Abstract:
Introduction: A leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers
but norovirus outbreaks are not routinely investigated in Kenya. We estimated norovirus prevalence and
associated factors among food handlers in an informal urban settlement in Nairobi, Kenya.
Methods: We conducted a cross-sectional survey among food handlers using pretested questionnaires and
collected stool specimens from food handlers which were analyzed for norovirus by conventional PCR. We
observed practices that allow norovirus transmission and surveyed respondents on knowledge, attitudes, and
practices in food safety. We calculated odd ratios (OR) with 95% confidence intervals (CI) to identify factors
associated with norovirus infection. Variables with p < 0.05 were included in multivariate logistic regression
analysis to calculate adjusted OR and 95% CI.
Results: Of samples from 283 respondents, 43 (15.2%) tested positive for norovirus. Factors associated with
norovirus detection were: reporting diarrhea and vomiting within the previous month (AOR = 5.7, 95% CI =
1.2–27.4), not knowing aerosols from infected persons can contaminate food (AOR = 6.5, 95% CI = 1.1–37.5),
not knowing that a dirty chopping board can contaminate food (AOR = 26.1, 95% CI = 1.6–416.7), observing
respondents touching food bare-handed (AOR = 3.7, 95% CI = 1.5–11.1), and working in premises without hand
washing services (AOR = 20, 95% CI = 3.4–100.0).
Conclusion: The norovirus infection was prevalent amongst food handlers and factors associated with
infection were based on knowledge and practices of food hygiene. We recommend increased hygiene
training and introduce more routine inclusion of norovirus testing in outbreaks in Kenya.