Socio-Demographic and Food Safety Practices Correlates of Diarrhoea Among Mothers, Nursing 6-12-Month-Old Children in the Sekyere South District, Ghana

Socio-Demographic and Food Safety Practices Correlates of Diarrhoea Among Mothers, Nursing 6-12-Month-Old Children in the Sekyere South District, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socio-Demographic and Food Safety Practices Correlates of Diarrhoea Among Mothers, Nursing 6-12-Month-Old Children in the Sekyere South District, Ghana Richard Mensah, Salome Amissah-Essel, Jacob Owusu Sarfo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7385210/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2026 Read the published version in Discover Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Diarrhoea remains a leading cause of morbidity and mortality in many low- and middle-income countries, especially among children under five. Its transmission is strongly linked to poor socio-demographic conditions, inadequate food handling, and unsafe food storage practices. Understanding the predictors of diarrhoea is essential to guide effective public health interventions. Objective: This study aimed to assess the association between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants in the Sekyere South District of Ghana. Methods: A cross-sectional study design was used, involving 571 respondents selected through a multi-stage sampling technique. Purposive and random sampling were used to select six health facilities, followed by quota and convenience sampling to recruit participants. Data were collected through structured questionnaires and analysed using both bivariate (Chi-square tests) and multivariate (logistic regression) analyses to identify significant predictors of diarrhoea. Results: Marital status, occupation, and educational level were significantly associated with diarrhoea in both bivariate and multivariate analyses (p < .05). Participants who were unemployed, had lower educational attainment, or were divorced/separated had higher odds of reporting diarrhoea. Among food handling practices, reading nutritional labels and avoiding food preparation during skin infections were significantly associated with reduced diarrhoea occurrence. Furthermore, all four food storage practices assessed: covering dustbins, appropriate refrigeration of perishables, separating raw and cooked foods, and timely consumption of leftovers, were significantly linked to lower diarrhoea prevalence. Conclusion: The findings highlight the critical role of socio-demographic and food safety factors in the prevalence of diarrhoea. Public health interventions should focus on improving food hygiene knowledge and practices, particularly among vulnerable groups with lower education or employment status. Diarrhoea Food handling Food storage Socio-demographic factors Ghana mothers Figures Figure 1 1. Introduction Food safety has become a significant global concern due to its profound implications for public health and its critical role in national food security. Unsafe food practices are strongly linked to foodborne diseases, which remain major contributors to global morbidity and mortality [1, 2]. These illnesses not only compromise individual well-being but also impede socioeconomic development, particularly in low- and middle-income countries. Despite efforts to quantify the global burden, foodborne diseases continue to cause substantial health losses. According to the World Health Organization [3], 31 known foodborne hazards were responsible for an estimated 600 million illnesses and 420,000 deaths in 2010 alone. Alarmingly, this includes 125,000 children under the age of five and the loss of approximately 33 million disability-adjusted life years. In Africa, diarrhoea illnesses remain a leading cause of child mortality, with food-related transmission playing a more significant role than water. Children under five account for nearly 40% of this burden [4]. Food safety lapses, particularly improper food handling, preparation, and storage, are frequently implicated in the spread of foodborne illnesses [5]. Food handlers, defined as individuals who directly handle food or interact with surfaces likely to come into contact with food, are essential actors in maintaining food hygiene standards [6]. Globally, research attributes 10–20% of foodborne illness cases to contamination by food handlers [7, 8]. In the domestic context, caregivers, especially mothers, serve as the final line of defence against food contamination. Their practices and knowledge are vital in ensuring the safety of food consumed within households [9]. Studies have revealed that over 50% of foodborne disease outbreaks originate from home settings, often due to inadequate food safety knowledge and poor hygiene [10, 11]. The risks are particularly acute among infants and young children, as poor food hygiene during the complementary feeding stage can lead to growth faltering and increased vulnerability to foodborne infections. In underdeveloped countries, food poisoning remains a major cause of child mortality. Out of the 2.2 million global deaths annually due to foodborne diseases, 1.9 million occur among children [12]. In Ghana specifically, the Food and Drugs Authority reported approximately 185,000 cases of staphylococcal food poisoning annually. Additionally, diarrhoea and dehydration claim an estimated 84,000 lives each year, with about 25% of deaths occurring in children under five [13]. These alarming statistics underscore the urgent need to understand and improve the food safety practices of parents and caregivers, particularly during early childhood feeding. 2. Materials and Methods 2.1 Study area The Sekyere South District (previously Afigya Sekyere District) is one of the 43 MMDAs in the Ashanti Region and the capital city of Agona. It is one of Ghana’s 261 Metropolitan, Municipal, and District Assemblies (MMDAs). Along the Kumasi-Mampong trunk route, the Sekyere South District is 37 kilometres from Kumasi in the northern Ashanti Region. 416.8 square kilometres, or around 1.7% of the Region’s total area of 24,389 square kilometres, comprise the district’s entire land area. The area is bounded by longitudes 10 40’W and 10 25’W and latitudes 60 50’N and 70 10’N. Facility-based study was done which included SDA Hospital Asamang, Agona Government Hospital, SDA hospital Wiamoase, Jamasi Health Centre, Kona Health Centre, and Boanim Health Centre. 2.2 Study Design The study design was a descriptive quantitative survey. The study adopted a quantitative research design because numbers were generated from the responses and analysed with appropriate statistics to determine the socio-demographic and food safety practices correlates of diarrhoea among post-natal mothers nursing 6-12-month-old children. 2.3 Study Population The population of this study consisted of all mothers nursing 6-12-month-old children who were receiving post-natal care at the child welfare clinic sessions of all the health facilities in the Sekyere South district. 