revealed positive relationships between the extent
However, Malaysian consumers pay less attention to the of knowledge on food safety and the adoption of food
preparation of the food [7]. Instead, they prioritise food safety handling procedures. Nevertheless, some other
taste, presentation, and price. Food safety importance studies suggested that the transfer of food safety
requires high prioritisation from the public because poor knowledge to practice is unpredictable. A survey by
food safety will lead to foodborne infections. Food Akabanda et al. [14] also indicated that food handlers
handlers must maintain the highest level of hygiene and might not necessarily apply strict food safety procedures
adhere to the hygiene practices imposed by the government during food handling, even when they were adequately
to ensure the preparation of food is clean and safe. They are trained in the practices.
mandated by law to have immunization against typhoid In terms of literature review from food handlers,
and cholera and attend mandatory food handling training specifically on food handling and regulation, it is very
courses as stipulated in the Food Hygiene Regulation 2009. limited. Hence, a study on the awareness of food handling
Since onsite training could not be offered during the regulations and foodborne disease among food handlers is
pandemic, the Ministry of Health (MOH) has approved timely and deserves due attention because of the increasing
some accredited food handler training schools to conduct trend of online food business, especially during
online food handling training courses. With this course, COVID-19.
food handlers are expected to be well-versed in Good Food Thus, this study aims to assess the level of knowledge,
Hygiene, Food Safety, and Food-borne Illnesses topics. In attitudes and adopted practices among food handlers. The
addition, Food manufacturers must obtain any certification following three research questions were developed to
of Good Manufacturing Practice (GMP), Hazard Analysis assess the main variables of the current research, including
Critical Control Points (HACCP), or Food Safety is the the awareness of food handlers about the foodborne disease
Responsibility of the Industry (MeSTI). and food handling regulations:
RQ1. Do food handlers have sufficient knowledge of
food handling regulations?
2.1. Food Safety Practices in Food Handling
RQ2. What is the level of food handlers’ attitudes
Food safety and hygiene practices are essential in food toward food safety?
handling as they help protect consumers' health from RQ3. Are food handlers complying with food handling
foodborne illnesses and food poisoning. According to practices when preparing food?
Youn and Sneed [8] and Ansari-Lari, Soodbakhsh and
Lakzadeh [9], a high proportion of reported foodborne
diseases were caused by unsafe practices in food handling. 3. Materials and Methods
Hence, it is of utmost importance that good safety practices
in food handling be adopted by food service establishments The target population are food handlers who are
Food Science and Technology 11(2): 125-132, 2023 127
involved in food business in Malaysia. Purposive sampling experience, 85.4% indicate that they work in food outlets
was employed in identifying the appropriate sample size. (restaurants, stalls, and canteen). İn terms of food handling
This method is appropriate when the research needs to training, 96.1% attended the training while only 59.4% of
achieve a target sample and where sampling them were immunised against typhoid.
proportionality is not a major consideration [15]. The Table 1 shows the result of food safety knowledge
questionnaires were adapted from Soon, Wahab, Hamdan during COVID-19. Respondents, in general, reported
and Jamaludin [4] by using KAP model. For assessing having sufficient food safety knowledge. 97.2% of the
knowledge, thirteen items were developed to measure if the participants agreed that hands should be washed before
food handlers were with the food handling regulations. For meal preparation (K1). This outcome indicates that the
assessing attitudes, eleven items were developed to food handlers knew their hands were the primary source of
indicate the level of awareness of food handling food contamination. Thus, proper hand cleansing is very
regulations. For assessing practices, seven items were effective in limiting the transmission of foodborne diseases.
developed to measure the frequency of complying with the This finding is supported by a study done in Indonesia,
regulations. The authors assured the survey content which reported that 99.2% of the respondents knew that it
validity by seeking comments and suggestions from the was necessary to wash their hands regularly when handling
officers of Food Safety and Quality Division, Ministry of foods [16]. A similar study conducted in Lesotho also
Health Malaysia. Negative statement in the KAP found that all participants are well aware of the need to
statements (K3.K6, K8, K12, A20, A22, A23, A24, P27, wash hands before food preparation [17].
