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1]

Original Article

Assessment of the food hygiene practices of food

handlers in the Federal Capital Territory of Nigeria

Chigozie O. Ifeadike1, Okechukwu C. Ironkwe2, Prosper O. U. Adogu1,

Chinomnso C. Nnebue1,3
1
Departments of Community Medicine and 3HIV Care, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching
Hospital, Nnewi, 2IO Chuks Atlas Health Care Services Ltd, Abuja, Nigeria

Abstract
Background: The principle of food hygiene implies that there should be minimal handling of food items. Food handlers
are thus expected to observe proper hygiene and sanitation methods as the chances of food contamination largely
depend on their health status and hygiene practices. Objective: This study assessed the food hygiene practices of food
handlers and made recommendations for improved food safety measures within food establishments in the Federal Capital
Territory. Materials and Methods: The study design was cross‑sectional descriptive. A multistage sampling technique was
employed to select 168 food handlers of various types. Data was collected using a mix of quantitative methods (structured
interviewer‑administered questionnaires and observation checklist). Data were analyzed using the statistical package for social
sciences version 14. Results: Four categories of food handlers were identified in 45 food establishments. Seventy‑one (42.3%)
of the subjects are males, whereas 97 (57.7%) are females. Most of them, 122 (72.7%), had secondary education and above,
whereas 46  (27.3%) had primary education and below. One hundred and fifty  (89.3%) of them wash their hands after the
use of toilets, whereas only 44 (26.7%) change their hand gloves at work. One hundred and twenty (71.4%) of them undergo
regular medical checkup, whereas 53 (31.5%) are isolated from workplace when ill. A few of them, 51 (30.4%) use sanitizers/
disinfectants at workplace, whereas 38 (22.6%) check food temperature with thermometer. Also, 103 (61.3%) use ideal waste
disposal methods at workplace (P < 0.01). Conclusion: Establishments should train staff regularly on basic personal hygienic
techniques, self care and good house‑keeping practices.
Keywords: Food hygiene, food handlers, Federal Capital Territory

Introduction a manner as to ensure that food is safe to consume and is

According to e‑How, a food handler is a person with any
job that requires him/her to handle unpackaged foods or
beverages and be involved in preparing, manufacturing,
serving, inspecting, or even packaging of food and beverage
items.[1] All food handlers are required to use proper
hygiene and sanitation methods when working with food.
Food hygiene is the set of basic principles employed in the
systematic control of the environmental conditions during
production, packagng, delivery/transportation, storage,
processing, preparation, selling and serving of food in such
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DOI:
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of good keeping quality.[2] However, food itself can pose
a health threat, a problem that is serious in developing
countries due to difficulties in securing optimal hygienic
food handling practices. The public health objective
of food hygiene and safety is the prevention of illness
attributable to consumption of food. This is because of
adequate supply of safe, wholesome and healthy food
are essential for the health and well‑being of humans.[3]
Okojie et al.,[4] in an assessment of food hygiene practices
among food handlers in a Nigerian university campus
reported that the knowledge and practice of food hygiene
and safety was poor. Only 30.4% of respondents had
pre‑employment medical examination, whereas 48%
had received any form of health education on food
Address for correspondence: Dr. Chinomnso C. Nnebue,
Department of HIV Care, Department of Community Medicine,
Nnamdi Azikiwe University Teaching Hospital, PMB 5025,
Nnewi, Anambra, Nigeria.
E‑mail: nnebnons@yahoo.com

