2Laboratory of Disease Dynamics & Molecular Epidemiology, Laboratory of Health Data Analytics & Visualization Environment, ¬Amity Institute of Public Health, Amity University, Noida, India
Objective: To study knowledge, attitude and practice (KAP) towards food safety and hygiene among students of a private university of Delhi, NCR.
Method: A Cross-Sectional study design using self-administered, pre-tested questionnaire containing a total of 40 questions was conducted among 500 private university students in Delhi, NCR. Information was collected from various disciplines through self-administered survey forms. For assessing the knowledge, a score of 1 and 0 was given to every correct and incorrect answers respectively. For assessing Attitude and Practice each correct response was awarded a score of 2, for neutral response a score of 1 and for incorrect response a score of 0 was awarded. Quartiles were generated for each component. Based on quartiles, knowledge, attitude and practice were divided into adequate and inadequate.
Result: The study participants included 31.6% males and 68.4% females. 29% participants belonged to postgraduate course and 71.1% from undergraduate course. Regarding food safety & hygiene, 74.8% participants had adequate knowledge, 53% had adequate attitude and 46% had adequate practice.
Conclusion: Continuous education is necessary to increase the awareness among young adults in the near future; they will be the ones directly handling food and play an important role to help maintain a hygienic and clean environment.
Keywords: Food safety; Food hygiene; Food Borne Disease; Knowledge; Attitude; Practice
A cross sectional study was conducted among 500 private university students of Delhi, NCR belonging to various study disciplines between September and October, 2019.
Sample Size Calculation
We assumed 50% knowledge about food safety and hygiene among university students. Considering 5% level of significance and 5% margin of error, the computed sample size was 384. After taking 30% as non-response rate, the final sample size came out to be 500.
Development of Study Tool (Questionnaire)
A self-administered, pre-tested questionnaire for this study was prepared to assess KAP on food safety and hygiene. The idea for preparing questionnaire was taken from studies previously conducted on food safety and hygiene among university students. We modified the questions as per our study’s requirement and designed a self-administered KAP questionnaire. The questionnaire was pretested within the university premises among various students. The questionnaire included four parts. The first part of the questionnaire obtained information about the socio-demographic characteristics of the respondents. Second part consisted of 10 questions covering aspects of knowledge about food safety and hygiene. Respondents were asked to choose among three options – Yes, No and Don’t Know wherein we have clubbed Don’t Know & No. For assessing the knowledge, Yes was assigned a score of 1 and No & Don’t Know was assigned a score of 0. The third and fourth part consisted of 10 questions each covering the aspects of Attitude and Practice. Respondents were asked to choose among four options- Strongly Agree, Agree, Neutral and Don’t Agree wherein we have clubbed Strongly Agree and Agree based on which, scores were assigned as 2, 1 & 0 respectively. Quartiles were generated for each component. Based on quartiles, knowledge, attitude and practice were divided into adequate and inadequate. Informed consent taken from the study participants.
Ethical Consideration
Ethical consent taken from the institution.
Inclusion Criteria: Students who gave informed consent to participate in the study.
Exclusion Criteria: Students suffering from acute and chronic gastrointestinal infections. Statistical Analysis of Data
The data was analysed using SPSS version-23 for windows. The categorical variables were illustrated using descriptive statistics for frequency, percentage and p-value computed using Chi square test. A p value < .05 was considered statistically significant.
VARIABLES |
NO. OF PEOPLE (n) |
PERCENTAGE |
SEX |
||
Female |
342 |
68.4% |
Male |
158 |
31.6% |
AGE |
||
16-19 |
155 |
31% |
20 & above |
345 |
69% |
RELIGION |
||
Hindu |
419 |
83.8% |
Others |
81 |
16.2% |
CATEGORY |
||
General |
433 |
86.6% |
Others |
67 |
13.4% |
COURSE |
||
Post-Graduation |
145 |
29% |
Under-Graduation |
355 |
71% |
YEAR OF STUDY |
||
First year |
208 |
41.6% |
Second year |
97 |
19.4% |
Third year |
133 |
26.6% |
Fourth year |
24 |
4.8% |
FIELD OF STUDY |
||
Health & Allied Sciences |
291 |
58.2% |
Others |
209 |
41.8% |
RESIDENCE |
||
With parents |
227 |
45.4% |
Hostel & PG |
273 |
54.6% |
EDUCATION OF FATHER |
||
Graduation |
279 |
55.8% |
Postgraduation |
221 |
44.2% |
EDUCATION OF MOTHER |
||
Graduation |
313 |
62.6% |
Postgraduation |
187 |
37.4% |
Table 2 shows that 94.8% participants thought that lack of good food hygiene is a cause of disease. 90% participants thought that there is a need for regular medical check-up. 82% participants were aware that food borne disease are infectious and toxic. Majority of study participants have heard about food hygiene (95.2%). Based on the scores generated 74.8% of study participants showed adequate knowledge.