P33, P36, P37, R3 and R9) were reversely scaled prior to 89.7% of respondents recognised that diarrhea could be
analysis. transmitted by contaminated food (K2). Only 60.5% of
Before collecting the data, Food Safety and Quality respondents thawed frozen food at room temperature (K10).
Division, Ministry of Health Malaysia had been consulted According to the standard thawing practice, the process
to clarify the objectives and validate the questionnaire. shall be carried out under refrigeration, microwaves, or
With their cooperation and assistance, an online survey running water. Thawing food at room temperature can
was given to the food handlers who attended food handler cause bacteria growth and lead to food poisoning. A study
training. in Jordan [18] during the COVID-19 pandemic reported
An online survey was given to the food handlers with the that more than half of the respondents demonstrated poor
assistance of Food Safety and Quality Division, Ministry of knowledge of this matter. The vast majority of the
Health Malaysia. The participants were asked on their respondents (94%) knew that cross-contamination could be
awareness of the regulations and foodborne diseases in prevented by using separate equipment/utensils for raw
food handling. The process of distributing questionnaires meat and cooked food (K7). They also had accurate
was undertaken within the span of 4 months, from July knowledge concerning cleaning the utensils (K9). They
2021 to November 2021. A total of 281 responses from disagreed with the statement that food preparation utensils
food handlers representing 4 types of food premises (food can be washed with pipe water only. In order to prevent
factory, catering, outlet and vehicle that has been used to cross-contamination, the food preparation utensils should
sell food) were received. Data for this study was exported be washed with hot water and detergent. The results are
into SPSS 27.0 (IBM) for statistical analysis. Descriptive quite contrary to those revealed by Tuglo et al. [19] that
statistics were used to report results from the study. The most of the street-cooked food handlers in Ghana did not
authors assured the survey content validity by seeking know that food cooking utensils should not be cleaned
comments and suggestions from the officers of Food using tap water only.
Safety and Quality Division, Ministry of Health Malaysia. Furthermore, the respondents also rejected the statement
The survey protocol and questionnaire were revised and that raw meat can be stored anywhere as long as it is chilled
accepted by the Ethics Review Committee of the Universiti (K8). The disagreement demonstrated that they were aware
Teknologi MARA (UiTM) (REC/06/2021 (MR/432)). that raw meat should be stored separately to avoid
cross-contamination. Bou-Mitri et al. noted that over 90%
of the food handlers knew that cooked and raw foods must
4. Result and Discussion be stored separately to prevent food contamination [20].
However, the study revealed that the respondents lacked
Demographic data reveals that 42.0% of respondents are the knowledge on the effect of wearing a watch during
male whereas 58.0% are female. All the food handlers meal preparation (K13). Most of them were uncertain
received formal education, and out of this, 54.1% have whether wearing such item while preparing meals could
secondary and 30.6% have tertiary qualifications. contribute to food contamination. This result is consistent
Concerning age, 54.8% of the respondents are in the age with the findings of Nur Izyan et al. [21]. They discovered
group 18–25 years old, while 19.2% belonged to the 26-30 that most home-based food providers had limited
age cohorts. Most food handlers (59.4%) have less than one understanding about wearing a watch during food
year of experience, while 32.0% have 1-3 years of preparation. Most of the food handlers are aware of the
128 The Awareness of Food Safety Knowledge, Attitudes and Practices among Food Handlers during COVID-19
requirement to separate raw from cook food to prevent water before handling or preparing food to prevent
food contamination [22]. However, the study revealed that foodborne illness. A similar finding was reported by Kwol
the respondents also lacked an understanding on the effect et al. [24], who noted that almost all of male food
of wearing jewellery during meal preparation (A24). Most handlers in Saudi Arabia agreed that hands need to be
of them were uncertain whether wearing such items while washed before handling food. In addition, the respondents
preparing meals could contribute to food contamination. also concurred that hand injuries and cuts must be covered
97.9% of the food handlers in this study battled over the to minimise cross-contamination (96.8%).
