{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:00:35Z","timestamp":1790064035817,"version":"4.0.1"},"reference-count":29,"publisher":"AOSIS","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: The National School Nutrition Programme (NSNP) provides food to approximately 9.7 million learners across South Africa. Children are more vulnerable to foodborne disease, especially if food is prepared unhygienically. Although foodborne disease outbreaks occur in South African schools, few studies have examined the knowledge and practices of food handlers in the NSNP.\nAim: The aim of the study was to determine whether food hygiene knowledge training intervention at schools offering the NSNP will improve food handlers\u2019 knowledge and practices regarding food hygiene and safety.\nSetting: The study was conducted at 10 schools within a Cape Winelands sub-district municipality offering the NSNP.\nMethods: A quantitative longitudinal design was employed, utilising a pre-test\u2013post-test intervention study. Data were collected using structured questionnaires to assess knowledge, and an observation checklist was used to assess the practices of the food handlers before and after training.\nResults: Pre-training findings showed that most food handlers have a high baseline food hygiene knowledge, yet observations found poor compliance with required practices. After the training intervention, no statistically significant differences (p &lt; 0.05) were found between pre- and post-training questionnaire results. However, post-training observations found clear improvement in hygiene practices.\nConclusion: Despite improvement, the study revealed that a lack of resources is the main challenge in implementing safe food handling practices in the NSNP.\nContribution: This study underscores the need to strengthen compliance and routine inspections and prioritise food safety within the NSNP. Future studies should explore behavioural and attitude factors that influence these food handlers.<\/jats:p>","DOI":"10.4102\/hsag.v31i0.3423","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:03:08Z","timestamp":1790060588000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A longitudinal quantitative study of the effects of training on food handlers\u2019 hygiene knowledge and practices in the National School Nutrition Programme, Western Cape, South Africa"],"prefix":"10.4102","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0225-0823","authenticated-orcid":false,"given":"Hayley K.","family":"Langley","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/056e9h402","id-type":"ROR","asserted-by":"publisher"}],"name":"Cape Peninsula University of Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0749-3608","authenticated-orcid":false,"given":"Izanne S.","family":"Human","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/056e9h402","id-type":"ROR","asserted-by":"publisher"}],"name":"Cape Peninsula University of Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5814-8142","authenticated-orcid":false,"given":"James P.","family":"Odendaal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/056e9h402","id-type":"ROR","asserted-by":"publisher"}],"name":"Cape Peninsula University of Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Berkhout, C., Berbra, O., Favre, J., Collins, C., Calafiore, M., Peremans, L. et al., 2022, \u2018Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis\u2019, Frontiers in Medicine 9, 1033486. https:\/\/doi.org\/10.3389\/fmed.2022.1033486","DOI":"10.3389\/fmed.2022.1033486"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Chakma, S.K., Hossen, S., Rakib, T.M., Hoque, S., Islam, R., Biswas, T. et al., 2024, \u2018Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital\u2019, Heliyon 10(5), e27286. https:\/\/doi.org\/10.1016\/j.heliyon.2024.e27286","DOI":"10.1016\/j.heliyon.2024.e27286"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Da Cunha, D.T., De Rosso, V.V., Pereira, M.B. & Stedefeldt, E., 2019, \u2018The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling\u2019, Food Research International 125, 108637. https:\/\/doi.org\/10.1016\/j.foodres.2019.108637","DOI":"10.1016\/j.foodres.2019.108637"},{"key":"ref3","unstructured":"Department of Health, 2018, Regulations governing general hygiene requirements for food premises, the transport of food and related matters, Government Printer, Pretoria."},{"key":"ref4","unstructured":"Department of Health, 2025, National environmental health norms and standards, Government Printer, Pretoria."},{"key":"ref5","unstructured":"Department of Social Development, 2019, Mid-year population estimates, 2018, Government Printer, Pretoria."},{"key":"ref6","unstructured":"Devereux, S., Hochfeld, T., Karriem, A., Mensah, C., Morahanye, M., Msimango, T. et al., 2018, School feeding in South Africa: What we know, what we don\u2019t know, what we need to know, what we need to do, Food Security SA Working Paper Series No. 004, DST-NRF of Excellence in Food Security."},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Grower, T., Pham, J., Jouriles, E.N., Rosenfield, D. & Bowen, H.J., 2022, \u2018Cognitive biases in perceptions of posttraumatic growth: A systematic review and meta-analysis\u2019, Clinical Psychology Review 94, 102159. https:\/\/doi.org\/10.1016\/j.cpr.2022.102159","DOI":"10.1016\/j.cpr.2022.102159"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Insfran-Rivarola, A., Tlapa, D., Limon-Romero, J., Baez-Lopez, Y., Miranda-Ackerman, M., Arredondo-Soto, K. et al., 2020, \u2018A systematic review and meta-analysis of the effects of food safety and hygiene training on food handlers\u2019, Foods 9(9), 1169. https:\/\/doi.org\/10.3390\/foods9091169","DOI":"10.3390\/foods9091169"},{"key":"ref9","unstructured":"Kilungu, O., 2010, Hygiene and sanitation practices of street food vendors in Nairobi, Kenya, LAP Lambert Academic Publishing, Saarbr\u0215cken."