Theory-Based Intervention Module on Occupational Safety and Health (TRIMOSH) in Improving Knowledge, Attitude, and Practice Among Food Industries Workers: Study Protocol for A Randomized Controlled Trial

Food Industries workers are defined as individuals who are directly involved in the food preparation, come into contact with food or food contact surfaces, and handle packaged or unpackaged food, or appliances, on any food premises (1). Since 1996, the Ministry of Health Malaysia (MOH) has launched the food handler training course to give exposure and awareness to food Industries workers on food safety, hygiene, self-hygiene, and premise hygiene, mainly to prevent food poisoning incidents in the country (2). Subsequently, under Food Hygiene Regulations 2009, all food Industries workers are compulsory to attend the Food Handler Training Programme organized by any school or institute that has been certified by MOH. Under this regulation, any food industries workers who fails to undergo training or obtain a Certificate of Food Handlers Training shall be liable to a fine or compound not exceeding RM10,000 or imprisonment for a term not exceeding 2 years (3).

Regarding occupational safety and health of workers who work as food industries workers in Malaysia, they are generally governed and regulated by Act 514 Occupational Safety and Health (OSHA) Act 1994 as for any other occupations (4). It is within the spirit of the act to secure the safety, health, and welfare of persons at work to protect the workers and others from any risk or health implication associated with the activities of persons at work and prevent occupational diseases. An occupational disease is defined as any disease contracted due to exposure to risk factors arising from work activity (5). However, there is currently no occupational safety and health training module, required or made compulsory by the government for food industries workers to equip them with appropriate knowledge, attitude, and practice on occupational safety and health to prevent injuries and illnesses related to their work.

The food and beverages industry contributed a significant income to Malaysia's Gross Domestic Products (6). The contribution is projected to swell more in the upcoming years. As the industry expands, the demand for the workforce in the food premises will also continuously increase. The workforce substantially involves workers from the food processing sector, food distribution sector, and food service sector in the food premises. They are exposed to risks arising from physical, chemical, biological, mechanical, and social hazards while performing their duties. As the workers' volume increases, the number of accidental injuries or occupational diseases related to the food and beverages industry is expected to increase as well. Thus, it is essential for food industries workers who work in food premises to be equipped with the proper knowledge, attitude, and practice (KAP) towards safety and health.

At global level, 14.1% of nonfatal occupational injuries and illnesses involving days away from work (DAFW) in private Industry in 2020 goes to manufacturing industry including the food and beverages sector while 7.2% from food services (7).The highest number of nonfatal occupational injuries and illnesses involving days away from work (DAFW) in private Industry involving food industries workers within the industries contribute about 22% of total reported cases or around 0.3 million cases (8). Of all the reported injuries and illnesses cases, cuts, lacerations and punctures (15%) were the highest contributors of injuries and illnesses for known classified cases among food industries workers, followed by sprain, strains, and tears (15%), soreness and pain (13%), thermal burn (8%), bruises and contusions (5%), fractures (4%), multiple traumatic injuries (1%), chemical burns and corrosions (1%), carpal tunnel syndrome (1%), amputation (0.4%) and tendonitis (0.06%). However, there was a sum of reported cases that were non-classifiable and contributed to about 35% of the total reported cases among food industries workers (9). The highest number of injuries and illnesses experienced by food industries workers have resulted from exposure to harmful substances or environments (34%), followed by contact with objects or equipment (22%), falls, slips, and trips (21%), overexertion and bodily reaction (19%), transportation incidents (2%), violence and other injuries by persons or animal (1%), other events or exposures (0.4%) and fires and explosions (0.09%) (10). the top ten occupations that have been reported to have the highest incidence of occupational injuries and illnesses among food industries workers were observed among those who work in food preparation and serving related occupations (25%), cooks, and food preparation workers (10%), food and beverage serving workers (9%), food processing workers (6%), cooks (5%) fast food and counter workers (5%), food preparation workers (5%), supervisors of food preparation and serving workers (4%) butchers and other meat, poultry and fish processing workers (3%) and other food preparation and serving related workers (3%) (9).

Based on local statistics, the manufacturing industry, including the food and beverages sector, accounted for the most significant contributor to all confirmed occupational poisoning and disease cases at 82.3%. On the other hand, the percentage of confirmed cases from hotels and restaurants and wholesale and retail trades accounted for 0.5% and 0.3% of total confirmed cases. According to the sector, in terms of accidental injury at the workplace, DOSH Malaysia generally reported an increasing trend of accidents among food industries workers from year to year. In 2020 only, 62% of accidents with temporary disability, 84% of accidents with a permanent disability, and 34% of death reported to DOSH were coming from the manufacturing industry. On the other hand, 2% of accidents with temporary disability, 0.4% of accidents with a permanent disability, and 0.7% of death reported to DOSH came from the hotel and restaurants industry. Wholesale and retail trade reported a 2% of accidents with temporary disability, 0.4% of accidents with a permanent disability, and 0.4% of death to DOSH (5).