Objective: This study aimed to assess food handlers' knowledge, attitudes, and self-reported practices towards the safer donated foods.

Design: This cross-sectional study was conducted within a 5-month consecutive time period in 2021.

Setting: This study was conducted in the eThekwini District, South Africa.

Participants: A convenience sampling-based cross-sectional survey of food handlers (n=252) served as the study's main source of data. A total of eight study sites across five municipal planning regions (MPRs) of eThekwini District were visited. The principal investigator administered the validated structured standardised questionnaire, using participant’s language of choice, which was either English or isiZulu. All the questions in the questionnaire were asked in exactly the same manner, following the same flow, in order to avoid bias and ensure consistency. Furthermore, the close-ended nature of questions in the questionnaire mitigated the risks of question manipulation. The questionnaire was adapted from the World Health Organization's (WHO) five keys to a safer food manual.

Primary and secondary outcome measures: The primary outcome was the knowledge, attitudes, and self-reported practices towards the safer donated foods. The secondary outcomes were the sanitary conditions of infrastructure and facilities, food handlers’ observed food handling behaviour, and nutritional information/labeling.

Results: The results show that the food handlers had good knowledge, positive attitude, and acceptable behaviours towards safe food handling and general hygiene, with mean scores (SD) of 62.8 (14.6), 92.5 (14.1), and 80.4 (13.3), respectively. Significant correlations were found between knowledge and attitudes (p=0.001), knowledge and practices (p<0.001), and attitudes and practices (p=0.02). However, the correlations between knowledge versus attitude and attitude versus practice were poor (spearman's rho<0.3), and the association between knowledge versus practice was moderate (0.3–0.7). The majority of food handlers (92.5%) did not understand the value of thorough cooking and temperature control. About 53% of respondents acknowledged to never adequately reheating cooked meals, 5% did not see the significance of preventing cross-contamination, and 5% were unsure.

Conclusions: Despite the relatively positive KAP levels of the food handlers, safe food handling and hygiene practices, such as thorough cooking and temperature control, properly reheating cooked meals, and taking precautions to prevent cross-contamination, require some emphasis.