2.4 Sampling Technique A multi-stage sampling technique was employed to select study locations and participants in a systematic and unbiased manner. This approach was deemed appropriate as it allowed for the structured selection of health facilities and the subsequent recruitment of participants within those settings. In the first stage, a purposive sampling technique was used to select three health centres within the Sekyere South District based on their accessibility, patient volume, and relevance to the study. In the second stage, simple random sampling was employed to select three hospitals from a list of eligible facilities in the district, ensuring each had an equal chance of being included. Following the selection of facilities, quota sampling was used to determine the number of participants to be recruited from each site. This was done in proportion to the estimated monthly patient attendance at each facility, ensuring adequate representation across the different centres. Finally, convenience sampling was used to recruit individual participants at each selected facility. Participants who met the inclusion criteria and were available and willing to participate during the data collection period were selected. This approach facilitated efficient data collection while accommodating practical constraints such as time and participant availability. 2.5 Sampling Procedure Kish’s (1965) approach for known study populations was used to choose an appropriate sample size that adequately reflects the total research population [15]. The generic formula for this approach is; n = N/ [1 + N (α) 2 ] Where: n = sample size, N = sampling frame and α = margin of error or confidence level. Given the population size, [N] of the mothers with children between the ages 6 and 12 months in the district was 2,553, the margin of error [α] is 5% (i.e., 𝛼 = 0.05) and a 95% confidence interval, this gave a sample size of 346. A 10% upward adjustment was calculated to account for the non-response rate, which equals 35 respondents. The study’s ultimate adjusted sample size was 381. However, Ogah (2013) and Cohen, Mannion, and Morrison (2007) have said that the higher the sample size, the better for cross-sectional research [16, 17]. As a result, the sample size of 381 was increased by 50%, totalling 571 mothers. 2.6 Inclusion and Exclusion Criteria Inclusion criteria 1. The participant had a child within the age range of 6-12 months. 2. The participant had lived in the district for more than six months before the study. 3. The participant was a mother or caregiver who purchased foodstuffs and prepared food for their babies. 4. The individuals should be feeding the child for at least six months from birth. Exclusion criteria 1. The person willfully refused to offer consent to participate in the study. 2. Participants with sick children on admission. 2.7 Independent Variables A range of independent variables, including socio-demographic characteristics, food handling behaviours, and food storage practices, were analysed to determine their predictive relationship with the occurrence of diarrhoea among participants. These variables were selected based on their theoretical relevance and empirical support in the context of food safety and public health. The socio-demographic variables included age, marital status, occupation, and level of education. Food handling variables assessed practices such as reading nutritional labels, checking expiry dates, and personal hygiene during food preparation. Food storage practices included methods of storing leftovers, refrigerating perishables, and separating raw from cooked food. 2.8 Dependent Variable The primary outcome variable for this study was the occurrence of diarrhoea among participants. Diarrhoea was assessed using a single self-report question: “Have you experienced diarrhoea in the past one month?” Participants responded with either “yes” or “no”, indicating the presence or absence of diarrhoea symptoms during that period. This binary outcome was used in both bivariate and multivariate analyses to explore its association with various socio-demographic characteristics, food handling behaviours, and food storage practices. 2.9 Data Processing and Analysis Data entry was done using SPSS software version 21.0, where it was cleaned and analysed. The descriptive statistics were analysed, and the data for each variable were presented as frequencies and percentages. Regarding the analysis of the factors that were associated with food safety practice among post-natal mothers, a logistic regression analysis was performed. The p-value < 0.05 was considered as a significant association, and it was generated with a 95% confidence interval (95% CI) and Cramér’s V value. 2.10 Ethical statement This study received approval from the University of Cape Coast Institutional Review Board under approval number (UCCIRB/CHAS/2022/126). The Sekyere South Health Directorate granted permission to carry out the study in the district. Informed consent was sought from the study participants in order to make free decisions about their involvement. 3. Results 3.1. Demographic characteristics of respondents Most of the participants, 219 (38.4%), were aged 24-29 years. Moreover, most of the participants 321(56.2%) were married and 315(55.2%) were self-employed. Additionally, the majority of participants (216, 37.8%) had SHS/Vocational as their highest level of education (Table 1). 3.2. Bivariate analysis between independent variables and diarrhoea A comprehensive analysis was conducted to examine the association between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants. The bivariate analysis revealed significant associations between diarrhoea and several socio-demographic variables. Marital status was significantly associated with diarrhoea (χ² = 7.327, p = .026), with divorced/separated individuals having a higher prevalence compared to single or married participants. Occupation showed a strong association (χ² = 29.105, p < .001), with unemployed participants reporting higher rates of diarrhoea. Similarly, educational level was significantly associated with diarrhoea (χ² = 23.886, p < .001), where individuals with no formal education or lower educational attainment had higher rates of diarrhoea. Regarding food handling practices, reading nutritional facts before purchasing packaged food was significantly associated with reduced diarrhoea (χ² = 23.584, p < .001), as was avoiding handling food during a skin infection (χ² = 8.153, p = .004). Other practices, such as checking expiry dates, dented cans, and handwashing before food handling, did not show significant associations. For food storage practices, all examined behaviours: covering dustbins, not keeping leftovers for more than five days, separating raw and cooked foods, and refrigerating perishables, were significantly associated with lower diarrhoea prevalence (p < .01) (Table 2). 