Food safety practice and associated factors in public food establishments of Ethiopia: A systematic review and meta-analysis

Background: In terms of global impact, foodborne infections have been likened to major infectious diseases such as HIV/AIDS, malaria, and tuberculosis, with 1 in 10 people becoming ill and 420,000 deaths per year. A large number of these incidents are caused by improperly handled food in foodservice establishments. Therefore, this systematic review and meta-analysis aims to estimate the proportion of food handlers in Ethiopian commercial food service establishments who have safe food handling practices and their associated factors. Methods: Studies conducted before 02-05-2022 were explored in PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE®, as well as other sources. A total of fourteen studies were included in the final synthesis. Data were extracted using a standardized data extraction format prepared in Microsoft excel and the analysis was done using STATA 16 statistical software. The quality of included studies was assessed using the Joanna Briggs Institute’s Critical assessment checklist for prevalence studies. To evaluate publication bias, a funnel plot and Egger’s regression test were employed. The I2 statistic was calculated to examine for study heterogeneity. To assess the pooled effect size, odds ratios, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. Results: Of 323 identified articles, 14 studies were eligible for analysis (n = 4849 participants). The pooled prevalence estimate of safe food handling practices among Ethiopian food handlers was 47.14% (95% CI: 39.01–55.26, I2 = 97.23%). Foodservice training (OR, 3.89; 95% CI: 2.37–5.40), having on-site water storage facilities (OR, 4.65; 95% CI: 2.35–6.95), attitude (OR, 4.89; 95% CI: 1.39–8.29), hygiene and sanitary inspection certification (OR, 3.08; 95% CI: 1.62–4.45) were significantly associated with safe food handling practice among food handlers. Conclusion: This review identified that improvements are needed in food handling training, government regulation, and infrastructure. Standard regulations for food service enterprises must be implemented on a local and national level. Though long-term food safety requires legislation and training, failure to address infrastructure challenges can harm public health efforts. Access to safe drinking water and the presence of sanitary waste management systems should all be part of the basic infrastructure for ensuring the safety of food in food businesses.