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Ifeadike, et al.: Assessment of the food hygiene practices of food handlers
hygiene and safety.[4] Isara and colleagues reported
good knowledge and practice of food hygiene and
safety among food handlers in fast food restaurants
in Benin City, Edo State.[5] But the study showed that
knowledge and practice were influenced by previous
training (P = 0.002), whereas food handlers who had
worked for longer years in food restaurants had better
practices of food hygiene and safety (P = 0.036). The level
of education did not significantly influence practice.[5]
The consumption of contaminated or unsafe foods may
result in illness, also referred to as foodborne disease.[6,7]
Foodborne diseases remain a major public health problem
across the globe. Even in developed countries, an
estimated one‑third of the population are affected by
microbiological foodborne diseases each year.[3] Kaferstein
and Abdussalam reported that up to 10% of the population
of industrialized countries might suffer annually from
foodborne diseases.[8] An estimated 70% of cases of
diarrheal diseases are associated with the consumption
of contaminated food.[3,9] Statistics show that every year,
there are estimated 76 million foodborne illness in the
United States (26,000 cases for 100,000 inhabitants)
and 2 million in the United Kingdom (3,400 cases for
100,000 inhabitants). [9] Diarrheal diseases, mostly
caused by foodborne or waterborne microbial pathogens,
remain the leading causes of illness and deaths in these
countries, killing an estimated 1.9 million people annually
worldwide. Yet, it is expected that a large number of
illnesses remain under‑reported as only the most serious
cases are usually investigated. In most developing
countries, reliable statistics on foodborne diseases are not
available due to poor or non‑existent reporting systems.[9]
Transmission of intestinal parasites and entero‑pathogenic
bacteria is affected directly or indirectly through
objects contaminated with feces. These include food,
water, nails, and fingers, indicating the importance of
feco‑oral human‑to‑human transmission.[8] Accordingly,
food handlers with poor personal hygiene working in
food‑serving establishments could be potential sources
of infections of many intestinal helminths, protozoa, and
enteropathogenic bacteria.[10] Food‑handlers who harbor
and excrete intestinal parasites and enteropathogenic
bacteria may contaminate foods from their feces via their
fingers, then to food, and finally to healthy individuals.[3]
Compared to other parts of the hand, the area beneath
fingernails harbors the most micro‑organisms and is
most difficult to clean.[11] Biological contaminants largely
bacteria, viruses, and parasites constitute the major
cause of food‑borne diseases. In developing countries,
such contaminants are responsible for a wide range of
diseases, including cholera, campylobacteriosis, E. coli
gastroenteritis, salmonellosis, shigellosis, typhoid
Tropical Journal of Medical Research | Vol 17 • Issue 1 • Jan-Jun 2014
and paratyphoid fevers, brucellosis, amoebiasis, and
poliomyelitis.[12]
Various factors such as the general sanitary standards of
the house, the proper use of sanitary facilities like latrines,
hand‑washing lavatories, refuse management systems,
and dishwashing facilities affect food safety in food
establishments. Food handling, preparation, and service
practices are other important factors in determining the
safety of food. Conditions of cooking utensils, food storage
systems (time and temperature), as well as food handlers’
knowledge and practices similarly affect food safety directly
or indirectly.[13‑15]
Food hygiene rests directly on the state of personal
hygiene and habits of the personnel working in the
establishments.[2] In developing countries such as Nigeria,
the normal atmospheric temperature is ideal for the
multiplication of micro‑organisms which cause food
poisoning.[16] Sometimes the food may look attractive
and may be normal in smell and taste, and yet cause
acute illness almost immediately after consumption
or after a period of time due to toxins produced by
bacteria. Globally foodborne illness affects an estimated
30% of individuals annually.[17] Meals prepared outside
the home have been implicated in up to 70% of traced
outbreaks. And with urbanization, industrialization and
development, people tend to increasingly patronize public
food vendors. Thus proper handling of foods, utensils and
dishes together with emphasis on the necessity for good
personal hygiene are all of great importance. This study
assessed the food hygiene practices of food handlers in
the Federal Capital Territory (FCT) and made appropriate
recommendations for the improvement of food safety and
sanitary conditions within food establishments in the FCT.
Materials and Methods
Abuja is Nigeria’s FCT. It was created in 1976, covers
an area of 800 km2 and has a population of about
1.4 million.[18] The FCT is subdivided into 6 area councils.
The study design was descriptive cross sectional. A sample
size of 168 was calculated based on the assumption
of 5% expected margins of error and 95% confidence
interval using the formulae for calculating sample size for
descriptive studies in population >10,000, n = z2pq/d2.[19]
where, n = calculated sample size, z = standard
normal deviate at 95%, Confidence Interval = 1.96,
P  = percentage of food handlers with acceptable food
hygiene practice (50%),[19] q = the complementary
probability of P which is (1 − p) that is, percentage of food
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Ifeadike, et al.: Assessment of the food hygiene practices of food handlers

handlers without acceptable food hygiene practice (50%), include: Socio‑demographic characteristics of food
d = precision level 5% = 0.05. handlers; physical infrastructure of premises; availability of
water supply, toilet facility, refuse management and dish/
Calculated sample size ( n ) hand washing facility. Five sanitarians were recruited and
trained for 3 days on the purpose of the study, the format of
(1.96 ) × ( 0.5) ×(0.5)
2

