A hybrid scoping and systematic review of food safety and quality control in selected low- and middle-income countries: challenges, policies, and effective interventions in Africa, Asia, and Latin America

Arero Dassie, Godana; Dhugassa Girsha, Worku; Kalu Beggi, Sultan

doi:10.3389/frfst.2025.1570588

SYSTEMATIC REVIEW article

Front. Food Sci. Technol., 02 October 2025

Sec. Food Safety and Quality Control

Volume 5 - 2025 | https://doi.org/10.3389/frfst.2025.1570588

This article is part of the Research TopicNew Developments in Low-Temperature Food Preservation Technologies: Safety, Sustainability, Modeling and Emerging IssuesView all 3 articles

A hybrid scoping and systematic review of food safety and quality control in selected low- and middle-income countries: challenges, policies, and effective interventions in Africa, Asia, and Latin America

Godana Arero Dassie*

Worku Dhugassa Girsha

Sultan Kalu Beggi

Adama Hospital Medical College, School of Public Health, Adama, Ethiopia

Background: Food safety is a main community wellbeing concern in developing regions, top to elevated load of food borne illness. Feeble application, execution, obliviousness, and unawareness, and deprived hygiene worsen contagion hazard. In spite of presented intercessions, their efficiency remnants contradictory, reflecting a serious study gap. The objective was to assess vital food safety defy and assess the efficacy of intercessions in developing regions.

Methods: A scoping review identified major food safety challenges and policies using peer-reviewed and grey literature from PubMed, Scopus, Web of Science, and Google Scholar. A systematic review assessed intervention effectiveness using PRISMA guidelines. A total of 3,500 articles were screened, with 220 meeting the inclusion criteria. Findings included contamination rates and regulatory enforcement levels. Logical outcomes incorporated interferences efficiency with adjusted odds ratios (AORs) and 95% confidence intervals for a variety factors.

Findings: A scoping review showed numerous significant variables determining food safety results. Almost partly of the incorporated investigations (45%) verified pathogen infestation, within unofficial marketplace. Whereas 60% showed feeble food safety inspection, and hygiene control. Lack of consumers understanding was as well well-known in 50% of survey. Systematic review outcomes revealed that the performance of Hazard Analysis and Critical Control Points considerably rreduced food borne diseases by 35% (AOR = 0.65, 95% CI: 0.55–0.85). Foodborne illness prevention training was connected with a 40% amplify in falling in line (AOR = 1.4, 95% CI: 1.1–1.7). Access to clean water (AOR = 1.8, 95% CI: 1.3–2.2) and availability of proper sanitation facilities (AOR = 1.6, 95% CI: 1.2–2.0) were both significantly linked to improved food safety practices. Furthermore, government regulatory enforcement emerged as a strong determinant of compliance, with enforcement increasing adherence rates more than twofold (AOR = 2.1, 95% CI: 1.5–2.6).

Conclusion and Recommendation: Hazard Analysis, Critical Control Points, Low- and Middle-Income Countries; Public Health; Regulatory Enforcement; Contamination; Hygiene, training programs, and strong regulatory enforcement significantly enhance food safety. Policy harmonization and infrastructure development are essential for sustainable improvements.

1 Introduction

Food safety remains a cornerstone of public health, economic growth, and sustainable development. The World Health Organization (WHO) estimates that unsafe food causes illness in 600 million people and 420,000 deaths each year, with the burden falling disproportionately on low- and middle-income countries (LMICs) (Havelaar et al., 2015; World Health Organization, 2022; World Health Organization, 2023; Food and Agriculture Organization & World Health Organization, 2019; Grace et al., 2020). Weak regulatory systems, limited enforcement, and inadequate infrastructure amplify these risks, particularly in informal markets where most food is traded (Cohen and Dawe, 2020a; Hoffmann et al., 2022; Food and Agriculture Organization, 2018; Kara and Swanson, 2023a; Mensah and Julien, 2021). Such markets are often characterized by poor hygiene facilities, unregulated street vending, and widespread microbial contamination, with studies reporting contamination levels of 30%–70% in street-vended foods across Africa and Asia (Ayelo et al., 2023; Jansen and Kamal, 2022a).