3.3. Multivariate Regression Analysis on the Predictors of diarrhoea Multivariate logistic regression was conducted to identify independent predictors of diarrhoea while controlling for confounders. Age was not a significant predictor in the adjusted model (p = .949). However, marital status remained significant, with divorced/separated participants having significantly higher odds of diarrhoea compared to single individuals (AOR = 2.417; 95% CI: 1.248–4.684; p = .023). Occupation emerged as a strong independent predictor. Compared to unemployed participants, the odds of diarrhoea were significantly lower among the self-employed (AOR = 0.482; 95% CI: 0.253–0.919), civil servants (AOR = 0.357), and private-sector employees (AOR = 0.156; p < .001). Education level also independently predicted diarrhoea. Participants with tertiary education had a markedly reduced risk (AOR = 0.391; 95% CI: 0.164–0.934), while those with only primary education had increased odds (AOR = 2.898; 95% CI: 1.171–7.169; p < .001), emphasising the protective effect of higher educational attainment. Among food handling practices, reading nutritional labels remained a significant protective factor (AOR = 2.501; 95% CI: 1.719–3.638; p < .001). Likewise, handling food during a skin infection was associated with increased risk (AOR = 2.396; 95% CI: 1.296–4.429; p = .003). Other variables, such as checking expiry dates, inspecting for dents, and washing hands, were not significant predictors in the adjusted model. All four food storage practices retained significance in the multivariate model. Participants who covered dustbins near food preparation areas had lower odds of diarrhoea (AOR = 0.581; 95% CI: 0.395–0.856; p = .006), and storing raw meat separately from cooked food also conferred protection (AOR = 0.551; 95% CI: 0.360–0.845; p = .006). Not keeping leftovers beyond five days (AOR = 1.523; p = .014) and properly refrigerating perishables (AOR = 1.724; p = .002) were associated with better outcomes (see Table 3). 4. Discussion This study examined the relationship between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants. The analysis revealed that several factors, particularly marital status, occupation, education level, and specific food-related behaviours, were significantly associated with diarrhoea prevalence. These findings are consistent with and expand upon existing literature, although some variations were noted across studies. Socio-demographic characteristics emerged as important determinants of diarrhoea. Marital status was significantly associated with diarrhoea in both bivariate and multivariate analyses, with divorced or separated individuals having a higher risk compared to those who were single or married. This finding is supported by [18], who reported that divorced or single-parent households may face heightened challenges related to food safety due to reduced social support and economic constraints. The increased risk in this group may be attributed to limited time, financial resources, or knowledge required to maintain proper hygiene and food safety practices. However, [12] found no significant relationship between marital status and diarrhoea disease, suggesting that such associations may vary by region and socioeconomic context. Occupation also proved to be a strong predictor of diarrhoea. Unemployed participants reported significantly higher rates of diarrhoea compared to their employed counterparts. The multivariate model further confirmed that being self-employed, a civil servant, or privately employed significantly reduced the odds of diarrhoea. This observation aligns with findings by [19, 20], who emphasized the role of employment in improving access to health information, sanitation infrastructure, and financial means to practice safe food handling. Employment status may also correlate with a more structured lifestyle that encourages routine food hygiene practices. Education level was another key factor, with higher educational attainment offering significant protection against diarrhoea. Participants with tertiary education had lower odds of experiencing diarrhoea, while those with only primary education showed increased risk. These findings support earlier studies by [9, 10, 21], which emphasized the role of education in fostering awareness and implementation of food safety measures. However, [22] reported a weak relationship between education and actual food hygiene behaviors, highlighting that knowledge alone may not always translate into practice particularly in settings with limited access to resources or competing household demands. Among food handling practices, reading nutritional facts on packaged foods before purchasing was significantly associated with reduced diarrhoea prevalence. This remained a strong protective factor in the adjusted model, echoing findings by [11], who identified food label reading as a proxy for health literacy and conscientious food choices. Conversely, practices such as checking expiry dates, inspecting for dents, and handwashing before food handling, though widely recommended, were not significantly associated with diarrhoea in the multivariate model. This contrasts with findings from [3] and [5], which highlight these behaviors as essential to preventing foodborne illness. The lack of significance in this study may reflect discrepancies between self-reported practices and actual behaviors. Social desirability bias may lead participants to overstate adherence to recommended practices, or these behaviors may be performed inconsistently or inadequately. Notably, handling food during an active skin infection was significantly associated with increased risk of diarrhoea. This finding supports existing literature by [6] and [7], who identified food handlers with skin infections as a critical vector in the transmission of Staphylococcus aureus and other pathogens. It underscores the importance of avoiding food preparation during illness and the need for education on personal hygiene, particularly among caregivers. Food storage practices were consistently significant predictors of diarrhoea. Participants who reported covering dustbins near food preparation areas, refrigerating perishable foods, separating raw and cooked foods, and not storing leftovers for more than five days all had reduced odds of diarrhoea. These results are consistent with [23] food safety guidelines and corroborated by [12], who emphasized the role of safe storage in preventing microbial contamination. However, [24] found no significant relationship between leftover storage and foodborne illness in a European context, suggesting that regional variations in refrigeration access, ambient temperatures, and food types may influence outcomes. 5. Conclusion This study identified significant associations between socio-demographic characteristics, food handling behaviors, and food storage practices with the occurrence of diarrhoea among participants in the Sekyere South District. Factors such as marital status, occupation, and educational level were key socio-demographic predictors, with unemployed and less-educated individuals at higher risk. Among behavioral factors, practices like reading nutritional labels and avoiding food handling during skin infections were protective against diarrhoea. In addition, safe food storage practices including proper refrigeration, separating raw and cooked foods, and limiting leftover storage were strongly associated with reduced diarrhoea prevalence. Addressing these factors through targeted health education, improved food safety awareness, and behaviour change interventions could significantly reduce diarrhoea-related morbidity. These efforts align with the Sustainable Development Goals (SDGs), particularly SDG 3.9 and SDG 6.2. Therefore, a collaborative approach involving government agencies, healthcare providers, community leaders, and households is essential. Strengthening public health policies, food hygiene education, and access to safe food storage and preparation resources can improve health outcomes and reduce the burden of diarrhoea diseases in Ghana and similar settings. Future interventions should prioritise community-based