FACTORS ASSOCIATED WITH FOODBORNE PATHOGENS AMONG FOOD 

HANDLERS IN THIKA, KIAMBU COUNTY, KENYA 

 

 

 

 

JOSEPH MAINA KIMEMIA 

 

 

 

 

A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE 

REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH 

DEGREE OF 

MOUNT KENYA UNIVERSITY 

 

 

 

 

 

 

 

 

 

JUNE 2023 



 

ii 

DECLARATION AND APPROVAL 

  



 

iii 

DEDICATION 

This project is dedicated to my family. Special thanks to my late grandpa, Mr. Joseph 

Maina, for his words of wisdom and motivation. 

  



 

iv 

ACKNOWLEDGEMENT  

Firstly, I would like to acknowledge God who has given me the gift of life, grace, and the 

strength to develop and accomplish this work. I would like to recognize the DAAD 

organization for granting me this opportunity in pursuing this master’s scholarship. I 

appreciate all my friends and family members for their ceaseless support to ensure that I 

finish this course successfully. My utmost gratitude goes to my supervisors Dr. John 

Kariuki and Dr. Alfred Owino, who dedicated their time and effort to make sure that I 

accomplish my academic goal. Not forgetting my Data collection team, the Sub-County 

ward public health officers, and Mount Kenya librarians who greatly dedicated their time 

and efforts to see this work done. Lastly, Special thanks go to Mount Kenya University's 

department of Community Health Epidemiology and Biostatistics for their ceasless 

support. 

  



 

v 

ABSTRACT  

Increasing risks of infections with foodborne pathogens may occur as a result of poor 

food handling practices. The present cross-sectional study employed a mixed-methods 

approach to determine the factors associated with foodborne pathogens among food 

handlers working in food establishments in Thika, Kiambu County, Kenya. Random 

sampling was used to enrol respondents in the survey. A single stool specimen was 

collected from each study participant. Laboratory analysis of the specimen was done to 

test for selected foodborne pathogens. Overall, 44 out of the 285 food handlers who 

took part in the study had at least one food-transmitted pathogen, putting the prevalence 

of foodborne infections among the food handlers at 15.4% (95% confidence interval 

(CI) 11.7%–20.1%). The findings from binary logistic regression indicated the 

following protective factors for foodborne pathogens among the studied food handlers: 

being female (adjusted odds ratio (AOR) 0.098 (95% CI 0.0304 to 0.315, p< 0.001); 

having a valid medical examination certificate (AOR 0.141 (95% CI 0.141 to 1. 0.439, 

p = 0.001)); not boiling or treating water before serving the water to customers was a 

risk factor for having infections with foodborne pathogens (AOR 3.043 (95% CI 1.2225 

to 7.577, p = 0.017)). The presence of foodborne pathogens among the food handlers in 

the study area potentially highlights the need to address the spread and transmission of 

foodborne infections in the study area. There is a need to institute appropriate control 

measures, including reducing the duration of regular screening of food handlers for 

foodborne illnesses in addition to training them on safe food handling practices, hand 

hygiene practices with provision of running water should be mandatory, regular 

monitoring of the food handling practices and policies on antimicrobial resistance of 

foodborne pathogens should be included in food safety control. 

  



 

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TABLE OF CONTENTS 

DECLARATION AND APPROVAL ........................................................................... ii 

DEDICATION ............................................................................................................... iii 

ACKNOWLEDGEMENT ............................................................................................. iv 

ABSTRACT ..................................................................................................................... v 

LIST OF TABLES ......................................................................................................... ix 

LIST OF FIGURES ........................................................................................................ x 

LIST OF ABBREVIATIONS AND ACRONYMS ..................................................... xi 

CHAPTER ONE .............................................................................................................. 1 

INTRODUCTION ........................................................................................................... 1 

1.1 Background of the study ............................................................................................. 1 

1.2 Statement of the Problem ............................................................................................ 3 

1.3 Objetives of the Study ................................................................................................. 4 

1.3.1 General Objetive ...................................................................................................... 4 

1.3.2 Specific Objectives ................................................................................................... 4 

1.4 Research Questions ..................................................................................................... 5 

1.5 Justification of the Study ............................................................................................. 5 

1.6 Significance of the Study ............................................................................................ 6 

1.7 Scope of the Study ...................................................................................................... 6 

1.8 Study Limitations ........................................................................................................ 7 

1.9 Delimitations ............................................................................................................... 7 

1.10 Study Assumptions .................................................................................................... 7 

1.11 Definitions of Operational Terms ............................................................................. 8 

CHAPTER TWO .......................................................................................................... 10 

LITERATURE REVIEW ............................................................................................. 10 

2.0 Introduction ............................................................................................................... 10 

2.1 Theoretical Framework ............................................................................................. 10 

2.2 Empirical Literature .................................................................................................. 11 

2.2.1 Prevalence of foodborne pathogens ....................................................................... 11 

2.2.2 Food-borne pathogens ............................................................................................ 15 

2.2.3 Sociodemographic factors ...................................................................................... 20 

2.2.4 The level of knowledge of food hygiene and safety practices ............................... 20 



 

vii 

2.2.5 Association between food handling practices and prevalence of foodborne 

pathogens. ................................................................................................................ 22 

2.3 Conceptual Framework ............................................................................................. 23 

2.4 Summary of Literature Review ................................................................................. 24 

CHAPTER THREE ...................................................................................................... 27 

RESEARCH METHODOLOGY ................................................................................ 27 

3.0 Introduction ............................................................................................................... 27 

3.1 Study design .............................................................................................................. 27 

3.2 Study Variables ......................................................................................................... 27 

3.3 Study Area ................................................................................................................. 27 

3.4 Target Population ...................................................................................................... 28 

3.4.1 Inclusion Criteria .................................................................................................... 28 

3.4.2 Exclusion Criteria ................................................................................................... 29 

3.5 Sample Size ............................................................................................................... 29 

3.6 Sampling Technique .................................................................................................. 29 

3.7 Data Collection method and procedures ................................................................... 30 

3.7.1 Questionnaire ......................................................................................................... 30 

3.7.2. Focus group discusión guides and key informant interview ................................. 31 

3.7.3 Observation Checklist ............................................................................................ 31 

3.7.4 Sample collection and laboratory procedures. ....................................................... 32 

3.8 Testing for Validity and Reliability .......................................................................... 33 

3.8.1 Pilot Testing ........................................................................................................... 33 

3.8.2 Testing for Validity and Reliability ....................................................................... 33 

3.9 Data Analysis Techniques and Procedures ............................................................... 33 

3.10 Ethical Considerations ............................................................................................ 34 

CHAPTER FOUR ......................................................................................................... 35 

RESEARCH FINDINGS AND DISCUSSIONS ......................................................... 35 

4.0 Introduction ............................................................................................................... 35 

4.1 Response Rate ........................................................................................................... 35 

4.2 Demographic Information ......................................................................................... 35 

4.3 Prevalence of selected foodborne pathogens ............................................................ 37 

4.4 Knowledge of food hygiene and safety practices. .................................................... 39 

4.5 Food handling practices ............................................................................................ 45 



 

viii 

4.6 Biviriate analysis on assessment of the association between sociodemographic 

characteristics and prevalence of foodborne pathogens. .......................................... 48 

4.7 Biviriate análysis on evaluation of the association between food handling practices 

and prevalence of foodborne pathogens................................................................... 53 

4.8 Findings based on observations made on the studied food establishments .............. 59 

CHAPTER FIVE ........................................................................................................... 63 

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS .............................. 63 

5.0 Introduction ............................................................................................................... 63 

5.1 Summary of Findings ................................................................................................ 63 

5.2 Conclusions ............................................................................................................... 63 

5.3 Recommendations ..................................................................................................... 64 

5.4 Recommendation for Further Studies ....................................................................... 65 

REFERENCES .............................................................................................................. 66 

APPENDICES ............................................................................................................... 71 

Appendix I: Introduction Letter ...................................................................................... 71 

Appendix II: Informed Consent form. ............................................................................ 72 

Appendix III: Questionnaire ........................................................................................... 75 

Appendix IV: Observation Checklist .............................................................................. 81 

Appendix V:  Introduction Letter .................................................................................... 83 

Appendix VI: ERC Certificate ........................................................................................ 84 

Appendix VII: Research Permit Nacosti ......................................................................... 85 

Appendix VIII: Clearance To Conduct Research In Kiambu County ............................ 86 

Appendix IX:Map of Kiambu County ............................................................................ 87 

Appendix X: Similarity Index ......................................................................................... 88 

 



 

ix 

LIST OF TABLES 

Table 1: Sampling framework ........................................................................................ 30 

Table 2: Sociodemographic characteristics of the study Participants ............................ 36 

Table 3: Responses on the causes of foodborne pathogens. .......................................... 41 

Table 4: Assessment of knowledge on food hygiene practices, routes of transmission of 

foodborne pathogens and symptoms of foodborne illnesses. ......................................... 42 

Table 5: Assessment of knowledge of food hygiene ..................................................... 43 

Table 6: Assessment of knowledge on food contamination ........................................... 44 

Table 7: Level of knowledge on food hygiene and safety practices .............................. 44 

Table 8: Food handling practices ................................................................................... 46 

Table 9: Association between sociodemographic characteristics and prevalence of 

foodborne pathogen. ....................................................................................................... 52 

Table 10: Bivariate analysis of the association between food handling practices and the 

prevalence of foodborne pathogens. .............................................................................. 57 

Table 11: Multivariable analysis on the association between food handling practices and 

the prevalence of foodborne pathogens. ......................................................................... 59 

Table 12: Distribution of the food premises .................................................................. 60 

Table 13: Distribution of food handlers ......................................................................... 60 

Table 14: Observations on food handling practices and hygiene .................................. 62 

 

  



 

x 

LIST OF FIGURES 

Figure 1: The worldwide problem of foodborne ailment (DALYs per 100,000 

population) by risk clusters and subregions for 2010. ................................................... 13 

Figure 2: Foodborne Disability-Adjusted Life Years (DALYs) per 100,000 population, 

per World Health Organization sub-region. ................................................................... 13 

Figure 3: Conceptual Framework ................................................................................... 24 

Figure 4: Food handling experience of the studied food handlers ................................. 37 

Figure 5: Prevalence of selected foodborne pathogens .................................................. 38 

Figure 6: Source of information on food hygiene and safety practices among food 

handlers .......................................................................................................................... 40 

 

  



 

xi 

LIST OF ABBREVIATIONS AND ACRONYMS 

CAC : Codex Alimentarios Commission 

CDC  : Centre for Disease Control and Prevention 

CIDP              : County Integrated Development Plan 

COR             : Crude Odds Ratio 

DPH          : Department of Public Health 

FBD  : Foodborne diseases 

FDG        : Focus Group Discussion 

ISO     : International Organization for Standardization 

KEBS         : Kenya Bureau of Standards  

KII        : Key Informant Interview 

LMICs            :  Lower middle-income economies 

OFSP              : Orange Fleshed Sweet potato 

PPEs             : Personal Protective Equipment 

SCFHs        : Street Cooked Food Handlers 

SPSS               : Statistical Package for Social Sciences 

TCBS        : Thiosulfate Citrate Bile  Salts Sucrose 

WHO              : World Health Organization 

 



 

1 

CHAPTER ONE 

INTRODUCTION 

Chapter one provides an introduction to the study by discussing the background and 

context of the research, including the problem that the study aims to address. It also 

outlines the objectives of the study and explains the meaning and scope of the research. 