= = 384 the questionnaire and checklist, interviewing techniques,

( 0.05)
2
and data quality management, which was also ensured
by regular supervision, spot checking and reviewing
Correction for finite population, less than 10,000, is the completeness and consistency of questionnaire and
given by; checklist on a daily basis. Data were analyzed using the
[19] n 384 statistical package for social sciences (SPSS) version 14.
Final sample size ( nf ) = = = 168 The results were presented in tables for easy appreciation.
1+(n) 1 + ( 384 )
(N) 285 The researchers obtained Ethical clearance from the Ethics
Committee of NAUTH, Nnewi.
A multistage sampling technique was used and this included
the following stages: First, out of the six council areas in
Abuja, two (Abuja municipal and Kuje) council areas were
Results
selected by a simple random sampling method. Secondly,
The socio‑demographic characteristics of the food
a comprehensive list of existing catering establishments
handlers are shown in Table 1. Of the four categories of
was obtained from the Department of Public/Occupational
food handlers identified, 71 (42.3%) of participants are
Health, Federal Capital Development Authority (FCDA),
males while 97 (57.7%) are females. While 87 (51.8%) of
Abuja. This list was then stratified by the type of service
participants are married, 81 (47.6%) are single. As many
they provide into the following strata: Restaurant 16,
as 122 (72.7%) of the subjects had secondary education
bar 8, butcher shop 12, juice vendor 9, totaling 45 food
and above, while 46 (27.3%) had primary education
establishments. The main purpose of stratification was
and below. Sixty‑six (39.3%) of the respondents are
to avoid over or under‑representation of certain types
semi‑urban dwellers, while 62 (36.9%) and 60 (23.8%)
of establishments. A proportional sample size was then
reside in rural and urban centers, respectively.
determined for each stratum, and selection performed
using a table of random numbers to obtain a sample size
Table 2 shows the personal hygiene practices of the
of 168 from an estimated population size of 285. Four
participants. One hundred and fifty (89.3%) of the subjects
categories of food handlers were identified, which include:
engaged in hand wash after the use of toilets, 83 (49.4%)
Production staff, cooks, butchers, and waiters. Participants
use hand gloves, while 44 (26.2%) practice changing
were selected from the list of work groups mentioned above
of hand gloves at work. Furthermore, 57 (33.9%) of
and included all the staff that prepare and serve food. subjects were observed with an open wound or cut while
94 (55.9%) make use of apron/head tie at work.
“Bar” includes establishment that serves alcoholic drinks:
Beer, wine, liquor cocktails and pepper soup for consumption
Table 1: Socio‑demographic characteristics of the food
on the premises. “Restaurant” includes establishments that
handlers
prepare and serve food, drink to customers. Meals are
Parameter Frequency (n=168) %
generally served and eaten on premises, but may also offer
Sex
take‑out and food delivery services. “Butcher/suya shop”
Male 71 42.3
includes establishments that slaughter animals, dress their Female 97 57.7
flesh and sell their meat or any combination of these three Marital status
tasks. They may prepare standard cuts of meat, poultry, Married 87 51.8
fish and shellfish for sale in retail or wholesale to other Single 81 47.2
food establishments. “Ice cream/fruit juice shop” includes Educational status
No formal education 11 6.5
establishments that prepare frozen dessert usually made
Primary 35 20.8
from dairy products, such as milk and cream, and often Secondary 107 63.7
combined with fruits or other ingredients and flavors. Tertiary 15 8.9
Place of residence
Data was collected using a mix of quantitative Rural 62 36.9
methods (structured, pre‑tested interviewer administered Semi‑urban 66 39.3
questionnaires and observation checklist). Data collected Urban 40 23.8

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Ifeadike, et al.: Assessment of the food hygiene practices of food handlers

In Table 3 which shows the medicare practices of the Table 2: Personal hygiene practices
respondents, 120 (71.4%) of the subjects undergo regular Personal hygiene practices Frequency (n=168) %
medical checkup (medical check up includes: History Hand wash after toilet 150 89.3
taking and examination for signs and symptoms of medical Use of apron/hair tie 94 55.9
conditions such as diarrhea, dysentery, typhoid, sore throat, Use of hand gloves 83 49.4
Wash of apron/hair tie 79 47.0
which can lead to food poisoning, stool and urine analysis.),
Open cut/wound 57 33.9
53 (31.5%) are isolated from work place when ill, while Change of hand gloves 44 26.2
32 (19.0%) are provided with medication when ill.