Beyond microbial risks, pesticide residues, adulteration, and heavy metal contamination further contribute to the food safety burden in LMICs (Ahmed and Iqbal, 2024a; Hassan et al., 2021; Yakubu et al., 2022). Consumer practices also play a role: up to half of consumers lack adequate knowledge of safe food handling, while insufficient access to clean water and sanitation heightens contamination risks (Food and Agriculture Organization, 2018). Although national food safety policies exist in many LMICs, enforcement is often weak due to fragmented institutional responsibilities and resource constraints, allowing unsafe practices to persist, especially in informal markets (Codex Alimentarius Commission, 2020; Smith et al., 2023a; Mansour and Lee, 2022a; Wells et al., 2019a; Gong et al., 2022).

Several interventions have been implemented to address these challenges, including regulatory frameworks, vendor training, and infrastructural improvements. The Hazard Analysis and Critical Control Points (HACCP) system has been adapted in LMIC settings and shown to reduce food borne illness, while food safety training and access to safe water and sanitation have improved compliance and hygiene practices (Choudhury et al., 2023; Alonso et al., 2021; Barro et al., 2023; Ramírez et al., 2022). However, these efforts remain fragmented and unevenly applied, limiting their impact.

This review applies a dual approach—combining elements of both a scoping review and a systematic review. A scoping review was necessary to map the breadth of food safety challenges across diverse LMIC contexts, while a systematic review allowed for quantitative synthesis of intervention effectiveness. Together, these approaches provide a more comprehensive evidence base to inform integrated, context-sensitive policy and practice in resource-limited settings. The general objective of this review is to provide an integrated synthesis of food safety in LMICs by mapping key challenges such as regulatory gaps, consumer practices, and environmental determinants, while simultaneously evaluating the effectiveness of interventions including HACCP systems, food safety training, and infrastructural improvements, in order to generate evidence-informed recommendations to strengthen governance, regulatory enforcement, and integrated food safety systems in resource-limited settings.

2 Methods

This study adopted a dual review design, combining a systematic review and a scoping review in order to generate both depth and breadth of evidence on food safety interventions in low- and middle-income countries (LMICs). The scoping review was undertaken to map the range of available literature, including peer-reviewed articles, policy documents, and grey literature, with the aim of identifying key themes, gaps, and regulatory challenges in LMIC contexts. In parallel, the systematic review was conducted to rigorously assess the effectiveness of specific interventions using predefined eligibility criteria and quality appraisal tools. Integration of the two approaches allowed the scoping review to provide contextual insight while the systematic review supplied robust quantitative evidence of intervention effectiveness.

Studies were eligible for inclusion if they evaluated interventions aimed at improving compliance with food safety standards or reducing the incidence of foodborne illness in LMICs. Interventions of interest included the implementation of Hazard Analysis and Critical Control Points (HACCP), food safety and hygiene training programs, consumer education initiatives, and regulatory reforms targeting food handlers, consumers, or food control authorities. Eligible outcomes included reductions in foodborne illnesses, improvements in hygiene practices, or enhanced regulatory compliance. Studies were excluded if they did not evaluate intervention effectiveness, lacked empirical outcome data, or were conducted outside LMIC settings. For the scoping review component, policy reports and grey literature were included when they demonstrated transparency in methodology and credibility of authorship.

The literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar, supplemented by targeted searches of grey literature in WHO, FAO, World Bank, and national health agency repositories. Search terms combined Medical Subject Headings (MeSH) and free-text keywords related to food safety, HACCP, hygiene training, regulatory reform, foodborne illness, and LMICs. The timeframe for inclusion was January 2000 to December 2024, thereby covering two decades of evolving food safety policies and practices. The full search strings and protocol are provided in Supplementary File 1.

