medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023.

The copyright holder for this

It is made available under a CC-BY 4.0 International license .

Title: Compliance to food safety standards - Determining the barriers within the hotel

industry

Authors: Cynthia Esinam Segbedzi1 ¶*, Edward Wilson Ansah2 ¶ & Daniel Apaak3 ¶

Affiliations: 1. Department of Health Physical Education and Recreation, University of Cape

Coast, Ghana. Email: esenam306@gmail.com orcid.org/0000-0002-4349-1896

2. Department of Health Physical Education and Recreation, University of Cape

Coast, Ghana. Email: edward.ansah@ucc.edu.gh orcid.org/0000-0001-9450-

7774

3. Department of Health Physical Education and Recreation, University of Cape

Coast, Ghana. Email: daniel.apaak@ucc.edu.gh orcid.org/0000-0002-9114-0062

NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

Abstract

The safety of food served to customers is obligatory for all food service establishments for public

health effects. However, workplace barriers have led to noncompliance with safety standards

resulting in food contamination and outbreak of foodborne diseases. This study assessed the

compliance of restaurant facilities to standards by the Food and Drugs Authority’s (FDA) code of

standards, awareness and training on the code and the workplace barriers to compliance. The

study involved 233 respondents, 205 food handlers, 10 managers, and 18 officers from the

regulatory authorities, who were at work after the COVID-19 restrictions. Questionnaire was used

to obtain data from the food handlers and face-to-face interview for managers/chefs and officers

from the regulatory authorities. Data was analysed using frequencies and percentages, and

thematic content analysis. Results revealed that majority of the hotels did not comply with the

FDA’s code of standards on the provision of facilities. However, in segregating the items

individually, 70% of the hotels had high compliance with the provision of proper storage facilities

for raw and cooked food, 81.5% of the food handlers had in-service training, but this was not

routine. Most of the food handlers were aware of the FDA’s code on hygiene for food service

establishments, but only a few were trained on it. The food handlers reported unconducive

working environment, poor monitoring and supervision, inadequate supply of equipment, time

pressure and workplace policy as barriers to compliance with food safety standards. We

recommend that hotel owners/managers should be adequately trained to provide the required

training and supervision for food handlers, provide the needed tools/equipment to enhance work

flow and safe food to consumers. Also, regulatory authorities are encouraged to conduct regular

and effective monitoring/supervision to ensure adherence to standards, to improve the safety of

food served to the public.

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 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

Key words: Food safety; public health; compliance to food safety code; hotel restaurants; food

handlers; Ghana.

Introduction

Access to safe and healthy food is a right to every human being for healthy living [1]. Safe and

quality food therefore, contribute to food and nutrition security and sustainable development of a

nation [2]. Yet, there is recurrent foodborne disease outbreaks worldwide due to noncompliance

to safe food standards [3]. This is because food can be a latent avenue for infectious contaminants

from preparation to consumption and it is more plausible in establishments where food is prepared

on a large scale. Besides, the risk of getting infections is high, where asymptomatic food handlers

prepare and serve foods to customers [4]. Foods contaminated by microbes are usually difficult to

detect since these microbes are imperceptible and can cause illness [5,6]. The problem is

exacerbated in countries where lack of food handling practices, inadequate food safety laws, weak

regulatory systems, lack of financial resources to invest in safer equipment, and lack of food

safety training are common leading to noncompliance to safe food standards [7,8,9]. Meanwhile,

most foodborne diseases may be self-limiting yet, some can be very fatal leading to increased

morbidity and mortality [5,10]. For instance, globally, over 600 million people die after

consuming contaminated food [11]. The [1] estimates that over 47.8 million people fall ill with

128,000 hospitalizations and 30,000 deaths occur annually from foodborne diseases. However,

the burden of foodborne diseases is estimated to be high in developing countries, including the

Africa region [11].

