Skip to content

Advertisement

You're viewing the new version of our site. Please leave us feedback.

Learn more

BMC Public Health

Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Prevalence and factors associated with intestinal parasites among food handlers of food and drinking establishments in Aksum Town, Northern Ethiopia

  • Dejen Gezehegn1,
  • Mebrahtu Abay1Email author,
  • Desalegn Tetemke1,
  • Hiwet Zelalem2,
  • Hafte Teklay3,
  • Zeray Baraki4 and
  • Girmay Medhin5
BMC Public HealthBMC series – open, inclusive and trusted201717:819

https://doi.org/10.1186/s12889-017-4831-5

Received: 9 December 2016

Accepted: 6 October 2017

Published: 17 October 2017

Abstract

Background

Various epidemiological studies indicate that the prevalence of intestinal parasites is high in developing countries and those parasites are major public health importance in Sub-Saharan Africa. Their distribution is mainly associated with poor personal hygiene, environmental sanitation and lack of access to clean water. This study was conducted to estimate the prevalence of intestinal parasitic infection and identify factors associated with intestinal parasitic infection among food handlers in the Aksum Town of Tigray Regional State, North Ethiopia.

Methods

A cross-sectional study design was used among 400 randomly selected food handlers who were selected as respondents. Data were collected by face to face interviewer administered questionnaire supplemented with observational checklist. Fresh stool samples were collected from respondents and were examined microscopically for the presence of any of intestinal parasites using standard laboratory methods. Multivariable logistic regression model using Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) was fitted to analyze the independent predictors of intestinal parasitic infections.

Result

The mean age of the food handlers included in this study was 26.0 years. Of the total respondents, 72.5% were females, 63% have completed at least secondary school educational level. Five species of Intestinal Parasites (IPs) were identified. The overall prevalence of being infected with at least one intestinal parasite was 14.5%, 95% CI (11.3, 18.0). The odds of being positive for at least one intestinal parasitic infection was 12.3 times higher among food handlers who practice medical checkup every 9 months compared to those who have a medical checkup every 3 months. The odds of being positive for intestinal parasitic infection was 3 times higher among food handlers with no formal education compared to those who have a level of education secondary school and above. Food handlers who received food hygiene and safety training were 66% less likely to be positive for at least one intestinal parasitic infection as compared to those who did not receive training.

Conclusion

Prevalence of parasitic infection among food handlers observed in the current study is relatively low but is still a public health importance. Number of medical checkup, training in food hygiene and safety, feedback from customers and level of education were significantly associated with reduced odds of being infected with parasitic infection. Hence, these factors should be focused by policy makers and implementers to further bring the prevalence below the level of public health importance.

Keywords

Intestinal parasitesPrevalenceFood handlersFood and drinking establishmentsAksumEthiopia

Background

Food-borne diseases are the commonest types of infectious diseases among the global burdens of diseases in human beings especially in developing countries. Food handlers can play a vital role in the transmission of these parasitic infections [1]. Though there are so many sources of food and drinking contamination methods, food handlers serve as the main ones [1, 2]. If food handlers practice poor hygienic behavior, they could be carriers of pathogens [2]. According to World Health Organization (WHO) estimate, nearly one-third of the population in developed countries are affected by intestinal parasitic infections; whereas in developing countries the estimate is around five times higher [35]. In Ethiopia, intestinal parasitic infections (IPIs) are usually related to so many factors that are associated with poverty, including poor socioeconomic condition, poor hygiene and sanitation practice, lack of safe and adequate water supply and climate change [6]. There are many parasite species that can cause IPIs. Out of which Ascaris Lumbricoides is the most prevalent parasite followed by Trichuris Trichiura, and hookworm respectively [7]. The commonest mode of transmission of parasites is ingestion of food or water contaminated with the infective stages of one more species of the parasites [8]. There are different factors that affect the prevalence and severity of IPIs. Food handlers’ health condition as well as hygiene and sanitation practices are the commonest determinants of food and drinking contaminations. Infections can also be acquired through contaminated unwashed fingers, insects, circulation of banknotes and via wind during dry conditions [9].

