Environmental and sanitation determinants of safe food handling practices among food handlers in Kobo Town, northeastern Ethiopia

Foodborne diseases remain a major public health challenge in low- and middle-income countries, driven by inadequate sanitation and unsafe food handling practices. However, little is known about how environmental and workplace conditions jointly influence food hygiene behaviors in small urban towns. Therefore, this study aimed to assess how sanitation facilities and workplace environmental conditions are associated with safe food handling practices among food handlers in Kobo Town, northeastern Ethiopia. A cross-sectional study was conducted among 400 food handlers in Kobo Town, northeastern Ethiopia, from January to March 2025. Structured interviews and direct observations were used to assess sanitation infrastructure, workplace environment, and food handling practices. Logistic regression analysis was performed to identify environmental determinants of safe food handling practices. Only 48% of food handlers practiced safe food handling. The availability of functional hand washing facilities (AOR = 2.1; 95% CI: 1.4-3.2) and adequate kitchen ventilation (AOR = 1.8; 95% CI: 1.2-2.7) were significant predictors of safe practices, while poor sanitation conditions and vector infestation were common environmental risks. These findings indicate that structural and environmental factors play a central role in shaping safe food handling practices, highlighting the need for integrated interventions to strengthen WASH infrastructure, improve kitchen design, and enhance regulatory oversight in low-resource urban settings.