In the Central and Western Regions of Ghana, foodborne disease infestation is on the rise and this

may be due to asymptomatic food handlers that may be contaminating food and water [12]. The

evidence is that, surveillance and epidemiological data indicate that poor food handling practices,

inadequate infrastructural facilities and ineffective monitoring/supervision in food service

establishments are linked to the causative chain of foodborne diseases [5,6,13]. Several previous

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 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

studies [5,13,14,15,16,17] reported poor food safety knowledge, attitude and practices of food

handlers however, few studies have been conducted on the barriers affecting compliance with

food safety standards. Previous studies indicate that food preparation processes expose food to

many contaminants and this needs to be addressed [18,19,20]. On the basis of this, it is imperative

to investigate the barriers to food safety compliance by hotels in the Central and Western Regions

of Ghana. Three research questions guided the study: (1) what is the level of compliance to

FDA’s code of standards on the provision of restaurant facilities among hotels in the Central and

Western Regions, Ghana? (2) What is the level of awareness and training on the FDA’s code of

standard on food safety among food handlers at hotels in the Central and Western Regions,

Ghana? and (3) What workplace barriers impede compliance to the FDA’s code of standard on

food safety among food handlers at hotels in the Central and Western Regions, Ghana?

Methods and Materials

A total of 21 hotels with restaurants located in the Central and Western Regions, which were in

full operation after COVID-19 restrictions, were included in this study. This study surveyed 233

respondents consisting of 205 food handlers, 10 managers/chefs and 18 officers from the

regulatory agencies (FDA, Environmental Health and sanitation Unit [EHS], & Ghana Tourism

Authority [GTA]). The hotels included five 1star, nine 2star and seven 3star hotels. The census

and purposive sampling techniques were used to select the participants and the hotels. The census

procedure was used to include all hotels while purposive sampling was used to select the food

handlers, managers/chefs and regulatory officers.

We secured ethical clearance (ID: UCCIRB/CES/2020/28) from the Institutional Review Board

(IRB), University of Cape Coast. Besides, permission was obtained from the FDA, EHS, GTA,

and the various hotel managers. The purpose of the research was clarified to the respondents and

their anonymity and confidentiality were guaranteed. Informed consent forms were made available

for the respondents who signed before taken part in the study [21].

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 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

The instruments were then distributed and collected two weeks after administration. Interviews for

the food and beverage mangers/chefs and the regulatory officials were audio recorded and notes

were also taken. The interviews were conducted at the offices of the regulatory officials and each

session lasted about 40 minutes. Data collection commenced January 25 - May 20, 2021.

Measures

The instruments included a questionnaire, an interview guide and an observation checklist. The

instruments were adapted from related literature [6,16,22]. The questionnaire for food handlers

was divided into four segments (A, B and C). Section ‘A’ surveyed the demographic

characteristics of the respondents such as sex, age, level of education, training, and work

experience. Section ‘B’ consisted of 16 items which responses ranged from “Yes” and “No”. This

section dealt with the FDA code guidelines on compliance with food safety standards on the

provision of facilities at hotels. Meanwhile, section ‘C’ consisted 11 items with a “Yes” and “No”

responses measuring the perceived workplace barriers to compliance with food safety standards.

We used an observation checklist based on the FDA’s code for food service establishments [23],

to conduct an on-site observation at all the 21 hotels to ascertain conformity of the facilities and

kitchen environment to the code of practice. This covered areas like ventilation, lighting,

wall/floors/ceilings, sanitary facility conditions, kitchen equipment and their locations, and

storage facilities. Interviews were also conducted with the regulatory officials to explore their role

in ensuring compliance with food safety standards at the hotels. Validity and reliability of the

instrument were established through peer-review and pre-testing using four fast food restaurants

in Winneba.

Data analysis

To determine compliance to FDA’s code of standards, assessment of restaurant facilities was

conducted by a member of the research team, observing the COVID-19 protocols (nose masking,

hand-sanitizing, physical distancing, etcetera). The assessment was to examine the extent to

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 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

which facilities (storage, work surfaces, water supply, sinks, washrooms, etc.) within the hotels

complied with standards prescribed by FDA (FDA, 2013). Frequencies and percentages were used

to analyse the observed data and compliance scores. The level of compliance was categorized into

low <50, average 50-69 and high ≥ 70 [24]. The compliance scores were calculated using the

equation below:

Compliance Score (C- score) = Nh

Nh = Number of hotels complying with a particular food safety standard.

T = Total number of hotels.

The self-reported barriers to compliance with food safety standards were analysed quantitatively

via frequencies, simple percentages and tabulations.

