Evaluation of Compliance to Food SAafety Standards Amongst Food Handlers in Selected Hospitals in Kenya
Food borne diseases presents a widespread and growing public health problem both in developed and developing countries including Kenya. Diseases spread through food still remain a common and persistent problem resulting in appreciable morbidity and occasional mortality. Food hygiene in hospital poses peculiar problems, particularly given the presence of patients who could be more vulnerable than healthy individuals to microbiological risks. Kitchen environment and food handlers play an important role in ensuring food safety throughout the chain of production, processing and preparation; the common involvement of food handlers who are not specifically trained in food hygiene and HACCP and kitchen environments that do not meet food safety standard is a cause of concern. The objectives of this study were to assess the levels of compliance to food hygiene standards in selected hospitals in Kenya; to determine perceived barriers to implementing food safety practices amongst food handlers, and to evaluate the effectiveness of food safety training on food safety knowledge and practices among hospital food handlers. The main aim was to provide baseline data for implementing food safety standards and in hospital food services in order to enhance compliance. This study utilized a quasi-experimental study design. Through a simple random stratified sampling, 42 hospitals (22 interventional group and 20 control group) were selected for the study with a total of 343 food handlers (129 interventional group and 141 control groups). All hospitals were evaluated on their compliance to food hygiene standards; Nine FGDs having food handlers from both interventional groups and control groups were undertaken to determine barriers to implementing food safety practices. Pre and post-training assessments were conducted on knowledge and behavior related to three key food safety practices; personal hygiene, food hygiene and environmental hygiene. The study identified gaps with regard to status of the hospital kitchen, status and storage of equipments, some aspects of personal hygiene and sanitation and vector control. The following were identified in all FGDs; lack of food safety training, poor working conditions, rapid turnover, lack of sufficient equipments, lack of water, lack of recognition by the hospital management and insufficient supervision as the major barriers influencing non compliance to food safety standards. Overall food handlers knowledge scores increased from 50.6 ±16.5 pre- training to 76.4 ±15.5 post training (P<0.05), and reported practices scores increased from 101.3±11.6 pre-training to 105.3±12.2 post training (P<0.05) in the intervention group. However, when each practice was examined independently significant changes were not observed, results indicate that training can improve knowledge and behavior, but knowledge alone does not always improve behavior. The findings of this study highlight the importance of regular inspection of hospital kitchens; providing health education in food and personal hygiene to food handlers and incorporation of the same in existing guidelines and policies for food establishments.