A community-based cross-sectional study with a mixed-methods approach was conducted in Addis Ababa from 1 March to 30 March 2024. Addis Ababa is divided into 11 sub-cities and had an estimated population of 5,704,000 in 2024.

All street food vendors operating in Addis Ababa constituted the source population. Street food vendors working within the selected sub-cities formed the study population. Vendors engaged in the preparation and/or sale of ready-to-eat street foods were eligible for inclusion, whereas mobile vendors and those selling exclusively pre-packaged foods were excluded from the study.

The sample size was calculated using the single population proportion formula: n = z α / 2 2 * p 1 − p d 2 where n is the required sample size, Zα/2 is the standard normal value corresponding to a 95% confidence level (1.96), p is the estimated prevalence of good food hygiene practice (27.5%) obtained from a previous study [27], and d is the margin of error (0.05). After calculating the initial sample size, a 10% non-response rate was added. Accordingly, the final sample size for the study was 337 participants.

For the qualitative component, participant numbers for in-depth interviews were determined using the principle of saturation, where no new themes or insights emerge. The researcher iteratively reviewed transcripts, identifying and verifying categories as data collection progressed. Earlier transcripts were revisited to ensure that additional interviews were not yielding novel information. Once saturation was achieved, a total of 18 in-depth interviews and three focus group discussions were conducted, providing diverse perspectives relevant to the study objectives. This approach ensured comprehensive coverage of participants’ experiences while capturing the full range of themes and insights.

Of the 11 sub-cities in Addis Ababa, four (Addis Ketema, Kolfe Keraniyo, Kirkos, and Lemi Kura) were selected using simple random sampling. Within each selected sub-city, three vending sites were chosen through convenience sampling. Sample sizes were proportionally allocated based on preliminary estimates of the number of vendors at each site, and participants were recruited consecutively to ensure representation across all selected locations.

For the qualitative component, participants were selected using purposive sampling to capture a range of perspectives relevant to the study objectives. Selection criteria included age, sex, type of street food activity, and level of involvement in food preparation and sale. While the use of purposive and consecutive sampling may limit statistical representativeness, this approach was appropriate for in-depth exploration of contextual factors influencing hygiene practices. To mitigate potential selection bias and enhance diversity of perspectives, vendors were recruited from multiple districts across Addis Ababa, and interviews were conducted on different days of the week and at varying times of day to capture variation in operating conditions, customer flow, and hygiene practices.

Food hygiene knowledge: Vendors scoring ≥8 out of 10 knowledge questions were considered to have good knowledge, while those scoring <8 were classified as having poor knowledge [15].

Hygiene practice level: Vendors scoring ≥17 out of 21 hygiene practice questions were considered to have good practices, while those scoring <17 were classified as having poor hygienic practices [15].

Quantitative data were collected using a pretested, structured, interviewer-administered questionnaire, and an observational checklist was employed by trained data collectors. Observations were conducted prior to administering the questionnaires to ensure that the data collectors could record actual food handling practices without influencing participant responses. The data collection tool was prepared in English, translated into Amharic for clarity, and back-translated into English by two language experts to ensure consistency. The instrument was adapted from previous studies [14, 17].

For the qualitative component, baseline demographic and contextual information was collected before data collection. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted to obtain rich insights. IDIs were conducted face-to-face in private settings to ensure confidentiality and typically lasted 30–45 min, while FGDs, each comprising eight participants and lasting 90–120 min, were held in neutral venues with informed consent and audio recording. A trained facilitator led the sessions using a semi-structured guide, and a note-taker documented key points, non-verbal cues, and group dynamics. Field notes captured contextual details and researcher reflections. The guides explored participants’ experiences, perceptions, and challenges, with flexibility to probe emerging issues while addressing study objectives.

Quantitative and qualitative data were collected concurrently and analyzed separately. Integration was conducted at the interpretation stage using a side-by-side comparison approach. Quantitative findings on hygiene practices and associated factors were compared with qualitative themes to identify convergence and divergence. Qualitative data were used to explain statistically significant associations, contextualize non-significant findings, and clarify underlying mechanisms. Cross-validation was achieved by examining consistency between self-reported quantitative responses and qualitative accounts of routine practices and constraints, thereby strengthening the credibility and interpretability of the findings.

Quantitative data were entered into Epi Info version 7 and exported to SPSS version 25 for analysis. Food hygiene knowledge was assessed using ten closed-ended questions, with scores based on correct responses. Food handling practices were evaluated using 21 items, with each standard practice scored as 1 and unsafe practices as 0. The internal consistency of the instrument was assessed using Cronbach’s alpha, yielding a value of 0.78, indicating acceptable reliability. Bivariate and multivariable logistic regression analyses identified associations between independent and dependent variables. Variables with p < 0.25 in bivariate analysis were entered into the multivariable model. Crude odds ratios (ORs), adjusted odds ratios (AORs), and 95% confidence intervals (CIs) assessed the strength and significance of associations. Variables with p < 0.05 in the multivariable model were considered statistically significant.