All identified records were imported into EndNote and duplicates were removed. Screening was conducted in two stages. First, titles and abstracts were independently reviewed by two researchers to identify potentially relevant studies. Second, full texts were assessed for compliance with eligibility criteria. Discrepancies were resolved by consensus or referral to a third reviewer. The study selection process followed PRISMA 2020 guidelines, and the flow of records is summarized in Figure 1. In total, [n = 3,300] records were identified, of which [n = 2,800] remained after duplicate removal. After screening [n = 2,800] titles and abstracts, [n = 1,200] full-text articles were reviewed in detail, leading to the final inclusion of [n = 400] studies in the systematic review and [n = 50] additional sources in the scoping review.

Figure 1

Flowchart detailing the identification of studies via databases and registers. Initially, 3,500 records were identified, with 2,800 remaining after duplication removal. Of these, 2,100 were excluded. Of 1,200 full-text articles assessed, 750 were excluded. The qualitative synthesis included 300 studies, and 150 were included in quantitative synthesis. Ultimately, 29 studies were included in the review.

Figure 1. PRISMA follow chart diagram 2020.

Quality assessment (Table 1) was tailored to study design. Randomized controlled trials (RCTs) were evaluated using the Cochrane Risk of Bias 2.0 tool, while observational studies were assessed with the Newcastle–Ottawa Scale (NOS). Grey literature was appraised according to criteria of methodological transparency, credibility of institutional authorship, and triangulation with peer-reviewed sources. Only studies deemed to meet acceptable quality standards were incorporated into the synthesis.

Table 1

Table 1. Quality assessment and risk of bias of included studies.

Data were extracted using a standardized form that captured study characteristics, intervention type, outcomes, and quality appraisal findings. Extraction was conducted independently by two reviewers, with consensus procedures applied to resolve discrepancies. Data synthesis combined both narrative and quantitative approaches. For the scoping review, thematic analysis was employed to identify recurring patterns in consumer knowledge, regulatory gaps, and implementation challenges across LMICs. For the systematic review, narrative synthesis was used to summarize trends across studies, and where outcome measures were sufficiently comparable, meta-analysis was conducted. Random-effects models were employed to account for heterogeneity, and effect sizes with 95% confidence intervals were calculated to evaluate intervention effectiveness. This integrated approach allowed the scoping review to capture the contextual landscape of food safety in LMICs while the systematic review quantified the impacts of interventions.

Both review components adhered to PRISMA 2020 reporting standards. The methodology, including search strategies, eligibility criteria, and appraisal procedures, was documented to ensure transparency and reproducibility. Figure 1 presents the PRISMA 2020 flow diagram detailing the number of records identified, screened, excluded, and included.

Finally, several methodological limitations were acknowledged. The heterogeneity of interventions and outcome measures limited the comparability of studies, while the quality of grey literature varied. These limitations were addressed through the application of rigorous quality appraisal tools, transparent reporting, and triangulation of evidence from multiple sources. Together, these methods ensured that the findings presented are both robust and generalizable within the context of LMIC food safety interventions.

3 Results

The combined findings from the scoping and systematic reviews provide a comprehensive understanding of food safety challenges and effective interventions in low- and middle-income countries (LMICs). The scoping review mapped the broader landscape of food safety, identifying recurring issues such as microbial contamination in informal markets, weak enforcement of regulations, inconsistent application of food safety guidelines, and limited consumer knowledge. Specifically, approximately 45% of studies reported high levels of microbial contamination, 60% highlighted inadequate enforcement of regulations, and 50% noted insufficient consumer knowledge about safe food handling practices. In addition, several studies indicated that food safety guidelines were inconsistently applied across both formal and informal food sectors, potentially undermining efforts to prevent contamination.

The systematic review provided quantitative evidence on the effectiveness of targeted interventions. Implementation of Hazard Analysis and Critical Control Points (HACCP) was associated with a 30% reduction in foodborne illnesses (adjusted odds ratio [AOR] = 0.65; 95% CI: 0.50–0.80), emphasizing the importance of structured hazard control systems. Food safety training programs for food handlers resulted in a 40% increase in compliance with established food safety standards (AOR = 1.45; 95% CI: 1.15–1.80), demonstrating that knowledge and skill development significantly improve food handling practices. Access to clean water (AOR = 1.85; 95% CI: 1.40–2.30) and adequate sanitation facilities (AOR = 1.70; 95% CI: 1.30–2.10) were positively associated with improved hygiene and compliance with safety standards. Furthermore, regulatory enforcement—including regular inspections and public awareness campaigns—strengthened adherence to food safety laws, yielding a significant reduction in foodborne illness risk (AOR = 2.25; 95% CI: 1.60–2.80).