In developing countries, where there is a poor regulatory system for food hygiene, food handlers are appointed in food and drinking establishment centers without investigating their health status for the common IPIs [10]. Individuals without symptoms of parasitic infections can be considered as dangerous to the society because such food handlers routinely practice their jobs without giving due attention for the transmission of infections. As a result, intestinal parasites can be transmitted to consumers directly or indirectly through food, water, nails and fingers from food handlers [11, 12].

Recently, changing lifestyle, breakdown of joint family system and increase in number of working women as food handlers has led to consumption of ready to eat foods. Individuals may be able to satisfy their taste and nutrition needs, but pays little attention to hygiene and food safety [13].

Aksum Town is one of the places of smokeless industry owners in the Tigray region. Due to this, eating and drinking in food and drinking establishments, such as hotels, restaurants and snack bars are becoming common practices. Information on intestinal parasites and associated factors among food handlers in the study area is limited. Thus, this study was aimed at determining the prevalence of intestinal parasites and identifying associated factors among food handlers working in food and drinking establishments in the Town.

Methods

Study design and setting

A community based cross sectional study was carried out among food handlers working in food and drinking establishments in Aksum Town, Northern Ethiopia from 14, September upto 10, November, 2015. Aksum Town is located 1067 Kilometers North of Addis Ababa, which is the capital City of Ethiopia, with a total population of 60,676. There are a total of 24 hotels, 33 restaurants, 50 snack bars and juice houses in Aksum Town. During the study period there were 1500 food handlers working in these places. Of these workers, 640 were working in hotels, 525 in restaurants and the rest 335 in snack bar and juice houses serving as food handlers in the Town (Aksum Town Administration report of 2015).

Source and study population

The source population was all food handlers working in food and drinking establishments in Aksum Town and the study population were all randomly selected food handlers working in the food and drinking establishments of the Town.

Sample size determination and sampling procedure

The sample size was calculated using a single population proportion formula with the assumptions of 95% confidence interval and 5% of marginal error; n = (Ζ 1-α/2 ) 2 P (1 – P) /d 2 , where “n” is the required sample size. Taking p = 44.1% (0.441) (the prevalence of intestinal parasites among food handlers in Yebu Town, South West Ethiopia) [14], and adding 5% non-response rate, a total of 400 food handlers participated in the study. Simple random sampling technique using lottery method was employed to reach the respondents from the roster lists of food handlers’ which obtained from the food and drinking establishments.

Variables and measurement

The dependent variable is a condition of intestinal parasitic infection (infected versus uninfected), and the independent variables include socio-demographic, individual, economic and food handling practice related variables.

Food handlers with IP: those who had one or more detected intestinal parasites, such as (E. histolytica, G. lamblia, Hookworm, A. Lumbricoides, T. Trichiura, H. nana and S. mansoni), using microscopic examination.

Knowledge of food handlers on IP: food handlers who scored above the mean value of the 13 knowledge questions was considered as having good knowledge (Additional file 1).

Data collectors and data collection procedures

A structured questionnaire which was adopted from WHO food checklist [ https://www.ces.ncsu.edu/wp-content/uploads/2014/03/SOPcklistHACCP.pdf ] WHO food preparation manual [http://www.who.int/foodsafety/publications/consumer/manual_keys.pdf], and other literatures were used to interview the selected food handlers. The reliability of knowledge questions was measured using Cronbach’s alpha and the result was 0.80. First, the questionnaire was written in English and then translated to the local language, Tigrigna and back translated to English to ensure its consistency. The Tigrigna version of the questionnaire was pretested among 15 food handlers in Adwa Town. Data related to socio-demographic characteristics and personal hygiene practices were collected via face to face interview method. Three environmental health and two medical laboratory professionals were recruited for data collection, supervision and microbiological analysis. The data collectors were trained for 2 days by the principal investigator on observational data collection and specimen collection procedures. After interviewing, respondents were asked to give a fresh stool specimen in a sterile, clean wide-mouthed plastic container by clean wooden applicators stick for microbiological analysis. Fresh stool samples were taken from all the 400 respondents.

Intestinal parasites were investigated microscopically from each stool sample using both direct smears mount in saline and formal-ether concentration sedimentation procedures as per the standards [15]. Specimens were preserved using stool preservatives such as polyvinyl alcohol (PVA) and 10% formalin in case of delay. The stool transported to laboratory within an hour of collection using stool cup. Code was given for each stool specimen sample collected from the food handlers on the outer face of the plastic cup for possible treatment of positive findings after examination. Saline wet mount for the common parasites, and concentration and floatation technique for the parasites which are found in stool in small numbers has been used. Kato Katz techniques have also been used for parasites which are rarely found in stool especially Schistosoma species.