forms in which food safety should be maintained, such as Regarding food hygiene, nearly all of the respondents
raw chicken should be washed before preparation (K4), held extremely favourable attitudes. They wash fruits and
and 88.3% ensured that when cooking meat and poultry, vegetables prior to consumption (99.6%), avoid using
the juices should be clear and not pink when cooked (K5). damaged eggs (91.1%), and wash the chopping board
In the aspect of time and temperature control, the frequently after using it to prepare raw
respondents' knowledge is considered high (K11). They meat/poultry/seafood (90%). It is encouraging to discover
were sure that cooked food should be kept and served hot that food handlers have a positive attitude toward personal
above 60ºC (71.9%). hygiene because a favourable attitude may prevent food
Based on the overall results on the knowledge of the poisoning outbreaks. There are, however, two
respondents, the researchers believe that attending the hygiene-related items that receive the lowest scores from
training on food handling contributes to their high respondents. Only 50.5% of respondents agreed with the
understanding on the food safety. However, according to statement that they cough or sneeze inside the elbow and
Souza, Azevedo and Seabra, although the level of food 66.5% clean their thermometer with water and soap each
safety knowledge has a direct influence on food safety time after using.
practices, they believe that there may be other factors that In addition, most respondents have a good attitude
also influence food safety practices [23]. toward preventing cross-contamination during food
Table 2 presents the findings of a survey on food preparation. It was reported that they do not wear jewellery
handlers' attitudes. The findings revealed that food while handling food (95.5%), use a separate towel for
handlers' general attitude toward food safety was cleaning and drying purposes (84%), and reheat the
satisfactory, with the proportion of agreed replies ranging leftover food, which is kept at room temperature (81.5%).
from 50.5% to 99.6%. The vast majority of food handlers The results are also supported by Kwol et al. [24] who
demonstrated positive attitudes towards personal and food emphasized that food handlers' attitude positively
hygiene (A14, A16, A17, A21). The results showed that influences their perception to kitchen hygiene.
90.7% of respondents wash their hands with soap and
Table 1. Knowledge of food handlers during COVID-19
Not Sure
No Knowledge Yes (%) No (%)
(%)
K1 Hands should be washed before meal preparation to prevent food borne disease 97.2 2.5 .3
K3 Pets are allowed into the kitchen area 95.0 3.6 1.4
If cooking meat and poultry, the juices should be clear and not pink when
K5 88.3 6.0 5.7
cooked
Separate equipment such as chopping boards and utensils are used for raw meat
K7 94.0 5.3 .7
and cooked food
K8 Raw meat can be stored anywhere in the refrigerator as long as it’s chilled 81.5 15.7 2.8
K9 Food preparation utensils can be washed with pipe water only 50.9 44.5 4.6
K11 Cooked food should be served hot (more than 60ºC) 71.9 17.1 11.0
K12 Leftover food can be stored at room temperature to be eaten at the next meal 63.7 28.1 8.2
K13 Wearing a watch during food preparation can cause food contamination 55.5 41.3 3.2
Food Science and Technology 11(2): 125-132, 2023 129
Strongly
Strongly Uncertain
No Attitude Disagree (%) Agree (%) Agree
disagree (%) (%)
(%)
A18 I do not use damaged or cracked eggs 3.9 3.6 1.4 39.9 51.2
Based on the results obtained from the survey conducted store harmful bacteria that when they get into foods that
on the food handlers’ practices (Table 3), they were found cause serious illness. All utensils and crockery need to be
to have complied with all the assessed aspects accordingly, cleaned for the same reasons.
