Knowledge, attitudes, and practices of food handlers regarding food safety in urban areas of Southeast Asia: a narrative review.

This narrative review synthesizes recent evidence on knowledge, attitudes, and practices (KAP) related to food safety among food handlers in urban areas of Southeast Asia, with particular emphasis on migrant workers in Malaysia. The review aims to identify context-specific barriers and enablers that influence effective food safety practices, focusing on structural, linguistic, and institutional determinants in dense urban settings. Literature published between 2020 and 2024 was retrieved from Scopus, PubMed, Web of Science, and Google Scholar. The results of the study indicate significant variations in KAP, where the trained food handlers had a higher level of compliance (85%) than the untrained food handlers (55%). Workers with documentation had higher adherence to food safety practices (73%) than those without documentation (38%), illustrating the importance of legal status and training availability. Findings consistently demonstrate that food safety compliance is strongly associated with access to training, legal documentation, and employer support. Migrant food handlers, especially undocumented workers, face compounded challenges, including language barriers, limited formal training, and fear of regulatory engagement. Evidence indicates that multilingual, visual, and workplace-based training interventions substantially improve compliance in urban contexts. Kuala Lumpur emerges as a critical case study due to its heavy reliance on migrant labor, high food outlet density, and multicultural workforce. This review provides targeted insights to inform urban food safety policy, employer practices, and inclusive public health interventions in Southeast Asia.