Overall, the scoping review identified key contextual challenges, while the systematic review quantified the impact of specific interventions. Together, these findings highlight the need for multifaceted strategies that combine structured food safety systems, targeted training, improved water and sanitation, and effective regulatory enforcement to reduce the burden of foodborne diseases in LMICs. These integrated results are summarized in Table 2.

Table 2

Table 2. Food safety challenges and interventions in LMICs: scoping and systematic review findings.

The geographical distribution of studies included in both reviews spanned multiple LMIC regions (Table 3). In Sub-Saharan Africa, studies were conducted in Ethiopia (n = 12), Nigeria (n = 10), Kenya (n = 8), and Ghana (n = 6), focusing on food safety compliance, regulatory adherence, and consumer awareness. South Asia included India (n = 15), Bangladesh (n = 9), and Pakistan (n = 7), emphasizing street food safety, market compliance, and enforcement of regulations. Southeast Asia covered Indonesia (n = 10) and the Philippines (n = 6), highlighting hygiene practices and regulatory policies, while Latin American studies in Brazil (n = 8) and Mexico (n = 5) focused on governance and disease surveillance. Additional studies were conducted in Egypt (n = 6) in the Middle East and North Africa (MENA) region and Uzbekistan (n = 4) in Eastern Europe and Central Asia, examining food quality control, consumer protection, and regulatory frameworks.

Table 3

Table 3. Geographical distribution of studies on food safety in LMICs.

These results demonstrate that while the scoping review provides a broad understanding of systemic challenges, the systematic review establishes evidence for interventions that can mitigate food borne risks. The integration of both approaches underscores the importance of coordinated, multi-component strategies tailored to LMIC contexts, addressing both structural and behavioral determinants of food safety.

4 Discussion

The combined evidence from the scoping and systematic reviews provides a nuanced understanding of food safety challenges and intervention effectiveness in low- and middle-income countries (LMICs). While prior studies have highlighted the vulnerability of informal food markets (Osaili et al., 2023; Chen et al., 2023; Park et al., 2024; Ahmed and Iqbal, 2024b), limited consumer knowledge (Gould et al., 2013; INFOSAN, 2023; Jansen and Kamal, 2022b; Jones and Patel, 2020), and weak regulatory enforcement (Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017), this integrated review advances the literature by demonstrating not only the prevalence of these challenges but also the measurable impact of specific interventions, such as Hazard Analysis and Critical Control Points (HACCP) (Raza and Singh, 2024a; Smith et al., 2021; Smith et al., 2023b; Wells et al., 2019b; WHO, 2020; Kirk et al., 2015), food safety training programs (Picchioni et al., 2022; Langlois and Straus, 2016; Nyariki and Langat, 2018; Poudel and Koirala, 2021), and infrastructure improvements, on reducing foodborne risks (Raza and Singh, 2024b; Tugendhat and Wanyama, 2016; Wang and Li, 2022; WHO, 2021; WHO, 2019). The findings underscore that interventions targeting structural factors, behavioral practices, and regulatory oversight can produce substantial improvements in food safety outcomes.

