Knowledge and Practices on Food Hygiene among Caregivers of Malnourished Children in Uganda: A Cross-Sectional Study

Jennifer Nantongo; Abel W Walekhwa; Saul Kamukama; David Musoke

doi:10.51168/7a8qxs15

Autori

Jennifer Nantongo Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
Abel W Walekhwa Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
Saul Kamukama IDEMU Mathematical Modelling Unit, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
David Musoke Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.

DOI:

https://doi.org/10.51168/7a8qxs15

Cuvinte cheie:

Food Hygiene Knowledge, Food Hygiene Practices, Malnutrition, Caregivers, Uganda

Rezumat

Background:

Food hygiene is crucial in the prevention of diarrhoeal infections, and malnourished children with diarrhoea have been shown to have lower chances of survival than their counterparts without diarrhoea. The study was carried out to determine the food hygiene knowledge and practices of caregivers with malnourished children in Mwanamugimu Nutrition Unit (MNU) and Kisenyi Health Centre IV (HC IV).

Methodology:

This was a cross-sectional quantitative study where a semi-structured questionnaire was administered to caregivers of malnourished children using both face-to-face and telephone interviews. Data were transferred to Microsoft Excel 16 and later imported to STATA 14, where they were analysed using descriptive statistics.

Results:

A total of 120 respondents (71 from MNU and 49 from Kisenyi HC IV) were involved in the study. Respondents were aged between 15 and 80 years, and the majority were female (94.2%). Only 9.2% of the caregivers had good food hygiene knowledge, and 25.8% knew that leftover food should be kept for two hours before serving/eating if kept at room temperature. Only 66 (55.0%) of the respondents reported having ever had a health education session on food hygiene. The majority (82.5%) of respondents had good self-reported practices on food hygiene. Many (81.7%) reported always washing their hands with soap and water after visiting the toilet, and none reported not washing their hands. Less than half (42.5%) reported feeding their children on leftover food, and of the 49 who kept leftover food at room temperature, 63.3% served food to their children after two hours.

Conclusion:

Generally, caregivers of malnourished children had poor knowledge but good self-reported practices on food hygiene.

Recommendation:

Health workers should educate caregivers about safe handling practices of leftover foods to help prevent the occurrence of diarrhoea among children with malnutrition.

Biografii autori

Jennifer Nantongo, Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.

holds a Bachelor’s Degree in Environmental Health Sciences (BEHs) from Makerere University School of Public Health (MakSPH), Kampala, Uganda. She supports various projects at MakSPH under the Department of Disease Control and Environmental Health. Since completion of her degree, she has supported the partnership between MakSPH and Nottingham Trent University (NTU), UK, on a number of projects, including one on antimicrobial stewardship and capacity building of health managers in Wakiso District on leadership and management. This paper is developed from her final-year undergraduate research submitted in partial fulfilment of the award of the BEH.
Abel W Walekhwa, Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.

helps countries to prepare for emerging and re-emerging diseases. He does this through Mathematical modeling and field simulation exercises. In this 2026 Bundibugyo Ebola Virus Disease outbreak, he has developed three mathematical models that have been presented to different stakeholders, including Uganda’s Ministry of Health and the World Health Organization Collaboratory community of practice. His 2025 modeling work quantifying the benefits of the Government of Uganda adopting the 7-1-7 framework for Ebola, Measles and Anthrax was internationally recognised, and Uganda received an award in Malaysia in June 2026. He has organised up to two field simulations for Anthrax and Ebola in Namisindwa District and the West Nile Emergency Operations Centre under the Ministry of Health, Uganda. In terms of his educational background, he completed his PhD in Mathematical modeling of Rift Valley fever Disease at the University of Cambridge, UK, where he worked with Assoc Prof Andrew James Kerr Conlan at the Disease Dynamics Unit, Department of Veterinary Medicine.
Saul Kamukama, IDEMU Mathematical Modelling Unit, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

is an Assistant Lecturer in the Department of Disease Control and Environmental Health at the Makerere University School of Public Health (MakSPH). He holds a Bachelor's degree in Food Science and Technology and a Master's degree in Public Health, both from Makerere University. His research interests focus on nutrition among disadvantaged and vulnerable populations, with particular emphasis on improving health and nutrition outcomes through evidence-based interventions. He has contributed to several research projects in this field and continues to engage in research, teaching, and community initiatives aimed at addressing nutrition-related public health challenges.
David Musoke, Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.

is an Associate Professor and Head of the Department of Disease Control and Environmental Health at MakSPH. He holds a Bachelor’s Degree in Environmental Health Science from Makerere University, an MSc in International Primary Health Care from the University of London, UK, and a PhD in Public Health from Cardiff Metropolitan University, UK. He is the President of the International Federation of Environmental Health, an affiliate member of the African Academy of Sciences, and a Fellow of the Uganda National Academy of Sciences. His research focuses on environmental health, including water, sanitation, and hygiene (WASH), and health systems/services (such as maternal health, mental health, and human resources for health, particularly community health workers). He is an Academic Editor for the following journals: PLOS Global Public Health, BMC Public Health, and BMC Health Services Research. He has over 150 peer-reviewed publications and 100 international conference presentations.

