Knowledge, Attitudes and Practices Regarding Risk to Human Infection due to Mycobacterium bovis among Cattle Farming Communities in Western Uganda

Systematic review of knowledge, attitudes, and practices of dairy farmers and consumers towards bovine tuberculosis in low- and middle-income countries

Bovine Tuberculosis (bTB), caused by Mycobacterium bovis, is a neglected zoonotic disease primarily associated with cattle. The incidence of bTB is highest in low-income settings with high cattle density and unpasteurised dairy consumption. Smallholder dairy farming has steadily grown in low- and middle-income countries (LMICs) with limited professional support for adequate bTB surveillance and risk mitigation. Several studies have explored the knowledge, attitudes, and practices (KAP) of milk value chain stakeholders towards bTB in LMICs, but this evidence has not been collated and synthesised. We conducted a systematic review to determine what is known, believed, and done in relation to bTB among dairy producers and consumers in LMICs. We performed a systematic search of studies in OVID Medline, Scopus and CABI on 11 September 2023. KAP data were summarised using narrative synthesis and forest plots. We retrieved 2763 articles, retaining 51 for the review. Only studies from Africa (n = 38) and Asia (n = 13) met the eligibility criteria. Most populations reported awareness of human tuberculosis and knew it could be treated, but there was limited awareness of bTB and its zoonotic potential. Knowledge of bTB transmission routes and bTB mitigation varied across populations, and risky practices were also variable. Inconsistencies in study design and survey tools suggest some results may have a mid- to high-risk of bias. Awareness of bTB is surprisingly low among African and Asian populations with high bTB exposure risk, possibly due to the long-standing divide between animal and human health messages that has obscured the One Health implications of bTB. Addressing bTB in LMICs requires a structural One Health approach and standard KAP survey tools to adequately explore the socio-cultural, political, and economic processes and drivers favouring bTB spread and persistence.

Knowledge, attitudes and practices towards tuberculosis: results of a community-based survey in the Karamoja subregion, North Eastern Uganda

BACKGROUND

The Karamoja subregion in north-eastern Uganda has very high Tuberculosis (TB)case notification rates and, until recently, had suboptimal treatment completion rates among patients diagnosed with TB. We evaluated community knowledge, attitudes and practices towards Tuberculosis in order to identify barriers to TB control in this region.

METHODS

From September to October 2022, we conducted a community-based survey in four districts in the Karamoja subregion. We collected data on TB knowledge, attitudes, and practices using a structured electronic questionnaire. We generated knowledge, attitude and practice scores. We used a survey-weighted zero-truncated modified Poisson model to assess the association between knowledge/attitude scores and respondents' characteristics and a complementary log-log model to assess the association between practice scores and respondents' characteristics. Data analysis was carried out using STATA version 14.

RESULTS

A total of 1927 respondents were interviewed. Of these, 55.5% were female, and 1320 (68.6%) had no formal education. Overall, 68.5% 95% CI (59.6-76.7%) had knowledge scores of ≥ 60%. Higher TB knowledge scores were associated with being employed (adjusted prevalence ratio, aPR = 1.22, 95% CI 1.04-1.42, p = 0.01) while being a wife in a household was associated with lower TB knowledge (aPR = 0.90, 95% CI 0.82-0.99, p = 0.03). Being 25-34 years old was associated with a positive attitude towards TB (PR = 1.06, 1.01-1.11, p = 0.01). Over 85% of respondents would go to the health facility immediately if they had TB signs and symptoms. Almost all respondents (98.6%) would start TB treatment immediately if diagnosed with the disease.

CONCLUSION

More than two thirds of patients had good knowledge and practices towards TB which can be leveraged to improve uptake of TB control interventions in the region. Additional interventions to improve TB knowledge and practice should focus on specific segments within the communities e.g., older women in the households.

Knowledge and Practice for Prevention of Bovine Tuberculosis and Its Derivers Among HIV Positive People in Bahir Dar City Public Hospitals, Ethiopia

Introduction

Bovine tuberculosis is an important zoonotic disease caused by Mycobacterium bovis, known to exist in all parts of the world especially in un-hygienic environments. It has a public health impact and humans acquire the infection from infected animals through consumption of raw or unpasteurized milk and dairy products.

Methods

An Institutional-based quantitative cross-sectional study was conducted from February to April 2020 to assess the knowledge and practice level along with their derivatives of bovine tuberculosis among adult HIV-positive people in Bahir Dar city public hospitals. The data were collected using structured interviewer questionnaire and systematic random sampling was employed to select study subjects. Thus, a total of 435 people living with HIV were considered for this study.

