- While urban consumers in lower-income countries often have basic food safety awareness, there is a significant “knowledge-practice gap” where this theoretical understanding fails to translate into safe kitchen behaviors.
- Poor food safety practices, such as unsafe thawing and cross-contamination, are frequently driven by systemic constraints rather than just a lack of information, including limited access to clean water, reliable refrigeration, and adequate waste disposal.
- Effective interventions must move beyond simple awareness campaigns to supportive regulations that provide necessary infrastructure and shifts consumer training toward practical, action-oriented skills.
By Glenn Concepcion
According to World Health Organization estimates, every year 600 million people (roughly one in ten people on Earth) fall ill after eating contaminated food. For many, the result is a few days of discomfort, but for over 400,000 people annually, foodborne diseases are fatal. This health burden is staggering, comparable to that of malaria, HIV/AIDS, or tuberculosis. However, this weight is not shared equally: populations in low- and middle-income countries (LMICs) account for a massive 75% of these deaths, despite representing less than half of the world’s population.
As cities in these regions expand at breakneck speeds, a new study published in the journal Foods has taken a deep dive into the front lines of this crisis: the urban kitchen. A team of researchers from the International Rice Research Institute (IRRI) and the University of Exeter conducted a comprehensive scoping review, analyzing 26 studies across 14 low-income and lower-middle-income countries (LLMICs) to understand the Knowledge, Attitudes, and Practices (KAP) of urban consumers. Their findings reveal a startling “knowledge-practice gap” that suggests simply telling people to wash their hands may not be enough to save lives.
Food consumption is changing
The study focuses on urban centers because urbanization is fundamentally changing how the world eats. In rapidly growing cities across Africa, Asia, and the Caribbean, more people are moving away from subsistence farming and toward purchasing food from markets. While home-cooked meals are often seen as safer, the reality is that the household represents the final barrier, and sometimes a critical point of failure, against foodborne disease.
“Consumers play a pivotal role in ensuring food safety,” the authors note, pointing out that 60% to 80% of food poisoning cases actually originate from improper handling in the home. To understand why this happens, the researchers looked at the “KAP Triad”:
- What do people know about safety?
- What are their attitudes toward it?
- What do they actually do in practice?
Inconsistencies in knowledge and attitudes
The review, which looked at data from countries ranging from Haiti and Ethiopia to Vietnam and Pakistan, found that most urban consumers have a basic “common sense” understanding of food safety, but they often lack the technical details.
Across 25 studies assessing knowledge, many respondents understood the importance of handwashing and separating raw and cooked foods. However, critical gaps remained. For example, in Lebanon and Jordan, students struggled to identify specific pathogens like salmonella or the safe temperatures required to kill bacteria during cooking. In Nigeria and India, awareness of chemical contaminants, such as heavy metals in vegetables or pesticide residues, was notably low.
When it came to attitudes, the results were even more complex. While most people expressed a desire for “fresh” and “clean” food, their beliefs were often inconsistent. In Haiti, 82.5% of respondents knew hand hygiene was vital, yet over 60% incorrectly believed that as long as food is well-cooked, it is 100% free of all pathogens.
Furthermore, even when people recognized a safety risk, they were often hesitant to act. A study in Vietnam found that 63% of consumers were unwilling to report food safety violations to authorities, suggesting that social and systemic factors might discourage consumers from demanding higher standards.
The Knowledge-Practice Gap
The most concerning finding of the review is what the researchers call the “knowledge-practice gap”. In study after study, consumers who scored high on safety knowledge still failed to follow safe practices in their own kitchens.
Out of 15 studies that tracked actual behavior, nine reported poor or unsatisfactory practices. Common failures included:
- Unsafe thawing: Using improper methods to defrost meat.
- Cross-contamination: Using the same cutting board for raw meat and ready-to-eat vegetables.
- Hygiene failures: Wearing jewelry while preparing food or failing to wash hands at critical moments.
In some regions, like Lao PDR, fewer than 10% of consumers consistently separated their cutting boards. “Knowledge is expected to influence attitudes, which in turn drives practices,” the researchers explain, “but this fragmented application… has limited our understanding of how knowledge translates into actual safe food handling”.
Why the gap exists
Why do people who know better still take risks? The study argues that individual choices are often constrained by systemic weaknesses. In many urban LLMIC settings, consumers face structural barriers that make safety difficult:
- Lack of infrastructure: Limited access to clean, running water or reliable electricity for refrigeration.
- Economic pressure: The high cost of specialized equipment like food thermometers.
- Market realities: A heavy reliance on traditional or “wet” markets where food safety regulations are often weak or unenforced.
The researchers also found that demographics play a huge role. Age and education were the most consistent predictors of safety awareness; older, more educated consumers generally had better KAP scores. Interestingly, income also mattered: wealthier households in India, Ethiopia, and Ghana showed significantly better safety practices, likely because they had better access to both information and safe storage environments.
More supportive, not punitive, regulation
The implications for policy are clear: the old method of simply handing out educational brochures is failing. “Interventions focused solely on improving food safety knowledge are unlikely to be sufficient,” the study warns.
Instead, the authors advocate for “supportive regulation”. Rather than just punishing small vendors or lecturing consumers, governments should provide the infrastructure—like clean water and waste disposal—that makes safety possible. They also suggest that future education should move away from abstract theory and toward “action-oriented skills,” using visual-heavy learning modules for populations with varying literacy levels.
Moving forward in food safety
Despite the importance of this issue, the researchers noted that the current evidence base is thin. Most of the 26 studies were deemed of “low quality” due to small sample sizes and a reliance on self-reporting, which can be biased by “social desirability”, or people telling researchers what they think they should be doing rather than what they actually do.
As cities continue to grow, the risk of foodborne disease will only increase. Filling these research gaps and moving toward more holistic, systemic solutions is no longer just a scientific goal, it is a public health necessity. In the fight for food safety, knowing the rules is just the first step; building a world where it is possible to follow them is the real challenge.
Read the study:
Samira Choudhury, Antonieta Medina-Lara, Afrin Zainab Bi, Phoebe Ricarte, Nia Morrish, Prakashan C. Veettil
Food Safety Knowledge, Attitude, and Practices (KAP) of Urban Consumers in Low-Income and Lower-Middle-Income Countries (LLMICs): A Scoping Review
Foods, 2026
https://doi.org/10.3390/foods15081381
