1 Introduction

Food safety is a crucial public health concern that necessitates strict adherence to protocols throughout the food supply chain, ensuring high-quality, nutritious, and suitable food products for human consumption, from preparation to distribution and final food service [1]. Food safety practices are essential for minimizing health risks from foodborne contaminants. Food service establishments must follow specific regulations and best practices to ensure the safety and well-being of consumers [2]. Restaurants, cafeterias, hotels, and similar food businesses are increasing in number in wealthy and impoverished countries. This rise may be attributed to more people living in urban areas and population growth [3]. In addition, the progression of technology and the heightened demand for maximizing food palatability, alongside preferences for texture, flavor, variety, and accessibility, are influential elements [4]. This trend has caused an unchecked expansion of food service establishments that commonly display poor sanitation practices, which include unsanitary kitchen conditions, inadequate access to clean toilet facilities, and a lack of proper training in food safety protocols [5].

Food safety is crucial for improving health, productivity, development, and poverty reduction, as it ensures reliable access to safe food, which positively impacts overall health [6]. There, people who handle food are very important for keeping food safe and stopping foodborne illnesses, as infected individuals can spread gastrointestinal infectious agents due to poor personal hygiene [7]. This risk arises from the extensive supply chains involved, which include the transportation of bulk raw materials from farms or wholesalers to retailers, the subsequent transfer to food establishments, and the processes of preparation, storage, refrigeration, and serving [5]. The germs making people sick are very similar to those found in food workers, suggesting that these workers acted as conduits for the spread of foodborne pathogens [8]. Maintaining proper personal hygiene and adhering to effective food handling practices are crucial for mitigating the risk of pathogen transmission from food handlers to consumers [9].

Globally, over 50% of all food poisoning incidents have been linked to inadequate food handling practices [10]. Foodborne diseases cause more than 40,000 deaths, 600 million instances of illness, and a staggering 33 million years of healthy life lost annually [11], affecting one in ten people around the world [12]. In developing nations, tainted food causes about 10%–20% of food-related sickness outbreaks [13]. Southeast Asia and Africa face significant challenges related to foodborne illnesses, with sub-Saharan Africa alone accounting for approximately 700,000 deaths each year [5]. More foodborne infections and deaths in Africa are due to poor food handling in places that serve food [14]. Unsafe food practices in poorer countries cost more than $100 billion in medical costs each year [15].

Foodborne diseases in Africa are a significant public health concern, causing substantial distress and affecting 34.2% of food samples [16]. In particular, the Horn of Africa faces significant challenges from these illnesses, with bacteria like Salmonella [17], Diarrheagenic Escherichia coli [18], Shigella [19], and Campylobacter [18], along with parasites such as Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia, and hookworm infections [20], are the predominant causes of these health issues in the region. A study in Ethiopia [21] demonstrates that the dry season is the most prone to harmful bacteria, as evidenced by 37.1% of foodborne diseases occurring in December. Foodborne illnesses are prevalent in the area due to socioeconomic challenges, inadequate sanitation, inadequate food safety measures, and limited access to safe drinking water [19].

Catering establishments are often linked to foodborne outbreaks due to poor handling, inadequate safety laws, weak regulations, lack of resources, and limited education for food handlers [22, 23]. In Somalia, especially in Mogadishu, food establishments have increased significantly. However, there are concerns about safe food service, as many individuals likely suffer from food and water contamination each year, often going unrecognized or unreported. Research on food handling practices in Mogadishu is scarce, highlighting the need to determine factors influencing safe food handling, especially during preparation and serving. This study aims to evaluate the factors associated with food handling practices among food handlers in food establishments in Mogadishu, Somalia.

2 Materials and Methods

3 Ethics Approval and Consent to Participate

The Research Ethics Committee of the Faculty of Health Sciences at Mogadishu University has approved this study (Reference No: 29/2023). It follows the ethical principles outlined in the Declaration of Helsinki. Before collecting data, food handlers and business owners were told about the study's possible risks and advantages. Additionally, participants' rights and duties were explained so they could give their verbal consent to participate. All responses were gathered anonymously, treated as confidential, and intended solely for research purposes.