Results

Out of the total 435 participants 51.5% were male and the mean age was 37.6 years. The overall level of good knowledge and practice of HIV-positive persons for bovine TB were 46.2% and 41.1%, respectively. Moreover, education status, religion, cattle holding, and environmental hygiene were statistically significant associations (p < 0.05) with knowledge level. Likewise, education status, age, and marital status were statistically significant associations with the practice level for bovine TB. Education was a key determinant factor affecting both knowledge and practice.

Conclusion

In conclusion, the present study showed that the level of good knowledge and practice of the participant for bovine TB was low. Hence, tailor-made training by medical and veterinary professionals on the identified risk factors is recommended.

One hundred years of zoonoses research in the Horn of Africa: A scoping review

BACKGROUND

One Health is particularly relevant to the Horn of Africa where many people's livelihoods are highly dependent on livestock and their shared environment. In this context, zoonoses may have a dramatic impact on both human and animal health, but also on country economies. This scoping review aimed to characterise and evaluate the nature of zoonotic disease research in the Horn region. Specifically, it addressed the following questions: (i) what specific zoonotic diseases have been prioritised for research, (ii) what data have been reported (human, animal or environment), (iii) what methods have been applied, and (iv) who has been doing the research?

METHODOLOGY/PRINCIPAL FINDINGS

We used keyword combinations to search online databases for peer-reviewed papers and theses. Screening and data extraction (disease, country, domain and method) was performed using DistillerSR. A total of 2055 studies focusing on seven countries and over 60 zoonoses were included. Brucellosis attracted the highest attention in terms of research while anthrax, Q fever and leptospirosis have been comparatively under-studied. Research efforts did not always align with zoonoses priorities identified at national levels. Despite zoonoses being a clear target for 'One Health' research, a very limited proportion of studies report data on the three domains of human, animal and environment. Descriptive and observational epidemiological studies were dominant and only a low proportion of publications were multidisciplinary. Finally, we found that a minority of international collaborations were between Global South countries with a high proportion of authors having affiliations from outside the Horn of Africa.

CONCLUSIONS/SIGNIFICANCE

There is a growing interest in zoonoses research in the Horn of Africa. Recommendations arising from this scoping review include: (i) ensuring zoonoses research aligns with national and global research agendas; (ii) encouraging researchers to adopt a holistic, transdisciplinary One Health approach following high quality reporting standards (COHERE, PRISMA, etc.); and (iii) empowering local researchers supported by regional and international partnerships to engage in zoonoses research.

Occupational exposure and challenges in tackling M. bovis at human-animal interface: a narrative review

Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal–human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal–human interface.

Risk practices for bovine tuberculosis transmission to cattle and livestock farming communities living at wildlife-livestock-human interface in northern KwaZulu Natal, South Africa

Bovine tuberculosis (bTB) is a disease of cattle that is transmitted through direct contact with an infected animal or ingestion of contaminated food or water. This study seeks to explore the local knowledge on bTB, obtain information on social and cultural practices regarding risk of bTB transmission to cattle and humans (zoonotic TB) in a traditional livestock farming community with a history of bTB diagnosis in cattle and wildlife. Information was collected using a qualitative approach of Focus Group Discussions (FGDs) targeting household members of livestock farmers that owned bTB tested herds. We conducted fourteen FGDs (150 individuals) across four dip tanks that included the following categories of participants from cattle owning households: head of households, herdsmen, dip tank committee members and women. The qualitative data was managed using NVivo Version 12 Pro software. Social and cultural practices were identified as major risky practices for bTB transmission to people, such as the consumption of undercooked meat, consumption of soured /raw milk and lack of protective measures during slaughtering of cattle. The acceptance of animals into a herd without bTB pre-movement testing following traditional practices (e.g. lobola, 'bride price', the temporary introduction of a bull for 'breeding'), the sharing of grazing and watering points amongst the herds and with wildlife were identified as risky practices for M. bovis infection transmission to cattle. Overall, knowledge of bTB in cattle and modes of transmission to people and livestock was found to be high. However, the community was still involved in risky practices that expose people and cattle to bovine TB. An inter-disciplinary 'One Health' approach that engages the community is recommended, to provide locally relevant interventions that allows the community to keep their traditional practices and socio-economic systems whilst avoiding disease transmission to cattle and people.