Results

The study involved 205 food handlers from 21 hotels, 10 managers/chefs and 18 officials from the

regulatory agencies. Most of the food handlers were females (57.6%), while the rest (42.4%) were

males. Many were between 21 and 30 years (68.8%), and 45.4% of the food handlers had 2 to 4

years working experience. Also, a greater proportion (81.5%) of the respondents have been

trained on food safety.

Compliance to food safety standards

The results indicated that half (50%) of the hotels did not comply with the FDA’s code on

availability of facilities “Table 1”. However, in segregating the items individually, majority (70%)

of the hotels had high compliance with the provision of proper storage facilities for raw and

cooked foods. Furthermore, observation showed that a large percentage (80%) of the hotels have

changing rooms and washrooms for food handlers. Moreover, a little over half (55%) of the hotel

kitchens were well- ventilated, while some (55%) had poor work surfaces. Besides, a good

proportion (65%) of the restaurants have their walls, ceilings and floors of light colour and made

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

of easy to clean materials. Meanwhile, 75% of the hotels lacked probe thermometers for checking

the doneness of cooked and held foods. Additionally, 75% of the doors to the food

preparation/service areas and washrooms were not self-opening. Similarly, most (60%) of the

hotels do not have a designated area for food handlers to eat, and 65% lacked separate sinks for

handwashing in the kitchen. In addition, a large percentage (80%) of the restaurants were

observed to have used same chopping boards for handling different foods, while a greater

proportion (90%) did not have reminders or posters at vantage areas and above hand washing

sinks to remind food handlers to wash their hands regularly, especially during the period of

infectious disease outbreak like the Covid-19 pandemic.

Table 1: Compliance Scores and Corresponding Compliance Levels of Hotel Facilities to

Food Safety Standards in Central and Western Regions

Compliance to food safety Yes No Compliance Compliance

F % F % Score Level

This hotel has adequate storage facilities for storing 14 70 6 30 70 High

raw and cooked foods.

In this hotel thermometers are available for checking 5 25 15 75 25 Low

the temperature of cooked foods

This hotel has spacious and well organized kitchen. 7 35 13 65 35 Low

This hotel has changing rooms for employees. 16 80 4 20 80

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

This hotel has a wash room that is conveniently12 60 8 40 60 Average

located and readily accessible for food service

employee.

This hotel has a designated place for employees 8 40 12 60 40 Low

to eat their meals.

This hotel has a designated sink for hand washing 7 35 13 65 35 Low

solely for food service workers with adequate

handwashing materials.

In this hotel appropriate materials are used for 12 60 8 40 60 Average

surfaces and they are easy to clean and maintain.

Walls, ceilings and floors of this hotel is made of 13 65 7 35 65 Average

light coloured and easy to clean materials.

The doors to washrooms, food preparation and 3 15 15 75 15 Low

service areas in this hotel is self-opening.

In this hotel food handlers use separate chopping 4 20 16 80 20 Low

boards for handling foods.

In this hotel, there is a sign/poster above every hand 2 10 18 90 10 Low

washing facility that reminds employees to wash their

hands

In this hotel there are waste bins with fitting lids. 9 45 11 55 55 Average

In this hotel the kitchen is well lit. 12 60 8 40 60 Average

This hotel has a well-ventilated kitchen. 11 55 9 45 55 Low

In this hotel, work surfaces are sound and in good 9 45 11 55 55 Low

condition (Rust free, smooth, not chipped).

This hotel has adequate supply of water. 8 40 10 60 60 Low

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

Training of food handlers on food safety

The results showed that 81.5% of the food handlers reported they have ever been trained, and

58.5% received this training in 2019. However, in 2020, less than half (45.9%) of the food

handlers received training “Fig 1”.

Training and awareness of the FDA code

The result further indicated that less than half (47%) of the food handlers were aware of the code,

while only 40% reported to have been trained on these standards.

Figure 1: Food Safety Training among Food Handlers at Hotels in Central Western Regions

Workplace barriers to food safety compliance

From Table 2, 66.3% of the food handlers indicated their workplace was not conducive for safe

food preparation, posing as a barrier to safe food compliance. In contrast, more than half (63.4%)

and 58.5% of the food handlers did not consider lack of motivation and inadequate knowledge on

what they were expected to do as barriers to compliance. Meanwhile, 55.1% of the food handlers

agreed that poor monitoring/enforcement are poor at their restaurants. In addition, 71.7%

considered time pressure as barriers to safe food practices. Moreover, 55.6% and 63.9% of the

food handlers indicated lack of equipment and their inconvenient locations are barriers to their

food safety practices. Similarly, 63.9% and 78.5% of the food handlers agreed that food safety

culture and employee welfare/workplace policies are barriers to safety practices. Besides, 64.9%

of the food handlers indicated forgetfulness could compromise compliance with food safety

standards in their hostels.

