Norovirus infections and knowledge, attitudes and practices in food safety among food handlers in an informal urban settlement, Kenya 2017

Eliud Wainaina,Christina A Otieno,Joseph Kamau,Sara A Lowther,Atunga Nyachieo

doi:10.1186/s12889-020-8401-x

Abstract

IntroductionA leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers but norovirus outbreaks are not routinely investigated in Kenya. We estimated norovirus prevalence and associated factors among food handlers in an informal urban settlement in Nairobi, Kenya.MethodsWe conducted a cross-sectional survey among food handlers using pretested questionnaires and collected stool specimens from food handlers which were analyzed for norovirus by conventional PCR. We observed practices that allow norovirus transmission and surveyed respondents on knowledge, attitudes, and practices in food safety. We calculated odd ratios (OR) with 95% confidence intervals (CI) to identify factors associated with norovirus infection. Variables with p < 0.05 were included in multivariate logistic regression analysis to calculate adjusted OR and 95% CI.ResultsOf samples from 283 respondents, 43 (15.2%) tested positive for norovirus. Factors associated with norovirus detection were: reporting diarrhea and vomiting within the previous month (AOR = 5.7, 95% CI = 1.2–27.4), not knowing aerosols from infected persons can contaminate food (AOR = 6.5, 95% CI = 1.1–37.5), not knowing that a dirty chopping board can contaminate food (AOR = 26.1, 95% CI = 1.6–416.7), observing respondents touching food bare-handed (AOR = 3.7, 95% CI = 1.5–11.1), and working in premises without hand washing services (AOR = 20, 95% CI = 3.4–100.0).ConclusionThe norovirus infection was prevalent amongst food handlers and factors associated with infection were based on knowledge and practices of food hygiene. We recommend increased hygiene training and introduce more routine inclusion of norovirus testing in outbreaks in Kenya.

Highlights

A leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers but norovirus outbreaks are not routinely investigated in Kenya
While norovirus is documented as a leading cause of foodborne diseases globally [1], the epidemiology of norovirus is poorly characterized in Kenya
Of the 283 respondents, 43(15.2%) stool specimens were positive for norovirus polymerase chain reaction (PCR)

Summary

Introduction

A leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers but norovirus outbreaks are not routinely investigated in Kenya. The leading cause of foodborne illness worldwide, is frequently transmitted by food handlers [3], and is a major cause of acute gastroenteritis among persons of all ages globally [1]. While norovirus is documented as a leading cause of foodborne diseases globally [1], the epidemiology of norovirus is poorly characterized in Kenya. Transmitted by fecal-oral spread, norovirus can enter the food chain at multiple points, but most commonly when food products, water, or fomites are contaminated by infected food handlers [3]. Norovirus contamination has occurred further upstream in the food chain, such as one instance of contamination of prepackaged delicatessen meat [5]

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Discussion

Conclusion