Assessment of sanitary status

Abstract

Objective: Lack of basic infrastructure, poor practices of hygiene in food service establishments can contribute to outbreaks of foodborne illnesses. The aims of this study was to explore the sanitary conditions of food and drink catering establishment services in South East Asmara, Eritrea. Methods: A descriptive observational study was conducted among 139 food and drinks catering establishments in South East Asmara from June to September 2019. Data were collected using semi-structured questionnaire for obtaining socio-demographic information of the manager or owner and observation checklist was used to assess the overall physical sanitary status of the establishment. Factors infl uencing vermin infestation, kitchen and latrine cleanliness were further investigated. Data analysis was done using SPSS version 22. The descriptive results were summarized using frequencies and percentages in tables and graphs. Dining premises, kitchens and stores were categorized as clean, if the fl oor, wall, and ceiling of the premises were found clean. Moreover, bivariate and multivariate logistic regression analysis were done to fi nd out the main factors infl uencing vermin infestation, kitchen and latrine cleanliness. Results: Out of the total 139 food and drink catering establishments assessed, about one-tenth (8.6%) of the establishments' dining room, a third (33.3%) of the stores and 31.5% of the kitchens were in a poor and unclean sanitary conditions. Good premise fl oor status (AOR=18.03; 95%CI (2.09-155.1), P<0.05), availability of adequate light (AOR=5.02; 95%CI (1.01, 24.99), P<0.05), running water (AOR=0.26; 95%CI (0.09, 0.72), P<0.05) and dustbin availability (AOR=4.32; 95%CI (1.06, 21.6), P<0.05) were found having signifi cant association with overall cleanliness of the kitchen. Two-third (65%) of the establishments' latrines were clean. Availability of separate latrine for male and female (AOR=2.34; 95%CI (1.06, 5.18), P<0.05), and separate latrine for clients and workers (AOR=3.41; 95%CI (1.10, 10.57) were the main factors potentiating latrine cleanliness. More than a third (37.4%) of the establishments were found to be infested by vermin. Nearer kitchen distance from latrine (AOR=3.65; 95%CI (1.60, 8.35), p<0.05), presence of pets (AOR=4.1; 95%CI (1.17, 14.40), and breeding of insects in the liquid waste disposal (AOR=4.08; 95%CI (3.37, 12.17), p<0.01) had signifi cantly increased the presence of vermin infestation. Conclusion: The sanitary condition of the food and drinks catering establishments in the study area was found to be poor. There is a need to impose regulations and guidelines governing the basic sanitary requirement of the food and drinks catering establishments.

Full text

233
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
https://dx.doi.org/10.17352/acmphDOI:
2455-5479ISSN:
MEDICAL GROUP
Abstract
Objective: Lack of basic infrastructure, poor practices of hygiene in food service establishments can contribute to outbreaks of foodborne illnesses. The aims of this
study was to explore the sanitary conditions of food and drink catering establishment services in South East Asmara, Eritrea.
Methods: A descriptive observational study was conducted among 139 food and drinks catering establishments in South East Asmara from June to September 2019.
Data were collected using semi-structured questionnaire for obtaining socio-demographic information of the manager or owner and observation checklist was used to
assess the overall physical sanitary status of the establishment. Factors infl uencing vermin infestation, kitchen and latrine cleanliness were further investigated. Data
analysis was done using SPSS version 22. The descriptive results were summarized using frequencies and percentages in tables and graphs. Dining premises, kitchens
and stores were categorized as clean, if the fl oor, wall, and ceiling of the premises were found clean. Moreover, bivariate and multivariate logistic regression analysis were
done to fi nd out the main factors infl uencing vermin infestation, kitchen and latrine cleanliness.
Results: Out of the total 139 food and drink catering establishments assessed, about one-tenth (8.6%) of the establishments’ dining room, a third (33.3%) of the stores
and 31.5% of the kitchens were in a poor and unclean sanitary conditions. Good premise fl oor status (AOR=18.03; 95%CI (2.09-155.1), P<0.05), availability of adequate light
(AOR=5.02; 95%CI (1.01, 24.99), P<0.05), running water (AOR=0.26; 95%CI (0.09, 0.72), P<0.05) and dustbin availability (AOR=4.32; 95%CI (1.06, 21.6), P<0.05) were found
having signifi cant association with overall cleanliness of the kitchen. Two-third (65%) of the establishments’ latrines were clean. Availability of separate latrine for male
and female (AOR=2.34; 95%CI (1.06, 5.18), P<0.05), and separate latrine for clients and workers (AOR=3.41; 95%CI (1.10, 10.57) were the main factors potentiating latrine
cleanliness. More than a third (37.4%) of the establishments were found to be infested by vermin. Nearer kitchen distance from latrine (AOR=3.65; 95%CI (1.60, 8.35),
p<0.05), presence of pets (AOR=4.1; 95%CI (1.17, 14.40), and breeding of insects in the liquid waste disposal (AOR=4.08; 95%CI (3.37, 12.17), p<0.01) had signifi cantly
increased the presence of vermin infestation.
Conclusion: The sanitary condition of the food and drinks catering establishments in the study area was found to be poor. There is a need to impose regulations and
guidelines governing the basic sanitary requirement of the food and drinks catering establishments.
