Systematic review and meta-regression of food safety knowledge and behaviour of primary food preparers for young children in the home setting

Young children are at greater risk of foodborne illness than adults. They are affected more severely due to low stomach acid production, immature immune systems, lower body weight, and lack of control over their meal preparation. Consequently, foodborne illness disproportionately affects children, with the highest incident rate among those less than five years of age. Our goal was to synthesize evidence of food safety knowledge and behaviour of parents/caregivers who regularly prepare meals for young children at home. A comprehensive search strategy was conducted using six databases to identify relevant articles published between 1994 and 2021. Articles were screened for relevance and characterized, data extracted, and articles assessed for risk of bias. Meta-analysis of comparable outcomes was used to estimate the trend across studies. Meta-regression was conducted to explain possible sources of variability. Forty-six relevant articles were included in the meta -analysis, and there was high heterogeneity across studies and outcomes. Knowledge and behaviour gaps included participants' knowledge and use of food thermometers to check cooking doneness. Parents/caregivers across studies had high knowledge of handwashing (median prevalence of 95%, IQR = 90-97%, n = 8 studies) and practices related to discarding leftovers after 2 or more hours at room temperature (median = 85%, IQR = 84-91%, n = 5 studies). Meta-regression results showed studies conducted in low-middle-income countries (vs. high-income countries) were more likely to report a lower prevalence of time-temperature control knowledge (beta =-0.25; 95%CI =-0.50, -0.03; I2 = 98.75%; adj R2 = 29.3%; n = 11 studies) and practices related to cleaning kitchen utensils before and after meal preparation (beta =-0.28; 95%CI =-0.53,-0.03; I2 = 98.83%; adj R2 = 18.23%; n = 18). Studies using self-reported behaviour measures (vs. in-person observation) tended to report a higher prevalence of handwashing with soap after handling raw meat (beta = 0.48, 95%CI = 0.23, 0.74; I2 = 98.34%; adj R2 = 52%; n = 14). This review highlights the need for food safety interventions to target knowledge and behaviour gaps for parents of young children. Research gaps were also identified, including investigating other high-risk food consumption (e.g., cookie dough and sprout) and applying behavioural change theories to address this population's barriers to safe food handling.