Table 4 depicts the workplace hygiene practices of the Table 3: Medicare practices of the subjects (n=168)
subjects in which 51 (30.4%) of them used sanitizers and Medicare practices of the subjects Frequency (n=168) %
disinfectants at workplace, also 51 (30.4%) of respondents Regular medical checkup 120 71.4
observe proper hand washing with soap and water and Isolated from work place when ill 53 31.5
Provided medication when ill 32 19
38 (22.6%) checked food temperature with thermometer.
Furthermore, 103 (61.3%), of the participants make use
of proper waste disposal methods in their workplace. Table 4: Work place hygiene practices of subjects
Work place hygiene practices of subjects Frequency %
Table 5 shows that only 54 (32.1%) of the food handlers (n=168)
had undergone regular food hygiene training/health Use of proper waste disposal methods 103 61.3
education as opposed to 114 (67.9%) who had not. Proper hand washing with soap and water 51 30.4
Use of sanitizers and disinfectants 51 30.4
Table 6 shows the observed work place practices of Food temperature check with thermometer 38 22.6
establishments. Sixteen (35.6%) had their facilities
regularly inspected by sanitary officers (for adequacy Table 5: Food handlers who attend regular training/receive
of size, water supply, lighting, toilet facilities etc), health education on food hygiene
21 (46.7%) practiced meat inspection by the FCT public Regular food hygiene training Frequency (168) %
health department. There was good environmental Yes 54 32.1
hygiene in 27 (60.0%) of them. None of the food No 114 67.9
establishments practiced posting of food safety info Total 168 100.0
sheets, notification of carriers or food handlers with
communicable diseases to local authority, certification Table 6: Observation on ideal work place hygiene practices
of medical fitness of workers. of establishments
Work place practices Frequency %
Discussion (n=45)
Regular inspection of food premises by sanitary 16 35.6
Poor and faulty food handling practices have been officers (for adequacy of size, water supply,
lighting, toilet facilities etc)
identified as the leading cause of the majority of
Meat inspection 21 46.7
foodborne diseases.[20] This study identified some poor Good environmental hygiene 27 60.0
hygiene practices exhibited at work. These include: Posting of food safety info sheets 0 0
Lack of provision of medication by establishment, non Notification of carriers or food handlers with 0 0
isolation from work environment when sick, irregular communicable diseases to local authority
use of sanitizers and disinfectants, lack of change of Certification of medical fitness of workers 0 0
hand gloves between ready‑to‑eat meal, irregular food
hygiene training, non use of thermometer to check food hygiene and safety among food handlers in fast food
food temperature. This finding of our study is a strong restaurants in Benin City, Edo State.
indication of the poor health status and poor hygiene
practices of food handlers/establishments in the FCT It is a known fact that chlorinated tap water kills
and agrees with the findings of Okojie and colleagues in Salmonellae,[21] yet many food handlers living in the city
Benin, who in an assessment of food hygiene among food slums and shanty towns do not have access to potable
handlers in a Nigerian university campus reported that pipe‑borne water and so are at a high risk of infection,
the knowledge and practice of food hygiene and safety especially with enteric fever known to be endemic in
were poor.[4] It, however, differs from the findings of Isara places of low personal hygiene and environmental
et al.,[5] who reported good knowledge and practice of sanitation.[22] This study has also established that food

