Food Safety Knowledge, Attitudes, and Practices among Food Handlers in the School Feeding Program in Addis Ababa, Ethiopia

Food safety is critical in school feeding programs to protect children's health. This cross-sectional study assessed food safety knowledge, attitudes, practices, and associated factors among 632 food handlers in the Addis Ababa School Feeding Program. Five subcities, four woredas per subcity, and one public primary school per woreda were selected using multistage sampling; all eligible food handlers were included. Data collected through structured interviewer-administered questionnaires in April-May 2023 were analyzed using descriptive statistics, Spearman's rank correlation, and logistic regression. Overall, 85.8% of food handlers were classified as having adequate knowledge, 79.6% as having positive attitudes, and 72.3% as having satisfactory practices; approximately 96% reported previous food safety training. Satisfactory practice was significantly associated with separate storage of raw and ready-to-eat foods (AOR = 0.45, 95% CI: 0.01-0.90), water availability (AOR = 0.54, 95% CI: 0.16-0.93), handwashing facilities (AOR = 0.65, 95% CI: 0.36-0.95), and attitude score (AOR = 0.19, 95% CI: 0.11-0.28). Knowledge was weakly positively correlated with attitudes (ρ = 0.139, P < 0.001) and practices (ρ = 0.127, P = 0.001), while attitudes showed a stronger positive correlation with practices (ρ = 0.340, P < 0.001). Despite high reported training coverage, satisfactory practices were less prevalent than adequate knowledge and positive attitudes, indicating that training exposure alone may not translate into consistent food safety practices. Practical training, supportive supervision, routine monitoring, and adequate infrastructure may improve food safety. Given the cross-sectional design and reliance on self-reported practices, causal relationships and objectively verified compliance could not be established.