Qualitative data were transcribed verbatim, translated into English, and imported into Atlas ti for analysis. Thematic analysis began with repeated transcript readings to ensure familiarity. Codes were generated inductively and deductively, grouped into categories, and refined into overarching themes. Themes were interpreted in relation to study objectives and illustrated with participant quotes to enhance credibility. Trustworthiness was maintained through systematic analysis and careful interpretation.

To ensure credibility, qualitative data were analyzed systematically using thematic coding. Preliminary findings and emergent themes were shared with a subset of vendors (member checking) to confirm accurate representation of their experiences. Triangulation was conducted by comparing qualitative insights with quantitative results, enhancing interpretive validity. Additionally, coding and theme development were independently reviewed by a second researcher (peer debriefing) to minimize bias and strengthen the reliability and trustworthiness of the analysis.

Ethical clearance was obtained from the Institutional Review Board of Yanet College (Ref: YC/IRB/214/2024). Verbal consent was obtained from participants, and privacy, confidentiality, and anonymity were ensured. The study was conducted in accordance with the Declaration of Helsinki.

A total of 337 street food vendors participated (response rate: 100%), with the majority (97.6%) being female. The mean age was 31.5 ± 6.3 years, and 78% were married. Over one-third had completed primary education, and 24.6% had less than 1 year of vending experience (Table 1).

Among 337 participants, most vendors (94.1%) obtained water from kiosks, while 5.9% relied on water from home. Nearly all (98.8%) paid for water services, and for storage, 75% used jerrycans and 25% used buckets. Over two-thirds (67.9%) reported experiencing interrupted water supply, which affected their ability to maintain hygiene practices.

These quantitative findings were reinforced by qualitative insights. Vendors described how limited water availability constrained hand washing and utensil cleaning: one 29-year-old participant explained, “I bring water from home every morning, but if it finishes before noon, I just have to manage without it.” Similarly, a 41-year-old vendor noted, “Sometimes we buy bottled water to wash hands, but it’s too expensive to do that every day.” Lack of nearby hand washing facilities also emerged as a barrier, with a 36-year-old woman stating, “There is no hand washing station nearby, and walking far just to wash hands is not practical when we have customers waiting.” The practical impact on utensil hygiene was highlighted by a 26-year-old participant: “We only wash utensils once or twice a day because water is limited.”

Qualitative insights provide context for these patterns. A 38-year-old vendor explained, “No one has ever told us how to prepare or store food safely. We do it the way we learned from others,” illustrating the reliance on informal learning. Similarly, another participant noted, “They say you need a license and training, but I’ve never been given a chance or support,” highlighting gaps in access to formal training. Limited knowledge about basic hygiene concepts was also evident: a 28-year-old vendor reported, “I’ve never heard of cross-contamination [menekakat]. We cut meat and vegetables on the same board because we only have one.” Together, these quantitative and qualitative findings demonstrate that lack of formal training and reliance on informal learning contributes to unsafe hygiene practices among street food vendors.

Food preparation and handling practices varied among vendors. Nearly half (45.7%) prepared food both at home and at the vending site, while 42.4% prepared food exclusively at the stall and 11.9% at home. Most of them (96.1%) cooked food in the morning prior to sales, with only 3.9% preparing food during selling hours. Regarding food handling, 65.3% of vendors handled ready-to-eat foods using bare hands, whereas 34.7% used utensils. In terms of food storage, 50.7% kept food items openly at the stall, while 49.3% used covered containers. Leftover food was discarded by 65.3% of vendors, consumed at home by 24.9%, and resold the following day by 9.8%. For cross-contamination prevention, 75.7% reported using separate utensils for raw and cooked foods, while 24.3% did not. Utensil sanitization practices showed that 75.4% cleaned utensils once daily, 18.7% twice daily, and 5.9% three times per day.

Most vendors (95%) reported washing hands before handling food, but only 123 (36.5%) washed hands after handling raw food. All 337 (100%) washed hands after using the toilet, yet only 66 (19.5%) used soap. Observations showed that just 27 vendors (8%) frequently washed hands. Only 94 (27.9%) wore aprons, and 79.5% did not cover their hair. Long nails were observed in 212 (63.2%), and 221 (65.6%) wore hand jewelry while cooking. About 328 (97.3%) handled money without washing hands, 235 (69.7%) used bare hands for cooked food, and 10% had open skin lesions. After data collection, health education sessions were conducted to address critical hygiene gaps.

