Food handlers' knowledge, attitudes, and practices regarding food safety in Sulaimani governorate, Iraq: A cross-sectional study

Objective: To determine the initial level of knowledge, attitude and practice of food handlers regarding food safety and to show the association between Knowledge, Practice and Attitude and various variables such as workers’ socio-demographic characteristics. Methods: A cross-sectional study was conducted in Sulaimani Governorate, Iraq, from May 2024 to December 2024, surveying 450 food handlers in restaurant to assess their KAP regarding food safety and hygiene. The WHO's Five Keys to Safer Food served as the basis for a pre-tested questionnaire which was confirmed by several experts. The Cronbach Alpha test for the questionnaire's reliability was 7.4. Age, gender, place of residence, level of education, marital status, ethnicity and monthly income were among the data collected. Results: The study revealed poor knowledge, fair practice and positive attitude among food handlers in restaurants. poor knowledge was identified in some issues, such as causes of foodborne illness, handling raw food, personal hygiene and cross-contamination (23.8%, 24.4%, 42.7% and 36.7%) respectively. Poor score ​​was reported in the categories of washing hands 26.4%, wearing gloves 28%, storing leftovers 38% and changing work clothes 47.6%. A significant association was revealed between knowledge and practice with workers’ education level (p = 0.001 and p = 0.002) respectively. A significant association was also found between knowledge and practice (p-value < 0.001). Furthermore, an association was found between knowledge and practice with employees who have participated in previous training (P-value < 0.001). Conclusion: While food handlers had only poor knowledge (49.2%) and fair practices (47.3%), fair practices were significantly linked to their level of education. Employees who had participated in previous training had significantly better knowledge and practices.