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 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

Table 2: Barriers to Food Safety Practices among Food Handlers at Hotels in Central and

Western Regions

Yes No
Barriers to Food Safety compliance
F % F %

Unconducive work environment in terms of structure (physical

layout). 136 66.3 69 33.7

Lack of motivation. 75 36.6 130 63.4

Inadequate knowledge on what one is expected to do. 85 41.5 120 58.5

Lack of training and education on appropriate food safety practices. 109 53.2 96 46.8

Small working space 112 54.6 93 45.4

Poor monitoring and enforcement by supervisors and regulatory 113 55.1 92 44.9

authorities.

Time pressure or busy work schedules. 147 71.7 58 28.3

Lack of necessary equipment and resources. 114 55.6 91 44.4

Inconvenient location of equipment such as sinks. 131 63.9 74 36.1

Food safety culture. 131 63.9 74 36.1

Employee welfare and workplace policies 161 78.5 44 21.5

Forgetfulness 133 64.9 72 35.1

Discussion

The aim of this research was to examine the barriers to food safety compliance by hotels in the

Central and Western Regions of Ghana. The findings revealed that a greater number of the hotels

have high compliance levels for the provision of only storage facilities, but they neglected the

other facilities. Besides, majority of the food handlers had in-service training, but this was not a

routine practice. Meanwhile, many of the food handlers reported they work in an unconducive
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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

work environment, with time pressure, lack of equipment/inconvenient location and small work

space. These factors pose as workplace barriers to compliance with food safety standards in these

hotels.

Compliance with food safety standards

Our finding revealed that most (70%) of the hotels have facilities for storage (refrigerators,

freezers, chillers and dry storage areas), changing rooms, washroom solely for food handlers to

use, well-ventilated kitchens with the walls, floors and ceiling in good condition. This agrees with

the results of [25] who also observed decreased violations in compliance regarding cold and dry

storage facilities, personnel facilities, utensils and equipment in the Greater Accra Region of

Ghana. Thus, the availability of these facilities helps food handlers to prevent contamination,

spoilage of food and transmission of foodborne infections.

Unfortunately, most of the hotels lack thermometers for checking the temperature of cooked

foods, a place for food handlers to eat their meals, handwashing sinks, separate chopping boards

for different foods and no reminders on top of handwashing sinks. The lack of these facilities

suggests low level of compliance to standards that could result in the exposure of consumers to

foodborne diseases. Unfortunately, this does not align with the FDA’s code of standards on the

provision of facilities at food service establishments. The consequence is that this is likely to

hinder safe food handling practices and expose consumers to health risks [15,22,26]. Thus, the

two regions may continue to record high foodborne infection rates.

Training of food handlers on food safety

The finding further showed that most of the food handlers received in-service training on the

FDA’s code of standard, though not regularly (see Figure 1). This may pose a barrier to

compliance because there are inadequate opportunities for the food handlers to update their

knowledge and skills needed for safe food handling. Then, it becomes important to increase

employee’s awareness of workplace practices through consistent training or workshops to

It is made available under a CC-BY 4.0 International license .

increase their motivation and confidence to improve adherence to proper food handling practices

to minimize food contamination and its associated hazards on consumers’ health [14]. In addition,

training should target all food handlers, be regular, tailored to specific function and level of

knowledge, eliminate irrelevant information, use appropriate media to disseminate information

and in the preferred language of the food handlers [18].

For instance, manager (CWR2) responded this way:

We organize training but we don’t have specific days for it. Our training is on needs

basis. That is when there is customer complaint or we observe a bad practice among the

food handlers. Sometimes we combine training and work due to time constraints. We

would prefer to have the regulators add their bit from-time-to-time to reinforce what we

do.

