Foodborne diseases are characterized as a burning public health issue in industrialized and middle-income nations (Sharif & Al-Malki, 2010). In most cases, foodborne diseases occur because of improper food preparation or mishandling at home, food service establishments, or street food vendors (Food Safety factsheet, WHO; Rane, 2011). In addition to eating food handled by parents, students also take food from the outside like food service outlets/canteens in educational institutions, restaurants, and street food vendors. The hygienic practices of food preparation are rarely maintained in these places, especially by small restaurants and street food vendors which has been a great public health concern for years (Amegah et al., 2020; Her et al., 2019; Wen-Hwa & Ko, 2011). The current study focused on evaluating the Bangladeshi student’s basic food safety knowledge, attitudes, and practices when buying, preparing, and storing foods and on the role of a student as a food consumer which plays an important role in the reduction of foodborne illnesses.
In this cross-sectional study, the participants' responses (Fig. 1) revealed that a larger proportion of the students (53.46%) were poor in overall food safety knowledge. The inadequate level of food safety knowledge among students was also reported in previous similar kinds of studies (Ashkanani et al., 2021; Azanaw et al., 2021; Lazou et al., 2012; Osaili et al., 2011). Better performance was also observed in former studies (Al-Shabib et al., 2017; Courtney et al., 2016; Stratev et al., 2017). This variation might be because of their difference in sociodemographic characteristics, questionnaire format, study time, study setting, and study design.
With regard to individual questions, this study found that the majority of the students answered correctly that “food is decayed by microorganisms (86.74%)”, “expired food should not be eaten (80.82%)”, “knife can be washed with soap and water (72%)”, “teenagers/ younger adults are less likely to get food poisoning (64.22%)”, “hands should be washed with soap and water before cooking or eating (85.59%)” which was aligned with prior research findings (Al-Shabib et al., 2017; Cheng et al., 2017; Hassan & Dimassi, 2014b; Lazou et al., 2012). In this study, it was revealed that 47% of the respondent knew that a person with Diarrhea should not be involved in food preparation for others but it is reported in a study that only 9.4% of students of Lebanese university knew about this (Hassan & Dimassi, 2014b). It is reported that if food is left in the danger zone temperature (5–60˚ C), within 20 minutes, the bacteria multiply and double their number which increases the threat of foodborne diseases (FSIS, USDA). However, only 16.73% of the respondents knew the food contamination danger zone (5–60˚ C) for food safety which was in line with the previous findings (Hassan & Dimassi, 2014b). In addition, students also had low correct response percentages on “the recommended temperature for freezers is -18˚C or below”, “three to four days should leftovers be stored in the refrigerator”, “any food to be safe to eat, it needs to be cooked until its internal temperature reaches 74˚C”. Such outcomes point out an increased risk of foodborne illnesses, as they reveal an extensive lack of knowledge about basic food safety.
This study found that females were more knowledgeable in terms of food safety knowledge than their male counterparts (Table 3). In addition, female students outperformed male students in terms of food safety attitudes and practices (Table 5 &7). This may be because females are traditionally more involved in food handling in the household as well as maintaining the kitchen hygiene and sanitation in Bangladesh. This finding conforms to the previous study, in which female students answered better than male students (Hassan & Dimassi, 2014b; Lazou et al., 2012; Osaili et al., 2011). Multivariate analysis showed that those who completed food safety courses were more knowledgeable than those who haven’t completed them. These results suggest that food safety-related book chapters or topics can be incorporated into the curriculum to further improve the current food safety knowledge level among students by consultation with the appropriate authority. It was also found that mothers’ education has a significant impact on the food safety knowledge of students. This can be since students are closer to their mothers than fathers acquired basic food safety knowledge from their mothers.