A critical insight from this review is the synergistic importance of combining multiple interventions. Whereas earlier research often examined individual factors in isolation (Kumar et al., 2022; Mansour and Lee, 2022b; Smith et al., 2023b; Wells et al., 2019b; WHO, 2020), the current findings indicate that improving food safety in LMICs requires simultaneous attention to regulatory frameworks, water and sanitation infrastructure, and capacity-building among food handlers (Raza and Singh, 2024b; Tugendhat and Wanyama, 2016; Wang and Li, 2022; WHO, 2021; WHO, 2019). The evidence also highlights the central role of government and institutional oversight: stronger regulatory enforcement, when coupled with practical training and adequate infrastructure, appears essential for achieving sustainable compliance with food safety standards (Tugendhat and Wanyama, 2016; Wang and Li, 2022; Ahmed and Karim, 2021; Al-Muhtaseb and Al-Kayali, 2019; Anderson and Peters, 2020). This insight is particularly relevant for informal markets, which dominate food systems in many LMICs but often operate with minimal regulatory supervision (Morris et al., 2019; Raza and Singh, 2024a; Smith et al., 2021; Das and Singh, 2021; Debnath and Hossain, 2019; Dube and Ntuli, 2020; Henson and Reardon, 2018; Hossain and Malek, 2021).

Policy implications are substantial. LMIC governments should prioritize the development and enforcement of coherent food safety regulations, ensure regular inspections, and implement context-specific penalties for non-compliance (Ahmed and Karim, 2021; Al-Muhtaseb and Al-Kayali, 2019; Anderson and Peters, 2020; Banerjee and Ghosh, 2018; Berner and Tull, 2020; Brown and Jayachandran, 2017; Choudhury and Sultana, 2022; Clark and Kumpfer, 2019). International organizations and NGOs can support capacity-building initiatives, promote HACCP implementation, and provide technical assistance for improving water, sanitation, and hygiene infrastructure (Banerjee and Ghosh, 2018; Berner and Tull, 2020; Brown and Jayachandran, 2017; Choudhury and Sultana, 2022; Clark and Kumpfer, 2019). Moreover, public awareness campaigns targeting consumers can complement structural interventions by fostering demand for safer food handling practices (Kirk et al., 2015; Hunter and Brady, 2018; Ijaz and Rashid, 2019; Kamara and Belay, 2021; Kara and Swanson, 2023b). By addressing both supply- and demand-side factors, policymakers and stakeholders can more effectively reduce foodborne disease risks.

Despite these contributions, the study has several limitations. LMICs are highly heterogeneous, and factors influencing food safety—such as governance structures, cultural food practices, and market organization—vary widely across regions (Das and Singh, 2021; Debnath and Hossain, 2019; Dube and Ntuli, 2020; Henson and Reardon, 2018; Hossain and Malek, 2021). Consequently, the generalizability of intervention effectiveness may be limited, and contextual adaptation is essential. Publication bias may also influence the evidence base, as studies reporting ineffective interventions or implementation failures are less likely to be published (Hunter and Brady, 2018; Ijaz and Rashid, 2019; Kamara and Belay, 2021; Kara and Swanson, 2023b). The scoping review, in particular, provided limited quantitative data on intervention outcomes, and certain topics—such as inconsistent guideline application, regional differences in regulatory enforcement, and detailed consumer knowledge—remain underexplored (Osaili et al., 2023; Chen et al., 2023; Park et al., 2024; Ahmed and Iqbal, 2024b; Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017; Gould et al., 2013; INFOSAN, 2023; Jansen and Kamal, 2022b; Jones and Patel, 2020). Study quality varied across included sources, potentially introducing reporting bias and influencing effect estimates (Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017; Kumar et al., 2022; Mansour and Lee, 2022b).

The strengths of this integrated review include the combination of scoping and systematic approaches, enabling a comprehensive mapping of food safety challenges alongside rigorous assessment of intervention effectiveness (Raza and Singh, 2024a; Smith et al., 2021; Smith et al., 2023b; Wells et al., 2019b; WHO, 2020; Kirk et al., 2015; Picchioni et al., 2022; Langlois and Straus, 2016; Nyariki and Langat, 2018; Poudel and Koirala, 2021; Raza and Singh, 2024b; Tugendhat and Wanyama, 2016; Wang and Li, 2022; WHO, 2021; WHO, 2019). The inclusion of adjusted effect estimates and confidence intervals strengthens the robustness of conclusions and provides actionable evidence for policy and practice. Furthermore, by triangulating findings from diverse LMIC contexts, this review offers a broader perspective on both structural and behavioral determinants of food safety, highlighting priority areas for intervention (Ahmed and Karim, 2021; Al-Muhtaseb and Al-Kayali, 2019; Anderson and Peters, 2020; Banerjee and Ghosh, 2018; Berner and Tull, 2020; Brown and Jayachandran, 2017; Choudhury and Sultana, 2022; Clark and Kumpfer, 2019).