Only 106 vendors (31.5%) worked in a clean environment, and 95% operated in areas without designated refuse sites. Waste bins were available at 38.3% of vending sites, and 64.7% of vendors disposed of waste via open dumping. Handwashing facilities were present at 197 sites (58.7%), but soap was available at only 139 units (41.2%). Overall, just 68 vendors (20.2%) operated under good environmental sanitation conditions.

Qualitative insights help explain these patterns. A 34-year-old vendor described, “The area is very dusty, and vehicles pass by all the time. I try to cover my food, but it still gets dirty,” illustrating the challenge of maintaining cleanliness in busy, exposed locations. Similarly, a 28-year-old participant noted, “I work under a tree near the market. There’s no clean place to cut vegetables or keep cooked food,” highlighting the lack of appropriate food preparation surfaces. Adverse conditions were echoed by a 42-year-old woman: “When it rains, the place gets muddy and dirty. But we can’t stop working because of that.” Lack of nearby sanitation facilities further constrained hygiene practices, as a 33-year-old male vendor reported, “There are no toilets nearby. If we need to go, we either wait or use unsafe places.” Together, these quantitative and qualitative findings demonstrate that limited infrastructure, poor waste management, and inadequate sanitation facilities significantly hinder vendors’ ability to maintain safe environmental conditions, even when they are aware of proper hygiene practices.

Only one-fourth (25%) of street food vendors demonstrated good knowledge of food handling practices. While all vendors (100%) recognized the importance of hand hygiene, 77.7% were unaware of the benefits of separating raw and cooked foods. Additionally, 81.3% lacked knowledge about the risks of uncovered hand wounds, and 81% did not know that individuals with infections should refrain from food handling (Table 2).

Qualitative insights help explain these gaps. A 25-year-old vendor stated, “I don’t know why we should keep raw and cooked food separate. I just put them in one place to save space,” reflecting the high proportion unaware of cross-contamination risks. Similarly, a 28-year-old participant reported, “I wash my hands only when they look dirty. I didn’t know you have to wash before touching food every time,” illustrating partial understanding of hand hygiene. Limited awareness of broader food safety risks was captured by a 40-year-old woman: “I thought food poisoning only happens when food smells bad [metfo shita]. If it smells okay, I sell it.” Knowledge gaps regarding proper food storage were also evident, with a 41-year-old vendor noting, “We don’t know the right temperature to store food. We just cover it with cloth to keep it warm.”

These qualitative narratives contextualize the quantitative findings, showing that limited food handling knowledge underlies unsafe practices, including improper storage, insufficient hand hygiene, and failure to separate raw and cooked foods.

Enforcement of food safety regulations was limited among street food vendors. Over half of the vendors (202, 59.9%) were unregistered, and 189 (56.1%) had not been visited by health professionals. Additionally, the majority (314, 93.2%) had not undergone medical checkups in the past 6 months. These quantitative findings were reflected in vendors’ accounts. A 37-year-old woman explained, “No one has ever asked me why I don’t wear gloves or apron, so I think it’s not necessary,” illustrating how limited regulatory oversight and lack of health professional visits reduce adherence to recommended hygiene practices. Together, the findings suggest that insufficient enforcement, irregular HP visits, and absent medical checkups contribute to gaps in hygiene compliance, despite vendors’ awareness of basic food safety principles.

Economic constraints were a major barrier to proper food hygiene among street food vendors. Many vendors reported that daily expenses for gloves, soap, and food covers were unaffordable. A 26-year-old participant explained, “Buying gloves, soap, or covers every day is not possible with the little we earn.” Similarly, one vendor noted, “Sometimes I reuse cooking oil for 3 or 4 days because I can’t afford new oil every time.” Concerns about profit loss were also common: a 45-year-old woman stated, “Food is expensive, so if I throw it away, I lose profit. I sell leftovers the next day.” Limited financial support further constrained their ability to maintain safe practices, as a 40-year-old participant added, “We would like to improve, but no one supports us with loans or materials to start properly.

Customer expectations and market pressures influenced vendors’ hygiene practices. Many vendors reported prioritizing speed and affordability over strict hygiene compliance. A 32-year-old participant explained, “Customers don’t want to wait long, so I serve fast even if I haven’t washed my hands properly.” Another vendor noted, “People buy from me because the food is cheap, not because it is clean.” Focus group discussions further emphasized the trade-off between cleanliness and business: “When we clean too much or raise prices, customers leave and go to cheaper places.”