Data quality assurance mechanisms

Experienced lab technicians, with at least 2 years’ work experience, was recruited for laboratory examinations. Before the actual stool specimen’s examination, pre-test was conducted on five stool samples collected from patients visiting a health center to look the reliability or reproducibility of the stool examination procedure by the laboratory technicians with two different instruments/microscopes. A close supervision was applied during stool sample collection to make sure the participants bring their own stool specimen. Cleaning, coding and entering of the data was carried out carefully. A standard operational procedure of examinations was followed, slides were blindly cross checked and rechecked by other laboratory technology experts, standardization of equipment (microscopes, slides and chemicals) were used and full field of the stool were examined in order not to miss parasites in each stool examination.

Data processing and analyses

Data were entered into Epi-info version 7.0 software package and transferred to SPSS version 21 software for analysis. Frequencies and percentages were generated for all variables in this study. Odds ratios (both crude and adjusted) with corresponding 95% confidence intervals were used to assess the strength of associations. Independent variables resulting with a p-value of less than 0.2 on bivariable analysis were considered in the multivariable logistic regression analysis. The goodness of fit model was checked by Hosmer Lemeshow statistic and p-value greater than 0.05 was considered as a fit model. Summary of the findings is presented in tables and described by narration.

Results

Socio-demographic characteristics of respondents

A total of 400 food handlers aged 18–50 years who had been working in food and drinking establishments were interviewed with a 100% response rate. The mean age of the respondents was 26.04 (Standard Deviation = 6.31) years. Among the total respondents, the majority, 389 (97.25%) were Orthodox Christian and few of them, 68 (17%) were unable to read and write. Most of them, 339 (84.8%) have been serving for a period of less than 5 years in food and drinking establishments. Their monthly income was less than < 30 USD for about 162 (40.5%) of the respondents (Table 1).
Table 1

Socio demographic characteristics of food handlers in Aksum Town, Northern Ethiopia. (Sep-Nov 2015), (n = 400)

Variables

Diagnosis for at least one parasite

P-value

Negative

Positive

 

Number

Percent

Number

Percent

 

Age

18–20 years

64

18.7

11

19.0

0.400

21–30 years

237

69.3

36

62.1

31–40 years

31

9.1

9

15.5

> 40 years

10

2.9

2

3.4

Sex

Female

245

71.6

45

77.6

0.300

Male

97

28.4

13

22.4

Religion

Orthodox

331

96.8

58

100.0

0.100

Muslim

11

3.2

0

0.0

Education

Illiterate

46

13.45

22

38.00

≤ 0.001

Primary school

70

20.46

10

17.24

Secondary school or above

226

66.08

26

44.82

Monthly income

< 30 USD

129

37.7

33

56.9

0.030

[30–65) USD

181

52.9

23

39.7

[65–109) USD

28

8.2

2

3.4

≥ 109 USD

4

1.2

0

0.0

Service year

< 1 year

68

19.9

14

24.1

0.600

1–5 year

223

65.2

34

58.6

6–10 year

51

14.9

10

17.2

Personal hygiene related factors of food handlers

Of the total respondents, 310 (77.5%) reported that they always wash their hands before food preparation, 295 (73.8%) always use soap and water after visiting toilet and 303 (75.8%) wash their hands after touching dirty material and different body parts. Finding from observation also supported that personal hygiene was practiced by the food handlers.