food hygiene training, particularly for mothers and caregivers of infants, to further reduce diarrhoea risk in similar rural settings. Limitation This study relied on self-reported data, which may be subject to recall and social desirability bias. Additionally, the cross-sectional design limits the ability to infer causality between exposure and outcome variables. Despite these limitations, the large sample size and robust statistical analysis strengthen the validity of the findings. Declarations Ethical approval and consent to participate The University of Cape Coast Institutional Review Board (IRB) approved the study under approval number (UCCIRB/CHAS/2022/126) in accordance with the Declaration of Helsinki. The Sekyere South Health Directorate granted permission to carry out the study in the district. Informed consent was sought from the study respondents to make free decisions about their involvement. Competing interest The authors declare that they have no competing interests. Funding The authors did not receive any money or funding for this research. Author Contribution RM: Conceptualisation, Writing – original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing – review & editing, Software, Project administration. SA-E: Conceptualisation, Writing – original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing – review & editing, Software, Project administration. JOS: Conceptualisation, Writing – original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing – review & editing, Software, Project administration. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on request. References Singh, R., & Puniya, A. K. (2024). Role of food safety regulations in protecting public health. Indian Journal of Microbiology, 64(3), 1376–1378. Naumova, E. N. (2024). Tipping points, still-points, and missing points in the public health agenda for climate change, food safety and food security. Journal of Public Health Policy, 45(1), 1–7. World Health Organization. (2022). WHO global strategy for food safety 2022–2030: towards stronger food safety systems and global cooperation. 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Geneva: Switzerland. Jevšnik, M., Česen, A., Šantić, M., & Ovca, A. (2021). Food Safety Knowledge and Practices of Pregnant Women and Postpartum Mothers in Slovenia. Foods, 10(10), 2–12 Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table13.docx Cite Share Download PDF Status: Published Journal Publication published 14 Apr, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviews received at journal 27 Sep, 2025 Reviews received at journal 17 Sep, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers invited by journal 15 Sep, 2025 Editor invited by journal 30 Aug, 2025 Editor assigned by journal 23 Aug, 2025 Submission checks completed at journal 23 Aug, 2025 First submitted to journal 16 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7385210","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518180823,"identity":"49d4cc6b-7945-4526-8760-f746c5bb504a","order_by":0,"name":"Richard 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1","display":"","copyAsset":false,"role":"figure","size":71966,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Sekyere South district.\u003c/p\u003e\n\u003cp\u003eSource: Sekyere South District Assembly (Town and Planning Department, 2023) [14].\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7385210/v1/87dc3e73642bc31a5f37df1c.jpeg"},{"id":107352151,"identity":"b659c535-c7e1-4c4d-9888-cb7949831fc7","added_by":"auto","created_at":"2026-04-20 16:13:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":366416,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7385210/v1/5946ce96-e79e-40b9-a853-dc79c46dc049.pdf"},{"id":92012895,"identity":"fd831b7a-7daa-4f77-ac8e-81e8424fd85c","added_by":"auto","created_at":"2025-09-23 15:57:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25954,"visible":true,"origin":"","legend":"","description":"","filename":"Table13.docx","url":"https://assets-eu.researchsquare.com/files/rs-7385210/v1/ffdf1461051403f0418e64f0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Socio-Demographic and Food Safety Practices Correlates of Diarrhoea Among Mothers, Nursing 6-12-Month-Old Children in the Sekyere South District, Ghana","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFood safety has become a significant global concern due to its profound implications for public health and its critical role in national food security. Unsafe food practices are strongly linked to foodborne diseases, which remain major contributors to global morbidity and mortality [1, 2]. These illnesses not only compromise individual well-being but also impede socioeconomic development, particularly in low- and middle-income countries. Despite efforts to quantify the global burden, foodborne diseases continue to cause substantial health losses. According to the World Health Organization [3], 31 known foodborne hazards were responsible for an estimated 600 million illnesses and 420,000 deaths in 2010 alone. Alarmingly, this includes 125,000 children under the age of five and the loss of approximately 33 million disability-adjusted life years. In Africa, diarrhoea illnesses remain a leading cause of child mortality, with food-related transmission playing a more significant role than water. Children under five account for nearly 40% of this burden [4]. Food safety lapses, particularly improper food handling, preparation, and storage, are frequently implicated in the spread of foodborne illnesses [5].\u003c/p\u003e\n\u003cp\u003eFood handlers, defined as individuals who directly handle food or interact with surfaces likely to come into contact with food, are essential actors in maintaining food hygiene standards [6]. Globally, research attributes 10\u0026ndash;20% of foodborne illness cases to contamination by food handlers [7, 8]. In the domestic context, caregivers, especially mothers, serve as the final line of defence against food contamination. Their practices and knowledge are vital in ensuring the safety of food consumed within households [9]. Studies have revealed that over 50% of foodborne disease outbreaks originate from home settings, often due to inadequate food safety knowledge and poor hygiene [10, 11]. The risks are particularly acute among infants and young children, as poor food hygiene during the complementary feeding stage can lead to growth faltering and increased vulnerability to foodborne infections. In underdeveloped countries, food poisoning remains a major cause of child mortality. Out of the 2.2 million global deaths annually due to foodborne diseases, 1.9 million occur among children [12]. In Ghana specifically, the Food and Drugs Authority reported approximately 185,000 cases of staphylococcal food poisoning annually. Additionally, diarrhoea and dehydration claim an estimated 84,000 lives each year, with about 25% of deaths occurring in children under five [13]. These alarming statistics underscore the urgent need to understand and improve the food safety practices of parents and caregivers, particularly during early childhood feeding.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Sekyere South District (previously Afigya Sekyere District) is one of the 43 MMDAs in the Ashanti Region and the capital city of Agona. It is one of Ghana\u0026rsquo;s 261 Metropolitan, Municipal, and District Assemblies (MMDAs). Along the Kumasi-Mampong trunk route, the Sekyere South District is 37 kilometres from Kumasi in the northern Ashanti Region. 