Assessment of food safety knowledge, attitudes, and self-reported practices among secondary school students in Bangladesh: A geographic information system-based cross-sectional study.

Foodborne diseases are a significant public health problem in Bangladesh, particularly among school students with unsafe handling and consumption of food is a common practice. Therefore, this study assessed food safety knowledge, attitudes, and practices (KAP) among secondary school students across Bangladesh and examined socio-demographic predictors and division-wise variations in these areas. This cross-sectional study was conducted from 10 January to 25 May 2024 in eight districts covering all administrative divisions of Bangladesh. Using a multistage sampling method, 48 secondary schools were chosen, and 2,226 students aged 12-17 years and enrolled in grades 9 and 10 (the secondary education level in Bangladesh) participated in the study (94.4% response rate). A structured questionnaire was used to collect data on socio-demographics and the food safety KAP. Descriptive statistics and non-parametric tests were conducted using SPSS 26.0, and the division-wise variations were explored using ArcGIS 10.8. The mean knowledge score obtained was 5.04/10 (50.4%), indicating moderate knowledge with respect to personal hygiene and considerable gaps in handling expired foods and food storage practices. The average attitude was 24.56/50 (49.1%), indicating borderline positive attitudes with common misconceptions about food additives and expired foods. Food safety practices were low, with a mean score of 19.92/50 (39.8%), indicating low adherence to appropriate reheating, storage, and hygienic practices. Gender, academic class, parents' education, income, and participation in food preparation were the major predictors, according to the regression models. There were variations across divisions, with Rangpur, Sylhet, and Mymensingh performing better in the KAP domains. Secondary school students in Bangladesh have moderate knowledge with borderline attitudes and poor food safety practices. Knowledge did not correlate with behavioral performance; however, attitudes strongly predicted practice. Personalized and targeted division-specific food safety education programs should be promoted to enhance adolescents' food safety behaviors and mitigate their potential liability in unnecessary future outbreaks.