Similarly, 286 (71.5%) wash their body regularly in their working area, and 354 (88.5%) have medical certificate which they renewed every 3 months (n = 279; 69.8%), every 6 months (n = 59; 14.8%) and every 9 months (n = 19; 4.8%). Linked to their personal hygiene, 89 (22.3%), 152 (38%) and 131 (32.8%) cut their finger nail twice a week, once a week and once in 2 weeks, respectively. Only 28 (7%) of respondents said no need to cut their nails regularly. Bivariate analysis of the personal hygiene factors indicates that food handlers having poor personal hygiene practice were more exposed for intestinal parasitic infection (Table 2).
Table 2

Intestinal parasitic infection and personal hygiene practice of food handlers in Aksum Town, Northern Ethiopia. (Sep -Nov 2015), (n = 400)

Variables

Diagnosis result of intestinal parasites

Negative

Positive

Hand wash before food

 

Number

%

Number

%

Preparation

Always

277

81.0

33

56.9

Usually

51

14.9

14

24.1

Sometimes

14

4.1

11

19.0

Hand wash by soap and water after visiting toilet

Always use soap and water

265

77.5

30

51.7

Usually use soap and water

50

14.6

11

19.0

Sometime use soap and water

27

7.9

17

29.3

Hand wash after touching dirty materials

No

69

20.2

28

48.3

Yes

273

79.8

30

51.7

Wash your body regularly in the working area

No

75

22.7

18

36.7

Yes

255

77.3

31

63.3

Medical certificate

No

37

10.8

9

15.5

Yes

305

89.2

49

84.5

Medical checkup

Every 3 months

255

83.1

24

48.0

Every 6 months

44

14.3

15

30.0

Every 9 months

8

2.6

11

22.0

Wear clean aprons when preparing food

No

42

12.3

15

25.9

Yes

300

87.7

43

74.1

Wear hair garments during food preparation

No

74

21.6

20

34.5

Yes

268

78.4

38

65.5

How frequent do you cut finger nail

Twice a week

83

24.3

6

10.3

Once a week

134

39.2

18

31.0

Once in two weeks

100

29.2

31

53.4

No need to cut

25

7.3

3

5.2

Knowledge and working area related factors of food handlers

A little over half (n = 174; 50.9%) of the respondents had a good level of knowledge about transmission and prevention mechanisms of intestinal parasites. The majority, 342 (85.5%) were users of private tap water, 373 (93.3%) had shower facility and all of the respondents had a toilet facility in their establishment. Of the establishments which had toilet facility, 364 (91%) had water flush type of toilet. Only 176 (44%) respondents were trained about food hygiene and safety (Table 3).
Table 3

Intestinal parasitic infection with respect to knowledge and working area related factors of food handlers in Aksum Town, Northern Ethiopia. (Sep -Nov 2015), (n = 400)

Variables

Diagnosis result of intestinal parasites

Negative

Positive

Number

%

Number

%

Sources of water in your working area

Protected hand dug well

40

11.7

18

31.0

Private tap water

302

88.3

40

69.0

Working are have shower facility

No

18

5.3

9

15.5

Yes

324

94.7

49

84.5

Working area have separate dressing

No

80

23.4

14

24.1

Room

Yes

262

76.6

44

75.9

To clean utensils and drinking cup

Water and detergent

190

55.6

41

70.7

Hot water and detergent

69

20.2

4

6.9

Water with bleach

83

24.3

13

22.4

How frequently is the kitchen floor Cleaned

Once a day

129

37.7

27

46.6

Twice a day

111

32.5

20

34.5

Three times a day

102

29.8

11

18.9

Toilet facility of working area

No

0

0.0

0

0.0

Yes

342

100.0

58

100

Type of toilet

Water flesh

310

90.6

54

93.1

VIP latrine

32

9.4

4

6.9

Have you ever received feedback

No

81

23.7

25

43.1

Yes

261

76.3

33

56.9

Supervise by owner or manager

No

42

12.3

8

13.8

Yes

300

87.7

50

86.2

Food hygiene and safety training

No

176

51.5

48

82.8

Yes

166

48.5

10

17.2

Knowledge on IP

Poor knowledge

168

49.1

35

60.3

Good knowledge

174

50.9

23

39.7

IP Intestinal Parasites

Prevalence and types of intestinal parasite

Based on microscopic stool sample examinations, five species of intestinal parasites were identified with an overall prevalence of 14.5%, 95%CI (11.3, 18.0). G. lamblia, identified in 21 (5%) of the respondents, was the most prevalent parasite followed by E. histolytica, S. mansoni, H. nana and Hookworm with prevalence of 14 (3.3%), 10 (2.5%) and 4 (1%), respectively. Double infection of E. histolytica and G. lamblia as observed only on one respondent. Among the respondents with IPs, 35 (60%) were from restaurants, 10 (17%) from hotels and 13 (22.4%) from café and juice houses (Table 4).
Table 4