Attitude is an important characteristic that may impact food safety practices, consequently reducing the incidence of foodborne illnesses (Abdullah Sani & Siow, 2014; Sanlier & Konaklioglu, 2012). In this study, from the overall attitude questions, 87% of the study participants had a positive attitude toward food safety. It was higher than findings conducted in Ethiopia (Azanaw et al., 2021), Iran(Abolhassani et al., 2018), and China (Sun et al., 2015). This difference might be due to dissimilarity in their sociodemographic profile, study period, study area, and study design. Though lack of sufficient knowledge was revealed regarding food safety, the attitude of students towards food safety was demonstrated to be at a great level. This report was supported by the study conducted at Shahid Sadoughi University of Medical Sciences in Iran (Eslami et al., 2015). In our study, students were concerned about food safety issues. Among them, the respondents were most worried about the use of food additives (54%), pesticide residues (47%), transfer of plasticizers in food containers and packaging materials (43%), heavy metals, and microbe pollution (38%), and veterinary drug residue (27%). A study by Sun et al., 2015 found that students were most worried about the use of food additives (43.7), pesticide residues (9.5), and heavy metals and microbe pollution (46.8). More than 80% of respondents worried about the food safety of small restaurants and street food which was quite a similar finding toCheng et al., 2017 study. In this study, it was found that more than 94% of the student keen to enrich their knowledge of food safety and willing to improve the food safety situation of their educational institution canteen/hall, home, as well as restaurants/streets where they eat frequently. It was also revealed from this study that more than 80% of respondents think a student can play a significant role to improve the food safety situation in Bangladesh. These positive attitudes of students could be utilized with utmost care for the improvement of the food safety situation in Bangladesh as the students are going to be the leaders/head of their families. Before that students need to be equipped with proper food safety knowledge and food safety-related agencies should come forward in this regard. In logistic regression analysis, it was found gender, level of education, having food safety courses and mother’s education were significantly correlated with students’ attitudes towards food safety. These findings were not consistent with the report of Azanaw et al., 2021, but were consistent with the report ofEslami et al., 2015 and Abolhassani et al., 2018.
Around 50% of the respondents had good practice toward food safety (Fig. 3). Concerning food safety practices, the majority of the students (65%) showed risky behavior by storing raw chicken or meat separately from cooked food. This risky behavior can lead to cross-contamination of microorganisms from raw food to cooked foods which may cause foodborne illnesses. The participants displayed a poor habit of checking labels or expiry dates of packaged foods before buying, storing foods according to food labels, and washing hands before eating food. Although there is a difference in the study setting, this finding is lower than other studies done in Bulgaria and China (Cheng et al., 2017; Stratev et al., 2017). However, the majority of the students displayed good habits of unwillingness to eat deteriorated and expired food, and not consuming food kept at room temperature for long. This finding is consistent with a study conducted in China (Luo et al., 2019b). Most of the surveyed students always wash dishes with detergent and water or in a dishwasher after preparing food and before new usage. This finding is similar to those reported by Stratev et al., 2017. A considerable number of students reported that they purchased food from small restaurants and street peddlers, though as many as 85.33% of the students showed anxiety about the safety of food prepared by them. It is observed from the data that many chose to omit their concerns and continued buying food from these places. According to Byrd-Bredbenner et al., 2008, when the stage of change (movement to higher stages) and self-efficacy increased, risky eating scores decreased. Food safety strategies and education ameliorating self-efficacy may be a key to helping students move to the next stage of action (firm changes in food safety behavior are happening). In logistic regression analyses, it was found that the food safety practices were influenced by gender, education level, having a food safety course as well as mother’s education level. These findings are supported by studies conducted by Al-Shabib et al., 2017; Azanaw et al., 2021; Luo et al., 2019.
This study, to the best of our knowledge, is the first that explored the knowledge, attitudes, and practices toward food safety among the student population in Bangladesh. Also, our sample size is large enough for statistical tests to have significant power. However, this study has some limitations. First, surveys were conducted online and distributed through social media connections/databases. Therefore, those who didn’t have access to the internet/social media, could not participate. Second, the proportion of younger student participants (< 18 years) was as low as 11%. The study findings would be stronger if we could survey more young students (grades 8–12).