The prevalence of good hygienic practices among street food vendors in Addis Ababa was 33.2% (95% CI: 28.2–38.3). While 123 vendors (36.5%) reported washing their hands after handling raw foods, only 27 (8%) were observed washing hands frequently during cooking and serving. This discrepancy between self-reported and observed behaviors suggests potential social desirability and reporting biases, where vendors may overestimate compliance when responding to surveys. Observational data provide a more objective assessment of routine practices, revealing that actual hygiene behaviors are substantially lower than reported. These findings highlight the importance of triangulating self-report with direct observation in assessing food handling practices, as reliance on reported behaviors alone may overstate adherence to hygiene standards. Additionally, 76.9% stored cooked food in uncovered utensils, 81.9% cleaned utensils in visibly dirty water, and 56.4% exposed food to flies (Table 3).

Multivariable logistic regression identified several factors significantly associated with good food hygiene practices among street food vendors, even after adjusting for confounders. Vendors with 1–3 years of experience had 4.68 times higher odds of good hygiene compared to those with less than 1 year (AOR: 4.68; 95% CI: 1.96–11.14), and those with over 3 years of experience had 8.87 times higher odds (AOR: 8.87; 95% CI: 3.72–21.15). Continuous water supply increased the likelihood of good hygiene by 2.52 times (AOR: 2.52; 95% CI: 1.37–4.62). Formal food handling training raised the odds by 2.43 times compared to learning through observation (AOR: 2.43; 95% CI: 1.12–5.27). Regular visits from health professionals increased the odds by 5.42 times (AOR: 5.42; 95% CI: 2.90–10.12), and vendors with good food hygiene knowledge were 3.44 times more likely to demonstrate proper practices than those with poor knowledge (AOR: 3.44; 95% CI: 1.60–7.38) (Table 4).

Continuous water supply was significantly associated with good hygiene practices, increasing the likelihood by 2.52 times. Qualitative findings provide context to this association, revealing that vendors face practical challenges in maintaining adequate water throughout the day. Many rely on water brought from home or purchased bottled water, which is often insufficient or costly, limiting both hand washing and utensil cleaning. The lack of nearby hand washing facilities further constrains hygiene practices, as walking long distances to access water is impractical during busy service hours. Together, these insights explain how limited water availability and infrastructural constraints directly impact vendors’ ability to maintain proper hygiene, complementing the quantitative results.

Qualitative interviews and focus group discussions underlined the practical challenges behind these numbers. One 29-year-old vendor explained, “I bring water from home every morning, but if it finishes before noon, I just have to manage without it.” Similarly, a 41-year-old vendor noted, “Sometimes we buy bottled water to wash hands, but it’s too expensive to do that every day.” Lack of nearby hand washing facilities further constrained hygiene practices, as a 36-year-old woman from FGD mentioned, “There is no hand washing station nearby, and walking far just to wash hands is not practical when we have customers waiting.” Limited water availability also affected utensil cleaning, with a 26-year-old participant stating, “We only wash utensils once or twice a day because water is limited.”

Regular visits from health professionals were strongly associated with good hygiene practices, increasing the odds by 5.42 times. Qualitative findings provide context for this effect, revealing that vendors often underestimate the importance of hygiene when external monitoring or guidance is absent. Some vendors reported that, without oversight, they do not consistently use protective equipment such as gloves or aprons. Focus group discussions further highlighted the tension between maintaining strict hygiene and sustaining business, as vendors may limit cleaning or protective measures to avoid inconveniencing customers or raising prices. These insights help explain how regular health professional visits can reinforce hygiene practices by providing guidance, accountability, and encouragement, complementing the quantitative results.

Vendors with good food hygiene knowledge were 3.44 times more likely to demonstrate proper practices than those with poor knowledge. Qualitative findings help explain this association, showing that limited understanding of food safety leads to unsafe handling practices. Many vendors were unaware of the need to separate raw and cooked foods, wash hands consistently before handling food, or maintain proper storage conditions. Misconceptions about foodborne illness were also common, with some vendors believing that food is safe as long as it looks or smells acceptable. These knowledge gaps directly affect hygiene practices, reinforcing the quantitative finding that better food hygiene knowledge significantly increases the likelihood of safe food handling.

Formal food handling training was significantly associated with good hygiene practices, increasing the odds by 2.43 times compared to vendors who learned informally through observation. Qualitative findings provide important context for this association. Many vendors reported that they had never received structured guidance on safe food preparation or storage and instead relied on practices learned informally from peers or through experience. Participants also indicated limited access to licensing support and formal training opportunities, suggesting systemic gaps in capacity-building efforts. In addition, misunderstandings about basic food safety principles such as cross-contamination and the importance of using separate equipment for raw and cooked foods were common, often compounded by resource constraints like limited utensils. These qualitative insights help explain the quantitative findings, indicating that formal training not only improves knowledge but also equips vendors with practical skills and risk awareness that informal learning alone may not provide (Table 5).