with the percentage of agreed responses between 65.1% to According to the Centres of Disease Control and
99.3%. In fact, ten (10) of the evaluated practices indicated Prevention [25], handwashing is one of the most important
a very encouraging score of over 90.0%. These outcomes steps that can be taken to prevent food poisoning when
may be due to the fact that majority of the respondents preparing food, since hands have high potential to spread
(96.1%) are food handlers who have attended food germs in the kitchen and some of these germs, like
handling courses. Hence, it is very likely that they are Salmonella, can be very harmful to the health. In fact, hand
already aware of proper food handling procedures and have washing accounts for 33% of all related food poisoning
even practiced them prior to COVID-9 pandemic. cases [26]. Therefore, it is necessary for the people who
Very high compliance was recorded in the cleaning and prepare foods to maintain good personal hygiene practice
washing routines (P25, P26, P29, P31) proving that this by washing hands frequently with soap and water to
exercise is very much emphasized by the food handlers prevent germs from spreading around the kitchen and to
involved. The respondents agreed that they wash raw meat other food.
before cutting (99.3%); clean food preparation areas and The respondents also expressed strong agreement with
utensils after preparing raw meat, poultry and seafood the practice of using separate utensils and equipment (P32,
(99.3%); wash hands with soap after using the toilet P33) to avoid contamination or germs being transferred
(98.2%); and wash hands if they sneezed or coughed into from one material to another such as using different
them while preparing food (97.1%). chopping boards for meats and vegetables (98.9%) and
Cleanliness is a key factor in preventing foodborne different kitchen towels to wipe kitchen surfaces and dry
illness. Therefore, all cooking utensils must be cleaned and hands (93.5%).
sanitized properly before starting any food preparation. There are various kitchen tools and appliances designed
This is especially important for equipment in direct contact for different purposes. Therefore, food providers should
with food such as cutting boards, knives, mixers, blenders, use the right tools at the right time to avoid
countertops, etc. These equipment and areas are known to cross-contamination. The use of appropriate equipment,
130 The Awareness of Food Safety Knowledge, Attitudes and Practices among Food Handlers during COVID-19
such as separate cutting boards is to prevent bacterial, not go through physical changes as applied to processed
physical, chemical, and allergic infection [27]. foods. The food handlers also took a stand not to use
The food handlers seemed to place great importance on expired food items. This action shows that they are aware
healthy and safe food choices (P28, P30). This practice is of the dangers of expired food to the human body.
proven through a significant score of 97.9% for selecting Although sometimes the effects of consuming expired
fresh and wholesome food to purchase, as well as 93.9% substances do not occur immediately but gradually, yet the
for not using food beyond its expiry date. In addition, side effects should not be taken lightly because the
respondents are also very careful and meticulous with the chemical reactions in the food will turn into poisons and
prohibitions set by food handling regulations and avoid injure the digestive organs and cause poisoning.
doing things that are contrary to hygienic practices (P27, However, the results revealed that three (3) of the
P37). practices received less attention by the food handlers, with
They ensure that pets are not permitted to roam in the relatively low scores of only between 73.1% to 65.1%. The
kitchen area (96.8%) and would avoid wearing accessories habits that need to be further improvised are: checking if
and jewellery while handling foods (94.0%). According to the food is cooked by visual appearance, e.g., fish should
Food Safety Information Council, pets can carry bacteria, be opaque and flaky and egg yolk and white should be firm
viruses, parasites, and fungi which can be transmitted to (73.3%); not keeping leftover food at room temperature
humans, through bites, poop, saliva or dander [28]. until the next meal (68.7%); and checking if the food is
Respondents also have made the right decision to choose cooked by tasting it (65.1%). The lack of consideration on
fresh and wholesome food because it is more nutritious and these measures may be based on their perceived
healthier as it does not have artificial flavours, assumption that these aspects are less harmful or do not
preservatives, other additives or genetically modified affect food quality and safety.
substances found in the industrialised food, since it does
P30 I do not use food beyond its expiry date 2.5 3.2 .4 37.7 56.2
P34 I check if the food is cooked by tasting it 10.3 17.8 6.8 47.0 18.1
P37 I wear jewellery while handling food 2.5 1.8 1.8 29.9
Food Science and Technology 11(2): 125-132, 2023 131
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