Food Safety Model Development in Schools Implementing National School Nutrition Programme in Tshwane South District, Gauteng Province, South Africa

Abstract

Introduction: Food safety is an important global health and economic concern. In South Africa, ensuring safe meals for schoolchildren poses a significant challenge, particularly due to the rising incidence of foodborne illnesses. The National School Nutrition Programme (NSNP) has historically been a cornerstone of public health initiatives, improving the nutritional status of over 9 million learners by providing cooked meals on school days. However, the persistence of foodborne illness outbreaks highlighted the urgent need for robust food safety measures within school feeding frameworks. This research aimed to develop a food safety model tailored for the NSNP implementation in the Tshwane South District of Gauteng Province. By employing a multifaceted approach that incorporated risk assessment, hazard analysis, and management strategies, the study critically evaluated existing food safety practices and identified gaps contributing to foodborne hazard exposure among schoolchildren. Using qualitative and quantitative methods, the research synthesised data from various stakeholders, including school personnel, district coordinators, and learners. The resulting model advocates strengthening training programs, standardizing monitoring protocols, and implementing community engagement initiatives to foster a food safety culture. The implications of this model extended beyond individual health outcomes, influencing policy-making and enhancing the overall efficacy of the NSNP. Ultimately, the study contributes to a deeper understanding of food safety in educational settings and provides evidence-based recommendations to safeguard the health of one of the country’s most vulnerable populations. The primary objective of this study was to develop a food safety model for schools implementing the school feeding programme in the Tshwane South District of Gauteng Province, South Africa. Methodology: A parallel, convergent mixed-methods approach was employed to investigate the issue. In-depth interviews were conducted to gain qualitative insights into the problem. For the quantitative component, surveys and observations were utilised to characterize a cross-sectional study. Census sampling was used for schools, purposive sampling for role players, and systematic random sampling for learners. Both in-depth interviews and surveys, along with observations, supported the qualitative and quantitative approaches. A conceptual framework was developed as a guiding tool for the National School Nutrition Programme value chain and to identify critical control points, in line with Hazard Analysis and Critical Control Points principles. Descriptive statistics, including means, standard deviations, and distribution frequencies, were calculated using the Statistical Package for the Social Sciences (SPSS) version 29. Inferential analysis utilised Chi-Square and the Fisher’s Exact tests to explore associations, with significant relationships identified at p < 0.05. Reflexive thematic analysis was used to capture participants' responses to the programme. Audio recordings of the interviews were transcribed using TurboScribe, and the researcher verified their accuracy by comparing the transcripts to the original recordings. A PRECEDE and SWOT analysis was conducted to inform the development of the food safety model. Results: A total of 48 schools participated in the study across five cluster circuits in the Tshwane South District, comprising 31 primary schools (64.6%), 15 secondary schools (31.3%), and 2 special schools (4.2%). Most schools (16, 33.3%) were classified in Quantile 3. Furthermore, 19.7% of learners reported illnesses after consuming meals from the NSNP, compared with 10% among those who consumed food purchased elsewhere. Fish was identified as the most frequently implicated food. Chi-Square and Fisher's Exact tests indicated that illnesses associated with NSNP meals were related to hygiene risk factors linked to infrastructure and compliance. A chi-square test was performed to assess the association between illness symptoms and hygiene risks after consuming NSNP meals. The results demonstrated statistically significant differences at p < 0.05. Importantly, the chi-square analysis revealed that demographic factors such as age, sex, grade group, and school quantile were not significantly associated with self-reported illness after consuming these meals (p > 0.05). This indicates that illness occurrence was not correlated with the learners' sociodemographic factors, but rather that hygiene infrastructure and related practices were significant contributors. The Fisher's Exact test further demonstrated a statistically significant association between learners' perceived safety of NSNP meals and self-reported illness (p < 0.001). These findings highlighted critical hazards and provided a model to address the identified, explainable risks. Notable weaknesses were identified in kitchen design, layout, and staff adherence to hygiene standards, with many kitchens failing to meet the legal requirements set out in Regulation 638. Enhancing the infrastructure is essential to ensure the safe preparation and serving of meals to learners. The study involved a comprehensive analysis of 240 learners across 48 schools in the Tshwane South District. Many sampled schools were primary schools (31, 64.6%), followed by secondary schools (15, 31.2%) and special schools (2, 4.2%). Most learners were in Mamelodi (25, 52.1%) and Pretoria West (18, 37.5%). Schools in quantiles 3 (16, 33.3%) and 4 (15, 31.3%) had the highest representation, suggesting a low socio-economic status, while quantile 1 exhibited the lowest participation. Primary schools had the highest enrollment figures (156, 65%), while the special school had the fewest participants (11, 4.6%). Learners aged 13 to 17 constituted 57.5% of the population, with female students accounting for approximately 59.6%. Additionally, the study examined the demographics of key role players within the NSNP. Findings revealed that coordinators and food handlers each comprised 25.9% of participants, while 22.2% of the surveyed schools involved School Governing Bodies (SGB). A significant proportion of participants (43.9%) were aged 50-59 years, with an average age of 46.9 years; moreover, 76.7% were female. Regarding educational qualifications, 42% of participants held university degrees, 22% held diplomas, and only 20% held qualifications equivalent to Grades 10-12 or to Adult Basic Education and Training (ABET). The length of service among participants varied notably: coordinators served between 3 months and 20 years, SGB members between 2 months and 20 years, district monitors for 5 to 9 years, and food handlers for 5 to 8 months. These findings underscore the diverse backgrounds and experiences within the NSNP, indicating a critical need for targeted training and support interventions. The investigation also assessed the food safety infrastructure across the 48 NSNP schools. The results indicated that only 4.2% of schools had approved municipal plans, while merely 37.5% complied with established kitchen structure standards. Although 93.8% of the institutions had access to running water, 48.3% reported deficiencies in wastewater drainage, and many schools exhibited inadequate ventilation. Additionally, only 35% of schools provided cold storage facilities for perishable goods. While designated eating areas were generally available, shower facilities were notably absent. Despite 85.4% of schools holding certificates of acceptability, substantial compliance gaps raise critical concerns about the adequacy and safety of food-preparation environments. This study highlights significant disparities within the NSNP, emphasizing the urgent need for enhanced training, improved infrastructure, and stricter compliance with food safety standards. Addressing these issues is crucial to ensuring a safe and healthy environment for learners and maximizing the effectiveness of the NSNP in promoting their well-being. In conclusion, the findings underscore the importance of prioritizing food safety and hygiene in school meal programmes. By implementing necessary infrastructure improvements and adopting comprehensive training programs for personnel, stakeholders can significantly enhance the safety and effectiveness of the NSNP, ultimately fostering a healthier learning environment for all learners.