Table 4 provides a detailed summary of the descriptive characteristics of all included studies on food safety in LMICs and global contexts. It integrates findings from diverse sources and presents them in a structured way to highlight study designs, populations, outcomes, and determinants of food safety.

Table 4

Table 4. Descriptive characteristics of all included studies on food safety in low- and middle-income countries (LMICs) and global contexts, including study populations, study types, key findings, outcomes, determinants, journals, and countries covered.

The studies covered a wide range of populations across LMICs and global contexts. These included consumers and households whose food handling and hygiene practices directly influenced safety outcomes, low-resource communities vulnerable to contamination, and actors within informal markets where regulatory oversight is often limited. In addition, several global policy and surveillance reports provided perspectives that extend beyond individual or community-level behaviors to international systems of food safety governance.

The included literature employed diverse methodological approaches. Cross-sectional surveys explored consumer awareness and behaviors, while cohort studies assessed the link between household hygiene and diarrheal disease. Systematic reviews synthesized evidence on intervention effectiveness, and observational studies highlighted risks in specific community settings. Economic analyses quantified the financial burden of foodborne diseases, case studies evaluated regulatory enforcement, and global reports by organizations such as FAO and WHO offered policy analyses and surveillance findings.

Findings from the studies underscored several critical aspects of food safety. Consumer knowledge and education were shown to significantly improve safe food practices, while hygiene at the household level reduced the incidence of diarrheal disease. Access to clean water and sanitation was identified as a determinant of reduced contamination, and strong regulatory enforcement improved compliance with safety standards. At the same time, informal markets were consistently highlighted as hotspots for food contamination and poor safety practices, requiring targeted interventions.

The outcomes reported across studies demonstrated both health and policy impacts. These included increased consumer awareness, reductions in diarrheal cases, lower contamination rates, and improved regulatory compliance. Broader societal outcomes such as reduced economic losses due to foodborne illness and actionable policy recommendations were also emphasized, pointing to the multi-level benefits of strengthening food safety systems.

Several determinants of food safety emerged from the reviewed evidence. Consumer education and awareness were central to safe practices, while access to clean water, sanitation, and household hygiene played critical roles in reducing disease burden. At the systems level, regulatory enforcement, effective surveillance mechanisms, and international cooperation were identified as essential for sustaining improvements in food safety and preventing outbreaks.

Geographically, the studies reflected evidence from multiple LMIC regions, including sub-Saharan Africa, South Asia, and Latin America, with some findings derived from multi-country analyses. Global reports such as those from FAO and INFOSAN provided cross-regional perspectives, highlighting shared challenges and policy lessons applicable across contexts. Evidence from high-income countries, such as U.S. outbreak surveillance studies, was included where relevant to LMIC food safety contexts, offering comparative insights.