Research Article
Assessment of sanitary status
of food and drinks catering
establishments: A descriptive
observational study in south
East Asmara, Eritrea, 2019
Idris M Idris1*, Samuel J Wolday2, Amanuel T
Ghebremariam2, Habtom Kidane3, Misgina Leake3, Hagos
Milkias3 and Kahsay Ghebremichael3
1Department of Anesthesia, Orotta National Referral Hospital, Asmara, Eritrea
2School of Nursing, Asmara College of Health Sciences, Asmara, Eritrea
3School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
Received: 28 September, 2020
Accepted: 16 October, 2020
Published: 19 October, 2020
*Corresponding author: Idris M Idris, MSc, MPH,
Department of Anesthesia, Orotta National Referral
Hospital, Asmara, Eritrea, Tel: 00291729695:
Email:
Keywords: Food catering establishments; Food
safety; Hygiene; Eritrea; Observational
https://www.peertechz.com

234
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
Abbreviations
ACHS: Asmara College of Health Sciences; AOR: Adjusted
Odds Ratio; COR: Crude Odds Ratio; SEA: South East Asmara;
FAO: Food and Agriculture Organization; SPSS: Statistical
Package Social Science; USA: United States of America; WHO:
World Health Organization
Background
Annually, food borne diseases affects up to 30% of the
populations in developed countries and kills millions in
developing countries [1]. Food borne diseases are common in
developing countries due to the prevailing poor food handling
and sanitation practices, inadequate food safety laws, weak
regulatory systems, lack of fi nancial resources to invest safer
equipment, and lack of education for food handlers [2]. It is
depicted that around 70% of diarrhea cases in developing
countries were attributed to food-borne routes. On the top
of its morbidity and mortality, worldwide fi nancial expenses
of foodborne diseases is hard to be determined [3]. Due to
the increments in the cases of food borne outbreaks, food
safety has increasingly gaining attention of authorities
worldwide [4]. Occurrence of food borne illnesses can be
attributed to many socio-demographic and environmental
factors, handling process of food preparation being the main
factor [5]. Good hygiene practices include proper storage
of food items, maintenance of clean environment during
food preparation, and assurance of clean and free of bacteria
dishes served [6]. Food safety is defi ned as the assurance that,
when food is consumed in the usual manner does not cause
harm to human health and wellbeing [7]. Poor food and drink
catering establishments, and irresponsible food handlers are
considered as sources of food borne illnesses [8]. Lack of basic
infrastructure, poor knowledge about hygiene, absence of
potable water, lack of proper storage facility and unsuitable
environments for food operations (such as proximity to sewers
and garbage dumps) and inadequate facilities for garbage
disposal are considered factors compromising food safety [9].
Moreover, poor sanitary practices in food storage, handling,
and preparation can create an environment in which bacteria
and other infectious agents are more easily transmitted [10-
12]. Poor personal hygiene could also contribute to foodborne
illness, indicating that food handlers’ knowledge and their
handling practices is quite important [13]. It is suggested that
improper food handling practices contribute to about 97% of
food borne illnesses in food services establishments and homes
[14]. Therefore, to reduce foodborne illnesses, it is crucial to
explore the sanitary and hygienic conditions of food providing
services [15]. Ensuring safe food service has been one of the
major challenges and concerns for producers, consumers and
public health offi cials [16]. In Eritrea, even though there is
no published data available about food safety, it is assumed
that every year many people suffer and even die to the intake
of contaminated food and water. Based on the records of the
ministry of tourism, the total number of customers utilizing
food and drink establishments in South East Asmara (SEA) per
day was 11,260 [17]. This suggests that the health and well-
being of such a big number of people subsequently depends on
the sanitary status of the catering establishments. The aim of
this study was therefore to obtain current information on the
sanitary conditions of food and drinks catering establishment
services in South East Asmara (SEA).
Methods
Study design and setting
Descriptive observational study design was used to assess
the sanitary conditions of food and drink catering establishment
services in South East Asmara from June to September 2019.
Study population
The study and source population were all food and drink
catering establishments situated in South East Asmara.
Establishments which had full-fi lled the selection criteria were
included in the study.
Selection criteria
The included subjects were all type of establishments
licensed and registered by the ministry of tourism to provide
both food and drink services. Whereas establishments not
registered and licensed by the Ministry of Tourism, that serve
only bottled drinks, like bars, and whose owners or managers
were not willing to be participants in the study were excluded.
Sample size estimation
The sample size was determined using a single population
proportion by assuming that 50% proportion of the food and
drink establishments practiced safe and clean procedures
with 95% confi dence interval and 5% margin of error. Using
population correction formula and adding non-response rate
the sample size was 139 establishments.
Sampling design
The research was done using a stratifi ed random
proportionate to size method. The total list of all food and
drink establishment services which are found in SEA was
obtained from Ministry of Tourism; the establishments were
then stratifi ed in to fi ve strata based on the type of service they
provided. The fi ve type of establishments were: restaurants,
hotels, juice/coffee shops, snack bars and fast food places.
Sampling frame was prepared for each stratum. Then the
sample was distributed to each stratum proportional to its size.
Finally, simple random sampling was used to select
individual sample (Figure 1).
Data collection instrument
A Semi structured questionnaire was used to interview
the manager/owner for obtaining socio-demographic
information. This was pretested to ensure its consistency,
validity and reliability. Observation checklist adopted from
extensive literature review and from checklists used by
Ministry of Tourism and Ministry of Health was used to
assess and/or observe the overall physical sanitary status of
the establishment. Observation checklist focused on assessing
food premise’s physical condition, handling cleanliness and

235
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
arrangement of utensils and provision of sanitary facilities
including lavatory, waste handling and disposal facilities and
the hygienic practices of food handlers. Factors infl uencing
vermin infestation, kitchen and latrine cleanliness were further
investigated.
Data analysis procedure
Data entry was done using CSpro version 6.3, then the data
was exported to statistical package for social sciences (SPSS)
version 22 for analysis. Socio-demographic information of
the managers, environmental factors and physical sanitary
status of the food premises, repair conditions and cleanliness
of dining rooms, store and kitchen premises, sanitary and
lavatory facilities of the establishments, vermin infestation
and provision of latrine and fi nal solid waste disposal were
described using descriptive statistics. Dining premises,
kitchens and stores were categorized as clean, if the fl oor, wall,
and ceiling of the premises were found clean. Binary logistic
regression analysis was done to fi nd out the main factors
infl uencing vermin infestation, kitchen and latrine cleanliness.
The results are presented in the form of tables and graphs.
Adjusted odds ratio (AOR) and crude odds ratio (COR) are
reported to show the strength of association and p value ≤ 0.05
was considered as statistically signifi cant.
Ethical consideration
The proposal was approved by the “Ethical and Scientifi c
Committee” of the School of Public health, Asmara College
of Health Sciences (ACHS). A formal letter was then written
from the head of School of Public Health ACHS to Ministry of
Tourism. Clear communications was done with Ministry of
Tourism on the objectives and signifi cance of the study, and
then the Ministry gave Permission letter to collect data from
the selected catering establishments. Confi dentiality of the
respondents was assured by excluding their name and had the
full right to reject or withdrawal participation at any time from
the study.