},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Kirchner, M., Goulter, R.M., Bernstein, C., Lavallee, A., Schaffner, D., Chapman, B. et al., 2023, \u2018The role of hands in cross-contamination of kitchen surfaces during meal preparation\u2019, American Journal of Infection Control 51(11), A44\u2013A57. https:\/\/doi.org\/10.1016\/j.ajic.2023.04.162","DOI":"10.1016\/j.ajic.2023.04.162"},{"key":"ref11","unstructured":"Madlala, S.S., 2022, \u2018Food hygiene in the national school nutrition programme among primary schools in Vryheid, Kwazulu-Natal, South Africa\u2019, Master of Health Science in Environmental Health, Faculty of Applied Science, Durban University of Technology."},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Mafugu, T., 2021, \u2018Challenges encountered in a South African school nutrition programme\u2019, Journal of Public Health Research 10(1), 1982. https:\/\/doi.org\/10.4081\/jphr.2021.1982","DOI":"10.4081\/jphr.2021.1982"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Mohamed, A.I.A. & Evans, E.W., 2024, \u2018Observation of food handlers\u2019 hand hygiene behavior during production at a sandwich-making factory\u2019, Journal of Food Protection 87(12), 100386. https:\/\/doi.org\/10.1016\/j.jfp.2024.100386","DOI":"10.1016\/j.jfp.2024.100386"},{"key":"ref14","unstructured":"National Institute of Communicable Diseases, 2021, \u2018Communicable disease communique\u2019, NICD Division of Public Health Surveillance and Response 20(5), 3\u20135."},{"key":"ref15","unstructured":"News24, 2023, Suspected food poisoning outbreak among 120 learners reportedly spreads to third school in Komani, viewed 21 May 2024, from https:\/\/www.news24.com\/news24\/community-newspaper\/komani-karoo\/over-100-learners-from-two-different-schools-in-komani-allegedly-suffer-from-food-poising-20231027."},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Sheehama, W.L.N. & Singh, T., 2025, \u2018Food safety in informal markets: How knowledge and attitudes influence vendor practices in Namibia\u2019, International Journal of Environmental Research and Public Health 22(4), 631. https:\/\/doi.org\/10.3390\/ijerph22040631","DOI":"10.3390\/ijerph22040631"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Sibanyoni, J.J., Tshabalala, P.A. & Tabit, F.T., 2017, \u2018Food safety knowledge and awareness of food handlers in school feeding programmes in Mpumalanga, South Africa\u2019, Food Control 73, 1397\u20131406. https:\/\/doi.org\/10.1016\/j.foodcont.2016.11.001","DOI":"10.1016\/j.foodcont.2016.11.001"},{"key":"ref18","unstructured":"South Africa, 2013, Protection of Personal Information Act, Act 4 of 2013, Government Printer, Pretoria."},{"key":"ref19","unstructured":"South Africa, 2026, What is the National School Nutrition Programme (NSNP)?, viewed 15 January 2026, from https:\/\/www.gov.za\/faq\/education\/what-national-school-nutrition-programme-nsnp."},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Teffo, L.A & Tabit, F.T., 2020, \u2018An assessment of the food safety knowledge and attitudes of food handlers in hospitals\u2019, BMC Public Health 20, 311. https:\/\/doi.org\/10.1186\/s12889-020-8430-5","DOI":"10.1186\/s12889-020-8430-5"},{"key":"ref21","unstructured":"Western Cape Government, 2021, Socio-economic profile: Langeberg municipality, viewed 21 May 2024, from https:\/\/lg.treasury.gov.za\/ibi_apps\/rs\/ibfs\/\/WFC\/Repository\/Public\/Municipal_Socio-Economic_Profiles\/Profiles\/Municipal_Profiles\/Western_Cape\/Langeberg_Municipality.pdf?IBIRS_action=run."},{"key":"ref22","unstructured":"Western Cape Government, 2024, Annual report for 2023\/2024 financial year, vote 5, Department of Education, viewed 16 November 2024, from https:\/\/wcedonline.westerncape.gov.za\/documents\/annual-report24\/WCEDAnnualReport23-24.pdf."},{"key":"ref23","unstructured":"WHO, 2006, Five keys to safer food manual, WHO Press, Geneva."},{"key":"ref24","unstructured":"WHO, 2015, WHO: Five keys to safe food, viewed 29 January 2023, from https:\/\/www.youtube.com\/watch?v=ONkKy68HEIM."},{"key":"ref25","unstructured":"WHO, 2017, Diarrhoeal disease, viewed 09 November 2022, from https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diarrhoeal-disease."},{"key":"ref26","unstructured":"WHO, 2020, Food Safety, viewed 24 March 2022, https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/food-safety."},{"key":"ref27","unstructured":"World Food Programme (WFP), 2022, State of school feeding worldwide 2022, viewed 05 September 2024, from https:\/\/www.wfp.org\/."},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Zelalem, A., Abegaz, K., Kebede, A., Terefe, Y., Schwan, C.L. & Vipham, J.L., 2021, \u2018Food safety knowledge, attitudes, and hygienic practices of abattoir workers in Ethiopia: A cross-sectional study\u2019, Food Protection Trends 41(5), 501\u2013509. https:\/\/doi.org\/10.4315\/1541-9576-41.5.501","DOI":"10.4315\/1541-9576-41.5.501"}],"container-title":["Health SA 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