KNOWLEDGE QUESTIONS |
YES |
NO |
DON’T KNOW |
K1. Have you ever heard of food hygiene? |
475 |
10 |
14 |
95.2% |
2.0% |
2.8% |
|
K2. Do you think lack of good food hygiene is a cause of disease? |
474 |
18 |
8 |
94.8% |
3.6% |
1.6% |
|
K3. Are you aware of any food borne disease? |
444 |
38 |
18 |
88.8% |
7.6% |
3.6% |
|
K4. Do you think the need for regular medical check-up is a necessity? |
450 |
33 |
17 |
90.0% |
6.6% |
3.4% |
|
K5. Are you aware that food borne disease are infectious and toxic? |
410 |
49 |
41 |
82% |
9.8% |
8.2% |
|
K6. Is it wrong to eat canned food if the cover of the tin is bloated or tight? |
336 |
80 |
84 |
67.2% |
16% |
16.8% |
|
K7. Raw chicken, fish and meat should not come in contact with each other? |
232 |
72 |
196 |
46.4% |
14.4% |
39.2% |
|
K8. Other than holding your hand under tap water one should also wash it with soap before touching the food so as to get rid of bacteria? |
295 |
148 |
57 |
59% |
29.6% |
11.4% |
|
K9. The best way to keep from getting food poisoning from fresh fruit and vegetables is to wash them with cool running water? |
303 |
114 |
83 |
60.6% |
22.8% |
16.6% |
|
K10. Fresh vegetables tend to produce nitrite when stored in high temperature and humid places? |
161 |
21 |
318 |
32.2% |
4.2% |
63.6% |
Table 3 shows that 60.0% participants strongly agreed that one should wash their hands before eating. 45.2% participants strongly agreed that unclean/uncut fingers can cause contamination of food. Also 72.4% strongly agreed that mouth should be covered in order to avoid cross-contamination. 48.2% were concerned about current situation of food safety in college canteen. Of the total participants, 53% displayed adequate attitude. Table 4 shows that 77.2% participants strongly agreed that it is necessary to check the expiry date on food packaging before purchasing the food item. 65.4% participants strongly agreed that it is important to ensure that the food is well cooked before consumption. 59.4% strongly agreed that food should be purchased when it is in clean and fresh condition. Out of total participants, only 46% showed adequate practice. On bivariate analysis it was seen that education of mother had a statistically significant association with knowledge on food hygiene(p=0.033) Table 5. The bivariate analysis supports that women do need formal education as it will have a considerable impact on the community[10].