A female officer (TCR2FG2) also remarked:

In fact, as regulators, one of our core functions is to inspect to prevent violations and

train hotel staff. However, we are resource constrained. We expect the hotels to be a bit

more committed to training their employees, but the hotel industry is one with a high

employee turnover. So, they feel it’s a waste to commit resources into training staff only

for them to leave in a few months.

These findings are consistent with the observations from previous studies [16,18,27] indicating

that most food handlers do not receive regular training resulting in increased food safety

violations and risk to public health. We are of the view that the reduction in the number of food

handlers trained in 2020 is attributable to the outbreak of the COVID-19 pandemic which resulted

in restrictions/ban on hotel activities and staff lay-offs.

Training and awareness of the FDA code

To ensure that food handlers complied with the FDA’s code on food safety standards, it is

mandatory for food handlers to be aware of the regulatory requirements and be trained to manage

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

any condition that has the potential for risk within the food service environment. We found

however, that not many of the food handlers were aware of this code of practice and only a few of

them had training on such codes (see Figure 1). Although, many of the food handlers have high

level of education, the lack of awareness and training on their specific roles may result in

noncompliance with food safety standards. Meanwhile, the food safety standards are numerous

and require training to understand current trends and requirements within the industry [28,29].

Therefore, it is important that managers/owners or supervisors are equipped with adequate

knowledge and resources to be in position to train their workers as stipulated in the FDA’s code

of standards for food hygiene practices at food service establishments. A regulator (TCR1FG1)

observed:

Most of the time we only stress on managers/owners train the food handlers. Some of

the managers are highly educated but do not have the required knowledge in food

safety. So, we think the managers also need training so as to impart the required

knowledge and skills to the food handlers.

Thus, the lack of awareness and training on the code of practice is likely to be a serious barrier in

complying with food safety standards. This is because food handlers are likely to engage in poor

food safety practices that would expose consumers to myriad of health conditions [9,14,17].

Workplace barriers to food safety compliance

The finding showed that many of the food handlers perceived that their work settings

areunconducive with high level of time pressure, lack of equipment/inconvenient location, small

working space, unpleasant food safety culture and employee welfare which serve as major

barriers to compliance with food safety standards at hotel restaurants. A male chef (CWR1l)

llamented:

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

Most of the hotel kitchens are not properly designed with food safety in mind. As I

speak with you now, we are planning to restructure our kitchen to make it more

convenient and comfortable to work in.

A manager (CRW3) also observed:

I think hotel owners need to do broader consultation with architects and chefs to

provide the technical ideas before construction of their facilities. This will enable the

facilities to have the fine details to meet the standard requirements of a hotel kitchen.

Sometimes you visit a hotel kitchen and the size is just too small for even a household

usage. This makes it difficult to install the needed equipment to facilitate efficient

workflow and also prevent cross-contamination.

Another male chef (CWR2) bemoaned:

We are constrained in terms of resources in this hotel. Most of our equipment are

broken down and a process which could be undertaken within a few minutes takes

hours to complete.

These admissions have dire implications because they could lead to increased risk of food

contamination and poisoning of consumers increasing the burden of food-related illnesses.

Therefore, awareness of these barriers and their effects on public health will provide the

motivation for managers/regulators and employees to improve food safety practices. For

instance, the observations of [6,25] are that most restaurant kitchens are the last to be designed,

and some are residential facilities which were converted to restaurants. Therefore, the layout of

such facilities does not conform with standards and do not also have sufficient space to install

equipment needed for easy flow of work, efficiency and safety of food.

Furthermore, although all the barriers identified could hinder compliance to safe food standards,

lack of training, lack of equipment, poor monitoring and supervision and forgetfulness are of

greater concern. These could result in increased level of work-related stress leading to poor safe

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

food practices which inadvertently endanger public health. This calls for a strong regulator

activity, which seems relegated at these hotels.

A female regulator (TCR2FG2) decried:

We wish to go for visits and inspections at least thrice in a year, but we lack the

personnel and the resources to carry it out. The number of personnel in-charge for

ensuring enforcement and compliance is inadequate. Besides, some of the hotels are

located far away from town. Sometimes we have to go on visits in hired taxis at our

own expense.

A male participant (TCR3FG3) bemoaned:

Sometimes we try to put human face to some of the activities of the various facilities, so,

it may seem as if we are not doing our work. If we want to strictly enforce the

regulations most facilities will be closed down. At times we go on visits unannounced,

but usually we inform the facilities of our visit to afford them time to put their house in

order. Yet, we still observe a number of food safety violations.