4 Results

4.3 Food Safety Practices of Food Handlers

The study revealed that food handling practices among participants were largely inadequate, with only 83 out of 304 food handlers (27.3%) demonstrating good food handling practices (Figure 1). A significant number of food handlers did not wear gloves while serving unwrapped food, and only 32.6% consistently washed their hands before handling cooked food. Over half of the participants reported that they did not attend routine medical checkups, and 42.1% had taken sick leave for various ailments. About 40.8% of food handlers consistently avoided preparing meals in advance. The study also highlighted that 69.4% of food handlers did not wear masks when distributing unwrapped foods. Furthermore, only 28.3% practiced wearing aprons while serving food. More than half of the respondents used sanitizer when washing service utensils; however, 52.6% did not clean the food storage area before adding new products, and 52% did not verify the expiry dates of products upon delivery. Only 18.1% of the participants consistently cleaned their work surfaces after each task, while 62.2% did not cover their hair during food handling and preparation. Moreover, 42.4% reported using separate utensils when preparing raw and cooked foods, but only 19.4% had short-trimmed and clean fingernails. Additionally, 31.6% of participants did not thaw frozen foods at room temperature, and 53% failed to avoid eating or drinking in the workplace (Table 3).

Table 3. Safe food handling practices of food handlers.

Question	Response n (%)
	Always	Sometimes	Never
Do you use gloves when serving unwrapped food?	26 (8.6)	105 (34.5)	173 (56.9)
Do you wash your hands before touching cooked foods?	99 (32.6)	80 (26.3)	125 (41.1)
Do you have a medical checkup assigned by the food establishment?	63 (20.7)	50 (16.4)	191 (62.8)
Do you get sick leave for any sickness?	128 (42.1)	72 (23.7)	104 (34.2)
Do you refrain from preparing a meal in advance (i.e., from one shift to another)?	124 (40.8)	85 (28.0)	95 (31.3)
Do you wear a mask when you distribute unwrapped foods?	36 (11.8)	57 (18.8)	211 (69.4)
Do you wear an apron while working?	86 (28.3)	92 (30.3)	126 (41.4)
Do you use the sanitizer when washing service utensils (plates, mugs, and spoons)?	180 (59.2)	35 (11.5)	89 (29.3)
Do you properly clean the food storage area before storing new products?	44 (14.5)	100 (32.9)	160 (52.6)
Do you check the expiry dates of all products at the time of delivery?	77 (25.3)	69 (22.7)	158 (52.0)
Do you clean the work surfaces after each task?	131 (43.1)	118 (38.8)	55 (18.1)
Do you wear a hat or head covering when serving food?	47 (15.5)	68 (22.4)	189 (62.2)
Do you use separate utensils when preparing raw and cooked foods?	129 (42.4)	74 (24.3)	101 (33.2)
Do you trim and clean your fingernails?	154 (50.7)	91 (29.9)	59 (19.4)
Do you not thaw frozen foods at room temperature?	69 (22.7)	139 (45.7)	96 (31.6)
Do you avoid eating or drinking at your workplace?	74 (24.3)	69 (22.7)	161 (53.0)

5 Discussion

The study revealed that 27.3% of food handlers in food establishments exhibit good food-handling practices. This finding was consistent with studies in Addis Ababa Ethiopia and Gamo Gofa Zone Ethiopia, which had safety food handling practices of 27.4% [24], and 32.6% [31], respectively. However, this result is less than those of other research conducted in Brazil (76%) [32], Indonesia (82%) [33], and Saudi Arabia (80.29%) [34]. The differences observed in our study might be due to variations in sociodemographic factors, especially food handlers' educational level, with 66.8% unable to read and write. Environmental factors, the efficacy of food safety training, and regulatory oversight also play a role. Additionally, contrasting findings from other studies may be linked to differing study settings, such as hotels in Brazil, hospitals in Indonesia, and universities in Saudi Arabia, which typically have better resources for food handling than our study area.

According to the survey, 77.3% of participants who handled food were males, which is a substantial percentage. This highlights a notable gender disparity in the workforce of food establishments in Mogadishu, Somalia. The preference for hiring males in these establishments may reflect cultural biases, which highlight issues of unequal access to jobs and challenge traditional gender roles in food handling and preparation within these food establishments [35]. Moreover, only 23.7% had taken food preparation and handling training. This is less than what studies in Ethiopia [36] and Brazil [37] found. This study reveals that low training rates result in inadequate initiatives and enforcement, jeopardizing food safety and public health. Combining theoretical and practical training for food handlers significantly enhances food safety practices [38].

In this study, it was discovered that young food handlers, defined as those aged 25 years or younger, exhibited a staggering 90% lower likelihood of adhering to proper food handling practices compared to their older counterparts, who were over 25 years of age. This significant discrepancy highlights a critical gap in food safety awareness and training among younger individuals. The findings are consistent with previous research [39], which indicates that as food handlers age, they typically acquire greater experience and knowledge in safely managing food. This increased experience likely enhances their understanding of best practices, such as effective sanitation techniques, proper food storage methods, and the importance of hygiene in preventing foodborne illnesses [40].