Results
Socio demographic information of the managers
A total 139 managers were interviewed and 139 food and
drink establishments were observed. Majority of the managers
were males (69.1%), married (74.8%), younger age (38.8%),
and have reached secondary school (48.9%). Though nearly
half (47%) of the managers were owners, about 72% have
never been trained about food hygiene. Yet, more than half of
the mangers (52.5%) work as food handlers (Table 1).
Environmental factors and physical sanitary status of
the food premises
Out of the total 139 establishments, the highest number
of establishments type were restaurants (41.7%), followed by
snack bars (23.7%), fast food places (19.4%), hotels (8.6%),
and Coffee/Juice shops (6.5%). There was separate rooms for
each food premises in majority of the establishments (80.6%),
whereas the rest 19.4% didn’t have separate kitchen or store
for raw food. Majority of the establishments were newly
constructed (89.9%), individually owned (87.1%), and had the
requirements for hiring food handler (92%). However, only
half of the establishments (49.7%) have never been inspected
for sanitary conditions (Table 2).
Repair conditions and cleanliness of dining rooms, store
and kitchen premises
Among the assessed food and drink establishments, almost
all (95%) of the dining room fl oors were constructed of tiles. The
Table 1: Socio demographic information of the managers, Asmara, Eritrea, 2019
(N=139).
Characteristics Frequency (n) Percentage (%)
Sex Male 96 69.1
Female 43 30.9
Age
20- 35 54 38.8
36 - 50 51 36.7
51 - 65 20 14.4
66 - 82 14 10.1
Marital status
Single 26 18.7
Married 104 74.8
Divorced 8 5.8
Widowed 1 0.7
Educational level of manager
Illiterate 2 1.4
Primary* 6 4.3
Secondary** 68 48.9
College
level*** 63 45.3
Manager position status
Owner 62 44.6
Hired Person 45 32.4
Delegate 32 23
Manager trained about food
hygiene?
Yes 39 28.1
No 100 71.9
Manager works as a food handler Yes 73 52.5
No 66 47.5
The manager as a food handler
(n=73)
Cooker only 7 9.59
Waiter only 9 12.33
Store man only 6 8.22
More than one 51 69.86
*Grade 1-5, ** Grade 6-12, *** Grade 12 and above
Total food and drink catering
establishments in SEA (184)
establishments were selected as a 139
sample, in each stratum the sample was
allocated using propoƌƟonate to size
method, the individual samples were
then selected usingůŽƩery method
Hotels (16) Juices/ĐŽīĞĞ
shops (12)
Restauran ts
(77)
Fast foods
(34)
Snack bar
(43)
Hotels
(12)
Juices/ĐŽīĞĞ
shops (9)
Restaurant
(58)
Fast food (27) Snack bar
(33)
Figure 1: Sample Recruitment Procedures.

236
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
dining room fl oors (84.2%), walls (95%) and ceilings (94.2%)
of the establishments were kept properly clean. Moreover,
almost all (98.6%) and 92.1% of the establishments’ dining
room had adequate lightning and ventilation respectively.
However more than half (55.4%) of the establishments had
no notice of no smoking and about 47% had lack of dustbin.
Among 108 establishments which had separate room for store,
the store fl oor was constructed of tiles in about 83% of the
establishments. The store’s fl oor, ceilings and wall were found
clean in only 45.4%, 48.1% and 43.5% of the establishments
respectively. The stores had adequate ventilation in more than
half (54.6%) of the establishments and only 43% had adequate
lighting. However, dustbin was not available in most (96.3%)
of the establishments store and all the establishments’
store had not notice of no smoking. Considering the kitchen
premises, 53% of the establishments’ kitchen fl oor, 54.7%
of the wall and 54.7% ceiling were properly cleaned. With
regard to the ventilation and lighting of the kitchens, in
45.3% of the establishment’s there was adequate ventilation
and in 88.5% of the establishment’s the kitchen had adequate
lighting. However, management of solid wastes was poorly
addressed with more than half (54%) of the premises had no
covered dustbin available. Dining premises, kitchen and store
were categorized as clean, if the fl oor, wall, and ceiling of
the premises are clean. Based on the assumption, 91% of the
establishments’ dining room, 66.7% of the stores and 68.5%
of the kitchens were clean (Table 3).
Table 2: Environmental factors and physical sanitary status of the food premises
associated with the establishment N=139.
Characteristics Frequency (n) Percentage (%)
Establishment ownership
Individual 121 87.1
Organization 6 4.3
Association 12 8.6
Building Ownership Private owned 68 48.9
Private-Rented 37 26.6
Government-owned 34 24.5
New construction (in 5 years)
Yes 125 89.9
No 14 10.1
Type of establishment Restaurants 58 41.7
Hotels 12 8.6
Juices/coffee place 9 6.5
Fast food places 27 19.4
Snack bars 33 23.7
Separate room for each food premises
Yes 112 80.6
No 27 19.4
Sanitary inspection per year
6 times 4 2.87
4 times 15 10.8
2 times 31 22.3
Only 1 time 20 14.38
Not at all 69 49.65
Action taken after inspection(n=70)
Warning 24 34.3
Closure 4 5.7
Monetary penalty 14 20
Nothing 28 40
Any requirements for hiring food handler
Yes 128 92
No 11 8
Requirement for hiring (n=128)
Certifi cation 15 11.7
Experience 103 80.5
Both 10 7.8
Table 3: Physical sanitary status of the dining room (N=139) and store premises
(N=108), Asmara, Eritrea, 2019.
