Knowledge, attitude and practices regarding food hygiene and sanitation of food handlers in Kuala Pilah, Malaysia Noor-Azira Abdul-Mutalib a , Mohammad-Faid Abdul-Rashid b , Shuhaimi Mustafa c , Syafinaz Amin-Nordin a , Rukman Awang Hamat a, d , Malina Osman a, * a Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia b Kuala Pilah Health Office, 72000 Kuala Pilah, Negeri Sembilan, Malaysia c Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia d Diagnostic Nuclear Imaging Centre, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia article info Article history: Received 19 January 2012 Received in revised form 30 March 2012 Accepted 3 April 2012 Keywords: Food handlers Knowledge Attitudes Practices abstract This study evaluates the knowledge, attitude and practices (KAP) of food handlers working in restaurants in Kuala Pilah, Malaysia. Data were collected in 2010 involving 64 food handlers. The results show that the food handlers have excellent knowledge and attitude, and good practices toward food hygiene with mean score (SD) of 83.98 (13.26), 82.8 (10.94) and 77.04 (14.98), respectively. There is significant correlation between educational level and attitude (p ¼ .008), knowledge and attitude (p  .001), knowledge and practice (p ¼ .007) and attitude and practice (p ¼ .041). Even though the result shows satisfactory KAP levels of the food handlers, some aspects on hygiene measures like refreezing food item, clean working area and wearing of jewelry and watch need to be emphasized. Ó 2012 Elsevier Ltd. All rights reserved. 1. Introduction Foodborne diseases have caused a significant morbidity and mortality around the world. The United States of America reports that around 76 million foodborne diseases occur annually with 325,000 people hospitalized and 5200 cases of mortality (Buzby & Roberts, 2009). WHO also reports that 18% of children aged below 5 years old in developing countries die due to diarrhea globally (Bryce, Boschi-Pint, Shibuya, Black, & the WHO Child Health Epidemiology Reference Group, 2005). In one study food handlers were identified as the main cause of food contamination (Campos et al., 2009). The food industry in Kuala Pilah also is increasing. Due to the fast pace of living, most people take advantage of eating in restaurants and buying readymade food (Haryani et al., 2007). However, food contamination by food handlers could occur and leading to food- borne diseases if they neglect proper food handling practices in their premises. In Malaysia setting food handlers or the merchants that need a license or to renew their license need to attend courses on food handling. During the courses food handlers will be exposed on the causes of foodborne diseases, the agent of transmission, the importance of personal hygiene and the correct food handling practices. According to information from the Ministry of Health Malaysia (2010), there has been an increase in the incidence rate of foodborne diseases from 2005 to 2008. In 2009 the incidence rate decreased, however, death due to foodborne diseases was reported in that year with the same mortality rate as 2008. The hands of food handlers can be the vector to spread harmful microorganism through cross contamination (Bas ¸ , Ersun, & Kıvanç, 2006). This can occur if they ignore the importance of washing hand during food preparation. Some of the bacteria that can be found on the hands of food handlers are Escherichia coli and Staphylococcus aureus (Lues & Tonder, 2007). Food handlers can also spread harmful microorganism during and after they experience gastrointestinal infection (Bas ¸ et al., 2006). Food handlers should have excellent hygiene practice to ensure cross contamination can be reduced, thus protecting the consumers from foodborne diseases. To ensure food handlers practice the correct way of handling food, knowledge and training are essential as part of their job (Martins, Hogg, & Otero, 2012). Previous studies have assessed the important of knowledge, attitude and practices among food handlers (Ansari-Lari, Soodbakhsh, & Lakzadeh, 2010; Bas ¸ et al., 2006; Gomes-Neves, Araújo, Ramos, & Cardoso, 2007; Martins et al., 2012). This shows that the assessment is very crucial to provide sufficient data for further action. The purpose of this study was to evaluate the knowledge, atti- tude and practices of food handlers in Kuala Pilah, Malaysia and to * Corresponding author. Tel.: þ603 89472366, þ6013 6298572 (H/p); fax: þ603 89413802. E-mail address: malina@medic.upm.edu.my (M. Osman). Contents lists available at SciVerse ScienceDirect Food Control journal homepage: www.elsevier.com/locate/foodcont 0956-7135/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.foodcont.2012.04.001 Food Control 27 (2012) 289e293