Additionally, the chapter discusses the limitations and delimitations of the study, which 

may affect the generalizability and applicability of the findings. 

1.1 Background of the study  

Food safety is an essential public health matter to prevent foodborne diseases. To respond 

to the expanding cases of foodborne diseases, governments in different parts of the world 

are increasing their strategies for improving food safety Dagne et al., (2019). Both food 

producers, processors, distributors, and customers are interested in having safe food for 

healthy living. Those foods that do not cause injury or sickness to the customer have been 

defined as safe food. In the context of food safety, handling, preparing, and storing food 

in such a way as to prevent contamination by harmful chemicals is referred to as food 

safety. Pathogenic microorganisms that cause food-borne illnesses are also included in 

Mekonnen et al., (2021b). 

Food that has been contaminated with toxins or bacteria may be the source of food 

poisoning. If insufficient preservation measures are performed, the food may also get 

contaminated due to the bacteria that are present on the nails or skin of the person 

handling the food. This may also happen if incorrect handling practices are used, as can 

filthy contact surfaces. In an environment that is polluted due to improper food 

preparation and storage practices, disease-causing microbes including viruses, bacteria, 

and other food-borne pathogens have the potential to flourish and spread Zyoud et al., 

(2019). Signs and symptoms of toxigenic food poisoning mostly appear within the first 



 

2 

24 hours after consumption of filthy foods, symptoms of contaminated food include 

vomiting, nausea, fever, severe headache, pain in the abdomen, and diarrhea. Life-

threatening conditions such as hepatic failure, neurological and renal failure may occur 

which can cause severe morbidity and mortality depending on the virulence of pathogens 

and microbes ingested  Tshipamba et al., (2018). 

Foodborne pathogens are rampant in developing nations, including Kenya, due to the 

current poor food handling methods, poor regulatory systems, and inadequate safety laws 

on food, lack of education among handlers, and inadequate funds to buy safety equipment 

for use in food industries Karari, (2019). Between the years 2017 and 2018, there was an 

outbreak of Listeriosis in South Africa from a company that was processing meat and it 

led to 978 people being infected and 183 people dying while 15 countries that imported 

the meat from the processing company were put at risk Smith et al., (2019). Consequently, 

this reveals how the core activities of food safety such as control and assurance policies 

have been neglected. It is the lack of precautionary measures, inadequate oversight 

systems, poor certification as well the absence of training on proper hygiene measures 

that contribute to food-borne disease outbreaks, Boatemaa et al., (2018). 

In Kenya, the informal food sector largely accounts for at least 80% of the local 

markets. The hygiene control of this sector is limited because monitoring is difficult. It 

is because of inadequate hygiene control in these informal sectors that promotes the 

incidences of food-borne illnesses Oloo, (2015).  

In the Kenyan context, guided by Kenyan law (food drugs and chemical substances Act, 

Cap 254), every food handler must be subjected to routine medical examination of food 

handlers to reduce the spread of foodborne diseases. This entails Stool and urine tests 

for Salmonella Enterica, Campylobacter spp, Entamoeba histolytica, parasites, and 

urethra infections. 



 

3 

Studies on the factors related to food safety practices among food handlers have been 

carried out in specific regions of Kenya, such as hospital environments Abuga et al., 

(2017). These studies are important because they provide a countrywide analysis of 

foodborne diseases, safe food knowledge practices, training and awareness on food 

safety, safe food handling practices, and compliance levels of food handlers on 

regulatory bodies of food safety. However, published information concerning food 

safety in Thika sub-County is lacking. It is from this backdrop that this study aims to 

shed more light.  

1.2 Statement of the Problem 

In both developed and developing countries, food safety is still a menace.  According to 

WHO 2021 reports, over 200 infections reported were as a result of consuming food 

contaminated by pathogens. Food contamination can occur at any stage of the food chain 

leading to foodborne illnesses Jung et al., (2021). 

The careless handling of food by food handlers can increase the transmission of 

foodborne pathogens. Studies suggest that approximately 10% to 20% of foodborne 

illness outbreaks occur due to contamination of food by food handlers Dagne et al., 

(2021). According to Erick Yen et al., (2020), in Kenya, contaminated food contributed 

to recent cholera outbreaks that killed 76 and 3967 hospitalizations in the initial months 

of 2017. Studies have reviewed the cost of care among those affected by food-borne 

illness as at KSH 1,034  and KSH 4,136 in Nigeria and Ethiopia per case respectively  

Hoffmann & Baral, (2019). 

However, data concerning foodborne diseases in Africa is still rare  Legesse et al., (2017). 

Research has confirmed that food poisoning can result from the absence of knowledge on 

food safety practices and failure to implement the acquired knowledge. Additionally, 

inadequate training and awareness of hygiene and handling techniques among traders and 



 

4 

retailers can also play a role in the spread of foodborne diseases WHO (2016). The role 

of food handlers to ensure food safety practices in food premises is highly significant. 

Likewise, it is paramount to understand their level of food handling knowledge. 

Different cross-sectional studies have been conducted. However, foodborne illnesses 

among food handlers in food premises have been rarely studied in the Kenyan context 

Carron et al., (2018). Therefore, it is significant to comprehend the association of the 

existing food safety practices, and knowledge of food handlers with food-borne illnesses 

to reduce foodborne outbreaks. From the above backdrop, the study aimed to determine 

factors associated with food-borne pathogens among food handlers in food premises of 

Thika, Kiambu County, Kenya. 

1.3 Objetives of the Study 

1.3.1 General Objetive 

To assess factors associated with food-borne pathogens among food handlers of Thika 

Sub County, Kiambu County, Kenya. 

1.3.2 Specific Objectives  

1. To determine the prevalence of selected foodborne pathogens among food handlers 

in Thika, Kiambu County. 

2. To assess the level of knowledge on food hygiene and safety practices among food 

handlers in Thika, Kiambu County. 

3. To examine social-demographic characteristics of food handlers associated with 

food-borne pathogens in Thika, Kiambu County. 

4. To determine the association between food handling practices and the prevalence 

of foodborne pathogens among food handlers in Thika, Kiambu County. 



 

5 

1.4 Research Questions 

1. What are the most prevalent selected foodborne pathogens among food handlers 

of Thika, Kiambu County? 

2. What is the level of knowledge on food hygiene and safety practices among food 

handlers in Thika, Kiambu County? 

3. What are the social-demographic factors associated with foodborne pathogens 

among food handlers in Thika, Kiambu County? 

4. What is the association between food handling practices and the prevalence of 

foodborne pathogens among food handlers in Thika, Kiambu County? 

1.5 Justification of the Study  

In Africa particularly Kenya, little research work has focused on the surveillance of 

foodborne pathogens. There may be a far larger number of cases of foodborne illness than 

the Ministry of Health reports, due to both underreporting and a lack of proper diagnostic 

facilities. 

A report by WHO on foodborne diseases in 2015 reported that FBDs in LMICs are a 

menace due to poor hygienic practices, inappropriate food handling methods, and lack of 

infrastructure. This is connoted by ignorance, poor food sanitation practices, poor 

enactment of food safety laws, inadequate regulatory systems, and inadequate financial 

resources. 

Even though governments worldwide have different approaches to improving food safety 

in the food supply, the prevalence of foodborne disease continues to be a considerable 

issue. In this regard, the safety of food handlers is thus one of the most indispensable 

health and safety aspects that many developing countries experience in food-eating 

premises that it results in social and public health problems. These foodborne diseases 

pose a big public health challenge and are foreseeable to be of concern in the future 



 

6 

despite some global and local successes in fighting them due to the increase of local food-

eating premises. Based on the above background, it is imperative to determine the factors 

associated with food foodborne pathogens among food handlers in the food premises of 

Thika, Kiambu County, Kenya. 

1.6 Significance of the Study 

The findings derived from this research may be used to formulate interventions at the 

community level aimed at deepening the knowledge and food handling practices of food 

handlers concerning the prevention and control of foodborne pathogens, and information 

on safe practices on food handling to reduce the cases of food poisonings and the outbreak 

of foodborne diseases at the communities. Likewise, from these research outcomes, the 

government can establish the effectiveness of regulatory bodies in food safety practices 

among food handlers. If the policies are not well implemented, the government can put 

stricter measures to ensure food safety. The findings and suggestions from this study may 

also contribute to the formulation of policies that fund extensive educational initiatives 

on food safety and cleanliness. The study will also provide important information to 

current and potential scholars on the factors associated with foodborne illnesses among 

handlers. It will enable them to expand their knowledge on the same topic, identify gaps 

and find specific areas to conduct further research. The information from the study will 

aid in bridging the gap in information on the prevalence of foodborne pathogens, and the 

association with food safety practices among food handlers in food-eating premises of 

Thika, Sub-County through documentation of the research findings. 

