Study area
The study was carried out in Addis Ababa city and Burayu town. Addis Ababa is Ethiopia’s capital located on the highland close to the Great Rift Valley at 2,355 m above sea level. It is the center of commerce and culture for the nation. Population of Addis Ababa is estimated to be 5,70, 628 in 202412. There are two primary abattoirs in Addis Ababa city that supply the city’s more than 4,000 registered butcher shops. There are currently ten sub cities, of which eight sub cities were included in the current study. Burayu is located at an elevation of 2,399 m above sea level and a projected population of 96,604 in 2021, The town is one of the first-level regional metropolitan centers under the Oromia National Regional State. According to Ethiopian statistics from 2021, the town contains about 800 butcher shops and one abattoir13.
Study design and period
Across-sectional study was conducted to assess the knowledge, attitude and practices of butcher shop workers on foodborne pathogens in Addis Ababa city and Burayu town from November 2021 to April, 2022.
Source population and study subjects
The source population for this investigation was all butcher shop workers working in Burayu town and Addis Ababa city administration. The study subject was butcher shop workers working in Addis Ababa city and Burayu town.
Sample size determination and sampling technique
Sample size was calculated using a single population proportion formula with 95% CI, 5% marginal error, and p = 9% proportion of food handlers having good food safety knowledge, attitude, and practices, from the previous study14; n=(z2 * p(1-p)/d2; where n = total number of samples; p = expected prevalence from previous study; Z = 95 confidence interval; ,d = margin of error. Hence calculated sample size was 126.
The butcher shop workers were selected conveniently from 8 sub cities in Addis Ababa and Burayu town.
Number of butcher shops involved in the study from Addis Ababa (n = 83) and Burayu (n = 43) was distributed proportionally based on the total number of butcher shops in Addis Ababa and Burayu. Interviewer-administered data collection technique was used to collect epidemiological and other required information. Only butcher shop workers involved in processing of the raw beef were selected in a single Bucher shop. Usually, two workers are assigned in a single butcher shop to serve the customers: the one who is mainly involved in cutting of the carcasses was considered for the study. The butcher shop workers who were willing to participate in the study were included in current study.
Data collection procedure
The questionnaire was originally prepared in English and then translated into local language (Amharic), and Oromifa. A pretested interviewer-based structured questionnaire adapted from different literatures to fit with both the subject area, and local context was used. Close-ended questions focusing on personal hygiene, cross-contamination, safe food handling, and hand-washing practices were employed. Each knowledge question was followed by three implicit responses (yes, no, and I don’t know), Attitude was measured using two alternatives (agree or disagree) and the practice was using questions geared to practices and supplemented with observation during data collection time.
Study variables
Dependent variables
The response variables of this study were food safety practices, such as using plastic handled or wooden knife, knowledge in this aspect the participants were checked whether they know or not commonly known foodborne pathogens name, impact of food borne diseases, and attitude of butcher shop workers towards the role of regulatory bodies, the advantage and disadvantage of consuming raw meat over cooked one to reduce foodborne diseases were assessed.
Independent variables
The predictor variables of this study were sex, age, frequency of hand washing, distance of sink from the butcher shops formal educational level of the butcher shopworkers.
Measurement method and scoring
The questionnaire was divided in to four sections, Demographic information, Knowledge, Attitude and Practices. In addition, observational checklists were used to collect relevant data. Butcher shop workers were interviewed and observation was made using a value of 0 and 1. One and zero score was given to the wrong (No and do not know) and correct answers respectively. A total number of 11 questions on food safety knowledge were used. Meat handlers who scored overall score < 7.5 points were considered to have “unsatisfactory” and those who scored ≥ 7.5 points (≥ 68%) accuracy) “satisfactory” knowledge of food safety. The third part of the questionnaire was about the food safety attitude of meat handlers. It comprises 11 questions related to hand washing, cross-contamination, food handling, storage, etc. In this section, the respondents’ answers were “agreed”, “disagree”, and “don’t know”. The response was analyzed as categorical variables (Yes, no, or Don’t Know). A score of one was given to the right answer and zero to the wrong and I do not know answers.
The butcher shop workers were interviewed for their attitude towards raw meat consumption in the community, importance of training to improve food quality was assessed using11 questions. Food handlers who answered 7.7 or more questions correctly were considered to have a “good” attitude, whereas respondents who answered less than 7.7 questions correctly were considered to have a “poor” attitude.
The last section was hygienic practices. It comprises the issues of personal hygiene, hand washing practices against foodborne diseases, and cross-contamination. With 16 questions with possible responses: “yes”, and “no”. For evaluation, a score ≥ 70% means food handlers practiced 11.2 or more out of 16 hygienic practices which are listed in the questions were considered as having “good” hygienic practices. The result interpretation was done based on the previous study cut of value.
Statistical analysis
Descriptive statistics was computed to summarize data, including frequencies, percentages for categorical, and mean for continuous variables respectively using Statistical Package for Social Sciences (SPSS) version 26. Bivariable and multivariable logistic regression analysis was conducted to identify factors associated with the dependent variable such as practice, Knowledge and Attitude and independent variables such as age, education, frequency of practices that showed 0.2 odd’s ratio were examined using multivariate analysis was done to avoid confounder’s risk. The strength of the association was presented by the odds ratio with 95% CI, a p-value of less than 0.05 was considered statistically significant.
Ethical considerations
The protocol was approved by the Institutional Review Board of Addis Ababa University, Aklilu Lemma Institute of pathobiology, with minute reference number (ALIPB-IRB/59/2013/21 dated 25/06/2021) and from Ethiopian Public Health Institute with reference no (EPHI/6.13/565 dated 22/09/2021). Written informed consent was obtained from the butcher shop workers and the butcher shop owners. The confidentiality of data was assured by deidentifying of each participant. In addition, the information was accessed only by the investigators and the hard copy of the information was physically locked.
Guidelines and regulations
The work has performed based on materials and methods previously published and in accordance with country’s relevant research guidelines and data confidentiality regulation.