416.8 square kilometres, or around 1.7% of the Region\u0026rsquo;s total area of 24,389 square kilometres, comprise the district\u0026rsquo;s entire land area. The area is bounded by longitudes 10 40\u0026rsquo;W and 10 25\u0026rsquo;W and latitudes 60 50\u0026rsquo;N and 70 10\u0026rsquo;N. Facility-based study was done which included SDA Hospital Asamang, Agona Government Hospital, SDA hospital Wiamoase, Jamasi Health Centre, Kona Health Centre, and Boanim Health Centre.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design was a descriptive quantitative survey. The study adopted a quantitative research design because numbers were generated from the responses and analysed with appropriate statistics to determine the socio-demographic and food safety practices correlates of diarrhoea among post-natal mothers nursing 6-12-month-old children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe population of this study consisted of all mothers nursing 6-12-month-old children who were receiving post-natal care at the child welfare clinic sessions of all the health facilities in the Sekyere South district.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Sampling Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multi-stage sampling technique was employed to select study locations and participants in a systematic and unbiased manner. This approach was deemed appropriate as it allowed for the structured selection of health facilities and the subsequent recruitment of participants within those settings. In the first stage, a purposive sampling technique was used to select three health centres within the Sekyere South District based on their accessibility, patient volume, and relevance to the study. In the second stage, simple random sampling was employed to select three hospitals from a list of eligible facilities in the district, ensuring each had an equal chance of being included. Following the selection of facilities, quota sampling was used to determine the number of participants to be recruited from each site. This was done in proportion to the estimated monthly patient attendance at each facility, ensuring adequate representation across the different centres. Finally, convenience sampling was used to recruit individual participants at each selected facility. Participants who met the inclusion criteria and were available and willing to participate during the data collection period were selected. This approach facilitated efficient data collection while accommodating practical constraints such as time and participant availability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Sampling Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKish\u0026rsquo;s (1965) approach for known study populations was used to choose an appropriate sample size that adequately reflects the total research population [15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe generic formula for this approach is;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;n = N/ [1 + N (\u0026alpha;)\u003csup\u003e2\u003c/sup\u003e]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhere:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003en = sample size,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN = sampling frame and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026alpha; = margin of error or confidence level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven the population size, [N] of the mothers with children between the ages 6 and 12 months in the district was 2,553, the margin of error [\u0026alpha;] is 5% (i.e., 𝛼 = 0.05) and a 95% confidence interval, this gave a sample size of 346. A 10% upward adjustment was calculated to account for the non-response rate, which equals 35 respondents. The study\u0026rsquo;s ultimate adjusted sample size was 381. However, Ogah (2013) and Cohen, Mannion, and Morrison (2007) have said that the higher the sample size, the better for cross-sectional research [16, 17]. As a result, the sample size of 381 was increased by 50%, totalling 571 mothers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Inclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e1. The participant had a child within the age range of 6-12 months.\u003c/p\u003e\n\u003cp\u003e2. The participant had lived in the district for more than six months before the study.\u003c/p\u003e\n\u003cp\u003e3. The participant was a mother or caregiver who purchased foodstuffs and prepared food for their babies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. The individuals should be feeding the child for at least six months from birth.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExclusion criteria\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e1. The person willfully refused to offer consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e2. Participants with sick children on admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.7 Independent Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA range of independent variables, including socio-demographic characteristics, food handling behaviours, and food storage practices, were analysed to determine their predictive relationship with the occurrence of diarrhoea among participants. These variables were selected based on their theoretical relevance and empirical support in the context of food safety and public health. The socio-demographic variables included age, marital status, occupation, and level of education. Food handling variables assessed practices such as reading nutritional labels, checking expiry dates, and personal hygiene during food preparation. Food storage practices included methods of storing leftovers, refrigerating perishables, and separating raw from cooked food.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.8 Dependent Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome variable for this study was the occurrence of diarrhoea among participants. Diarrhoea was assessed using a single self-report question: \u0026ldquo;Have you experienced diarrhoea in the past one month?\u0026rdquo; Participants responded with either \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo;, indicating the presence or absence of diarrhoea symptoms during that period. This binary outcome was used in both bivariate and multivariate analyses to explore its association with various socio-demographic characteristics, food handling behaviours, and food storage practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.9 Data Processing and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData entry was done using SPSS software version 21.0, where it was cleaned and analysed. The descriptive statistics were analysed, and the data for each variable were presented as frequencies and percentages. Regarding the analysis of the factors that were associated with food safety practice among post-natal mothers, a logistic regression analysis was performed. The p-value \u0026lt; 0.05 was considered as a significant association, and it was generated with a 95% confidence interval (95% CI) and Cram\u0026eacute;r\u0026rsquo;s V value.