1.7 Scope of the Study 

The study examined the factors related to foodborne pathogens among food handlers 

working in Thika Sub County, located in Kiambu County, Kenya. The participants of the 

study were food handlers working in specific food establishments within the selected 



 

7 

areas. These premises must have been licensed to operate by the local county government, 

and there is a record of their existence. The study covered social demographic factors, 

knowledge of foodborne pathogens, and food handlers’ practices that are associated with 

foodborne pathogens in selected food establishments. 

1.8 Study Limitations  

The present study is not without limitations. Time limitation when collecting data was a 

big challenge due to busy working hours. Only one stool specimen was collected from 

each participant. However, it is known that the studied foodborne pathogens are 

transmitted intermittently in the stool of chronic carriers (Salvato, et, al, 2005) Thus, our 

study may have underestimated the prevalence of foodborne pathogens infections among 

food handlers.   

1.9 Delimitations 

Time limitation was addressed by employing more data collection team members to help 

in data collection. The study was delimited to licensed food handlers of the Thika sub-

county, the prevalence of selected foodborne pathogens, socio-demographic factors, and 

knowledge of food handlers on factors associated with foodborne pathogens. The study 

was further delimited to a questionnaire, checklist, and laboratory analysis of stool 

samples, focus group discussion guide, and key informants interview guide as tools for 

data collection. 

1.10 Study Assumptions 

The study assumed that the participants willingly collaborated and, in the right 

conscience, provided genuine responses to the questionnaires provided to them. Further, 

the researcher assumed that the conclusions derived from the study sample were adequate 

to give a general deduction concerning the factors connected with foodborne pathogens 

among food handlers in Thika, Kiambu County, Kenya.  



 

8 

1.11 Definitions of Operational Terms    

Eating and drinking premises: In this study, this applies to licensed premises where 

food is prepared and served for commercial purposes (Cap 242 laws of Kenya). 

Food handler: This refers to any person who works in the kitchen as a cook, chef, 

waitress, or waiter; this person comes into close contact with food and food 

substances during its preparation, processing, production, packaging, and 

distribution (Cap 254 laws of Kenya) 

Food handling: Refers to those aspects involved in the preparation, storage, transport, 

packaging, covering, or delivery of food (Cap 254 laws of Kenya) 

Food premises: Includes both eating and drinking establishments (Cap 254 laws of 

Kenya) 

Food safety: Guarantee that the food provided will not cause any health danger to the 

consumers after its preparation and consumption to satisfy their needs. Dagne et 

al., (2019) 

Foodborne disease outbreak -this is defined as: -Two or more people suffering from a 

similar disease, usually gastrointestinal after consuming a common food and 

epidemiological analysis links food as the common source of illness CDC, (2019). 

Foodborne diseases: These are the disease that arises after consuming contaminated 

food. Various disease-causing pathogens or microbes can contaminate food; thus, 

there are various kinds of foodborne diseases. Many foodborne illnesses are due 

to contaminations caused by parasites, bacteria, and viruses CDC, (2019). 

Knowledge: An awareness, understanding, or familiarity of something, for instance, 

skills or information, which is attained through learning, education, or discovering 

Mekonnen et al., (2021). 

Licensed: limited under the county government. 



 

9 

Personal hygiene:  It is a personal protective responsibility practice that enhances 

cleanliness and reduces infectious diseases, mainly those spread through direct 

contact. These practices include cleaning hands with sanitizer, soap, and water 

and keeping clothes and the body always clean (Cap 242 laws of Kenya). 

Regulatory bodies: They are government entities, for example, the Kenya Bureau of 

Standards (KEBS) and the Public Health that ensure the safety of food products. 

Selected food establishments: Includes hotels, restaurants, and butcheries licensed by 

the county government of Kiambu. 

 

  



 

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CHAPTER TWO 

LITERATURE REVIEW 

2.0 Introduction 

The conceptual framework and empirical review are presented in this chapter. This is 

followed by a criticism of the examined literature, the identification of research gaps, and, 

ultimately, a summary of the reviewed literature 

2.1 Theoretical Framework 

The epidemiological triangle model is the theoretical framework. The model has three 

corners: the host, the agent, and the environment. The agent produces the illness, the host 

has the sickness, and the environment allows the disease to spread. In public health, this 

model is often used to examine the transmission of infectious illnesses Merrill, (2012). 

The chain of infection occurs when an infectious agent reaches a susceptible host after 

leaving the source, whether via indirect or direct contact CDC, (2015). The 

microorganism is the agent, the food handler is the host, and the food premise is the 

setting in which this research will be conducted. 

It is possible to have a food-borne epidemic in a hotel if two or more guests become sick 

after eating anything from the same dish. The Centers for Disease Control and Prevention, 

(2012) food can be contaminated by biological, chemical, or physical means. ServSafe, 

(2013) 

Working with raw and cooked food on the same tabletop while cleaning food-contact 

surfaces is a common way for food handlers to contaminate both the food they prepare 

and the food they serve. Other ways include touching soiled surfaces, being ill at the time 

of the job, and cooking the food incorrectly ServSafe, (2013). 

People with Escherichia Coli infections are more likely to have eaten ground beef from a 

fast-food restaurant, according to a study by Kassenborg et al. Over half of the hotel 



 

11 

managers failed to use a thermometer to verify the meal's temperature before serving, and 

a third failed to wash and rinse food-contact surfaces before serving, according to research 

on food handling procedures conducted by Brown et al. (2013). According to Summer 

and co-authors Summer et al. (2011), 20% of respondents experienced working while 

unwell with symptoms including vomiting and diarrhea at least once, while another 12% 

reported working while ill for more than two shifts. 

Foodborne infections are caused by food handlers' ignorance, simple errors, and unsafe 

food handling methods in food outlets. Interfering with the chain of transmission destroys 

the relationship between the agent, host, and environment and thereby prevents the food-

borne disease from spreading CDC, (2012). 

2.2 Empirical Literature 

2.2.1 Prevalence of foodborne pathogens 

Global prevalence 

Globally one person in ten falls ill from foodborne pathogens, and 420,000 people die 

yearly, WHO, (2015). The Centers for Disease Control and Prevention (CDC) reported 

that in the United States, approximately 9 million instances of foodborne illness, 56,000 

hospitalizations, and 1,300 deaths occur each year as a result of foodborne infections. 

This is an indication that the prevalence of foodborne infections is a challenge for not 

only underdeveloped but also developed nations CDC, (2019). 

Globally, the prevalence of food-borne pathogens is high and most of them remain 

undetected and untreated. A study done in Pakistan reported a 9.1% prevalence of 

Salmonella typhi among food handlers Siddiqui et al., (2015). Different research 

conducted in Ethiopia revealed a salmonella prevalence rate of 5.04% across the board 

and Shigella spp Marami et al., (2018). In Nigeria, a high prevalence of 31.5% was 

reported among food handlers JO et al., (2015). 



 

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Regional Prevalence 

Food safety continues to be an essential requirement for the protection of public health 

all over the world. Both developed and developing countries are equally at risk from the 

widespread threat posed by food-borne infectious diseases, which pose a serious threat to 

public health. According to a report published by the WHO in 2018, there were 

approximately two million deaths among children under the age of five that were 

attributed to diarrheal disease. It is important to remember that hundreds of millions of 

children do suffer from frequent episodes of diarrhea and the associated effects. This has 

been strongly linked to the presence of food or waterborne pathogens WHO, (2009). 

Around 290 million people are living in the United States of America, and according to 

research published by the Center for Disease Control and Prevention in those states, food-

borne diseases are responsible for more than 76 million infections each year. It is 

important to keep in mind that approximately 18% of cases of the disease and 36% of 

mortality cases are caused by known pathogens, while the remaining cases are caused by 

unrecognized agents. There are more than 325,000 cases of diseases caused by food 

contamination that results in hospitalizations, resulting in more than 5000 cases of 

mortality. Figure 1 and Figure 2 present similar data on the international problem of 

foodborne diseases despite being collected at different timeframes. 



 

13 

 

Figure 1: The worldwide problem of foodborne ailment (DALYs per 100,000 

population) by risk clusters and subregions for 2010. 

Source: Havelaar et al., (2015) 

 

 

Figure 2: Foodborne Disability-Adjusted Life Years (DALYs) per 100,000 

population, per World Health Organization sub-region. 

Source: Torgerson et al., 2015; Kirk et al., (2015). 

 

 



 

14 

Africa Prevalence 

Foodborne pathogens are rampant in developing nations, including Kenya, due to the 

current poor food handling methods, poor regulatory systems, and inadequate safety laws 

on food, lack of education among handlers, and inadequate funds to buy safe equipment 

Karari, (2019). Studies carried out in the Northern area of Ethiopia indicate that 30.3 

percent and 52.5 percent among handlers of food had effective food handling methods in 

Dangila and Gondar town correspondingly Gizaw, (2014). The study done in humans 

Metropolis Ghana found that the majority of the incidents leading to foodborne deaths 

are linked to poor knowledge and lack of awareness attributed to lack of food handlers’ 

pieces of training Ababio & Adi, (2012). Between the years 2017 and 2018 there was an 

outbreak of Listeriosis in South Africa from a company that was processing meat and it 

led to 978 people being infected and 183 people died while 15 countries that imported the 

meat from the processing company were put at risk Smith et al., (2019).  

Prevalence in Kenya, Kiambu County 

A demographic health survey of 2014 reported that over 15% of Kenyans were reported 

suffering from diarrhea two weeks before this survey was undertaken, of these cases, 

4.4% were foodborne. The survey concluded that 1,328 Kenyans die yearly due to 

diarrheal Infections.  

Hospital data from 4 health centers in Thika Sub-County revealed that 725 cases of 

foodborne illnesses were reported between February 2021 and August 2021 as follows; 

Salmonella-200,campylobacter-165, E.histolytica-156 and parasitic infections-100 and 

UTIs-104 respectively. 

On 19th Oct 2022, the Ministry of Health Kenya announced the multi-County cholera 

outbreak alert as follows;  Kiambu(31), Nairobi(17), Muranga(1), Kajiado(2), Nakuru(2), 

Uashi Gishu(8) resulting from a wedding occasion that was held in Kiambu County. This 



 

15 

led to thirteen(13) cases being hospitalized and forty (40) treated as outpatients. 