Characteristics Dining room (n=139)
N (%)
Store (n=108)
N (%)
Kitchen
(n=108) N (%)
Premise fl oor constructed of
Tile 132 (95) 90 (83.3) 128 (92.1)
Concrete 1 (0.7) 13 (12) 9 (6.5)
Plastered stone 5 (3.6) 1 (0.9) 1 (0.7)
Wood 1 (0.7) 4 (3.7) 1 (0.7)
Premise Floor cleanliness
Clean 117 (84.2) 49 (45.4) 74 (53.2)
Moderately clean 17 (12.2) 43 (39.8) 45 (32.4)
Dirty 5 (3.6) 16 (14.8) 20 (14.4)
Premise wall cleanliness
Clean 132 (95) 47 (43.5) 76 (54.7)
Moderately clean 6 (4.3) 50 (46.3) 38 (27.3)
Dirty 1 (0.7) 11 (10.2) 25 (18)
Premise ceiling cleanliness
Clean 131 (94.2) 52 (48.1) 76 (54.7)
Moderately clean 7 (5) 43 (39.8) 37 (26.6)
Dirty 1 (0.7) 13 (12) 26 (18.7)
Adequate light
Yes 137 (98.6) 71 (65.7) 123 (88.5)
No 2 (1.4) 37 (34.3) 16 (11.5)
Adequate ventilation
Yes 128 (92.1) 59 (54.6) 63 (45.3)
No 11 (7.9) 49 (45.4) 76 (54.7)
Notice of no smoking
Yes 62 (44.6) 0(0) 0(0)
No 77 (55.4) 108 (100) 139 (100)
Dustbin in the premise
Yes 65 (46.8) 4 (3.7) 64 (46)
No 74(53.2) 104 (96.3) 75 (54)
Overall cleanliness
Clean 127 (91.4) 93 (66.7) 95 (68.5)
Unclean 12 (8.6) 46 (33.3) 44 (31.5)

237
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
Factors infl uencing kitchen cleanness
Good premise fl oor status, availability of adequate light,
running water and dustbin availability were found having
signifi cant association with overall cleanliness of the kitchen.
A kitchens whose fl oor was in a good repair condition (well
fi t and easily to be cleaned) were 18 times more likely to be
clean compared to a kitchen whose fl oor was in a poor repair
condition (cracked or detached) (AOR=18.03; 95%CI (2.09-
155.1), P<0.05). Kitchens which had adequate light were found
5 times more likely to be clean (AOR=5.02; 95%CI (1.01, 24.99),
P<0.05). Those kitchens which lacked running water were
74% less likely to be clean when compared to those kitchens
where running water was available at the time of observation
(AOR=0.26; 95%CI (0.09, 0.72), P<0.05). Kitchens which were
provided with dustbin were 4.3 times more likely to be clean
compared to the counterpart (AOR=4.32; 95%CI (1.06, 21.6),
P<0.05). Despite the fact that wall and ceiling repair conditions
and the availability of adequate ventilation were found to have
signifi cant association with overall cleanliness of the kitchen
at the bivariate level, these factors were no more signifi cant
after adjusting the confounding effect (Table 4).
Kitchen cleanliness by type of establishments
The highest proportion of unclean kitchen was hold by
snack bars, in which 69.7% of the total participated snack bars
had unclean kitchen, followed by Coffee/Juice shop (55.6%)
and restaurants (50%). The lowest proportion of unclean k
itchen was observed in hotels in which only 16.7% of the total
participated hotels had unclean kitchen (Table 5).
Sanitary and lavatory facilities of the establishments
Out of the total establishments, about 70% have lacked
running water during inspection, and there was discontinuation
of water supply in majority (95%) of the establishments i.e. in
88.7% of them, piped water had been discontinued for more
than three months.
Only 20.9% of the establishments were observed to use
the conventional three compartments dish washing facility.
Additionally, in 23(16.5%) of the establishments there was
no distance separating the dish/cup washing place from the
latrine that is, they were adjacent to each other. Moreover, only
about a third, 41(29.5%), of the establishments placed their
sanitized utensils appropriately (dried, closed, and separated),
and majority of the establishments (92.1%) were not observed
to use hot water while washing dishes (Table 6).
Provision of latrine and fi nal solid waste disposal
About two-third (66.2%) of the establishments had separate
latrines for male and female. Urinal was also available in 54%
of the establishments and more than half of the establishments
(54.2%) had detergent for hand washing. However, dish
washing facility and the latrine were built attached in 16.5%
of the establishments. In addition 10 % of the establishments
had a closed toilet during the observation time and more than
onethird (34.5%) of the opened toilets were not clean (Table 7).
Latrine cleanliness
Two-third (65%) of the establishments’ latrines were
clean, whereas the remaining 35% were unclean (Figure 2).
Factors facilitating latrine cleanliness
A multivariate analysis showed that establishments which
had separate latrine for male and female were about 2 times
more likely to be clean than those which hadn’t (AOR=2.34;
95%CI (1.06, 5.18), P<0.05). Likewise, establishments which
had separate latrine for clients and workers were about 3
times more likely to be clean as compared to those who had
common latrine for clients and workers (AOR=3.41; 95%CI
(1.10, 10.57), P<0.05). Though signifi cance was not attained at
the multivariate level, univariate analysis showed that latrines
where running water available during observation were more
likely to be clean when compared to those latrines where no
running water was available during the time of observation
(Table 8).
Infestation of vermin
As indicated in Figure 2, more than one-third (37.4%)
of the establishments were found to be infested by vermin.
The infesting vermin were either fl ies (55.8%), cockroaches
(26.9%) rats (3.8%) and/or by more than one of the vermin
(13.5%).
Table 4: Cleanliness of kitchen in relation to physical status of the kitchen premise,
dustbin availability, and availability of adequate light, ventilation and running water
availability, Asmara, Eritrea, 2019 (N=139).
Variables N (%)
Clean
Kitchen N
(%)
COR (95% CI) AOR (95% CI)
Good premise
fl oor
121
(87.1)
71 (58.7) 24.14 (3.11,
187.3)*** 18.03 (2.09, 155.1)**
Good premise
wall
125
(89.9) 70 (56) 7.63 (1.64, 35.5)** 3.74 (0.53, 26.11)
Good premise
ceiling
115
(82.7) 67 (58.3) 5.3 (1.85, 15.19)** 2.62 (0.73, 9.46)
Adequate light 123
(88.5) 69 (56.1) 5.53 (1.50, 20.41)** 5.02 (1.01, 24.99)**
Adequate
ventilation 76 (54.7) 34 (44.7) 2.7 (1.24, 5.88)** 1.3 (0.46, 3.67)
Unavailable
pipe water 93 (66.9) 37 (39.8) 0.28 (0.07, 0.82)** 0.26 (0.09, 0.72)**
Available
dustbin
125
(89.9) 69 (55.2) 4.51 (1.20, 11.9)** 4.32 (1.06, 21.6)**
**, ***: P-value < 0.05, P-value < 0.01
Table 5: Kitchen cleanliness by type of establishment, Asmara, Eritrea, 2019 (N=139).
