Maintaining proper food safety standards throughout the stages of production, processing, and preparation is essential to prevent contamination and minimize the risk of foodborne diseases, which pose a significant threat to public health. In Ethiopia, the definition of food encompasses all substances intended for human consumption. Prioritizing food safety is a crucial step towards enhancing overall human well-being and quality of life [1, 2, 3].

The rapid expansion of restaurants globally, fueled by factors such as urbanization, industrialization, tourism, and globalization, has heightened food safety risks throughout the food supply chain, necessitating increased vigilance from all parties involved. Foodborne illnesses represent a significant threat to public health worldwide, particularly in developing countries, where a substantial proportion of diarrheal diseases, up to 70%, are attributed to contaminated food. This contamination often arises from inadequate hygiene practices, insufficient regulatory standards, ineffective oversight, and low levels of education among food workers [4, 5, 6, 7, 8].

Ensuring food safety and hygiene is crucial for protecting the health of consumers. Organizations such as the World Health Organization (WHO) and the European Union (EU) stress the importance of reevaluating community strategies related to food and water safety based on scientific evidence to combat foodborne illnesses. These diseases impact millions each year in the United States and disproportionately affect developing countries, often resulting from inadequate hygiene practices during the preparation, handling, and storage of food [9, 10, 11, 12].

Food-safety-related illnesses and deaths remain a significant threat to public health in Sub-Saharan Africa [13]. In Ethiopia, the government recognizes that communicable diseases like diarrhea and parasitic infections, which are largely attributed to inadequate food safety practices, are major contributors to hospital admissions and outpatient visits. Additionally, numerous reported cases of foodborne viral diseases in the catering industry have been traced back to infected food handlers [14]. The COVID-19 pandemic has prompted the WHO to emphasize the importance of respiratory hygiene, physical distancing, handwashing, and personal protective equipment (PPE) as key preventive measures [14].

The WHO advocates for the “Five Keys to Safer Food” as essential measures to prevent foodborne illnesses. These key practices include ensuring cleanliness, keeping raw and cooked foods separate, cooking food thoroughly, maintaining safe temperatures for food storage, and using safe water and quality raw materials [15, 16]. Although food preparation techniques can differ depending on the type of food and the environment, following these five fundamental principles is essential for maintaining food safety. This is particularly important in facilities that cater to large groups of customers, as even a small mistake could affect a significant number of individuals [17].

Ethiopia’s food systems are under pressure due to resource limitations, urban expansion, and a growing population. Research indicates that only 20% to 70% of food establishments implement safe handling practices, which include maintaining cleanliness in the environment, ensuring food handlers are clean and properly trained, providing sanitary facilities, disposing of waste correctly, obtaining legal licenses, and practicing good personal hygiene [18, 19]. Additional crucial factors that influence food safety include household cleanliness, access to sanitation facilities, procedures for food handling, preparation, and storage, as well as the condition of kitchen equipment and the skills and habits of food service workers [20].

To effectively safeguard human health, food safety regulations must be grounded in scientific evidence; however, strategies that work well in affluent countries may not be suitable for developing nations with varied food systems and regulatory frameworks. In Ethiopia, dining at hotels, restaurants, and local eateries is prevalent, where large volumes of food are prepared, handled, and served rapidly, creating contamination risks that are frequently associated with food handlers [21]. Although many studies have been conducted, researchers in Ethiopia have not yet explored the factors contributing to the inconsistent implementation of safe food-handling practices within the commercial sector. There is a need for more flexible models to effectively ensure food safety in environments that are high-risk, costly, and have weak enforcement of regulations [22].

Maintaining food safety is critical in reducing mortality and morbidity associated with foodborne diseases. However, improper food handling practices can still lead to severe consequences, including loss of life. This study aimed to assess food safety practices and associated factors among food handlers in food establishments in Bako Town, West Shawa Zone, Oromia Region, Ethiopia.

Bako Tibe Woreda, situated 251 kilometers from Finfinnee, the capital of Ethiopia, in the West Shoa zone of Oromia, was the focus of this study conducted from August 19 to September 16, 2023. The Woreda has a population of 196,418, evenly split between males and females, distributed across 32 Kebeles (28 rural and 4 urban), with 40,920 households and 28,703 children under the age of five. The healthcare infrastructure includes one district hospital, five health centers, and 28 health posts. According to data from the Bako Trading Office, 78 food and beverage establishments were identified in Bako town. An institution-based cross-sectional study design was utilized, with the source population comprising all food handlers employed in the food and drinking establishments of Bako Town. The study population consisted of selected handlers who met the inclusion criteria, excluding those providing temporary services, street food vendors, and handlers of canned or packaged foods.

In this study, the dependent variable was food safety practices. The independent variables encompassed sociodemographic factors, including age, gender, marital status, income, and responsibility. Additionally, the study examined the handlers’ knowledge of food safety practices and the Attitude of food handlers on food safety practices. Availability of sanitary facilities like water supply, disposal system, and protective equipment. Sanitary conditions of the vending site, like cleanness, distance from dump sites, and free from dust, flies, and rodents.