MOH,(2022). 

2.2.2 Food-borne pathogens 

A great number of diseases have been caused by different types of Foodborne 

pathogens causing substantial effects on human health and the entire population. Some 

of these pathogenic micro-organisms include; (Bacillus cereus, Campylobacter jejunitis, 

Clostridium botulinum, Clostridium perfringens, Cronobacter sakazakii, Escherichia 

coli, Listeria monocytogenes, Salmonella spp., Shigella spp., Staphylococcus aureus, 

Vibrio spp., and Yersinia enterocolitica), viruses (Hepatitis A and Noroviruses) and 

parasites (Cyclospora cayetanensis, Toxoplasma gondii, and Trichinella spiralis), 

together with other outbreaks. Foodborne pathogens studied in this research included 

Salmonella Enterica, Campylobacter spp, and Entamoeba histolytica. 

Salmonella Enterica  

This bacterium is gram-negative and is responsible for causing typhoid fever. It has a rod-

like shape, is flagellated, and can only survive within the human body. The prevalence of 

this bacterium is particularly high in developing countries due to inadequate sanitation 

and insufficient food safety measures Siddiqui et al., (2015). This microorganism belongs 

to the Enterobacteriaceae family. There are more than 2,500 distinct serotypes, or 

serovars, that have been identified among the two main species of Salmonella, Salmonella 

enterica, and Salmonella bongori. Salmonella is a type of bacteria that is widely 

distributed and very hardy, capable of surviving for many weeks in dry conditions and 

several months in water Siddiqui et al., (2015). 

On the other hand, each serotype has the capability of causing disease in people. When 

some serotypes of bacteria infect people, the resulting illness is frequently severe and in 

some cases can even be fatal. On the other hand, the overwhelming majority of serotypes 



 

16 

can be found in several different hosts. These serotypes are responsible for the majority 

of instances of gastroenteritis, which is typically a basic condition that does not require 

any treatment from a doctor. Those who are young, old, or who have a damaged immune 

system are more likely to experience severe symptoms from this illness. The most 

widespread serovars of Salmonella that can be transmitted from animals to humans 

globally are Salmonella enterica serovar Typhimurium and Salmonella enterica serovar 

Enteritidis. Both of these serovars can result in severe sickness in humans Siddiqui et al., 

(2015). 

The World Health Organization (WHO) identifies these two serovars in this 

classification. Salmonellosis, an illness characterized by abrupt onset of symptoms such 

as fever, abdominal pain, diarrhea, nausea, and occasional vomiting, is caused by the 

Salmonella bacterium. Other symptoms may also be present. The development of 

sickness symptoms may occur anywhere from 6 to 72 hours (typically between 12 and 36 

hours) after consumption of Salmonella, and the duration of the illness can range 

anywhere from 2 to 7 days. Salmonellosis is characterized by relatively moderate 

symptoms, and in the majority of instances, patients will recover even in the absence of 

any special therapy.  

Nevertheless, the related dehydration may sometimes progress to a severe state, which 

poses a significant risk to the patient's life, especially in younger patients and those who 

are older. Instances of salmonellosis may not be identified as part of a known outbreak 

and are categorized as sporadic cases, or they may not be recognized as such at all, even 

though significant Salmonella outbreaks often draw media attention. The percentage of 

sporadic cases ranges from 60–80 percent of all salmonellosis cases. WHO,(2018). 

Children and young adults in nations with low per capita income have a higher risk of 

contracting typhoid fever Crump et al., (2015). It is projected that there were 11.9 million 



 

17 

cases of typhoid fever in the year 2010 and that there were 129 thousand deaths that 

happened as a direct consequence of typhoid fever in poor and middle-income nations 

Mogasale et al., (2014). On the other hand, these cases may be underreported because the 

majority of cases are not reported because they are treated on an outpatient basis, and 

some of them are not treated at all. A person contracts typhoid fever by ingesting food 

contaminated with excreta and can survive in the stomach before attaching it to the small 

intestine.  

Campylobacter spp. 

Campylobacter spp is one of the most common infectious infections, and it is anticipated 

that it will continue to provide a threat to the health of people all over the world in the 

years to come. Both the incidence and prevalence have seen a significant rise in recent 

years around the globe, particularly in the Americas, Europe, Australia, and Africa. 

Campylobacter spp is an endemic disease that affects children across Asia and the Middle 

East. The primary reservoir of the disease and its primary route of transmission to people 

is poultry Legesse et al., (2017a). In 1886, Theodor Esherich may have detected 

campylobacters in the intestines of infants who had died of cholera infantum. Esherich 

named this condition "cholera infantum" Skirrow and Butzler (2019). Although 

Campylobacter was recognized in the 1940s, it was not until 1972 that it was identified 

by Dekyser and Butzler from the feces and blood of a young, previously healthy woman 

with acute febrile hemorrhagic enteritis Skirrow and Butzler (2019). Members of the 

Campylobacteraceae family, such as Campylobacter, Arcobacter, and Bacteroides 

ureolyticus, are generally benign commensal organisms present in humans and domestic 

animals Vandamme (2017). 

Individuals often move around either of the extremities of their cells with a single polar 

unsheathed flagellum in a distinctive corkscrew-like motion Vandamme (2017). 



 

18 

Menaquinones are the sole respiratory quinones that have been detected, and the primary 

components are menaquinone-6 and menaquinone-5. The Campylobacteraceae family 

does not ferment or oxidize carbohydrates to produce energy but instead relies on amino 

acids or tricarboxylic acid cycle intermediates for energy Vandamme (2017). All 14 

Campylobacter spp. except for Campylobacter gracilis, exhibit oxidase activity Fitzgerald 

et al; Vandamme (2017). Since campylobacters are typically microaerophilic, they may 

be grown in environments that include 3–15% oxygen and 1–10% CO2 Forsythe (2016).  

Human gastrointestinal sickness is most often linked to the thermophilic campylobacters 

C. jejuni, C. coli, C. lardis, and C. upsaliensis. In the United Kingdom, C. coli and C. 

jejuni ssp. jejuni accounts for 95% of all clinical isolates Silva, Jet. al (2011). There is a 

preferred host for each strain of Campylobacter; for example, C. jejuni, the most frequent 

human pathogen, is strongly linked to chickens and has adapted to thrive in the digestive 

tract of birds kept at temperatures about 42 degrees Celsius van Igwaran, A., & Okoh, A. 

I. (2019). Because of its relatively high minimum growth temperature (>30°C), C. jejuni 

often does not replicate once ejected into the environment Wagenaa et al. (2015). 

Contrary to Salmonella, campylobacters are often unable to proliferate in food and are 

not typically associated with significant outbreaks of campylobacteriosis. In the summer, 

sporadic instances account for more than 90% of all cases. However, campylobacters,  

are to blame for the bulk of intestinal infectious disorders around the globe. Due to 

underreporting, the real public health incidence is thought to be up to ten times greater 

than the number of reported cases Allos (2015). Campylobacteriosis causes significant 

yearly losses due to medical expenses and missed workdays, amounting to $1 to $2 billion 

annually in the USA Forsythe (2016). 

 

 



 

19 

Entamoeba histolytica 

Protozoa known as Entamoeba histolytica is responsible for amoebic dysentery and 

amoebiasis. There is a possibility that a Sanskrit account of bloody mucoid diarrhea from 

3000 BCE was the earliest episode of amebiasis ever recorded. 50 million individuals 

around the world are afflicted with amoebiasis, and the disease is responsible for over 

100,000 fatalities each year, most of which occur in underdeveloped nations. At the 

worldwide level, Entamoeba histolytica is the third biggest cause of death from parasite 

diseases. Infection with E. histolytica is often asymptomatic; nonetheless, the parasite has 

the potential to cause severe disease. The origins, advantages, and precipitating factors of 

amoebic virulence are all quite complicated. The pathophysiology of the amoebic disease 

involves the breakdown of the mucosal barrier of the host, adhesion to the lumen of the 

colon, cytotoxicity, and invasion of the epithelium of the colon. Damage caused by the 

parasite might manifest as colitis and, in certain instances, as widespread illness. Both the 

genotypes of the host and the parasite, as well as the regulatory responses that each 

genotype is responsible for regulating at the interface between the host and the pathogen, 

have an effect on the course of the sickness. The environmental components of the host 

have an effect not only on the transmission of the parasite but also on the intestinal 

microenvironment that is influenced by E. histolytica infection. In this article, we focus 

on research that provides fresh light on previously undiscovered links between the host, 

the parasite, and environmental variables in the control of E. histolytic's virulence. This 

research was conducted by a team of scientists from the United States and the United 

Kingdom. Transmission may take place via the consumption of food and water infected 

with cysts as well as through fecal-oral pathways Kantor et al., (2018). 



 

20 

2.2.3 Sociodemographic factors 

Concerning age, a study done in Ethiopia significantly linked age with food safety 

practices Legesse et al., (2017a). However, other studies reported no significant 

difference between age and food safety practices Addo-Tham et al., (2020). Regarding 

gender, diverse results have been reported from previous research. One study done in 

Ethiopia reported that the female gender was more likely to have good food hygiene 

practices as compared to their male counterparts Lema et al., (2020). Contrary to this, 

several other studies did not have any significant relationship between gender and food 

hygiene and practices Oumer, (2019). Marital status, a study in Ghana reported a 

significant association between marital status and food safety practices Addo-Tham et al., 

(2020). However, some studies did not report any statistical association between marital 

status and food safety practices Lema et al., (2020). Concerning education status, a study 

done in Nigeria reported no significant association between education status and food 

hygiene knowledge and practices (Amelia Ngozi). This is dissimilar to a study in Ethiopia 

that significantly linked education status and food hygiene practices Lema et al., (2020). 

A study was done on the prevalence and associated factors of intestinal parasitic 

infections work experience were associated with intestinal parasitic infections Kumma et 

al., (2019). However, another study done in Ghana revealed no significant association 

between working experience and food safety practices Legesse et al., (2017b). Income 

was significantly associated with food hygiene practices among street vendors (Sarawak). 