Kitchen cleanness
Type of establishment N (%) Clean N (%) Unclean N (%)
Restaurant 58 ((41.7) 29 (50) 29 (50)
Snack bar 33 (23.8) 10 (30.3) 23 (69.7)
Fast food 27(19.4) 19 (70.4) 8 (29.6)
Hotels 12 (8.6) 10 (83.3) 2 (16.7)
Juice/coffee shop 9(6.5) 4 (44.4) 5 (55.6)

238
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
Factors affecting vermin infestation
A multivariate logistic regression analysis showed that
establishments which had pets and insect breeding around the
liquid waste disposal were a times more likely to be infested
with vermin in comparison to those which hadn’t (AOR=4.1;
95%CI (1.17, 14.40), p<0.05) and (AOR=4.08; 95%CI (3.37,
12.17), p<0.01) respectively. And kitchens whose distance is
less than four meter from the latrine were 3.6 times more
likely to be infested with vermin than those with a distance of
greater than 4 meters (AOR=3.65; 95%CI (1.60,8.35), p<0.05).
Establishments with unclean latrine were found more likely to
be infested with vermin than those with clean latrine though no
signifi cant statistical association was found in the multivariate
logistic regression (Table 9).
Food handler’s hygienic practices
Among the 139 assessed food and drinks catering
establishments, food handlers with appropriate cover-coat and
short trimmed and clean nail were found in 79.1% and 59.7%
of the establishments. Likewise, food handlers whose hair was
properly covered were observed in only 54.7% institutions.
Surprisingly, in about 60% of the establishments’, food
handlers were observed wearing different kind of fi nger or
hand ornament (Figure 3).
Situation of food storage and preservation
As described in Table 10, Majority (38.8%) of the
establishments had complete separation of raw foods and other
non-food materials, while 36.7% were found to separate the
materials side by side (close to each other) and in the remaining
24.5% institutions the items were found mixed. About half
(51.8%) of the establishments stored raw foods on the fl oor.
Majority (97.8%) of the establishments were found to have
Table 6: Water supply, utensils washing facility, Asmara, Eritrea, 2019 (N=139).
Characteristics Frequency (n) Percentage (%)
Running water available during inspection
Yes 46 33.1
No 93 66.9
Discontinuation of water supply
Yes 131 94.9
No 7 5.1
How long discontinued
One day 1 0.8
Four days 1 0.8
a week 0 0
More than a week 13 9.8
>3 months 118 88.7
Utensils washing equipment
Fixed basin with water tap 102 73.4
Fixed basin without water tap 20 14.4
Bowls/bucket 1 0.7
One or more of the above 16 11.5
Number of compartments for dish washing
One 16 11.5
Two 93 66.9
Three 29 20.9
Four 1 0.7
Hot water used for washing dishes
Yes 11 7.9
No 128 92.1
Detergents used for washing dishes
Yes 123 88.5
No 16 11.5
Utensils placed appropriately
Yes
No
41
98
29.5
70.5
Table 7: Provision of latrine and fi nal solid waste disposal, Asmara, Eritrea, 2019
(N=139).
Characteristics Frequency Percentage (%)
Distance of dish washing from latrine
0 m (attached) 23 16.5
up to 4 meters 53 38.1
>4 meters 63 45.3
Type of toilet facility
Water-Flush type 137 98.6
Dry pit latrine 2 1.4
Drainage/ plumbing connected
Sewerage system 134 96.4
Drainage 2 1.4
Septic tank 3 2.2
Separate latrine for male an d female
Yes 92 66.2
No 47 33.8
Urinals available
Yes 64 46
No 75 54
Toilet during Observation
Yes 125 89.9
No 14 10.1
Yes 120 86.3
No 19 13.7
Hand washing functional
Yes 102 85
No 18 15
Detergent available for hand washing
Yes 55 45.8
No 65 54.2
Solid waste collected
by waste collecting trucks 113 81.3
To municipal container 16 11.5
On site burning 4 2.9
On site burial or to latrine 6 4.3

239
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
at least one refrigerator. Nevertheless, a third (33.1%) of the
establishments’ perishable and nonperishable foods were
found stored together in the same refrigerators. Moreover,
only 20% of the refrigerators had fi xed thermometers
reading below 100C. Besides, in more than half (55.4%) of the
establishments, the distance between the ready to eat foods
preservation room and latrine was less than 4 meters. During
the study time, spoiled food was observed among 28.7% of the
establishments. Storage of perishable and nonperishable foods
in the same refrigerators was strongly related to spoilage of
food (OR=5.343(1.729, 16.507) 95% CI and p-value of 0.004).
Discussion
To reduce food borne illness related to poor hygiene
practices, food hygiene procedures and practices in different
food establishments should be improved [18]. The study
revealed that, majority (91.4%) of the establishments’’ dining
room, about two-third (66.7%) of the kitchens and 68.5% of
the store room had good and clean sanitary conditions. Safer
food preparation and handling were reported by persons who
were females, at least 40 years of age and at least having high
school level education in some studies conducted elsewhere
[19,20].Majority of the food handlers in our study were found
Table 8: Latrine cleanliness in relation to availabilities of separate latrine for male
and female, for clients and workers and Insects breeding around the liquid waste
disposal facility, Asmara, Eritrea, 2019 (N=139).
Variables N (%)
Clean
latrine COR (95% CI) AOR (95% CI)
Separate latrine for
male and female
92
(66.2) 67(72.8) 2.56 (1.23,5.34)** 2.34 (1.06,5.18)**
separate latrine for
clients and workers
31
(22.3) 26(83.8) 3.44 (1.22,9.65)** 3.41 (1.10,10.57)**
Availability of running
water
46
(33.1) 35 (76.1) 2.1 (1.1,4.7)** 1.8 (0.42,3.64)
**, ***: P-value < 0.05, P-value < 0.01
65.5 , 65 %
34.5 , 35 %
Latrine Cleanliness
Yes No
Figure 2: Latrine cleanliness, Asmara, Eritrea, 2019 (N=139).