Furthermore, compared to their married colleagues, unmarried food handlers were 90% less likely to demonstrate proper food handling techniques. This suggests that married food handlers are more likely to demonstrate proper food handling practices in food establishments. One possible explanation for this finding is that married individuals may have gained experience in maintaining good food handling standards during their marriage [13]. Married food handlers may feel more accountable and committed to maintaining high food safety and hygiene standards [41, 42]. This discovery highlights how marriage and food safety habits are linked in complicated ways, indicating that someone's home life can greatly affect how they handle food at work.

The study did not explore the relationship between education level and food handling practices. This suggests that variations in educational attainment did not correlate with differences in how food is handled. Similar studies have also found that education level was not statistically significant in influencing the food handling practices of food handlers [43, 44]. Evidence suggests that despite the potential for education to elevate awareness of food safety, it does not always lead to better food management [45]. This suggests that simply knowing facts is insufficient to influence behavioral change. For instance, individuals with less formal education may have valuable insights gained through personal experience and cultural traditions. Furthermore, having an education does not necessarily mean that someone will diligently adhere to important food safety guidelines.

In addition, food handlers with fewer than 2 years of work experience demonstrated an 80% reduced likelihood of adhering to good food safety practices when compared to their colleagues with two or more years of experience. This significant difference underscores the importance of hands-on experience in the food service industry. Research studies [46, 47] further corroborate this finding, revealing that food handlers with under 2 years of experience are considerably more prone to engage in unsafe food-handling behaviors. In contrast, those with more than two or more years of experience showed markedly better compliance with established safety protocols. This implies that the accumulation of experience is vital for food handlers, as it equips them with essential skills and knowledge that are critical for maintaining safety and hygiene standards in food preparation and handling [48].

Food handlers earning over $150 were 210% more likely to demonstrate good food handling practices than those who made $150 or less. This could be because higher-paid workers tend to be better educated, more experienced, and know more about safe food handling [13]. Furthermore, a food handler who receives appropriate wages is more likely to be highly accountable and dedicated to following food safety and hygiene regulations, because when food workers receive fair compensation, they take more pleasure in their work and strictly follow food safety guidelines [49]. This contributes to an overall culture of excellence in food safety by fostering job satisfaction, decreasing turnover, and creating a safer workplace to handle food [50].

There are many limitations to the study. It is unable to demonstrate a causal link between the independent variables and the outcome of interest because of its cross-sectional nature. Furthermore, the research depended on self-reported food safety procedures, which raises the possibility that participants could give answers they think are anticipated rather than ones that truly represent their activities. Additionally, the results' applicability to the larger population of food handlers is limited by the small sample size. When making generalizations, care must be used since these restrictions may influence how results are interpreted. Even with these issues, the study gives us a good starting point and ideas for future research and health programs in the area.

6 Conclusion and Recommendations

The research indicated that most of the participants in the study area did not practice safe food handling. This raises significant public health concerns, as improper food handling can lead to foodborne illnesses. The research identified several crucial factors influencing these practices, including participants' age, marital status, work experience, and monthly income. To effectively improve food handling practices, relevant authorities are encouraged to use these insights to address the identified gaps and implement targeted interventions. These interventions should include enhanced training programs, stricter enforcement of food safety regulations, and public awareness campaigns that play a vital role in promoting better behaviors. Additionally, it is essential to have robust monitoring and inspection procedures, along with clear communication channels for stakeholders to report concerns. Furthermore, the government of Somalia should prioritize training and support for food handlers to cultivate safer food practices and promote better health outcomes in the community moving forward.

Author Contributions

Walid Abdulkadir Osman: conceptualization, methodology, data curation, formal analysis, writing – original draft, writing – review and editing, and supervision. Saeed Mohamed Saeed: conceptualization, methodology, software, data curation, and formal analysis. Hassan Muse Ahmed: methodology, formal analysis, writing – review and editing. Qali Ahmed Nageye: conceptualization, data curation, writing – review and editing. Mahad Abdi Malin: conceptualization, data curation, writing – review and editing. Abdullahi Ahmed Hassan: conceptualization, data curation, and software. All authors have read and approved the final version of the manuscript. Corresponding Author Walid Abdulkadir Osman had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author, Walid Abdulkadir Osman, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.