Knowledge, Attitude, and Practices, Hand Hygiene, and Preferred Food Safety Interventions of Butchers Operating in Nairobi County, Kenya

Foodborne diseases are a major public health concern globally, often linked to unhygienic food handling. In Kenya, meat is frequently sold through small, informal butcher shops with limited infrastructure. This study assessed the food safety knowledge, attitudes, and practices (KAP) of butchers, evaluated microbial contamination of their hands, explored latent dimensions of KAP, and food safety interventions preference. We conducted a cross-sectional study among 200 butchers randomly selected from four peri-urban areas of Nairobi. A semi-structured questionnaire captured KAP and intervention preferences, with pre- and post-meat handling hand contamination assessed using contact plate cultures. Psychometric properties of KAP domains were assessed using principal component analysis (PCA), Cronbachs alpha, and item response theory (IRT). Exploratory factor analysis (EFA) and cluster analysis were used to segment butchers by intervention preferences. Respondents were predominantly male (96.9%), 42.7% were aged 20-30 and 52% reported > 5 years work experience. Knowledge of regulatory requirements was high (98% were aware that meat must be inspected), yet awareness of WHOs Five Keys was extremely low (1%). Attitudes toward hygiene were generally positive, and many reported good practices (daily changing of towels (82%)). However, risky behaviors were common, including storing meat at ambient temperatures and selling ready-to-eat food alongside raw meat. Hand contamination exceeded acceptable limits in 64% of butchers before and 86% after meat handling. Psychometric analysis confirmed the validity of the KAP indices, with modest internal consistency and good discrimination for low-performing respondents. Cluster analysis revealed three butcher typologies: Collectivist Effective Oversight Avoiders (48%); Formal System-Embracers (37%); and Forward-Facing Self-Reliant (15%). Despite positive attitudes and good self-reported practices, high levels of contamination and risky behaviors persisted. Effective policy approaches should combine conventional training, regulation and infrastructure upgrading with innovative, demand-driven and technology-based interventions. Initial efforts could focus on the minority already receptive to consumer-focused solutions, using them as entry points for more modern and impactful approaches.