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.10 Ethical statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the University of Cape Coast Institutional Review Board under approval number (UCCIRB/CHAS/2022/126). The Sekyere South Health Directorate granted permission to carry out the study in the district. Informed consent was sought from the study participants in order to make free decisions about their involvement.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Demographic characteristics of respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the participants, 219 (38.4%), were aged 24-29 years. Moreover, most of the participants 321(56.2%) were married and 315(55.2%) were self-employed. Additionally, the majority of participants (216, 37.8%) had SHS/Vocational as their highest level of education (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Bivariate analysis between independent variables and diarrhoea\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive analysis was conducted to examine the association between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants. The bivariate analysis revealed significant associations between diarrhoea and several socio-demographic variables. Marital status was significantly associated with diarrhoea (\u0026chi;\u0026sup2; = 7.327, p = .026), with divorced/separated individuals having a higher prevalence compared to single or married participants. Occupation showed a strong association (\u0026chi;\u0026sup2; = 29.105, p \u0026lt; .001), with unemployed participants reporting higher rates of diarrhoea. Similarly, educational level was significantly associated with diarrhoea (\u0026chi;\u0026sup2; = 23.886, p \u0026lt; .001), where individuals with no formal education or lower educational attainment had higher rates of diarrhoea. Regarding food handling practices, reading nutritional facts before purchasing packaged food was significantly associated with reduced diarrhoea (\u0026chi;\u0026sup2; = 23.584, p \u0026lt; .001), as was avoiding handling food during a skin infection (\u0026chi;\u0026sup2; = 8.153, p = .004). Other practices, such as checking expiry dates, dented cans, and handwashing before food handling, did not show significant associations. For food storage practices, all examined behaviours: covering dustbins, not keeping leftovers for more than five days, separating raw and cooked foods, and refrigerating perishables, were significantly associated with lower diarrhoea prevalence (p \u0026lt; .01) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Multivariate Regression Analysis on the Predictors of diarrhoea\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression was conducted to identify independent predictors of diarrhoea while controlling for confounders. Age was not a significant predictor in the adjusted model (p = .949). However, marital status remained significant, with divorced/separated participants having significantly higher odds of diarrhoea compared to single individuals (AOR = 2.417; 95% CI: 1.248\u0026ndash;4.684; p = .023). Occupation emerged as a strong independent predictor. Compared to unemployed participants, the odds of diarrhoea were significantly lower among the self-employed (AOR = 0.482; 95% CI: 0.253\u0026ndash;0.919), civil servants (AOR = 0.357), and private-sector employees (AOR = 0.156; p \u0026lt; .001). Education level also independently predicted diarrhoea. Participants with tertiary education had a markedly reduced risk (AOR = 0.391; 95% CI: 0.164\u0026ndash;0.934), while those with only primary education had increased odds (AOR = 2.898; 95% CI: 1.171\u0026ndash;7.169; p \u0026lt; .001), emphasising the protective effect of higher educational attainment. Among food handling practices, reading nutritional labels remained a significant protective factor (AOR = 2.501; 95% CI: 1.719\u0026ndash;3.638; p \u0026lt; .001). Likewise, handling food during a skin infection was associated with increased risk (AOR = 2.396; 95% CI: 1.296\u0026ndash;4.429; p = .003). Other variables, such as checking expiry dates, inspecting for dents, and washing hands, were not significant predictors in the adjusted model. All four food storage practices retained significance in the multivariate model. Participants who covered dustbins near food preparation areas had lower odds of diarrhoea (AOR = 0.581; 95% CI: 0.395\u0026ndash;0.856; p = .006), and storing raw meat separately from cooked food also conferred protection (AOR = 0.551; 95% CI: 0.360\u0026ndash;0.845; p = .006). Not keeping leftovers beyond five days (AOR = 1.523; p = .014) and properly refrigerating perishables (AOR = 1.724; p = .002) were associated with better outcomes (see Table 3).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study examined the relationship between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants. The analysis revealed that several factors, particularly marital status, occupation, education level, and specific food-related behaviours, were significantly associated with diarrhoea prevalence. These findings are consistent with and expand upon existing literature, although some variations were noted across studies. Socio-demographic characteristics emerged as important determinants of diarrhoea. Marital status was significantly associated with diarrhoea in both bivariate and multivariate analyses, with divorced or separated individuals having a higher risk compared to those who were single or married. This finding is supported by [18], who reported that divorced or single-parent households may face heightened challenges related to food safety due to reduced social support and economic constraints. The increased risk in this group may be attributed to limited time, financial resources, or knowledge required to maintain proper hygiene and food safety practices. However, [12] found no significant relationship between marital status and diarrhoea disease, suggesting that such associations may vary by region and socioeconomic context. Occupation also proved to be a strong predictor of diarrhoea. Unemployed participants reported significantly higher rates of diarrhoea compared to their employed counterparts. The multivariate model further confirmed that being self-employed, a civil servant, or privately employed significantly reduced the odds of diarrhoea. This observation aligns with findings by [19, 20], who emphasized the role of employment in improving access to health information, sanitation infrastructure, and financial means to practice safe food handling. Employment status may also correlate with a more structured lifestyle that encourages routine food hygiene practices. Education level was another key factor, with higher educational attainment offering significant protection against diarrhoea. Participants with tertiary education had lower odds of experiencing diarrhoea, while those with only primary education showed increased risk. These findings support earlier studies by [9, 10, 21], which emphasized the role of education in fostering awareness and implementation of food safety measures. However, [22] reported a weak relationship between education and actual food hygiene behaviors, highlighting that knowledge alone may not always translate into practice particularly in settings with limited access to resources or competing household demands. Among food handling practices, reading nutritional facts on packaged foods before purchasing was significantly associated with reduced