Initially, the collected data were reviewed, coded, and entered into Epi-data version 3.1, Manufacturer: The EpiData Association (Odense, Denmark) after which it was exported to SPSS version 25 (IBM, Armonk, NY, USA) for analysis. Descriptive statistics were employed to summarize the variables in terms of frequencies and proportions. A binary logistic regression analysis was conducted to identify independent variables related to food safety practices. In the bivariate analysis using this model, variables with a p-value of less than 0.25 were selected as candidates for the final model. For the multivariable analysis, all candidate variables were included in a multivariable binary logistic regression model to assess the effects of independent variables on the outcome variable. The finding of Hosmer and Lemeshow’s test for model fitness is insignificant (the p-value of the test was 0.140), indicating the model fits the data. Variance inflation factor (VIF) was done, and the presence of multicollinearity was detected. Independent variables were considered statistically significant determinants of the outcome variable if they had a p-value of 0.05, a 95% confidence interval (CI), and an adjusted odds ratio (AOR). The findings were ultimately presented in both text and tables.

This study aimed to evaluate food safety practices and the factors associated with them among food handlers in food establishments located in Bako Town, West Shoa zone. The findings revealed that the prevalence of good food handling practices was 30.4% (95% CI = 25.4–35.8). This prevalence was low as compared to the finding of a study conducted in Ireland which was 67% [29] and Nigeria, where the good practice was 92.1% [30]. The reason for the observed discrepancy might be the difference in the socioeconomic status of study participants and the levels of hotels and restaurants. In addition, this observed prevalence is lower as compared to the previously conducted systematic review and meta-analysis in Ethiopia, which was 48.36% [31]. The difference in findings may be attributed to variations in the study participants. Additionally, this prevalence is lower than that reported in a study conducted in northwest Ethiopia, which found a prevalence of 40.1% [24]. The possible reason for the observed prevalence might be differences in the study area and the socio-economic status of the participants. In addition, this prevalence was lower compared to the study done in Woldia Town, which was 46.5% [29], Metu town 55.1% [32], Gondar City 49.0% [19], Fitche town 50.5% [26], and Debra Markos 54% [27]. The reason for the difference would be the difference in the study population, study area, and sampling technique.

It was found that participants with good knowledge were twice as likely to engage in good food safety practices compared to those with poor knowledge (AOR = 2.06, 95% CI: 1.25–3.40). This result aligns with findings from studies conducted in Mettu, Ethiopia [32], Fitche town [26], Bole, Addis Ababa [18], and Debra Markos [27]. The possible reason for this higher food safety practice among those with good knowledge might be that good knowledge has a positive effect on attitude, which in turn could have improved the practice. Therefore, improving food safety knowledge for those who have poor practices could improve food safety in the study area. To improve food safety practices, mandatory training programs for food handlers, focusing on enhancing knowledge and practical skills. In addition, awareness creation should be necessary to foster positive attitudes towards food safety. This initiative can be supported by strengthening regulatory monitoring and engaging local stakeholders.

Participants who had received training were four times more likely to engage in good food safety practices compared to those who had not attended any training (AOR = 4.26, 95% CI: 2.10–8.63). This finding aligns with results from a study conducted in Debra Markos [27], Gondar City [19], Beshoftu town [6], and SNNPR, Ethiopia [28]. The possible justification for this could be better awareness, experience sharing from experts, and motivation or improved attitude during the training. Therefore, identifying skill gaps among study participants and providing necessary training could improve the food handling practice in the study area [33]. This improved food handling practice could reduce the burden of feco-orally transmitted and other communicable diseases.

Participants with positive attitudes toward food safety were nearly three times more likely to engage in good food handling practices compared to those with negative attitudes (AOR = 2.83, 95% CI: 1.68–4.77). This finding is consistent with results from a study conducted in Debra Markos [27], Bole, Addis Ababa [18], California [6], and Ethiopia [7].

The prevalence of good food safety practices among handlers was relatively low. The key determinants identified were good knowledge, participation in training, and positive attitudes. To address this issue, a multifaceted approach is necessary, including prioritizing educational and training programs to enhance knowledge, launching awareness campaigns emphasizing food safety principles, strengthening policies and regulations with regular monitoring, implementing incentive programs, and collaborating with stakeholders to develop targeted interventions. The municipality and health department should provide periodic training, awareness, and support to local establishments, as investing in handlers’ knowledge could help reduce feco-orally transmitted diseases, a leading cause of health facility visits. Future researchers should conduct additional studies to address limitations and expand insights.

AOR, Adjusted Odds Ratio; CI, Confidence Interval; FBDs, Food-Borne Diseases; PPE, Personal Protective Equipment; WHO, World Health Organization.

The data supporting the findings of this study can be obtained from the corresponding author upon request.

DT & TB conceptualization, and designed the study. DT & TB performed the research. ND and AT provided help and advice throughout the study. TB & DT analyzed the data. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

All procedures were conducted according to applicable guidelines and regulations. An ethical clearance letter was obtained from our institution (approval number Ref.NO./Lakk.Ambo. RVU/4267/2015). Before data collection, all participants or their families/legal guardians were informed about the study’s purpose and their right to participate voluntarily, from all study participants verbal informed consent was obtained with ethical approval. Confidentiality was upheld throughout all phases of the research, ensuring that the names of study subjects and any personal identifiers were not used during data collection. The collected data were stored on a secure, password-protected computer.

This research received no external funding.

The authors declare no conflict of interest.