ATTITUDE QUESTIONS |
STRONGLY AGREE |
AGREE |
NEUTRAL |
DON’T AGREE |
A1. Before eating, one should wash their hands? |
300 |
180 |
14 |
6 |
(60.0%) |
(36%) |
(2.8%) |
(1.2%) |
|
A2. Students do not wash their hand before eating because the wash basin in not kept clean? |
81 |
168 |
136 |
115 |
(16.2%) |
(33.6%) |
(27.2%) |
(23.0%) |
|
A3. Students should complain to the person in charge if any insects are found in their meal? |
346 |
112 |
25 |
17 |
(69.2%) |
(22.4%) |
(5.0%) |
(3.4%) |
|
A4. Students with unclean/uncut-finger nails can cause contamination to their food? |
226 |
226 |
36 |
12 |
(45.2%) |
(45.2%) |
(7.2%) |
(2.4%) |
|
A5. Students should cover their mouth with napkin when they sneeze or cough, to avoid cross-contamination? |
362 |
117 |
17 |
4 |
(72.4%) |
(23.4%) |
(3.4%) |
(0.8%) |
|
A6. You are concerned about pesticide residues in vegetables? |
213 |
227 |
49 |
13 |
(42.6%) |
(45.4%) |
(9.8%) |
(2.6%) |
|
A7. You are concerned about heavy metal pollution of food? |
25 |
200 |
62 |
13 |
(45.0%) |
(40.0%) |
(12.4%) |
(2.6%) |
|
A8. You are concerned about transfer of plasticizers in food containers and packing materials |
213 |
221 |
60 |
6 |
(42.6%) |
(44.2%) |
(12.0%) |
(1.2%) |
|
A9. You are concerned about current situations of food safety in the college canteen? |
241 |
181 |
69 |
9 |
(48.2%) |
(36.2%) |
(13.8%) |
(1.8%) |
|
A10. You are willing to improve your knowledge about food safety? |
243 |
193 |
59 |
5 |
(48.6%) |
(38.6%) |
(11.8%) |
(1.0%) |
PRACTICE QUESTIONS |
STRONGLY AGREE |
AGREE |
NEUTRAL |
DON’T AGREE |
P1. Is it necessary to check the expiry date on food packaging before purchasing the food item? |
386 |
95 |
13 |
6 |
77.2% |
19.0% |
2.6% |
1.2% |
|
P2. Do you think it is important to ensure the food is well cooked before consumption? |
327 |
156 |
16 |
1 |
65.4% |
31.2% |
3.2% |
0.2% |
|
P3. The catering management should educate and train their employees on personal hygiene and food safety regularly? |
354 |
123 |
20 |
3 |
70.8% |
24.6% |
4.0% |
0.6% |
|
P4. Food handlers should avoid using their bare hands to rub/touch/scratch their face, hair or any part of their body in order to prevent contamination? |
355 |
115 |
26 |
4 |
71.0% |
23.0% |
5.2% |
0.8% |
|
P5. We should wash and peel the fruit before eating? |
260 |
174 |
60 |
6 |
52.0% |
34.8% |
12% |
1.2% |
|
P6. Do you look at the sensory characteristics of food when buying it? |
189 |
188 |
113 |
10 |
37.8% |
37.6% |
22.6% |
2.0% |
|
P7. Always ensure purchasing food that is in clean and fresh condition? |
297 |
167 |
32 |
4 |
59.4% |
33.4% |
6.4% |
0.8% |
|
P8. I do not eat raw or uncooked eggs and food made from eggs? |
193 |
139 |
104 |
64 |
38.6% |
27.8% |
20.8% |
12.8% |
|
P9. I taste the food to see if it is safe or not? |
110 |
141 |
135 |
114 |
22.0% |
28.2% |
27.0% |
22.8% |
|
P10. I dry my hands with paper towel or tissue after washing it? |
187 |
218 |
80 |
15 |
37.4% |
43.6% |
16.0% |
3.0% |
Variables |
Number Percent |
Food Hygiene |
p-value |
||
YES |
NO |
DON’T KNOW |
|
||
SEX |
|||||
Female |
342 (68.4%) |
95.6% |
1.5% |
2.9% |
0.460 |
Male |
158 (31.6%) |
94.4% |
3.1% |
2.5% |
|
AGE |
|||||
16-19 |
155 (31%) |
92.9% |
3.2% |
3.9% |
0.255 |
20 & above |
345 (69%) |
96.2% |
1.4% |
2.3% |
|
RELIGION |
|||||
Hindu |
419 (83.8%) |
95.5% |
1.7% |
2.9% |
0.482 |
Others |
81 (16.2%) |
93.8% |
3.7% |
2.5% |
|
FIELD OF STUDY |
|||||
Health & Allied Sciences |
291 (58.2%) |
95.9% |
1.7% |
2.4% |
0.706 |
Others |
209 (41.8%) |
94.3% |
2.4% |
3.3% |
|
RESIDENCE |
|||||
Day scholars |
227 (45.4%) |
95.6% |
1.8% |
2.6% |
0.898 |
Others |
273 (54.6%) |
94.7% |
2.2% |
3.1% |
|
EDU OF FATHER |
|||||
Graduation |
279 (55.8%) |
96.1% |
1.8% |
2.2% |
0.567 |
Post-Graduation |
221 (44.2%) |
94.1% |
2.3% |
3.6% |
|
EDU OF MOTHER |
|||||
Graduation |
313 (62.6%) |
97.1% |
1.3% |
1.6% |
0.033 |
Post-Graduation |
187 (37.4%) |
92.0% |
3.2% |
4.8% |
As per our result of practice score it revealed at being 46% which goes on to show in spite of good/positive knowledge and attitude towards food safety & hygiene, practice among university students remains inadequate. In comparison with another study carried by Aluh et.al the food hygiene practice by adolescents of secondary rural school in Nigeria showed good/positive results, mean score being at 82.48% and more than half of the respondents had good/positive food hygiene practice (54.4%) [15]. Regarding practice of tasting food to ascertain if it’s safe to consume or not, according to study conducted in Turkey, 46.6% tasted food to check its safety, which is contrary to our score of 22%[14].