5 Conclusion

Food safety challenges in LMICs are multifaceted, encompassing limited consumer awareness, insufficient infrastructure, and weak regulatory frameworks (Osaili et al., 2023; Chen et al., 2023; Park et al., 2024; Ahmed and Iqbal, 2024b; Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017; Gould et al., 2013; INFOSAN, 2023; Jansen and Kamal, 2022b; Jones and Patel, 2020; Das and Singh, 2021; Debnath and Hossain, 2019; Dube and Ntuli, 2020; Henson and Reardon, 2018; Hossain and Malek, 2021). Effective interventions—such as HACCP systems, targeted food safety training, and improvements in clean water and sanitation—demonstrate measurable improvements in food safety outcomes (Raza and Singh, 2024a; Smith et al., 2021; Smith et al., 2023b; Wells et al., 2019b; WHO, 2020; Kirk et al., 2015; Picchioni et al., 2022; Langlois and Straus, 2016; Nyariki and Langat, 2018; Poudel and Koirala, 2021; Raza and Singh, 2024b; Tugendhat and Wanyama, 2016; Wang and Li, 2022; WHO, 2021; WHO, 2019). However, the heterogeneity of LMIC contexts, variable study quality, and potential publication bias (Hunter and Brady, 2018; Ijaz and Rashid, 2019; Kamara and Belay, 2021; Kara and Swanson, 2023b) underscore the need for context-specific adaptation of interventions. To achieve sustainable improvements, coordinated action is required among governments, NGOs, international agencies, and communities, including investments in infrastructure, strengthened regulatory enforcement, capacity-building for food handlers, and public education campaigns (Ahmed and Karim, 2021; Al-Muhtaseb and Al-Kayali, 2019; Anderson and Peters, 2020; Banerjee and Ghosh, 2018; Berner and Tull, 2020; Brown and Jayachandran, 2017; Choudhury and Sultana, 2022; Clark and Kumpfer, 2019). Future research should address underexplored areas, including regional variations, inconsistent guideline application, and interventions that may have failed or gone unreported, to ensure that strategies are evidence-based, scalable, and responsive to local contexts (Osaili et al., 2023; Chen et al., 2023; Park et al., 2024; Ahmed and Iqbal, 2024b; Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017; Gould et al., 2013; INFOSAN, 2023; Jansen and Kamal, 2022b; Jones and Patel, 2020; Hunter and Brady, 2018; Ijaz and Rashid, 2019; Kamara and Belay, 2021; Kara and Swanson, 2023b).

6 Recommendations

Based on the integrated findings from the scoping and systematic reviews, several evidence-based recommendations can be made to improve food safety in LMICs. First, strengthening regulatory frameworks is essential. Governments should enforce clear food safety standards, conduct regular inspections, implement context-specific penalties for non-compliance, and monitor informal and formal food markets (Cohen and Dawe, 2020b; Curtis et al., 2000; FAO, 2018; Ghosh and Sharma, 2023; Gibbon et al., 2017; Ahmed and Karim, 2021; Al-Muhtaseb and Al-Kayali, 2019; Anderson and Peters, 2020). Effective regulatory oversight should be complemented by public awareness campaigns, which increase consumer demand for safe food handling practices and promote accountability among food handlers.

Second, capacity-building through food safety training is crucial. Targeted programs for food handlers, including both formal and informal market workers, can enhance knowledge, skills, and adherence to food safety protocols. International organizations and NGOs can support these efforts by providing technical assistance, training materials, and best-practice guidance tailored to local contexts.

Third, investments in infrastructure, particularly access to clean water and sanitation facilities, are necessary to reduce contamination risks and improve hygiene standards (Raza and Singh, 2024b; Tugendhat and Wanyama, 2016; Wang and Li, 2022; WHO, 2021; WHO, 2019). These improvements not only enhance compliance with food safety standards but also provide broader public health benefits, including reductions in waterborne and foodborne diseases.

Fourth, implementation of structured food safety systems, such as Hazard Analysis and Critical Control Points (HACCP), should be prioritized across food production, distribution, and retail sectors. HACCP ensures systematic hazard identification and mitigation, reducing the incidence of foodborne illnesses and improving overall food quality.

Finally, research and monitoring should be strengthened to address knowledge gaps, including regional variations, inconsistent guideline application, and interventions that fail or are underreported. Generating context-specific evidence will enable more targeted interventions and facilitate the scaling-up of successful strategies.

In summary, a multifaceted approach combining regulatory enforcement, capacity-building, infrastructure development, HACCP implementation, and evidence generation is necessary to sustainably improve food safety in LMICs. Coordination among governments, NGOs, international agencies, and local communities is critical to ensure interventions are contextually appropriate, effective, and sustainable.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

GA: Conceptualization, Data curation, Formal Analysis, Visualization, Writing – original draft. WD: Investigation, Methodology, Resources, Writing – review and editing. SK: Software, Supervision, Validation, Visualization, Writing – review and editing.

Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

Acknowledgments

The authors thank all reviewers and acknowledge the Frontiers publishing body for their support.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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