Table 9: Infestation of vermin in the food premises in relation to presence of pets in
the premise, latrine cleanliness, insects breeding around the liquid waste disposal
facility, distance of kitchen from latrine, Asmara, Eritrea, 2019 (N=139).
Variables N (%) Vermin
Infested
N (%)
COR (95% CI) AOR (95% CI)
Presence of pets 14
(10.1) 9 (64.3) 3.4 (1.08,10.88)*** 4.1 (1.17,14.40)**
Unclean latrine
Insects breeding
around
48
(34.5) 24 (50) 2.25 (1.09,4.62)** 1.5 (0.67,3.37)
the liquid disposals
Kitchen distance from
22
(15.8) 14(63.6) 3.6 (1.4,9.4)*** 4.08 (3.37,12.17)***
latrine (0-4meters) 40
(28.8) 37(92.5) 2.89 (1.39,6.03)*** 3.65 (1.60,8.35)**
**, ***: P-value < 0.05, P-value < 0.01.
Table 10: Situation of Food Storage and Preservation, Asmara, Eritrea, 2019 (N=139).
Characteristics Frequency (n) Percentage (%)
Does food and other non-food materials separated
Completely separated 54 38.8
Side by side (very close to each other) 51 36.7
All mixed 34 24.5
Where is food stored
Pallets and shelf 67 48.2
Floor 72 51.8
Presence of refrigerator
Yes 136 97.8
No 3 2.2
Perishable and nonperishable foods storage in
refrigerator
In the same refrigerator 46 33.1
In different refrigerator 93 66.9
Refrigerators with thermometers reading < 10ºC
Yes 28 19.9
No 111 80.1
Distance between foods preservation room and
latrine
< 4 meters 77 55.4
≥ 4 meters 62 44.6
Food status of spoiling
Spoiled 40 28.7
Not spoiled 99 71.3
37.40 %
62.60 %
Infestation of vermin
Yes No
Figure 3: Infestation of vermin.

240
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
to be males, in the age range between 20 and 35 years and a
few of them had reached higher educational level. The reason
for more number of young males as food handlers’ might be
due to the higher unemployment rate in other sectors of the
country. It is quite advisable that food establishments have
separate premises for their different kinds of services. Luckily,
the fi ndings of this study showed that a high percentage of
the surveyed establishments had separate rooms for kitchen
and other services. Besides, majority of the establishments had
separate room for store. Similarly, the presence of separate
rooms had facilitated good food handling process in a study
conducted in Ethiopia [2]. Rooms where food is prepared, stored
and served should be of impervious, smooth, and not having
cracks or crevices. However, a proportion of the establishments’
kitchens fl oor was cracked and not easy to clean. Likewise, the
ceiling status of the kitchen and dining premises was seen to
vary, the dining rooms were clean and smooth whereas the
kitchens’ were rough and dirty. This suggests that more focus is
given to the maintenance and repairing of the dining rooms, to
attract customers, than the kitchen premises. Moreover, about
a third of the kitchens and store rooms were found unclean. It
is apparent that sanitary inspections are very important tools
in food and drink establishment services for regulating the
cleanliness of the premises and preventing food borne diseases.
Studies have revealed that, the probability of having good food
safety practice was higher among food handlers supervised by
health professionals [16,21]. However, fi ndings of this study
indicated more than half of the establishments have never
been inspected in the former year. This could be the reason
for the higher proportion of dirty kitchens. Along with the
cleanliness of the premises, adequate ventilation (having open
able windows, chimneys and free of disagreeable odor) needs
to be provided to remove odors, condensation and to enable
comfortable working conditions. Nonetheless, it was shown
that less than half of the establishments’ kitchen premises
lack the minimum ventilation requirement. This might be due
to the fact that majority of the kitchens were not built in a
planned manner.
The requirement for providing adequate and safe water
supplies to public food catering establishments is too obvious
and there is no need to justify its importance. Conversely,
as the results indicated, almost all establishments’ water
supply had discontinued for more than three months. It could
be due to this reason that majority of the establishments
had their main source of water supply from water trucks at
the time of observation. As a matter of fact, running tap
water under pressure should be easily accessible to all rooms
where food is prepared and served, and utensils and food
containers are washed. However, out of the total food catering
establishments, more than two-third had no access to running
tap water inside the facility for food preparation and utensils
washing. Food utensils can be washed by hand (manually)
or by machine. In Eritrea and particularly in the study site,
hand washing was the most common method of washing food
utensils. The cleaning of soiled dishes is an important way of
preventing communicable diseases. One of the most widely
used and accepted methods of washing food utensils is the
three compartment sink or vat system. Nevertheless, very low
proportion of the establishments had the conventional three
washing compartments. Similarly, the use of boiled water for
washing utensils was poorly practiced.
Factors such as latrine condition, hand washing facilities,
solid waste storage and solid waste disposal of the food
and drink establishment were highly associated with food
safety [1,5,22]. Sanitized utensils must be stored in a clean
protected place, and unnecessary and improper handling
should be reduced to a minimum level. Only about a third of
the establishments placed the sanitized utensils appropriately
(dried, closed, and separated), while the majority of the
establishments were observed to place the sanitized utensils
inappropriately. In a similar way, kitchen cleanliness is highly
crucial to ensure the safety of prepared food. With this regard,
the fi ndings of our study revealed that, well fi tted and clean
fl oor, presence of adequate lightning, availability of running
water and dustbin were the main factors easing kitchen
cleanliness. However, infestation of vermin was observed in
more than a third of the establishments’ kitchen. Presence
of pets and breeding of insects in the liquid waste disposal
had signifi cantly increased the presence of infesting vermin.
Additionally, the nearer was the kitchen (< 4 meters) to the
latrine, the higher was the possibility of vermin infestation.
These factors have negatively affected kitchen cleanliness.