In a study conducted in Bulgaria good/positive food safety knowledge was observed which is similar to our study’s results[16]. When comparing with Majmaah city among school students of different level primary, intermediate, and high, scores on attitudes were 60.84%, 55.62% and 59.67% respectively revealed similar scores[17]. In spite of differences between level


In a study conducted by Courtney et al it was seen that students in faculties apart from science if given food safety education through courses or via extra-curricular activities it may be beneficial[21]. Food safety requires proper handling from production through consumption. Although standards in the United States are among the highest in the world and consumer guidance on proper food handling is available through magazines, newspapers, food labels, and other sources, mistakes still occur[22].
From the results of our study it was also observed that there is an association between Education of Mother and Food Safety knowledge of participants. The p-value 0.033 shows that the mother’s education plays a role in food safety knowledge of university students. The study conducted by Nurcan, Ibrahim & Suzan revealed that educational status of mother is linked to children’s eating habits[23]. In their study it was also observed that highly educated mother’s children had higher scores about healthy eating attitudes. In another study conducted by Fathea El-Nmer, Amal A Salama & Dalia Elhawary it revealed that there was a highly significant correlation between father and mother’s education and their children’s nutritional practice[24]. The findings in the study conducted by Sa’ed Zyoud, Jawad Shalabi et al supports the idea that females are more informed about appropriate food handling behaviors[25].
Foodborne illnesses cause both damage to individual & the economy. By focusing on food safety improvements, in addition to reducing foodborne diseases, it can help in yielding economic and social benefits- Reduced health care cost, & loss of income of the affected individual, Improvement in productivity, Decrease in burden of country’s health care sector by improved public health and finally Consumer confidence in the country’s food supply leading to financial stability [26].
Young adults involve into risky eating behaviors like eating raw or uncooked food of animal origin that puts them at an increased risk for foodborne diseases we recommend that educational material should be included in the curriculum of universities to enhance student’s perception toward food hygiene; awareness campaigns should be conducted and media and social network applications must be actively used in order to enhance student’s knowledge regarding food safety and hygiene[27].
The challenge, however, is linking theory and research and then further linking them to program planning and evaluation[30].
Foodborne disease will continue to be a matter of major concern around the world in the foreseeable future if appropriate education and awareness are not propagated widely. Students will continue to eat from the college cafeterias and mess where the food is prepared by the food handlers who do not have sufficient knowledge about ensuring food safety. Thus, it is the need of the hour to evaluate the knowledge, attitude and practice of students towards food borne illnesses and food safety measures so that appropriate steps could be directed towards its improvement and safety. Public education will act as a key factor in improving food safety and hygiene practices and the benefit shall ensure reduction in the foodborne illnesses[31].
Furthermore, study is limited with respect to number of respondents and it gives an insight for future studies regarding food safety and hygiene awareness.
- WHO foodborne diseases. https://www.who.int/topics/foodborne_diseases/en/
- Centre for Disease Control and Prevention; Foodborne Germs and Illnesses.