Referințe

1. Achiro, E., Okidi, L., Echodu, R., Alarakol, S.P., Nassanga, P., Ongeng, D., 2023b. Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda. Food Sci. Nutr. 11, 5472–5491. https://doi.org/10.1002/fsn3.3504

2. Aloysius, N., Ananda, J., Mitsis, A., Pearson, D., 2025. The Last Bite: Exploring behavioural and situational factors influencing leftover food waste in households. Food Qual. Prefer. 123, 105327. https://doi.org/10.1016/j.foodqual.2024.105327

3. Brown, K.H., 2003. Diarrhoea and Malnutrition. J. Nutr. 133, 328S-332S. https://doi.org/10.1093/jn/133.1.328S

4. Byamukama, T., 2019. Assessing Knowledge, Attitudes and Practice of Hand Washing with Soap among Mothers and Caregivers of Children under Five years in Ntungamo District, Uganda. TEXILA Int. J. PUBLIC Health 7, 259–265. https://doi.org/10.21522/TIJPH.2013.07.04.Art027

5. Chen, H., Martínez, V., Feng, Y., 2020. Food safety education attitude and practice among health professionals in China, Peru, and the U.S. Food Control 109, 106945. https://doi.org/10.1016/j.foodcont.2019.106945

6. Chidziwisano, K., Tilley, E., Morse, T., 2020. Self-Reported Versus Observed Measures: Validation of Child Caregiver Food Hygiene Practices in Rural Malawi. Int. J. Environ. Res. Public. Health 17, 4498. https://doi.org/10.3390/ijerph17124498

7. Cho, T.J., Kim, S.A., Kim, H.W., Rhee, M.S., 2020. A Closer Look at Changes in High-Risk Food-Handling Behaviors and Perceptions of Primary Food Handlers at Home in South Korea across Time. Foods 9. https://doi.org/10.3390/foods9101457

8. Dagne, H., Raju, R.P., Andualem, Z., Hagos, T., Addis, K., 2019. Food Safety Practice and Its Associated Factors among Mothers in Debarq Town, Northwest Ethiopia: Community-Based Cross-Sectional Study. BioMed Res. Int. 2019, 1–8. https://doi.org/10.1155/2019/1549131

9. Deborah P. Waber, G.M.F., Cyralene P. Bryce, Jonathan M. Girard, Miriam Zichlin, Galler, J.R., 2014. Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: A 40-year study. Nutr. Neurosci. 17, 58–64. https://doi.org/10.1179/1476830513Y.0000000061

10. Delelegn, M.W., Endalamaw, A., Belay, G.M., 2020. Determinants of Acute Diarrhoea Among Children Under-Five in Northeast Ethiopia: Unmatched Case–Control Study. Pediatr. Health Med. Ther. Volume 11, 323–333. https://doi.org/10.2147/PHMT.S256309

11. Dharod, J.M., Pérez-Escamilla, R., Paciello, S., Bermúdez-Millán, A., Venkitanarayanan, K., Damio, G., 2007. Comparison between Self-Reported and Observed Food Handling Behaviors among Latinas. J. Food Prot. 70, 1927–1932. https://doi.org/10.4315/0362-028X-70.8.1927

12. Eslami, H., Nasirzadeh, M., Nabizadeh, F., Salari, M., Alinaghizadeh, Z., 2022. Food Safety and Hygiene Knowledge and Attitudes among the Health-Care Staff in the Southeast Area of Iran. J. Nutr. Food Secur. https://doi.org/10.18502/jnfs.v7i2.9333

13. Guennouni, M., Admou, B., Bourrhouat, A., El Khoudri, N., Zkhiri, W., Talha, I., Hazime, R., Hilali, A., 2022. Knowledge and Practices of Food Safety among Health Care Professionals and Handlers Working in the Kitchen of a Moroccan University Hospital. J. Food Prot. 85, 676–685. https://doi.org/10.4315/JFP-21-305

14. Hock, R.S., Bryce, C.P., Fischer, L., First, M.B., Fitzmaurice, G.M., Costa, P.T., Galler, J.R., 2018. Childhood malnutrition and maltreatment are linked with personality disorder symptoms in adulthood: Results from a Barbados lifespan cohort. Psychiatry Res. 269, 301–308. https://doi.org/10.1016/j.psychres.2018.05.085

15. Jaffee, S., Henson, S., Unnevehr, L., Grace, D., Cassou, E., 2019. The safe food imperative: Accelerating progress in low-and-middle-income countries. World Bank Publications.