Consistently, the presence of insects and rodents had
compromised good food handling practice in Dangila town of
Ethiopia [2]. Human excreta and sewage is the potential source
of almost all enteric infections. Thus all public food service
establishments shall provide adequate, safe and conveniently
located toilet facilities. Presence of latrine and liquid waste
disposal had increased the probability of providing safe food in
Gambella region of Ethiopia [20]. According to the fi nding of
this study almost all the establishments had water fl ush type
toilet, which could be due to the fact that, most parts of Asmara
are connected to a modern sewerage system. Availability of
separate latrine for male and female, separate latrine for
clients and workers and the availability of running water were
the main factors potentiating latrine cleanliness. Provision of
lavatory and hand-washing facilities is also another important
requirement that public food premises must have. All food
premises should provide adequate and conveniently located
lavatory and hand-washing facilities with soap. Some studies
reported that the presence of hand washing facility played a
vital role for good food handling practice [20]. During the time
of this study, hand washing facilities were available in majority
of the establishments, but only half of them had detergents for
hand washing.
Preparation of hygienic and safe food begins with proper
handling of raw food and its storage so as to decrease the growth
of the microorganisms already present and to minimize the risk
of contamination. Studies indicate that, cross-contamination
of raw and cooked ingredients, defects in food preparation
and hygiene and subsequent timetemperature abuses were the
most common scenarios which lead to foodborne outbreaks in
restaurants and fast [18]. Yet, lower proportion of the assessed
food and drinks establishments were observed to completely
separate raw foods and other non-food materials in our study.

241
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
Additionally, perishable and non-perishable food were found
together in the same refrigerator in more than a third of the
establishments, this procedure had signifi cantly increased the
spoilage of food. It was fi tting to fi nd out that almost all of
the food and drinks catering establishments had at least one
refrigerator, but only a fi fth of them had fi xed thermometers
with temperature readings ≤ 100C. our fi ndings are in line with
the study conducted in Australia [23], reporting unsafe food
preparation practices in majority of the respondents leading to
food borne illnesses knowledge of food handling, increased
educational status and training of food handlers’ had a direct
association with good food handling practices in studies
conducted in many countries [5, 16, 24-28].The presence of
well-maintained and proper food handling practices, such as
wearing clean working garment, hair covering, and keeping
fi ngernails short and clean have a benefi cial ultimate impact
on serving safe food to consumers. Still, more than a third
of the establishments’ food handlers were not observed to
appropriately cover their hair. Avoidance of wearing fi nger
or hand ornament is also an essential prerequisite for a food
handler as it is a potential cause of chemical and microbiological
food poisoning, but the current study showed that about
two-third of food handlers worn fi nger or hand ornament
while serving or preparing food. Improvements of practices
during food preparation, storage and cleaning practices, can
be obtained through education and training of food handlers
involved in preparation, processing and service of meals [29].
Limitations of the study
Limitations of the research stem from the use of descriptive
observational study due to its inherent limitation to defi ne
cause and effect relationship. No laboratory analysis was made
for detecting microbial quality of food utensils. Assessing
perceptions or satisfaction level of consumers about the
services provided by the establishments might have enriched
the fi ndings of the study. Since, the study was only done in a
particular site of Asmara, generalization of the fi ndings to that
of the country is not feasible. Hence, nationwide research is
recommended to fi ll the abovementioned gaps and to deepen
the factors behind the unhygienic practices. Moreover, given
the great cultural differences within the country, more research
is necessary to determine if similar results would be derived
across the country. This study did not try to specify hypothesis
regarding food hygiene profi le.
Conclusion
The sanitary condition of the food and drinks catering
establishments in the study area was found to be poor. The
researchers observed unavailability of running water, poor
handlers hygienic practice, frequent interruption of water
supply, poor food storage and preservation, inconsistent
inspection activities, improper solid waste handling and
disposal, lack of standard dish washing compartments, unclean
kitchen and toilet facilities. There is a need to impose regulations
and guidelines governing the basic sanitary requirement of the
food and drinks catering establishments. Training of managers
and food handlers’ should be among the priority promotion
and advocacy activity. Memorandum of understanding among
Ministry of tourism; Municipality and Ministry of health is
recommended for joint planning, monitoring and evaluation of
activities in food and drink establishments.
Acknowledgements
Our appreciation goes to Ministry of Health Scientifi c and
Research Ethical Committee and Ministry of Tourism central
region for giving us the permission to carry out the study and
also the owners of food and drinks catering establishments for
agreeing to participate in this study.
Authors’ contributions
All authors participated in all phases of the study including
topic selection, design, data collection, data analysis and
interpretation. Idris M. Idris and Samuel Jirom contributed in
writing the critical revision of the manuscript for publication.
All authors approved the manuscript for publication.
Ethical approval
The proposal was approved by the “Ethical and Scientifi c
Committee” of the School of Public health, Asmara College of
Health Sciences. A formal letter was then written from the head
of School of Public Health ACHS to Ministry of Tourism. Clear
communications was done with Ministry of Tourism on the
objectives and signifi cance of the study, and then the Ministry
gave Permission letter to collect data from the selected catering
establishments. Confi dentiality of the respondents was assured
by excluding their name and had the full right to reject or
withdrawal participation at any time from the study.
Availability of data and materials
The complete data set supporting the conclusions of this
article is available from the corresponding author and can be
accessed up on reasonable request.
References
1. Havelaar AH, Cawthorne A, Angulo F, Bellinger D, Corrigan T, et al. (2013)
on behalf of the Foodborne Disease Burden Epidemiology Reference Group
(FERG): WHO initiative to estimate the global burden of foodborne diseases.
Lancet 381: S59. Link: https://bit.ly/3j7j0cg
2. Tessema AG, Gelaye KA, Chercos DH (2014) Factors affecting food handling
Practices among food handlers of Dangila town food and drink establishments,
North West Ethiopia. BMC Public Health 14: 571. Link: https://bit.ly/2FzwfF0
3. Meleko A, Henok A, Tefera W, Lamaro T (2015) Assessment of the sanitary
conditions of catering establishments and food safety knowledge and
practices of food handlers in Addis Ababa University Students’ Cafeteria.