2.2.4 The level of knowledge of food hygiene and safety practices 

According to the WHO, contaminated food is responsible for 1.5 billion incidents of 

diarrhea in children and adults each year.  

The occurrence of food-borne diseases depends on food hygiene measures applied in the 

food production chain. However, this can also be affected by inadequate unhygienic 



 

21 

measures by the consumers. Studies carried out in the Northern area of Ethiopia indicate 

that 30.3 percent and 52.5 percent among handlers of food had effective food handling 

methods in Dangila and Gondar town correspondingly Gizaw, (2014). The study done in 

humans Metropolis Ghana found that the majority of the incidents leading to foodborne 

deaths are linked to poor knowledge and lack of awareness attributed to lack of food 

handlers’ pieces of training Ababio & Adi, (2012). Studies have recommended the use of 

different safeguarding measures to ensure the safety of humans during food consumption 

Eshetu et al., (2020). This includes washing hands after using the toilet, before touching 

any food, and after coming into contact with raw food by the use of soap and water for at 

least 15 seconds. It is also necessary to separate cooked and raw foods. Washing 

vegetables and fruits and other preventive measures. Studies done in Ethiopia have 

indicated that people fail to comply with hygiene and preventive techniques Eshetu et al., 

(2020). 

In the upcoming nations, many cases of food poisoning have risen due to the uptake of 

unhygienic foods, pesticide residues in water, and animal food products. Food poisoning 

does not only affect developing nations but also developed countries. This has been linked 

to a rise in demand for low-priced food and the inability to provide ideal care under the 

unhygienic condition when cooking and packaging foods Zyoud et al., (2019). The ability 

to comply with the lessons of food safety in the population should be highlighted and 

endorsed. Food consumers together with food handlers have been recognized as a critical 

factor in foodborne disease outbreaks which may arise from poor food handling in the 

process of planning, processing, and packaging.  

Foodborne illnesses can happen both in homes and at social events. In developing 

countries, a lack of knowledge regarding food safety can lead to a decrease in personal 

hygiene practices, poor handling of food, and inadequate household food preparation, 



 

22 

which all contribute to the outbreak of foodborne illnesses. This is often due to the 

contamination of raw foods with processed foods. Household preparation of food usually 

has a vital role in foodborne pathogens Tshipamba et al., (2018). 

Recognizing and understanding the significance of individuals' food safety knowledge, 

attitudes, and actions involved in food handling is a crucial step in assessing approaches 

to mitigate the incidence of foodborne illnesses. Therefore, food safety education is key 

to ensuring positive practices and good knowledge which can lead to increased food 

safety issues and thereby reduce the occurrence of foodborne pathogens Eshetu et al., 

(2020). 

2.2.5 Association between food handling practices and prevalence of foodborne 

pathogens.  

Most food-borne infections caused by pathogens in humans are a result of the person 

handling that food having transmitted the pathogen to the food through improper handling 

of the food or poor sanitation of the environment in which the food is being kept. Food-

borne infections have been recognized as a public health problem on a global scale and 

have been linked to the unsanitary handling of food and lack of sanitation procedures 

among those who work in the food industry Hossen et al., (2020). Foodborne illness 

results from the consumption of contaminated food, which can lead to the multiplication 

of pathogens in the human body or the ingestion of toxins produced by toxigenic 

pathogens in food. There are two main types of foodborne diseases: foodborne infection 

and foodborne intoxication. Foodborne infection typically involves an incubation period 

and a long time from ingestion to the onset of symptoms compared to foodborne 

intoxication Bintsis, (2017 ). Some of the common practices in handling food that results 

in to spread of pathogens include; inadequate handwashing, cross-contamination, storage 

and cooking temperatures, and lastly food contamination by animal wastes. There is a 



 

23 

need to advocate for good hygiene practices, especially on premises where food is being 

handled. This has been viewed as an effective strategy for protecting consumers from 

various public health risks. Insufficient and unhygienic handling practices account for a 

bigger proportion of food-borne disease outbreaks within society. Studies have estimated 

that 200 types of illnesses can be spread through food and water Hossen et al., (2020). 

For instance, in a study done in Bangladesh, the manifestation of foodborne illnesses and 

other food safety hazards was noticeably high due to the presence of dense populations, 

poor water sanitation, underdeveloped infrastructure, and unhygienic conditions. This has 

led to the occurrence of more than 30 million cases of foodborne illness in Bangladesh, 

of which the most occurring disease are diarrhea, hepatitis, and enteric fever. To keep the 

food free of contamination by microorganisms, chemicals, or other impurities that may 

render it unsuitable for human consumption, a variety of philosophies and practices have 

emerged around food safety Murimi & Waweru, (2020). The association between food 

handling practices and the prevalence of foodborne pathogens is very essential to prevent 

the spread of infectious pathogens linked to food and food processing, as well as to 

guarantee that food served to customers is not deceived Dagne et al., (2021). 

2.3 Conceptual Framework 

Figure 3 shows the conceptual framework. The independent variables are social 

demographic factors, knowledge and awareness, and food handling practices related to 

food handlers in selected food premises. The intervening variable is law enforcement, 

while the dependent variable connotes the decrease in the prevalence of selected 

foodborne pathogens. 

 

 

 



 

24 

 

 

 

 

 

 

 

Figure 3: Conceptual Framework 

2.4 Summary of Literature Review 

In Kenya, the majority population is in the middle-income and low-income groups who 

majorly work in the informal sector. Most of these populations eat their breakfast, lunch, 

and supper in the local food premises. Local food establishments constitute restaurants, 

Social demographic factors 

 Age 

 Gender 

 Level of education 

 Income status 

 Training 

 Religion 

 Work responsibility 
 Prevalence of selected 

Foodborne pathogens. 

 Salmonella 

Enterica 

 Campylobacter 

spp 

 Entamoeba 

histolytica 

 

 

Food handling practices  

 Working environment 

 Personal Hygiene 

 Person Behaviors 

 Personal protective 

equipment 

 Valid required food safety 

certificates 

 HACCP 

 

Law Enforcement (regulatory 

systems) 

 Health policy 

 Existing health laws 
 

Independent variable 

Intervening variable 

Dependent variable 

Knowledge and awareness 

 Foodborne illnesses 

 Mode of transmission 

 Transmission paths 

 Food safety practices 

 Food laws and HACCP 

principles 



 

25 

market stalls, fast foods, and temporary food eateries. These premises are on arise 

especially in urban centers. 

Internationally and regionally, food-borne infections remain a serious public health 

problem. Every year, contaminated food is responsible for around 600 million cases of 

foodborne illness and 420,000 deaths in the United States. The World Health 

Organization (WHO) estimates that each year, 33 million healthy years of life are lost all 

over the world as a consequence of ingesting dangerous food, and this statistic is most 

definitely an understatement. World Health Organization, (2022)  

To ensure food safety, food handlers play a crucial role since they may introduce 

infections into foods during manufacturing, processing, and distribution (Ansari-Lari, 

Soodbakhsh & Lakzadeh, 2010). According to Siobhan S.reilly, Ph.D. Norovirus, 

Entamoeba histolytica, Salmonella, Clostridium perfringens, Campylobacter, and 

Staphylococcus aureus are the most frequent foodborne infections in Kenya. Foodborne 

infections are often caused and transmitted by food workers who lack enough expertise 

and engage in improper procedures. Food-borne disease transmission risks may be 

reduced in restaurants by enforcing strict food safety measures. To minimize the spread 

of food-borne diseases, all workers engaged in food preparation and handling must get 

proper training. Food safety knowledge, personal behaviors, limited resources, 

accessibility, equipment, training, and management all play key roles in improving food 

workers' knowledge and behavior, but education is also shown to be an important aspect 

of the process Phillips et al. (2014). Additionally, Pragelet al. (2013) revealed that food 

handling methods are influenced by management, training, and education. It was 

observed that certification affected food handling procedures Cates et, al., (2009). 

At the international level, a significant number of studies concerning the topic have been 

published.  However, in the Kenyan context, there are scanty published works; further, 



 

26 

the same studies have focused on a few areas of the food industry. For example, Abuga, 

Nyamari, and Njagi (2017) focused on consumer food hygiene and safety practices in 

households while Malavi (2017) focused on the OFSP puree processing plant and bakery. 

There is limited information on the state of food safety in the food premises of Thika Sub-

County. 

Therefore, this study intends to close the knowledge gap in information on the prevalence 

of foodborne pathogens in the sub-county by extending its focus to these premises. 

Recommendations will aid in the future development of policies that will provide a wide-

ranging of training programs on food safety and hygiene practices. 

  



 

27 

CHAPTER THREE 

 RESEARCH METHODOLOGY 

3.0 Introduction 

This chapter focuses on various aspects of the methodology section such as the study 

design, study area, target population, study population, sampling techniques, data 

collection tools, reliability and validity, data analysis, and ethical considerations. 

3.1 Study design 

A research design is a strategy or framework for conducting a study. As a consequence 

of this, the strategy is recommended since it allows respondents to express their views in 

a setting that is more natural Mugenda & Mugenda, (2010). A combination of qualitative 

and quantitative techniques was used in a descriptive analytical study design to 

investigate the factors associated with food-borne pathogens among food handlers in 

licensed food establishments located in Thika Sub-County, Kiambu County, Kenya. 

Employing a descriptive cross-sectional study enabled the researcher to collect data that 

made it possible to portray the relationship between food-borne pathogens and associated 

factors. Quantitative methods, according to Creswell (2009), are based on meticulous 

observation and measurement of the world's objective reality by generating numerical 

measurements of observation Creswell, (2009). 

3.2 Study Variables 

The independent variables included socio-demographic attributes, knowledge, medical 

certification, working environment, personal hygiene and food safety practices while the 

dependent variable was the prevalence of selected foodborne pathogens. 

3.3 Study Area 

Kiambu County is one of the 47 Counties in the country. It is adherent to Nairobi county 

and it is a fast-growing town. Geographically, the County is found in the Central region, 



 

28 

it covers an area of 2543.5 km2 of the region of which approximately one-fifth of this 

area is forest (NBS,2009). The geo-coordinates of Kiambu County are 1◦8′46.28″ S and 

36◦57′59.4″ E. 