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Ifeadike, et al.: Assessment of the food hygiene practices of food handlers
handlers in the FCT constitute significant risk in the
spread of enteric fever. It has also buttressed the role
that food handlers play in disease transmission as several
authors have reported.[2,5,23] However, given the time and
money required to improve environmental sanitation,
and increase the accessibility to potable water, the most
rewarding option are regular food hygiene education
and periodic screening of food handlers with a view to
following up those found infected and getting them cured.
According to Okojie and others, only about a third of
respondents had premployment medical examination.[4]
Majority of the respondents in this study (89.3%)
reported that they usually washed their hands before
starting the preparation of food and after handling raw
meat. A smaller number reported that they do not use
hand wash detergent to wash their hands before starting
the preparation food and after handling raw meat. In
studies conducted by Altekruse et al.,[24] Yang et al.,[25]
and Shiferaw et al.,[26] 87% to 92% of the respondents
also indicated that they usually washed their hands before
handling food, and 62% to 100% that they also usually
washed their hands after handling raw meat or poultry.
Effective hand washing therefore has been an essential
control measure for prevention of pathogen Pathogen.
Any agent capable of causing disease. The term pathogen
is usually restricted to living agents, which include viruses,
rickettsia, bacteria, fungi, yeasts, protozoa, helminths,
and certain insect larval stages transmission in food
service establishments. Facilities for personnel should be
adequate and all hand washing basins in toilet areas must
be supplied with hot and cold water, and hand‑cleaning
preparations in dispensers and paper towels or air
hand‑dryers should be provided Codex Alimentarius.
A document entitled ‘Recommended International Codes
of Hygienic Practice for Fresh Meat, for Ante‑Mortem
and Post‑Mortem Inspection of Slaughter Animals
and for Processed Meat Products’ pub. The potential
for cross‑contamination is reduced, however, when
disposable paper towels are used.[27]
Less than one‑third of these respondents indicated using
soap and water for washing their hands before starting
the preparation of food and or after handling raw poultry
or meat. Furthermore, it is most probable that majority
of the participants do not wash hands according to good
hygienic practices. This may be connected with lack
of potable water and standard hand wash facilities in
establishments. Even when such facilities are available,
most participants do not have basic understanding
of standard hand washing procedures. Other notable
violations include; nonprovision of thermometers for
14 Tropical Journal of Medical Research | Vol 17 • Issue 1 • Jan-Jun 2014
temperature control. It is important to note that further
evaluation of the above mentioned factors is vital in
food safety and how best to control these factors is of
importance in improving the system.
The safety of food in the FCT was further challenged
by the sanitary condition of some food outfits that
participated in this study. The observations made include
the fact that personnel with infections are not restricted
from potentially hazardous work, inadequate provision
of disinfectants/sanitary products including hand gloves,
apron and head tie. Also, observed work place practices
of establishments indicated that about one‑third had
their facilities regularly inspected by sanitary officers (for
adequacy of size, water supply, lighting, toilet facilities).
None of the food establishments practiced posting of
food safety infosheets, notification of carriers or food
handlers with communicable diseases to local authority,
certification of medical fitness of the workers. The Centre
for Disease Control and Prevention (CDC) has called
for food safety communication to design methods and
messages aimed at increasing food safety risks reduction
practices from farm to fork.[17] The CDC advocated that
posting food safety info sheets is a tested and an effective
intervention tool that positively influence the food safety
behavior of food handlers.[17]
This study showed that approximately one‑third of
respondents had regular training and health education
on food hygiene and safety. This agrees with the finding
by Okojie et al.,[4] where poor food hygiene practice was
linked to the fact that barely half of the respondents
had received any form of health education on food
hygiene and safety. Isara et al.,[5] also concurred that
knowledge and practice were influenced by previous
training (P = 0.002). These findings emphasized the place
of training and health education on good food hygiene
practices among food handllers.
In a bid to maintain good health, the establishments
should provide disposable rubber gloves, plasters and
other measures for minor cuts for use as necessary to the
personnel who have contact with food. Establishments
should train and re‑train staff on good hygienic practices
with emphasis on the importance of good hygiene and
ideal hand washing practices. The staffs should be made
to appreciate the impact of poor personal cleanliness and
unsanitary practices on food safety. Equally important,
is the need to educate food handlers on the avoidance
of unwholesome practice of scratching the head, placing
finger in or about the mouth or nose and indiscriminate and
uncovered sneezing. Finally, they should be encouraged to
inculcate the habit of thorough and proper hand washing
after using the toilet/bathroom, before and after eating.
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Ifeadike, et al.: Assessment of the food hygiene practices of food handlers
The FCT public health departments should ensure the
posting of food safety infosheets as advocated by the CDC
as well as the notification of carriers or food handlers
with communicable diseases by the establishments to
local authority. The FCT public health departments in
collaboration with public and private health facilities
should enforce compliance of pre‑placement and periodical
medical examination of food handlers in the FCT and a
certificate by a medical practitioner should be submitted,
stating whether such person is fit to handle food or not.
Health inspectors/sanitary officers should work out
modalities to ensure that persons with any foodborne
infection are restricted and treated. Also, there should be
periodic inspection of food premises by sanitary officers,
to ensure compliance with minimum standards in terms
of housekeeping, equipment and materials.
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How to cite this article: Ifeadike CO, Ironkwe OC, Adogu PO,
Nnebue CC. Assessment of the food hygiene practices of food
handlers in the Federal Capital Territory of Nigeria. Trop J Med Res
2014;17:10-5.
Source of Support: Nil, Conflict of Interest: None declared.
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