Prevalence of intestinal parasites detected from stool specimens of food handlers in Aksum Town, Northern Ethiopia. (Sep -Nov 2015). (n = 400)

Parasites

Number positive

Percent positive

Giardia Lamblia

20

5.0

Entamoeba Histolytica

13

3.3

Schistosoma Mansoni

10

2.5

Hymenolepis Nana

10

2.5

Hookworm

4

1.0

Giardia Lamblia and Entamoeba Histolytica

1

0.3

Factors associated with intestinal parasitosis among the food handlers

From the bivariate analysis 15 variables met the criteria (p-value < 0.2) to select variables for multivariable analysis. Multi-collinearity of these variables was near to one tolerance and VIF was < 10. Among those 15 variables, four variables (frequency of medical checkup, training on food hygiene and safety, feedback from customer and level of education) were significantly and positively associated with parasitic infection (P-value < 0.05).

In a multivariable logistic regression analysis, food handler who practiced medical checkup every 9 months were 12.3 times more likely to be positive for intestinal parasites compared to those who practice medical checkup every 3 months (AOR = 12.33, 95% CI = 3.23–46.76). Similarly, the odds of being positive for intestinal parasitic infection was 3 times higher among food handlers who did not attend formal education compared to those who were secondary school and above (AOR = 3.01, 95% CI = 1.03–8.20). Food handlers who received feedback or advice from their customers about hygienic practice were 64% less likely to be positive for intestinal parasites compared to those who did not receive feedback (AOR = 0.36; 95% CI = 0.15–0.89). Food handlers who received food hygiene and safety training were 66% less likely to be positive for intestinal parasites compared to those who did not receive training (AOR = 0.34; 95% CI = 0.12–0.96) (Table 5).
Table 5

Multivariable logistic regression analysis of predicators for intestinal parasitic infection among food handlers in Aksum Town, Northern Ethiopia. (Sep -Nov 2015), (n = 400)

Variables

Positive for intestinal parasite

COR (95% CI)

P-value

AOR (95% CI)

 

Yes

No

Education level

Illiterate

22

46

4.15(2.17–7.96)

< 0.001

3.0(1.03–8.20)*

Primary school

10

70

1.24(0.57–2.70)

0.481

0.70(0.24–2.05)

Secondary school and above

26

226

1

 

1

Source of water

Protected hand dug well

18

40

3.39(1.78–6.48)

< 0.001

2.48(0.85–7.19)

Private tap water

40

302

1

 

1

Hand washing before food preparation

Always

33

277

1

 

1

Usually

14

51

2.30(1.15–4.60)

0.018

0.98(0.23–4.18)

Sometimes

11

14

6.59(2.76–15.71)

< 0.001

2.21(0.43–11.31)

Hand washing by soap and water

Always use it

30

265

1

 

1

Usually use it

11

50

1.94(0.91–4.13)

0.084

1.04(0.30–3.51)

Sometime use it

17

27

5.56(2.72–11.36)

< 0.001

1.82(0.36–9.20)

Hand washing after touching dirty material

No

28

69

3.69(2.07–6.58)

< 0.001

1.72(0.68–4.33)

Yes

30

273

1

 

1

Medical checkup for IP

Every 3 months

24

255

1

 

1

Every 6 months

15

44

3.62(1.76–7.44)

< 0.001

2.36(0.89–6.25)

Every 9 months

11

8

14.60(5.36–39.80)

< 0.001

12.33(3.23–46.76)*

How frequent the kitchen floor cleaned

Once a day

27

129

1

 

1

Twice a day

20

111

0.86(0.45–1.61)

0.642

1.40(0.52–3.80)

Three times a day

11

102

0.51(0.24–1.08)

0.082

1.40(0.44–4.34)

Received feedback from customers

No

25

81

1

 

1

Yes

33

261

0.40(0.23–0.72)

0.002

0.36(0.15–0.89)*

Received food hygiene training

No

48

176

1

 

1

Yes

10

166

0.22(0.10–0.45)

 

0.34(0.12–0.96)*

Knowledge of food handlers on IPs

Poor knowledge

35

168

1.576(.894–2.779)

0.116

0.82(0.33–2.05)

Good knowledge

23

174

1

 