Community, system and policy level drivers of bovine tuberculosis in smallholder periurban dairy farms in India: a qualitative enquiry

BACKGROUND

Rapid urbanization has led to expansion of peri-urban fringes, where intensive, industry-style livestock rearing has led to emerging vulnerabilities at the human-animal-environment interface. This study was undertaken to understand the health system and farm-level factors that influenced the risk of transmission of bovine Tuberculosis (bTB) in animals and humans in peri-urban smallholder dairy farms of India.

METHODS

Thematic guides were developing through literature review and expert consultation. In-depth interviews were conducted till attainment of saturation. Identification of core themes was followed by etiological enquiry and generation of a conceptual model.

RESULTS

Veterinarians were consulted as a last resort after home-remedies and quacks had failed. Damage control measures, especially with respect to- selling or abandoning sick animals, added to the risk of disease transmission. Although civic authorities believed in the adequacy of a functioning laboratory network, end users were aggrieved at the lack of services. Despite the presence of extension services, knowledge and awareness was limited, promoting risky behaviour. The absence of cogent policies in dealing with bTB was a significant barrier. Stakeholders did not consider bTB to be a major concern. It is possible that they underestimate the problem.

CONCLUSION

The current study helps to identify gaps which need to be addressed through collaborative research, and OneHealth interventions to build community awareness.

Health workers' knowledge of zoonotic diseases in an endemic region of Western Uganda

Many factors, including lack of knowledge, influence diagnosis and reporting of disease in Sub-Saharan Africa. Health Care workers (HCWs) are in constant interaction with communities and play an important role in the prevention, diagnosis and treatment of infectious diseases, including zoonoses. We determined knowledge of HCWs regarding cause, vector, transmission, diagnosis and clinical symptoms of five zoonotic diseases: anthrax, brucellosis, rabies as well as Ebola and marburg haemorrhagic fevers in endemic western Uganda. This was a descriptive cross-sectional study among HCWs based at health centres in and around Queen Elizabeth Conservation Area, Western Uganda. A self-administered questionnaire was used to measure knowledge of these five most common zoonoses recently recorded in the area. Data were captured as true if the responses were correct or false if incorrect. Analyses were in STATA and inferential statistics by cross-tabulation, and a chi-square P-value of less than 0.05 was considered significant. A majority (114/140; 81.4%) of the respondents had heard about zoonoses. The most accurately identified zoonoses were anthrax (128/140; 91.4%) closely followed by rabies (126/140; 90%), while only 21 (15%) respondents knew that cryptosporidiosis was zoonotic. Up to 20% (28/140) and 12.8% (18/140) thought that malaria and HIV, respectively, were zoonotic. There was poor overall knowledge of the endemic diseases brucellosis among all the participants, where only 1.4% (2/140) knew its causative agent, clinical symptoms and transmission. There was a total lack of knowledge (0%) about anthrax and Ebola whereby none of the 140 HCWs knew all the three above aspects required to be knowledgeable for each of the two diseases. Generally, there was poor knowledge of the five zoonoses. We recommend that medical curricula incorporate training on zoonotic and other emerging diseases, and continuing medical education regarding zoonoses should be designed for the HCWs practicing in hotspot zones.

Mycobacterium tuberculosis Complex Members Adapted to Wild and Domestic Animals

The Mycobacterium tuberculosis complex (MTBC) is composed of several highly genetically related species that can be broadly classified into those that are human-host adapted and those that possess the ability to propagate and transmit in a variety of wild and domesticated animals. Since the initial description of the bovine tubercle bacillus, now known as Mycobacterium bovis, by Theobald Smith in the late 1800's, isolates originating from a wide range of animal hosts have been identified and characterized as M. microti, M. pinnipedii, the Dassie bacillus, M. mungi, M. caprae, M. orygis and M. suricattae. This chapter outlines the events resulting in the identification of each of these animal-adapted species, their close genetic relationships, and how genome-based phylogenetic analyses of species-specific variation amongst MTBC members is beginning to unravel the events that resulted in the evolution of the MTBC and the observed host tropism between the human- and animal-adapted member species.

Updated Reference Genome Sequence and Annotation of Mycobacterium bovis AF2122/97

We report here an update to the reference genome sequence of the bovine tuberculosis bacillus Mycobacterium bovis AF2122/97, generated using an integrative multiomics approach. The update includes 42 new coding sequences (CDSs), 14 modified annotations, 26 single-nucleotide polymorphism (SNP) corrections, and disclosure that the RD900 locus, previously described as absent from the genome, is in fact present.