Thika Sub-County is one of Kiambu County's twelve sub-counties, and it is located in the 

western part of the county with five administrative wards namely, Hospital ward, 

Township ward, Gatuanyaga ward, Kamenu, and Ngoliba ward. According to the 2019 

National census, Thika has a population of 279,429 with a total area of 217.5 km2 and an 

elevation of 5,351 ft from sea level. 

Thika Sub-County is the commercial hub and industrial town of Kiambu County. The 

economy of the Thika depends on agriculture, Industries like textile industries, bakeries, 

oil industries, pharmaceutical and chemical industries, moto vehicle dealers, and cigarette 

manufacturing industries. Thika sub-County is home to three universities, tens and 

hundreds of middle-level colleges, and secondary and primary schools consecutively, the 

sub-county also has many financial institutions. This makes the sub-county have a big 

number of food and drinking establishments which amounts to around 2000, bringing the 

importance of conducting this kind of research in this fast-growing area.  

3.4 Target Population  

"Population" is defined by Sekaran, (2010) as the total number of units from whom a 

sample will be drawn. In the work of Schindler and Cooper (2006), the individuals or 

items being measured are referred to as "population elements". The study targeted food 

handlers in licensed food eateries (eating premises) within Thika Sub-County, Kiambu 

County, Kenya. Key informants comprised public health officers and hotel managers. 

3.4.1 Inclusion Criteria 

The research included food handlers in the area of study, working in the sampled licensed 

food eating premises for at least a month and who have consented to take part in the study. 



 

29 

3.4.2 Exclusion Criteria 

The research excluded food eateries which had not been approved for operation by 

Kiambu county government and food handlers who were recently employed (had worked 

less than 3 weeks). 

3.5 Sample Size 

The minimum sample size was calculated using the Yamane formula (1967) at a 95% 

confidence level and p-value of 0.05  

 

Whereby; 

         n   =       994 

               1 + 994(0.05) 2 

N = is the total number of food handlers (N=994, obtained from Kiambu County revenue 

office and Sub-County Public Health Office) 

e = is the degree of precision. (0.05) 

then n(sample size) was 285 study participants 

3.6 Sampling Technique  

From the perspective of Kumar (2012), research sampling procedures describes how 

cases are going to be selected. Kiambu county was purposively selected as it is the 

second-most populous county after Nairobi county(KNBS,2022). Thika sub-county was 

randomly selected from a list of 12 sub-counties that constitute Kiambu county 

(CADP,2021.22). All the wards of Thika Sub-County were sampled. Using a list of 

licensed food premises in all five wards in the Thika sub-county, obtained from the county 

revenue office, probability proportion to size was used to determine the number of 



 

30 

licensed food premises that participated in the study. Further, the probability proportional 

to size sampling technique was used to determine the number of food handlers enrolled 

in the research from the selected food premises. 

Simple random sampling by use of rotary method was used to sample individual food 

handlers per premise. Two key informant interviews were conducted and the key 

informants were selected purposively. The key informants included one public health 

officer per ward. A total of eight focus group discussions, comprising eight to ten 

individuals, were also conducted.  Table 1 shows the distribution of the study participants 

by ward. 

Table 1: Sampling framework 

Ward  No. of licensed food 

premises by county 

government 

No. of food 

handlers per 

ward  

No.of sampled food 

handlers per ward 

Township 63 357 102 

Kamenu 40 209 60 

Hospital  32 230 66 

Gatuanyaga  15 90 26 

Ngoliba 15 108 31 

Total  165 994 285 

Source: Kiambu county Revenue office and Sub-County Public Health Office November 

(2021) 

3.7 Data Collection method and procedures 

3.7.1 Questionnaire 

The equipment used to gather data, according to Oso and Onen (2009), is referred to as a 

research instrument. An interviewer-administered questionnaire was used to capture data 

from the participants. A questionnaire is a trustworthy research tool because it allows the 

researcher to collect information that would otherwise be impossible to get via open 

observation. After all, they probe deeper into the motives, experiences, sentiments, and 



 

31 

successes of those involved Bryman & Bell, (2015). It is an appropriate instrument for 

data collection to gather objective information since it does not allow for the respondents 

to the study to be under the control of the investigator. 

The questionnaire had closed-ended questions. It was divided into four sections, including 

Section A, which covered socio-demographic characteristics, Section B, which covered 

the knowledge of food hygiene and safety practices, Section C, which covered food safety 

practices and Section D, which covered the Effectiveness of regulatory bodies. 

3.7.2. Focus group discusión guides and key informant interview 

 FGD and KII were used to obtain qualitative data from the participants to answer 

research questions and the conversation was recorded digitally. One Public health officer 

in every ward and hotel managers were included in the Key informant interviews. 

Sampled food handlers were included in the focused group discussions.One supervisor 

and 10 research assistants with background training in environmental health and medical 

laboratory were hired and trained to familiarize themselves with data collection tools, 

procedures, and research ethics. 

3.7.3 Observation Checklist  

An observation checklist was used to evaluate the cleanliness of the surroundings, the 

overall cleanliness of the food, and the practices of food handlers when it comes to 

handling food. The observation was carried out using a developed and standardized 

scoring methodology by the main principles of Codex Alimentarius food hygiene. This 

study adopted the checklist used by Fields (2014). Study participants were issued with a 

checklist to fill on arrival to laboratory being tested for foodborne pathogens. Variables 

like the presence of running water, toilet, hand sink, ordinary or antibacterial soap, 

refrigerators, slicing board for chapati, meat, and vegetables, insect traps, sleeping rooms 

for workers, lavatories for males and females, cooking in an open environment, having a 



 

32 

municipal license and a fence to ward off animals. All mentioned variables were 

examined to assess the vendor's commitment to ensuring good food handling practices. 

3.7.4 Sample collection and laboratory procedures. 

The prevalence of foodborne pathogens among the food handlers was conducted through 

laboratory testing of stool samples of consenting food handlers from licensed food 

premises in the area of study. The stool sample collection was matched with respondents 

when filling out questionnaires. A stool specimen was collected from each food handler 

in a tight-lid plastic container. Participants were instructed to collect a spoonful of stool 

samples in the provided containers and take the samples to the Thika level 5 hospital 

where the food handlers go for their routine food handler’s medical examination. Stool 

processing and examination were conducted at Thika level 5 hospital laboratory 

department by qualified laboratory technicians.  

For salmonella specimen’s rapid antigen test cassette was used. This rapid test was used 

for the qualitative identification of S. typhi antigens in human feces specimens to help in 

the diagnosis of S. typhi infections. In the absence of any T lines (IgM and IgG), the test 

results are considered negative. The presence of a colored control line (C) should always 

be shown whether a positive or negative result is obtained. Its absence suggests that the 

test findings were faulty. (Source: Biozek Medical.) To detect Campylobacter, a stool 

culture (inoculated onto Mac-agar, Conkey's xylose lysine deoxycholate, and TSCB agar 

according to the World Health Organization protocol was done. Negative results (no 

bacteria found) were reported while positive results (bacteria found) were reported 

(campylobacter infection). Entamoeba histolytic: A direct microscopic examination test 

(formol ether concentration (Ritchie), and staining with modified acid-fast staining 

procedures) was done for the detection of cysts and trophozoites in the stool for 

Entamoeba. Positive (amoebiasis), negative (amoebiasis) (No amoebiasis). This was done 



 

33 

from May 2022 to July 2022 until all the food handlers were subjected to laboratory 

testing. Sample collection was per the Ministry of Health Kenya laboratory sample 

collection guidelines.  

3.8 Testing for Validity and Reliability 

3.8.1 Pilot Testing 

According to Mugenda and Mugenda (2003), a pilot test is a test run of the methods and 

tools that the researcher intends to use throughout the study. The researcher can avoid 

making costly blunders by first conducting an inexpensive pilot study. Piloting is vital for 

eliminating any ambiguity, finding items that are expressed wrongly, and identifying 

occasions when there is not enough room to type responses. Pilot testing was conducted 

among 29 food handlers (10% of the sample size) randomly selected in a neighboring 

county (Murang’a County). Their views were analyzed, and results were used to improve 

the validity of the questions. 

3.8.2 Testing for Validity and Reliability 

The researcher's questions should be able to be answered by the data that was obtained 

using the data gathering equipment. To ensure the questionnaire's validity, the feedback 

received from the experts was included in the final version. To ensure the validity and 

reliability of the laboratory tests, known samples were compared to the tests performed 

on an unknown patient's sample. 

3.9 Data Analysis Techniques and Procedures 

After being imported into a sheet in Microsoft Excel, the quantitative data was then 

transferred into IBM SPSS version 24 for further analysis. To describe the categorical 

data, we employed both frequencies and percentages. The summary of the data was 

derived using the mean and the median for continuous data. Knowledge of food safety 

procedures was evaluated using a binary scale based on a set of 21 items to conduct an 



 

34 

inferential analysis. Those who answered correctly received a score of one, while those 

who did not receive any got 0. After the summation of all the scores, the respondents were 

dichotomized into those who had a low level of knowledge (scored less than 50%) and 

those who had a high level of knowledge (scored 50% or more). The study utilized various 

statistical methods to analyze the data. The Chi-square test of independence was used to 

examine the relationship between independent categorical variables and the dependent 

variable. For testing the association between a continuous variable and the categorical 

dependent variables, a t-test was used. Binary logistic regression analysis was employed 

to identify factors associated with foodborne illnesses while adjusting for confounders. 

The study also used Wilson's method to determine the 95% confidence interval Hald, 

(2008). The threshold of significant in hypothesis testing was set at a p-value <0.05. 

Qualitative data were transcribed and analyzed thematically using NVIVO v. 12 software. 