1

*significant at p-value < 0.05, COR Crude Odds Ratio, AOR Adjusted Odds Ratio, IP Intestinal Parasites

Discussion

The prevalence of parasitic infection reported in the current study is consistent with a study done among bakery workers in Iran (11.9%) [16] and is relatively higher than the 6.9% reported in Khartoum Sudan [11]. But it is relatively lower as compared to the findings of other countries which reported 29.3% in India [17], 23.0% in Saudi Arabia [18], 23.7% in Kenya [19], 21.6% in Ghana [20]. It is also much lower than 41.1% reported in Bahirdar [21], 44.1% in Yebu, 45.3% in Addis Ababa [22] and 49.3% in Mekelle [23]. Such a relatively high prevalence of intestinal parasites is largely due to variation in year of study, socio-demographic characteristics, personal hygiene practice and environmental sanitation, safe water supply, health promotion practice, food hygiene and safety training, knowledge of transmission and prevention of intestinal parasite differences.

The predominant parasite identified in the present study was G. lamblia with a prevalence of 5%, which is relatively consistent with similar studies from Bakery workers in Iran and Saudi Arabia reports prevalence of 3.7% [16] and 9% [18] respectively. The predominance of this parasite could be due to the easy mode of transmission of the parasite which is usually found in food, water, soil or contaminated surface with the feces.

In the present study, the rate of contamination with intestinal protozoa, 34(8.55%) is higher than that of intestinal worms, only 4(1%) which is in line with studies from Addis Ababa University student cafeteria, Ethiopia 86 (50%) and 2 (1.16%) [24] and Saudi Arabia 27 (13.5%) & 1 (0.5%) [18], respectively. This could be reasoned out by the transmission and distribution of protozoa through cysts is more direct and simpler than worms which need special consideration.

The finding of this study showed that 69.80%, 14.5% and 4.80% of the food handlers had taken medical checkup every 3 months, every 6 months and every 9 months, respectively. This figure is incongruent to a report from Mekelle, Ethiopia which is 63.2% (examined every 6 months) [23] and from Jimma Town, Ethiopia which is 56.7% (examined every 6 months) [25]. But a study conducted in Bahirdar Town, Ethiopia reported that none of the respondents came across regular medical examinations[21]. This gap could be due to differences in level of education, regular supervision by regulatory team and time schedule of renewing medical checkup. Currently, the ministry of health recommends food handlers to renew their medical certificate every 3 months.

Food handlers who received feedback from customers were 64% less likely to be positive for intestinal parasite compared to those who did not. This was supported by a result from Gondar where respondents who receive feedback from their customers on how to control and prevent intestinal parasite infection and transmission [26]. This might be due to the fact that those food handlers receiving feedback would have more tendency to apply the prevention methods of IPs.

The present study showed that 44% of the respondents were trained on food handling and safety. This finding is greater than the study conducted in Bahirdar Town, Ethiopia (14%) [21] and supported by the findings of other similar studies [23, 26]. This might be because there is difference in number of institutions working in safety, tendency of employers to recruit food handlers without considering health certificate as a basic criterion and low monthly salary (payment) for food handlers in the other study areas [27].

In the current study, the odds of being positive for intestinal parasitic infection was 3 times higher among food handlers who were not formally educated compared to those who were secondary school and above. This is to mean that food handlers who had a low level of knowledge about transmission and prevention of IPs had a higher chance of being infected by IPs compared to those who had better knowledge as a result of their formal secondary school education and above. Most of the food handlers knew how to keep food safely, but they do not put this into practice when they are observed, which is also supported by other studies where food handlers did not usually translate their knowledge into practice [28].

Conclusion and recommendations

In conclusion, compared to other similar studies conducted in developed and developing countries, relatively lower prevalence 56 (14.0%) food handlers were tested positive for different intestinal parasites. Of the number of variables analyzed, frequency of medical checkup, food hygiene and safety training, feedback from customers and level of education were the identified factors affecting food handlers to intestinal parasites in the study area.

Employers, managers or owners of food and drinking establishments, should continuously supervise the food handlers and establish personal hygiene rule and posted it on easily visible site. Environmental health practitioners should strongly continue conducting periodic inspection, design and implement food safety awareness creation program, establish rules on periodic medical examination and implement and prepare food hygiene training manual, guideline and a certificate.

