This cross-sectional study was conducted from February to March 2023 in three major cities in Burkina Faso: Ouagadougou (12˚21'58" N, 1˚31'05" W), Bobo-Dioulasso (11˚11'00" N, 4˚17'00" W), and Koudougou (12˚15'04" N, 2˚22'28" W). These cities are located in the Central (Kadiogo Province), Hauts-Bassins (Houet Province), and Central West (Boulkiemdé Province) regions, respectively ( Figure 1 ).

To identify potential risk factors and assess hygiene practices in the attiéké production and distribution chain in Burkina Faso, a field study was conducted. Three hundred (300) vendors were interviewed face-to-face using structured questionnaires, complemented by direct observation of production, processing, distribution, and sales sites. The sample size was estimated by the simple random sampling method performed by [8] using ɛ = 1.96 for an accuracy α = 5%, the formula is as follows:

$\text{N}=\frac{{\epsilon }^2\times \text{p}\times \text{Q}}{{\text{i}}^2}$

Q = 1 − p, i being the precision. The prevalence (p) is estimated to be 68% among sellers [9] . With this method, 318 vendors were obtained. The required sample sizes for all the 3 cities were 367 vendors with 10% relative precision. The sample sizes were further adjusted as indicated above.

A total of 225 attiéké samples, each weighing 500 g, were collected in a reasoned manner from various public markets in Ouagadougou, Bobo-Dioulasso, and Koudougou ( Table 1 ). The samples, representing individually sold portions, were labeled, placed in freezer bags, stored in coolers with ice, and transported to the laboratory for microbiological analysis.

Staphylococcus aureus was isolated from attiéké samples following [10] . Serial dilutions (10⁻¹, 10⁻², 10⁻³) were prepared and spread-plated onto Chapman selective medium (Mannitol Salt Agar, Liofilchem, Italy) at pH 7.4 ± 0.2. Plates were incubated at 37˚C for 24 - 48 hours, and small yellow colonies (0.5 - 2 mm) were selected for further analysis. Suspected S. aureus colonies were subcultured onto Mueller-Hinton (MH) agar and subjected to standard microbiological tests, including Gram staining, catalase and coagulase tests. A total of 89 S. aureus isolates were identified.

Antibiotic susceptibility testing was performed using the disk diffusion method (Kirby-Bauer method) according to EUCAST guidelines [11] . The following antibiotics were tested: cefoxitin (FOX), trimethoprim-sulfamethoxazole (SXT), chloramphenicol (C), fosfomycin (FOS), fusidic acid (FC), clindamycin (CD), penicillin G (P), linezolid (LNZ), ofloxacin (OFX), gentamicin (GEN), and erythromycin (E). S. aureus ATCC 29213 was used as a quality control strain. Multidrug resistance was defined according to [12] as resistance to at least three antibiotics from three different classes. Reading of antibiotic disks was performed by measuring the diameters of the inhibition zone or clear halo and interpretation was performed according to [11] . The diameter of the zones or diameter of inhibition is proportional to the antibacterial activity of the antibiotic. Thus, these diameters of inhibition were measured using a caliper, which also made it possible to define three categories of strains: sensitive (S), intermediate (I) and resistant (R). Phenotypic identification of methicillin-resistant S. aureus (MRSA) strains was made using cefoxitin disks (30 µg).

Descriptive statistics were performed for all variables using the statistic software package (SPSS) version 20.0 and Microsoft Excel version 2016.

The characteristics of the surveyed vendors are presented in Table 2 . The results show that over 42% of the participants received no training in food hygiene. Selling conditions are extremely precarious, characterized by unsanitary environments, direct handling of food without handwashing and inadequate packaging. Vendors often operate in crowded areas, exposing food to multiple sources of contamination. These findings highlight the high risk of food contamination associated with the sale of attiéké under current conditions. Urgent measures must be taken to improve hygiene practices in this sector.

S. aureus resistance varies across regions according to antibiotic use and hygiene conditions. High antibiotic use and poor hygiene are correlated with increased resistance to ofloxacin, clindamycin, and trimethoprim-sulfamethoxazole. Improved hygiene and responsible antibiotic use are essential to combat these problems. The antibiogram showed that the strains of S. aureus isolated from the food were predominantly resistant to several antibiotics, while maintaining some susceptibility to penicillin G and fusidic acid. This multiple resistance is particularly pronounced for ofloxacin, clindamycin, and trimethoprim-sulfamethoxazole ( Figure 2 ). Multiplex PCR showed that 7.86% of the S. aureus strains expressed sea enterotoxins. This finding highlights the risk of enterotoxin-mediated food poisoning because sea is a common and potent staphylococcal enterotoxin.