3.10 Ethical Considerations 

According to Saunders, Lewis, and Thornhill (2012), a scientific study needs to offer 

adequate relevance to ethical considerations to make the entire research activity more 

credible. For this study, the investigator handed out informed consent papers for the 

subjects to fill out. The MKU Institutional Research Ethics and Review Committee were 

contacted to receive ethical approval (IREC). It was requested that the National 

Committee for Science, Technology, and Innovation provide additional permission 

(NACOSTI). The study was discussed with the relevant local authorities who were in 

charge. Before the presentation of the questionnaires and collection of the samples, it was 

determined whether the respondents had provided their informed consent. The findings 

were kept a secret from everyone, and personnel in the food industry who tested positive 

for any pathogen were given the appropriate treatment. 

  



 

35 

CHAPTER FOUR 

RESEARCH FINDINGS AND DISCUSSIONS 

4.0 Introduction 

This chapter comprises the statistical analysis, presentation, and interpretation of the 

findings resulting from this study. The data analysis and interpretation of data were 

carried out in two phases. The first phase was based on the analysis of quantitative data 

captured using questionnaires. The second phase involved the analysis of qualitative data 

(data from observational checklists, key informant interviews, and focus group 

discussions). 

4.1 Response Rate 

A total of 285 questionnaires were distributed to the study participants. Fifteen had 

missing data but the researcher was able to assess and include them in the analysis. 

Consequently, data analysis was done on all 285 questionnaires thus a response rate of 

100%. The findings were presented in relationship to the research objectives stated in the 

study. In addition, the results were analyzed in the context of prior research and other 

relevant works of literature to highlight any parallels or discrepancies between the 

findings of this study and those of others. 

4.2 Demographic Information 

In the current study, 285 food handlers were included and their socio-demographic 

characteristics were presented in Table 2. More than half of the participants were females 

(52.6%).This mighty have impacted on the high prevalence of foodborne pathogens 

among the females. The age of the participants varied from 18 to 58 years, with a mean 

age and standard deviation of 40.0 ± 11.63 years. Those who were aged twenty years and 

below were 6.3% while those who were aged more than fifty years were 22.5%. 

Participants who were aged between 41 and 50 years were 29.8%. The rest were aged 



 

36 

between 21 and 30 years and between 31 and 40 years (17.5% and 23.9% respectively). 

Analysis of the highest level of education attained by the study participants indicated that 

those who had attained primary, secondary, and tertiary education were 24.6%, 45.3%, 

and 27.7% respectively. The minority had no formal education (2.5%). Further, the 

majority were Christians (92.3%) and had not undergone training on food safety (74.4%). 

The study enrolled cooks (15.8%), cashiers (14.0%), service personnel (15.1%), and 

cleaners (12.3%) among other cadres of staff.  

Table 2: Sociodemographic characteristics of study participants 

 Characteristic             Frequency (n=285 (%)) 

Gender Male                            135(47.4) 

 Female                            150(52.6) 

Age (years) ≤20                           18(6.3) 

 21-30                              50(17.5) 

 31-40                              68(23.9) 

 41-50                              85(29.8) 

 >50                              64(22.5) 

Level of education Primary                              70(24.6) 

 Secondary                             129(45.3) 

 Higher education                                79(27.7) 

 No formal education                                7(2.5) 

Religion Christians                             263(92.3) 

 Muslim                              22(7.7) 

Location Gatuanyaga                              26(9.1) 

 Hospital                                65(22.8) 

 Kamenu                                61(21.4) 

 Ngoliba                                 31(10.9) 

 Township                            102(35.8) 

Work experience < 1 month                            20(7.0) 

 1-6 months                             76(26.7) 

 >6 months - 1 year                             80(28.1) 

 > 1 year                          109(38.2) 

Work responsibility Cook                             45(15.8) 

 Cashier                            40(14.0) 



 

37 

 Service                            43(15.1) 

 Cleaner                            35(12.3) 

 All                            98(34.4) 

 Other                          24(8.4) 

Trained in food safety Yes                            73(25.6) 

 No                          212(74.4) 

Source: Field Data (2022) 

Figure 4 displays the work experience of the studied food handlers. The minority had 

worked for less than one month (7.0%). Those who had worked for more than one year 

were 38.2% while the rest had worked for a period of between one and six months 

(26.7%) and between 6 months and one year (28.1%). 

 

Figure 4: Food handling experience of the studied food handlers 

4.3 Prevalence of selected foodborne pathogens 

Laboratory analysis of stool samples from the enrolled food handlers revealed 8, 12, and 

24 cases of Campylobacter spp., S. typhi, and E. histolytica infections respectively. The 

corresponding prevalence of infections was as follows 4.2% (95% CI 2.4% - 7.2%), 2.8% 

(95% CI 1.4% - 5.4%), and 8.4% (5.7% - 12.2%) respectively. Overall 44 out of the 285 



 

38 

food handlers who took part in the study had at least one food-transmitted pathogen 

(prevalence 15.4%, 95% CI 11.7% - 20.1%) as shown in figure 5. 

Figure 5 illustrates the prevalence of selected foodborne pathogens isolated from the 

samples collected from the participating food handlers.  

 

Figure 5: Prevalence of selected foodborne pathogens 

Compared to the findings from our study, a similar survey done in Southwestern Nigeria 

showed a much similar prevalence of salmonellosis (7.0%) Olalekan (2018). The 

prevalence of foodborne pathogens documented in a study conducted among food 

handlers in catering establishments of public institutes in Dawuro Zone, South-Western 

Ethiopia was similar to the findings of the present study. In the Ethiopian study, the 

prevalence of salmonellosis was 6.4% Derso et al., (2017). However, another study 

conducted in the Conghua district of Guangzhou China revealed a higher prevalence of 

salmonellosis ranging at 20.39% Gong et al., (2022). Another study conducted in Gondar 

town in Ethiopia revealed a much lower prevalence of salmonellosis ranging to 5.5% Ejo 

et al., (2016). This was also consistent with another study conducted in Ambo and Holeta 

Towns in Ethiopia which recorded a prevalence of salmonella at 5.7% Gebremedhin et 

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

E.histolytica Campylobacter spp. S.typhi Overall

Prevalence of selected foodborne pathogens 



 

39 

al., (2021). Another study done in a chicken slaughterhouse in Jiangsu china recorded a 

higher prevalence of 57% Gu et al., (2020). 

From this study, the prevalence of Entamoeba histolytica was 4.2%, these findings were 

similar to a study done in northeastern Brazil which recorded a prevalence of Entamoeba 

histolytica at 6.8%Silva et al., (2014). Another study conducted in Nishtar Hospital, 

Multan recorded a higher prevalence of entamoeba at 21.7% Alam et al., (2015), this was 

consistent with a study conducted on stool specimens at Muhondo Health Center, Rwanda 

recorded a prevalence of 16.8% regarding Entamoeba histolytica/dispar Gahamanyi et 

al., (2016). 

The current study found a 2.8% prevalence of Campylobacter spp. However, other studies 

conducted in different settings have reported a higher prevalence of this pathogen. For 

instance, a study conducted in South Africa reported a higher prevalence of 14.7% (Samie 

et al., 2022). A similar study done in West Africa recorded a higher prevalence of 

Campylobacter spp standing at 34%(Paintsil et al., 2022). The most probable explanation 

for the discrepancy in the findings between the surveys is the study population variance. 

4.4 Knowledge of food hygiene and safety practices. 

Asked about their main source of knowledge on food hygiene and safety practices, the 

studied food handlers mentioned mass media (35.4%), health professionals (31.9%), and 

health centers (32.6%) as shown in Figure 6. These findings were similar to another study 

done in the metropolitan city of Nepal and among food handlers in Bahir Dar town, 

northwest Ethiopia Derso et al., 2017; Gautam et al., (2019)  



 

40 

 

 

Figure 6: Source of information on food hygiene and safety practices among food 

handlers 

Inquiries on the causes of foodborne pathogens yielded the responses displayed in Table 

3. The majority of the interviewed food handlers mentioned germs as the causative agent 

of foodborne illness (64.6%). Those who responded in the affirmative on being asked if 

Salmonella spp. and Campylobacter spp. were causative agents of foodborne illness were 

49.8% and 38.9% respectively. Similar findings were also reported in two similar studies 

done in the Desie region of Ethiopia and Northwest of Ethiopia Adane et al., 2018; 

Alemayehu et al., (2021). 

  

Mass media
35%

Health 
professionals…

Health centre
33%

%

Mass media Health professionals Health centre



 

41 

Table 3: Responses on the causes of infections with foodborne pathogens among food 

handlers 

 Response         Number (n=285(%)) 

Salmonella spp. Agree                       142(49.8) 

 Disagree                       143(50.2) 

Campylobacter spp. Agree                       111(38.9) 

 Disagree                       174(61.1) 

Causes of foodborne illnesses Germs                       184(64.6) 

 Chemicals                         75(26.3) 

 Do not know                       26(9.1) 

Source: Field Data (2022) 

 

Table 4 exhibits the findings on the assessment of the participant's knowledge of food 

hygiene practices, routes of transmission of foodborne pathogens, and symptoms of 

foodborne illnesses. The respondents reported that hand washing should be done at 

specific times, which include after using the restroom (41.9%), before and after preparing 

food (42.5%), after touching any object (33.3%), and after handling money (33.7%). The 

main routes of transmission of food-borne illnesses are contaminated food (42.5%), 

contaminated water (40.0%), and vectors (60.7%), as stated by the study participants. 

Symptoms of foodborne illnesses mentioned by the study participants included vomiting 

(31.9%), fever (36.5%), and diarrhea (32.6%).  

  



 

42 

Table 4: Assessment of knowledge on food hygiene practices, routes of transmission 

of foodborne pathogens, and symptoms of foodborne illnesses. 

 Attribute    Number (n=285 (%)) 

Best time for handwashing After using toilet         140(41.9) 

 Before and after food 

preparation         121(42.5) 

 After touching anything           95(33.3) 

 After counting money           96(33.7) 

Main routes of transmission 

of food-borne illnesses Contaminated food        121(42.5) 

 Contaminated water        114(40.0) 

 Vectors        173(60.7) 

 Do not know          35(12.3) 

Symptoms of foodborne 

illnesses Vomiting           91(31.9) 

 Fever        104(36.5) 

 Diarrhea          93(32.6) 

 Do not know          30(10.5) 

Source: Field Data (2022) 

The majority of the respondents (52.6%) were in agreement with the statement that “Poor 

hygiene causes cross contamination” with those who agreed and strongly agreed to be 

17.2% and 35.4%. Those who were in agreement and strong agreement with the statement 

that good hygiene practices prevent diarrhea were 17.9% and 33.3% respectively (Table 

5). 

