| Summary: | The presence of crowds during Hajj increases the risk of foodborne infection. Yet, research on the practices of food handlers during Hajj is limited. This study aimed to assess compliance with food safety practices and its associated factors during Hajj 2022. An observational cross-sectional study was conducted in Mecca and Madinah before and during Hajj 2022 and involved 195 food-serving establishments (FSEs) contracted for Hajj catering. Collected data included visit time, establishment location, licensure, whether food handlers had food safety training (professional training), and whether FSEs were under supervision from a consulting office (professional supervision). The included FSEs were 168/195 (86.2%). Two-thirds of FSEs surveyed (113, 67.3%) were under professional supervision, and 91 (54.2%) hired trained food safety workers. Compliance rates varied between outcomes (72.67 ± 17.21% to 88.3 ± 18.8%). Compared to Mecca, Madinah FSEs were more adherent to cleanliness (80.5 ± 27.9% vs. 91.5 ± 19.9%, respectively, <i>p</i> = 0.006). FSEs with trained workers were more likely to comply with proper food safety practices compared to those with untrained workers: cleanliness (OR: 7.2, 95% CI [2.6–20.23], <i>p</i> < 0.001); workers’ commitment to health requirements (OR: 2.8, 95% CI [1.1–6.9], <i>p</i> = 0.025); handling of refrigerated and frozen food (OR: 5.27, 95% CI [1.83–15.20], <i>p</i> = 0.004); and food storage practices (OR: 12.5, 95% CI [2.0–12.5], <i>p</i> < 0.001). The role of professional training in increasing food safety practices compliance was highlighted. FSEs in Madinah were more compliant with food safety practices than those in Mecca. Therefore, Mecca FSEs may need stringent safety measures.
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