16. Kajjura, R.B., Veldman, F.J., Kassier, S.M., 2019. Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderately Acutely Malnourished Children in Uganda. Food Nutr. Bull. 40, 221–230. https://doi.org/10.1177/0379572119840214

17. La, N.Q., Hoang, M.L., Tran, T.T., Dang, C.K., Tran, B.T., 2023. Assessing the knowledge and practice toward food safety: An investigation of food selection and processing among primary food caregivers in a town in Ha Tinh province, Vietnam. Heliyon 9, e20004. https://doi.org/10.1016/j.heliyon.2023.e20004

18. Lee, H., Yoon, Y., 2021. Etiological Agents Implicated in Foodborne Illness Worldwide. Food Sci. Anim. Resour. 41, 1–7. https://doi.org/10.5851/kosfa.2020.e75

19. Meysenburg, R., Albrecht, J.A., Litchfield, R., Ritter-Gooder, P.K., 2014. Food safety knowledge, practices and beliefs of primary food preparers in families with young children. A mixed-methods study. Appetite 73, 121–131. https://doi.org/10.1016/j.appet.2013.10.015

20. Ministry of Health Uganda, 2021. Annual Health Sector Performance Report 2020/21.

21. Ministry of Health Uganda. Annual Health Sector Performance Report 2022/23.

22. Nakayiza, S., Walekhwa, A.W., Tumwine, G., Muleme, J., Musewa, A., 2022. Critical SWOT analysis of fresh fruit handling practices by traders in Uganda’s Capital City. A rapid cross-sectional study (preprint). In Review. https://doi.org/10.21203/rs.3.rs-1219774/v1

23. Obande, D., Young, I., Gao, J.L., Pearl, D.L., Papadopoulos, A., 2023. Systematic review and meta-regression of food safety knowledge and behaviour of primary food preparers for young children in the home setting. Food Control 145, 109455. https://doi.org/10.1016/j.foodcont.2022.109455

24. Rocha, M.K.S.F., Souza, L.A.D., Reis, A.C.S., Cabral, A.L.V., Bueno, B.B.N., Sousa Neto, E.A.D., Silva, G.D.S.A.D., Sousa, H.D.S., Costa, N.J., Sousa, R.L., 2025. DOENÇAS TRANSMITIDAS POR ALIMENTOS: UM ESTUDO DE REVISÃO DAS ESTRATÉGIAS DE INTERVENÇÃO EM SURTOS E DA IMPORTÂNCIA DA SAÚDE PÚBLICA. Rev. Ft 29, 15–16. https://doi.org/10.69849/revistaft/fa10202504270015

25. Schorling, J.B., Mcauliffe, J.F., De Souza, M.A., Guerrant, R.L., 1990. Malnutrition is Associated with Increased Diarrhoea Incidence and Duration among Children in an Urban Brazilian Slum. Int. J. Epidemiol. 19, 728–735. https://doi.org/10.1093/ije/19.3.728

26. Uganda Bureau of Statistics 2023, 2023. Uganda Demographic Health Survey, 2022, Vol. 1. Kampala, Uganda.

27. (USDA) Food Safety and Inspection Service (FSIS), 2020. Leftovers and Food Safety.

28. WHO, 2015. Estimating the burden of foodborne diseases [WWW Document]. URL https://www.who.int/activities/estimating-the-burden-of-foodborne-diseases

29. WHO, 2013. Ending preventable diseases from pneumonia and diarrhoea by 2025.

30. WHO, UNICEF. HAND HYGIENE FOR ALL. 2020

31. Wierzba, T.F., El-Yazeed, R.A., Savarino, S.J., Mourad, A.S., Rao, M., Baddour, M., El-Deen, A.N., Naficy, A.B., Clemens, J.D., 2001. The Interrelationship of Malnutrition and Diarrhoea in a Periurban Area Outside Alexandria, Egypt: J. Pediatr. Gastroenterol. Nutr. 32, 189–196. https://doi.org/10.1097/00005176-200102000-00018

32. Zyoud, S., Shalabi, J., Imran, K., Ayaseh, L., Radwany, N., Salameh, R., Sa’dalden, Z., Sharif, L., Sweileh, W., Awang, R., Al-Jabi, S., 2019. Knowledge, attitude and practices among parents regarding food poisoning: a cross-sectional study from Palestine. BMC Public Health 19, 586. https://doi.org/10.1186/s12889-019-6955-2