  



 

43 

Table 5: Assessment of knowledge of food hygiene 

Response     Number (n=285 (%)) 

Poor hygiene causes cross contamination  

Strongly agree 101(35.4) 

Agree 49(17.2) 

Neutral 44(15.4) 

Disagree 46(16.1) 

Strongly disagree 45(15.8) 

Good hygiene practices prevent diarrhea  

Strongly agree 95(33.3) 

Agree 51(17.9) 

Neutral 42(14.7) 

Disagree 55(19.3) 

Strongly disagree 42(14.7) 

Source: Field Data (2022) 

Table 5 shows the results of the assessment of knowledge on food contamination among 

the food handlers. Those who agreed the following statements; “When hands are cleansed 

before beginning work, the risk of food contamination is reduced”, “Preparing meals 

ahead of time lowers the likelihood of infection” and “When people eat and drink at their 

desks, the risk of food contamination rises” were 49.8%, 46.7% and 52.3% respectively. 

Asked if pregnant women who get a foodborne illness are more likely to have an abortion 

and that when one has a skin problem, it is vital to take time off from work 49.1% and 

52.3% responded in the affirmative. 

  



 

44 

Table 6: Assessment of knowledge on food contamination 

Characteristic Response (n (%)) 

  Agree Uncertain Disagree 

When hands are cleansed before beginning 

work, the risk of food contamination is 

reduced. 

142  

(49.8) 70(24.6) 73(25.6) 

Preparing meals ahead of time lowers the 

likelihood of infection. 

133 

(46.7) 76(26.7) 76(26.7) 

When people eat and drink at their desks, the 

risk of food contamination rises. 149(52.3) 72(25.3) 64(22.5) 

Pregnant women who get a foodborne illness 

are more likely to have an abortion. 140(49.1) 68(23.9) 77(27.0) 

When you have a skin problem, it is vital to 

take time off from work. 149(52.3) 62(21.8) 74(26.0) 

Source: Field Data (2022) 

A summation of the scores derived from the nineteen knowledge assessment items 

revealed that the minimum and maximum scores were four and fifteen respectively. The 

mean ± sd score was 9.2 ± 1.77. Further analysis of the knowledge scores indicated that 

the respondents who were deemed to be highly knowledgeable on food hygiene and safety 

practices were 44.2% (95% confidence interval (CI): 38.6% - 50.0%). The majority were 

classified as having low knowledge on food hygiene and safety practices (55.8%, 95% 

CI: 50.0 - 61.4%) as shown in Table 7. 

Table 7: Level of knowledge on food hygiene and safety practices 

Knowledge level      Frequency (n=285(%) )         95% Confidence interval 

  Lower Upper 

Low (<50%)                          159(55.8) 50.0  61.4 

High (≥50%)                     126(44.2) 38.6  50.0 

 

Source: Field Data (2022) 



 

45 

Data from KII indicated that lack of skills and knowledge of handling food safely is a 

major reason for inadequate food safety measures.  

“In my opinion, the cause of incorrect food handling is due to a lack of 

understanding regarding what is considered safe and unsafe. When there is a 

shortage of knowledge and information, individuals may resort to relying on their 

own common sense and natural instincts. Unfortunately, this approach can lead to 

improper food handling practices and mistakes. …” (KII 5, Male, 38 years) 

4.5 Food handling practices 

Table 8 presents the findings of the self-reported assessment of assorted food handling 

practices among the interviewed food handlers. Those who reported that they had a valid 

medical examination certificate, washed hands with soap and water before handling food, 

and always donned gloves and hairnets when handling food were the majority (62.8%, 

67.4%, and 63.2% respectively). Half of the respondents refuted undertaking the 

following; Chewing/smoking while working, working when having a cold and handling 

food when having diarrhoea (34.7%, 34.0% and 35.1% respectively). Most of the 

respondents mentioned that they adhered to the following food handling practices; 

cleaning food contact surfaces before and after preparing food (70.9%), checking the 

expiry dates/shelf life of food (65.3%), boiling or treating water before serving the 

customers (71.9%) and drying hands, after washing them, with a towel (70.2%). 

  



 

46 

Table 8: Food handling practices 

Practice Response (n (%)) 

 Yes No 

Valid medical examination certificate 179(62.8) 106(37.2) 

Washes hands with soap and water before handling food 192(67.4) 93(32.6) 

Wears gloves and hairnets when handling food 180(63.2) 105(36.8) 

Chews/smokes while working 186(65.3) 99(34.7) 

Works when having a cold 188(66.0) 97(34.0) 

Handles food when having diarrhea 185(64.9) 100(35.1) 

Cleans food contact surfaces before and after preparing food 202(70.9) 83(29.1) 

Checks the expiry dates/shelf life of food 186(65.3) 99(34.7) 

Boils or treats water before serving the customers 205(71.9) 80(28.1) 

Dries  hands after washing them with a towel 200(70.2) 85(29.8) 

 

Source: Field Data (2022) 

According to the participants in the focus group discussion, certain food safety measures 

cannot be put into practice due to a variety of limitations, such as time constraints and, 

most importantly, the absence of necessary resources like running water, freezers, and 

refrigerators. Despite having the correct understanding and awareness of the dangers of 

foodborne pathogens, they are also hampered by time constraints.. 

“The issue at hand is the absence of piped or running water, which is a prevalent 

problem in this region, not just specific to me. While acknowledging the hygienic 

and convenient benefits of having running water, there are no such facilities 

available in the vicinity, and the residents are accustomed to washing themselves 

in a basin.…” (FGD 1). 

The qualitative survey data indicated that pursuing quality of life affected risk perception 

and the adoption of measures to curb food-borne pathogens. Individuals who have a 

greater awareness and concern for their personal hygiene and health, as well as a desire 

for tasty food, were found to be more likely to practice safe food handling. 



 

47 

“Some individuals prioritize hygiene and take precautions such as washing their 

hands while cooking, while others may not consider it as important.. … (FGD 6)  

It is important to prioritize hygiene to avoid getting sick from stomach problems or 

food poisoning. Neglecting hygiene can be harmful, so it is necessary to take it 

seriously. …” (KII 7, Female, 42 years). 

Analysis of qualitative interview data showed that not adopting recommended food 

hygiene and safety standards was related to personality, including personal handling 

habits, laziness and past experiences.  

“Don't bother with safe operations, hygiene, or cleanliness, and I don't even 

consider the risks of foodborne illnesses or food safety. However, it is essential to 

make safe behaviour a habit. If you believe a habit is safe, you can continue doing 

it. I feel lazy and can't do everything for safety, or I will become too tired.…. 

“(FGD 8, Female 28 years) 

In the local culture, being sparing, or frugal is emphasized and praised. Further, the frugal 

culture also moderates the paths from food safety knowledge to behaviors and practices. 

“Despite being aware of the need to discard leftovers, I tend to keep them instead. 

This is because I feel it's wasteful to throw away food and money, and I would 

rather save and increase my earnings. ….”( FGD 6,Male 44 years) 

Additionally, many participants were highly pessimistic about the state of food safety; as 

a result, they either felt helpless or thought that adopting the recommended standards of 

food safety, maintaining hygiene and cleanliness would be rather costly and time-

consuming. 

“Proper food handling measures can be expensive to implement, and the monetary 

benefits may not be immediately apparent, making it seem like they don't exist. This 



 

48 

can make your business less competitive as the cost of food may be too high. …” 

(FGD 3,Male 34 years) 

4.6 Biviriate analysis on assessment of the association between sociodemographic 

characteristics and prevalence of foodborne pathogens. 

Table 9 shows the outcomes of the evaluation of sociodemographic characteristics of food 

handlers associated with foodborne pathogens. The mean ± standard error (SE) age of the 

group that was found infected with at least one foodborne pathogen was 41.2 ± 1.77 years. 

The average age of the healthy volunteers was 39.8 0.75 years (mean SE). The age 

difference between the groups was not statistically significant (p=0.861). When the age 

of infected and uninfected food workers was a factor in the study, no significant 

differences were found. These findings agreed with a study conducted in the USA which 

found no association between age and having a foodborne pathogen Stratev et al., (2017). 

This could be attributed to age being reported in an aggregate manner whereby interaction 

between the two variables i.e age and presence of foodborne pathogens could not be 

meaningfully assessed. However, another study conducted in Bulgaria was contrary to 

the study findings as the study reported that older food handlers were more likely to report 

having a foodborne disease as compared to their fellow counterparts Strassle et al., 

(2019). 

 As indicated in table 9, male food handlers were 2 times less likely to be positive for 

foodborne pathogens as compared to their fellow counterparts who were females(odds 

ratio (COR) 2 (95% CI 0.234-0.916, p=0.031). According to a study of food handlers in 

Bahir Dar town, northwest Ethiopia, males were found to be four times more likely than 

females to get a foodborne disease  Derso et al., (2017). This could be attributed to males 

being less likely to observe hygiene practices during food preparation, handling, and 

cooking thus increasing their exposure to foodborne diseases. These findings were 



 

49 

contrary to a study done in the USA which revealed that female partners were more likely 

to be involved in foodborne diseases. Sex distribution has predicted that women are more 

likely to engage in food preparation and cooking hence increased vulnerability to 

foodborne illnesses Strassle et al., (2019). Furthermore, owing to the difficulties of 

cleaning among female food workers, untrimmed fingernails may serve as a channel for 

the passage of intestinal parasites or enteric germs from source to food.  In another two 

studies conducted in India and Nepal, they found no association between gender and 

having a food-borne pathogen Gautam et al., 2019; Sharma et al., (2022). 

 From the present study, training on food safety reduced the odds of having a foodborne 

disease by 3 times as compared to lack of training on food safety(odds ratio (COR)3 (95% 

CI 0.234-0.916, p=0.031). A study of food handlers in hospitals and hotels found that 

those who had received formal training in food safety were much less l