- World Health Organization (WHO) (2007-2015) Estimates of the Global Burden of Food Borne Diseases; Foodborne Disease Burden Epidemiology Reference Group. http://apps.who.int/iris/bitstream/10665/199350/1/9789241565165_eng.pdf?ua=1
- WHO Food Safety Fact Sheet No. 399. (2015). http://www.who.int/mediacentre/factsheets/fs399/en/
- WHO International Food Hygiene. https://www.who.int/foodsafety/areas_work/food-hygiene/en/
- Camila De Souza, Paulo de Azevedo and Larissa Seabra. Food safety in Brazilian popular public restaurants: Food handlers’ knowledge and practices. Journal of Food Safety. 2018;38(5):e12512.
- Fortune Akabanda, Eli Hope Hlortsi & James Owusu-Kwarteng. Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC Public Health. 2017;17:40.
- Redmond EC, Griffith CJ. Consumer food handling in the home: a review of food safety studies. J Food Prot. 2003;66(1):130–161.doi: 10.4315/0362-028x-66.1.130
- Yarrow L, Remig VM, Higgins MM. Food safety educational intervention positively influences college students’ food safety attitudes, beliefs, knowledge, and self-reported practices. J Environ Health. 2009;71(6):30–35.
- Tara Gopaldas, Poonal Patel, and Meenakshi Bakshi. selected socio-economic, environmental, maternal, and child factors associated with the nutritional status of infants and toddlers. Food and Nutrition Bulletin. 1988;10(4):1-6.
- Abdul Nazer Ali, Angeline Francis William. A KAP Study on Food Safety and Hygiene Among Private University Students in Kedah State, Malaysia. JOURNAL OF NATURAL REMEDIES. doi:10.18311/jnr/2018/22289
- Hussein FH. Dimassi H. Food safety and handling knowledge and practises of Lebanese university students. Food control 2014;40;127-133.
- Labib S. Talal Al-Malkhi. KAP of Taif University Students on food poisoning. Food Control. 2010;21(1):55-60.
- Aluh et al. International Journal of Adolescent Medicine and Health.2019;20180252.
- Nevin Sanlier. The knowledge and practice of food safety by young and adult consumers. Food Control. 20(6):538–542.
- D.Stratev et al.Journal of Infection and Public Health. 10(2017)778-782.
- Mohammed Almansour, Waqas Sam et.al. Knowledge, attitude and practice (KAP)of food hygiene among school students' in Majmaah city, Saudi Arabia. J Pak Med Assoc. 2016;66(4):442-446.
- Pinfold JV. Analysis of different communication channels for promoting hygiene behaviour. Health Educ Research. 1999; 14(5):629-639.
- Int Marit Health. 2018;69,4:270-277.
- Joseph A et.al. College Students Food Safety Practices. Journal of Agriculture and Environmental Sciences. 2015. 4(1):118-126.
- Courtney et al. BMC Public Health (2016) 16:1147.
- Christine M Bruhn and Howard G. Schutz. Consumer Food safety Knowledge and Practises.
- NurcanYabanci, Ibrahim Kisac& Suzan Siren Karakus. The effects of mother’s nutritional knowledge on attitudes and behaviours of children about nutrition. Procedia-Social and Behavioural Sciences. 116(2014):4477– 4481.
- Fathea El-Nmer, Amal A Salama & Dalia Elhawar. Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children. Menoufia Medical Journal. 2014;27(3):612–616.
- Sa’edZyoud, Jawad Shalabi et al. Knowledge, attitude and practices among parents regarding food poisoning: a cross-sectional study from Palestine. BMC Public Health. 2019;19(1):586.
- Food Safety, United States Department of Agriculture, National Institute of Food & Agriculture.
- Byrd-Bred Benner C, Abbot JM, Wheatley V, Schaffner D, Bruhn C, Blalock L. Risky Eating Behaviour of Young Adults: Implications for Food safety education. J Am Diet Assoc. 2008;108(3):549-552.
- Grol R, Bosch M, Hulscher M, Eccles M, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. MilbankQ. 2007;85(1):93–138.
- Glanz K, Rimer B, Viswanath K. Health behaviour and health education. Theory, research, and practice. San Francisco, Calif.: Jossey-Bass.
- Carol Byrd-Bredbenner, Jaclyn Maurer Abbot, and Virginia Quick. Food Safety Knowledge and Beliefs of Middle School Children: Implications for Food Safety Educators.
- Elizabeth Scott. Food Safety and Foodborne Disease in Homes. Can J Infect Dis. 2003 Sep;14(5):277-280. doi: 10.1155/2003/3639