Household Food Safety, WASH and Environmental Health Practices in the Context of Nutrition-Sensitive Agriculture: A Comparative Study in Northwest Ethiopia

Background Household food safety and Water, Sanitation, and Hygiene (WASH) are critical determinants of nutritional status and the prevention of infectious diseases. This study provides an integrated assessment of food safety, WASH, and environmental health practices among beneficiaries of the Productive Safety Net Programme (PSNP) and Nutrition-Sensitive Agriculture (NSA) interventions in rural Ethiopia. Methods A cross-sectional survey was conducted among 586 households in the Ebinat and Farta woredas of Northwest Ethiopia, stratified by intervention status. Data were collected using structured questionnaires. Composite indices were constructed using mean values and Bloom’s cut‑off criteria to classify knowledge and practices related to food safety, hygiene, and sanitation; WASH adequacy; and environmental health. Binary logistic regression identified predictors of food safety, WASH adequacy, and environmental health conditions. Results Food safety was the weakest domain; 74.2% of households engaged in poor practices, and only 9.0% achieved a “good” rating. A notable knowledge–practice gap was observed in hygiene, where 26.6% had good knowledge but only 12.5% practiced well. In contrast, 59.2% reported adequate WASH conditions, with a peak of 73.5% among PSNP + NSA participants. Regression analysis showed that food safety was primarily influenced by paternal literacy, prior awareness, and socioeconomic status, while program participation and wealth were the strongest predictors of WASH adequacy. Maternal literacy and program support significantly improved environmental health practices. Conclusion Integrated programs have strengthened WASH infrastructure but remain less effective at shifting entrenched food‑handling behaviors. Achieving sustainable health outcomes will require culturally tailored interventions, greater investment in parental literacy, and the integration of practical hygiene demonstrations into multisectoral platforms. Together, these strategies can bridge the knowledge–practice gap and enhance the long‑term effectiveness of nutrition‑sensitive initiatives.