Nutrition and food safety knowledge, attitudes and practices of food handlers in primary schools in the Westrand district, Gauteng province, South Africa

Technical Summary: Nutrition and Food Safety KAP of Food Handlers in Westrand Primary Schools

Problem Statement
Malnutrition remains a critical global public health challenge, manifesting in South African school-aged children as a dual burden of undernutrition and obesity/non-communicable diseases. The National School Nutrition Programme (NSNP) is a strategic intervention designed to provide daily meals to learners from low-income households to alleviate hunger and improve nutrient intake. The success of the NSNP relies heavily on food handlers, who are responsible for meal preparation and safety. However, existing literature indicates a gap in understanding the interplay between nutrition knowledge, attitudes, and practices (KAP) among these handlers. While food safety knowledge has been studied, research often neglects nutrition knowledge or relies on quantitative methods that fail to capture the contextual realities and motivations influencing food preparation. Furthermore, pre-service training for food handlers in South Africa is reported to be insufficient regarding nutrition and health education.

Methodology
This study employed a qualitative phenomenological design to explore the KAP of food handlers in eight quintile 1–3 public primary schools within the Westrand District, Gauteng Province.

• Participants: A purposive sample of 31 full-time food handlers (aged 18+) was recruited. The demographic profile showed 74% female participants, with 74% aged over 35 years. Notably, 93% had less than six months of experience in the NSNP, and only 39% had completed Grade 12. None held higher education qualifications related to nutrition or food safety.
• Data Collection: Data were gathered through face-to-face semi-structured interviews and observational checklists. Interviews were conducted in English and local languages (Tswana and Tsonga) and covered three sections: demographics, nutrition/food safety knowledge (based on South African Food-Based Dietary Guidelines and WHO Five Keys to Safer Food), and observational assessment of food preparation practices.
• Analysis: Interview transcripts and observational data were analyzed using content analysis with a combination of inductive and deductive coding to identify emerging themes. Data saturation was achieved after 31 interviews.

Key Findings
The study identified five main themes and twelve sub-themes across three categories: Nutrition Knowledge, Food Safety Knowledge, and Attitudes/Practices.

1. Nutrition Knowledge:

   • Limited Formal Awareness: Awareness of the South African Food-Based Dietary Guidelines (SAFBDG) was low; more than half of the participants had never seen the guide.
   • Fragmented Understanding: While participants generally understood the concept of "healthy eating" as balance and variety (e.g., including starch, vegetables, and protein), specific knowledge of food group functions was inconsistent. For instance, while fruits and vegetables were correctly linked to vitamins, many incorrectly attributed "body-building" properties to them rather than protein sources. Starchy foods were often misidentified as muscle-builders rather than energy sources.
   • Fats and Oils: Participants generally understood the need for moderation regarding fats but lacked depth regarding different fat types.

2. Food Safety Knowledge:

   • Strong Hygiene Awareness: Participants demonstrated strong knowledge of personal hygiene (handwashing, clean uniforms, no jewelry) and the prevention of cross-contamination (e.g., washing knives between tasks).
   • Stock Rotation Gaps: Knowledge of stock rotation (FIFO) and expiry date management was limited. Only 32% reported using FIFO principles, and only 13% actively checked expiry dates before cooking, often discovering expired items only during preparation.
   • Resource Barriers: Despite knowledge of hygiene, resource shortages (lack of soap, detergents, and pest control) frequently hindered the consistent application of these practices.

3. Attitudes and Practices:

   • Positive Attitudes: Food handlers expressed overwhelmingly positive attitudes toward providing nutritious meals and recognized the role of diet in disease prevention.
   • Practice-Attitude Gap: Positive attitudes did not consistently translate into practice. Meals were often nutritionally unbalanced due to resource constraints (e.g., insufficient vegetable portions) and a lack of standardized portion guidelines.
   • Inconsistent Measurement: Although participants were aware of the risks of excessive salt, sugar, and fat, the absence of standardized measuring tools led to reliance on estimation and "taste buds," resulting in inconsistent food preparation.
   • Infrastructure Constraints: Observations revealed that equipment shortages (e.g., lack of knives) forced handlers to use personal utensils or reuse knives without proper color-coding systems, despite their knowledge of cross-contamination risks.

Significance and Claims
The paper claims that the primary significance of this study lies in its use of a qualitative phenomenological design to provide an in-depth understanding of the KAP of NSNP food handlers, moving beyond the limitations of previous quantitative studies.

The authors argue that food preparation practices are not solely determined by individual knowledge and attitudes but are significantly constrained by structural and resource realities within NSNP kitchens. The study highlights a critical gap between the handlers' positive intentions and their ability to execute safe, nutritious meal preparation due to:

• Lack of formal, structured nutrition training.
• Inadequate infrastructure and equipment (e.g., storage space, cleaning supplies, knives).
• Absence of standardized guidelines for portion sizes and ingredient measurement.

Conclusion
The study concludes that while food handlers possess adequate food safety knowledge and positive attitudes, these are insufficient to ensure optimal nutritional outcomes without addressing systemic barriers. The authors recommend comprehensive, continuous training programs that integrate both nutrition education (specifically SAFBDG) and food safety. Furthermore, they emphasize the necessity of providing essential resources—such as standardized measuring utensils, adequate storage, and cleaning supplies—and developing clear, standardized guidelines for portion sizes and ingredient usage to enable handlers to effectively apply their knowledge.