Ethnic food markets and restaurants are the main source of immigrants’ traditional foods in South Africa. Despite this, the actual availability and accessibility of ethnic foods from the ethnic food markets and restaurants has not been investigated. Furthermore, factors that influence the role of ethnic foods in the diets of immigrants, like perceptions of Sub-Saharan Immigrants towards South Africa food culture, and the safety of ethnic foods have not been established. Although a number of studies have been conducted on the identification of microbial hazards of cooked food in the informal sector, none have been conducted on ethnic foods of Sub-Saharan Immigrants. Aim and objectives The aim of this study was to assess the availability and accessibility of Sub-Saharan African immigrants’ traditional food from ethnic food markets, shops and restaurants, establish immigrants’ perceptions towards South African’s food culture, and determine predictors of contamination of selected cooked food sold in the ethnic food markets, and restaurants. From this aim, eight objectives were formulated as follows: (i) describe the immigrants’ perceptions towards South Africa’s food culture, (ii) investigate the contribution of the ethnic food markets on the dietary patterns of immigrants, (iii) investigate the availability, and accessibility of the ethnic foods available in the ethnic food markets, and restaurants, (iv) document coping strategies adopted by immigrants when faced with shortage of their traditional foods or ingredients in South Africa (v) identify factors associated with a move away from their ethnic foods and adoption of South African foods, (vi) investigate the microbiological quality of selected cooked foods found in the ethnic food markets and restaurants, and (vii) investigate predictors of contamination of ethnic foods bought from the restaurants and markets. A cross-sectional research design using a mixed methods approach was adopted to achieve the objectives of this study. The mixed method employed three instruments, namely: questionnaire, checklist, and laboratory microbial analysis. The study was conducted in Tshwane and Johannesburg metropolitan municipalities. The study focused on two study populations: (i) immigrant households from West, East and Central Africa regions, and ii) entrepreneurs selling Sub-Saharan ethnic ready-to-eat (RTE) foods. The snowball sampling method was adopted to sample both study populations. A total of one hundred and ninety four (n=194) women and forty (n=40) entrepreneurs who met the inclusion criteria and agreed to participate were included in the study. A checklist was employed to assess restaurants and vending sites. Two samples of RTE ethnic foods were collected from each entrepreneur and submitted to the microbiology laboratory at the Council for Scientific and Industrial Research (CSIR). Data obtained from the questionnaire, checklist and microbial analysis were analysed, and descriptive statistics were presented as tables and figures. Multivariable and binary logistic regression models were fitted to the data to assess predictors of adoption and contamination respectively. Results Ethnic foods still featured prominently in the diets of immigrants, with only 7.7 % (n=15) indicating that they strictly followed a South African diet. Ethnic food markets are the main sources of ethnic foods for immigrants living in Gauteng. Efforts to maintain ethnic diets by Sub-Saharan immigrants resident in South Africa are hindered by factors such as unaffordability (39.2%;n=76) and unavailability (25.3%; n=49) of their ethnic foods. Meanwhile, relying on less preferred food (38.7%; n=75) and replacing unavailable ingredients with similar ingredients (37.6%; n=73%) were identified as two main coping strategies that are adopted by immigrants when facing unavailability of their traditional food ingredients. Four patterns of dietary acculturation were identified, namely, strict continuity with traditional foods (21.6%; n=42), very limited adoption (21.1 %; n=39), limited adoption (50.5%; n=98) and complete adoption (7.7%; n=15) of South African foods. The following were the most common food items that the respondents tended to adopt: pap (84.5%; n=164); fried potato chips (43.8%; n=85); cold drinks (42.8%; n=83); fast foods (37.6%; n=73); sphathlo (30.9%; n=60); and vetkoek (30.4%; n=59). Four factors that were associated with adoption of South African foods included:  spending R2500-R3499 (OR 3.34; p=0.017) and 3500-4500 (OR 3.99; p=0.030) on food,  residing in the country between 3-6 years (OR 5.16; p=0.001),  earning between 5000-10 000 (OR 0.52; p=0.040) and >R11 000 (OR 0.380; p=0.057), and  being in part-time/temporary employment (OR 5.85; p=0.025). The majority of the ethnic food entrepreneurs were West Africans (70%; n=28), belonging mainly to the 30-49 years old age group (88%; n=35). Over 35%% (n=14) of the entrepreneurs indicated that they had completed high school education, while 42.5% (n=17) had tertiary education. The majority (80%, n= 34) of vendors of ethnic foods did not have a certificate in food handling or hygiene practices. The majority (95%, n=38) of entrepreneurs operated in permanent structures with ceilings and walls. A majority (95%; n=38) also had access to tap water and flushing toilets. However, ownership of appliances such as thermometers (0%, n=0), microwaves (55%, n=22), and freezers (37.5%, n=15) was very low. There was also low adherence with regards to the following aspects: wearing of protective clothing such as caps (40%; n=24), apron (62.5%, n=25) and gloves (0%, n=0); not wearing jewellery (50%; n=20); keeping fingernails short and clean; and proper reheating of food. Samples contaminated with total viable counts above the threshold of satisfactory counts (<10⁵ CFU/g) was very high (71.3% , n=57). Over twenty percent (22.5%; n=18) of the food samples had unsatisfactory levels of coliforms (>10 ³ CFU/g), and 17.5% (n=14) had unsatisfactory levels (>3 CFU/g) of E. coli. Salmonella was observed in only 3.8 % (n=3) food samples. Being new in business (OR=0.010, p=.033), owning a freezer (OR .477; p= .052), not owning a microwave (OR .013, p=.074), and reheating per serving (OR .187, p=.048) were identified as significant drivers of contamination. Conclusion In the two metropolitans that were investigated only 40 vendors of ethnic foods could be identified. This number is too low to be able to supply the whole immigrant community with ethnic foods. Thus their role as a contributor to household food security is limited. As a result, although the majority of immigrants attempt to preserve their traditional diets, high ethnic food prices and unavailability of traditional ingredients forces them into bicultural eating patterns. Although bicultural eating patterns are supposed to protect against food insecurity, the adoption of unhealthy dietary habits and could render them vulnerable to food insecurity. Lack of knowledge of South Africa foods results in poor food choices. In the long run these unhealthy eating patterns could have negative implications choices. In the long run these unhealthy eating patterns could have negative implications on the nutritional health of immigrants and the health system of South Africa. Therefore, studies to identify foods with similar taste and nutritious ingredients could aid prevention of obesity and lifestyle diseases and inform culture-specific nutrition education programmes. The high number of entrepreneurs without training on food hygiene and handling practices limits the role of the ethnic restaurants in the food security of immigrants living in Gauteng, and food quality is thus compromised. Therefore, there is a need for targeted training programmes which cater for the unique needs of the ethnic entrepreneurs to enable them to play a meaningful role in ensuring that immigrants who want to maintain their food culture are food secure. These programmes should also address the poor handling and hygiene practices that were observed in this study. This could be done by emphasising the World Health Organization’s (WHO) five keys to safer food. Results of the food contamination indicate that entrepreneurs are able to produce safe food, (as supported by only moderate contamination levels of coliforms and E. coli, which also suggests low risk of environmental and enteric contaminants). However, if these concerns are not addressed immediately by proper training and monitoring, they could further compromise the role played by ethnic food markets in food security. Training and monitoring programmes should place more emphasis on the four factors that were identified as drivers of contamination / Agriculture, Animal Health and Human Ecology / Ph. D. (Agriculture)