Science 3: 733-743. Link: https://bit.ly/2T3cBV2
4. Abdul-Mutalib NA, Abdul Rashid MF, Mustafa S, Amin-Nordin S, AwangHamat
R, et al. (2012) “Knowl- edge, Attitude and Practices Regarding Food Hygiene
and Sanitation of Food Handlers in Kuala Pilah, Malaysia. Food Control 27:
289-293. Link: https://bit.ly/37b67ff
5. Bas M, Ersun AS, Kıvanç G (2006) The Evaluation of Food Hygiene Knowledge,
Attitudes, and Practices of Food Handlers in Food Businesses in Turkey. Food
Control 17: 317-322. Link: https://bit.ly/3lVNy2Q
6. FAO (2012) Fisheries and Aquaculture Topics. Hygiene and Fish Safety.
Topics Fact Sheets. Link: https://bit.ly/31fErSJ

242
https://www.peertechz.com/journals/archives-of-community-medicine-and-public-health
Citation: Idris IM, Wolday SJ, Ghebremariam AT, Kidane H, Leake M, et al. (2020) Assessment of sanitary status of food and drinks catering establishments: A descriptive
observational study in south East Asmara, Eritrea, 2019. Arch Community Med Public Health 6(2): 233-242. DOI: https://dx.doi.org/10.17352/2455-5479.000112
7. WHO (2002) Global Strategy for Food Safety. Geneva. Link:
https://bit.ly/2FzwGiC
8. Olson SL, MacKinon L, Goulding J, Bean N, Slutsker L (2000) Surveillance for
foodborne diseases outbreaks – United States. 1993-1997. Morb Mortal Wkly
Rep 49: 1-62. Link: https://bit.ly/3dyLD12
9. FAO (1997) Food and nutrition paper M 80: Street foods. Report of an FAO
Technical Meeting on Street Foods Expert Consultation, Calcutta, India, 6-9
November 1995 Food and Agriculture Organization of the United Nations.
Rome.
10. Fielding JE, Aguirre A, Palaiologos E (2001) Electiveness of altered
incentives in a food safety inspection program. Prev Med 32: 239–244. Link:
https://bit.ly/2HhD2DG
11. Gent RN, Telford DR, Syed Q (1999) An outbreak of Camphylobacter food
poisoning at a university campus. Commun Dis Public Health 2: 39-42. Link:
https://bit.ly/31iGFRg
12. Wilson M, Murray AE, Black MA, McDowell DA (1997) The implementation
of hazard Analysis and critical control points in hospital catering. Managing
Service Qual 1: 150-156. Link: https://bit.ly/3kaeds3
13. Abera B, Biadegelgen F, Bezabih B (2010) Prevalence of Salmonella typhi
and intestinal parasites among food handlers in Bahir Dar Town, Northwest
Ethiopia. Ethiop J Health Dev 24: 46-50. Link: https://bit.ly/2HgAu9e
14. Howes M, McEwen S, Griffi ths M, Harris L (1996) Food handler cortication
by home study: Measuring changes in knowledge and behavior. Dairy, Food
Environ Sanitation 16: 737-744. Link: https://bit.ly/35avqvn
15. WHO (2000) Foodborne disease: Focus on Health Education. Geneva. Link:
https://bit.ly/37dWexf
16. Azanaw J, Gebrehiwot M, Dagne H (2019) Factors associated with food safety
practices among food handlers: facility-based cross-sectional study. BMC Res
Notes 683. Link: https://bit.ly/2IAXbW5
17. Ministry of tourism, Eritrea: Management record system, 2018
18. Djekic I, Smigic N, Kalogianni E, Rocha A, Zamioudi L, et al. (2014) Food
hygiene practices in different food establishments, Food Control 39: 34-40.
Link: https://bit.ly/353JfeZ
19. Klontz KC, Timbo B, Feins S, Vevy A (1995) Prevalence of selected food
consumption and preparation behaviors associated with increased risks of
foodborne diseases. J Food Prot 58: 927-930. Link: https://bit.ly/346kzmB
20. Okugn A, Woldeyohannes D (2018) Food hygiene practices and its associated
factors among model and non-model households in Abobo district,
southwestern Ethiopia: Comparative cross-sectional study. PloS One 13:
e0194-391. Link: https://bit.ly/2Tfgzu5
21. Legesse D, Tilahun M, Agedew E, Haftu D (2017) Food handling practices
and associated factors among food handlers in arba minch town public
food establishments in Gamo Gofa Zone, Southern Ethiopia. Epidemiology
(Sunnyvale) 7: 2161-2165. Link: https://bit.ly/37rRiFl
22. Donkor ES, Kayang BB, Quaye J, Akyeh ML (2009) Application of the WHO keys
of safer food to improve food handling practices of food vendors in a poor
resource community in Ghana. Int J Environ Res Public Health 6: 2833-2842.
Link: https://bit.ly/37kIf97
23. Milazzo A, Giles L, Zhang Y, Koehler A, Hiller J, et al. (2016) Factors
Infl uencing Knowledge, Food Safety Practices and Food Preferences during
Warm Weather of Salmonella and Campylobacter Cases in South Australia.
Foodborne Pathog Dis 14: 125-131. Link: https://bit.ly/357p4MZ
24. Nigusse D, Kumie A (2012) Food hygiene practices and prevalence of intestinal
parasites among food handlers working in Mekelle university student’s
cafeteria, Mekelle. Global Adv Res J Soc Sci (GARJSS) 1: 065-071.
25. Kibret M, Abera B (2012) The sanitary conditions of food service establishments
and food safety knowledge and practices of food handlers in Bahir Dar town.
Ethiopian J Health Sci 22: 27-35. Link: https://bit.ly/2Haamww
26. Zain M, Naing N (2002) Sociodemographic characteristics of food handlers
and their knowledge, attitude and practice towards food sanitation: a
preliminary report. Southeast Asian J Trop Med Public Health 33: 410-417.
Link: https://bit.ly/2Hal86a
27. Mudey D, Goyal R, Dawale A, Wagh V (2010) Health status and personal
hygiene among food handlers working at food establishment around a rural
teaching hospital in Wardha district of Maharashtra, India. Global J Health Sci
2: 198-206. Link: https://bit.ly/3jayexk
28. Rabbi SE, Dey NC (2013) Exploring the gap between hand washing knowledge
and practices in Bangladesh: a cross-sectional comparative study. BMC
Public Health 13: 89-10. Link: https://bit.ly/3kah0BI
29. Gibson LL, Rose JB, Haas CN, Gerba CP, Rusin PA (2002) Quantitative
assessment of risk reduction from hand washing with antibacterial soaps. J
Appl Microbiol 92: 136S-e143S. Link: https://bit.ly/3dzrp7f
Copyright: © 2020 Idris IM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.