Another female participant (TCR4FG2) responded:

You see…...our work as regulators would have been much easier but there is no

collaboration among the agencies. We do not share information, meanwhile we are

regulating the same facilities.

The finding of the current study bears similarity with several previous studies [6,13,15,26,30]

instance, a study carried out by [31] to examine compliance to safe food standards among fast-

food business in Jamaica revealed that food safety regulators could be considered as barriers to

compliance due to inconsistencies in their actions to ensure adherence to national food safety

codes.

Many of the food handlers may be working against time pressure, which could make them forget

to follow laid down procedures. To minimize this, employees and managers can examine their

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

work processes and alter or restructure work processes to increase productivity. For example,

strategies such as location of work stations, ergonomic design of equipment, or training focused

on smart working, will help increase compliance to food safety standards during meal preparation

and service to protect consumers’ health [6,15,30,26]. Such restaurant may be said to have a good

food safety culture that influences compliance with food safety standards. Food safety culture

demonstrates how owners, managers and employees think and act on daily basis as well as their

understanding, adopting and committing to measures to ensure food served to consumers is safe

[15]. According to [32], employees specified that it is crucial for food service managers to be

keenly involved within the operations of the organization, by demonstrating exemplary

leadership, create supportive environment and regularly stress on the importance of food safety

even during busy hours, to ensure that proper food safety behaviour is being practiced.

A good number of the food handlers indicated employee welfare and workplace policies pose as

barriers to their food safety compliance. Workplace policies serve as the basis for building

organizational culture. If workplace policies are unfavourable or not employee-friendly, it may

affect work performance and compliance to safety standards. This implies that any policy which

does not factor employees needs like their career progression, physical and mental health, may

impact productivity negatively and lower safe food practices. This has implications for public

health because of effect on increased contamination of food resulting in outbreak of foodborne

diseases such as cholera, typhoid, dysentery, among others. For instance, previous studies [6, 33,

34] involving chefs, highlighted the practice of working for long hours in the kitchen as having an

adverse effect on the physical and mental health of the chefs. It was recommended that

management review their policies and promoted good work and motivating environment to

increase attention to details, prevent high turnover of key employees, absenteeism and strikes or

sabotage.

Limitations

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

This study had some limitations. The COVID-19 restrictions placed limitation on the number of

hotels included in the study. It would have been prudent to interview the food handlers in

addition to the managers and regulators to properly triangulate the issues. However, we are

confident that the information gathered with the study is relevant and can be generalised for the

large population.

Conclusions

We conclude that many of the hotels did not comply with the FDA’s code of standard on the

provision of restaurant facilities to ensure safe food handling practices. Also, a large percentage

of the food handlers received in-service training, but this was not routine. Several workplace

barriers such as unconducive work environment, lack of training, time pressure, poor

monitoring/enforcement, lack of equipment, poor food safety culture, forgetfulness, and

workplace policies were reported by the food handlers to influence their low level of compliance

to food safety standards. The cases of cholera and diarrheal diseases are likely to continue and

increase in the Central and Western Regions of Ghana if compliance to food safety protocols are

not enforced to the later. Thus, owners/managers of hotels owe it a responsibility to procure the

required tools/equipment to ensure smooth work flow, proper training of food handlers and

effective supervision to curb the risk of food contamination and safeguard public health.

Moreover, the regulatory authorities need to increase the number of visits to the various hotels

for proper monitoring and supervision.

Competing Interests: The authors declare no competing interest.

Funding: This study did not receive any funding in any form.

Ethical Approval

Ethical approval for the study was obtained from the Institutional Review Board (IRB) at

University of Cape Coast, Ghana (UCCIRB//CES/2020/28) and medical screening and

17
 medRxiv preprint doi: https://doi.org/10.1101/2023.12.13.23299917; this version posted December 15, 2023. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

It is made available under a CC-BY 4.0 International license .

certification of first author by Environmental Health and Sanitation Unit of Cape Coast, Ghana

(Cert. No: 1,057).

Acknowledgement

We are grateful Mr. Botha Nkosi Nkosi of Air Force Medical Services, Takoradi, for

proofreading the draft manuscript.

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