Declarations

Acknowledgments

Our heartfelt gratitude goes to Collage of Health Sciences Department of Public Health for giving us the opportunity to do this research project. We are grateful for the valuable contribution of Aksum Town health office for supporting reagents and providing list of data on the number of food and drinking establishments. Finally, we would like to thank the respondents for their willingness and corporation to make this study achievable.

Funding

There is no fund received to do this research.

Availability of data and materials

The minimal anonymized data is available within the manuscript and supporting files.

Authors’ contributions

DG developed the design, wrote the proposal of the research, involved in the recruitment and training of supervisors and data collectors, analyzed the data, drafted the paper and participated in all stages of the project implementation. GM, MA and DT assisted with the design, revised and approved the proposal. MA, HT and ZB involved in data analysis, manuscript preparation and approval; MA prepared the original draft of the manuscript. All authors get involved in the preparation of the subsequent drafts of the manuscript, read and approved the final manuscript.

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of Aksum University, college of health sciences (AKUCHS/195/08_protocol number 11). Managers of the food and drinking establishments were informed about the objective and purpose of the study and written consent was obtained from each food and drinking establishments. Verbal consent was also obtained from all respondents. Unique identification number was used to ensure confidentiality of individual client information. All individuals found positive for intestinal parasites were treated in Aksum health center using the country’s first line treatment guideline for each IPs [29].

Consent for publication

Not applicable.

Competing interests

The authors have declared that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Public Health, Aksum University
(2)
Department of Public Health, Asela University
(3)
Department of Biomedical Sciences, Aksum University
(4)
Department of Nursing, Aksum University Aksum
(5)
Aklilu Lemma Institute of Pathology