diarrhoea prevalence. This remained a strong protective factor in the adjusted model, echoing findings by [11], who identified food label reading as a proxy for health literacy and conscientious food choices. Conversely, practices such as checking expiry dates, inspecting for dents, and handwashing before food handling, though widely recommended, were not significantly associated with diarrhoea in the multivariate model. This contrasts with findings from [3] and [5], which highlight these behaviors as essential to preventing foodborne illness. The lack of significance in this study may reflect discrepancies between self-reported practices and actual behaviors. Social desirability bias may lead participants to overstate adherence to recommended practices, or these behaviors may be performed inconsistently or inadequately. Notably, handling food during an active skin infection was significantly associated with increased risk of diarrhoea. This finding supports existing literature by [6] and [7], who identified food handlers with skin infections as a critical vector in the transmission of Staphylococcus aureus and other pathogens. It underscores the importance of avoiding food preparation during illness and the need for education on personal hygiene, particularly among caregivers. Food storage practices were consistently significant predictors of diarrhoea. Participants who reported covering dustbins near food preparation areas, refrigerating perishable foods, separating raw and cooked foods, and not storing leftovers for more than five days all had reduced odds of diarrhoea. These results are consistent with [23] food safety guidelines and corroborated by [12], who emphasized the role of safe storage in preventing microbial contamination. However, [24] found no significant relationship between leftover storage and foodborne illness in a European context, suggesting that regional variations in refrigeration access, ambient temperatures, and food types may influence outcomes.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study identified significant associations between socio-demographic characteristics, food handling behaviors, and food storage practices with the occurrence of diarrhoea among participants in the Sekyere South District. Factors such as marital status, occupation, and educational level were key socio-demographic predictors, with unemployed and less-educated individuals at higher risk. Among behavioral factors, practices like reading nutritional labels and avoiding food handling during skin infections were protective against diarrhoea. In addition, safe food storage practices including proper refrigeration, separating raw and cooked foods, and limiting leftover storage were strongly associated with reduced diarrhoea prevalence. Addressing these factors through targeted health education, improved food safety awareness, and behaviour change interventions could significantly reduce diarrhoea-related morbidity. These efforts align with the Sustainable Development Goals (SDGs), particularly SDG 3.9 and SDG 6.2. Therefore, a collaborative approach involving government agencies, healthcare providers, community leaders, and households is essential. Strengthening public health policies, food hygiene education, and access to safe food storage and preparation resources can improve health outcomes and reduce the burden of diarrhoea diseases in Ghana and similar settings. Future interventions should prioritise community-based food hygiene training, particularly for mothers and caregivers of infants, to further reduce diarrhoea risk in similar rural settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study relied on self-reported data, which may be subject to recall and social desirability bias. Additionally, the cross-sectional design limits the ability to infer causality between exposure and outcome variables. Despite these limitations, the large sample size and robust statistical analysis strengthen the validity of the findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003cp\u003e The University of Cape Coast Institutional Review Board (IRB) approved the study under approval number (UCCIRB/CHAS/2022/126) in accordance with the Declaration of Helsinki. The Sekyere South Health Directorate granted permission to carry out the study in the district. Informed consent was sought from the study respondents to make free decisions about their involvement.\u003c/p\u003e\u003ch2\u003eCompeting interest\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors did not receive any money or funding for this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRM: Conceptualisation, Writing \u0026ndash; original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing \u0026ndash; review \u0026amp; editing, Software, Project administration. SA-E: Conceptualisation, Writing \u0026ndash; original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing \u0026ndash; review \u0026amp; editing, Software, Project administration. JOS: Conceptualisation, Writing \u0026ndash; original draft, Validation, Methodology, Investigation, Data curation, Formal analysis, Writing \u0026ndash; review \u0026amp; editing, Software, Project administration.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSingh, R., \u0026amp; Puniya, A. K. (2024). Role of food safety regulations in protecting public health. Indian Journal of Microbiology, 64(3), 1376\u0026ndash;1378.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaumova, E. N. (2024). Tipping points, still-points, and missing points in the public health agenda for climate change, food safety and food security. Journal of Public Health Policy, 45(1), 1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2022). WHO global strategy for food safety 2022\u0026ndash;2030: towards stronger food safety systems and global cooperation. Geneva: Switzerland.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDas, S., Fahim, S. M., Alam, M. A., Mahfuz, M., Bessong, P., Mduma, E., ... \u0026amp; Ahmed, T. (2021). Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: Results from a multi-country birth cohort study. Public Health Nutrition, 24(6), 1428\u0026ndash;1437.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdurahman, A. A., Chaka, E. E., Bule, M. H., \u0026amp; Niaz, K. (2019). Magnitude and determinants of complementary feeding practices in Ethiopia: A systematic review and meta-analysis. Heliyon, 5(7), e01865.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwuchi, C. G. (2023). HACCP, quality, and food safety management in food and agricultural systems. Cogent Food \u0026amp; Agriculture, 9(1), 2176280.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, Y., Wan, G., Song, J., Dai, J., Shi, W., \u0026amp; Wang, L. (2024). Food safety practices of food handlers in China and their correlation with self-reported foodborne illness. Journal of food protection, 87(1), 100202.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTappes, S. P., Folly, D. C. C., da Silva Santos, G., de Aquino Feij\u0026oacute;, C., \u0026amp; Pustiglione, M. (2020). Food handlers and foodborne diseases: grounds for safety and public and occupational health actions. Revista Brasileira de Medicina Do Trabalho, 17(3), 431.