Food safety knowledge, practices, and microbial hand hygiene of food handlers in public primary schools in Gaborone Botswana

Abstract

Background Foodborne illnesses remain a persistent challenge in Botswana, and schools are particularly vulnerable because many children rely on on-site meals. Despite national food-safety standards, outbreaks linked to poor hygiene and inadequate food-handling practices continue to be reported in school environments. International studies show that food handlers often act as sources of contamination due to insufficient knowledge and poor personal hygiene. Given the scale of Botswana’s school feeding program and the vulnerability of young children to foodborne diseases, there is a critical need to assess whether food safety knowledge and reported practices among school food handlers align with actual behavior and microbial hygiene outcomes. This gap underscores the importance of evaluating both behavioural and microbial indicators to strengthen food safety within school kitchens. Methods: A mixed-methods design was employed involving questionnaires, direct observations, and laboratory analysis of hand swab samples. Seventy-seven food handlers from ten randomly selected schools participated. Quantitative data were analysed using EPI Info 7 and Stata 14, while qualitative observations were thematically analysed. Hand swab samples were cultured on selective chromogenic media, enabling simultaneous detection and differentiation of Escherichia coli and total coliforms. Contamination was categorised as none, low (1–49 CFU), moderate (50–99 CFU), or high (≥100 CFU). Comparative and regression analyses were conducted to explore associations between demographic factors, knowledge, practices, and microbial outcomes. Results: Participants demonstrated high self-reported practice scores (89.37%), moderate knowledge levels (79.7%), and lower observed practice performance (75.75%). Despite strong awareness in areas such as hand hygiene, knowledge gaps persisted, particularly in temperature control: 37.66% of food handlers had misconception that freezing food eliminates or destroy bacteria completely, and only 35.06% recognised the existence of heat-resistant toxins. Only 55.8% had received formal food safety training, and none had undergone HACCP training. Mask usage during food preparation was low (22.08%), and 12.99% indicated willingness to work while ill. Demographic factors, including age, gender, education, employment status, and work experience, were not significantly associated with food safety knowledge (p > 0.05). However, hygiene practice scores were significantly higher among older handlers, those with longer work experience, permanent employees, and individuals with prior food safety training (p < 0.05). Knowledge significantly predicted practice (F(1,75) = 5.29, p = 0.024; R² = 0.066), though the effect was weak. Microbial assessments revealed that E. coli was absent in all 77 samples, while total coliform bacteria were detected in 32.47%. Contamination varied across schools, with School 2 displaying the highest prevalence. Knowledge and practice scores did not significantly predict microbial contamination. However, handwashing technique was strongly associated with contamination levels (χ² (4)=13.53, p=0.009), indicating that specific behavioural competencies rather than general knowledge are most influential in determining microbial outcomes. Conclusion: Although food handlers demonstrated moderate to high knowledge and self-reported practices, substantial behavioural gaps persisted, particularly in temperature control, mask use, and handwashing technique. Demographic characteristics were not reliable predictors of knowledge, though practical experience, employment stability, and training significantly influenced hygiene practices. The absence of E. coli indicates acceptable baseline hygiene, yet the presence of coliforms in one-third of handlers highlights continued risks. These findings emphasise that knowledge alone does not ensure food safety compliance; rather, hands-on training, continuous supervision, improved hygiene infrastructure, and institutional support are essential for strengthening food safety culture in school kitchens and protecting the health of children.