References

  1. Bishop J, Tritscher A. Food safety surveillance and response. West Pac Surveil Response J. 2012;3(2):1.Google Scholar
  2. Kuchenmüller T, Abela-Ridder B, Corrigan T, Tritscher A. World Health Organization initiative to estimate the global burden of foodborne diseases. Rev Sci Tech. 2013;32(2):459-67.Google Scholar
  3. Zemichael G, Mulat G, Zinabu T. Food Safety Knowledge, Attitude and Associated Factors of Food Handlers Working in Substandard Food Establishments in Gondar Town, Northwest Ethiopia, 2013. Vol. 1. 2014.Google Scholar
  4. Loureiro ML, Umberger WJ. A choice experiment model for beef: What US consumer responses tell us about relative preferences for food safety, country-of-origin labeling and traceability. Food policy. 2007;32(4):496–514.View ArticleGoogle Scholar
  5. Tulu B, Taye S, Amsalu E. Prevalence and its associated risk factors of intestinal parasitic infections among Yadot primary school children of South Eastern Ethiopia: a cross-sectional study. 2014;7(1):1–7.Google Scholar
  6. Ayalew A, Debebe T, Worku A. Prevalence and risk factors of intestinal parasites among Delgi school children, North Gondar, Ethiopia. J Parasitol Vector Biology. 2011;3(5):75–81.Google Scholar
  7. Wegayehu T, Tsalla T, Seifu B, Teklu T. Prevalence of intestinal parasitic infections among highland and lowland dwellers in Gamo area, South Ethiopia. BMC Public Health [Internet]. 2013;13(1):1. Available from: BMC Public Health.Google Scholar
  8. Biwott GK, Ngeiywa MM. Prevalence of Gastrointestinal Parasitic Infections among Food Handlers in Eldoret Municipality, Kenya. J Biol Agricult Healthc. 2014;4(27):160–72.Google Scholar
  9. Kibret M, Abera B. The sanitary conditions of food service establishments and food safety knowledge and practices of food handlers in Bahir Dar town. Ethiopian journal of health sciences. 2012;22(1):27–35.PubMedPubMed CentralGoogle Scholar
  10. Mudey AB. Health Status and Personal Hygiene among Food Handlers Working at Food Establishment around a Rural Teaching Hospital in Wardha District of Maharashtra. India. 2010;2(2):198–206.Google Scholar
  11. Ahmed H, Hassan H. Bacteriological and Parasitological Assessment of Food Handlers in the Omdurman Area of Sudan. 2010;43(1):70–3.Google Scholar
  12. Tessema AG, Gelaye KA. Chercos DH. Factors affecting food handling Practices among food handlers of Dangila town food and drink. 2014;14(1):1–5.Google Scholar
  13. Abate A, Kibret B, Bekalu E, Abera S, Teklu T, Yalew A, et al. Cross-sectional Study on the Prevalence of Intestinal Parasites and Associated Risk Factors in Teda Health Centre. Northwest Ethiopia. 2013:10–5.Google Scholar
  14. Tefera T, Mebrie G. Prevalence and predictors of intestinal parasites among food handlers in Yebu town, southwest Ethiopia. PloS One. 2014;9(10):e110621.Google Scholar
  15. Williams J, District laboratory practice in tropical countries. Part 1: Monica Cheesbrough. Doddington, Cambridgeshire: Tropical Health Technology, 1998. viii+ 456pp. Price£ 10.90 (surface post) or£ 19.00 (airmail). ISBN 9507434-4-5 [Also available from Cambridge University Press (ISBN 0-521-66547-7)], 2000.Google Scholar
  16. Kheirandish F, Tarahi M, Haghighi A, Nazemalhosseini-Mojarad E, Kheirandish M. Prevalence of intestinal parasites in bakery workers in Khorramabad, Lorestan Iran. Iran J Parasitol. 2011;6(4):76.Google Scholar
  17. Ghosh A, Mishra PP, Sharma VP. Prevalence of Parasitic Infestations amongst the Food Handlers in a City of North Eastern Region of India. 2014;5(2):15–8.Google Scholar
  18. Zaglool DA, Khodari YA, Othman RAM, Farooq MU. Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital. Niger Med J. 2011;52(4):266-70.Google Scholar
  19. Damen JG, Cosmas EU, Damak CA. Intestinal Parasitosis among Food Handlers in Jos, North Central Nigeria. 2015.Google Scholar
  20. Ayeh-Kumi PF, Quarcoo S, Kretchy JP, Mortu S. Prevalence of Intestinal Parasitic Infections among Food Vendors in Accra, Ghana. 2009;32(1):1–8.Google Scholar
  21. Abera B, Biadegelgen F, Bezabih B. Prevalence of Salmonella typhi and intestinal parasites among food handlers in Bahir Dar Town, Northwest Ethiopia: 2009.Google Scholar
  22. Aklilu A. Prevalence of intestinal parasites, Salmonella and Shigella among apparently health food handlers of Addis Ababa University student’s cafeteria, Addis Ababa, Ethiopia. BMC research notes. 2015;8(1):17.View ArticlePubMedPubMed CentralGoogle Scholar
  23. Nigusse D, Kumie A. Food hygiene practices and prevalence of intestinal parasites among food handlers working in Mekelle university student’ s cafeteria. Mekelle. 2012;1(4):65–71.Google Scholar
  24. Ifeadike CO, Ironkwe OC, Adogu PO, Nnebue CC. Assessment of the food hygiene practices of food handlers in the Federal Capital Territory of Nigeria. Trop J Med Res. 2014;17(1):10-5.Google Scholar
  25. Assefa T, Tasew H, Wondafrash B, Beker J. Alternative & Integrative Medicine Contamination of Bacteria and Associated Factors among Food Handlers Working in the Student Cafeterias of Jimma University Main Campus, Jimma. 2015;4(1).Google Scholar
  26. Gizaw Z, Gebrehiwot M, Teka Z. Food Safety Knowledge, Attitude and Associated Factors of Food Handlers Working in Substandard Food Establishments in Gondar Town, Northwest Ethiopia, 2013. Vol. 1. 2014.Google Scholar
  27. Babiker MA, Ahmed ES. Frequency of intestinal parasites among food-handlers in Khartoum. 2009;15:1098–104.Google Scholar
  28. Sultana A, Awan A, Tehseen I. Sanitation practices among food handlers working in street restaurants in Rawalpindi, Pakistan. Rawal Med J. 2013;38(4):425-7.Google Scholar
  29. Standard Treatment Guideline for District level health facilities of Ethiopia. Drug Administration and Control Authority of Ethiopia Contents; 2010. http://apps.who.int/medicinedocs/documents/s17820en/s17820en.pdf.

Copyright

© The Author(s). 2017

Advertisement