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChidziwisano, K., Slekiene, J., Kumwenda, S., Mosler, H. J., \u0026amp; Morse, T. (2019). Toward complementary food hygiene practices among child caregivers in rural Malawi. The American Journal of Tropical Medicine and Hygiene, 101(2), 294\u0026ndash;311.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDagne, H., Raju, R. P., Andualem, Z., Hagos, T., \u0026amp; Addis, K. (2019). Food safety practice and its associated factors among mothers in Debarq town, northwest Ethiopia: Community-based cross-sectional study. BioMed Research International, 2019, 12\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeidu, J. A. (2020). Food safety knowledge and practices of food handlers in restaurants in the tamale metropolis, Ghana. Unpublished PhD thesis, University of Cape Coast.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyaz, W. O., Priyadarshini, A., \u0026amp; Jaiswal, A. K. (2018). Food safety knowledge and practices among Saudi mothers. Foods, 7(12), 193. https://doi.org/10.3390/foods7120193\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFood and Drugs Authority. (2012). Annual report on food safety in Ghana. Accra, Ghana: Food and Drugs Authority.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSekyere South District Assembly, Town and Planning Department. (2023). Map of Sekyere South District. Sekyere South District Assembly.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKish, L. (1965). Sampling organizations and groups of unequal sizes. American Sociological Review, 564\u0026ndash;572.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOgah, J. K. (2013). Decision making in the research process: Companion to students and beginning researchers. Accra: Adwinsa Publications (Gh) Limited.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen, L., Mannion, L., \u0026amp; Morrison, K. (2007). Quantitative data analysis. Research methods in education. 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Preventive Measures for Diarrhea in Communities Lacking Clean Water Supply: A Scientific Review. 4(3), 39\u0026ndash;43. https://doi.org/10.59298/rijbas/2024/433943\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang, J. (2022). Hygiene practices as a contributing factor to diarrhoea in preschool children in Mpumalanga Township, KwaZulu-Natal. https://doi.org/10.51415/10321/3994\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaadat, A., Siddique, M., \u0026amp; Hashim, M. M. (2024). Knowledge, attitude and practice (kap) study of food safety and hygiene practices of household consumers. Health Sciences Journal/Health Sciences Journal (Dera Ismail Khan), 2(2), 80\u0026ndash;86. https://doi.org/10.59365/hsj.2(2).2024.95\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2015). WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007\u0026ndash;2015. Geneva: Switzerland.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJevšnik, M., Česen, A., Šantić, M., \u0026amp; Ovca, A. (2021). Food Safety Knowledge and Practices of Pregnant Women and Postpartum Mothers in Slovenia. Foods, 10(10), 2\u0026ndash;12\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diarrhoea, Food handling, Food storage, Socio-demographic factors, Ghana, mothers","lastPublishedDoi":"10.21203/rs.3.rs-7385210/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7385210/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Diarrhoea remains a leading cause of morbidity and mortality in many low- and middle-income countries, especially among children under five. Its transmission is strongly linked to poor socio-demographic conditions, inadequate food handling, and unsafe food storage practices. Understanding the predictors of diarrhoea is essential to guide effective public health interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: This study aimed to assess the association between socio-demographic characteristics, food handling and storage practices, and the occurrence of diarrhoea among participants in the Sekyere South District of Ghana.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A cross-sectional study design was used, involving 571 respondents selected through a multi-stage sampling technique. Purposive and random sampling were used to select six health facilities, followed by quota and convenience sampling to recruit participants. Data were collected through structured questionnaires and analysed using both bivariate (Chi-square tests) and multivariate (logistic regression) analyses to identify significant predictors of diarrhoea.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Marital status, occupation, and educational level were significantly associated with diarrhoea in both bivariate and multivariate analyses (p \u0026lt; .05). Participants who were unemployed, had lower educational attainment, or were divorced/separated had higher odds of reporting diarrhoea. Among food handling practices, reading nutritional labels and avoiding food preparation during skin infections were significantly associated with reduced diarrhoea occurrence. Furthermore, all four food storage practices assessed: covering dustbins, appropriate refrigeration of perishables, separating raw and cooked foods, and timely consumption of leftovers, were significantly linked to lower diarrhoea prevalence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The findings highlight the critical role of socio-demographic and food safety factors in the prevalence of diarrhoea. Public health interventions should focus on improving food hygiene knowledge and practices, particularly among vulnerable groups with lower education or employment status.\u003c/p\u003e","manuscriptTitle":"Socio-Demographic and Food Safety Practices Correlates of Diarrhoea Among Mothers, Nursing 6-12-Month-Old Children in the Sekyere South District, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 15:41:18","doi":"10.21203/rs.3.rs-7385210/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T12:25:11+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"40940977769790692262491479344597665000","date":"2025-09-28T13:00:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-27T07:05:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-17T21:01:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277974525961360254684695053986902659167","date":"2025-09-17T20:23:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296681921147279318459742123750120914119","date":"2025-09-17T05:47:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-15T17:24:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-30T06:16:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-23T12:17:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-23T12:16:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-08-16T05:24:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2020371-571b-4988-b48f-f333e0c82d02","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:10:14+00:00","versionOfRecord":{"articleIdentity":"rs-7385210","link":"https://doi.org/10.1186/s12982-026-01898-y","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-04-14 15:59:16","publishedOnDateReadable":"April 14th, 2026"},"versionCreatedAt":"2025-09-23 15:41:18","video":"","vorDoi":"10.1186/s12982-026-01898-y","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01898-y","workflowStages":[]},"version":"v1","identity":"rs-7385210","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7385210","identity":"rs-7385210","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}